CHANGE OF SEXUAL ORIENTATION
REVIEW OF THE LITERATURE
Is it possible for therapy to produce a change in sexual orientation? Is such therapy ethical?
C.A. Tripp in a 1971 debate with Lawrence Hatterer insisted that “there is not a single recorded instance of a change in homosexual orientation which has been validated by outside judges or testing.” Tripp claimed to have treated him because they do not want to disappoint their previous therapist. The full text of the debate reveals Tripp was offered clinical evidence of change by Hatterer. Hatterer’s book published in 1970 contains extensive case material drawn from tape recorded sessions and follow-up information.
Warren Throckmorton, who has reviewed the literature, sums up the evidence:
“Narrowly, the question to be addressed is: Do conversion therapy techniques work to change unwanted sexual arousal? I submit that the case against conversion therapy requires opponents to demonstrate that no clients have benefited from such procedures or that any benefits are too costly in some objective way to be pursued even if they work. The available evidence supports the observation of many counselors — which many individuals with same-gender sexual orientation have been able to change through a variety of counseling approaches.”
This report contains numerous reports of change of orientation and this list is by no means exhaustive. The material is sufficient to demonstrate that change is possible and that many forms of therapy — including some that are no longer used — have produced change. Some therapists appear to be more successful than others. The reports of change are well documented, backed up by case histories, extensive follow-up, and autobiographical material.
The surveys and analyses of collected data provide evidence that approximately 30% of those who enter therapy and persist can expect to experience a change of orientation. Even taking the extreme position that change applies only to an individual who was in behavior, attraction, and fantasy exclusively homosexual for a significant period of adult life and became exclusively and permanently heterosexual in behavior, attraction, and fantasy, it is clear that such persons do exist. The prognosis is more positive for those who had heterosexual experiences. Given the make-up of the human brain and the power of habit, occasional homosexual attraction experienced in times of stress for a number years after the cessation of homosexual behavior should not be surprising. Ex-Gay ministries counsel members that full freedom may take years.
Behavior modification techniques for eliminating homosexual behavior and attraction have largely been abandoned; nonetheless the numerous reports of their use from 1946 to 1976 points to the desire of homosexual men to rid themselves of unwanted thoughts and behaviors. These men appear willing to try anything. The fact that some succeeded may be attributed to their desire for change, their willingness to seek help, the effect of revealing to the therapist of the nature of the problem, and the confidence of the therapist that change is possible. In some cases, it may be that a man, who believed that he was incapable of being excited by women, was surprised to discover that his body was capable of heterosexual arousal and that this helped to overcome a phobia-rooted homosexuality.
It is also worthy of note that a number of studies contain reports on clients who entered therapy seeking help for other problems for whom the change of sexual orientation was an unexpected outcome. There is also evidence that change occurs spontaneously.
References to autobiographical accounts of religiously medicated change have been included in this report. While this type of change has not received extensive scientific study, many of those claiming religiously mediated change have testified publicly and their claims can be documented.
None of these studies claim that every person who seeks change will succeed. Given the reported failure rates, one would expect to find a large group of homosexuals who were dissatisfied with therapy. These could be the source of Tripp’s anecdotal evidence.
CRITICS OF CHANGE
The critics of therapy claim that studies report only changes of behavior and that the underlying “orientation” or sexual attractions remain untouched. This is simply untrue. Many of the therapists query clients about homosexual attractions and fantasy. And many therapists do not consider a person fully “changed” unless the attractions and fantasies were also exclusively heterosexual.
The opponents of change have criticized the studies which claim to document change on the grounds that the rely on the testimony of therapists. However in 1998, when a large group men and women who were once homosexuality attracted or active publicly announced that they are “ex-gay,” their testimony was derisively dismissed. Homosexual activists pressured networks to refuse to air commercials containing “exgay” testimonies. The “exgays” were accused of never being really homosexual or of “suppressing” their gayness. The intensity of the reaction against ex-gays suggests that those who “accept” their homosexuality feel threatened by the possibility of change.
Section 8 of this report contains quotes from writers who oppose therapy for change. A number of these writers admit that change is possible, but condemn therapy even when the client wants change because the availability of therapy oppresses homosexuals who don’t want to change. According to Begelman (1977), who condemns therapy for change as unethical:
“Administering these programs means reinforcing the social belief system about homosexuality. The meaning of the act of providing reorientation services is yet another element in a causal nexus of oppression.”
Therapists who view homosexuality as a normal variety of sexual orientation insist that there is no “excess” psychopathology among homosexuals and then discuss at length the psychological problems associated with “internalized homophobia,” a condition, which, according to them, effects most homosexuals. Those who normalize homosexual orientation, usually also normalize sexual promiscuity and extreme sexual practices since homosexuals routinely engage in these behaviors. There is the overwhelming evidence that during early childhood homosexual men had negative relationships with their fathers and that their mothers who did not support their masculine identity development. This forces homosexual activists, like Gerald Davison(1982), to argue such childhood experiences don’t cause with excess pathology because they are part of the histories of homosexuals and homosexuality is normal. By this reasoning Davison dismisses the accumulated research of developmental psychologists and the pain of the children.
RELIGION AND THERAPY
If therapy for change is declared unethical or illegal, persons whose religion opposes all sexual activity outside traditional marriage would be denied their right to receive therapy consistent with their faith. It is interesting to note that a number of those who oppose therapy to change sexual orientation, support therapists who try to change their clients’ religious beliefs. This includes encouraging therapists to tell their clients that Christian teaching permits homosexual activity. James Nelson, a professor of Christian Ethics at United Theological Seminary of the Twin Cities MN, is among those who supports telling clients that Christianity doesn’t consider homosexual sexual activity, including non-monogamous activity, sinful.
It appears inconsistent for a society which supports a client’s right to controversial therapies, such as sex change operations, extensive plastic surgery, and reproductive technologies, to deny clients who desire a change of sexual orientation access to therapies known to be effective.
Currently individuals seeking change are forced to contact a shrinking pool of therapists willing to take on this work or to seek religiously mediated change through support group membership. Those who are not interested in adopting a religious world view may feel uncomfortable in a religiously based ex-gay ministry. For example, Homosexuals Anonymous adopts some of the traditions of AA, but combines these with an explicitly Christian world view. Alan Medinger, an exgay and leader of the religion-based Regeneration Ministries, has expressed concern for non-Christian homosexuals seeking help. He is concerned that those who are not religious currently have no support groups available to them. On the other hand those who wish to be free from homosexual behavior for religious reasons feel abandoned by the mental health profession.
The public and homosexuals have a right to know that successful change is possible. Homosexuals, who desire treatment, have the right to the best treatment available.
This report contains information on and excerpts from articles, books, and studies on treatment for homosexuality — including those opposed to treatment. Not all the studies contain positive results. A wide variety of treatments and theoretical approaches are represented. Some of the authors have changed their point of view on treatment. The information on change has been arranged in the following manner.
1) Reviews of the literature on therapy and change – Some of these are written by therapists who include their own experience and case material.
2) Surveys and meta-analysis of studies – Most of the studies included in the meta-analysis are referenced individually. It should be noted that a number of studies appear in several meta-analyses.
3) Reports from therapists who treated homosexual clients with some form of individual psychotherapy. It should be noted that a number of theoretical approaches are employed. In some cases change of orientation was not the therapist’s or client’s goal. Extensive case histories and client/therapist exchanges are included in a number of the articles and books in this section.
4) Reports from therapists who treated homosexual clients with some form of group therapy. — Group therapy was sometimes combined with individual therapy or behavior modification. Some groups involve only homosexuals, in other cases homosexuals are included in heterogeneous groups.
5) Studies in which some form of behavior modification therapy was the primary treatment method — It should be noted that most of these therapies were short term, although some employed “booster sessions.” Most of the methods employed are considered by the pro-gay activists to be degrading and inhumane. Many psychotherapists consider these techniques to be superficial, leaving untouched the underlying problems. Those associated with ex-gay ministries find many of the methods and goals to be morally unacceptable.
6) Reports of religiously mediated change, including studies and autobiographical material — Celibacy and marriage are both viewed as acceptable outcomes.
7) Reports of spontaneous or adventitious change of sexual orientation. — Various studies of sexuality suggest that some persons engage in exclusive homosexuality during adolescents and early adulthood and then move on to exclusive heterosexuality. Change of orientation has occurred when no change was sought or expected.
8) Articles by persons who oppose therapy with the goal of change or believe that change is impossible — These articles focus on the psychological effects of therapy on those who fail to achieve their goal and on those who do not want such therapy.
9) Responses to critics of change
10) Recent articles on the subject
Within each grouping the sources are arranged alphabetically by author. Additional works by the same author are included since many of the authors discussed the same cases in a number of articles and books. It should be noted that each author has his own definition of improvement and/or change.
The subtitles in capital letters are provided to help the reader find information on specific topics. Material in quotations marks are quoted directed from the original source. Page numbers are in parentheses at the end of the quotation.
This is a work in progress. At this date, not all of the original articles have been found and reviewed and not all the bibliographic information is complete. The incomplete information has been included as a guide to those who may wish to do more research. Those articles or books which have been reviewed and are in the Irving Bieber Memorial Library East Coast are marked with @ in the bibliography.
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1) REVIEW OF LITERATURE
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Acosta, F. (1975) Etiology and treatment of homosexuality: A review. Archives of Sexual Behavior. 4,1: 9 – 27.
ABSTRACT: “The major causal theories of and treatment approaches to male and female homosexuality are critically reviewed. Neither biological, psychoanalytic, nor learning and social-learning theories are found to provide convincing evidence for the etiology of homosexuality. All of these accounts, however, are viewed as providing mixed empirical support for their predictions, with social-learning research presenting the most consistent evidence. It is argued that both social learning research findings and results from retrospective studies suggest that homosexuality may best be linked to the early qualitative learning and development of one’s gender identity and gender role. Both psychoanalytic therapy and the behavior therapy are found to have minimal successes and many failures. Most therapeutic success seem to be with bisexuals rather than exclusive homosexuals. The combined use of psychotherapy and specific behavioral techniques is seen to offer some promise for heterosexual adaptation with certain kinds of patients. However, it is argued that better prospects for intervention in homosexuality lie in its prevention through the early identification and treatment of the potential homosexual child.” (9)
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Barnhouse, R. (1977) Homosexuality: A Symbolic Confusion. NY: Seabury Press.
ADOLESCENCE: “The crucial fact is that, while homosexual behavior may be only experimental in adolescence, it can all too easily become a fixed pattern because of the great importance of learning, experience, and habituation in the development of human sexuality. Many men come for treatment who regret having made the homosexual choice at an age when they were too immature to understand its full implication.” (60)
CHANGE: “Approximately thirty percent of those coming to treatment for any reason can be converted to the heterosexual adaptation. Of course these figures cannot speak to the question of those persons whose homosexuality is relatively encapsulated in an other wise functional personality and who therefore are less likely to seek psychiatric help. Strong motivations do sometimes cause such people to request psychotherapy in order to change their sexual orientation. Their reasons may be religious or social and may even include having formed a sufficiently deep friendship with someone of the opposite sex so that marriage could be contemplated if they were only able to engage in sexual relations. In such instances the prognosis for a successful therapeutic outcome is extremely good. This conforms to the general principle that a very well motivated individual seeking help for an isolated symptom, whose personality is otherwise intact, is always among the best candidates for successful psychotherapy or psychoanalysis. These facts and statistics about cure are well known and not difficult to verify. In addition, there are many people to have experienced their homosexuality as a burden either for moral or social reasons who have, without the aid of psychotherapy, managed to give up this symptom; of these, a significant number have been able to make the transition to satisfying heterosexuality. Quite apart from published studies by those who have specialized in the treatment of sexual disorders, many psychiatrists and psychologists with a more general type of practice (and I include myself in this group) have been successful in helping homosexual patients to make a complete and permanent transition to heterosexual.”
ANTI-CHANGE: “The distortion of reality inherent in the denials by homosexual apologists that the condition is curable is so immense that one wonders what motivates it.” (109)
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Barnhouse, R. (1984) What is a Christian view of homosexuality? Circuit Rider, Feb. 12 -15.
ANTI-CHANGE: “The frequent claim by ‘gay’ activists that it is impossible for homosexuals to change their orientation is categorically untrue. Such a claim accuses scores of conscientious, responsible psychiatrists and psychologists of falsifying their data.”
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Berkowitz, B., Newman, M. (1971) How to be your own best friend. NY: Lark.
CHANGE: “We’ve found that a homosexual who really wants to change has a very good chance of doing so. Now we’re hearing all kinds of success stories.”
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Crawford, D. (1979) Modification of deviant sexual behavior: The need for a comprehensive approach. British Journal of Medical Psychology. 52:151 – 156.
ABSTRACT: “This paper gives four main lines of evidence to support the view that it is too simple to view sexual deviance as a problem of deviant arousal only. Firstly, clinical experience leaves the clear impression that sex offenders are not stable, well adjusted men with sexual arousal problems, but have difficulties in many areas of their lives. Secondly, research on human sexuality has resulted in a greater appreciation of the complexities of sexual behaviour. It is inconsistent to accept that “normal ” sexual behaviour is complex and varied but maintain that deviant sexual behavior is just an inappropriate penile response. Thirdly, treatment studies aimed at modifying homosexual behavior have found that changes in heterosexual measures are most important. This suggests that for sex offenders most attention should be paid to increasing non-deviant arousal and interests. Fourthly, studies of sex offenders have consistently reported that they experience of wide variety of problems. It is unrealistic to consider the problem of deviant sexual behaviour in isolation from these other problems.
“It follows that comprehensive treatment programmes will be necessary, covering such problems as sexual dysfunction, anxiety, deficient social skills, inadequate sexual knowledge, poor self-control, lack of non-deviant sexual arousal as well as the presence of deviant sexual arousal.”
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Fine, R. (1987) Psychoanalytic Theory (in Diamant L. (ed) Male and Female Homosexuality: Psychological Approaches. Washington: Hemisphere Publishing.) 81 – 95.
CHANGE: “Whether with hypnosis…, psychoanalysis of any variety, educative psychotherapy, behavior therapy, and/or simple educational procedures, a considerable percentage of overt homosexuals became heterosexual… If patients were motivated, whatever procedure is adopted a large percentage will give up their homosexuality… The misinformation that homosexuality is untreatable by psychotherapy does incalculable harm to thousands of men and women… All studies from Schrenk-Notzing on have found positive effects virtually regardless of the kind of treatment used.”
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Glover, B. (1953) Observations on homosexuality among university students. Journal of Nervous and Mental Disorders. 113: 377 – 387.
CHANGE: “… the lassitude and inertia of homosexuals greatly contribute to the poor psychotherapeutic results. They respond to the preliminary work of preparing them for their ecological change during the heat of remorse at being publicly exposed or legally punished, but the stigma of their pattern follows them in time, and their socialization is most difficult thing even in the relatively enlightened atmosphere of the university. Those who have sought help without public pressure also quickly deteriorate in strength and vigor of their efforts. In the course of the first year Glover found significant improvement in only 1 of his 12 patients.”
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Glover, E. (1960) The Roots of Crime: Selected Papers on Psychoanalysis. Vol.11. London: Imago Publishing.
CHANGE: “Psychotherapy appears to be unsuccessful in only a small number of (homosexual) patients of any age in whom a long habit is combined with psychopathic traits, heavy drinking or lack of desire to chance.”
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Harvey, J. (1987) The Homosexual Person: New Thinking in Pastoral Care. San Francisco: Ignatius Press.
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Harvey, J. (1996) The Truth about Homosexuality: The Cry of the Faithful. San Francisco: Ignatius.
REVIEW: Review of the literature on change, including authors who denied change was possible, secular therapists, and therapists who use secular insights in combination with Christian principles.
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Hinrichsen, J., Katahn, M. (1975) Recent trends and new developments in the treatment of homosexuality. Psychotherapy: Theory, Research and Practice. 12, 1.
REVIEW: Reviewing work of authors who supported replacement of homosexuality by heterosexuality. Methods of treatment discussed included: analytic psychotherapy, existential-transactional therapy, hypnotherapy, brain surgery, aversion procedures, desensitization, combined approaches, and group therapy.
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John J. (nd) Once Gay… Always Gay. Reading PA: Homosexual Anonymous.
QUOTATIONS: From: Barnhouse, Berkowitz, Bergler, Bieber, Bieber, T., Cappon, Caprio, Ellis, Feldman, Fine, Freeman, Freud, Fried, Hadden, Hadfield, Hatterer, Janov, Karpman, Kaye, Keefe, Kinsey, Kronemeyer, Marmor, Masters, Mayerson, Mintz, Pattison, Siegel, Socarides, Stekel, van den Aardweg, Williams, Willis, Wilson
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Lowenstein, L., Lowenstein, K. (1984) Homosexuality — A review of research between 1978 – 1983. Projective Psychology. 29, 2: 21 – 24.
REVIEW: A listing of the wide variety of literature on the treatment of homosexuality — very little detail.
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Marmor, J. (1965) Introduction (in Marmor, J. Sexual Inversion: The Multiple Roots of Homosexuality. NY: Basic) 1 – 26.
CHANGE: “The clinicians represented in this volume present convincing evidence that homosexuality is a potentially reversible condition. There is little doubt that much of the recent success in the treatment of homosexuals stems from the growing recognition among psychoanalysts that homosexuality is a disorder of adaptation.” (21)
“It is to be hoped that the following chapters may contribute to better understanding of some of the complex factors that enter into the development of patterns of homosexual behavior and so enable us ultimately to institute more effective means of prevention than now exist.” (22)
THEORY: “We are probably dealing with a condition that is not only multiply determined by psychodynamic, sociocultural, biological, and situational factors but also reflects the significance of subtle temporal, qualitative, and quantitative variables. For a homosexual adaptation to occur, in our time and culture, these factors must combine to (1) create an impaired gender identity, (2) create a fear of intimate contact with members of the opposite sex, and (3) provide opportunities for sexual release with members of the same sex.”
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Marmor, J. (1975) Homosexuality and sexual orientation disturbances. (in Freedman et al (ed) Comprehensive Textbook of Psychiatry II Baltimore: Williams and Wilkins) 1519.
ANTI-CHANGE: “The conviction of untreatability also serves an ego-defensive purpose for many homosexuals.”
CHANGE: “As the understanding of the adaptive nature of most homosexual behavior has become more widespread, however, there has evolved a greater therapeutic optimism about the possibilities for change, and progressively more hopeful results are being reported. There is little doubt that a genuine shift in preferential sex object choice can and does take place in somewhere between 20 and 50 percent of patients with homosexual behavior who seek psychotherapy with this end in mind. the single most important prerequisite to reversibility is a powerful motivation to achieve such a change.”
“The myth that homosexuality is untreatable still has wide currency among the public at large and among homosexuals themselves. This view is often linked to the assumption that homosexuality is constitutionally or genetically determined. This conviction of untreability also serves an ego-defensive purpose for many homosexuals. As the understanding of the adaptive nature of most homosexual behavior has become more widespread, however, there has evolved a greater therapeutic optimism about the possibilities for change, and progressively more hopeful results are being reported… There is little doubt that a genuine shift in preferential sex object choice can and does take place in somewhere between 20 and 50 per cent of patients with homosexual behavior who seek psychotherapy with this end in mind.”
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Rekers, G. (1988) The formation of homosexual orientation. (In Fagan, P.(ed.) Hope for Homosexuality. Washington DC: Free Congress Foundation.)
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THEORETICAL INTEGRATION OF THE DATA: “The review by Acosta (1975) argued that the best intervention for homosexuality lies in its prevention “through the early identification and treatment of the potential homosexual child.” Davenport (1972) offers a similar analysis. Since 1970, I have published 50 academic articles and book chapters on my research on the assessment and treatment of childhood gender identity and behavior disorders (Rekers 1975, 1976, 1977a, 1977b, 1977c, 1977d)… With major research grants from the National Institute of Mental Health, I have experimentally demonstrated an affective treatment for “gender identity disorder of childhood” which appears to hold potential for preventing homosexual orientation in males, if applied extensively in the population.”
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Rogers, C., Roback, H., McKee, E., Calhoun, D. (1976) Group psychotherapy with homosexuals: A review. International Journal of Group Psychotherapy. 31,3 : 3 – 27.
CHANGE: “In general, reports on the group treatment of homosexuals are optimistic; in almost all cases the therapists report a favorable outcome of therapy whether the therapeutic goal was one of achieving a change in sexual orientation or whether it was a reduction in concomitant problems.”
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Satinover, J. (1996) Homosexuality and the Politics of Truth. Grand Rapids MI: Baker.
CHANGE: “…in the eight years between 1966 and 1974 alone, just the Medline database — which excludes many psychotherapy journals — listed over a thousand articles on the treatment of homosexuality… These reports clearly contradict claims that change is flatly impossible. Indeed, it would be more accurate to say that all the existing evidence suggests strongly that homosexuality is quite changeable. Most psychotherapists will allow that in the treatment of any condition, a 30 percent rate may be anticipated.”
“I have been extraordinarily fortunate to have met many people who have emerged from the gay life. When I see the personal difficulties they have squarely faced, the sheer courage they have displayed not only in facing these difficulties but also in confronting a culture that uses every possible means to deny the validity of their values, goals, and experiences, I truly stand back in wonder… It is these people — former homosexuals and those who are still struggling, all across America and aboard — who stand for me as a model of everything good and possible in a world that takes the human heart, and the God of that heart, seriously. In my various explorations within the worlds of psychoanalysis, psychotherapy, and psychiatry, I have simply never before seen such profound healing.”
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Socarides, C. (19** ) A survey of treatment results. Understanding Homosexuality. Encino CA: NARTH.
CHANGE: “An unpublished and informal report of the Central Fact-gathering Committee of the American Psychoanalytic Association (1956) was one of the first surveys to compile results of treatment. I showed that of 56 cases of homosexuality undergoing psychoanalytic therapy by members of the Association, they describe 8 in the completed group (which totaled 32) as cured; 13 as improved, and 1 as unimproved. This constitutes one third of all cases reported. Of the group which did not complete treatment (total of 34), they described 16 as improved, 10 as unimproved, 3 as untreatable, and 5 as transferred. In all reported cures, follow-up communications indicated assumption of full heterosexual role and functioning.”
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Throckmorton, W. (1996) Efforts to modify sexual orientation: A review of outcome literature and ethical issues. Journal of Mental Health and Counseling. 20, 4: 283 -305.
REVIEW: A review of the literature and the debate over treatment, discussion of sexual orientation, and religious issues.
THERAPY: “Neither gay-affirmative nor conversion therapy should be assumed to be the preferred approach.”
RELIGION: “Therapists should inform clients of different opinions and “suggest clients choose consistent with their values, personal convictions and/or religious beliefs. Since religion is one of the client attributes that mental health counselors are ethically bound to respect, counselors should take great care in advising those clients dissatisfied with same-gender sexual orientation due to their religious beliefs.”
ANTI-CHANGE: “Broadly, opponents of shifting sexual orientation as a therapeutic goal express doubts that sexual orientation can be changed by any means. From the gay affirming perspective, Martin (1984) and Haldeman (1994) review studies that claimed to demonstrate change in sexual orientation. Their view is that there were no empirical studies that supported the idea that conversion therapy can change sexual orientation. However, they omitted a number of significant reports and failed to examine the outcomes of many studies that have demonstrated change.
CHANGE: “Narrowly, the question to be addressed is: Do conversion therapy techniques work to change unwanted sexual arousal? I submit that the case against conversion therapy requires opponents to demonstrate that no clients have benefited from such procedures or that any benefits are too costly in some objective way to be pursued even if they work. The available evidence supports the observation of many counselors — that many individuals with same-gender sexual orientation have been able to change through a variety of counseling approaches.”
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Welsh, A. (1994) On the origins and treatment of homosexuality: Change is possible. Social Justice Review. 39 -40.
REVIEW: Short article reviewing key studies.
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West, D. (1977) Homosexuality re-examined. London: Duckworth.
CHANGE: “Although some militant homosexuals find such claims improbably and unpalatable, authenticated accounts have been published of apparently exclusive and long-standing homosexuals unexpectedly changing their orientation.”
CASE: Man exclusively homosexual for 8 years became heterosexual; Man homosexual became heterosexual when his mother stopped trying to dominate him.
RESULTS: West summarizes the results of studies: behavioral techniques have the best documented success (never less than 30%); psychoanalysis claims a great deal of success (the average rate seemed to be about 25%, but 50% of the bisexuals achieved exclusive heterosexuality.)
CHANGE: “Every study ever performed on conversion from homosexual to heterosexual orientation has produced some successes.”
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2) SURVEYS AND META-ANALYSIS
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Bieber, I. et al. (1962) Homosexuality: A Psychoanalytic Study of Male Homosexuals. NY: Basic Books.
METHOD: Reports from psychoanalysts who treated homosexual men, compared with a control group of heterosexual men in therapy.
SUBJECTS: 106 homosexual men. 100 heterosexual controls. All patients in psychoanalysis
RESULTS: 35 changed (peer reviewed with 5 year follow)
CHANGE: “The therapeutic results of our study provide reason for an optimistic outlook. Many homosexual became exclusively heterosexual in psychoanalytic treatment. 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.”
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Canton-Dutari, A. (1976) Combined intervention for controlling unwanted homosexual behavior: An Extended Follow-up. Archives of Sexual Behavior. 5, 4: 269 – 274.
RESULTS: Of 49 patients… 31 (63 percent) were contracted for follow-up. The average period since the end of treatment was 4 years. 19 subjects (61 percent) have remained exclusively heterosexual, whereas 9 (29 percent) have had homosexual intercourse. Heterosexual intercourse was reported in 28 including the previous 9 subjects. Three (10 percent) subjects have had neither homo nor heterosexual intercourse.
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Clippinger, J. (1974) Homosexuality can be cured. Corrective and Social Psychiatry and Journal of Behavior Technology Methods and Therapy. 21, 2: 15 – 28.
REVIEW: Hadfield, Bieber, Socarides, Bergler, associates of Bergler, Mayerson, Hatterer, Cappon, Hadden, Birk, Feldman, Cautela.
SUBJECTS: In 12 studies of therapy the percentage changed was included. For ten of the studies the number of patients was also included – the total was 785 patients treated.
METHODS: A number of different therapy methods were used.
RESULTS: “Of 785 patients treated, 307 – or approximately 38% — were cured. Adding the percentage figures of the two other studies, we can say that at least 40% of the homosexuals were cured, and an additional 10 to 30% of the homosexuals were improved, depending on the particular study for which statistics were available.”
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Goetze, R. (1997) Homosexuality and the Possibility of Change: A Review of 17 Published Studies. Toronto Canada: New Directions for Life.
METHOD: A carefully designed meta-analysis of 17 studies. The author focused on the studies where it could be determined that the clients were exclusively or predominantly homosexual and results could be determined, and did not use studies without data or poorly defined categories. Carefully sought to determine Kinsey rating before and after therapy and follow-up information.
