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The construct “internalized homophobia” put forth in the 1980s (Malyon, 1982) has been found to be helpful in clinical work, particularly with gay and lesbian patients. Strictly speaking, the symptom complex denoted by the words “internalized homophobia” might perhaps have been better described by a different term. The mental mechanisms involved in phobias are primarily repression, projection, and displacement with resultant avoidance of the phobic object. What is actually “internalized” in patients who manifest clinically significant “internalized homophobia,” however, are object relationships that symbolically represent narratives expressing antihomosexual attitudes and values. This results in negative feelings about the self—primarily guilt and shame at being gay or lesbian or of experiencing homosexual desire. Because the term “internalized homophobia” has already gained wide acceptance, we continue to use it here.
In the terminology of Freud's structural theory elucidated in “The Ego and the Id” (1923), the contents of the superego/ego ideal systems of patients with “internalized homophobia” are incompatible with their sexual orientation. Many of the wishes, fears, and conflicts leading to this negative self-valuation may be unconscious. Thus, the patient may not experience conscious shame, guilt, or self-hatred. The formative conflictual object relationships leading to irrationally negative