Content area
Full text
Until the American Psychiatric Association removed homosexuality from its list of mental disorders in 1973, ' psychiatrists generally treated homosexuality as a type of perversion or illness, seeking to find its cause and to eliminate homosexual desire and behavior. Publication of the work of Alfred Kinsey and his colleagues2 and of the psychologist Evelyn Hooker3 began the revolution in thinking about homosexuality that eventually led to viewing it as a normal variation of sexual desire. Since the 1970s, the availability of a large and growing number of volumes about homosexuality and about gay men and lesbians has increased understanding about sexual orientation, gay and lesbian development and identities, and sexual minority communities. Within the mental health field, the availability of numerous books on psychotherapy with gay men, as well as lesbians/ ~13 has enabled the mental health practitioner to leam about the types of problems with which gay men present and to develop specific approaches to working with these men.
Several issues are important to understand when working with gay men, including the origins of homosexuality, coming out, development of a gay identity, the impact of discrimination and anti-gay violence, the role of diversity, and the nature of male relationships.
Origins of Homosexuality
Perhaps no topic is of greater interest in relation to homosexuality than its origins. The debate about whether homosexuality is biological or developmental, the result of nature or nurture, or the product of an essentiah'st or a socially constructed process creates an unnecessary opposition between interactive influences that ultimately contribute mutually to the development of sexuality. Biological factors such as anatomy, genetics, and hormones serve, at the very least, as the physical and behavioral matrix within which sexual orientation expresses itself, and are considered by many to be the determinants of sexual orientation for some persons. Environmental factors such as family influences and social experiences also help to shape sexual orientation and identity, serving to mold particular forms of desire, behavior, and relationship and to create the individual dynamics within which sexual lives are enacted. Together these biological and environmental factors create a unique sexuality in each person, the precursors of which are determined in early childhood and which is relatively immutable to change through psychotherapy or other exogenous factors.14
Coming Out