This attitude never was universal; it is said that even Sigmund Freud was skeptical of it. Even so, it was not until 1962 that efforts began to remove homosexuality from the DSM. It was decided, in 1973, to remove the diagnosis from the subsequent edition. The American Psychiatric Association issued a statement at that time, in support of civil rights protection for homosexual persons. The American Psychological Association followed suit in 1974. In 1991, the American Psychoanalytic Association finally saw the light. In 1992, homosexuality was removed from the World Health Organization's International Classification of Diseases.
Even so, a small number of licensed mental health practitioners continued their efforts to pathologize and "treat" homosexuality.
The American Psychological Association's Task Force on Appropriate Therapeutic Responses to Sexual Orientation set out to research this matter and issue a definitive proclamation. This is described:
Sexual "Conversion"? American Psychological Association Says Not Through Psychotherapy
October 10, 2009
Psychiatric Times. Vol. 26 No. 10
Natalie Timoshin
In August, the American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation released a report based on its systematic review of research on the effectiveness of sexual orientation change efforts.
The report stated that there is little evidence to suggest that efforts to change a person's sexual orientation from gay or lesbian to heterosexual are successful.
In fact, the report found that such efforts can cause harm. The findings of the American Psychological Association's task force indicate that efforts to switch a person's sexual orientation through psychological interventions not only don't work but also can lead to loss of sexual feeling and to depression, anxiety, and suicidality...
I find it interesting that the Task Force does not use the terms "reparative therapy," or "conversion therapy." These terms would seem to imply that these activities are a form of therapy, which they are not. Instead, the Task Force uses the term sexual orientation change efforts (SOCE). This is -- suitably -- a descriptive, nonjudgmental term.
The Task Force issued a 138-page report, which appears to be a reasonably comprehenive review of the work that has been published on the subject. They endeavored to be fair and balanced.
Their "key findings" are as follows:
- Our systematic review of the research on SOCE found that enduring change to an individual's sexual orientation as a result of SOCE was unlikely. Further, some participants were harmed by the interventions.
- What appears to shift and evolve in some individuals' lives is sexual orientation identity, not sexual orientation.
- Some participants in SOCE reported benefits, but the benefits were not specific to SOCE. Rather, clients perceived a benefit when offered interventions that emphasized acceptance, support. and recognition of important values and concerns.
In other words, SOCE is 90% dangerous bunk, and the 10% that isn't bunk is due to the fact that the therapists doing it could not prevent themselves from doing some real therapy mixed in with the bunk.
The Task Force considered proposing changes to the Amercian Psychological Association's Ethical Principles for Psychologists and Code of Conduct. However, they decided that it is not necessary to make any changes. In their view, the existing principles already lead to the appropriate conclusions. The prinicples they cited are:
- Bases for Scientific and Professional Judgments
- Beneficence and Nonmaleficence
- Justice
- Respect for People's Rights and Dignity
So if a practitioner sticks to the science, tries to do no harm, and attends to principles of justice and respect, then that practitioner will reject SOCE. Instead, the practitioner will offer appropriate assessment, affirmation, acceptance, support, and promote active coping.
They recommend that practioners adopt a therapuetic approach that includes what they call identity exploration:
Licensed mental health providers address specific issues for religious clients by integrating aspects of the psychology of religion into their work, including by obtaining a thorough assessment of clients' spiritual and religious beliefs, religious identity and motivations, and spiritual functioning; improving positive religious coping; and exploring the intersection of religious and sexual orientation identities.
This sounds reasonable to me, although it can be difficult. In my experience, it tends to be particularly difficult with persons for whom value judgments are so reflexive, that they are unable to appreciate the distiction between observation and conclusion. They experience any attempt at description as necessarily implying judgment. As a result, whenever the practitioner tries simply to describe what he or she sees and hears, the patient automatically assumes that the therapist is making a value judgment.
It takes a particular kind of mental discipline, in order to maintain a strict separation between description and judgment. It seems obvious that it is entirely possible to form a judgment without actually making any observations, so it is hard to understand why it is so diffiucult to make an observation without making a judgment. But that seems to be the case, fairly often.
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It seems obvious that it is entirely possible to form a judgment without actually making any observations, so it is hard to understand why it is so diffiucult to make an observation without making a judgment.
