Working With Teenagers

From the NARTH Collected Papers, 2003

Every year, my office receives calls from concerned parents of teenagers. These calls typically result from the shocking discovery of their son's visits to gay pornographic web sites.

This revelation usually prompts a long-overdue family discussion to face the problem of the direction of their son's developing sexual identity. This discussion often culminates in the parents bringing their son to therapy.

Parents who send their sons to me are aware that I work only with men who seek to overcome their homosexuality. These are parents who would not knowingly bring their child to a Gay-Affirmative therapist. Out of respect for the parent's values, the therapist should work within previously understood parameters. Too many naïve parents are angered to discover, very belatedly, that a trusted therapist has been working in direct opposition to the parents' values and objectives, and has been confirming their son in a gay identity--linking him up with gay political groups, undermining the family's religious beliefs, even encouraging the teenager to experiment sexually.

We believe that parents deserve to have assurance of any therapeutic agenda involving their child. In such an intensely values-laden area of psychotherapy as sexuality, no therapist should have free rein to support the child in claiming any lifestyle option he chooses. The false claim of many therapists that they are operating with "complete therapeutic neutrality" on such values-laden issues rightly frustrates parents, and in practice - is not even workable, or in fact honest. Directly clarifying our view of homosexuality to parents will reduce their anxiety about the therapeutic process and facilitate their own "backing off" from pressuring their son about his lifestyle.

At the first session, the teenage client is told clearly where I'm coming from, and we attempt to establish a working alliance within that boundary.

Only a very small percentage of teenagers who are brought in unwillingly by the parents actually continue in such therapy. However, even if we fail to build a therapeutic alliance, these sessions are an opportunity for them to consider how their own childhood experiences may have shaped their attractions, and also, to hear a perspective that they won't hear elsewhere.

The distinct needs of the young male between the ages of 13-20 call for particular intervention strategies. (For pre-teenagers, we recommend a different approach involving parental coaching, detailed in A Parent's Guide to Preventing Homosexuality, Nicolosi and Nicolosi, 2002).

Special considerations for the adolescent male in treatment include ambivalent commitment to treatment; intense sexual feelings; unformed personal identity; high susceptibility to the influence of media, peers and pop culture; teenage narcissism; age-appropriate rebellion; poor impulse control; the need to learn through experience; having an uncertain sense of morality; and high vulnerability to the influence of gay websites. Added to this, is the overall difficulty in maintaining disciplined commitment to anything. In spite of all the above obstacles, we continue to be impressed by the rare teenager who sustains a clarity and conviction toward overcoming his same sex attractions.

Confidentiality
The issue of confidentiality is especially important, requiring the therapist's ongoing sensitivity in preserving a working atmosphere of uncompromised privacy. Limits of confidentiality should be spelled out, including the therapist's obligation to inform parents about self-destructive behaviors, with special mention of dangerous sexual activities.

Often it is the parents who attempt to compromise the bounds of confidentiality, seeing the therapist as their paid agent to "fix Junior." They may expect clandestine progress reports.

In the first session, I clearly inform the client that he has been asked by his parents to consider exploring the possibility of change, but we agree from the start that I will not manipulate him in that direction. Ultimately, his life choices must be his own, and I explain to him that if he should feel like I am manipulating him or negatively judging him, that he needs to address this problem with me openly.

Also during the first session, it may be helpful for the therapist to explain that he will not convey specific details of their son's life to the parents, but instead, will give them a general report of his overall progress. In practice, this is what most assures parents. Nevertheless, to avoid problems, the therapist should first "clear" with the teen what he can say before speaking to his parents
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The Importance Of Salient Men

To offset his susceptibility to the popular cultural influences of television, movies and the internet, the adolescent requires additional support beyond psychotherapy, most importantly from salient men. A "salient man" is defined as a male perceived by the client as both benevolent and strong. The therapeutic necessity for salient men cannot be overstated. Men who understand, accept, and actively support these efforts for change can be the single most important factor in determining the therapeutic outcome.

