8 September 2001.

Anonymous writes: "It was suggested that you might post the attached article. I have been threated by the Mormon Church's lawyers about posting this. I would like to link to it."

I have posted this as a public service. I am still working on cleaning up this document so there may be mistakes in formatting and content.

UNDERSTANDING AND HELPING INDIVIDUALS WITH HOMOSEXUAL PROBLEMS

Copyright 1995

LDS Social Services

USE OF THE DOCUMENT

This training document has been prepared for the exclusive use of LDS Social Services to assist staff, interns, and contract providers in their work with individuals having homosexual problems. Because the document is approved only for "in house" use, it should not be reproduced nor distributed to others outside of LDS Social Services.

UNDERSTANDING AND HELPING INDIVIDUALS WITH HOMOSEXUAL PROBLEMS

HISTORICAL PERSPECTIVE

For more than 100 years homosexuality has been a topic of scientific and psychotherapy inquiry and debate. Freud and his contemporaries viewed homosexuality as a deviation or "inversion" of natural psychosexual development, the causes of which being as varied and numerous as the theorists espousing them. According to Freud, the deviation resulted primarily from a distorted parent-child relationship which led the child to reject his or her own gender role and identify with the opposite~sexed parent. This view received considerable empirical support later in this century through studies by Irving Bieber and a number of other researchers (Siegelmm, 1987).

Psychiatrist Kraft-Ebing (Bullough, 1987), on the other hand, viewed homosexuality as the result of a diseased psychosexual center of the brain,set off by mastu~bation in certain individuals. The treatment was the removal of masturbatory impulse through post-hypnotic suggestion, and the encouragement of heterosexual interest.

Yet another nineteenth century theorist, Morton Prince, believed homosexuality could be accounted for by socialization. The cure: strengthening the will of the individual and helping him develop a sense of morality (ibid, 1987).

In the contemporary scientific community the controversy over the influence of nature and nurture in the etiology of homosexuality continues as it did in the early 20th century. Dorner and associates (1980) noted that experimentally induced prenatal stress has been shown to irreversibly alter the sexual behavior male rats. Dorner hypothesized that a deficiency in Certain prenatal hormones creates a biological predisposition to human female homosexuality. He further hypothesized that the same biological process that leads to homosexuality in the female would also lead to homosexuality in the male although through different mechanisms.

Gooren and colleagues (1984) criticized the Dorner studies by asserting that hormonal studies in rats cannot be used to assess the effect of organic brain substances on the sexual behavior of primates.

Simon LeVay (1991) tested the hypothesis that a portion of the anterior hypothalamus was involved in the origin and regulation of male sexual behavior. LeVay found that a region of the anterior hypothalamus was larger in heterosexual men than in either women or homosexual men. The study showed no difference in the size of that same brain region in the brains of women and homosexual male

Dr. William Byne (1993) cited problems with LeVay's study. He pointed to a lack of willingness on LeVay's part to assist in the replication of his findings and to the fact that the medical histories of LeVay's case samples were not screened carefully enough to support his conclusions.

Byne suggests an interactional model, or a combination of biological and environmental factors which lead to the emergence of homosexual behavior.

It seems reasonable to suggest that the stage for future sexual orientation may be set by experience during early development, perhaps the first four years of life. This is not only the period during which gender identity is established largely in response to social cues, but also a period of tremendous brain development....(L)earning and environment influence the chemistry and structure of the brain itself....biological factors influence temperament rather than sexual orientation per se. We then offer some ex\amples of how one's temperament could then bias the emergence of sexual orientation in the context dependent manner. This model is interactional because biology influences temperament which, in turn influences how an individual shapes and is shaped by his environment. Such an interactional model allows for multiple developmental pathways leading to homosexuality and is consistent with the replicable research suggesting an influence of biological factors on sexual orientation. Moreover, it could explain that failures of various psychosocial theories that have focused on either the personality of the individual or on his familial milieu but not on the interaction of the two (Byne, 1993, p. 33).

John Money (1987) reached similar conclusions. He suggested that homosexuality resulted in part from a combination of prenatal and pubertal hormones rather than from the direct influence of chromosomes and genes. He concluded that although humans are influenced by prenatal brain hormonalization, they are also strongly dependent on postnatal socialization.

The treatment of homosexuality has a long history in the psychiatric and psychological professions. Beginning with Sigmund Freud at the turn of the 20th century, many clinicians have attempted to treat homosexual clients (Bancroft & Marks, 1968; Barlow & Agras, 1973; Berg & Allen, 1958~, Nintz, 1966; Socarides, 1969; Stevenson & Wolpe, 1960; van den Aardweg, 197n; and Ellis, 1959). Elizabeth James (1978), in a comprehensive review of the homosexuality-treatment literature, acknowledged that the recovery and improvement rates for both bisexuals and homosexuals using several different types of therapy was encouraging. Citing a 45 percent recovery and improvement rate for exclusively homosexual clients, James noted that there is room for the development of new treatments and combinations of techniques that will enhance the effectiveness of those procedures already in use (Ibid, 1978).

During the 1960's, gay activists began to more openly and vigorously fight to legitimize the homosexual lifestyle (Bayer, 1981). They moved to ensure that homosexuals would be accorded all of the civil rights heterosexuals enjoy. As gay activists grew in power, they became more radical in their efforts to shape public and professional perceptions of homosexuality. They fought not only for public tolerance of homosexuality, but to persuade the public and professionals to value and endorse homosexuality as a desirable alternative lifestyle (Bayer, 1981).

Some gay activist groups have concluded that society would be more tolerant of homosexuality if sexual orientation can be shown to be innate. Thus, they view any criticism of biological determinism as "anti-gay." Byne (1993) suggested that the Gay Liberation Movement is attempting to subjugate scientific rigor to political expediency.

An important landmark in the gay activist battle to reshape public and professional perceptions of homosexuality came on December 14, 1973. -n that date the Board of Trustees of the American Psychiatric Association voted to remove homosexuality as a diagnostic category from the APA's Diagnostic and Statistical Manual (DSM). According to Bayer (1981) the decision to remove homosexuality from the DSM was made after APA officers and members had endured several years of intense political pressure and disruptive lobbying efforts by militant, gay activist groups. In discussing the APA decision, Socarides (1988). leading researcher and theoretician on homosexuality, stated:

The action was all the more remarkable when one considers that it involved the out-of-hand and peremptory disregard and dismissal, not only of hundreds of psychiatric and psychoanalytic research papers and reports, but also of a number of other serious studies by groups of psychologists, psychiatrists, and educators over the past seventy years (p. 53).

