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In Treatment begins after Jesse has been in therapy for some time. As gradually becomes clear, Jesse's birth parents abandoned Jesse at some point in his life, and he was adopted sometime later. Jessie is understandably bitter about his birth mother, whom he characterizes as a "crack whore" but seems not to blame his birth father, who he fanaticizes is a professional of some type. Jesse is also "gay" and has had anal sex with at least two gay men who own a bar. We pick up Jesse's story as someone who claims to be his birth mother leaves a message on his cell phone, saying that she would like him to return the call.
We are all led by our genes to take the blame for hurtful events even when we have no rational basis for believing that we are at fault. So it is genetically natural for a child to consciously wonder why his parents abandoned him and to unconsciously supply the reason that there must be something wrong with him. This mistaken belief makes the person feel uncomfortable when people around him don't act as though they see this damning fault and reject him for it. Jesse acts provocatively in part to expose peoples' presumed rejection of him, which he feels they would otherwise keep hidden behind a facade of hypocritical approval. To him, approval makes no sense. So Jesse takes on the personality of someone who is unpredictably provocative. Under these circumstances, the reason he claims to be gay is not at all clear.
The politically correct view is that a person is gay because of his/her genes. This view flies in the face of quite a bit of science, which demonstrates that as highly social, highly adaptable beings, our behavior is determined both by genetics and experience, with the genetics/experience ratio varying considerably from one person to another with respect to a specific mode of behavior. As for gayness, the politically correct view would put the genetics/experience ratio at an extremely large number for everyone who claims to be gay, which I believe may be true for some of those people, but not for many. For those such as Jesse who have had exceptionally hurtful childhood experiences, the ratio may in fact be vanishingly small.
William James wrote of the twice born, people who because of genetics and experience are led to make a dramatic break with the past that amounts to a kind of rebirth. Invariably this quest is experienced subjectively as a crisis. Jesse is seeking such a rebirth, and is using Paul as a father-substitute in bringing it about. Paul reacts to him as a father who cared would, which explains why he is sterner with Jesse than he would be with other patients and why Jesse continues coming to therapy when doing so was probably somebody else's idea. Jesse's quest for a new male personality makes dealing with women problematic at this stage in his development. @VicComello