Conversion therapy

Reparative therapy (also called conversion therapy and reorientation therapy) refers to methods aimed at eliminating same-sex sexual desires. A large number of techniques have been tried, including systems of rewards and punishments, psychoanalysis, bible reading, and bioenergetics. People who claim they have changed their sexual orientation to heterosexual call themselves "ex-gays".

The medical and scientific consensus is that "reparative therapy" is not effective and is potentially harmful. The ethics and efficacy of these methods are rejected by all mainstream medical and mental health associations that have taken a position on the topic. Their stance is that sexual orientation is unchangeable, and that attempts to do so are often damaging to the person's well-being. The American Psychiatric Association states that "ethical practitioners refrain from attempts to change individuals' sexual orientation."

The ex-gay phenomenon appears in the news with relative frequency. Reparative therapists characterize the movement as offering the possibility of a choice to gay men and women who are discontented with their lifestyle. LGBT rights supporters characterize the phenomenon as "the Christian Right [having] repackage[d] its anti-gay campaign in kinder, gentler terms. Instead of simply denouncing homosexuals as morally and socially corrupt, the Christian Right has now shifted to a strategy of emphasizing... the ex-gay movement. Behind this mask of compassion, however, the goal, remains the same: to roll back legal protections for lesbian, gay, bisexual and transgender people..."

History and doctrine

The late Charles Socarides, a conversion therapist.

Scientific research into sexual orientation began in earnest in the 1950s. At that time, LGBT people largely remained in the closet and homosexuality was listed as a mental disorder in the APA's Diagnostic and Statistical Manual of Mental Disorders. In 1957, Evelyn Hooker published The Adjustment of the Male Overt Homosexual, finding that "homosexuals were not inherently abnormal and that there was no difference between homosexual and heterosexual men in terms of pathology." In 1969, the Stonewall riots gave birth to the gay rights movement and increased the visibility of LGBT people. In 1973, the APA declassified homosexuality as a mental disorder; in 1974 the ABA endorsed the Model Penal Code, including its decriminalization of consensual adult homosexual acts; in 1981 the WHO removed homosexuality from its list of mental illnesses.

Against this backdrop of increased visibility and understanding, opposition movements arose taking the view that homosexuality is in fact a mental disorder and is changeable. Old (and today largely unused) conversion techniques included electroshock therapy, administration of Metrazol to induce convulsions, and nausea-inducing drugs.

Starting in 1976, Exodus International began referring people to religious ministries that attempted to change their subjects' sexual orientations. The Exodus ministries begin from the Christian perspective that same-sex relations are a sin. They believe that same-sex attraction is caused by environmental factors including "poor family dynamics, a rift in the father-son or mother-daughter relationship growing up, feelings of being an outsider among one's peers during childhood and adolescence, and instances of sexual abuse/incest." Exodus calls subjects "strugglers." Today Exodus is the most visible ex-gay organization, occasionally taking out full-page newspaper ads or renting billboards.

In 1992, Joseph Nicolosi and the late Charles Socarides founded NARTH, a secular reparative therapy organization. They adopted the view that homosexuality is the product of a mental disorder they describe as "gender-identity deficit" caused by alienation from, and perceived rejection by, people of the same gender. This, it is argued, leads to a quest for bonding and fulfillment through same-sex relations. "We eroticize what we are not identified with. The focus of treatment therefore is the full development of the client's masculine gender identity." Nicolosi suggests the subject, as a boy, first experiences rejection by his father, then lapses into helplessness and finally retreats to the security of his mother and defensively detaches from his father. According to his theories, this defensive detachment emotionally isolates him from other males and from his own masculinity hence, according to Nicolosi, causing homosexuality.

Socarides held that all men have a need for camaraderie and bonding, and that same-sex sexual attractions can be stopped by fulfilling these needs. Socarides distinguished between the innate emotional need for same-sex bonding and its dysfunctional expressions, and tried to correct the latter. Socarides saw homosexuality as a result of pre-oedipal (toddler) trauma or deficit that resulted not only in a homosexual orientation, but also in a personality disorder.

Elizabeth Moberly, a research psychologist, coined the term "reparative drive," to refer to homosexuality itself, as if it were an attempt to repair emotional deficits. She encourages same-sex bonding with both mentors and peer relationships as a way of stopping same-sex sexual attraction.

