Conversion therapy

Conversion therapy (sometimes called sexual reorientation therapy) refers to methods aimed at changing gay, lesbian, and bisexual people's sexual orientations to heterosexual, or at eliminating or diminishing same-sex desires and behaviors. Many techniques have been tried, including behavior modification, aversion therapy, psychoanalysis, prayer, and religious counseling. Conversion 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 mental health consensus in the United States is that there is little or no scientific evidence that conversion therapies are effective at changing sexual orientation and some evidence that they are potentially harmful. No major U.S. medical organization endorses conversion therapy and some have expressed concerns over some of the ethics and assumptions surrounding its practice. The view of such organizations as the American Psychological Association is that there is currently no convincing evidence that sexual orientation can be changed by therapy, that attempts to do so may be damaging to the person's well-being, and that "the positions espoused by [reparative therapy advocates] NARTH [National Association for Research and Therapy of Homosexuality] and Focus on the Family create an environment in which prejudice and discrimination can flourish." The label conversion is often preferred over reparative, as the latter suggests that same-sex desire is something which can or should be "repaired." The American Psychological Association has issued several cautionary statements against sexual conversion therapy, but has never condemned it. As a result of the medical view, conversion therapy is a largely marginalized practice. Today's conversion therapists characterize the movement as offering the possibility of a choice to gay men and lesbian women who are unhappy with their sexuality.

Changing sexual orientation has become highly politicized, and the ensuing debates "have obscured the scientific data by calling into question the motives and even the character of individuals on both sides of the issue." Some LGBT rights supporters have described 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 ..." In turn, individuals who feel conversion therapy has been helpful have felt oppressed by such activists. Randy Thomas has said "As a former homosexual, when I was involved in the 1980s promoting the gay agenda, our only focus was to seek tolerance, whereas today's political activism has moved from true tolerance into political domination and power. It's an amazing thing to watch a group that said they were oppressed become oppressors."

History and doctrinal development

The development of conversion therapy can roughly be traced through three periods: an early Freudian period, a period of mainstream approval of conversion therapy during a time when the mental health establishment became the "primary superintendent" of sexuality, and a post-Stonewall period wherein the mainstream medical profession disavowed conversion therapy.

File:Sigmund Freud-loc.jpg

Freud (1856–1939) was skeptical of the possibility of therapeutic conversion.

Freud and early sexologists (1886–1939)

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 proposed that homosexuality was caused by either "congenital [during birth] inversion" or an "acquired inversion".

In 1896 Sigmund Freud published his ideas on psychoanalysis. Freud believed that all humans were innately bisexual and that whether a particular person manifests heterosexuality or homosexuality could result from environmental factors interacting with biological sexual drives. Freud expressed serious doubts about the potential for therapeutic conversion. In a famous letter to a mother who had asked Freud to treat her son, he wrote:

By asking me if I can help [your son], you mean, I suppose, if I can abolish homosexuality and make normal heterosexuality take its place. The answer is, in a general way, we cannot promise to achieve it. In a certain number of cases we succeed in developing the blighted germs of heterosexual tendencies which are present in every homosexual, in the majority of cases it is no more possible. It is a question of the quality and the age of the individual. The result of treatment cannot be predicted.

In that letter, he also states that "homosexuality is assuredly no advantage but it is nothing to be ashamed of, no vice, no degradation, it cannot be classified as an illness....".

From this period through the middle of the 20th century, medical attempts to "cure" homosexuality have included surgical treatments such as hysterectomy, ovariectomy, clitoridectomy, castration, vasectomy, pudic nerve surgery, and lobotomy. Substance-based treatment attempts have included hormone treatment, pharmacologic shock treatment, and treatment with sexual stimulants and sexual depressants. Other attempts include aversion therapy, the attempted reduction of aversion to heterosexuality, electroshock treatment, group therapy, hypnosis, and psychoanalysis. While some of these, including the use of electric shock and nausea-inducing drugs, are still used, even today's prominent conversion therapists who advocate psychoanalytic conversion denounce the other methods as "quackeries."

Nazism

Main article: History of homosexual people in Nazi Germany and the Holocaust

Nazi ideology considered homosexuality a disease, as it antagonized the notion of the perfect Aryan (Master) race Nazi scientists sought to perfect. Homosexuality was regarded as a character flaw and hence likely to be "cured" through some kind of therapy.