. .it amounted to a full approval of homosexuality and an encouragement to aberrancy by those who should have known better, both in the scientific sense and in the sense of the social consequences of such removal (p. 58).

As LDS Social Services practitioners we need to be aware of the political climate, but not be persuaded by it. There is sufficient scientific research and clinical evidence to conclude that homosexuality is treatable and preventable when we understand its origin and development.

Professionals who resist the tide of the current political movement are often criticized for offering a choice of change to those who have homosexual attractions. The gay community offers an "either/ or" position; people are either gay or straight. They purport that if someone has any same~sex tendencies he or she is most likely gay, and there is little that can be done about it. They also teach that if homosexuals are to find any measure of happiness, they must acknowledge their innate "gayness" and live a life consistent with it (Schow, Schow & Raynes, 1991). In light of the political climate, it is important to make a distinction between "gays" and "homosexuals" (Nicolosi 1992). "Gays" generally have accepted their sexual orientation and attempt through the media and the political arena, to secure social acceptance and special legal rights based upon their sexual preference. There are, however, homosexuals who are distressed by their homosexuality and who do not identify themselves with the gay, social/political movement. These men and women are interested in overcoming their homosexuality and developing normal heterosexual interests and relationships. These "non-gay homosexuals" are those for whom the efforts of LDS Social Services are focused.

FIRST PRESIDENCY STATEMENT

To provide appropriate help, it is important that practitioners and clients understand sexual relationships in light of Church doctrine. The following statement by the First Presidency provides important guidance:

The Lord's law of moral conduct is abstinence outside of lawful marriage and fidelity within marriage. Sexual relations are proper only between husband and wife appropriately expressed within the bonds of marriage. Any other sexual contact, including fornication, adultery, and homosexual and lesbian behaviors, is sinful. Those who persist in such practices or who influence others to do so are subject to Church discipline.

Individuals and their families desiring help with these matters should seek counsel from their bishop, branch president, stake or district president. We encourage Church leaders and members to reach out with love and understanding to those struggling with these issues. Many will respond to Christlike love and inspired counsel as they receive an invitation to come back and apply the atoning and healing power of the Savior (Understanding and Helping Those Who Have Homosexual Problems, 9/92).

HEALTHY MALE SEXUAL DEVEL-PMENT

As infants, both boys and girls are identified first with the mother, who is the primary source of nurturance and care. Whereas the girl maintains primary identification with mother, the boy has the additional developmental task of shifting identification from his mother to his father. It is through the relationship with his father or other males that the boy Will formulate his masculine identification, which is necessary in order for him to develop normal masculine personality traits. According to Dallas (1991), this additional developmental task for boys might explain why males seem to have more difficulty than females in developing gender identity and may also explain the higher number of male homosexuals.

Nicolosi (1991) suggests that in the course of the child~s life, every significant developmental lesson has its critical period. The******************************************************************************************************************************************************************************************************************************************************************************************************************************************************************************************************************************************************************************************************************************* reports that a male child has some sense of his father as early as 4 months of age. By 18 months he can differentiate pictures of boys and girls, men and women -n a social level he himself is increasingly treated as a male. During this time the acquisition of language further reinforces the basic division of people as either male or female. Blos (1985) states that a boy develops a need to move away from his mother.

In his move towards autonomy, his father becomes the model the boy naturally tries to emulate. The boy gradually begins to view his father as a self-like object. When the boy is open and receptive to maleness, he will exhibit a special interest in his father and attempt to be like him Nicolosi (l991) concludes that a young boy does not yet understand that his emerging interest in his father comes from an innate similarity based in their shared masculinity. Neither does he realize that his father incorporates an image of what he himself is destined to become, but somehow there is a natural attraction to his father's male image.

With the boy's emerging sense of being like his father, a dependency arises desires his father's acceptance. The emerging masculine self-image is very fragile and must be nurtured and supported by the father to fully develop.

For appropriate gender identity development, a boy needs the encouragement of his father or other male figure. The boy, with ample encouragement and support, will seek to emulate that which is exciting, fun, and energizing about his father. With this support comes the freedom and power to outgrow his dependency upon his mother.

A father has a very significant influence in a boy's life (Wyden, 1968). According to Nicolosi (1991) if the father is warm and receptive, the boy will be encouraged to disidentify from his mother and begin to identify with his father. He will then become masculine~identified and probably heterosexual. If both parents encourage the boy this way, he will be well on his way to developing a male gender-identification and ultimate heterosexuality.

Kennel and Klaus (1982) state the motherrs maternal instincts are strong. She needs to be needed by her children. -ne of the father's roles is to help his son move beyond the mother's inherent need to prolong the mother and infant bond. Through his example, the father demonstrates to the boy that it is possible to maintain an intimate but separate relationship with his mother. Ideally the mother and father should work together to assist the boy in the identification shift from feminine to masculine (Blos, 1985).

Wyden (1968) states that in a healthy masculine relationship, the father commits himself to the development of maleness in his son. For this purpose, it is not necessary for the father himself to be defined as overly masculine. A gentle, creative father has no adverse effects upon the boy's gender identity as long as the boy respects and identifies his father and himself as male. Once the boy identifies himself as male, he is open to male models in his father, other adult men and his peers.

HEALTHY FEMALE SEXUAL IDENTITY

Bowlby (1969) and Brazelton (1990) have found that the female identifies her mother as her first significant other. She begins life dependent upon her mother and later begins to move toward autonomy. Because the female begins her sexual identity with her original care giver, her core identity issues are not as difficult as they might be for a male. Males are three times more likely to have gender identity problems than females (Dallas, 1991). If a girl is secure in her relationship with her mother, a healthy curiosity can develop about males. This curiosity leads to a desire for discovery. The sexual desire comes from a sense of mystery about the unknown (Nicolosi, 1991). Mother is known, father is not. That sense of mystery in combination with adolescent hormonal changes, leads to a desire to investigate. The father becomes the object of that investigation.

