Sexual “Conversion”? American Psychological Association Says Not Through Psychotherapy

Natalie Timoshin;

Publication

Article

October 10, 2009

Psychiatric Times

Psychiatric Times Vol 26 No 10

Volume26

Issue 10

Sexual “Conversion”? American Psychological Association Says Not Through Psychotherapy

Author(s):

Natalie Timoshin

In August, the American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation released a report based on its systematic review of research on the effectiveness of sexual orientation change efforts.1

The report stated that there is little evidence to suggest that efforts to change a person’s sexual orientation from gay or lesbian to heterosexual are successful.

In fact, the report found that such efforts can cause harm. The findings of the American Psychological Association’s task force indicate that efforts to switch a person’s sexual orientation through psychological interventions not only don’t work but also can lead to loss of sexual feeling and to depression, anxiety, and suicidality.

The task force reviewed the literature on 87 studies undertaken from 1960 through 2007. It found serious methodological problems with the majority of the studies. The few studies that were methodologically strong showed that lasting change was rare. Judith M. Glassgold, PsyD, chair of the task force, said that “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.”

According to the American Psychological Association²:

Most scientists today agree that sexual orientation is most likely the result of a complex interaction of environmental, cognitive, and biological factors . . . ; human beings cannot choose to be either gay or straight. For most people, sexual orientation emerges in early adolescence without any prior sexual experience. Although we can choose whether to act on our feelings, psychologists do not consider sexual orientation to be a conscious choice that can be voluntarily changed.

However, there are many people who believe that sexual orientation is a choice that can be changed with some effort. The task force found that although public opinion is slowly changing, hostility toward and discrimination against homosexuals persists. Much of the discrimination against gays, lesbians, and the transgendered population stems from stereotypes. Although studies have shown that homosexual relationships are in all significant respects similar to heterosexual relationships, many of the stereotypes remain: homosexual relationships are dysfunctional, unhappy, and unstable; or that the goals and values of homosexual couples are different from those of heterosexual couples.³

Conversion therapy-also called reparative therapy-can be traced back to Freud, who was skeptical of therapeutic conversion.⁴ Nevertheless, conversion therapy has been used for years by mental health professionals and various religious groups to “convert” homosexuals to heterosexuality. Conversion therapy includes psychoanalysis, group therapy, aversive conditioning using electric shock therapy or nausea-inducing drugs, fantasy modification, and sex therapy.⁵

The American Psychiatric Association⁶ has stated that conversion therapy is “based upon the assumption that homosexuality per se is a mental disorder or based upon the a priori assumption that a patient should change his/her homosexual orientation” and suggests that psychiatrists not practice conversion therapy. Homosexuality was removed from DSM classification of mental disorders in 1973.

Difficulties arise because of the differing views of the psychiatric/psychological community and the more conservative and traditional religions. Same-sex sexual attraction is considered, by both the American Psychiatric Association and the American Psychological Association, to be a normal variant of human sexuality, an orientation that cannot be altered through therapy. On the other hand, some religious denominations consider homosexual orientation to be a choice that can be changed with time and effort.¹ This view is further supported by men in the ex-gay movement, who have gone through conversion therapy and believe that they have been successfully reoriented.

The view that homosexuals can change their orientation, if highly motivated to do so, is also supported by a small minority of psychotherapists, as evidenced by groups such as the National Association for Research and Therapy of Homosexuality (NARTH), founded by Dr. Joseph Nicolosi. NARTH states, “We respect the right of all individuals to choose their own destiny. NARTH is a professional, scientific organization that offers hope to those who struggle with unwanted homosexuality. . . . NARTH upholds the rights of individuals with unwanted homosexual attraction to receive effective psychological care and the right of professionals to offer that care.”⁷

It should be noted that the American Psychological Association task force report carefully reviewed Nicolosi’s findings and found them seriously flawed. The report also concluded that the theoretical basis for NARTH’s position is not supported by the best empirical evidence.¹

The American Psychological Association report contrasts scientific with faith-based beliefs. Scientific beliefs are based on evidence, which is “in contrast to viewpoints based on faith, as faith does not need confirmation through scientific evidence.”¹ An American Psychological Association policy statement released in 2007 said, “While we are respectful of religion and individuals’ right to their own religious beliefs, we also recognize that science and religion are separate and distinct. For a theory to be taught as science it must be testable, supported by empirical evidence and subject to disconfirmation.”⁸

In the past, this dichotomy has resulted in conflict and mutually held negative views of each other: psychology/psychiatry versus religion, and vice versa. More recently, however, psychology/psychiatry has acknowledged the role of religion and spirituality as forms of meaning making, culture, tradition, identity, community, and diversity.¹ Correspondingly, the beliefs and practices of many religious denominations have progressed to reflect evolving scientific evidence and civil rights perspectives on sexual orientation.¹

With all the scientific evidence that homosexual orientation is not pathological and that conversion therapy is not effective, why would anyone voluntarily submit to conversion therapy? The answer differs from person to person: some people are unhappy about their sexuality and want to change. Some feel shame or rejection, or they have strong religious convictions and want to adhere to the tenets of their faith; some may want a traditional family; or some may already be in a heterosexual relationship with a spouse and children and are happy. Ben Newman, a member of the ex-gay movement 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.”⁹

The debate over orientation versus choice of sexual behavior will no doubt continue. In its report, the American Psychological Association task force concludes that “these debates can only be resolved through an evidence-based appraisal of the potential benefits and harm of sexual orientation change efforts.” Thus far, the evidence is scant, and there is a limited amount of methodologically sound research. The evidence cited in the American Psychological Association report1 does show that enduring changes in sexual orientation is unlikely and that, in fact, attempts to induce change may be harmful.

The task force recommends that rather than conversion therapy, affirmative therapeutic interventions should be used when working with a person who is troubled about his or her same-sex attraction. This approach would provide support and acceptance, would help the individual cope with social prejudices and stigma, and would help the individual resolve any internal conflicts.