Sexual Orientation Change

There was a post on the MA forum about sexual orientation change, which was appropriately locked by T4C. However, it occurred to me that this would be a chance to engage in one of those research discussions people have been gunning for! So, let's stay away from giving anyone advice, but let's talk sexual orientation change!

Sexual orientation conversion therapy was a common topic of published studies throughout the 1960's and 1970's. Interventions included but were not limited to aversive conditioning using electrical shock or nausea-inducing drugs (Masters & Johnston, 1979), or so-called "Playboy therapy" in which clients were conditioned to become aroused to erotic images of members of the opposite sex (Davison, 1968). Many of these studies claimed exceptionally success rates (those rates are obviously now disputed) (Tozer & McClanahan, 1999).

Though outcome studies have not been released by conversion therapy agencies, studies have been conducted into the efficacy the therapy. In literature favorable to conversion therapy, the most oft-cited study is one conducted in 2003 by Spitzer. Spitzer acquired a sample of 200 individuals who classified themselves as conversion therapy "successes" and concluded that these results indicate that sexual orientation change is possible, and that conversion therapies should not be banned. Further, he calls for prospective studies examining the efficacy of the therapy (Spitzer, 2003).

Spitzer's study generated fifty pages of peer replies, and the vast majority were not favorable. Spitzer's methods are heavily criticized; the sample used in his study was acquired by asking agencies which perform conversion therapy to solicit members to be participants in the study. The demand characteristics of study increased pressure on participants as they were now publicly committed to conversion therapy, could very well have contributed to exaggeration of responses in the direction of indicating a larger change had occurred, than actually had (Bancroft, 2003; Beckstead, 2003; Hartmann, 2003; Hill & DiClementi, 2003). Indeed, participants in this study have been suggested to be in an ideal situation for studying cognitive dissonance (Rind, 2003). It has been known for some time that many man and women experience changes in degree of sexual attraction toward their own and the opposite sex throughout the lifetime, without the influence of conversion therapies (Kinsey, Pomeroy, and Martin, 1948).

Shidlo and Schroeder (2002) conducted what they called a ‘consumer's report' on conversion therapy, gathering feedback from individuals who had been clients in such therapy. Overall, 87% of the 202-person sample declared themselves to be conversion therapy failures. Participants who reported failing conversion often felt that their sense of identity was damaged. As well, they experienced high levels of confusion, depression, substance abuse, and suicidal ideation. Eleven of the participants attempted suicide after conversion therapy, 3 of those individuals having attempted before. Some conversion therapy failures also felt betrayed by their therapists for misleading them as to the efficacy of the therapy.

Beckstead and Morrow (2004) conducted a qualitative study into the experiences of members of the Church of Latter-Days Saints who had experienced conversion therapy. Many of the participants reported some positive aspects of conversion therapy. They cited increased hope from therapy, relief at being able to express their same-sex attractions, a sense of belonging in group therapy, and a favorable change in same-sex relations. Participants no longer found homosexual ideation itself to be aversive. Even some of the participants for whom conversion therapy failed completely reported that this outcome served to solidify their identity as a homosexual and make them more secure. Participants also reported feeling false hopes when conversion did not work as well or as quickly as it had been advertised to. Lower self-esteem, emotional stress, feelings of being duplicitous and untrue to oneself, depression, and suicidal ideation were reported. Families of participants were also disappointed when therapies did not deliver the promised results. Participants who ‘failed' conversion therapy internalized this failure, blaming themselves for failing rather than the therapy (Beckstead & Morrow, 2004). Of 42 individuals in the sample, 8 had attempted suicide after therapy. Twenty reported seriously contemplating attempting suicide during therapy. Only 3 had attempted suicide before therapy. Additionally, many of the participants knew of other homosexuals in the same religious group who has attempted or completed suicide.

So, what does everyone think? To me it seems clear that the practice of sexual orientation change therapy violates the ethical principles of the practice of psychology. Clients have a right to self-determination, but does that extend to therapies which seem to be necessary only because their culture condemns them? It also seems to me that organizations providing this therapy aren't being responsible in providing real data about the efficacy (and thus not really obtaining informed consent).