REVIEW: Bieber, Birk, Freeman, Hadden, Hadfield, Hatterer, Kaye, MacIntosh, Masters, Mayerson, Mintz, Pattison, Poe, Socarides, van den Aardweg, Wallace, Wolpe.
RESULTS: 69 persons who were exclusively or predominantly homosexual acquired heterosexual behavior
283 persons who were exclusively or predominantly homosexual experienced a partial shift in sexual orientation
A total of 44 persons who were exclusively or predominantly homosexual experienced a full shift of sexual orientation.
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Goetze, R. (1996) A developmental view of homosexuality. Toronto: New Direction for Life.
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James, E. (1978) Treatment of Homosexuality: A Reanalysis and Synthesis of Outcome Studies. Dissertation presented to the Dept. of Psychology, BrighamYoungU.
REVIEW: 101 studies from 1930 to 1976. Studies involved behavior modification and psychotherapy. One or more articles with the following primary authors are included. Alexander, Bancroft, Barlow, Berg, Beaukenkamp, Bieber, Birk, Blitch, Braaten, Callahan, Cautela, Coates, Colson, Conrad, Curran, Curtis, Deutsch, DiScipio, Eliasberg, Ellis, Feldman, Fookes, Freeman, Freund, Gordon, Gray, Hadden, Hadfield, Hallam, Hanson, Hatterer, Herman, Huff, Ince, Jacobi, James, Kaye, Kendrick, Kraft, Lamberd, Levin, London, LoPiccolo, Mandel, Matetzky, Marquis, Mastellone, Mayerson, McConaghy, McCrady, Mintz, Moan, Monroe, Myerson, Ovesey, Pittman, Poe Quinn, Regardie, Rehm, Roper, Ross, Rutner, Salter, Sandford, Schmidt, Segal, Shealy, Skene, Smith, Socarides, Solyon, Stekel, Stevenson, Tanner, Thompson, Thorpe, Truax, Turner, van den Aardweg, Wallace, Woodward,
METHODS: Different forms of therapy
RESULTS: For combined studies: 37% of clients not improved; 27% improved; 35% recovered. Bisexuals, females, and clients participating in long-term therapy achieved great gains with respect to sexual reorientation.
“… slight, inconsistent indications that behavioral techniques (especially when a combination of procedures was used) were associated with more favorable outcome than traditional verbal psychotherapies.”
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Kaye, H., Beri, S., Clare, J., Eleston, M., Gershwin, B., Gershwin, P., Kogan, L., Torda, C., Wilber, C. (1967) Homosexuality in Women. Archives of General Psychiatry. 17: 626 – 634.
SUBJECTS: 24 female homosexual patients and 24 female nonhomosexual patients in therapy.
METHOD: An effort to replicate the Bieber study with homosexual women. Solicited case material on homosexual women in treatment from therapists.
REASON FOR THERAPY: “The primary reasons for our H[omosexual] group entering analysis were depression and anxiety. Only seven stated that they wanted their homosexuality cured, while ten definitely did not want their homosexuality cured; two were undecided. We had no answer to this question in five questionnaires.”
RESULTS: “… the 15 cases in the homosexual range were reduced to eight at the end of therapy, approximating a 50% shift toward the heterosexual end of the spectrum. Furthermore, of the nine patients who were exclusively homosexual at the beginning of their analyses, only four were still exclusively homosexual either at the termination of treatment or at the time during their treatment when their analysts filled out their questionnaire.”
CHANGE: “… this indicates a substantial positive treatment potential which should not be lost sight of in evaluating the treatability of female homosexuals who present themselves for therapy. Apparently at least 50% of them can be significantly helped by psychoanalytic treatment.”
“Finally, we have indications for therapeutic optimism in the psychoanalytic treatment of homosexual women. We find, roughly, at least a 50% probability of significant improvement in women with this syndrome who present themselves for treatment and remain in it.”
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MacIntosh, H. (1994) Attitudes and experiences of psychoanalysts. Journal of the American Psychoanalytic Association. 42, 4 : 1183 -1207.
METHOD: Survey of 285 psychoanalysts reported having analyzed 1,215 homosexual patients, resulting in 23% changing to heterosexuality and 84% receiving significant therapeutic benefit.
RESULTS: Asked analysts if homosexuals can change – 29.1% rarely or never, 68.5% sometimes or frequently.
Male Patients – 824 clients of 213 analysts; 197 (23.9%) changed to heterosexuality, 703 received significant therapeutic benefit
Female Patients – 391 clients of 153 analysts; 79 (20.2%) changed to heterosexuality; 318 received significant therapeutic benefit.
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Nicolosi, J., Byrd, A., Potts, R. (1998) Towards the Ethical and Effective Treatment of Homosexuality. Encino CA: NARTH.
METHOD: Survey of 850 individuals and 200 therapists and counselors — specifically seeking out individuals who claim to have made a degree of change in sexual orientation.
RESULTS. Before counseling or therapy, 68% of respondents perceived themselves as exclusively or almost entirely homosexuality, with another 22% stating they were more homosexual than heterosexual. After treatment only 13% perceived themselves as exclusively or almost entire homosexuality, while 33% described themselves as either exclusively or almost entirely heterosexual. 99% of respondents said they now believe treatment to change homosexuality can be effective and valuable.
3) PATIENTS TREATED BY PSYCHOTHERAPY
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Berg, C., Allen, C. (1958) The problem of homosexuality. NY: Citadel Press.
SUBJECTS: 13 males, 1 females.
METHOD: Psychoanalytically oriented therapy
RESULTS: 11 (10 males, 1 female) apparent cures, 1 social cure, 1 failure
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Berger, J. (1994) The psychotherapeutic treatment of male homosexuality. American Journal of Psychotherapy. 48, 2: 251 – 261.
ABSTRACT: “In recent years very few psychodynamic contributions to the aetiology or treatment of male homosexual behavior have been made. This paper based on material from patients, and noting the contributions of others, indicates that such patients can be understood and treated successfully.”
“A possible aetiological factor that has not been mentioned before in the literature, the abortion of a pregnancy conceived by the male patient may have led to the patient ‘coming out’ or declaring his homosexuality, is discussed.”
“Three main conclusions are reached. First that human sexuality is not rigidly compartmentalized into either hetero- or homosexuality but varies on a continuous spectrum, and is affected in any individual by psychodynamic influences. Second, that before ‘coming out,’ young people should have the opportunity to explore their sexual identity with a psychodynamically oriented psychotherapist. Third, that some patients whose fantasies and behavior have been homosexual at some time, can become comfortably and fulfillingly heterosexual with psychotherapeutic treatment.”
SUBJECTS: 3 homosexual men.
ABORTION: Abortion triggers homosexual behavior in two patients. Turning away from women did not totally relieve anxiety and other symptoms emerged.
CASE: 1 male turned to homosexuality after his baby was aborted. After therapy he experienced pleasurably heterosexual relations with occasional homosexual fantasies; 1 male, narcissistic personality, after abortion exclusively homosexual, left therapy and remained homosexual; 1 male, before therapy homosexual fantasies and encounters, after therapy, married, heterosexually fulfilling, 3 children, fears acting on occasional fleeting homosexual fantasies, but has not acted out in 20 years.
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Bergler, E. (1962) Homosexuality: Disease or Way of Life. NY: Collier Books.
DEFINITION OF CHANGE: “And ‘cure’ denotes not bisexuality, but real and unfaked heterosexuality.”
THEORY: Homosexuals are severe, psychic, masochists who unconsciously reject love, admiration, approval and kindness, and posses wishes for exact opposite — pain, humiliation, reject, and conflict.
SUBJECTS: 250 homosexuals seen for treatment, 150 sent to colleagues.
RESULTS: 112 cases successful treated, 50 successes by colleagues.
Many of those not changed did not complete treatment.
CHANGE: “In nearly thirty years, I have successfully concluded analyses of one hundred homosexuals… and have seen nearly five hundred cases in consultation. On the basis of the experience thus gathered, I make the positive statement that homosexuality has an excellent prognosis in psychiatric-psychoanalytic treatment of one to two years’ duration, with a minimum of three appointments each week — provided the patient really wishes to change. A considerable number of colleagues have achieved similar success. ”
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Bergler, E. (1961) Counterfeit Sex. NY. Grove Press
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Bergler, E. (1959) One Thousand Homosexuals. Patterson, NJ: Pagent.
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Beukenkamp, C. (1960) Phantom Patricide. Archives of General Psychiatry. 3: 282 – 288.
SUBJECT: 1 male, sought treatment following arrest for soliciting in a public washroom.
METHOD: Psychoanalytic analysis, plus group therapy.
RESULTS: Recovered, married
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Bieber, I., Dain, H., Dince, P., Drellich, M. Grand, H., Gundlach, R., Kremer, M., Rifkin, A., Wilbur, C., Bieber, T. (1962) Homosexuality: A Psychoanalytical Study. NY: Vintage.
SUBJECTS: 106 homosexual men, 100 controls, all in psychoanalysis.
CASE
METHOD: Psychoanalysis with male and female therapists, reports from the therapists. Careful analysis of each case: childhood experiences systematically compared with results of therapy.
RESULTS: 29 patients had become exclusively heterosexual during the course of psychoanalytic treatment. Of those who were exclusively homosexual before treatment 19% became exclusively heterosexual, 19% bisexual. Of those who were bisexual before treatment 50% became exclusively heterosexual.(276)
DISORDER: “The capacity to adapt homosexually is, in a sense a tribute to man’s biosocial resources in the face of thwarted heterosexual goal-achievement. Sexual gratification is not renounced; instead, fears and inhibitions associated with heterosexuality are circumvented and sexual responsivity with pleasure and excitement to a member of the same sex develops as a pathologic alternative.”(303)
“Any adaptation which is basically an accommodation to unrealistic fear is necessarily pathologic; in the adult homosexual continued fear of heterosexuality is inappropriate to his current reality. We differ with other investigators who have taken the position that homosexuality is a kind of variant of ‘normal’ sexual behavior.”
FATHER: “We have come to the conclusion that a constructive, supportive, warmly related father precludes the possibility of a homosexual son; he acts as a neutralizing protective agent should the mother make seductive or close binding attempts.”(311)
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Bieber, I. (1965) Clinical aspects of male homosexuality (in Marmor, J. (ed.) Sexual Inversion: The Multiple Roots of Homosexuality. NY: Basic Books.) 248 – 267.
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Bieber, I. (1967) Homosexuality. (in Freeman, A., Kaplan, H. (eds) Comprehensive Textbook of Psychiatry. Baltimore: Williams and Wilkins.) 963 – 976.
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Bieber, I. (1977) Sexuality: 1956 -1976. Journal of the American Academy of Psychoanalysis. 5, 2: 195 – 205.
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Bieber, I., Bieber, T. (1979) Male Homosexuality. Canadian Journal of Psychiatry. 24, 5: 409 – 421.
CHANGE: “We have followed some patients for as long as 20 years who have remained exclusively heterosexual. Reversal estimates now range from 30% to an optimistic 50%”.
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Bieber, T. (1967) On treating male homosexuals. Archives of General Psychiatry. 16, 68.
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Braaten, L., Darling, C. (1965) Overt and covert homosexual problems among male college students. Genetic Psychology Monographs. 71:269 – 310.
SUBJECT: 76 male (42 overt homosexuals, 32 covert) 50 male controls
METHOD: Psychotherapy
RESULTS: 12 (29%) of overt homosexuals moving toward heterosexuality, 7 (21%) of the covert.
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Caprio F. (1954) Female Homosexuality: A Psychodynamic Study of Lesbianism. NY: Citadel Press.
CASE HISTORIES: Review of early literature and treatment.
THEORY: “Lesbianism is a symptom not a disease entity. It is the result of a deep-seated neurosis which involves narcissistic gratifications and sexual immaturity. It also represents a neurotic defense mechanism for feelings of insecurity — a compromise solution for unresolved conflicts involving one’s relationship during childhood and adolescence to one’s parents.”
THERAPY: ” Lesbians can be cured if they are earnest in their desire to be cured. Adequate self-knowledge via psychoanalysis is essential to effect a permanent cure. Psychoanalysis and psychotherapy constitute today the most effective means of treating sexual inversions. Since lesbianism is a symptom of a personality disorder, it may be reiterated that treatment must be aimed at influencing the personality structure rather than the treatment of homosexuality as though it were a disease entity.”
RESULTS: “Many patients of mine, who were formerly lesbians, have communicated long after treatment was terminated, informing me that they are happily married and are convinced that they will never return to a homosexual way of life.”
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Coates, S. (1962) Homosexuality and the Rorschach test. The British Journal of Medical Psychology. 35: 177 – 190.
SUBJECTS: 33 males
METHOD: Psychoanalytically orientated
RESULTS: 5 (15%) better, 5(15%) not having any sexual activity
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Curran, D., Parr, D. (1957) Homosexuality: An analysis of 100 male cases seen in private practice. British Medical Journal. 12: 797 – 801.
SUBJECTS: 100 males with homosexuality as the presenting problem
METHOD: 23 psychotherapy, 11 in patient care, 66 simple counseling
RESULTS: 24 homosexuals diagnosed 100% homosexual no chance of change – 1 changed; 14 predominantly homosexual – 2 changed; 14 reasonable hope of change – 6 changed.
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Deutsch, H. (1932) On female homosexuality. The Psychoanalytic Quarterly. 1:484 – 510.
SUBJECT: 1 female, not homosexually active
METHOD: Psychotherapy
RESULTS: Became homosexual active
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Eidelberg, L. (1956) Analysis of a case of a male homosexual. (in S. Lorand, Balint, M. (eds.) Perversions, Psychodynamics, and Therapy. NY: Gramercy) 279 – 289.
SUBJECT: 1 male
METHOD: Psychotherapy
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Ellis, A. (1955a) On the cure of homosexuality. International Journal of Sexology. 5: 135 – 138.
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Ellis A. (1955b) Are homosexuals necessarily neurotic. One. 3, 4: 8 – 12.
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Ellis, A. (1956) The effectiveness of psychotherapy with individuals who have severe homosexual problems. Journal of Consulting Psychology. 20, 3: 191 -195.
SUBJECTS: 40 patients presenting with homosexual behavior; 28 were moderately or distinctly emotional disturbed, 12 were severely emotionally disturbed.
METHOD: Psychotherapy, treated for their homosexual problem or neurosis rather than for their homosexual desire or activity per se.
RESULTS: Of the 20 patients who came to therapy with a serious desire to overcome homosexual problems, all made some improvement and 16 made considerable improvement in their sex-love relations with members of the other sex.”
Of the 20 male and female patients who entered therapy with little or moderate desire to over being homosexual problems (but who came, instead, mainly to work on other problems or to relieve their guilt over being homosexual), 10 (50%) achieved some improvement, and 3 (15%) achieved considerable improvement.
DISORDER: “… women who do become lesbians will tend to be more emotionally disturbed, on the whole than male homosexuals… it should be noted that 29 per cent of the males and 67 per cent of the females studied were found to be very severely emotionally disturbed – a quite high percentage in both instances.”
CHANGE: “… it is felt that there are some grounds for believing that the majority of homosexuals who are seriously concerned about their condition and willing to work to improve it may, in the course of active psychoanalytically-oriented psychotherapy, be distinctly helped to achieve a more satisfactory heterosexual orientation.”
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Ellis, A (1959) A homosexual treated with rational therapy. Journal of Clinical Psychology. 15: 338 – 343.
SUBJECT: 1 male – The client had no prior heterosexual experience and had a great fear of rejection.
GOAL: Ellis made no attempt to rid the client of homosexual feelings but rather wrote that the goal of therapy was to help the client overcome his irrational blocks against heterosexuality.
METHOD: Rational-Emotive Behavior Therapy (REBT) This is a report of one of the first clients treated with a special therapeutic approach which the therapist developed after many years of practicing orthodox psychoanalysis and psychoanalytically orientated psychotherapy.
RESULTS: By the 12th week of rational psychotherapy, the client “had changed from a hundred per cent fixed homosexual to virtually a hundred per cent heterosexual.
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Ellis, A. (1965) Homosexuality: Its causes and cures. NY: Lyle Stuart
CHANGE: “I have treated in my private practice in New York City, scores of homosexual patients during the last 10 years, and I have found that the rational therapeutic approach is much more effective … than was my previous psychoanalytic approach to therapy.”
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Ellis, A. (1968) Sexual manifestation of emotionally disturbed behavior. Annals of the American Academy of Political and Social Science. 100, 376
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Ellis, A. (1992) Are gays and lesbians emotionally disturbed? The Humanist. Sept. Oct. :33 – 45
DISORDER: Ellis no longer believes that same-gender sexual orientation is a sign of inherent emotional disturbance – people are free to “try a particular sexual pathway such as homosexuality for a time and then decide to practically abandon it for another mode, such as heterosexuality.”
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Etchegoyen, R. (1978) Some thoughts on transference perversion. International Journal of Psycho-Analysis. 59: 45 – 53.
SUBJECT: 1 female
METHOD: Psychoanalysis for 10 years
RESULTS: Change of orientation
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Freud, A. (1951a) Clinical observations on the treatment of manifest male homosexuality. Psychoanalytic Quarterly. 20: 337.
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Freud, A. (1951b) Some clinical remarks concerning the treatment of male homosexuality. the International Journal of Psychoanalysis. 30: 195.
CHANGE: Reported that many of her patients lost their inversion as a result of analysis, and this happened even in those who proclaimed their wish to remain homosexual when entering treatment.
SUBJECTS: 8 males
METHOD: Psychoanalysis
RESULTS: 50% success rate
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Fried, E. (1960) The Ego in Love and Sexuality. NY: Grune & Stratton.
THEORY: “The high degree of narcissistic isolation with which many homosexual persons are burdened makes them unable to tolerate dissimilarities in other people. They have not managed to acquire the ability to perceive and enjoy in others… physical attributes and personal qualities that differ from their own.”
METHOD: “If attention is directed primarily to the emotional and mental problems of the homosexual and homosexuality is regarded as a symptom that will disappear after the personality has been put on a sounder basis, it impossible to achieve a good percentage of cures.”
CHANGE: “Practicing homosexuals can be helped to achieve a normal and indeed passionate love relation with the other sex. They can be helped to build satisfactory marriage relationships and to start a family. This has occurred both with several patients whom I have treated and with those of other therapists.”
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Fry, C., Rostow, E. (1942) Mental Health in College. London: Oxford U. Press.
SUBJECTS: 16 established homosexuals students pressured by Yale U. to consult therapist.
METHOD: Psychotherapy
RESULTS “Psychiatric contact with such patients were not at all satisfactory.”
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Gordon, A. (1930) The history of a homosexual: His difficulties and triumphs. Medical Journal and Record. 130: 152 – 156.
SUBJECTS: 1 male
METHOD: Psychoanalytically oriented therapy
RESULTS: Follow up at two years. Complete change, happily married.
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Gutheil, E. (1939) The Language of the Dream. NY: Macmillan.
CHANGE: Dr. Emil Gutheil, practicing psychoanalyst and editor of the American Journal of Psychotherapy. “There have been cures; all experienced psychiatrists have them. These cures should be better known to give hope to people.”
DISORDER: “In every single case a neurotic structure can be discovered. Therapy seeks to lower the anxiety and to remove the unnecessary defenses against the opposite sex. In the treatment do not ask why the homosexual is so, but what stops him from being heterosexual. If you find out, you release the heterosexual element.”
CHANGE: “Many patients of mine, who were formerly lesbians, have communicated long after treatment was terminated… informing me that they are happily marred and are convinced that they will never return to a homosexual way of life.”
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Hadfield, J. (1958) The cure of homosexuality. British Medical Journal. 1:1323 – 1326.
SUBJECTS: 13 cases
METHOD: Dynamic psychotherapy
RESULTS: Eight complete changes (some followed up over 30 years – 1 lost homosexual tendencies, 1 married with children, 1 no homosexual desires); 1 case cessation of behavior but not fantasy; 4 no change (3 failure due to lack of persistence, 1 failure even though persistent.)
DEFINITION OF CHANGE: “By cure I do not mean… that the homosexual is merely able to control his propensity … Nor .. do I mean that the patient is rendered capable of having sexual relations and bearing children; for … he might do this by the help of homosexual fantasies. By ‘cure’ I mean that he loses his propensity to his own sex has his sexual interests directed towards those of the opposite sex, so that he becomes in all respects a sexually normal person.”
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Hatterer, L. (1970) Changing homosexuality in the Male. NY: McGraw-Hill Book Co.
SUBJECTS: “Over the past 17 years I have evaluated 710 males troubled and untroubled by a vast spectrum of homosexual fantasy, impulse act and milieu. Since 1953 I have successfully and unsuccessfully treated well over 200 of them.” Study of 143 men, 3 still in treatment.
RESULTS: 49 patients changed (20 married, of these 10 remained married, 2 divorced, 18 achieved heterosexual adjustments); 18 partially recovered, remained single; 76 remained homosexual (28 palliated – 58 unchanged).
CHANGE: “A large undisclosed population has melted into heterosexual society, persons who behaved homosexually in late adolescence and early adulthood, and who, on their own, resolved their conflicts and abandoned such behavior to go on to successful marriages or to bisexual patterns of adaptation.” =======================================
Jacobi, J. (1969) A case of homosexuality Journal of Analytical Psychology. 14: 48 – 64.
SUBJECT: 1 male
RESULTS: Felt like new man, heterosexual attraction increasing
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Janov, A.(1970) The Primal Scream. NY: Dell.
CASES
METHOD: Primal therapy
THEORY: “It is the primal hypothesis that when needs are deprived and feelings are blocked early in life, they emerge in symbolic form. In sex this means that the act will be experienced (usually via the fantasy) as fulfilling the need”
THEORY: “I think that it is essential for us to see sexually deviate behavior as part of a total neurosis and not as some special, bizarre act disconnected from what the person is as a whole. But I do not think that it requires a specialist in homosexuality to treat him, any more than it requires a specialist to treat any other flight from Pain. The treatment of homosexuality does not mean producing either masculine or feminine behavior. It means, to me, producing real behavior.”
“The homosexual act is not a sexual one. It is based on the denial of real sexuality and the acting out symbolically through sex of a need for love… The homosexual has usually eroticized his need so that he appears to be highly sexed. Bereft of his sexual fix, his lover, he is like an addict without his connection… I have found that homosexual habits that have persisted for years have faded away in the face of reality.”
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Kronemeyer, R. (1980) Overcoming Homosexuality. NY: Macmillan.
CASES
METHOD: Syntonic therapy
THEORY: “From my 25 years’ experience as a clinical psychologist, I firmly believe that homosexuality is a learned response to early painful experiences and that it can be unlearned, For those homosexuals who are unhappy with their life and find effective therapy it is ‘curable'”.
RESULTS: “About eighty percent of homosexual men and women in Syntonic Therapy have been able to free themselves and achieve a healthy and satisfying heterosexual adjustment. These individual were selected as follows: (1) They were not psychotic and had the ability to work and function as self-supporting people. (2) They were not psychopathic and had the ability to experience the emotions of fear and guilt and to be aware that they we re not fulfilling their human potential. (3) They came to therapy for themselves and not to please someone else. (4) They were able to direct their aggression therapeutically and were able to learn to work with themselves, between sessions, when in anxiety or panic states, rather than act out their problem homosexuality. 5) They were strongly enough motivated to go through the inevitable rough spots of change without quitting, staying till they resolved their problems.”
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Lamberd, W. (1969) Treatment of homosexuality as a monosymptomatic phobia. The American Journal of Psychiatry. 126: 512 – 518.
SUBJECTS: 3 males
METHOD: Psychological therapy
RESULTS: Complete change: 1 love affair and rejection, but no homosexual desire; 1 married satisfactory; 1 no homosexual impulses.
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Mayerson, P., Lief, H. (1965) Psychotherapy of Homosexuals: A follow-up study of nineteen cases. (in Marmor (ed) Sexual Inversion: The Multiple Roots of Homosexuality. NY: Basic Books) 302 – 344.
SUBJECTS: 19 homosexuals (14 males, 5 females). Follow-up study of patients who had been treated in Hutchinson Memorial Psychiatric Clinic of Tulane U. of Department of Psychiatry and Neurology..
METHOD: Psychotherapy
RESULTS: 47% heterosexual at follow-up. (57% of bisexuals, 22% of exclusively homosexual)
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Monroe, R., Enelow, M. (1960) The therapeutic motivation in male homosexuality. American Journal of Psychotherapy. 14, 474 – 490.
SUBJECTS: 7 males
METHOD: Psychotherapy
RESULTS: 3 married, 1 not sexually active, 3 outcome unknown
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Nicolosi, J.(1991) Reparative Therapy of Male Homosexuality. Northvale NJ: Aronson.
CASES
METHOD: Reparative therapy
FATHER: “…the primary cause of homosexuality is not the absence of a father figure, but the boy’s defensive detachment against male rejection. As long as the boy remains open to masculine influence, he will eventually encounter some father-figure who will fulfill his needs. Every male has a healthy need for intimacy with other males.”
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Ovesey, L. (1963) Psychotherapy of male homosexuality — Psychodynamic formulation.. Archives of General Psychiatry. Sept.
SUBJECTS: 3 males
METHOD: Psychoanalysis
RESULTS: Married, fully heterosexual.
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@ Ovesey, L, Gaylin, W. (1965) Psychotherapy of male homosexuality: Prognosis, selection of patients, technique. American Journal of Psychotherapy. 382 – 396.
GOALS: “Full potency in itself is not a final solution to a homosexual patient’s problem. It is too narrow a therapeutic goal. It is doubtful that heterosexuality once established can be sustained without the framework of a total relationship with a woman.
The approach looks upon homosexuality as a multidetermined symptom of a neurosis. Psychotherapy is then based on an understanding of the unconscious motivations that impel the patient to flee from women and to seek contact with men.”(395)
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Ovesey, L. (1954) The homosexual conflict: an adaptiational analysis. Psychiatry. 17: 243.
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Ovesey, L (1955) The pseudohomosexual anxiety. Psychiatry. 18: 17.
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Ovesey, L. (1955) Pseudohomosexuality, the paranoid mechanism, and paranoia.: An adaptational revision of a classical Freudian theory. Psychiatry. 18: 163.
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Ovesey L. (1969) Homosexuality and Pseudohomosexuality. NY: Science House.
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Ovesey, L., Woods, S. (1980) Pseudohomosexuality and homosexuality in men: Psychodynamics as a guide to treatment. (in Marmor (ed.) Homosexual Behavior: A Modern Reappraisal. NY: Basic Books) 325 -341.
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Poe, J. (1952) The successful treatment of a 40-year-old passive homosexuality based on an adaptational view of sexual behavior. Psychoanalytic Review. 39:23 – 33.
SUBJECT: 1 male
CHILDHOOD: Mother wanted him to be a girl. Father threatened to cut off penis if he masturbated.
METHOD: Psychodynamically directed therapy
RESULTS: Married, heterosexual fantasy
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Quinodoz, J. ( 1989) Female homosexual patients in psychoanalysis. International Journal of Psycho-Analysis. 70: 55 – 63.
