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PSYCHIATRIC SERVICES ♦http://ps.psychiatryonline.org ♦September 2004 Vol. 55 No. 9
11007722
BOOK REVIEWS
are saying. These models have a
testable predictive utility that is not
often found in post hoc psychody-
namic analyses. Transference is treat-
ed very lucidly and directly in the
context of self-evaluation and capaci-
ty to change.
More personally, the relevance of
this book to my beliefs and habits
made me uneasy. After reading sever-
al chapters at a cerebral distance, I re-
alized, “Wait, all this stuff applies to
me too, and not flatteringly.” In par-
ticular, thinking about what it means
to stake worth on accomplishments
instead of attributes, and to value per-
formance instead of mastery, called
into question the hypercompetitive
scramble guiding me into and through
our profession. Much of the research,
when applied to myself, was down-
right scary, and led me to wonder
deeply who I am, how I construe my-
self and the world, and what I hope
for and suggest to my kids. Had I read
this book at other times, especially
during medical school, it might have
trashed my sense of self. I expected it
to be a pure thinking cap, but it was a
blasting cap too. I doubt I am alone in
this; let the reader beware.
The editors’ care and scrutiny are
evident throughout this attractive vol-
ume. The book is well-organized,
well-indexed, and easy to read. It
would be of interest to anyone who
works in mental health as well as to a
broader audience.
flations of science, religion, and pol-
itics. For example, many in the ex-
gay movement subscribe to a “name
and claim theology . . . [meaning
that one] may not be completely
healed [or heterosexual] now, but by
claiming that [one is] healed [that is,
calling oneself ex-gay] . . . God will
eventually reward that faithfulness
and cause the actual healing.” In
other words, to be ex-gay, one does
not have to have a heterosexual
arousal system; one only has to pray
for one.
The shaky ground on which ex-gay
identities are constructed is de-
scribed in the book’s first section, in
which Besen details the tragic, per-
sonal foibles of prominent ex-gay
leaders who either had “homosexual
lapses” or publicly went back to be-
ing gay. The second section intro-
duces reparative therapists, ques-
tioning their character, their psycho-
analytic theories, and their cure
rates. The third section focuses on
religious right organizations and op-
eratives who use homosexuality as a
wedge issue for personal and politi-
cal gain.
Besen persuasively argues that
reparative therapists and conserva-
tive religious groups use the ex-gay
movement to counter growing pub-
lic acceptance of lesbians and gays.
Because this acceptance is based on
a belief that homosexuality is “bio-
logical”—by which most people
mean “immutable”—ex-gays, repar-
ative therapists, and the religious
right contend that people are not
“born gay”; that homosexuality is a
sick “behavior,” not an “identity”;
and that “homosexuals” can change
if they try hard enough. As docu-
mented in Anything But Straight,
this is not just a clinical or religious
position; it is also a political argu-
ment against lesbian and gay civil
rights.
Besen—formerly associate direc-
tor of communications for the Hu-
man Rights Campaign Fund, a non-
partisan lobbying group for lesbian
and gay civil rights—spent four
years monitoring ex-gay ministries.
Clearly, he was distressed and an-
gered by what he found. Conse-
AAnnyytthhiinngg BBuutt SSttrraaiigghhtt:: UUnnmmaasskkiinngg tthhee
SSccaannddaallss aanndd LLiieess BBeehhiinndd tthhee EExx--GGaayy MMyytthh
by Wayne R. Besen; New York, Harrington
Park Press, 2003, 311 pages, $19.95 softcover
JJaacckk DDrreesscchheerr,, MM..DD..
Wayne R. Besen’s Anything But
Straight: Unmasking the
Scandals and Lies Behind the Ex-
Gay Myth chronicles the so-called
ex-gay movement’s 30-year history.
In many ways, this is a story of cul-
tural developments after 1973,
when the American Psychiatric As-
sociation (APA) stopped classifying
homosexuality as a mental disorder
in the Diagnostic and Statistical
Manual.
Before that time, APA meetings
routinely featured programs on how
to “treat” and “cure” homosexuality.
In 1970 and 1971, gay and lesbian
activists disrupted those events. The
protests led to formal meetings with
APA officials as well as deliberations
and debates in APA’s scientific com-
mittees on the question of what con-
stituted a psychiatric illness. In
1973, APA’s board of trustees voted
to remove homosexuality from
DSM-II.
Those who were opposed to this
move petitioned APA to hold a
membership referendum to put ho-
mosexuality back in. However APA’s
membership voted to support the
removal. After their loss, clinicians
who pathologized homosexuality—
today referred to as “reparative ther-
apists”—were gradually marginal-
ized from mainstream scientific
journals and meetings. However,
they found new audiences else-
where. Their clinical theories
meshed with the political agenda of
social-conservative groups that op-
posed normalizing same-sex rela-
tionships. What eventually emerged
was a faith-healing movement based
on biblical values trying to cloak it-
self with a scientific mantle of re-
spectability—not altogether unsur-
prising given that the political
groups supporting “reparative” ther-
apies also promote and endorse the
pseudo-science of “creationism.”
Anything But Straight details
some of the confusing linguistic con-
Dr. Drescher chairs the American Psy-
chiatric Association’s committee on gay,
lesbian, and bisexual concerns and is au-
thor of Psychoanalytic Therapy and the
Gay Man.