Fun topic! Research, practice, ethics, and politics all rolled into one!

Ollie (and others!), you might find this article interesting:

http://www-rcf.usc.edu/~gdaviso/Lib.../1976 Homosexuality the Ethical Challenge.pdf

This is written by G. C. Davison, a psychologist who used to perform sexual orientation change therapy at the request of his clients until he had a change in his thinking about the issue. The article is very short (just over 5 pages) and is a very interesting read, especially considering its age. It addresses some of the issues you mentioned, Ollie, as well as other important ones.

RayneeDeigh said:

Hey smartypants, can I steal this whole idea as a basis for my vignette that I have to present for Ethics in a couple weeks? I'll give you credit for it, haha.

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Of course you can. I steal your ideas all the time.

RayneeDeigh said:

I have a pretty simple philosophy about life and it's... let people do whatever the heck they want as long as they're not hurting themselves or others. I don't care if people are having sex with men, women, or telephones, I don't see why anyone has the right to "reassign" sexual orientation... and you'd think mental health professionals would all agree since it's in line with "respect for the dignity of all persons".

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The ethical difficulties arise when you get something like a situation in which religious identity conflicts with sexuality. Even though big dumb atheists like me like to poo-poo religion, you can't really say that religious identity is any less legitimate than sexual identity. For many people, giving up religious identity is far more frightening an idea than giving up sex. And, if you think along the lines that I do and believe that nearly everyone has, or has a capacity for, some degree of sexual attraction to both sexes, is it unethical for a therapist to work with a client to develop that slim attraction into something workable? I think Davison is right (read that article!) that the faults lie not in the therapy, the therapist, or the client, but in the society that forces the faulty rules.

KillerDiller said:

I find it odd that Spitzer, who was chair of the DSM III task force, fought to get homosexuality stricken from the DSM in the 70s and then placed so much faith in conversion therapy later. To me, those views seem to be at least partially in opposition to each other. Should psychology really throw its support behind treatment for something that the field doesn't recognize as needing treatment?

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Spitzer's a little wacky. So, he was for getting homosexuality out of the DSM, but ALSO for retention of ego-dystonic homosexuality. For those not in the know, ego-dystonic homosexuality basically means "the client has a problem with being gay." This, as Davison and others mention, is impossible to extract from "society tells the client to have a problem with being gay." So, his research isn't really inconsistent with his position that being gay can be pathological.

He defends his research quite strongly, though, which is odd considering its probably the single worst methodology I've ever seen in published work, along with one really terrible paper I once read about human pheromones. It's really pretty terrible science. If anyone ever wants to use a published paper in a research methods course to let undergrads play "find the flaws," the Spitzer study is pretty good. In interviews done after the fact, he does lament organizations like NARTH using the data to try to justify sexual reorientation therapy, but that doesn't change the fact that his original paper contains conclusions that are not even CLOSE to being justified by the data he got.

The Spitzer study also had some interesting background stuff going on, especially in regards to its publication. Anyone looking into going into sexuality research can ask some researchers who've been around for a while about the while story behind the paper

PsyKardinal said:

1. We are still not sure how much of sexual orientation is biologically or environmentally determined. Back to the very 1st lecture we all had in Psych 101, Nature vs. Nurture. We all know that it is a combination and there are so many factors that are involved in the make up of an individual.

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This is a really interesting point for two reasons. First, sexuality is a bit of a different topic when you talk about nature vs nurture, because societies have very different rules about the expression of sexuality than they do for almost anything else. Wherever you look to place the origin of sexual orientation--the third interstitial nucleus of the anterior hypothalamus, region q28 on the X chromosome, or an absent father (all of which are among the many suggested origins)--you'll be wrong, ultimately. When we look at cultures that not only tolerated but encouraged homosexuality, we can reason pretty easily that the prev rate of whatever is being hypothesized to cause homosexuality probably wasn't through the roof for some magical reason in that society.

Second, what you seem to be alluding to and I what might suggest anyone reading this thread to try to look at in another way, would be the viewing of sexuality as a bipolar concept. So, something is "causing" homosexuality by pushing the individual away from heterosexuality, and vice versa. If sexuality in conceptualized differently--as a combination of two entirely different things (other-sex and same-sex attraction), this at least to me makes far more sense both intrinsically and in terms of research.

