Reviews of the Book: “Shame And Attachment Loss: The Practical Work Of Reparative Therapy”

Reviews of Dr. Nicolosi’s book, Shame and Attachment Loss

An advocate for gay men and women who are serious about striving to overcome their same-sex orientation and achieving sexual fulfillment heterosexually, Nicolosi--like a voice in the wilderness--audaciously defies conventional psychologists who cling to the belief that changing from homosexuality to heterosexuality is neither possible nor advisable.

Disseminating his point of view is desirable and necessary for society, as well as for gay men and lesbians. Now this is not to definitively assert that for many homosexuals, heterosexuality is preferable to homosexuality; only that this quest should be freely accessible to the homosexual person, if indeed that is his or her wish.

Nicolosi's treatise on reparative therapy is a groundbreaking and courageous navigation of the tricky shoals, perilous undertows, and precipitous twists and turns required to bypass the psychological community's declaration that homosexuality is appropriate for all homosexual men and women. Though still controversial, his treatise is punctuated and made more believable through his reliance on the client's perceptions, feelings, and family dynamics.

In a word, Nicolosi's thrust in promoting his point-of-view on behalf of this contentious hot-button issue is broad and deep, abstract and experiential, and theoretically and practically depicted.

The policies and resolutions of organizations such as the American Psychological Association and probably the American Psychiatric Association as well, would be better framed and more truthfully based were these organizations cognizant of, and open to, the sentiments promoting reparative therapy.

Nicolosi's book deserves widespread readership, by friend and foe alike, whether or not, truth to tell, it is still a work in progress; even if in the long run, he is shown to be right, wrong, or somewhere betwixt and between. The paths to ultimate truth can only be forged when consummated fully and unconditionally, and certainly not with impeding and competing ideological polestars misdirecting their voyages...

The author has contributed enormously to the sexual literature by offering his not unreasonable views for consideration by gays and lesbians, by scholars in the field, by the man in the street, and by practicing psychotherapists. His challenging and forceful commentary is must-reading from top to bottom, from stem to stern.

---Robert Perloff Ph.D.
Former President, American Psychological Association
Distinguished Service Professor Emeritus, University of Pittsburgh


In the current contentious and divisive climate that surrounds the treatment of homosexuality, the well-being of thousands of patients is at stake. Therefore, it is imperative that militant attempts at censorship and ideologies that would limit open inquiry be set aside in the interest of clinical integrity. The right of the patient to choose his or her therapeutic goals is paramount, and attempts to stifle the patient's freedom-of-choice are not only egregious, but also contrary to the basic commitment of all health care itself. For this reason, even though I disagree with some cause-and-effect relationships proffered in this book, Dr. Nicolosi's point of view must be part of the equation in an honest, open deliberation until we arrive at ultimate scientific and clinical fact. In my over 60 years of practice as a psychologist I have seen many conditions, both medical and psychological, that were once regarded as incurable to now be readily treatable. In this early stage of the heated debate on the treatment of homosexuality and same-sex-attraction, to prematurely remand all homosexuals to an unchangeable life style would be a disservice to the worst order.

---Nicholas A. Cummings, Ph.D., Sc.D.
Distinguished Professor, University of Nevada, Reno
President, Cummings Foundation for Behavioral Health
Board Chair, The Nicholas & Dorothy Cummings Foundation
Executive Board Chair, CareIntegra
Former President, American Psychological Association as well as Division 12 (Clinical) and Division 29 (Psychotherapy), recipient of psychology's gold medal for "Lifetime contributions to practice"


"In this richly detailed book, Dr. Nicolosi shares his experiences of many years working with same-sex attracted men who want to diminish their unwanted attractions and develop their heterosexual potential.

Nicolosi is convinced that the world's great religious traditions are right: humanity was designed for gender-complementary coupling. The mental-health associations must respect this viewpoint; to do otherwise would be a gross violation of worldview diversity as well as the client's right to freedom and self-determination.

This new book is a rich source of information-- written by an astute clinician whose work with same-sex attracted clients has been groundbreaking, beginning with his 1991 book, Reparative Therapy.

