Sexual identity therapy and neutrality, Part two

In this second post about therapeutic neutrality, I want to discuss what it does and doesn’t mean in sexual identity therapy. Again, I want to react to some of the thoughts from Dr. Nicolosi in his article, Why I Am Not a Neutral Therapist.

Dr. Nicolosi writes:

What will happen when the uncommitted (“neutral”) therapist hears his client revealing self-destructive behaviors that are statistically proven to be associated with SSA? How will he interpret these behaviors? Staying out of philosophical territory with the client would require a sort of “Rogerian neutrality” that even Carl Rogers himself couldn’t live up to. I can’t imagine any psychologist who actually does this therapy on a regular basis believing that such an approach would be successful.

This needs to be unpacked a bit. First of all, when clients, either gay or straight or in between, describe self-destructive behavior, I believe therapists should confront the consequences to the client and others of this behavior. Asking clients about the consequences and pointing out denial is a standard therapeutic stance. SIT can be used by directive and non-directive therapists. There is nothing in the SIT framework that prevents the confrontation of self-harm.

What Dr. Nicolosi seems to be implying about the behavior of homosexuals in this paragraph, he make more explicit in the next:

Along the way, clients always report a host of maladaptive, self-defeating behaviors that restrict their maturation. The successful clinician must have an understanding of the meaning of these common factors. He will also observe fundamental distortions of self-identity. Once seen, how can these factors — including their meaning and likely origins — be ignored?

Apparently, he sees self-destructive behaviors in all of his clients. I do not, and in my research investigations, I have not found this to be invariably true. Statistical association is not cause nor does statistical significance implicate an entire group of people. I have addressed elsewhere on this blog, to wit:

Thus, it would be inconsistent with the research on psychiatric risk to deny members of at-risk groups “even the possibility” of a “fulfilling life,” whether partnered or not. Higher risk, yes; inevitable mental health maladjustment for all members of a group of people? No.

To further address Dr. Nicolosi’s question: when maladaptive, self-defeating behaviors are evident, therapeutic respect for the client’s value position does not mean that these behaviors are ignored. They are not. However, not all clients who are attracted to the same sex have the same issues. The SI therapist does not assume that all same-sex attracted clients have the same concerns, problems, issues, behaviors or backgrounds. This is more like theoretical neutrality; the SI therapist interprets the literature to depict a varied clinical landscape, not one of uniform histories and dynamics. We also do not tell clients that being attracted to the same sex assigns them to a life of despair and promiscuity. Nor do we tell them that their attractions to the same sex mean one thing. In the advanced informed consent phase, we discuss the research on the health and mental health correlates of behavior. Thus, if we have a client who is engaged in risky behavior, we inform them of the risks. If we learn that a client’s draw to the same sex has some historical referent, we certainly help that client process the issue. However, we do not assume that all attractions to the same sex mean the same thing, or that such attractions are of necessity tied to some historical set of deficits.

Dr. Nicolosi then contrasts himself further:

As Charles Socarides once said, the therapist must be neutral in judging the client, his behavior, and his choices; but he cannot be neutral about the condition of homosexuality.

Indeed the SI therapist is open to the distinct possibility that sexual preferences derive from multiple pathways and follow multiple trajectories. The SI therapist agrees with APA past president Nicholas Cummings who said: “There are as many kinds of homosexuals as heterosexuals. Homosexuality is not a unitary experience.”

So to summarize, SI therapists are not neutral when confrontation of self-destructive behavior is warranted, but we do not presume a uniform set of antecedents and outcomes of homosexual attractions. I guess you might say, we have an “Ask, Don’t Tell” policy.