Critique of Sexual Conversion Therapy, May 27, 2003
Given at the More Light Presbyterians Luncheon, 215th General Assembly of the Presbyterian Church USA, at Denver , Colorado
by Cleveland K. Evans, Ph.D.
As Michael said, one of the courses I teach is Human Sexuality. Some of my students have threatened to have T shirts made printed with the slogan “I had sex with Dr. Evans.” Of course my response to that is that having me teach the course is a great example of the old joke about “Those that can do; those that can’t, teach.” But as the joke points out, I am an academic psychologist, not a psychotherapist. That actually may give me a slight advantage here, as my training focused more on evaluating research than that of many psychotherapists. There are quite a few techniques in psychotherapy, such as rebirthing therapy and primal scream therapy, which some well-meaning therapists have adopted on the basis of superficially plausible theories even though research has found them to be ineffective or even harmful. Most psychologists, whether academics or therapists, believe that reorientation therapy for homosexuality is another ineffective or harmful technique, in spite of the fact that proponents often claim research backing for it.
But there are many problems with this research. One of the chief problems is in basic definitions. What does it mean to say someone is gay, lesbian, or bisexual? As the text for my Human Sexuality course points out, there are three different ways to do this. The first is identity, or self-labeling. Do persons call themselves, gay, lesbian or bisexual? The second is behavior. Does the person have sexual contact with members of the same gender? The third is orientation. Are the person’s immediate sexual attractions and experiences of romantic love focused on members of the same gender? Most psychologists, and most lesbian, gay, and bisexual persons themselves, believe that orientation is the most appropriate definition to use for psychological research, precisely because behavior and identity are more subject to outside situational pressures. But many advocates of reorientation therapy focus mainly on behavioral change in their claims of success. For example, one of the latest such claims is in an article by Schaeffer and colleagues titled “Religiously Motivated Sexual Orientation Change”, which in spite of its title defines change only behaviorally, stating that 60% of men and 70% of women recruited as research participants at conferences sponsored by Exodus International had “changed orientation” simply because they had not had sexual contact with another same-gender person over the past year. Some other reports on reorientation therapy actually claim that people must have been healed of homosexuality since they have married someone of the opposite sex and have children. When I see that I always remember the lesbian woman I once met who had given birth to ten children before she came out. By the way, it’s interesting that those in favor of reorientation therapy are now referencing Shaeffer’s article without mentioning that Exodus members who had been individual clients of reorientation or reparative therapists were no more likely to have been homosexually celibate during the past year than those who had not had such therapy.
So what is this reparative or reorientation therapy? Almost all of it is based on theories derived from psychoanalysis and fully developed by Irving Bieber in the 1960s. It has since been championed by Charles Socarides and Joseph Nicolosi. These theories (which almost always focus on men and have much less to say about lesbians) postulate that homosexuality develops because one’s mother is too dominant and one’s father is weak or rejecting, leading the son to be unable to identify with the father and develop a heterosexual identity. Over time these theories have shifted from putting most of the blame on the mother to emphasizing the father’s role, and have put forward more strongly the idea that gay men or lesbians feel inadequate in their masculine or feminine identities, respectively. They therefore desire support and companionship from same-gender partners because they missed such gender-role affirmation while they were children, and then misunderstand this desire for affirmation from same-gender others as being sexual attraction. Over the years therapies based on these theories have shifted from a more classic psychoanalytic examination of one’s childhood to a more cognitive reframing kind of therapy, where whenever clients feel a sexual or romantic attraction for someone of the same gender, they are encouraged to tell themselves that such attractions are not really sexual but are disguised wishes for friendship or affirmation that come about when they are hungry, lonely, angry, or tired. Therapists of the Nicolosi school also often encourage women take cooking or sewing classes and men to participate in team sports or groups like Promise Keepers, to develop their true feminine or masculine identity.
But does this really work? Reorientation therapists since Irving Bieber have claimed to have data saying that it does, but their research is flawed for several reasons. It usually depends on reports to one’s therapist, (who the client of course wants to please), instead of to independent researchers. It almost never includes independent evaluation of the sexual orientation of clients before they start therapy, depending on retrospective recollections and not taking the possibility of initially bisexual clients into account. There is little long term follow-up of these clients to see if change is lasting, and change in behavior or identity is often assumed to mean change in orientation.
