Reparative therapy

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Reparative therapy (also called conversion therapy and reorientation therapy) refers to methods aimed at changing gay, lesbian, and bisexual people's sexual orientations to heterosexual, or at eliminating or diminishing homosexual desires and behaviors. Many techniques have been tried, including behavior modification, aversion therapy, psychoanalysis, prayer, and religious counseling. Reparative therapy is closely associated with the "ex-gay" movement, which is more explicitly religious. Ex-gay groups tend to focus primarily on avoiding same-sex sexual activity, and secondarily (or sometimes not at all) on changing the underlying orientation.

The medical and scientific consensus in the United States is that reparative therapy is not effective at changing sexual orientation and is potentially harmful. No mainstream U.S. medical organization endorses reparative therapy and some have expressed concerns over some of the ethics and assumptions surrounding its practice. The mainstream view is that sexual orientation cannot be changed by therapy, and that attempts to do so may be damaging to the person's well-being, and that "the positions espoused by NARTH and Focus on the Family create an environment in which prejudice and discrimination can flourish." However, Gerald Koocher, the president of the American Psychological Association, has stated that "the APA has no conflict with psychologists who help those distressed by unwanted homosexual attraction."

Since the 1990s, reparative therapy and ex-gays have appeared 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 unhappy with their sexuality. LGBT rights supporters characterize the phenomenon as "the Christian Right repackag[ing] 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

Charles Socarides (1922-2005), a conversion therapist.

The first attempts to classify homosexuality as a disease were made by the fledgling European sexologist movement in the late nineteenth century. In 1886 noted sexologist Richard von Krafft-Ebing listed homosexuality along with 200 other case studies of deviant sexual practices in his definitive work, Psychopathia Sexualis. Krafft-Ebing, however, proposed that homosexuality was caused by either congenital (during birth) inversion or an acquired inversion.

In 1896 Sigmund Freud published his ideas on psychoanalysis. Dealing as it did with sexual urges, psychoanalysis was frequently used in the treatment of homosexuality, and much discussion of psychoanalysis was devoted to the issue of homosexuality as a paraphilia, or sexual disorder. For example, psychoanalysts theorized that castration anxiety was the basis for male homosexuality. Researchers attempted to use a variety of therapies to "cure" homosexuality, including aversion therapy, nausea producing drugs, castration, electric shock, brain surgery, and breast amputations.

In his work Sexual Inversion Havelock Ellis proposed that homosexuality was the product of a combination of upbringing and biological factors. Various other theories were proposed by sexologists classifying homosexuality as a physical disease, a "third sex," or a psychological aberration. Most concluded that homosexuality was a curable condition. Various 'cures' were proposed including castration, hypnosis and aversion therapy.^{[How to reference and link to summary or text]}

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 her influential paper "The Adjustment of the Male Overt Homosexual," where she found that "homosexuals were not inherently abnormal and that there was no difference between homosexual and heterosexual men in terms of pathology."

In 1968, Charles Socarides (1922-2005), who would go on to become a central figure in the reparative therapy movement, developed a psychoanalytic theory which interpreted same-sex desires as an illness arising from a conflict between the id and the ego. The conflict usually arose from an early age in "a female-dominated environment wherein the father was absent, weak, detached or sadistic." Commentators have found it ironic that Socarides' son Richard Socarides is openly gay and was Bill Clinton's Senior Advisor for Public Liaison for gay and lesbian issues.

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, and in 1992 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 electroconvulsive 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," and they call subjects "strugglers." Today Exodus is the most visible ex-gay organization, occasionally taking out full-page newspaper ads or renting billboards.

The label reparative originates from 1983 when Elizabeth Moberly, a research psychologist, coined the term reparative drive to refer to male homosexuality itself, interpreting same-sex male desires as attempts to repair for a lacked connection between father and son during childhood. She encouraged same-sex bonding with both mentors and peer relationships as a way of stopping same-sex sexual attraction.