SUBJECTS: 2 females
RESULTS: One left analysis and the other found her way back to a “better established female identity.”
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Regardie (1949) **
SUBJECTS: 1 male
METHOD: Psychotherapy and hypnosis
RESULTS: Satisfactory marriage with no homosexual fantasies.
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Richardson, D. (1987) Recent challenges to traditional assumptions about homosexuality: Some implications for practice. Journal of Homosexuality. 13: 1.
CHANGE: Individuals can change orientation from homosexual to heterosexual, or heterosexual to homosexual.
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Ross, M., Mendelson, F. (1958) Homosexuality in college. American Medical Association Archives of Neurological Psychiatry. 80: 253 – 263.
SUBJECTS: 15 overt male homosexuals, 5 overt female homosexuals college students
METHOD: Psychotherapy from 2 to 20 months
RESULTS: 4 considerable improvement, 10 mild improvement. These results were equal or better than the results for treatment by the same therapists for a matched group of students with nonhomosexual related problems.
CHANGE: “To our surprise, the initial signs of strong motivation for change were not ordinarily present in the homosexuals benefiting from therapy.” ===========================================
Siegle, E. (1988) Female Homosexuality: Choice without Volition – A Psycho analytic Study. Hilldale, NJ: Analytic Press.
SUBJECTS: 12 women patients self-identified as homosexual, with homosexual behavior, and fantasies.
GOALS: “As with any other patient, I did not set out to ‘cure’ them or to dissuade them from their lifestyle.”
METHOD: Reduction of conflicts reduction of anxiety through psychoanalysis
THEORY: “I came to understand their difficulties as developmental arrests that precluded heterosexual object choices… As conflicts were resolved and distanced from, anxiety was reduced and life became more joyful and productive for all these analysands… With the attainment of firmer inner structures, interpersonal relationships also solidified and became more permanent…
RESULTS: 50% heterosexual change. “Although I never interpreted homosexuality as an illness, more than half of the women become fully heterosexual. ”
ANTI-CHANGE: “The homosexual community and networks to which … my patients belonged reacted very much like the families of disturbed children when the child, as a result of treatment, is no longer forced to express conflict for them…. I was struck by their common need to idealize homosexuality as better than heterosexuality and by the volatility of their suffering…”
CHANGE: “To be a liberal and liberated women and yet to view homosexuality as the result of untoward development seemed at times a betrayal of all I then believed. But viewing my patients through the lens of psychoanalytic thinkers and clinicians soon showed me that allowing myself to be seduced into perceiving female homosexuality as a normal lifestyle would have cemented both my patients and myself into a rigid mode that precluded change of whatever nature.”
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Socarides, C. (1968) The Overt Homosexual. NY.: Grune & Stratton
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Socarides, C. (1974) Homosexuality. (in American Handbook of Psychiatry. Vol. 3. NY: Basic Books) 308.
METHOD: Psychoanalytic therapy
RESULTS: 50% changed
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Socarides, C. (1978) Homosexuality. NY: Aronson.
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Socarides C. (1979) The psychoanalytic theory of homosexuality: With special references to therapy. (in Rosen, I. (ed) Sexual Deviation. NY: Oxford U.P.) 243 – 277.
SUBJECTS: 45 over homosexuals treated between 1966 and 1977
METHODS: Psychoanalytic psychotherapy
RESULTS: 20 of 45 (44%) achieved “full heterosexual functioning.”
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Stekel, W. (1930) Is homosexuality curable? Psychoanalytic Review. 17: 443 – 450.
SUBJECT: 1 male
METHOD: Psychoanalysis
RESULTS: Married, absolutely overcome homosexual tendencies.
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van den Aardweg, G (1972) A grief theory of homosexuality . American Journal of Psychotherapy. 26: 52 -68.
SUBJECTS: 20 males
METHOD: Exaggeration therapy
RESULTS: 10/20 real cures at follow-up
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van den Aardweg, G. (1985) Homosexuality and Hope. Ann Arbor: Servant.
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van den Aardweg, G. (1986) On the Origins and Treatment of Homosexuality: A Psychoanalytic Reinterpretation. Westport, CT: Praeger.
SUBJECTS: 101 males
METHOD: Psychotherapy
RESULTS 65% improved
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van den Aardweg, G. (1997) The Battle for Normality: A Guide for (Self-) Therapy for Homosexuality. San Francisco: Ignatius
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Wallace, L. (1969) Psychotherapy of a male homosexual. Psychoanalytic Review. 56: 346 – 364.
SUBJECT: 1 male
METHOD: Psychotherapy
RESULTS: Happily married
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Williams, C. (1991) Forever a Father, Always a Son. Wheaton IL: Victor Books.
RESULTS: “…my clinical experience and that of my professional peers “We have had successes with homosexuals who are unhappy with their lifestyles and want to experience a heterosexual orientation.”
“In working with homosexuals, my experience is that they can make a shift in sexual orientation if they are interested and motivated.”
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Willis, S. (1967) Understanding and Counseling the Male Homosexuality. Boston: Little Brown.
THEORY: “As a ritualistic compulsion, homosexual behavior is basically no more or less refactory to treatment than any other compulsive ritual not involving homosexual behavior.”
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Woodward, M. (1958) The diagnosis and treatment of homosexual offenders: A clinical survey. British Journal of Delinquency. 9: 44 – 59.
SUBJECTS: 113 males (including 10 juveniles, 20 adult pedophiles)
METHOD: Psychotherapy (5 psychotherapy with hormones)
RESULTS: Of the 48 who completed therapy: 7 had no homosexual impulses and heterosexual interests and activities, 21 had no homosexual impulses.
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4) PATIENTS TREATED IN GROUP THERAPY
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Review of the literature on group therapy
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Rogers, C., Roback, H., McKee, E., Calhoun, D. (1976) Group psychotherapy with homosexuals: A review. Journal of Group Psychotherapy. 24, 1: 3 – 24.
REVIEW: Review of the literature on group therapy with homosexuals. Discussion of the advantages of all homosexual groups versus inclusion of homosexuals in other groups.
CHANGE: “In general, reports on the group treatment of homosexuals are optimistic, in almost all cases the therapists report a favorable outcome of therapy whether the therapeutic goal was one of achieving a change in sexual orientation or whether it was a reduction in concomitant problems.”
GROUP: “The major therapeutic advantages of the treatment of homosexuals in heterogeneous groups seem to be in providing a setting in which homosexuals may develop meaningful relationships with members of the opposite sex, in which models of appropriate sex-role behaviors are present, and in which the homosexual desiring to change will be given encouragement and support.”
“The major therapeutic advantages of the treatment of homosexuals in homogenous groups seem to be the power of the group in breaking down defensive rationalizations about homosexuality, in providing an exceptionally supportive and empathic group in which to deal with problems related to homosexuality, and in the case of groups oriented toward changing sexual preferences, providing a supportive and encouraging atmosphere for change, including the beneficial effect of seeing others make progress toward a heterosexual adjustment.”
A “… homosexual can be successfully treated in group psychotherapy whether the treatment orientation is one of a change in sexual pattern of adjustment, or whether a reduction in concomitant problems is the primary goal.”
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Case Studies
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Birk, L., Miller, B., Cohler, B. (1970) Group Psychotherapy for Homosexual Men. Acta Psychiatrica Scandinavia. 218: 1 – 33.
SUBJECTS: 30 patients
METHOD: Group therapy, individual counseling plus 1/3 had aversive conditioning. RESULTS: Four dropped out; 9 experienced heterosexual relations for first time. 3 married, 3 engaged (33% of 26 who remained in therapy)
CHANGE: Birk reports probably the highest success rates of any therapist. In a subgroup of 14 exclusively homosexual men who wanted to change 100% attained heterosexual adaptation. Of those 14 clients who achieved change – 10 were satisfactorily married at follow-up. Pretreatment motivation considered key. In a subgroup of clients not expressing any pretreatment interest in sexual orientation change 4 out of 15 (27%) reported a shift to heterosexual adaptation. .
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Birk, L. (1974) Group psychotherapy of men who are homosexual. Journal of Sex and Marital Therapy. 1: 29 – 52.
SUBJECTS: 26 males (includes 16 from 1971 study)
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Birk, L. (1980) (in J. Marmor (ed.) Homosexual Behavior: A Modern Reappraisal. NY: Basic Books. 376 – 390.
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Bromberg, W., Franklin, G. (1952) The treatment of sexual deviates with group psychodrama. Group Psychotherapy. 4: 274 – 279.
SUBJECTS: 75 male patients who had been committed for a variety of sexual offenses.
RESULTS: Open rift developed between homosexual and heterosexual patients. with homosexual patients verbally assaulting the heterosexuals, becoming exhibitionistic in terms of homosexual affectations.
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Buki, K. (1964a) A treatment program for homosexuals. Diseases of the Nervous System. 25: 304 -360.
SUBJECTS: 40 hospitalized male sexual offenders: among these seven had a diagnosis of homosexuality, four homosexuality-pedophilia, two homosexuality-exhibitionism, and two homosexuality-transvestitism.
METHOD: Chemotherapy (antidepressants and tranquilizers) coupled with group and industrial therapy.
RESULTS: 6 of the 15 homosexual patients were judged to be significantly improved, 4 showed promising results and 5 were unsatisfactory.
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Buki, K. (1964b) The use of psychotropic drugs in the rehabilitation of sex-deviated criminals. American Journal of Psychiatry. 120: 1170 – 1175.
SUBJECTS 36 male patients committed for a variety of homosexual offenses
METHOD: Medications and, in some cases group psychotherapy.
RESULTS: After 90 days of treatment, 13 patients were judged to show significant remission of homosexual behavior and impulses, and 12 were judged to have improved but required additional treatment.
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Cabeen, C., Coleman, J. (1962) The selection of sex offender patients for group psychotherapy. International Journal of Group Psychotherapy. 12: 326 -334.
SUBJECTS: 120 male sexual offenders committed to a state mental hospital of whom 40 were considered to be homosexual (i.e., had been committed for a sexual offense with a male subject, usually a child.
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Cappon, D. (1965) Toward an Understanding of Homosexuality. Englewood Cliffs. NJ: Prentice Hall.
SUBJECTS: “…a distillation of diagnosing and treating some 200 homosexual patients among a population of 2,000 psychiatric patients who happened to come for therapy.”
METHOD: Individual and group therapy.
RESULTS: “Bisexual problems: 90 per cent cured (i.e., no reversions to homosexual behavior, no consciousness of homosexual desire and fantasy) in males who terminated treatment by common consent. Male homosexual patients: 80 per cent showed marked improvement (i.e., occasional relapses, release of aggression, increasingly dominant heterosexuality)… 50 per cent changed.” females 30% changed.
DEFINITION OF CHANGE: “loss of all symptoms, cure of main problem and change in sleep dream forms and content.”
CHANGE: “In the experience of the author, reorientation occurs at least as frequently in homosexual persons as in people afflicted by any other disorder”
“When all is said and done, the therapeutic attitude is nothing if it is not utterly optimistic.”
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Covi, I. (1972) A group psychotherapy approach to the treatment of neurotic symptoms in male and female patients of homosexual preference. Psychotherapy & Psychosomatic. 20:176 – 180.
SUBJECTS: 30 homosexual patients (8 female, 22 male);10 classified as anxiety neurosis, 5 borderline schizoid personality, 3 sociopaths; 8 males, 1 female expressed desire to change sexual orientation (7 of these were under some form of legal pressure.)
GROUP: Main benefits of the group therapy is supplying group pressure to prevent therapeutic dropouts, in distributing dependence on the group and aiding the therapist in his understanding of the “gay” subculture.
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Eliasberg, W. (1954) Group treatment of homosexuals on probation. Group Psychotherapy. 7: 218 -226.
SUBJECTS: 12 male homosexuals on probation for a “homosexual offense” one diagnosed as schizophrenic.
METHOD: 2 six member therapy groups,
RESULTS. 1 discontinued all homosexuality and got married.
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Finney, J. (1960) Homosexuality treated by combined therapy. Journal of Social Therapy. 6: 27 – 34.
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Fort, J., Steiner, C., Conrad, C. (1971) Attitudes of mental health professionals toward homosexuality and its treatment. Psychological reporters. 29: 347 – 350.
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Fried, E. (1955) Combined group and individual therapy and passive-narcissistic patients. International Journal of Group Psychotherapy. 5: 194 – 203.
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Hadden, S. (1957) Attitudes toward and approaches to the problem of homosexuality. Pennsylvania Medical Journal . 60: 1195 – 1198.
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Hadden, S. (1958) Treatment of homosexuality by individual and group psychotherapy. American Journal of Psychiatry. March. 810 – 815.
SUBJECTS: 3 homosexuals
METHOD: Group therapy
RELAPSE: “The homosexual drive may be remarkably diminished, or even absent, and patients may be adjusting to an heterosexual pattern but final “commitment” is difficult. This means giving up friends who have accepted them in their homosexuality. … More than once I have felt that some of my patients have reached this stage in individual treatment and have discontinued because they could not make the final commitment. In the group the members are supported in this final phase. ”
GROUP: “From my experience I have concluded that homosexuals can be treated more effectively by group psychotherapy when they are started in groups made up exclusively of homosexuals. In such groups the rationalization that homosexuality is a pattern of life they wish to follow is destroyed by their fellow homosexuals. (814)
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Hadden, S. (1966a) Treatment of male homosexuals in groups. International Journal of Group Psychotherapy. 17, 1:13 – 22.
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Hadden, S. (1966b) Group psychotherapy of male homosexuals. Current Psychiatric Therapies. 6: 177 – 186.
CHANGE: “While there is little doubt that the homosexual is difficult to treat and is prone to break off treatment… if psychotherapists themselves come to adopt a less pessimistic attitude and view homosexuality simply as a pattern of maladaptation, greater numbers of such patients will be significantly helped.”
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Hadden, S. (1966c) Male homosexuality: Observations on its psychogenesis and on its treatment of group psychotherapy. (in Proceedings of Third International Congress of Group Psychotherapy. NY: Philosophical Library.) 272 – 278.
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Hadden, S. (1967a) A way out for homosexuals. Harper’s Magazine. March. 107 – 120.
MOTHER: Harold’s mother frequently told the story of how when he was three he told a woman on the playground that he didn’t want to play with her son because he might spoil his clothes, he might get hurt and “other children play silly games.” In turn other members of group shared repressed anger over how their “adored” mothers never let them do what they wanted, but convinced them they wanted to do things mother’s way.
CHILDHOOD: “I am fully convinced that the delicate, effeminate physique of some homosexuals is not due to any constitutional of glandular difference but results from the fact that they have been deprived of rough physical play in early childhood….
In my observation, homosexuals are deeply troubled people.”
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Hadden, S. (1967b) Male homosexuality. Pennsylvania Medicine. Feb.: 78 – 80.
THEORY: “In group treatment, the male homosexual finds acceptance by individuals who have found their homosexuality unacceptable and are seeking a heterosexual adjustment. Acceptance in such a group can motivate the individual to work toward a heterosexual adjustment. The banter, the teasing, and the blunt critical comments of the group serve as a verbalized equivalent of the scrambling kind of play so important in the preschool life of the child. Through these verbalized reassuring comments of the group, he is able to gain confidence to feel wanted, not as a sexual object, but as a friend at an adult masculine level. He begins to think of himself more as ‘all man’ and begins to expand his heterosexual integration…”
- We consider homosexuality to be an experientially determined patterns of maladaptation and as such it is amenable to treatment.
- Disturbed child-parent relationships and inter-parental conflict contribute to the development of various patterns of maladaptation.
- Lack of effective scrambling peer play relationships in the toddling and pre-school period is a most important factor in creating the loneliness and aloofness that predisposes to homosexuality.
- Effective rough and tumble peer play relationships may compensate for defective child-parent and inter parental relationships.
- Homosexuality can be altered by individual treatment but group psychotherapy is a superior method.
- As our knowledge of etiologic factors increases, prevention can be anticipated.
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Hadden, S. (1968) Group psychotherapy for sexual maladjustments. American Journal of Psychiatry. 125: 85 – 88.
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Hadden, S. (1969) Rehabilitation of sexual delinquents with special references to the homosexually oriented. Pennsylvania Medicine. 72;49 -51.
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Hadden, S. (1971) Group therapy for homosexuals. Medical Aspects of Human Sexuality 5: 116 – 127.
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Konietzko, K. (1971) (in Karlen, A. Sexuality and Homosexuality. NY: W.W. Norton)
CHANGE: Dr. Kurt Konietzko is a Philadelphia psychologists with wide experience in individual and group psychotherapy. He was originally a Rogerian, but many years’ work with delinquents, addicts and criminals made him turn to an active directive approach.
“I usually have four to sex homosexuals in therapy. I give individual and group treatment, with one or two homosexuals in each group. First we work on their anxieties and nonsexual problem. Then on sex.”
ANTI-CHANGE: “The vast majority come in saying, “Just adjust me to my homosexuality.” And that’s what you have to do with the greater number of them. But change is possible, and one of the problems is their resistance to that fact. The existence of one cured homosexual changes the nature of the condition in homosexuals’ eyes. It challenges them. So they try to deny it.” (569)
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Litman, R. (1961) Psychotherapy of a homosexual man in a heterosexual group. International Journal of Group Psychological Therapy. 11:440 – 448.
SUBJECT: 1 male, 27 year old, seeking treatment to become a better adjusted homosexual
METHOD: Group therapy with heterosexuals — three men and four women.
RESULTS: Behavior became non-homosexual, masculine identification increased as a result of support from female members of the group.
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Mintz, E. (1966) Overt male homosexuals in combined group and individual treatment. Journal of Consulting Psychology. 30, 3 : 193 – 198.
ABSTRACT: “Of 10 homosexual men who voluntarily entered treatment and remained in combined therapy (CT) for 2 or more years, all report improved general adjustment. 3 report satisfactory heterosexual adjustment, 3 hope to achieve it eventually. advantages of CT for such patients include: Dissolution of rationalizations about homosexuality; development of a stronger sense of personal identity through contact with women and with heterosexual men; emergence of hitherto unconscious anxieties related to their heterosexual drives; and corrective emotional experiences, often resulting in enhanced self-esteem.”
SUBJECTS: 15 males
METHOD: Combination of individual and mixed group therapy.
RESULTS: 5 terminated treatment (2 accepted themselves as homosexual); 5 completed therapy (2 are enjoying heterosexuality, 1 still in conflict); 5 still in treatment (1 lost interest in homosexuality, 1 does not intend to change homosexual adjustment, 3 appear to be moving toward heterosexuality).
MOTHER: “One young man shared with his devoted mother the secret fiction that he was a special person, so delicate and gifted that for him the heterosexual way of life was inappropriate. Mother and son used his homosexuality to maintain their intense mutual dependency. When the group assailed his claim that homosexuality was somehow precious and superior, the patient’s tie to his mother began to weaken, and he developed a growing interest in girls.”
GROUP: “Homosexuals frequently associate almost exclusively with other homosexuals. Many have never had any more than a superficial relationship with any women or heterosexual men. In the group they develop these non-sexual relationships.”
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Mintz, E. (1965) Male-female co-therapists. American Journal of Psychotherapy. 19: 293 -301.
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Moore, K., Query, W. (1963) Group psychotherapy as a means of approaching homosexual behavior among hospitalized psychiatric patients. Journal of Kentucky State Medical Association. 61 : 403 – 407.
SUBJECTS: Patients identified by hospital staff as having engaged in homosexual behavior on the ward were recruited for a therapy group. All members of the therapy group carried a diagnosis of schizophrenic reaction of predominantly paranoid and hebephrenic features of long duration.
GOAL: Reduce homosexual behavior on ward.
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Munzer, J. (1965) The treatment of the homosexual in group psychotherapy. Topical Problems in Psychotherapy. 5: 164 – 169.
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Nobler, H. (1972) Group therapy with male homosexuals. Comprehensive Group Studies. 3: 161 – 178.
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Pittman, F., De Young, C. (1971) The treatment of homosexuals in heterogeneous groups. The International Journal of Group Psychotherapy. 21: 62 -73.
SUBJECTS: 4 males, 2 females
METHOD: Heterogeneous group therapy
RESULTS 1 male happy marriage and baby; 3 males improved; 1 female dropped out; 1 female became heterosexual
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Powdermaker, F., Frank, J. (1953) Group Psychotherapy. Cambridge: Harvard U.P.
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Shealy, (1972)
SUBJECTS: 1 male
METHOD: Rational emotive psychotherapy
RESULTS: Overt homosexuality eliminated, homosexual images decreased
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Skene, R. (1973) Construct shift in the treatment of a case of homosexuality. The British Journal of Medical Psychology. 46: 287 -292
SUBJECT: 1 male
METHOD: Fixed role therapy
RESULTS: Improved
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Smith, A., Basin, A. (1959) Overt male homosexuals in combined group and individual treatment. Journal of Social Therapy. 5: 225 – 232.
SUBJECTS: 2 males
METHOD: Group therapy
RESULTS: 1 marked improvement; 1 seeking adjustment to homosexuality.
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Singer, M., Fischer, R. (1967) Group psychotherapy of male homosexuals by a male and female co-therapy team. International Journal of Group Psychotherapy. 17: 44 – 52.
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Stone, W., Schengber, J., Seifried, F. (1966) The treatment of a homosexual woman in a mixed group. International Journal of Group Psychotherapy. 16: 425 – 433. ===================================
Truax, R., Moeller, W., Tourney, G. (1970) The medical approach to male homosexuality. Journal of the Iowa Medical Society. 60: 397 – 403.
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Truax, R., Tourney, G. (1971) Male homosexuals in group psychotherapy: A controlled study. Diseases of the Nervous System. 32: 707 – 711.
SUBJECTS: 25 males, 20 waiting list controls
METHOD: 6 sub groups
RESULTS: Follow-up interviews 1 to 3 years – 5 discontinued treatment (2 improved); 14 terminated at the end of 7 months (6 improved); 5 continued group (5 improved); 6 continued individual therapy (5 improved).
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Whitman, R., Stock, D. (1958) The group focal conflict. Psychiatry. 21: 269 – 276. ============================
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5) BEHAVIOR MODIFICATION AND CONDITIONING
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Alexander, L. (1967) Psychotherapy of sexual deviation with the aids of hypnosis. American Journal of Clinical Hypnosis. 9:181 – 183.
SUBJECT: 1 male, married
METHOD: Clinical hypnosis and psychotherapy
RESULTS: Free from homosexual desires, no longer regarded as homosexual by other homosexuals, closer to wife, better sexual relations, disappearance of effeminate mannerisms.
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Bancroft, J., Marks, I. (1968) Electric aversion therapy of sexual deviations. Proceedings Royal Society of Medicine. 61:796 -799
SUBJECTS: 19 males including 3 pedophiles
METHOD: Treated with aversive instrumental conditioning with shock.
RESULTS: 13/18 (72%) are changed or somewhat changed; at one year follow-up 1/10 much improved, 4/10 improved
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Bancroft, J. (1970) A comparative study of aversion and desensitization in the treatment of homosexuality (in Burns, L. & Worsley, J. Behavior Therapy in 1970’s: A Collection of Original Papers. Bristol, England: John Wright & Sons.) 12 – 33.
SUBJECTS: 23 males
METHOD: 11 treated by systematic desensitization, 12 treated by aversive instrumental conditioning with shock.
RESULTS: 3 men much improved, 7 improved, considered as changes in sexual orientation and behavior that are likely to continue. (Aversion — 1 much improved, 4 improved; Desensitization — 2 much improved, 3 improved)
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Barlow, D., Leitenberg, H., Agras, W. (1969) Experimental control of sexual deviation through manipulation of the noxious scene in covert sensitization. Journal of Abnormal Psychology. 74: 597 – 601.
SUBJECT: 1 male, married
METHOD: Covert sensitization
RESULTS: Increased heterosexual behavior and fantasies
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Barlow, D. (1972a) Review of M.P. Feldman & M. J. MacCulloch “Homosexual behavior: therapy and assessment.” Behavior Therapy. 3: 479 – 481.
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Barlow, D., Agras, W., Leitenberg, H., Callahan, E., Moore, R. (1972b) The contribution of therapeutic instruction to covert sensitization. Behavior Research and Therapy. 10: 411 – 415.
SUBJECTS: 4 males
METHOD: Covert sensitization
RESULTS: Changes in penile arousal
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Barlow, D., Agras, W. (1973a) Fading to increase heterosexual responsiveness in homosexuals. Journal of Applied Behavior Analysis. 6: 355 -366.
SUBJECTS: 3 males
METHOD: Aversion therapy and psychotherapy
RESULTS: 1 – asexual; 1 considering marriage; 1 heterosexual behavior, no homosexual.
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Barlow, D. (1973b) Increasing heterosexual responsiveness in the treatment of sexual deviation: A review of the clinical and experimental evidence. Behavior Therapy. 4: 655 – 671.
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Barlow, D. (1974) The treatment of sexual deviation: Toward a comprehensive behavior approach. (in Calhoun, K., Adams, H., Mitchell, K. (ed) Innovative Treatment Methods in Psychopathology. NY: John Wiley & Sons .
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Barlow, D., Agras, W., Abel, G., Blancard, E., Young, L. (1975) Biofeedback and reinforcement to increase heterosexual arousal in homosexuals. Behavior Research and Therapy. 13: 45 – 50.
SUBJECT: 1 male
METHOD: Positive instrumental conditioning with feedback
RESULTS: Continued homosexual behavior
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Bergin, A. (1969) A self regulation technique for impulse control disorders. Psychotherapy: Theory, Research and Practice. 6: 113 – 118.
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Blitch, J., Haynes, S. (1972) Multiple behavioral techniques in a case of female homosexuality. Journal of Behavior Therapy and Experimental Psychiatry. 3:319 – 322.
SUBJECT: 1 female
METHOD: Behavior rehearsal, role playing, systematic desensitization to heterosexuality, masturbatory conditioning
RESULTS: Heterosexual behavior and images.
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Callahan, E., Leitenberg, H. (1973) Aversion therapy for sexual deviation: Contingent shock and covert sensitization. Journal of Abnormal Psychology 81: 60 -73
SUBJECTS: 2 males (1 married)
METHOD: Covert sensitization and counseling, aversive instrumental conditioning with shock.
RESULTS: Married subject – sexual and non-sexual aspects of marriage improved; other subject had a subsequent homosexual contact but felt no excitement, dating women.
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Cautela, J. (1967) Covert sensitization. Psychological Reports. 20: 459 – 469
SUBJECTS: 2 males
METHODS: Covert sensitization in vivo
RESULTS: No homosexual behavior.
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Cautela, J., Wisocki, P. (1969) The use of male and female therapists in the treatment of homosexual behavior (in Rubin, R., Franks, C. Advances in behavior therapy. NY: Academic Press.) 165 – 174.
