Confronting Religious Moralism in Therapy for Gay Men

Background

I’m very proud to have been a gay men’s specialist psychotherapist, life/career/relationship coach, and AASECT Certified Sex Therapist.  I run my full-time, Monday through Friday, online private practice out of my home office in West Hollywood, California.  And even though I’ve been doing this for 32 years now, in 2024, I’m really bad at publicizing myself so you might not have heard of me rather than other “big names” among gay male therapists.  That’s show biz.

And as much as I enjoy supporting gay men’s mental health and well-being, through my practice, blog, and podcasts, I also feel an obligation to also identity as an activist.  Ever since the height of the AIDS crisis, I made a commitment to myself and my brothers in the gay male community, as well as others in the broader LGBT community, to speak out, in honor of my friends, colleagues, and heroes who died during the AIDS crisis and aren’t around to speak up anymore.  You could say I found my voice, when they lost theirs.

There’s only so much any one person can do when it comes to activism, advocacy, and social justice work, and a previous (blog article/podcast episode) talked about this, about acting as an individual in order to affect the collective; to act locally to effect change globally.

So when you combine my identity as a mental health professional clinician, with the coaching and sex therapy components that came later, with my identity as an LGBT/gay men’s advocate and activist , I end up having lots to say.

I also have a  lot to say because not only am I the most experienced gay men’s specialist psychotherapist in the United States today, I also have over 20 years of experience as a clinical supervisor, teaching new graduates of Master’s programs therapy interventions, assessment, diagnosis, legal/ethical issues, and professional development to those new therapists who are accumulating the over 3,000 hours of supervised clinical experience that is required before you can sit for state licensing exams to become a therapist in California (and other USA states).  I’m also a retired educator from the University of Southern California (USC), where I taught an LGBT course, psychotherapy practice, and couples therapy to graduate MSW students.

Mental Health Professional Disciplines

Clinical Social Workers, like me, as opposed to most psychologists, have a greater emphasis on their clinical work at the individual, small group, and large system levels being in the context of working for social justice, and being the “agents of social change.”  This takes into consideration the cultural context, and the cultural competency, that it takes to work with our clients, who are very diverse.  Even though I work exclusively with gay men, with rare exceptions, I still see a great variety of ages, ethnicities, nationalities, cultures, and personalities, mostly in California but also all over the United States, and the world.

So when I look at the current state of psychotherapy and other professional mental health services delivery systems across the state, country, or the world, I have a lot to say.

Perhaps the biggest frustration I have, when I look at how mental health services in general and psychotherapy services in particular are delivered, I see way too much influence of religious bias in therapy, which is a secular science, like medicine, or chemistry, or physics, or mathematics.  I cringe when I hear about “Christian Counselors” because I see this not as an attempt to really help clients in need, but to help clients in need with an agenda of proselytizing to promote a social – and legal, as in “black letter Law of the Land” conservative Christian point of view, which usually includes “support” as the outer shell or clothing for the Trojan Horse of some pretty dangerous bigotry, especially against women and LGBT people, but also against immigrants and others.  I see “Christian Counselors” as being zealots who are not content to practice their religion in private, or in groups of like-minded people, but trying to split the difference between a secular science like mental health, psychology, and psychiatry, and their identity as a “true believer” devotee and adherent to a very specific – and very limited – world view that conservative Christians have.

The“liberal Christian counselors”, although they exist, I find rare.  Most “Christian counselors” that are around are associated with conservative churches, conservative dogma, and a very aggressive mission to promote a conservative Christian worldview on their clients and everyone in their sphere of influence, regardless of what their client is going through.

I’ve often said, “What is a Christian appendectomy?” meaning that if medicine is about body systems, biochemistry, anatomy, and pathology, so is mental health.  An appendectomy doesn’t change based on what religion you are, and neither should Cognitive Behavioral Therapy for a Major Depressive Disorder, either.

While helping a client rally their strengths as part of treatment is customary, and this can include their spirituality, as a positive internal (their faith/religion/belief) and external (their church, pastor, community peers) can aid in overall mental health and well-being, so can anything a client finds empowering or supportive or comforting or amusing, like watching their favorite TV show, but we don’t have “TV Counselors.” (although my clients would be the first ones to say I make a lot of television history references in my sessions, with clients, especially from gay iconic shows like “The Golden Girls.”

