Appropriate Therapeutic Responses to Questioning Sexual Orientation

Abstract

Adolescence is accompanied by an emergence of strong sexual feelings that occur while the individual is learning to navigate the social world. For some, questions about sexual orientation and identity are confusing. Therapeutically, adolescents need a safe and value-free environment to understand their internal experiences of admiration, affection, sexual fantasies, and sexual attraction. This article describes a client-centered therapeutic approach in working with questioning adolescents. Gay clients may need additional support in exploring their internal experience, their social environment, coping strategies, and sexual identity development. You received a call from an anxious father of a 15-year-old boy who has recently expressed confusion about his sexual orientation and identity. According to the father, the boy indicates that he thinks he might be gay, based on what he describes as a strong attraction to another boy in his school. He doesn't know if his feelings are just due to admiration of his classmate or actual sexual attraction. The son denies ever having had sex with another male, but is confused about how to interpret his feelings for his friend. He has asked, "Dad, how do I tell if I am gay? And, if I am, what does that mean? Do I have to tell everyone? What if I change my mind later?" The boy's father correctly recognizes that these are questions that only his son can answer for himself; still, he wants to be helpful-and supportive. The family (and you) live in a state that prohibits licensed mental health practitioners from engaging in Sexual Orientation Change Efforts (SOCE), also known as "sexual orientation conversion therapy." The boy's father is not seeking anything like that. He wants to be as supportive as possible as his son explores attractions, his sexual feelings, and what "identity" to claim. The dad recognizes that his son, like many adolescents, may be experiencing a range of sexual feelings and needs help making sense of them. What guidance do you offer to this parent, and what guidance would you need in working with his son? Emergence of Sexual Impulses in Adolescence Adolescence is a time when sexual feelings-and attractions-begin to emerge. Navigating the social world of adolescence, for many teenagers, is a time of exploration-and with it comes the question of how the social and sexual selves are related. The dilemma faced by the young man in the above case is common to many adolescents. It is estimated that more than three times the number of adolescents who identify as gay have actually had sexual experiences with partners of the same sex (Canadian Pediatric Society, 2008). There was a time when same-sex attractions were pathologized and public opinion about homosexuality was overwhelmingly negative. That time has given way to an evolution toward a more inclusive view of same-sex attractions and behavior as a normal variant of the human experience. With this normalizing of same-sex orientation, however, has come a freedom of exploration for adolescents that is often accompanied by confusion. The situation of an orientation-questioning adolescent and a supportive but equally confused (as in how to be helpful) parent brings a thought-provoking dynamic to the therapeutic relationship. In some ways, the father's experience of confusion in this case is mirrored by the therapist: You want to work with his son in a way that facilitates clarity, but does not impose a pre-ordained outcome, as would be the treatment goal of so-called "conversion therapy." (Note that the term "conversion therapy" has been discredited as a legitimate form of therapy, and is replaced in this article by the acronym SOCE.) The line between these two paths is not always so clear. Even the most neutral therapist can be perceived as "encouraging" one outcome over another, owing to the power differential that is especially acute in the dynamic between clinician and adolescent client. Douglas C. Haldeman, PhD, is Professor and Chair of the doctoral program in clinical psychology at John F. Kennedy University. He was in clinical practice for thirty years, specializing in treatment of survivors of so-called "con-version therapy." His scholarship on LGBT issues, and on "conversion therapy" in particular, spans over three decades.