Same-sex attraction: a therapist’s view

Not everyone attracted to the same sex is happy about it. What help is there for those who want to change?
Philip Sutton | Apr 18 2011 | comment  

We hear a lot from people who claim they are happy with their homosexual or lesbian orientation and want social recognition for it. But what of people who are unhappy with their attraction to others of the same sex? What help is available and on what scientific and ethical grounds is it based? We asked Phillip Sutton, PhD, a licensed psychologist, therapist and counselor based in Indiana and Michigan in the US. Dr Sutton is also Editor of the Journal of Human Sexuality, a peer-reviewed scholarly publication of the National Association for Research and Therapy of Homosexuality (NARTH)

In the first part of a two-part email interview Dr Sutton describes his experience and methods of serving people with these issues.


MercatorNet: You have been providing professional care to a variety of people for over 30 years. Have you dealt with many homosexual persons of either sex in that time, and what were they looking for from you?

Dr Sutton: My first introduction to serving persons with unwanted homosexuality same-sex attractions or behaviors (SSA) as a mental health professional occurred while teaching in an MA in Counseling Program, 11 years before beginning such service. I have written about my initiation into this work elsewhere. In 2000, I served my first client who wanted help to resolve or better manage unwanted same-sex attractions. While some therapists do specialize in serving such clients, my overall caseload remains diversified, with clients ranging from children to retirement age, and married couples and families in the mix.

I’ve served only a handful of women who reported unwanted SSA as either the primary or a co-occurring issue of therapy. I do not tend to think of my clients in terms of the label unwanted SSA or not, so at best could only make an educated guess at the number of male clients I’ve seen over the past 11 years. In the past 12 months, for example, I have had contact at least once with at least 25 different persons for whom unwanted SSA was an issue. It is not uncommon for some clients to come for only one or several sessions and not continue. In a “busy” week eight of my weekly clients were persons who have unwanted SSA, and they now represent perhaps a quarter to a third of my overall caseload.

I hesitate to generalize too much about what brings my clients to therapy. The challenge in serving clients with any presenting issue -- especially unwanted SSA -- is to focus too much on the diagnosis and thus fail to truly meet and serve the (entire) person who has courageously chosen to meet with me. Given my referral networks, most of my clients (for all issues) are practicing Christians, and a desire to be faithful to living how they believe God wants them to, as well as to use the resources of their faith to achieve this goal, are common underlying motivations. I do serve persons who report that they do not practice religious faith or find it important. I try to understand, value and serve clients as they come to me.

In terms of unwanted SSA, many of the men, whether single or married, commonly seek help stopping habits of SS pornography or masturbation. Some of the men and all of the women also come seeking help with emotionally (co-) dependent relationships.  A few have had or still struggle with actual physical encounters with others, but most of my clients have not. Some of my clients simply experience attractions which they have not acted upon. Others truly have an anxiety disorder (i.e., are obsessive or scrupulous about same-sex issues, but have had no true desire or experience of ever doing so.) Co-occurring issues (anxiety, depression, substance and other self-defeating behavior habits) likewise either are a secondary and sometimes the primary issue. 

Do you practice “reparative therapy” with such clients? What does the term mean? Are there alternative approaches? What is yours?

The simple answer is “No.” Reparative therapy technically is an approach to providing psychological care for unwanted SSA which is strongly influenced by the ideas and techniques of the psychoanalytic and other psychodynamic schools of therapy. Joseph Nicolosi is perhaps the best known therapist practicing and teaching this approach at the present time.

While I certainly have studied and received professional training in the conduct of “reparative therapy”, and do use some of the interventions commonly practiced for helping clients become aware of, feel and express or otherwise resolve feelings about which they are unaware, my own approach looks and sounds different. To those knowledgeable about psychotherapy, my approach reflects a number of influences: cognitive-behavior therapy (CBT), assertiveness training, family systems (especially structural, strategic, conjugal relational enhancement), the Twelve Step model (fraternal and mentor support to achieve sobriety -- sexual self-control, the resolution of “core issues” in the pursuit of “serenity”, or peace of mind and joy of heart). I also encourage the regular practice of journaling, relaxation and meditative prayer in my work (as do many “reparative therapists” and others trained in other approaches to psychotherapy).

Could you outline for us how you would go about treating an adult person who came to you wanting help to overcome same-sex attraction?

In one sense, the same way I would treat any client who came to me. During the first session, ask them to imagine that this is their last session with me and what they were glad that they were able to accomplish in meeting with me. I have a “one step at a time” or “next step” approach.

I try to work on issues that clients want to, and invite them to come to therapy with one or more practical experiences (“high-lights” or “low-lights”) about which either they have a sense of growth or feel frustration, disappointment or pain. Doing so typically involves my helping them realize -- and sometimes actually “feel” for the first time in their adult lives -- leftover and “real time” unmet needs, unhealed hurts, unresolved feelings, unrealized growth and maturation, unreconciled relationships, unclear boundaries, unrealistic hopes, fears and expectations, an unfulfilling and inauthentic self image/identity, untimely abuse or other mistreatment (such never are “timely”, but when such experiences happen to the immature, their harmful effects may be even more significant), and/or unmanaged co-occurring difficulties.

