Introducing Gay Affirmative Therapy
According to his Instagram, the young man who walks into my office seems to have it all. Married, kids on the way, a husband who playfully tackles him on sun-drenched beaches, six-packs galore. But beneath this curated perfection sits a host of symptoms that tell a different story: depression, undiagnosed ADHD, a strange distrust bordering on disgust in regards to his own body, and intimate struggles with his partner of blaming or slamming doors that whisper of deeper wounds. While some of his anxiety stems from the cutthroat movie industry and family illness, none of this fully explains the man before me, masking his suffering, using substances to numb an underlying pain that Instagram filters can't touch, and still trying to charm me.
Yes, he’s affable—perhaps too affable. He is also, through no fault of his own, profoundly ahistorical. This means is not aware of his own developmental history and less aware of gay history—even though is an active part of it. Me, well, at 65 (though very youthful looking, I must add), I carry with me the weight of being a journalist and activist during the AIDS crisis. I am a student of a still “older generation" who embraced the joy and wonder of the early gay movement. They followed in the footsteps of lesbians who created ethical guidelines that broke with heteronormative values and rejected the hierarchies we see now—those based on looks, race, and class. By the time I had ended my first five-year relationship from 18 to 23, that was when Larry Kramer’s famous impassioned front page piece for the _New York Native_, entitled "1,112 and Counting", which was published on March 14, 1983. The following years led me to become an AIDS activist and journalist and then to enter into the field of gay-affirmative therapy to address the attack on gay lives my generation experienced.
I move quickly but carefully, helping him feel at ease by acknowledging the irony: those men in the waiting room who recognize him, who assume he's got it made, while we all hide our injuries from ourselves and the world. I paint him a picture of gay history with broad, cinematic strokes—he's a movie guy. A little bit of Stonewall, a touch of our gay icons: Plato, Sappho, Shakespeare, the homosexual gods of the Aztecs, queer traditions in Native American tribes. Then I gently probed what it was like for him growing up as a gay kid. I'm not diving deep into family trauma yet—just touching the surface where symptoms might spring from.
This is my way of challenging the notion that "the past is past." The imagination never forgets what happened to us; the proto-gay child within lives inside the present, showing up in tantrums, rebellion, greed, and self-destructive behavior. He might say, "Oh, I didn't realize I was gay until I was 15," but I know better. Gay feeling and experience exists from the beginning as a potential, an energy system that includes but extends beyond sexuality. I weave in the ideas that Gay Spirituality from 19th-century luminaries such as Edward Carpenter, Karl Ulrichs and Walt Whitman say what we today call Gay Spirit as an evolutionary force.
The story unfolds a father who was a homophobic bully who beat him for walking "like a girl" or trying on girls' clothes and an evangelical Christian mother managing her own OCD through prayer and an aversion to touch. While my new client loves his husband, he secretly pines for a man who rejected him five years ago, habitually torturing himself by scrolling through this man's Instagram, feeling the sting of rejection anew as he watches this former flame thrive in a new relationship with someone impossibly attractive.
While creating a safe space, I'm also mapping our therapeutic journey. He probably needs proper medication management—I suspect his depression might be more ADHD-related than mood-based (see Trevor Noah on YouTube). I want to give him a gay version of Harville Hendrix's "Getting the Love You Want," teaching him and his partner to speak in I-statements, to respond rather than react, to self-soothe rather than use each other as emotional dumping grounds without consent.
If possible, I'd like to introduce him to the Jungian method, helping him personify his feelings of numbness, sadness, and people-pleasing as a wounded gay child. Through active imagination, we can give voice to this child and the Inner Attacker who secretly shames him. His hatred of his body isn't really about his body at all—it's an innocent bystander. Perhaps it carries his mother's OCD-driven reluctance to hold him or his father's disgust at his gayness. With work, we can help him see that his shame body (appearing in dreams as a deformed, obese child) can be loved and separated from his actual physical self.
For now, we start with identifying feelings, labeling them, learning how to regulate them, noticing how he runs from a feeling into a thought, trying to teach him the value of “taking turns” in the therapy instead of monologuing, as his previous therapists have had no choice but to allow. Short-term goals include ADHD assessment, proper medication, journaling his rage rather than dumping it on his lover, possibly couples therapy, and reigniting his creativity through gratitude journaling and gay-positive media.
The longer arc of our work—the gay person's search for greater meaning, learning to embrace the shadow so that a bigger inner love can emerge—is the birthright of every gay man and the subject of another essay.
This Gay-Affirmative therapy/depth psychology I've developed arose from the birth of modern Gay Liberation, shaped by therapists who came out during and after Stonewall in 1969 and the Gay Sexual Revolution of the early 1970s. We rejected the sickness model that pathologized homosexuality, tracing our ideas back to Plato and his myth of the original round people in the Symposium. By 2000, the American Psychological Association had developed ethical guidelines for treating gay clients, asking clinicians to examine their own homophobic biases and understand the unique ways gay people create families, navigate internalized homophobia, and handle issues of coming out, career, and sexuality. Freudian and Jungian orientations, which concern the psychology of the soul, were wedded to LGBTQ perspectives, and I am a devotee of those marriages of gay and soul perspectives.
I'm proud to say I have been an active leader in part this movement, founding the nation's first LGBT Specialization in Clinical Psychology in 2006 and Colors LGBTQ Youth Counseling Center. The field continues to evolve, enriched by the work of pioneers like Don Clark, Richard Isay, Betty Berzon, Alan Downing, Mitch Walker, Alan Malyon, Carlton Cornett, and Dr. Lauren Costine. My forthcoming book, "Gay Sex and Love: One Group Learns How to Heal Itself," carries this torch forward.