According to Howard (1991) the relationship between a female child and her father is also very significant. A young girl needs her father to affirm her femininity. She needs to have a safe arena in which to "reality test" her femininity and receive support, not rejection from her father.

ETIOLOGY OF MALE GENDER IDENTITY CONFUSION

The confusion of early core sexual identity has been identified as one of the most crucial factors in the development of homosexuality among males (Green, 1987). "Core gender identity" refers to the culturally fixed signals that discriminate males from females. Depending on the person's age, the signals may be, for example, the toys one chooses to play with such as a doll or a toy truck or the activities one chooses to engage irk such as football or ballet. In the homosexual male, this core gender identity has become confused.

In order for the core gender identity to become confused, the boy must disidentify with his father. According to ~oberly (1983) this disidentification may result from abuse, from an absent or an emotionally distant father, or simply from the boy viewing himself as different from the men in his world. This disidentification leaves the boy no other alternative than to cling to his mother. This mother-son relationship should not be seen as an abnormal attachment to mother but as an abnormal detachment from father.

Initially the boy may openly protest his father's nonnexistent or negative attention. If the boy's protest is ignored or punished, he concludes that the expression of his needs is futile or even dangerous. This leaves the boy with no attachment to his father except in his imagination and no real-life human connection except to his mother and the female ale world.

Wyden (1968) indicates that fathers have an absolute veto power over rprolonged mother-son attachment. A father's inability or unwillingness to use his veto opower by forming a positive, affirmative relationship with his son leaves the boy vulnerable to ambivalence in his gender identity.

Worthen (1984) indicates that if the son is detached from his father there is a good possibility that a wifeUhusband detachment exists as well. The pre-homosexual male's mother may see men as representing that which is unfeeling, competitive, uncompassionate, and even brutal. In this situation the mother might send a message that civilization, culture and feeling relationships are things which the mother and the daughter, or the mother and the sensitive son share in common. In this case the mother contributes to the disidentification between the father and the son. As the boy connects with his mother he also begins to identify with his mother's perception of father. If the boy is ever to repair his relationship with his father, he must not only overcome his own negative images, he must resolve the image he learned from his mother as well. If a boy has no father or other male to identify with, he is dependent on his mother's impression of the male gender. It is in the three-way relationship between the parents and the child that the homosexual's family background is commonly dysfunctional. Homosexuality is, in part, a symptom of some type of relational deficit. Typically there is an overly close relationship between mother and son, with the father non-existent or distant from both of them.

Bly (1990) states that a boy needs a male model to make the shift to a masculine identity. The abusive, absent, or distant father leaves a void in the life of the young boy which creates a "father-hunger" or an intense desire for the male-to-male contact that was missed.

During adolescence young men and young women begin to experience a natural emergence of sexual desires. If a young man is experiencing a father hunger, his emotional needs become confused with his emerging sexual stimulation. When homo emotional needs become combined with sexual stimulation, the need for same-sex associations becomes sexualized. This leaves the boy with the false impression that he had a homoerotic desire for male companionship all his life. A male's homosexual sexual desires are a result of unmet needs.

Dallas (1991) observes that sexual needs are natural to sexual beings. Sexualized needs run a different course. These emotional needs are expressed indirectly through sexual activity. The needs are usually legitimate, but sometimes the vehicle used to express them is not. For example, many men use sex as a means of reassuring themselves that they are virile, competent and masculine. The need for being viewed as competent and masculine is legitimate. The exploitation is not. The comfort and peace of mind which comes from satisfying, emotionally intimate relationships is important for all of us. The need for a nurturer, mentor or close friend is legitimate and intense.

According to Fine (1987) the real pain for.those with homosexual struggles is the inability to get what they need from a male relationship without the sexual component. Says Fine, "The love between homosexuals is a pseudo-love, more often than not simply a reaction formation against hatred. The abundant case material in the literature demonstrates this point over and over again" (1987, p. 91). In reality the need for and sex are separate. In the mind of the homosexual they are combined and intermingled. The emotional needs become mixed in and confused with a sexual release.

For example, the young boy may begin by fantasizing about an intimate relationship with his father or a father substitute. As an adolescent, he continues that fantasy with the addition of erotic thoughts, fantasy and masturbation. He is then left with the mistaken conclusion that his new erotic fantasies and impulses about male-to~male sexual encounters were present since his earliest recollections. In reality, what actually existed since the earliest recollections was the desire for a healthy, intimate, non-sexual relationship with a man. The sexual component was added at a time when those interests become a natural part of that individual's development (Moberly, 1988). The motivation to repair the loss of the father-son relationship creates a sexualized father-hunger or reparative drive. Along with the male identity hunger comes a great deal of guilt, shame and doubt. The shame and doubt, combined with the reparative drive, make the male homosexual very ambivalent about male relationships.

The shame and doubt result in secrecy and isolation which puts the male homosexual in the mode of desiring, but painfully avoiding whatever male support may be available. If the individual feels so much ambivalence and shame about his feelings that he cannot bring his dilemma to light; hiding is his only other option. When he hides his feelings from everyone, particularly males, he isolates himself from the solution to his problem.

The difficulty of homosexuality arises when the pain associated with male interactions is accompanied by an unwillingness to relate to the love source which was perceived as hurtful. This interruption of, and reaction against, masculine identification has been referred to as a "defensive detachment" (Moberly, 1983). The child not only detaches from his father, but resists restoring the attachment. Thoughts such as, "All men are cruel," or "I don't want to be like him," put the young boy in a position to further detach from all male relationships and all activities which identify him as a man. Cutting himself off from male activities such as rough and tumble play, contact sports, and competition, effectively dooms the young boy to being labeled as a sissy or momma's boy which adds to his isolation This lack of involvement in male activities and the resulting isolation from peers further reinforces his perception that all males are different from himself (Green, 1987).

According to Nicolosi (1991) the boy faces a serious dilemma: on the one hand he yearns for attachment to his father or other males; on the other, his defensive detachment prevents him from developing relationships with men. It is this attraction repulsion ambivalence which makes male homosexual relationships so promiscuous and unstable. This is better described as a same-sex ambivalence rather than a homosexual attraction. Most homosexual males missed this "myself-as-male" identification process by maintaining a certain distance from other boys during their formative years. The boy who will later identify himself as homosexual is attracted to other males by his same-sex deficits and need for identification (Moberly, 1983).

