To illustrate the way in which psychoanalysis has changed its perspective on homosexuality, one need only consider two speakers at the Chicago Psychoanalytic Society’s conference on "Clinical Issues with Lesbians and Gay Men" in March.

The first, Ralph Roughton, M.D., began his psychoanalytic training in 1967 and is now a training and supervising analyst at the Emory University Psychoanalytic Institute.

The second, R. Dennis Shelby, Ph.D., is a candidate at the Chicago Institute for Psychoanalysis and a faculty member at the Institute for Clinical Social Work.

The difference between them is that when Shelby entered psychoanalytic training, he was openly gay. Welcomed into a institute that had once considered his sexual orientation a pathology and perversion, Shelby said his orientation is no longer an issue. "I don’t have the horror stories. It’s a very different time," he said.

Roughton’s experience was not so pleasant. His institute never questioned that homosexuality was a disorder. And so in analysis, he worked to rid himself of homosexual feelings and maintain a marriage that had produced two children. Roughton maintained the marriage for 38 years and only acknowledged his homosexuality a few years ago.

With great remorse, he recalled at the conference that during his early years in practice, he also worked to help homosexual patients "cure" themselves. As one of his married patients described his attraction for men and his occasional sexual encounters with them, Roughton noted it was a "narcisstic attempt to repair an incomplete sense of self."

If he had the same patient today, Roughton said he would be more careful to avoid subtle or not-so-subtle signs of disapproval or interpretations that recognize homosexuality as anything other than a natural form of sexual expression.

As chair of the American Psychoanalytic Association’s (ApsaA) Committee on Issues of Homosexuality from 1992 to 1998, Roughton has worked to bring about the acceptance that Shelby now enjoys, and he sees change.

"In the year 2000, the majority of the affiliated psychoanalytic training institutes have openly gay and lesbian candidates. Some of this group have already graduated, and more and more faculty members—like me—are now open," Roughton said.

In other signs of change, he said, the APsaA’s committee has actively addressed the institutes’ attitudes and policies by offering educational workshops and discussion groups and providing welcoming social events for gay and lesbian attendees at meetings.

"Reparative" therapy also seems to have been largely thrown by the wayside. "There is now very wide acceptance—but still not universal—that treatment for lesbians and gay men is not to be a goal-directed effort to change their sexual orientation," Roughton said.

Benjamin Garber, M.D., a training and supervising analyst at the Chicago Institute for Psychoanalysis, agreed there is far more acceptance. "There is no question there has been a change," Garber said. "We’ve realized over the years that [homosexuals don’t want help becoming heterosexuals]."

That’s not to say there aren’t individuals who hold on to the field’s older views of homosexuality.

"Things are changing out there in the psychoanalytic institutes, but it is a slow change," said Elisabeth Young-Bruehl, Ph.D., a psychoanalyst and faculty member at the New School for Social Research. She recalls attending a lecture as recently as 1998 that listed homosexual perversions on the syllabus. What’s different now is that "there are some of us who are around to protest it," she said.

As Young-Bruehl has found, curriculum is the current battlegound.

The theories of normal development for gay men and lesbians have yet to be developed, Roughton said. "There is a new generation coming behind me of openly gay and lesbian candidates. It’s up to that generation to develop our theories of what is normal development. My message is to tell how we have been wrong," he said.

As training institutes take on the task, they already face conflict between those who want a whole curricula in lesbian and gay identity and the meaning of homosexuality and those who don’t want to see the subject compartmentalized.

Karen Martin, L.C.S.W., an openly gay candidate at the Chicago Institute for Psychoanalysis, is one who thinks the field has already put too much emphasis on homosexuality.

"We frankly have studied homosexuality much more than we have studied heterosexuality. The challenge to the next generation ought to be to study sexuality, period. And to try to get to some understanding about the variables that go into those choices," Martin said.