Therapy for People Who Experience Same-Sex Attraction

glasses man Summary: Professional therapy can help you clarify your identity and make life choices that are consistent with your personal values and religious beliefs.

People who experience same-sex attraction often seek therapeutic treatment to understand and deal with certain emotional and psychological issues. (See Issues Common Among Men Who Experience Same-Sex Attraction.)

Helpful therapy focuses on exploring the sources of distress, the person’s beliefs and values about sexuality and gender, and the nuances of their experience with sexuality and gender.

The goal of therapy is to help men better understand and resolve dissonance between their values and same-sex desires, develop a secure sense of self and male identity, and help them make healthy life choices that are consistent with their personal values and religious beliefs. It is a process of self-understanding, self-acceptance, and growth.

Personal Choice

People who experience same-sex attraction have the right to direct the course of their lives congruent with their values and religious beliefs. You can choose whether or not to self-identify as gay. You can choose whether or not to engage in same-sex sexual behavior. You can choose if you want to pursue a traditional heterosexual life. People have found these alternatives to be positive, self-affirming, and congruent with their values and beliefs.

Client Self-Determination

If you are conflicted over your same-sex attractions, you have the right to decide whether to seek professional counseling or therapy, what kind of counseling to seek, and to determine the desired direction of your therapy program. See the section “Professional Ethics” below.

Choosing The Right Therapist

Choosing the right therapist is critical because the wrong therapist could do more harm than good. Look for a therapist who can understand and support you in your personal values, beliefs, and goals. If you are a strongly religious person, your ideal counselor would be one who supports your religious values and understands your spiritual motivations.

A therapist should not exert his personal values on you. A therapist should not push you to accept a gay identity or experience homosexual relationships if you do not desire to do so. The therapist should help you understand your issues and assist you in making choices congruent with your personal values and religious beliefs. He or she should help you understand the social and emotional variables that influence your sexual attractions.

Consider what type of therapist you need. Psychiatrists are medical doctors specializing in treating individuals with emotional problems and thus can prescribe medication if necessary. Psychiatrists usually charge higher fees than other practitioners. Clinical psychologists usually have an academic doctoral degree (Ph.D.) and are trained in testing and individual therapy. Social workers may have doctorates or Master of Social Work degrees, and may counsel individuals, work with small groups or troubled families, and handle much the same range of emotional problems as these other practitioners.

It is advisable that men who experience same-sex attraction choose a male therapist and that women choose a female therapist. Since many same-sex-attracted men experience defensive detachment from men, a male therapist is in a better position than a woman to help a man work through some of these issues. The same is true for women. A therapist of the same gender is also in a better position to help you understand your gender and guide you into relationships with others of your gender. If your therapy experience is successful, the close emotional relationship you develop with your therapist will be healing in itself and will encourage you to develop deeper relationships with others of your gender.

Some of the organizations listed on this site can provide recommendations of therapists who fit the descriptions above.

Since therapy is a major investment of time and money, be sure that your therapist will be able to provide you the help you need. Discuss with your therapist how he or she will approach therapy with you. Talk about your values and what you expect from therapy. Don’t hesitate to talk about the finances involved and be sure they fit within your budget. Your medical insurance may cover some of the visits.

The Therapeutic Process

Part of the therapeutic process may be to explore the past. If we learn from the past, we have improve the present. Understanding the past is helpful to many people. However, there are four cautions:

Don’t blame the past for your situation and assume the role of a victim who has no control over the present. No matter how painful the past has been, you cannot avoid responsibility for what you do in the present. Your goal now is to try to understand the causes of your struggles to learn what you can do to resolve them.
Watch out for invented memories. There is a tendency to invent past experiences to explain the present. If you read that certain childhood experiences can cause certain reactions, you may come to believe that those things happened to you in your childhood. You may reinterpret or skew the past or even invent in your mind events that never happened, all in an effort to make sense of the present.
Not finding all the answers in the past does not mean you can’t resolve the present. Jason described his experience as follows: “At one point during my therapy I was trying to understand why I developed certain feelings during grade school. My therapist gave me an assignment to go back to my elementary school and spend an hour walking around the playground and try to recreate the feelings I had during a certain event. I did as he suggested, but never found any clues. To this day, I don’t understand why I reacted to the event the way I did. Although I didn’t find any clues to the present, I don’t let that bother me. The past doesn’t need to be completely explained.”
Don’t concentrate on the past to the exclusion of the present. Although the past may hold keys to help you understand the present, concentrate the majority of your time on your current feelings, actions, plans, failures, and successes. The past is only valuable inasmuch as it helps you to deal with the present. The extent to which the past is important depends on the level of trauma in the past. If you have not suffered abuse, you may not need to spend much time dealing with the past. If you have been abused, you may need to grieve and resolve past trauma.

