Sexual Re-Orientation Therapy for
Homosexual Male Clients:
The Safe Journey of Self-Discovery
By Dr. Codrina Cozma
1. Defining Abnormality in Male
Homosexual Behavior
According to Gazzaniga et al. (2010), the criteria for classifying behavior as abnormal
are 1) deviation from cultural norms, 2) maladaptive nature of behavior, and 3) distress
caused to the affected individual (p. 619). Again, we should also consider harmful
psychological and physical effects on the affected individual as essential factors in
categorizing a behavior as abnormal. In this respect, Gazzaniga et al. (2010) mention
interference "with at least one aspect of the person's life, such as work, social relations, or
self-care" (p. 619). This section will address cultural norms and psychological and physical
distress. The maladaptive nature of male homosexual behavior will be covered in the next
section that deals with the etiology of male homosexuality.
1.1 Cultural Norms
Gay activism often argues that male homosexuality should be culturally accepted
because homosexual behavior can be observed in several animal species. Even if science
relies significantly on animal tests to attempt to explain and to treat human behavior, we find
insufficient and logically flawed the argument that human homosexuality may be justified as
normal because of the incidence of homosexual behavior among animal species. There are
many behaviors that animals display and which are neither biologically healthy for humans,
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nor culturally/legally acceptable. For example, animals eat other animals; lions attack zebras
and eat them raw. But if a human individual kills and eats another human being (raw or
cooked), we will likely attribute this behavior to the antisocial personality disorder and
commit the cannibal to an institution. On the other hand, there are some female lizards that
kill their male mate immediately after copulation, but a woman who does that is very likely to
be accused of murder and get either life in prison or the capital punishment. Again, there are
some bird species that have only one mate in a lifetime, but not all humans copy that behavior.
So there is an obvious discrepancy between animal behavior and human culturally and legally
accepted behavior.
Further, we will look at religious traditions that shaped cultural norms with farreaching societal and medical ramifications. The three Abrahamic religions (Mosaic,
Christian, and Islamic) coincide in their position towards homosexuality as unacceptable
behavior. In the next section, we will see why these cultural norms are not homophobic in
nature, but they are actually rooted in practical evidence.
Early Christian writings specifically censure homosexuality. In his letter to the
Romans, the apostle Paul addresses both lesbianism and male gay behavior: "Because of this,
God gave them over to shameful lusts. Even their women exchanged natural sexual relations
for unnatural ones. In the same way the men also abandoned natural relations with women
and were inflamed with lust for one another. Men committed shameful acts with other men,
and received in themselves the due penalty for their error" (Romans 1:26, 27). Further, in his
first letter to the Corinthians, Paul includes male homosexuality in the list of sinners who will
not qualify for eternal life: "Or do you not know that wrongdoers will not inherit the kingdom
of God? Do not be deceived: Neither the sexually immoral nor idolaters nor adulterers nor
men who have sex with men nor thieves nor the greedy nor drunkards nor slanderers nor
swindlers will inherit the kingdom of God" (1 Corinthians 6:9-10).
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The Islamic sacred book, the Qur'an, elaborates on the Mosaic story of the destruction
of the two cities in which homosexual behavior occurred, Sodom and Gomorrah. Mission
Islam (2012) indicates that in the Qur'an, Lot (the only believer in that grographical area)
engages in a dialogue with male homosexuals, condemning their sexual practices: ": "Do ye
commit lewdness such as no people in creation (ever) committed before you? For ye practice
your lusts on men in preference to women: ye are indeed a people transgressing beyond
bounds" (Qur'an 7:80-81) and "What! Of all creatures do ye come unto the males, and leave
the wives your Lord created for you? Nay, but ye are forward folk" (Qur'an 26:165). Mission
Islam (2012) also points out that lesbianism is classified as an unacceptable behavior in
Hadith, which are collections of sayings attributed to Muhammad: "Sihaq (lesbian sexual
activity) of women is zina (illegitimate sexual intercourse) among them."
The Mosaic religion labels homosexuality as abnormal among other sexual behaviors.
The specific command against homosexual male behavior reads as follows "Do not have
sexual relations with a man as one does with a woman; that is detestable" (Leviticus 18:22).
In fact, Leviticus 18 establishes a number of rules for healthy sexual relations, which prohibit
adultery, relations with family members, homosexual relations, and bestiality.
Now, let us consider each of these biblical prohibitions from a social and medical
perspective: The divorce courts worldwide can testify to the catastrophic financial and
psychological consequences of adultery for all members of families that experience divorce
due to adultery. Again, it has been scientifically proven that consanguineous marriages lead
to congenital diseases," such as Tay-Sachs and Niemann Pick Disease, as well as hereditary
breast cancer associated with the BRCA mutation. Historically, European royal families have
provided us with perhaps the best examples of the dangers of consanguinity in the mental
retardation of the Hapsburgs and the hemophilia of the Russian czars" (Asmal, 2008). In
addition, a plethora of studies have shown the acute psychological scars produced by incest.
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As for the consequences of LGBT behavior, they are truly alarming and will be covered in
the following section of this paper.
