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It is my clinical position that preferential or exclusive homosexuality represents an adaptation enforced by a disturbance in normal psychosexual development: the natural and undisturbed outcome of psychosexual development would be preferential heterosexuality. This adaptation is apparently subjectively successful for some people. But an adaptation to any disrupted development is inevitably more fragile and constricting than could ideally result from an undisrupted developmental process. This view is in contrast with those of some current vogue that regard homosexuality as a normal alternative sexual orientation.
I will focus essentially upon issues relating to treatment, scanting the details of etiological theories and psychodynamics except where necessary to illuminate specific therapeutic problems. I will limit my attention to adolescent males for a simple and practical reason: I have never seen in my practice an adolescent female homosexual. I have no explanation for that skew, since my heterosexual patients are quite evenly distributed between the sexes.
The literature on the treatment of homosexuality in adolescence is very sparse. Even in the one extensive annotated bibliography (Weinberg and Bell 1972) there is only one entry. Most discussions that do treat adolescents separately are descriptive (e.g., Bieber et al. 1962, Kremer 1969, Roessler and Deisber 1972, Saghir and Robins 1973). Those that do address themselves specifically to therapy derive from reports of single cases (Fraiberg 1961, Sprince 1964), a superficial description of very few (Bentler 1968), or focus upon those whose homoerotic activity is essentially