Questions to ask yourself after your first session: (1) Does the therapist seem to understand and care how I feel? (2) Does he or she see clearly what is going on? (3) Do this person’s ideas make common sense or do they seem strange or outrageous? If the answers to these questions are not satisfactory, you may want to find another therapist. Don’t be intimidated by the strategy of certain counselors who may imply that the real problem is related to your personal values or religious beliefs. Reject any diagnosis which suggests that unless you adopt the counselor’s philosophy, you cannot be helped. Don’t be afraid to stand your ground if the counselor’s requests violate your personal values or standards. The best counselors will respect your position even if they don’t share it.

If Therapy is Not Available to You

If you cannot afford therapy or if there is not a good therapist available, you can still benefit by reading carefully-selected books, by journaling, and by trying to analyze your life. Set up a plan of action and follow through on that plan. Look at your life as though you are watching a video and identify the things you want to change, then make specific assignments to yourself to develop relationships and do things to build your self-image. You can be accountable to God through prayer, to yourself by using your journal, and to a friend in person.

Individual Therapy

A trained therapist can guide you through your personal growth process. He is your personal counselor to help you put all the pieces of the puzzle together. He can help you see how to integrate efforts such as support groups, personal relationships, spiritual growth, and efforts to control sexual behavior. He can help you see in an objective way how to keep your life in balance. He can be your mentor and your confidant.

Individual therapy may be an essential part of the process of understanding your same-sex attractions and related issues. Although it will not take care of all your needs, it can give direction to all your activities. For example, if you also participate in a sports program, group therapy, support group, or a community men’s group, your therapist can help you see how all these pieces fit together and help you keep them in balance.

As you talk with your therapist, you will discover things about yourself. Often, because of shame or guilt you may have buried some things so deep within that you don’t even realize them yourself. The therapist is trained to ask the right questions to help you see things in perspective and guide you through the process. Use him as a sounding board. Be honest with him about your problems, concerns, and fears. Don’t keep any secrets from him. Therapy will be most effective when you have a completely open and honest relationship. The therapist is bound by ethical standards to keep everything you say confidential. He can’t even tell another person that you are seeing him. Together you can develop action plans and you can report back to him on both your successes and failures. The journey won’t seem so lonely or difficult if you have a therapist by your side the whole way. Individual counseling can help you to:

Identify and resolve personal issues and underlying factors.
Identify and clearly define your personal goals.
Develop a personal action plan then help you keep working on the plan.
Identify and work around the roadblocks.
Receive encouragement when you get discouraged.
Increase your awareness of things you need to work on.
Give insight into your feelings and actions.
Give an outside perspective.
Identify your personal strengths and weaknesses.
Provide a forum to talk things out and get feedback.
Provide someone to be accountable to for your behavior, growth, and personal plan of action.
Learn to generalize lessons learned to other situations.
Learn to internalize new information.
Learn how to live congruently with your personal values and belief system.
Learn to control compulsive behaviors and overcome addictions.

Make your sessions count. Not only are these therapy sessions expensive, but if making changes in your life is important to you, do all you can to make them as effective as possible. Many people find it helpful to make written notes about their sessions and refer to them often. Some find it helpful to write in a journal as much detail about each session as they can. That allows them to later review the things discussed and monitor progress. Especially make notes about things you want to think about further or pursue in a future session. Be sure to write down the assignments you receive from your therapist and be sure you follow through with them.

Group Therapy

Group therapy can also be helpful, but is usually of secondary importance to individual therapy. Group therapy has some of the same advantages as a support group. The difference is that group therapy is run by a trained therapist who is there to facilitate the discussion in meaningful ways. Since support groups are not guided, it may be easy for members of the group to hide or even deny their feelings. But in a therapy group, the therapist can help members confront issues head-on and then be sure the issues are brought to healthy conclusions.

If you are involved in group therapy, it is important that you also receive individual therapy so that you can work out issues that come up in the group setting. Group therapy can help you to:

Get the mutual support of others who share your struggles.
Hold each other accountable.
Learn to accept others and feel accepted by them.
Learn to disclose.
Discuss issues of importance and get the feedback of others.
Learn to generalize to other situations the lessons you learn.
Learn to internalize new information.
Learn relationship and communication skills.
Learn to be assertive.
Reinforce newly learned traits.
Experience relationships and activities in a safe environment, as a bridge to the outside world.
Learn compassion for others as you begin to see their challenges from their perspective.

Ralph explained, “My friend Todd had been so closed up that no one in his life really knew much about him. Then he went to group therapy where he had the chance to explain his troubles to others and he began to open up. He wrote the following: ‘Each time, it became a little easier. I noticed that rather than being dangerous, opening up and sharing feelings and being really close to people on an emotional level was kind of nice. For the first time in my life, I no longer felt like I was unacceptable because I started to find out that people could know everything about me and still want to be my friend. In fact, through the sharing of deep emotions, I gained some of my closest friends.'”