All these scientific data point back to the fact that breaking the rules in Leviticus 18,
in the apostle Paul's letter, and in the Qur'an, may be called sin by theologians and believers,
but that these prohibitions are in fact health warnings, thoroughly justified by our genetic
makeup and issued by Someone who has a superior understanding of it because He created it.
Freedman (1980) shares this pragmatic perspective on Torah's mandates in the rabbinical
tradition:
This sanction of failure is viewed by the rabbis as empirical in nature; failure
is a natural accompaniment of the acts in question, not a super-added
punishment which God provides for the disobedient. As Aharon Halevy
writes (Commandment 62): "for God knows that the outcome of actions for
men growing out of these aspects is harmful, and therefore He prevents [these
acts] of theirs." On this view, the failure is the reason for the prohibition, rather
than the prohibition being a reason for failure (p. 107).
1.2 Psychological and Physical Distress
This section will provide evidence to support the fact that there is a pathological basis
for the cultural traditions that censure homosexuality. Assessments of male homosexuals
based on the DSM-IV-TR often signal mood disorders such as depression and bipolar
disorder on Axis I, medical conditions, such as STD's (including a high incidence of HIV and
Hepatitis B) on Axis III, problematic relationships with parents or friends on Axis IV, and
relational dysfunctions (such as an inability to relate to males in a non-sexual way or
avoidance of interactions with heterosexual males) on Axis V.
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Perhaps the most life-threatening symptom, heavily associated with homosexual
behavior, is critical episodes of depression that often lead to suicide. Gay rights supporters
invoke social stigmatization as a factor that triggers suicide. However, suicide rates remain
high in gay males in Scandinavian societies that display lax moral standards and that have
long ago legalized gay marriage. In a 2010 meta-analysis, Whitehead et al. compile statistics
from Netherlands, Denmark, and Norway, that indicate that "gay men in partnerships were
eight times more likely to commit suicide than heterosexual men."
Last month, New York Times published a heart-wrenching article about the life and
death of therapist Bob Bergeron (Bernstein, 2012). With a master's degree in psychological
counseling, an annual income of $150,000, a property in Manhattan and one in Miami, at the
age of 49, Mr. Bergeron displayed a sunny optimism and seemed to be an accomplished, selfsufficient individual. After starting out as heterosexual in college, Bergeron turned to an
exclusively gay sexual life and constantly encouraged his gay clients to overcome depression
and acknowledge the positives in the homosexual lifestyle. However, since narcissism is so
prevalent in the gay community and body image is crucial for sexual acceptance, Mr.
Bergeron started to feel he was losing momentum as he was facing a mid-life crisis. Perhaps
to re-assure himself, Bergeron completed the manuscript for a self-help book called The Right
Side of Forty: The Complete Guide to Happiness for Gay Men at Midlife and Beyond. On
New Year's Eve, he methodically prepared instructions for his finances and left a suicide note
on the title page of his book manuscript, in which he called his book "a lie based on bad
information" (Bernstein, 2012). He was found dead, "with a plastic bag over his head," in his
New York apartment on January 5, 2012 (Bernstein, 2012). His suicide note indicates that in
fact, gay life is not "gay" as he tried to convince himself and his clients all his adult life. The
tragic end of Mr. Bergeron is just one more example that proves that the kind of therapy that
avoids a deep analysis of homosexuality causes and effects and that encourages people to
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remain in this lifestyle is a therapy that does not work for the benefit of its gay clients
because it leaves them completely unprotected against depression, self-loathing, and fear of
rejection by their potential sexual partners. According to Bernstein (2012), "a 2002 survey
by researchers at the University of California, San Francisco, found that 12 percent of
urban gay and bisexual men have attempted suicide in their lifetime, a rate three times
higher than the overall rate for American adult males."
Aside from suicide, male homosexuality results in considerably higher risks for STD's,
including HIV and Hepatitis B. In September 2011, the U.S. Center for Disease Control
published a fact sheet that shows, among others, that 49% of the HIV positive individuals in
the U.S. are males who engage in homosexual sex (MSM), and comparatively that "while
CDC estimates that only 4 percent of men in the United States are MSM, the rate of new HIV
diagnoses among MSM in the United States is more than 44 times that of other men." A
CDC report published in 2000, Tracking the hidden epidemics, mentions that gonorrhea was
on the rise in MSM as opposed to other population groups (p. 17) and that 18% of the
Hepatitis B cases "were associated with homosexual activity" (p. 26).
In terms of Axis V -- dysfunctional relationships, we will further explore deficiencies
associated with homosexual behavior as presented in scientific literature and will engage in a
critical contextualization of these findings. In his recent book, Shame and Attachment Loss,
Dr. Nicolosi (2009) views homosexual acting out as “a narcissistic defense against truly
mourning the loss of an authentic attachment to one or both parents” (p. 356). In fact,
narcissism ranks high among the symptoms of homosexuality explicated in this book, and it
appears to be responsible for many of the relational barriers in the life of a homosexual.
Again, being aware of how these symptoms work and what their causes and consequences are
is an invaluable tool for people who work on a professional or personal level with
homosexual men.
