Homosexuality and psychology
||The examples and perspective in this article deal primarily with USA and do not represent a worldwide view of the subject. (May 2011)|
||This article needs attention from an expert in Psychology, Sexuality or LGBT studies. (November 2008)|
Psychology was one of the first disciplines to study homosexuality as a discrete phenomenon. Prior to and throughout most of the 20th century, common standard psychology viewed homosexuality in terms of pathological models as a mental illness. That classification began to be subjected to critical scrutiny in the research, which consistently failed to produce any empirical or scientific basis for regarding homosexuality as a disorder or abnormality. As a result of such accumulated research, professionals in medicine, mental health, and the behavioral and social sciences, opposing the classification of homosexuality as a mental disorder, claimed the conclusion that it was inaccurate, and that the DSM classification reflected untested assumptions that were based on once-prevalent social norms and clinical impressions from unrepresentative samples which consisted of patients seeking therapy and individuals whose conduct brought them into the criminal justice system.
Since the 1970s, the consensus of the behavioral and social sciences and the health and mental health professions globally is that homosexuality is a normal variation of human sexual orientation, while there remain those who maintain that it is a disorder. In 1973, the American Psychiatric Association declassified homosexuality as a mental disorder. The American Psychological Association Council of Representatives followed in 1975. Thereafter other major mental health organizations followed and it was finally declassified by the World Health Organization in 1990. Consequently, while some still believe homosexuality is a mental disorder, the current research and clinical literature demonstrate that same-sex sexual and romantic attractions, feelings, and behaviors are normal and positive variations of human sexuality, reflecting the official positions of the American Psychiatric Association and the American Psychological Association.
Major areas of psychological research 
Major psychological research into homosexuality is divided into five categories:
- What causes some people to be attracted to their own sex?
- What causes discrimination against people with a homosexual orientation and how can this be influenced?
- Does having a homosexual orientation affect one's health status, psychological functioning or general well-being?
- What determines successful adaptation to rejecting social climates? Why is homosexuality central to the identity of some people, but peripheral to the identity of others?
- How do the children of homosexual people develop?
Etiology of homosexuality 
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Numerous different theories have been proposed to explain the development of homosexuality, but there is so far no universally accepted account of the origins of a homosexual sexual orientation.
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Anti-gay attitudes and behaviors (sometimes called homophobia or heterosexism) have been objects of psychological research. Such research usually focuses on attitudes hostile to gay men, rather than attitudes hostile to lesbians. Anti-gay attitudes are often found in those who do not know gay people on a personal basis. There is also a high risk for anti-gay bias in psychotherapy with lesbian, gay, and bisexual clients.
One study found that "families with a strong emphasis on traditional values – implying the importance of religion, an emphasis on marriage and having children – were less accepting of homosexuality than were low-tradition families." One study found that parents who respond negatively to their child's sexual orientation tended to have lower self-esteem and negative attitudes toward women, and that "negative feelings about homosexuality in parents decreased the longer they were aware of their child's homosexuality."
One study found that nearly half of its sample had been the victim of verbal or physical violence because of their sexual orientation, usually committed by men. Such victimization is related to higher levels of depression, anxiety, anger, and symptoms of post-traumatic stress.
Mental health issues 
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Psychological research in this area includes examining mental health issues (including stress, depression, or addictive behavior) faced by gay and lesbian people as a result of the difficulties they experience because of their sexual orientation, physical appearance issues, eating disorders, or gender atypical behavior.
- Psychiatric disorders: In a Dutch study, gay men reported significantly higher rates of mood and anxiety disorders than straight men, and lesbians were significantly more likely to experience depression (but not other mood or anxiety disorders) than straight women.
- Physical appearance and eating disorders: Gay men tend to be more concerned about their physical appearance than straight men. Lesbian women are at a lower risk for eating disorders than heterosexual women.
- Gender atypical behavior: While this is not a disorder, gay men may face difficulties due to being more likely to display gender atypical behavior than heterosexual men. The difference is less pronounced between lesbians and straight women.
- Minority stress: Stress caused from a sexual stigma, manifested as prejudice and discrimination, is a major source of stress for people with a homosexual orientation. Sexual-minority affirming groups and gay peer groups help counteract and buffer minority stress.
