The treatment of…
The treatment of ego-dystonic homosexuality in men poses many therapeutic challenges. From a technical standpoint, the patient typically presents with many conscious and unconscious resistances to growth. There are fears of heterosexual functioning that manifest themselves through sexual acting out, suicidal gestures, passivity, threatened premature termination, avoidance, rationalization, and so on.
The therapist must prepare for these and many other hurdles and readily ally himself with the side of the patient’s personality that strives for change. Such an alliance requires that the patient feel safe, understood, and hopeful that change is possible. If these conditions are not met, or if ruptures in the alliance are not sufficiently repaired, the patient will not experience the therapist as “being on his side” and the outcome will be seriously undermined.
In the several years that I have been treating men with this condition they have taught me a great deal about themselves –about their internal turmoil and their efforts to cover up their secret lives; about their interpersonal sensitivities; and especially, about their deep sense of masculine inadequacy.
In my way of thinking, masculine inadequacy is a feeling state arrived at after years and years of wounds to a boy’s developing masculine self-image. My experience has taught me that the overriding therapeutic aim in working with these men is to reverse this damage and ensure the integrity of masculine self-image. The evolution into this “phallic being” creates a safer context for these men to overcome their fears and feel more hopeful about growth because they can identify behavioral changes. Therapy provides the patient a second chance to receive the masculine mirroring via the therapist which is so vital to treatment outcome.
The patient’s success in this effort is directly related to his acceptance and recognition of the various factors that have interfered and continue to interfere with an adequate masculine self-image. Therefore, the therapist guides the patient in revisiting the significant situations of childhood, linking them up with past and present feeling states, and labeling the patterns. Once this is accomplished the groundwork is laid for leading the patient towards masculinization. Laying the groundwork involves using the patient’s personal history to demonstrate how childhood situations left him with a sense of exclusion from the “masculine club” and produced deep feelings of “not measuring up.”
The persistence of these scenarios led to strongly engrained patterns of submission and self-exclusion. Submissive behavior became a tool for temporary, albeit humiliating, entry into the male world, and self-exclusion was relied upon for protection from further wounding to the boy’s fragile sense of masculinity.
The reconstruction of this boyhood disenchantment with masculinity provides reference points for the therapist to refer back to when the patient discusses the failures and disappointments of life today. A common language that incorporates the terms used by the patient, the specific circumstances surrounding damage to the masculine self, and the therapist’s syncretizing comments provide the patient with verbal mechanisms to endure the surfacing of adverse feelings. In one case, a man’s easily evoked feelings of victimization were lessened by telling himself that he was not helpless in the face of bullying by his cruel older brother and that he retained certain powers and choices to change circumstances if he so desired.
Richfield, S. A. (8 February 2008). The Treatment of Ego-Dystonic Homosexuality: The Development of a Masculine Self-Image., from http://narth.com/docs/richfield.html
