Reparative therapy and the power of an explanation

Yesterday, I posted a link to an article titled “My So-called Ex-gay Life” from the website of the American Prospect and written by Gabriel Arana. In that post, I focused on psychiatrist Robert Spitzer’s desire to retract his 2001 study of ex-gays. I also reported on my brief exchange with Bob about his study and his current views on sexual orientation.

Today, I want to comment about Arana’s description of Narth co-founder Joseph Nicolosi. Arana summarizes his three year therapy episode with Nicolosi which ended with Nicolosi’s prognosis to Arana’s parents that their son would never enter the gay lifestyle:

Late into my last year of high school, Nicolosi had a final conversation with my parents and told them that the treatment had been a success. “Your son will never enter the gay lifestyle,” he assured them.

I once had an experience with Nicolosi which is similar to what happened with Arana and his parents. I was in a meeting with several psychologists, including Nicolosi, debating the merits of his theory of paternal deficit as the sole cause for adult male homosexuality. I presented the basics of a clinical case involving a young adult who consulted me about his distress over his same-sex attractions. The young man told me that he came out to his father because he was closer to his father than to his mother. In addition, there were other indications of paternal warmth and closeness that I mentioned in the presentation. In the midst of some discussion over the case, Nicolosi abruptly interrupted me and said, “He’ll be fine. He’s not gay.” Nicolosi then explained that a boy like that who has such a close relationship with his father could not possibly remain attracted to the same sex. In fact, the young man did remain attracted to the same sex, although he did not come out as gay at that point. The only follow up I ever heard was that he had determined to live a celibate life. That case was presented as an illustration of other cases with the same basic narrative — gay men with close warm relationships with their fathers.

Nicolosi’s theoretical statements reveal the most obvious confirmation bias. Despite the fact that Nicolosi has been exposed to evidence which would invalidate his narrow theory, he persists in holding on. Witness what he said to Arana:

What about people who don’t fit his model? “After almost 30 years of work, I can say to you that I’ve never met a single homosexual who’s had a loving and respectful relationship with his father,” he says. I had heard it all before.

He said the same thing in the meeting where I introduced cases of gay males who had a loving and respectful relationship with their fathers. However, in the face of the disconfirming evidence, he simply changed the rules – those men weren’t gay, they couldn’t be because they were close to their dads. Even though the clients were attracted to the same sex; according to Nicolosi, they would not continue with those attractions because of their closeness to their dads.

Arana articulates well how different explanatory narratives can become inculcated into an identity. Arana describes how he perceived the therapeutic narrative:

We mostly talked about how my damaged masculine identity manifested itself in my attractions to other boys. Nicolosi would ask me about my crushes at school and what I liked about them. Whether the trait was someone’s build, good looks, popularity, or confidence, these conversations always ended with a redirect: Did I wish I had these traits? What might it feel like to be hugged by one of these guys? Did I want them to like and accept me?

Of course, I wanted to be as attractive as the classmates I admired; of course, I wanted to be accepted and liked by them. The line of questioning made me feel worse. Nicolosi explained, session after session, that I felt inadequate because I had not had sufficient male affirmation in childhood. I came to believe that my attraction to men was the result of the failure to connect with my father. Whenever I felt slighted by my male friends—for failing to call when they said they would, for neglecting to invite me to a party—I was re-experiencing a seminal rejection from my father. Most guys, I was told, let things like that roll off their back—an expression of their masculine confidence—but I was hurt by these things because it recalled prior trauma.

Arana eventually bought into the narrative saying he “believed in Nicolosi’s theory.” Arana’s article shows the power of an explanation. In other contexts, this power can help create coherent but faulty narratives. Watching a video on depression yesterday, I heard a female client say about herself, “I used to think I was just lazy.” Instead, she found out she had chronic depression which improved with medication and therapy. She wasn’t lazy, but initially, she had no other explanation for her need for sleep and lack of motivation. Lazy made sense but it was wrong. The right information and explanation made all the difference in the world. For same-sex attracted men, Nicolosi offers an explanation: masculine deficit caused by a trauma in the father-son relationship. It can be no other way.

At first, it seemed to make things make sense. Arana writes, “As I progressed in therapy, I felt that I was gaining insight into the source and causes of my sexual attractions. The problem was, they didn’t go away.” Even though his attractions persisted, Arana “still believed in Nicolosi’s theory.” He came to see any frustration from his parents as an indication that Nicolosi was right. Predictably, his parents disengaged.

Arana did not let go of his narrative easily, saying, “Nicolosi’s ideas did more than haunt me. The first two years of college, they were the basis for how I saw myself: a leper with no hope of a cure. I stayed in the closet but had sexual encounters with classmates nonetheless.” After reaching a suicidal crisis, he checked himself into a hospital and was visited by his father. His father, realizing then that the wrong explanation can have severe consequences, said, “I’d rather have a gay son than a dead son.”

The remainder of the article reveals the rest of Arana’s story including a conversation between Arana and Nicolosi. Arana wondered if the adverse disclosures from reparative therapy clients might soften the theoretical position of his former doctor. Go read the rest of the article to find out, but I’ll give you one guess what Arana found out.

In fairness, I have talked to a few people who say they have had really good experiences in reparative therapy. That fact is one of the disconcerting aspects of therapy – some people seem to derive benefit, at least at the time, from what others describe as harmful. One thing seems sure: explanations have consequences which makes it critically important for therapists to maintain our theories with a loose grip. Arana’s article, as well as many other reports like his, provides ample evidence for skepticism and caution when it comes to reparative theory.