PSYCHIATRIC SERVICES ♦http://ps.psychiatryonline.org ♦September 2004 Vol. 55 No. 9 11007733
BOOK REVIEWS
quently, even sympathetic readers
may find the polemical and ad
hominem tone a distraction from
the book’s substantial documenta-
tion and thoughtful analyses.
This book is recommended to cli-
nicians who are interested in cultur-
al beliefs about homosexuality as
well as the interface between poli-
tics and clinical practice. I would
also strongly recommend that any-
one who is considering a visit to an
ex-gay ministry or a sexual conver-
sion therapist read this book first.
temporary issues in psychotherapy
with lesbian, gay, and bisexual clients.
The book looks at the relationship go-
ing on in therapy between the thera-
pist and the client and the complicat-
ed issues that occur. In addition,
thinking outside the box is evident on
many topics, including gender, sexual
orientation, subjectivity, and counter-
transference. The book’s value lies in
the discussions and critiques of how
these and other issues get played out
in therapy. Many of the issues are
contentious and thus are not settled.
Agreements and disagreements are
evident.
LLiivviinngg OOuuttssiiddee MMeennttaall
IIllllnneessss:: QQuuaalliittaattiivvee
SSttuuddiieess ooff RReeccoovveerryy
iinn SScchhiizzoopphhrreenniiaa
by Larry Davidson, Ph.D.; New
York, New York University Press,
2003, 228 pages, $34.95
FFrreeddeerriicckk JJ.. FFrreessee,, PPhh..DD..
PPssyycchhootthheerraappyy WWiitthh GGaayy MMeenn aanndd LLeessbbiiaannss::
CCoonntteemmppoorraarryy DDyynnaammiicc AApppprrooaacchheess
edited by Jack Drescher, Ann D’Ercole, and Erica Schoenberg; New
York, Harrington Park Press, 2003, 258 pages, $24.95 softcover
SSkkii HHuunntteerr,, PPhh..DD..
The chapters in this book, previ-
ously published in the Journal of
Gay and Lesbian Psychotherapy, ad-
dress practice with lesbian, gay, and
bisexual clients. In addition to an in-
troduction by the editors, the book
has four sections: “Gay Patient–Gay
Therapist,” “Erotic Transference/
Countertransference,” “Gender Iden-
tity and Creativity,” and “Two Cases
of Psychotherapy With People with
HIV/AIDS.” The contributors in-
clude faculty members in universities
or institutes, members of editorial
boards of journals, and private practi-
tioners. The focal interest of all the
contributors is psychotherapy and
psychoanalysis.
Key themes of Psychotherapy With
Gay Men and Lesbians: Contempo-
rary Dynamic Approaches include
whether there is a lesbian, gay, and bi-
sexual therapy; whether a therapist’s
sexual orientation makes for a type of
therapist; changing views of cate-
gories such as lesbian and gay (what
do they really mean in changing cul-
tural contexts?); gender and sexuality
(are we passing for a certain gender
or sexual orientation?); essentialism
and constructionism; postmodernism
(for example, subjectivity, such as
one’s values and attitudes, is part of
the therapeutic process); the inter-
pretative subjects of therapist and
client; whether the therapist should
take the same risks asked of clients,
such as discussing with clients one’s
emotions and feelings; relational psy-
chotherapy; countertransference;
negative transference; erotic transfer-
ence in same-sex therapeutic dyads;
self-disclosure by therapists (for ex-
ample, sexual orientation and experi-
encing sexual feelings for clients); and
other boundary issues.
This book essentially represents
contemporary and developing views
of psychoanalysis versus the old or
traditional views, which, for example,
were moralistic and judgmental of
lesbian, gay, and bisexual clients. Oth-
er examples include subjectivity (ver-
sus objectivity) and transference-
countertransference (versus being
seen as neurotic). These phenomena
are now seen as having a legitimate
place in the foreground of therapy. A
theme present throughout the chap-
ters is what is happening to the thera-
pist during therapy. Sexual issues are
particularly grappled with, such as
whether a therapist should disclose
his or her sexual reactions to a client.
One of the case studies involving a
client with AIDS raises another
boundary issue in the context of a
client who is seriously ill and hospital-
ized. Should the therapist visit the
client? There is also the provocation
when working with these clients for a
therapist in terms of his or her own
mortality, potential future illnesses,
and losses. Are these issues to be kept
in the background, or disclosed to the
client?
The editors’ purpose was to have
the book’s contributors discuss con-
Dr. Hunter is affiliated with the School of
Social Work at the University of Texas at
Arlington.
The concept of recovery is having
greater influence in the mental
health field. Recovery is mentioned
prominently in the President’s New
Freedom Commission Report on
Mental Illness (1) as well as in nu-
merous recent professional and con-
sumer publications.
Larry Davidson, Ph.D., the author
of Living Outside Mental Illness:
Qualitative Studies of Recovery in
Schizophrenia, is an associate profes-
sor of psychology in the department
of psychiatry at Yale and has a long-
time interest in the experiences of
persons with schizophrenia. In this
his latest book he proposes an emerg-
ing model of recovery that draws
heavily on the value of the profession-
als attending to such experiences. He
bases his thesis primarily on the work
Dr. Frese is assistant professor of psychol-
ogy in clinical psychiatry at Northeastern
Ohio Universities College of Medicine in
Rootstown and serves on the board of di-
rectors of the National Alliance for the
Mentally Ill.