Lists of gay people were compiled and as many as 100,000 men were arrested on the charge of homosexuality and sent to concentration camps to find a "cure." Nazi Germany thought of German gay men as part of the Aryan "Master Race" and thought it could "force" gay men into sexual and social conformity. Gay men who would not switch in sexual orientation were sent to concentration camps under the "Extermination Through Work" campaign. Lesbian Germans were not as prosecuted, as it was thought that "conversion" to Nazi moral and social standards was easier for women.

Nazi Doctor Carl Vaernet (1893-1965) used hormone injection, castration, and other techniques in attempts to "cure homosexuals" during the Nazi period. After the War, Dr. Vaernet was caught by the British authorities and handed to the Danish authorities for prosecution for his war crimes against gay people, although he seemingly managed to escape.

Entrenchment (1939–1969)

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

During the three decades between Freud's death (1939) and the Stonewall riots (1969), conversion therapy enjoyed a "gilded age" of aggressive treatment of homosexuals and approval from the psychiatric establishment. Prominent researchers arguing for therapeutic conversion included Edmund Bergler, Irving Bieber, Albert Ellis, Abram Kardiner, Sandor Rado, and Charles Socarides. Rado rejected Freud's theory of innate bisexuality and argued instead that heterosexuality is nature's default setting and that homosexuality is caused by parental psychopathology. Socarides and Kardiner developed similar theories: Socarides interpreted same-sex desire as an illness arising from a conflict between the id and the ego usually arising from an early age in "a female-dominated environment wherein the father was absent, weak, detached or sadistic".

The conversion therapists also rejected Freud's pessimism about therapy being able to change sexual orientation: Bieber published a 1962 study concluding that "although this change may be more easily accomplished by some than by others, in our judgment a heterosexual shift is a possibility for all homosexuals who are strongly motivated to change." Homosexuality was assumed to be a psychopathology: Ellis found that "fixed homosexuals in our society are almost variably neurotic or psychotic ... therefore, no so-called normal group of homosexuals is to be found anywhere." This view was endorsed by the 1952 first edition of the APA's Diagnostic and Statistical Manual of Mental Disorders (DSM-I), which classified homosexuality as a mental disorder.

Evelyn Hooker was a contrary voice when she published her influential 1957 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."

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 another case 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.

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 treated men who did stop having sex with men were actually bisexual. Among men who were primarily gay, aversion therapy was far less successful.

Governments have used these methods as well. In 1952, the British government subjected Alan Turing to these techniques after he was arrested for having sex with a man. In the 1970s and 1980s, the South African Defence Force administered it to people who were suspected of being gay. As recently as 1992, the Phoenix Memorial Hospital was using these methods on children as young as 10. Aversion therapy is no longer sanctioned by the APA as an appropriate treatment for homosexuality. In India, where homosexuality is illegal, these methods are still used.

Post-Stonewall reaction against conversion therapy

The 1969 riots at the Stonewall Inn began a movement of LGBT visibility and policy reform.

In 1969, the Stonewall riots gave birth to the gay rights movement and increased the visibility of LGBT people. In 1973, after intense lobbying by homosexual groups, new scientific information from researchers like Evelyn Hooker and Kinsey, and dissension from the psychiatric ranks, the APA declassified homosexuality as a mental disorder with a vote of 58% of the membership supporting the measure. 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, replacing it with egodystonic sexual orientation. Today, American mainstream mental health organizations maintain that conversion therapy is potentially harmful and that there is little or no evidence of its effectiveness.

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 not a choice and is caused by many factors, including environmental factors such as an absent or distant same-sex parent, over-involvement with an opposite-sex parent, sexual abuse, early exposure to pornography or sexual language, bad experiences with gender-specific activities, isolation from same-sex peers, or name-calling from a young age; they call subjects "strugglers". Today, Exodus is the most visible ex-gay organization, occasionally taking out full-page newspaper ads or renting billboards.

New psychoanalytic models and the "reparative" label

The label reparative originates from 1983 when research psychologist Elizabeth Moberly coined the term reparative drive to refer to male homosexuality itself, interpreting male–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. Sometimes reparative therapy is misleadingly used synonymously with conversion therapy, though in fact it is only one type of conversion therapy.

