From the NARTH Collected Papers, 2004

Philip M. Sutton, Ph.D.

"Do you do reparative therapy?" Since becoming a clinical member of NARTH, I have been asked this questions many times by phone callers -- referred by NARTH -- who were looking for help for themselves or a loved one. My usual first response to this question is to ask the caller: "What do you mean?" As they explain, I begin to learn how I can serve them best during the remainder of the call, and possibly afterward. (At the end of the paper, I explain how I usually answer this question.)

In The Making of a NARTH Psychologist, I talk about why and how I became a family psychologist who treats unwanted ("ego-dystonic") homosexuality as part of my clinical caseload. My hope is that newcomers to NARTH and professionals considering doing so may be encouraged by my story and guided to learn more, as I have learned and still am learning. I hope also that non-mental health professionals may find it helpful as I describe how ideas about homosexuality and counseling techniques that I've learned through NARTH have helped me to become a better psychologist with all of my clients.

Clinical members of NARTH and resources published by NARTH have played a major role in my beginning to serve men, women and children, who either experience unwanted same sex attractions/ behaviors (SSA or homosexuality) themselves or who have a family member who does. Some of my clients also have included parents who have wanted to help their young children with gender identity confusion to avoid developing same-sex attractions. I have been a clinical member of NARTH for five years and was an associate member for a few years before that. I became a clinical member when I began serving my first client who was dealing with unwanted SSA. But that is the most recent chapter of the story my professional life, and I start at the beginning.

Preface

The preface to my story begins as an undergraduate at the University of Notre Dame where I majored in philosophy. Questions such as: What is real? What is true? What is good? What makes people happy? What does it mean to be human? What are emotions?, etc., interested me back then, and such questions intrigue me still. I think that every mental health professional has been taught answers to these questions, often wrong answers, without every formally asking the questions. I mention this because so much of poor mental health theory, research and practice, particularly in the area of homosexuality, is based on incomplete or false answers to such questions. In general, I find many professional philosophers difficult to read and understand, but colleagues sometimes find me too "philosophical" for their tastes -- I'm giving you fair warning!

Chapter I: Graduate School

The first chapter of my formal development as a NARTH psychologist -- I am skipping my experiences of marriage, early parenthood, studying undergraduate psychology courses at night school, and my first "real world" job with a toy manufacturing company -- began when I entered graduate school at Purdue University 26 years ago in 1978. While earning an MA in the Clinical Psychology Program and a PhD in the Marriage and Family Therapy Program, I was introduced formally to the diagnosis of homosexuality. As a teaching assistant for an undergraduate class in Abnormal Psychology, I had to assist several tutorials at which a member of the Purdue Gay and Lesbian Alliance spoke. I remember nothing of what he said, but I still remember his face and his being the first self-identified homosexual I'd ever met.

The title of this conference: "Ego-Dystonic Homosexulaity: The Integration of Theory, Research and Practice" reminds of another important influence from my five years and a summer in graduate school. In 1978, five years after the APA changed the diagnostic criteria, we were taught that to diagnose homosexuality with the Diagnostic and Statistical Manual of Mental Disorders (DSM), we needed to learn whether a client's "homosexuality" were "ego-syntonic" or "ego-dystonic." That meant that we had to learn whether the person was happy or unhappy about his/her homosexual feelings or behaviors, whether his/her homosexuality was wanted or unwanted. Our clinical faculty had little to say about the treatment of homosexuality.

The clinical psychology faculty was split between humanistic- and behavior modification-oriented psychologists, and the historically successful psychoanalytic approaches for the treatment of unwanted homosexuality -- or of any psychological or behavioral problem -- were not discussed. The only research on behavioral approaches to treating SSA was aversive conditioning. In one instance, this involved giving someone an unpleasant negative experience while viewing a series of erotic, same-sex pictures so that over time, ideally the viewer would come to have a negative instead of a positive feeling about such pictures and other same gender stimuli.

