By Dr. Codrina Cozma
1. Defining Abnormality in Male Homosexual Behavior
According to Gazzaniga et al. (2010), the criteria for classifying behavior as abnormal are 1) deviation from cultural norms, 2) maladaptive nature of behavior, and 3) distress caused to the affected individual (p. 619). Again, we should also consider harmful psychological and physical effects on the affected individual as essential factors in categorizing a behavior as abnormal. In this respect, Gazzaniga et al. (2010) mention interference "with at least one aspect of the person's life, such as work, social relations, or self-care" (p. 619). This section will address cultural norms and psychological and physical distress. The maladaptive nature of male homosexual behavior will be covered in the next section that deals with the etiology of male homosexuality.
1.1 Cultural Norms
Gay activism often argues that male homosexuality should be culturally accepted because homosexual behavior can be observed in several animal species. Even if science relies significantly on animal tests to attempt to explain and to treat human behavior, we find insufficient and logically flawed the argument that human homosexuality may be justified as normal because of the incidence of homosexual behavior among animal species. There are many behaviors that animals display and which are neither biologically healthy for humans, nor culturally/legally acceptable. For example, animals eat other animals; lions attack zebras and eat them raw. But if a human individual kills and eats another human being (raw or cooked), we will likely attribute this behavior to the antisocial personality disorder and commit the cannibal to an institution. On the other hand, there are some female lizards that kill their male mate immediately after copulation, but a woman who does that is very likely to be accused of murder and get either life in prison or the capital punishment. Again, there are some bird species that have only one mate in a lifetime, but not all humans copy that behavior. So there is an obvious discrepancy between animal behavior and human culturally and legally accepted behavior.
Further, we will look at religious traditions that shaped cultural norms with far-reaching societal and medical ramifications. The three Abrahamic religions (Mosaic, Christian, and Islamic) coincide in their position towards homosexuality as unacceptable behavior. In the next section, we will see why these cultural norms are not homophobic in nature, but they are actually rooted in practical evidence.
Early Christian writings specifically censure homosexuality. In his letter to the Romans, the apostle Paul addresses both lesbianism and male gay behavior: "Because of this, God gave them over to shameful lusts. Even their women exchanged natural sexual relations for unnatural ones. In the same way the men also abandoned natural relations with women and were inflamed with lust for one another. Men committed shameful acts with other men, and received in themselves the due penalty for their error" (Romans 1:26, 27). Further, in his first letter to the Corinthians, Paul includes male homosexuality in the list of sinners who will not qualify for eternal life: "Or do you not know that wrongdoers will not inherit the kingdom of God? Do not be deceived: Neither the sexually immoral nor idolaters nor adulterers nor men who have sex with men nor thieves nor the greedy nor drunkards nor slanderers nor swindlers will inherit the kingdom of God" (1 Corinthians 6:9-10).
The Islamic sacred book, the Qur'an, elaborates on the Mosaic story of the destruction of the two cities in which homosexual behavior occurred, Sodom and Gomorrah. Mission Islam (2012) indicates that in the Qur'an, Lot (the only believer in that grographical area) engages in a dialogue with male homosexuals, condemning their sexual practices: ": "Do ye commit lewdness such as no people in creation (ever) committed before you? For ye practice your lusts on men in preference to women: ye are indeed a people transgressing beyond bounds" (Qur'an 7:80-81) and "What! Of all creatures do ye come unto the males, and leave the wives your Lord created for you? Nay, but ye are forward folk" (Qur'an 26:165). Mission Islam (2012) also points out that lesbianism is classified as an unacceptable behavior in Hadith, which are collections of sayings attributed to Muhammad: "Sihaq (lesbian sexual activity) of women is zina (illegitimate sexual intercourse) among them."
The Mosaic religion labels homosexuality as abnormal among other sexual behaviors. The specific command against homosexual male behavior reads as follows "Do not have sexual relations with a man as one does with a woman; that is detestable" (Leviticus 18:22). In fact, Leviticus 18 establishes a number of rules for healthy sexual relations, which prohibit adultery, relations with family members, homosexual relations, and bestiality.
Now, let us consider each of these biblical prohibitions from a social and medical perspective: The divorce courts worldwide can testify to the catastrophic financial and psychological consequences of adultery for all members of families that experience divorce due to adultery. Again, it has been scientifically proven that consanguineous marriages lead to congenital diseases," such as Tay-Sachs and Niemann Pick Disease, as well as hereditary breast cancer associated with the BRCA mutation. Historically, European royal families have provided us with perhaps the best examples of the dangers of consanguinity in the mental retardation of the Hapsburgs and the hemophilia of the Russian czars" (Asmal, 2008). In addition, a plethora of studies have shown the acute psychological scars produced by incest.
As for the consequences of LGBT behavior, they are truly alarming and will be covered in the following section of this paper.