Lecturer Richard Cohen calls same-sex sexual attraction "same-sex attachment disorder." He sees "male bonding" as being very similar to same-sex sexual desire, but lacking a sexual element.

Today, the movement tends to characterize itself as offering the possibility of a choice for gay men and women who are unsatisfied with their sexual orientation. There is often an emphasis on minimizing and not acting on same-sex attractions, rather than eliminating them outright. This has received much support, both ideological and financial, from some religious conservatives. John Paulk, formerly of Focus on the Family, said "As the church, we must continue to speak out boldly against the radical homosexual agenda while we minister to those who are trapped in this lifestyle... it is compassionate to warn about the dangers of homosexuality in order to spare individuals the heartache and grief of that behavior. At the same time, we must always remember that many turn to homosexuality precisely because they have experienced rejection from the people closest to them. The church must not compound that rejection, but rather be an oasis of grace, healing and hope."

Techniques

In 1997, the American Psychological Association Council of Representatives issued a statement outlining principles to be followed in treatments to alter sexual orientation. They emphasized that homosexuality should not be portrayed as a mental disorder and any discriminatory practices should not be condoned. Psychologists should obtain consent before giving treatment to alter sexual orientation and respect their patient’s right to self-determination and autonomy.

Reparative therapists focus on individual and group counseling:

Techniques used by Love in Action include workshops on "child development, gender roles, and personal sexuality," one-on-one Biblical guidance, "a structured environment help[ing] establish new routines and healthy patterns of behavior", "challenging written assignments and interactive projects," "family involvement to improve communication... and to facilitate marital reconciliation," and "hiking, camping, canoeing, and rafting."

Techniques recommended by Exodus International include: a subject who finds him or herself attracted to someone of the same sex should "immediately look around for someone of the opposite sex... and start searching for the beauty in that person"; a subject should disentangling sexual desire from the desire for affection or affirmation; and a subject should repent and confess his or her sins.

Techniques recommended by NARTH include: seeking non-sexual male relationships, experimenting with more traditional male activities, reliving the pain of being different, and working on "Oedipal, enmeshment, and early abandonment" issues.

File:Cohensholding.jpg

Richard Cohen demonstrating his "holding" technique to Paula Zahn on CNN.

Lecturer Richard Cohen tries to identify subliminal emotional needs behind same-sex desires and attempts to replace them with non-sexual means of expression, usually by encouraging the subject to form a non-sexual, emotional bond with another adult of the same gender. This is supposed to substitute for the bond between the client and their same-sex parent which therapists allege did not properly form during childhood. For example, Cohen might hold a male patient in his lap with the patient curled into the fetal position. Cohen also advocates what he calls "bioenergetics," which involves hitting a pillow with a tennis racket while shouting "Why did you do that to me?" (Videoclip of Cohen's techniques via YouTube.)

Particularly controversial (and probably largely outdated) techniques include electroconvulsive therapy and aversion therapy. Documented cases include electric shocks being administered to patients' genitalia, "sometimes paired with disturbing images, including a bowl of feces and pictures of Kaposi's Sarcoma lesions." The most recent reported incidences of these kinds of aversion therapy were in 1992.

Mainstream medical view of reparative therapy

There is much debate in the medical community as to whether treatments to alter sexual orientation should be available. Currently, both the American Psychological Association and the American Counseling Association allow treatments to alter sexual orientation. Dr Fowler, CEO of APA said “those who wished to explore developing heterosexual feelings or behavior had a right to do so.” The treatment is still discouraged and strict guidelines are given for psychiatrists to follow.

There is a movement within the APA to ban reparative therapy. Proponents have argued that “it is more ethical to let a client continue to struggle honestly with her or his identity than to collude, even peripherally, with a practice that is discriminatory, oppressive, and ultimately ineffective in its own stated ends." They argue that clients who request it do so out of social pressure and internalized homophobia, pointing to evidence that rates of depression, anxiety, alcohol and drug abuse and suicidal feelings are roughly doubled in those who undergo reparative therapy.

Those defending the APA's stance state "Psychologists have an ethical responsibility to allow individuals to pursue treatment aimed at curbing experiences of same-sex attraction or modifying same-sex behaviors, not only because it affirms the client's rights to dignity, autonomy, and agency, as persons presumed capable of freely choosing among treatment modalities and behavior, but also because it demonstrates regard for diversity." They argue the need of respect for a patient’s values system. They also point to evidence that reparative therapy can be effective in changing homosexual thoughts and behaviors.