Konrad (1992) suggests that the type of males an individual homosexual is attracted to are often those possessing the characteristic he-feels he most lacks in himself. His quest for the perfect partner often includes a search for a clear complexion, large muscles or a virile appearance. This search is one of trying to possess through someone else those quaLities he believes to be lacking in himself.

The process of development of male homosexuality could be summarized as follows:

Child exper:

(a page is missing here: I'll scan it later!)

of thoughts and feelings, particularly if the family is not open to the sharing of those feelings.

Howard (1991) suggests that traumatic events such as rape or sexual abuse are often a common denominator for female same-sex attractions. Physical, sexual and emotional abuse can affect a woman's ability to relate to both men and women. If the abuse came from a woman, there may be a longing for female attention that was never given. If the abuse came from a man, the woman may decide that men are tyrants to be avoided at all cost. As she cognitively associates men with childhood trauma, she may find the idea of sex with a male body repulsive or frightening (Dallas, 1991). Women may be seen as safe, loving and non-threatening. In many cases, a woman will turn to other women for the most intimate forms of love and comfort.

Blumstein and Schwartz (1983) state that while men are more likely to seek homosexual relationships for sex, women, in the long run, seem to seek lesbian relationships more for companionship and nurturance. This is not to say that the lesbian relationship is devoid of sex, but some lesbians seem to feel the presence of men limits their creativity, spontaneity and imagination.

Bogle (1985) states that peer interaction is also a crucial factor in the development of lesbian relationships. She suggests that female peers with common sexual and abuse struggles can form a relationship and solidify a same-sex identity.

Both male and female homosexuals have a reparative drive or a desire to repair the breech between them and their same-sex parent (Moberly, 1983). Even though sexual contact is part of both lesbian and homosexual relationships, one difference seems to exist between the genders. Men appear to have sexualized the drive and use sex as a substitute for the relationships they really need. Women, on the other hand, seem to value the relationships and have a tendency to develop overly dependent or enmeshed emotional relationships to meet their needs (Howard, 1991). Their overdependent relationship is unhealthy for both parties but is seen as the only solution to unmet needs. According to Howard (1991) a dependent relationship might be characterized by the following:

1. Jealousy, possessiveness and exclusivism in the relationship.

2. -ther people are viewed as a threat to the relationship.

3. Preference to be alone with a special friend rather than in the company of others.

4. Irrational anger, depression or irritation if the friend withdraws from the relationship.

5. Romantic or sexual feelings about a person who is a friend.

6. Loss of interest in all other relationships.

7. Preoccupation with the friend's appearance, personality problems and interests.

8. Unwillingness to make short-term or long-term plans that do not include the friend.

9. Unable to see the friend's faults realistically.

10. Defensiveness when asked about the relationship.

11. A display of affection such as physical contact which is inappropriate for a friendship.

12. Speaking freely for the friend in conversations.

13. Other people feeling uncomfortable around the members of the friendship.

In normal heterosexual relationships, the male, who has been trying since early childhood to achieve separation from his mother and establish his male identity, insists on a certain amount of distance from his female partner. A female child, on the other hand, seeks to identify with her mother even while making real boundaries between herself and her same-sex role model. When two women are lovers, however, the boundaries tend to blur. These women have a tendency to gel wrapped up in each other. They often feel they must do everything together, enjoy all the same things, and dislike all the same things. They often feel that any individuality dooms the relationship (Schow, et. al., 1991). Sexual interests occur among lesbians but they seem to follow the pattern of women in general. Sexual responses occur in the context of feeling loved and safe.

Blumstein and Schwartz (1983) found in research on sexual frequency among various types of couples that lesbian couples have the lowest frequency of sexual interaction in long-term relationships. Few male homosexual couples, on the other hand, were able to attest to any type of sexual fidelity for more than five years. McWhirter and Mattison (1984) claim that sometimes gay males settle into long term relationships while maintaining a continual string of outside affairs.

SEXUAL ADDICTI-NS

According to Earle and Crow (1989) male homosexuality is often associated with addictive behaviors. It is seen much less often with females. True intimacy includes sharing pain and understanding, and accepting the complexities of a partner's personality. It is characterized by a commitment to a positive, evolving relationship over a long period of time (Paul ~ Paul 1983). Homosexuality, in most cases, grows out of substituting the need for true intimacy with sex. When sex is substituted for intimacy an addictive property is added to the picture.

For some who have given up hope of achieving intimacy, sex provides a momentary anesthetic relief from tension, pressure, worry, and the responsibility of forming functional relationships. The sexual outlet (either masturbation or actual homosexual contact) becomes an exclusive, self-absorbing "pleasure button" that must be reused again and again to achieve momentary relief and block the pain of isolation. The repeated, exclusive use of one pleasure source becomes part of a ritualized, addictive pattern. The addict has a powerful memory of an intense high from the orgasmic release and a desire to recapture the associated euphoric feeling. This pushes the addict into a constant vigil attempting to organize and shape the environment to provide another sexual opportunity. The homosexual addict becomes keenly attuned to every possible opportunity for the next sexual contact. The drive becomes compulsive (Carnes, 1991).

When sex is used as a chronic anesthetic, thoughts become consuming. Low self- esteem is constant; "I canrt do it. n "I am a horrible person. n "Nobody accepts me." These become part of a constant distorted belief system about oneself and the outside world. The addict begins to feel that if success becomes dependent upon his or her own social skills, it will never happen. The addict has a strong desire to escape the unpleasant emotions created by the erroneous belief system. This belief system creates a difficulty in dealing with stress which is fairly constant.

The compulsive thoughts result in a consuming fantasy about the next high. The fantasy crowds out thoughts of friends, family, worth and any other possible forms of gratification. At this point all values and everything of worth Ann be sacrificed for the sexual anesthetic which gives the homosexual momentary but inset relief from sadness, anger, anxiety, fear, and pain (Carnes, 1989).

Beck and Beck (1990) state that compulsive or addictive behavior is the result of a compulsive cycle. The cycle begins with feelings of isolation. Next, compulsive behaviors are developed to block the feelings of isolation. "A true victim of the compulsive cycle will become more and more absorbed in the action of self-indulgence, will ignore responsibilities and relationships in favor of participation in the activity, and will eventually realize that he or she is unable to stop the behavior, even by the most determined effort" (p. 17).

