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What is reparative therapy?
Warren Throckmorton, PhD
Reparative therapy is a term describing a counseling approach to sexual reorientation. The main proponent of this approach is psychologist, Joseph Nicolosi, PhD. 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 Approach. It is important to understand that there are many approaches to sexual reorientation and reparative therapy is just one, although perhaps the best known.
Reparative therapy takes its name from the basic idea of the approach: Homosexual arousal and identification are efforts on the part of the person to repair a damaged bond with the same-sex parent. Thus, in this theory, gay men in their relationships are looking for affirmation and emotional intimacy from other men as a means of repairing the broken or non-existent relationship 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.
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.
Is reparative therapy a religious form of counseling?
While this approach is fairly popular in conservative and even Christian circles, it important to understand that the principles are derived from psychoanalytic psychology. It is beyond the scope of this essay to go into the differences in psychological schools to a great extent but if you are considering this approach you need to understand the implications. Reparative therapists usually see same sex attraction and homosexual identification as the results of poor parenting in the formative years.
Many people assume it is religious because of the association of Dr. Nicolosi with groups like Exodus International and Focus on the Family. However, as mentioned it is primarily based around an interpretation of psychoanalytic theory first popularized by Elizabeth Moberly within a religious context.
What other approaches to reorientation counseling are there?
In a 1998 article I summarized the psychological writings on reorientation counseling and found that there were many approaches to change, all claiming a degree of success. Some emphasized behavioral change and manipulation of rewards and punishments, some emphasized changing the way one thinks to achieve feeling change, some used very emotionally draining and provocative methods such as screaming and crying as a part of the counseling time. Others emphasized support groups, reconciling with oneís parents (even where there were no obvious problems), developing non-erotic same-sex friendships, etc. The striking aspect to this research is that all of the approaches had ďsuccessfulĒ cases, if success is defined as the reduction of same sex attraction (SSA) and the development of heterosexual relationships. I found one case study where the client changed spontaneously without any conscious effort to make sexual orientation change.
Observing the fact that so many approaches seemed to have some success, I set out to examine all of them for their common elements. I looked at each approach and tried to discern what was alike about the methods and theories more so than what distinguished them from each other. I found 6 factors common to all of the theories. They are:
Personal choice and motivation to reorient is necessary
A detailed history is important
The belief that change is possible
A theory to explain same sex attraction
Interventions to minimize or cope with same sex attraction
An explanation for behavioral and/or cognitive relapse
Personal choice and motivation is necessary
This seems almost too obvious to state but it is important for several reasons. I often have parents or friends of strugglers ask if there is anyway counseling can help even if the person does not want to change. I have conducted counseling with some individuals who are only coming for the sake of family or friends. By and large, this is not effective. This should be expected since it is true for most reasons people come to counseling.
Having noted the importance of choice to pursue the reorientation objective let me hasten to add that it is quite common to be ambivalent about entering counseling. Being motivated does not mean 100% certainty that all will work out fine. I begin many counseling episodes by taking several sessions to clarify the personís motives for change and the strength of their desire to seek that course. In fact, many people are undecided and counseling for them is a safe place to talk through the course they want to follow. And so in looking for a counselor, it seems wise to find one who will let you describe your concerns and ambivalence for as long as it takes for you to come to a settled decision about your counseling objectives.
A detailed history
All theoretical models of reorientation counseling value the historical understanding of an individualís experience of SSA. Some individual counselors may not take as much history as others and those following the solution-focused model of counseling may take only the barest of detail. However, the existing counseling approaches geared toward application with problems of SSA do seek understanding of the origins of SSA. Some approaches (notably reparative therapy) have the historical factors practitioners expect to find built into the theory. Thus, when a client comes in, the practitioner already has a theory about what caused SSA for every client. Approaches vary concerning the adherence to a general belief in certain causal factors.
This point is quite relevant in seeking a counselor. I believe it is best for the counselor to allow you to tell your individual story. As we have discussed, a popular theory of causation is the same sex parent deficit model. However, if that model doesnít describe your life, then hopefully your counselor will not try to fit your experience into that theory. If however the model does fit you, then you may profit from seeing a counselor who is knowledgeable about the dynamics of family interaction.
