Case Stories of Reparative Therapy
Repairs Self-Esteem and Relatedness
"This insightful and readable book will help therapists and patients alike. Today, Gay Affirmative Therapy rightly demands respect for patients' own goals. In that spirit, one must respect some gay men's unhappiness with their identities and lifestyles. Reparative therapy, as the author says, does not explain all homosexuality, and it is not right for all gay men, but it can allow' some to claim what they desire. What is repaired is self-esteem and relatedness to others."
-Arno Karlen, author of Sexuality and Homosexuality
About the Author
Joseph Nicolosi, Ph. D is founder and Clinical Director of the Thomas Aquinas Psychological Clinic, and co-founder of the National Association for the Research and Therapy of Homosexuality. He is a frequent lecturer and is in private practice in Encino, California.
Book Excerpt: Chapter Ten
How Reparative Therapy Works
Frequently I am asked the question, "How does reparative therapy work?" Like all forms of treatment rooted in psychoanalysis, reparative therapy proceeds from the assumption that some childhood developmental tasks were not completed. It is understood that when the client was a child, he experienced his parents as failing to assist him through these developmental phases.
One of the best definitions of psychotherapy is "the opportunity to give to ourselves what our parents did not give us." Nevertheless we still need help from others. Reparative therapy requires the active involvement of male therapists, male friends, and male psychotherapy group members.
The basic premise of reparative therapy is that the majority of clients (approximately 90%, in my experience) suffer from a syndrome of male gender-identity deficit. It is this internal sense of incompleteness in one's own maleness which is the essential foundation for homoerotic attraction. The causal rule of reparative therapy is "Gender identity determines sexual orientation." We eroticize what we are not identified with. The focus of treatment therefore is the full development of the client's masculine gender identity.
Reparative therapy works on issues of both the past and the present. Work on the past involves understanding early relationships with parents. The client often realizes that while his mother may have been very loving, she probably failed to accurately reflect his authentic masculine identity. Mother has often fostered in her son a false identity, namely that of the "good little boy," with an unrealistic over-intimacy where mother is confidante, soul-mate, or best friend. The client may also have had an over-identification with grandmother, aunts or older sisters.
Although the mother has more often been over-involved, the father is more often under-involved and emotionally withholding. He has typically failed to recognize the boy both as an autonomous individual and a masculine child. He was emotionally unable to reach out to the son to get the relationship on its proper course. The father was either unaware of what was happening in the relationship, or incapable of doing anything to rectify it. He was most likely what I call "the acquiescent father." Emotional neglect by the father is a particularly painful memory to be dealt with in treatment.
Other work on the past includes understanding hurtful childhood relationships with male peers, and often a hurtful relationship with a domineering older brother. Any early homosexual experiences with peers or older men need examination and interpretation. It is not unusual to uncover a history of victimization through sexual molestation in the client's childhood.
Work on the present includes understanding how the client has given up his sense of intrinsic power. Intrinsic power is one's view of self as separate and independent. Failure to fully claim one's gender identity always results in a loss of intrinsic power. As one client said:
"As a kid, I didn't go out and ask for what I wanted...I expected others to know what I wanted, so I just waited."
"And if you didn't get it?" I asked.
"I've held secrets all my life. I kept my power secret."
"My power of getting what I wanted indirectly...you know, manipulatively."
Central to reparative therapy is the client's understanding of how his masculine deficit becomes projected onto idealized males--"The other man has something I lack--therefore I need to be close to him [sexually]."
Reparative therapy is initiatory in nature. It requires not just a passive musing over self-insights, but an active initiation of new behaviors. The client must struggle to break down old patterns of avoidance and defensive detachment from males in order to form close, intimate, non-sexual male friendships.
Therapy challenges the client to master gender-related tasks missed in early boyhood. His developmental path requires mastering of these tasks during adulthood.
He is called to "catch up" to what the heterosexual man achieved years before. Thus he may eventually arrive at a heterosexual place, but from a different direction.
Many early feelings toward the father and other significant male figures will be transferred onto the male therapist. Therapy will offer a valuable opportunity to work through these reactions. Feelings for the male therapist may include anticipation of rejection and criticism, a tendency toward dependency--including hostile dependency--and also sexual feelings and anger.