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Communication shutdown is, for example, one major impediment that discourages
most people from relating long-term and on a deep level to a homosexual individual. The
majority of people who have ever gravitated around a homosexual man will report that the
latter may go into periods of complete shutdown when phone calls and emails are not
returned and replied, the homosexual man does not engage in initiating any contact, and
sometimes, he acts out an utter avoidance or plain rejection; these periods may range from
weeks to years. This kind of behavior may be taken as offensive by a friend or relative who is
ignorant about what goes on beyond this silence and sheer rejection of the relationship. So
this may alienate the straight friend/relative. On the other hand, persisting in maintaining this
relationship, without being aware of how the homosexual man feels during a shutdown period,
may also drain and discourage the other. Dr. Nicolosi (2009) not only acknowledges
“emotional distancing” as a symptom (p. 45), but he also explains what causes it:
a) fear of disappointing the other person and shame that drives the homosexual man
to hiding and avoiding -- “I always assume that if somebody really knows me,
they won’t like me,” confesses one of his clients (p. 201).
b) a “chronic emptiness, the inability to feel and trust and the inability to relate
intimately to others and to love” (p. 367). Most of it is based on a fear of criticism
and of being hurt (p. 77) as the homosexual man projects past trauma on current
relationships and anticipates that this person, too, will hurt him eventually. More
particularly, there’s a fear of straight men who might “diminish” and “degrade”
him (p. 51) and a fear of women who may “manipulate and control” him (p. 51) in
a way similar to his parents or childhood mentors.
According to Dr. Nicolosi (2009), affect inhibition leads to shallow relationships.
The homosexual man who has not processed childhood trauma uses affect inhibition as a
defense against being further hurt. He deliberately refuses to invest emotionally in a
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relationship, so that he won’t expect something he may not get out of the other, and this way
he avoids additional trauma. Hence, he strives to create and maintain shallow relationships
that do not take and give much. It is obvious that this train of thinking is not exclusively a
symptom of homosexuality, but it is pervasive with any individual who has experienced
emotional trauma.
Dr. Nicolosi (2009) takes the workings of the psyche even further when he explains
that the next step after the defense of affect inhibition is actually another defense meant to
establish emotional balance and ‘aliveness,’ which in fact is the homosexual acting out: “Our
clients typically report a lifelong emotional numbness,” he writes. “They claim that only
sexual conquests with a variety of men offer an intense-enough excitement (however brief) to
‘bring them alive’” (p. 402). This could be the thrill sought by some people with low
dopamine production or a manic manifestation of the bipolar disorder.
At the other pole from emotional withdrawal lies what Dr. Nicolosi (2009) calls “the
nice guy persona,” a “one dimensional, co-dependent pleaser personality, habitually seeking
the approval of others” (pp. 76-77), caused by fear of criticism or disappointment, a false self
that conceals emotional emptiness because, as Dr. Nicolosi (2009) indicates, the homosexual
who strives to appear as a nice-guy does not feel genuine care for others. This is illustrated
by one of the therapist-client dialogues in which a client clearly recounts a situation in which
he wore a caring mask, but in fact he was only pretending to care.
Perhaps Dr. Nicolosi’s focus on the “nice-guy persona” builds on the prominent
narcissism he detects in most of his clients. He lists some of the narcissistic features as
“self-preoccupation, emotional distancing, excessive concern with external appearances,
restricted self-insight, a tendency to choose image over substance, and a tendency to be easily
hurt and offended by others. There is an excessive need for reassurance and a persistent need
to be made to feel ‘special’” (2009, p. 45). But underneath these “narcissistic” needs lies the
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homosexual man’s insatiable need for love, something he lacked while living his traumatic
childhood or teenage years. One of Dr. Nicolosi’s clients states: “I’d like to be covered by
love—wanted and loved. I want to be wanted and loved when I’m feeling all alone” (2009, p.
384).
Another symptom of homosexuality Dr. Nicolosi (2009) touches on is addiction,
whether it may be substance abuse or sexual promiscuity. He presents addiction as a way of
self-regulating shame or self-punishing and an immediate and temporary relief from pain and
“emotional emptiness” (p. 80), a distraction from facing “his fundamental inability to
establish authentic emotional attachments” (p. 80). However, the author warns that “Sex,
food, compulsive hyperactivity and the drive for ‘distractions’ and ‘entertainment’ will not
override the distress of emotional disequilibrium for long. After enactment, the
disequilibrium returns” (p. 81). The social hyperactivity associated with addiction fosters
shallow relationships, and all these together lead to both emotional and physical selfdestruction. Although Dr. Nicolosi (2009) recognizes the causes and effects of addictions,
and the fact that they are part of the homosexual package, his therapeutical approach does not
target them in particular.
2. The Etiology of Homosexuality in Males
After numerous failed attempts to prove the genetic determinism of homosexuality,
the American Psychological Association acknowledged in a 2008 brochure, Sexual
Orientation and Homosexuality, that the etiology of homosexuality remains entangled in a
combination of nature and nurture factors, thus leaving room for the possibility of change:
There is no consensus among scientists about the exact reasons that an individual
develops a heterosexual, bisexual, gay, or lesbian orientation. Although much research
has examined the possible genetic, hormonal, developmental, social, and cultural
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influences on sexual orientation, no findings have emerged that permit scientists to
conclude that sexual orientation is determined by any particular factor or factors.