And the reason I’m not a fan of Christian counseling or any other therapy/counseling opportunity in an organized religious context is because it creates a dichotomy or a split focus between the mission of helping the client and the forwarding of a social and cultural crusade to have society be a certain way, which in their world view is correct, and right, and righteous, and all other opinions, beliefs, practices, and ways of life are “sinful” or otherwise illegitimate.

And when gay men seek therapy, just any other client, and they are confronted with finding therapy and a therapist who is contaminated with religious moralism, however subtle – and it’s often very subtle, as I will explain — in their treatment, it’s a problem.  It undermines true progress and can actually do more harm than good, when therapists have the same Hippocratic Oath that physicians do, “First, do no harm.”

I spend a considerable portion of my clinical hours with gay male clients trying to “un-do” the damage some of these therapists have caused in their prior treatment.  It’s a lot to recover from, so much so that “religious abuse recovery” is a topic in therapy, because it’s so corrosive to the person, and so unfortunately unwelcome and prevalent in our society.

There can be religious moralism in Law, too, such as conservative judges we hear about in the news, and among physicians who refuse to treat certain types of patients (often illegally), or who refuse to prescribe medications they don’t agree with in their own personal religious moralism, regardless of their patient’s needs, such as PrEP for gay men (and others) or birth control or medical abortion medications for cisgender women.  Some religious moralist physicians won’t even treat someone with an STD/STI, or HIV, because they can’t in their “good faith” treat someone to mitigate or cure something they believe the patient should suffer with in the first place because it’s payback for the “wages of sin” they brought on themselves.  The State of Tennessee is exactly such a place where this is legal, “black-letter-law of the land,” and other states either have, or are trying to have, laws that allow religious moralism of the provider to be held in greater importance than health care services delivery to those in need., especially and most specifically LGBT people, and it’s a toss-up on whether gay men or trans women get the bigger brunt of that; it used to be gay men, nowadays, it’s more often trans women, but even single women seeking birth control or abortion are targeted socially and legally in the current political climate.  That’s a problem, because it impedes the access to competent, compassionate, and effective care that people have a human right to receive.

Religious Moralism in Therapy for Gay Men

How does religious moralism find its way into therapy for gay men?  There are a number of ways that are prominent and surrounded by, whether we are in a socially oppressive country, province, state, county, or town.

Let’s review some of these ways; some are more subtle, and some are notoriously controversial:

1. Dumbing down and de-professionalized “mental health” services to enable indoctrination and avoid evidence-based science

In this practice, therapy settings such as certain clinics, hospitals, community mental health centers, public city or county clinics, and certainly in “faith-based organizations”, I have observed that the administration here likes to try to not hire educated professionals with graduate degrees and professional clinical licenses, if they can “get by” with either paraprofessionals or outright amateurs who align with anti-LGBT values instead.  For example, Florida recently had a movement to replace professional school counselors with “chaplains,” whether they had a mental health training background and licensure, or not.  They wanted to both “save money” by hiring basically amateur religious people as “chaplains”, rather than the relatively (and I mean relatively) higher-paid mental health professionals, as well as a strategy to influence school-age children with religious doctrine by way of their counseling process for children troubled by any number of issues not related at all to spiritual issues.

Early in my career, in the early 1990s, I worked at psychiatric hospital that tried to increase its profits (or the equivalent in the highly-questionable “not-for-profit” model) by hiring barely high school graduates to run therapy groups for psychiatric patients in a Partial Hospitalization (weekday) Program for people with chronic mental illness.  Inevitably, these lesser-trained non-professionals were more concerned with spiritual perspectives than scientific psychological or psychiatric ones.

Religious conservatives as a group do not like credentialed, mainstream mental health professionals because we assert the ethics of equal human rights and legal opportunities for all people, and we tend to de-emphasize the role of God or Jesus or Mary or whoever in a person’s overall recovery from a mental health or personal crisis, except to the extent of supporting a client’s use of their spiritual practice as a solace or coping mechanism, although not the expense of taking formal, secular psychotherapy, and evidence-based prescription medications that are known to widely treat different psychiatric diagnoses.  Just like you can’t “pray away the gay,” you can’t “pray away” the Bipolar Disorder, either, among all the other diagnoses.

