My Ex-Gay Life :: Dissecting Reparative Therapy

[Editor's Note: this article is the third in a four-part exclusive EDGE series on "ex-gays." Click here to begin with the first article.

"Sexuality is a fluid, dynamic thing. There's no such thing as sexually-fixed identities - those are things that are fabricated by man." - Michael Glatze

Counseling those who are distressed by their same-sex attractions is a field around which ethical battles are far more subtle than their religious counterparts. Psychologists who practice one of a number of forms of "reparative therapy" (also known as "conversion therapy" or "reorientation therapy") are quick to distance themselves from ex-gay ministries; however, their targeted results are similar, and their degrees of success are similarly low (approximately 30% on average in the short-term).

At heart: what should be done therapeutically with a man or a woman who no longer wishes to be attracted to their own sex?

Building up to the 1940s, homosexuality was largely understood to be a mental illness - a pathology that presumably resulted from any number of perceived "issues" with a person's upbringing. For a period of time, psychologists set about attempting to "cure" homosexuality with a variety of documented therapies, from hysterectomies for women to castration for males. More holistically damaging treatments including the widely-used electro-shock therapies offered the increasingly desperate opportunities for extreme pain. It was not until 1948, when Alfred Kinsey published the first moderately exhaustive study on homosexuality, that these physical treatments were proved to be entirely ineffective in suppressing same-sex desires. Largely speaking, the psychological world foundered on the issue for nearly thirty years.

The American Psychiatric Association's 1973 Position Statement on Homosexuality and Civil Rights, in which homosexuality was removed from that body's list of mental disorders, ushered in a new era of confrontation surrounding ex-gay therapies.

In 1983, psychologist-theologian Elizabeth Moberly ("Homosexuality and the Truth") coined the term "Reparative" with regard to the pursuit of repairing the damage done early in life as a result of an inferior relationship between a father and his son. This theory was refined and expanded, leading to the development in 1992 of NARTH, the National Association for the Research and Therapy of Homosexuality, a body of psychologists who remain at the forefront of reparative therapy today.

"We are an organization of psychologists, psychiatrists, and psychotherapists around the country who really are committed to helping individuals who are dissatisfied with their same-sex attractions," says Joseph Nicolosi, one of the founders of the organization who currently serves as its President. "We're defending their right to receive such treatment, and our right to offer such treatment."

Implicit in Dr. Nicolosi's statement to EDGE is a building confrontation between NARTH and the American Psychological Association, which published a resolution in 1997 that hinted against practices that claim to be able to convert homosexuals to heterosexuals, urging that therapists not make "false or deceptive statements concerning... the scientific or clinical basis for... their services" - and who recently commissioned the Task Force on Appropriate Therapeutic Responses to Sexual Orientation. Nicolosi believes the task force will lead to an overt statement by the APA banning reparative therapy.

Both sides are grasping at the small amount of research data available on reparative therapy in order to respectively support or condemn the practice - and for those who truly wish to denounce their same-sex lifestyle, the result is a confusing crossfire.

"When I feel down and lonely, the idea of having a guy pay attention to me, put his arm around me, etc, is at it's strongest. But when I'm feeling good, confident, strong, loved and happy, all of my erotic and emotional desires turn to the opposite sex." - Jake Taylor

Reparative therapy requires a significant amount of time (usually 1-2 years) working with a therapist at least once a week.

"[Success] occurs by their understanding the causes of their same-sex attraction," Nicolosi explains. "We call it the three A's: attention, affection, approval. These are underlying emotional needs that were not fulfilled by their same-sex parent - the father for the male homosexual and the mother for the lesbian.

"There are two jobs [for the patient]," he continues. "The first task is about the past, and the other is about the present. The past aspect is facing the reality that they did not get this love, making it very clear and conscious, and then going through a grief process. They have to grieve that their father never did and never will love them the way they need to be loved - to the extent they need it. And what that does is free them up from the illusion that they are going to get it somehow either by that father or by somebody else of the same sex."

According to Nicolosi, the next challenge is to replace that need with an emotional connection in their present.