Many think that nature and nurture both play complex roles; most people experience
little or no sense of choice about their sexual orientation.
For specific male homosexual clients who experienced rape (either heterosexual or
homosexual) at the debut of their sexual activity, Dr. Nicolosi (2009) implies a diathesisstress model in assessing the emergence of homosexual behavior and/or feelings/thoughts as
a combined effect of a genetic predisposition and a traumatic event (Gazzaniga et al., 2010, p.
625).
Dr. Nicolosi (2009) does not discard social causes that may occur in late childhood or
early teenage years such as peer-pressure, the fad of homosexuality, curiosity,
experimentation, the need of belonging, and the thrill of joining a socially marginalized
minority. He also admits to the existence of psycho-biological factors, namely an in-born
“sensitive temperament” (Nicolosi, 2009, p. 31) and “prenatal hormonal influences…that
may result in a low-masculinized brain” (Nicolosi, 2009, p. 18). But he views the above
factors as secondary to family upbringing, so he uses primarily a family systems model
(Gazzaniga et al., 2010, p. 626) in assessing the emergence and development of same-sex
attraction.
The fundamental cause that Dr. Nicolosi (2009) has recorded for most of his clients is
a narcissistic-triadic family, dysfunctional or malattuned to the child’s needs, with an “overinvolved mother and [a] critical / detached father” (p. 39). His scientific findings point to the
root of homosexuality as being either a traumatic childhood that causes the young boy not to
want to identify with an oppressive male figure, hence his homosexual effemination, or “a
history of being victimized by manipulation and control” (Nicolosi, 2009, p. 35) especially by
mothers or other influential females who were “inconsistent in their emotional responsiveness”
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and offered “conditional love” (Nicolosi, 2009, p. 73-74), a system of emotional enticement
followed by withdrawal and blackmailing.
As part of the family background, Dr. Nicolosi (2009) mentions two parenting errors
that may cause inhibitions that later lead to homosexuality. One is parental reprimand of
sexual self-exploration at a critical age. “The male genitals are the embodied symbol of the
boy’s essential difference from his mother,” explains the author. “A negative parental
reaction when the child is engaged in genital exploration or play may (especially in the very
sensitive child) prompt the boy’s shame-filled disavowal of his masculinity” (Nicolosi, 2009,
p. 69). One of the 2009 re-runs on Univision of the Televisa episodes of the television show
“Mujer: Casos de la vida real” (“Women: Real Life Cases”) documents a real situation of a
man who develops same-sex attractions and is sexually inhibited towards his wife because he
never had a chance to process the trauma of his mother’s violently scolding him after
catching him masturbating at some point during his puberty years. This is one tragic case
since the wife, hurt at the discovery that her husband is homosexual, shames him publicly at a
family party, blaming him for his sexual orientation. The man leaves the party in a hurry,
goes home, and commits suicide. Thus, this case indicates what extreme consequences such
a parental shaming moment may have.
The other traumatic situation mentioned by Nicolosi (2009) is a family that inhibits
the boy’s natural reaction to pain and shames him for expressing his feelings of anger,
discontent, sorrow, crying, etc. “The child of the narcissistic family has been taught that to be
sad is to be shameable,” explains Nicolosi (2009, p. 371). The author further shows how the
therapist can take the message of critical parents -- “‘You’re not supposed to cry, you’re not
allowed to feel sorry for yourself.’…’You’re upsetting everybody else. There’s no reason to
be unhappy. You have everything you need, and nothing to complain about.’” – and can use
it as a gateway to trauma processing: “But to deny the existence of the loss, I [Nicolosi] told
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him, is to continue to punish himself” (2009, pp. 366-7); hence, Dr. Nicolosi’s insistence on
exercising and affirming his clients’ feelings (especially the negative ones).
3. Sexual Re-Orientation Therapy
From the 1948 Kinsey Scale to Klein Sexual Orientation Grid developed in 1993 and
complex calculations and analysis carried out by Haslam in 1997, using the "Minnesota
Multiphasic Personality Inventory-2 (MMPI-2) Masculinity-Femininity (Mf) Scale," sexual
orientation was defined as occurring on a continuum rather than being locked in distinct
categories. Based on these studies, in February 2011, APA acknowledged that "research has
suggested that sexual orientation does not always appear in such definable categories and
instead occurs on a continuum (e.g., Kinsey, Pomeroy, Martin, & Gebhard, 1953; Klein,
1993; Klein, Sepekoff, & Wolff, 1985; Shiveley & DeCecco, 1977) In addition, some
research indicates that sexual orientation is fluid for some people…(e.g., Diamond, 2007;
Golden, 1987; Peplau & Garnets, 2000)."