2. Reparative or Conversion Therapy, “Pray Away the Gay”

Of course, the most notorious contamination of mental health services delivery by religious moralism is in so-called “Reparative Therapy,” where a “broken” LGBT person (very disproportionately gay men, by the way) is attempted to be “healed” or “repaired” away from their “unwanted same-sex attraction” feelings and “living in Christ” to live, act, feel, and “be” heterosexual, or at least act like it as much as they can in the name of all that is Holy.

The stories of documented abuse by these practitioners and programs are abundant, and covered well in other places.  And while sometimes Reparative or “Conversion” “therapy” is sometimes delivered by paraprofessionals who are merely elders of a church, it can certainly be by otherwise “credentialed” mental health professionals, including PhDs like Joseph Nicolosi, probably the most well-known and published of the reparative therapists.

Many gay male clients in my practice have received treatment for PTSD from their experiences in these programs, and these programs leave a mess that clinicians like me have to try to clean up, so the client’s sense of self, safety, confidence, self-value, and mental health are restored again.  “First, do no harm,” indeed.

The Codes of Ethics of the National Association of Social Workers, the American Psychological Association, the American Psychiatric Association, the American Association of Marriage and Family Therapists, the American Medical Association, and others and their regional components all have admonishments against discrimination in mental health services delivery based on client demographics like race, age, ethnicity, and sexual orientation.  In addition to everything else, “Christian Counselors” are often in violation of these, because they advocate – or demand, or assert – that the LGBT person simply “stop doing that,” as if being LGBT is merely something that you do, rather than something that you are, and just as you can choose to do it, in your wayward, sinful, and self-indulgent way, you can also choose not to by simply making “God’s word” the priority of your life.

3. Sex Addiction

Perhaps more subtly, but just about as harmfully, is the whole “Sex Addiction” movement.  Much has been written on this, perhaps the best materials such as “The Myth of Sex Addiction” by Dr. David Ley (who was a guest on a previous podcast episode), and the books and essays by Dr. Marty Klein, who often confronts conservative America’s problematic views on sex and sexual ignorance.  “Sex Addiction” is not a formal diagnosis in either the DSM-5 in the United States or the ICD-11 worldwide classification of psychiatric disorders, mostly due to its lack of consistent diagnostic criteria, and lack of scientific evidence for either its diagnosis or treatment.  Gay men are very much disproportionately “diagnosed” by unscrupulous clinicians as “sex addicts”, because if sex is bad, gay sex is even worse; if infrequent or vanilla gay sex is bad, frequent or kinky gay sex is even worse.

These clinicians, because Sex Addiction is not a formal diagnosable disorder whose treatment is therefore covered by health insurance plans in the United States, must be all “cash pay” clients, which are lucrative – for individual sessions, couples sessions, “intensive” treatment, even “inpatient rehabilitation” treatment, based on the religious Twelve Step model and less on anything in mental health, such as Depression, Anxiety, Trauma, or Compulsivity (like OCD).

Things like “frequent sex” and “how much is too much” debates are very subjective, and vary by person, community, and culture.  Any form of even Consensual Non-Monogamy is seen  as “unhealthy sex” by their definition, as is kink or often any sex that is not heterosexual, heteronormative, and for procreation purposes or in the context of (holy) matrimony.  Recent ideas in this movement have been a little more lax, because there were fewer “takers” of the hard line view, but they still tend to be overall sex-negative for anything that lies outside what they consider “healthy,” which usually coincides with religious conservative views.

Gay men are “diagnosed” with this more often, and are more vulnerable to being viewed this way, because if “men” in general are self-indulgent, sex-crazed fiends who can’t control their overwhelming carnal, self-indulgences, gay men are even worse, because you know “how promiscuous they are,” as evidenced by the AIDS crisis.

While “sex addiction” treatment is often the purview of cisgender women clinicians, who apparently are trying to work out their abandonment rage at an ex-partner man who “cheated” on them through their clinical work (clinical crusade, more like), this can be a practice even among gay male therapists, who tend to “make up” for being gay by espousing otherwise conservative sexual views, such as the insistence on monogamy, marriage, having children, and eschewing kink, in a way as closely hewn to heterosexual life as possible as a compromise.  It’s also a way for new clinicians, straight and gay, to build a commercial caseload quickly, as it is lucrative, especially with spouses who demand that their partner undergo expensive “sex addiction” treatment, or an expensive divorce, their choice, but somebody is going down (so to speak) for their egregious “betrayal” of their “innocent” partner, which is both misandrist (anti-male) and misogynist (anti-female), portraying women as “devastated” in life if their “man” doesn’t stay home to guard the mouth of the cave against dangerous intruders” and instead is off with another woman making new offspring to support as well.

