Source: Collected Papers from the NARTH Annual Conference, Saturday, 29 July 1995.
Paul Popper, Ph.D. has a private practice in San Francisco. He has been a practicing therapist for 25 years, and is currently the clinical director of a private, nonprofit health center working with clients dealing with issues of sexual abuse. He also consults on forensic psychology issues.
In 1992 I attended a workshop given by Dr. Nicolosi on "The Reparative Therapy of Male Homosexuality". I was impressed by what he had to say, how he said it and who he was.
During the last three years, through church programs and in my private practice, I began working with male homosexuals who wanted to leave the lifestyle, increase their male identification, and change the orientation of their sexual object choice.
I became involved quietly because I saw the pain of these men and because I thought I could help. I wanted to continue quietly because it was safer, easier and there was less accountability. However, during the last few years as I became aware that the professional organizations of psychotherapists which govern the ethical standards of the different disciplines were seriously considering ruling that it was unethical to treat homosexuals who wanted to change their orientation, my timidity and fear was overcome by indignation. (Haynes, NASW, APA)
This presentation today is a statement, that although I am still timid and would still like to hide out within the quieter confines of my private practice, the time has come to publicly state: This work is important and I want to be counted among the people who stand up against the cultural, political and professional forces which are working towards eliminating it.
It is my firm conviction that most therapists choose their profession as a means of attempting to heal themselves. If they are honest enough, they will enter into therapy for their own sake, and having successfully made changes in their life, they will have greater confidence and knowledge base for helping others make similar changes.
Due to the vicissitudes of World War II, I didn't get to meet my father until I was more than two years old, and he didn't come into my life on a regular basis until I was three years old. As a result of this, throughout my childhood, adolescence, and early adulthood I struggled with issues of being passive, being insecure in my male identity and compensating for this by soothing myself with compulsively sexualizing the world around me.
I was fortunate to find a therapist who brought into our relationship a powerful male identity, whose assertive male attitudes I could internalize, and who also had the skills to help me uncover early conflicts in my life which became embedded in my rigid character structure. As I resolved these characterlogical issues with the help of my therapy, my capacity to pursue intimacy within my marriage increased, I was able to assume the role of a benevolent authority figure with my children and professionals I supervised, and I started pursuing excellence in my vocation. I also learned to respect the hard work I put into accomplishing changes in my life, to treasure the satisfaction, love and balance which were available as a result of the hard work, and not to give away these accomplishments by choosing to pursue self-indulgent neurotic shortcuts.
Conducting long-term psychodynamically oriented psychotherapy in my own practice, I was able to observe my clients in the process of making character and structural changes in their personalities, which resulted in clear-cut behavioral changes in the way they conducted their lives. I was able to see the satisfaction they received from love and work and the clarity and singleness of purpose they were able to focus on in order to maintain their gains.
I enjoyed working with men and usually my individual and group therapy practice consisted of more males than females. Not coincidentally, many of my male clients had issues with being passive, unassertive and experiencing a lack of confidence in their maleness, and a lot of them also struggled with sexual compulsiveness/sexual addiction issues.
As a staff therapist in a clinic working with Juvenile Court, I began to specialize working with adolescent sex offenders and their families. Later on, I started and became clinical director of a comprehensive program for adolescent sex offenders. Through a psychodynamic approach, along with cognitive-behavioral measures, the therapeutic program was able to reach many adolescents by addressing some of their male identity issues and by decreasing their propensity to use sexual arousal to soothe themselves.
In my forensic practice I also had the opportunity to conduct long-term psychodynamic psychotherapy with adult sex offenders. Several of these men, as they reworked their childhood issues of inadequacy and terror of intimacy, lost interest in their choice of sexual object (younger children) and found greatly increased emotional and sexual fulfillment in their adult relationships.
In 1992, when I heard Dr. Nicolosi present a workshop on the reparative therapy of male homosexuality, it was clear to me that my life experience, and the experience of the majority of men in my psychotherapy practice had prepared me to work with homosexuals who wanted to change.
