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Psychology was one of the first disciplines to study homosexuality as a discrete phenomenon. In the late 19th century, and throughout most of the 20th century, it was standard for psychology to view homosexuality in terms of pathological models. In 1973 the American Psychiatric Association declassified homosexuality as a mental disorder. The American Psychological Association Council of Representatives followed in 1975
* 1 Major areas of psychological research
o 1.1 Etiology of homosexuality
o 1.2 Discrimination
o 1.3 Mental health issues
o 1.4 Suicide
o 1.5 Sexual orientation identity development
o 1.6 Fluidity of homosexuality
o 1.7 Parenting
* 2 Psychotherapy
o 2.1 Relationship counseling
o 2.2 Gay affirmative psychotherapy
o 2.3 Sexual orientation identity exploration
* 3 Developments in Individual Psychology
* 4 See also
* 5 References
* 6 Resources and external links



Major areas of psychological research

Major psychological research into homosexuality is divided into five categories:[2]

1. What causes some people to be attracted to their own sex?
2. What causes discrimination against people with a homosexual orientation and how can this be influenced?
3. Does having a homosexual orientation affect one's health status, psychological functioning or general well-being?
4. 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?
5. How do the children of homosexual people develop?

Psychological research in these areas has been important to counteracting prejudicial attitudes and actions, and to the gay and lesbian rights movement generally

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 sexual preference for persons of one's own sex.[3]
Discrimination

Homophobia and Societal attitudes toward homosexuality


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.[2] Anti-gay attitudes often found in those who do not know gay people on a personal basis.[4] 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."[6] 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

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.

* Drug and alcohol use: Gay men are not at a higher risk for drug or alcohol abuse than heterosexual men, but lesbian women may be at a higher risk than heterosexual women. This finding is contrary to a common assumption that, because of the issues people face relating to coming out and anti-gay attitudes, drug and alcohol use is higher among lesbian, gay, and bisexual people than heterosexuals.[9] Several clinical reports address methods of treating alcoholism in lesbian, gay, and bisexual clients specifically, including fostering greater acceptance of the client's sexual orientation


* Psychiatric disorders: In a Dutch study, gay men reported significantly higher 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.[11] This difference may be caused by the stresses gay and lesbian people face stemming from anti-gay attitudes. However, a Netherlands study (where homosexuality is much more widely accepted than that in the U.S.) shows that mental health problems in homosexuals are still much higher than in heterosexuals, despite the more tolerant society


* Physical appearance and eating disorders: Gay men tend to be more concerned about their physical appearance than straight men.[13] 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.[15] 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 ex-gay 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.[17] 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 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.[17] Sexual relationship disorder is a disorder where the gender identity or sexual orientation interferes with maintaining or forming of a relationship.

Suicide

The likelihood of suicide attempts are increased in both gay males and lesbians, as well as bisexuals of both sexes when compared to their heterosexual counterparts.[18][19][20] The trend of having a higher incident rate among females is no exception with lesbians or bisexual females and when compared with homosexual males, lesbians are more likely to attempt than gay or bisexual males.[21]

Studies vary with just how increased the risk is compared to heterosexuals with a low of 0.8-1.1 times more likely for females[22] and 1.5-2.5 times more likely for males.[23][24] The highs reach 4.6 more likely in females[25] and 14.6 more likely in males.[2]

Race and age play a factor in the increased risk. The highest ratios for males are attributed to caucasians when they are in their youthhood. By the age of 25, their risk is down to less than half of what it was however black gay males risk steadily increases to 8.6 times more likely. Through a lifetime the risks are 5.7 for white and 12.8 for black gay and bisexual males. Lesbian and bisexual females have opposite effects with less attempts in youthhood when compared to heterosexual females. Through a lifetime the likelihood to attempt nearly triple the youth 1.1 ratio for caucasion females, however for black females the rate is effected very little (less than 0.1 to 0.3 difference) with heterosexual black females having a slightly higher risk throughout most of the age-based study.[2]

Gay and lesbian youth who attempt suicide are disproportionately subject to anti-gay attitudes, and have weaker skills for coping with discrimination, isolation, and loneliness,[2][26] and were more likely to experience family rejection[27] than those who do not attempt suicide. Another study found that gay and bisexual youth who attempted suicide had more feminine gender roles,[28] adopted an LGB identity at a young age and were more likely than peers to report sexual abuse, drug abuse, and arrests for misconduct.[28] One study found that same-sex sexual behavior, but not homosexual attraction or homosexual identity, was significantly predictive of suicide among Norwegian adolescents.[29]
Sexual orientation identity development
Main article: Sexual orientation identity

* Coming out: Many gay and lesbian 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 or lesbian 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')."[2] However, the process is not always linear[30] and it may differ for lesbians and gay men.[31]

* Different degrees of coming out: One study found that gay men are more likely to be out to friends and siblings than co-workers, parents, and more distant relatives.[32]

* Coming out and well-being: Same-sex couples who are openly gay are more satisfied in their relationships.[33] 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.[34]

* 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.[35][36][37][38][17] After reviewing the research, Dr. Glassgold of the American Psychological Association said some people are content in denying a gay identity and there is no clear evidence of harm.[39]

Fluidity of homosexuality

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".[40] 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".[41] 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".[42] 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".[43][44]
Research here focuses on the impact (if any) on children of growing up with one or more parents who have a homosexual orientation.
[edit] Psychotherapy

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. Whatever the issue, there is a high risk for anti-gay bias in psychotherapy with lesbian, gay, and bisexual clients.[5]
Relationship counseling

Most relationship issues are shared equally among couples regardless of sexual orientation, but LGB 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 of successful relationships as opposite-sex couples. There may be issues with gender-role socialization that does not affect opposite-sex couples.[45]

A significant number of men and women experience conflict surrounding homosexual expression within a mixed-orientation marriage.[46] 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.[47] 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.[48]
Gay affirmative psychotherapy
Main article: 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.[49] 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.[49] 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.[50]
[edit] Sexual orientation identity exploration
See also: Ego-dystonic sexual orientation

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.[51] One example of sexual orientation identity exploration is Sexual Identity Therapy.[17]

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.[17] 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).[17] Some therapies include Gender Wholeness Therapy.[52] Participation in an ex-gay groups can also help a patient develop a new sexual orientation identity.[17]
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 pathologise 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.