This begs the question of what people, especially gay men, do when they feel that their day-to-day sexual behavior is not congruent with what they want to be doing, whether it’s more infrequent sex, or sex only with their partner/spouse, or non-kink sex, or safer sex (such as avoiding a lewd conduct arrest for having sex in a public place from an undercover vice cop), or more enjoyable sex that doesn’t feel “driven” by a sense of compulsive or “perceived” lack of control.  For this, my colleagues Doug Braun-Harvey, LMFT, and Michael Vigorito, LMFT, wrote the seminal book, “Treating Out of Control Sexual Behavior: Rethinking Sex Addiction,” which offers both a different perspective on what the “problem” is, and more on how to deal with it, from which I later expounded on that book’s “Six Principles of Sexual Health,” which I applied more specifically to gay men in a previous (blog article/podcast episode).

Not all behavior that is or feels “compulsive’ has the quite the “ooomf” of sex, which is, ooooh, titillating and naughty, and both attractive and taboo at the same time, especially in American culture that is heavy (still!) influenced by the Puritanism of the early White American settlers.  Many straight American men watch TV football games on Sundays at 1pm, 4 pm, and 7 pm, and again on Monday night, but we don’t have “television football addiction,”  at least not as something that is as ubiquitous in its (rageful) discussion as “sex addiction” or “porn addiction.”  What is “addiction” to one might be your average Saturday night among gay men in New York in the 1970s.

And this comes, in my theory, from the original religious context of “Original Sin” and the misogyny of the “Sin of Eve” in tempting Adam in the Garden of Eden, where forever after, women’s “punishment” was the pain in childbirth, we are born with the “original sin” and are condemned to eternity in Hell unless otherwise redeemed, and a woman’s value in society to a man is only valuable if she is a virgin with an intact hymen and a large dowry her father provides for the man to take her and support her for life.  It wouldn’t do for him to try to support other women, because that would mean less for her and her children.  Plus, such as in Borderline Personality Disorder, we experience any kind of real or perceived “abandonment” as catastrophe, and a Narcissistic wound (not unlike “God’s” commandment) to have “no others before me.”

When the idea that women are only valuable to society as virgins and in service to men, and that women who don’t adhere to this are “sinners” or “sluts”, that idea can be carried over to gay men, who are far too often compared to women, and gay men end up being “slut shamed” by society or by each other.  It’s a problem.

Feminism says that women’s bodies are their own to control, whether that’s the right to abortion, birth control, freedom from domestic violence, freedom from workplace sexual harassment, or to seek their own sexual fulfillment.  As simple as that is, those ideas and rights are more challenged now than they were over 50 years ago when Roe v. Wade first came to be, and the legal ability for women to own their own credit cards without a husband co-signing.

Similarly, gay men’s self-empowerment means that our bodies are our own, regardless of what our sexual abuse perpetrators, or judgmental peers, or the Pope, or the Televangelist, or our homophobic “incel” brother, has to say about it!

Psychology, just like sex, are secular pastimes.

4. Porn Addiction

Similarly, the current atomic rage against all porn from so many corners of society has its base in anti-sex religious moralism, along with a huge component of hypocrisy, in that Internet porn download usage statistics are higher in “red” or “conservative” states than in “blue” or progressive ones.  Straight women’s atomic abandonment rage can be directed at male partners who watch any porn, not realizing how men’s sexuality (gay and straight, and let’s not forget bisexual, please) is different from women’s, and it’s not “wrong” in being different, especially with the emphasis naturally on visual stimulation. That’s also a misreading about the education about masturbation, in that masturbation for both/all genders is a normal part of functioning, even in the context of relationships.

Men’s ideas (especially straight ones) about perceived “benefits” of not masturbating (“No Fap”) are erroneous; there is no evidence that abstaining from masturbation enhances focus or productivity or whatever; those are spurious claims wrapped in “health talk” but they are really just re-hashings of both sexual guilt and religious moralism that declared masturbation as a “sin” because it deferred procreation by “spilling the seed” on the ground.