As I listened to him and later when I read his book, I was impressed by how the homosexual attraction is redefined by Moberly as a yearning for a connection with the father and for a stronger male identity because of an early defensive detachment from the father. Homosexuality was seen as a symptom, a natural reparative drive to make up for the loss of a profound connection between son and father during the boy's childhood.
Such reframing of the problem, along with the recommendation that the therapist needs to actively engage the client, fit perfectly with my approach to working with men who were struggling with issues of sexual compulsivity. In the employ of this approach, I had on occasion, during the beginning phase of therapy, placed an ammonia capsule into my client's hands, suggesting that he didn't need therapy, since a whiff of ammonia on a regular basis would give him total control over his compulsive sexual arousal pattern. Interestingly enough, not one man would take me up on this offer. However, to a man, each was willing to consider the possibility that the real issue was his fear and lack of a capacity for intimacy in human relationships and that his sexual acting out (in fantasy or fact) served the purpose f self-soothing, creating a temporary sense of cohesive self and an avenue for displaced acting out of repressed affects.
This clinician's conceptualization of how therapy works was similar to the reparative processes described by Nicolosi, Moberly and Socarides:
1. When the client allows himself to enter into a dependent transference relationship, all of his defenses which were established as a way of surviving his dysfunctional relationship with his parents are mobilized. (For a homosexual, the major defense would be his refusal as a boy to identify with his father and to individuate without ambivalence from his mother.) As these defenses are analyzed and interpreted within the transference relationship, the client gains an awareness of rigid affective states, thought patterns, and behaviors (they are the building block of character attitudes) which were useful in the past as a way of survival, but which are limiting him in the present from having his needs for intimacy and mastery met.
2. The client begins to regain the capacity for surrender to emotional experiences and expressions lost in his early childhood, and therefore his capacity for emotional flexibility, vulnerability and intimacy is increased. In the context of a relationship with a supportive, nurturing, benevolent authority figure, the client recovers affects and memories and re-experiences them as a child; through this process a loosening of the client's defensive structure takes place.
3. He begins to relate to the therapist in a more earnest, vulnerable and accepting manner and just as a child who identifies with his father during the preoedipal years, he allows himself to be called away from the feminine hold of his mother. The increased identification with being a man during these structural changes in the client's personality, and the organization of the client's sense of self around this increased sense of being a male, is similar to Nicolosi's and Moberly's concept of the reparative process.
4. At a certain point in therapy, the client feels strong enough to confront the therapist directly with perceived injuries he has experienced within the relationship. This takes enormous courage since the client still feels "young" and perceives a terrifying lack of balance of power in the relationship between himself and the therapist. As the therapist responds by being accepting and firm and remains committed and present, the client learns that assertion and aggression is appropriate in a relationship. Not only does it not destroy it, but in fact it creates stronger bonds. The repetition of such experiences increases the client's capacity for aggression, assertion and mastery in the outside world, which is essential for his sense of self-security. (Since passivity is such a predominant syndrome of homosexual character structure, this is obviously an important part of the healing process.) (Mintz, Dallas).
5. Often within the therapeutic process, the client who is feeling the love and acceptance of a benevolent authority figure, and who is grateful for his new experience of himself as an adult, recognizes deep within himself a need to accept a greater authority which transcends humanity. It is at this point that the now adult client completes the organization of his self experience, making it meaningful as he allows it to fit into a larger cosmic vision.
Such a therapeutic process can at times take up to ten years, and allows the therapist an intimate view of the correlation between the internal changes in the character structure and the organization of the self of the client, with the changes the client makes in the world as he actualizes his newly-found capacity for intimacy and mastery. This takes place most often by finding a committed monogamous love relationship, raising children and providing for their well-being by a vocational choice which in the long run offers him satisfaction and a clear sense of service to the larger community.
