Do Ask — and Do Tell!

Musicians' Assistance Program

Volume CVII, No. 6June, 2007

Janet Becker, LCSW, Ph.D.

In June of 1969, a group of gay, lesbian, bisexual and transgender people rioted in protest when the police raided the Stonewall Inn, a gay bar in New York City. The Stonewall riots are generally considered to be the beginning of the modern gay movement, marked each June by the celebration of Gay Pride Month.

Over the past 38 years, there has been marked progress with regard to gay and lesbian civil rights, although many biases and legal barriers persist.

The term “homophobia” has been coined to describe the anti-gay sentiments which pervade our society.

As a mental healthcare provider, I have become aware of and sensitized to the anti-homosexual prejudice which continues to hold sway in the field of psychiatry and psychotherapy.

Most interesting is the history of the Diagnostic and Statistical Manual, published by the American Psychiatric Association.

This tome is the so-called bible of psychopathology classifications, which gets revised every decade or so.

Until 1974, homosexuality was listed as a mental disorder As a result of the influence of the gay rights movement, the DSM no longer classified it as a mental illness.

However, there appeared a new “disorder” called “ego-dystonic homosexuality,” a term used to describe an individual’s inner conflict and discomfort with his or her homosexuality.

In the DSM-IV (1994) this category was omitted, although replaced by “Sexual Dysfunction Not Otherwise Specified.” This included “persistent and marked distress about sexual orientation,” thus continuing to provide an “official” psychiatric category for those therapists who wish to “diagnose” someone as homosexual.

When homosexuality was first considered “ego-dystonic” (which means “at odds with one’s self”), it was viewed as a psychiatric disorder within the individual.

In fact, the problem of stigmatization originates in the social environment and inevitably has adverse effects on the self-esteem of the homosexual individual.

If one is shamed and shunned by a biased society because he or she is gay, wouldn’t it follow that one would internalize and identify with the global hatred directed at him or her?

Is the resulting angst a disorder of the individual, or the effects of a disordered society?

As gay activist Larry Kramer writes, “Homosexuality is not, in and of itself, the problem that causes gay people to seek treatment. It is the world’s response to homosexuality. That and that alone is the ‘trouble’ with homosexuality.”

Although the scientific community cannot say definitively what determines sexual orientation — whether it is nature or nurture, or some combination of both — research indicates that homosexuality is not a matter of individual choice.

Homosexual orientation is apparently in place very early in life, perhaps even before birth.

It seems to occur in ten percent of the population, a fairly constant figure across cultures.

These research findings suggest that efforts to “repair” homosexuality are nothing more than “social prejudice garbed in psychological accoutrements.”

Nevertheless, there exist practitioners, mostly religious conservatives, who cling to the belief that homosexuality can be “treated” and “reversed” through therapy.

Some claim that complete change is possible, while others focus on helping gays and lesbians live celibately.

In light of the current controversy over gay marriage, and the exposure of sex scandals in the Roman Catholic Church, this so-called “ex-gay” movement has become more prominent across the country, in centers offering what is often called “reorientation” or “reparative therapy.”

Despite their claims of successful outcomes, the majority of mental health experts dispute the accuracy of these reports.

Moreover, the resulting damage to self-esteem, triggering serious depression, if not suicide, is well documented.

It follows then, that a homosexual individual who seeks psychological services needs to be cautious and selective when embarking on a search for a therapist.

It is most essential to be sure that the therapist holds the view of homosexuality as a natural variation of human sexuality, and not as a mental disorder.

In addition, the therapist must appreciate and be sensitive to the effects of prejudice and discrimination on homosexual and bisexual people, and the extent to which society’s stigmatization is internalized and manifested.

In short, it is important to be sure that the therapist a gay individual chooses to work with practices “gay affirmative” psychotherapy, meaning that he or she does not view being gay as problematic, but as a healthy form of normal human sexuality.

How can one tell if this is the case?


And, if it is important to you that your therapist is gay or lesbian, don’t be afraid to ask about his or her sexual orientation.

Much can be revealed about the person by how he or she answers this question.

Contrary to the military credo — “Don’t ask, don’t tell” — the opposite is true when interviewing potential therapists.

There is much at stake, and you need to know that the therapist you will work with will truly support you and your best interests.

If you or someone you know is gay or bisexual, and would like some guidance in selecting a therapist, we at the MAP office can help to guide you through the interviewing and selection process.

Call us!

This article is based on material from “Finding a Gay Affirmative Psychotherapist,” by Fran Brown,; “Gay, Lesbian and Bisexual Issues,” Ball State University Counseling Center,; “Issues in Psychotherapy with Lesbians and Gay Men: A Survey of Psychologists,” by Linda Garnet, Kristin Hancock, et al,.; “Reports From the Holocaust: The Story of an AIDS Activist,” by Larry Kramer; “Some Tormented by Homosexuality Look to a Controversial Therapy,” by Michael Luo, The New York Times, Feb. 12, 2007.