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Although the World Health Organization deleted homosexuality as a mental disorder in ICD-10, it included the diagnosis of ego-dystonic sexual orientation. There are many ways a person may go about receiving therapy for ego-dystonic sexual orientation associated with homosexuality. There is no known therapy for other types of egodystonic sexual orientations. Therapy can be aimed at changing [[sexual orientation]], [[sexual behavior]], or helping a client become more comfortable with their sexual orientation and behaviors. Human rights groups have accused some countries of performing these treatments on [[egosyntonic]] homosexuals.<ref name=India /> One survey suggested that viewing the same-sex activities as compulsive facilitated commitment to a [[mixed-orientation marriage]] and to [[monogamy]].<ref>{{cite journal |author=Schneider JP, Schneider BH |title=Marital satisfaction during recovery from self-identified sexual addiction among bisexual men and their wives |journal=J Sex Marital Ther |volume=16 |issue=4 |pages=230–50 |year=1990 |pmid=2079706 }}</ref> In addition, some people seek non-professional methods, such as religious counseling or attendance in an [[ex-gay]] group.
Although the World Health Organization deleted homosexuality as a mental disorder in ICD-10, it included the diagnosis of ego-dystonic sexual orientation. There are many ways a person may go about receiving therapy for ego-dystonic sexual orientation associated with homosexuality. There is no known therapy for other types of egodystonic sexual orientations. Therapy can be aimed at changing [[sexual orientation]], [[sexual behavior]], or helping a client become more comfortable with their sexual orientation and behaviors. Human rights groups have accused some countries of performing these treatments on [[egosyntonic]] homosexuals.<ref name=India /> One survey suggested that viewing the same-sex activities as compulsive facilitated commitment to a [[mixed-orientation marriage]] and to [[monogamy]].<ref>{{cite journal |author=Schneider JP, Schneider BH |title=Marital satisfaction during recovery from self-identified sexual addiction among bisexual men and their wives |journal=J Sex Marital Ther |volume=16 |issue=4 |pages=230–50 |year=1990 |pmid=2079706 }}</ref> In addition, some people seek non-professional methods, such as religious counseling or attendance in an [[ex-gay]] group.


The American Psychological Association "encourages mental health professionals to avoid misrepresenting the efficacy of sexual orientation change efforts by promoting or promising change in sexual orientation when providing assistance to individuals distressed by their own or others’ sexual orientation and concludes that the benefits reported by participants in sexual orientation change efforts can be gained through approaches that do not attempt to change sexual orientation".<ref name=apa2009>American Psychological Association: [http://www.apa.org/pi/lgbc/publications/resolution-resp.html Resolution on Appropriate Affirmative Responses to Sexual Orientation Distress and Change Efforts]</ref>
[[Psychotherapy]], [[support group]]s, and life events can change religious identity or [[sexual identity|sexual orientation identity]], but not [[sexual orientation]].<ref name=apa /> There is no evidence whether or not recent sexual orientation change efforts can change sexual orientation. Participants have reported both harm and benefit from such efforts, but no casual relationship has been determined between either the benefit or the harm. According to a recent APA study, participants who reported harm generally reported "anger, anxiety, confusion, depression, grief, guilt, hopelessness, deteriorated relationships with family, loss of social support, loss of faith, poor self-image, social isolation, intimacy difficulties, intrusive imagery, suicidal ideation, self-hatred, and sexual dysfunction. These reports of perceptions of harm are countered by accounts of perceptions of relief, happiness, improved relationships with God, and perceived improvement in mental health status, among other reported benefits."<ref name=apa>[http://www.apa.org/pi/lgbc/publications/therapeutic-response.pdf Appropriate Therapeutic Responses to Sexual Orientation]</ref>

There is not enough evidence to show that efforts to change sexual orientation are effective. There is some evidence that such efforts cause harm. Religious identity and [[sexual identity|sexual orientation identity]] develop through life, and [[psychotherapy]], [[support group]]s, and life events can influence identity development, as self-awareness, selfconcept, and identity may evolve during treatment.<ref name=apa /> Changes that do happen concern sexual orientation identity (private and public identification, and group belonging), emotional adjustment, (self-stigma and shame reduction), and personal beliefs, values and norms (change of religious and moral belief, behavior and motivation) .<ref name=apa />


