From the NARTH Collected Papers, 2002

A Psychodynamic Approach with Clients Who Want to Change Their Same-Sex Attraction
Presented by Paul Popper, Ph.D. I stood here seven years ago presenting to you why I decided to treat same-sex attracted (SSA) clients who wanted to change. I presented four clients at the beginning of their therapy, and the hope they experienced as their compulsive same-sex attractions began to decrease (Popper, 1995).

Paul Popper, Ph.D.

Today, a third of my full-time practice consists of men who are working on changing their same-sex attractions. I want to talk about some of them, the course of their therapy, the ones who have achieved full heterosexual capacity, and the challenges they still face. The Initial Reparative Phase SSA clients usually come to me knowing that I am a reparative therapist who believes they have the right to hope that change is possible and work towards it, even at the risk of not being able to achieve it. After taking some history, I usually present my clients with a synopsis of their probable developmental story, based on a reparative understanding of their same-sex attractions (Moberly 1983, Nicolosi, 1991). The story, filled in with their individual histories, spoken for them, from an early age, in the first person, goes like this: I am profoundly hurt, disappointed, let down by my father. I know I am not like him. Do not want to be like him (Protest). I am different, unacceptable to him, to all men. It is all too much to handle, too overwhelming to feel so different and so alone (Despair). I do not need him. I do not need anybody like him. I don't need men. I don't need masculinity (Detachment). I am uncomfortable in my body, feel like an outsider, I am sensitive and creative. I hate boys who are strong, aggressive, competitive and fit in. I am attracted to boys who are strong, aggressive, competitive and fit in. In secret I fantasize about their square jaws, big shoulders, confident carriage and I yearn for those qualities, to be accepted by them, to be one of them, to be them. All the while in school and on the streets I fear them, feel picked on by them and experience them as the "other," further reinforcing my detachment from them, and the qualities in them to which I am ambivalently attracted.

The story goes on about how these reparative yearnings become sexualized either in the Oedipal or adolescent stages of development, and about the rest-of-the-life dilemmas faced by the client. This story is more fully developed by Dr. Satinover in his article (1995). The more the potential client resonates with this story, and the stronger he identifies with the "little guy" who became disconnected from his father, the better is his potential prognosis towards change. By "resonate" I mean the capacity of the client to regress to a particular moment in the story and experience it as his own. As an illustration, let me recount an early session with a client. He is a slightly awkward young man, brought up in a family with a physically available but emotionally distant father and a critical and controlling mother. In this session, he was describing a memory from age five, of being in the living room and joining his younger brother, dancing and twirling to the piano playing of his father. He re-entered that scene and relived it in my consultation room. He remembered how at that time he was imagining he was wearing a skirt, which billowed as he turned, and his lacy underwear was showing. He felt like a little girl. I asked him to imagine himself sitting next to his father on the piano stool. He pictured himself at the end of the piano bench, his father ignoring him. He felt awkward and hesitant. I asked him to scoot his body next to his father's, and hit a few notes on the piano. He reported experiencing his father's rejection, as his father looked annoyed with him for interrupting his practice. He felt like getting back on the floor and continuing his dancing as a girl. Later in the session, I asked him if he would be willing to re-enter the scene with his father, but this time to lean into his father's body as they sat next to each other on the piano bench. With some effort he forced himself closer and, as he visibly relaxed, I asked him to imagine his father lifting him into his lap and letting him play a few notes. We finished the scene with his father placing his hands over his little hands on the piano, guiding him. By this time the whole atmosphere in the room had changed. He was relaxed, appeared to be more comfortable in his body, his voice was deeper and more resonant. Later, he spontaneously reported that for a few moments, being close to his father, he felt much more like a boy than a girl. Clients who benefit from reparative therapy often relive memories from an early age which signify times they experienced their alienation from their father. These are moments of power, because they are the first indications to the client that their detachment from their father is energized by anger, hurt, yearning, and need. Whether it is a client re-living seeing in his father's eyes a total lack of understanding of him at age five, or re-living a feeling of his skin literally crawling as his father passed close by his high chair, these moments become metaphors for the pain that exists in that relationship.