Professional Ethics

If you decide that same-sex attractions are incongruent with your personal values and you seek therapy, the professional is ethically bound to respect your choice. It is unethical for a therapist to try to impose his personal beliefs on you. A therapist acts ethically by presenting all your alternatives and letting you make decisions for yourself. A therapist should ensure that you make a free and voluntary choice by using an informed consent to treatment.

Don’t enter therapy with the express goal of changing homosexuality into heterosexuality. It is more helpful to identify specific issues that you want to work on, such as self-perception, emotions, shame, difficulty in relationships, anxiety, depression, compulsions, addictions, or trauma. (See Issues Common Among Men Who Experience Same-Sex Attraction.)

Homosexuality is no longer classified as a clinical disorder. However, therapists may treat people who seek treatment for same-sex attraction because of their distress about it. See the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition), American Psychiatric Association, Washington, DC, 1994, p. 528, section 302.9, “sexual disorders not otherwise specified,” “persistent and marked distress about sexual orientation.”

Raymond Fowler, Executive Director of the American Psychological Association, said “The APA’s position on…therapy is that those who wish to explore developing heterosexual feelings or behavior have a right to do so as part of every client’s right to self-determination. If an individual is comfortable with homosexuality, it is not the role of the therapist to convince the client otherwise. If one’s feelings are ego-dystonic and there is a desire to talk about changing, that is an acceptable choice and a psychologist may participate if he or she desires.”

No one should be coerced into treatment against their wishes. As well, no one should be denied treatment if they want it. Ultimately, it is an issue of personal freedom and self-determination.

Success Rates in Therapy for Distress About Same-Sex Attraction

A 2012 survey found that therapy among same-sex attracted people achieved the following results:

69% said their self-esteem improved.
69% said their shame diminished.
71% became more self-accepting.
66% felt more at peace.
55% said the counseling was effective in diminishing the frequency and intensity of their homosexual attractions and that any remaining homosexual attractions became less troubling.
53% said their unwanted homosexual behaviors were reduced or eliminated.
38% said heterosexual attractions emerged or increased.
Among respondents who had experienced serious suicidal thoughts at one time, 76% said that as a result of the counseling, those thoughts became either much less (60%) or somewhat less (16%) serious and frequent.

Dr. William Consiglio, an associate professor of clinical social work at Southern Connecticut State University, worked with men and women who sought to minimize distress about their same-sex attractions. He reported that 40% of his clients found personal resolution, with many entering marriage and parenthood. Another 40% achieved a functional resolution in that they are able to control their homosexual thoughts and behaviors. The remaining 20% discontinued working with him. He reported that 80% achieved “a significant degree of emotional healing, growth in self-esteem, and spiritual well being…compatible with their spiritual values and convictions.” (“Counseling Overcomers: A Four-Focus Framework.” Also quoted by Bob Davies in “Mainstreamed Homosexuality,” Leadership, Summer 1995, p. 82.)

Dr. Reuben Fine, Director of the New York Center for Psychoanalytic Training, stated, “I have recently had occasion to review the results of psychotherapy with homosexuality, and been surprised by the findings….all studies from Schrenck-Notzing on have found positive effects, virtually regardless of the kind of treatment used….” (“Psychological Theory,” in Male and Female Homosexuality: Psychological Approaches, ed. Louis Diamant, Hemisphere, New York, 1987, p. 84.)

Dr. Houston MacIntosh reported in the Journal of the American Psychoanalytic Association a survey of 285 psychoanalysts who treated 1,215 patients with same-sex attraction. The psychoanalysts reported that…84% received significant therapeutic benefit. (“Attitudes and Experiences of Psychoanalysts in Analyzing Homosexual Patients,” Journal of the American Psychoanalytic Association, vol. 42, no. 4, pp. 1183–1207.)

For her doctoral dissertation at Brigham Young University in 1978, Elizabeth James conducted perhaps the most comprehensive review to date of the literature on the treatment of people who experience same-sex attraction. In her analysis of 101 studies, she found that approximately 35% of the clients recovered and 27% improved. She concluded that “significant improvement and even complete recovery are entirely possible.” (James, Elizabeth C. Treatment of Homosexuality: A Reanalysis and Synthesis of Outcome Studies, doctoral dissertation, Brigham Young University, Provo, UT, 1978, p. 183.) She noted an 81% recovery and improvement rate for bisexuals, 69% for long-term therapy clients, 53% for short-term therapy clients, and 42% for exclusively same-sex attracted clients. She noted that “there is certainly room for the development of new treatments and combinations of techniques that will enhance the effectiveness of those procedures already in use.” (James, p. 99.)

These success rates are as good as, or better than, those for treating other conditions. For example, when treating general depression—one of the most commonly treated behavioral issues—about one third get better, one third stay the same, and one third continually get worse in spite of treatment. This division of thirds holds true for the treatment of many conditions. A Masters & Johnson study showed the success rate for relieving distress over same-sex attraction at 71.6% when there was motivation and support. (Masters, William H. and Johnson, Virginia E. Homosexuality in Perspective, Bantam, New York, 1979, p. 400.)