Reparative/Reorientation

Key Texts

  1. APA position statement on  Therapies Focused on Attempts to Change Sexual Orientation (Reparative or Conversion Therapies), located here.

Key Abstracts

Professional Care for Unwanted Same-Sex Attraction: What Does the Research Say? (Sutton, review, 2015)

In recent years, national and international medical and mental-health associations typically have emphasized the potential harmfulness of professional care for unwanted same-sex attraction (SSA or homosexuality) and behavior. State legislatures in the US and legislative bodies in other countries either have passed or are considering passing laws which would penalize professionals who provide professional care for unwanted SSA-to minors and/or adults-including the loss of the license to practice. This paper was written as a response to the present situation in the UK. The paper reviews the universal ethics of all medical and mental-health professionals to avoid harm and do good (non-maleficence/non-malfeasance and beneficence); discusses the documented potential for harm when using every mental-health treatment for every presenting problem; clarifies steps taken by the Alliance for Therapeutic Choice and Scientific Integrity (Alliance), its clinical and research divisions, the National Association for Research and Therapy of Homosexuality Institute (NARTH Institute) and its international division, the International Federation for Therapeutic Choice (IFTC), to promote ethical professional care for unwanted SSA; clarifies the injustice and presumed ideological biases of the medical and mental-health associations’ warning about the potential for harm for psychotherapy only for unwanted SSA and not all psychotherapy approaches; and documents that the research purporting to show this harmfulness, in the research authors own words, does not do so. Recommendations to promote scientific integrity in the conduct and reporting of relevant research are offered.

A Need for Orientation: the WMA Statement on Natural Variations of Human Sexuality (Mahler and Mundle, report, 2015)

An alarming stigmatization and discrimination of homosexual people persists despite the formal depathologization of homosexuality, which occurred through the removal of the diagnosis from the DSM- (1973) and classification from the ICD (1991). The adoption of an expedited Statement on sexual orientation by the majority at the 64th General Assembly of the WMA is therefore an important and overdue measure. The Statement clearly asserts, among other things, that homosexuality is not an illness and therefore requires no cure. It also suggests that direct and indirect discrimination and stigmatization of people due their sexual orientation often leads to psychological and physical illnesses. Furthermore, delegates of the WMA condemned so-called reparative or conversion “therapies”, which strive to induce heterosexual or asexual behavior. These are not only ineffective and unethical, but are strongly associated with serious negative impacts on health. Such a statement from the World Medical Association (WMA) is of particular importance as ambivalence and uncertainty in regards to homosexuality exists even within the medical and therapeutic professions. The latent or manifest attribution of homosexuality as an illness or developmental disorder is still widespread. One possible explanation for this may be the disruption of an open and sustainable discourse on causes, effects and definitions of sexual orientation following the “official depathologization”. Especially those working in the medical and therapeutic contexts should be aware of their special responsibility not to pathologize homosexuality.

Professional care for unwanted same-sex attraction: What does the research say? (Sutton, review, 2015)

In recent years, national and international medical and mental-health associations typically have emphasized the potential harmfulness of professional care for unwanted same-sex attraction (SSA or homosexuality) and behavior. State legislatures in the US and legislative bodies in other countries either have passed or are considering passing laws which would penalize professionals who provide professional care for unwanted SSA-to minors and/or adults-including the loss of the license to practice. This paper was written as a response to the present situation in the UK. The paper reviews the universal ethics of all medical and mental-health professionals to avoid harm and do good (non-maleficence/non-malfeasance and beneficence); discusses the documented potential for harm when using every mental-health treatment for every presenting problem; clarifies steps taken by the Alliance for Therapeutic Choice and Scientific Integrity (Alliance), its clinical and research divisions, the National Association for Research and Therapy of Homosexuality Institute (NARTH Institute) and its international division, the International Federation for Therapeutic Choice (IFTC), to promote ethical professional care for unwanted SSA; clarifies the injustice and presumed ideological biases of the medical and mental-health associations’ warning about the potential for harm for psychotherapy only for unwanted SSA and not all psychotherapy approaches; and documents that the research purporting to show this harmfulness, in the research authors own words, does not do so. Recommendations to promote scientific integrity in the conduct and reporting of relevant research are offered. Lay Summary: There has been a lot of controversy about the potential harmfulness of professional care for unwanted same-sex attraction and behavior (SSA or homosexuality). This paper reviews the ethics of all medical and mental health professionals to avoid harm and do good; discusses the known potential for harm when using any mental health treatment for any problem; clarifies steps taken to promote ethical professional care for unwanted SSA; notes the injustice and possible biases of those who warn about the potential for harm of psychotherapy for unwanted SSA; and documents that the research said to show this harmfulness, in the research authors own words, does not do so.

Sexual orientation change efforts through psychotherapy for LGBQ individuals affiliated with the Church of Jesus Christ of Latter-day Saints (Bradshaw et al, survey, 2015).

This study reports the results of a comprehensive online survey of 1,612 current or former members of the Church of Jesus Christ ofLatter-day Saints, many of whom engaged in psychotherapy to cope with (i.e., understand, accept, or change) their same-sex attractions. Data obtained from written and quantitative responses showed that therapy was initiated over a very wide age range and continued for many years. However, counseling was largely ineffective; less than 4% reported any modification of core same-sex erotic attraction. Moreover, 42% reported that their change-oriented therapy was not at all effective, and 37% found it to be moderately to severely harmful. In contrast, affirming psychotherapeutic strategies were often found to be beneficial in reducing depression, increasing self-esteem, and improving family and other relationships. Results suggest that the very low likelihood of a modification ofsexual orientation and the ambiguous nature of any such change should be important considerations for highly religious sexualminority individuals considering reorientation therapy.

