Gay-affirmative Therapy and Emerging Integrative Solutions.
Authors: Kirby Andrew 
Published: October 2024

A dichotomy exists in the literature in relation to treating ego-dissonant gay clients who struggle to reconcile their same-sex attraction with opposing values and beliefs. Historically, conversion therapy was the treatment of choice, which aimed to treat the "condition" (homosexuality) by changing an individual's homosexual orientation to heterosexual. In recent years, as public opinion has shifted toward increased tolerance and acceptance of homosexuality, gay affirmative therapy has gained popularity and advanced as the modality most likely to benefit the majority of ego-dissonant gay clients. However, each position has tended to respond with a limited, exclusionary choice: to either reject or accept one's sexual orientation. This dichotomised treatment option may not serve all clients who seek help in dealing with conflicts regarding sexual orientation. The first instalment of this two-part discussion appeared in the New Zealand Journal of Counselling, vol. 28(2), and reviewed gay-affirmative therapy: its history, the developing relationship between the mental health profession and homosexuality, and key concepts of practice from different theoretical perspectives. In this second instalment, emerging integrative solutions appearing in the literature are examined, including a sexual identity management model, and a Kleinian perspective is offered as a way of working with individuals who are unable to accept, change or integrate competing aspects of their identity. This study recognises that each approach caters, to some degree, to the uniquely different needs of individuals. This article, the second in a two-part series, continues to explore the issue of working with ego-dissonant gaymale clients. In the first part of this series, the author examined gay-affirmative therapy, recognising that this relatively new approach, which values and endorses individuals' sexual orientation, has advanced to become the modality of choice for most clinicians working with individuals who struggle to accept their sexuality. Whereas historically, conversion therapy attempted to change one's sexual orientation, many contemporary gay-affirmative therapists assert that the target of change is not the individual, but rather, culture. Current research suggests that gay-affirmative therapy helps most of those who experience their homosexuality as ego-dissonant to achieve an increased sense of identity, integration and wellbeing. Yet there are others who value all aspects of their identity equally, and do not wish or are not ready to choose a conventional gay-affirmative approach for fear that their sexuality might be validated at the expense of competing values or beliefs, such as holding on to traditional values regarding marriage and family, or religious doctrines that view homosexuality as unnatural and immoral. The ongoing debate about whether one should accept or reject one's sexuality has rendered dichotomous explanations insufficient for such clients, for whom neither conversion therapy nor gay-affirmative therapy seems appropriate. In this article, emerging integrative solutions which cater to the needs of this minority of ego-dissonant gay clients are examined. Following this review, a Kleinian model is proposed as a way to think about and work with clients who are unable to resolve perceived irreconcilable differences between sexual feelings and opposing personal values and beliefs. [ABSTRACT FROM AUTHOR] Copyright of New Zealand Journal of Counselling is the property of New Zealand Association of Counsellors and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)