This loss of self-control and deterioration of life-style and relationships that accompany an addiction lead to the third stage of the compulsive cycle: feelings of selfhatred. If the action is specifically forbidden or considered a sin, the addict's feelings of guilt, shame and selfhatred become overwhelming.

Feelings of self-hatred move the behavioral addict along to the fourth stage of the cycle: actions of self-concealment. These actions include lies and deceit which reconfirm the beginning of the cycle: feelings of isolation (Beck and Beck, 1990).

STEPS OF RECOVERY AND TREATMENT

Step 1. Establish an environment of safety and trust. The client must be helped to build an emotionally intimate relationship with the therapist which includes a clear understanding of the therapeutic boundaries. The client needs to understand that he or she can explore behaviors, perceptions and feelings in an environment of honesty and trust. -bviously homosexuality is far too deep-seated to be blunted, much less reversed, by any kind of punishment or aversion therapy. Punishment causes fear, isolation and silence which were all major contributors to the problem in the first place.

The case studies mentioned in the literature all describe years of hiding, shame and silence. Like childhood abuse, homosexuality develops in an environment of secrecy and is maintained by silence. To overcome this wall of silence, a special intimacy must occur between the therapist and the client or between the client and someone who accepts the client even when the very worst is shared.

Recovery is unlikely without a genuine, emotionally intimate, non-sexual connection with at least one other person of the some sex. The experience of closeness with one significant, same-sex individual can then be duplicated as the client deepens bonds with others in his or her life. Relationships are a major key to recovery. When the client has a trusting relationship with another person the chances of recovery are greatly enhanced. Beck and Beck (1990) suggest that the compulsive cycle mentioned in the previous section must be replaced by the "joy cycle." Feelings of isolation in the compulsive cycle must be replaced by feelings of belonging. This is where the priesthood leader, the therapist, or significant, same-sex individual fit into the recovery process.

Overcoming the sense of isolation helps preclude the need for continued self-defeating behavior. A safe environment also is one that helps the client overcome his homosexual impulses and control his behaviors. This is accomplished by empowering the client to develop a history of sexual sobriety and self-control. The therapist must help the client make a commitment to cease all sexual activity, eluding masturbation. Beck and Beck (1990) suggest that the second step in their compulsive cycle, "actions of self-indulgence," must be replaced by actions of progression. -vercoming feelings of loneliness and isolation is not enough if the destructive behavior is allowed to continue. This resolve for a positive behavior change might begin with a daily pledge to sexual sobriety and move to a weekly and then monthly commitment.

Expecting a homosexual to change his orientation while still sexually active is like expecting an alcoholic to change his behavior while still drinking. Changing the behavior pattern helps the homosexual addict replace feelings of self-hatred with feelings of self-esteem.

Step a. Help the client begin to understand the roots of his or her homosexuality bv exploring the past. After a trusting relationship is established, the client must have the opportunity to examine and come to understand how his or her life's experiences have contributed to his or her homosexual attraction. The client must be assisted to understand the erroneous conclusions that were formed as a result of his or her life experiences. Because of the complexity of the homosexual identity, this step of the treatment process requires that all of the following issues which apply to the Life of a particular client be explored and understood:

1. Childhood

a. Dysfunctional family. b. Difficulties in relationship with father. c. Difficulties in relationship with mother. d. Incidents of physical emotional, or sexual abuse.

2. Problems with intimacy

a. Difficulty in establishing close relationships with family or friends. b. Isolation and a feeling of being "on the outside." c. An overwhelming desire for intimacy with another individual.

3. Diminished sense of self-worth

a feelings of ineptness or intimidation. b. A tendency to devalue oneself and to overvalue others who are perceived as superior.

Dwelling on past failures and perceived inadequacies.

Masculine identity (male homosexuals)

Lack of healthy male modeling and bonding.

Seeing oneself as less masculine; poor body image.

Objectifying and idealizing other, "more masculine" males. Stronger social identification with females; feeding of being more comfortable with women in social situations.

Feminine identity (female homosexuals)

Distrust of men.

Male authority issues.

Lack of feminine models.

Overly dependent relationships.

Sexual Addictive Behavior

Obsessions with sexuality.

Frequent use of pornography.

Involvement in exhibitionism, voyeurism, pornography, etc.

Frequent homosexual acts with numerous or random anonymous partners.

Other addictions and depression

a Substance abuse. b. A sense of incongruence between one's values or belief system and his feelings and behavior. c. Feelings of being out of control of one's life. d. Feelings of weakness, helplessness, and inadequacy (Evergreen, 1993).

Step 3. Help the client set specific goals to challenge these erroneous conclusions and build a renewed sense of self with an appropriate gender identity. -nce the client has identified the factors contributing to his or her homosexual identity he or she must be assisted to set goals to overcome these factors and challenge the erroneous self perceptions. Such goals might include associating with non-homosexual same-sex individuals to meet emotional needs, and developing skills in communication and gender related activities. Genuine self-acceptance includes a renewed awareness of the love of God. The client must be helped to understand that God loves all His children including those struggling with same-sex attractions. A re-handling of spiritual awareness is a precursor to change (Consiglio, 1993).

Step 4. Help the client establish and carry out specific tasks to achieve the goals set in Step 3. For example, if improving non-intimate, same-sex relationships is established as a goal for a man or woman, the task might be to develop non-sexual friendships with at least two other same-sex peers. The client then must be helped and supported to be successful in the task

Step 5 Help the client develop a support network which will carry him or her through the recovery process and through life. This step may include bringing a spouse or other family members into the therapeutic process so the client will not have to be totally dependent on the therapist. The client should be helped to repair his or her relationship with the Church. Encourage consistent effort toward involvement in priesthood quorum or Relief Society assignments and activities, and regular meetings with his or her ecclesiastical leader.

Step 6. Assist the client in making a life plan and a commitment to life-long self development. The client's thoughts need to be turned toward the future so he or she can see himself or herself as a self-reliant individual prepared for whatever is to come in the future. Educational and vocational plans should be established and implemented.