The phrase: "Integration of Theory, Research and Practice" from our conference title, also brings to mind the guiding pillars of graduate education in clinical psychology. According to the model adopted by the American Psychological Association (referred to back then the "Boulder [Colorado] model"), all graduates of clinical and counseling psychology programs needed to be competent in psychological theory, research and practice. While it was recognized that all professionally trained psychologists did not continue to do research after their dissertation, and some did nothing but research, the Boulder Model assumed that practicing psychologists would continue to integrate these three areas in their professional work lifelong.

Upon completing an MS degree, I decided to switch programs to specialize in marriage and family therapy. While continuing to complete the professional psychology coursework, I studied the various family systems approaches to helping couples and family. When I graduated from Purdue, I considered myself a "cognitive-behavioral" and "structural/strategic" family psychologist.

Chapter II: Getting Started Professionally

My first post-graduate years included taking an elective internship and launching my career. I completed a one year post-doctoral internship in child clinical psychology at the Philadelphia (PA) Child Guidance Clinic, joined a family therapy-oriented private practice group, under the supervision of an experienced family psychologist, and began general practice. I spent a lot of my professional time at an agency which served children who had been abused or neglected or were "at risk." After two years, I was licensed as a psychologist. I also began teaching as an adjunct professor in a local counseling and guidance graduate program. My professional and teaching experiences -- and my philosophical interests -- led me to learn more about the problems of fatherlessness -- physically or emotionally absent fathers -- on children and families, and to look for more opportunities to teach.

Chapter III: Teaching Graduate Student Counselors

A significant crossroads on my path to becoming a NARTH psychologist occurred in 1989 when I became the first director of the Master of Arts in Counseling Program at Franciscan University of Steubenville, Ohio. In doing so, I found the old saying true, that I, the teacher, learned much in teaching my students and, concerning NARTH, especially from one of my students. The Franciscan University graduate counseling program was designed to educate professionals who respect human and Christian values through integrating counseling theory and techniques with a Christian understanding of the human person.

In launching the program and leading it for two and a half years, I was introduced to a number of ideas that, fifteen years later, still guide my professional work and particularly my service to clients with unwanted SSA. At Franciscan University, I learned and taught about the psychology of Thomas Aquinas, as understood and applied by Catholic psychiatrists Anna Terruwe and Conrad Baars.¹ Of practical relevance to my becoming a NARTH psychologist was their Thomistic-inspired understanding of emotions, repression and affirmation.

Emotions are like "psychic motors" which move us to love, seek and enjoy what is good for us; to dislike and avoid what is not; and to protect ourselves at need. I found helpful the ideas that emotions help to move or energize our will (like power steering fluid makes it easier to steer -- or power brake fluid to stop -- a car) and that emotions speak with a voice of "truth." For example, desiring something means that we have perceived -- consciously or unconsciously -- that having something would be good for us, or being angry means that we have perceived that something is unfair. My perceptions may be wrong -- what I desire may not be good for me or what happened may not have been unfair, but my emotions don't know that. Sometimes our will needs to override our emotions, but our emotions are intended to help us choose and do what is best. While it may take a lot of effort and time, our emotional life -- including compulsive sexual desire -- can be brought to cooperate with our will in serving our well-being.

I found Baars and Terruwe's ideas about emotional repression particularly enlightening. They teach that when one emotion suppresses (intentionally, consciously puts out of our awareness) or represses (unconsciously, habitually puts out of awareness) another emotion, the suppressed/repressed emotion remains active but is less or non-responsive to our will. For example, someone may experience which "smothers" anger which the person dreads feeling or expressing; or anxious energy which prevents their facing inner sadness, depression or emotional pain; or sexual desire which covers or contains deeper desires for affirmation, sadness or other emotions. Emotional repression occurs as involuntary self-protection, to help us avoid being overwhelmed by feelings which we perceive unendurable. (Such a constructive explanation of repression was a helpful way undoing the effects of the general dismissal of the concept from my behavior modification oriented graduate education.)