According to APA guidelines, the therapist must make clear that homosexuality doesn't signal a mental or emotional disorder. The counselor must advise clients that gay men and women can lead happy and healthy lives, and emphasize that there is no evidence therapy can change sexual orientation. The therapist should neither promote nor reject the idea of celibacy, but help the client come to their own conclusion by evaluating the reasons behind the patient's goals.<ref name=apa />
According to APA guidelines, the therapist must make clear that homosexuality doesn't signal a mental or emotional disorder. The counselor must advise clients that gay men and women can lead happy and healthy lives, and emphasize that there is no evidence therapy can change sexual orientation. The therapist should neither promote nor reject the idea of celibacy, but help the client come to their own conclusion by evaluating the reasons behind the patient's goals.<ref name=apa />

Revision as of 08:15, 15 August 2009

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Egodystonic sexual orientation is an egodystonic condition. The World Health Organization lists egodystonic sexual orientation in the ICD-10, under "Psychological and behavioural disorders associated with sexual development and orientation". The WHO describes it thus:

The gender identity or sexual preference (heterosexual, homosexual, bisexual, or prepubertal) is not in doubt, but the individual wishes it were different because of associated psychological and behavioural disorders, and may seek treatment in order to change it. (F66.1)

The WHO applies the following note to the entirety of part F66: "Sexual orientation by itself is not to be regarded as a disorder."[1]

The diagnostic category of "ego-dystonic homosexuality" was removed from the American Psychiatric Association's DSM in 1987 (with the publication of the DSM-III-R), but still potentially remains in the DSM-IV under the category of "sexual disorder not otherwise specified" including "persistent and marked distress about one’s sexual orientation”.

The Medical Council of India uses the WHO classification of ego-dystonic sexual orientation.[2] The Chinese Classification and Diagnostic Criteria of Mental Disorders includes ego-dystonic homosexuality, but does not include ego-dystonic heterosexuality, bisexuality, or prepubertal sexuality.[3] The American Psychological Association has officially opposed the category of ego-dystonic homosexuality since 1987.[4]

Professional treatments

Ego-dystonic sexual orientation
SpecialtyPsychiatry, psychology Edit this on Wikidata

Although the World Health Organization deleted homosexuality as a mental disorder in ICD-10, it included the diagnosis of ego-dystonic sexual orientation. There are many ways a person may go about receiving therapy for ego-dystonic sexual orientation associated with homosexuality. There is no known therapy for other types of egodystonic sexual orientations. Therapy can be aimed at changing sexual orientation, sexual behavior, or helping a client become more comfortable with their sexual orientation and behaviors. Human rights groups have accused some countries of performing these treatments on egosyntonic homosexuals.[5] One survey suggested that viewing the same-sex activities as compulsive facilitated commitment to a mixed-orientation marriage and to monogamy.[6] In addition, some people seek non-professional methods, such as religious counseling or attendance in an ex-gay group.

The American Psychological Association "encourages mental health professionals to avoid misrepresenting the efficacy of sexual orientation change efforts by promoting or promising change in sexual orientation when providing assistance to individuals distressed by their own or others’ sexual orientation and concludes that the benefits reported by participants in sexual orientation change efforts can be gained through approaches that do not attempt to change sexual orientation".[7]

There is not enough evidence to show that efforts to change sexual orientation are effective. There is some evidence that such efforts cause harm. Religious identity and sexual orientation identity develop through life, and psychotherapy, support groups, and life events can influence identity development, as self-awareness, selfconcept, and identity may evolve during treatment.[8] Changes that do happen concern sexual orientation identity (private and public identification, and group belonging), emotional adjustment, (self-stigma and shame reduction), and personal beliefs, values and norms (change of religious and moral belief, behavior and motivation) .[8]