This evidence validates the fact that individuals may shift in any direction on this
continuum, with or without psychological intervention. Hence, sexual re-orientation therapy
is deeply rooted in this possibility of shifting on this continuum. It is also based on the
premise that while attractions are involuntary (not chosen) and may have been caused by
environmental factors combined with certain predispositions, sexual behavior is a choice and
can be controlled; further, such modified behavior will re-wire mental processes and feelings,
so that eventually, after stopping homosexual behavior and through understanding the
dynamics of one's own SSA, same-sex attraction will also diminish and disappear. In this
section, we will examine sexual re-orientation efforts conducted in the U.S. by religious
organizations and by Dr. Joseph Nicolosi, who has been a pioneer clinical psychologist in this
area for over three decades.
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Sexual re-orientation addresses exclusively the needs of clients who present
unwanted same-sex attraction (SSA) and/or engage in homosexual behavior and who
voluntarily opt to change their behavior and/or thoughts and feelings. Clients who benefit
from professional or lay counseling aimed at this purpose attain different levels of success:
For some, the outcome may be a better understanding of the causes that triggered
homosexuality, a re-processing of trauma, and a better connection to one's self and to others.
Others experience diminished SSA, stop homosexual behavior, but are not ready for a
committed heterosexual marriage. Yet others find fulfillment in a heterosexual marriage,
experience very low or no SSA, and will not engage in homosexual behavior for the rest of
their lives. People who have benefited from re-orientation therapy are known as "ex-gays"
and many of them have become involved with the Ex-Gay Movement which extensively uses
media, literature, and scientific resources to create awareness of the need to accept people's
right to change if they so wish and the fact that change is possible.
3.1 U.S. Religious Organizations for Sexual Re-Orientation
U.S. religion-based organizations that promote sexual reorientation do not in any way
foster homophobia, but they support the idea that unwanted same-sex attraction (SSA) can be
transformed either into a commitment to celibacy or a change toward heterosexuality.
As expressed by the Islam Mission (2012) of North America, the U.S. Muslim
community does not endorse punitive measures such as execution or Taliban-type physical
punishments and discourages homosexuals from committing suicide: "While homosexuality
is wrong, it doesn't justify suicide under any conditions or circumstances. Please know that if
you ever commit suicide, you would have seriously misunderstood Islam and its spirit."
They also make the distinction between involuntary desires, thoughts, or emotions and acting
on them (behavior): "Please note that there is a difference to actually being involved in a
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homosexual act - which is a sin - from having sexual feelings that you try to control, that you
don't express in public, which is not sinful if you try to control them." This differentiation
between mental/emotional processes and behavior is widely used in addiction recovery
professional programs and also extensively emphasized by other Christian organizations that
cater to homosexuals, such as Exodus International (2012).
Islam also shares with other Christian organizations some of the steps recommended
for those who wish to deal with their unwanted homosexuality: "If you were ever involved in
sexual homosexual acts in the past, you should truly and sincerely repent to Allah, The
Merciful, The Gracious, and pledge to Him never to get involved in any homosexual acts
anymore…If medical or psychological counseling helps, then get it, but know that Allah is
The Curer, and the Qur'an is your best companion. Give charity, pray, make dua', and Allah
will not leave you alone…Try to avoid all of the circumstances that trigger your homosexual
feelings…keep yourself busy in different useful things…Keep a POSITIVE thinking in your
mind and keep saying to yourself that you can do something about it." (Mission Islam, 2012)
Mission Islam (2012) has also aligned its position to that of Christian organizations,
such as Exodus International (2012) and PFOX (2012) which emphasize the idea that
homosexuality is a problem like other addictions (a sin against one's one body), so society
needs to treat homosexuals with respect and oppose bullying: "Remember, there is in this
world many compulsive gamblers, alcoholics, adulterers, thieves, but many of them control it
and refrain from doing it...You have got to believe in the infinite amount of Mercy Allah
provides to His servants, and you should also realize that He forgives, if He wishes, all types
of sins, except the sin of disbelieving in Him."
JONAH International (2012), a Mosaic organization, views reparative therapy from a
behavioral-cognitive perspective, defining homosexuality as "a learned behavior which can
be unlearned," promote respect for "the dignity and humanity of every individual created in
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the image of G-d," and also acknowledges that the change from homosexuality to
heterosexuality "is a lifelong process." This is also the position of Mission Islam (2012) that
encourages the homosexual male not to share their homosexual tendencies with his wife and
parents, but instead to "make it a lifelong struggle for [himself]."
While Mission Islam (2012) encourages the homosexual male to consider marriage to
a woman not so much for sexual gratification, but also for other emotional needs -- "You will
discover that marriage is more than simply fulfilling your sexual needs... Your wife will
insha'Allah bring you peace, tranquility, joy, security, and many other feelings that every
human being needs" --, the U.S. Catholic organization, Courage, advocates celibacy as a
resolution for unwanted SSA. In its "Five Goals" statement, Courage (2012), similarly to
Mission Islam, encourages homosexuals, to commit their lives to Christ and to service to
others, but the Catholic culture promotes a support system that includes "chaste friendships"
in order to "ensure that no one will have to face the problems of homosexuality alone."
