from Clinical/Therapeutic Issues
By Joseph Nicolosi, Ph.D.
All the psychotherapists who join NARTH agree on one essential point--that reorientation therapy is ethical, and that it can be effective for clients who seek it. All strongly defend the client's right to choose his own direction in treatment.
Beyond that point of agreement around which we all rally, there are some differences.
Some take the position that the condition is a developmental disorder--particularly, a gender-identity disorder--which leads to a romantic idealization and sexualization of the qualities that the individual experiences as deficient within himself.
But other therapists disagree. Some prominent members--even some of our Scientific Advisory Committee members--refuse to take a position on the question of pathology.
Massachusetts psychologist Dr. Uriel Meshoulam, for example, believes the therapist should address the subjective problem of the client's suffering, and not concern himself with the objective question of disorder. "We must allow the person who seeks treatment to define undesirability and unhappiness," he says.
In an editorial, Dr. Meshoulam explained the reasoning behind this view:
"Psychotherapy is appropriate when applied to unwanted behaviors and unhappy constructions, rather than to so-called abnormal disorders...Preventing a person who is unhappy with his or her construction of self from seeking treatment is...oppressive.
"Many men and women are unhappy with their construction of their sexuality. It is of questionable ethics to try to convince them that they are 'wrong,' and try to convert them to the therapist's way of thinking. Clients who had been greeted with 'gay-affirmative' statements from therapists often told me that they felt grossly misunderstood, and despaired over the prospect of having nowhere to go with their problem.
"...I have seen people who enter therapy with a wide range of unhappy constructions and attitudes toward their sexuality. As a result of therapy, many of them learn to redefine themselves and their sexuality, and thus enhance their potential."
Some other therapists, including our Scientific Advisory Board member Dr. Mark Stern, take the position that homosexuality is not a disorder, but a missed potential--a closing off of a part of oneself and a "saying no" to generativity.
Some prominent practitioners outside of NARTH take an apparent middle ground on this issue. Dr. Robert Spitzer, the psychiatrist known as the architect of the 1973 decision to remove homosexuality from the list of disorders, maintains that homosexuality was not "normalized" when it was removed from the DSM--only that it was no longer categorized as a disorder. He believes this decision was appropriate because the condition is not invariably assoaciated with subjective distress, nor a generalized impairment in social effectiveness or functioning.
At that time he referred to homosexuality as an "irregular" form of sexuality, and more recently, he agreed that when a person has no capacity for heterosexual arousal, "something is not working."
There is clearly room for practitioners of both persuasions within NARTH, all working together to defend the client's right to pursue change.
I myself take the view that homosexuality is a developmental disorder and is potentially preventable. I see strong evidence for the classic psychodyamic position that homosexual behavior is rooted in a sense of gender-identity deficit, and representative of a drive to "repair" that deficit. When the underlying emotional needs and identification deficits are addressed, clinical experience has shown me that the fantasies and behavior diminish, and for many people, there follows an awakening of heterosexual responsiveness.
Yet others--such as NARTH's Scientific Advisory Board member Dr. Mark Stern, for example--see same-sex attraction not as a disordered form of sexuality, but in terms of a potential having been unmet, with a repertoire of responses lacking their full extension to include generativity.
NARTH is happy to welcome and support the efforts of practitioners of both viewpoints. Indeed, the debate continues.
For more information see: Joseph Nicolosi.com.