According to APA guidelines, the therapist must make clear that homosexuality doesn't signal a mental or emotional disorder. The counselor must advise clients that gay men and women can lead happy and healthy lives, and emphasize that there is no evidence therapy can change sexual orientation. The therapist should neither promote nor reject the idea of celibacy, but help the client come to their own conclusion by evaluating the reasons behind the patient's goals.[8]

Behavior Modification

Aversion therapy uses associate negative stimuli with homoerotic pictures and positive stimuli with heteroerotic pictures. A series of 1966 experiments showed promise, and the practice became popular, but it fell out of practice after the reports were shown to be flawed.[9] Since 1994, the American Psychological Association has declared that aversion therapy is a dangerous practice that does not work, but it is still in use in some countries.[5]

Psychotherapy

Psychotherapy may result in one of four sexual orientation identities:

  1. LGB identity
  2. Heterosexual sexual orientation identity
  3. Disidentifying from LGB identities (e.g., ex-gay)
  4. Not specifying an identity.[8]

Several therapies have been established, including:

  • Conversion therapy uses psychotherapy to turn people's sexual orientation identity from homosexual to heterosexual.[citation needed] It may be harmful if the client is egosyntonic and does not wish to change their sexual orientation.[10] American medical associations recommend practitioners avoid the practice.[11]
  • Sexual Identity Therapy was designed by Warren Throckmorton and Mark Yarhouse, and is endorsed by Robert L. Spitzer.[12] Its purpose is to help patients line up their sexual identity with their beliefs and values. Therapy involves four phases: (1) assessment, (2) advanced or expanded informed consent, (3) psychotherapy, and (4) social integration of a valued sexual identity. According to a Regent University website, which describes a client's adoption of the "gay affirmative" or "integrative" therapeutic model as a clinical failure, sexual identity therapy is not a form of conversion therapy.[13]
  • Group psychotherapy uses group sessions lead by a single psychologist and focuses on conflict surrounding homosexual expression.[14]
  • Gender Wholeness Therapy was designed by an ex-gay Licensed Professional Counselor, David Matheson.[15] "The emphasis in Mr. Matheson's counseling is on helping men — all his clients are male — develop 'gender wholeness' by addressing emotional issues and building healthy connections with other men. He [says] he believe[s] that help[s] reduce homosexual desires.[15]
  • Context Specific Therapy was designed by Jeffrey Robinson. It does not work with any one theory of homosexuality, but uses several theoretical backgrounds according to the client's need,[16] and is based on phenomenological research.[17] It does not seek to change the client's orientation, but instead focuses on diminishing homosexual thoughts and behaviors. It works within the client's own view of God, noting that "individuals who are successful at overcoming homosexual problems are motivated by strong religious values".[18]
  • Gender-affirmative therapy has been described by A. Dean Byrd as follows: "The basic premise of gender-affirmative therapy is that social and emotional variables affect gender identity which, in turn, determines sexual orientation. The work of the therapist is to help people understand their gender development. Subsequently, such individuals are able to make choices that are consistent with their value system. The focus of therapy is to help clients fully develop their masculine or feminine identity".[19]
  • Gay affirmative psychotherapy helps LGB people to examine and accept their sexual orientation and related sexual relationships. Psychologists understand that homosexuality and bisexuality are not indicative of mental illness.[20] Psychologists are encouraged to recognize how their attitudes and knowledge about homosexual and bisexual issues may be relevant to assessment and treatment and seek consultation or make appropriate referrals when indicated. Psychologists strive to understand the ways in which social stigmatization (i.e., prejudice, discrimination, and violence) poses risks to the mental health and well-being of homosexual and bisexual clients. Psychologists strive to understand how inaccurate or prejudicial views of homosexuality or bisexuality may affect the client’s presentation in treatment and the therapeutic process. Douglas Haldeman has argued that for individuals who seek therapy because of frustration surrounding "seemingly irreconcilable internal differences" between "their sexual and religious selves... neither a gay-affirmative nor a conversion therapy approach [may be] indicated," and that "[just as] therapists in the religious world [should] refrain from pathologizing their LGB clients... so, too, should gay-affirmative practitioners refrain from overtly or subtly devaluing those who espouse conservative religious identities."[21] Data suggest that clients generally judge therapists who do not respect religiously-based identity outcomes to be unhelpful.[22]