---A Dean Byrd, Ph.D., M.B.A., M.P.H.
Clinical Professor of Psychiatry, University of Utah
President, National Association of Research and Therapy of Homosexuality (NARTH)


Joseph Nicolosi has written a book that can only be the culmination of decades of clinical observation and scholarly integration of what we know today about the origins and treatment of homosexuality when it is not ego-syntonic. The popular press fosters an idea that the reason for rejecting homosexual impulses must be traditional social disapproval. Objective scientific study says otherwise. Freud noted that all children go through phases of assigning their sexual fantasies alternately to one parent or the other. Most children outgrow this phase and settle on same-sex self identification, with sexual impulses directed toward the opposite sex. Dr. Nicolosi's work is with the few who do not. The subject fascinates practically everyone, however, because we all have had experience with conflicting attitudes during our formative years. There is not one polemical statement in this treatise.

The theoretical section that begins the discussion is thorough and anyone who follows the literature in the field will enjoy reasoning with Dr. Nicolosi. In Shame and Attachment Loss, Dr. Nicolosi distills the emotional effects of critical family constellations that complicate the sexual development of a child, then adolescent and finally adult. He manages to make a scientific and clinically significant book that any intelligent adult might read with understanding and ease. One help is the excellent organization of the material. Secondly, the book is rich in clinical examples. Even the first part of the book, which provides underlying theory, is saturated with clinical examples that bring theory to life. Close study revealed for Dr. Nicolosi three syndromes which he observed in the groups of men who come for reparative treatment because the continuing early conflicts are inwardly for them so upsetting He discerned when homosexuality is a shame-based behavior, a repetition compulsion to resolve specific disturbing memories, or a reparative drive to make up for angers hidden within the person's unconscious. The challenge to the therapist is enormous of unraveling the complexities these motivations create for someone.

The treatment section of the book requires therefore 13 chapters to illustrate the various ways in which the men who come to a therapist need to be understood.

What makes this book unique, even beyond the considerable theoretical and clinical contribution I have outlined, is Dr. Nicolosi's original formulation of the role of grief in these patients. The disruption of attachment that is implied in the book's title has never been clarified before in psychological literature in efforts to understand homosexual impulses. How shame and the other basic affects interplay in personalty development is vital knowledge for any therapist who wants to work deeply enough with patients to be able to help them at the level of their greatest grief. The clinical examples again show how expectable it is that such work can be freeing to those with the courage to explore sources of pain so long hidden from consciousness. To read Shame and Attachment Loss may seem to some in the psychological field a thing to avoid on grounds of wanting to hold on to prevailing notions about homosexuality. Anyone who does read it will be rewarded with a cogent understanding of personality development and family dynamics and our need to take the psychotherapeutic journey with each individual as a fresh adventure.

---Johanna Tabin, Ph.D.
Member American Psychological Association
Member Division 38 Psychoanalysis
Author, On the Way to Self Ego and Early Oedipal Development


"For the therapy of unwanted same-sex attraction, very few people have had the depth of experience and wide-ranging success of Joe Nicolosi. A master in the field has here distilled that experience equally for the professional and the interested layperson.

Every genuinely open-minded therapist should be familiar with the important insights that Dr. Nicolosi provides. This book can and should likewise provide the foundation for courses that train interested professionals in the art and science of helping to reverse homosexuality and restore heterosexual desire and functioning to those who seek such changes."

---Jeffrey Burke Satinover, M.D.
Diplomate, American Board of Psychiatry
Diplomate, American Board of Neurology
Diplomate, C.G. Jung Institute of Zurich, Switzerland
Author, Homosexuality and the Politics of Truth


"In this groundbreaking book, Nicolosi, a pioneer in the field of reparative therapy, introduces clinicians to the influence of shame and attachment loss within a same-sex drive. By integrating multiple theoretical bases, Nicolosi has developed and effectively presents a fresh and comprehensive framework for understanding and treating male SSA. The techniques and strategies discussed within this cutting-edge work will guide therapists in their work with homosexual strugglers.

This is a must-read and an essential resource for any counselor's library. It will have a lasting impact on how the scientific and professional mental health communities view and comprehend homosexuality."

---Janelle Hallman, MA, LPC
Author, The Heart of Female Same-Sex Attraction: A Comprehensive Counseling Resource


Nicolosi brings extensive professional clinical perspective and deep immersion in the historical literature in this area to his reflections on work with individuals experiencing unwanted SSA. This volume offers fruitful clinical hypotheses for exploration.