In a 1991 book Joseph Nicolosi argued "[e]ach one of us, man and woman alike, is driven by the power of romantic love. These infatuations gain their power from the unconscious drive to become a complete human being. In heterosexuals, it is the drive to bring together the male-female polarity through the longing for the other-than me. But in homosexuals, it is the attempt to fulfill a deficit in wholeness of one’s original gender." This book has been criticized as "a religious treatise on homosexuality thinly disguised as a scientific document. In the new religious cum scientific paradigm, mental health is defined as conformity to traditional values and norms."

In 1992, Nicolosi, Socarides, and Benjamin Kaufman founded NARTH, currently the most prominent reparative therapy organization.

The shadow of Freud and the psychoanalytic basis of Moberly's, Nicolosi's, and Socarides' theories have helped earn psychoanalysis "its present mythic status as an implacable foe of lesbian and gay identities." This status continues even though many psychoanalysts have repudiated the anti-gay bias within the field and both the American Psychoanalytic Association (APsaP) and the American Academy of Psychoanalysis have issued non-discrimination statements. The APsaP has spoken against NARTH specifically, stating "that organization does not adhere to our policy of nondiscrimination and... their activities are demeaning to our members who are gay and lesbian."

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. Some religious conservatives support this movement, both ideologically and financially. 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

See also: Reparative therapy#Ethics guidelines

Techniques used by reparative therapists and ex-gay groups roughly fall into three categories, depending on the practitioner's theoretical view of sexual orientation: (1) behavior modification techniques, (2) psychoanalytic techniques, and (3) religious techniques.

Behavior modification

See also: Aversion Therapy

Practitioners who view same-sex orientations as resulting from learned behavior may adopt behavioral modification techniques. These may include masturbatory reconditioning, visualization, and social skills training. The most radical involve aversion therapy such as electroconvulsive 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."

In 1966, psychologist Martin E.P. Seligman reported that using aversion therapy to change sexual orientation "worked surprisingly well," with up to 50% of men subjected to such therapy not acting on their homosexual urges. These results produced what Seligman described as "a great burst of enthusiasm about changing homosexuality [that] swept over the therapeutic community" after the results were reported in 1966. However, Seligman notes that the findings were later demonstrated to be flawed: most of the men treated with aversion therapy who did in fact stop homosexual behaviour were actually bisexual. Among men with an exclusive or near-exclusive homosexual orientation, aversion therapy was far less successful.

In another case therapists used plethysmography, which uses electric sensors attached to a person's genitals to measure sexual arousal, was used, in conjunction with shock therapy, to electrically shock the patient's penis when he became sexually aroused by same-sex images. One residential adolescents treatment center used sedation, isolation, physical restraints, hypnosis, and "hold therapy," in which a girl was held down while staff members screamed at her until she admitted that she was hurting her family by being a lesbian.

Governments have used these methods as well. In 1952, the British government subjected Alan Turing to these techniques after he was arrested for homosexual conduct. In the 1970s and 1980s, the South African Defense Force administered it to suspected homosexuals. As recently as 1992, the Phoenix Memorial Hospital was using these methods on children as young as 10. In 1994, the American Psychological Association declared aversion therapy to be a dangerous practice that doesn't work.^{[How to reference and link to summary or text]} In India, where homosexuality is illegal, these methods are still used.

Psychoanalysis

Nicolosi and Socarides are the lead representatives of the view that same-sex desires are a form of arrested psychosexual development, resulting from "an incomplete bond and resultant identification with the same-sex parent, which is then symbolically repaired in psychotherapy." Their corresponding psychoanalysis-based intervention plans involve conditioning a man to a traditional masculine gender role. He should "(1) participate in sports activities, (2) avoid activities considered of interest to homosexuals, such art museums, opera, symphonies, (3) avoid women unless it is for romantic contact, (4) increase time spent with heterosexual men in order to learn to mimic heterosexual male ways of walking, talking, and interacting with other heterosexual men, (5) Attend church and join a men’s church group, (6) attend reparative therapy group to discuss progress, or slips back into homosexuality, (7) become more assertive with women through flirting and dating, (8) begin heterosexual dating, (9) engage in heterosexual intercourse, (10) enter into heterosexual marriage, and (11) father children." Nicolosi has stated that, in all cases, if a father and son have a normal relationship, the son will not be gay.