"[They need to] get those needs met thought a relationship with other men," he says. "The focus is not on not having gay sex... it's putting the emphasis on making deep emotional attachments. And we have seen that when these men make deep emotional attachments to other men, their sexual interest diminishes."

For such a conversion to be considered clinically supportable, the scientific basis for the change - that homosexuality is the result of patterns of family relationships in the early part of a person's life - must be proved viable.

According to Robert-Jay Green, PhD, Executive Director of the Rockway Institute, there is no evidence to support such a claim.

"All these theories are all promulgated by the ex-gay people," he points out. "They have this theory that distant fathers and overly-close mothers cause homosexuality. Well, that's been disproved. The research shows that there is no similarities in the pattern of family development in kids who grow up to be lesbian or gay versus kids who grow up to be straight."

This struggle is not new; since the advent of psychotherapy itself, researchers have eagerly attempted to trace those factors of a human's nurturing process that may result in higher incidences of homosexuals. Sigmund Freud was considered a pioneer of contemporary studies.

"He claimed that everyone is sort of born bisexual and has the capacity for being sexually attracted to people of either gender," summarizes Green.

But the Kinsey studies repudiated Freud's claims, proposing that homosexuality and heterosexuality exist on a continuum, and asking individuals to rate themselves with respect to their pull to the polar "opposites" presented. Yet Kinsey eventually articulated that in many cases, those who were practicing heterosexuality in his study were doing little more than repressing their same-sex attractions.

Numerous studies followed; the most debated in recent history was a study published in 2001 by Dr. Robert Spitzer, whose study of 143 "ex-gays" and 57 "ex-lesbians" showed that 66% of the men and 44% of the woman were now functioning successfully as heterosexuals. Nicolosi and other reparative therapists heralded the study as a defense of their practices - but critics of it derided its uncontrolled methods (data was accumulated over 45-minute telephone interviews with no follow-up) and reliance on self-reporting alone.

"All we have here is data over one point in time that's retrospective, where people can tell you they were gay and have or have not had sex with a man over a certain time," asserts Green. "The Spitzer study was conducted with participants who were largely nominated by the ex-gay groups. So these were people who were under tremendous pressure to say they converted form homosexuality to heterosexuality. In many cases these people were in the first stages of their treatments, so we really don't know if their changes last over time. Some of these people were actually on the payroll of the ex-gay ministries, working as counselors, so they had an additional investment in claiming to have been cured."

A 2002 study by Drs. Ariel Shidlo and Michael Schroeder seemed to agree, reporting that 88% of 202 similar subjects reported a failure in changing in their sexual attraction - and 7 of 8 respondents who reported a lasting change were involved with ex-gay groups or ministries.

Jack Drescher, MD, a past chair of the American Psychiatric Association's Committee on Gay, Lesbian and Bisexual Issues, is a critic of both recent studies; he contends that these "self-reporting" studies merely provide anecdotal data of how people are self-identifying - and offer little proof of a change in a person's underlying sexual attraction.

"To me, identity and orientation are not the same thing," he says. "For example, if you put straight people in prison, they will often have homosexual intercourse with people of their same-sex - and when they come out they act heterosexually. Are they gay? No. They were doing something but it may have nothing to do with their orientation. There are lots of people who end up being gay who spent many years in a hetero marriage, have children, have sex with their spouses, and then at one point in their life decide that's not who they really are.

"You can switch identities, they're not fixed. But sexual orientation is not as flexible as identities. A person can come out, say they're gay, change their mind, say they're not gay, change their mind again, say they're gay again. It has nothing to do with their perceptual feelings - because people who call themselves gay don't have all the same sexual feelings, and people who call themselves ex-gay don't have all the same sexual feelings either. These are just labels."

So what *do* we really know?

"In an environment like that, when you don't know the answer to what causes sexual orientation, it's really not proper in my opinion to inform clients of anything different than that." - Warren Throckmorton

"There is some evidence that people who experience predominantly homosexual feelings are self-labeling as lesbian and gay at an earlier age," reports Green, "and that they are coming out at an earlier age to others. There's no evidence that the percentage of such people is increasing over time."