In a 1991 book Joseph Nicolosi argued that "[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".

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 (APsaA) and the American Academy of Psychoanalysis have issued non-discrimination statements. The APsaA 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."

Most mental health professionals today consider conversion therapy discredited, but some professionals still attempt it. Nicolosi, Socarides, and Benjamin Kaufman founded the National Association for Research & Treatment of Homosexuality (NARTH) in 1992, a currently marginal mental health organization that is the most vocal advocate of conversion therapies. Conversion therapists tends to characterize themselves 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 desires, 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."

Outside the U.S.

The development of theoretical models of sexual orientation in non-U.S. countries with established mental health professions often tracks the history within the U.S. (although often at a slower pace) as a shift from pathological to non-pathological conceptions of homosexuality. Some countries (e.g., China) have never widely practiced conversion therapy, regardless of the theoretical model, while others have seen the practice decrease as views of homosexuality changed.

• In the United Kingdom and Ireland the Royal College of Psychiatrists, the main professional organization of psychiatrists in those countries, issued a report stating that:

evidence shows that LGB people are open to seeking help for mental health problems. However, they may be misunderstood by therapists who regard their homosexuality as the root cause of any presenting problem such as depression or anxiety. Unfortunately, therapists who behave in this way are likely to cause considerable distress. A small minority of therapists will even go so far as to attempt to change their client's sexual orientation. This can be deeply damaging. Although there is now a number of therapists and organisation in the USA and in the UK that claim that therapy can help homosexuals to become heterosexual, there is no evidence that such change is possible.

• In China, Western psychiatry and psychology were imported during a "Westernization Movement" in the late 19th century. At that time, the West viewed homosexuality as a mental disorder, and that became the prevailing view in China as well. During this period, same-sex sexual behavior was grounds for persecution, a marked change from the attitude of general (but not total) acceptance found in pre-19th-century China. These views lasted throughout the 1970s, despite changed theoretical models of sexuality orientation in the West, during a period when the Chinese government held a "closed-door" policy on information about human sexuality. After 1980, information became more available, and views began to change. In 2000 and under pressure from both the APAs and the ACA, the Chinese Classification of Mental Disorders (CCMD-III) declassified homosexuality, but added a diagnosis resembling ego-dystonic sexual orientation. Attempts at conversion therapy are rare in China.

• In India, psychiatry and psychology scholars have "preserved an almost complete silence on the subject of homosexuality". One paper discusses behavior modification methods used to treat the sexual orientation of thirteen gay patients. They use the WHO classification of egodystonic sexual orientation, but the People's Union for Civil Liberties reports that doctors will often diagnosis the patient as egodystonic even if the patient really is egosyntonic.

• In Italy, little research has been conducted in the mental health community on homosexuality. Early work tended to describe homosexuality as a pathology or a developmental arrest. More recently, attitudes have begun to change: "with a lag of about ten years, Italy has followed ... the attitudes of American mental health professions toward homosexuality".

• In Germany, the psychiatry, psychology, and sexology establishment from the early 20th century viewed homosexuality as pathological. However, following the increased visibility of the gay community during the AIDS epidemic of the late 1980s and the declassification of homosexuality as a mental disorder in the ICD-10, biological, rather than pathological, models of homosexuality became mainstream.

• Japan's psychiatric body removed homosexuality from its list of psychiatric disorders in 1995.

• In Norway, a country known for its strong LGBT rights legislation, the shift from a pathological to non-pathological understanding of homosexuality began in the 1970s, following the APA's declassification in 1973. In 2000, the General Assembly of the Norwegian Psychiatric Association overwhelmingly voted for the following position statement on conversion therapy:

Homosexuality is no disorder or illness, and can therefore not be subject to treatment. A ‘treatment’ with the only aim of changing sexual orientation from homosexual to heterosexual must be regarded as ethical malpractice, and has no place in the health system.

• The World Health Organization's ICD-10, which along with the DSM-IV is widely used internationally, states that "sexual orientation by itself is not to be regarded as a disorder". It lists ego-dystonic sexual orientation as a disorder instead, which it defines as occurring where "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." The APA 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.

Contemporary theories and techniques

Psychoanalytic theories

Nicolosi is today's leading 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". His 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. These anti-gay psychoanalytic approaches toward gay people have been repudiated by the psychoanalytic mainstream and the theories that underlie them countered by analysts offering more gay affirmative approaches.

