by Joseph Nicolosi, Ph.D.

The American Psychological Association has officially proclaimed that homosexuality is not a psychological disorder.  We do not attempt to challenge their decision. Similarly, many individuals say they are happy identifying as gay, and we do not oppose their right to define themselves, and to live their lives as they wish.

However, some clients come to us with a different understanding of what it means to live out their lives in the most satisfying way. It is to these people– who come to us with their own, self-defined problems in living– that we offer our help.

So then, what is Reparative Therapy®, and why is it so controversial? Opponents of the practice say that it involves shaming the client, causing him to deny his true self, and breaking up family ties. I would like to take this opportunity to explain what Reparative Therapy® actually is.

Equally important, I would like to explain why “sexually questioning” teens must have the chance to investigate all of their options — not just be encouraged by counselors into adopting a gay identity and living a gay lifestyle.

First: The Client Sets The Goals

First, as with all good therapy, Reparative Therapy® never involves coercion. The client has come to the therapist seeking assistance to reduce something distressing to him, and the RT psychotherapist agrees to share his professional experience and education to help the client meet his own goal. The therapist enters into a collaborative relationship, agreeing to work with the client to reduce his unwanted attractions and explore his heterosexual potential.

The foundation of RT, as with all good therapy, is the establishment of the therapeutic alliance. This important alliance is defined as follows: the client and therapist agree to work together toward clearly defined objectives as defined by the client, and those goals and objective can always be redefined. Beyond his determining what he wants from therapy as a whole, the client is further encouraged to explain what his goals are for each session, i.e. to bring into each session his “identified conflict.” In short, the client must always lead.

This collaborative relationship could not, of course, include imposing methods or techniques attempting to “cause” sexual-orientation change — which would, anyway, be quite impossible!– but utilizes four basic methods of intervention. These interventions will result in reducing, and sometimes eliminating, sexual or romantic attractions toward individuals of the same sex. But no outcome can be guaranteed. There must be an understanding from the outset that reducing same-sex attraction and developing heterosexual potential will be achievable along a continuum from complete change, to partial change (management and reduction of the unwanted feelings), to, for some people, no change at all. Some clients decide to return to a gay lifestyle. Others, particularly religiously committed clients, will ultimately decide to accept the persistence of their unwanted feelings but commit to chastity.

Sometimes, the client does not know what he wants, as is often the case with the teenager asked to come into treatment by his parents. In those cases, if the teenager does decide to come in, we agree NOT to work on his homosexuality, and the therapeutic alliance is founded upon some other of the client’s goals, such as managing parental disapproval without family breakup, or dealing with problems of peer rejection.

The Gay-Affirmative Therapist Fails To Ask Questions

The RT therapist does not simply accept at a surface level the client’s sexual or romantic feelings and behaviors, but rather, invites him into a non-judgmental inquiry into his deeper motivations. The RT psychotherapist always asks “why” and invites the client to do the same.

The gay-affirmative therapist, however, typically addresses this clinical material regarding homosexual attractions “phenomenologically” (i.e. accepting the attractions at face value without questioning their origins). This is a highly unprofessional omission.

The RT therapist must go much deeper: he recognizes, for example, that a teen may believe he is gay for a variety of reasons that have nothing to do with his core sexual identity. His sexual feelings may be rooted in a need for acceptance, approval, of affection from males, or may reflect his loneliness, boredom, or simple curiosity. He may engage in same-sex behavior for adventure, money, peer pressure; or to express hostility against male peers, or general rebellion. He may also find himself reenacting an early trauma of sexual molestation by another male (Fields, Malabranche and Feist-Price, 2008).

A higher-than-average percentage of homosexually oriented men were sexually abused in childhood by an older male. One study found that 46% of homosexual men compared with just 7% of heterosexual males reported homosexual molestation. The same study also found that 22% of lesbians reported homosexual molestation compared with just 1% of heterosexual women (Tomeo, et.al., 2001). In these cases where the person was molested in childhood, homosexual behavior reenacted in adulthood can represent a repetition compulsion.

Indeed, a teenager may become convinced that he is gay through the influence of a persuasive adult– a gay-affirmative therapist, mentor, teacher, or even his own molester. Such influential adults could succeed in swaying an uncertain youth that homosexuality, is for him, simply inevitable.

Homosexual behavior may also reflect some kind of developmental crisis that has evoked insecurities, prompting the fantasy that he can receive protection from a stronger male. Anxieties and insecurities regarding approaching the opposite sex (heterophobia) may also prompt the search for the perceived safety and ease of finding a partner for same-sex behavior.

Environmental factors such as incarceration in a prison, or living in a residential treatment facility where young males sleep together and are isolated from females, may promote same-sex behavior and consequent gay self-labeling. In addition, gay self-identification may represent a political or ideological statement to the world, as seen in radical-feminist lesbianism in the women’s movement (Whisman, 1996). In short, any textbook on adolescence will acknowledge that homosexual feelings and/or behavior can be seen within the normal (i.e., “not unusual”) range of the adolescent experience.

