Mental health articles

Homoerotic students who present for counseling in the early stages of sex-
ual identity development may request a therapist’s aid in determining their
sexual orientation. But oft en behind this appeal is understandable ambiva-
lence about self-discovery, since acknowledging homoeroticism risks loss of
self-esteem and may trigger social rejection. In fact, clients’ requests some-
times contain the hidden message, “Please assure me that I’m not gay.” It is a
good idea therefore for therapists to empathically inquire whether a student
truly wants to know “the answer” and to explain associated risks—one cannot
unlearn insight or guarantee the desired outcome. Doing so secures clients’
collaboration and respects their need for psychological safety.
A therapist begins by discussing three related, but distinct, domains of sex-
uality: sexual orientation, sexual behavior, and sexual identity (Cohen & Savin-
Williams, 2004, pp. 361–362). Sexual orientation refers to the predominance of
a person’s erotic feelings, thoughts, and fantasies for members of a particular
sex, both sexes, or no sex. Sexual orientation is likely to be established by birth
or early childhood and is usually immutable, stable, resistant to conscious con-
trol, and internally consonant. A person may choose or change behavior and
identity, but he or she cannot easily, if at all, choose or change sexual orienta-
tion. Sexual behavior refers to an individual’s sexual activities. Depending on
cultural and individual factors, sexual partners may be consistent or inconsis-
tent with a youth’s underlying sexual orientation. Sexual identity is a socially
recognized label that names sexual feelings, attractions, and behaviors and is
symbolized by such statements as “I am gay” and “I am straight.”
Th ese three domains are oft en confused and may be incongruent. Th us, it is
possible for a female to be attracted to both males and females (bisexual sexual
orientation), engage in sex only with a boyfriend (heterosexual behavior), and
identify as lesbian in order to partake in a women’s community. Depending
on whether orientation, behavior, or identity is considered, very diff erent con-
clusions will by drawn about her.
Further clarifi cation is possible by inviting clients to answer four sexu-
ally explicit questions, any of which they can elect to skip. For each one,
they are to determine the extent (percentage) to which their experience
is toward both males and females, where the combined total is 100%. Th e
questions are:

1. To whom are you emotionally attracted? By this, I do not mean erotically
or sexually attracted, but rather to whom you feel emotionally closest.
2. To whom are you erotically or sexually attracted? When you walk
around campus, who turns your head? You need not become physi-
cally aroused.
3. When you are home alone, in the privacy of your bedroom, which
sex are you thinking about when you masturbate? If you are viewing
pornography, where (and at which sex) are you looking?
4. When you are home alone, masturbating in the privacy of your own
bedroom, and you are on the verge of coming and then when you
come, about which sex are you thinking or looking?
Males and females usually report high emotional connectedness (question
1) toward females, thus confusing some heterosexual females who fear this
implies that they are lesbian, and some gay and bisexual males, who embrace
this as evidence that they are heterosexual. However, responses to this ques-
tion are usually quite discrepant from the others. As clients become increas-
ingly aroused—during masturbation or other highly erotic experiences,
and especially as orgasm approaches—culturally imposed prohibitions
temporarily recede and lust predominates. Questions 2 to 4 incremen-
tally measure authentic erotic and sexual attractions. Th us, a consistent,
clear pattern can be observed among gay males. Although they may be
80% emotionally attracted to females (20% to males), they are increasingly
homoerotic as orgasm approaches—60% attracted to males when walking
around campus, 85% during masturbation, and 98% just prior to and dur-
ing orgasm. Th is suggests that for males, at least, emotional connectedness
is related to, but diff erent from, sexual orientation and should be inter-
preted with caution.
It is noteworthy that these questions better determine male than female
sexuality, because the latter is far more contextual and emotion based (Dia-
mond & Savin-Williams, 2003). Whereas males usually describe homoeroti-
cism in sexual terms and as arising in childhood, females more oft en recall
their homoerotic experiences beginning years aft er puberty and in the context
of preexisting, highly intimate relationships with friends in which sex was
oft en secondary. As females recount their sometimes surprising sexual attrac-
tions toward female friends, they oft en conclude that they fall in love with the
individual rather than the gender (personality matters more than body) and
that emotional attraction precedes sexual attraction. Further, whereas male
sexual experiences correspond to pubertal hormone levels, female behavior
is far more variable and oft en regulated by environmental and interpersonal
factors, such as opportunities for experimentation. Although there is diver-
sity among the sexes, when working with females it is prudent to inquire
about strong emotional and loving feelings more than erotic lusts. Emotional connectedness is certainly important to males but is less useful for determin-
ing sexual orientation than are measures of erotic arousal.