SUBJECTS: 4 males
METHOD: Systematic desensitization in vivo, covert sensitization, assertiveness training
RESULTS: 1 married; 1 engaged; 2 dating.
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Cautela, J. (1970) Covert reinforcement.
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Cautela, J., Wisocki, P. (1971) Covert sensitization for the treatment of sexual deviation. Psychological Record. 21: 37 – 48.
SUBJECTS: 8 males
METHOD: Covert sensitization.
RESULTS: 3 changed (37%) year follow up.
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Colson, S. (1972) Olfactory aversion therapy for homosexual behavior. Journal of Behavior Therapy and Experimental Psychiatry. 3: 185 – 187.
SUBJECT: 1 male
METHOD: Aversive instrumental conditioning in vivo and marital counseling
RESULTS: Marriage improved substantially
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Conrad, S., Wincze, J. (1976) Orgasmic reconditioning: A controlled study of its effects upon the sexual arousal and behavior of adult male homosexuals. Behavior Therapy. 7: 155 -166.
SUBJECTS: 3 males
METHOD: Masturbatory conditioning
RESULTS: 1 no longer bothered by homosexual thoughts; 1 pleased by successful heterosexual relations; 1 heterosexual interests.
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Curtis, R., Presly, A. (1972) The extinction of homosexual behavior by covert sensitization: A case study. Behavior Research and Therapy 10:81 – 83.
SUBJECT: 1 male, married
METHOD: Covert sensitization in vivo, aversion relief conditioning
RESULTS: Complete abstinence of homosexuality in fantasy and reality, marriage improved
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DiScipio, W. (1968) Modified progressive desensitization and homosexuality. The British Journal of Medical Psychology. 41: 267 – 272.
SUBJECTS: 1 male hospitalized for manic depression
METHOD: Systematic desensitization to heterosexuality with photos and in vivo
RESULTS: Decided to live as a passive homosexual
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Feldman, S. (1956) On homosexuality (in Lorand, S., Balint, M. Perversions: Psychodynamics and Therapy. NY: Random House.) 71 – 96.
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Feldman, M., Mac Culloch, (1965) The application of anticipatory avoidance learning to the treatment of homosexuality. Behaviour Research & Therapy. 2: 165 – 183.
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Feldman, M., MacCulloch, M. (1971) Homosexual Behavior: Therapy and Assessment. Oxford: Pergamon Press.
SUBJECTS: 41 males, 7 females.
METHOD: Anticipatory avoidance conditioning, aversion relief conditioning therapy.
RESULTS: “Treatment… was successful in nearly 60% of the cases after a follow-up of at least a year.”
At follow-up 20 neither homosexual fantasy or practice; 4 still using homosexual fantasy
DEFINITION OF CHANGE: “Our criteria for accepting the occurrence of change were severe, and we have attempted to prove patients’ claims to be false rather than accepting them at face value. Failure to appear was rated as a failure.
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Fookes, B (1968) Some experiences in the use of aversion therapy in male homosexuality, exhibitionism and fetishism-transvestitism. The British Journal of Psychiatry. 115: 339 – 341.
SUBJECTS: 15 males
METHOD: Aversive classical conditioning with shock
RESULTS: 9 successes defined as unrefuted claim to have lost desire for homosexuality, supported claim to have enjoyed heterosexual coitus on more than 1 occasion. Average follow-up of successes 37.5 months.
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Freeman, W., Meyer, R. (1975) A behavioral alteration of sexual preferences in the human male. Behavior Therapy. 6: 206 – 212.
ABSTRACT: “Sexual behavior is analyzed as a complex social episode composed of alternating instrumental and respondent behaviors. The type of sexual consummatory behavior selected by an individual is mainly a function of the type of stimuli eliciting sexual arousal and penile erection. A therapy was designed to alter the arousal eliciting stimuli for nine male homosexuals by classical conditioning techniques.”
SUBJECTS: 9 males
METHOD: Aversive classical conditioning with shock
RESULTS: At 18 months follow-up, 7 continued exclusive heterosexual adjustment
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Freund, K. (1960) Some problems in the treatment of homosexuality (in Eysenck, H. Behavior Therapy and Neurosis. London: Pergamon Press) 312 – 326.
SUBJECTS: 67 males (20 were court referred cases)
METHOD: Aversive classic conditioning with drugs
RESULTS: 17 (26%) of the 47 non-court referred and 0% of the court-referred showed adaptation lasting several years. 7 (15%) of the non-court referred and 3% of the court-referred showed short term change in adaptation.
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Freund, K. (1971) A note on the use of phallometric method of measuring mild sexual arousal in the male. Behavior Therapy. 2: 223 -228.
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Greenspoon, J., Lamal, P. (1987) A behavioristic approach (in Diamant, L. (ed) Male and Female Homosexuality: Psychological Approaches. NY: Hemisphere) 109 – 127.
THEORY: ” …the effects of office-based conditioning programs can be undone by lack of reinforcement in heterosexual functioning. They stress the development of social skills necessary in heterosexual situations through role playing, homework, and supportive counseling.”
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Gray, J. (1970) Case conference: Behavior therapy in a patient with homosexual fantasies and heterosexual anxiety. Journal of Behavior Therapy and Experimental Psychiatry. 1: 225 – 232.
SUBJECT: 1 male
METHOD: Systematic desensitization
RESULTS: Partial recovery
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Hallam, R., Rachman, S. (1972) Some effects of aversion therapy on patients with sexual disorders. Behavior Research and Therapy. 10: 171 – 180.
SUBJECTS: 3 males
METHOD: Systematic desensitization
RESULTS: 1 improved; 2 remained homosexually active
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Hanson, R., Adesso, V. (1972) A multiple behavioral approach to male homosexual behavior: A case study. Journal of Behavior Therapy and Experimental Psychiatry. 3: 323 – 325
SUBJECTS: 1 male
METHOD: Systematic desensitization
RESULTS: At 6 months continued enjoying heterosexual activity, homosexual inclination negligible
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Herman, S., Barlow, D., Agras, W., (1974a) An experimental analysis of classical conditioning as a method of increasing heterosexual arousal in homosexuals. Behavior Therapy 5: 33 – 47.
SUBJECTS: 2 males
METHOD: Classic conditioning
RESULTS: 1 some change, 1 failure
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Herman S., Barlow, D., Agras, W., (1974b) An experimental analysis of exposure to “explicit heterosexual stimuli as an effective variable in changing arousal patterns of homosexuals. Behavior Research and Therapy. 12 : 335 – 345.
SUBJECTS: 3 males
METHOD: Exposure to heterosexual imagery
RESULTS: 1 failure; 1 married homosexual fantasies during masturbation; 1 no sexual activity, frequent homosexual urges
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Huff, F., (1970) The desensitization of a homosexual. Behavior Research and Therapy. 8: 99 – 102.
SUBJECTS: 1 male
METHOD: Systematic desensitization
RESULTS: At 6 month follow-up both homosexual and heterosexual behavior had increased.
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Ince, L. (1973) Behavior modification of sexual disorders. American Journal of Psychotherapy. 27: 446 – 451.
SUBJECTS: 1 male
METHOD: Covert sensitization
RESULTS: Felt sexually neutral
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James, B. (1962) A case of homosexuality treated by aversion therapy. British Medical Journal. 1:768 – 770
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James. B., Early, D. (1963) Aversion therapy for homosexuality. British Medical Journal. 1:538.
Follow up of previous articles
SUBJECTS: 1 male
METHOD: Aversive classical conditioning with shock
RESULTS: 18 month follow-up no recurrence of homosexual drives, some homosexual attraction.
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Kendrick, S., McCullough, J. (1972) Sequential phases of covert reinforcement and covert sensitization in the treatment of homosexuality. Journal of Behavior Therapy and Experimental Psychiatry. 3: 299 -231.
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Kraft, T. (1967) A case of homosexuality treated by systemic desensitization. American Journal of Psychotherapy. 21: 815 – 821.
SUBJECTS: 1 male
METHOD: Systematic desensitization
RESULTS: 9 months follow-up, no recurrence of homosexual desires, desires heterosexual intercourse.
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Kraft (1970)
THEORY: “Desensitization techniques are preferable to aversion techniques because they promote the incorporation of heterosexual activity as opposed to merely the elimination of homosexual attraction.”
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Kraft, T., (1971) A case of homosexuality treated by combined behavior therapy and psychotherapy: A total assessment. Psychotherapy and Psychosomatics. 19: 342 – 358.
SUBJECTS: 1 male
METHOD: Systematic desensitization and psychoanalytic treatment
RESULTS: Homosexual thoughts had disappeared, better general adjustment.
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Larson, D. (1970) An adaptation of the Feldman and MacCulloch approach to treatment of homosexuality by the application of anticipatory avoidance learning. Behavioral Research and Therapy. 8: 209 – 210.
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Levin, S., Hirsh, T., Shugar, G., Kapche, R. (1968) Treatment of homosexual and heterosexual anxiety with avoidance conditioning and systematic desensitization: Data and case report. Psychotherapy: Theory, Research, and Practice. 5: 160 -168.
SUBJECT: 1 male
METHOD: Avoidance conditioning
RESULTS: Satisfactory heterosexual relations with occasional homosexual fantasy.
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LoPiccolo, J. (1971) Case study: Systematic desensitization of homosexuality. Behavior Therapy. 2: 394 – 399.
SUBJECTS: 1 male
METHOD: Systematic desensitization
RESULTS: Heterosexually active, no homosexual urges at 11 month follow-up.
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Maletzky, B., George, F. (1973) The treatment of homosexuality by ‘assisted’ covert sensitization. Behavior Research and Therapy. 11: 655 – 657.
SUBJECTS: 10 males
METHOD: Covert sensitization
RESULTS: 4 passed temptation test at follow-up (one of these required 10 booster sessions.)
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Mandel, K.(1970) Preliminary report on a new aversion therapy for male homosexuals. Behavior Research and Therapy. 8: 93 – 95.
SUBJECTS: 2 males
METHOD: Aversive classical conditioning.
RESULTS: Improvement, but concerned about possible relapse.
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Marquis, J. (1970) Orgasmic reconditioning: Changing sexual object choice through controlling masturbation fantasies. Journal of Behavior Therapy and Experimental Psychiatry. 1: 263 – 271.
SUBJECTS: 6 males, 1 female
METHOD: Masturbatory conditioning and other methods
RESULTS: Female achieved satisfying relationship with man. Males saw improvement but with relapses
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Mastellone, M. (1974) Aversion therapy: A new use for the old rubber band. Journal of Behavior Therapy and Experimental Psychiatry. 5: 311 – 312.
SUBJECTS: 1 male
METHOD: Aversive instrumental conditioning
RESULTS: Heterosexual activity
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Master, W., Johnson, V. (1979) Homosexuality in Perspective. Boston: Little Brown, Co.
SUBJECTS: 67 homosexuals, 14 lesbians who requested reversion therapy to heterosexuals
METHOD: Sexual training
RESULTS: Success rate of 71.6% after a follow-up of six years.
THERAPY: “No longer should the qualified psychotherapist avoid the responsibility of either accepting the homosexual client in treatment or… referring him or her to an acceptable treatment source.”
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Max, L. (1935) Breaking up a homosexual fixation by the conditioned research technique: A case study. Psychological Bulletin. 32: 734.
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McConaghy, N. (1969) Subjective and penile plethysmograph responses following aversion-relief and apomorphine aversion therapy for homosexual impulses. British
Journal of Psychiatry. 115 : 723 – 730.
SUBJECTS: Total 40 – 20 drug therapy group (10 males + 10 males in a delayed therapy control group); 20 shock therapy (10 males + 10 males in delayed therapy control group)
METHOD: Aversive classical conditioning with drugs compared to aversive classical conditioning with shock.
RESULTS: After treatment, 27 of the patients were rated as more heterosexual, 9 as more homosexual. Final outcome: 10 marked improvement; 15 some improvement; 10 no improvement; 5 lost to follow-up.
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McConaghy, N. (1971) Aversion therapy of homosexuality: Measures of efficacy. American Journal of Psychiatry. 127, 9 : 1221 – 1224.
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McConaghy, N., Barr, R., (1973) Classical, avoidance and backward conditioning treatments of homosexuality. The British Journal of Psychiatry. 122: 151 – 162.
SUBJECTS: 46 males
METHOD: 31 treated with aversive classical conditioning with shock; 15 with avoidance conditioning
RESULTS: At 9 month follow-up 13 had an increase in heterosexual desire. 25% ceased homosexual relations
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McConaghy, N. (1975) Aversive and positive conditioning treatments of homosexuality. Behavior Research and Therapy. 13: 309 – 319.
SUBJECTS: 16 males aversive conditioning, 15 males positive conditioning
METHOD: Aversive classical conditioning with shock compared to positive conditioning.
RESULTS: At one year follow-up – 14 reported an increase in heterosexual desire, 7 reported an increase in heterosexual relations.
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McCrady, R., (1973) A forward-fading technique for increasing heterosexual responsiveness in male homosexuals. Journal of Behavior therapy and Experimental Psychiatry. 4:257 – 261.
SUBJECTS: 1 male
METHOD: Forward fading and group therapy
RESULTS: Remained homosexually active
CASE: Successful treatment of a 27-year-old gay man who had occasional same-sex experiences from the age 16. However, “for both moral and practical reasons, when he entered therapy, he was highly motivated to increase his heterosexual behavior (and to decrease his homosexual behavior)” McCrady showed the client a nude female and then faded the image into a nude male. During the course of therapy, the client began referring to himself by saying, “when I used to be homosexual.”
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Myerson, A., Neustadt, R. (1946) Essential male homosexuality and results of treatment. AMA Archives of Neurology and Psychiatry. 55:291 – 293.
SUBJECT: 15 males (essential homosexuals)
METHOD: Treatment with methyl testosterone
RESULTS: 1 reported homosexual feelings disappeared
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Philips, D., Fischer, S., Groves, G., Singh, R.(1976) Alternative behavioral approaches to the treatment of homosexuality. Archives of Sexual Behavior. 5: 223 -228.
SUBJECT: 31-year-old homosexual man who requested sexual reorientation because the gay world was losing its appeal. The client experienced anxiety concerning heterosexual physical contact.
METHOD: Therapy used two desensitization hierarchies.
RESULTS: Client able to initiate heterosexual contact and at 18 months follow-up reported no same-gender sexual activity.
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Ramsey, R., van Velzen, V. (1968) Behavior therapy for sexual perversions. Behavior Research and Therapy. 6: 233.
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Rehm, L., Rozensky, R. (1974) Multiple behavior therapy techniques with a homosexual client: A case study. Journal of Behavior Therapy and Experimental Psychiatry. 5: 53 – 57.
SUBJECT: 1 male
METHOD: Various forms of behavior modification, including hypnosis
RESULTS: No homosexual activity, heterosexual dating
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Roper, P. (1967) The effects of hypnotherapy on homosexuality. Canadian Medical Association Journal. 96: Feb., 11: 319 – 327
ABSTRACT: “Fifteen homosexuals were treated with hypnosis. The patients were selected from a general psychiatric practice and had a long history of confirmed homosexual behavior and showed no evidence of organic or psychotic illness. The type of hypnotic induction attempted in all cases is described. In those where a satisfactory depth of hypnotic trance was achieved a change in sexual orientation was suggested to the patient.”
CHANGE: “Before therapy, each patient was assessed using the Kinsey scale. Results were evaluated in terms of the patient’s subsequent behavior and his subjective feelings . Of the 15 patients, three showed no improvement, four showed a mild improvement and eight showed a marked improvement. There as a significant correlation between the depth of hypnosis achieved and the therapeutic outcome. Those patients who reached a deep level of hypnotic trance were most likely to show a marked improvement. There were no significant correlations with other factors such as degree of homosexuality as measured on the Kinsey scale and the patient’s marital status.”
“Treatment of homosexuals with hypnosis may produce more satisfactory results than those obtained by other means. The best results are likely to be achieved with patients who are good hypnotic subjects.” The deeper the hypnosis more likely improvement.
SUBJECTS: 15 males
METHOD: Hypnosis
RESULTS: 3 no improvement; 4 mild improvement; 8 marked improvement.
——
Roper, Rozensky (1974)
SUBJECTS: 13 males
METHOD: Hypnosis
RESULTS: Homosexuality no longer attractive, dating female
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Salter, Melville (1972)
SUBJECT: 1 male
METHOD: Masturbatory conditioning
RESULTS: Client satisfied with change
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Sandford, D., Tustin, R., Priest, P. (1975) Increasing heterosexual arousal in two adult male homosexuals using a differential reinforcement procedure. Behavior Therapy. 6: 689 – 693.
SUBJECTS: 2 males
METHOD: Aversive and positive instrumental conditioning with shock
RESULTS: Lost desire for homosexual contact, aroused at sight of women
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Schmidt, E., Castell, D., Brown, P. (1965) A retrospective study of 42 cases of behavior therapy. Behavior Research and Therapy. 3: 9 – 19.
SUBJECTS: 9 homosexual subjects
METHOD: Behavior therapy
RESULTS: 3 marked improvement
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Schwartz, M., Masters, W. (1984) The Masters and Johnson treatment program for dissatisfied homosexual men. American Journal of Psychiatry. 141: 173 – 181.
SUBJECTS: Individuals who want to change homosexual preference
METHOD: Psychotherapy – short term intensive intervention
RESULTS: Failure rate after intervention – 20.9%, after 5 year follow-up – 28.4%
CASE: 25 year-old-man had first homosexual experience at 13 arranged by lesbian mother with older gay man. Complete change of orientation.
RELIGION: “A common situation is that of the man who accepts the Biblical dictum that homosexuality is a sin. He feels guilty each time he has a homosexual experience. No matter how the man is encouraged to understand the unfolding of his homosexuality, he says, “Yes, but it is a sin.” Such a man may be helped to 1) realize that there are different theological interpretations of the Bible, 2) understand that he is using his religion to castigate himself, or 3) see that he is playing games with his religion by using confession as permission to do what he considers to be a sin. Restructing of the belief that homosexuality is a sin is necessary before the man in therapy can make heterosexuality a “want-to” rather than “have-to” goal. (178)
CHOICE: “… to ignore the goals of clients who want to change their preference is both paradoxical and prejudiced. The paradoxical messages is “You are a homosexual and have to learn to live with it,” which is contradictory to a major research finding of the last decade: Homosexuality is simply a descriptive term applied to a person who has a preference for same-sex romantic and sexual consorts.
“The Institute does not subscribe to the concept that all homosexuals could or should establish heterosexual intimacy. This in not, however, because homosexuality causes in some people and is therefore resistant to change. The current position is that if and when demonstrable biologic influences are firmly established there is no evidence that they will systematically affect prognosis in therapy. Environmental influences may be demonstrated to be equally influential or noninfluential in polarizing sexual development.”
CHANGE: “Beyond low levels of patient motivation and unattractive or disturbed partners, there are no secure indicators of poor prognosis for therapy. We have not found that presence or absence of previous homosexual or heterosexual experience or imagery can affect prognosis in a predictable way. Attention is focused on improving therapists’ skills rather than identifying certain groups of patients as poor risks. In the absence of secure data or well established prognostic indicators, it is obvious that the strongest positive predictor of successful conversion or reversion therapy is the patient’s rejection of homosexual identity and an unambivalent desire to pursue heterosexuality.” (180)
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Segal, B., Sims, J. (1972) Covert sensitization with a homosexual: A Controlled replication. Journal of Consulting and Clinical Psychology. 39:259 – 263.
SUBJECT: 1 male
METHOD: Covert sensitization
RESULTS: Some change, 1 relapse at 4 months, felt disgust and shame
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Solyom, L., Miller, S. (1965) A differential conditioning procedure as the initial phase of behavior therapy of homosexuality. Behavior Research and Therapy. 3: 147 – 160.
SUBJECTS: 10 practicing homosexuals, 6 latent homosexuals
METHOD: Behavior therapy
RESULTS: Practicing (3 marked improvement.) Latent (5 marked improvement, 1 moderate improvement.)
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Srnec, Freund (1953) Treatment of male homosexuality through conditioning. International Journal of Sexology. 7: 92 -93.
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Stevenson, I., Wolpe, J. (1960) Recovery from sexual deviations through overcoming non-sexual neurotic responses. The American Journal of Psychiatry. 116: 737 – 742
SUBJECTS: 2 males
METHOD: Assertiveness training
RESULTS: Both married, one had homosexual relapse under stress
CASE: Use of reeducation and assertiveness training in the successful reorientation of two gay men. In one case the authors describe a 22-year old man whose same-gender sexual experience began at age 14. The client had begun to consider himself exclusively homosexual and viewed counseling as his last possibility before accepting this conclusion. The counselor suggested to the man that he may have been “premature in assigning himself to the group of permanent homosexuals” and that the man’s homosexual activity ” was chiefly drive by a wish for friendly companionship with other men. After 10 sessions of encouragement of assertive behavior, the client terminated with plans to marry. The man reported heterosexual adjustments at a 3-year follow-up.
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Tanner, B. (1973) Shock intensity and fear of shock in the modification of homosexual behavior in males by avoidance learning. Behavior Research and Therapy. 11: 213 – 218.
SUBJECTS: 12 males
METHOD: Anticipatory avoidance conditioning
RESULTS: Outcome seen as change in penile circumference
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Tanner, B. (1974) A comparison of automated aversive conditioning and waiting list control in the modification of homosexual behavior in males. Behavior Therapy. 5: 29 -32.
SUBJECTS: 6 males
METHODS: Anticipatory avoidance conditioning
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Tanner, B., (1975) Avoidance training with and without booster sessions to modify homosexual behavior in males. Behavior Therapy. 6: 649 – 653.
SUBJECTS: 5 males
METHOD: Booster sessions for previous therapy
RESULTS: No significant differences between those receiving booster sessions and those not.
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Tarlow, G. (1989) Clinical Handbook of Behavior Therapy: Adult Psychological Disorders. Brookline MA: Brookline Books.
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Thompson, G. (1949) Electroshock and other therapeutic considerations in sexual psychopath. The Journal of Nervous and Mental disease. 109 : 531 -539.
SUBJECTS: 3 males, with other serious psychological problems
METHOD: Electric shock therapy
RESULTS: Did not change homosexual drive. Other areas somewhat improved
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Thorpe, J., Schmidt, E. (1964) Therapeutic failure in a case of aversion therapy. Behavior Research and Therapy. 1: 293 – 296.
SUBJECT: 1 male, homosexual fantasy no behavior
METHOD: Aversive classic conditioning with shock
RESULTS: Client was very upset by treatments and terminated
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Thorpe, J., Schmidt, E., Castell, D. (1963) A comparison of positive and negative (aversive) conditioning in the treatment of homosexuality. Behavior Research and Therapy. 1:357 – 362.
SUBJECT: 1 male
METHOD: Masturbatory conditioning and aversive classic conditioning with shock
RESULTS: Small change with relapses
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Turner, R., Pielmaier, H., James, S., Orwin, A. (1974) Personality characteristics of male homosexuals referred for aversion therapy: A comparative study. British Journal Psychiatry. 125: 447 – 449.
SUBJECTS: 51 homosexuals referred for treatment; 59 non-patient homosexuals (41 had never sought treatment, 18 had previously done so.)Patients were “markedly neurotic”.
RESULTS: Significant differences were found.
==============================
von Schrenck-Notzing, A (1895) Therapeutic suggestion (in Psychopathia Sexualis.Philadelphia: Davis.) 320
CHANGE: One of the first studies of the treatment of homosexuality. Used hypnosis on 70 male patients. The hypnotic suggestion consisted of commanding the patient to suppress perverse practices and ideas, to think of perversion as repulsive and to think of heterosexual objects as attractive. This mode of treatment seemingly a forerunner of modern behavioral therapy, was reported to achieve 37.5 per cent cures and another 34 per cent improvement. The criterion of cure was the patient’s ability to have heterosexual intercourse.
METHOD: Collected data from a number of different psychiatrists of 27 patients treated with hypnosis, 21 had a “cure” or great improvement of these, 19 reached a deep or moderate depth of hypnosis.
SUBJECTS: 27 patients
METHOD: Hypnosis
RESULTS: 21 cure or great improvement
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Wilson, G., Davison, G. (1974) Behavior therapy and homosexuality: A critical perspective. Behavior Therapy. 5: 16 – 17.
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6) RELIGIOUSLY MEDIATED CHANGE
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Consiglio, W. (1991) Homosexual No More: Strategies for Christians Overcoming Homosexuality. Wheaton IL: Victor Books
THEORY: Encourages “overcomers” to force themselves to “overcome the tendency to continue protecting yourself and hiding your sensitive emotions.” If the “overcomer” persists “He will begin to feel whole and manly. He will start to see the end of the homosexual attraction and desire.”
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Fitzgibbon, R. ( 1996) The origins and healing of homosexual attractions and behavior (in Harvey, J. (1996) The Truth about Homosexuality: The Cry of the Faithful. San Francisco: Ignatius) 307 -343.
CASE: Discussion of treatment of homosexual individuals using traditional methods, forgiveness, and religious faith
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Henry, G. (1951) Pastoral counseling for homosexuals. Pastoral Psychology. 2, 18: 33 – 39. [in Ellis]
Henry, G. (1955) All the sexes. NY: Rhinehart.
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Hurst, E. (1980) Homosexuality: Laying the Axe to the Roots. Minneapolis MN: Outpost.
CASE: Autobiographical material from an exgay
RELIGION: “There is no biblical precedent for claiming that God desires certain individuals to remain in bondage to any sin. There is also no solid ground for questioning the traditional Bible view that all homosexual behavior is sin.”
“Behind these homosexual temptations — behind these homosexual “orientations” — is a root problem of envy. I have seen this problem so many times that I wonder whether it isn’t the prevailing root of homosexual “orientation.” I know that in my own life it was the hardest one to deal with.”
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Moberly, E. Homosexuality: A New Christian Ethic. James Clark & Co.
CHILDHOOD: “No particular incident must inevitably disrupt the attachment to the same sex parent. But any of a wide variety of incidents may, in certain cases, happen to result in this particular form of psychological damage. The common factor in every case is disruption in the attachment to the parent of the same sex, however it may be caused.”(3)
“Whatever the particular incident may be, it is something that has been experienced as hurtful by the child, whether or not intended as hurtful by the parent. The parent may or may not be culpable, but in either case the child has genuinely been hurt. The difficulty arises when which a hurt is accompanied by an unwillingness to relate any longer to the love-source that has been experienced as hurtful. This implies an abiding defect in the child’s relational capacity. The tragedy is that subsequent to this effect the behavior of the same-sex parent becomes irrelevant, since the child is no longer able to relate normally to him or her. Even if love is offered, it cannot be received.” (5)
“At the same time it must be emphasized that the relational defect may not be evident, or not more than partially evident, to appearances… It is perhaps more surprising how often the difficulty and the cause of the difficulty are obvious.”
“The homosexual condition is itself a deficit in the child’s ability to relate to the parent of the same sex which is carried over to members of the same sex in general.”
