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I Am Not a Reparative Therapist
Warren Throckmorton, PhD
Many people ask me if I do reparative therapy or if I believe it works, or some variation on that theme. This is a natural question given that I have defended the right of people to seek sexual re-orientation change and take an accepting stance toward those who give an account of such change, by whatever means.
Thus, it is often assumed that in my clinical work, I practice reparative therapy. This is a false assumption. I am not a reparative therapist nor do I recommend that people seek someone trained in reparative therapy as an exclusive approach to homosexual attractions. As this will be confusing to some, I will explain.
What is reparative therapy?
Coined by psychologist, Joseph Nicolosi, reparative therapy is a term describing just one specific, therapeutic effort to effect sexual reorientation. Another well-known name in reparative therapy circles is Elizabeth Moberly. She wrote perhaps the seminal work on the subject called Homosexuality: A New Christian Ethic. The basic premise of Moberly’s book is that homosexuals have “suffered from deficit in the relationship with the parent of the same sex and that there is a corresponding drive to make good this deficit – through the medium of same sex, or homosexual relationships.”
According to Dr. Nicolosi, homosexuality is a disorder of gender identity. Due to shame about personal masculinity (not feeling masculine in comparison to other men), homosexuals seek to connect with men through sex. In an interview with Social Work Today, Dr. Nicolosi said that he:
“sees the male homosexual condition as rooted in a failure to bond with the father, and the homosexual attraction a conflict between the desire to connect with the masculine and a fear of connecting. It’s what we call anticipatory shame. The child was not supported by his parents in his early masculine strivings, and as an adult, he is now in conflict with his normal desire to connect with other males. The boy who grows up homosexual was often born with an unusually sensitive temperament. This is the identifiable biological element—‘gender atypicality’—that can predispose some children to homosexuality. While the boy’s parents may have successfully raised their other sons to be heterosexual, this one particular son needed the males in his life to actively elicit his masculine gender identity—and somewhere along the way, there was a failure in this regard.”
Thus, reparative therapy takes its name from the basic idea of the approach: In this theory, men in homosexual encounters seek affirmation and emotional intimacy from other men as a means of repairing their sense of masculinity which was damaged due to failure to bond with their fathers. The same is true for lesbians; they have had weak or inconsistent mothering and so they are looking for the perfect mother in lesbian relations. These dynamics are asserted to be true of all, or nearly all of those who are attracted to the same sex.(1)
The therapy attempts to re-direct the reparative drive toward healthy nonsexual relationships with same sex peers via the therapist, group counseling, and support groups. A major aspect of this effort is to generate or support gender identification. That is, men are encouraged to develop a solid sense of masculinity and women are encouraged to become more feminine. The belief is that if people have a solid sense of gender identification, then they will experience sexual attractions consistent with heterosexuality. For instance, if a woman who has identified as a lesbian develops a solid sense of herself as a feminine woman, she will begin to find the opposite sex attractive.
From my perspective there are many problems with this theory.
The theory leaves many unaddressed questions. For instance, how much fulfillment of same-sex attachment need is required to avoid homosexual feelings? Do parent-child attachments fall along a continuum or are parents and kids attached or unattached with no shades of gray? Does one need a little connection, a moderate amount or is an intensely close connection needed?
These questions highlight the difficulty in assessing what are essentially emotionally experienced private events. Without verification, one must assume that the presence of same-sex attraction is a sign of detachment even if there are no obvious signs of unmet same-sex needs from the parent-child relationship. No matter how positive and loving a parent-child relationship appears to be, according to the reparative theory, if same sex attractions are a part of a person’s experience, then that person is or has been detached from his or her same-sex parent.
Another problem for this theory is the observation that many people who have had verifiably negative relationships with their parents do not experience same-sex attraction. The theory predicts the need for detachment to occur in order for same sex attractions to arise. How about those who have detached from their same-sex parent and experience no same-sex feelings? Many such people exist and some ethnic groups (e.g., African-American, Hispanic) where father absence is pronounced would seem to be more vulnerable than other groups. However, this does not seem to be the case.
Any theory that purports to describe the typical homosexual is suspicious. In fact, there appear to be multiple developmental trajectories that lead to experiences of same-sex attraction. The weak-father-too-close-mother theory describes some homosexuals but not all of them. The landmark psychoanalytic study of homosexuality often cited by reparative therapists was conducted by Irving Bieber and colleagues and published in 1962. This work is often advanced as evidence for the classic reparative pattern. However, 76 of Bieber’s 106 homosexual subjects did not fit the triadic pattern. A majority of men had some disturbance in the home but the typical pattern was not so typical.
How does the reparative drive theory impact reparative therapy?
