Psychotherapy and Gay Men

By Jeremy Younger

Given the history of the relationship between psychotherapy and the lesbian and gay community, gay psychotherapists and gay clients are well advised to approach psychotherapy with caution and suspicion. The psychoanalytic world has pathologized gay identities for much of the twentieth century and, although this is now officially not the accepted position, the echo of anti-homosexuality still resonates, consciously or unconsciously, within psychotherapeutic agencies and with individual therapists. Those of us gay men, who are considering either entering therapy or exploring training as therapists, need to have our wits and our critical faculties well honed.

As you can see this article is about ?we? not ?them?!

I want to state from the outset that I?m writing this as a Pakeha, gay, male psychotherapist. And behind this statement is my belief that as a therapist I am always the agent of my client rather than a representative of his social world. Of course this world in which both of us, therapist and client, are brought up and live, and in which heterosexist social pressures for sexual and gender conformity are enshrined, cannot be ignored, but taking such a world seriously involves us questioning, rather than embracing the embedded cultural beliefs; only if this is done can we make therapeutic progress.

Gay identity

Those of us who come for therapy and define ourselves as gay men usually understand by this that we are sexually attracted and romantically drawn to other men. Some of us will remember an awareness of these feelings from a very early age, though we may have spent much effort and time trying to deny them. Some of us will have been aware of these feelings since we were as young as four; for others the origins are identified with our adolescence, and some of us may not have become aware of our sexual identity until we were adults. Our acceptance as gay men of our sexual identity ranges widely along a continuum from our living openly as gay men within the gay community to living covert lives in which our sexual identity is hidden from friends, family and even ourselves.

Therapists who wish to work empathetically with gay men need to be aware of the various aspects of defining what it means to be gay and that these dimensions are interwoven and often difficult to separate from each other.

So what?s different?

It is often claimed that working as a therapist with gay men is no different from working with straight men. This is not so, for it ignores the fact that for us, growing up gay is a different cultural experience from men who grow up straight. Inevitably specific issues come up for us when we live our lives as members of a sexual minority. The straight man?s world isn?t shrouded in secrecy and furnished with closets: ours is. The straight man belongs to the world around him: we know and feel ourselves as different. The straight man has his sexual feelings mirrored in his family and in society: we don?t. The straight man doesn?t have to contend with issues around ?coming out?: we do. The straight man has his relationships supported in society, in the media and in marriage: we don?t. The straight man knows himself morally affirmed: we often experience intense moral judgement from others, and even from ourselves.

It would be easy from these socially constructed paradigms to extrapolate simplistic, ontological stereotypes about us as gay men. This Mickey-mouse theorising, attempting as it does to create over-easy resolutions of complex and sensitive issues, only results in the undergirding of damaging, therapeutic work. One unfortunate result of the confrontational, politicised debate about homosexuality that exists today is that it inhibits the complex discussion of shared ?not knowing? which is always the starting point of creative, psychotherapeutic work.

Gay affirmative therapy

What then should make up a model of gay affirmative therapy? What should we as gay men look for when seeking a therapist? At heart there is much that is similar to any other form of person affirmative therapy, but for the gay man and his therapist it goes much further. The work needs to be informed by a respect for diverse expressions of sexual identity, understanding of the dangers of sexual hierarchies such a straight over gay, oral over anal, and issues of personal and cultural safety for us as gay men in a heterosexist society. Such a model of therapy will expect therapists, be they gay or straight, to have trained specifically to work with members of our community. It is of the utmost importance for therapists who do this work to have explored as deeply as possible their own sexual identities and the discourses they use to express them and protect them. Therapists who work with gay men need to have a specific understanding of issues particular to our lives such as homophobia, coming-out, same-sex relationships, and the complex ideas around the construction of gay identity and gay culture. As gay affirmative therapists we need always to be vigilant in our monitoring of issues around power in our work with gay men, given that therapeutic power has been used during much of the twentieth century to control us and to negate our gay identity. However, we have become very skilled in assessing and recognising issues around power and safety; in order to survive as gay men in a heterosexist society we have had to develop an intense sensitivity to issues of respect, acceptance and celebration. This serves us well as we seek out appropriate therapists and risk staying with them. Not all therapists who see themselves as ?gay friendly? are what they claim!

I have sought in this article to avoid singular definitions and sweeping generalisations about gay men and what we need to achieve within therapy. To over define is often to over delimit! Our identities as gay men are not static or easily defined; they vary as widely as any other group in society. We may share a common journey of self-acceptance but the map for each of us on that particular journey is unique.

So also for us, gay or straight, who are therapists and work with gay men. In the therapeutic relationship we are called to hold the humility and creativity of not knowing and not understanding. To hold this is not easy in a world that is full of sexual signifiers and simplistic understandings. In each therapeutic relationship we are caught up in the excitement of a conversation that both of us, therapist and client, want to continue even if we are not sure why.

For further reading:

Cornett, Carlton. 1995. Reclaiming the Authentic Self. Northvale & London: Jason Aronson Inc.

Davies, Dominic & Charles Neal (eds). 1996. Pink Therapy. Buckingham and Philadelphia: Open University Press.

Drescher, Jack. 1998. Psychoanalytic Therapy and the Gay Man. London & Hillsdale: The Analytic Press.

Group for the Advancement of Psychiatry. Homosexuality and the Mental Health Professions: The Impact of Bias. Hillsdale, NJ: The Analytic Press, 2000.

Isay, Richard A. 1989. Being Homosexual: Gay Men and Their Development. New York: Avon Books.

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