Reparative therapy is only offered to clients out of a commitment to respect the client's right of self-determination. The consensus among mainstream medical organizations is that sexual orientation is unchangeable.

The American Psychological Association states:

Even though most homosexuals live successful, happy lives, some homosexual or bisexual people may seek to change their sexual orientation through therapy, sometimes pressured by the influence of family members or religious groups to try and do so. The reality is that homosexuality is not an illness. It does not require treatment and is not changeable.

Major organizations that do not support reparative therapy and are concerned about its potential for harm include the American Psychiatric Association, the American Psychological Association, the American Counseling Association, the National Association of Social Workers, the American Academy of Pediatrics, the American Association of School Administrators, the American Federation of Teachers, the National Association of School Psychologists, and the National Education Association.

United States Surgeon General David Satcher issued a 2001 report urging tolerance for gays and lesbians and maintaining that homosexuality is not "reversible."

Mainstream gay rights organizations and some religious organizations oppose reparative therapies, including the National Gay and Lesbian Task Force, The Interfaith Alliance, New Ways Ministries and People for the American Way.

Scientific research on reparative therapy

The medical consensus is that sexual orientation is unchangeable. For example, the American Academy of Pediatrics says, "Therapy directed specifically at changing sexual orientation is contraindicated, since it can provoke guilt and anxiety while having little or no potential for achieving changes in orientation." (emphasis added) [1]. According to Norcross et al (2006) a delphi poll survey of the American Psychological Association (101 respondents) indicated their view that reparative therapy is a discredited therapy.

Although reparative therapists believe that homosexuality is changeable, and they cite anecdotal evidence of conversions, major medical organizations and others reject this anecdotal evidence for many reasons, including:

• Results are not published in peer-reviewed journals, but tend to be released to the mass media and the Internet (see Science by press conference);
• Random samples of subjects are not used and results are reliant upon the subjects' own self-reported outcomes or on the therapist's own evaluations which may be subject to social desirability bias;
• Evidence is gathered over short periods of time and there is little follow-up data to determine rates of relapse over the long-term;
• The evidence does not demonstrate a change in sexual orientation, but merely a repression of same-sex attraction;
• The evidence does not take into consideration that subjects may be bisexual and may have simply been convinced to restrict their sexual activity to the opposite sex;
• Reparative therapists falsely assume that homosexuality is negative or unhealthy, and thus that change is desirable;
• Reparative therapists' research focuses on gay men almost exclusively and rarely includes lesbians.

Shidlo and Schroeder study

A 2002 peer-reviewed study by Dr. Ariel Shidlo and Dr. Michael Schroeder found that 88% of participants failed to achieve a sustained change in their sexual behaviour and 3% reported changing their orientation to heterosexual. The remainder reported either losing all sexual drive or struggling to remain celibate, with no change in attraction. Schroeder said many of the participants who failed felt a sense of shame. Many had gone through reparative therapy programs over the course of many years. Their study sample included both participants connected with reparative therapy advocates, as well as participants recruited through the Internet. Of the 8 respondents (out of a sample of 202) who reported a change in sexual orientation, 7 were employed in paid or unpaid roles as ex-gay counselors or group leaders, something which has led many to question whether even this small "success" rate is in fact reliable.

Spitzer study

In May 2001, Dr. Robert Spitzer, who was involved in the original declassification of homosexuality as a mental disorder, presented a paper on reparative therapy at the APA annual convention. He reported that 66% of the men and 44% of the women he sampled had achieved "good heterosexual functioning" through interventions. This paper was widely reported by proponents of reparative therapy as evidence of success of the therapy, and as the first step towards official acceptance and the legitimisation of reparative therapy.

The APA immediately issued an official disavowal of the paper, noting that it had not been peer-reviewed and bluntly stating that "There is no published scientific evidence supporting the efficacy of reparative therapy as a treatment to change one's sexual orientation."

Two years later, Spitzer published the paper in the Archives of Sexual Behavior. The publication decision sparked controversy and one sponsoring member resigned in protest. The paper has been criticized on various grounds, including using non-random sampling and poor criteria for "success". Critics argue that it relied upon samples selected by reparative therapists themselves (86 participants were handpicked by ex-gay organizations), that proper random samplings were not used, that small samplings were used, that the subjects appeared to be ex-gay advocates who may have been biased in favor of reparative therapies, that 60% of the subjects had previously reported being bisexual, and that no follow-up study had been carried out to acertain long-term conversion.

