How Sexual Identity Therapy Begins
In 2005, I was filmed providing consultation to David Akinsanya of the British Broadcasting Corporation. The BBC produced a documentary called Sad to be Gay surrounding the quest of David to reorient his sexuality. He had lived as a gay man for 20 years but decided he was not happy and wanted to explore American change therapies. He first went to Love in Action in Memphis. However, he left there ahead of schedule because he did not like the rigid rules or the religious emphasis. He clearly was discouraged when we began our interview. We met in a little bed and breakfast in Grove City for an hour each on consecutive days. The footage never made it in the documentary but I have video of the meetings provided by the BBC. To illustrate how I begin with a client, I reproduce selected verbatim interactions and descriptions of the narratives of our two meetings.
David Akinsanya (DA): I’m nearing 40 now and for the last 20 years, I’ve tried to live as an out gay man and not been happy with it at all. Never fit in really into the lifestyle, you know the clubs and the one night stands and the bars, and the bathhouses and all that sort of stuff and thought that I would find love and companionship and haven’t been able to find that.
So I’m just on a journey you know around just to find out people’s views and to see if there is anything I can do to change.
I’ve been on the Love in Action course, the program there. And the problem for me with that particular program was the heavy emphasis on religion. I’m not heathen, in fact I spent the first ten years of my life in church, Sunday school, Boy’s Brigade, very heavily involved. But as I got older, I couldn’t reconcile that with my sexuality and so I’ve gotten away from that, probably a little bit too far for Love in Action’s point of view. So that’s why I’ve come to see you really. To see what kind of information, help, advice, whatever you could tell me.
Warren Throckmorton (WT): So your thinking about change, or living heterosexually really doesn’t relate to your upbringing, your religious upbringing, or your religious background at all?
DA: No, not really. It’s more that I’m 40 now. If I’m going to make a family, then I am pushing the boundaries of that.
WT: This may seem like a simple question but – What keeps you then from pursuing opposite sex relationships? Do you have not have feelings for opposite sex? Or do you? What is that like for you?
DA: The way I describe it is: If I’m on the Tube [transit] going to work in the morning I might see one woman that I find attractive and maybe 4 men. If I do find myself attracted to women, then they are usually the sort of stereotype of an attractive woman. So they’re always slim, they’re always kind of really pretty and all the rest of it. So I do have attractions to the opposite sex, but I think the attraction to the same sex is a bit stronger.
WT: Have you thought of yourself as bisexual?
DA: During the process of making this, I’ve thought more about that. In the last 7 years I have been having a relationship with a woman. She describes herself as bisexual and doesn’t want to commit to a heterosexual relationship. I mean she would be ideal for me, really, but as they say, it takes two to tango and it’s not what she wants. I imagine if that’s what she wanted I could have a proper partnership with her and talk to her about the feelings I’m having which is the other thing that’s important to me: honesty. I don’t want to get involved with a woman and not tell her my feelings and where I am coming from and all of those sorts of things, do you see what I mean?
WT: Right, and this woman may not be available in the way you want her to be but does she know aboutâ€¦I assume she knows?
WT: Does the way you’ve been thinking lately that, ‘I might be bisexual,’ does that help you think that maybe you could enter a relationship that would be workable.
DA: Yeah, but it’s the honesty thing, you kind of think, you know, if you say that to a woman, it’s going to scare her off. And often, Iâ€™ll be honest with you, Iâ€™ve thought about just going out to a club and picking a girl up and just starting from there. But the trouble is because Iâ€™ve lived this way for the last 20 years, thereâ€™ll be lots of people I will have to keep away from her or else its going to get, you know what I mean, I just donâ€™t like that, the dishonesty, I just donâ€™t like that.
WT: So you really feel that a woman would not be able to handle the fact that you have been gay identified for as long as you have been?
DA: Yeah, a heterosexual woman, I think, yeah. And then if itâ€™s a bisexual woman there are other issues, arenâ€™t there? About whether we are allowed to do what we want to do when weâ€™re not together, do you know what I mean?