Experiences of ex-ex-gay individuals in sexual reorientation therapy: reasons for seeking treatment, perceived helpfulness and harmfulness of treatment, and post-treatment identification (survey,  Flentje et al, 2014).

Therapy meant to change someone’s sexual orientation, or reorientation therapy, is still in practice despite statements from the major mental health organizations of its potential for harm. This qualitative study used an inductive content analysis strategy (Patton, 2002) to examine the experiences of thirty-eight individuals (31 males and seven females) who have been through a total of 113 episodes of reorientation therapy and currently identify as gay or lesbian. Religious beliefs were frequently cited as the reason for seeking reorientation therapy. Frequently endorsed themes of helpful components of reorientation therapy included connecting with others and feeling accepted. Harmful aspects of reorientation therapy included experiences of shame and negative impacts on mental health. Common reasons for identifying as LGB after the therapy included self-acceptance and coming to believe that sexual orientation change was not possible. The findings of this study were consistent with recommendations by the American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation (2009), which concluded that helpful aspects of reorientation therapy could be achieved through affirmative treatment methods while avoiding potential harms that may be associated with reorientation therapy. Limitations of the findings, including a small, self-selected sample, are discussed.

A systematic review of the research base on sexual reorientation therapies (Serovich et al, systematic review, 2008).

In the past few years, members of the AAMFT, like members of other professional groups, have engaged in a discourse as to the necessity and effectiveness of sexual reorientation therapies. The purpose of this article is to review, critique, and synthesize the scientific rigor of the literature base underpinning sexual reorientation therapy research. Using a systematic narrative analysis approach, 28 empirically based, peer-reviewed articles meeting eligibility criteria were coded for sample characteristics and demographics as well as numerous methodology descriptors. Results indicate the literature base is full of omissions which threaten the validity of interpreting available data.

Homosexuality: An Islamic Perspective (Ahmed, essay, 2006)

Homosexuality can be defined as a sexual orientation and a sense of personal and social identity with or without alternative life style. Homosexuality was regarded as an illness, but in 1973 it was removed from Psychiatric diagnostic categories. The majority of psychiatrists believe that homosexuality is an alternative life style rather than a mental disorder. It needs to be clarified that the expression of homosexuality (behavior) is a matter of choice, which is under one’s control. Islam and other major religions condemn homosexual behavior. Homosexuals are not emotionally disturbed or socially dysfunctional. If they are engaged in a homosexual act, they are committing a prohibited act which is a major sin. They are committing a sin which is similar to a heterosexual individual who indulges in a sexual relation without marriage. Islam teaches self-restraint. As Muslims, we do not make religious laws, but we obey God’s commands. We cannot impose our views on others but we know the clear instructions from Qur’an about homosexual behavior and we have a duty to teach the correct teachings of Qur’an. Muslim physicians and clinicians must have a non-judgmental attitude to help individuals who are suffering the consequences of their behavior. A homosexual patient may be suffering from any illness, including Acquired Immune Deficiency Syndrome (AIDS). A sick homosexual patient is a person entitled to treatment with dignity and respect. When personal attitude interferes with our optimal doctor-patient relationship, the ethical course is to refer the patients to other colleagues.

Homosexuality, ethics and identity synthesis (Yarhouse, essay, 2004).

Implicit metaphysical assumptions concerning the nature of sexual orientation are reflected in the language used to frame ethical debates concerning “reorientation” therapies. An alternative metaphysical construal is presented concerning sexual orientation and sexual identity development and synthesis. This alternative construal allows for humility concerning what we know and do not know about sexual orientation, underscores the client’s self-determination and autonomy, and demonstrates regard for personal and religious valuative frameworks. Rather than focusing on therapies aimed specifically at sexual reorientation, clinicians would do well to provide clients with informed consent and to facilitate identity development and synthesis in keeping with their clients’ requests for professional services.

Can some gay men and lesbians change their sexual orientation? 200 participants reporting a change from homosexual to heterosexual orientation (Spitzer, survey, 2003).

Position statements of the major mental health organizations in the United States state that there is no scientific evidence that a homosexual sexual orientation can be changed by psychotherapy, often referred to as “reparative therapy.” This study tested the hypothesis that some individuals whose sexual orientation is predominantly homosexual can, with some form of reparative therapy, become predominantly heterosexual. The participants were 200 self-selected individuals (143 males, 57 females) who reported at least some minimal change from homosexual to heterosexual orientation that lasted at least 5 years. They were interviewed by telephone, using a structured interview that assessed same sex attraction, fantasy, yearning, and overt homosexual behavior. On all measures, the year prior to the therapy was compared to the year before the interview. The majority of participants gave reports of change from a predominantly or exclusively homosexual orientation before therapy to a predominantly or exclusively heterosexual orientation in the past year. Reports of complete change were uncommon. Female participants reported significantly more change than did male participants. Either some gay men and lesbians, following reparative therapy, actually change their predominantly homosexual orientation to a predominantly heterosexual orientation or some gay men and women construct elaborate self-deceptive narratives (or even lie) in which they claim to have changed their sexual orientation, or both. For many reasons, it is concluded that the participants’ self-reports were, by-and-large, credible and that few elaborated self-deceptive narratives or lied. Thus, there is evidence that change in sexual orientation following some form of reparative therapy does occur in some gay men and lesbians.