Religious techniques

See also: Religion and homosexuality

Religious doctrines regarding homosexuality range from full acceptance to advocating capital punishment. Most Abrahamic religions view homosexual behavior as a sin and a small minority also views homosexual orientation as sinful.^{[How to reference and link to summary or text]} These religions typically do not teach members how to change their sexual orientation, instead relying on generic teachings for dealing with temptation or sin, depending on the religion’s view of homosexuality.^{[How to reference and link to summary or text]} Techniques for avoiding temptation often include worship, meditation, prayer, fasting, church attendance, scripture reading, religious counseling, willpower, and (for Christians) dependence on divine grace through the atonement of Jesus. If sin is involved, 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.

Recently, however, some churches have begun publishing specific instructions to clergy on how to minister to gay and lesbian people. These publications include On the Pastoral Care of Homosexual Persons, produced by the Roman Catholic Church, and Understanding and Helping Those Who Have Homosexual Problems, produced by The Church of Jesus Christ of Latter-day Saints. In 1994, the Presbyterian Church (USA) held a conference entitled “The Path to Freedom: Exploring healing for the Homosexual.”

Many members have also sought religious guidance from ex-gay organizations. Some ex-gay organizations specialize in the tenets of a specific religion, while others try to encompass a more general spirituality. Although most ex-gay organizations were started by evangelical Christians, there are now ex-gay organizations for Catholics, Mormons, Jews and Muslims.

"[T]his modality is thought to be one of the most common for individuals seeking to change their sexual orientation."

Practical applications

The actual practices used by organizations and their members often fall into a cross section of these categories. For instance, 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."

Likewise, Exodus International members recommend, for example, that 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. Other reported techniques include having the men play basketball and football, and having the women learn how to manicure their fingernails and wear makeup. In another, therapists placed the two genders together in a "misogyny training course" and had the women apologize to the men for the feminist movement because it had "created so many unattractive women that, of course, gay men would turn away from them."

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

Lecturer Richard Cohen, whose recent television appearances have sparked controversy, holds male patients in his lap with the patient curled into the fetal position. NARTH opposes such "holding" techniques. He also advocates bioenergetics methods involving slamming a pillow with a tennis racket while shouting "Mom! Why did you do that to me?" (Videoclip of Cohen's techniques via YouTube.)

New Age therapies are also employed by reparative therapists, including EMDR, buddha therapy,^{[How to reference and link to summary or text]} and chiropractic adjustments. Some have tried "beauty therapy," during which butch lesbians are given "a beautiful and professionally coiffured hairstyle, taught to use cosmetics, and taught to wear the most elegant feminine styles to bring out the charm and beauty in their bodies."

Distinguishing between the reparative therapy and ex-gay movements

The reparative therapy movement is different from the ex-gay movement, but the two are closely linked and there is no consistent distinction drawn between them in the literature. Very roughly, reparative therapists tend to use secular approaches to changing sexual orientation while ex-gay organizations focus on using religion to help members not act on their same-sex desires, or sometimes to diminish or eliminate the desires. Ex-gay organizations such as Exodus International often consider reparative therapy to be a useful tool, but not a necessary one.

For some ex-gay groups, merely choosing not to act on one's same-sex desires counts as a "success" whereas reparative therapists tend to understand success in terms of actually reducing or eliminating those desires. For example, some ex-gays in opposite-sex marriages acknowledge that their sexual attractions remain primarily homosexual, but seek to make their marriages work regardless. The mere act of adopting the label "ex-gay" is seen as a narrative device whereby "individuals us[e] language as the primary tool to not only express identity but also create and transform it." Ex-gays try to analogize this to the coming out process.

Christian right political and social advocacy groups, such as Focus on the Family, the Family Research Council, PFOX, and the American Family Association, constitute third category of organizations interrelated with both reparative therapy and the ex-gay movement.