These and many other examples of homosexuality may appear in adolescence but then discontinue as the teen moves on to adulthood. This is confirmed by studies which show that as these teens get older they are increasingly less likely to self-identify as gay. A study of 34,707 Minnesota youth reported that 25.9 % of 12-years-olds were uncertain if they were heterosexual or homosexual (Remafedi et. al, 1992). In contrast, only about 2 to 3% of adults eventually label themselves as homosexual. This means that approximately 90% of these “sexually questioning” teens could erroneously be identified as homosexual, if they are affirmed as gay by a gay-affirmative therapist, school counselor or an on-campus gay club.

For all these reasons the teenager deserves the right to explore the reasons he thinks, feels, acts or believes he is gay.

Why The Name, “Reparative” Therapy?

Attempts have been made to stigmatize the term “reparative therapy,” and to marginalize those who participate in it. However, the “reparative” view of homosexuality provides a special dimension of understanding between the client and the therapist that can further the client’s goals.

Many gay-identified persons find the word “reparative” offensive: “I don’t need to be fixed, mended or repaired.” Our answer is, “Of course not; no one can ‘fix’ another person. But if you wish to promote your own change, you do have options.”

In contrast to the gay-identified person who is offended by this term, many reparative clients find comfort and reassurance in the awareness that their homosexual behavior may be an unconscious attempt to “self-repair” feelings of masculine inferiority and that such feelings represent an attempt to meet normal, healthy, masculine emotional needs.

For such a client, understanding the “reparative” concept increases self-acceptance and compassion regarding his desire for this unwanted behavior, which previously evoked only confusion, shame and self-hatred. The therapist who adopts the reparative theoretical model will also find a gratifying conceptual link between his work and the rich psychodynamic tradition spanning pre-Freud to the present. This body of literature better informs his work with the client through which he can connect the searching client to an established therapeutic modality.

The term “reparative,” then, conveys an insight about the nature of homosexuality, which is that same-sex attraction may be an unconscious effort at self-reparation. Through this shared perspective, client and therapist collaborate as they probe deeper for a fuller understanding of the client’s experience.

The Four Principles Of Reparative Therapy®

The four principles of RT are (1) the therapist’s disclosing of his own views; (2) encouragement of the client’s open inquiry; (3) resolving past trauma; and (4) education regarding associated features of homosexuality.

(1) Disclosing versus imposing

From the very start of therapy, the RT psychotherapist should disclose his views on homosexuality, not only as a scientist-practitioner but also his views from a personal, philosophical or religious perspective. (The gay-affirmative therapist will also disclose his philosophical views to the client, but from a quite different, gay-affirmative perspective that sees homosexuality as a developmental path that is parallel and equivalent to heterosexuality.) The RT client needs to be clear about the therapist’s understanding of homosexuality as an adaptation to childhood trauma and as often representing a reparative behavior with serious future consequences. At the same time, the therapist must not impose those views on his client, but give him space to explore his own sexual identity and make his own self-determination. The RT therapist (like the gay-affirmative therapist) must not pressure or manipulate the client to believe or accept the same viewpoint as he does. Indeed, the therapist accepts and values the client as a person, no matter what his sexual orientation, behavior or self-label.

(2) Encouraging Inquiry

While the client may be motivated to enter RT to reduce his SSA, the RT therapist does not suggest any techniques that attempt to directly eliminate the client’s SSA. Such attempts never work. Rather, the RT psychotherapist invites and encourages the client to inquire. He is encouraged to ask questions of himself, and to look into his feelings, wants and desires that may lie beneath his SSA.

This brings us to another important rule of RT: The therapeutic alliance must include the mutual understanding that the client can always feel free to disagree with the therapist (Nicolosi,J.,2009).

(3) Resolving Past Trauma

Reparative Therapy® views most same-sex attractions as reparations for childhood trauma. Such trauma may be explicit, such as sexual or emotional abuse, or implicit in the form of negative parental messages regarding one’s self and gender. Exploring, isolating and resolving these childhood emotional wounds will often result in reducing unwanted same-sex attractions.

(4) Education

It is the responsibility of the therapist not to withhold information that can be of use to the client. What the client does with that input is left for him to decide.

The RT psychotherapist is better informed than most general-practice mental-health professionals about same-sex attraction. His educational responsibility consists of three general areas:

(a) Causation. Research shows that same-sex attraction is associated with particular types of negative peer and family experiences (Bieber at al, 1962; Green, 1996). When combined with a sensitive nature in the client, the consequent trauma can have damaging effects on both individuation and gender-identity development. The focus of treatment is identifying and resolving those traumatic experiences (Bieber,et.al.,1962; Greenson, 1968; Tabin,1985; Nicolosi, Byrd and Potts, 2002).

(b) Underlying motivations. There is a substantial body of evidence supporting the understanding of at least some forms of homosexual orientation as based upon disturbances in gender-identity formation (Coates, 1990; Green, 1993; Horner, 1992; Fast, 1984; Coates and Zucker, 1988; Nicolosi, Byrd and Potts 2002). The fulfillment of those needs can reduce, and sometimes eliminate, same-sex attraction (Nicolosi, Byrd, and Potts, 2002).