Having treated several ego-syntonic homosexuals in the past with moderate success, mostly for symptoms related to their sexual abuse, lack of assertiveness and fear of intimacy, I never experienced the effects of their defensive detachment directly within a transference relationship. This changed when I became a facilitator in a group of homosexuals who were in a church-related program, working on removing themselves from the lifestyle and decreasing their homosexual attractions. Through a six-month period, I established relational connectedness with each member of the small group (four people). I had seen one particular member warm up to me very slowly, but giving indications week by week that he was accepting me and connecting with me emotionally. After a minor confrontation, the content of which I cannot recall, this man withdrew from the relationship totally, acting cold, detached, unresponsive and unavailable, and refusing to admit that any change in the relationship had taken place. It was only a year later when this man joined one of my short-term educational men's groups that he was able to relate to me how angry and threatened he was in his relationship with me and that is why he withdrew in such a profound manner.
During the last two years I have worked with four men who came to therapy specifically to address the issue of their homosexuality. It is clear that each one of them decided to be in therapy with me because of my active and expressive therapeutic style. It became clear to me from the first phone call I received from them or the first time I started working with them, that because of their great distrust of men, they also required of me a higher level of self revelation and transparency than I was used to offering to my clients up to that point.
Gary was the member of the small group I facilitated in church. Although he clearly had a strong, positive transference relationship with me within the group, it took him more than half a year after the group ended to give me a call and initiate the therapeutic process. He is a man who was actively involved in the gay lifestyle for many years and was living with another man who used to be his lover, but with whom he now had a platonic relationship.
Andrew met this clinician several years ago during family sessions focused on the relationship between his mother and father and his other siblings, during which this therapist was highly active, directive and somewhat confrontational. He is a married man, who has never had a homosexual experience, but has had an almost exclusively homosexual fantasy life since adolescence. He read an article in the New York Times which described how members of Exodus International in giving their testimony, stated not only that they had decreased their homosexual attractions, but that they clearly developed heterosexual ones and during a period of a decade, several of them had married and had begun to raise families.
Nathan decided to choose me as his therapist after interviewing close to 50 therapists in the Bay Area. Later in the therapy, he related that he decided to come to me because of my forthright, direct, no-nonsense style and because I was willing to reveal my own experiences in therapy and upon his request shared how my own issues were ameliorated through the process of therapy. Nathan was a young man who recently left a rigidly fundamentalist church in which, for several years, he remained celibate.
Bill decided to join the long-term psychodynamic therapy group for men after having experienced my style in a short-term group dealing with psychoeducational issues of sexual addiction. He had an extensive history in the gay lifestyle and was experiencing a clear renewal of his religious convictions and his relational connection to a personal God.
Except for Nathan, all of these clients had slight effeminate characteristics and again, except for Nathan, they all implicitly contracted for wanting to decrease their homosexual attractions and, if possible, increase their heterosexual desires. Nathan, in principle, agreed that he did not want to be a homosexual because of his religious convictions, and therefore he had rejected the idea of entering therapy with a gay affirmative therapist. What he wanted was a lack of condemnation from this therapist for his attempt to form relationships with gay men, so he could meet his affectional needs and gain some measure of happiness.
All four of these men had family constellations typical of those that facilitate the development of homosexuality. All four showed various levels of defensive detachment from their father and from men in general, and a confused and ambivalent separation/individuation from their mothers.
1. Andrew describes a scene which he has relived in therapy. He is between the age of 3 to 5. He is in the kitchen with his mother who is putting on makeup, drying and spraying her hair, sensually exhaling on her cigarettes while Andrew is sitting there for hours watching her, mesmerized, listening to her. During this experience the smell of the cigarette smoke and her hair spray are prevalent and are still clearly available to him as he relives the experience.
Between the age of 3 to 5, Andrew recalls anxiously waiting for his father to come home, sitting on the curb outside and then walking up to him to greet him because he was looking forward to his return. He remembers being crushingly disappointed when his father gave him only a perfunctory acknowledgment and went on with his busy, compulsive, rigid lifestyle which excluded Andrew.