“First, and perhaps most surprisingly, the defensive detachment from the same-sex parental love-source will be marked by hostility, whether overt or latent, toward parental figures and towards other members of the same sex. This hostility may be a component of actual sexual relationships.” (7)
“A defensive detachment from the parent of the same sex also implies blocking of the normal identificatory process. This may in some instances, but by no means in all, be expressed in effeminacy in male homosexuals.”
“The important point to note is that we are not suggesting any genuine identification with the opposite sex, but rather ‘disidentification from the same sex…”
“To be attached to one’s mother is in itself entirely normal. However, if there is a defensive detachment from the father, the only remaining channel for attachment is to the mother. What is normal when complemented by a father-attachment becomes abnormal when isolated from it.”
DISORDER: “…the defensive detachment from the person’s own sex, where the process of same-sex identification has been checked at an early point of development.”
“One’s own self-image is dependent on identification with the same sex…” (13)
“…heterosexuality is the ability to relate to both sexes, not just to the opposite sex as a psychologically complete member of one’s own sex.” (22)
“Homosexual relationships must therefore be regarded as inherently self-limiting, since they belong to the process of maturation, and cease if they have fulfilled their purpose. .By contrast, heterosexuality has no goal beyond itself.(23)
“… heterosexuality as such is never “cured’ . because it is not something requiring to be healed in the first place.”
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Moberly, E. (1984) Psychogenesis: Early development of Gender Identity. Routledge
THEORY: Moberly is considered one of the most influential thinkers on treatment. She has influenced a number of Ex-gay ministries. Her approach resonates with those seeking help.
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Mesmer, R. (1992) Homosexuals who change lifestyles. The Journal of Christian Healing. 14, 1:12 – 17.
SUBJECTS: 100 people who sought help for a change of sexual orientation
METHODS: Survey of attitudes.
RESULTS: 55% reported “exclusively heterosexual interest
47% some homosexual interest that they rarely felt compelled to act on.
13% still had some homosexual behavior.
88% felt “more able to have friendly relationships
88% felt “more self-respect”.
17% of the respondents had married,
94% felt closer to God.
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Pattison, E., Pattison, M. (1980) “Ex-gays”: Religiously mediated change in homosexuals. American Journal of Psychiatry. 137, 12: 1553 -1562
SUBJECTS: Study of 11 men who changed from exclusive and active homosexuality to exclusive homosexuality.
METHOD: None of these men had ever sought professional treatment for either psychiatric reasons or for their homosexuality. The men underwent a religious conversion and while no effort was made to effect of change of “orientation” the men participated in prayer groups with heterosexual men and women.
RESULTS: “that 8 of our 11 subjects amply demonstrated a ‘cure’. The remaining 3 subjects had a major behavioral and intrapsychic shift to heterosexual behavior, the persistence of homosexual impulses was still significant.” (1560).
CHANGE: “Thus all subjects in our sample demonstrated a strikingly profound shift in sexual orientation… The evidence suggest that cognitive change occurs first, followed by behavioral change, and finally intrapsychic resolution.” (1562).
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Pattison, M. (1985) “Survey data on ‘Ex-Gay’ Change in Sexual Orientation. May 18, American Psychiatric Association
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Payne, L.(1981) Broken Image. Westchester IL: Crossways Books
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Payne, L. (1995) Crisis in Masculinity. Grand Rapids MI: Baker Books
CASES
METHOD: Healing prayer. Ms. Payne works through Pastoral Care Ministries.
CHANGE: “As a sexual neurosis, homosexuality is regarded as one of the most complex. As a condition for God it heal, it is (in spite of the widespread belief to the contrary) remarkably simple.”
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Rekers, G. (1982) Growing up Straight. Chicago IL: Moody Press.
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Satinover, J. (1994) Psychotherapy and the cure of souls: Faith and religious belief in the treatment of Homosexuality. (in New Techniques in the Treatment of Homosexuality. Encino, CA: NARTH.)
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Satinover ( ) Reflections from a spiritual, medical and philosophical perspective. Understanding Homosexuality. Encino CA: NARTH.
CHANGE: After reading Leanne Payne’s book he went to a conference sponsored by her organization. “There I met hundreds of people struggling with [homosexuality] and many who had successfully emerged on the other side and were married with children. As I got to know them, I found them to be quite remarkable. The struggle to be healed had left an indelible imprint. I saw a humility, an empathy, and a fearlessness about life. They knew exactly what it mean to stand up for what they believe in, since the struggle to become who they truly were had exacted such a cost in suffer.”
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Throckmorton, W. (nd) Touched by His Grace. Rochester NY: One by One
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Wilson, E. (1988) Counseling and Homosexuality. Waco, TX: Word.
CHANGE: “Treatment using dynamic individual psychotherapy, group therapy, aversion, therapy or psychotherapy with an integration of Christian principles will produce object-choice reorientation and successful heterosexual relationships in a high percentage of persons.”
RESULTS: 55% success rate in treating homosexuals who were professing Christians.
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AUTOBIOGRAPHIES OF RELIGIOUSLY MEDIATED CHANGE
Andre, W., Balsiger, D. Face in the mirror.
Andre was involved for 20 years in the homosexual lifestyle. Now married.
Baker, D. (1985) Beyond Rejection: The Church, Homosexuality and Hope. Portland OR: Multnomah
Bergner, M. Setting love in order
Breedlove, J. Once gay, always gay
Comiskey, A. (1988) Pursing Sexual Wholeness. Los Angeles CA Desert Streams Ministries.
Dallas, J. Desires in conflict.
Dallas, J. A Strong Delusion. Harvest House
Former member of pro-gay church, now ex-gay
Davis, B., Rentzel, L. (1994) Coming out of homosexuality. Downers Grove IL: Intervarsity P.
Davis, B. (1992) Presbyterian report: Gays can change. Exodus Standard. 9, 1: 4.
Hurst, E. Factors in Freedom: The struggle with life-dominating sin.
recovered homosexual
Howard, J.(1991) Out of Egypt. England: Monarch
Johnson, Michael On Wings Like Eagles. (video tape.)
Konrad, J., You don’t have to be gay.
Linamen, K., Wall, K. Broken dreams.
Nancy, Homosexual struggle
Personal struggle with lesbian
Paulk, J. Not afraid to change.
Paulk, John (1998, Aug. 17 ) Gay for Life?. Newsweek
Rise, M. Michelle Danielle is dead.
From homosexual and female impersonator to Christian father and husband
Saia, M. (1988) Counseling the homosexual. Minneapolis MN: Bethany House
Stribling, T. Love broke through
Whelchel, M. If you only knew: Stories of women forever changed by God’s astounding grace
Worthen, A., Davies, B. Someone I love is gay. Inter Varsity Press
Worthen, F. Helping People Step out of Homosexuality
Worthen F. (1984) Steps out of Homosexuality. San Rafael CA: Love in Action.
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____, Experience, Strength and Hope: HA members share their recover.
Testimonies of members of Homosexuals Anonymous.
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Exodus International Bulletin
CASE HISTORIES: Testimonies published in monthly bulletin over a number of years.
Names and pictures included with testimony.
METHODS: Religious conversion. Participation in support group. Some had therapy.
RESULTS: Autobiographies provide sufficient evidence of prechange Kinsey rating and post change rating to show that all move from a Kinsey 4, 5, and 6 to 0 or 1. Period from last homosexual behavior averages from 5 to 12. The autobiographies reveal a periods of struggle and relapse before individuals achieve freedom.
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Cole, Tom (1998 June)
SUBJECT: Began sexual relationship with male at 12. From age 19 to 26; had 300-400 partners.
MEANS: Converted. Married.
RELAPSE Engaged in phone sex with men.
RESULTS: Found freedom from gay past. Ministers to others.
Dalton, Penny (1997 Dec.)
SUBJECT: Age 3 months to 3 1/2 years father absent; Parental alcoholism and Sexual abuse. High School – Drug and alcoholism abuse, psychiatric hospitalization, lesbian relationship.
MEANS: Christian conversion. Forgiveness of father lead to emotional healing.
Epstein, Andre (1997 Nov.)
SUBJECT: Jewish, poor at sports, parents divorced age12, age 15 – father died, age 17 came out, mother, stepfather and friends accepting of gay identity, high school involvement with drugs.10 years searching for “Mr. Right; 1980 contracted Hepatitis A; 1981
MEANS: Christian conversion.
RESULTS: Married and father of two sons. Troubled for some time by “old thoughts” and panic attacks.
Foster, Darryl,
SUBJECT: Black, fatherless, struggled against homosexual thoughts. Sought solace in Church. Molested by older boy. Entered gay scene hooked on “poppers”. Contemplated suicide.
MEANS: Converted.
RESULTS: Married 1992.
Jernigan, Dennis (1997 May)
CASE: Famous singer’s journey to freedom from homosexuality [also Gallardo, M. (1995) The song of a wounded heart. Charisma. July. Article on Dennis Jernigan.]
SUBJECT: Musically gifted; felt different from other boys. Christian conversion as a child. Engaged in secret homosexual relationships in high school and college.
MEANS: 1982 reconverted.
RESULTS: 1988 married
Johnston, Jeff (1999 Jan.)
SUBJECT: Christian youth, involved pornography and masturbation, acted out homosexually for one year,
MEANS: Reconversion 1988,
RESULTS Married with a son.
Leach, Jerry (1998 Oct.)
SUBJECT: Cross-dresser, considered a sex-change, married, not involved homosexually,
RESULTS; Free from behavior for 13 years.
Ludwig, Dottie, (1997, Feb.)
SUBJECT: Maternal loss at 3, emotional and sexual child abuse. Lesbian experience in early 20’s.
MEANS: Christian conversion in 1974. Gradual emotional healing.
RESULTS: Freedom from behavior for 27 years.
Lumberger, Michael (1999 Feb)
SUBJECT: Drugs, bisexuality, prostitution. Marriage failed. Two homosexual relations. MEANS: Converted and married. Confessed his previous experiences to his wife and pastor.
RESULTS: Leader of a support group for homosexuals. Recently celebrated 12 anniversary.
Medinger, Alan
SUBJECT: Married but acting out homosexually.
MEANS: Converted.
RESULTS: Leader of ex-gay ministry
Newman, Michael (1999 May)
SUBJECT: Homosexual experiences in college, conversion, relapse
MEANS: Conversion,
RESULTS: In ministry from 1985
Paulk, Anne
SUBJECT: Wild behavior in high school led to lesbian involvement.
MEANS: Conversion, relapse. 1 year residential program.
RESULTS: Married and mother.
Phillips, Ann (1999 March)
SUBJECT: Tried to be a Christian, and remain active in lesbian relationship.
MEANS: Left relationship and received help from Christian changed from masculine to feminine appearance.
Ragan, Bob, (1998 Nov.)
SUBJECT: 10 years in the homosexual life.
MEANS: Christian conversion in 1986.
Rogers, Sinclair (Sy) (1997 Oct) .
: Homosexual active since before age of 10. Had a profound desire to be a girl. Alcoholic mother died when he was 4. Sexually molested. Father left him with relatives. Lived as a woman for over a year in preparation for a sex-change operation.
MEANS: Christian conversion 1980.
RESULTS: Married
Shores, Jim (1997 June)
SUBJECT: Homosexually active in high school, in the gay “fast lane,” conversion and relapse.
MEANS: At 26 focused on healing.
RESULTS: Married in 1992. Still has temptations.
Thompson, Jason (April 1999)
SUBJECT: Struggled with homosexual temptations and pornography.
MEANS Became involved in an Exodus ministry.
RESULTS: Married in 1997.
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7) SPONTANEOUS OR ADVENTITIOUS CHANGE OF SEXUAL ORIENTATION
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Cameron, P., Crawford, J. et al (1985) Sexual orientation and sexually transmitted disease. Nebraska Medical Journal. 70: 292 -299.
RESULTS: 2% of their sample who claimed to be heterosexual said they had once been homosexual. This appeared to be spontaneous change not therapy. Only 4.4% of the sample claimed to be homosexual or bisexual.
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Fluker, J. (1976) A 10-year study of homosexually transmitted infection. British Journal of Venereal Diseases. 55: 155 – 160
REPORT: Experience of a doctor who specializes in the treatment of STDs among homosexual men.
CASE: One patient was permanently reoriented. Two years later he returned for treatment of another problem and claimed he was happily married and that all his homosexual inclinations had disappeared. One man returned and said he was free of homosexual activity
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Golwyn, D., Sevlie, C. (1993) Adventitious change in homosexual behavior during treatment of social phobia with phenelzine. Journal of Clinical Psychiatry. 141: 173 -181.
SUBJECT: 23 year old self-identified homosexual man with severe social phobia; homosexual since teens and sexually active exclusively with homosexual male. Fantasies homosexual.
METHOD: Treatment with phenelzine for shyness.
RESULTS: During treatment, however, there was an unexpected change in his sexual orientation.. Started dating women and had heterosexual fantasies.
THEORY: Subject blamed homosexuality on childhood teasing by peers and acceptance by homosexual men who courted him.
“We conclude that social phobia may be a hidden contributing factor in some instances of homosexual behavior.”
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Wolpe, J. (1969) The Practice of Behavior Therapy Elmsford, NY: Pergamon
SUBJECT: 1 male
METHOD: Assertiveness training
RESULT: Full sexual orientation shift
RELIGION: Wolpe did not believe change of orientation was possible. He refused to help the client overcome his homosexuality, because he felt that the client’s religious convictions and beliefs were responsible for anxiety and worked to give the client a different religious perspective. By the 6th session the client had come to “see that he had taken sin, particularly in relation to sexuality, too seriously.” Wolpe then helped the client use assertive behavior.
CHANGE: The client left therapy but later communicated to the therapist that he no longer responded sexually to men. He dated, married and reported a complete shift.
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Kinsey, A., Pomeroy, W., Martin, C. (1948) Sexual behavior in the human male. Philadelphia: W.B. Saunders.
CHANGE: “Some of the males who are involved in one type of relation at one period in their lives, may have only the other type of relation at some later period. There may be considerable fluctuation of patters from time to time. Some males may be involved in both heterosexual and homosexual activities within the same period of time.”
KINSEY: Data collected by Kinsey on males shows that six percent of those who were exclusively heterosexual had once been exclusively homosexual. Additionally the percentages of homosexuals and heterosexuals by age show substantial decrease in the homosexual categories suggesting that as males age some of those who were homosexual cease to be so (or that homosexuals die at younger ages).
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Kinsey, A., Pomeroy, W., Martin C., Gebhard, P. (1953) Sexual behavior in the human female. Philadelphia: W. B. Saunders
CHANGE: “Some individuals may materially change their psychosexual orientation in successive years.”
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Pomeroy, W. (1972) Dr. Kinsey and the Institute for Sex Research. NY: Harper and Row.
KINSEY: Kinsey discovered “more than eighty cases of (previously homosexual ) men who had made a satisfactory heterosexual adjustment.” He summarized successful change in therapy as being never less than 30%.
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Pincu., L (1989) Sexual compulsivity in gay men: Controversy and treatment. Journal of Counseling and Development. 68, 1: 63 – 66.
ADDICTION: The adrenalin rush associated with forbidden excitement is also addictive and well documented.
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Ross, M (1983) The Married Homosexual Man. London: Routledge & Kegan Paul.
RESULTS: Surveyed married homosexuals – 5% said their homosexuality became less intense during marriage.
KINSEY: On Kinsey data: “Given these data it would seem more accurate to classify sexual orientation in terms of direction at a given point in time rather than of its history. Sexuality can thus be seen as a fluctuating variable rather than as a constant.”
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Schneider, J., Schneider, B. (1990) Marital satisfaction during recovery from self-identified sexual addiction among bisexual men and their wives. Journal of Sex and Marital Therapy. 16, 4: 230 – 250
CHANGE: 60% of men in study had no sexual encounters with other men over periods ranging from four months to sex years, a mean of 2.6 years. The changes were greater the more heterosexual the initial orientation.
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________, Sex in America: The Social Organization of Sexuality.
CHANGE: 2.8% of the men in their sample were essentially homosexual. But a much larger percentage had been homosexual at some point in their lives previously. Somewhere between 10% and 16% had apparently gone through a homosexual phase.
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8) OPPOSITION TO THERAPEUTIC CHANGE
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Barrett, R., Barzan, R. (1996) Spiritual experiences of gay men and lesbians. Counseling and Values. 41: 4 – 15.
RELIGION: “…assisting gay and lesbians to step away from external religious authority may challenge the counselor’s own acceptance of religious teachings.”(8)
“most counselors will benefit from a model that help them understand the difference between spiritual and religious authority.” (8)
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Begelman, D.(1975) Ethical and legal issues of behavior modification (in Hersen, M., Eisler, R., Miller, P (ed) Progress in Behavior Modification NY: Academic.
ETHICS: The efforts of behavior therapists to reorient homosexuals to heterosexuals by their very existence constitute a significant causal element in reinforcing the social doctrine that homosexuality is bad. Indeed, the point of the activist protest that behavior therapists contribute significantly to preventing the exercise of any real option in decision-making about sexual identity, by further strengthening the prejudice that homosexuality is a “problem behavior,” since treatment may be offered for it. As a consequence of this therapeutic stance, as well as a wider system of social and attitudinal pressures, homosexuals tend to seek treatment for being homosexuals.”
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Begelman, D. (1977) Homosexuality and the ethics of behavioral intervention. Journal of Homosexuality. 2, 3: 213 – 218.
ETHICS: “My recommendation that behavior therapists consider abandoning the administration of sexual reorientation techniques is based on the following considerations. Administering these programs means reinforcing the social belief system about homosexuality. The meaning of the act of providing reorientation services is yet another element in a causal nexus of oppression. I realize this is a serious charge, especially in relation to therapists sensitive to the abstract issues involved. But I believe the charge is valid, even when therapists administer these techniques out of concern for the alleviation of client distress, in contrast to harboring traditional biases against homosexuality. The recommendation is not based on any abstract disagreement with the principle that clients have a right to seek aid in reducing their anxiety or upset. But it does take cognizance of the fact that the homosexual person who seeks treatment does so most of the time because he has been forced into adopting a conventional and prejudicial view of his behavior. On what ethical basis, it may be asked, are we obliged to desert the client in favor of allegiance to an abstract set of considerations.” (217)
DISORDER: “… investigators have also argued that since recent studies reveal homosexuals do no worse than heterosexual subjects on such measures, there is no evidence to confirm that homosexuality is a disorder. However, such studies actually have no bearing on the issue at hand. At best, they only confirm the hypothesis that homosexual persons are not as crazy as many have hitherto believed, not that homosexuality is not a disorder. If a poor showing on independent measures of adjustment confirms the hypotheses under investigation, wouldn’t a reverse finding confirm the hypotheses that heterosexuality is disorder? The answer is it wouldn’t. The question “is Heterosexuality a disorder? It is not an empirically determinable one; it is a senseless one. Homosexuality has not been classified as a ‘mental illness’ on the basis of presumptions about a showing on measures of adjustment. It has been so categorized because it is perceived as significant departure from acceptable standards of conduct in the areas of sexual behavior… Coming to regard homosexuality as simply another life-style in contrast to a disorder is merely to expand the criteria for a concept of acceptable behavior. This is not equivalent to learning something new about homosexuality; it is more akin to judging it differently, while in possession of the same old facts.” (218)
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Blair, R. (1972) Etiological and Treatment Literature on Homosexuality. NY: National Task Force on Student Personnel Services and Homosexuality.
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Blair, R. (1982) Ex-Gay. NY: Homosexual Community Counseling Center.
RELIGION: In studying the Ex-Gay movement he found that although many of these practitioners publicly promise change, they privately acknowledge that celibacy is the realistic goal to which gay men and lesbians must aspire. He further characterizes many religious conversionists as individuals deeply troubled about their own sexual orientation, or whose own sexual conversion is incomplete. Blair reports a host of problems with such counselors, including the sexual abuse of client.
“Since leaving the ‘ex-gay’ movement Evans [a former member of an ex-gay ministry] writes: ‘I have met other born-again Christians who have accepted their homosexuality as I have, as our natural way of life. We have dedicated this to the Lord…Instead of trying to reject or suppress this portion of myself, I must present my entire being, including my homosexuality, as a loving sacrifice to God.'”
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Bohan, J. (1996) Psychology and Sexual Orientation: Coming to Terms. NY: Routledge.
HETEROSEXISM: “…contemporary theory has undertaken to theorize heterosexuality itself, to ask what are the assumptions that underlie it, what is the origin of the hostility toward LGB identity, and what is the impact on human experience of the privileging of heterosexuality.” (33)
RELIGION: “Religious beliefs and strongly held political ideologies are examples of values. This function might explain the correlation between psychological heterosexism and conservative political beliefs, as well as the relation to religiosity, especially a commitment to conservative religious institutions whose teachings about homophilia are extremely negative. Indeed, the religious arguments for homonegativity is arguably the most powerful force in contemporary social movements to limit gay rights. Also, the frequent finding that homonegativity is correlated with other forms of prejudice may be explicable from this perspective. The cohesiveness of these attitudes suggests that they serve an important function for the individual”
“Homonegative attitudes of this sort may change if the individual recognizes a conflict between this value and another value… attitudes might change if a revered authority, such as a member of the clergy or a biblical scholar, were to present a more positive view of LGB experience, still grounded in religious teaching.” (p. 58)
“Diminishing anti-LGB prejudice and discrimination will require institutional as well as individual change.
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Cabaj, R. (1988) Homosexuality and Neurosis. Journal of Homosexuality. 15, 1/2: 13 – 24
CHOICE: “If the patient is truly dissatisfied [with being gay], once the evaluation is completed, he must be clearly advised of the difficulties involved in attempting to change one’s sexual orientation and the unlikelihood that any such attempt would be successful. Better use of therapy would be to help the patent accept his orientation and explore his fears of and resistance to being homosexual. If the patient insists, a referral to a sensitive therapist willing to work on changing orientation may be in order, but only if such a therapist is objective, and not biased against homosexuality, and can help the patient accept homosexuality if change is not possible.”
CHILDHOOD: It will be a relief for some patients to learn that there is no evidence that parental upbringing plays a role in sexual orientation development, but such information may serve to cut short the anger being expressed toward their parents in the therapy, anger that may really be tied to other parent-child issues. The probably role of genetics and biological and biochemical factors in utero may serve to confuse some patients and obscure the target of anger if the patient resents his or her orientation. … the patient may see the therapist (one of the targets) as being too accepting and objective, and as avoiding or dismissing the patient’s feelings. The common wish to blame someone or something for a perceived problem, whether it be sexual orientation or failed relationships, may help obscure the poor self-esteem of the patient, which is only intensified by internal homophobia.”
ALCOHOLISM: ‘The illness of alcoholism must always be considered in evaluating the gay patient, especially since alcoholism causes depression, anxiety, phobias, and social isolation — common complaints for seeking psychotherapy.’
SEXUAL ADDICTION: “Many gay men find themselves locked into sexual promiscuity and may wish to change for health reasons, or in order to establish an intimate relationship. Such obsessive-compulsive behavior can be treated by traditional means, but group therapy seems to be particularly useful.”
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Coleman, E. (1978) Toward a new model of treatment of homosexuality: A review. Journal of Homosexuality. 3, 4: 345 – 357.
ABSTRACT: A review of the literature of outcome studies in the psychoanalytic or behavioral treatment of homosexuality reveals limited results when “heterosexual shift” is the goal. Recently, however, a growing body of empirical knowledge has accumulated that challenges the illness or maladaptive model of homosexuality. Consequently, a new model has been emerging that is designed to assist homosexuals to recognize, accept, and value their sexual identity and to help them adjust to this identity in a predominantly heterosexual society. Unfortunately, only a few studies exist that examine the results of this new approach.
ETHICS: “… to offer a cure to homosexuals who request a change in their sexual orientation is, in my opinion unethical. There is evidence, as reviewed in this paper, that therapists can help individuals change their behavior for a period of time. The question remains whether it is beneficial for clients to change their behavior to something that is inconsistent or incongruent with their sexual orientation. In most cases, I would say not… Exploring heterosexual behavior should always be available as a treatment goal, but it should never be viewed as denying or changing sexual orientation.” (355)
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Coleman, E. (1982.) Changing approaches to the treatment of homosexuality: A review (in Paul, W., Weinrich, J., Gonsiorek, J., Hotvedt, M.(eds) Homosexuality: Social, Psychological and Biological Issues. The Final Report of the Society for the Psychological Study of Social Issues Task Force of Sexual Orientation. Beverly Hills CA: Sage.) 81 – 88.
ETHICS: “… therapists should enlist the aid of clients to combat the social system that has been responsible for unjustifiably creating their negative self-image. It is unethical and morally questionable to offer a ‘cure’ to homosexuals who request a change in their sexual orientation.”
CHOICE: “There is the problem clients who simply will not accept treatment that is based on improving homosexual functioning. Therapists such as Freund (1977) have thought that for these clients counseling toward heterosexual adjustment is acceptable as a “second-best choice.”… This treatment approach should be offered cautiously. Clients must explore their reasons for wanting such goals. They must understand the meaning and significance of their decision to act in a way that is incongruent with their sexual orientation. they must understand the external forces that affect their decision to do so. The danger with this approach is that in helping clients increase their sexual repertoire to include heterosexual activity this may lead to the feeling that their basic sexual orientation is not acceptable or tolerated. This would lead to the same sense of failure that is generated by attempts to “cure” individuals of their homosexuality.”
ETHICS: “It is naive to think that we are, can, or should be value-free agents. We cannot continue to participate in society’s unfair discrimination against homosexuality. There has been and should continue to be more emphasis in treatment of homosexuals on assisting them to recognize and accept their sexual identity, to improve interpersonal and intersocial functioning, and to help them value this identity in a predominantly heterosexual society.”
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Coleman, E. (1982) Developmental stages of the coming-out process (in Paul, W., Weinrich, J., Gonsiorek, J., Hotvedt, M.(eds) Homosexuality: Social, Psychological and Biological Issues. The Final Report of the Society for the Psychological Study of Social Issues Task Force of Sexual Orientation. Beverly Hills CA: Sage.) 149 – 157.
SUICIDE: “The conflict of this stage is resolved in several ways. Some individuals decide to commit suicide. Others hid their true sexual identity from themselves and others and continue to suffer from chronic low-grade depression.”
PROMISCUITY: “When gay men and lesbians finally give themselves permission to become sexual with members of their own sex, there is naturally a surge of interest and intrigue… This natural and essential social and sexual experimentation can be viewed as promiscuous behavior.”
CASE: David, 20-year-old college student, out of the closet for two years, spent every weekend in gay bars and baths, was depressed. “He began to doubt whether anyone was interested in him for other than for sex.” He saw his behavior as “immature and sinful.” Therapist encourages him to explore and experiment. “I think it is a mistake to push people to form long-term committed relationships at this point. I remember as an adolescent that I was always told to play the field.”
CASE: Gary 35-year-old graduate student referred after serious suicide attempt after first long-term lover cheated on him and then left. Had been through bar and bath scene.