Like all psychotherapies, reparative therapy creates a meaning transformation. This meaning transformation is the result of the client's gains in insight. When he comes to see the true needs that lie behind his unwanted behavior, he gains a new understanding of this behavior. His unwanted romantic attractions are de-mystified. He begins to perceive them as expressions of legitimate love needs--attention, affection and approval from men--which were unmet in childhood. He learns that such needs indeed can be satisfied, but not erotically.
When this is understood, there is a meaning transformation--"I do not really want to have sex with a man. Rather, what I really desire is to heal my masculinity." This healing will occur when the legitimate love needs of male attention, affection and approval are satisfied.
Meaning transformation includes not just intellectual understanding (insight) but also the experience of the self in the doing of new behaviors.
Embodied experience--that is, the experience of the body in the world in a new way--transforms personal identity. Transformation in personal identity occurs through repeatedly feeling different about oneself in relationship to others. In the case of gender deficit and homosexuality, increased ownership of one's maleness diminishes erotic attraction toward other men. The gradual internalization of the sense of "masculinity as me" distances previously distressing temptations.
In recent years, Gay Affirmative Therapy (GAT) has emerged to help homosexuals accept and affirm their sexual orientations. GAT presumes that dissatisfied homosexuals would be "satisfied" if they could only be free of the internalized prejudices of society. GAT sees reparative therapy as playing on a man's self-deception, guilt and low self-esteem. It makes the arbitrary assumption that "coming out" is the answer to every homosexual client's problems.
Reparative therapy, on the other hand, sees homosexuality as a developmental deficit. According to reparative theory, Gay Affirmative Therapy is expecting the client to identify with his pathology in the name of health.
William Aaron, in his biographical book, Straight, says: "To persuade someone that he will make a workable adjustment to society and himself by lowering his sights and settling for something that he inwardly despises (homosexuality) is not the answer."
GAT presumes that homosexuality is a natural and healthy sexual variation. It then proceeds to attribute every personal and inter-personal problem of the gay man to social or internalized homophobia. Its theoretical model frames the life experiences of the client in the context of victimization, inevitably setting him against conventional society.
One cannot help but wonder how GAT would explain the obvious benefits of reparative therapy---increased self-esteem, with a diminishing of distress, anxiety and depression. Better relationships with others and freedom from distressing distractions are typically reported by men in reparative therapy.
Interestingly, GAT and reparative therapy agree on what the homosexual man needs and desires: To give himself permission to love other men. But GAT works within the gay ideology of eroticization of these relationships, while reparative therapy sees sex between men as sabotaging the mutuality necessary for growth toward maturity. Reparative therapy frees the homosexual man to love other men--not as sex partners, but as equals and as brothers.
Group therapy poses a special challenge to each man. The group must decide who will speak, for how long, about what, and for what purpose. Each man must decide for himself how he will use the group's assistance. Every member is expected to take responsibility for speaking up and making a place for himself in the flow of verbal expression.
Group therapy challenges the men to give up the old habit of passive listening. This is a removed, self-centered way of hearing that stimulates private associations, rather than an active response to the speaker's expression. The habit of passive listening--a consequence of defensive detachment--perpetuates emotional isolationism.
Active listening, in contrast, means forgetting oneself in order to maintain a felt connection with the speaker. The active listener feels an internal response to what the other says. He can then choose to express his response in the form of questions, comments or advice.
Group therapy offers the men the opportunity to relate to other males--a lesson never completely learned in boyhood. As one new client told me, "As a kid, I didn't know how to be a friend. If I liked a boy, I'd come on too strong, too intense, too possessive. Today, if I meet a potential friend, I still end up doing the same thing; I start with the 'Let's go to dinner, let's go to a movie [laughs], what are you doing for breakfast?"
Most clients have never spoken openly about their sexuality with other men who share the struggle. This is a frightening but exciting new adventure. Therefore every client is cautious, even fearful, at his first group meeting. There is a sense of excitement, and perhaps even the fantasy of meeting an attractive man with whom he might develop a particularly close, even sexual relationship.