Baars and Terruwe also introduced me to the idea of affirmation, the universal human need to recognize and "feel" our own goodness or worth through the presence and actions of significant others, particularly our parents. Those who do not experience that they are loved and lovable unconditionally, for who they are instead of for what they may do, achieve or produce, they may experience a lifetime of frustration attempting to make themselves feel "worthy." Common pseudo-self-affirming behaviors include amassing money or material possessions; obtaining academic degrees or professional credential; seeking fame or prestige, or associating with famous people; gaining power through positions of authority; engaging in sexual behavior; abusing alcohol and other substances; other obsessive-compulsive behaviors (e.g., eating disorders, gambling, or workaholism); harboring resentments with emotional or physical aggression, or withdrawal. In particular, homosexual behaviors were understood as pseudo-self-affirming, and ultimately self-defeating, attempts to experience unconditional love.²

At Franciscan University, I had the privilege of meeting Dr. Elizabeth Moberly who had been invited by University staff members involved in the psychological and pastoral care of students. I learned much listening to her describe how she came to recognize the "reparative drive" which gives rise to SSA and to her observations that so many of the persons whom knew who were living a homosexual lifestyle seemed to experience a great deal of repressed anger, as well as unresolved histories of emotional deprivation. I also was struck by how such a frail-appearing person as Dr. Moberly needed and had sufficient courage to continue to talk about her professional observations and theories in spite of rude, if not hostile, opposition from gay activists.

Finally, at Franciscan University I was introduced to Courage, a Roman Catholic apostolate (ministry) to Catholics with SSA who want to live chastely (with sexual purity). A student in the counseling program was a priest-chaplain in Courage. Along with learning about this "Twelve Step" approach to pastoral care for students and other Catholics with SSA, Fr. Ed Sylvia, CSC shared many resources about therapeutic approaches for helping persons with unwanted SSA not only learn to live chastely, but also to develop their heterosexual potential.

Through Fr. Ed, I learned also about the discussions among Courage members about whether to add "change of orientation" as a formal goal of Courage and the decision not to do so. Courage would -- and still does -- support those who wished to seek the appropriate help. However, since all who have begin the therapeutic process do not invariably achieve such change, it was decided that making it an explicit expectation or goal of the ministry would be an unreasonable burden to Courage members in general.

Chapter IV: IPP, Fatherhood, and Courage: NARTH comes to Me

When family needs required my leaving Franciscan University in 1991, I went into full-time professional practice. I devoted some of my professional time as a psychologist in an outpatient clinic and the rest as a school psychologist and counselor. I chose to do the latter -- and have ever since -- because I believed I should do what I had advised my male graduate student counselors: to help meet the needs of "fatherless" children by serving in schools.

During the next eight years before becoming a clinical member of NARTH, it would be fair to say that NARTH first came to me, and then I came to NARTH. One year after NARTH first was organized, I attended a professional retreat in Bethesda, Maryland at which Joe Nicolosi was one of several speakers on a variety of topics. Along with learning about the existence of NARTH, his ideas about reparative therapy reminded me of what I already had learned about the causes and treatment of SSA from Elizabeth Moberly, Baars and Terruwe, and Fr. Ed, and about the consequences of fatherlessness on children. Nicolosi's idea that SSA is essentially an attempt to seek the "3 A's: attention, affection and approval" paralleled all that I had learned about "affirmation."

As I was leaving the University, Fr. Ed advised me to find some way to "keep on teaching." Trying to heed his advice led me to further study and work that made me more aware of NARTH. One effort involved helping to form the short-lived Institute for Personalist Psychology (IPP) and to speak on Thomistic Psychology (see above) at the first of its two conferences. My participation in IPP also led to my next contact with a NARTH member, Dr. Jeffrey Satinover, who spoke at the second and last IPP conference.³ A year later, he spoke again at a Catholic university not far from where I live on the causes and treatment of homosexuality. I still find insightful and profound, his concept of the "childhood vow," which is an immature decision to "defensively -- self-protectively -- detach" from the same gender parent to avoid feeling future emotional rejection or abandonment.