PsyKardinal said:

2. More purely from a practice point of view. What about the efficacy of treatment modalities that are not aversive. How well could CBT or Psychodynamic work in providing conversion? Particularly if you run across a case of truly ego dystonic hetrosexuality/homosexuality?

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Most of the modern religious groups use what can be called behaviourist methods to try to change sexual orientation (thought-stopping, conditioned aversive thoughts, rewards in group, etc.), and many of the therapists (J. Nicolosi being probably the most famous among them) adopt a quasi-psychodynamic orientation to the therapy. So, most of the people in the Backstead and Morrow article and the Shindlo and Schroeder article weren't shocked or nauseated. The efficacy is very low--Spitzer spent 3 years looking across the country for 200 people who called themselves "success stories." I think people can be trained to focus and utilize some existing splinter of other-sex attraction if it exists already, if they really desired to, but that attraction can't be implanted if it doesn't exist.

A mother once wrote to Freud to ask him to perform a sexual orientation change on her son. His reply was that it probably wouldn't work, for the same reason I just said, and that it was unnecessary anyway.

I'm glad you read the Davison article. I'm really happy that this thread is getting attention.

Kinsey scales are an improvement on dichotomous categorization, but it's interesting how they're used in research. I've seen work that loops all Kinsey 2-6 together (so, even people predominantly heterosexual!). The problem I have with the Kinsey grid is its linearity. Although Kinsey graphed it in two dimensions, it's implemented as a unidimensional scale in which the orientations trade off each other--being somewhat attracted to the same sex requires "giving up" some attraction to the opposite sex. This really doesn't seem to jive with the really good research on sexuality, or some of the research with which I am intimately acquainted (). Better measurement of sexuality involves assessing attraction to either sex separately, on a scale that can sum over 100% across sexes.

Suicide is a good point. Anyone on here who does a lot of work in that area can contradict me or back me up, since my knowledge of the area is only as it intersects with sexuality, but my understanding was that among teen suicides, the number of teens who were LGBT is very very high--I've read up to 20%--and that's only for teens who were known to be LGBT or mentioned that in a note (this 20% number comes from training material I have that I can't find right now. I'll try to find a ref for it).

PsyK,

Efficacy is discussed in this article

Tozer, E. E., & McClanahan, M. K. (1999). Treating the purple menace: Ethical considerations of conversion therapy and affirmative alternatives. The Counseling Psychologist, 27, 722-742.

The paper briefly reviews some of the efficacy findings and then lists why they're not accurate. It does have a few citations of work you might find interesting. If you're interested in psychodynamic then I'd suggest you skim Nicolosi's book which is called (I think) Treating Homosexuality.

The trouble with efficacy rates is that the religious organizations conducting the therapy don't keep track (wonder why? ) and simultaneously make grandiose claims (I think Exodus International has claimed "hundred of thousands" of converts...). The organizations also don't really seem to provide much in the way of detail about the therapy, though my recollection of Nicolosi's book is that he lists both his psychodynamic-inspired theory of the etiology of homosexuality and lists some of the behavioural techniques used in group as well. NARTH's web site probably has efficacy data too, although I wouldn't believe it.

Toby, those are interesting points. The line between "dysfunction" and "variance on normality" is at best fuzzy and at worst entirely a social construct that means nothing at all. My opinion on that is usually why I stay out of all those fun-looking threads on diagnosis and treatment It certainly applies to the history of homosexuality in psychology.

About evolution... you can find a lot of really neat stuff on homosexuality and evolution, actually. I'm friends with a biologist who used to teach a course with a major component dealing with homosexuality in animals and particularly in higher-ability animals (large cats, dolphins and whales, primates, some others). The seminal work in this area is probably Biological Exuberance by Bruce Bagemihl. My friend had some interesting examples of the evolutionary advantage of homosexuality. One of his examples was lion packs, in which some males routinely engaged in receptive anal intercourse with the alpha male. While this was going on, all the subalpha males took the opportunity to mate with the females in the pack, preventing inbreeding. Not that I endorse biological models of sexuality per se, but still interesting.