All these scientific data point back to the fact that breaking the rules in Leviticus 18, in the apostle Paul's letter, and in the Qur'an, may be called sin by theologians and believers, but that these prohibitions are in fact health warnings, thoroughly justified by our genetic makeup and issued by Someone who has a superior understanding of it because He created it. Freedman (1980) shares this pragmatic perspective on Torah's mandates in the rabbinical tradition:
This sanction of failure is viewed by the rabbis as empirical in nature; failure is a natural accompaniment of the acts in question, not a super-added punishment which God provides for the disobedient. As Aharon Halevy writes (Commandment 62): "for God knows that the outcome of actions for men growing out of these aspects is harmful, and therefore He prevents [these acts] of theirs." On this view, the failure is the reason for the prohibition, rather than the prohibition being a reason for failure (p. 107).
1.2 Psychological and Physical Distress
This section will provide evidence to support the fact that there is a pathological basis for the cultural traditions that censure homosexuality. Assessments of male homosexuals based on the DSM-IV-TR often signal mood disorders such as depression and bipolar disorder on Axis I, medical conditions, such as STD's (including a high incidence of HIV and Hepatitis B) on Axis III, problematic relationships with parents or friends on Axis IV, and relational dysfunctions (such as an inability to relate to males in a non-sexual way or avoidance of interactions with heterosexual males) on Axis V.
Perhaps the most life-threatening symptom, heavily associated with homosexual behavior, is critical episodes of depression that often lead to suicide. Gay rights supporters invoke social stigmatization as a factor that triggers suicide. However, suicide rates remain high in gay males in Scandinavian societies that display lax moral standards and that have long ago legalized gay marriage. In a 2010 meta-analysis, Whitehead et al. compile statistics from Netherlands, Denmark, and Norway, that indicate that "gay men in partnerships were eight times more likely to commit suicide than heterosexual men."
Last month, New York Times published a heart-wrenching article about the life and death of therapist Bob Bergeron (Bernstein, 2012). With a master's degree in psychological counseling, an annual income of $150,000, a property in Manhattan and one in Miami, at the age of 49, Mr. Bergeron displayed a sunny optimism and seemed to be an accomplished, self-sufficient individual. After starting out as heterosexual in college, Bergeron turned to an exclusively gay sexual life and constantly encouraged his gay clients to overcome depression and acknowledge the positives in the homosexual lifestyle. However, since narcissism is so prevalent in the gay community and body image is crucial for sexual acceptance, Mr. Bergeron started to feel he was losing momentum as he was facing a mid-life crisis. Perhaps to re-assure himself, Bergeron completed the manuscript for a self-help book called The Right Side of Forty: The Complete Guide to Happiness for Gay Men at Midlife and Beyond. On New Year's Eve, he methodically prepared instructions for his finances and left a suicide note on the title page of his book manuscript, in which he called his book "a lie based on bad information" (Bernstein, 2012). He was found dead, "with a plastic bag over his head," in his New York apartment on January 5, 2012 (Bernstein, 2012). His suicide note indicates that in fact, gay life is not "gay" as he tried to convince himself and his clients all his adult life. The tragic end of Mr. Bergeron is just one more example that proves that the kind of therapy that avoids a deep analysis of homosexuality causes and effects and that encourages people to remain in this lifestyle is a therapy that does not work for the benefit of its gay clients because it leaves them completely unprotected against depression, self-loathing, and fear of rejection by their potential sexual partners. According to Bernstein (2012), "a 2002 survey by researchers at the University of California, San Francisco, found that 12 percent of urban gay and bisexual men have attempted suicide in their lifetime, a rate three times higher than the overall rate for American adult males."
Aside from suicide, male homosexuality results in considerably higher risks for STD's, including HIV and Hepatitis B. In September 2011, the U.S. Center for Disease Control published a fact sheet that shows, among others, that 49% of the HIV positive individuals in the U.S. are males who engage in homosexual sex (MSM), and comparatively that "while CDC estimates that only 4 percent of men in the United States are MSM, the rate of new HIV diagnoses among MSM in the United States is more than 44 times that of other men." A CDC report published in 2000, Tracking the hidden epidemics, mentions that gonorrhea was on the rise in MSM as opposed to other population groups (p. 17) and that 18% of the Hepatitis B cases "were associated with homosexual activity" (p. 26).
In terms of Axis V -- dysfunctional relationships, we will further explore deficiencies associated with homosexual behavior as presented in scientific literature and will engage in a critical contextualization of these findings. In his recent book, Shame and Attachment Loss, Dr. Nicolosi (2009) views homosexual acting out as “a narcissistic defense against truly mourning the loss of an authentic attachment to one or both parents” (p. 356). In fact, narcissism ranks high among the symptoms of homosexuality explicated in this book, and it appears to be responsible for many of the relational barriers in the life of a homosexual. Again, being aware of how these symptoms work and what their causes and consequences are is an invaluable tool for people who work on a professional or personal level with homosexual men.
