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. But 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.
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.
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.
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.
Sexual identity and orientation encompasses one's sexual and romantic identity, in which thoughts, fantasies, and behaviors work together in concert. It's the alignment of affectional, romantic, psychological, spiritual, and sexual feelings and desires for those of the same or opposite gender. Sexual orientation doesn't change over time. One's sexual behaviors and preferences might change, but like one's temperament, one's orientation remains mostly stable. The term also refers to how someone self-identifies, not how others may categorize him or her. Some people self-identify as straight, while others self-identify as gay or lesbian, bisexual, or questioning. It's important as therapists to ask your clients how they self-identify, regardless of with whom they have sex.
Sexual preferences refer to sexual acts, positions, and erotic scenarios that someone prefers to have while engaging in sexual activity. The term takes into account what individuals like to do and get into sexually, not necessarily with whom they like to do it. Preferences and erotic interests can change over time, as one becomes more open or closed to certain thoughts and behaviors.
Sexual fantasies are any thoughts that one finds arousing. They can encompass anything—sexual positions, romantic encounters, body parts, clothing and shoe fetishes, even rape. Sexual fantasies aren't necessarily acted out. In fact, in many cases, they aren't.
Sexual behavior is any behavior intended to pleasure oneself and/or one's sexual partner. It doesn't necessarily reflect one's orientation. For example, men who are imprisoned engage in sexual behaviors with other men, but do so out of sexual necessity, not because of erotic interest in another man. They desire the behavior and the sexual release it achieves, and the gender of the partner is secondary.
Why Men Have Sex with Men
For straight men who have sex with men, same-sex encounters aren't about romance or sexual attraction and desire, but about sexual and physiological arousal—"getting off" with another who's male and accessible. They don't sexually desire or get aroused by looking at other men, only by the sexual act. But if they don't actively desire other men, how do they get to the point of having sex with them? These men typically want to bond with and get affection from other men. Their behavior may reflect a desire to experiment, to engage in something that's taboo, or to express inner psychological conflicts involving their sexual feelings and desires that have nothing to do with having a gay or bisexual identity.
Straight men who have sex with men do so for a variety of reasons. Some have been sexually abused and are compulsively reenacting childhood sexual trauma by male perpetrators; some find sexual release with another man more accessible; some have sex with men because it's easier and requires fewer social skills than those required to have sex with women; some are "gay for pay" and get financial rewards; some like the attention they receive from other men; some like anal sex, which they're otherwise too ashamed to talk about or engage in with their female partners.
When I learn that a straight client is having sex with men, I ask a series of questions: What is your interest in men? Do you prefer one type over another? Do you feel drawn and compelled to satisfy your sexual urges with men? Do you care about the physical appearance of the man? Do women play any role in the fantasy? Is it different for you if they aren't? I also try to listen for the themes running through their sexual interests and fantasies, which often decode aspects of their personal identity and histories.
I used this approach with Paul. When I asked him to describe his situation, he told me he was sexually aroused only by women, and that his fantasies mostly were about women and brought him to orgasm. I asked him what the men who were occasionally included in his fantasies looked like, and he told me that they were faceless; even their physiques didn't matter to him. Paul also told me that he always had sexual fantasies about men "controlling him" by telling him to please them. His most common and peak erotic fantasies included being "hypnotized or drugged" by the man whose spell he was under.
Links with the Past
In subsequent sessions, I asked Paul about sexual abuse because it can lead to homosexual behavior (not homosexual orientation), but he denied it. His father, he told me, was an alcoholic who frequently physically abused and humiliated him. Because Paul wasn't good at sports, his father taunted him, calling him a "girly" man. To test his mettle as a fighter, his father once initiated a fist fight that left Paul bruised and bleeding from his mouth. He longed to have his father's love and acceptance, but didn't know how to get it. His mother never intervened; instead, she'd comfort her son after these abusive episodes.
Paul was sympathetic to his mother. He saw how his father humiliated and intimidated her. Although she was never beaten, she lived under the threat of violence. He recalled that, as a child, he hated his father and wished him dead, so that he and his mother could have a nice life together.
I consider sexual fantasies and erotic interests—whether expressed in healthy or unhealthy ways—as inseparable extensions of our core identity. They're clues to the past. Often they're unsuccessful attempts to resolve problems from childhood that are somehow eased in the erotic realm.
I began to see Paul's sexual contacts with men as an attempt to resolve the conflictual relationship with his father. As he attempted, unconsciously, to master the abuse and humiliation he received from his father as a child, he placed himself in sexual situations where he was at risk and felt humiliated all over again. With the other man in control, Paul was "helpless." He was under the spell of the other man, who was intoxicated, just as his father had been.
Paul soon began to understand that he was "returning to the scene of the crime" for several reasons. First, he realized that he was not only angry at his father, but also "hungry" for the father he'd never had. He'd sought sex with men as a way of finding the nurturance and male acceptance he never received from his father. He tried to talk to his father about all the anger he'd accumulated since his childhood, but his father—still an active drinker—just laughed and called him weak.
Fortunately, he was able to feel my empathy for him and my sorrow for what he'd been through. He allowed me to "father" him in appropriate therapeutic ways. For example, he didn't have a lot of money, so he couldn't come more than once weekly, but I thought he needed more frequent sessions. So I allowed him to call me outside the therapy hour on my cell phone if he felt like going out and having sex with a man, so I could help him withstand the urge. He needed to feel that I was there for him when he experienced anxiety and traumatic feelings, and was overwhelmed with what he felt was my sincere interest in being available to him. His calls never lasted more than 15 minutes and were never more frequent than twice weekly for several months. He brought in his journal and left it with me to read, and I didn't charge him for my time.
Ultimately, Paul was able to hold his mother and father accountable for their negative behavior toward him in childhood. Having had an abusive father and neglectful mother, he came into treatment letting them off the hook and reenacting the trauma by displacing the anger and shame on himself and his fiancée. He needed a safe place to explore his sexual behavior without being labeled gay, bisexual, or even questioning. This wasn't a case that revolved around whether he was gay, but rather what his original trauma was and how it could be resolved. Had Paul not been heterosexual, his gay identity would have surfaced during treatment.
Coming Out Straight
Therapists who work with this population have to follow their clients' leads. The work is as much about education as psychotherapy. It's crucial to give each man who has sex with men information about homosexuality and the coming-out process, sexual abuse, sexual addiction, family-of-origin issues, and mood disorders that could contribute to the desire to have sex with males. However, as the work evolves, it's up to the client himself to decide if this is the beginning of the coming-out process, a sign of early sexual abuse, a sexual addiction, or some other form of acting out. It could also just be that once-in-a-while sex with men is something that a man might want, and means nothing more than that. As Freud is often said to have remarked, "Sometimes a cigar is just a cigar!"
This blog is excerpted from "Gay Guise" by Joe Kort. The full version is available in the July/August 2007 issue, Is Your Waiting Room Still Waiting?: How to Create a Successful Private Practice.
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Topic: Sex & Sexuality
Tags: 2007 | childhood trauma | childhood traumas | gay | gay clients | gay men | love | love and relationships | male sexuality | post-traumatic stress disorder ptsd | sex | Sex & Sexuality | sex life | sex therapist | sexual abuse | sexual fantasies | sexual orientation | sexuality | Trauma | trauma therapy | Traumatic memory | traumatized clients