- Ego-dystonic sexual orientation: Conflict between religious identity and sexual orientation identity can cause severe stress, causing some people to want to change their sexual orientation. Sexual orientation identity exploration can help individuals evaluate the reasons behind the desire to change and help them resolve the conflict between their religious and sexual identity, either through sexual orientation identity reconstruction or affirmation therapies. Therapists are to offer acceptance, support, and understanding of clients and the facilitation of clients’ active coping, social support, and identity exploration and development, without imposing a specific sexual orientation identity outcome. Ego-dystonic sexual orientation is a disorder where a person wishes their sexual orientation were different because of associated psychological and behavioral disorders.
- Sexual relationship disorder: People with a homosexual orientation in mixed-orientation marriages may struggle with the fear of the loss of their marriage. Therapists should focus exploring the underlying personal and contextual problems, motivations, realities, and hopes for being in, leaving, or restructuring the relationship and should not focus solely on one outcome such as divorce or marriage. Sexual relationship disorder is a disorder where the gender identity or sexual orientation interferes with maintaining or forming of a relationship.
The likelihood of suicide attempts is higher in both gay males and lesbians, as well as bisexual individuals of both sexes, when compared to their heterosexual counterparts. The trend of having a higher incident rate among females encompasses lesbians or bisexual females; when compared with homosexual or bisexual males, lesbians are more likely to attempt suicide.
Studies dispute the exact difference in suicide rate compared to heterosexuals with a minimum of 0.8–1.1 times more likely for females and 1.5–2.5 times more likely for males. The higher figures reach 4.6 times more likely in females and 14.6 times more likely in males.
Race and age play a factor in the increased risk. The highest ratios for males are attributed to young Caucasians. By the age of 25, their risk is more than halved; however, the risk for black gay males at that age steadily increases to 8.6 times more likely. Over a lifetime, the increased likelihoods are 5.7 times for white and 12.8 for black gay and bisexual males. Lesbian and bisexual females have the opposite trend, with fewer attempts during the teenager years compared to heterosexual females. Through a lifetime, the likelihood for Caucasian females is nearly triple that of their heterosexual counterparts; however, for black females there is minimal change (less than 0.1 to 0.3 difference), with heterosexual black females having a slightly higher risk throughout most of the age-based study.
Gay and lesbian youth who attempt suicide are disproportionately subject to anti-gay attitudes, often have fewer skills for coping with discrimination, isolation, and loneliness, and were more likely to experience family rejection than those who do not attempt suicide. Another study found that gay and bisexual youth who attempted suicide had more feminine gender roles, adopted a non-heterosexual identity at a young age and were more likely than peers to report sexual abuse, drug abuse, and arrests for misconduct. One study found that same-sex sexual behavior, but not homosexual attraction or homosexual identity, was significantly predictive of suicide among Norwegian adolescents.
Sexual orientation identity development 
- Coming out: Many gay, lesbian and bisexual people go through a "coming out" experience at some point in their lives. Psychologists often say this process includes several stages "in which there is an awareness of being different from peers ('sensitization'), and in which people start to question their sexual identity ('identity confusion'). Subsequently, they start to explore practically the option of being gay, lesbian or bisexual and learn to deal with the stigma ('identity assumption'). In the final stage, they integrate their sexual desires into a position understanding of self ('commitment')." However, the process is not always linear and it may differ for lesbians, gay men and bisexual individuals.
- Different degrees of coming out: One study found that gay men are more likely to be out to friends and siblings than to co-workers, parents, and more distant relatives.
- Coming out and well-being: Same-sex couples who are openly gay are more satisfied in their relationships. For women who self-identify as lesbian, the more people know about her sexual orientation, the less anxiety, more positive affectivity, and greater self-esteem she has.
- Rejection of gay identity: Various studies report that for some religious people, rejecting a gay identity appears to relieve the distress caused by conflicts between religious values and sexual orientation. After reviewing the research, Judith Glassgold, chair of the American Psychological Association sexuality task force, said some people are content in denying a gay identity and "there is no clear evidence of harm".
Fluidity of sexual orientation 
The American Psychiatric Association (APA) states that "some people believe that sexual orientation is innate and fixed; however, sexual orientation develops across a person’s lifetime". In a statement issued jointly with other major American medical organizations, the American Psychological Association states that "different people realize at different points in their lives that they are heterosexual, gay, lesbian, or bisexual". A report from the Centre for Addiction and Mental Health states that, "For some people, sexual orientation is continuous and fixed throughout their lives. For others, sexual orientation may be fluid and change over time". Lisa Diamond's study "Female bisexuality from adolescence to adulthood" suggests that there is "considerable fluidity in bisexual, unlabeled, and lesbian women's attractions, behaviors, and identities".