Around age 5-1/2 Andrew remembers hiding out behind the washing machine when he was supposed to go to school. He was holding on, refusing to leave the house, refusing to go into the outside world because he was petrified and wanted to stay home with his mom.
He has lots of memories of being Mom's confidant, listening to her about how men are brutes, bad, insensitive, identifying with her and feeling himself more and more different from men.
Andrew recalls that at age 8 to 9 his father wanted him to work in the garden with him, in the dirt, under the hot sun. He remembers he ran to his mother who was very sympathetic, washed him up and told him he did not have to do that.
This is the age at which Andrew is sure that his defensive detachment coalesced and was reinforced by the bullying he experienced by his schoolmates.
2. Nathan, who grew up in an extremely violent family in which both his mother and father fought verbally and physically, recalls becoming responsible for keeping his mother happy by being aware of every one of her moods, making her laugh, taking flowers out of garbage cans and presenting them to her, washing the dishes, cleaning the house in order to maintain some peace in the home. At age 10 he recalls being severely beaten by his father as punishment for some transgression, a not unusual occurrence. He remembers walking away from his father with a contemptuous smile on his face, feeling inside that he would never be "touched" by him again. Nathan, who fought with other kids throughout his preadolescence and adolescence and is quite masculine in his carriage and appearance, still identifies men as macho, as fighters, as insensitive and as bullish, and through his therapy has begun to identify how, in all of his relationships, his role was to make others feel comfortable in order to assuage his guilt and his feeling of being condemned.
3. Bill recalls that at age 3 he was at his mother's side with his little ironing board, imitating her. He remembers hiding out behind the bed in his room and playing with his dolls at age 5 in fear of his father who was violent in his style of punishment. At the same age Bill also recalls that his grandfather was gruff and smelly and unkempt and how he didn't like that and was feeling much more comfortable with grandmother who was genteel and soft and had a wispy voice. (The first seeds of defensive detachment.)
Several times Bill re-experienced being 3 to 4 years old, at his mother's side with the ironing board. First he would become weepy and feel helpless and then become angry and yell at his mother to let him out and play with the other kids who were out on the street. Each time his mother warned him not to get dirty, insisted that he be very careful and resisted his impulse to leave her presence.
4. Gary recalls being approximately 3 to 4 years old and seeing the outline of his mother's waist close-by and experiencing genital stirrings and the beginning of an erection. In later sessions this was followed by memories of his mother standing by him when he went to the bathroom, hovering over him, at least until he reached his teens, and being in his room with him and dressing him until his early teens.
His mother had a negative attitude towards adolescent boys who were too lively and rambunctious and an almost spiteful attitude towards women who dressed in a way that was at all suggestive of their attractiveness. He felt confused since he found all these folks attractive, lively, healthy and interesting.
Gary recalls his father using him to try to stand up to his wife when they disagreed. He remembers his father losing the argument and apologizing to his mother. He felt ashamed for both of them.
Gary clearly recalls from age 5 to 6 being interested in adolescent boys, liking the aliveness of their bodies, wanting to hang around them, wanting to be like them. He also recalls around this time making a decision not to be like them. (The beginning of defensive detachment.)
By age 6 to 9 he had the fantasy of being a girl and acting out roles of being a basketball player or being a sexy woman, as if he was his mother and was a fully alive, vibrant woman, to compensate for her deficiencies.
By age 10 he recalls feeling totally alone and empty, going into the woods and stimulating his anus by putting a stick into it. This would give him some feeling of aliveness in his pelvis and genitals.
Until age 16, several nights a week Gary would go into his parent's bedroom in the middle of the night, wake up his mother, tell her he was scared and have her join him in his bed. They would lie next to each other. He would feel comforted, although he would experience his own body and hers as like stone, motionless and without contact.
