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Nicolosi treats male homosexuals who want to give up their homosexuality. He takes the unequivocal position that homosexuality is neither genetic nor simply an alternative lifestyle. He describes the American Psychiatric Association's decision in 1973 to omit homosexuality as a diagnostic category as a “politicization of psychiatry.” He asserts that Gay Affirmative Therapy encourages homosexuals to identify with their pathology and call it health, and that his clients have been “victims” of this kind of thinking.
Reparative therapy, which borrows heavily from psychoanalytic theory about the preoedipal origins of homosexuality, particularly the work of Charles Socarides, sees homosexuality as a developmental deficit. Most homosexuals, according to Nicolosi, fail to successfully complete the gender identity phase, in that they are unable to individuate from their mothers and develop a masculine identification through their fathers. Intrusive, anxious mothers and neglectful, emotionally unavailable fathers create an environment which makes it impossible for the prehomosexual boy to claim his maleness. Early homosexual sex play is often an attempt to secure masculinity through contact with other males. The masculine deficit is projected onto idealized males. What cannot be identified with, is eroticized. Other males are either overvalued or denigrated with a defensive detachment.
Though Nicolosi's theories are clearly influenced by psychoanalysis, his clinical technique diverges from both classical and modern analysis. He insists that homosexuals can't work with the neutral analyst. They need a “benevolent provocateur” to become a salient male presence, a father, a mentor, a teacher. The therapist must provide, in a very directive style, a long-term relationship that is intimate, accepting, honest, and nonsexual, meeting the three basic