Bias in Affirmative Therapy for Sexual Compulsivity in Men

Rear view of silhouette of man sitting on bench watching the sun set in a cloudy gold skyGay men may be among the individuals who seek help for sex addiction. Some of these men may have recognized and accepted their orientation years earlier. Others may come to identify this part of who they are while they’re in the therapeutic process. There are also those who are heterosexual, though they may have had or fantasized about sex with men. People in any of these situations may experience a debilitating amount of shame. To truly help those who come to therapy for compulsive sexual behavior, therapists must be constantly mindful of the effects of stigma and how they, as therapists, might inadvertently contribute to those effects.

Affirmative therapy is a form of psychotherapy that focuses on helping non-heterosexual individuals work toward self-acceptance. In the context of men specifically, this approach can help create a safe space for men attempting to define who they are and who they want to be in a way that feels authentic to them, whether they are questioning their sexual orientation or identity or identify solely as heterosexual even though they have had or thought about having sex with men.

Taking an affirmative approach is critically important in clinical assessments and screening for sexual compulsivity. Clinical assessments and screening tools are almost always biased to represent particular groups; in the case of sexual compulsivity, such tools are likely to be skewed to represent heterosexuality. Therapists must recognize assessment biases and take their time to help the person seeking treatment develop a clearer picture of the issues that are important to them, in the process building affirming therapy goals.

Therapists helping men for sexual compulsivity also need to be aware of their biases and perceptions regarding LGBTQ+ populations and sexuality in general. LGBTQ+ people, as well as people who identify as heterosexual despite same-sex activities or fantasies, are at great risk of being shamed, judged, and labeled in therapy settings. Heterosexism can be used to attribute heterosexualized assumptions onto gay sex, for example. Furthermore, therapists must take care to avoid compressing sexual orientation into a binary system that excludes the self-identity of the person seeking help.

‘Healthy’ and ‘Unhealthy’ Sexuality

Men who identify as gay, bisexual, or queer, among other identities, have likely had to contend with people insinuating their orientation is “unhealthy” in some way. This can create shame surrounding this part of who a person is. Affirming therapy provides space for a person to identify personal definitions of healthy sexuality in a way that feels safe and open.

Affirming therapists also work with people to help them identify what types of relationship styles they want—committed, monogamous, nonmonogamous, or polyamorous, etc. They don’t support or advocate for relationship styles, as doing so is only likely to trigger the pain that has already been imposed by a long-standing, shameful belief system determined by the majority. Again, working to identify biases and counteract stigma is key here.

Considerations Regarding Porn

For many non-heterosexual men, pornography plays a unique role, as sexual education frequently avoids the topic of gay sexual experience. This isn’t to say pornography is the best educational tool, but it should be acknowledged as a reality for many gay men. Thus, sexual compulsivity therapy for gay men should include non-shaming sexual education, not simply an examination of the role pornography may play in any compulsive behavior.

It hurts to know and recognize where we judge and label others. However, not owning this reality may make it more likely a person in therapy will feel shamed by a therapist’s words or actions.

Of course, to provide meaningful sexual education, therapists need to make educating themselves an ongoing priority. There are many programs, continuing education courses, and classes that therapists can take. The American Association of Sexuality Educators, Counselors, and Therapists (AASECT) offers several educational resources. Many of these courses are offered via distance and web-based coursework.

Affirming therapists should talk with the individuals they work with about their beliefs surrounding the role of pornography in their lives, as doing so can help them further identify what, for them, constitutes healthy, authentic sexual expression.

All Therapists Hold Biases

It goes without saying that only helping professionals who are aware of their own biases should work with people in affirmative therapy. As with anyone else, it can be difficult for therapists to accept that they hold biases. It hurts to know and recognize where we judge and label others. However, not owning this reality may make it more likely a person in therapy will feel shamed by a therapist’s words or actions. A lack of awareness regarding their own biases and a reluctance or inability on the part of people in therapy to point them out may leave a therapist not even knowing that they have said or done something harmful.

Affirming therapists must be comfortable helping people explore their sexuality, but they also must be careful. When a therapist makes an assumption about a person’s sexual orientation, they can easily push the person toward something that doesn’t feel authentic. For example, a man might be gay or bisexual but not yet ready to accept that fact. If a therapist labels the person as non-heterosexual before that person is ready to accept their identity, it can create a much longer, more painful, and more shameful journey toward self-acceptance. Likewise, subtle pushing toward heteronormativity can have the same shame-inducing, negative effect.

Like many people, therapists often think about sexual orientation and expression in a binary framework: gay and straight. This excludes a multitude of other sexual orientations and identities. Orientation and identity labels are things people have to take on for themselves; they are not to be assigned by someone else. Anyone who is in the process of coming out or working toward acceptance of their orientation or identity will require time, space, and nonjudgmental support. It is the role of the affirming therapist to offer this space and to allow for the support needed for a person to identify who they are in a way that feels authentic to them.

© Copyright 2016 All rights reserved. Permission to publish granted by Michael J. Salas, MA, LPC-S, LCDC, CSAT, CST, Sexuality/Sex Therapy Topic Expert Contributor

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • Leave a Comment
  • Chris

    October 25th, 2016 at 9:10 AM

    That has to be so confusing you are trying your best to figure out what feels best for your life and to have no real guidance I assume it would be overwhelming.

  • cleo

    October 25th, 2016 at 10:26 AM

    I wouldn’t be good at this at all. I am pretty sure that my advice for others generally comes more from the point of view of looking at how it impacts me and not necessarily what would be best for the other person. In other words, I’m a pretty selfish person and I know that.

  • nate

    October 26th, 2016 at 8:23 AM

    It seems odd to me that you would have these thoughts and feelings and yet not really wish to act out on them?

  • Paulina

    October 26th, 2016 at 2:24 PM

    What does being gay have to do with being sexually addicted? That seems like it is simply an antiquated way of thinking, that you are gay so you are deviant. People this is the 21st century! It is time to move beyond this type of thinking and learn to be more accepting of others for who they are. Period. Don’t make someone feel so ashamed for who or what they are and cause them to see out therapy for something that they are not or do not even need!

  • Doug

    October 27th, 2016 at 7:31 AM

    No one ever wants to believe that their therapist could be biased against them, but they too are human and we all have our shortcomings.
    Now I would hope to figure this out about them before getting in too deep with them into therapy before they had a chance to really mess things up for me!

  • Solita

    October 28th, 2016 at 11:40 AM

    When you are in a professional position this is the time you have to NOT let your biases control your actions.

  • paige

    October 29th, 2016 at 10:33 AM

    Don’t you ever wish that people would simply be able to go into the professions that they are good at and not the ones where they may either be really terrible or have the chance to hurt another person?

    I think of therapists and teachers especially as a profession where you may go into it with the intent to only hurt but then you see that you really have these things that are holding you back from being great but you stick with it because, you know, that’s what you do.

    It is easier said than done, I get it, but wow, wouldn’t it be great if we could all find a place for ourselves where we would do no harm and make everyone feel good?

  • Jeremy

    October 30th, 2016 at 12:42 PM

    I am pretty sure that gay men are not the only people who seek answers to questions about their sexuality.

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