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Homosexuality was not removed as a mental disorder from the DSM until 1980 with the publication of DSM-III. In the 1980s a number of observations and inferences were published about male homosexuality that reflected a radical change in views about homosexuality generally. Important books from that time included Friedman's Male Homosexuality: A Contemporary Psychoanalytic Perspective , Lewes's The Psychoanalytic Theory of Male Homosexuality , and Isay's Being Homosexual . Interestingly, female homosexuality was still understood as stemming from psychopathology well into the 1990s.
Richard Friedman and I began writing about sexual orientation together in 1990. We were the only people we knew who were interested in what determines sexual orientation itself, whether hetero- or homosexual. This shared interest as well as the belief that medical terminology should not be used to harm people—a human rights issue—were the intellectual values that drew us together.
“Internalized Homophobia and the Negative Therapeutic Reaction” was the first paper Richard and I wrote together that addressed treatment issues and only the 5th of the 24 articles and books we wrote together about sexual orientation. Gay-affirmative psychotherapy had been described a decade earlier. Many individuals received relief from symptoms in a psychotherapy in which the clinician provided positive regard and support for the patient's gay self. We theorized that the patients benefiting from this approach had experienced love and nurturance from their families at an early age. If they subsequently developed internalized homophobia (predictable since our society was homophobic), this self-criticism and shame was layered over a solid sense of having been loved once. Such patients responded well to the restoration of self-esteem from gay-affirmative therapy.