PREVENTION

Because the lack of proper identification with the same-sex parent is often a predictor of adult homosexuality, early intervention for children who meet a criteria for sender confusion can be very helpful (Newman, 1976). It is necessary to involve the parents in the intervention, help them deal with their resistance, and identify their contribution to the identity confusion. Problems within the marital relationship also may be affecting the child's behavior. Sexual identity questions are common among children. Children, however, are remarkably responsive to intervention between the ages of 5 and 12. With intervention, children in this age group can become more comfortable with their sexual identity. The major key to prevention is to allow the child to discuss his or her identity confusion in open, honest conversations (Newman, 1976). Newrnan (1976) suggests the following three phases of early intervention and prevention.

PHASE I: EVALUATION

Evaluate childhood behaviors associated with adult homosexuality (Green, 1974, 1987).

1. Cross-gender clothing preferences.

2. Verbal statements expressing the wish to become a member of the opposite sex.

3. Taking opposite sex roles in fantasy games while protesting if given the role of a same~sex individual.

4. Imitating the gestures and mannerisms of the opposite sex.

The following observable nminor behaviors" might suggest a need for a "selfperception" check but do not necessarily constitute gender confusion. Encouragement of gender appropriate behavior and a solid same-sex support system should be sufficient.

1. Dislike and avoidance of roughs competitive boy's games.

2. Dislike of mechanical toys-such as trucks, metal airplanes, construction equipment, etc.

3. Preferences for artistic activities (painting or listening to music) or for other sedentary activities.

4. Enjoyment of girls as playmates.

5. Gracefulness in bodily movements and gestures. 6. Reports of being teased as a "sissy" by other boys.

Girls

1. A preference for roughness and competition.

2. A dislike of feminine toys.

3. Preferences for boys as playmates and being seen as a tomboy.

4. Imitation of masculine gestures.

PHASE II: INTERVENTION

Discuss with the father his attitude that the son is a nsissy" or, worse, that he wants nothing to do with his son. Help the father understand that regardless of his son's personality he needs to be affirmed as valuable by his father. The typical scenario is that the father is absent and the mother is ambivalent about upsetting her son's happiness if his gender identity is challenged (Green, 1974). The mother may feel that because her son has so little else (no boy friends, girl friends whose parents dislike him ostracism at school) it would be cruel to deprive him of his feminine activities. The mother must be helped to overcome her own need to keep the boy emotionally close by feminine activities.

If the client is female her relationship with her father is also crucial. The father should be assisted in affirming his daughter's feminine identity. If the father is absent from the home, the relationship between the mother and the daughter should be closely examined to determine if the mother is contributing to her daughter's lack of feminine characteristics. Another important goal in working with the parents of feminine boys and masculine girls is to improve the marital relationship-schisms between the parents are apparent in almost all cases. Gender confusion is less likely whe~ love and harmony are present in the parents' marriage (Newman, 1976). Treatment for the parents is aimed at overcoming their distance from each other.

Newman (1976) and Wyden ~1968) suggest it is essential to help single mothers understand that a boy can get along quite well without having a father in the home day to-day, but he must have a father substitute to whom he can relate. It is essential to provide the boy with an opportunity to associate with adult males such as uncles, priesthood leaders or teachers. The boy must be able to formulate at least one positive, male-to-male relationship in which he has the opportunity to be accepted by a warm, nurturing male figure. It is necessary for a single mother to be aware of her son's need for this male contact and guard against her own anxious tendency to manage the boy's life too much.

Girls can also get along without a father on a day-to-day basis but, like boys, need the influence of a healthyGfunctioning male. A young girl's fear or discomfort with men can have a long-term impact on her adult sexual adjustment. A young girl also needs a female who is able to model healthy, male-female relationships.

PHASE III: P-STTREATMENT

If a boy can be helped to reduce overtly feminine gestures and play preference he will become more acceptable to boys who previously teased and avoided him. A boy's experiences of being ostracized and ridiculed may play a more important part than has been recognized in his total abandonment of the male role at a later time (Konrad, 1987). Intervention should be directed not at turning the artistic boy into an athlete or suppressing his aesthetic yearnings, but rather at developing his pride in being male by being able to develop a broader view of what being a man really means. He can be helped to understand that artistic abilities and pursuits are as much a part of the masculine world as football and stock car racing.

A young woman should be helped to become comfortable with her individuality while still seeing herself as a female. A happier childhood and primary prevention of an adult gender identity disorder are two related goals of prevention (Newman, 1976).

The bishop can play an important role in a young person's life by being aware of the presence of sex-role conflicts and helping him or her become involved in appropriate activities with peers and youth leaders.

CASE STUDIES

Case I

Darlene had ached for a secure home life from the time she was a child. Abused sexually, abandoned by her father, brought to bars night after night by her mother, she longed to find the love her parents had never provided.

As a teenager a spiritual awakening transformed Darlene's adolescence and gave her a new set of values. She decided to give her life to Christ. She became actively involved in a Christian youth group and found herself genuinely impressed and attracted to Greg, the son of a local minister. -ne night during a walk in the forest, Greg told Darlene he loved her. He suggested that if she truly cared about him she would consent to sexual intercourse. The proposition incensed Darlene who concluded that no man, even those who professed strong Christian ideals, could be trusted.

A few years later, a college roommate introduced Darlene to the first sensitive, caring relationship of her lifeaaone in which she felt loved for who she was, not because someone wanted something from her. This roommate turned -ut to be a practicing lesbian who slowly but carefully seduced Darlene into the lesbian life style. Although the lesbian relationship violated her new found faith, it seemed to offer what she had been looking for.

A succession of relationships followed, each defaulting on their promise of long term commitment and security. This all added up to seventeen years in the gay community.

Many of Darlene' 5 homosexual acquaintances said, "God doesn't care who you sleep with so long as you don't hurt anyone. n Even though Darlene could not reconcile casual sex with the morality she had known as a teenager, her efforts to shake loose of the gay life style failed miserably. She said, "I was always drawn bade into the lifestyle I both detested and loved."

Also while in college, Darlene become acquainted with Irene, an adult female counselor, who seemed to take a special interest in Darlene. Irene provided Darlene with an opportunity to discuss her conflicts and eventually divulge her abuse, her lesbian experiences and her distrust of men. The bond between Darlene and Irene was the anchor that gave Darlene the incentive to eventually reject the gay lifestyle. Wherever Darlene traveled, Irene kept in touch. Irene even traveled a few hundred miles on several occasions to check on Darlene. Because Irene never gave up on her, Darlene come to see Irene as the only source of true friendship she had. Irene's strong Christian commitments and genuine concern helped Darlene regain the hope she had lost in the "Comma commonality of God. " It was through Irene that Darlene met several men who challenged Darlene's old perception that all men were untrustworthy.