Communication shutdown is, for example, one major impediment that discourages most people from relating long-term and on a deep level to a homosexual individual. The majority of people who have ever gravitated around a homosexual man will report that the latter may go into periods of complete shutdown when phone calls and emails are not returned and replied, the homosexual man does not engage in initiating any contact, and sometimes, he acts out an utter avoidance or plain rejection; these periods may range from weeks to years. This kind of behavior may be taken as offensive by a friend or relative who is ignorant about what goes on beyond this silence and sheer rejection of the relationship. So this may alienate the straight friend/relative. On the other hand, persisting in maintaining this relationship, without being aware of how the homosexual man feels during a shutdown period, may also drain and discourage the other. Dr. Nicolosi (2009) not only acknowledges “emotional distancing” as a symptom (p. 45), but he also explains what causes it:
fear of disappointing the other person and shame that drives the homosexual man to hiding and avoiding -- “I always assume that if somebody really knows me, they won’t like me,” confesses one of his clients (p. 201).
a “chronic emptiness, the inability to feel and trust and the inability to relate intimately to others and to love” (p. 367). Most of it is based on a fear of criticism and of being hurt (p. 77) as the homosexual man projects past trauma on current relationships and anticipates that this person, too, will hurt him eventually. More particularly, there’s a fear of straight men who might “diminish” and “degrade” him (p. 51) and a fear of women who may “manipulate and control” him (p. 51) in a way similar to his parents or childhood mentors.
According to Dr. Nicolosi (2009), affect inhibition leads to shallow relationships. The homosexual man who has not processed childhood trauma uses affect inhibition as a defense against being further hurt. He deliberately refuses to invest emotionally in a relationship, so that he won’t expect something he may not get out of the other, and this way he avoids additional trauma. Hence, he strives to create and maintain shallow relationships that do not take and give much. It is obvious that this train of thinking is not exclusively a symptom of homosexuality, but it is pervasive with any individual who has experienced emotional trauma.
Dr. Nicolosi (2009) takes the workings of the psyche even further when he explains that the next step after the defense of affect inhibition is actually another defense meant to establish emotional balance and ‘aliveness,’ which in fact is the homosexual acting out: “Our clients typically report a lifelong emotional numbness,” he writes. “They claim that only sexual conquests with a variety of men offer an intense-enough excitement (however brief) to ‘bring them alive’” (p. 402). This could be the thrill sought by some people with low dopamine production or a manic manifestation of the bipolar disorder.
At the other pole from emotional withdrawal lies what Dr. Nicolosi (2009) calls “the nice guy persona,” a “one dimensional, co-dependent pleaser personality, habitually seeking the approval of others” (pp. 76-77), caused by fear of criticism or disappointment, a false self that conceals emotional emptiness because, as Dr. Nicolosi (2009) indicates, the homosexual who strives to appear as a nice-guy does not feel genuine care for others. This is illustrated by one of the therapist-client dialogues in which a client clearly recounts a situation in which he wore a caring mask, but in fact he was only pretending to care.
Perhaps Dr. Nicolosi’s focus on the “nice-guy persona” builds on the prominent narcissism he detects in most of his clients. He lists some of the narcissistic features as “self-preoccupation, emotional distancing, excessive concern with external appearances, restricted self-insight, a tendency to choose image over substance, and a tendency to be easily hurt and offended by others. There is an excessive need for reassurance and a persistent need to be made to feel ‘special’” (2009, p. 45). But underneath these “narcissistic” needs lies the homosexual man’s insatiable need for love, something he lacked while living his traumatic childhood or teenage years. One of Dr. Nicolosi’s clients states: “I’d like to be covered by love—wanted and loved. I want to be wanted and loved when I’m feeling all alone” (2009, p. 384).
Another symptom of homosexuality Dr. Nicolosi (2009) touches on is addiction, whether it may be substance abuse or sexual promiscuity. He presents addiction as a way of self-regulating shame or self-punishing and an immediate and temporary relief from pain and “emotional emptiness” (p. 80), a distraction from facing “his fundamental inability to establish authentic emotional attachments” (p. 80). However, the author warns that “Sex, food, compulsive hyperactivity and the drive for ‘distractions’ and ‘entertainment’ will not override the distress of emotional disequilibrium for long. After enactment, the disequilibrium returns” (p. 81). The social hyperactivity associated with addiction fosters shallow relationships, and all these together lead to both emotional and physical self-destruction. Although Dr. Nicolosi (2009) recognizes the causes and effects of addictions, and the fact that they are part of the homosexual package, his therapeutical approach does not target them in particular.
2. The Etiology of Homosexuality in Males
After numerous failed attempts to prove the genetic determinism of homosexuality, the American Psychological Association acknowledged in a 2008 brochure, Sexual Orientation and Homosexuality, that the etiology of homosexuality remains entangled in a combination of nature and nurture factors, thus leaving room for the possibility of change:
There is no consensus among scientists about the exact reasons that an individual develops a heterosexual, bisexual, gay, or lesbian orientation. Although much research has examined the possible genetic, hormonal, developmental, social, and cultural influences on sexual orientation, no findings have emerged that permit scientists to conclude that sexual orientation is determined by any particular factor or factors. Many think that nature and nurture both play complex roles; most people experience little or no sense of choice about their sexual orientation.
