Psychotherapy for the Gay Teenager

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 his choices. Clients must be aware that gay-affirming therapy is available 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 when even a potentially "straight" youngster could be encouraged to try gay sex, and could well establish an addiction to dangerous behavioral patterns. As 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?

And what about the health risks? One report estimates that by the age of thirty, 30% of gay men will be HIV-positive or dead of AIDS [3].

But who is "really" homosexual?

The risk of disease and death is not the only factor of concern in counseling. How can we expect a child to "choose" whether or not he is homosexual unless we as psychologists are convinced that there exists a certain population for whom being gay is normal and natural?

This is the fundamental question. Is any person "really" -- that is, inherently and unchangeably -- homosexual? I myself answer that question in the negative. I believe that we are all heterosexual, but that some people have a homosexual problem.

Many psychotherapists, educators, public policy makers, pastors, and judges have accepted the fallacy that gay is "who some people simply are." This truism has permeated the popular culture because we, as the opposition, have failed to speak up with a convincing counter-argument.

As the late Ayn Rand once observed:

"In the absence of intellectual opposition, the rebel's notions will gradually come to be absorbed into the culture. The uncontested absurdities of today are the accepted slogans of tomorrow. They come to be accepted by degrees, by precedent, by implication, by erosion, by default, by dint of constant pressure on one side, and constant retreat on the other...until the day when they are suddenly declared to be the country's official ideology."

The conventional wisdom -- "It's biological"

Not long ago, before the taping of a Fox News show, I was waiting in what the studios call the "green room," alongside a nationally recognized psychologist who specializes in television advice shows. Naturally, she and I began talking. I told her that my specialty is working with homosexual men.

"Oh," she said, apparently misunderstanding my position, "I've come to believe in those biological studies. They're born gay, don't you think?"

I explained that I help people change -- not affirm their homosexuality. She looked mystified.

I explained the origins of same-sex attractions and therapeutic interventions available. After a few minutes of listening, she saw the other side of the issue and expressed appreciation for the idea of reparative therapy.

I'd like to believe that this psychologist's abrupt change of mind was the result of my eloquent defense. But most probably, she had simply accepted superficial ideas that did not run deep. With a little education, she quickly saw the legitimacy of the developmental perspective. Time and time again, I have seen the same scenario: people (from cab drivers I speak to, to psychotherapy professionals) will often understand homosexuality to be a treatable condition if you just expose them to new ideas they never have a chance to hear.

Most people who strongly defend against this idea are so deeply invested in the civil-rights mentality of liberating the oppressed that they cannot see the issue through any other framework; or they are gay themselves, or the loved ones of someone personally committed to a gay lifestyle. But barring this personal investment in the "born gay" philosophy, people are, I've found, quite quick to grasp and accept the "developmental and potentially changeable" position, if only they are given the chance to hear about it.

But the chance to hear about it rarely comes through the media.

Endnotes:

1. Remafedi, G., Resnick, M., Blum, R., and Harris, L., "Demography of Sexual Orientation in Adolescents," Pediatrics vol. 89, April 1992., pp. 714-21. Back to text.
2. Satinover, J., (1996) Homosexuality and the Politics of Truth. Grand Rapids, MI: Baker Books.
   Back to text.
3. Goldman, E.L., "Psychological Factors Generate HIV Resurgence in Young Gay Men," Clinical Psychiatry News, October 1994, p. 5. Back to text.