by Julie Hamilton, Ph.D.
I was reminded again today about the incredible misinformation that abounds among professionals in our field. I received a letter regarding “ethical concerns” from a psychologist whom I’ve never met who lives in another state. He was concerned about scientifically grounded statements that I made in a video recording. While the letter had no basis whatsoever as an ethical complaint, the letter did reveal the fact that not only the general public, but also many professionals are themselves unaware of the scientific research on the topic of homosexuality. NARTH exists to correct that problem. As a scientific organization, we are familiar with the research and seek to disseminate it to the benefit of the public at large, the therapeutic community, and also for individual clients who want to better understand their homosexual attractions and options for change.
It is wonderful that fellow-professionals care about clients and want to be sure that clients are not harmed by their therapists, and even commendable that fellow-professionals are willing to confront others who they fear could potentially harm clients. Unfortunately, however, when the concerns and compassion are rooted in misinformation, greater harm is sometimes the result. Even more concerning are instances where misinformation leads to confrontation, or even, in some cases, harassment of fellow-professionals. The problem here is the misinformation. Another example would be the outrageous legislation being proposed in the state of California, again, possibly well-meaning, but based in outlandish claims, NOT rooted in scientific research. In fact, some of the claims made by the sponsors of this bill are not even based in reality – such as the ridiculous notion that shock therapy is used for treating this issue. I am reminded of the ancient proverb that addresses “zeal without knowledge.”
The letter that I received seems to reveal a lot about the mistaken assumptions of both the general public as well as even members of the professional body in the mental health field. The writer stated: It is my obligation as an ethical psychologist to directly address other psychotherapists who are engaged in behaviors that I believe are unethical. In watching the video… I became concerned about your work as a representative of NARTH as well as within your private counseling practice.
Specifically, you state: “While the general public seems to believe that people are born gay and can’t change, that has not been the conclusion of researchers.”
Let me not mince words here Julie, you are simply wrong. There is no credible evidence in any peer reviewed journal that provides substantive empirical evidence to suggest that so-called reparative therapy is effective or ethical. I would like to believe that this writer does not represent the majority within our field, but I am becoming concerned that his inaccurate assumptions are widely held. Therefore, let me address the first part of my quote, that people are not simply born gay. Although in 1998 the American Psychological Association (APA) made claims of biological contributors to homosexuality, in 2008 they updated their claims. In their newer document the APA (2008) admits that researchers have not found a biological basis for homosexuality: There is no consensus among scientists about the exact reasons that an individual develops a heterosexual, bisexual, gay, or lesbian orientation. Although much research has examined the possible genetic, hormonal, developmental, social, and cultural influences on sexual orientation, no findings have emerged that permit scientists to conclude that sexual orientation is determined by any particular factor or factors. Many think that nature and nurture both play complex roles; most people experience little or no sense of choice about their sexual orientation.(www.apa.org/topics/sexuality/orientation.aspx; see also,
It is clear that people are not simply born homosexual. It is also important to note that most people do not choose their attractions. Instead, homosexual attractions are most likely a complex combination of factors, just as is the case with any other developmental issue.
Regarding the second part of my statement referenced in this psychologist’s letter, the myth that people cannot change is a myth for the following reasons:
1. It only takes one person having changed to nullify the myth that change is not possible.
2. There are thousands of people who claim various degrees of change in behavior, lifestyle, attractions, or all of the above.
3. Change is documented in the professional literature spanning at least the past one hundred years. A review of the
literature demonstrating that change is possible is published in a peer-reviewed journal, Journal of Human Sexuality. This particular volume contains hundreds of references (NARTH, 2009).
In an attempt to evaluate the research findings, the APA put together a very biased, six member task force of individuals to look at the scientific literature regarding the issue of sexual orientation change efforts (SOCE). Each member of this task force was opposed to SOCE, and not one proponent of SOCE was included on the task force. They looked at all of the literature and dismissed any studies showing SOCE to be successful. They dismissed credible studies by applying research standards that are not applied to any other homosexuality research – not the gay parenting literature, not outcome studies on gay-affirmative therapy (which by their standards has never been found to be successful and has not been shown to be without harmful effects). In the end, they could not, as reasonable professionals, definitively claim that SOCE is ineffective or that it is harmful. At best, all they could claim was, “…there is little in the way of credible evidence that could clarify whether SOCE does or does not work in changing same-sex attractions” (APA, 2009, p. 28, emphases added).