Non-professional methods

Some therapeutic methods are entirely outside the purview of professional health associations, and hence do not have to obey professional ethics guidelines.[23] Many of these methods fail to look at the many external social or psychosocial causes of the distress, and instead focus on sexual orientation as the source of the distress. Some of these sources include coaches, religious organizations, and ex-gay groups.

Coaches

Coaches work like psychologists, but are not licensed and hence do not have to follow ethical guidelines set by professional associations, giving them more room to experiment. One of the largest organizations is the International Healing Foundation, whose motto is "Changing From Gay To Straight Is Possible."[24] They provide classes for people trying to change their orientation, as well as training for those trying to help. Higher Path Life Coaching is another organization started by ex-gay Rich Wyler centered in the Virginia area.[25]

One of the more well-known coaches is Richard Cohen, founder of the International Healing Foundation. His television appearances have sparked controversy. He holds male patients in his lap with the patient curled into the fetal position, and also advocates bioenergetic methods involving slamming a pillow with a tennis racket while shouting "Mom! Why did you do this to me?"[26]

Retreats

Several organizations have started retreats lead by coaches aimed at helping participants diminish same-sex desires. These retreats tend to use a variety of techniques. Journey into Manhood, put on by People Can Change uses "a wide variety of large-group, small-group and individual exercises, from journaling to visualizations (or guided imagery) to group sharing and intensive emotional-release work."[27] Weekends put on by Adventure in Manhood support "healthy bonding with men, through masculine activity, teamwork, and socialization."[28] Though not specific to gay men, several gay men attended the New Warrior Training Adventure, a weekend put on by Mankind Project, which is a "process of initiation and self-examination that is designed to catalyze the development of a healthy and mature masculine self."[29] Joe Dallas, a prominent ex-gay, leads a monthly five-day men's retreat on sexual purity titled, Every Mans' Battle.[30]

Religious organizations

Further information: [[:Religion and homosexuality]]

Some gay people have turned to pastoral care. Some churches publish specific instructions to clergy on how to minister to gay and lesbian people. These publications include Ministry to Persons with a Homosexual Inclination, produced by the Roman Catholic Church, and God Loveth His Children, produced by The Church of Jesus Christ of Latter-day Saints. In 1994, a church in the Presbyterian Church (USA) held a conference entitled “The Path to Freedom: Exploring healing for the Homosexual.”[31] The APA encourages religious leaders to recognize that it is outside their role to adjudicate empirical scientific issues in psychology.[8]

Mental health practioners can incorporate religion into therapy by "integrating aspects of the psychology of religion into their work, including by obtaining a thorough assessment of clients’ spiritual and religious beliefs, religious identity and motivations, and spiritual functioning; improving positive religious coping; and exploring the intersection of religious and sexual orientation identities."[8] Reading religious texts can reduce identity conflicts by reducing the salience of negative messages about homosexuality and increasing self-authority or understanding.[8] Distress may also be alieviated by coming to the belief that God continues to love and accept them, because of or despite their sexual orientation.[8] Other techniques include worship, meditation, prayer, casting-out evil spirits, fasting, church attendance, scripture reading, religious counseling, willpower, and (for Christians) dependence on divine grace through the atonement of Jesus. If the member had same-sex sex, the member may be asked to confess, seek forgiveness, repent, and give restitution. The member may also be asked to observe or stop observing certain rituals or sacraments, or the church may excommunicate the individual.

Other gay people may turn to LGBT-affirming religious groups.

LGB support groups

LGB groups help counteract and buffer minority stress, marginalization, and isolation.[8] The focus on helping a person with ego-dystonic sexual orientation accept their sexual orientation.