To the extent that clients have unwanted, self-defeating habitual, sometimes compulsive or addictive behaviors, abstinence becomes a goal. Otherwise, the legitimate needs which these behaviors are attempting to meet will go unmet. Willpower to stop unwanted behaviors is necessary, but often not sufficient. Unless clients are helped to recognize these needs and to develop virtuous ways of meeting them -- both of which may take quite some time -- attempts to “just say no” and to achieve positive change and growth is unlikely.

Whatever we work on, I think that clients need to feel understood and cared about as they are. I also think they need to better understand and have compassion for the younger self who tried to deal with their needs, hurts, feelings, etc., in the best way he or she knew how. Many habits unwanted in a person’s adult life had unintended if not innocent beginnings in a person’s youth. Learning to recognize, stop and replace habits of self-shaming and condemning with inner self-talk which “speaks the truth in love (Eph 4: 15)” is crucial. Shame and other feelings built on falsehoods retrigger the desire to engage in a self-defeating habit. Also, helping clients to grieve over the unfortunate things which did -- or did not -- happen to them while growing up and recently, and to “forgive” those who offended -- whom they perceive offended -- them may be indispensable helps.

How successful have you been with this kind of client? Does the effect last?

It would be better if my clients and independent evaluators answered this question! It is my impression -- and clients tell me -- that, if we have worked together for a reasonable length of time, they have found that the process of therapy has been worthwhile for them. Most of my clients have been “younger,” and commonly less actively or not involved in a “gay or lesbian” lifestyle, and/or significant substance abuse habits. Such circumstances on average help those seeking to resolve less entrenched, unwanted habits of same-sex gratification or emotionally dependent relationships to do so in a shorter time.

Former clients often keep in touch, sometimes coming for periodic “checkups’ to fine tune or tweak their ongoing psychological and relational growth. Perhaps I should do more regular follow-up, but I err on the side of letting clients take this initiative, just like I let them take the initiative in beginning and continuing in therapy.  I do see the changes that my clients have made in finding healthy ways to meet their needs, heal their hurts, resolve their feelings, develop a realistic (i.e., humble and loving) self identity, etc. are long-lasting.

What is your advice to men and women, fathers and mothers, who are confronting this issue?

Parents -- or anyone with a loved one who experiences SSA -- please carefully discern what you actually did, can, may, and ought to do -- and didn’t, can’t, may and ought not do. Properly understood, you did not cause your loved one’s SSA, although what you have or have not done may have contributed to their developing such desires. Be wary of excessive or “false” guilt! You cannot cure, control or change their SSA -- or any other tendency or behavior you consider unacceptable. Be wary of a sense of over-responsibility, especially for trying too hard to change the lives of older teens and younger adults who do need to learn to live their own lives.

Please do not condone, excuse or enable behavior that ultimately will be harmful to their medical, psychological, relational, and spiritual health. “Misguided mercy” is not loving, even if in the short run it avoids or minimizes conflict and leads them to feel less rejected by us and us less rejected by them.

You can and ought to communicate to your loved one your concern(s) and feelings about how they act when they are with you and how they report behaving when away. Please wisely, lovingly confront any unacceptable behavior which they may do in your presence, and also confess and ask their forgiveness for anything you may have done in the past or recently that may have harmed them or otherwise left them feeling poorly loved. Please show compassion to your loved one -- and if appropriate yourselves -- especially over past hurts, weaknesses, and things we or they did or didn’t do. Please remain or become involved in the life of your loved one, and his/her friend(s) if at all possible.

Isolation from others who could help you is a real danger. Doing the above realistically requires that you partner with understanding family members, friends, members of your faith community, perhaps other parents with similar struggles, with whom you can team up, receive and give mutual support, sometimes in confidentiality. Consider participating in groups for family and friends of persons with SSA, which offer support for learning how to love those persons better without condoning or enabling SSA behavior.

If your children are in secondary school, be wary of school counselors or groups who insist on affirming teenagers in being and acting on their “gay and lesbian” feelings. Research shows that virtually all of teenagers who profess SSA at 16 years old -- less than 5% -- will not do so one or two years later, as New Zealand researchers Neil and Briar Whitehead have documented. The earlier in life that a person develops a habit (e.g., pornography, same or opposite-sex), the more difficult will that habit be to break. And with SSA, the more entrenched and seemingly unchangeable the SSA itself will be. I think that such counselors and groups are at best irresponsible in encouraging young persons to accept such feelings as proof of an innate, immutable identity and to begin acting on them.

Next week in Part 2 of this interview Dr Sutton addresses the scientific and philosophical issues raised by same sex attraction.

Correction: An earlier version of this article stated: "Research shows that virtually all of teenagers who profess SSA at 16 year old -- less than 5% -- will still do so one or two years later..." This has been corrected to read: "Research shows that virtually all of teenagers who profess SSA at 16 years old -- less than 5% -- will not do so one or two years later.."


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