Gender-affirmative therapy

A. Dean Byrd, Vice-President of NARTH describes a technique called gender-affirmative therapy 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". These therapies do not work under the assumption that homosexuality is a mental illness and therefore are not considered reparative therapies. There is no one set method to this therapy, and several psychologists have developed their own flavor of gender affirmative therapy:

• Sexual Identity Therapy was designed by Throckmorton and Yarhouse, and is endorsed by Robert L. Spitzer. 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.

• Gender Wholeness Therapy was designed by Dave Matheson. "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.

• Context Specific Therapy was designed by Jeff Robinson. It does not work with any one theory of homosexuality, but uses several theoretical backgrounds according to the client's need, and is based on phenomenological research. 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".

Other methods

Some therapeutic methods are entirely outside the purview of professional health associations, and hence do not have to obey professional ethics guidelines. Some of these sources include coaches, religious organizations, and ex-gay groups.

File:Cohensholding.jpg

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

One of the more well-known coaches is Richard Cohen, whose 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 that to me?"

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." Weekends put on by Adventure in Manhood support "healthy bonding with men, through masculine activity, teamwork, and socialization." Though not specific to gay men, several gay men attended the New Warrior Training Adventure, which is 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."

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.” Common techniques 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 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.

Ex-gay organizations

Main article: ex-gay

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 American evangelical Christians, there are now ex-gay organizations for Catholics, Mormons, Jews and Muslims and in other parts of the world. "[T]his modality is thought to be one of the most common for individuals seeking to change their sexual orientation." Ex-gay ministries typically are staffed by volunteer counselors, as opposed to reorientation counseling which is conducted by licensed clinicians.

The conversion 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, conversion therapists may use either secular or religious approaches—or both—in trying to change sexual orientation while ex-gay organizations tend to focus on religious and spiritual approaches to help members avoid acting on their same-sex desires, or sometimes to diminish or eliminate those desires. Ex-gay organizations such as Exodus International often consider conversion therapy to be a useful tool, but not a necessary one. Evergreen International does not advocate nor discourage any particular form of therapy and has taught that "therapy will likely not be a cure in the sense of erasing all homosexual feelings."

For some ex-gay groups, merely choosing not to act on one's same-sex desires counts as a "success" whereas conversion therapists tend to understand success in terms of actually reducing or eliminating those desires, although some also count not acting on one's desires as a success. 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-gay advocates sometimes analogize this to the coming out process.

There are several techniques used by ex-gay groups. 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 disentangle sexual desire from the desire for affection or affirmation; and a subject should repent and confess his or her sins.

Some Christian right 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.

Mainstream medical view in the U.S.

See also: Conversion therapy § Outside the U.S.

Further information: [[:Biology and sexual orientation, sexual orientation and medicine and homosexuality and psychology]]

The medical and scientific consensus is that conversion therapy is potentially harmful and that there is no evidence that it is effective. No mainstream medical organization endorses conversion therapy and many have expressed concerns over some of the ethics and motivations surrounding its practice. A survey of the American Psychological Association rated conversion therapy as "certainly discredited", along with topics like "crystal healing" and "dolphin-assisted therapy".

The ethics guidelines of the mental health establishment discourage, and sometimes prohibit, its practice. The APA 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." Jack Drescher, former chair of the American Psychiatric Association's Committee on Gay, Lesbian and Bisexual Issues stated: "There's not a debate in the profession on this issue... This is like creationism. You create the impression to the public as if there was a debate in the profession, which there is not."

Mainstream health organizations critical of conversion therapy 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. Mainstream gay rights organizations and some religious organizations opposing conversion therapies include the National Gay and Lesbian Task Force, The Interfaith Alliance, New Ways Ministries and People for the American Way.

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 conversion 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." In Nicolosi's survey, 7.1% of patients reported that they were worse after therapy than before. He concluded that "clients who have decided they wish to affirm a gay identity could feel shamed and emotionally hurt if therapists attempted to impose conversion therapy on them."

Mainstream medical bodies state that conversion therapy can be harmful because it may exploit guilt and anxiety, thereby damaging self-esteem and leading to depression and even suicide. Participants are at increased risk for guilt, depression, anxiety, confusion, self-blame, suicidal gestures, unprotected anal intercourse with untested partners, and heavy substance abuse. 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 conversion 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 conversion 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." The APA encourages and supports research to determine risks versus benefits.

