Author: Jon David Johnson
At the risk of cliché, the weather just turned from raining to pouring for the reparative (gay-to-straight) therapy community. After having been panned in two nationally released movies in the last year, the community faces its most definitive reprobation yet in the form of a meta-study released by the American Psychological Association. The study covered 83 peer-reviewed articles since 1960, and concludes:
Contrary to claims of sexual orientation change advocates and practitioners, there is insufficient evidence to support the use of psychological interventions to change sexual orientation…At most, certain studies suggested that some individuals learned how to ignore or not act on their homosexual attractions…psychologists cannot predict the impact of these treatments and need to be very cautious, given that some qualitative research suggests the potential for harm.[1]
In 1975, the American Psychiatric Association removed homosexuality from its Diagnostic and Statistical Manual of Mental Disorders, but that hasn’t stopped some reparative therapy advocates, like the overtly religious Exodus International[2] or the quasi-secular NARTH[3] from gaining traction in recent years, following the “culture wars” of the last two decades and a couple dubious and widely misrepresented studies in the early part of this decade. Most notable among those studies is the Spitzer study[4] conducted in 2001 and reported incorrectly by many news outlets as reflecting a change of heart on the value of reparative therapy by one of the vocal advocates of removing homosexuality from the DSM. As with many studies on the subject, the Spitzer study suffered both sample bias (two-thirds of his participants were referred by NARTH or by Christian advocates of reparative therapy) and lax questioning methodologies. What is perhaps most eye-catching in the study is that in spite of the large sample bias in favor of proponents of reparative therapy, 86% of men and 63% of women reported the persistence of homosexual feelings and attractions. Another prominent study in the same year by Ariel Shidlo and Michael Schroeder[5] suffered similar sample and question bias (seeking out participants harmed by the therapy, a large majority not surprisingly said they had been, while 3% said the therapy was successful) and has been misused by parties on both sides of the issue.
My Two Cents
I am no expert on this subject, and I don’t pretend that reading 10 or 15 articles makes me one. That being said, what seems clear to me in reading some of the available literature is that a very large majority of “successful” gay-to-straight cases are actually cases of the suppression of behavior (many of which don’t last) rather than an actual psychological change. Furthermore, while studies like Shidlo and Schroeder have their own problems, the number of people who have potentially suffered genuine harm or distress as a result of these therapies likely outweighs the number of people who have potentially made a genuine and happy conversion. Finally, a lot of the material offered in support of reparative therapy by groups like NARTH is either self-referential or based on the recycled articles of a very few people (Joseph Nicolosi, the group’s founder, Mark Yarhouse, Warren Throckmorton, and the misrepresented Spitzer study noted above). Given the number of people working in the fields of psychology and psychiatry, this is a pretty thin lineup and, combined with the setting up of gay activists or gay-affirmative therapists as straw men, reminds me of the pseudo-science Discovery Institute.
While it is certainly the case that there exist psychologists and counselors of all ideological persuasions who abuse their patient relationships to promote their own beliefs, it is not in my mind the case that there is a categorical problem with gay-affirmative therapy practices as there is with reparative practice. The reason is pretty straightforward: most anyone entering into gay-affirmative therapy is going to have significant pre-existing feelings of homosexuality or bi-sexuality, so that the practitioner is usually swimming with the current, so to speak – though there may be some who can be criticized for too strongly advocating a gay lifestyle to someone merely curious or confused. With reparative therapy however, the practitioner is by definition swimming against the current of the patient’s feelings. It seems to me intuitively obvious that the effort to fundamentally alter one’s emotional constitution is going to be much more jarring and potentially harmful than the effort to affirm it. In the event of a severe mental disorder, in which one is an imminent danger to themselves or to others, the effort may be worth it. Homosexuality, however, is neither a disorder nor a danger, though the advocates of reparative therapy are implicitly accepting one or both of those ideas.
The influence of conservative religion, even in supposedly secular groups like NARTH, cannot be underestimated here. In much of the literature at the NARTH website and elsewhere, conflict with religious values is cited as a reason for seeking reparative therapy, as though when one’s feelings are in conflict with his religion, it must be his feelings that are wrong. And, of course, the notion of homosexuality as a danger or disorder derives principally from religious texts. At the risk of expanding the issue, it is easy to argue that reparative therapies are driven by the attempt of religion to exert control over the society around it.
Regardless, in all cases the job of the practitioner should be to provide support and help the patient feel comfortable, first with themselves, and then with the society in which they live. The practitioner should do no harm. There is too much reason to think that reparative therapy can do harm, and too little evidence that it works at any significant rate for the responsible practitioner to employ it.
[1] http://www.apa.org/releases/therapeutic.html
[2] http://www.exodus-international.org/
[3] http://www.narth.com/index.html
[4] http://www.religioustolerance.org/hom_spit.htm
[5] http://wthrockmorton.com/tag/shidlo/ http://www.fair.org/index.php?page=1075