Sexual Identity Therapy

Sexual Identity Therapy

Sexual Identity Therapy (SIT) provides a place for clients to sort out how they wish to live and form an identity in light of their beliefs and values. The focus of this approach is to assist clients as they seek congruence – so that their behavior and sexual identity line up with their beliefs and values.

The SIT Framework developed by Dr. Warren Throckmorton and Dr. Mark Yarhouse identifies four phases of therapy: (1) assessment, (2) advanced or expanded informed consent, (3) psychotherapy, and (4) social integration of a valued sexual identity. Each of these aspects of the SIT Framework is discussed in the document that they coauthored, but it should be noted that the psychotherapy portion of SIT is rather broad with no specific ties to a theoretical orientation of model of practice. It is, generally speaking, client centered and identity focused, but it is intentionally broad to allow for many approaches to practice.

The SIT Framework has been endorsed by a range of professionals. For example, Dr Nicholas Cummings, Past President of the American Psychological Association, offered this statement of support:

Drs. Throckmorton and Yarhouse have brilliantly resolved contention in psychotherapy by providing the field with unbiased guidelines that are responsive to scientific evidence, are sensitive to professional practice, and which restore patient determination in choosing his/her goals in psychotherapy.

Dr. Robert Spitzer, Professor of Psychiatry at Columbia University and co-editor of DSM-III & DSM-IIIR, wrote:

I have reviewed the sexual identity framework written by Warren Throckmorton and Mark Yarhouse. This framework provides a very necessary outline to help therapists address the important concerns of clients who are in conflict over their homosexual attractions. The work of Drs. Throckmorton and Yarhouse transcend polarized debates about whether gays can change their sexual orientation. Rather, this framework helps therapists work with clients to craft solutions tailored to their individual situations and personal beliefs and values. I support this framework and hope it is widely implemented.

Dr. Stanton Jones, Provost and Professor of Psychology at Wheaton College, also offered his reflection on the SIT Framework:

Throckmorton and Yarhouse have advanced a masterful synthesis of best practice in the confusing and troubled area of sexual orientation, sexual identity, and personal values.  No one should be forced toward a resolution of personal identity that violates their personal conscience; our commitment to being guided by the findings of scientific inquiry and respect for client autonomy and religious freedom should lead us toward empowering individuals to make informed choices about their lives. These guidelines are consistent with the ethical principles of the major mental health professional organizations and are superior to any other existing guidelines for practice in this area.

In his previous writing on the topic of SIT, Dr. Mark Yarhouse has discussed how he approaches sexual identity issues when following the SIT Framework. His approach to therapy is based on four key concepts: (1) a three-tier distinction between attractions, orientation and identity; (2) weighted aspects of identity; (3) attributional search regarding the meaning a person makes of their attractions; and (4) congruence.

A 3-Tier Distinction

Some people may find it helpful to distinguish between same-sex attraction, a homosexual orientation, and a gay identity. To talk about having same-sex attractions is the most descriptive way people can discuss their experiences. They have feelings of attraction toward members of the same sex.  In one national study about 6% of men and 4% of women reported experiencing same-sex attraction.

Sexual orientation: refers to the direction and persistence of one’s experiences of sexual attraction toward the opposite sex, same sex, or both. In the same national study noted about, about 2.0% of men and 1% of women reported a homosexual orientation.

A gay identity is a sociocultural label that helps people communicate to others something about their sexual preferences (e.g., “gay”, “straight”, and “bi”).  It may be based upon a person’s sense of his or her biological sex (as male or female), gender identity (as masculine or feminine), direction and persistence of sexual attractions (sexual orientation), intentions and behaviors (what one intends and chooses to do with the attractions one experiences), and beliefs and values about sexual behavior.