Previously, we attempted to connect the teenage client with his peers in treatment, but that strategy proved these youngsters to be unprepared to offer the necessary support and guidance. Rather, we seek older men as mentors - counselors and coaches; and for older teens, straight male friends; an older brother, and most importantly, the father.

The Role Of The Father

Unlike the adult client whose father may be deceased or very old, the adolescent's younger-aged father may be more available to participate in treatment. To whatever extent possible, we attempt to include the father in the treatment.

A critical evaluation must be made to determine the father's emotional availability. The father's psychological limitations will determine the extent to which he can actively participate in his son's healing - namely, responding to his son's emotional needs - and to what extent the teen must resolve (grieve) his father's unavailability.

When appropriate, father-son dyadic sessions can be helpful to create a deeper level of communication. In such sessions, the therapist is listening in terms of double binds and double loops. These father-son dyads are of further value to both client and therapist to later assess the father's realistic potential to respond to the son's needs.

The Obstacle Of The Gay Self-Label

Particularly for the adolescent, growth in sexual identity and self-identity are strongly intermeshed. For the teen who is resistant to change, claiming a gay identity can serve as a means of distancing himself from the therapist. The gay self-label can serve a double-bind function by engaging the therapist in intellectual sparring in order to keep this emotional distance.

The teenager may have already discovered the power of gay advocacy in neutralizing his own parents' influence. Avoid debate; rather than try to convince him, return to his own experience, listening in terms of the assertion-vs.-shame conflict.

Fundamental to reparative therapy is the understanding that homosexuality is a symptom of this A«S conflict. Without making the diminishment of homosexuality the agreed-upon goal of therapy, the therapist can still focus on assisting the teen solve his day-to-day problems, which often involve interpersonal conflicts, and those conflicts often prove to be Assertion-Shame conflicts. The client will soon discover that much of his assertion needs are direct or indirect expressions of his masculine drives. Rather than being a "covert" therapeutic strategy, it is advisable that this understanding be clearly explained to the client

"Expose" Versus "Impose"
If the client disagrees with the therapist's views on homosexuality, then the foundation of the working alliance can be to "agree to disagree." In other words, the therapist exposes his views on homosexuality, but he doesn't impose them on the client. We explain that we see homosexual attractions as an adaptation to certain early emotional deprivations, and that the attempt to compensate for ("repair") these early deprivations is, in our view, the reason for the client's same-sex attractions. Further, we explain that with corrective experiences in the present, those attractions may diminish.

It is important to remember that many homosexual clients, feeling betrayed by their earliest relationships, are hyper-distrustful and alert to manipulation. This is especially true for the adolescent client who is negotiating with an adult. By openly explaining his views on homosexuality, the therapist avoids imposing his ideas and clarifies that the client is free to disagree.

A«S Conflict:
Begin And End With His Experience
The high level of narcissism common to all adolescents requires any and all therapeutic interventions to be closely linked to their personal experience. Typically, the teenager's personal frame of reference must be the beginning and end of any intervention. This means that we will not focus primarily on the question of "gay" versus "not gay," but instead, we will address the development of the confident, assertive, manly, and strong person that he himself wants to be--overcoming the "false self" that harbors feelings of intimidation, inhibition, unmanliness, and hidden shame.

We, therefore, put aside the issue of change as the goal, and rather we address the assertion issues and interpersonal conflictual issues that concern him. These issues inevitably return the client to the original conflict of self-assertion vs. yielding to shame.

The therapist must believe that supporting the client's assertion of self - even if he is gay-identified - will in fact diminish his same-sex attractions. More importantly, regardless of whether or not there is any sexual-orientation change as a result of therapy, an authentic therapeutic relationship with a man who respects, values and understand him will ultimately be of benefit to the client.

References

Nicolosi, Joseph and Linda Ames Nicolosi (2002) A Parent's Guide to Preventing Homosexuality. Downers Grove, Ill.: InterVarsity.