It isn't a symmetrical situation at all. It is sadly far too common to bull one's way through life without good observational skills -- at least, I seem to see a lot of people doing this [irony noted]. However, it genuinely isn't possible to go through life without making judgements -- even if they aren't overt moral judgements, there is ALWAYS some basic, instinctual good/bad/pursue/accept/avoid type judgement going on in the back of our heads, because we interact with the world and other individuals all the time, and those interactions involve actions that WE also have to take, which are guided by choices (conscious or not), and choices have to be made somehow. We make judgements because we have to make choices, because it is not physically possible to take all possible actions and reactions.
It is possible to be objectively aware of one's own value judgements. It is possible to consciously guide one's own value judgements, to control how they manifest, and perhaps to control how obvious they are to other people. But is it actually possible not to make them at all? ...How?
...And that, I think, is what people are reacting to. At some deeply intuitive level, people can't imagine how it would be possible to live without making value judgements -- fair enough -- and so judgements are assumed to exist as inseparable even to conscious descriptive processes, even when that is not accurate.
This is only exacerbated in situtiations where overt moral judgements are considered "natural", "normal", and "right" as well as inevitable, like in highly religious communities. Given that this is the population most likely to seek "therapy" for sexual orientation -- that is, the population which has been most subject to near-reflexive value judgements against this type of orientation anyway -- and you have an increased sensitivity. And then, if the person seeking therapy is sensitised to criticism or negative judgement by having had such criticism and/or negative judgement levelled at them or their identity frequently, you have the problem in spades. After all, in ANY individual, if they are frequently criticised they come to expect most interactions to be criticism, if they are frequently judged they come to expect to be judged, so even the most innocent observations come to be viewed through a reflexive defensiveness.
So, it isn't really that surprising.
Sorry, I hope that made sense. Kinda sleep deprived right now. I have the shape of this in my head, but I can't be sure it's making its way into English correctly.
Posted by: Luna_the_cat | October 26, 2009 11:29 AM
Better late than never.
I would hope that the therapy could be converted to some family intervention which might enlighten those non-supportive friends and parents to recognize the harm they do when they do NOT accept sexual orientation as it exists. That effort might provide the best of all possible outcomes.
Posted by: MikeMa | October 26, 2009 11:34 AM
A possibly stupid question: under these guidelines, what are therapists supposed to do if the patient wants to change their sexual orientation, and continues to want this even after the above is explained to them?
It seems like a very sticky issue.
Also, one other thing: "enduring change to an individual's sexual orientation as a result of SOCE was unlikely." Does that mean it has happened? I had heard that it had never been successfully changed.
Posted by: intercostalwaterway | October 27, 2009 1:06 AM
-Also, one other thing: "enduring change to an individual's sexual orientation as a result of SOCE was unlikely." Does that mean it has happened? I had heard that it had never been successfully changed.-
No it's possible. Someone pretends to be cured, or they were bi and make a choice not to go with the same sex anymore. Or they stop having sex all together. Or they were gay as a teen and swapped back once the hormones stop leaping about...or a host of other possibilites.
Posted by: Richard Eis | October 27, 2009 5:18 AM
There's also the question of what constitutes "enduring change." Does an unhappy heterosexual relationship, and wishing for same-sex partners, count as "success"? For some people, it might: if someone defines homosexual acts as sinful, they may think it's good enough as long as they don't do anything. Would they be satisfied by support in celibacy, and not thinking too much about what they fantasize about in the privacy of their own bedrooms?
I suspect that a sensible therapist, faced with a patient who insisted that they wanted to change their orientation, might say "as far as we know, there's no therapy that can do that. What I can do is help you figure out how to have a satisfying single life." And encourage the idea that even if certain acts are wrong, or wrong for them, they are better off noting the desire and then thinking about something else than obsessing about it. And some therapists may say "I'm sorry, that's not doable. I can't make you not notice other women. Are there other things you'd like to work on?"
Posted by: Vicki | October 27, 2009 10:27 AM
What is unspoken in all this is the unbending Evangelical bigotry behind these efforts. It has nothing to do with psychology or psychiatry. It's about Evangelical bigots and the damage they do to their gay sons and daughters. Not even the Catholic church advocates for conversion therapy. The perpetuation of this cruel and stupid madness belongs almost exclusively to Evangelicals.
Posted by: kevin | October 28, 2009 4:40 PM