For specific male homosexual clients who experienced rape (either heterosexual or homosexual) at the debut of their sexual activity, Dr. Nicolosi (2009) implies a diathesis-stress model in assessing the emergence of homosexual behavior and/or feelings/thoughts as a combined effect of a genetic predisposition and a traumatic event (Gazzaniga et al., 2010, p. 625).
Dr. Nicolosi (2009) does not discard social causes that may occur in late childhood or early teenage years such as peer-pressure, the fad of homosexuality, curiosity, experimentation, the need of belonging, and the thrill of joining a socially marginalized minority. He also admits to the existence ofpsycho-biological factors, namely an in-born “sensitive temperament” (Nicolosi, 2009, p. 31) and “prenatal hormonal influences…that may result in a low-masculinized brain” (Nicolosi, 2009, p. 18). But he views the above factors as secondary to family upbringing, so he uses primarily a family systems model (Gazzaniga et al., 2010, p. 626) in assessing the emergence and development of same-sex attraction.
The fundamental cause that Dr. Nicolosi (2009) has recorded for most of his clients is a narcissistic-triadic family, dysfunctional or malattuned to the child’s needs, with an “over-involved mother and [a] critical / detached father” (p. 39). His scientific findings point to the root of homosexuality as being either a traumatic childhood that causes the young boy not to want to identify with an oppressive male figure, hence his homosexual effemination, or “a history of being victimized by manipulation and control” (Nicolosi, 2009, p. 35) especially by mothers or other influential females who were “inconsistent in their emotional responsiveness” and offered “conditional love” (Nicolosi, 2009, p. 73-74), a system of emotional enticement followed by withdrawal and blackmailing.
As part of the family background, Dr. Nicolosi (2009) mentions two parenting errors that may cause inhibitions that later lead to homosexuality. One is parental reprimand of sexual self-exploration at a critical age. “The male genitals are the embodied symbol of the boy’s essential difference from his mother,” explains the author. “A negative parental reaction when the child is engaged in genital exploration or play may (especially in the very sensitive child) prompt the boy’s shame-filled disavowal of his masculinity” (Nicolosi, 2009, p. 69). One of the 2009 re-runs on Univision of the Televisa episodes of the television show “Mujer: Casos de la vida real” (“Women: Real Life Cases”) documents a real situation of a man who develops same-sex attractions and is sexually inhibited towards his wife because he never had a chance to process the trauma of his mother’s violently scolding him after catching him masturbating at some point during his puberty years. This is one tragic case since the wife, hurt at the discovery that her husband is homosexual, shames him publicly at a family party, blaming him for his sexual orientation. The man leaves the party in a hurry, goes home, and commits suicide. Thus, this case indicates what extreme consequences such a parental shaming moment may have.
The other traumatic situation mentioned by Nicolosi (2009) is a family that inhibits the boy’s natural reaction to pain and shames him for expressing his feelings of anger, discontent, sorrow, crying, etc. “The child of the narcissistic family has been taught that to be sad is to be shameable,” explains Nicolosi (2009, p. 371). The author further shows how the therapist can take the message of critical parents -- “‘You’re not supposed to cry, you’re not allowed to feel sorry for yourself.’…’You’re upsetting everybody else. There’s no reason to be unhappy. You have everything you need, and nothing to complain about.’” – and can use it as a gateway to trauma processing: “But to deny the existence of the loss, I [Nicolosi] told him, is to continue to punish himself” (2009, pp. 366-7); hence, Dr. Nicolosi’s insistence on exercising and affirming his clients’ feelings (especially the negative ones).
3. Sexual Re-Orientation Therapy
From the 1948 Kinsey Scale to Klein Sexual Orientation Grid developed in 1993 and complex calculations and analysis carried out by Haslam in 1997, using the "Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Masculinity-Femininity (Mf) Scale," sexual orientation was defined as occurring on a continuum rather than being locked in distinct categories. Based on these studies, in February 2011, APA acknowledged that "research has suggested that sexual orientation does not always appear in such definable categories and instead occurs on a continuum (e.g., Kinsey, Pomeroy, Martin, & Gebhard, 1953; Klein, 1993; Klein, Sepekoff, & Wolff, 1985; Shiveley & DeCecco, 1977) In addition, some research indicates that sexual orientation is fluid for some people…(e.g., Diamond, 2007; Golden, 1987; Peplau & Garnets, 2000)."
