2007 July/August Psychotherapy Networker Magazine
What to do when your client has sex with men, but is straight
By Joe Kort
Paul, a slim, attractive, 29-year-old white man who owns a landscaping company, was referred to me by his therapist (with whom he was making no progress) shortly after he attempted suicide. He told me that eight months previously, Julie, his fiancée, had discovered that he’d been having unprotected anal sex with men. When she confronted him, he denied it, but soon broke down and confessed. Devastated and angry, she broke off their engagement, accusing him of being duplicitous (she believed they were monogamous) and secretive. Worst of all, she felt frightened that he’d put her at risk for HIV and other sexually transmitted diseases.
Paul loved Julie and said he knew she was the woman for him. They’d dated for three years and been engaged for one. He hadn’t told her about his homoerotic tendencies, nor had he confessed his suspicions that he might be bisexual. Then again, he thought every guy had some homoerotic thoughts that he probably kept private. He couldn’t understand why Julie was so angry with him or why she didn’t try to understand what he was going through.
Instead, Julie had rebuffed all his desperate and obsessive attempts to win her back. Ultimately, she’d had a restraining order issued against him. Shortly after this, Paul engaged in a binge of sexual acting-out with both men and women, culminating in the suicide attempt that brought him to my office.
This has happened many times: a man comes into my office, referred by his own therapist and clutching coming-out literature the therapist has given him. He explains that his therapist has tried, unsuccessfully, to help him come out as a gay or bisexual man. But even though he’s had sex with other men or gone to gay male Internet porn sites, he insists he isn’t gay. He says he isn’t homophobic, either; if it turns out that he is gay or bisexual, he’ll accept it and move on with his life—but it just doesn’t feel right to him.
Historically, psychotherapy assumed homosexuality was a psychological disorder. Therapists focused on helping clients “recover” and find their innate heterosexuality, much to the harm of many gays and lesbians. During the last three decades, in reaction to these prejudiced and destructive attitudes, we’ve seen the pendulum swing so far the other way that it’s now become almost a therapeutic credo, not to mention a requirement of political correctness, to assume that men who have sex with men are “in denial,” and that the clinician’s job was to help them recognize and accept their “true” homosexual orientation. In fact, neither extreme represents the experience of many men.
The truth is that many men who have sex with men aren’t gay or bisexual. Although their confused mental and emotional state resembles that of the initial stages of coming out, gay men go on to develop a gay identity, whereas these men don’t.
Therapists who treat such men need to realize that just because a client is sexual with the same gender doesn’t necessarily reflect his sexual or romantic orientation. While we may believe we’ve accurately assessed whether a client is gay, it isn’t up to us as therapists to make this judgment. Countertransference, cultural stereotypes, and personal feelings too often enter the therapy room and complicate our work—particularly with these clients. Therapists need to help such clients discover for themselves whether they’re acting out a gay or bisexual identity by asking the right questions and by agreeing on a shared vocabulary.
Understanding Straight Men Who Have Sex with Men
There’s growing evidence that many men who have sex with men aren’t all gay or bisexual. According to the Centers for Disease Control, more than 3 million men who self-identify as straight secretly have sex with other men—putting their wives or girlfriends at risk for HIV infection and other sexually transmitted diseases. A recent New York City survey that appeared in the September 19, 2006, issue of the Annals of Internal Medicine found that nearly 1 in 10 men say they’re straight and have occasional sex with men. In addition, 70 percent of these men are heterosexually married. In fact, 10 percent of all married men in this survey reported engaging in same-sex behavior during the previous year.
To best treat these men, therapists and clients need to be able to differentiate four terms that are often confused: sexual identity and orientation; sexual preferences; sexual fantasies; and sexual behavior. Contrary to common usage, they aren’t always in alignment.
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