Porn has not only religious moralism to challenge it, but also Radical Feminism, which holds that all women in porn are inherently “trafficked” or coerced, and while human trafficking, especially of women, especially in commercial sex, is a horrible and horribly pervasive crime the world over, not allowing that women can ever truly consent to porn performance (or sex work) is misogynistic in saying women aren’t capable of these choices, in situations where they are not literally held hostage, or under undue influence (usually by men, but occasionally by female perpetrators, such as convicted sexual abuse perpetrator Ghislaine Maxwell, now serving prison time for the abuse and trafficking of young girls with the late Jeffrey Epstein).

The use of porn in healthy ways has been discussed in another David Ley book, “Ethical Porn for Dicks,” which has a somewhat straight emphasis.  But the gay men’s relationship to porn is generally seen as more lax, and certainly with the “democratization” of gay porn through OnlyFans, JustForFans, and others, which is an opportunity for exhibitionistic sexual expression, peer validation, and lucrative economics for many.

But where the radical Feminism and the Religious Right (hypocritically) converge is where mythic “disorder” like “porn addiction” lie.

Even therapists who don’t claim (key word) to be acting out of religious moralism often challenge the “use” of porn; but the antipathy toward porn wouldn’t be there without a foundation of religious moralism, and it’s especially insidious when supposedly non-religious therapists are actually, perhaps unconsciously, influence by religious moralism biases.  While they might even be relatively pro-gay, they are often against non-monogamy, even consensual non-monogamy, polyamory, kink play, and any use of porn, as if a religious moralistic conservative view was a mainstream, secular clinical view of “healthy behavior”, which it’s not.

5. Recreational Drugs

Religious moralism affects gay men not just in sexual ways, but in cases like recreational drugs and the use of alcohol.  In modern times, we see addictions to truly (physically) addictive substances as a science, but before it was seen as science, drug and alcohol addictions were seen as numerous but still individual failings in behavior in the eyes of a (male, fearsome) God.

Before we had Alcoholics Anonymous (which is still quite religious-based, but likes to emphasize more of its peer support model), we only had the religious Temperance Movement (Women’s Christian Temperance Union, WCTU), led mainly by Southern Protestants (usually Baptists) in America (my great-grandmother was a Temperance Movement activist, but she was a good egg and a generous and smart lady, well ahead of her time).  Gay men who are either still in, or left, Twelve Step programs often complain to me about its religiosity when it speaks of “getting right with God,” “God Shots,” or claiming to be non-denominational but still reciting the very Christian “Lord’s Prayer” as part of meeting tradition.   Gay men who have been abused by religion chafe at religiosity, especially feeling judged by peers for relapsing (“ooooh, gurl, here she is again as a newcomer!”) in the bad Twelve Step rooms.

Too often, conservative therapists don’t understand the science of substance addiction as a science or disease, and not a moral failing, or don’t understand truly non-addictive recreational use of substances (which are a part of social cultural life, gay and straight), or even the “self-medication theory”, that perhaps this “alcoholic” or “drug addict” gay male client is self-medicating for a lifetime of abuse for being gay and a bunch of drinks or some hits of crystal tame the internal raging judgmental voices about gay sex.

More therapists today “allow” for recreational use of marijuana, perhaps carefully assessed as to its impact on the client, and possibly others; “molly,” or MDMA, is in clinical trials to be used as a treatment for PTSD and other psychological/psychiatric challenges, which is how it began to be used in the first place before it was declared illegal and “scientifically useless.”  More therapists are trained and certified (such as it is) in “Ketamine-assisted therapy” or “psychedelic assisted therapy,” but this is in recent times; when I was in training as a therapist in the early to mid 90s, my gay male therapist colleagues didn’t “say” “circuit party,” they spit out “circuit party,” in extreme judgment of their gay male peers, without knowing anything about Harm Reduction techniques, set-and-setting, and Safer Use protocols.  There is some “evolution” (pun intended) from the religious moralism to the secular science of substance use and abuse.

6. Kink

As an AASECT Certified Sex Therapist, I often hear about how religious moralism finds its way into therapists’ approach to clients who present reporting “kinky” sex, or being a sex worker.  Kink-negative and sex-negative therapists theorize (erroneously) that kink sex, particular BDSM, is an “acting out” of past sexual abuse trauma, without understanding “mainstream” kink play that is not about “repetition compulsion” about abuse experiences, but simply an enhancement to stimulation, arousal, and roles in relationships (such as role-play).  More recently, there has actually been more evidence about kink play as being healing and therapeutic for survivors, done in a certain way and treatment context, rather than a pathological exacerbation of the abuse history.  But try telling that to the generally unconscious religious moralism bias in the community counseling services of many small (and large!) towns that offer psychotherapy.