Mainstream medical view on changing sexual orientation

Further information: Biology and sexual orientation, Sexual orientation and medicine and homosexuality and psychology

The medical and scientific consensus is that reparative therapy is not effective at changing sexual orientation and that it is potentially harmful. No mainstream medical organization endorses reparative therapy and many have expressed concerns over some of the ethics and motivations surrounding its practice. The mainstream view is that sexual orientation cannot be changed by therapy, and that attempts to do so may be damaging to the person's well-being.

Professional organizations that have said they "do not support efforts to change young people's sexual orientation through "reparative therapy" and have raised serious concerns about its potential to do harm" include the American Medical Association, 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, the American Academy of Physician Assistants, and the National Education Association. The ethics guidelines of these organizations discourage, and sometimes prohibit, its practice. The American Psychiatric Association opposes any treatment that is “based upon the assumption that homosexuality per se is a mental disorder or based upon the a priori assumption that the patient should change his/her sexual homosexual orientation.” A survey of the American Psychological Association rated reparative therapy as "definitely discredited".

Gerald Koocher, the president of the American Psychological Association, has stated that "In a full multifaceted therapeutic relationship, the therapist has every duty to respond to patient choice and to help patients achieve their goals.... BUT... [First, t]herapists must determine whether patients understand that their motives may arise purely from the social pressures of a homophobic environment.... [and second, p]atients must understand that [treatments to modify sexual orientation] lack a validated scientific foundation and may prove psychologically harmful."

There is extensive debate on reparative therapy. Organizations that support reparative therapy include NARTH, Deutsches Institut für Jugend und Gesellchaft (German Institute for Youth and Society), Pathway to Freedom, VenSer,, Healing Homosexuality,, Center for Gender Wholeness and the Institute for the Study of Sexual Identity.

The APA has created a task force to revisit its policy on reparative therapy, with an official statement expected in 2008^{[How to reference and link to summary or text]}. Anderson, the director of the APA’s lesbian, gay, bisexual and transgender concerns office, said the task force may or may not rewrite the policy, and they are sure to consider religious influences^{[How to reference and link to summary or text]}. Ex-gay advocates claim that the task force is biased against ex-gays, and one gay rights activist expects the new policy to take a stronger position against reparative therapy.

The World Health Organization lists ego-dystonic sexual orientation under part F66 of the ICD-10; "Psychological and behavioural disorders associated with sexual development and orientation". It describes ego-dystonic sexual orientation as occurring where "[t]he 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." Part F66 notes that "[s]exual orientation by itself is not to be regarded as a disorder."

In China, the Chinese Psychiatric Association removed homosexuality from its list of psychiatric disorders in the 2001 edition of the Chinese Classification and Diagnostic Criteria of Mental Disorders, although it retained a classification of ego-dystonic homosexuality, the treatment of which can include therapy meant to change a patient's orientation to heterosexual, but that is rare in China. Japan's psychiatric body removed homosexuality from its list of psychiatric disorders in 1995. Not all national professional psychiatric associations have done likewise, and homosexuality remains classified as a disorder in some countries. The American Psychiatric Association dropped ego-dystonic homosexuality from the DSM-IV in 1987 and opposes the diagnosis of either homosexuality or ego-dystonic homosexuality as any type of disorder. The APA now classifies persistent and marked distress about one's sexual orientation under Sexual Disorders Not Otherwise Specified.

Evidence cited by reparative therapists and ex-gays

Reparative therapists and ex-gay groups cite anecdotal evidence of change. One wrote “I can say with certainty that I cannot imagine returning to my past behaviors. I know that change is possible. I am living proof."

The American Psychiatric Association stated that these success stories are anecdotal, and that "there are no scientifically rigorous outcome studies to determine either the actual efficacy or harm of "reparative" treatments." It called for more scientific research to determine the risks and benefits involved, and until such research is available, recommended that "ethical practitioners refrain from attempts to change individuals' sexual orientation." Major medical organizations and others do not accept the anecdotal evidence offered by reparative therapists and ex-gay groups for 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 whether it was effective over the long-term;
• the evidence does not demonstrate a change in sexual orientation, but merely a reduction in same-sex behavior;
• 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 a mental disorder;
• reparative therapists' research focuses on gay men almost exclusively and rarely includes lesbians.