Although the first group sessions are characterized by an intense curiosity about one another, there is also great anxiety about disclosing personal issues. These men are not proud of their sexual orientation, and there is some sense of shame they must face. There is the thought, "God forbid I should meet someone I know!" But eventually, these concerns recede to the background as friendships begin to form.
Once a part of the group, however, each man discovers that this is a place to feel accepted and understood. The group is a place where men share common problems, hard-won insights, and inspiration.
As one man explained, "For me, the group has been like putting on a pair of glasses when you're nearsighted. Before, I could only see vague images and patterns."
Another client said, "I figured out that I suffered this male deficit before I came here. I came because I knew I needed help in figuring out what to do about it. The reason I never made much progress before was that I was working in a vacuum, all alone and not talking to anybody
The basic model of our weekly group discussions is divided into three levels of communication:
Level One: "Without"
Level Two: "Within"
Level Three: "Between"
Level One, "Without" is typical of the first part of each group session. Both in individual and group therapy, it serves as safe warm-up talk. Typically, it involves conversation about what has happened during the week, and is a reporting of external events with no consideration of interior motivations.
Level 2, "Within", occurs when two or more people begin to investigate and clarify a member's motivations behind the events he reports. There is a shared attempt to understand how he participated in causing the events to happen.
Level 3, "Between," is the most therapeutic level. It is the most personally challenging and risky, but offers the greatest opportunity for building trust. It occurs when at least two members of the group talk about their relationship with each other, while it is happening. Timing is central to this third level and members must speak in the present. When expressing both their positive and negative feelings for each other at the moment, they describe what they are experiencing.
Considerable time may be required to break through to Level Three of direct dialogue. Group members may be easily hurt at this level and there is much approach-avoidance and fault finding. When a member feels hurt, he often makes veiled references to his doubts about whether the group is really of benefit to him. He may threaten not to return the next week.
For all groups, Level Three is the most rewarding. It affords the opportunity to experience mutuality, with its balance of challenge ("kick in the pants") and support ("pat on the back.")
In the first few sessions of a newly forming group, there is an initial phase of "blemish-finding." There is resistance to identifying with the group, as complaints fly. "They're not my type, they're too old," "too young" or "too promiscuous" or "too inexperienced or "too religious" or "not religious enough." This blemish-finding is a symptom of defensive detachment, perpetuating what Brad Sargent calls "terminal uniqueness"--i.e., the idea that "my specialness makes it impossible for other men to understand me." This fantasy keeps each man emotionally isolated as he is locked into the frustrating pattern of creating two kinds of men from all significant male relationships. He either devaluates, minimizes, dismisses and delegates other men to an inferior position, or he elevates, admires and places them on a pedestal.
Placement of other men on this scale is determined by "type," the symbolic representation of valued masculine attribute he unconsciously feels he lacks and which the other man supposedly possesses. These qualities usually have little to do with the character of the person. Once a realistic familiarity develops, the person eventually loses his erotic appeal.
In our group process we frequently return to the distinction made between two kinds of males by our clients: ordinary and mysterious. Mysterious men are those who possess enigmatic masculine qualities that both perplex and allure the client. Such men are overvalued and even idealized, for they are the embodiment of qualities the client wishes he had attained.
This emotionally crippling pattern of scaled importance is always reenacted in the group process. Obsession with "type" is the source of much of the anger and disappointment in homosexual relationships and accounts for much of the gay relationship's volatility and instability.
Besides devaluing or overvaluing other men, there is a third possible mode of response: mutuality. This is the one toward which we strive. A relationship characterized by mutuality has the qualities of honesty, disclosure and equality. Even where there is an imbalance of age, status or life experience, deep sharing with one another man serves as an equalizer. Mutuality in relationships is the goal of group psychotherapy, for it is on this level of human interaction that healing occurs. Mutuality creates the opening through which passes masculine identification. It is the passage through which each man enters into healing.
One group member said, "If I came to therapy with the thought that I just had to abstain from sex without any positive new direction toward intimacy with other men, I don't think I would be hopeful for real change. Now I have accepted my need for real intimacy, not the sexual expression of it."