Saying there is not enough evidence is not saying that it does not work. More research is needed, as is the case with many approaches to therapy and treatment for many therapeutic issues. There are countless methods of therapy that have never been proven through rigorous research studies to be both “effective or ethical,” as the writer of the letter is suggesting must be done before one can claim that any type of change is possible.
Furthermore, regarding misguided claims of harm, the APA task force also admitted there is not enough evidence to claim that this type of therapy is harmful, “There are no scientifically rigorous studies of recent SOCE that would enable us to make a definitive statement about whether recent SOCE is safe or harmful and for whom” (APA, 2009, p. 83).
The study most frequently cited to support claims of harm is a study conducted by Shidlo and Schroeder (2002). These researchers actually advertised for participants with the statement, “Help Us Document the Damage of Homophobic Therapists”. However, even despite their biased solicitation of clients who had been harmed by therapy, the results of their study are quite similar to outcomes for other forms of therapy (Whitehead, 2010). Across any therapeutic modality and with any
therapeutic issue, some clients report successful outcomes and other clients do not. Additionally, research studies indicate that clients sometimes become worse before they become better (Whitehead, 2010). What’s even more noteworthy is that despite Shidlo and Schroeder’s (2002) very biased solicitation of participants who had been harmed in therapy, some of their participants actually reported positive outcomes from therapy. (For an analysis of this study, see http://narth.com/2011/08/sexual-orientation-change-efforts-do-not-lead-to-increased-suicide-attempts/).
It seems since the professional associations, having looked at the literature firsthand, are unable to claim a basis for banning SOCE or limiting it to adults only, the activists have to rely on the misinformed legislators to ban or limit it, as we’re witnessing in California.
The other point made by the psychologist who sent me the concerned letter is that the professional associations no longer consider homosexuality a mental disorder. Let me also note, NARTH does not describe homosexuality as a mental disorder. However, declassifying homosexuality as a mental disorder does not mean that homosexual clients have suddenly stopped seeking therapy for change in their lives. As they have done for hundreds of years, many homosexual clients continue to seek treatment for change. Not everyone who finds himself or herself with homosexual attractions happily embraces those attractions. There are, in fact, many dissatisfied, even suicidal homosexuals who desire change for their lives. Those clients should be accommodated in their search for a different life.
Ethical therapists do not solicit clients or coerce clients into seeking change. The clients served by NARTH therapists are clients requesting change. This includes minors brought to therapy by their parents. Ethical therapists do not help clients who are not requesting change – they help voluntary clients pursue their own goals for therapy. If parents seek change for their minor child who is perfectly content with a homosexual orientation and does not desire change, ethical therapists do not continue to work with those minor clients. An ethical therapist would never try to force or coerce someone to change. An ethical approach to this issue is made clear in NARTH’s Practice Guidelines (NARTH, 2010; also see http://narth.com/2011/12/narth-practice-guidelines).
Misinformation is very dangerous. Therapists who believe clients were born homosexual and cannot change end up passing this false information along to their clients. Although well-intended, telling clients who seek change that they have no other option for their lives can lead to hopelessness. Many individuals have shared their stories of experiencing depression, substance abuse, self-hatred, and even suicidal ideation having found no alternative to their homosexual attractions. It is so very important that therapists understand that clients have options – they were neither born homosexual, nor should they be forced to embrace something they did not choose. Ethical therapists are aware of what the research can and cannot say on this issue and provide options to their clients. Ultimately, it is the client who must choose, with proper informed consent, and without therapist-coercion, the most satisfactory life for himself or herself.
American Psychological Association (2009). Report of the APA task force on appropriate therapeutic response to sexual orientation. Retrieved from http://www.apa.org/pi/lgbt/resources/therapeutic-response.pdf
American Psychological Association (2008). Answers to Your Questions for a Better Understanding of Sexual Orientation and Homosexuality. Retrieved from http://www.apa.org/topics/sexuality/orientation.aspx
NARTH Scientific Advisory Committee (2009). What research shows: NARTH’s response to the American Psychological Association’s (APA) claims on homosexuality. Journal of Human Sexuality, 1, 1-128.
NARTH Task Force on Practice Guidelines for the Treatment of Unwanted Same-Sex Attractions and Behavior (2010). Practice Guidelines for the Treatment of Unwanted Same-Sex Attractions and Behavior, Journal of Human Sexuality, 2, 5-65.
Shidlo A., & Schroeder, M. (2002). Changing sexual orientation: A consumers’ report. Professional Psychology: Research and Practice, 33, 249-259.
Whitehead, N. (2010). Homosexuality and Co-Morbidities: Research and Therapeutic Implications. Journal of Human Sexuality, 2, 125-176.