With respect to the last point, one commentator argues that the reason for the focus on gay men is more political than medical. He argues that conservative and rigidly defined gender roles are the core value system used by reparative therapists, and that male sexuality, with its emphasis on masculine and patriarchal hierarchies, is seen as more important and valuable than female sexuality.

Peer-reviewed research

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.

In 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.

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

The American Psychiatric Association has stated that "anecdotal reports of "cures" are counterbalanced by anecdotal claims of psychological harm." It further states that there are no scientifically rigorous outcome studies to determine the actual harm of reparative treatments. However, they have also stated that the "potential risks of 'reparative therapy' are great, including depression, anxiety, and self-destructive behavior, since therapist alignment with societal prejudices against homosexuality may reinforce self-hatred already experienced by a patient."

Mainstream medical bodies state that reparative therapy can be harmful because it may exploit 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. Michael Bussee, founder of Exodus International, reports that "One man slashed his genitals with a razor and poured Drano on his wounds," and that another man impulsively underwent an incomplete sex-change operation because he believed his sexual desires might receive divine approval were he biologically a woman. Psychology Today states:

"The danger is that some individuals are going to end up feeling that in some important way their life is a lie and a sham," observes Christopher Wallis, M.D., a member of the American Psychoanalytic Association's committee on issues of homosexuality. The consequences can be devastating. Terry Norman, [a professional counselor], says "orientational repression" sometimes leads to drug and alcohol abuse, workaholism and compulsive sex. There also have been reports of people killing themselves, or attempting to, after failing to convert. "After hearing the categorical promises that these programs work, what do people conclude when they do these things and it doesn't work for them?" asks Norman. "That God doesn't bless them, that they really are pieces of trash that pollute the Earth."

Beyond harms caused to individual people, there is a broad concern in the mental health community that the advancement of reparative therapy itself causes social harm by disseminating inaccurate views about sexual orientation and the ability of LGB people to lead happy, healthy lives. The APA warns that the reparative therapy and ex-gay movements "create an environment in which prejudice and discrimination can flourish." A commentator summarizes: "To attempt to 'cure' is to reinforce bigotry."

Some counselors have cited benefits from reparative therapies. David Matheson, an ex-gay and licensed professional counselor wrote:

When I think carefully about the therapeutic work I did in those years, I see clearly that it wasn't about switching the gender of my sexual preference. It was about escaping the bondage of some deeper problems -- anxiety, shame and fear... The work I did in those seven years was to make choices that gradually freed me from the bondage of these deeper problems. Tremendous rewards followed - fulfilling friendships with other men, better health and greater confidence with my body and emotional freedom and power. Yes, my sexual orientation changed too.

Ethics guidelines

The American Psychological Association opposes practicing reparative therapy, but its ethics guidelines do not explicitly prohibit it; rather, they caution that any psychologist attempting to change someone's sexual orientation must, among other things, eliminate the effects of biases about sexual orientation on one's practice and avoiding making deceptive claims about the scientific basis for reparative therapy. The ethics guidelines of the American Psychiatric Association and the American Counseling Association adopt a stronger stance and recommend that ethical practitioners avoid using reparative therapy or referring clients to people who do use it. NARTH, a reparative therapy organization, "advises its members to provide psychological care in a professional, ethical manner which is consistent with the codes of ethics of the national mental health organizations and state licensing boards."

Some commentators, recommending a hard stand against the practice, have found reparative therapy inconsistent with a psychologist's ethical duties because “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.

Even where professional ethics guidelines do not explicitly forbid reparative therapy, there still 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, Evergreen 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.