Darlene was able to change her sexual orientation by changing her belief system and discovering a new way to live. She describes the process as "God changing a deeply rooted part of herself" (Bogle, 1985).

Gerald is a 53 year-old white male who grew up in a small Mormon community in Southern Idaho. Gerald was the second of four children who, with his younger siblings, was left in the almost continual care of his oldest sister. Because Gerald was the most sensitive and vulnerable of the children, his sister bullied him continually. Gerald's younger sister tried to protect him and became his only confidant. Gerald had very little to do with his younger brother whom he described as "just a normal boy disinterested in everything but himself. n

-nce, when his parents were not at home, Gerald was sexually abused by his sister and an older female cousin. Gerald tried to protect himself from further abuse by Welling his father. His father accused him of lying. Gerald felt his artistic and musical interests separated him from his peers who were baseball-playing farmers. Gerald can remember his father telling him often that even his sisters were better at baseball than he was. Gerald developed a deep loathing of baseball. Gerald remembers being the butt of the family jokes and receiving constant ridicule from his father and his older sister for his lack of athletic prowess. Gerald said he hated M.I.A The thought of an all male class was horrifying. Scouting activities and camping with boys so different from himself were things he just could not tolerate.

Gerald felt close to his mother who encouraged his interests in music. Gerald learned from his mother to be an artistic flower arranger. Gerald said he remembered many standards night presentations where sex between males and females was forbidden. Gerald's sensitivity gave him an abiding fear of doing anything wrong. At age 12 he made a personal commitment never to have sex with a woman. About age 13 the thought of having sex with a man occurred to him. Because it had never been forbidden by the Church or his parents he began to seriously consider it as a logical outlet to his budding sexual urges. Gerald said he spent a lot of time thinking about this new concept but was too inhibited to talk about it to anyone. Around age 17 Gerald attended another standards night where the subject of homosexual encounters was described as "sinful. n He was devastated by the information particularly in light of the fact that by this time his sexual fantasies were well entrenched. He still wanted to do the right thing and made a commitment to give up his fantasies.

Gerald had moderate success at repressing his homosexual impulses and fantasies. After high school he went on a mission, returned home, went to college and married. Gerald and his wife had two children. He found his sexual desires for his wife to be somewhat passive. He began to find it almost impossible to continue to repress his adolescent fantasies and urges. Gerald made a painful decision to live a dual lifestyle.

Gerald spent 20 years living a lie. Because of the humiliation and shame he felt during that period Gerald made several attempts to reconcile his behavior with the Church. He met with several bishops who told him to fast and pray until the urges went away. -ne bishop tried to help Gerald by holding a Church disciplinary council. Gerald was excommunicated but was not offered any support or solutions. Subsequently Gerald went to two other bishops whom he described as being unwilling to discuss the issue with him. Gerald's continual cycle of resolve, uncontrollable urges, shame and disgust drove him to make one final attempt to resolve his feelings with the Church. Gerald said he received a spiritual confirmation that heterosexual attraction was a commandment and "

. . the Lord giveth no commandments unto the children of men, save He shall prepare a way for them that they may accomplish the thing which He commandeth them" ~1 Nephi 3:7).

Even today Gerald says he is very sensitive to any situation where he feels he is being treated differently than others. He said he definitely felt like he was different from the boys his age. He knew he never fit in his family, and many of his priesthood leaders gave him the message that they didn't know what to do with him either. Even when Gerald was in the midst of his sexual acting out he had several what he describes as, spiritual experiences. -ne impression that Gerald felt was, 'The Church is true but I only have imperfect people to run it. Be patient. "

Gerald's visit to the next bishop brought the results he was looking for. This bishop was retired and had spent most of his adult life inactive in the Church. He had a feeling for people that seemed to come from many years of his own pain This bishop welcomed Gerald with open arms, kneeled with him in prayer and openly conveyed his love. This bishop concluded his first meeting with Gerald by saying, "I will help you get what you need and stay with you as long as it takes."

At that point Gerald was directed by his bishop into therapy with LDS Social Services. After a year and one half of treatment, which included bringing his wife into his therapy as his confidant, Gerald feels he is making definite progress. Gerald has been rebaptized and is serving as executive secretary to the bishop who first became the basis of his support system.

Gerald feels he has a very personal relationship with God who, he says, has told him, "No matter what happens to you, you will never lose my love."

Gerald says that when he is scared he sometimes has a desire to go back to his old ways but now he has a safety net. He has a bishop, a therapist and his wife with whom he can share his most intimate thoughts. "Most. importantly," he says, "I know that God will never give up on me;~

Gerald says that knowing he has a spiritual backup system, the understanding and support of his bishop, is the key to the problems Gerald also feels strongly that any suggestion that same-sex attraction is biological and therefore untreatable is the most serious detriment to recovery that anyone in his situation can experience.

References

Bancroft, J., & Marlcs, I. (1968). Electric aversion therapy of sexual deviations. Proceedings Royal Society of Medicine, 61, 7960799.

Barlow, H. H., & Agras, W. S. (1973). Fading to increase heterosexual responsiveness in homosexuals. Journal of Applied Behavior Analysis. 6, 3500366.

Bayer, R. (1981). Homosexuality and American psychiatry: The politics of diagnosis. New York: Basic Books, Inc.

Beck M., & Beck, J. C. (1990). Breaking the cycle of compulsive behavior. Salt Lake City: Deseret Book Company.

Bell, A. (1976). The homosexual as patient, in Human sexuality: A health practitioner's, Richard Green-~ed). Baltimore: Williams and Wilkins.

Berg, C., & Allen, C. (1958). The problem of homosexuality. New York: Citadel Press.

Blos, P. (1985). Son and father: Before and beyond the -edipus complex. New York: The Free Press.

Blumsteit; P., & Schwar; P. (1983). American couples: Money, work, sex. New York: William Morrow.

Bly, R. (1990). Iron John: A book about men. Reading, Mass.: Addison-Weslev Publishing Company, Inc.

