Isay has confronted this resistance in a number of ways. In Being Homosexual he argued that homosexuality in men was 'constitutional and probably genetically determined' not the product of 'a disturbed early relationship with parents'. Dovetailing with this theoretical defence of male homosexuality has been Isay's own actions in coming out as a gay man. Becoming Gay traces both the theory and practice of Isay's reconceptualisation of male homosexuality and the remaking of his own life as a homosexual. If being homosexual is probably genetic, then, for Isay, becoming gay is the conscious refashioning of one's life to complement one's sexual desires. As a collection of essays, this book presents various phases in the therapeutic fashioning of gay male identity.

If nothing else, psychoanalysis is supposed to heighten the individual's awareness of his/her conflicted desires. Isay takes this dictum as a starting point by chronicling his own experiences as a man struggling to come to terms with homosexual desires and then, later, his experiences as a gay therapist with the troubled desires of his patients. There are some candid, if somewhat clinical, moments in these stories. I could not help but giggle at Isay's confession of his early visit to a gay pornographic movie whilst in New York for a meeting of the American Psychoanalytic Association. Not, I suspect, what the psychoanalytic elders had in mind for a young analyst visiting New York. Isay goes on to describe his gradual acceptance of his homosexuality; the years he juggled a gay life with his professional commitments, his relationship with his wife, children and lover, and his eventual embrace of 'a more authentic life' with his male partner.

As a therapist, Isay suggests that it is important for his patients that he acknowledge his own homosexuality within the therapeutic setting. Isay recognises that this is watering down the psychoanalytic contract whereby the patient knows as little of the analyst's life as possible. This analytic relationship, or so the argument goes, enables the patient's phantasies to emerge more freely. Isay, however, argues that the gay therapist's openness about his sexuality, at the appropriate moments, provides the patient with an important role model. Talk of role models is a long way from the unconscious, but one can see the point Isay is making. Nevertheless, I suspect an equally compelling case for maintaining a stricter psychoanalytic alliance could be made.

From his chapter on 'The Gay Therapist', Isay turns explicitly to the concerns of his gay patients. A series of chapters follow where Isay discusses the particularities of treating gay adolescents, gay men who are married, those living and dying with HIV/AIDS, and men who become gay late in life. Through all of this, Isay's deep concern for the well being of his patients is clear. And yet, the orthodoxy of American Freudianism continues to haunt Isay's explication of his patients' miseries. There is a certainty in some of his short, clinical diagnoses which is, at least to this reader, disconcerting. A few more qualifiers, even a simply 'maybe' and 'perhaps', might have opened up Isay's case studies further. In paraphrasing the narratives of his patients, particularly when he adds his own diagnostic asides, Isay veers towards the expert who knows best. And perhaps he does, but in lacking a certain late modern irony, Isay runs the danger of replicating the prescriptiveness he finds so oppressive in the psychoanalytic establishment. By the end of the book, for example, I had lost patience with Isay's oft-repeated model of healthy gay development which reaches its peak in sustaining 'sexual, intimate, and mutually loving relationships'. Chalk me up as unhealthy and pass the Medicare card.

And yet, as a read, Isay's book remains interesting. The analytic setting is a difficult place to describe, with many of its exchanges defying easy transcription. In his longer case studies, Isay begins to show us the complexity of his patients' everyday lives and the delicate negotiations which can evolve in the therapeutic relationship as experience and history is recast. In these moments, at least, Isay gives us a valuable glimpse of the uncertainty and pleasures of becoming gay in contemporary America.