Ethics guidelines

The ethics guidelines of the American Psychiatric Association and the American Counseling Association recommend that ethical practitioners avoid using conversion therapy or referring clients to people who do use it. The American Psychological Association opposes practicing conversion 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 conversion therapy. The President of the APA has said: "The APA has no conflict with psychologists who help those distressed by unwanted homosexual attraction." NARTH, a conversion 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 conversion 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 conversion therapy.

With respect to ex-gay programs, "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."

Self-determination argument

Conversion therapists focus on patient self-determination when discussing whether conversion therapy should be available. Mark Yarhouse, of Pat Robertson's Regent University, wrote: "[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, of the private Christian school Grove City College, 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 conversion therapy to be pseudoscientific, similarly argues for a client's right to access to conversion 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."

The American Psychological Association's code of conduct states: "Psychologists respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self-determination," but also: "Psychologists are aware that special safeguards may be necessary to protect the rights and welfare of persons or communities whose vulnerabilities impair autonomous decision making." Gerald Koocher, president of the APA, stated: "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,] therapists must determine whether patients understand that their motives may arise purely from the social pressures of a homophobic environment.... [and second,] patients must understand that [treatments to modify sexual orientation] lack a validated scientific foundation and may prove psychologically harmful."

Jack Drescher, responding to Yarhouse's paper, argued that "any putative ethical obligation to refer a patient for reparative therapy is outweighed by a stronger ethical obligation to keep patients away from mental health practitioners who engage in questionable clinical practices." Chuck Bright wrote 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."

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.

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.

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." Mainstream health organizations state that: "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." The American Psychological Association has claimed that homosexuality "is not changeable."

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."

Conversion 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." Some in the ex-gay community believe that sexual orientation cannot be completely changed, but others in the camp disagree.

The director of the APA's LGBT Concerns Office said: "I don't think that anyone disagrees with the idea that people can change because we know that straight people become gays and lesbians.... the issue is whether therapy changes sexual orientation, which is what many of these people claim."

Evidence cited by conversion therapists

Conversion therapists point to scientific studies that show anecdotal evidence of effectiveness. Studies from the 1950s–1980s generally reported rates of positive outcomes at about 30%, with more recent survey research generally consistent with the extant data. In a survey of 882 people who were undergoing therapy, attending ex-gay groups or ex-gay conferences, 22. 9% reported they had not undergone any changes, 42.7% reported some changes, and 34.3% reported much change in sexual orientation. As a group, they reported large reductions in homosexual thoughts and fantasies and improvements in their psychological, interpersonal, and spiritual well-being.

They also point to non-peer-reviewed studies that show evidence of change, conducted either by NARTH or other professional therapists. For example, many groups point "Ex-Gays? A Longitudinal Study of Religiously Mediated Change in Sexual Orientation", a book publisher by researchers Stanton Jones and Mark Yarhouse. The study showed that out of a sample size of 98 people who sought a change in their sexual orientation, 15% reported a change in orientation over a three year period. They also point to several people who say they have either changed orientation or have diminished homosexual attractions, including:

• Alan Chambers identified as being a homosexual as a youth, but after years of therapy, he says he has mostly conquered his homosexual feelings and now identifies as straight. He says he is happily married, and he and his wife have two children.

• Andrew Comiskey said he left homosexuality after turning his life over to Christ. He joined a church group for previous homosexuals, and under the advice of his pastor, started the group Desert Stream Ministries. He is now married and has four children.

• Mike Haley was living as a gay man for 12 years, and at one point was arrested for gay prostitution. He left gayhood when he was 28. After what he calls a long and painful struggle, he made a switch to heterosexuality. Today, he's married with three children.

• Randy Thomas was in gay relationships since he was a teenager, but stopped when he found Christianity in his mid-20s. He now says "I am 15 years on the other side of identifying as gay. I have had a sexual orientation shift, and I'm not gay."

• Melissa Fryrear lived as a lesbian for ten years before her Christian conversion and subsequent years of therapy, which she says made her life "fuller and happier." She has now says "I'm changed. I'm a heterosexual woman now. I'm not sexually attracted to women."

