ALBERT ELLIS, PH. D.

the use of PSYCHOTHERAPY with homosexuals

PSYCHOTHERAPY

Albert Ellis, Ph. D. VIRTUALLY NOWHERE in the extensive literature on homosexuality is to be found an account of the treatment of a sizeable number of homosexuals with psychotherapy. Accordingly, the writer began in 1951 to keep detailed records on all individuals with severe homosexual problems who were seen in his private practice in New York City. A report on some of the data gathered in this connection will soon be published in a professional journal; in the meantime, a summary of this report will now be given.

During the years 1951 to 1955, largely because of my publications on homosexuality and my known sympathetic attitudes toward inverts, I saw 53 individuals (41 males and 12 females) who had distinct homosexual problems and who came for psychotherapy mainly because of their homosexuality. Of these, 40 patients were seen for five or more sessions; 29 for ten or more sessions; and 7 for more than 50 şesions.

In seeing the 40 individuals who were seen for five or more sessions, an active form of psychoanalytically oriented phychotherapy was ployed, with the goal being as I have previously pointed out [1, 2, 3, 4] not. one of trying to get the patient to

forego ALL homosexual activities, but to enable him to overcome the EXCLUSIVENESS, the FEAR, the FETICHISTIC FIXATION, or the OBSESSIVE-COMPULSIVENESS which prevents him from having satisfactory heterosexual contacts. The 40 homosexuals seen for psychotherapy. therefore, were considered to be distinctly or considerably improved when, during the course of therapy, they began to lose their fears of the other sex and fully to enjoy and be effective in heterosexual relations.

The patients seen were largely young people: 18 being under 25 years; 19. between 26 and 35; and 3 over 36 years. Thirty-one of the patients were single; 5 married, 4 divorced or separated. One had a grade school education; 10 were on the high school level; 23 had some college training: 6 had graduate work.

Of the 40 patients who were seen for five or more sessions of psychotherapy, 28 were males and 12 females. Of the 28 males, 11 were found to show considerable improvement in their heterosexual relations, 7 to show distinct improvement, and 10 to show little or no improvement. Of the 12 females, 8 were found to show considerable improvement and 3 distinct improvement.

The female patients, when com-

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pared to the males, were found to be not as educationally advanced, to have had more previous heterosexual activity, and to be more desirous of making a better heterosexual adjustment. These differences did not prove to be statistically significant. At the same time, the female patients were found to be more improved as a result of treatment, to be more often married or divorced, and to be more seriously emotionally disturbed; and these differences did prove to be statistically significant.

Other relationships suggested by the data, but not proving statistically significant, were these: The better educated males seemed to improve more while being treated; the less disturbed males were more improved but the more disturbed females were more improved with treatment; individuals who had engaged in little or

heterosexual activity prior to treatment were more improved while undergoing psychotherapy; and the greater the length of the treatment, the more the tendency of the patients to improve in the course of it.

The one relationship that proved to be highly significant was that between the patients' desires to achieve heterosexual adjustment and their benefitting from psychotheraphy. Those who entered therapy with little or moderate desire to overcome their. homosexual problems (but who came, instead, mainly to work on other problems or to relieve their guilt over being homosexual) made some strides toward heterosexuality in 50 percent and considerable, strides in 15 percent of the cases. Those who came to therapy with a considerable desire to surmount their homosexual problems became somewhat more heterosexual in 100 percent and considerably more heterosexual in 80 percent of the cases.

The fact that there was such a significant relationship between the improvement in heterosexual relations of the patients studied and their desire for such improvement certainly seems understandable enough. This is often true for all kinds of psychotherapy patients: those who really want to get better, and who will do the hard work that is required in the course of active psychoanalytically oriented therapy, almost invariably make considerable improvements, and often in a relatively short length of time. Homosexuals, in particular, who are essentially phobic in that they fear hetersosexual participations and therefore take what seems to be the "easier" way out by engaging in homosexual activity, can, like most other phobics, overcome their emotional difficulties if they will (a) acquire insight into the origin of their fears and (b) get into action and begin to do the things they are afraid of doing. If, with the help of good motivation, they will permit a competent therapist to help, persuade, cajole, goad, and sometimes virtually force them to acquire this insight and to start doing what they fear, they will almost certainly succeed in overcoming their homosexual neurosis-or succeed in achieving satisfactory, eagerly sought after heterosexual relations. That, if anything, seems to be the main moral of this study.

In conclusion, it may be said that p:ychotherapeutic experience during the last several years with 28 males and 12 females with serious homosexual problems has conclusively indicated that exclusive homosexuality is certainly not constitutional, innate, or inherited, It is an acquired, or socially learned, pattern of behavior which can definitely be changed, and often in a surprisingly short per-