Scenes from early childhood, such as spending hours with a little ironing board next to mom as she ironed, being raised with five sisters and playing only with dolls, or being dressed up as a girl by grandmother and paraded around, are the painful metaphors for being too closely identified with females. These clients resonate with the need to be called out by a man, away from mother, into the world of men, where they are accepted, challenged, and encouraged to grow up as part of the male fraternity. In this phase of treatment, the clients begin to recognize that their sexually compulsive same-sex yearnings are based more on a need for the masculinity they rejected and are envious of, and less on a constitutional preference for same-sex objects. The following comment represents the work of this phase: "To think it has to do with sex is ridiculous; it has to do with a gaping hole in my heart." The Reparative Integration Phase It is in this phase of work that the reparative gains are solidified. One client, after a year of work, distilled the qualities he yearned for in men he was attracted to and tended to put on a pedestal: They had to be reserved, cold, jaded, and cynical. Anybody who did not fill that bill was a "dork," and was not desirable. He would continuously have crushes on men like these, put them on a pedestal, and yearn for them. The cartoon like one-dimensional nature of the pictures of the men he created to envy and to yearn for started to break down as he allowed himself to enter ongoing, non-sexual relationships with this very type of man. As they became three- dimensional, it was their "dorky," human qualities which allowed him to be in a relationship with them. As he started to identify more and more with them, he started to accept those dorky qualities in himself. It is from this position of self-acceptance as an imperfect man that the likelihood of the re-emergence of his heterosexual impulses would increase. The client who re-experienced himself in the highchair as his skin bristled upon the approach of his father, was able to build towards an emotional rapprochement with his father after experiencing and expressing his grief and rage towards him, over a year long mourning period. This culminated in a dream in which he felt his father's arms around him, melted into his arms, and felt safe. At this point in his therapy, his male relationships became stronger, his same-sex attractions became almost minimal, and the female form began to capture his attention more and more. He started struggling with his fear of approaching females and felt confused by how his increased heterosexual attraction resulted in his freezing up around them. As the theme of his relationship with his mother surfaced in therapy, he became more and more afraid, his old symptoms began to reappear, so he decided to handle his intimacy issues with women with the help of a sex therapist.

Clients who do not fully enter this phase of therapy usually experience only transitory diminution of their same-sex attractions and do not start experiencing heterosexual impulses. However, there are exceptions. One young client, after having been in the gay lifestyle for several years, over a period of a year-and-a-half in therapy, conscientiously changed his effeminate mannerisms, made male friends with whom he roughhoused, raced bikes, hiked, and found his attraction towards them decrease dramatically. He joined a support group, stopped hanging out with his female friends, worked on separating from his mother, and had one serious and satisfying talk with his father about his same-sex issues. His heterosexual capacity developed fully and as he dated he had a difficult time restraining himself from being fully sexual with his girlfriend, although expressing his sexuality outside of marriage went against his values. When he broke up with his girlfriend, (he was enmeshed with her), and experienced some painful situational losses, he gave up doing the work, started looking for comfort from his old female friends, and began a slide back towards his old lifestyle. He was a client who did most of the reparative work from the "good boy" stance, mostly out of the need to please and to avoid conflict. He never allowed himself to re-experience the pain of his being a nerdy, lonely, bullied child, who did not feel the support of his father. He protected himself from experiencing the despair of being different and therefore he never became aware of the way he built up his defensive detachment, which separated him from other men and his therapist. He hid behind being cooperative and a good boy and when met with unexpected stresses and setbacks in his life, he turned towards the comfort he knew best, his female friends and the lifestyle. The Intimacy Phase Some clients reach full heterosexual attraction and functioning, having integrated the reparative work into their life. They get married and come face-to-face with their fear of closeness and intimacy. In reaction to this they often fall back into their old coping patterns of isolation, same-sex yearnings and wallowing in shame. One client found himself withdrawing from his wife more and more as she tended to lose sight of his needs and was preoccupied with her own work and stresses. He was unable to talk to her about his need for her, freezing up every time he thought of approaching her. The reality of his issues was re-enacted within the transference relationship as he started to experience his therapist as less and less available. When his therapist left for a week long vacation, he complained, "You are leaving me all the time, over and over and over again." This experience within the transference brought into his awareness the memory of himself as a baby when his mother would drop him off at his grandmother's house over and over again, sometimes for a months at a time. Only as he worked through the experience of this loss in therapy for over a year, did his extreme, immobilizing fear of abandonment abate and his ability to communicate his needs to his wife, increase. Needless to say, his same-sex yearnings diminished to an imperceptible level at this point and he enjoyed a robust heterosexual relationship with her.