The APA stated: "In the last four decades, 'reparative' therapists have not produced any rigorous scientific research to substantiate their claims of cure." 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 conversion 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;

• conversion therapists falsely assume that homosexuality is a mental disorder;

• conversion 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 conversion 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 found that 88% of participants failed to achieve a sustained change in their sexual behavior and 3% reported changing their orientation to heterosexual. The remainder reported either losing all sexual drive or attempting to remain celibate, with no change in attraction. Some of the participants who failed felt a sense of shame and had gone through conversion therapy programs for many years. Others who failed believed that therapy was worthwhile and valuable. Of the 8 respondents (out of a sample of 202) who reported a change in sexual orientation, 7 worked as ex-gay counselors or group leaders.

In 2001, Dr. Robert Spitzer, who was involved in the APA's declassification of homosexuality as a mental disorder, presented a paper on conversion 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 conversion 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 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 conversion 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 conversion therapies, that 60% of the subjects had previously reported being bisexual, and that no follow-up study had been carried out to ascertain 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 gay people who could successfully become heterosexual was likely to be "pretty low". He also conceded that the study's participants were "unusually religious."

Reaction by conversion therapists

Conversion 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 conversion therapy) is the result of political beliefs and lobbying. Second, they argue that there is evidence that conversion therapy does 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 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."

Legal status in the U.S.

There have been few, if any, medical malpractice lawsuits filed on the basis of conversion therapy. One law journal suggested this is because there is an "historic reluctance of consumers of mental health services to sue their care givers" and because of "the difficulty associated with establishing the elements of... causation and harm... given the intangible nature of psychological matters." The same article suggested that a tort cause of action for intentional infliction of emotional distress might be sustainable against therapists who use conversion therapy on patients who specifically say that his or her anxiety does not arise from his or her sexuality.

In one of the few published U.S. cases dealing with conversion therapy, the Ninth Circuit addressed the topic in the context of an asylum application. A Russian citizen "had been apprehended by the Russian militia, registered at a clinic as a 'suspected lesbian,' and forced to undergo treatment for lesbianism, such as 'sedative drugs' and hypnosis.... The Ninth Circuit held that the conversion treatments to which Pitcherskaia had been subjected constituted mental and physical torture. The court rejected the [] argument that the treatments to which Pitcherskaia had been subjected did not constitute persecution because they had been intended to help her, not harm her.... The court stated that 'human rights laws cannot be sidestepped by simply couching actions that torture mentally or physically in benevolent terms such as "curing" or "treating" the victims.'"

Legal status in Germany

In Germany all parties of the german Bundestag are against Conversion therapy. The german executive wrote, that Conversion therapy is dangerous and that homosexuality is no reason for conversion therapy.

Scandals

There have been some notable scandals, but scandals among leaders are far less common than in the early days, probably due to increased organizational accountability and growing awareness that those ministering in their area of temptation are vulnerable.

Scandals involving minors

One of the most controversial aspects of conversion therapy has been the focus on gay teenagers, including occasions where teenagers have been forcibly treated in ex-gay camps. A 2006 report outlined evidence that ex-gay and conversion therapy groups are increasingly focusing on children. Several legal researchers have responded to these events by arguing that parents who force their children into aggressive conversion therapy programs are committing child abuse under various state statutes.

• In 1991 14-year-old 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.

• 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, 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.

• In July 2005, the New York Times ran a feature story about 16-year-old Zachary Stark, whose parents forced him to attend an ex-gay camp run by Love in Action. In May 2005, Zachary 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 [sic] the rest of those kids who complain about their parents on blogs - and I can't help it.

In July 2005, Stark was released from the ex-gay camp. 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 Love in Action, closed the case.

"Relapses" and other scandals

Further information: [[:Ex-gay#People who left the ex-gay movement, Ex-ex-gay|Ex-gay § People who left the ex-gay movement, Ex-ex-gay]]

File:00sep29Paulk.jpg

Controversy arose when ex-gay John Paulk was photographed leaving a gay bar. (Photograph by Wayne Besen.)

• Exodus International's co-founder Michael Bussee and his partner, a fellow ex-gay counselor, Gary Cooper quit the group and in 1979, held a life commitment ceremony together. Bussee went on to become an outspoken critic of Exodus and the ex-gay movement. He flatly rejects therapies designed to change or "cure" gay people, but recently acknowledged potential for therapy that "does not promise change, but instead offers patients help in managing their desires and modifying their behavior to match their religious values -- even if that means a life of celibacy".