So a person may experience same-sex attraction, and that person may experience sufficient same-sex attraction so that they can say of themselves, “I have a homosexual orientation.” By this they may mean that the attractions to the same sex are rather durable and persistent.  The person may also decide to integrate these experiences of attraction into a gay identity, to take on the self-defining attribution, “I am gay.”  Others may dis-identify with their experiences of same-sex attraction or they may choose to dis-identify with a gay identity and the persons and organizations who support such an identity.ISSI SIT 2013-14

Weighted Aspects of Identity

A second key concept is that people give weight to different aspects of their experience in ways that lead to an identity. Many factors may contribute to the preference for one label over another. These include the following:

  • Biological sex (as male or female)
  • Gender identity (how masculine or feminine a person feels)
  • Persistence and direction of sexual attraction (toward the same- or opposite-sex or both)
  • Intentions (how a person intends to act, the kind of person one intends to become)
  • Valuative framework (one’s beliefs and values about sexual behavior)
  • Behavior (what one does with the intentions and attractions one has)

These facets or aspects of sexual identity appear to be given different “weight” by different people in terms of the extent to which they inform or shape their sexual identity (see illustration above, which reflects a person who gives greater weight to experiences of same-sex attraction and personal values rather than biological sex or gender identity). In any case, in sexual identity therapy the focus is on helping a person reflect on these aspects of their sexual identity. What you are doing is helping your client reflect purposefully on a gay identity and then make a decision to integrate their experiences of attraction into a gay identity or make other decisions about their identity that rest on the relative weight they give to other aspects of their experience, such as their biological sex or beliefs/value. This suggests that a gay identity has become the dominant paradigm for people who experience same-sex attraction in our culture. As was suggested above, our culture makes little if any distinction between same-sex attraction, a homosexual orientation, and a gay identity. These three different constructs have been collapsed into one construct, so that experiences of same-sex attraction are taken to signal who a person “really is.”

Attributional Search

Concerning attributional search for identity, this refers to making meaning out of one’s experiences of same-sex attraction. In therapy this means that clients are sorting out how to think about themselves in light of their attractions. They might think of themselves as gay, bi, bi-curious, curious, questioning, or they may not feel comfortable adopting an identity label. There are many ways to reflect on attributions. Dr. Yarhouse explores two primary ways. The first refers to causal inferences (or etiology) in terms of how a person believes they came to experience same-sex attraction – “What caused me to experience same-sex attraction?” The second way to explore attributions is to look at the existential and/or religious meaning attached to sexual identity questions – “What purpose or relevance do I find in my attractions today?” This has more to do with having a person give their present dilemma some sense of meaning or significance. In any case, clients may benefit from a safe place to sort out their attributions and make meaning out of their experiences.


The last key focus in how Dr. Yarhouse practices SIT is facilitating personal congruence. Congruence is thought of as bringing behavior and identity into alignment with beliefs and values (or vice versa). To facilitate personal congruence, it seems helpful to discuss the very concept. This allows people to have a frame of reference and to acknowledge that some people experience a conflict between their religious and sexual identity. Clients also share their experiences and their beliefs and can reflect on them, often helping others understand where beliefs come from, how they came to play a role in decision-making, and whether they will continue to hold specific beliefs. This can lead to a kind of exploration and eventual sense of “ownership” of beliefs.

In his advanced informed consent to SIT, Dr. Yarhouse introduces SIT as follows:

The specific approach provided here sexual identity therapy. The goal of this approach is to assist clients so that they can experience greater congruence, which we see as being able to live and identify themselves in ways that are consistent with their beliefs and values.  This approach is not designed to integrate same-sex attractions into a gay identity as such, though this is a decision you may make over time. Nor is this approach designed to change sexual orientation as such, though you may make decisions that contribute to decreased behavior and attraction that may signal a change in your sense of your sexual orientation. The goals of this approach include but are not limited to: (1) recognizing the distinction among experiences of attraction, a homosexual orientation, and a gay identity, so that you are able to use more descriptive language if you wish; (2) increase your knowledge of the possible multiple influences on your current experiences of attraction and behavior; (3) make choices about attraction and behavior in keeping with your beliefs and values; and (4) recognize and give weight to the different aspect of your sexual identity in a manner that facilitates congruence.

If you are interested in finding a therapist in your area, check our Referrals page for clinicians who have indicated that they follow the SIT Framework.