It is during this phase of therapy that Oedipal issues can surface. One client, who was continuously having a depersonalization experience whenever he became emotionally involved with females, either at work or in his personal life, started bringing this facet of himself into the consultation room. As he walked into the room his eyes would start floating, his breathing would become minimal, his head would bob, and he would give the appearance of someone who was about to float away. When, over a period of time, we examined his experience, he related that he was afraid of having sexual feelings in the presence of his therapist because he was afraid he could not resist reaching out and sexually grabbing him. Initially, the assumption was that this was a same-sex yearningdriven impulse. However, that interpretation did not fit that reality, since this client had traversed major milestones in his reparative work, and also the floating away symptom did not diminish in the consultation room or with women as the interpretation was worked through. As he struggled with staying in the room and not floating away, the client became aware that if he allowed himself to feel aroused, his penis would be in danger of being damaged, most probably by his father. This sense brought back a flood of memories of his mother's inappropriate closeness to him and one specific memory, of when he was four, responding erotically to the silhouette of his mother's thighs and buttocks as she was attending to him. At the present, this client is still working out his conflicted erotic feelings towards his mother, but castration anxiety no longer results in a depersonalization experience when he is forming closer relationships with women. Some clients traverse the difficulties of both the reparative and the intimacy work and integrate them into their life with relative ease. One such client entered therapy with an overwhelming crush on a male co-worker. He had already been involved in reparative work within a self-help program but was unable to extricate himself from the power of the yearnings that still controlled him. Within the first year of his therapy, he allowed himself to enter into a transference relationship with his therapist. He was able to get angry as he experienced his therapist as withholding and started to become aware of his own contributions to the distance in the relationship. Soon he recovered painful memories of his relationship with his father in which he recognized his own role in shutting his father out, i.e., his defensive detachment from him. Allowing this realization to penetrate his defenses, he mourned the loss of his father's role in his life and allowed his father to nurture him, ending up with both of them crying in each other's arms. At this point, his tendency to form dependent crushes on men decreased dramatically and his heterosexual capacity started to blossom. He was married within a year, worked hard at intimacy issues, and graduated after four years, with the awareness that his fear of having children and being a father might later bring him back to therapy. Summary and Conclusion The reparative concept was first elucidated by Moberly (1983) and later adopted by Nicolosi (1991). It is based on the assumption that men who, due to their defensive detachment, do not identify with their father, will unconsciously seek the masculine in

other men in order to overcome their developmental arrest, and continue to grow in their male identification. Moberly (1983) became aware of the concept of detachment through the work of Bowlby (1960), who studied the reaction of babies and young children when they were separated from their mothers and discovered that they went through three stages of mourning: first protest, then despair, which then was followed by a complete detachment from the love object. She applied this concept to the boy's loss of connection to his father in which, at the end, defensive detachment predominates, thwarting further internalization of the masculine and resulting in a developmental arrest. She also made use of the concept of the need for self objects, developed by Kohut (1977). In this case, male self objects, whose presence can offer a solution to the dilemma experienced by a man with unmet male developmental attachment needs. In the initial reparative phase of treatment, the therapist mostly serves as a self object for the client. His presence, encouragement, guidance, and faith in the existence of the "little guy," the one who was ready to join the male fraternity before the mismatch with his father resulted in his creation of a defensive wall against all that is male, is an essential element of the beginning process of change. The client is challenged to seek non-sexual male relationships, experiment with more traditional male activities, and is encouraged to keep getting back on the proverbial bicycle each time he falls. Usually out of a "good boy" stance of cooperation and fear of conflict, the client makes attempts in this direction, a period which might last for years and can result in some improvements, often including a significant decrease of same-sex attraction. For most men going through this process, it is the reparative integration phase which brings about the rediscovery of their heterosexual capacities. It is only through their willingness to enter into re-experiencing again and again the pain of the despair they felt as little boys, along with the rage they experienced, that they are able to experientially break down the walls of their detachment, become more and more aware of its power over them, and choose over and over again not to identify with its outdated, self-protective functions. Not until they regress back to experiences of feeling weak, the outsider, a nerd, different, effeminate, dorky, a victim of bullies, can they feel what they are defending themselves from by detaching and can they choose to risk again feeling the same way by approaching men in earnest, with their deepest needs for affiliation and attachment. At this junction the therapist becomes more and more the object of their transference experience. He is experienced as all-powerful, as abusive, insensitive, a bully, in other words, "the other," a male. The client works through this experience, occasionally hiding behind his defensively detached posture, but also reappearing to challenge and work with the therapist. This results in the client internalizing an aspect of maleness within which he no longer automatically fears male power and authority and in fact can more and more identify with it. Having relived the pain of being different (Despair), having re-owned their aggression (Protest), the client is able to admit his need for his therapist, his father, and men in

general, and keep on choosing to resist hiding behind his now no-longer-out-of-awareness tendency to detach. The intimacy phase of therapy addresses issues in the psychology of the client which are not exclusively related to rejoining the male fraternity. Oedipal, enmeshment, early abandonment, etc. issues are worked on within the transference relationship with the therapist. At this point the therapist's stance becomes more neutral, since his function is now less of a male selfobject for the client and more of a co-observer who helps the client explore his own psyche. The focus of the exploration tends to be more the client's relationships with women and the transference relationship is more that of the client's relationship with his mother. This phase resembles the course of therapy with clients who do not bring same-sex attraction issues to their therapy as their main concern. As with all change, especially that having to do with change on the level of personality organization, humility is essential. As clients leave, they need to understand that life brings on more challenges: marriage, which falters unless it is worked on; children who need to be called away from their mother; loss of parents, etc. The greatest danger they face is that under such stresses and the vicissitudes encountered in everyday life, they will allow themselves to choose again, with regularity, their defensive detachment as the way of coping with inevitable pain and disappointment. In a long-term psychodynamically oriented therapy, they have the opportunity to experience over and over again their tendency to choose the shortcut of re-establishing their defensive detachment patterns. With the help of the therapist, they can identify this tendency, become aware and experience its various costs, and enter their life better equipped to avoid the slippery slope of indulging it in the future.