Self-determination argument

Reparative therapists focus on patient self-determination when discussing whether reparative therapy should be available, citing the APA's code of ethics, which states "Psychologists respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self-determination." Mark Yarhouse writes "[p]sychologists 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." Yarhouse and Throckmorton argue that the procedure should be available out of respect for a patient’s values system and because they find evidence that it can be effective. Douglas Haldeman, who considers reparative therapy to be pseudoscientific, similarly argues for a client's right to access to reparative therapy if requested from a fully informed position: “we must respect the choices of all who seek to live life in accordance with their own identities; and if there are those who seek to resolve the conflict between sexual orientation and spirituality with conversion therapy, they must not be discouraged.”

Chuck Bright argued that refusing to endorse a procedure that "has been deemed unethical and potentially harmful by most medical and nearly every professional psychotherapy regulating body cannot be justifiably identified as prohibiting client self-determination." Fowler countered Bright's argument stating "If an individual is comfortable with his or her homosexuality, it is not the role of the therapist to convince the client otherwise. If one's feelings are egodystonic and there is a desire to talk about changing, that is an acceptable choice and a psychologist may participate if he or she desires."

Ethics guidelines with respect to ex-gay groups

"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." The applicability of professional ethics guidelines to ex-gay organizations is, thus, unclear.

Reasons why people seek to change sexual orientation

Some people are unhappy with their sexuality for a variety reasons, including religious or personal beliefs, the desire for a traditional family, shame, rejection (actual or feared), or a general dissatisfaction with the contemporary gay lifestyle. One ex-gay man wrote:

I resented the suggestion that the only “correct” solution for me was to abandon my wife and children and throw myself into a gay life... While dating men, adopting a gay identity, and throwing myself into a gay life had been exhilarating at first, it had soon felt like it was killing my spirit, alienating myself from my goals in life, from God and a sense of higher purpose. I had realized then that I didn't want to be affirmed as gay; I wanted to be affirmed as a man.

However, Psychology Today states: "Just who tries to change? Not the average gay man or woman. Would-be converts, say psychologists, typically come from deeply authoritarian backgrounds where homosexuality is branded immoral or a sin, while others are married and cannot reconcile their family commitments with their erotic desires."

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. In one extreme case, an Exodus member attempted to recruit lesbians by going to lesbian bars or hangouts posing as a lesbian, flirting with women, exchanging phone numbers, and eventually having sex with women for the purpose of getting close to lesbians to convert them to heterosexuality.

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

Malleability of sexual orientation

United States Surgeon General David Satcher issued a 2001 report urging tolerance for gays and lesbians and maintaining that "there is no valid scientific evidence that sexual orientation can be changed." In a statement endorsed by mainstream medical organizations, the Just the Facts Coalition stated "Sexual orientation develops across a person's lifetime-different people realize at different points in their lives that they are heterosexual, gay, lesbian, or bisexual" (emphasis added). The American Psychological Association has stated that homosexuality "is not changeable." Clinton Anderson, director of the APA Lesbian, Gay and Bisexual Concerns Office, explained the APA's position: "I don't think that anyone disagrees with the idea that people can change because we know that straight people become gays and lesbians." However, both do not view sexual orientation as "a conscious choice that can be voluntarily changed."

Other researchers view sexual orientation as being more malleable. In 1985, Fritz Klein presented his theory that sexual orientation is a "dynamic, multi-variable process" - dynamic in that it may change over time, and multi-variable in that it is composed of various elements, both sexual and non-sexual. A report from the Centre for Addiction and Mental Health states "For some people, sexual orientation is continuous and fixed throughout their lives. For others, sexual orientation may be fluid and change over time."

Reparative therapists do not believe sexual orientation can be changed instantly and completely, but instead believe that they can bring about a gradual change to heterosexuality. Nicolosi explains that when a man changes orientation, he "doesn't immediately walk down a street and get a sexual charge from looking at a woman. But he will begin to notice women. He will begin to feel a desire to get married and have a family." Nicolosi admits a successful client may still have same-sex attractions, but adds "that sexual desire is greatly diminished."