• Colin Cook, founder of Homosexuals Anonymous, was in 1986 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. Cook had engaged in phone sex, practiced long and grinding hugs, and asked patients to bring gay pornography to sessions so that he could help desensitize them against it.

• John Paulk, then leader of Focus on the Family's Love Won Out conference and chairman of the board for Exodus International North America, was photographed in September of 2000 exiting a Washington, D.C. gay bar. This led to Paulk stepping down from the two organizations.

• Michael Johnston, an HIV-positive man who is featured in the film It's Not Gay, promoted by the American Family Association, had frequently been interviewed on U.S. television and radio regarding his claimed change in sexuality, and even featured in a national television advertising campaign in 1998 stating that Jesus Christ empowered him to leave his homosexual past. In 2002, he was exposed as having recently resumed having sex with men, and he admitted to having had unprotected sex with multiple male partners without disclosing his HIV-positive status, despite knowing he that he was HIV-positive, for over a period of two years.

• Christopher Austin was an ex-gay counselor who was sentenced to 10 years in prison in 2007 for sexually assaulting a male client. Austin was affiliated with and gave presentations at NARTH and Evergreen International, which describes him as "a therapist specializing in homosexual and sexual addiction recovery [and] the creator of RENEW, a multi-dimensional treatment approach for men struggling with homosexuality".

• Terrance Lewis was a minister and former counsellor at Providence Bible College in Winnipeg, Canada who was found guilty in February 2008 for sexually assaulting a young man who sought counselling to make him straight. The alleged victim, now 29, told court he started meeting Lewis for counselling sessions in early 2000 after his parents caught him viewing gay pornography on the family computer. The man said Lewis started a program of “touch therapy,” which included the two kissing and fondling each other and engaging in sexual roleplaying.

• 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 stated that Haggard "is completely heterosexual". The minister later said he meant to say that therapy "gave Ted the tools to help to embrace his heterosexual side."On February 6, 2008, Haggard had requested to leave the "restoration program" created for him by the New Life Church. In a press release, the New Life Church states it "recognizes the process of restoring Ted Haggard is incomplete and maintains its original stance that he should not return to vocational ministry. However, we wish him and his family only success in the future."

Cultural references

Conversion 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 after being outed by her worried friends and family. In 2003 the ex-ex-gay actor and playwright Peterson Toscano premiered his one-person comedy Doin' Time in the Homo No Mo Halfway House--How I Survived the Ex-Gay Movement, which he has presented throughout the US and parts of Europe. 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 and criticized conversion therapy and ex-gay camps.

Conversion therapy was derided on Penn and Teller's television show Bullshit!. Conversion therapist Richard Cohen was satirically interviewed by Jason Jones in a segment for the March 19, 2007 episode of The Daily Show. 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.

External links

Pro-conversion therapy perspectives

• National Association for Research & Therapy of Homosexuality
• Exodus International a Christian ex-gay organization
• Christian Anthropology and Homosexuality
• "Homosexuality & Hope Catholic Medical Association
• People Can Change
• Same Sex Attraction Morality League
• Courage
• Evergreen International

Mainstream scientific community perspectives

• American Psychological Association (sexual orientation "does not require treatment and is not changeable.")

• American Counseling Association ("Research does not support conversion therapy as an effective treatment modality.... There is potential for harm when clients participate in conversion therapy.")

• American Psychiatric Association ("In the last four decades, 'reparative' therapists have not produced any rigorous scientific research to substantiate their claims of cure. Until there is such research available, APA recommends that ethical practitioners refrain from attempts to change individuals' sexual orientation, keeping in mind the medical dictum to first, do no harm.")

• American Academy Of Paediatrics ("Therapy directed specifically at changing sexual orientation is contraindicated, since it can provoke guilt and anxiety while having little or no potential for achieving changes in orientation.")

• Joint coalition of health organizations ("[H]ealth and mental health professional organizations 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.)

• World Health Organization (Those with an egodystonic sexual orientation "may seek treatment in order to change it.")

• The Pseudo-science of Sexual Orientation Conversion Therapy detailed summary of the case against conversion therapy.