Imagine a young man seeking counseling from a reparative therapist. He has experienced homosexual attractions since puberty. He has fleeting, weak opposite-sex attractions. He feels love and closeness from both of his parents and has a positive group of male and female friends. He is well liked and respected by most peers and does well in school. He shares with his father first and then mother that he has sexual feelings for boys. There is no yelling or shaming. There is shock, bewilderment and some tears along with a shared desire to find out more about what they all agree is a problem. Thus, dad calls a reparative therapist to set an appointment.
Now imagine that on the first visit, the therapist listens to the young man tell his story. The therapist then explains to the client that the roots of his feelings stem from estrangement from his father and begins to ask questions about the family’s history, focusing on his feelings about his parents. After awhile, the therapist explains the feelings of same-sex attraction as reflecting unmet needs to connect with men. The therapist asks about the young man’s interests in sports and suggests that the client most likely had mostly female friends during elementary school.
This session presents the young man with conflicts. He knows he is close to his parents, and notably, his father. He has lots of friends of both sexes but is unhappy about having same-sex attractions. So what does he believe? His own experience or the expert offering help based on the reparative model? He might come to view genetic determinism as a more plausible alternative since the only environmental alternative he has heard doesn't fit his life.
One of my most serious complaints about reparative therapy is that adherents often recommend directly telling clients that they are homosexual due to the operation of the reparative drive. Despite the obvious bias this introduces into the situation, reparative therapists advocate this directive approach to therapy. Therapists operating in this manner have been known to ask about family relationships and ignore other factors. One of my former clients said that a prior reparative therapist always wanted to focus on his relationship with his father, even though the relationship was pretty good. Eventually, the therapist gave him an ultimatum of sorts: either talk about the real (assumed to be poor) relationship with father or there will be no hope for change.
If the results of this approach were uniformly positive then perhaps my concerns would be less compelling. However, no outcomes studies have been conducted that would help specifically test reparative therapy effects. The studies we do have examine benefit and risk from making change attempts but do not single out the various therapy approaches for analysis. So we know some people find benefit from change and some people do not but we know very little about why.
There are many problems here. I remember when many clinicians thought that autism was the product of a seriously disturbed mother. Another sad example of assuming that current symptoms reliably signal past events is the repressed memory controversy. In the 1980s and 1990s, clients came to therapists in droves seeking to find out whether or not their psychological distress might be caused by repressed memories of past abuse. During these years, many clients sought my advice to find out whether hypnosis or some other technique would uncover the issues that plagued them. Clients with the book, Courage to Heal by Bass & Davis in hand came in saying they knew they had been abused because they checked off a variety of symptoms in the book that indicated past sexual abuse. Even though many of these clients could not remember anything abusive in their pasts, therapists and clients too frequently collaborated to reconstruct stories of abuse.
I am concerned that the same kind of bias about family history could plague the reparative therapy approach to homosexuality. In fairness, I recognize that some men do appear to be seeking a father’s love through connection with older homosexual men. These situations are pretty obvious. However, some other clients describe a good relationship with father until the father became aware of a difference in his son. These clients have related to me that the relationship with father was good until they, as sons, disclosed their homosexual struggle to their dads. Then things became strained, if not hostile. In other words, the predicted father-son estrangement can occur after a son’s awareness of same-sex attractions. And in some cases, there is no estrangement at all.
However, the reparative practitioner actively offers clients a family-based explanation for their attractions. In a recent speech regarding homosexuality, Dr. Nicolosi recommends that therapists tell adolescent clients that the reparative drive is the reason for their same-sex attractions. Reparative drive theory makes specific predictions about the family dynamics of any family with a child who is same-sex attracted and these predictions are “explained” to the client and family as being what research has shown to be true.
In a handout given to clients authored by Dr. Nicolosi, a list of experiences and feelings is provided as being consistent with either “the true self” or “the false self.”(2) All of the negative behaviors and feelings are on the side of the false self along with homosexuality and the positive feelings, behaviors and true self are on the “no homosexuality” side. About this diagram, he writes:
Most patients will passively resist comparing their feelings and behavior to a diagram. It seems somehow demeaning to impose a blueprint over their personal lives. Everyone prefers to believe his personality is so unique, so exceptional that it can never be reduced to a simplistic schema. Only by repeatedly seeing how his own confused and disordered inner life so predictably conforms to the diagram, does the client come to admit that the diagram is worthwhile.
Analogous to repressed memory therapy, the therapist tells clients what they experience, and what their families were like. Such dogmatism is unwarranted by research and can be incredibly offensive. It doesn’t just seem demeaning; it is demeaning.
So then what do you believe?
I think it is prudent to be skeptical of a theory and treatment which claims to account for all the variant data points associated with homosexuality, when clearly it doesn’t. Current research data await a better theory. I favor placing emphasis on observable, measurable factors which seem to be representative of biology, development, attachment and behavior.