There is debate within the ex-gay community on how malleable sexual orientation is. Some advocate only diminishing homosexual attractions. Alan Chambers, the president of Exodus International, has stated that "by no means would we ever say change can be sudden or complete." Others, such as ex-gay activist Stephen Bennetts, disagree that homosexuality can't be completely changed, calling such statements "irresponsible and false."

Reaction by reparative therapists

Reparative therapists generally respond to the mainstream medical view with three 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. Third, they argue that people should be able to determine their own therapeutic goals (see self-determination argument, supra).

Robert Perloff, former president of the American Psychological Association, in 2001 (and at age 80) charged that APA is "too politically correct, too bureaucratic, too obeisant to special interests." He stated that APA’s view of conversion therapy is "all wrong. First, the data are not fully in yet. Second, if the client wants a change, listen to the client. Third, you're barring research."

Controversies, criticisms, and scandals

Reparative therapy/ex-gays as a means to shape the LGBT rights debate

LGBT rights

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History · Groups · Activists

Same-sex relationships

Opposition · Persecution

Violence

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 therefore does not warrant the legal protections and social acceptance afforded to others who are protected on the basis of age, race, gender, disability, etc. This pattern of reasoning has seen some results: for example, LGBT students at religious universities have been expelled because they refused to be "cured."

Some gay rights supporters 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..." Mental health organizations hold that conversion attempts are caused by, and reinforce, negative attitudes and mistaken beliefs about homosexuality.

Not all gay rights activists support this view. Camille Paglia, a lesbian activist, wrote in her book Tramps and Vamps, "Is the gay identity so fragile that it cannot bear the thought that some people may not wish to be gay? Sexuality is highly fluid and reversals are theoretically possible."

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. A 2006 report has outlined evidence that ex-gay and reparative therapy groups are increasingly focusing on youth. Several legal researchers have responded to these events by arguing that parents who force their children into aggressive reparative therapy programs are committing child abuse under various state statutes.

Lyn Duff

Main article: Lyn Duff

In 1991, at the age of 14, Lyn Duff came out publicly as a lesbian. Reportedly concerned about her daughter's sexual orientation, Lyn Duff's mother had her taken by force from her grandparents' home to Rivendell Psychiatric Center, a residential treatment center near Salt Lake City. Duff's placement was paid for by the State of California through special education funds on the basis of her diagnosis with "Gender Identity Disorder". Her treatment reportedly included shock therapy, aversion therapy, psychotropic drugs, hypnosis, and behavioral counseling (for instance, being told to wear dresses and make up, etc). After 168 days in Rivendell, Duff escaped. In 1992, she initiated legal action against the facility and her mother. In 1993, Duff's therapist at Rivendell, R. Mark Hinckley, left Rivendell to start Turnabout, a similar camp to treat gay youth in Salt Lake City.

Duff Wright

In Tennessee in 1995, a 16-year-old gay male sought legal emancipation from his parents because they were forcing him to attend reorientation counseling with a Memphis psychologist, Dr. Duff Wright. 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.

In April 2005, Dr. Duff Wright lost his license to practice as a psychologist, due to a get-rich-quick scheme that resulted in a $81,000 loss to a client.

Love in Action

In May 2005, 16-year-old Zachary Stark posted on his blog:

Well today, my mother, father, and I had a very long 'talk' in my room where they let me know I am to apply for a fundamentalist christian program for gays. They tell me that there is something psychologically wrong with me, and they "raised me wrong." I'm a big screw up to them, who isn't on the path God wants me to be on. So I'm sitting here in tears, joing the rest of those kids who complain about their parents on blogs - and I can't help it.

In July 2005, Zachary Stark was released from a Love in Action camp.

Zachary Stark's blog prompted an investigation of the camp. The investigation did not uncover signs of child abuse, but in September 2005, the camp was shut down when Tennessee authorities discovered that unlicensed staff had been administering prescription drugs to the people attending the camp.

In October 2005, the father of 17-year old DJ Butler drove him to the camp in handcuffs.

In February 2006, Tennessee authorities, unwilling to pursue further actions against LIA, closed the case.

