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from What do clinical studies say?
Questions and Answers
by Sander Breiner, M.D.
Question: My 20-year-old son just told me he is
homosexual. What can I do to change him?
Answer: Your son is no longer a small child,
and your major influence and impact on his life is
past. So at this point in his life, you can no
longer want things for him; he must want those
things for himself. You can't want him to be a
doctor if it is his choice to be an architect.
Neither can you want him to be heterosexual if he
wishes to be homosexual. However if he himself
seeks a change in sexual orientation, then your
support--coinciding with his own wants, not mere
compliance with our wishes--can often come to a
successful conclusion.
Your best contribution to his life today, and in
the future, is in your loving kindness toward him,
and in his awareness of your respect for him.
The knowledge that his mother and father care for
each other--and that there is an intact, loving
family always there for him--will now be your
major contribution to his welfare.
Question: What is the most effective type of
treatment?
Answer: The most effective therapy is one based
on the working relationship between the therapist
and the patient, respecting the patient's
conscious and unconscious goals for change in his
life.
Assuming that the patient is well-motivated and
capable of participating in the intense and
difficult process of dynamic psychotherapy, I
believe that psychoanalysis will produce the most
beneficial result. At the very least, some form
of insight-oriented and psychologically supportive
psychotherapy should be part of the course of
treatment the patient chooses. Without in-depth
dynamic psychotherapy, the benefits will likely be
temporary and some other form of psychological
symptomatology will eventually emerge.
In my experience I have found that dealing with
the underlying anxiety and depression is the most
efficient way of reaching the patient's
unconscious conflicts, whether the patient is
dealing with homosexuality or another problem.
Question: What are the most common causes for
male or female homosexuality?
Answer: Since homosexuality is a complex
emotional and behavioral response to a variety of
internal conflicts, there is no one good answer.
However, certain facts emerge.
First, certain family influences may bring about
homosexuality in one child, but not in another.
This is why it is important not to blame parents
for a child's homosexual development.
Second, it is necessary for the child to identify
with and love an adult member of the same sex as
he or she advances in early childhood. Without
that normal experience, the individual will not
develop normally (although the result will not
always be homosexuality).
Third, since mothers are the most important person
in a child's life prior to three years of age, how
the mother responds to that child and how the
other adults (particularly the father) in that
household respond to the mother will prepare the
child for its orientation to itself and for all
future interpersonal relations. Homosexuality can
result as a defense against the anxiety that has
been evoked.
Fourth, between 15 to 20 months of age, a little
girl comes to see herself as a female, and for
little boys, gender identification occurs between
18 and 24 months. Both boys and girls require the
benign relationship of father as a loving
caretaker for healthy gender-role establishment.
Fifth, the three-to five-year age period is the
time when both boys and girls learn basic social
interactions with their parents and peers.
Successfully passing through this time of
development establishes their gender role, in
which they should identify with a parent (or
surrogate) of the same sex. Failure to
successfully pass through this stage may conclude
in a homosexual outcome.
In summary, though many problems can lead to a
homosexual expression, the outstanding elements
are as follows: hurt self-esteem (damaged
self-image); incomplete or conflicted gender-role
development; conflict over identifying with a
member of the same sex, and conflict over being
needful of a member of the opposite sex.
Question: I am a gay man, and most of the time
I feel depressed and unhappy. What can I do?
Answer: Despite the term "gay," depression is a
common experience (both conscious and unconscious)
of most homosexuals, both male and female. But
before you proceed in therapy, you must understand
that there are two parts to the question. First,
is your major concern the depression, or your
homosexual orientation? If your concern is
primarily about your homosexual orientation; and
you wish to understand yourself further, and
thereby work on changing that orientation, then
therapy is available to assist you.
Or if your main concern is depression, with
homosexuality being of less significance for you,
then there is also psychotherapy aimed at
alleviating depression. If you are able to
participate in intensive dynamic psychotherapy
(e.g., psychoanalysis), you can expect a favorable
outcome.
Since hurt self-image, injured self-esteem, and
blocks to emotional freedom are common conscious
and unconscious experiences of the homosexual, the
resolution of the depression may also include a
resolution of the homosexual orientation into
heterosexuality--but not necessarily.
Whatever the choice, you decide what route you
will take, and how far you will travel. The wishes
of society, family, therapist--even professional
organizations--do not enter into that choice.
Also be aware that when a patient comes in for an
initial evaluation, their diagnosis and treatment
will not be determined solely by the unwanted
symptom. Accurate diagnosis is reached through a
complex understanding of the patient's
psychodynamics. After the diagnosis is made, we
embark on a course of treatment which takes into
consideration the patient's level of psychological
development, capacity to tolerate psychological
stress without significant decompensation, and
motivation to understand themselves and make the
appropriate changes. Finally, the type of
treatment chosen and the extent of that treatment
will be a decision initiated by the patient with
the therapist concurring.
In my 45 years of work in this field, I have found
that the most significant predictor of success has
been the patient's motivation to understand
themselves. Some patients' motivation is simply
to relieve the symptom in order to feel better,
but enduring success in therapy will require that
the patient strongly desire to understand and
resolve the underlying conflicts.
Updated: 8 February 2008
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