LGBT parenting is when lesbian, gay, bisexual, and transgender (LGBT) people are parents to one or more children, either as biological or non-biological parents. Gay men have options which include "foster care, variations of domestic and international adoption, diverse forms of surrogacy (whether "traditional" or gestational), and kinship arrangements, wherein they might coparent with a woman or women with whom they are intimately but not sexually involved." LGBT parents can also include single parents; to a lesser extent, the term sometimes refers to parents of LGBT children.
In the 2000 U.S. Census, 33 percent of female same-sex couple households and 22 percent of male same-sex couple households reported at least one child under eighteen living in their home. Some children do not know they have an LGBT parent; coming out issues vary and some parents may never come out to their children. adoption by LGBT couples and LGBT parenting in general may be controversial in some countries. In January 2008, the European Court of Human Rights ruled that same-sex couples have the right to adopt a child. In the U.S., LGB people can legally adopt, as individuals, in all fifty states.
Although it is sometimes asserted in policy debates that heterosexual couples are inherently better parents than same-sex couples, or that the children of lesbian or gay parents fare worse than children raised by heterosexual parents, those assertions are not supported by scientific research literature. There is ample evidence to show that children raised by same-gender parents fare as well as those raised by heterosexual parents. Much research has documented the lack of correlation between parents' sexual orientation and any measure of a child's emotional, psychosocial, and behavioral adjustment. These data have demonstrated no risk to children as a result of growing up in a family with one or more gay parents. No research supports the widely held conviction that the gender of parents influences the well-being of the child. If gay, lesbian, or bisexual parents were inherently less capable than otherwise comparable heterosexual parents, their children would present more poorly regardless of the type of sample. This pattern has not been observed. Given the consistent failures in this research literature to disprove the null hypothesis, the burden of empirical proof is on those who argue that the children of sexual minority parents are worse off than the children of heterosexual parents.
Professor Judith Stacey, of New York University, stated: “Rarely is there as much consensus in any area of social science as in the case of gay parenting, which is why the American Academy of Pediatrics and all of the major professional organizations with expertise in child welfare have issued reports and resolutions in support of gay and lesbian parental rights”. These organizations include the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, the American Psychiatric Association, the American Psychological Association, the American Psychoanalytic Association, the National Association of Social Workers, the Child Welfare League of America, the North American Council on Adoptable Children, and Canadian Psychological Association (CPA). CPA is concerned that some persons and institutions are misinterpreting the findings of psychological research to support their positions, when their positions are more accurately based on other systems of belief or values.
The vast majority of families in the United States today are not the "middle class family with a bread-winning father and a stay-at-home mother, married to each other and raising their biological children" that has been viewed as the norm. Since the end of the 1980s, it has been well established that children and adolescents can adjust just as well in nontraditional settings as in traditional settings.
Most people with a homosexual orientation who seek psychotherapy do so for the same reasons as straight people (stress, relationship difficulties, difficulty adjusting to social or work situations, etc.); their sexual orientation may be of primary, incidental, or no importance to their issues and treatment. Regardless of the issue that psychotherapy is sought for, there is a high risk of anti-gay bias being directed at non-heterosexual clients.
Relationship counseling 
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Most relationship issues are shared equally among couples regardless of sexual orientation, but LGBT clients additionally have to deal with homophobia, heterosexism, and other societal oppressions. Individuals may also be at different stages in the coming out process. Often, same-sex couples do not have as many role models for successful relationships as opposite-sex couples. There may be issues with gender-role socialization that does not affect opposite-sex couples.
A significant number of men and women experience conflict surrounding homosexual expression within a mixed-orientation marriage. Therapy may include helping the client feel more comfortable and accepting of same-sex feelings and to explore ways of incorporating same-sex and opposite-sex feelings into life patterns. Although a strong homosexual identity was associated with difficulties in marital satisfaction, viewing the same-sex activities as compulsive facilitated commitment to the marriage and to monogamy.