Until early adolescence Gary recalls being fascinated by older boys in his school, by their penis, having a slight feeling of excitement but no specific genital arousal or specific sexual fantasies. It was in his late adolescence that he started to trade in his admiration of these older boys whom he consciously decided not to be like, for a sexual yearning, which at that point was passive and anal.
1. At first Andrew used his therapy mostly to confront his defensive detachment towards men. We have spent many hours taking apart his negative stereotype of men, and as this began to succeed, he started reporting how he has been able to relate to co-workers, friends and sometimes to strangers by seeing them as complex human beings with strengths and weaknesses. During this working-through period, he has spontaneously reported that he no longer saw himself as a homosexual, but as a man with a problem of homosexuality.
His homosexual preoccupations which used to drive him to the bathroom two or three times during his workday for a private encounter, decreased significantly very early on in his therapy.
As he began to approach looking at his relationship with his wife, he started becoming hopeless about therapy and about the changes he would be able to make. It was at this point that he was challenged to allow a transference relationship to be expressed between himself and me, and not be in denial about therapy being relational as opposed to only interpretive and educational. At this juncture he admitted that he was afraid that if he was to start talking about his sexual feelings, he would either seduce or be seduced by me. ("We would end up on the rug together.") Only after some of his issues were worked through did he start describing the intensity of the self-stimulation he experienced in his adolescence as he began masturbating in front of a mirror and cathecting his penis as his love object. "Yeah, I keep my sexuality totally isolated in that act of focusing on my penis and the pornographic masturbation and I don't let it go any place. It's like a cannibalistic kind of a feeling, it's like I want to ingest myself." As he relived these initial homosexual memories he would hyperventilate and the room would be vibrant with his sexual energy. Living through this in the presence of this clinician and experiencing the safety of the structure of the therapy, Andrew started removing his sexuality from its narcissistic isolation and letting go of some of the intense shame connected to it.
Recently he spontaneously reported that he made love twice in one week with his wife and he felt more pleasure than he ever felt before. He sounded quite genuine. Then he talked about how, during intercourse, he was afraid that he was going to lose his erection. How at that point he switched to homosexual fantasies to keep himself aroused, and that when he tried to stop his homosexual images from taking over during intercourse, he couldn't keep an erection, since something like a switch went off inside of him. As he said this his face contorted and he looked terrified.
As we explored this he began to realize that he did not at this point want to give up his relationship with his penis because if he did he would have to let in all of the pain he felt as a sixteen-year-old; the pain of witnessing his father beating his sister, his parents fighting, his peers bullying him in school, his total aloneness, emptiness and shame about identifying with his mother.
2. Nathan went through a period of dating gay men. He found that what he wanted from them was to be cuddled and held. He was in a relationship with one man for approximately four months, during which time he felt validated and cared for, an experience he never had before. All of his homosexual experiences had been one night events while he was drunk. Recently he decided that he did not want to pursue his dating behavior because other aspects of his life were more important. Soon after this decision, the theme of his relationship with his father appeared. He talked about a movie he saw in which a boy was giving his father a shoulder massage. He stated he could never imagine doing that to his father. He would be too scared. It was during this time that his stereotypically negative attitude towards men came to the surface and started being explored.
Nathan is very reticent about entering into a dependent relationship with this therapist. After a year he attends therapy regularly and basks in the narcissistic enjoyment of being accepted and liked. He literally believes that he will go to hell because he has been condemned. This rigid belief has loosened during the last year. He now accepts some of his own imperfections without total self-judgment.
Although he has had two one-half year-long romantic relationships with women (at age 16 and at age 28) and does not appear to enjoy homosexual sex, it is too early to tell what his goals will become.
3. Bill's contact with this clinician has been through a once-a-week psychotherapy group. He has made good use of his prayer life and his spiritual relationship with his Creator. He visualizes Jesus as his father who cares for him, who holds him, who allows him to run around as a rambunctious boy and plays with him, and these are all reparative experiences for him. In the group he has formed a relationship with a heterosexual man, and at one point after a conflict they ended up sobbing in each other's arms. Bill reports a clear lessening of his homosexual preoccupations after this incidence. Throughout his year of therapy he has had a positive transference with me. He receives a clear gratification from my idealized presence. Recently he started challenging me at times and feeling secure in doing so. This correlates with his report of breaking off a long-term co-dependent relationship in his life and for the first time ever striking out on his own.