This evidence validates the fact that individuals may shift in any direction on this continuum, with or without psychological intervention. Hence, sexual re-orientation therapy is deeply rooted in this possibility of shifting on this continuum. It is also based on the premise that while attractions are involuntary (not chosen) and may have been caused by environmental factors combined with certain predispositions, sexual behavior is a choice and can be controlled; further, such modified behavior will re-wire mental processes and feelings, so that eventually, after stopping homosexual behavior and through understanding the dynamics of one's own SSA, same-sex attraction will also diminish and disappear. In this section, we will examine sexual re-orientation efforts conducted in the U.S. by religious organizations and by Dr. Joseph Nicolosi, who has been a pioneer clinical psychologist in this area for over three decades.
Sexual re-orientation addresses exclusively the needs of clients who present unwanted same-sex attraction (SSA) and/or engage in homosexual behavior and who voluntarily opt to change their behavior and/or thoughts and feelings. Clients who benefit from professional or lay counseling aimed at this purpose attain different levels of success: For some, the outcome may be a better understanding of the causes that triggered homosexuality, a re-processing of trauma, and a better connection to one's self and to others. Others experience diminished SSA, stop homosexual behavior, but are not ready for a committed heterosexual marriage. Yet others find fulfillment in a heterosexual marriage, experience very low or no SSA, and will not engage in homosexual behavior for the rest of their lives. People who have benefited from re-orientation therapy are known as "ex-gays" and many of them have become involved with the Ex-Gay Movement which extensively uses media, literature, and scientific resources to create awareness of the need to accept people's right to change if they so wish and the fact that change is possible.
3.1 U.S. Religious Organizations for Sexual Re-Orientation
U.S. religion-based organizations that promote sexual reorientation do not in any way foster homophobia, but they support the idea that unwanted same-sex attraction (SSA) can be transformed either into a commitment to celibacy or a change toward heterosexuality.
As expressed by the Islam Mission (2012) of North America, the U.S. Muslim community does not endorse punitive measures such as execution or Taliban-type physical punishments and discourages homosexuals from committing suicide: "While homosexuality is wrong, it doesn't justify suicide under any conditions or circumstances. Please know that if you ever commit suicide, you would have seriously misunderstood Islam and its spirit." They also make the distinction between involuntary desires, thoughts, or emotions and acting on them (behavior): "Please note that there is a difference to actually being involved in a homosexual act - which is a sin - from having sexual feelings that you try to control, that you don't express in public, which is not sinful if you try to control them." This differentiation between mental/emotional processes and behavior is widely used in addiction recovery professional programs and also extensively emphasized by other Christian organizations that cater to homosexuals, such as Exodus International (2012).
Islam also shares with other Christian organizations some of the steps recommended for those who wish to deal with their unwanted homosexuality: "If you were ever involved in sexual homosexual acts in the past, you should truly and sincerely repent to Allah, The Merciful, The Gracious, and pledge to Him never to get involved in any homosexual acts anymore…If medical or psychological counseling helps, then get it, but know that Allah is The Curer, and the Qur'an is your best companion. Give charity, pray, make dua', and Allah will not leave you alone…Try to avoid all of the circumstances that trigger your homosexual feelings…keep yourself busy in different useful things…Keep a POSITIVE thinking in your mind and keep saying to yourself that you can do something about it." (Mission Islam, 2012)
Mission Islam (2012) has also aligned its position to that of Christian organizations, such as Exodus International (2012) and PFOX (2012) which emphasize the idea that homosexuality is a problem like other addictions (a sin against one's one body), so society needs to treat homosexuals with respect and oppose bullying: "Remember, there is in this world many compulsive gamblers, alcoholics, adulterers, thieves, but many of them control it and refrain from doing it...You have got to believe in the infinite amount of Mercy Allah provides to His servants, and you should also realize that He forgives, if He wishes, all types of sins, except the sin of disbelieving in Him."
JONAH International (2012), a Mosaic organization, views reparative therapy from a behavioral-cognitive perspective, defining homosexuality as "a learned behavior which can be unlearned," promote respect for "the dignity and humanity of every individual created in the image of G-d," and also acknowledges that the change from homosexuality to heterosexuality "is a lifelong process." This is also the position of Mission Islam (2012) that encourages the homosexual male not to share their homosexual tendencies with his wife and parents, but instead to "make it a lifelong struggle for [himself]."
While Mission Islam (2012) encourages the homosexual male to consider marriage to a woman not so much for sexual gratification, but also for other emotional needs -- "You will discover that marriage is more than simply fulfilling your sexual needs... Your wife will insha'Allah bring you peace, tranquility, joy, security, and many other feelings that every human being needs" --, the U.S. Catholic organization, Courage, advocates celibacy as a resolution for unwanted SSA. In its "Five Goals" statement, Courage (2012), similarly to Mission Islam, encourages homosexuals, to commit their lives to Christ and to service to others, but the Catholic culture promotes a support system that includes "chaste friendships" in order to "ensure that no one will have to face the problems of homosexuality alone." Moreover, Courage (2012) has adopted "twelve steps" of recovery from homosexual behavior, inspired by the original AA twelve steps and adapted with the AA permission; these steps imply that homosexuality is viewed as an addiction that has self-destructive effects (Step 2), that is detrimental to relationships with friends and family (Steps 8, 9), and that requires a rigorous accountability to the Divinity and to a mentor (Step 5).