(c) Health Consequences. As part of his discernment process, the client deserves to know the longterm medical and emotional liabilities associated with of a gay lifestyle, including the common maladaptive behavioral patterns (2). The timing and manner of delivery of these educational opportunities should be determined by the RT psychotherapist’s sensitivity to the client and when it is in the client’s best interest.

All such therapeutic interactions are in accord with the NARTH Practice Guidelines for Treatment of Unwanted Same-Sex Attractions and Behaviors. These guidelines assure respect for the client and offer ethical parameters for treatment and educational interventions.

Endnotes

1. “All the Facts about Youth and Homosexuality,” NARTH, The National Association for Research and Therapy of Homosexuality, (www.narth.com).

2. Journal of Human Sexuality, vol.1, 2009; see also Winn, Robert, The Gay and Lesbian Medical Association, “Ten Things Gay Men Should Discuss with Health Care Providers,” 2012, wwwglma.org.

References

Bieber, I., Dain, H., Dince, P., Drellich, M., Grand, H., Gundlach, R., Kremer, M., Rifkin, A., Wilbur, C., and Bieber T. (1962). Homosexuality: A Study of Male Homosexuals. New York: Basic Books.

Greenson, R. (1968). Disidentifying from mother: its special importance for the boy. In Explorations in Psychoanalysis, pp. 305-312. New York: International Universities Press.

Coates, S. (1990) Ontogenesis of boyhood gender identity disorder. Journal of the American Academy of Psychoanalysis 18:414-418.

Coates, S. and Zucker, K. (1988). “Gender Identity Disorder in Childhood.” In Clinical Assessment of Children: A Biopsychosocial Approach, Eds. C.J. Kestenbaum and D.T. Williams. New York: New York University Press.

Fast, Irene (1984). Gender Identity, A Differentiation Model; Advances in Psychoanalysis Theory, Research, and Practice, vol. 2. University of Michigan: The Analytic Press.

Fields, S.D., Malebranche, D. and Feist-Price, S. (2008), Childhood sexual abuse in black men who have sex with men: Results from three qualitative studies. Cultural Diversity and Ethnic Minority Psychology, 14,385-390.

Green, Richard (1993). The Sissy Boy Syndrome. New York: Harper Collins.

Horner, Althea, “The Role of the Female Therapist in the Affirmation of Gender in the Male Patient,” Journal of the American Academy of Psychoanalysis, vol. 20, n. 4, 1992, pp. 599-610.

Nicolosi, Joseph, (1991). Reparative Therapy of Male Homosexuality, Northvale, N.J.: Jason Aronson.

Nicolosi, Joseph, (1993. Healing Homosexuality: Case Stories of Reparative Therapy. N.J.: Jason Aronson.

Nicolosi, Joseph (1993). “Treatment of the Non-Gay Homosexual Man,” Journal of Pastoral Counseling, Vol. XXVIII, p. 76-82.

Nicolosi, Joseph (2009). Shame and Attachment Loss, The Practical Work of Reparative Therapy. Downers Grove, Ill.: InterVarsity Press, pp. 23-26.

Nicolosi, J., Byrd, D., Potts, R.W. (June, 2002). “A Meta-Analytic Review of Treatment of Homosexuality,” Psychological Reports.

Nicolosi, Joseph, and Nicolosi, Linda Ames (2002). A Parent’s Guide to Preventing Homosexuality, Downers Grove, Ill.: Intervarsity Press.

Remafedi, G., Resnick, M., Blum, R. and Harris, L., “Demography of Sexual Orientation in Adolescents,” Pediatrics, vol. 89, April 1992., pp.714-21.

Rekers, George, “Homosexuality: Developmental Risks, Parental Values and Controversies,” In Handbook of Child and Adolescent Sexual Problems, G. Rekers, Ed., N.Y.: Lexington Books, 1995.

Satinover, Jeffrey, B., The “Trojan Couch”: How the Mental Health Associations Misrepresent Science.” National Association for Research and Therapy of Homosexuality, http://www.narth.com/docs/ TheTrojanCouch Satinover

Tabin, Johanna (1985) On the Way to the Self: Ego and Early Oedipal Development. New York: Columbia University Press.

Tomeo, E. Marie, et.al., “Comparative Data of Childhood and Adolescence Molestation in Heterosexual and Homosexual Persons,” Archives of Sexual Behavior, Vol. 30, No.5, 2001.

Whisman, V. (1996) Queer by Choice: Lesbians, Gay Men and the Politics of Identity. N.Y., N.Y.: Routledge.

Zucker, Kenneth, and Bradley, Susan (1995). Gender Identity Disorder and Psychosexual Problems in Children and Adolescents. New York: Guilford.

Zucker, K. and Green, R., “Psychosexual Disorders in Childhood and Adolescence,” J. of Child Psychiatry, 33, 107-151, 1996.

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by Joseph Nicolosi, Ph.D.

All the psychotherapists who join NARTH (now known as The Alliance for Therapeutic Choice and Scientific Integrity) 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 represents a developmental adaptation to trauma, and that it 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 unwanted fantasies and behavior diminish, and for many people, there follows an awakening of some degree of heterosexual responsiveness.

Indeed, the debate continues.