A few weeks ago Texas Governor Rick Perry, speaking in San Francisco, defended his state’s Republican Party Platform endorsing gay conversion therapy (also called reparative therapy), essentially stating that homosexuality is a choice. So once again this topic is in the news and in need of intelligent discussion. Somewhat amazingly, the basic questions being asked about homosexuality and conversion therapy haven’t changed much in the last 50-plus years, despite the almost incalculable progress we’ve made in our scientific understanding of human sexuality and romantic attraction. The two primary questions seem to be:
- Is homosexuality a psychological disorder (or the result of a psychological disorder)?
- Can homosexuals be repaired (i.e., converted into heterosexuals) via psychoanalytic treatment or any other methodology?
The answer to both of these questions is a resounding NO. Yet here we are again, fighting off painfully misguided, highly moralistic efforts to judge healthy forms of sexuality.
The Official Clinical Stance on Homosexuality
Once upon a time the American Psychiatric Association listed homosexuality as a mental illness. In 1973, however, the APA reversed its stance and since that time the organization has worked hard to suppress the ignominy of ever having supported that idea. Today the APA, along with pretty much every other credible medical and psychoanalytic professional organization across the globe, believes that human sexuality exists on a continuum. The American Psychological Association (the “other” APA) has perhaps stated the matter best, releasing an official statement in 2005 reading, in part:
Sexual orientation is an enduring emotional, romantic, sexual, or affectionate attraction toward others. It is easily distinguished from other components of sexuality including biological sex, gender identity (the psychological sense of being male or female), and the social gender role (adherence to cultural norms for feminine and masculine behavior). Sexual orientation lies along a continuum that ranges from exclusive heterosexuality to exclusive homosexuality and includes various forms of bisexuality.
The two APA organizations are not alone in their recognition of heterosexuality, homosexuality, and everything in between as healthy, natural, and perfectly normal variations of sexual orientation. Once again, pretty much every major medical and psychotherapeutic professional organization has backed this position. In short, homosexuality is not in any way a medical, emotional, or psychological disorder. End of discussion.
What Is Gay Conversion Therapy?
Gay conversion therapy is an attempt to change a person’s sexual orientation. Usually these efforts are promoted by right-wing religious groups and/or therapists affiliated with such groups. Oftentimes the meat and potatoes of conversion therapy is some form of aversion treatment—usually electric shock and/or nausea-inducing medications applied in conjunction with homoerotic stimuli. Other “therapeutic techniques” may also be utilized. These include masturbatory reconditioning (masturbating when exposed to heterosexual stimuli), visualization (picturing oneself as “normal”), social skills training (teaching gay males to “act like a man”), prayer, and social pressure applied by family members, religious entities, and others in treatment.
The social skills portion of conversion therapy programs can be particularly fun to examine. Joseph Nicolosi, author of the 1997 book, Reparative Therapy of Male Homosexuality, suggests the following 11-step plan for social reconditioning:
- Participate in sports and other manly activities
- Avoid museums, opera, symphonies, and other non-manly activities
- Avoid women except for romantic contact
- Mimic the ways heterosexual men walk, talk, and interact
- Attend church and join a men’s group
- Attend reparative therapy groups to discuss progress and/or slips back into homosexuality
- Become more assertive with women through flirting
- Begin heterosexual dating
- Engage in heterosexual intercourse
- Enter heterosexual marriage
- Father children
Apparently Nicolosi is unaware of relatively common things like gay athletes, straight artists and musicians, metrosexuals, and gay men who marry women and father children, only to divorce and “come out” later in life.
Despite the somewhat bizarre and utterly unsuccessful (see the information below) nature of gay conversion therapy, many people do attempt it. Usually these are individuals who feel deep shame about who and what they truly are. Sadly, their emotional dysphoria is most often instilled by “loving” family members, who simply don’t understand (and therefore fear and loathe) any form of non-hetero sexual orientation. Even worse, adolescents are sometimes pushed into gay conversion therapy by their parents. Rather than “curing” these individuals, efforts at conversion merely denigrate and shame them—potentially leading to depression, anxiety, and similar long-term emotional and/or psychological issues (again, see the information below).