Bogle, D. (1985). Long road to love. -ld Tappan, New Jersey Fleming H. Revell Company.

Bowlby, J. (1969). Attachment and loss. London: The Hogarth Press.

Brazeltons T. B. (1990). The earliest relationship: Parents. infants. and the drama of early attachment. Reading, Mass: Addison-Westley.

Bullough, V. (1987). The first clinicians. In Diamant, L (Ed.), Male and female homosexuality. New York: Hemisphere Publishing Corporation.

Byne, W., & Parsons, B. (1993). Human sexual orientation: The biologic theories reappraisal. Archives of General Psychiatry 5Q 30239.

Byne, W. (1993). Interview: The biological theories of homosexuality reappraised. AMCAP Journal, 19(1).

Carnes, P. (1989). A gentle path through the twelve steps. Minneapolis: CompCare Publishers.

Carnes, P. (1991). Don't call it love: Recovery from sexual addiction. New York: Bantam Books.

Consiglio, W. (1993). Reorientation therapy for Christians overcoming homosexuality. -ctober.

Dallas, J. (1991). Desires in conflict. Eugene, -R: Harvest House Publishers.

Dobson, J. (1993). Focus on the family. Colorado Springs: July.

Dorner G., Geier T.

_ ___ _ __ __ (1980). Prenatal stress as possible aetiogenetic factor of homosexuality in human males. Endokrinolgie, 75, 3650368.

Durant, W., & Durant, A. (1968). Tile lessons of history New York: Simon & Schuster.

Earle, R., & Crow, G. (1989). Lonely all the time. New York: Pocket Books.

Ellis, A. (1965). Homosexuality: Its causes and cure. New York: Lyle Stuart, Inc.

Ellis, x (1959). A homosexual treated with rational psychotherapy. Journal of Clinical Psychology, 15, 3380343.

Ellis, H. (1928). Studies in the psychology of sex. Volume II sexual inversion. Philadelphia: F. x Davis Company, Publishers.

Evergreen International. (1993). Participant's Guide. Salt Lake City: Evergreen International, Inc.

Fine, R. (1987). In Diamant, L. (Ed.), Male and female homosexuality New York: Hemisphere Publishing Corporation.

Gooren. L, Rao D., & Van Kessel H., et al (1984). Estrogen positive feedback on LH secretion in transexuality. Psychoneuroendocrinology, 9:2490259.

Green, R. (1974). "Children's quest for sexual identity. Psvchology Today. February.

Green, R. (1987). The sissy boy syndrome and the development of homosexuality. New Haven, CN: Yale University Press.

Haith, M. (1980). Rules that babies look by; The organization of newborn visual activity. Hillsdale, NJ: L. Erlbaum Associates.

Hatterer, L. J. (1970). Changing homosexuality in the male. New York: McGraw Hill Book Company.

Horton, A., Harrison, B., & Johnson, B. (Eds.) (1993). Confronting abuse. Salt Lake City: Deseret Book Co.

Howard, J. (1991). -ut of Egypt. Kent, England: Monarch Publications LTD.

James, E. C. (1978). Treatment of homosexuality: A reanalysis and synthesis of outcome studies. Unpublished doctoral dissertation, Brigham Young University, Provo, Utah.

Kennel, J., & Klaus, M. (1982). Parent-infant bonding (2nd ed.). St. Louis: Mosby.

Konrad, J. A. (1987). You don't have to be gay. Pacific Publishing House.

LeVay S. (1991). A difference in hypothalamic structure between heterosexual and homosexual men. Science, 253:103401037.

McWhirter, D., & Mattison, Al (1984). The male couple: How relationship develop. Englewood Cliffs, NJ: Prentice-Hall.

McDonald, H. B., & Steinhorn, A. I. (1990). Homosexuality: A practical guide to counseling lesbians. gay men and their families. New York: The Continuum Publishing Company.

Mintz, E. E. (1966). -vert male homosexuals in combined group and individual treatment. Journal of Consulting Psychology, 30, 1930198.

Moberly, E. R. (1983). Homosexuality: A new Christian ethic. Greenwood, SC: The Attic Press Inc.

Money, J. (1986). Lovemaps. New Yorlc: Irvington Publishers Inc.

Money, J. (1987). Sins sickness, or status? American psychologist 42(4), 3840399.

Nardi, P. M. (ed). (1992). Men's friendships. New Park CA: Sage Publications, Inc.

Newman, L. E. (1976). Treatment for the parents of feminine boys. American Journal of Psychiat~

Nicolosi, J. (1991). Jason Aronson Inc.

Reparative therapy of male homosexuality. Northvale, NJ:

Paul, J., & Paul, M. Minneapolis: CompCare ruvllsners.

(1983). Do I have to give up me to be loved by you?

Schow, R., Schow, W., ~ Raynes, M. ~1991). Peculiar people: Mormons and same-sex orientation. Salt Lake City: Signature Books.

Shilts, R. (1987). And the band played on: Politics. people and the aids epidemic. New York: St. Martin's Press.

Siegelman, M. (1987). Kinsey and others: Empirical Input. In Diamant, L (Ed.), Male and female homosexuality. New York: Hemisphere Publishing Corporation.

Socarides C. W. (1969). Psychoanalytic therapy of a male homosexual. The Psychoanalytic -uarterly. 38, 1730190.

Socarides, C. W. (1978). The sexual deviations and the diagnostic manual. American Journal of Psychotherapy, 32, 419 426.

Socarides, C. W. (1988). Sexual politics and scientific logic: The issue of homosexuality. In P. F. Fagan (Ed.), Hope for Homosexuality. Free Congress Foundation: Washington D.C.

Stevenson, I., & Wolpe, J. (1960). Recovery from sexual deviations through overcoming non-sexual neurotic responses. The American Journal of Psychiatry, 116, 7370742.

Understanding and helping those who have homosexual problems: Suggestions ecclesiastical leaders. (1992). Salt Lake City: The Church of Jesus Christ of Latter-day Saints.

van den Aardweg, G. J. (1972) Journal of Psychotherapy, 26, z2068. heory of homosexuality. American

Worthen, F. (1984). Steps out of homosexuality. San Rafael CA: Love In Action.

Wyden P., & Wyden, B. ~1968). Growing up straight. New York: Stein and Day Publishers.