A scientific perspective is also offered by Courage through articles, such as “Gay Genes,” Sexual Attractions, and the Call to Chastity, written by Rev. Pacholczyk, a prominent Catholic clergy with a solid scientific educational background (a doctorate in neuroscience from Yale and post-doctoral work at Harvard). Pacholczyk (2011) postulates that on the one hand, "we are not creatures of sexual necessity" and that on the other hand, we do possess the tools that enable us to refrain from behaviors that may be triggered by genetic predispositions: "Even if we have genes that predispose us towards certain behaviors, we still have a space of freedom within ourselves, and do not have to engage in those behaviors." Moreover, "the self-mastery" advocated by Pacholczyk (2011) is bound to result in "inner freedom and peace."
Exodus International (2012) is a U.S.-based, international organization founded by an ex-gay, Frank Worthen, who has spent over 30 years counseling gay males willing to change their orientation and who has also published several books on this topic. It is important to note that the policies of this organization exclude holding/touching therapy and exorcism as reparative therapy methods and clearly stand against bullying. PFOX (Parents and Friends of Ex-Gays and Gays) is a national U.S. organization with deep involvement in the legal support of ex-gays as an acceptable social minority group; PFOX lobbies for protective ex-gay legislation and for inclusion of ex-gay literature in public outlets (2012). These organizations share a Protestant Christian doctrine and regard both celibacy and heterosexual marriage as valid confirmations of successful sexual re-orientation. They do not endorse heterosexual promiscuity as a purpose in itself or as a validation of desired sexual orientation change.
The same perspective on healing is shared by a number of lay counselors who are individuals who have successfully overcome their homosexuality. Among them, it is worth mentioning for the state of Georgia, Chris Delaney, who offers free counseling to those affected by unwanted SSA through his ministry, Joseph's Coat Ministries, Inc. (JCM). JCM (2012) uses as a premise a divine provision that ensures that homosexuals can also experience a change of heart and mind like other types of sinners; gay males are mentioned in 1 Corinthians 6:9-10 as part of those categories that will be banned from eternal life, but in the next verse, the apostle Paul uses the past tense in his statement "And that is what some of you were. But you were washed, you were sanctified, you were justified in the name of the Lord Jesus Christ and by the Spirit of our God" (1 Corinthians 6:9-11), which is interpreted as including homosexuals in the spectrum of addictions and maladaptive behaviors that can be corrected through transformational faith since anyone in Christ is a new creation (2 Corinthians 5:17).
3.2 Professional Psychological Reparative Therapy
In the U.S., the National Association for the Research and Therapy of Homosexuality (NARTH) was founded in 1992 by Drs. Charles Socarides, Benjamin Kaufman, and Joseph Nicolosi with the purpose of conducting research in the area of reparative therapy and of upholding the LGBT clients' rights to self-determination, to pursue change in accordance to their cultural and religious values, and to take measures that will safeguard their mental and physical health (NARTH Practice Guidelines, 2012). NARTH represents a much needed equalizer in a political and scientific climate hostile to unbiased scientific inquiry, following the removal of homosexuality from the inventory of mental disorders by APA in 1973 and the highly politicized dialogue on sexual freedom and gay rights.
At the Thomas Aquinas Psychological Clinic in Encino, California, Dr. Joseph Nicolosi, founder and director of this clinic, has devised a complex system of therapy that could be best identified as the dialectical behavioral therapy described by Gazzaniga et al. (2009, p. 696); this reparative therapy includes a psychodynamic element (exploring the client's past traumas as a way of exploring causes of present symptoms), and a behavioral-cognitive approach (helping the client identify his own feelings -- cognitively and through body work--, analyze these feelings, and then engage in grief work).
Addressing emotional inhibitions that are so prevalent with homosexual men, the therapist asks the client to verbalize a feeling triggered by a certain conflictual situation and then to identify the bodily reactions associated with that feeling. The body work approach stems out of the scientific theory that “…all the functions of the brain are mediated through the body. It is the body that mediates between the brain and the world. An altered bodily response to an object will alter the cognitive meaning of that object” (Nicolosi, 2009, p. 169). Dr. Nicolosi (2009) emphasizes the role of body work in processing the awareness of the shame moment: “These sensations alert the client to a shame moment that would otherwise go unnoticed by the cognitive functions” (p. 261). For a man who has been inhibiting his feelings all his life, it may be difficult to cognitively articulate them, so watching his body reactions may actually help him identify, anticipate, and actively engage his feelings. Scientifically, this is rooted in the “dual-brain psychology” established by Schiffer in 1998 which attempts to connect the affects in the right brain to the cognition in the left brain, thus “building a link between thinking and feeling” (Nicolosi, 2009, p. 211). It is clearly a way of “re-wiring” the client into staying with himself, acknowledging his feelings, and processing them cognitively at the same time. It definitely increases self-awareness and empowers the client to be more in control of his thoughts, feelings, and actions. A direct effect of body work may be the client’s realization “that his homosexual attractions are generated primarily not by the attractiveness of the other man, but by the way he is feeling about himself” (Nicolosi, 2009, p. 107), which is an important step in the progress of therapy.