At present, I believe that same-sex attractions arise much in the same way preferences for musical styles, food preferences and activity inclinations occur: through an interaction of temperament and environment. All such preferences are judged as good, neutral or bad based on moral, religious and practical considerations. While reparative therapists will often agree that temperament may make an impact, they invariably come back to the parental relationships as the inevitable root of all things homosexual. My clinical experience and reading of research leads me to believe the situation is much more complex. I believe that environment is much broader than a child and same-sex parent or both parents for that matter. Environment involves school, peers, siblings, camp experiences, television and other media, etc.
Because I believe environment, broadly speaking, to be involved in the formation of sexual feelings, I predict there will be much diversity in the histories of those who identify as gay, lesbian or bisexual. However, I also believe that there may be some similarities among homosexually oriented people because biological factors are also at work. Some temperamental traits may be more common among those experiencing same-sex attractions than those who never do. As examples, temperamental traits involving gender cross sex-typed preferences and visual motor skills have been shown to vary between gays and straights. Along with Daryl Bem, psychologist from Cornell University, I believe childhood gender nonconformity is implicated in the formation of homosexual feelings for an undetermined number of people. I suspect there are other differences but with the current state of research, nothing much can be said with certainty.
On the basis of these temperamental givens, I believe many of our most personal preferences arise via interaction with an infinite variety of different family situations, school environments and social worlds. Most gay identified people do not remember choosing to have same-sex attractions. Most straight identified people have no such recollections either. I suppose most of us do not know why we like most of what we like but almost assuredly our personal preferences are not hard-wired but rather a confluence of our temperament, environment and life experiences. Whether or not we want to change or avoid them are matters of religious, moral and practical reflection and commitment.
Let me be clear: I am not discounting the experience of many ex-gays who are convinced that the reason they developed same-sex attractions revolves around a dysfunctional relationship with their same-sex parent. I would contradict myself if I did not seriously regard the wounds they experienced. No doubt, for them, these experiences helped shape their perceptions, expectations and feelings about themselves and others of both sexes. At present, however, I am persuaded that parent-child experience is only part of a very big and complex picture that is not an invariant route to homosexual desire.
I have worked with quite a few same-sex attracted clients who had wonderful parental relationships and by all accounts had always experienced this blessing. I have worked with young men who felt comfortable expressing their feelings to their fathers even though both father and son agreed that such feelings were against their religious beliefs. I have worked with clients who seemed to have average relationships, not unlike my own or other straight people I know. I have worked with same-sex attracted clients who were confused and injured by their parents. However, I have seen little of the consistency that is theorized by the reparative model as defined by Drs. Moberly and Nicolosi.
So what do you propose for therapy?
As this paper is getting lengthy, it may be best to outline my thoughts on therapy in another paper. For now, I will say that I believe therapy should focus on helping people clarify how they want to live based on a chosen set of values. Often that does involve a reflection on religion, history, upbringing, traumatization, culture, school influences, religious beliefs and the gamut of experiences that may be tied to current attractions to the same sex.
My approach is to ask clients to explain the problem as they see it, clarify their objectives and then pursue those objectives by whatever means we agree are consistent with their values. Thus, I often engage in helping people understand the difference between identity (chosen self) and attractions (feelings). Also, we often spend time understanding how our minds work. Feelings and desires are not standards or commands; they are reactions to whatever environment we find ourselves. Feelings often change as we change our environments and make commitments to chosen values. However, whether feelings change or not, we are always free to act in accord with our beliefs.
As I am able, I plan to write more about my approach to therapy with those experiencing conflicts involving homosexual attractions. For now, suffice it to say that I am not a reparative therapist.
(1) One exception noted by Dr. Nicolosi in his book Reparative Therapy of Male Homosexuality: A New Clinical Approach (1991) is a narcissistic client who does not fit the reparative pattern. He describes this client as follows: “Many such men show pronounced narcissistic features – inflated self-regard and feelings of entitlement, with a charming exterior but little empathy for others, they choose a same-sex love object, often with physical features similar to their own…This type of client usually has no particular difficulties with male friendships, shows no evidence of male gender-identity deficit, and has a family history that does not fit our pattern. The treatment issues we address are not relevant to his issues.” (pp. 220-221).
(2) For more explanation of this model, see "The Meaning of Same-Sex Attraction" available here: http://www.narth.com/docs/niconew.html.
Warren Throckmorton, PhD is Associate Professor of Psychology and Fellow for Psychology and Public Policy, Grove City College. He is the producer of the documentary I Do Exist.
To read guidelines for conducting therapy with clients who are in conflict surrounding sexual identity, go to Sexual Identity Therapy Guidelines page
To comment on this article, please go to my blog at www.wthrockmorton.blogspot.com
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