The Psychotherapeutic Treatment of Male Homosexuality

By Berger, Joseph | American Journal of Psychotherapy, Spring 1994 | Go to article overview

The Psychotherapeutic Treatment of Male Homosexuality


Berger, Joseph, American Journal of Psychotherapy


In recent years there have been very few psychodynamic contributions to the aetiology or treatment of homosexual behavior. This stands in sharp contrast to the 1960s, when the contributions of Bieber,(1) Socarides,(2) Ovesey,(3) Stoller,(4) and others significantly increased our knowledge and understanding.

One possible explanation for this change may be the success of the homosexual activism generally known as the "gay liberation" movement. In psychiatry, this activism has mainly been directed toward emphasizing the "normality" of homosexual identification and practice, and strongly discouraging any attempts to change homosexual orientation or behavior through psychotherapy.(5,6)

In 1974 the American Psychiatric Association voted to drop the term "Homosexuality" from its list of "Mental Disorders," and recent years have seen renewed attempts to establish an organic, genetic, nonpsychodynamic basis for homosexual choice and behavior.

However, these changes have not been helpful to psychotherapists whose psychodynamic training and clinical experience has given them a very different view from that considered "politically correct" today. Nor has it been helpful to those patients unhappy with their homosexual drives and activities, nor to those suffering from symptoms that appear to be classic examples of symptom substitution.

In presenting the case histories of two male patients who had thought of themselves as being homosexual and whose behavior had been homosexual, but who became comfortably and consistently heterosexual during successful, long-term psychodynamic psychotherapy treatment, I suggest to therapists that the psychodynamic understanding and treatment of such patients is still valid and helpful.

CASE HISTORIES

CASE 1

Mr. R. was referred to me by another physician because troubling thoughts and feelings that he had about people he worked with were pushing him toward taking a prolonged leave of absence from his work.

Mr. R. was a tall, handsome, well-dressed man in his mid-forties who kept himself fit with regular, early-morning jogging and evening swimming. Having entered his field of work quite young, he had reached a senior position with considerable responsibility for a large number of people. He had almost reached the peak of his career but was contemplating stopping because he was convinced that the people that he worked with were whistling at him. This supposed whistling upset him, and he was convinced that the whistlers intended to make him uncomfortable. He believed that knowledge of this discomfort was being disseminated among a wide range of people that he had professional contact with, and that some of the more senior people who had influence over his career progress were aware of his homosexuality and were talking about it.

There was absolutely no confirmatory evidence for these beliefs, but they were troubling him so much that he was strongly tempted to take a leave of absence that would probably have finished his career.

At an early stage in our meeting he told me that he was homosexual, that he had been so for many years, that he felt quite comfortable with that, and that it was not a problem. His problem was the attitude of the people he worked with, and did I agree that a leave of absence was the solution?

As his story emerged more fully it became clear that while most of his close friends were homosexual, that the restaurants and bars that he frequented were predominantly homosexual meeting places, and that the people that he appeared to be most physically attracted to were "beautiful" young males, nevertheless his sex life was furtive, limited, quite unsatisfying, and unfulfilling.

Furthermore, he revealed that in the past he had had relationships with women. While there had been one experience of sexual inadequacy with a woman who had ridiculed him, he had had a very successful and enjoyable sex life with another woman.

That relationship had occurred in his mid-twenties. …

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