The grief work ensues after body work and enables the client to not only re-live the past trauma, but also to feel the pain without any inhibitions. The therapist empathetically “stands in the grief” with the client, which represents the first time the client can freely experience pain in the presence of another, a supportive mentor. The positive effects of grief work are illustrated by the statement of one of Dr. Nicolosi’s clients: “Grief work helped me get in touch with all of my feelings—especially the negative ones I didn’t want to feel. When I am connected to my true feelings, I feel strong, masculine and alive. That’s when I’m no longer drawn to looking at other men, and my life can go on” (Nicolosi, 2009, p. 430). It is crucial for the success of therapy that grief work be used not only to process past trauma, but also current shame experiences; Dr. Nicolosi also uses “homosexual enactment as an opportunity for grief work” (Nicolosi, 2009, p. 419), thus turning a negative experience into a positive consequence. This is especially helpful in dealing with relapses.
The therapist’s empathy plays an essential role in Dr. Nicolosi’s approach, which clearly defines his therapy as a client-centered, humanistic one, among others. In a “working alliance” with the client, the therapist is constantly exposing vs. imposing (Nicolosi, 2009, p. 289), leads the client to acknowledge and affirm his need for 3 A’s -- attention, affection, approval (Nicolosi, 2009, p. 101) -- and guides him through a shift from self-hate/disgust to self-compassion, facilitating healing through compassion for self and others (Nicolosi, 2009, p. 115). Self-compassion triggered by an understanding of the client’s legitimate needs and constantly anchored in reality will also diminish shame, and thus open the channels of communication between therapist and client: “As the personification of the reality principle, the therapist attempts to expose the client’s illusions while avoiding shaming him. This is achieved by showing the historical necessity for his illusory creation. Highlighting his childhood need for his narcissistic defense diminishes the client’s shame reaction to such exposure” (Nicolosi, 2009, p. 119). With Dr. Nicolosi’s approach, the client takes precedence over the method; he advises that the therapist should be “willing to compromise the session sequence to follow the client’s affect. It is the pursuit of affective expression that produces therapeutic insight” (Nicolosi, 2009, p. 170).
The client-therapist sample dialogues presented in this book often feature an affective blockage, a breach in communication/relationship, which Dr. Nicolosi calls “the double-bind,” which is then corrected through the “double loop” (a reconnection, an opening) and followed by the Meaning Transformation (MT) phase, which involves the interpretation of feelings and events (Nicolosi, 2009). This approach of the double bind and double loop mirrors for the client the possibility of reconnecting after a breach in real-life relationships. The MT phase then evaluates the significance of the therapy session, leading the client to the realization that “These adaptational defenses that worked during childhood are now, in adulthood, maladaptive and self-defeating. In the process of recognizing and uprooting these defenses, the client exchanges this symptomatic behavior for a more realistic perception of himself and others” (Nicolosi, 2009, p. 169). As he invalidates these childhood defenses, Dr. Nicolosi clearly supports the client to grow out of being a little boy, to mature. This is also why he opposes Richard Cohen’s method that involves the therapist’s physically hugging the client: “…we understand the need to be held as regressive and as reinforcing the sense of dependency and weakness. Holding may reinforce the illusion that the client can return to being a little boy. What appears more transforming is for the client to feel and express the need to be held, and to have this need respectfully understood by another salient man (i.e. through the double loop), where the client admits his deep longing to be held; it is understood and accepted by the therapist, and he experiences the therapist’s acceptance of that need” (Nicolosi, 2009, p. 455).
One of the most efficient attitudes of the therapist illustrated in Nicolosi's book Shame and attachment loss, as a response to clients who are “hyper-distrustful and alert to manipulation” (Nicolosi, 2009, p. 290) is a genuine willingness to allow the client sufficient freedom to agree or disagree, to make discoveries and decisions for himself. “Ultimately, his life choice must be his own,” writes Dr. Nicolosi, “and if he feels manipulated or negatively judged, he is reminded that he needs to address this problem with the therapist. I reiterate, ‘Rule number one—never agree with anything I say unless it rings true for you’” (2009, p. 288). On the other hand, when dealing with minors, Dr. Nicolosi advises that certain confidentiality terms be established from the very beginning: “Legal limits of confidentiality should be spelled out, including the therapist’s obligation to inform parents about self-destructive behaviors, including dangerous sexual activities…to avoid problems, the therapist should first clarify with the teen what he ethically can and cannot tell his parents about their sessions” (Nicolosi, 2009, p. 288).
