Steve, you have raised an important issue with the role of compliance in this case. But in Joseph's case, compliance may be an understatement. His early experiences of parenting seem to have been fraught with punishment, failure of empathy and danger, especially in the threatened castration around masturbation at age three. The tenuous, even dangerous, nature of this attachment (and it's effect on the developing child ego) is probably reenacted in the intensity of the paranoid terrors he experiences, although not their content. It also sets the stage for the next act: the mother's death when Joseph is just pre-pubescent. Two or more forces may be at work at this time. Identification as a way of maintaining relationship with the lost object, and his father's effectively demanding that Joseph assume his mother's role. Since everything you have reported suggests a highly traditional family model, I assume that Joseph saw the tasks to which he was assigned as being "woman's work". Being in the compliant role to his father, being forced to violate his sense of maleness just as he entered puberty, may have constituted a deep violation of his sense of self. Rather than being affirmed in his maleness by his father, he was, instead, effectively told that the only acceptable identity for him was as a woman-surrogate. Such a sense of self-violation is often experienced as a kind of enforced prostitution, and coming at such a critical age, and at the time of such a difficult loss (since, as we all know, deep emotional ambivolence interferes with the capacity for mourning, thus destablizing the self structure) may have taken on the unconscious signicance of a kind of sexual bondage to his father, and threatened loss of his fundamental sense of self. If this view of Joseph's inner world is correct, then it would not be inappropriate to view him as, at least in his unconscious symbolic representions, a victim of sexual molestation and incest. Viewed from this perspective, his fantasies of sexual demands from older men, the prostitution ideation, and his terror of revelation of his "secret" (that is, the secret of incest, and the shame at loss of manhood and self-determination implied by it)seem totally consistant. Bringing it a step further, one would expect that being in treatment with a male therapist, even one as sensitive as you, could arouse for him the fear of another potential enslavement, or the unconscious fantasy that he would be expected to repay the therapist's acceptance and non-punitive stance with yet another prostitution. As you refuse to enter the role of enslaver, he might experience an ever-increasing anxiety, demanding that he somehow elicit the response he anticipates, i.e. that you become the enslaving, rapacious father. Hence, the testing with appointments, payments and such. It might also not be too far-fetched to suggest that the difficulties around payments touch directly on the prostitution fantasy/reenactments. After all, prostitutes are the ones who are paid. How can he maintain you in the role of a strong, positive father if you are actually his prostitute? Does any of this seem cognate with your experience of Joseph?
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