Psychotherapy for
the Sexually Confused Teenager

by Joseph Nicolosi, Ph.D.

Recently, I received a call from a psychologist who had heard that I specialized in the treatment of homosexuality. He was treating a 13-year-old boy who thought he might be gay, and he wanted some advice. I answered his questions, giving him some direction about his understanding of the case. After about twenty minutes, I said to him, "But tell me--I'm not clear about your approach. Are you trying to encourage his heterosexual potential, or are you affirming his gay identity?"

The psychologist answered, "I'm letting the boy decide."

Of course, as psychotherapists we must not coerce or "over-persuade" in therapy. Life decisions must ultimately be those of the client, and we must be clear that we can accept our clients’ choices—whatever they may be. Clients must be aware that gay-affirming therapy is available, even if we ourselves don't provide it.

But along with those obligations, there are other ethical questions. How can we encourage a 13-year-old boy to make the enormously significant decision that he is gay?

Not a Decision to be Made by a Teenager

I have heard of many school counselors directing confused teenagers to gay community centers to see if being gay "feels comfortable" for them. The gay community embraces these unhappy and searching youngsters. Many of them discover a new and exciting sense of belonging in a welcoming community when they are barely into puberty.

According to the reports of school counselors, even heterosexual teenagers--encouraged by some AIDS Awareness Programs to find out if they enjoy sexual pleasure with males--are now beginning to proclaim themselves "bisexual."

Clearly, there is a period of sexual-identity confusion when a young person can be easily influenced in either direction. A 1992 study published in Pediatrics [1] surveyed 34,707 Minnesota teenagers and found that fully 25.9% of 12-year-olds were uncertain if they were gay or straight.

The early teen years are a critical period. Should a youngster be encouraged to try gay sex? As psychiatrist Jeffrey Satinover says:

"The experience of pleasure creates powerful, behavior-shaping incentives. For this reason when biological impulses--especially the sexual ones--are not at least partially resisted, trained and brought under the civilizing influence of culture and will, the pressure to seek their immediate fulfillment becomes deeply embedded in the neural network of the brain...

"What starts out relatively free, becomes less so..."[2]

What about the teen's parents? Do they approve of their son being introduced into a notoriously promiscuous community? What about the life-threatening health risks? 

All things considered, the teen years are a good time to consider the question, “Who am I?” and “What do I value?” but a poor time to engage in sexual behavior that can have life-changing consequences.


[1] Remafedi, G., Resnick, M., Blum, R., and Harris, L., "Demography of Sexual Orientation in Adolescents," Pediatrics vol. 89, April 1992., pp. 714-21.

[2] Satinover, J., (1996) Homosexuality and the Politics of Truth. Grand Rapids, MI: Baker Books.


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