Homosexuality and neurosis: considerations for psychotherapy

Though there is no correlation between mental illness and homosexuality, there are unique concerns that play a role in symptomatology and psychotherapy around neurotic and characterological issues in gay patients. Homophobia, both in the therapist and in the patient, external and internalized, is the significant "hidden" factor. Lack of training around transference and countertransference issues with gay patients and lack of teaching about homosexuality in training programs contribute to the difficulties encountered in psychotherapy with gay people. There are some problems and concerns specific to being homosexual that may bring patients to therapy: "coming-out," deciding on sexual orientation, desire to change orientation, and a unique "AIDS neurosis." The therapist needs to have an objective knowledge of the gay community and be willing to examine personal beliefs and reactions to work effectively with gay patients.