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Conlin, D., Smith, J. (1982) Group psychotherapy for gay men (in Gonsiorek (ed) Homosexuality and Psychotherapy. NY: Haworth) 105 – 112.
INTERNALIZED HOMOPHOBIA: “None of the group members has requested a change of sexual orientation; all, however, have been either disturbed by or in conflict with their homosexual feelings, and have been socially inhibited as a consequence of their internalized homophobia.”
DISORDERS: “In our experience in working with both mixed and all-gay groups, we have found that mixed groups can be useful to the homosexual patient who is already functioning at a high level of self-acceptance and adaptation as a gay person, and presents with problems unrelated to sexual orientation, such as anxiety or depressive disorders.” (107)
CASES: Mr. A. in group “was able to admit and accept his own bitterness, alienation, and distance from his family, who rejected him.”
Mr. B. problem with alcohol.
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Corbett, K. (1993) The mystery of homosexuality. Psychoanalytic Psychotherapy. 10, 3: 345 – 357.
ABSTRACT: I contend that male homosexuality is a differently structured masculinity, not a stimulated femininity … the gay man’s gender identity is distinguished by his experience of passivity in relation to another man.
FATHER: “I have found that passive longings seen from the fact that a homosexual boy’s choice of love object is modeled on his father, leading to the boys wish to have his erogenous zones touched or filled by the father. The fantasy of being loved by a the father is essentially an expression of passive longing.”
“Gay men frequently harbor the belief that their experience of masculinity is flawed, especially in comparison to normative heterosexual masculinity. Recognizing the inherent dilemma in such experience, a gay male patient of mine commented, “There was this sense of otherness. You know, not being the norm — the normal boy’.”
“I have found that my gay male patients feel that their fathers did not comprehend their early gender experience . This lack of comprehension is often experienced by the son as signaling the father’s disappointment. Without exception, my gay male patients present themselves as having disappointed the parents, with greater emphasis generally placed on the disappointment of their fathers; they were not the sons their fathers wished for.”
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Davison, G. (1974) Behavior therapy and homosexuality: A critical perspective. Behavior Therapy. 5: 16 – 28.
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Davison, G. (1976) Homosexuality: The ethical challenge. Journal of Consulting and Clinical Psychology. 44:157 – 162.
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Davison, G. (1982) Politics, ethics and therapy for homosexuality. (in Gonsiorek, J. Homosexuality and psychotherapy. NY Haworth Press) 89 – 96.
FAMILY: “… in the Bieber study… there is also a major logical error in reasoning —
namely, that one has demonstrated pathology of homosexuality by showing that male homosexuals have child-rearing experiences that are different from those of male heterosexuals. One cannot attach a pathogenic label to a pattern of child rearing unless one a prior labels the adult behavior patter as pathological. For example, Bieber et al. found that what they called a “close-binding intimate mother” was present much more often in the life histories of the analytic male homosexual patients than among the heterosexual controls. But what is wrong with such a mother unless you happen to find her in the background of people whose current behavior you judge beforehand to be pathological? Moreover, even when an emotional disorder is identified in a homosexual, it could be argued that the problem is due to the extreme duress under which the person has to live in a society that asserts that homosexuals are “queer” and that actively oppresses them.”
ETHICS: “… even if one were to demonstrate that a particular sexual preference could be modified by a negative learning experience, there remains the question of how relevant these data are to the ethical question of whether one should engage in such behavior changes regimens. The simple truth is that data on efficacy are quite irrelevant. Even if we could effect certain changes, there is still the more important question of whether we should. I believe we should not.”
“Change of orientation therapy programs should be eliminated. Their availability only confirms professional and societal biases against homosexuality, despite seemingly progressive rhetoric about its normality…. Viewing therapists as contemporary society’s secular priests rather than as value-neutral technicians will sensitize professionals and laypeople alike to large-scale social, political, and moral influences in human behavior.”
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Davison, G. (1991) Constructionism and morality in therapy for homosexuality (in Gonsiorek, J., Weinrich (ed) Homosexuality: Research implications for public policy. Newbury Park CA: Sage) 137 – 148.
ETHICS: “… how can therapists honestly speak of nonprejudice when they participate in therapy regimens that by their very existence — and regardless of their efficacy — would seem to condone the current societal prejudice and perhaps also impede social?”
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Edwards, R. (1996) Can sexual orientation change with therapy? APA Monitor. 27:49.
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Garnets, L., Hancock, K., Cochran, C., Goodchilds, J., Peplau, L. (1991) Issues in the psychotherapy with lesbians and gay men. American Psychologist. 46, 964 – 972.
ABSTRACT: “In 1984, a task force of the American Psychological Association (APA) Committee on Lesbian and Gay Concerns was charged with investigation bias in psychotherapy with lesbians and gay men. The task force surveyed a large and diverse sample of psychologists (2,544 of whom completed a questionnaire) to elicit information about specific instances of respondent-defined biased and sensitive psychotherapy practice. Open-ended responses were used to separately identify major themes and biased and sensitive practice and to illustrate each with concrete examples. Results suggest that psychologists vary widely in their adherence to a standard of unbiased practice with gay men and lesbians. To bring individual practice into accord with APA policy will require continued and expanded effort to educate practitioners about sexual orientation.”
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Gittings, B. (1973) Gay, Proud, Healthy. Philadelphia PA: Gay Activists Alliance.
GENOCIDE: “While much of psychiatry seems unaware of this, it is felt with growing resentment and bitterness by the homosexual community who increasingly see psychiatry as THE major enemy in a battle against deeply rooted societal prejudice, and see psychiatrists as singularly insensitive and obtuse to the destruction which they are wreaking upon homosexuals… The homosexual community looks upon efforts to change homosexuals to heterosexuality, or to mold younger, supposedly malleable homosexuals into heterosexuality.. as an assault upon our people comparable in its way to genocide.”
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Gonsiorek, J. (1982a) Introduction (in Paul, W., Weinrich, J., Gonsiorek, J., Hotvedt, M.(eds) Homosexuality: Social, Psychological and Biological Issues. The Final Report of the Society for the Psychological Study of Social Issues Task Force of Sexual Orientation. Beverly Hills CA: Sage.)
DISORDER: “Therefore, if other studies find that some homosexuals are disturbed, the proper conclusion is that they are disturbed for reasons other than sexual orientation, or perhaps for reasons in conjunction with sexual orientation; but it cannot be maintained that sexual orientation per se and psychological adjustment are related.”(65)
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Gonsiorek, J. (1982b) Results of psychological testing on homosexual populations. (in Paul, W., Weinrich, J., Gonsiorek, J., Hotvedt, M.(eds) Homosexuality: Social, Psychological and Biological Issues. The Final Report of the Society for the Psychological Study of Social Issues Task Force of Sexual Orientation. Beverly Hills CA: Sage.)
DISORDER: “… in this chapter I intend to demonstrate that a careful examination of psychological test data can not only answer the important question of whether homosexuality per se is a sign of mental illness or psychological disturbance.”
FAMILY: “… much of the psychoanalytic theorizing about the causes of homosexuality focuses on certain family patterns which are alleged to predispose a child toward homosexuality… Whether or not one believes these theories of causality of homosexuality (and this topic is heatedly debated, with no apparent winner in sight), there is an implication in much of this research that since such a pattern is alleged to be more frequent in families of homosexuals, this is evidence that homosexuality per se is disturbed because such family patterns are indicative of psychological disturbance. On the face of it, this reasoning may sound plausible. In reality, however, such reasoning is circular. The veracity of theories which hold that certain family patterns are pathological are very much in question. When ‘differences’ are found, this is alleged to be evidence in favor of the theory. But the existence of difference does not explain what those differences mean.” (71)
“… if a group with allegedly disturbed family pattern also scored in a disturbed range on these measures, there world be strong evidence for both a conclusion of greater disturbance in the group and for one’s favorite theory.”
“Given the immature state of the behavioral sciences, it is not sufficient or even reasonable to assert that because one’s favorite theory would lead to a conclusion that family pattern x means disturbance, therefore individuals with family pattern x are more disturbed.” (72)
DISORDER: “Does the statement that homosexuality per se is not a sign of psychological disturbance mean that there are no disturbed homosexuals. Absolutely not. It means that the proportion, or base rate, of disturbed individuals in homosexual and heterosexual populations is roughly equivalent.” (73)
RESEARCH: “The vast majority of the studies to be reviewed in this chapter are flawed in that they sample from particular, as opposed to general, segments of homosexual populations.”
“Despite all these problems, a clear and consistent pattern emerges from studies on homosexuals using psychological testing. Homosexuality in and of itself is unrelated to psychological disturbance or maladjustment.” (74)
INTERNALIZED HOMOPHOBIA: “Further, if there are some reasons (one being increased levels of external stress) to believe that certain measures of disturbances may be higher in certain homosexual populations. This also can be congruent with a conclusion that homosexuality in itself is not an indicator of psychological disturbance, because if homosexuals as a group are subject to more environmental stress, then a proper comparison group may not be heterosexual in general, but heterosexuals with roughly equivalent environmental stress.”
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Gonsiorek, J. (1982c) The use of diagnostic concepts in working with gay and lesbian populations. (in Homosexuality and Psychotherapy. NY: Haworth Press)
DISORDERS: “When a clinical practitioner is faced with a gay or lesbian client who may be giving indications of severe depression, thought disorder, persistent characterological problems, neuropsychogical impairment, etc., in addition to or instead of issues related to societal oppression, coming out, etc. (which may at times fit reasonably well with the anti-diagnostic mode) anti-diagnostic views are not only less than helpful, but their sole application may constitute incompetence or malpractice.”
“…this paper makes certain assumptions. First that homosexuality per se is unrelated to psychopathology and psychological adjustment.”(Gonsiorek 1977, 1982b)
“There are a number of clinical conditions in which individuals at times manifest homosexual behavior or concerns, and the client may therefore appear to be coming out or having a sexual identity crisis when in reality, these behaviors or concerns are part of serious psychopathology. On the other hand, the coming out process in itself can produce in some individuals considerable psychiatric symptomatology reminiscent of serious underlying psychopathology; but in fact, such pathology does not exist and the individual is having a particularly difficult time coming to terms with his or her sexuality. Finally, the coming out process may serve as a precipitating event for some individuals who do have severe underlying problems; that is both may be present.”
PARANOIA: “Stoller’s view (1968) view, which suggests that any major threat to one’s core sexual identity may elicit paranoid defenses is probably a more useful statement of any linkage between paranoia and homosexuality.”
“Paranoia and other florid reactions of a sexual identity crisis in a genuinely homosexual person are more likely to be partially, or at times completely, reality-based.”
SCHIZOPHRENIA: “Some gay/lesbian affirmative therapists do an enormous disservice to their clients who are gay or lesbian and schizophrenic by minimizing or ignoring the client’s schizophrenia.” Some therapists “interpret aspects of schizophrenia (such as interpersonal awkwardness; chronic lack of desire, pleasure deficit; disordered thought process; pervasive ambivalence; etc. as signs of ‘not really accepting one’s gayness.’ They may then pressure or shame such client into moving beyond their capabilities. This can be genuinely damaging, particularly if done in a group therapy setting where group members mimic the therapists and provide considerable pressure. Some years ago, this author had to hospitalize one such individual who became psychotic and suicidal as a result of such pressure in a coming out group.”
BORDERLINE: “At time, the person having a sexual identity crisis may appear floridly disturbed and “borderline-ish” than a true borderline personality in crisis.”
“The processes of coming out are often profound and may shake an individual to his or her core. This alone may account for the production of florid symptoms.”
“…some individuals with obsessional or counter phobic personality features may experience a flooding when coming to terms with same-sex feelings.”
“…the development of borderline appearing personality features is response to repeated anonymous sexual behavior…A gay man begins to frequent back-room bars, baths, public restrooms, parks or other public places for anonymous sex. He, on occasion, does have anonymous sex, which may be reinforcing and perceived as a boost to self-esteem. On another level, it may elicit a variety of guilt and self-recrimination responses if the individual has beliefs that sexuality, or same-sex activity, or some forms of sexual activity in which he has been engaging in are immoral, improper… both the thrill of success at sexual conquest and the negative feelings may become even more highly charged…. One way of handling this situation is via splitting operations. The result in these individuals is an overlay of borderline-appearing personality functions on a variety of pre-existing personality styles.”
“…such disease-orientated writers have described lesbian relationships as a pathological interaction between two individuals with borderline features, if not actual borderline personalities.”
NARCISSISM: “…narcissistic-appearing overlay…The appearance of these individuals may be one of extreme narcissism, shallowness and almost complete immersion of the personality in the changing whirlwinds of high fashion, the latest chic, or the ‘right’ social circles.”
DISORDER: “…these overlays may be tenacious or even become permanent aspects of personality. Some victims may be scarred psychologically with the marks of social oppression of homosexuality.”
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Gonsiorek, J. (1991) The empirical basis for the demise of the illness model of homosexuality (in Gonsiorek, J., Weinrich, J. (ed) Homosexuality: Research Implications for Public Policy. Newbury Park CA: Sage) 115 – 136.
FAMILY: The model of pathological homosexuality is rejected. Rejects the theories of family dysfunction as a cause of homosexuality.
RESEARCH: Researcher bias, as well as methodological inadequacies characterize studies supporting the illness model. Hooker (1957) referenced.
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Gonsiorek, J., Sell, R., Weinrich, J. (1995) Definition and measurement of sexual orientation. Suicide and Life Threatening Behavior. 25( sup) : 40 – 51.
ABSTRACT: “Critically examines how sexual orientations (SO) are measured and defined. The conceptualization problems of homosexuality are highlighted along with the role played by cultural factors. Measurements of SO include in-depth interviews, survey and cross-cultural studies, which face problems of self-disclosure risks. Physiological measures, like plethysmyograph, also have limitations with involuntary Ss. The commonly used measurement, verbal self-report, faces limitations like Ss having to accurately appraise themselves. The limitation of current conceptualizations of SO is lack of research on change over time. Caution is raised against measurement concerns with adolescents are made, a specific measurement strategy, applicable at a number of different levels are described.”
CHANGE: “Perhaps the most dramatic limitations of current conceptualizations is change over time. There is essentially no research on the longitudinal stability of sexual orientation over the adult life span.”
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Green, R. (1988) The immutability of (homo) sexual orientation: Behavioral science implications for a constitutional (legal) analysis. The Journal of Psychiatry and Law. 16: 537- 573.
ABSTRACT: “The Supreme Court ruled in Bowers v Hardwick that there is no fundamental right under a substantive due process analysis to engage in homosexual behavior. Therefore, the remaining constitutional route to protecting homosexuals against discrimination is the equal protection clause of the fourteenth amendment. For the highest level of protection there, a class of persons must be declared “suspect.” To so qualify, the class should demonstrate, Inter alia, that the trait for which it is stigmatized is immutable. Growing research evidence exists for an innate origin of homosexuality. More importantly, whatever its origins, the low rate of sexual reorientation, via psychiatric intervention satisfies the concept of immutability. The Court’s criteria are met for applying the strictest of scrutiny to laws that discriminate against homosexuals.”
CHILDHOOD: Green uses results of a longitudinal study of 64 boys with extensive cross-gender behavior to argue for “the very early and essentially irreversible establishment of sexual orientation in the male.”
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Haldeman, C., (1991) Conversion therapy for gay men and lesbians: A scientific examination. (in Gonsiorek, J., Weinrich, J. (ed) Homosexuality: Research Implications for Public Policy. Newbury Park CA: Sage) 149 -160.
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Haldeman, D. (1994) The practice and ethics of sexual orientation conversion therapies. Journal of Consulting and Clinical Psychology. 62: 221 -227.
ABSTRACT: “Sexual orientation conversion therapy was the treatment of choice when homosexuality was thought to be an illness. Despite the declassification of homosexuality as a mental illness, efforts to sexually reorient lesbians and gay men continue. The construct of sexual orientation is examined, as well as what constitutes its change. The literature in psychotherapeutic and religious conversion therapies is reviewed, showing no evidence indicating that such treatments are effective in their intended purpose. A need for empirical data on the potentially harmful effects of such treatments is established. Ethical considerations relative to the ongoing stigmatizing effects of conversion therapies are presented. The need to develop more complex models for conceptualizing sexual orientation is discussed, as well as the need to provide treatments to gay men and lesbians that are consonant with psychology’s stance on homosexuality.” (p.211)
CHANGE: “The categories homosexual, heterosexual, and bisexual, conceived by many researchers as fixed and dichotomous, are in reality very fluid… Essentially, the fixed, behavior-based model of sexual orientation assumed by almost all conversion therapists may be invalid. For individuals, sexual orientation is a variable construct subject to changes in erotic and affectional preferences, as well as changes in social values and political philosophy that may ebb and flow throughout life.”
RELIGION: “Fundamentalist Christian conversion programs hold enormous symbolic power over many people. Possibly exacerbating the harm to naive, shame-ridden counselees, these programs operate under the formidable auspices of the Christian church….”
DISORDER; “Were there properties intrinsic to homosexuality that make it a pathological condition, we would be able to observe and measure them directly. In reality, however, there exists a wide literature indicating just the opposite: that gay men and lesbians do not differ significantly from heterosexual men and women on measure of psychological stability, social or vocational adjustment, or capacity for decision making.” (p.225)
RELIGION: “Such programs seek to divest the individual of his or her ‘sinful’ feelings or at least to make the pursuit of a heterosexual or celibate lifestyle possible. their theoretical base is founded on interpretations of scripture that condemn homosexual behavior, their often unspecified treatment methods rely on prayer, and their outcomes are generally limited to testimonials. Nonetheless, these programs bear some passing examinations because of the tremendous psychological impact they have on the many unhappy gay men and lesbians who seek their services and because of some psychologists’ willingness to refer to them. Lastly, many such programs have been associated with significant ethical problems.”
“Gay men who are most likely to be inclined toward doctrinaire religious practice are also likely to have lower self-concepts, to see homosexuality as more sinful, feel a greater sense of apprehension about negative responses from others, and are more depressed in general. (Weinberg & Williams, 1974) Such individuals make vulnerable targets for the ‘ex-gay” ministries, as they are know. Fundamentalist Christian groups, such as Homosexuals Anonymous, Metanoia Ministries, Love in Action, Exodus International, and EXIT of Melodyland are the most visible purveyors of conversion therapy. The workings of these groups are well documented by Blair (1982) who states that, although many of these practitioners publicly promise change, they privately acknowledge that celibacy is the realistic goal to which gay men and lesbians must aspire. He further characterizes many religious conversionists as individuals deeply troubled about their own sexual orientation, or whose own sexual conversion is incomplete. Blair reports a host of problems with such counselors, including the sexual abuse of client.”(p.224)
FATHER: “Nicolosi… cites numerous studies that suggest that gay men have greater frequencies of disrupted bonds with their fathers, as well as a host of psychological concerns, such as assertion problems. These observations are used to justify a pathological assessment of homosexuality. The error in such reasoning is that the conclusion has preceded the data. There may be cause to examine the potentially harmful impact of a detached father and his effect on the individual’s self-concept or capacity for intimacy, but why should a detached father be selected as the key player in causing homosexuality unless an a priori decision about the pathological nature of homosexuality has been made and unless he is being investigated as the cause? This perspective is not consistent with the available data, nor does it explain the millions of heterosexual men who come from backgrounds similar to those of gay men, or for that matter, those gay men with strong father-son relationships. Nicolosi does not support his hypothesis or his treatment methods with any empirical data.” (223)
RESEARCH: “APA “fact sheet of Reparative Therapy” opens with the following statement: ‘No scientific evidence exists to support the effectiveness of any of the conversion therapies that try to change sexual orientation.’ A review of the literature makes it obvious why this statement is made.”
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Hammersmith, S. Weinberg, M. (1973) Homosexual identity: Commitment, adjustment, and significant other. Sociometry. 36, 1: 56 – 79.
“… the young homosexual experiences guilt and shame, anxiety, depression and feelings of worthlessness, but that he is largely relieved of these feelings when he ‘accepts’ his homosexuality.”
“The person who defines himself as homosexual may still regret the identity. The homosexual may resign himself to his homosexuality as a fact of life and yet feel that he would really rather be “a homosexual.”
“… having ‘settled into’ a homosexual identity — leads to better psychological adjustment as indicated by a more stable, positive self-image, fewer anxiety symptoms, and less depression. In addition, one model proposes that support of his homosexual identity by significant others positively influences the homosexual’s commitment to that identity.”
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Harry, J. (1985) Sexual orientation as destiny. Journal of Homosexuality. 10, 3/4: 111 – 123.
CHILDHOOD: “My theses are that sexual orientation is (1) best defined in terms of attitudes or preferences rather than sexual behavior; (2) largely immutable during adult life; and (3) established at least as early as childhood.”
“The evidence indicates that the basis for sexual orientation, if not the orientation itself, is established by early childhood. The evidence for this is the repeated finding that, as children, homosexuals of both sexes were far more likely than heterosexuals to be gender nonconformists or cross gendered.
CHANGE: I believe that my review of the evidence indicates that sexual orientation is immensely resistant to change, that it is established early in life, and that most of the evidence suggesting flexibility pertains only to sexual behavior.
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Hencken, J. (1982) Homosexuality and psychoanalysis: Toward a mutual understanding. (in Paul, W., Weinrich, J., Gonsiorek, J., Hotvedt, M.(eds) Homosexuality: Social, Psychological and Biological Issues. The Final Report of the Society for the Psychological Study of Social Issues Task Force of Sexual Orientation. Beverly Hills CA: Sage.) 121 -148.
FAMILY: “There is another way to view the information about a person’s childhood one acquires in the psychoanalytic situation. This approach emphasizes not the search for causes in the past, but rather understanding of the ways in which people make psychological use of their childhood experiences in the current way they see their lives… In short , the emphasis in this approach is on psychological significance or meaning, rather than on causes.”
“Moreover, the model presupposes that there was only one form of mature, adult personality — the heterosexual ‘genital character.'”
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Herek, G. (1991a) Myths about sexual orientation: A lawyer’s guide to social science research. Law & Sexuality. 1: 133 – 172.
CHANGE: “Myth #3: Being homosexual is a choice that can be changed. The questions of whether sexual orientations are inborn or acquired and, if the latter, whether they are immutable or changeable, have aroused considerable controversy. some arguments for societal acceptance of lesbians and gay men have been based on the notion that homosexuality is an innate condition over which an individual has no choice. Writing as parents of gay children, for example, Griffin, Wirth, and Wirth described their own initial concerns that they might have caused their children’s homosexuality. They argued for a biological explanation of homosexuality partly because: ‘our society will accept gayness only if the vast majority of its citizens see it as a naturally occurring event. If most people understand that a certain percentage of society will be gay no matter what their family background is, or what their sexual experiences were, then gay people have a better chance of living lives free from fears of retaliation.’
“Perhaps agreeing with Griffin and others’ equation of ‘natural’ and ‘innate,’ Americans who believe that homosexuality ‘is something that people are born with’ are more likely to have accepting attitudes of gay people than are those who believe it is an acquired characteristic or a personal preference.”
“Given the current lack of knowledge about why some individuals develop a heterosexual orientation while others become homosexual, most social and behavioral scientists share Money’s view that sexuality is shaped through a complex interaction of biological, psychological, and social forces. The relative importance of each, however, remains a topic of dispute.”
“Even for the relatively small number of gay people who wish to become heterosexual, the many failures of so-called ‘conversion’ therapies indicate that, once established, sexual orientation is highly resistant to change.”
“As recently as January of 1990, Dr. Bryant Welch, Executive Director for Professional Practice of the American Psychological Association, stated that “no scientific evidence exists to support the effectiveness of any of the conversion therapies that try to change one’s sexual orientation’ and that ‘research findings suggest that efforts to ‘repair’ homosexuals are nothing more than social prejudice garbed in psychological accouterments.'”
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Herron, W., Kinter, T., Sollinger, I., Trubowitz, J. (1982) Psychoanalytic psychotherapy for homosexual clients: New concepts. (in Gonsiorek Homosexuality and Psychotherapy. NY: Haworth)
CHANGE: “Although a few psychoanalysts report success in his regard, their work gives no proof of absolute or eternal absence of all homosexual interests, desires and thoughts in their ‘changed’ patients.”
“The majority psychoanalytic position, however, remains at variance with the APA decision… the reigning psychoanalytic attitude continues to be that homosexuality is a developmental disturbance to be resolved by conversion to heterosexuality.”
“We view psychoanalysis as a developmental psychology with therapeutic applications that enable the patient to learn to make life choices based upon self-understanding. We believe sexual orientation to be one of these learned decisions, a decision based on constitutional and experiential occurrences.”
“Changing a person’s sexual behavior from homosexual to heterosexual might be accomplished by working with a potential already present, but this would not really change the person’s preference. While it may appear that psychoanalysis can change a person’s sexual orientation, in truth this is a limited accomplishment that happens only occasionally and even then is of questionable duration.”
CASE STUDIES: Describe the “various derivations and uses of homosexuality. All these people were experiencing problems they regarded as connected to their homosexuality, although not all saw their sexual orientation as a major source of concern.”
Client 1: “He identified most strongly with his mother and appeared to feel he was restoring symbiosis through homosexual acts… He was extremely anxious, intermittently depressed with suicidal ideation, and filled with rage toward the world.”
Client 2: Bisexual “His rather narcissistic orientation interferes with his comprehension of how his wife and lover feel about him and how they feel about his behavior towards them. The narcissism, rather than the homosexuality, has become the focal problem of his therapy.”
Client 3: Interested primarily in autoerotic sex. Domineering mother and sister and passive ineffectual father.
Client 4: Female suffered considerable rejection by her father. Angry and assertive.
Client 5: Feared intercourse with men. Lesbianism as a quest to regain the image of her lost mother.
Client 6: Priest, outwardly angry father, feels enhanced only be a sexual encounter with an attractive man.
Client 7: Priest, father passive and frightened, feels excessive guilt about sexual desires “Through therapy he has begun to realize that leaving the priesthood would allow him to pursue a homosexual life-style more freely.”
“Our belief that all sexual behavior can serve a variety of purposes includes the conviction that homosexuality can be a ‘healthy’ sexual orientation.”
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Hetrick, E., Stein, T. (1984) Ego-dystonic homosexuality: A developmental view. (in Innovations in Psychotherapy with Homosexuals. Washington DC: APA)
RELIGION: “… a child raised in a religiously orthodox family may have emotional and psychological difficulties reconciling religious and sexual identities.”
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Hooberman, R. (1979) Psychological androgyny, feminine gender identity, and self-esteem in homosexual and heterosexual males. The Journal of Sex Research. 15, 4: 306 – 315.
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Hooker, E., Ziemba-Davis, M. (1990) Epilogue.(in McWhirter (ed) Homosexuality/ Heterosexuality) 400 – 402.
KINSEY: “I … owe a great debt of gratitude to Alfred Kinsey without whom I would have had neither the courage to pose my questions nor the knowledge to frame them in the manner in which I did.”