I’m part of a community called Kink-Affirmative Therapists, and it’s a group who wants to know about, and be a help to, people from many kink subcultures who want therapy, but in an affirmative, non-judgmental way, where the therapy is not to “resolve” or excise kink play from their behaviors, as long as it’s in the context of the secular “principles of sexual health,” that are humanistically affirmative but not necessarily religious, which are not synonymous.

7. Misandry

Because the majority of professional mental health services are delivered by women, and by clinical social workers, or marriage-and-family therapists (not psychologists or psychiatrists, as most of the public says in the vernacular about who therapists are), there can be a pervasive “women’s bias” in the field.

What is anathema to women overall is anathema to therapists, overall – such as use of porn, non-monogamy (disbelieving that it is ever “consensual”), kink play, multiple partners, polyamory, or at times even being LGBT.  When men in general and gay men in particular are disproportionately labeled “sex addicts” and “porn addicts” by the Mental Health Industry, that’s not science – that’s misandry.  Men’s (gay and straight) psychological makeup, approach to sexuality, and certainly emotional and interpersonal needs that differ in general from women’s are seen as either non-existent or not legitimate or unimportant.  This is why, in general, gay men in general and gay men in particular are under-served as the consumers of mental health professional services.  Men’s specialist therapists, especially gay men’s specialist therapists (like myself), are in short supply outside of some concentrated areas where there is a supply that outweighs demand, such as in West Los Angeles, and some would say Manhattan, New York.

The mental health field would do well to just acknowledge, understand, and apply to practice how men’s needs in therapy differ, largely, from women’s, and straight differs from gay (although there is a ton of overlap between straight men’s psychology and gay men’s psychology; you just change the pronouns of the relational objects a lot).

Men actually have to advocate for themselves in mental health, because far too often, their very specific needs are not met, not from ignorance, poor training, or clinical skills delivery incompetence, but just from subjective point-of-view.  It’s the same with male clinicians treating female clients; we need to work awfully hard to understand and be of use, because there is a pitfall a mile wide of “just not getting it.”

There needs to be discussion in mental health of the subtle-but-there misandry that under-recognizes men’s needs because of the predominance of women as clinicians in the field, who often “don’t know what they don’t know” about the pressures, perspectives, outlook, and psychological makeup of their male clients, especially culturally.

8. Developmental Stages

Religious moralism in therapy manifests also when we talk about the Developmental Stages of Life that mental health writers and clinicians have discussed, such as Erik Erikson’s stages of life, or models from Harry Stack Sullivan, Margaret Mahler, Jean Piaget, and others.

Religious moralism in clinicians might manifest as them being alarmed at peer, same-sex sexual activity around puberty, such as in high school, for gay students versus straight (this happens politically when the Age of Consent laws are not on parity for gay versus straight adolescents).  If a gay student has an issue with a boyfriend and first sex, the emphasis might go to the idea of “gay sex” as opposed to focusing on the relational issues that the clinician might focus on if it were a straight relationship situation.

Religious moralism that is anti-gay might manifest in couples therapy where a gay male couple who is young might be questioned if they are “really ready” for marriage, while being the same age as a straight couple that is not questioned.

Religious moralism can manifest as a bias against a gay couple discussing becoming parents, whether through the foster system or surrogacy or adoption, wondering if they “really ready” to have kids, when a straight couple might not be challenged on this, especially when it’s a gay male couple, because, do men really know anything about raising children?  Especially newborn babies?  That’s both homophobic and misandrist.

Religious moralism might be subtly persuading a single person, mother or father, from having a child, because “children need a mother and a father”, which is not a psychological or developmental idea, but is a religious bias one for promoting heterosexism; children do just fine with same-sex male couples, same-sex female couples, or single male or female parents, if their needs are being met.  Saying children “need a mother and a father” for healthy development is not sound psychology; it’s heterosexism as a social idea, a religious moralistic idea, to not challenge the status quo or “Biblical tradition”.