Ex-gay organizations

OneByOne, an ex-gay organization, hosts a booth at a Love Won Out conference
Main article: Ex-gay

For some ex-gay groups, choosing not to act on one's same-sex desires counts as a success[13] whereas conversion therapists tend to understand success in terms of reducing or eliminating those desires. For example, some ex-gays in mixed-orientation marriages acknowledge that their sexual attractions remain primarily homosexual, but seek to make their marriages work regardless.[32] Ex-gay advocates sometimes compare adopting the label "ex-gay" to the coming out process."[33] Some conservative Christian political and social lobbying groups such as Focus on the Family, the Family Research Council, and the American Family Association actively promote to their constituencies the accounts of change of both conversion therapies and ex-gay groups.

Some ex-gay organizations follow the tenets of a specific religion, while others try to encompass a more general spirituality. Although most ex-gay organizations were started by American evangelical Christians, there are now ex-gay organizations in other parts of the world and for Catholics, Mormons, Jews and Muslims. According to Douglas Haldeman, "This modality is thought to be one of the most common for individuals seeking to change their sexual orientation."[34] Ex-gay ministries typically are staffed by volunteer counselors, unlike reorientation counseling, which is conducted by licensed clinicians.[35]

Ex-gay groups use several different techniques. Love in Action hosts 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."[36][37] Exodus International considers reparative therapy to be a useful tool, but not a necessary one.[38] Evergreen International does not advocate or discourage particular therapies[39] and states that "therapy will likely not be a cure in the sense of erasing all homosexual feelings."[40]

