Category: Professional issues

Taking a break from book writing, and inspired by the Satel article, I put some thoughts together than might be an op-ed when they grow up.

In my clinical work and on my website, I receive many inquiries from people who experience homosexual attractions. Most often, the writers are distressed by their feelings and want some advice or assistance. One of the most frequent questions I get is, “why do I have these feelings?”

The question is natural enough. Although widely discussed in the culture, having attractions to the same sex is statistically infrequent. The percentage of the population who identify as gay has been pegged at between 2-3%, so asking why one is in the minority reflects a natural human curiosity about being different.

However, what most people really want to know is what made them gay? Some questioners wonder if they inherited the feelings and many others wonder if their feelings came from conflicts with their parents.

My responses begin with an academic bent. I first inform them that there are many contradictory research findings. Some studies implicate pre-natal factors, while others point to a role for social environment, including family. I tell them that there is a group of researchers that line up on the side of biology, with others more aligned with the environmental camp, with still others (myself included) who see both nature and nurture as working together in different ways for different people to lead to one’s sexuality. However, I rarely stop there.

I ask what difference it would make to them if they knew why. In other words, how would knowing why help you in your life?

I ask because my research and experience leads me to be skeptical of two related ideas that permeate the field of psychotherapy generally and specifically, among those who help people make peace with homosexual desires. The first idea is that one can know with certainty why one feels attracted to the same sex. The second is that knowledge of why directly leads to an elimination or acceptance of homosexual attractions.

Recently Sally Satel, psychiatrist and scholar at the American Enterprise Institute covered similar ground in a New York Times essay. Writing about addictions, she says,

Reconstructing the story of one’s life is a complicated business for other reasons. What scientists call hindsight bias kicks in when we try to figure out the causal chain of events leading to the current situation. We may well come up with a tidy story but, inevitably, it will contain large swaths of revisionist history. It’s not that we bias ourselves deliberately; it happens because the mind tends to make events in the past appear comprehensible and orderly. We forget the uncertainties that might have beset us as we struggled in real time.

To be sure, humans seem driven to explain. Wondering why a co-worker didn’t say hello or why one fears speaking in public is a natural part of our mental lives. However as social psychologists teach us, we are biased observers, not only of others but of ourselves. Furthermore, human memory is far from being a tape recorder. Rather, our present memories are fuzzy reconstructions, sometimes involving events that never occurred, motivated by a need to reduce confusion.

Bias may also enter our deliberations because tidbits of our experience may conform to narratives we find in the culture or among social groups we like. About this phenomenon, Satel says,

Narratives are shaped also by a natural tendency to focus on information that confirms theories we already hold. These theories — for example, that molested children are likely to grow up to have sexual compulsions of their own — may be imbibed from the media, self-help books or therapists.

Dr. Satel’s illustration about child abuse is reminiscent of the frequent narrative offered by many conservative groups that homosexual attractions derive from detached relations with same-sex parents or from childhood abuse. However, pro-gay therapists may gravitate toward the media fueled narrative that regards homosexual attractions as being invariably inborn and immutable, despite weak evidence to that effect. Complicating the search for many people I work with is that they can scan their lives and find evidence for both narratives. Research has demonstrated that many therapists selectively ask questions and respond more favorably to information from clients that fit therapists’ theories. Thus, certain events may seem more meaningful when trusted advisors and conventional wisdom unite to provide a coherent story.

So people are biased observers and we really don’t know for sure why anyone feels attracted to the same sex. Doesn’t psychotherapy rely on psychological investigation to get results? Surely people feel better when they learn why, don’t they?

Dr Satel addresses this question well, writing,

If our own accounts of our actions are often so slanted and embellished, is composing them simply a misbegotten quest? Surely not. To a therapist, the attempt signals that patients are aware that they have a problem worthy of attention. And the narratives themselves can help them make sense out of confusion. This, in turn, can diminish anxiety and exaggerated guilt. Such relief might be sufficient in and of itself for some, or, depending on the goals of therapy, it could embolden a patient to make further healthy adjustments.

Searching for why may provide some benefit but it does not lead to a value judgment. I submit that whether one is born gay or is socialized to become gay, one still must make a value based decision about how one wants to live.

Case in point, one of my clients initially came to believe the reason he was drawn to men was due to his father’s distance and lack of love. This insight was powerful, meaningful, and full of emotion. However, even after this recognition, and an emotional reconciliation with his father, my client felt very little decline in his attractions to men. He decided perhaps he was predisposed to homosexuality. However, due to his religious convictions, he determined not to pursue gay relationships. He gained more satisfaction from therapy and his life when he stopped seeking insight and started to implement strategies to help him in the present.

So after why, perhaps, the better question is: “now what?”

As a practicing psychotherapist of nearly 25 years I have had a close up view of how people suffer, how they come to understand that suffering and how they change. Much of my early practice was organized around helping people construct a historically grounded narrative to understand their suffering and to free them up to behave in a way that would not recreate more suffering and actually improve wellbeing.

Sometime in the late 1990’s it became obvious to me that this intervention was at least not very efficient and at times distracting from the urgent work at hand for my clients. Clients and others had developed a compelling narrative for why they were being destructive, but they they showed little drive toward transforming that insight into action. Sally Satel, M.D. wrote in last month’s New York times (read it here) how she sees this everyday in her methadone clinic. She writes well and thoughtfully on this topic.

Currently, I still describe myself as a psychodynamic psychotherapist, but with an edge and an energy that focuses on quality of life in the now. I view people’s struggles as having their roots in developmental errors, injuries and neglect. But my focus is “how does that lead to you taking less responsibility or seeing that you have less choices for your wellbeing in the now?” I think I concluded somewhere in 2000 that people were finding ways to change their lives years before psychology was created and they were doing it will very little insight in some circumstances. It is that power that I am interested in harnessing for my clients.

That brings me to the topic of Same-Sex Attraction. It seems to me we have two compelling narratives which have, at best, incomplete scientific support: a) that SSA is biologically determined and b) that it is caused by a wound in the child’s relationship with their same sex parent.

So the questions for my readers today is:

How do these narratives interfere with our conversation about Same-Sex Attraction? and, in a related question,

How do these narratives limit our client’s ability to see themselves as fully formed persons able to choose their actions in the now?

Thanks for checking in on the blog today.