Spitzer himself played down the results of his own paper; upon being asked about the 200 patient sample after 16 months, and the percentage of people who might succeed, Spitzer said that it took almost a year and a half to only find 200 willing individuals, and therefore, the number of homosexuals who could successfully become heterosexual was likely to be "pretty low". He also conceded that the study's participants were "unusually religious."

Potential harms

Mainstream medical bodies state that reparative therapy can be harmful because it exploits guilt and anxiety, thereby damaging self-esteem and leading to depression and even suicide. There is evidence that rates of depression, anxiety, alcohol and drug abuse and suicidal feelings are roughly doubled in those who undergo reparative therapy.

Ethics concerns and lack of professional oversight

Reprarative therapists have come into conflict with the ethical guidelines laid down by the American Psychiatric Association and American Psychological Association. "Unlike many organizations and individuals who offer counseling and mental health treatment services, the majority of ex-gay programs market themselves as religious ministries and are therefore not governed or overseen by professional associations, licensing boards, state departments of health or other bureaucracies."

While professional ethical guidelines do not explicitly forbid reparative therapy, there are a number of potential clashes, as reported in another paper by Schroeder and Shidlo (see above) in particular on four particular issues: first, patients should not be pressured into therapy (many reparative therapists and those who approach them have strong religious views, and pressure is often placed on counsellees from that standpoint). Secondly, the therapist should not provide misleading information about the success rates of any treatment (the success rates claimed by groups such as Exodus International and NARTH are not substantiated by outside studies). Thirdly, the therapist should be prepared to provide alternative courses of treatment to those who were not progressing, or to refer them to counsellors or therapists offering alternative treatments. This often did not happen. Fourthly, the counsellor/therapist would be expected to refrain from direct criticism of the relevant professional associations.

Reasons why people seek to change sexual orientation

People may seek out reparative therapy for many reasons, including religious or personal beliefs, the desire for a traditional family, shame, rejection (actual or feared), fear of STIs, or a general dissatisfaction with the contemporary gay lifestyle.

The American Psychological Association states that harassment and abuse, as well as pressure from family, peers, and religious groups ignorant about and prejudiced against homosexuality, may cause high levels of emotional stress for lesbians, gays, and bisexuals. These pressures may lead people to feel forced into attempting to change their sexual orientation. Other researchers have found that social pressure plays a key role in a person's desire to change his or her sexuality.

One reparative therapist has argued that there is also social pressure not to enter reparative therapy..

Reaction by reparative therapists

Reparative therapists generally respond to the mainstream medical view with two main points. First, they argue that the mainstream medical view (from the 1973 declassification of homosexuality as a mental disorder to the current opposition to reparative therapy) is the result of political beliefs and lobbying. Second, they argue that there is no scientific data conclusively showing that reparative therapy does not work.

Controversies, criticisms, and scandals

Reparative therapy as a means of shaping the LGBT rights debate

Social conservatives sometimes use possibility of conversion therapy to argue against LGBT rights legislation and LGBT acceptance in general. The argument is that if sexual orientation is changeable, then remaining gay or lesbian is a mere choice and does not warrant the legal protections and social acceptance afforded to women and minorities.

Critics argue that "the Christian Right has seized the political opportunity offered by the ex-gay movement to repackage its anti-gay campaign in kinder, gentler terms. Instead of simply denouncing homosexuals as morally and socially corrupt, the Christian Right has now shifted to a strategy of emphasizing personal salvation for homosexuals — through the ex-gay movement. Behind this mask of compassion, however, the goal, remains the same: to roll back legal protections for lesbian, gay, bisexual and transgender people..."

The mainstream medical view is that conversion attempts are caused by, and reinforce, negative attitudes and mistaken beliefs about homosexuality.