Gay affirmative psychotherapy 
Gay affirmative psychotherapy is a form of psychotherapy for gay and lesbian clients which encourages them to accept their sexual orientation, and does not attempt to change their sexual orientation to heterosexual, or to eliminate or diminish their same-sex desires and behaviors. The American Psychological Association (APA) offers guidelines and materials for gay affirmative psychotherapy. Practitioners of gay affirmative psychotherapy states that homosexuality or bisexuality is not a mental illness, and that embracing and affirming gay identity can be a key component to recovery from other mental illnesses or substance abuse. Some people may find neither gay affirmative therapy nor conversion therapy appropriate, however. Clients whose religious beliefs are inconsistent with homosexual behavior may require some other method of integrating their conflicting religious and sexual selves.
Sexual orientation identity exploration 
The APA recommends that if a client wants treatment to change his sexual orientation, the therapist should explore the reasons behind the desire, without favoring any particular outcome. The therapist should neither promote nor reject the idea of celibacy, but help the client come to their own decisions by evaluating the reasons behind the patient's goals. One example of sexual orientation identity exploration is Sexual Identity Therapy.
After exploration, a patient may proceed with sexual orientation identity reconstruction, which helps a patient reconstruct sexual orientation identity. Psychotherapy, support groups, and life events can influence identity development; similarly, self-awareness, self-conception, and identity may evolve during treatment. It can change sexual orientation identity (private and public identification, and group belonging), emotional adjustment (self-stigma and shame reduction), and personal beliefs, values and norms (change of religious and moral belief, behavior and motivation). Some therapies include Gender Wholeness Therapy. Participation in an ex-gay groups can also help a patient develop a new sexual orientation identity.
The American Psychiatric Association states in their official statement release on the matter: "The potential risks of 'reparative therapy' are great and include depression, anxiety, and self-destructive behavior, since therapist alignment with societal prejudices against homosexuality may reinforce self-hatred already experienced by the patient. Many patients who have undergone 'reparative therapy' relate that they were inaccurately told that homosexuals are lonely, unhappy individuals who never achieve acceptance or satisfaction. The possibility that the person might achieve happiness and satisfying interpersonal relationships as a gay man or lesbian are not presented, nor are alternative approaches to dealing with the effects of societal stigmatization discussed. APA recognizes that in the course of ongoing psychiatric treatment, there may be appropriate clinical indications for attempting to change sexual behaviors."
The American Psychological Association aligns with this in a Resolution: it "urges all mental health professionals to take the lead in removing the stigma of mental illness that has long been associated with homosexual orientation" (Conger, 1975, p. 633); and "Therefore be it further resolved that the American Psychological Association opposes portrayals of lesbian, gay, and bisexual youth and adults as mentally ill due to their sexual orientation and supports the dissemination of accurate information about sexual orientation, and mental health, and appropriate interventions in order to counteract bias that is based in ignorance or unfounded beliefs about sexual orientation."
The American College of Pediatrics advises people struggling with their sexuality: "You are normal. Homosexuality is not a mental disorder. All of the major medical organizations, including The American Psychiatric Association, The American Psychological Association, and the American Academy of Pediatrics agree that homosexuality is not an illness or disorder, but a form of sexual expression. No one knows what causes a person to be gay, bisexual, or straight. There probably are a number of factors. Some may be biological. Others may be psychological. The reasons can vary from one person to another. The fact is, you do not choose to be gay, bisexual, or straight."
Developments in Individual Psychology 
In contemporary Adlerian thought, homosexuals are not considered within the problematic discourse of the "failures of life". Christopher Shelley (1998), an Adlerian psychotherapist, published a volume of essays in the 1990s that feature Freudian, (post)Jungian and Adlerian contributions that demonstrate affirmative shifts in the depth psychologies. These shifts show how depth psychology can be utilized to support rather than pathologize gay and lesbian psychotherapy clients. The Journal of Individual Psychology, the English language flagship publication of Adlerian Psychology, released a volume in the summer of 2008 that reviews and corrects Adler's previously held beliefs on the homosexual community.
See also 
- Association of Gay and Lesbian Psychiatrists
- Conversion therapy
- Ego-dystonic sexual orientation
- Minority Stress
- Case No. S147999 in the Supreme Court of the State of California, In re Marriage Cases Judicial Council Coordination Proceeding No. 4365(…)
- American Psychological Association: Appropriate Therapeutic Responses to Sexual Orientation
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