The most publicized such study recently was one done by Robert Spitzer, who in May 2001 presented a paper to the American Psychiatric Association where he claimed that after interviewing 143 men and 57 women over the phone for 45 minutes each, that 66% of the men and 44% of the women had “achieved good heterosexual functioning”. The problems with this study include that most of the participants were activists in the change therapy movement; 60% of them reported being at least mildly bisexual before having any therapy; and there were no follow-ups or checks for accuracy. While this study was widely reported in the media, another research project by Ariel Shidlo and Michael Schroeder presented at the same convention was ignored, though it had about the same number of participants and very different findings. Shidlo and Schroeder’s interviewees were recruited from ads in the gay media as well as requests sent to reparative therapists; they were interviewed for 90 minutes and most of those who claimed change were given follow-up interviews. Only eight of their 202 interviewees claimed complete reorientation, and seven of those eight were counselors in change therapy organizations (four paid staff, three volunteers). Obviously such counselors are going to be highly motivated to convince themselves and others that change is a real possibility. It should be noted that some of the 176 of Shidlo and Schroeder’s interviewees who reported no change stated that immediately after they had been in reorientation therapy, they would have said that they had changed; it was only months or years later that they came to believe they’d been fooling themselves, and no real change in their sexual orientation had occurred.
Personally I think another study done by Lee Beckstead, also reported in the book Sexual Conversion Therapy, is even more evidential than Shidlo and Schroeder’s research. Beckstead interviewed 50 members of the Mormon Church in Utah who had been through conversion therapy, 30 who saw themselves as failures and 20 who claimed to have changed sexual orientation. Now gay and lesbian Mormons have even more motivation to change than do fundamentalist Protestants. Even the strictest Protestant theology normally says that a celibate and repentant gay or lesbian can be saved, and once we get to heaven we’re all equal. In Mormon theology, we aren’t all equal in heaven. Only heterosexually married parents receive “everlasting joy” and “exaltation to Godhood.” So I’m not surprised Beckstead found 20 Mormons who said they had changed from homosexual to heterosexual. Beckstead’s data on these people was much more extensive than Schroeder and Shidlo’s. He had individual interviews, journal writings, and focus group discussion data on each. These 20 people had been through typical cognitive reframing sorts of reparative therapy, where they were taught to identify same-sex attractions as indicating non-sexual needs. Many reported feeling more peace, contentment, and self-acceptance. However, Beckstead himself places in italics the following statement: No substantial or generalized heterosexual arousal was reported, and participants were not able to modify their tendency to be attracted to the same sex. Yet, these same participants continued to identify as heterosexual.” I don’t think we have a better statement of what reparative therapy does: it changes your cognitive interpretations, identity, and behavior, but not your sexual orientation.
Perhaps being taught to distort and mislabel your own sexuality should be considered harmful in and of itself, but Shidlo and Schroeder’s research also focused on the harm that came to their 176 interviews who had attempted sexual conversion therapy but had not changed. Now it would be unethical of me to imply that those who go through this experience are always deeply harmed. Shidlo and Schroeder found 21 nonchangers who believed that their experience hadn’t hurt them at all, but instead had helped them develop a positive gay or lesbian identity by proving to them that change was not possible. There will always be such resilient people in any situation, and I’m even willing to bet that if Shidlo and Schroeder had had a true random sample of reparative therapy clients the percentage of resilient people would have been a bit higher. But the harm suffered by the other 155 failures of reparative therapy was often grievous. Many reported an increase in depression and guilt because of beliefs that they had somehow chosen to be especially sinful. Some developed an obsessive concern with their masculinity or femininity; some reported broken relationships with parents who they had been taught to blame for their sexual orientation. Many had increased feelings of alienation and loneliness, both from their loss of friends in the “ex-gay” community and the belief that they could never fit into society anywhere. Many had low self-esteem from believing the false information about gay and lesbian life that they had been taught. Perhaps most important for this audience, many of the two thirds who described themselves as religious suffered spiritual harm, such as loss of faith, or anger at and inability to trust God and the church.
Some of this harm was related to practices of some reparative therapists that Shidlo an Schroeder found to be unethical. These included telling patients that since they were straight-acting or religious they had to be successful; telling them that high motivation and hard work would always result in success, so if they failed it must be their fault; giving no preparation or counsel to patients who were leaving therapy without substantial change; and in a few cases encouraging clients to heterosexually marry as an aid to change. Perhaps one of the worst ethical violations was the giving of false information about gay and lesbian lives. Joseph Nicolosi and his followers in particular tell their clients that gay relationships are invariably either volatile immature infatuations, or are open relationships where the partners have more sex with strangers than with each other, and that gay relationships can never possess the consistency, trust, mutuality, and sexual fidelity of heterosexual marriages. The latest published professional article by a proponent of reorientation therapy, by Christopher Rosik in the January 2003 issue of The Journal of Marital and Family Therapy, quite specifically misuses survey research results to claim that homosexually-oriented men should be motivated to change if they wish to be monogamous, since monogamy is nonexistent in the gay community.
