When therapists do not want their clients to be homosexual: A response to Rosik's article

Journal of Marital and Family Therapy, Jan 2003 by Green, Robert-Jay

This commentary is a response to Rosik's "Motivational, Ethical, and Epistemological Foundations in the Treatment of Unwanted Homoerotic Attraction" (this issue). Such treatment raises complex questions that cannot be resolved by focusing on the therapist's conservative versus liberal values. Most such clients are deeply ambivalent about their homosexual attractions. The degree to which their homosexuality is "unwanted" is highly variable among them and sometimes within them over time. Clients who are exclusively homosexual are very unlikely to be able to change their sexual attractions, whereas some clients who are bisexual may be more able to "manage" their homoerotic attractions (acting only on their heterosexual feelings). Marriage and family therapists should be able to support a client along whatever sexual orientation path the client ultimately takes, and the client's sense of integrity and interpersonal relatedness are the most important goals of all.

Although the value of therapeutic "neutrality" has been challenged in the field of family therapy, it is preferable to strive toward neutrality rather than take a partisan position when it comes to the treatment of unwanted homosexuality. If a therapist is not able to support a client's explorations and decisions initially or over the course of treatment to live as heterosexual, homosexual, or bisexual, then I believe that the therapist should excuse her/himself from treating such clients. In contrast to the frame Rosik (this issue) suggests, the treatment of clients' "unwanted homosexuality" should not be approached as mostly a matter of therapists' politics with equal pro and con (liberal vs. conservative) positions or reduced to a matter of religious debate.

There is a crucial difference between religious exhortation/proselytizing and psychotherapy, and that difference lies primarily in whose needs and beliefs are at the center of attention. I do not believe that clients can resolve any major internal conflict in therapy when the continuation of treatment is contingent on the client accepting the therapist's preferred resolution. For example, although he does not state so explicitly, Rosik seems to believe (based on his personal interpretation of the Bible) that homosexuality is a sin, and he seems willing to agree with clients who assert that homosexuality is a sin. Thus, it is unclear how he would treat clients who decided over the course of treatment that they wanted to embrace their homosexuality, as many clients seeking reorientation therapy later do (Shidlo & Schroeder, 2001). Would Rosik reject these clients and refer them elsewhere at such a juncture? Or do these clients leave treatment without explanation, sensing that he would be unable to support their new direction?

Although Rosik (this issue)-in one of the more inflammatory remarks in his article-accuses our profession of risking "a large scale form of client discrimination and abandonment" (p. 14) toward gay or bisexual clients who wish to become heterosexual, this claim is unjustified. Gay-affirmative couple and family therapists such as myself (Green & Mitchell, 2002; Laird & Green, 1996) believe just as strongly that clients should set the goals of their treatment. For example, in my practice, I personally have helped lesbian/gay clients stay in heterosexual marriages, and I am comfortable with this goal if clients approach it with integrity (i.e., honesty with their spouse, rather than deception). Also, more than half of my clients at any given time tend to be heterosexuals, and I fully support their being so. In contrast, Rosik seems not to feel that homosexuality is a legitimate moral choice and presumably would have a hard time or find it impossible to work with clients who start out and wish to remain lesbian or gay or wish to increase their self-acceptance. Ironically (borrowing his words), it seems that Rosik and other conversion therapists advocate "discrimination and abandonment" of gay/lesbian clients who wish to remain gay-identified.

Thus, although Rosik would have us believe that his approach is the moral or political equivalent of a "prochoice" position, he is actually communicating a rather confusing double message. If he views the choice of homosexuality as a sin and believes that homosexuality can only to lead to unhappiness and a morally inferior life, it becomes impossible to accept his claim of giving clients any "choice" in therapy other than to adopt his views of homosexuality if they wish to remain in therapy with him. He states, for example: "MFTs who engage in reorientation therapy must respect a client's decision to leave treatment and pursue gay-affirmative therapy" (p. 19). Clearly, the implication of the phrase "leave treatment" is that such clients would be terminated and have to seek treatment elsewhere. Presumably this is because Rosik believes there is only one mentally healthy choice that could bring happiness and ethical fulfillment: heterosexuality.

Despite his pronouncements to that effect, the research literature on lesbian/gay psychology shows clearly that acceptance of one's sexual orientation and finding social support within the lesbian/gay community are the strongest predictors of mental health (Diplacido, 1998; Herek, 1998; Meyer & Dean, 1998). The majority of lesbian/gay people are as happy and mentally healthy as heterosexuals, even if the overall group means differ slightly in large population rates of substance use, depression, and attempted suicide (Bell & Weinberg, 1978; Cochran, 2001; Gonsiorek, 1991). The researchers attribute these small (but statistically significant) differences in group averages to the greater minority stress experienced by lesbian/gay people in society, whereas Rosik implies that these differences are endemic to homosexual orientation itself. If the latter were true, however, how would he explain that the vast majority of lesbian/gay people do not differ from the majority of heterosexuals in terms of substance abuse and mental health? In light of this research, it seems highly inappropriate for a therapist to support a client's jaundiced view that homosexuality is antithetical to psychological well-being and happiness, which is exactly what Rosik appears to do in his article.