The Official Stance on Gay Conversion Therapy
There is no credible evidence that any form of gay conversion therapy works. In fact, sexual orientation is now generally regarded as fixed and immutable. This means that gay men are sexually and romantically attracted to other men, lesbians are sexually and romantically attracted to other women, and bisexuals are sexually and romantically attracted to both genders—and no amount of aversion therapy, talk therapy, social pressure, or prayer is going to change that. Yes, a person can choose to not act on his or her same-sex attractions, but that doesn’t make those attractions go away. The American Psychological Association states this rather clearly, writing:
[People] cannot choose to be either gay or straight. For most people, sexual orientation emerges in early adolescence without any prior sexual experience. Although we can choose whether to act on our feelings, psychologists do not consider sexual orientation to be a conscious choice that can be voluntarily changed.
In addition to being a waste of time, energy, and money, conversion therapy may actually be harmful, especially to young people (who are often involuntarily subjected to it). For the most part this damage is caused by gay conversion therapy’s inherent reinforcement of social prejudices against homosexuality. One study looking at the effects of social and familial rejection on LGBT youth found that LGBT kids who experience significant feelings of rejection because of their sexual orientation, such as what occurs with gay conversion therapy, are 3 times as likely to use illicit drugs, 6 times as likely to report high levels of depression, and 8 times as likely to attempt suicide. Recognizing these dangers, two states, California and New Jersey, have passed laws outlawing the practice of gay conversion therapy on minors, and virtually every major medical and psychotherapeutic professional organization has issued a statement condemning it.
The American Psychiatric Association writes:
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 the patient. … Therefore, the American Psychiatric Association opposes any psychiatric treatment, such as reparative or conversion therapy, which 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.
The American Psychological Association writes:
The reality is that homosexuality is not an illness. It does not require treatment and is not changeable. Some therapists who undertake so-called conversion therapy report that they have been able to change their clients’ sexual orientation from homosexual to heterosexual. Close scrutiny of these reports, however, [casts] doubt on their claims. For example, many of these claims come from organizations with an ideological perspective that condemns homosexuality. Furthermore, their claims are poorly documented…. The American Psychological Association is concerned about such therapies and their potential harm to patients.
The American Academy of Pediatrics writes:
Confusion about sexual orientation is not unusual during adolescence. Counseling may be helpful for young people who are uncertain about their sexual orientation or for those who are uncertain about how to express their sexuality and might profit from an attempt at clarification through a counseling or psychotherapeutic initiative. 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.
The American Psychoanalytic Association writes:
Psychoanalytic technique does not encompass purposeful attempts to “convert,” “repair,” change, or shift an individual’s sexual orientation, gender identity, or gender expression. Such directed efforts are against fundamental principles of psychoanalytic treatment and often result in substantial psychological pain by reinforcing damaging internalized attitudes.
Numerous other organizations, including the American Association for Marriage and Family Therapy, the American Counseling Association, the American Medical Association, the American School Counselor Association, the National Association of Social Workers, and the Pan-American Health Organization have all issued similar statements.
The Alternative Approach
Amazingly, despite the nearly universal condemnation of gay conversion therapy, this potentially damaging practice has many proponents—and not just conservative politicians, either. Many well-educated therapists, both secular and religious, are out there promising they can “cure” homosexuality. Sometimes they try to pray the gay away; sometimes they try to scare the gay away (with aversion therapy); other times they suggest that clients just cover up their “differentness” by pretending to be straight. That said, any attempts at gay conversion therapy are unlikely to succeed and extremely likely to feed a client’s already high levels of shame about who he or she really is. The better approach when dealing with clients who report emotional discomfort with same sex attractions is to help those individuals understand that their same-sex feelings are both perfectly normal and not going away. Then you can help them to process that information, incorporating it into their lives in healthy, life-affirming ways.