Indeed, every major research article I’ve read recently mentions this false belief as a major reason why people choose to enter reparative therapy and why they stay in it, and why those who fail often feel despairing. People who for religious or other reasons believe strongly in monogamy and don’t want to participate in anonymous multipartner sex have been convinced that if they adopt a gay identity they will be compelled to engage in these unwanted behaviors. This is of course what the phrase “the gay lifestyle” is used as a code for in the church; I don’t think those who repeat that phrase are concerned with gay men going to operas or lesbians playing softball. Here I want to exhort our own movement a little. There’s tons of research showing that I could cite to show that this stereotype is false; unfortunately, there is other psychological research showing that personal anecdotal examples are better at changing people’s minds than statistical data. I think we’ve often done really well at telling our stories about how the church’s position has harmed us, telling our coming out stories, even telling about our joy in and commitment to the Christian faith. But I’m not sure we’ve always countered the incessant repetition by others about the so-called “gay lifestyle” by holding up the fact that many of us are sexually conservative people. Maybe we need to do more conscious celebration of relationships like Tabb Forster and Rosemarie Wallace’s, lasting 17 years since they met at a church function. Or Ralph Carter and his spouse Van, monogamously committed for almost 23 years. You know, I’d like to see Martha Juillerat and Tammy Lindahl write a book about how to maintain a strong marriage in the face of years of incredible stress and persecution. Most heterosexual couples could learn a lot from them. And as for single people---well, if that criterion of not having sex for twelve months is used, I guess I’ve been heterosexual for years. Many of us in the church prove that being an openly self-affirming GLBT activist is quite compatible with having staid conservative sexual mores, and we need to say that for many survivors of reparative therapy to know they’d feel comfortable among us.
Finally, I’d like to put in a plug for the book Sexual Conversion Therapy. This is the only full-length book I know critiquing sexual orientation change therapy. So far the WorldCat catalog says that only 41 libraries in the USA have copies of it, while over 300 have Joseph Nicolosi’s books, over 400 have Charles Socarides’s most popular works, and over 800 still have copies of Irving Bieber’s original book from the 1960s on change therapy. (The Denver Public Library has all three). Please go home and ask your local library to buy copies of this book. Reading in library stacks is still one of the main ways that people concerned about their sexual orientation have to anonymously find out information, and it’s a tragedy that so many of them will find the change therapists’ books in their library stacks and not have the critique to balance them.
Partial Reference List
Shidlo, A.; Schroeder, M.; & Drescher, J. (Eds.) (2001). Sexual conversion therapy: ethical, clinical, and research perspectives. Binghamton, NY: Haworth Medical Press. ISBN 0-7890-1910-8 (hardback); 0-7890-1911-6 (paperback).
Bieber, I. et. al. (1962). Homosexuality: A psychoanalytic study. New York, NY: Basic Books.
Green, R. (2003). When therapists do not want their clients to be homosexual: a response to Rosik’s article. Journal of Marital & Family Therapy, 29, 29-38.
Nicolosi, J. (1991). Reparative therapy of male homosexuality: A new clinical approach. Northvale, NJ: Aronson.
Rosik, C.H. (2003). Motivational, ethical, and epistemological foundations in the treatment of unwanted homoerotic attraction. Journal of Marital & Family Therapy, 29, 13-28.
Schaeffer, K.W., Hyde, R.A., Kroencke, T., McCormick, B., & Nottebaum, L. (2000). Religiously-motivated sexual orientation change. Journal of Psychology & Christianity, 19, 61-70.
Shidlo, A. & Schroeder, M. (2002). Changing sexual orientation: A consumer’s report. Professional Psychology, 33(3), 249-259.
Socarides, C. (1995). Homosexuality: A freedom too far. Phoenix, AZ: Adam Margrave Books.
Tozer, E. E. & McClanahan, M. K. (1999). Treating the purple menace: Ethical considerations of conversion therapy and affirmative alternatives. The Counseling Psychologist, 27, No. 5, 722-742.