Scandals involving minors

One of the most controversial aspects of reparative therapy has been the focus on gay teenagers, including occasions where teenagers have been forcibly treated in ex-gay camps. For example, in Tennessee in 1995, a 16-year-old gay male sought emancipation from his parents because they were forcing him to attend reorientation counseling with a Memphis psychologist. They intended to send him to either Love in Action, or another similar program. The Memphis Circuit Court judge agreed that the boy would be harmed by this treatment and indicated that he would sign the emancipation order. In a settlement agreement, the parents abandoned their plans to send the boy to treatment. The doctor in the case lost his license to practice as a psychologist, due to alleged ethics violations. In 2005, 16-year-old Zachary Stark posted on his blog protesting his parents' decision to send him to an ex-gay camp. In 2006, 17-year old DJ Butler was driven to the same camp in handcuffs. The camp, run by Love in Action ministries, was subsequently shut down when Tennessee authorities discovered that unlicensed staff had been administering prescription drugs to the patients.

A 2006 report from the National Gay & Lesbian Task Force has outlined evidence that reparative therapists are increasingly focusing on the young.

Relapses and ex-ex-gays

Further information: Ex-ex-gay

File:00sep29Paulk.jpg

Ex-gay John Paulk leaving a gay bar. (Photograph by Wayne Besen.)

• In 1979, Exodus International's co-founder Michael Bussee and his partner Gary Cooper quit the group and held a life commitment ceremony together.
• John Paulk left Focus on the Family after he was spotted by reporters in a Washington, D.C., gay bar. John Paulk is still married and champions the cause of the ex-gay movement.
• In 1986, Colin Cook, founder of Homosexuals Anonymous, was discovered to be engaging in sexual acts with his patients. He claimed that the nude massages of other men should desensitize them against homosexual desires. In 1987, he was expelled from Homosexuals Anonymous for sexual activity, and in 1995 a similar scandal happened with his newly founded group FaithQuest Colorado. According to the Denver Post, Cook had engaged in phone sex, practiced long and grinding hugs, and asked patients to bring homosexual pornography to sessions so that he could help desensitize them against it.

Financial and political motivations

Opponents argue that many reparative therapists may become involved for personal financial gain. They note that participants in conversion therapies frequently have to pay for the treatment they receive, as is true of any psychiatric treatment. It has also been noted that the organizations that sponsor ex-gay ministries, like Focus on the Family, use anti-gay political campaigns to generate funds but provide relatively few resources to their reparative therapy wings.

Terminology

The practice is alternatively called "conversion therapy." Those outside the movement may reject the label "reparative," as it presupposes that same-sex attraction is something which can or should be "repaired."

See also

• Ted Haggard
• But I'm a Cheerleader, a black comedy about a high school cheerleader who is sent to an ex-gay camp
• Saved!, a major motion picture comedy featuring one high school student trying to "straighten out" another
• Cartman Sucks, an episode of the animated television series South Park that criticizes youths being subjected to reparative therapy against their will.
• Julien Lowe, ex-gay character on The Shield.

References

• Norcross, JC, Garofalo. A, Koocher. G. (2006) Discredited Psychological Treatments and Tests; A Delphi Poll. Professional Psychology; Research and Practice. vol37. No 5. 515-522

External links

Mainstream positions on reparative therapy

• American Psychological Association Statement - sexual orientation is "not changeable."
• American Counseling Association: Ethical issues related to conversion or reparative therapy - "No empirical evidence exists"
• American Psychiatric Association Position Statement on Reparative Therapy - no "rigorous scientific research to substantiate their claims"
• American Academy Of Paediatrics Statement - "little or no potential for achieving changes"

Reparative therapists and advocates

• Exodus International, a Christian organization
• National Association for Research & Therapy of Homosexuality
• Family Research Institute
• The International Healing Foundation, a Christian organization.
• Evergreen International, an LDS ex-gay group
• Love In Action and Refuge, a Christian ministry
• Parents and Friends of ExGays and Gays
• True Freedom Trust, a Christian, ex-gay ministry based in the United Kingdom
• JONAH, a Jewish ex-gay group
• Throckmorton, Warren, Efforts to Modify Sexual Orientation: a Review of Outcome Literature and Ethical Issues
• People Can Change
• Courage, a Catholic ex-gay group

Other

• Donnie Davies' music video, a satirical 2007 meme.
• Ex-gay watch, watchdog blog following "ex-gay" organizations.
• The Pseudo-science of Sexual Orientation Conversion Therapy detailed summary of the case against conversion therapy.
• Fact sheet from UC Davis Psychology Department.
• Wayne Besen, former spokesman of the Human Rights Campaign and outspoken critic of conversion therapy.
• Tanya Erzen Straight to Jesus: Sexual and Christian conversions in the ex-gay movement American Sexuality Magazine