Moreover, Courage (2012) has adopted "twelve steps" of recovery from homosexual behavior,
inspired by the original AA twelve steps and adapted with the AA permission; these steps
imply that homosexuality is viewed as an addiction that has self-destructive effects (Step 2),
that is detrimental to relationships with friends and family (Steps 8, 9), and that requires a
rigorous accountability to the Divinity and to a mentor (Step 5).
A scientific perspective is also offered by Courage through articles, such as “Gay
Genes,” Sexual Attractions, and the Call to Chastity, written by Rev. Pacholczyk, a
prominent Catholic clergy with a solid scientific educational background (a doctorate in
neuroscience from Yale and post-doctoral work at Harvard). Pacholczyk (2011) postulates
that on the one hand, "we are not creatures of sexual necessity" and that on the other hand, we
do possess the tools that enable us to refrain from behaviors that may be triggered by genetic
predispositions: "Even if we have genes that predispose us towards certain behaviors, we still
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have a space of freedom within ourselves, and do not have to engage in those behaviors."
Moreover, "the self-mastery" advocated by Pacholczyk (2011) is bound to result in "inner
freedom and peace."
Exodus International (2012) is a U.S.-based, international organization founded by an
ex-gay, Frank Worthen, who has spent over 30 years counseling gay males willing to change
their orientation and who has also published several books on this topic. It is important to
note that the policies of this organization exclude holding/touching therapy and exorcism as
reparative therapy methods and clearly stand against bullying. PFOX (Parents and Friends of
Ex-Gays and Gays) is a national U.S. organization with deep involvement in the legal support
of ex-gays as an acceptable social minority group; PFOX lobbies for protective ex-gay
legislation and for inclusion of ex-gay literature in public outlets (2012). These organizations
share a Protestant Christian doctrine and regard both celibacy and heterosexual marriage as
valid confirmations of successful sexual re-orientation. They do not endorse heterosexual
promiscuity as a purpose in itself or as a validation of desired sexual orientation change.
The same perspective on healing is shared by a number of lay counselors who are
individuals who have successfully overcome their homosexuality. Among them, it is worth
mentioning for the state of Georgia, Chris Delaney, who offers free counseling to those
affected by unwanted SSA through his ministry, Joseph's Coat Ministries, Inc. (JCM). JCM
(2012) uses as a premise a divine provision that ensures that homosexuals can also experience
a change of heart and mind like other types of sinners; gay males are mentioned in 1
Corinthians 6:9-10 as part of those categories that will be banned from eternal life, but in the
next verse, the apostle Paul uses the past tense in his statement "And that is what some of you
were. But you were washed, you were sanctified, you were justified in the name of the Lord
Jesus Christ and by the Spirit of our God" (1 Corinthians 6:9-11), which is interpreted as
including homosexuals in the spectrum of addictions and maladaptive behaviors that can be
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corrected through transformational faith since anyone in Christ is a new creation (2
Corinthians 5:17).
3.2 Professional Psychological Reparative Therapy
In the U.S., the National Association for the Research and Therapy of Homosexuality
(NARTH) was founded in 1992 by Drs. Charles Socarides, Benjamin Kaufman, and Joseph
Nicolosi with the purpose of conducting research in the area of reparative therapy and of
upholding the LGBT clients' rights to self-determination, to pursue change in accordance to
their cultural and religious values, and to take measures that will safeguard their mental and
physical health (NARTH Practice Guidelines, 2012). NARTH represents a much needed
equalizer in a political and scientific climate hostile to unbiased scientific inquiry, following
the removal of homosexuality from the inventory of mental disorders by APA in 1973 and
the highly politicized dialogue on sexual freedom and gay rights.
At the Thomas Aquinas Psychological Clinic in Encino, California, Dr. Joseph
Nicolosi, founder and director of this clinic, has devised a complex system of therapy that
could be best identified as the dialectical behavioral therapy described by Gazzaniga et al.
(2009, p. 696); this reparative therapy includes a psychodynamic element (exploring the
client's past traumas as a way of exploring causes of present symptoms), and a behavioralcognitive approach (helping the client identify his own feelings -- cognitively and through
body work--, analyze these feelings, and then engage in grief work).
Addressing emotional inhibitions that are so prevalent with homosexual men, the
therapist asks the client to verbalize a feeling triggered by a certain conflictual situation and
then to identify the bodily reactions associated with that feeling. The body work approach
stems out of the scientific theory that “…all the functions of the brain are mediated through
the body. It is the body that mediates between the brain and the world. An altered bodily
17
response to an object will alter the cognitive meaning of that object” (Nicolosi, 2009, p. 169).
Dr. Nicolosi (2009) emphasizes the role of body work in processing the awareness of the
shame moment: “These sensations alert the client to a shame moment that would otherwise
go unnoticed by the cognitive functions” (p. 261). For a man who has been inhibiting his
feelings all his life, it may be difficult to cognitively articulate them, so watching his body
reactions may actually help him identify, anticipate, and actively engage his feelings.