WT: What I like to try to do is really identify what, in a sense, the problem or the issue is, and just in the first two or three minutes hereâ€¦I mean I certainly hear what you are saying that you have sexual feelings toward men and sexual feelings toward women, they seem a bit stronger toward men. And I can understand how that would seem like a turn off to pursuing a heterosexual identity. But is the problem that you have sexual feelings toward men or is the problem finding somebody who would be willing to accept your background but that could commit to you from here on out? Or that you could commit to from here on out?
DA: I suppose the worry for me is, I would be worried about deviating, thatâ€™s the wrong word reallyâ€¦how the balance would be, you know the 1 versus 4, Iâ€™d be worried that if I got bored in that relationship or that I wouldâ€¦(pause)
WT: Let me use a heterosexual analogy for a moment. Letâ€™s say someone who enters into a monogamous heterosexual relationship, do you suppose they wonder what would happen if they got bored?
David went on to say that knew friends who were in such relationships and did feel tempted to stray. Discussing this further, I wondered if problems were with his same- sex feelings or with monogamy.
WT: Let me establish first, that is what you are looking for? To establish a relationship withâ€¦
DA: â€¦a family
WT: â€¦a family, and that would include a monogamous relationship with your wife? Itâ€™s conceivable that many men might enter marriage wondering if at some time, â€˜I wonder if I will be bored.â€™ So I wonder if itâ€™s a matter of your sexual attractions, the direction of them or is it more a concern about just monogamy.
David then told me about his desire to have a long-term relationship with someone, as well as his history in gay relationships (one for 5 years and one for 7 years). I continued to press for what the barriers were in the way of him achieving what he said he wanted.
WT: Is the problem thatâ€™s impeding you or getting in the way of pursuing your objectives the fact that you have same-sex attractions or is it that youâ€™re concerned that you can be faithful to somebody?
DA: (After a pause) I think it could be a bit of both, really, to be honest with you. I think it could be a bit of both.
I asked him to break down how each of these experiences (same-sex attraction and worries about the capability to be faithful) was getting in his way.
He began by telling me that he has repaired his relationship with his father over the last 5 years. However, he has experienced no difference in his homosexual attractions but he does now want a family more and is less interested in developing homosexual relationships.
He said a psychiatrist he saw in Great Britain and LIA in the U.S. taught him the reparative drive theory. He asked me what I thought of it and I instead asked him for his view. He then went into his history.
Briefly, he was placed in boarding school when he was about 9 or 10. There was lots of sex there with both girls and boys. He had a girlfriend as well as numerous homosexual encounters. He disclosed that at 14, â€œan adult interfered with meâ€ meaning he was sexually molested. No details were given. He remembers seeing himself as a bisexual from ages 15-16. He recalled that â€œDavid Bowie was bi and it was very cool.â€
About being gay, he said, â€œIt was always ok. It was very cool to be gay. Iâ€™ve gone through life thinking that it was ok and accepting myself the way I am.â€ He volunteered that â€œthe majority of my friends are straight males.â€
After this exchange, he said: â€œI am feeling like I shouldnâ€™t be describing myself as gay. Thatâ€™s helpful to think I am not gay. That opens up the possibility that I could be with a woman. I had a lot more of those experiences than others while I was becoming a man.â€
About the possibility of his homosexual attractions being due to his fatherâ€™s absence, he said: â€œI wonder if thatâ€™s the theory talking â€“ I think itâ€™s the theory talking. I think itâ€™s myself telling me that. Now, I know he loves me and I still have SSA [same-sex attraction].â€
When I asked him how specifically his fatherâ€™s absence (which didnâ€™t take place until he was 9 or 10) related to his sexual feelings, he replied: â€œI donâ€™t know how it affected me; I assume it but maybe it is because it is the theory…â€
These exchanges illustrate several points. One, I begin by trying to elicit why he wants to change. Second, I wanted to know what he really wants from his efforts. He came to America saying he wanted to change sexual orientation because he thought he had to completely change before he could pursue what he really wanted: a traditional family. Since he also experienced attractions to women, he gradually began to entertain the idea that he might be bisexual instead of gay. Even with this shift, he began to limit himself by doubting that he could be faithful to a woman if he had homosexual desires. From my point of view, he went from one self-imposed limitation (Iâ€™m gay and therefore canâ€™t get what I want) to another (Iâ€™m bisexual and people with homosexual feelings canâ€™t be faithful to a mate). My questioning of these ideas allowed him to quickly explore the limitations he was placing on himself by his thoughts and feelings.
