Full, Wayne Stanley; (2021) Psychodynamic Psychotherapy and Same-Sex Sexual Orientation: An Empirical Investigation. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background. Historically, psychodynamic psychotherapy has pathologised same-sex sexual orientation and excluded lesbian, gay and bisexual (LGB) individuals from training as psychodynamic therapists. A mixed-method study aimed to clarify: (1) how UK psychodynamic therapists working today understood and thought about same-sex sexual orientation both theoretically and clinically; and (2) how the role of institutional psychodynamic training shaped the views and practice of UK psychodynamic psychotherapists working with LGB clients. / Methods. A self-completion clinical attitudes questionnaire was distributed to registrants of the British Psychoanalytic Council (BPC). Questionnaires were sent to 1403 registrants, 287 registrants returned valid responses — a 20% response rate. Descriptive statistics and chi-squared (2) tests were used to examine the quantitative data; open-ended responses were thematically analysed. Using a purposive sampling technique, 36 psychodynamic therapists were interviewed. A Framework Analysis identified ten overarching themes. / Results. The data suggests that, on the whole, psychodynamic therapists are now better informed about the ways in which societal stigma, family rejection, internalised homophobia, anti-LGB discrimination and the ‘coming out’ process contribute to the anxiety, depression and relationship conflicts reported by LGB clients in therapy. However, the research also indicates that therapists may not be as fully informed about specific aspects of LGB lives and norms as perhaps they could be, particularly in relation to sexual practices and relationship diversity. Many therapists continue to work within a predominantly heteronormative and monosexual understanding of love, relationships and sex. Therapists also showed less understanding of their bisexual clients compared to gay men and lesbians, and transgender emerged as an unexpected area of theoretical and clinical interest to therapists. Therapists continue to overvalue Oedipal, developmental and environmental theories for explaining the ‘origins’ of same-sex sexual orientation, despite empirical evidence showing that these types of explanations hold very little scientific weight, and that developmental and environmental factors play a negligible role in the development of same-sex sexual orientation. However, psychodynamic concepts about sexuality, such as the Oedipus complex, may still be useful therapeutic ideas for thinking about aspects of sexuality and relating (e.g., thirdness, identification, rivalry/exclusion) so long as they are understood more abstractly and metaphorically and are not assumed by practitioners to be ‘scientific’ theories of causation or aetiology of non-heterosexuality. The results further show that psychodynamic therapists’ clinical work with LGB clients oscillates between good practice in line with existing psychotherapy guidelines for this client group (APA 2012; BACP 2017; and BPS 2019) and practice that is biased, out-dated and potentially harmful. While the majority of therapists participating in the research no longer accept same-sex desire as an indicator of pathology or perversion, such thinking does not appear to be fully reflected in broader professional attitudes or psychodynamic trainings. Many clinical trainings do not appear to adequately cover LGB-specific issues or fully engage with other relevant disciplines (e.g., biogenetic studies, biopsychosocial studies, queer theory and social constructionism to name a few). While a few psychodynamic training organisations appear inclusive and are actively addressing issues of diversity and difference, anti-LGB discrimination persists at other training organisations and across the profession more generally. Quantitative analyses revealed some associations between therapists’ personal (e.g., gender, sexual orientation and age) and professional (e.g., therapeutic modality, theoretical affiliation) attributes and their theoretical thinking and clinical attitudes towards same-sex sexual orientation (e.g., Jungians were significantly more likely to acknowledge that their theories of same-sex desire needed updating than therapists with a purely psychoanalytic perspective). / Conclusions. In addition to their psychodynamic theories about same-sex sexual orientation, psychodynamic therapists may benefit from being better acquainted with the wider cultural and scientific evidence about sexual orientation that more fully accounts for and reflects LGB sexualities, including the evidence base demonstrating that: (1) sexuality has some biological and genetic basis; and (2) its meaning is inextricably shaped by cultural, social and historical factors. UK psychodynamic training organisations must continue their efforts to create a learning and professional environment that is non-discriminatory to LGB individuals. This may involve a broadening of the psychodynamic curriculum on sexuality and further institutional reform consistent with the BPC equality and non-discrimination polices in this area. The study contributes to knowledge by providing an up-to-date, descriptive analysis of UK psychodynamic therapists’ theoretical and clinical thinking about same-sex sexual orientation, consolidating findings from previous empirical attitudes research in this area.

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