Green's data suggests that the incidence of homosexuality in the general population is fairly stable, but that the number of people who self-identify as gay or lesbian changes for both personal and societal reasons, depending on the climate under which they mature. The gay rights movement certainly dragged more individuals out of the closet; and the encroachment of same-sex identities in the entertainment and news media in the last decade have also generated a more welcoming atmosphere for those who might have otherwise remained secretive.

The actual incidence of same-sex attractions remains a complete mystery - and assessing it is nearly impossible given the fluctuations of self-labeling, which even according to Kinsey's metrics remain, for many people, quite fluid. But, as many psychologists point out, research that relies on self-reporting defies the theoretical underpinnings of reparative therapies.

"The only difference that is consistent is that lesbian and gay kids in childhood tend to be less gender conforming than kids who turn out to be hetero," Green supplies. "That doesn't mean that future gay boys were markedly effeminate, but it means they were more androgynous in general. Likewise for future lesbians. It's also true that there's some evidence that kids who are at the extremes of gender nonconformity are much more likely to turn out to be lesbian or gay."

One 15-year study by Richard Green (no relation) reported that three-quarters of boys who were "feminine" in their youth identified as homosexual later in life. Green's study is one of the few longitudinal metrics available in the field.

Some sciences have also suggested that there may be a potential biological component to homosexuality, initially thanks to studies in the 1990s on gender dimorphism, wherein the brains of homosexuals and heterosexuals were analyzed for differences; these studies were harshly criticized, but many biologists believe the data is sound. More recently, the debate over the "gay gene" kicked into high gear after a 2005 report that suggested that certain common genetic patterns are shared by approximately 60% of gay men - higher than the 50% incidence expected.

Green suggests a third possibility: that being gay or lesbian may also be in part a result of factors in gestation.

"There's some evidence that androgynation of the brain in the third trimester creates a biological predisposition toward gender nonconformity and towards homosexuality," he remarks.

This research is young; and while certain proof of genetic or biological disposition would offer some clarity on the issues surrounding reparative therapies, it has not done so yet.

"This is simply not a mature body of research," says Warren Throckmorton, PhD, Associate Professor of Psychology at Grove City College in Pennsylvania.

"When I read the research, what appears to me to be the best rendering of it is that different factors operate differently for different people," he explains. "In an environment like that, when you don't know the answer to what causes sexual orientation, it's really not proper in my opinion to inform clients of anything different than that. The reparative therapists inform clients that their attractions are due to childhood dynamics. The gay-affirming therapists may go the other way and say that sexual orientation is an intrinsic aspect of who you are, it's because of your genetics or it's prenatal, and that it would be harmful to try to alter it in some way. I don't think the research would allow either dogmatic conclusion."

"You have to reinforce negative stereotypes about homo in order to get the patient not to behave on their homo tendencies. They suggest that homosexuality doesn't work, it's a phobia, it's an avoidance, it's something your parents did to you, God doesn't want you to be that way. And then, when it doesn't work, in addition to having all the baggage that every average gay person carries around having to deal with anti-gay attitudes, you also have that baggage that you got in therapy." - Jack Drescher

Polling the wide body of psychiatrists and psychologists we spoke to in researching this article, we could not find a single individual who could say with certainty that it's possible for a person to change their sexual orientation - we could therefore also not find a person who could say with certainty that reparative therapies do not work.

"I think it's possible that there's probably a small number of people for whom sexuality is not as fixed, but it's a small number," conceded Drescher.

"We can't say that nobody has ever done it, because as soon as you say that someone pops up and says 'I did it,'" agrees Green. "But it's very unlikely. Mental health profiessionals would say you can't easily change someone's sexual orientation; what you may be able to do in some cases is help people suppress their same-sex behaviors for some period of time. Usually under duress, threats, or tremendous social pressure, people will act heterosexually even though they're still experiencing underlying same-sex attraction."

Green also points out that, as with ex-gay ministries, those who undergo reparative therapy often experience difficult emotional upheavals.