The author shows balance in acknowledging possible biological and psychological contributors to causation; in exploring what full informed consent for consultation entails; in respecting appropriate clinical boundaries in professional consultation; and in acknowledging the experiences of those who find such work unproductive, as well as those reporting success.

---Stanton L. Jones, Ph.D.
Provost and Professor of Psychology, Wheaton College (Wheaton, Ill.)
Author, Ex-Gay? A Longitudinal Study of Religiously Mediated Change of Sexual Orientation, and Homosexuality: The Use of Scientific Research in the Church's Moral Debate


Dr. Nicolosi's latest book is, as ever, a continuation of insightful writing based firmly on his experience. Alongside long transcripts covering many facets of his clinical work are numerous superb and highly quotable pinpoint statements from clients, which illuminate many facets of same-sex attraction.

Some of these insights, for example about the sado-masochistic tendencies found among homosexually oriented men, the tendency to flip-flop between extreme views of others [devaluing vs. over-valuing them], and origins of bisexuality, seem underappreciated even in therapist circles, and are relatively new ideas.

Although the book is intended for therapists, there is also much here that deepens understanding for the non-therapist.

Many myths about reparative therapy are refuted by this book. No one taking the trouble to browse it could believe any longer that such therapists are primarily motivated by anti-gay feelings. Considerable care of clients is clear in the transcripts. The approach is refreshingly non-doctrinaire.

Although the basic therapy approach has stood the test of time, it has been refined in the light of experience, and clients who fall in groups demanding different approaches have also been considered, and their needs addressed.

Even critics who abhor this type of therapy might find their opinions modified if they read the book.

---Neil Whitehead, Ph.D.
Author of My Genes Made Me Do It - A Scientific Look at Sexual Orientation and over 120 published scientific papers


For those who have freely made up their mind to find a different way forward in dealing with the challenges of homosexuality this book is a godsend. Joseph Nicolosi has provided a first rate manual that tackles the issues head on, that works from the best evidence available, and that is rooted in years of therapeutic practice.

We have long needed a book like this: respectful of human choices, realistic in its central claims, clear about its theoretical foundations, aware of relevant objections, and robust in its proposed clinical solutions. Every pastor and therapist, whatever their personal theological or moral commitments, should have this book in their library. They owe this to all those who are reaching for an alternative to the sexual ideologies of our culture; they also owe it to the demands of common honesty and of intellectual virtue.

---William J. Abraham, Ph.D.
Albert Cook Outler Professor of Wesley Studies
Altshuler Distinguished Teaching Professor
Perkins School of Theology, Southern Methodist University


As an internationally-recognized clinical expert on Reparative Therapy for unwanted homosexual attractions, Dr. Joseph Nicolosi has written a theoretically-sound, clinically insightful, intellectually-brilliant, and highly compassionate practical book that will, no doubt, become a standard professional reference for psychologists, psychiatrists, and other mental health clinicians treating individuals troubled by their homosexual impulses.

Now that scientific studies have established that homosexual orientation can be successfully treated without harmful "side-effects," mental health professionals are now, more than ever, interested in the theoretical underpinnings of Reparative Therapy and in the specific therapy techniques that produce change. With his decades of clinical experience in successfully treating men with homosexual orientation, enhanced by many hours of systematically analyzing video recordings of actual psychotherapy sessions at his well-known clinic, Dr. Nicolosi presents sound psychodynamic models of the development of homosexual attractions as a basis for his therapeutic techniques. He offers a creative and sound integration of psychological research findings, psychodynamic understanding, recent findings on the neurological structure of the brain, and clinical advances in the art of psychotherapy. What makes this book especially helpful to clinicians are the numerous transcripts of therapy sessions illustrating therapeutic breakthroughs with homosexual clients.

Dr. Nicolosi's theory and therapeutic method is consistent with my decades of research on childhood gender identity disorders. His book shows how homosexual attractions and enactment functions as a situational reaction to feelings of gender inadequacy and to unmet emotional needs including a developmental lack of male attention, affection and affirmation from father-figures and/or other male mentors. Same-sex attractions function as attempts to "repair" an emotional deficit in a male's own "perfectly normal and authentic needs for male attention, affection, and approval.

