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Homosexuality Can’t be ‘Cured’ – but can we accept it?

Over the last 200 years or so, there has been ongoing debate about the relative role of psychology and biology in a range of human behaviours.  Autism and homosexuality are two good examples that research has placed firmly on the side of biology.  For many years professionals tried talking therapies to help people with autism and homosexuality overcome their ‘afflictions’.  In both cases all they served to do was increase the distress of the patient, and their families, by making them feel responsible for their behaviour.

 

With respect to homosexuality, the psychiatric profession for many years held it to be an illness.  This is no longer the case.  Although the causes of homosexuality are still debated in nuance, there is increasing consensus that it is biology that determines a person’s sexuality, not psychology, upbringing or indeed, personal choice.  Interestingly there are different biological reasons for male homosexuality and female homosexuality, rather than a unified reason that accounts for both.

 

Furthermore, a survey of all published research about therapies that have tried to change a person’s sexuality has shown that it has always failed to do so, and often causes harm.  This has recently led to the American Psychological Society issuing a declaration that therapy to change a person’s sexuality does not work, with the implication that it is unethical to try to do so.  Pressure is being put on the British Psychological Society and the Royal College of Psychiatry to issue a similar statement.

 

Given this backdrop it is alarming that a recent study in MBC Psychiatry found that as many as 1 in 6 therapists have attempted to change at least one person’s sexual orientation  in their professional career.  On the face of it this seems to go against the evidence.  I wonder, though, if something more subtle is going on – namely a difficulty knowing how to deal with gay clients who are unhappy about their sexuality.

 

In the life history of most gay men there is likely to be a period when they couldn’t accept their sexuality, and therefore really didn’t want to be gay.  The pressures of family and society to conform to a heterosexual norm seem insurmountable for many men.  It is clear that many gay clients have a lot of soul searching to do before they form an acceptance of their sexuality.  Indeed, it could be argued that many gay men, though superficially accepting and adopting a gay lifestyle, still suffer from a hangover of ‘internalised homophobia’ that continues to impact on their emotional wellbeing and ability to form meaningful relationships.

 

Given the very real unhappiness that finding oneself gay can bring to a person, it seems understandable, if ill advised, to try and help the person to lead a straight lifestyle.  I suspect this, rather than a real belief in its possibility, that has led so many of my colleagues to try and change a persons sexuality.

 

It is within this backdrop, however, that the real danger to gay men’s well-being lies – namely in those religious organisations that still offer ‘treatments’ for homosexuality. Against the grain of science but in the name of God, such organisations can only serve to enhance gay men’s unhappiness with their sexuality, and not in fact offer any real solution to it.  At best all they can hope to achieve is an asexual life where sex and relationships are sacrificed for a supposed ‘greater’ ideal of ‘what God wants’.  I can’t see this being beneficial to the individual, or, indeed, society.

 

Homosexuality will continue to be a contentious issue, not least because it raises tensions between individual behaviour and social and religious mores. All I can do as a therapist is help everybody, gay or straight alike, to be more accepting of homosexuality.  It is in accepting others how they really are, that we are best able to learn to accept ourselves as we really are.  Psychological health, after all, starts by seeing the world as it really is, rather than how we think it should be.

Dr Phil Tyson is a Men's Psychotherapist based in Manchester in the UK.  He offers counselling in Manchester, psychotherapy in Manchester, cognitive behavioural therapy in Manchester and telephone counselling nationally and internationally.

Sex Addiction.

As a men’s psychotherapist, I have talked more often to the media about sexual addiction than any other topic.  This is strange really because the assumption is that it is only men who become hooked on inappropriate sexual activity.  In fact 40% of sexual addicts are women. Women’s patterns of sexual addiction might be different to men’s, but they suffer in almost equal measure.  Having said that, this article is about sexual addiction in men, and if you are a man who thinks you have a problem with sex, you have come to the right place. 

 

So what kind of sexual activity can men get hooked on?  Well the main ones are ‘dogging’ areas, where straight men and couples cruise car parks for sex, public toilets and other gay cruising areas, prostitution (both selling and buying), masturbation and internet porn.  In fact internet porn is so easy to get hooked on that it has been dubbed the ‘crack cocaine’ of sexual addiction.  As a sexual addicts pathology develops, of course, he can often find himself moving into areas of sexual interest that are even more antisocial and/or illegal.

 

Sexual addiction first started to come to the attention of professionals who were involved in the treatment of other addictions, such as alcohol.  It was found that if a person has an addiction to a substance, there is a high likelihood that they will also be addicted to sex.  As many as 42% of people addicted to cocaine also have a co morbid sexual addiction.  Some theorists have argued that the neural pathways associated with sexual addiction are the basis for all addictions.  Whether this can be bourn out by the facts I don’t know, but what is clear is that sexual addiction is closely linked to other forms of addiction.

 

The natural history of the sex addict can often be quite tragic. The man starts to chase sexual ‘highs’ often involving situations of risk.  Risky sex enhances orgasm and sets the man in a trail of activity of escalating risk.  Eventually, it’s the chase of sexual activity that starts to take up more and more of the guys time.  In turn, sexual highs become harder and harder to achieve, a situation which, paradoxically, makes the ‘hit’ of a ‘good’ orgasm all the more addictive.  As the guy spends more and more time searching for sex and sexual activity, he spends less and less time with his friends and family. Social relationships are put at risk, and the man can become socially isolated.  Like other addictions, sex addicts can lose everything, partners, children, jobs, even liberty. 

