[A sexo-analytic view on homosexuality]. / Un regard sexoanalytique sur l'homosexualité.

After having defined the terminology, the author attempts to identify homosexuality through the sexual individuation process and to trace its different ontogenic inconsistencies. A typology based on non conformity of gender and the heterophobia is suggested. Two clinical case examples will be given to further illustrate the sexoanalytic treatment of egodystonic homosexuality.

Freud and sexual reorientation therapy.

Contrary to certain psychoanalytic interpretations, Freud himself generally resisted the possibility or desirability of sexual reorientation therapy. Yet his understanding of the origins and nature of homoeroticism does not suggest that conversion therapy is impossible. Although he did not believe homoeroticism to be an inherent impediment to human accomplishment and fulfillment neither did he see it as having the full value of heteroeroticism. For these reasons he did not altogether rule out the desirability or possibility of conversion therapy for some individuals even if he did not believe that it could be psychoanalysis alone that could redirect sexual orientation.

Ego-dystonic homosexuality.

The patient coming in with a dysphoria over his or her homosexual feelings, fantasies or behavior must be given the choice of working through the homophobia or the heterophobia. With the first choice, treatment is directed toward decreasing shame over the homosexual orientation and integrating the patient's social role and personal identity. If a move toward greater heterosexuality is chosen, techniques range from psychoanalysis to time-limited psychodynamic psychotherapy to behavioral techniques. Behavioral techniques may involve in vitro or in vivo desensitization. Issues in selecting the appropriate form of therapy are sometimes subtle and complex, and ethical issues frequently beset the therapist. The patient must be kept fully informed of his or her options, and the choice and the goals of therapy must be arrived at by both patient and therapist.

The Masters and Johnson treatment program for dissatisfied homosexual men.

Certain individuals who want to change their homosexual preference can be helped by a short-term intensive intervention adapted from the Masters and Johnson model for treating heterosexual disorders. Pretreatment counseling aims at improving the patient's dating, sexual, and intimacy skills; creative problem solving; and stress management. Then for 2 weeks the patient and an opposite-sex partner, living in social isolation, meet daily with a therapy team to address fears and anxieties about intimacy as they arise. The directive psychotherapy format alternates between confrontation of maladaptive belief systems and patterns of relating and support for finding new ways of coping that foster a positive self-image.

Behavior completion mechanisms rather than primary drives maintain behavioral patterns.

Anxiety is identified with a state of high arousal. Agoraphobia is differentiated from specific phobias which are inherent responses to situations which threatened primitive man. In agoraphobia, attacks of high arousal are produced by situations which delay ongoing activity. It is hypothesised that such delays produce arousal by activating behavior completion mechanisms. Evidence is reviewed which indicates desensitization has a specific effect in agoraphobia but not in specific phobias. It is suggested that desensitization reduces the arousal produced by behavior completion mechanisms. -- Aversive therapy in homosexuality reduces the subjects' drive to carry out compulsive sexual behaviors but does not alter sexual orientation. It is suggested that the compulsive sexual behaviors are not activated by primary sexual drive but by behavior completion mechanisms. Aversive therapy reduces the arousal produced by the behavior completion mechanisms. -- A similar mode of action is advanced for desensitization and aversive therapy. Both inhibit arousal by establishing a focal experimental neurosis which results from alternation of excitatory and inhibitory impulses.

A case of homosexuality treated by in vivo desensitization and assertive training.

Sexual deviation is not a unitary condition, amenable to a single treatment approach. Deviant sexual arousal has been overemphasized while inadequate attention has been given to associated behavioural problems such as deficient heterosexual arousal, deficient heterosexual skills and gender role deviation. A client with homosexual arousal and requesting aversion therapy was treated successfully and rapidly using in vivo desensitization and assertive training. The treatment is described and the importance of the behavioural analysis in directing the course of therapy is stressed.

Homosexuality and the ethics of behavioral intervention: Homosexuality, the ethical challenge.

It is suggested that behavior therapists have not attended sufficiently to the factors influencing the desire of some homosexuals to change their sexual orientation. Therapists of all persuasions constantly make decisions for their voluntary clients, encompassing both the goals of therapy and the means to be used to achieve those goals. A perusal of the psychotherapy and behavior therapy literature indicates that therapists generally regard homosexuality as undesirable, if not pathological. Since professionals are unlikely to work on treatment procedures unless they see a problem, it is probable that the very existence of change-of-orientation programs strengthens societal prejudices against homosexuality and contributes to the self-hate and embarrassment that are determinants of the "voluntary" desire by some homosexuals to become heterosexual. It is therefore proposed that we stop offering therapy to help homosexuals change and concentrate instead on improving the quality of their interpersonal relationships. Alternatively, more energy could be devoted to sexual enhancement procedures in general, regardless of the adult gender mix.