Another way to "remain teaching" was to research, write and give a paper on the causes and remedies for fatherlessness. What began as a paper eventually turned into a longer manuscript which integrated social science and Catholic teaching on the effects of fatherlessness and the importance and restoration of fatherhood. In writing, I was reminded of what Nicolosi⁴, Satinover⁵ and NARTH publications, as well as Fr. John Harvey, OSFS, the founder of Courage,⁶ had written about the role of "fatherlessness" in the development of SSA, and I referred to these ideas in my manuscript.⁷ As I began writing, I joined NARTH as an associate member, because I wanted to support NARTH's mission, and I valued all that I had learned from the members I'd already met.

When writing about fatherlessness and fatherhood, I noticed that adult men who had experienced physically absent or emotionally unavailable, non-nurturing or abusive fathers had similar needs, whether they experienced SSA or not. All tended to have trouble with knowing what it meant to be "a man," with com-mitment in relationships, and with chastity (self-disciplined sexual behavior).

Whether struggling with SSA or not, common approaches to overcoming the effects of fatherlessness typically involved helping men to make peace -- through grieving and perhaps psychotherapy -- with the memories, leftover emotions and ongoing relationships with their fathers, and sometimes their mothers; to seek the support of and share mutual accountability with other, like-minded men; to experience some form of surrogate fathering or mentoring (pastoral, therapeutic, etc.); to work a program of sexual sobriety aimed at serenity (peace of mind and joy of heart) and if married, fidelity to their spouse; and to use appropriate spiritual and religious activities as resources for change and growth.

During the time I was writing on fatherlessness, I was introduced to Courage again, and became personally involved with a local group. As part of the same lecture series which invited Jeffrey Satinover, Fr. John Harvey, OSFS was asked to speak on the Courage ministry. After his talk, a member of our diocesan Office of Family Life asked if I would be willing to help start a Courage group within the diocese. This invitation led to my becoming active in the Courage ministry, first by helping a local group to form, and for the last two years facilitating the meetings.

My involvement with Courage fostered my involvement with NARTH as well. While attending the first Courage conference for youth leaders in 1998, I again heard Joe Nicolosi speak. Since Courage records its presenters, I came away from the conference with a number of audiotaped talks by other clinical members of NARTH, including: Charles Socarides, Jeffrey Satinover, Bill Consiglio and Rick Fitzgibbons, as well as earlier talks by Nicolosi. I also had audio-tapes talks given by members of various Exodus ministries, including: Lori Rentzel, Alan Medinger and Andrew Comiskey. Five years ago, after receiving my first request -- through Courage -- to help a married man deal with unwanted SSA, I decided that it was time to join NARTH as a clinical member.

Chapter V: Becoming a Clinical Member of NARTH: I Come to NARTH

Seeing my first client with unwanted SSA and becoming a clinical member of NARTH was a watershed or defining moment. I remember feeling apprehensive and uncertain about identifying myself as a NARTH therapist. Although Courage and Encourage already had provide opportunities for serving men with SSA and meeting men and women with SSA and family members concerned about loved ones, my first client and NARTH membership felt like a "giant step" in my professional career.

Over my past five years of clinical membership and direct service to clients with unwanted SSA, I have counted a dozen ways that my involvement in NARTH has helped me to integrate psychological theory, research and practice, and more specifically to learn HOW to serve the needs of my clients better.