Religious moralism might lead an elementary school counselor to ask Billy if he “has a girlfriend” in class, but never ask if little Billy, age 7, “has a boyfriend,” in class, which is not only heterosexist (as informed by religious moralism), but also creepy to sexualize children of any gender in a way that is imposed.  I see those greeting cards with the photo of the little two year old girl and two year old boy kissing on the front stoop and I turn it around and hide it in the card display behind the envelopes; we do not need to be sexualizing children that way, but then religious conservatives scream that a man in a costume (drag queen) or kids reading “Heather Has Two Mommies” is “grooming” children for sexual abuse.  Fight the real enemy, please.

Religious moralism also manifests when anyone (teachers, parents, therapists) act their gender role enforcement rage (which is also a previous blog article and podcast episode), which has its basis in religion, as in the binary that God made man and woman, male and female, Adam and Eve, not Adam and Steve.  Anytime you see adults becoming enraged (which it is) at gender-non-conforming behavior (in their mind), it has its roots in religious moralism and the heterosexist notion of “procreation in the name of God.”  Which is why religious conservatives hate LGBT people, or women in “masculine” professions, or men as “single parents”, because their religious conservativism and gender role stereotypes are entwined, and it is their “duty before God” to punish all those who don’t comply; the gay and lesbian citizens of “Gilead” in “The Handmaid’s Tale” book and television series were executed by the State as “gender traitors” who failed to appropriately procreate if they physically could.

Straight and Gay Therapists

While everyone in the LGBT community can be grateful for the support from our Straight Allies, when it comes to therapists, the situation is not ideal.

Many straight-but-well-meaning therapists just  don’t know what they don’t know about LGBT people, whether it’s vocabulary, cultural practices, pastimes, rewards, challenges, and personality interpersonal dynamics, whether that’s professionally, socially, domestically, or sexually.

They often try their best to be “hip” but superficially, as to not appear bigoted, which they sincerely do not want to be, but they often lack the opportunity (or don’t seek it out; I’m not sure which), about what they don’t know, and it’s a lot.  It’s constant with therapy clients.

They assume that “everyone is the same” and “one size fits all” when it comes to personality structure, psychopathology, and life stressors.  Without thinking it through the nuances of cultural competency, they can appear naïve or even dismissive.

Professionally, many straight therapists want gay clients, especially gay male clients, because we tend to pay the bills and have the “disposable” income to afford private practice outpatient therapy, or the salaries/health insurance plans to make that feasible since we usually don’t have kids’ expenses to factor in.

Perhaps worse, there can be a certain “carpet-bagging” presumptuousness, where if a therapist is effective with many/most straight clients, it automatically translates into success with the well-behaved and lucrative gay clients, whom they can be superficially and even condescendingly “charmed” by, like the client as gay BFF.

The biggest mistake I hear about with straight therapists is in tossing around trying to be “hip” with the “LGBT community,” without realizing that’s an awfully big group whose psychological culture one seeks to master.  That’s not one group.  That’s the letters: Lesbians, Gay Men, Bisexual Men, Bisexual Women, Bisexual Trans Feminine, Bisexual Trans Masculine, Bisexual Non-Binary, hetero Trans Feminine, hetero Trans Masculine, Queer, Questioning, Intersex, Pansexual, Asexual – and they think they’re ready for anything (any clinical presenting issues) these people have because they had one, eight-hour seminar on “working effectively as a therapist with the LGBT community.”  Gotcha.  BAZINGA.

They try, though, and they want to try, because they are emotionally invested in looking like the stodgy therapists of the past, the sexist/homophobic patriarchal Freudians, or even in reaction to their own upbringing from conservative parents who were not only “not hip” to LGBT people, but to a lot of things, like getting a tattoo (especially as a woman) or dating a rock musician.  This is not your parents’ therapy!

It takes a lot of humbling for a straight therapist to presume to work with anyone from the broad LGBT community, but it’s necessary:  LGBT clients are still generally under-served and we need straight ones at least some of the time or those clients go without badly-needed help.  It’s the same with other cultural competencies; whether it’s Black, Jewish, Latino, Asian (and its many subcultures; I see a big difference working with Thai gay male clients versus Chinese-American gay male clients); rich versus poor, traditionally attractive with appearance privilege or not, ages, nationalities, professions, and, for me in Los Angeles, level of “fame” or celebrity status.  Therapists wouldn’t finish training until we were all old enough to retire if we tried to train in every cultural competency measurement, and there isn’t time.  We have to cross over and deal with the differences, whether it’s what the client thinks of us as “different” from them (client transference), or how the clinician feels about a client “different” from them (“counter-transference).  It doesn’t have to be perfect, but you have to try, and get help on cultural competence when you need it through consultation with peers or clinical consultation, but not necessarily from the client (perhaps sparingly) because the client isn’t there to spend time training on you on cultural vernacular, they are there to get help after the terms are understood to be defined.