4. Only after Gary decided to separate from his platonic lover (they did "fall" occasionally) did he start having access to early memories with his mother. This took place after approximately eight months in therapy, during which time Gary did a lot of testing by insisting that he needed to be held and touched because his skin was craving human contact. He would do this in a very demanding fashion, insisting in a somewhat effeminate, contactless falsetto-like voice. He also let me know that he had been fantasizing about me and might sexualize the hug he was asking for.
The next juncture in Gary's therapy took place when I became cognizant of how my counter transference reactions to Gary's attempting to sexualize our relationship was interfering with my acceptance of him. Although I made the proper interpretations about Gary' s need to want to reach out towards me in a sexual fashion, and could identify his false effeminate self as a defensive maneuver which helped him survive an impossible situation with his parents, unconsciously I remained quite judgmental of his dramatic, histrionic and manipulative interactions. Only when I realized that because of my own history of passivity and deficiency in masculinity, was I reacting to his "queen" self (as he described it in shorthand) in a rejecting manner, was I able to truly accept (but not give into) all of his defensive maneuvers as something he had to develop in order to survive. This acceptance gave Gary permission to start to verbally explore his sexual attraction towards me, and as he did, he began to recall early childhood experiences, of being terrified of his mother's seductive control and the emptiness he felt when he tried to separate from her. As he would sob, his eyes would reflect immense terror which he would later describe as having no sense of who he was, where the ground was, where he began and where he ended.
As the therapy progressed the transference relationship shifted back and forth with this clinician being more and more a benevolent supportive father-figure and less and less a castrating, seductive, suffocating mother-figure. While this was taking place, Gary became involved with men at his work and in his church, developing relationships with them without any sexual impulses or thoughts interfering.
During this time he would also begin to recall more and more instances in his childhood in which he had positive relationships with men with whom he enjoyed his maleness. He had several memories of his father, sitting next to him as an adolescent, talking with him and enjoying each other's company. He recalled telling him of his homosexual feelings at age 17. His father was sympathetic and supportive, looking at him with soft, caring eyes. He remembered that at that time Gary had only contempt for his father's softness.
Gary brought in pictures of himself showing the difference in his demeanor before age 5 and after. Up to age 5 his face was serious and his eyes appeared to be focused, almost hard. After age 5 his whole face and posture was effeminate and his eyes appeared to be vacuous and empty.
Gary, at this point, still experiences himself as a growing child within a transference relationship with a good father.
On Father's Day he wrote the following: "I'm desperately needing to be able to open my heart and identify with you -- to meet the world from a position of strength. I need to cultivate the fertile, trusting heart of the impressionable little boy whose picture you saw last week.
You have been there for me week in and week out. I seriously need a strong male identity but I don't want to get it sleazily. You have proven to be trustworthy and you have character. You are the brother/father I wanted to relate to, but I need my heart to be open the way it was before I took the 'poison pill'. (That's his metaphor for his decision to give up being a man.) It's been very confusing having mixed feelings of love and hostility.
I told you before that I have an active imagination life. It goes something like this: I'm a big boy like Daddy... I'm a big boy too... Me too. This frees me from the shame that generates inside me for being male."
Presently, when Gary feels empty and he wants to mobilize his homosexual fantasy life in order to feel something in his pelvis and feel some power, he imagines me standing close to him and this helps him feel a little bit more alive, less empty and less panicky.
Gary, Nathan and Andrew all report a clear decrease in the frequency of their homosexual impulses. Gary states that the frequency of his homosexual impulses have decreased 70% to 80%. Andrew identifies the decrease of his homosexual impulses as being between 60% and 90%, while Bill states that the decrease of his homosexual impulses is between 60% and 70%.