“In conclusion, we would like to note one other contribution of Dr. Kinsey: his validation of the many different variant of sexual orientation. Kinsey was very explicit in stating that, for example, homosexuality was a valid or as ” normal” as heterosexuality for the individuals involved.
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Hopcke, R. ( 1990) Dorothy and her friends. Quadrant. 22, 2: 65 – 77.
HETEROSEXISM: “Patriarchal values identify particular personal characteristics as exclusively male or female, and assign social roles largely in terms of gender; in general, the characteristics and roles assigned to men are valued over those assigned to women.”
“A heterosexist culture views heterosexuality as the only normal, and therefore acceptable, means of fulfilling human relationships. Accordingly all other forms of sexual relationship are considered either subordinate to or perversions of heterosexual relationships. The primacy of heterosexuality over same-sex or inter-sex relationships enjoys wide support from nearly every important cultural institution — and has a long but by no means monolithic history.”
HOMOPHOBIA: “Unlike heterosexuals, gay people have no model of self-image or relationship in the culture at large to support a growing awareness of their homosexuality. This lack of external cultural supports for their sexual and emotional development creates a peculiar and frequently destructive psychosocial vacuum for gay people, who often have a difficult time acknowledging their gay feelings and identity. Until quite recently, what seemed to be manifestations of pathology within homosexually oriented persons were understood as characteristics of homosexuality per se, rather than unfortunate adaptive responses to the fierce prejudice, horror, and hatred shown to homosexuality in Western society. By removing ‘homosexuality’ from their list of mental disorders in 1973, and in the latest revision eliminated even “ego-dystonic homosexuality” as a mental disorder, the American Psychiatric Association has at last acknowledged that social hatred, rather than same-sex love, is the true elements of pathology in gay people’s lives.
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Isay, R., Friedman, R. (1989) Toward a further understanding of homosexual men Journal of the American Psychoanalytic Association.
NARCISSISM: “Homosexuality may be considered a specific form of narcissism. clinical evidence provides evidence that homosexual object choice should not be taken as evidence of pathological narcissism, however. I propose that we take as their unique differentiating characteristic the conscious persistent choice of members of the same sex as objects of love or desire.
CHANGE: Isay suggests that “at some point in every intensive therapy, every gay patient expresses unhappiness and dissatisfaction with his homosexuality.” It is important to treat this dissatisfaction analytically rather than accept it at face value.
“With psychotherapy, the irrational aspects of the wish to become heterosexual emerged.”
“One reason previous therapy had failed was the expressed desire to give up homosexuality (agreed with by a well intentioned therapist) functioned in service of masochism.” .
BORDERLINE: “…homosexuality in any form, as far as we know, is not associated with any syndrome of psychopathology more than any other. .. The absence of such research to date is important since clinicians who see “borderline homosexuals” may assume a causal relation between the two conditions. In the case of individual borderline patients such causal relations may indeed exist. For example, the perception of a homosexual identity may be a symptom of identity diffusion in a borderline patient. In this type of situation it is not the homosexual identity per se that is pathological, but rather, a patient who suffers from a global character pathology uses the homosexual identity in a pathological manner.
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Isay, R. (1985) On the analytic therapy of homosexual men. Psychoanalytic Study of the Child. 40:235 -254.
ABSTRACT: “Defines a homosexual as a person who has a predominant erotic preference (expressed in fantasy), usually for a long period of time, for other s of the same sex. It is suggested, on the basis of clinical experience, that efforts to change sexual orientation in analysis may cause symptomatic depression and, in some cases, severe social problems later in life. It is posited that the analyst’s internalized social values interfere with the proper conduct of an analysis by causing the analyst to be unable to convey an appropriate positive regard for his/her patient or to maintain therapeutic neutrality. Five case examples are presented to illustrate this position and the emotional and social consequences of the attempted and seemingly successful change from homosexuality to heterosexuality.”
ANTI-CHANGE: Reorientation therapy can cause symptomatic depression and social problems later in life by contributing to an already damaged self-esteem.
“I believe it is likely that observations of successful conversion of “homosexual” patients to heterosexuality over an indefinite or extended period of time are, in fact, due to successful suppression of the homosexual component in men who have a strong bisexual orientation.” (p.251)
CASE: 47 year old married man with 2 daughters, who had completed analysis in his late 20’s. Previously an active homosexual life and a passionate love. Still had homosexual fantasy although he was content with his conventional life.
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Isay, R. (1990) Psychoanalytic theory and therapy of gay men. (in McWhirter, D. (ed) Homosexuality/Heterosexuality. NY: Oxford.) 283 – 306.
CASE: Defensive homosexuality in heterosexuals. Charles became increasingly aware during the course of his analysis of sadistic and spiteful rage toward her and toward other women because of frustrated sexual longings and the feeling of being demeaned by her.”
CHILDHOOD: “Every gay man I have seen reports that beginning at age 3 or 4 he experienced that he was “different” from his peers. This feeling is described as having been more sensitive, crying more easily, having his feelings hurt more readily, having more aesthetic interests, and being lies aggressive than others of such age. Such differences make children feel like outsiders in relation to peers and often to family as well.” “In my much smaller clinical sample I have found that many of the same characteristics described in these studies of effeminate boys, except for the cross-dressing , are recollected in gay men whom I do not consider to have gender identity disorders, that is, they experience and perceive themselves as men not women. Nor have I observed any qualitative distinction in the early experience described by those men who as adults are more conventionally masculine in appearance and those whose behavior appears are more androgynous or feminine.” (301)
DISORDER: “…there are homosexuals who are sadistic, masochistic, narcissistic, depressed, borderline, or psychotic, that is, who run the spectrum of psychological disturbances. Those men who are gay and have such psychological disturbances dynamically resemble their heterosexual counterparts more closely than they do each other.
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Jensen, J. (1999) A Psychiatrist’s Response to the Latter Day Saints Social Services National Affirmation Annual Conference.
REVIEW: LDS Social Services document “Understanding and Helping Individuals with Homosexual Problems”
LDS SS document “… unqualified and unjustified use of concepts steeped more in the prejudices of Western tradition which date back to the turn of century than in modern social or psychological sciences.”
RELIGION: “In order for LDS Social Services to “offer a reparative therapy approach which assumes that homosexual behavior can be changed,” they had to leave the mainstream of the mental health professions and shop around for anyone whose own prejudices match those of “the church” no matter how unjustified, antiquated, unscientific, ineffective, harmful and unethical their belief and practices may be. This unfortunate collision has compromised the scientific integrity of LDS Social Services and — by extension — the LDS Church; a retreated, closed, propagandistic and anxiety- maintained position which is untenable for a people whose prominent motto is ‘the glory of God is intelligence.'”
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Johnsgard, K., Schumacher, R. (1970) The experience of intimacy in group psychotherapy with male homosexuals. Psychotherapy: Theory, Research, & Practice. 7: 173 – 176.
Group therapy for male homosexuals which emphasized truth, openness, expression of feelings and intimacy.
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Koertge, N. (1990) Constructing concepts of sexuality: A philosophical commentary. (in McWhirter (ed) Homosexuality/Heterosexuality. NY: Oxford.
CONSTRUCTIONISM: “If sexuality is largely constituted by belief systems, why aren’t sexual orientations more labile? Shouldn’t I just be able to think myself into a new sexual category? Yet psychoanalysts, experts in the talking “cure” are remarkably unsuccessful in changing the preferences even of clients who really want to change. ..Artemis Moonglow, a so-called political lesbian reminds us, some people do appear to think their way into a new form of sexual life.”
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Kus, R. (1985) Stages of coming out; An ethnographic approach. Western Journal of Nursing Research. 7, 2: 177 – 198.
COMING OUT: “…’coming out’ is defined as: that process by which a gay individual identifies self as gay, changes any previously held negative notions of gays or homosexuality, accepts being gay as a positive state of being, and acts on the assumption that being gay is a positive state of being.
CASE: “But I can never view the heterosexual portion of our society without some, and probably a fair amount of distrust. I do not, and never will, really trust the straight world, And I don’t know why I should…”
CHILDHOOD: “… gay children grow up thinking they are straight persons. Thus unlike racial and ethnic minorities, gay have not had the opportunity of several years of childhood to learn adequately what being a minority in America means. Also, gays do not have gay parents and a host of gay relatives after whom to model themselves’ there is no anticipatory socialization process for the gay child. Therefore, upon learning one is gay, overwhelming feelings of aloneness can, and most often do, occur.”
“in retrospect, I’ve always been gay. I always knew that as a child I was somehow “different” from other people.
In the accounts of gay men, there is often seen what Reid (1973) calls “The Best Little Boy in the World” syndrome, characterized by a childhood of high achievement, heightened sensitivity to adult expectations with accompanying model performance, politeness, and non-commitment to the usual “rough-and-tumble” activities often seen in boys. ..Lesbians on the other hand, often recount what I call a ‘Rubyfruit Jungle (Brown 1973) type of childhood characterized by sports, and bucking of traditionally “feminine” trappings of dress and behavior.” (183)
CHANGE: “… many gays in Stage 1 report not wanting to be gay.”
DISORDER: “Some of the common health problems in this stage — as reported by my informants and the literature — include severe guilt and diminished self-esteem, stress and its physical manifestations (such as ulcers, a sense of overwhelming aloneness leading to loneliness, inability to focus on academic learning and other tasks at hand, and depression. Suicidal ideation, estimated to have occurred in 40% of the gay population (Jay & Young 1979, p. 728) often is experienced at this stage. Likewise, a pattern of drinking may begin here that can lead to alcoholism, perhaps the most severe and widespread health problem in both the gay and lesbian population. Finally, in rare instances, the gay man may experience an actual acute psychotic episode.
RELIGION: “…one must remember that this century has produced such antigay crusaders as Hitler, Stalin, Bryant, and Falwell, and such antigay movements as Nazism, the Klan, and the “Moral Majority.”
PROMISCUITY: “…gay men are often uncomfortable with what they initially define as ‘promiscuity’ in the gay community. ”
“…sexually transmitted disease (STD) is often seen in this stage especially among gay men. (187)
DRUGS: “…during eight years of practicing in acute psychiatric settings as a nurse therapist, I have seen many gay clients (almost all men) who overdose, are depressed, and are filled with a sense of hopelessness.
SCHIZOPHRENIA: “It is highly likely, for example, that the schizophrenic patient saying ‘I am gay’ is not gay at all. It is possible that the gay client accepts being gay as a positive life force yet is depressed for other reasons.”
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Lawson, R. (1987) Scandal in the Adventist-funded program to heal homosexuals: Failure, sexual exploitation, official silence, and attempts to rehabilitate the exploiter and his methods. Paper presented at the annual convention of the American Sociological Association Chicago IL . June.
Investigation of Colin Cooks’ Quest ministry, charges that Cook engaged in sexual relations with some clients.
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Lief, H., Kaplan, S. (1986) Ego-dystonic homosexuality. Journal of Sex and Marital Therapy. 12, 4: 259 – 266.
DISORDER: DSM-III diagnosis of Ego-dystonic homosexuality: a) heterosexual arousal is absent or weak; b) a pattern of homosexual arousal is a persistence source of distress and unwanted;
CASE: Homosexually active man, tried to give up homosexuality when mentor “gave the patient paternal interest and affection that he had never received from his own father.” Patient had severe depression, apathy, emotional detachment, and suicidal impulses. Therapy helped him accept homosexual impulses and lifestyle.
CHOICE: “The patient coming in with a dysphoria over his or her homosexual feelings, fantasies or behavior must be give the choice of working through the homophobia or the heterophobia. With the first choice, treatment is directed toward decreasing shame over the homosexual orientation and integrating the patients social role and personal identity.”
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Martin, A. (1984) The emperor’s new clothes: Modern attempts to change sexual orientation. (in Stein, T, Hetrick, E. Innovations in psychotherapy with homosexuals. Washington DC: American Psychiatric Press) 24 -57.
RELIGION: “… the patient told that success depends on his or her “motivation” and “choice.” In other words, in both therapy and religion, success or failure becomes the responsibility of the patient/believer. Unfortunately, clinicians pay little attention to the tactic’s potential for negative outcomes in therapy, particularly for those already burdened with societally induced guilt and shame.”
CHANGE: “Leaving aside for the moment the very important observation that there is no an iota of evidence to support the simplistic notion that because one can perform heterosexually or homosexuality under certain restricted conditions one can choose one’s sexual orientation, what does it mean when the client, convinced that the choice is his or hers, either suffers a “treatment reversal” or never succeeds?”
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May, E. (1977) Discussion of: recent trends and new developments in the treatment of homosexuality” by James J. Hinrichsen and Martin Katahn. Psychotherapy: Theory, Research and Practice. 14, 1: 18 – 20.
Review of literature on therapy supporting a homosexual adjustment – 1971 to 1976. Critical of Hinrichsen & Katahn who ignored this trend.
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Maylon, A. (1982) Psychotherapeutic implications of internalized homophobia in gay men. Journal of Homosexuality. 7, 2/3: 59 -70.
HOMOPHOBIA: “Since homophobic beliefs are a ubiquitous aspect of contemporary social mores and cultural attitudes, the socialization of the incipient homosexual individual nearly always involves an internalization of the mythology and opprobrium which characterize current social attitudes toward homosexuality.” (60)
“Other aspects of ego development may continue, but the rejection of homosexual proclivities truncates the process of total identity formation.”
“This theoretical disposition regards homosexuality as a non-pathological human potential…. gay-affirming approaches to psychotherapy consider oppression and ant-homosexual attitudes to be just two of many factors that influence the process of personality formation and psychological adaptation.”
INTERNALIZED HOMOPHOBIA: “Conscious attitudes are rather easily modified. Repressed anti-homosexual material, however, is much more difficult to apprehend and change. The derivatives, elaborations, and developmental consequences of introjected homophobia are as pernicious as the original internalized attitudes. Therefore, an important goal of this stage of psychotherapy is to illuminate the many complex secondary and tertiary adaptations which are abstractions of homophobia; for example, low self-esteem, lack of psychological congruity and integration, overly embellished and ossified defense, problems with intimacy, and a particular vulnerability to depression.”
“The initial awareness of more-than-incidental homosexual promptings usually has profound psychological implications. It is nearly always accompanied by feelings of intense anxiety, despair, and intrapsychic conflict. This affective response brings about a dramatic potentiation of suppressive defenses. Conflict over burgeoning homosexual awareness also activates the process of stimulus generalizations. This augments a gradual stigmatization of all intense affective phenomena (Clark 1977), prompting an even more profound elaboration of the already established defensive motif (suppression, denial, and over -compensation). This, in turn, leads to an inhibition and compartmentalization of all eroticized impulses. This psychological fragmentation of sexual and affectional proclivities interferes with the developmental process; that is, an integrated and positive identity cannot be established so long as eroticized desires and capacities are repugnant and constantly, estranged. In the absence of identity consolidation, further development cannot take adequate advantage of maturation of more differentiated and complex psychological and interpersonal capacities. Thus, one of the more significant outcomes of homophobic bias is an arrest of the developmental process. The other major consequence is the contamination of self-concept.”(p.66)
“… the therapist’s unconditional acceptance of homoerotic capacities is a necessary countervalence for earlier anti-homosexual cultural conditioning.”
“Anti-homosexual attitudes (both exogenous and internalized), masculine sex-role stereotypy and conditioning, insufficient eroticized and affectional pre-intimacy involvements with other males, and relative unavailability of models of male intimacy, all interfere with the development of the capacity for long-term and mutually satisfying love relationships among gay men.” (p.67)
RELIGION: “Traditions such as the nuclear family, orthodox, religious beliefs, rigid sex-role models, and conservative morality are not relevant reference points for most adult gay males in search of personal meaning and integrity.”(p.68)
HOMOPHOBIA: “Gay-affirmative therapy uses traditional psychotherapeutic methods but proceeds from a non-traditional perspective. This approach regards homophobia, as opposed to homosexuality, as a major pathological variable in the development of certain symptomatic conditions among gay men.” (p.69)
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McConaghy, N. (1987) Heterosexuality/homosexuality: Dichotomy or continuum? Archives of Sexual Behavior. 16, 5: 411 – 423.
ABSTRACT: “A recent reanalysis (Van Wyk and Geist (1984) Psychosocial development of heterosexual, bisexual, and homosexual behavior. Archives of Sexual Behavior. 13: 505 -544.) of Kinsey’s data rejected his conclusion that heterosexuality and homosexuality were a continuum.”
KINSEY: “The findings of the present study support Kinsey’s concept of a heterosexual-homosexual continuum with a significant percentage of the population aware of a homosexual component, rather than Van Wyk and Geist’s interpretation of the Kinsey data, that heterosexuality and homosexuality are polar extremes with only a small minority aware of homosexuality.”
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Murphy, T. (1992) Redirecting sexual orientation: Techniques and justifications. Journal of Sex Research. 29: 501- 523.
HETEROSEXISM: “There would be no reorientation techniques where there no interpretation that homoeroticism is an inferior state, an interpretation that in many ways continues to be medically defined, criminally enforced, socially sanctioned, and religiously justified. And it is in this moral interpretation, more than in the reigning medical theory of the day, that all programs of sexual reorientation have their common origins and justifications.”(520)
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Neisen, J. 1993) Healing from cultural victimization: Recovery from shame due to heterosexism. Journal of Gay and Lesbian Psychotherapy. 2, 1: 49.
ABSTRACT: The author draws parallels between the painful effects of sexual/physical abuse and heterosexism. Heterosexism is defined as a form of cultural victimization that oppresses gay/lesbian/bisexual person. Heterosexism stymies individual growth and development just as individuals who have been sexual/physically abused struggle with the painful effects of their own victimization. Recognizing heterosexism as a form of victimization and abuse, the parallels between the effects of sexual/physical abuse and heterosexism become more clear. A paradigm based on the healing process for individuals who have been sexually/ physically abused can also be used with individuals who have been culturally victimized. The utility of the paradigm is in providing helping professionals and their gay/lesbian/bisexual clients a means to articulate (1) how heterosexism is abusive, (2) the painful consequences of victimization, and (3) the healing process.
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Nelson, J. (1982) Religious and moral issues in working with homosexual clients.(in Gonsiorek, J. Homosexuality and Psychotherapy. NY: Haworth) 163
ABSTRACT: “While strict moral and religious neutrality in psychotherapy is problematic at best, the therapist working with homosexual clients particularly needs clarity about her or his own moral and religious assumptions, together with a knowledge of the Judeo-Christian tradition on the subject. This article examines the biblical evidence and current theological arguments about homosexuality. Christianity as an incarnational faith is a sex-affirming religion, with positive resources for lesbian and gay men. An analysis of homophobia concludes, maintaining the position that the church as a whole will benefit great from the liberation of gay men and lesbians from oppression.”
“I consider ‘homosexuality’ an abstraction. There is no such thing as ‘homosexuality’ per se.”
RELIGION: “…my own conviction … that homosexuality is a Christianly valid orientation; that homosexual genital expression should be guided by the same general ethical criteria as are appropriate for heterosexual expression, though with sensitivity to the special situation of an oppressed minority… ”
PROMISCUITY: “Given the realities of social oppression, it is insensitive and unfair to judge gay men and lesbians by a heterosexual ideal of the monogamous relationship. … that other sexual encounters and experiences can have elements of genuine good in them even while falling short of the optimum remains an open possibility.”
“For the gay male or lesbian couple who intend a covenant of indefinite duration, will ‘fidelity’ always mean ‘genital exclusivity’? Some such couples (as is true of some heterosexual couples) have explored relationship that admit the possibility of sexual intimacy with secondary partners. For these couples ‘infidelity’ does not have a simple biological meaning (sex with someone other than the permanent partner). Rather, infidelity means the rupture of the bonds of faithfulness, trust, honesty, and commitment between to the partners well-being and growth, a commitment to the primacy of this covenant over any other relationship. While there are undoubted risks for such a course of action, and while the weight of Christian tradition is on the side of sexual exclusivity, there are also risks when a couple’s relationship becomes marked by possessiveness.”
HOMOPHOBIA: “In a word, churches and society both desperately need release from homophobia, that irrational fear of same-sex orientation and expression.”
“While some resistance to homosexuality is, to be sure based upon calm and reasoned religious belief… undoubtedly much is based upon unreasoned, ill-understood emotional reactions.”
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Pillard, R. ( 1982) Psychotherapeutic treatment for the invisible minority. (in Paul, W., Weinrich, J., Gonsiorek, J., Hotvedt, M.(eds) Homosexuality: Social, Psychological and Biological Issues. The Final Report of the Society for the Psychological Study of Social Issues Task Force of Sexual Orientation. Beverly Hills CA: Sage) 99
CHANGE: “The conviction of therapists that treatment causes a change in sexual orientation sometimes comes not from studies of outcome but from intimate participation in process — that is, the observation that a shift in patient dynamics followed some technical maneuver or the recovery of a repressed memory or the overcoming of a resistance.”
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Reece, R. (1982) Group treatment of sexual dysfunction in gay men. (in Paul, W., Weinrich, J., Gonsiorek, J., Hotvedt, M.(eds) Homosexuality: Social, Psychological and Biological Issues. The Final Report of the Society for the Psychological Study of Social Issues Task Force of Sexual Orientation. Beverly Hills CA: Sage) 113 –
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Reiter, L. (1989) Sexual orientation, sexual identity, and the question of choice. Clinical Social Work Journal. 17, 2: 140.
ABSTRACT: “Sexual orientation, determined early in life, may or may not match sexual identity, which can change over time. Starting with a review of some definitions of homosexuality in the literature, the author offers a definition that differentiates between orientation and identity. She goes on to describe several possible routes from gay orientation to gay identity, explains discrepancies, acknowledges the potential threat to subjective identity when sexual identity shifts, and argues that identity, not orientation, is open to choice. Two case examples illustrate some of these points.”
CHANGE: Regards sexual orientation as immutable, but admits that there is change.
“Free will does indeed allow choice in lifestyle and the identities people construct. Sexual orientation, determined very early in life, is an enduring and essential psychological reality, transcending choice.”
CASE: Alice, 32-year old with a history of sexual child abuse. “Her parents’ willingness to maintain a relationship with (the abuser) was a source of rage for Alice.” She had a very of heterosexual intercourse and childbirth. A recovering alcoholic and drug addict. Ex-Catholic. Heterosexual fantasy. Self-identified as lesbian.
Alan, gay-identified, late 20s, “who remembers always feeling different and flawed and not fitting in with the other children for whose company he longed. Besides homosexual affairs, he has had pleasurable sexual experiences with women and occasional sexual fantasies about women. Has considered the possibility of marriage and fatherhood feels that as a gay man he has the freedom to choose a heterosexual lifestyle.
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Rich, A. (1980) Compulsory heterosexuality and lesbian experience. Signs. 5: 631 – 660.
HETEROSEXISM: Opposes the normativeness of heterosexuality and compulsory heterosexuality.
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Richardson, D. (1987) Recent challenges to traditional assumptions about homosexuality: Some implications for practice. Journal of Homosexuality. 13, 4: 1 -12.
ABSTRACT: “Discusses recent theoretical inquiry into homosexuality that is challenging the traditionally held view that people have an essential sexuality that is either homosexual or heterosexual, which remains fixed and unchanging throughout their lives. Clinical implications of these recent developments are addressed in particular, the suggestion that the homosexual as a certain type of person is an invention. The therapeutic value and difficulties associated with an acknowledgment that sexual preference and identity may change over time are considered. Goals are considered with regard to the person who seeks professional help in changing from a homosexual to a heterosexual orientation.”
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Rochlin, M. (1982) Sexual orientation of therapist and therapeutic effectiveness with gay clients.(in Paul, W., Weinrich, J., Gonsiorek, J., Hotvedt, M.(eds) Homosexuality: Social, Psychological and Biological Issues. The Final Report of the Society for the Psychological Study of Social Issues Task Force of Sexual Orientation. Beverly Hills CA: Sage) 21 –
ROLE MODELS: “It is widely recognized that lesbians and gay men are generally deprived of positive gay role models in their natural development, that such role models are growth-enhancing… without the availability of gay adults who are decent, accomplished and fulfilled human beings as role models,” it is not possible to escape … oppressive self-hatred and impoverishment.”
“Now I could be one of the living models for young gay people I wished I could have found in my own youth.”
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Ross, M. (1978) The relationship of perceived societal hostility, conformity, and psychological adjustment in homosexual males. Journal of Homosexuality. 4, 2: 157
ABSTRACT: The present study examined the relationship between the perception by homosexual males of positive or negative societal reaction to homosexuality (PSR), their degree of conformity to heterosexual norms, and their degree of psychological adjustment. In this study respondents with high PSR were those who perceived negative societal reaction to homosexuality. Respondents with low PSR were those who perceived positive societal reaction. The study differentiated between the effects of putative societal reaction and actual societal reaction and was based on a three-group sample of homosexual men who (a) were, (b) had been, or (c) had never been heterosexually married. Findings showed that putative societal reaction was a critical variable producing conformity and psychological maladjustment in homosexual males.
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Rothblum, E. ( 1994) Introduction to the special section: Mental health of lesbians and gay men. Journal of Consulting and Clinical Psychotherapy. 62, 2;
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Rothblum, E. (1994) “I only read about myself on bathroom walls”: The need for research on the mental health of lesbians and gay men. Journal of Consulting and Clinical Psychotherapy. 62, 2; 213 – 226.
SURVEY: “A survey of 2,500 members of the American Psychiatric Association (Time 1978 as cited by Marmor 1980 ) found that the majority of members considered homosexuality pathological and also perceived homosexual to be less happy, and less capable of mature and loving relationships than heterosexuals.”
CHOICE: “In general, lesbians tend to view sexual orientation as a political choice, whereas gay men are more likely to have an essentialist perspective. … For example, Chapman and Brannock (1987) found than 63% of the lesbians in their survey stated that they had chosen to be lesbians, 28% felt they had no choice, and 11% did not know way they were lesbians.”
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Russell, A., Winkler, R. (1977) Evaluation of assertive training and homosexual guidance service groups designed to improve homosexual functions. Journal of Consulting and Clinical Psychology. 45, 1: 1 – 15.
The four subjects who showed marked improvement on the behavioral measures described themselves on entering their group as being aware of their oppression as homosexuals in society and were at the point of taking some more positive action about this.
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Schramski, T., Giovando, K.(1993) Sexual orientation, social interest, and exemplary practice. Individual Psychology. 49, 2: 199 –
DISORDER: “Homosexuality, per se, implies no impairment in judgment, stability, reliability, or general social or vocational capabilities. Further, the American Psychological Association urges all mental health professionals to take the lead in removing the stigma of mental illness that has long been associated with homosexual orientation.” (APA 1975)
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Schreier, B. (1998) Of shoes, and ships, and sealing wax: The faulty and specious assumptions of sexual reorientation therapies. Journal of Mental Health Counseling. 20, 4: 305 – 314.
REVIEW: Literature on change – highly critical and dismissive of studies supporting change. Response to Throckmorton article in same issue.