Dr. Nicolosi’s reparative therapy system facilitates the shift from homosexuality to heterosexuality through gradual attainment of several goals:
desensitization and reprocessing of trauma
identifying what leads to homosexual acting out: powerlessness, failure to express anger, envy of others’ masculinity, fear; as an illustration, one client states his realization that “when he was feeling accepted and connected with other guys—especially on a physical level—his homosexual preoccupation disappeared. It was during times of social isolation and rejection that his same-sex fantasies resurfaced to preoccupy him” (Nicolosi, 2009, p. 299)
making the distinction between friendship and erotic feelings; the awareness and analysis of sexual (mental) engagement that implies a “disconnect” from friendly dialogue (Nicolosi, 2009, p. 109)
shifting from a passive to an assertive attitude; Nicolosi (2009) acknowledges that some SSA men are assertive in their profession, but not in their private relationships (p. 239)
the client should be able to achieve feeling and dealing at the same time by grief and assertion (Fosha 2000 qtd. in Nicolosi)
increasing self-participation in life decisions, community involvement, self-love, empowerment
the client should be able to face “the reality that happiness and fulfillment can never be ‘imported’ from any other human being” (Nicolosi, 2009, p. 91)
self-accounting exercise that should cover certain sections -- event, reaction, assumption, assessment, summary (2009, p. 284)--, and most importantly, a close relationship with a straight male who would act as mentor and who would serve as an accountability partner especially in the gap between homosexual temptation and acting out (2009, p. 253).
In addition to presenting the causes, symptoms, and treatment techniques outlined above, Dr. Nicolosi (2009) also launches in his book Shame and attachment loss, a number of relevant concepts and typologies, which certainly help both professionals and “lay” readers to understand the mechanics of homosexual behavior. First, he distinguishes between the “gay homosexual” who affirms his gay identity and has peace with it and the “non-gay homosexual” who experiences unwanted homosexuality and is willing to engage in reparative therapy and to potentially become an ex-gay. In this context, he then defines the concept of gay identity as a “false self,” and thus, reparative therapy becomes a self-discovering tool that reveals the true heterosexual identity of the homosexual client. Further, the author presents four types of false self that characterize the behavior of certain types of homosexual men (Nicolosi, 2009, pp. 122-124):
the passive-compliant – the “nice guy”
the theatrical entertainer
the outrageous, hyper-feminine, drag queen
the angry activist – hyper-masculine
Dr. Nicolosi (2009) also postulates that there are two main types of homosexuals:
pre-gender – attracted to macho men that would compensate for his lack of masculinity; and
post-gender (some are bi-sexual): attraction to women is present, but they relate to women only sexually; no female friendships; attraction to younger boys that remind him of his boyhood and something he missed at that age; this category has better prognosis for recovery
Another useful concept provided in this book is the difference between shame and guilt. Dr. Nicolosi (2009) defines shame as anxiety towards others and directed at what you are, and guilt as being directed to yourself and to what you do, and as leading to correction (p. 267).
Dr. Nicolosi (2009) also outlines four types of male friendships (pp. 308-9): gay, non-gay homosexual, straight non-attractive, straight attractive (the best because it allows the homosexual man to de-sexualize male friendships). Like all those who truly possess high-caliber intelligence, Dr. Nicolosi also practices humility, which he expresses in an awe-inspiring statement: “The fact remains that people do not change through the application of techniques. People change through relationships—relationships with caring people who apply these effective techniques” (2009, p. 25). It is a statement that may produce an epiphany in the minds of so many people who genuinely desire to be instruments of healing for their homosexual dear ones. And it is certainly a privilege for such caring people to have access to the expertise of a giant of reparative therapy like Dr. Nicolosi who shares these techniques in his books.
Given the high risks of exposure to mental and physical illnesses associated with homosexual behavior, and the fact that living the gay life fully and freely has been proven in so many cases not to resolve the real underlying issues that trigger homosexuality (such as trauma or developmental stalling), reparative therapy remains the genuine and only way in which homosexual men can achieve a strong sense of identity, grow in self-knowledge, and develop a deeper understanding of human relations and of the meaning and purpose of life.
There is a need for therapists who would go beyond supporting an affirmation of gay identity and who would instead help their clients explore the dynamics of their sexual attractions and behavior. The clients need to be empowered to repair old relations with family and build new healthy friendships outside their comfort zone. This kind of therapy, whether or not it may be conducive to shifting positions on the sexual orientation continuum, will foster emotional maturity, stress-coping tools, including the integration of a support system, and a better knowledge of self.
But there is also a crucial, massive need to educate the public to understand the real emotional and physical challenges faced by homosexual men, to become aware that heterosexual people need to provide more than a pat on the shoulder and ignorant indifference to homosexuals; they need to become mentors, friends, and fellow-travelers on this journey of self-discovery and self-defining.
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