Gay Male Therapists

Gay male therapists aren’t off the hook with a full pass, either.  Gay male therapists who are impeded in their clinical functioning due to their own yet-unresolved internalized homophobia, self-loathing, ignorance of many issues because of deficits in how they were trained (look at the appalling level of gay male therapists who are taught “sex addiction”), personal ambivalence and unresolved issues that their client’s material might be triggering, resulting in overwhelming and distracting countertransference that undermines their clinical effectiveness.  Gay male therapists who are not specialists can be grandiose as well about their “scope” of practice, assuming they are equally effective with gay or straight clients because they are gay but they were raised (usually) in very straight environments (parents, teachers, coaches, clergy).  Gay male therapists who had a poor undergraduate or graduate academic program would be vulnerable to work with any client, of if they had poor graduate and post-graduate clinical supervision that was either non-existent, inadequate, or ill-informed.  Gay male therapists need  a lot of peer support as well, not only for clinical issues and the complications from under- or over-identifying with clients (or even the “small town” dual relationships risk, where your client dated your ex ten years ago), but also for business issues, sorting out healthy collaboration from toxic competition (which anyone who has seen “RuPaul’s Drag Race” can attest that gay men can be a competitive bunch, in any field).

Cultural issues can also be intersectional, because People of Color can have religious moralism bias based on the dominant religious influence in their culture, such as Latino Catholics, Black Protestants, Asian Buddhists, or Middle Eastern Muslims.  The more complex the cultural influences, the more nuanced the difficulties can be, and yet we form productive, effective clinical relationships.

Next Steps and Advocacy

So, what can we actually do about religious moralism in therapy for gay men, now that we know more (maybe too much?) on how it can manifest:

• Acknowledge the extent of insidious cultural bias, learn to “see” it, IYKYK. It’s subtle and even clandestine, because if it were more visible, we could call it out more easily.  We have to “catch it” like a pickpocket.
• Know and assert alternative information to challenge the status quo, “real data”; Kristen Browde and “whoismakingnews.com” has data on the actual demographics of arrests of perpetrators of child sexual abuse and sex crimes. There are evidence-based practice studies, like about same-sex parenting or the “outcomes” of medical care for trans youth, or actual rates of “de-transitioning” versus propaganda or selective data.
• Validate individual and LGBT collective perspectives as legitimate social constructs and history; our social and legal rights, even if those rights were not formally recognized in history in much of the world, we were still here; we always have been. LGBTQ is not “new”, not “Western,” not “aberrant.”  We should be past this by now.
• Validate secular perspectives, period, knowing how religiosity (conservative) permeates even in so-called “secular” spaces (public schools, civic governments, the workplace).
• Be prepared and motivated to fight against rights backlash from aggressive, toxic, theocratic religious moralism paraded around as “protections” against phantom “harm” to women, children, “families” (as if LGBT people weren’t part of American families).
• Allow yourself to feel guilty or exposed for standing up for yourself, but still do it; you’re bucking the status quo of centuries of religious oppression, and for the better

If you would like more customized help that is specific to you and your situation, consider booking an appointment psychotherapy (for guys in California, where I’m licensed for that), or Coaching, anywhere in the world (we just figure out the time zone difference when we schedule appointments).  There are some areas of overlap in those services, but also some important legal and ethical differences that are important to differentiate between these types of professional services; see also GayCoachingLA.com for Coaching services.  I can also answer any questions you have about this.  See also other Blog articles on this website, or check out my Podcast, “Gay Therapy LA with Ken Howard, LCSW, CST” heard in over 175 countries around the world, with over 140 episodes to date.  I also offer online courses, including one on gay men starting your own business, available on the Thinkific course platform.  Other online course offerings are in the works.  If you have suggestions for future blog articles, podcast episodes, or online course topics, your suggestions are welcome.  If you want individualized help sooner, email Ken@GayTherapyLA.com, or Ken@GayCoachingLA.com, or call/text 310-339-5778, and I’d be happy to help.