Gary, during the last few months, found a female masseuse he likes. He talks about her without spite in his voice. Twice he enjoyed a full erection while getting a massage from her which pleased him immensely. He felt male, strong and grounded. He is beginning to talk about the two heterosexual relationships in his past, with some fondness. His masturbatory fantasies are heterosexual, missionary position. He feels like a male when he masturbates to these fantasies.
Andrew has recently made a decision to have children sometime in the future. He and his wife have just bought a house. He is scared about giving up his intense sexual connection with his penis but reports a gradual shift in spontaneity and pleasure when he and his wife make love.
Bill is old enough not to talk much about his future sexuality. He might be happy being celibate without an ongoing struggle. That clearly appears to be within his reach.
All four men report a drastic decrease in the intensity of their homosexual desires. All four men are less than half way through the process of their potential growth in therapy.
During the next few years I plan to report on the progress of these men in therapy and in their life.
The APA decision in 1973 which depathologized homosexuality was a political one. Even writers sympathetic to the gay affirmative position agree. (Bayer, Mass, Lewes). Although both sides state that based on the merit of their argument, their side would have won the day, this discussion has never taken place.
During the last three years I have become acutely aware that the gay affirmative therapists, point of view of homosexuality permeates the professional schools and, therefore, the opinions of the professionals who have graduated during the last 10 to 15 years. Having never been exposed to a dialogue between the two sides of the argument, nor to the documented results of therapy with men who sought to change their sexual orientation, these professionals tend to respond in an almost reflexive manner which causes me great concern.
The following are some examples:
Many adolescent sex offenders have been molested by men or have male victims. As a sequelae, they often experience severe anxiety, questioning whether they are homosexual, especially if some of the contact was emotionally satisfying and sexually pleasurable. One of these kids, at age 16 was actually sent to a gay bar by a therapist who wanted him to find out for himself what his "preference" was.
Last year one of the interns under my supervision, had in therapy an 8-year-old boy who was acting out sexually after having been sexually abused by several males. Since this youngster expressed through the therapist that he was experiencing homosexual feelings, and since he was approaching male children his own age or older, the therapist factually explained to him the difference between a heterosexual and homosexual lifestyle and suggested to him that they should discuss his preference as they continued meeting.
Recently, I began treating a man who was molested in his childhood by several males. His previous therapist seriously considered sending him to a gay affirmative therapist since he was compulsively re-enacting his own molest by going to pornography shops and involving himself with anonymous oral sex with men, and since some of his fantasy life was focused on men. This man experienced enormous anxiety around his issue of identity and sexuality. He was reassured that since he had many male friends towards whom he had never experienced sexual attraction and that since all of his sexual fantasizing involved impersonal homosexual activity which closely resembled his own molest, he did not fit the psychodynamic profile of men struggling with homosexuality.
He was immediately and immensely relieved and started working in earnest on his fears with regards to women.
During the last several years, as a psychotherapist and licensed psychologist, I've also received an even more ominous wake-up call. Based on the work and the influence of gay affirmative therapists, several of the professional organizations which regulate the ethical behavior of therapists had seriously considered making the treatment of homosexuals who wanted to change their orientation unethical.
Parallel with a redefinition of homosexuality as non-pathological and only identifiable as a persistent and marked distress about sexual orientation (DSM-IV) the very same diagnostic manual has redefined child molest as pathological and therefore treatable only if "the fantasies, sexual urges, or behavior cause clinically significant distress or impairment in social, occupational or other important areas of functioning." Therefore, according to this value-neutral definition of child molesting, it is only considered a dysfunction if the molester feels distressed by what he is doing and/or if what he is doing interferes with his functioning in other areas of his life.
A recent book by Dr. Levine, Sexual Life: A Clinician's Guide has the following statement on page 164:
"Since homosexuality is no longer considered an illness, it no longer is an ethically acceptable therapeutic goal to change a person into a heterosexual."