A belief that change is possible
While this point may also be fairly obvious, it is also important in examining counseling options. Some counselors will go along with a clientís desire to change but do so solely out of respect for a clientís wishes. These counselors often have no personal conviction that reorientation or successful management of SSA is possible. At least with the approaches currently available, it appears that this attitude on the part of the counselor is important. I think this is especially true given the mental health establishment view that sexual orientation is immutable. Clients want to know that the counselor has some confidence in the potential for success.
A theory to explain same sex attraction
In reviewing approaches to counseling for reorientation, I found a variety of views concerning the causes of SSA. Some emphasized deficits in the relationship with the same sex parent, some emphasized deficits in the opposite sex parent, some implicated both parents, some minimized the role of parental relationship in favor of other environmental factors and some emphasize a complex mix of environmental and temperamental factors. While the theories of cause are quite varied, the common factor is that all approaches have some explanation and then impart that understanding to the clients, whether directly or indirectly.
An implication of this observation is that the actual causes might matter less than the fact that a person has an explanation which is in itself comforting. There is a long line of research in counseling to support this notion. Often just having an explanation for a problem gives relief and the same may be true in working with SSA. Sometimes that is all people need to begin is an understanding of the problem.
The other implication is that SSA develops over time and the discussion of the historical shaping factors provides people with a way to think about their feelings that is not so self-judgmental. The reaction of many people I have worked with is to feel relief that circumstances help shape sexuality. They begin to feel that there is a set of factors that have shaped them rather than assume that they are bad, sick or doomed to have feelings they donít want.
One fairly recent approach called context specific therapy builds on the observation that there are different factors that seem to foster SSA. Building on his research with Latter Day Saint men who are former homosexuals, Dr. Jeff Robinsonís approach doesnít begin with a preconceived idea of what cause and resolution will be true for each client. Instead the client tells his or her story and the causes are discussed in terms of the clientís life story and not a theory. Treatment interventions are tailored to each client drawing from any theoretical background that seems to fit the clientís background and need.
Interventions to minimize or cope with same sex attraction
All counseling theories reviewed suggested interventions to respond to SSA. Some, such as the behavioral theories, emphasize breaking the patterns of action that have developed. Looking for and avoiding triggers for SSA and familiar places and people are involved. Cognitive approaches emphasize thinking patterns and self-esteem and seek to enhance oneís view of oneself consistent with the cause explanation adopted by the therapist. Reparative approaches emphasize the working through and healing of same sex wounds. And on it goes with each approach crafting interventions that conceptually fit the view of causation.
While there is considerable difference in the techniques used, there are some common factors here too. Nearly all approaches use a combination of individual and group counseling. So donít be surprised if your counselor wants you to try group counseling, either formally or via Exodus International support groups. Nearly all approaches focus on modifying a personís environment to avoid triggers, caution against being with people who pressure to have same sex relations, and request that the person do some kind of homework.
An explanation for continued same sex feelings
While not everyone re-engages in same sex fantasies or behavior, some people do. Such experiences are anticipated by the successful approaches to counseling and clients are given specific strategies to overcome the remorse of it and to normalize the experience.
This is a crucial point. Many people feel that if they slip and have same sex relations or have periods where temptation is strong that they really havenít changed. I would maintain that any change brings with it a temptation to return to the old ways. This is true of smoking cessation, weight management and other habit oriented issues presented to counselors. It is unrealistic to think such relapses wonít occur. So rather than getting discouraged it seems better to create a plan for dealing with the experience.
Reparative therapy and reorientation counseling are not synonymous terms. They often have similar outcomes but the theoretical assumptions and methods of the various approaches differ.
For anyone looking for counseling to assist with sexual identity formation, the varying approaches can be confusing. However, the diversity can also be helpful in that you should look for the counselor and the approach that seems to fit your personality and particular needs.
Some questions worth asking include:
- Do you believe change in sexual identity is possible?
- What conditions or circumstances or influences lead to same sex attraction?
- What is a typical counseling session like?
- Do people ever get to the point where they donít have same sex attraction anymore?
© 2003-2004 Warren Throckmorton, PhD. All Rights Reserved. www.drthrockmorton.com
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