Sexuality, Therapeutic Culture, and Family Ties in Modern America

In 1973, the American Psychiatric Association voted to remove homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (DSM).  This was a critical moment in the history of sexuality and psychiatry, but it was not the sole factor that shaped how all psychotherapeutic fields approached homosexuality.  This paper considers the case of family therapy’s shifting approach to same-sex relationships and families. in which changing cultural views of family life rather than changes in psychiatric diagnostic standards played a key role. 

Family therapy emerged as a new clinical field during the 1950s and 1960s.  Shifting the unit of treatment from the individual to the family dislodged psychiatrists’ traditional emphasis on individual psychopathology.  While early family therapists were largely unconcerned with treating homosexuality as a psychiatric problem, they also generally did not recognize same-sex relationships as a possible configuration of family life. Normative ideals embedded in early clinicians’ models of healthy family life were resolutely heterosexual, with clearly defined gender-differentiated roles and a sharp generational hierarchy between parents and children. 

Challenges to this model came from several sources and ultimately shifted the field to a self-proclaimed politics of openness about family life. Feminist family therapists during the l970s questioned the gender roles embedded in early approaches to family therapy.  Clinicians simultaneously paid growing attention both to ethnic and cultural differences among families who were increasingly seen not as deviations from a single norm or ideal type but as variations in their own right, as well as to extended kinship networks that did not fit into boundaries of the nuclear family.  By the 1980s and 1990s, family therapists increasingly came to see sexuality as another dimension of family life that might shape the issues for which couples and families sought treatment but which in and of itself did not warrant treatment.