People who "relapsed"

See also: Ex-gay#People who left the ex-gay movement

Further information: Ex-ex-gay

A controversy arose when ex-gay John Paulk was photographed 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.

• 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. In 2007, Cook introduced a new ministry online under the title FaithQuestRadio.

• John Paulk, former leader of Focus on the Family's Love Won Out conference and former chairman of the board for Exodus International North America, married a woman who also identified as ex-gay. In September of 2000, Paulk was spotted by reporters in a Washington, D.C. gay bar. This led to Paulk stepping down from the two organizations. John Paulk is still married and champions the cause of the ex-gay movement.

• Michael Johnston is an HIV-positive man who is featured in the film It's Not Gay, promoted by the American Family Association. Johnston had frequently been interviewed on US television and radio regarding his claimed change in sexuality, and even featured in a national television advertising campaign in 1998 stating that Jesus Christ he empowered him to leave his homosexual past. In the year 2000, the Southern Baptist Convention had chosen him for their Hero of the Faith Award. In 2002, Michael Johnston was exposed as having recently returned to sexual relations with men, and he later admitted to having had unprotected sex with multiple male partners without disclosing his HIV-positive status, despite knowing he that he was HIV-positive, over a period of two years. However, despite the reported "moral fall" exposed in 2002, Johnston later returned to evangelical ministry.

• Kirk Talley is a southern Gospel singer-songwriter. In 2003, Talley was subjected to an attempt at extortion: after Talley visited a gay chat room and revealed his sexual urges to another man, the man blackmailed Talley and attempted to extort $15,000. Talley called the FBI, and the man was arrested and sentenced to a prison term and a fine.

Financial motivations

Opponents argue that many reparative therapists may become involved for personal financial gain. 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.

Opposition from gay rights and religious groups

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.

Reparative therapy and ex-gays in popular culture

Reparative therapy and the ex-gay phenomenon occasionally appear in popular culture, usually in a satirical or skeptical context. In 1999, Lions Gate Entertainment released But I'm a Cheerleader, a black comedy about a high school cheerleader who is sent to an ex-gay camp. In the 2004 comedy film Saved!, one character is a gay high school student sent by his parents to a camp to turn him straight. A 2007 South Park episode Cartman Sucks satirized reparative therapy and ex-gay camps.

Reparative therapy was derided on Penn and Teller's television show Bullshit!. Reparative therapist Richard Cohen was satirically interviewed by Jason Jones in a segment for the March 19, 2007 episode of The Daily Show. Cohen later apologized for this appearance. Albeit not in relation to homosexuality, aversion therapy and its moral implications were explored in the 1962 novels One Flew Over the Cuckoo's Nest and A Clockwork Orange.

In 2006, Ted Haggard, former American evangelical preacher and leader of the National Association of Evangelicals resigned or was removed from all of his leadership positions after allegations of gay sex and drug abuse were made by Mike Jones, a former male prostitute. Initially Haggard denied even knowing Mike Jones, but as a media investigation proceeded he acknowledged that some allegations, such as his purchase of methamphetamine, were true. He later added "sexual immorality" to his list of confessions. After the scandal was publicized, Haggard entered three weeks of intensive counseling, overseen by four ministers. On February 6, 2007, one of those ministers, Tim Ralph stated that Haggard "is completely heterosexual." Ralph later said he meant to say that therapy "gave Ted the tools to help to embrace his heterosexual side."

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
• Christianson,A. (2005) A Re-emergence of Reparative Therapy. A Peer-Reviewed Article for Contemporary Sexuality readers Contemporary Sexuality, Oct2005, Vol. 39 Issue 10, p8-17, 10p; (AN 18639497)

External links

• National Association for Research & Therapy of Homosexuality
• Exodus International, a Christian ex-gay organization
• 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"
• Ex-gay watch, watchdog blog covering ex-gay and reparative therapy groups.
• The Pseudo-science of Sexual Orientation Conversion Therapy detailed summary of the case against conversion therapy.
• Donnie Davies' music video, a satirical 2007 meme. See also Donnie Davies.