Scientifically, this is rooted in the “dual-brain psychology” established by Schiffer in 1998
which attempts to connect the affects in the right brain to the cognition in the left brain, thus
“building a link between thinking and feeling” (Nicolosi, 2009, p. 211). It is clearly a way of
“re-wiring” the client into staying with himself, acknowledging his feelings, and processing
them cognitively at the same time. It definitely increases self-awareness and empowers the
client to be more in control of his thoughts, feelings, and actions. A direct effect of body
work may be the client’s realization “that his homosexual attractions are generated primarily
not by the attractiveness of the other man, but by the way he is feeling about himself”
(Nicolosi, 2009, p. 107), which is an important step in the progress of therapy.
The grief work ensues after body work and enables the client to not only re-live the
past trauma, but also to feel the pain without any inhibitions. The therapist empathetically
“stands in the grief” with the client, which represents the first time the client can freely
experience pain in the presence of another, a supportive mentor. The positive effects of grief
work are illustrated by the statement of one of Dr. Nicolosi’s clients: “Grief work helped me
get in touch with all of my feelings—especially the negative ones I didn’t want to feel. When
I am connected to my true feelings, I feel strong, masculine and alive. That’s when I’m no
longer drawn to looking at other men, and my life can go on” (Nicolosi, 2009, p. 430). It is
crucial for the success of therapy that grief work be used not only to process past trauma, but
also current shame experiences; Dr. Nicolosi also uses “homosexual enactment as an
18
opportunity for grief work” (Nicolosi, 2009, p. 419), thus turning a negative experience into a
positive consequence. This is especially helpful in dealing with relapses.
The therapist’s empathy plays an essential role in Dr. Nicolosi’s approach, which
clearly defines his therapy as a client-centered, humanistic one, among others. In a
“working alliance” with the client, the therapist is constantly exposing vs. imposing (Nicolosi,
2009, p. 289), leads the client to acknowledge and affirm his need for 3 A’s -- attention,
affection, approval (Nicolosi, 2009, p. 101) -- and guides him through a shift from selfhate/disgust to self-compassion, facilitating healing through compassion for self and others
(Nicolosi, 2009, p. 115). Self-compassion triggered by an understanding of the client’s
legitimate needs and constantly anchored in reality will also diminish shame, and thus open
the channels of communication between therapist and client: “As the personification of the
reality principle, the therapist attempts to expose the client’s illusions while avoiding
shaming him. This is achieved by showing the historical necessity for his illusory creation.
Highlighting his childhood need for his narcissistic defense diminishes the client’s shame
reaction to such exposure” (Nicolosi, 2009, p. 119). With Dr. Nicolosi’s approach, the client
takes precedence over the method; he advises that the therapist should be “willing to
compromise the session sequence to follow the client’s affect. It is the pursuit of affective
expression that produces therapeutic insight” (Nicolosi, 2009, p. 170).
The client-therapist sample dialogues presented in this book often feature an affective
blockage, a breach in communication/relationship, which Dr. Nicolosi calls “the doublebind,” which is then corrected through the “double loop” (a reconnection, an opening) and
followed by the Meaning Transformation (MT) phase, which involves the interpretation of
feelings and events (Nicolosi, 2009). This approach of the double bind and double loop
mirrors for the client the possibility of reconnecting after a breach in real-life relationships.
The MT phase then evaluates the significance of the therapy session, leading the client to the
19
realization that “These adaptational defenses that worked during childhood are now, in
adulthood, maladaptive and self-defeating. In the process of recognizing and uprooting these
defenses, the client exchanges this symptomatic behavior for a more realistic perception of
himself and others” (Nicolosi, 2009, p. 169). As he invalidates these childhood defenses, Dr.
Nicolosi clearly supports the client to grow out of being a little boy, to mature. This is also
why he opposes Richard Cohen’s method that involves the therapist’s physically hugging the
client: “…we understand the need to be held as regressive and as reinforcing the sense of
dependency and weakness. Holding may reinforce the illusion that the client can return to
being a little boy. What appears more transforming is for the client to feel and express the
need to be held, and to have this need respectfully understood by another salient man (i.e.
through the double loop), where the client admits his deep longing to be held; it is understood
and accepted by the therapist, and he experiences the therapist’s acceptance of that need”
(Nicolosi, 2009, p. 455).
One of the most efficient attitudes of the therapist illustrated in Nicolosi's book Shame
and attachment loss, as a response to clients who are “hyper-distrustful and alert to
manipulation” (Nicolosi, 2009, p. 290) is a genuine willingness to allow the client sufficient
freedom to agree or disagree, to make discoveries and decisions for himself. “Ultimately, his
life choice must be his own,” writes Dr. Nicolosi, “and if he feels manipulated or negatively
judged, he is reminded that he needs to address this problem with the therapist. I reiterate,
‘Rule number one—never agree with anything I say unless it rings true for you’” (2009, p.
288). On the other hand, when dealing with minors, Dr. Nicolosi advises that certain
confidentiality terms be established from the very beginning: “Legal limits of confidentiality
should be spelled out, including the therapist’s obligation to inform parents about selfdestructive behaviors, including dangerous sexual activities…to avoid problems, the therapist
20
should first clarify with the teen what he ethically can and cannot tell his parents about their
sessions” (Nicolosi, 2009, p. 288).
