Gay/Lesbian "Reparative" Therapy Persists

From time to time, we hear of faux psychotherapy interventions that are
intended to convert persons from homosexuality to
heterosexuality.  Mostly, the publicity has centered on
pseudomoralistic interventions that clearly have a religious agenda as
opposed to a health-enhancing agenda.  As such these interventions
cannot be classified as therapy.



However, a recent survey has shown that there still is a small minority
of therapists who will, in some circumstances, attempt to have their
clients convert from homosexuality to heterosexuality.  The
results were published in the open-access journal, BMC Psychiatry.

href="http://www.biomedcentral.com/1471-244X/9/11/abstract">The
response of mental health professionals to clients seeking help to
change or redirect same-sex sexual orientation ( href="http://www.biomedcentral.com/content/pdf/1471-244x-9-11.pdf">PDF
link)

Annie Bartlett, Glenn Smith, and Michael King

BMC Psychiatry 2009, 9:11

Published:     26 March 2009

doi:10.1186/1471-244X-9-11

Background We know very little about mental health
practitioners' views on treatments to change sexual orientation. Our
aim was to survey a representative sample of professional members of
the main United Kingdom psychotherapy and psychiatric organisations
about their views and practices concerning such treatments.



Methods We sent postal questions to mental health
professionals who were members of British Psychological Society, the
British Association for Counselling and Psychotherapy, the United
Kingdom Council for Psychotherapy and the Royal College of
Psychiatrists. Participants were asked to give their views about
treatments to change homosexual desires and describe up to six patients
each, whom they have treated in this way.



Results Of 1848 practitioners contacted, 1406 questionnaires
were returned and 1328 could be analysed. Although only 55 (4%) of
therapists reported that they would attempt to change a client's sexual
orientation if one consulted asking for such therapy, 222 (17%)
reported having assisted at least one client/patient to reduce or
change his or her homosexual or lesbian feelings. 413 patients were
described by these 222 therapists: 213 (52%) were seen in private
practice and 117 (28%) were not followed up beyond the period of
treatment. Counselling was the commonest (66%) treatment offered and
there was no sign of a decline in treatments in recent years. 159 (72%)
of the 222 therapists who had provided such treatment considered that a
service should be available for people who want to change their sexual
orientation. Client/patient distress and client/patient autonomy were
seen as reasons for intervention; therapists paid attention to
religious, cultural and moral values causing internal conflict.



Conclusions A significant minority of mental health
professionals are attempting to help lesbian, gay and bisexual clients
to become heterosexual. Given lack of evidence for the efficacy of such
treatments, this is likely to be unwise or even harmful.

Note that the survey was conducted entirely within the United
Kingdom.  Most of the press that I have seen about "reparative
therapy" focused on various characters in the USA.  Those reports
identify persons who clearly are engaging in pseudoscientific
interventions.  As such, they've been summarily criticized by my
colleagues here at SB. ( href="http://scienceblogs.com/bushwells/2007/06/wnd_get_this_says_stupid_thing.php">Bushwell's
Chimpanzee Refuge)  Read that post for background, if
desired. 



The BMC Psychiatry report, however, appears to have identified
some practitioners who are not of the same ilk as what has been
reported here in the USA.  They were all anonymous, so it is not
possible to find out any more about their practices than what they put
on the surveys.  However, the surveys were sent to members of
mainstream therapy societies.  The comments the therapists made
about their own treatment efforts seemed thoughtful, as opposed to
ideological. 



Few of the respondents reported any participation in anything
resembling "reparative therapy."  There were 55 in all (4%). 
However, 222  (17%), reported having assisted at least one client
to change his or her homosexual feelings in some way.  This,
presumably, was generally not an attempt to change sexual orientation;
rather, were attempts to have people modify some aspect of their
emotional experience.  However, the text of the article was not
entirely clear about the distinction between the group of 55, and the
group of 222.



A total of 413 clients were reported to have received such
intervention.  So the average is less than two clients per
therapist.  Note, however, that respondents were limited to
reporting no more than six clients, so we cannot tell if there were a
few who make this a large part of their practice.  Clearly,
though, the majority have done it only once or twice. 



The report makes it clear that there is no generally accepted evidence
that reparative therapy does anybody any good.  It certainly is
not within the realm of evidence-based practice.  So what
rationale did these therapists provide?  Here is one example
(there are more int he text):

"...where someone had a strong faith, then working to help
the person accept their feelings but manage them appropriately may be
the best approach if (the) person felt they would lose God and
therefore their life was not worth living."

The reason that I say this is thoughtful, as opposed to ideological, is
that the author states that the treatment "may be the best approach,"
as opposed to "it is the best approach."  Also, the implication is
that the client might otherwise feel that life is not worth living,
with the consequent implication being that the person could be at risk
for suicide. 



It is not possible to comment of the merits of this particular approach
with a particular client, without knowing the entire story. 



Some of the responses were surprising to me:

"These feelings can arise in the context of psychotic
illness where it can be difficult to be clear about the underlying
sexuality."

It is true that the feelings can arise in the context of psychosis,
because it is true that any feelings can arise in the context of
psychosis.  It also is true that in can be difficult to be clear
about anything when psychosis is present.  But I don't see how
that would provide a rationale for having the client try to change
homosexual feelings.  That just doesn't make any sense, at least
when quoted out of context (no context is provided in the paper.)



The paper noted that there were some, but "very few" respondents who
provided judgmental responses.  One example is given:

"Although homosexual feelings are usual in people, their
physical expression, and being a person's only way of having sexual
relations is problematic. The physical act for male homosexuals is
physically damaging and is the main reason in this country for
AIDS/HIV. It is also perverse.........."

This is not only judgmental, but medically unfounded.  It pains me
to think that a credentialed therapist would think or say such a
thing. 



Overall, the report was not as alarming as I though it would be, based
solely upon the title.  It appears that there are some reasonable
people who think that there are rare occasions when it can be
appropriate to help people to modify their emotional experiences of
homosexuality.  There still are a few, though, who engage in
non-evidence-based practice driven by bigotry. 



For therapists who might consider engaging in such practice, there are
some serious ethical questions to consider.  One is the decision
to venture into an area that is not based upon empirically-validated
research.  This may not be a mistake, in all cases.  The fact
is, research can only take you so far.  There are many important
decision points that arise in the course of therapy, in which adequate
research is not available.  Still, if one chooses to depart from
empirically validated practice, it is necessary to be cognizant of the
choice, and to consider carefully any informed consent issues that
might arise.



Another issue is the difficulty is being sure that the agenda is really
that of the client, as opposed to an unconscious agenda of the
therapist.  Again, this is a dilemma that arises often in the
course of therapy.  An adequately-trained therapist should be able
to recognize this situation, and know how to address it.



Perhaps the most treacherous issue, though, is the question of social
justice.  If a client has homosexual feelings that create
discomfort due to the adverse social milieu, then the client may wish
to change those feelings.  But isn't this colluding with social
injustice: teaching someone how to be a less miserable victim? 
Would it not be preferable, in most circumstances, to assist the person
to reject the victim role entirely?  It is hard to make general
statements about this, given the wide variety of personal circumstances
that exist. 



Moreover, would such a stance, on the part of the therapist, be yet
another kind of ideologically-bound departure from service of the
client's best interest?  There is no easy answer.