"With conversion therapy there are increased levels of depression, self-hatred, suicidality, sometimes reckless behavior in terms of not protecting yourself with encounters with members of the same sex," he argues.

And given the limited percentage of success stories and the potential harm to individuals undergoing reparative therapy, many believe that the work of Dr. Nicolosi and others in NARTH should be stopped with or without scientific proof that they are promising the impossible.

"I think they overstate what they can offer," remarks Drescher. "They're not very modest about their achievements, and if they were more modest they might be more helpful. But they're bait-and-switch. They present themselves as if change is something anyone can do, and once they have the customer in the store, then they lay out that it's a long and complicated process."

Nicolosi and gay advocates both suspect that this type of censure is an unspoken goal of the APA's new task force.

"There's a great gay lobby in the APA," Nicolosi says bluntly, accusing the APA of refusing to allow a proponent of reparative therapy into the task force. "Not only were we not invited, we were rejected. We submitted our names. I ask you: isn't it reasonable if you're going to have a task force on whether or not reparative therapy is a good thing or a bad thing, don't you think you'd invite Joseph Nicolosi?"

The APA pointedly says no.

"The idea that there was some process of rejecting people is just not at all consistent with what happened," articulates Clinton W. Anderson, PhD, the Director of the APA's Lesbian, Gay and Bisexual Concerns Office. "This was a process of selecting people. We think we selected excellent people who had the appropriate expertise for the job the task force was asked to do.

"Clearly one of the issues the task force is asked to produce policy recommendations to the association about is reparative therapy, sexual orientation conversion therapy, any situation where there are efforts being made to change sexual orientation," Anderson concurs.

But he also points out that due to the APA's stated agreement with the 1973 removal of homosexuality from the list of pathologies, the task force is rightly chartered to be gay-affirming.

"Joseph Nicolosi has really made an important part of his career the assertive promotion of reparative therapy," he claims.

Nicolosi rejects the idea that his group is in any way anti-gay.

"We do not want to diminish the rights or civil liberties of gays or lesbians - they have a right to pursue their lives, their happiness, their dreams; those rights should not be limited in any way," he counters. "But for those who are unhappy for any reason, for those who want a conventional sexuality, a conventional marriage, we want to help them achieve that."

That stated position may not be completely supportable; as of this writing the top article on NARTH's homepage is titled, "Marriage as Culture: The Case Against 'Same-Sex Marriage'" - a clear indication that NARTH is embroiled, at least philosophically, in more politically-charged issues surrounding gay and lesbian rights.

"People such as Joseph Nicolosi might today claim that they do not take a pathologizing perspective on homosexuality," Anderson agrees. "But if you look at the history of their careers and what they have advocated, that's just not a credible position. They do seem to bring a prejudiced attitude towards homosexuality to the table."

Throckmorton suggests that reparative therapies aside, it's not unhealthy for those struggling with their sexuality to seek relief in counseling.

"What we need to do is show clients what the research shows, that there are mixed results, and not misrepresent those results," he prescribes. "We need to tell people what we know, then help them determine what their personal beliefs and values are about what to do with their life, and how they want to live their life. When clients evaluate the research and they make a decision that their beliefs either favor or don't favor their homosexual identity, then a therapist should work with them to integrate a sexual identity that they value."

The APA's Task Force on Appropriate Therapeutic Responses to Sexual Orientation is scheduled to deliver its initial reports at the beginning of next year, which will then be considered by the association for potential policy action as early as August, 2008.

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Click here to read Part Four, "My Ex Gay Life: Reclaiming Homosexuality."

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On the net:

The Rockway Institute: http://rockway.alliant.edu/
American Psychological Association: http://www.apa.org
NARTH: http://www.narth.com
Dr. Warren Throckmorton: http://www.drthrockmorton.com/
American Psychiatry Association: http://www.psych.org
Jake Taylor's Blog: http://pfox.org/phpbb/viewtopic.php?t=158&sid=b3dc16ed0c1967492476d7e869250ceb