 

So what can be done to help the sex addict?  One really good intervention is sex addicts anonymous.  This format is similar to narcotics anonymous and alcoholics anonymous based on regular self help group meetings.  Group meetings are a format that does not suit everybody.  I have had good results with clients using various cognitive behavioural techniques such as active monitoring of sexual behaviour and understanding thought processes. 

 

One theory of sexual addiction is that ‘sexual maps’ are laid down in childhood about age 7, and it is these sexual maps that guys continue to ‘act out’ as adults.  It seems appropriate that there is some therapeutic work undertaken aimed at understanding the origin of the sexual behaviour before cbt work is started.

 

Like all addictions, the hardest thing for me to work with is clients ambivalence about changing their behaviour.  Men often come to me in the ‘pre-contemplation’ phase of trying to decide whether to stop or not.  The good news is that if a man really wants to change, then the approach I use is really effective.  I can’t, however, make a man want to stop.  Unfortunately, for some men, they really do need to loose everything before change seems the best option.

 

One final word on the matter of shame.  Many men feel ashamed of their sexual behaviour and this inhibits them from coming forward for treatment.  I really understand and respect this.  My suggestion is that men choose a therapist who is experienced at working with sexual addiction, because such a therapist will be best able to help you explore your behaviour comfortably.  If seeing someone face-to-face is too intimidating at first, consider telephone counselling as many men find this safer.

 

If you want to find out more about sexual addiction, either for yourself or someone else, I can really recommend Patrick Carnes book on the subject, Out of the Shadows: Understanding Sexual Addiction which is now in its third edition and published by Hazelden.

Dr Phil Tyson is a Men's Psychotherapist based in Manchester in the UK.  He offers counselling in Manchester, psychotherapy in Manchester, cognitive behavioural therapy in Manchester and telephone counselling nationally and internationally.

Why do men engage in risky sex?

In this post I want to make a few remarks about men who engage in risky sex.  These won’t be evidence based remarks, more a speculative discussion based on my experience of working with men who engage in risky sex.

I guess the place to start is to give an indication of what I mean by ‘risky sex’.  I mean any kind of outdoor sex which contravenes laws of public decency.  At a relatively mundane level, there is the thrill of joining the mile high club, or sex on the beach. Where men can really get into difficulties, though, is in cruising for sex in dogging sites (for straight men) and public toilets (gay and bisexual men).  For some men, there is something about risk that enhances their sexual experience... and keeps them coming back for more.  Why is that?

I suppose along with risk comes an adrenalin rush.  For those men who cruise public places regularly, this adrenalin rush shouldn’t be underestimated.  For one thing, I suspect it is addictive in its own right.  Furthermore, it will be instrumental in bringing about a shift in mood.  This is important if guys are engaging in risky sex in order to break down the pain of ordinary living.  The risk, and the adrenalin, can make you feel ‘more alive’.

It should be remembered that for most people who cruise public places for sex, the majority of the time spent is in the cruising, and not in the sex itself.  Men can ‘chase’ sexual experiences, turning down some offers on route, always looking for the next ‘ideal experience’.  So when it comes, the excitement can be overwhelming.  What appears to be going on here is what in psychology we call a variable ratio reinforcement schedule.  What this means is that it’s a bit like gambling.  If every time you gambled you won, it wouldn’t be very exciting.  Gambling becomes exciting because you win infrequently.  It’s the same with cruising for sex.  Most of the time you draw a blank, so when it does occur, it reinforces the behaviour tenfold.

There is also the link with early sexual experiences.  For most men, discovering the pleasures of our dick was a fraught process, shrouded in clandestine fumbles under the sheets, and with always the fear of being caught by the parents.  Outdoor sex is directly analogous, just the parents are replaced by the local thugs or the police.  This may also be coupled with the declining sensitivity of men’s dicks as they get older.  As men, we are at our most virile in our late teens / early twenties.  As time passes we find it harder to get turned on.  Risky sex can remind us of when we first discovered our bodies.

I have also noticed with some men, cruising for sex fills an existential void.  It fills time.  The alternative, living a lifestyle full of friends and fun activities, is beyond them.  What the cruising does is fill time and prevents them from facing the deeper issues of social anxiety.  Of course the more time they spend cruising, the less able they become to engage in more productive activity, and it becomes a kind of viscous cycle.

I have also met some men who, paradoxically, use cruising for sex as a way of coping with anxiety.  For most of us, cruising outdoor places would make us anxious.  It does for these men too, but what they are able to do is attribute their general background anxiety to the cruising and make the plausible (but false) attribution “I’m anxious because I cruise” rather than the implausible to them  (but accurate) attribution “I suffer from chronic anxiety which I manage by cruising for risky sex”.

Before leaving this topic, there is an evolutionary perspective that can be brought to bear here.  Studies of other primates show that even though where a ‘harem’ system is in operation, with one alpha male dominating the troop, there is still a tendency for the subordinated females and males to engage in ‘risky fucking’ (and that’s a technical term!) when they feel the alpha male is distracted.  So perhaps evolution casts a long shadow across our sexual behaviour, leaving a residual desire for risky sex.  Indeed it has been shown that women are more likely to engage in risky sex on the day they ovulate, and are therefore most fertile.  But that’s a topic for another post ... and probably a different blog.

Dr Phil Tyson is a Men's Psychotherapist based in Manchester in the UK.  He offers counselling in Manchester, psychotherapy in Manchester, cognitive behavioural therapy in Manchester and telephone counselling nationally and internationally.