I wonder how far we are from the time when such review of sexual life by an expert in the field will say the same thing about the ethicality of the treatment of sex offenders.
I say postulates that the origin of homosexuality is constitutional and that the lack of attachment between the male child and the father is a product of a child's experience of erotic feelings towards the father which are then repressed and their object is pushed away.
Later on in a developmental sequence, the boy will try some effeminate strategies, partially because that is his constitutional identity, and partially because he wants to engage the father. This usually results in the father's over-protection of the boy, furthering the distance between them.
The father's rejection and society's rejection are internalized as homophobia which reinforces the repression of the sexual feelings towards the father. The job of the therapy is to uncover the early sexualized feelings of the child towards the father through the transference relationship with the therapist. This allows the client to reown his sexual feelings towards his father and make peace with this part of himself.
The logic of this theory clearly implies that if somebody wants to change his orientation, it is only because of his internalized homophobia which reinforces the repression of the original sexual attraction towards his father, and therefore to treat gay men who want to change should be unethical.
Socarides, Moberly and Nicolosi, along with others, have been harbingers of hope for homosexuals who are deeply and earnestly conflicted about the object choice of their sexuality.
In 1992 I received a wake-up call from Dr. Nicolosi. I needed the information he was disseminating since I was barely aware of the need for therapists who are willing to move against the political, cultural and professional tides and channel their psychodynamic skills towards helping homosexuals in pain, who desire a change in their sexual object orientation. I also needed to hear about the demonstrated successes of such therapies. Thousands of other therapists need this information so that clients will have a clear-cut choice and much needed hope.
Such hope is illustrated by Andrew's last session with me, prior to this presentation.
He reported that after the last few sessions during which for the first time he shared with another human being about his crazy and shameful attachment to his penis at age 16 and the incredible fantasy-life and arousal pattern he developed around it, he has experienced several weeks in which the urge and intensity of his lust decreased greatly, and actually, several times when he tried to mobilize himself to masturbate he had a difficult time maintaining arousal.
As we explored the imagery connected with his fantasy-life, he talked about being attracted mostly to the bulk in men, liking hunky, muscular bodies with v-shaped shoulders. As he was describing his attraction to a dildo and his excitement about its size, he related this to the bulkiness and the mass of the man it represented and talked about the need to incorporate it into himself.
The interpretation was a natural one, and he pursued it back to the skinny little boy who, at age 3, was sitting in his mother's kitchen, seeing his father build a sandbox outside in the yard. He remembered not being allowed to go out because he would get dirty and instead was sent to bed. With a tearful voice he remembered yearning to be out there with his father and wishing his father would have come and taken him out there.
Immediately he remembered being 8-years-old and going out with his father in the morning to wash golf balls. He remembered the joy he felt and he also remembered the disappointment when eventually his father would no longer take him. He recalled his anger, crying in his room and having his mother telling him to "shut-up and stop whining".
Andrew spontaneously articulated how it really was highly likely that his wanting to incorporate the mass and bulk of men was a compensation for the feeling of emptiness he felt inside himself with regards to his own male identity as he was growing up.
He recalled that from age 16 when his full sexual focus became private masturbation to homosexual fantasies, he always felt a kind of depression about himself. Because of the conflict, the shame, and the incredible compulsion he was simultaneously experiencing, this aspect of his life became the total focus for the way he viewed himself.
He recalled that just before he met his wife, he had a chance of actually consummating a homosexual experience. He remembered feeling uncomfortable with himself and not going through with it.
Andrew stated that he has no regret or yearning for having not consummated the act. In fact, he started talking about how he is able to feel aroused while looking at his wife and to get excited and have an erection during their foreplay. Even her scent is becoming arousing for him.
He mused towards the end of the session, "I used to feel I would never change. I can't believe how the energy behind my lustful feelings dropped during the last few weeks. Do I dare to hope? Do I?"
He and men like him can only hope if there are therapists who offer them a legitimate choice. We do, and I thank God for that.
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