Dr. Nicolosi helps his clients to identify circumstances and emotional states when most tempted to homosexual behavior. He affirms human will, and the reality of the ability to choose to interrupt the sequence of psychological events would otherwise lead to homosexual temptation and to homosexual enactment. This book is not only psychologically sound and theoretically insightful, but it is consistent with the Judeo-Christian theological understanding of the creation of humans as male and female and the normality of close emotional, non-sexual, relationships among men as illustrated by the loving relationship between David and Jonathan. His book clearly illustrates how he assists men with same-sex attractions to adjust to created realities of human personality and relationships, while abandoning a False Self that emerged from a problematic development in early life.

Dr. Nicolosi shows theoretically and therapeutically how strengthening feelings of masculinity diminishes same-sex attraction and how mental health depends on acceptance of psychological realities. He does so with a compassionate understanding of the client's needs and problems.

---George A. Rekers, Ph.D., Th.D.
Distinguished Professor of Neuropsychiatry and Behavioral Science Emeritus, University of South Carolina School of Medicine
Adjunct Professor of Psychology, Graduate School of Trinity International University, Florida Regional Center


I would recommend publication of this volume for the following reasons: First, although Reparative Therapy has been maligned by some in Division 12 (Clinical) of the American Psychological Association, it has not been rejected as a therapeutic modality for those seeking to change their sexual orientation-- especially Christians.

Second, while there is strong current emphasis on empirically validated treatment modalities, all approaches initially began as theories which were clinically applied long before they were subjected to controlled clinical studies. Reparative therapy as described in Nicolosi's volume is one such modality. Empirical validation will be the next step in its development, but it should not be discounted for being in this stage of development.

Third, reparative therapy, as detailed by Nicolosi, is not presented as a therapeutic "cure-all," nor is it presented as a model that explains each and every incidence of homosexuality. Reparative therapy is offered as a hopeful remedy grounded in one environmentally significant determinant - namely, family interaction. It is also offered as an option for religiously motivated persons who seek some alternative to the view that they cannot change.

I would think Intervarsity would be honored to be its publisher.

---H. Newton Malony, Ph.D.
Senior Professor, Graduate School of Psychology, Fuller Theological Seminary, Pasadena CA


I have just finished reading this book, and . I only wish there had been such research and words of hope earlier in my ministry in counseling homosexuals. Nicolosi's book offers a refreshing cool cup of reason and hope on one of the most heated topics today. This is a must-read for not only the homosexual who is struggling over his sexuality, but for every parish pastor, counselor and therapist.

As a university professor of graduate studies in family ministry, it will be on my list of required textbooks.

--Roger Sonnenberg, M.Div., M.A. (Pastoral Psychotherapy)
Professor of Graduate Studies in Family Ministry, Concordia University
Author, Human Sexuality: A Christian Perspective


A legend in the world of gender affirmation, Joe Nicolosi devoted much of his professional career to educating the western world that a change of sexual orientation is possible. Having written three other books on the subject, this latest book, Shame and Attachment Loss: The Practical Work of Reparative Therapy, represents his most recent insights and personal growth in understanding and treating those with unwanted same-sex attractions.

Initially conceptualizing homosexual attraction as a striving "to repair gender deficits," he now sees it more broadly as a striving "to repair deep self-deficits" and as a "defense against trauma to the core self." From this profoundly insightful premise, the text principally addresses mental health professionals and faith-based ministry leaders to explain the psychodynamics of homosexuality, its treatment modalities, and the role and resolution of grief in Reparative Therapy.

Not only are brilliant new insights found through out this volume, but it shows how the Judeo-Christian worldview is aligned with practical psychological techniques for healing. I recommend this "must-read" book to anyone who cares to learn about either the causes or treatment of homosexuality. The library of every mental health professional, ministry-leader, and individual concerned about the sexual confusion that runs rampant in today's world should include this book.

---Arthur Goldberg
Co-Director, JONAH
Author, Light in the Closet: Torah, Homosexuality, and the Power to Change


As readers have come to expect from Dr. Nicolosi, Shame and Attachment Loss: The Practical Work of Reparative Therapy again is an enormous contribution to making the complexities of homosexuality and its treatment more coherent for parents, therapists, and anyone concerned about cultural issues. Dr Nicolosi continues his pathway of contributing clinically and philosophically in the traditions of a scholar.

---Benjamin Kaufman, M.D.
Clinical Professor of Psychiatry, University of California at Davis