RELIGION: “Throckmorton is critical about an article by Wolpe (1973) where Wolpe chose to offer religious reorientation rather than sexual reorientation. Perhaps instead of sexual reorientation, individuals could seek religious reorientation to any number of major U.S. religions that are affirming of people with same-sex orientations…. Not all religions are judgmental and condemning. Advocating for sexual reorientation while being critical of religious reorientation again demonstrates nothing more than bias.” (308)
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Schwartz, D. (1993) Heterophilia – the love that dare not speak its aim: Commentary on Trop and Stolorow’s “Defense analysis in self psychology: A developmental view. Psychohanalytic Dialogues. 3, 4: 543 – 652.
Their paper exemplifies two interrelated phenomena seen in psychoanalysis (1) the unarticulated belief in a particular sexual ideology, which I call “heterophilia,” and (2) the explicit belief that psychoanalysis is, or should be, free of ideology and politics. In what follows I try to show how heterophilia, the overvaluing of intimate relations between different-sexed partners, manifests itself in Trop and Stolorow’s case report and how it tends to immunize their ideological commitments against articulation and scrutiny. Moreover, I will try to show that as an artifact of heterophilia, same-sex desire is necessarily denigrated.”
BEHAVIOR: “For young gay men contending with societal oppression and superego anxieties, anonymous and uncomplicated sexual encounters may constitute a kind of tooth-cutting experience that allays anxiety for the pursuit of deeper kinds of intimacy later.”
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Stolorow, R., Trop, J. (1993) “Defense analysis in self psychology: A developmental view.” Reply Psychoanalytic Dialogues. 3, 4: 653 – 656.
POLITICAL: “They all seem to feel that it is now politically incorrect to publish a case in which the patient, during analysis, chose a heterosexual path over a homosexual (or, more accurately, a largely asexual one.)… All three commentators seem to hold, as an ideal for every analysis, the fullest exploration of all possibilities for sexual expression irrespective of whether the patient wishes to do this or not.”
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Shidlo, A. (1994) Internalized homophobia: Conceptual and empirical issues.(in Greens, B., Herek, G. Lesbian and Gay Psychology Thousand Oaks CA8/4/99 Sage.)176 – 205.
HETEROSEXISM: “… prejudicial attitudes toward gay persons can be a vehicle for expressing cultural or religious values. Other terms such as homonegativism provides a more neutral and inclusive designation for the total universe of negative attitudes toward homosexuality.”
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Silverstein, C. (1972) Behavior Modification and the Gay community. Paper presented at the annual convention of the Association for Advancement of Behavior Therapy. NY. Oct.
RELIGION: “To suggest that a person comes voluntarily to change his sexual orientation is to ignore the powerful environmental stress, oppression if you will, that has been telling him for years that he should change… What brings them into counseling is guilt, shame, and the loneliness that comes from their secret. If you really wish to help them freely choose, I suggest you first desensitize them to their guilt. Allow them to dissolve the shame about their desires and actions and to feel comfortable with their sexuality. After that, let them choose, but not before.”
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Sleek, S. (1997) Concerns about conversion therapy. APA Monitor. October. 28:16
ANTI-CHANGE: Quotes Linda Garnet, Chair of APA’s Board for Advancement of Psychology in the Public Interest who stated that reorientation therapies “feed upon society’s prejudice towards gays and may exacerbate a client’s problems with poor self-esteem, shame, and guilt.”
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Smith, J.(1988) Psychopathology, homosexuality, and homophobia. Journal of Homosexuality. 59
RELIGION: “Irrational prejudice against homosexuality has been a feature of Judeo-Christian culture for millennia, waning and waxing in intensity from amused but derogatory tolerance to outright genocide.”
GENOCIDE: “… all parents wish their children to be happy and to resemble themselves, and if it were possible to prevent homosexual adjustment (not to mention transsexualism) most parents would welcome the intervention. On the other hand, this raises ethical issues along the lines of other “Final Solutions” to minority problems.”
FAILURE: “… there is no unanimity of opinion either as to what is one to do with the patient who presents with the wish to change his or her sexual orientation. …These patients do present with psychopathology, but their psychopathology is not their homosexual thoughts, feelings, and behaviors, but rather their internalized and self-directed homophobia which impairs self-acceptance and the establishment of adaptive and sexually fulfilling lifestyles in the context of minority sexual orientation. My therapeutic approach to this concern is to teach the patient to redefine his or her problem, and eventually to promote an ego-syntonic state through individual and small group psychotherapy. At times a impasses is reached and therapy must be discontinued, but it should be remembered that, as with all developmental issues, time and nature are on the side of the maturational process, and even an unsuccessful conclusion to therapy may plant the seed for future growth in a healthy direction.”
“Many homosexually adjusted persons who have integrated successfully into mature adults have acquired superior coping skills as a consequence of having worked through the burdens of internalized homophobia and social stigmatization. It may be for this reason that there appears to be an over-representation of homosexually adjusted persons in caregiving occupations and professions.”
PEDOPHILIA: “Pedophilia may be a cultural label rather than anything inherently medical or psychiatric.”
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Stein, T., Cohen, C. (1994) Psychotherapy with gay men and lesbians: An examination of homophobia, coming out and identity. (in Stein, T, Hetrick, E. Innovations in psychotherapy with homosexuals. Washington DC: American Psychiatric Press)
HOMOPHOBIA: “The refusal by a psychotherapist to accept that homosexuality is a normal variation of human behavior must at this point be viewed as an absolute barrier to working with gay men and lesbians in psychotherapy.”
“The effects of societal pressure to be heterosexual have often been to inculcate a basic mistrust or hatred for one’s sexual and interpersonal identity when it is homosexual. A therapist who further encourages renunciation or denial of the homosexual feelings may destructively reinforce the patient’s own internalized homophobia.” (62)
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Tripp, C. (1975) The Homosexual Matrix. NY: McGraw-Hill.
CHANGE: “There are no known “cures” for homosexuality, nor are any likely, since the phenomena which comprise it are not illnesses in the first place. Of course, the issue does not end here. Smoking and drinking are not illnesses either, but they can be stamped out by various means. With these and other considerations in mind, the Kinsey Research made a concerted effort over a period of years to find and evaluate the histories of people whose sex lives had changed either during or following therapy of any kind. None was ever found. Several psychoanalysts who were friends of the Research promised to send particular patients they were proud of having “cured” but none of these was ever forthcoming. After Kinsey’s death and to this day, Wardell Pomeroy (a longtime member of the research and now a New York psychotherapist) has maintained a standing offer to administer the Kinsey Research battery to any person a therapist might send, and thus possibly validate a case of changed homosexuality. This offer has never had any “takers” except for one remarkable instance.”
“A New York psychiatrist who for a number of years has headed a large psychoanalytic research program on homosexuality — a man who has written an important book on the subject in which various percentages of changed cases were reported — did indeed make a definite commitment to exemplify these results. After several delays of several weeks each, the psychiatrist finally confessed to Pomeroy that he had only one case which he thought would qualify but that, unfortunately, he was on such terms with the patient he did not feel free to call him up. One possible case? — then what about his 358-page book claiming from 19 to 50 per cent cures? (Bieber 1962) Whether or not it qualifies as an outright misrepresentation is, in part, a matter of definition. The psychiatrist did not actually say in his much-quoted book that he, personally, had cured anybody, no did he claim to have actually seen or personally examined anybody else’s successful results. There were numerous implications of a firsthand knowledge, to be sure (along with elaborate statistical citations) but legalistically speaking, the psychiatrist was, and is, in the clear. No doubt he was clear. No doubt he was clear in his own mind too — fully believing both what other psychiatrists reported and what he himself was able to make these reports. In all this, he takes his place in a long tradition for this brand of reporting. Over the years there have been literally dozens of second-party accounts of “cured” homosexuality. Life the footprints of the Loch Ness monster, they very often appear, but without the presence of the elusive beast.”
“The efforts of the Kinsey Research to find people whose sexual response had changed as a result of therapy did manage to turn up a few instances worthy of mention, and in a few of these, the person was quite proud of the “progress” he or she had made. But on close examination all examples quickly failed to qualify. In most, it was a matter of sheer suppression — “I used to be a lesbian, but now I turn away when temptation knocks.” Others were slightly more complicated, often involving a man’s fantasizing males during heterosexual intercourse, and the like. Once when Kinsey was in Philadelphia, a man phoned him at his hotel to say he had heard they were interested in people whose homosexuality had been changed by therapy, as his had been. Kinsey immediately arranged to take his history. The man explained that he had once been a very active homosexual but that, thanks to therapy, “I have now cut out all that and don’t even think of men — except when I masturbate.”
“Actually, it is quite surprising that the Kinsey Researchers did not find any instances of people whose sexual responses were altered during therapy (and it surprised them too). One would expect changes to occasionally occur by accident, if nothing else. There are always a few people who are free to enter or to leave homosexual involvements by virtue of the fact that their preferences are not yet clearly defined. Others have clear-cut preferences which remain somewhat flexible due to a lack of aversion -reactions to their implied opposites; these individuals sometimes move back and forth across the heterosexual-homosexual line as a result of particularly good or bad experiences they have with members of either sex.”
“But, of course, the average therapist knows nothing of all this background. He does not realize that validated changes in homosexuality are nowhere to be found. And he certainly does not know that the most prestigious literature on the subject is all second-party reporting at best (if, indeed, it is not from still further back in some armchair). On the contrary he finds himself surrounded by colleagues and by published accounts suggesting that such changes are feasible and are actually being made. Not infrequently he feels almost a professional obligation to be able to see what others see (something of any Emperor’s New Clothes situation) and to be able to match their results, quite aside from the extent to which his attitudes may press in the same direction.”
“Thus there are a great many therapists — including those who are wise enough to avoid the word cure, and would not be fooled by the man from Philadelphia either — who feel the urge to launch major efforts to suppress and to change homosexual behavior. Their outlook and their level of sophistication vary considerably. More than a few have the notion that if they can get a patient to try out heterosexuality, he will “lose his fear of it”, come to like it, and in that case the homosexuality will automatically disappear (shades, once again, of a “blocked” heterosexuality). Other know better than this, but nevertheless persistently aim at essentially the same target. In their view, the only really bad thing about homosexuality is its exclusivity, that it supposedly cuts a person off from general society and from the conventional experiences of hearth and home. In both of these positions, and in all graduations between them, the patient’s marriage to a partner he cares about is considered the major breakthrough. (How interesting it is — and how alarming — that the risks and comforts of the spouse are never mentioned; the massive literature on how to alter homosexuality contains not a word on his or her behalf.)” (p.238)
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Troiden, R. (1988) Homosexual identity development. Journal of Adolescent Health Care. 9: 105 – 113.
CHILDHOOD: Majority of homosexuals felt different as children.
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Weinberg, M., Williams, C. (1974) Male Homosexuals. NY: Oxford UP.
RELIGION: “…respondents who attribute the most importance to religion are more worried about exposure of their homosexuality, more concerned with passing, and less known about than homosexuals for whom religious is not important at all.” (253)
“… holding religiosity constant… among those who regard religion as very important, those who perceive homosexuality as more in violation of religion score lower in stability of self-concept (and in the United States, self acceptance) and higher in depression than do those who do not perceive such a violation.”
“… we have suggested that the etiology of both the normal stage of unease with a homosexual orientation as well as dissatisfactions that more clearly need professional intervention result from society’s stigmatization of the homosexually oriented.”
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Weinberg, T. ( 1978) On “doing” and “being” gay: Sexual behavior and homosexual male self-identity. Journal of Homosexuality. 4: 2: 143 – 156.
CASE: “This respondent’s first ‘gay’ sexual experience, then, was not his first sexual experience with another male. It took the presence of what Strauss (1959) calls a “coach” to redefine his sexual activities and his own sexual identity as homosexual.”
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9) RESPONSES TO CRITICS OF THERAPY
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Bieber, I. (1976) A discussion of “Homosexuality: The ethical challenge.” Journal of Consulting and Clinical Psychology. 44, 2: 163 -166.
Response to Davison (1976)
ETHICS: “Davison’s thesis is simple is assumes that homosexuality is a normal sexual mode in the wide spectrum of human sexuality and that the psychological problems noted among homosexuals directly derive from societal prejudices. He suggests, therefore, that it is unethical for clinicians to cooperate with homosexuals who wish to change their sexual direction.”
FAMILY: “In most cases, the mother was indeed overly close, inappropriately intimate with her son, intrusive, overprotective, and demasculinizing, but the most striking of our findings was the consistency of a seriously disturbed father-son relationship. In not one homosexual case could the father’s attitude be described as affectionate or even reasonably constructive. Mostly, the fathers were reported as detached, and/or openly hostile or “never there.” Children perceive detachment as hostility, which in fact it is. One is not unremittingly detached from a love object. These sons emerged from the paternal influence hating and fearing their father on the one hand and deeply yearning for paternal affection on the other.”
FATHER: “If one were to choose any single criterion on which to base a prognosis for change, it is the degree of pathology of the father-son relationship. Where some positive elements exist there is comparatively less existing pathology and the prognosis for change is more encouraging.”
“Since 1962, I have examined about 850 male homosexuals in psychiatric consultation. … I also examined about 50 pairs of parents whose sons were homosexual. This sizable sample of parents and sons confirmed our research findings. In not a single case was there a good father-son relationship. In general, the parents’ relationship with each other was also poor. Mothers tended to be complainingly dissatisfied with their husbands and openly preferred their son to their spouse.”
CHANGE: “The goal [of therapy] is to resolve as much of a patient’s psychopathology as can be accomplished. When irrational beliefs and idea systems that distort interpersonal relationships are clarified and corrected, significant changes in various areas of personality and behavior occur.” (p.166)
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Throckmorton, W. (1996) Efforts to modify sexual orientation: A review of outcome literature and ethical issues. Journal of Mental Health and Counseling. 20, 4: 283 -305.
RELIGION: Throckmorton is critical of those who pressure homosexual clients to change their religious beliefs. “For instance, Barrett and Barzan (1996) in their article concerning spiritual and the gay experience, suggest that “assisting gay and lesbians to step away from external religious authority may challenge the counselor’s own acceptance of religious teachings.”(p.8) According to Barrett and Barzan (1996), “most counselors will benefit from a model that help them understand the difference between spiritual and religious authority.” (p.8)
Wolpe (1973) candidly reports on this tension in his work with a gay client in the 1950s. He described the case of a 32-year-old male who had never experienced sexual attraction or relations with women. The man had “formed a succession of attachments to men with whom he had sexual relations.” (p.258) However, he also felt such relations were against his religious belief causing severe anxiety. Wolpe chose to attempt to minimize his religious objections via giving him a book to read. While the client felt some guilt reduction, he still wished to “overcome his homosexuality” (Wolpe, 1973, p.259)Wolpe refused on the basis of a belief in the genetic basis for homosexuality. The client continued in assertiveness training, however, which resulted in significant reduction in anxiety and improvement in job performance. After several months, the man reported to Wolpe that he had become unable to have sex with men and was feeling attracted to a woman. Through the next year, he became sexually active with women and finally married. After a 3-year follow-up, Wolpe described the client’s heterosexual sex life as “in every way satisfactory” (p.261).
“Since religion is one of the client attributes that mental health counselors are ethically bound to respect, counselors should take great care in advising those clients dissatisfied with same-gender sexual orientation due to their religious beliefs. To accommodate such clients counselors should develop expertise in methods of sexual reorientation or develop appropriate referral resources.” (p. 301)
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Tripp, C. Hatterer, L. (1971) Can homosexuals change with Psychotherapy? Sexual Behavior. 1, 4: 42 – 49.
Excerpts from a transcribed discussion:
CHANGE: Dr. T. “I know Dr. Hatterer believes he has ‘cured’ homosexuals; similar claims have often been made. I have never seen a major change in any adult’s sexual response, although patients on other therapists’ ‘cure’ list (not yet Dr. Hatterer’s) often come to me and to other therapists I know because they do not want to ‘disappoint’ their first doctor. In any event, there is not a single recorded instance of a change in homosexual orientation which has been validated by outside judges or testing. Kinsey wasn’t able to find one. And neither Dr. Pomeroy nor I have been able to find such a patient. We would be happy to have one from Dr. Hatterer.
Dr. H. “I have ‘cured’ many homosexuals, Dr. Tripp. Dr. Pomeroy or any other researcher may examine my work because it is all documented on 10 years of tape recordings. Many of these ‘cured’ (I prefer to use the word ‘changed’) patients have married, had families and live happy lives. It is a destructive myth that ‘once a homosexual, always a homosexual.” It has made and will make millions more committed homosexuals. What is more, not only have I but many other reputable psychiatrists (Dr. Samuel B. Hadden, Dr. Lionel Ovesey, Dr. Charles Socarides, Dr. Harold Lief, Dr. Irving Bieber, and others) have reported their successful treatments of the treatable homosexual.
Dr. Tripp. There is quite a misunderstanding here as to what constitutes fundamental change…
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DISORDER: Dr. H. I have treated numerous young men who were supposedly disturbed by their ‘homosexuality.’ But I do not look upon homosexuality as an entity. Rather it is a common symptom which appears in many individuals in response to innumerable, dissimilar situations.
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PROMISCUITY: Dr. T. But I know of many, many homosexual couples who do stay together for ten, twenty, and many more years. They evidence quite the same mutual concern for each other’s well-being found in warm and stable marriages.
Dr. H. Your experience is very different from mine. The homosexuals I have seen were in the main disgusted with the brevity of their relationships, disgusted by how they squandered their time, interfered with their work, dispensed with their integrity , and sacrificed hopes of an enduring relationship and family life by their driven pursuit of homosexual sex partners.
—
Dr. T… I have a sample of 32 couples who have been together more than twenty-five years.
Dr. H. Are they still together sexually?
Dr. T. Yes, but not usually exclusively.
Dr. H. I have seen men who lived together for periods of five or seven years, but rarely for twenty. And those who do stay together generally allow each other a lot of freedom sexually, or they will both invite a third party in for sex relations. The sexual involvement declines or disappears.
Dr. T. Yes, that is often the case and it seems to work very well.
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Dr. T. All sexual arrangements work. Homosexuality especially works because it has very minor differences from heterosexuality; the overlap is tremendous and the differences are essentially trivial. But all sexual patterns work. Sadomasochistic relationships work, transvestitism works, even transsexualism for those individuals who manage to achieve the bodily changes they want.
Dr. H. I would strongly suggest Dr. Tripp examine in greater depth his word works’ when applied to all those situations he refers to. I believe he confuses it with ‘survive’ Obviously millions of men practicing homosexuality are productive at work and would report some periods of sexual happiness with their partners either in or out of sustained relationships.
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Dr. T. Let me get your reactions to a situation that we who do therapy with homosexuals have often heard about. There are about five or six Turkish baths in New York City that are frequented exclusively by persons who want to engage in homosexual acts. There used to be one near the train station that was a “commuters’ bath’ in that many of the customers were married men stopped off before they went home. They were primarily heterosexual, but engaged in this sporadically. If their lives were happy and well managed, would you say they were necessarily neurotic? Incidentally, many patients report that these men want to be passive in anal intercourse.
Dr. H. That’s a big if. In order to answer the question it would be necessary to investigate what was happening with these men and their wives at home. You are right that such men want to be ‘serviced by males or summit to them. But why? What and who drives them to such practices.
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Dr. T…. To see ‘humiliations’ and ‘sadism ‘ in the picture is quite unwarranted. Nor do labels of ‘abnormal’ help… From my point of view, there is no indication that fundamental changes in anybody’s sex life are ever wrought by therapy, nor would they be particularly desirable anyway. A person’s best sexual orientation is the one that helps him get the most out of himself, spontaneously. Killing off his guilt and his childish expectation that conformity is the road to heaven but tend to give him confidence and the energy to make a much smoother social integration… Since homosexuality is an alternate orientation and not a disease, ‘cure’ is patently impossible. What passes for ‘cure’ is surface symptom suppression or outright avoidance.
—
CHANGE: Dr. H. You define cure in one way; I define it in another. I see the patients sexual life in the context of his entire life style.
I had a patient recently who has had a rather extensive homosexual history . He’s married now and having seven heterosexual orgasms a week. He has occasional homosexual fantasies when under pressure or stress, which has nothing to do with his homosexual responsiveness but rather with his neurotic use of homosexual sex.
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Richardson, D. (1993) Recent challenges to traditional assumptions about homosexuality: Some implications for practice.(in Garnets, L., Kimmel, D. Psychological Perspectives on Lesbian Gay Males Experiences. NY: Columbia.) 117 -129.
This article challenges the idea of sexual orientation as unchangeable, while supporting the idea that homosexuality is a positive choice, and responses to Silverstein, Davidson and other writers quoted above.
Excerpts from the article.
CHANGE: “During the last decade there has been a change in professional attitudes toward homosexuality reflected in the development of new models of treatment. Rather than offering a cure the aim is to help homosexuals adjust positively to their orientation. Such attitudinal change on the part of the practitioners has not, in the main, questioned the fundamental assumptions of theories that seek to explain homosexuality. Recent theoretical inquiry into homosexuality, however, has done this, posing an important challenge to the traditionally held view that people have an essential sexuality that is either homosexual or heterosexual and that remains fixed and unchanged throughout their lives. This paper addresses some of the more important clinical implications of these recent developments, in particular, the suggestion that ‘the homosexual’ as a certain type of person is an ‘invention.’ In addition, the therapeutic value and difficulties associated with an acknowledgment that sexual preference and identity may change over time are considered. Finally, there is a consideration of what the goals should be in the case of the person who seeks professional help in changing from a homosexual to a heterosexual orientation.”
“The notion of the ‘homosexual’ is, Plummer (1981) suggested an ‘invention’: it is a categorization specific to certain societies and particular historical periods. On this basis it is not possible to make a direct comparison between ‘homosexuality’ in present day Western society with ‘homosexuality’ in different cultures and historical periods…”
“As a limited number of studies have shown (e.g. Pattison and Pattison 1980; Ponse 1978) despite the widespread belief that sexual ‘orientation’ is a permanent characteristic, individuals may undergo one or more redefinitions of sexual identity during their life time.
“Once homosexuality is defined with a society as a way of being people will frequently reconstruct their past in keeping with their present identification as homosexual (Richardson 1981). This may take the form of their saying ‘I must have really been gay all along,” it being a case of their ‘real’ selves having been ‘suppressed’ until they identified themselves as homosexual. This process of reconstruction may still occur even when it runs counter to a previous identification as heterosexual and a prior absence of homosexual attraction.”
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Plummer, K.(1981) Going gay: Identities, life cycles and life styles in the male gay world (in Hart, J., Richardson, D. (ed) The theory and Practices of Homosexuality.. London: Routledge) 93 – 110.
Ponse, B. (1978) Identities in the Lesbian World: The Social Construction of Self. Westport CT: Greenwood Press
Richardson, D. (1981) Lesbian Identities ( in Hart, J., Richardson, D. (ed) The theory and Practices of Homosexuality.. London: Routledge) 111 – 124.
Richardson, D. (1984) The dilemma of essentiality in homosexual theory. Journal of Homosexuality. 9, 2/3: 79 – 90.
10) RECENT ARTICLES ON THE CONTROVERSY
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Haldeman, Douglas, (2000) Gays, ex-gays, ex-ex-gays – Examining key religious, ethical, and diversity issues. Paper presented at American Psychological Associations Annual Meeting, August 7th, 2000, Washington, DC.
There appear to be many dissatisfied homosexually–oriented individuals who seek psychological guidance or spiritual intervention to achieve a goal they identify as a change in sexual orientation … some… particularly those who have experienced less invasive styles of conversion therapy, seem not to have been affected aversely.
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LeVay, Simon (in process) Sexual Orientation: The science and its social impact. http://members.aol.com/_ht_a/slevay/page12.html.
First , since itself cannot render judgments about human worth or about what constitutes normality or disease. These are value judgments that individuals must make for themselves, while possibly taking scientific findings into account.
Second, I believe that we should as far as possible, respect people’s personal autonomy, even it that includes what I would call misguided desires such as the desire to change one’s sexual orientation.
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Nicolosi, Linda (2002) Some gay advocates acknowledge reorientation therapy as a legitimate option: Simon LeVay joins Douglas Haldeman in qualified support. NARTH Bulletin. 11, 2: 21.
===============================================================Spitzer, Robert (2001) 200 subjects who claim to have changed their sexual orientation from homosexual to heterosexual. Presentation to the annual meeting of the American Psychiatric Association, May 9, 2001, in New Orleans LA
What we conclude:
Some highly motivated individuals through a variety of change efforts can make substantial changes in multiple indicators of sexual orientation and achieve good heterosexual function
Subjects who made less substantial changes still believed that such changes were extremely beneficial
Complete change which is generally considered an unrealistic goal in psychotherapy – is uncommon particularly in male subjects.
A better way to conceptualize “sexual reorientation” is to see it as diminishing of unwanted homosexuality and an increase in heterosexual potential – recognizing that change for some is possible along a multidimensional continuum.
Throckmorton, Warren (2002) Initial empirical and clinical findings concerning the change process for ex-gays. Professional Psychology: Research and Practice. 33, 3: 242-248.
This article describes the role of religious variables in the change process. Some kind of change appears to occur for many who identify themselves as ex-gay. Although sexual orientation is not an easily defined or measure phenomenon, change over time is not theoretically unfounded or empirically unprecedented. Many of the individuals who report efforts to become ex-gay feel that the efforts were helpful, and a small percentage feel the efforts were harmful.
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Yarhouse, Mark. (1998) When Clients seek treatment for same-sex attraction: Ethical issues in the “right to choose” debate. Psychotherapy 35, 2: 248-258
Psychologists take seriously the autonomy and agency of the individual. The human capacity to choose is relevant to therapeutic conceptualizations and interventions, and some clients choose to make moral concerns a focus of treatment, or they seek to change their behavior precisely because of an overarching moral evaluative framework. Individuals have the right to seek treatment aimed at curbing homosexual inclinations or modifying homosexual behaviors, not only because it affirms their right to dignity, autonomy, and agency as persons presumed capable of freely choosing among treatment modalities and behavior, but also because it demonstrates a high regard for cultural and religious differences.
CHANGE BIBLIOGRAPHY
Coding
@ Copy can be found in Irving Bieber Memorial Library East Coast
[ ] The citation followed by the name another citation in square brackets indicates that this material was referenced from the source named within the square brackets and has not yet been checked with the original for accuracy.
Referenced material is identified by the section of the report in which it appears
1 Reviews of the literature on change
2 Surveys and meta-analysis of research on change
3 Studies of psychotherapy and change
4 Studies of group therapy and change
5 Studies of behavior modification and change
6 Materials on religiously mediated change
7 Adventious change
8 Opposition to therapy for change
9 Response to criticism of reports on change
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Barlow, D. (1973a) Increasing heterosexual responsiveness in the treatment of sexual deviation: A review of the clinical and experimental evidence. Behavior Therapy. 4: 655 – 671.. [in James 1978] 5
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