Another group member described his experience with the words: "My group is the masculine energy I need every day. It has been a powerful, intense and enriching experience. Our group has become the father we all need and missed in our early years. There is a power, a presence among us that keeps us giving, healing, and caring."
All treatment must overcome some form of resistance against growth. We may say very simply that the treatment of homosexuality is the undoing of the resistance of defensive detachment from males. Group therapy is a powerful opportunity to work through this detachment, which is a refusal to identify with masculinity.
At times it seems as if all our group members are negatively charged magnets repelling each other. While there is a sensitivity and genuine concern for each other, there is also a guardedness and criticalness that can paralyze the entire group process.
Defensive detachment was described earlier as the blocking process that prevents male bonding and identification. Originally a protection against childhood hurt from males, in adulthood it is a barrier to honest intimacy and mutuality with men. The homosexual is torn between two competing drives: the natural need to satisfy his affectional needs with men, and his defensive detachment, which perpetuates fear and anger in male relationships.
Manifestations of defensive detachment in group appear as hostility, competitiveness, distrust and anxiety about acceptance. Group members are highly sensitive to issues of betrayal and deception. We see fearfulness, vulnerability and defensiveness, fragility of relationships and slow and tentative trust easily shattered by the slightest misunderstanding.
On the other hand, there is a resistance to developing friendship with familiar, nonmysterious males--those who do not possess these qualities. Ordinary men are devalued, sometimes contemptuously dismissed. One client described his perception of men as follows: "Unless I was attracted to a particular guy, I perceived men as these insensitive, Neanderthal types, these monolithic macho things I couldn't relate to, and had contempt for." As a result of this sort of misperception, most clients have had few or no male relationships characterized by mutuality. By placing other men in one of these two categories, a client justifies his detachment. He either feels too inferior or too superior to establish the mutuality necessary for friendship.
This resistance to friendships with nonmysterious males is one reason why, after an initial interest and excitement about meeting other group members, a client's feelings often turn to disillusionment. He sees the other members in the group as "just as weak as I am," and becomes contemptuous of them. He may be particularly disgusted by the "weaker" group members, those more effeminate, more emotional, who display personality traits of vulnerability. It is important this resistance be dealt with in individual therapy.
The essential therapeutic experience is the demystification of men from sex object to real person (eros to agape). Sorting out his experience of these two distinct perceptions, one twenty-eight year old client said:
"Immediately after every homosexual experience, it feels like something is missing. The closeness I wanted with another man just didn't happen. I'm left with the feeling that sex is just not what I wanted.
"This is in contrast to my relationship with my straight friend, Bob. I don't feel the need to be sexual with him. To be so close to him, getting everything I want from our friendship, but not even thinking about sex...when I allow myself to really be in those friendships, that's very empowering."
When group members meet socially, there is always the possibility that they will fall into a sexual relationship. On rare occasions, there has been such a "fall." Sexual contact unavoidably damages the friendship and can either destroy it completely, or furnish the opportunity for further growth through deeper honesty. The implications of such a fall are great, both for the individuals involved, and for the group as a whole. Therefore I challenge the men involved to self-reflect and dialogue.
"After the Fall," the men are asked to speak to each other in response to the following questions:
1. When did the possibility of a sexual experience first occur to me?
2. What things did I do to set you up for the situation?
3. What emotional effect did this sexual incident have on both of us? Did I violate your personal boundary?
4. Do I feel any anger toward you?
5. Was I manipulative? Was I selfish? Did I put my needs before yours?
6. What were the authentic emotional needs I wanted gratified by you? Comfort, attention, security, affection, power, sexual release?
7. Did I get what I wanted? If not, what did I get instead? Did we impede our progress?
8. How has sexual behavior now changed the quality of our relationship?
Regarding the future:
1. What authentic emotional needs do I have in relation to you now?
2. What do you want from me now?
3. How can I facilitate your development?
4. What lessons about male friendship do you want to learn from me?
5. What kinds of experiences do you still need from our friendship?
6. Do I need to ask your forgiveness?
7. Now, how are we to be for each other?
If these questions are answered in painful honesty, then these two men will find new, non-erotic ways of helping themselves and each other.