Dr. Nicolosi’s reparative therapy system facilitates the shift from homosexuality to
heterosexuality through gradual attainment of several goals:
a) desensitization and reprocessing of trauma
b) identifying what leads to homosexual acting out: powerlessness, failure to express
anger, envy of others’ masculinity, fear; as an illustration, one client states his
realization that “when he was feeling accepted and connected with other guys—
especially on a physical level—his homosexual preoccupation disappeared. It was
during times of social isolation and rejection that his same-sex fantasies
resurfaced to preoccupy him” (Nicolosi, 2009, p. 299)
c) making the distinction between friendship and erotic feelings; the awareness and
analysis of sexual (mental) engagement that implies a “disconnect” from friendly
dialogue (Nicolosi, 2009, p. 109)
d) shifting from a passive to an assertive attitude; Nicolosi (2009) acknowledges that
some SSA men are assertive in their profession, but not in their private
relationships (p. 239)
e) the client should be able to achieve feeling and dealing at the same time by grief
and assertion (Fosha 2000 qtd. in Nicolosi)
f) increasing self-participation in life decisions, community involvement, self-love,
empowerment
g) the client should be able to face “the reality that happiness and fulfillment can
never be ‘imported’ from any other human being” (Nicolosi, 2009, p. 91)
Outside therapy sessions, Dr. Nicolosi recommends journaling as a confidential
21
self-accounting exercise that should cover certain sections -- event, reaction, assumption,
assessment, summary (2009, p. 284)--, and most importantly, a close relationship with a
straight male who would act as mentor and who would serve as an accountability partner
especially in the gap between homosexual temptation and acting out (2009, p. 253).
In addition to presenting the causes, symptoms, and treatment techniques outlined
above, Dr. Nicolosi (2009) also launches in his book Shame and attachment loss, a number of
relevant concepts and typologies, which certainly help both professionals and “lay” readers to
understand the mechanics of homosexual behavior. First, he distinguishes between the “gay
homosexual” who affirms his gay identity and has peace with it and the “non-gay
homosexual” who experiences unwanted homosexuality and is willing to engage in
reparative therapy and to potentially become an ex-gay. In this context, he then defines the
concept of gay identity as a “false self,” and thus, reparative therapy becomes a selfdiscovering tool that reveals the true heterosexual identity of the homosexual client. Further,
the author presents four types of false self that characterize the behavior of certain types of
homosexual men (Nicolosi, 2009, pp. 122-124):
a) the passive-compliant – the “nice guy”
b) the theatrical entertainer
c) the outrageous, hyper-feminine, drag queen
d) the angry activist – hyper-masculine
Dr. Nicolosi (2009) also postulates that there are two main types of homosexuals:
a) pre-gender – attracted to macho men that would compensate for his lack of
masculinity; and
b) post-gender (some are bi-sexual): attraction to women is present, but they
relate to women only sexually; no female friendships; attraction to younger
22
boys that remind him of his boyhood and something he missed at that age; this
category has better prognosis for recovery
Another useful concept provided in this book is the difference between shame and
guilt. Dr. Nicolosi (2009) defines shame as anxiety towards others and directed at what you
are, and guilt as being directed to yourself and to what you do, and as leading to correction (p.
267).
Dr. Nicolosi (2009) also outlines four types of male friendships (pp. 308-9): gay,
non-gay homosexual, straight non-attractive, straight attractive (the best because it allows the
homosexual man to de-sexualize male friendships). Like all those who truly possess highcaliber intelligence, Dr. Nicolosi also practices humility, which he expresses in an aweinspiring statement: “The fact remains that people do not change through the application of
techniques. People change through relationships—relationships with caring people who
apply these effective techniques” (2009, p. 25). It is a statement that may produce an
epiphany in the minds of so many people who genuinely desire to be instruments of healing
for their homosexual dear ones. And it is certainly a privilege for such caring people to have
access to the expertise of a giant of reparative therapy like Dr. Nicolosi who shares these
techniques in his books.
4. Conclusion
Given the high risks of exposure to mental and physical illnesses associated with
homosexual behavior, and the fact that living the gay life fully and freely has been proven in
so many cases not to resolve the real underlying issues that trigger homosexuality (such as
trauma or developmental stalling), reparative therapy remains the genuine and only way in
which homosexual men can achieve a strong sense of identity, grow in self-knowledge, and
develop a deeper understanding of human relations and of the meaning and purpose of life.
23
There is a need for therapists who would go beyond supporting an affirmation of gay
identity and who would instead help their clients explore the dynamics of their sexual
attractions and behavior. The clients need to be empowered to repair old relations with
family and build new healthy friendships outside their
comfort zone. This kind of therapy, whether or not it
may be conducive to shifting positions on the sexual
orientation continuum, will foster emotional maturity,
stress-coping tools, including the integration of a
support system, and a better knowledge of self.
But there is also a crucial, massive need to
educate the public to understand the real emotional and
physical challenges faced by homosexual men, to
become aware that heterosexual people need to provide
more than a pat on the shoulder and ignorant
indifference to homosexuals; they need to become
mentors, friends, and fellow-travelers on this journey of self-discovery and self-defining.
24
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