As we talked, he came to see that he could pursue valued aspects of his life without a complete change in sexual feelings. He later described himself as being in a â€œgay box.â€ After we talked about the consequences of his self-definition, he began to think through his beliefs about bisexuality and what that would mean for his actions. Furthermore, he was able to explore the disengagement of his sexual attractions from his rather rigid self-definition as gay. I asked him if what he really wanted from therapy, and by extension, in his life was confidence in his capacity to be monogamous. As best as I can determine, he came to see the problem he was having not as having gay feelings but as a desire to pursue monogamous relationship with a woman.
These exchanges further illustrate several processes I find helpful. One, I did not ask him to approve or disapprove of his feelings. I treated them as givens and as such accepted their existence. I did not ask him to change them nor did I immediately collaborate with him to change his attractions. He was fresh from Love in Action and so he provided his history which was in fact, a match with some (although not all) aspects of reparative drive theory. He thought he may need to work through his past to achieve his objectives. However, when I probed this idea, he did not see how the theory specifically played itself out for him. In fact, he described a wonderful reconciliation with his father which did not impact his sexual attractions at all. His resolution of his anger with his dad, however, brought on more of a desire to create a traditional family. I find this to be a fairly typical result from those who have not succeeded with reparative style therapists. These clients often either do not match up well with the theory or they cannot see the relevance to their own situation since they have mended the same-sex parent relationship with no subsequent feeling change.
Focusing on what the outcomes (what will happen if you change?) allowed him to think more clearly about the actual barriers to his goals. He really wanted to have a monogamous marriage. Did his feelings prevent that? I questioned whether his homosexual feelings were in fact keeping him from his objective. If he had not responded so quickly, I would have needed to review his background more or pursue other techniques that could lead to enhanced flexibility.
Regarding the next step, I talked with David once by phone after the filming. He was continuing to think through how he could be monogamous, even with attractions to men. He had pursued some dating opportunities with women and was gaining some confidence that he might be able to treat his same-sex desires in the same manner as a straight man would treat temptations to stray from monogamy.
If I would have worked with David further, I suspect we would need to address panic surrounding a focus on one person in a trusting, committed relationship. He had not known this kind of commitment in his life. His doubts about his ability to be faithful would probably become stronger as he became more involved in a relationship. The doubts would not be avoided, as with all internal events, these feelings and thoughts would be acknowledged. Time would be needed for David to explore what function the doubts might serve, in other words, why are these doubts showing up now? What might your brain be trying to accomplish here? How might these be interpreted? As with other aspects of this approach, clients would explore competing interpretations. A series of questions would likely help clarify things: Could it be that your brain is trying to do you a favor by giving you thoughts of straying or fleeing into leaving the relationship for a fling? The accompanying panic feelings produced by the brain would then prevent him from getting hurt in a committed relationship. So these doubts could be efforts at self-protection. Or these thoughts could be serious reflections about what he is capable of doing. In any case, this approach to therapy would ultimately come back to what the client values. After discussing the internal dialogue, an important question would be: have you chosen different values? If he still values a monogamous relationship and believes he should pursue it, then the question becomes: can he move forward toward a life he desires even though he is feeling scared?
We would no doubt continue to revisit the question of what he valued and why. He was not a particularly religious person but he believed strongly in rearing children in a traditional manner. If his values change, then so might the objectives of the therapy. At risk of redundancy, it is not up to the therapist to tell clients what they ought to value. If he values a traditional partnership, then it is not for me to dissuade him.