1. Attending NARTH conferences. I admit to feeling nervous and uncertain when I attended my first conference in November, 2000 in Washington, D.C. While wondering "What am I getting myself into?" three conferences later I realize that I have gotten myself into an organization of mental health professionals and supporters who are dedicated to quality research, scholarship and service to those who experience unwanted SSA and their families. Familiar faces and more clinical experience have made returning to conferences a welcome experience.
2. Attending talks by NARTH members outside of annual conferences. As my first introduction to NARTH came outside of conferences, I continue to have contact with NARTH members at other gatherings, including conferences sponsored by groups supportive of NARTH's mission (e.g., Courage, PFOX, Society of Catholic Social Scientists.)
3. Personal contacts with other NARTH members. Contacts with NARTH members at and between conferences has given me a broader set of colleagues, and friends. Sharing case stories has helped me learn from my own and others' clinical experiences.
4. Contacts with and from the NARTH office. Although there are few NARTH therapists in my area of the country, the NARTH office is a source of referrals for clients with unwanted SSA's and their families, as well as an information resource for use with clients and non-professional groups. My occasional contacts with the staff in Encino are always friendly. They help me realize that in my counter-cultural efforts to serve the needs of my clients, I belong to a larger, therapeutic community.
5. Reading the NARTH Bulletin. I have found that NARTH Bulletin offers articles that reflect the wide range of theoretical orientations and clinical techniques that have proven useful for understanding the origins and treatment of unwanted SSA. I also welcome the articles which offer a different perspective on the latest breaking press release by "gay-affirmative" voices in the mental health professions and the reviews of both "gay" and "gender-affirming" books.
6. Surfing the NARTH Website. I have found www.narth.com to be an even more current source of information and perspective on the latest news (and controversy) about the causes and treatment of unwanted SSA. The website provides a handy archive to retrieve past articles from NARTH Bulletin for further review. The website also has been a ready source of pamphlets and other information for clients and other interested individuals and groups. I have found the following to be particularly helpful: Homosexual Advocacy Groups & Your School; Questions and Answers on Homosexuality, Parts I and II ; Understanding Same-Sex Attractions; and NARTH'S response To "Just the Facts about Sexual Orientation and Youth."
7. Reading Books. Books by Nicolosi and Satinover (mentioned above) helped me decide to become a clinical member of NARTH. Others have deepened my understanding. A Parent's Guide to Preventing Homosexuality⁸ has been another good introduction.
8. Listening to audio-tapes. As mentioned above, listening to audio-tapes -- and occasionally viewing video-tapes -- of presentations by clinical members of NARTH was a key way that I first learned about therapy for unwanted SSA. I think that most audio-visual materials are available through allied and religious-affiliated ministries (e.g., Courage, Exodus and PFOX).
9. Teaching and supervising with NARTH materials. While co-teaching a course on professional ethics for psychologists, I have used a number of the NARTH brochures and other materials to discuss informed consent and the empirical support for understanding the causes, consequences effective treatments for unwanted SSA behaviors. Such resources and my own clinical experiences have proved helpful when supervising therapists whose clients have SSA-related presenting problems.
10. Writing for the NARTH Bulletin. Writing for fellow the NARTH members and other readers of the Bulletin has deepened my involvement as a member. Specifically, I have written about my experience of teaching an ethics course with NARTH materials (see no. 9), written a book review, and a clinical note (about whether "SGSA" -- Same Gender Sexual Attraction -- was better abbreviation for homosexuality than "SSA" -- Same Sex Attraction).
11. Networking with religious-based ministries. My involvement in the Courage ministry led to increased contact with NARTH, and my clinical membership has enabled me to offer professional resources for members of Courage, other religiously-affiliated ministries and to religiously-motivated laypersons as well. Networking with, and newsletters and internet articles by, organizations such as Courage, PFOX, Exodus, and Homosexuals Anonymous have offered ideas and testimonies that have been helpful for supporting clients' use of their personal and communal faith resources to achieve their therapeutic goals. Membership in the Catholic Medical Association also has aided my integration of professional knowledge and skills with faith perspective and resources.⁹
12. Providing public education. When necessary, I find that the education on SSA issues that I have acquired through my active membership in NARTH enables me to speak or write in an informed, objective manner. NARTH brochures, and the NARTH web-site itself, are invaluable resources. Given the large number of excellent articles, I have developed a list of my own recommended articles on the web-site for newcomers.

During one of my first contacts with Joe Nicolosi, I asked him why and how he continues providing therapy and engaging in professional and public education in the face of mean-spirited and unscientific opposition. Joe answered that: "The gratitude of the hundreds of clients whom I -- and the therapists whom I've taught -- have helped work free of unwanted SSA makes it worthwhile." I would add that my involvement with NARTH not only has enabled me to serve clients with unwanted SSA better, but also has enabled me to become a better, all around therapist, period!

¹⁰A. Dean Byrd, Ph.D. Treatment of Male Homosexuality: A Cognitive-Behavioral and Interpersonal Approach, NARTH Web-site. Alan Medinger also has advocated for the use of "gender-affirming" ministry as an alternative to "ex-gay."