The perennial gay fantasy is that sex is possible within a male friendship. But the group becomes aware of one inescapable fact--that a sexual encounter between two men permanently alters the quality of their relationship. Those engaged in a sexual encounter may deny that anything destructive happened. Or, they may admit that "something" did happen, but insist that it is of no consequence. Now, we must bring into focus the fact that sex is never a part of healthy male friendships.
Over the months, the group addresses many issues. Many of these are related to self-assertion. Often the men report a tendency to "lose" or compromise themselves for male approval. There is a sense of victimization, and anger at what they had to do to gain the other's acceptance. The men see how quickly they can get caught up in hostile dependencies.
Psychotherapy is a process that allows us to grow toward wholeness. I tell the group that although supposedly the subject matter is homosexuality, the underlying process, in fact, is really the universal one of initiation, growth and change.
The men realize that every one is challenged to move forward into fullest adulthood, and each one--heterosexual and homosexual, client and therapist--has his own personal obstacles to overcome, based on past failures in emotional development. The distinctly human abilities to self-reflect and choose positive change are true miracles of human nature.
I am often asked the question, can a homosexual ever "really" become heterosexual?
Discussing his own healing, Alan Medinger, a prominent leader in the ex-gay movement, described the following concern: "Years after I had left behind virtually all homosexual attractions, and years after a blessed and pleasurable sexual relationship in my marriage, one factor continued to disturb me. If an attractive man and an attractive woman enter a room, it is the man I will look at first."
Indeed, critics of reparative therapy believe fantasy determines a man's sexual orientation. Yet if a straight man has a homosexual fantasy, does that make him homosexual? If someone has a fantasy of stealing something, does that make him a thief?
We might find an answer to this question of healing in Dr. Salmon Akhtar's book, Broken Structures, where he describes "The Parable of Two Flower Vases."
Dr. Akhtar describes teaching a course on character pathology to a class of clinical psychology interns. He was asked by one student if a severely disturbed client could ever be so completely healed by psychotherapy that he would be indistinguishable from a person who had always been well-adjusted. He replied:
"I paused for a moment and then prompted by an inner voice spontaneously came up with the following answer. I said to him, "Well, let us suppose that there are two flower vases made of fine china. Both are intricately carved and of comparable value, elegance, and beauty. Then a wind blows and one of them falls from its stand, is broken into pieces. An expert from a distant land is called. Painstakingly, step by step, the expert glues the pieces together. Soon the broken vase is intact again, can hold water without leaking, is unblemished to all who see it. Yet this vase is now different from the other one. The lines along which it had been broken, a subtle reminder of yesterday, shall always remain discernible to an experienced eye. However, it will have a certain wisdom since it knows something that the vase which has never been broken does not. It knows what it is to break and what it is to come together."
In my final meeting with the great researcher Dr. Irving Bieber, a few months before his death at eighty-two, I asked him, "Did the homosexual clients you treated, really change internally, or simply gain control of their behavior?"
Quickly, assuredly, he answered, "Of course! Many of my patients became completely heterosexual."
I continued, "But there often seem to be some remaining homoerotic thoughts and feelings."
With the same instant certainty he said, "Sure there are. There may always be some," and he shrugged.
Wishing not to argue with an old sage, I kept quiet but afterward thought, how could Irving Bieber so confidently describe an obvious contradiction?
Akhtar's vases offer an answer: "The broken vase is intact, can hold water without leaking, is unblemished to all who see it yet the lines along which it had been broken remain a subtle reminder of yesterday."
I can but conclude from Akhtar's parable that straight men, vases formed of soft clay, do not know the trauma of falling from their pedestals nor the wisdom that comes from knowing what it is to break and what it is to come together.
For many men, reparative therapy is that way of "coming together."
Healing Homosexuality (1993)
by Joseph Nicolosi, Ph.D.
(Jason Aronson, Northvale, N.J., publisher. For information, contact the publisher at www.aronson.com.)