See also

References

  1. ^ ICD-10: See part F66.
  2. ^ "Human rights violations against sexuality minorities in India" (PDF). People's Union for Civil Liberties. 2001. {{cite web}}: Unknown parameter |month= ignored (help)
  3. ^ CSSSM
  4. ^ Use of Diagnoses “Homosexuality” & “Ego-Dystonic Homosexuality” August 27 & 30, 1987
  5. ^ a b Chandran, Vinay (2006). "Prayer, punishment or therapy? Being a homosexual in India". InfoChange News & Features. Retrieved 2007-08-28. While social attitudes are slowly changing [in India] and the anti-sodomy law is being challenged, mental health professionals in many places still offer therapy to homosexuals. {{cite web}}: Unknown parameter |month= ignored (help)
  6. ^ Schneider JP, Schneider BH (1990). "Marital satisfaction during recovery from self-identified sexual addiction among bisexual men and their wives". J Sex Marital Ther. 16 (4): 230–50. PMID 2079706.
  7. ^ American Psychological Association: Resolution on Appropriate Affirmative Responses to Sexual Orientation Distress and Change Efforts
  8. ^ a b c d e f g h i Cite error: The named reference apa was invoked but never defined (see the help page).
  9. ^ Seligman, p. 156
  10. ^ Nicolosi, Joseph (2000). "Retrospective self-reports of changes in homosexual orientation: A consumer survey of conversion therapy clients". 86. Psychological Reports: 1071–88. {{cite journal}}: Cite journal requires |journal= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  11. ^ "Position Statement on Therapies Focused on Attempts to Change Sexual Orientation (Reparative or Conversion Therapies)" (PDF). American Psychiatric Association. 2000. Retrieved 2007-08-28. {{cite web}}: Unknown parameter |month= ignored (help)
  12. ^ Simon, Stephanie (2007-06-18). "New ground in debate on 'curing' gays". Los Angeles Times. Retrieved 2007-10-29. {{cite news}}: Check date values in: |date= (help)
  13. ^ a b "Frequently Asked Questions". Regent University: Institute for the Study of Sexual Identity. Retrieved 2007-10-29.
  14. ^ Wolf TJ (1987). "Group psychotherapy for bisexual men and their wives". J Homosex. 14 (1–2): 191–9. doi:10.1300/J082v14n01_14. PMID 3655341.
  15. ^ a b Luo, Michael (2007-02-12). "Some Tormented by Homosexuality Look to a Controversial Therapy". The New York Times. p. 1. Retrieved 2007-08-28.
  16. ^ Throckmorton, Warren (2004). "What is reparative therapy?". Self-published. Retrieved 2007-10-29.
  17. ^ "NARTH 2003 Annual Conference schedule". NARTH. 2004-04-14. Retrieved 2007-10-29. {{cite web}}: Check date values in: |date= (help)
  18. ^ Jeffrey, Robinson. "What is Context Specific Therapy?". Self-published. Retrieved 2007-10-29.
  19. ^ Byrd, A. Dean (2002). "Homosexuality: Innate and Immutable?" ([dead link] – Scholar search). 14 (513). Regent University Law Review: 537. Retrieved 2007-10-29. {{cite journal}}: Cite journal requires |journal= (help); External link in |format= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  20. ^ APA:Guidelines for Psychotherapy with Lesbian, Gay, & Bisexual Clients
  21. ^ Haldeman, Douglas (2004). "When Sexual and Religious Orientation Collide:Considerations in Working with Conflicted Same-Sex Attracted Male Clients". The Counseling Psychologist. 32 (5). The Counseling Psychologist: 691. doi:10.1177/0011000004267560.
  22. ^ Throckmorton, Warren (Winter 2005). "Counseling practices as they relate to ratings of helpfulness by consumers of sexual reorientation therapy" (PDF). 24 (4). Journal of Psychology and Christianity: 332–42. {{cite journal}}: Cite journal requires |journal= (help); Unknown parameter |coauthor= ignored (|author= suggested) (help)
  23. ^ Cianciotto, J.; Cahill, S. (2006). "Youth in the crosshairs: the third wave of ex-gay activism" (pdf). National Gay and Lesbian Task Force. Retrieved 2007-08-29.{{cite web}}: CS1 maint: multiple names: authors list (link)
  24. ^ International Healing Foundation
  25. ^ Higher Path Life Coaching
  26. ^ "Videoclip of Cohen's techniques". CNN. Retrieved 2008-08-28.
  27. ^ "Journey Into Manhood: A Healing Weekend Hosted by People Can Change". NARTH. 2006-04-20. Retrieved 2007-10-01. {{cite web}}: Check date values in: |date= (help)
  28. ^ "Adventure in Manhood homepage". Self-published. Retrieved 2007-10-29.
  29. ^ "The New Warrior Weekend". Self-published. Retrieved 2007-10-29.
  30. ^ "'Love Won Out' conference coming to Southern California". Christian Examiner. September 2007.
  31. ^ "OneByOne: About Us". Self-published. 2006. Retrieved 2007-10-29.
  32. ^ Anonymous (2002-03-11). "No easy victory". Christianity Today. Retrieved 2007-08-28. {{cite news}}: Check date values in: |date= (help)
  33. ^ Peebles, Amy E. (2003). "It's Not Coming Out, So Then What Is It? Sexual Identity and the Ex-Gay Narrative" (PDF). Texas Linguistic Forum. 47: 155–64. Retrieved 2007-08-28. {{cite journal}}: Unknown parameter |month= ignored (help)
  34. ^ Haldeman, Douglas C. (2002). "Gay Rights, Patient Rights: The Implications of Sexual Orientation Conversion Therapy". Professional Psychology: Research and Practice. 33 (3): 260–4. doi:10.1037//0735-7028.33.3.260. {{cite journal}}: Unknown parameter |month= ignored (help)
  35. ^ Throckmorton, Warren (2002). "Initial empirical and clinical findings concerning the change process for ex-gays". Professional Psychology: Research and Practice. 33 (3). American Psychological Association: 242–8. doi:10.1037/0735-7028.33.3.242. {{cite journal}}: Unknown parameter |month= ignored (help)
  36. ^ "the source". Love in Action. Retrieved 2007-08-28.
  37. ^ "the journey". Love in Action. Retrieved 2007-08-28.
  38. ^ "Exodus International Policy Statements". Exodus International. Retrieved 2007-08-28.
  39. ^ "Myths". Evergreen International. Retrieved 2007-10-29.
  40. ^ "Therapy". Evergreen International. Retrieved 2007-10-29.
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