In 1961 a research team of the Society of Medical Psychoanalysts completed a nine year study of male homosexuality in which 77 of its members each filled out a detailed questionnaire that tapped information on a sample of 106 male homosexuals and a comparison group of 100 male heterosexuals in psychoanalytic treatment.

Since then, the authors have seen well over 1000 male homosexuals and about 100 pairs of their parents in direct, psychoanalytically focused interviews. In all regards, the data obtained are in accord with the research findings, thus strengthening its validity and reliability.

The developmental picture and family background of homosexuals have the following salient characteristics: The parents generally have an unsatisfactory relationship with each other but the mother forms an overly close bond with her homosexual son. She tends to dominate and restrict him and she discourages his assertiveness. Though there are variations in the pattern, most such mothers are close, binding and intimate (CBI), sometimes in sexually inappropriate ways. This son is usually her favourite whom she openly prefers to her husband. Within the family system, the CBI mother and son form a romantically tinged dyad, while the father and other siblings remain on the periphery. The son develops a profound dependency on the mother who often remains the most beloved person and focus of his life.

The father-son relationship is strikingly different. The fathers are hostile, competitive and do nothing to neutralize deleterious maternal influences. Patients’ reports of their father are almost always negative. He is virtually non-existent, rejecting, hostile, harsh or brutal. The fathers show neither love nor respect for this son. The authors have repeatedly noted that constructive, affectionate fathers preclude the development of homosexuality, though, conversely, hostile fathers do not necessarily produce homosexual sons. Boys who become homosexual, leave childhood with a profound fear and hatred of the father, yet retain a deep longing for paternal affection and acceptance — a central determinant of a homosexual orientation.

Relationships with siblings also tend to be disturbed. The siblings’ intense jealousy of the mother's favourite is more corrosive among other sons than daughters and it results in marked rivalry and hostility. Closely similar are the difficulties with same-sex peer groups. Prehomosexual boys are so traumatized by a hostile father and brothers, that they cannot cope with the aggressive, combative behaviour of young boys at play, hence are deprived of the needed ancillary opportunities for masculine identification and support. Often, the first meaningful contact with peers occurs in adolescence when the combativeness of the earlier years has abated.

The widely held theory that homosexuals fear women is not supported. They fear only a sexual relationship with a woman, a fear stemming from expectations of retaliation from aggressive men. The bisexual theory, also, is not supported. It asserts that humans are by nature bisexual and that homosexuals, unlike sexually balanced, normal people, have a preponderance of femininity. Homosexuals are physiologically normal. They become oriented to homosexuality as a substitute for heterosexuality because women are psychologically beyond reach.

Homosexuality offers complex defensive and reparative mechanisms for coping with fear of aggressive, rejecting men. Sexual arousal cues offer insights into the dynamics of such mechanisms. In a study by I. Bieber, three categories of stimulae were delineated: 1. the displacement of the heterosexual stimulus to a homosexual object; 2. the eroticization of the feared object; 3. arousal associated with affection shown by men.

Recent work in sexual identity, gender identity and gender role behaviour emphasizes the view that effeminate homosexuals and transvestites have, in early life, identified with the mother leading, in adult life, to an identification with women. According to the Bieber studies, homosexuals have a basically masculine identification but have a sense of impaired masculinity. This distinction not only influences psychotherapeutic strategy but may extend to decisions involving transsexual change.

The authors’ method of treatment is cognitive psychoanalysis, a process which delineates and evaluates irrational beliefs and irrational belief systems associated with fears of threat and injury. For those patients who might derive benefit from a group experience, T. Bieber offers individual sessions in combination with group sessions. The all-male homosexual group is preferred to the heterogeneous group. It has a less threatening, more familiar atmosphere, it facilitates verbalization and affective responses and offers an important peer group support system.

Reversal estimates now range from 30% to an optimistic 50%. A shift to heterosexuality does not mean that the potential for homosexual arousal has been totally extinguished, though in some cases this does occur. Should a post-analytic patient be faced with a recurrence of homosexual interest, he may short-circuit it by identifying the situation that has triggered anxiety about heterosexuality. By thoughtfully working out the dynamics by himself or with the analyst in a session or two, homosexual obsessions and other symptoms may be dissipated.

The view that homosexuality is but an alternate way of loving and that the psychopathology is a consequence of social discrimination and prejudice is not supported. Societal bias may add to feelings of anguish and unacceptability but as demonstrated in the homosexuality study and other publications, it is the destructive family relationships and other deleterious interpersonal influences that induce a homosexual adaptation.

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The Five Therapeutic Relationships

Male Homosexuality