Andrew replied to my blog with the title, “What if 2 California gays “marry,” but then one gets therapy to be straight?” He said, “I have to say that out of all your posts, this one pushed me over the edge.” (click here to read his entire comment) I want to reach my hand down to Andrew and help help back up from over the edge.
Andrew and I agree on several matters. But we also disagree on other matters for which I can show that science and logic contradict some of Andrew’s conclusions.
I agree with Andrew that no one should be pressured to change from homosexuality to heterosexuality, because I believe each person should make that choice for themselves. I agree with Andrew that “many homosexual people feel isolated in a world where homosexual attraction is shunned.” And I agree with Andrew that “heterosexuality… is trumpeted as not only what is “normal” but also what is “moral.”
Let me clear up one of the disagreements Andrew had with my blog with some professional and scientific information. The selection of treatment goals by homosexually oriented and/or homosexually behaving individuals. While homosexuality (homosexual orientation or homosexual behavior patterns) by itself is no longer listed as a mental disorder, individuals with a “persistent and marked distress about sexual orientation” (whether homosexual or bisexual) are diagnosed as a “Sexual Disorder Not Otherwise Specified” in DSM-IV-TR and diagnosed as “Egodystonic Sexual Orientation” in the International Classification of Diseases (ICD) published by the American Medical Association and World Health Organization (American Medical Association, 2005; World Health Organization, 2007); “Egodystonic Sexual Orientation” is used in ICD when the individual desires that their orientation “were different because of associated psychological and behavioural disorders, and may seek treatment in order to change it” (World Health Organization, 2007, F66.1). Acknowledging that homosexuality per se is not a DSM-IV-TR diagnosis, a considerable number of individuals seek treatment because of distress often related to psychosocial and cultural factors.
On the one hand, some homosexual adults have embraced a “gay” identity that affirms homosexual behavior as acceptable, and those patients generally prefer “gay-affirmative” treatment. On the other hand, many other homosexually-oriented or homosexually-behaving individuals have legitimate health, cultural, value, social, or religious reasons for choosing to request reparative therapy to reduce or eliminate homosexual orientation and/or homosexual behavior patterns.
Ethically, the therapeutic choice should be up to the patient; it is unethical (unfair and lacking in compassion) and a violation of patient civil rights for the therapist to impose the therapist’s sexual values and a narrow range of treatment options on the patient. Because recent empirical research has demonstrated that therapeutic interventions to reduce or eliminate homosexual orientation and behavior in adolescents and adults have similar success rates as treatments for other comparable conditions, and that attempts at such therapy is not emotionally harmful to either successfully treated or unsuccessfully treated individuals, the most ethical practice (in terms of fairness, integrity, and compassion) is to allow the patient to select their own treatment goal pertaining to homosexuality, after a fair presentation of treatment options (Byrd & Nicolosi, 2002). Applying the moral principle of professional integrity, therapists uncomfortable with or unskilled in reparative therapies for reversing homosexuality should refer patients who make that treatment choice to other therapists who are willing and skilled in reparative therapies. Similarly, some therapists will be uncomfortable or unskilled in “gay-affirmative” therapies and will need to refer patients with that goal to other clinicians.
While many mental healthcare providers and professional associations have expressed considerable skepticism that sexual orientation could be changed with psychotherapy and also assumed that therapeutic attempts at reorientation would produce harm, recent empirical evidence clearly demonstrates that homosexual orientation can indeed be therapeutically changed in motivated clients, and that reorientation therapies do not produce emotional harm when attempted (e.g., Byrd & Nicolosi, 2002; Byrd, Nicolosi, & Potts, 2008; Jones & Yarhouse, 2007; Nicolosi, Byrd, & Potts, 2000; Shaeffer, Hyde, Kroencke, McCormick, & Nottebaum, 2000; Shaeffer, Nottebaum, Smith, Dech, & Krawczyk, 1999; Spitzer, 2003; Throckmorton, 2002). You may be particularly interested to read the longitudinal outcome study conducted over several years by Dr. Jones and Dr. Yarhouse that demonstrated that people with a homosexual orientation can change to a heterosexual orientation with group therapeutic intervention.
Andrew mentioned, “Most disturbing of all, you advocate public policy that strips people of their dignity and personal freedom based on very little information, much of it clearly seemingly non-academic in nature and contradicted by every psychology and sexual education professional I’ve ever met.” I disagree. I affirm the dignity and personal freedom of people. My statements were based in decades of academic research and experience as a clinical psychologist. And my conclusions are shared by thousands of other respected academic and mental health professionals. I pointed Andrew to two websites that provide evidence to the contrary to Andrew’s conclusions. [1] My own website at www.ProfessorGeorge.com, and [2] the website at www.narth.com, which is the website of a professional association of hundreds of psychologists, psychiatrists, and other mental health counselors, called the National Association for Research and Therapy of Homosexuality.
Finally, Andrew made a sad observation, “As a gay friend said to me ‘No one would choose this lifestyle’. This should be painfully obvious…” The word “lifestyle” describes behaviors or actions. The sad truth is that people do not participate in any adult sexual behavior (lifestyle) without making the choice to do so, unless they have a serious mental disorder (such as a psychotic condition) or unless they are forced into it by verbal threats or by violence (such as rape). Granted, many, if not most, people with same-sex attractions do not choose to have those attractions. See articles and books referenced at www.narth.com for scientific evidence that same-sex attractions are likely a result of psychological, developmental, and/or medical abnormalities. (However, psychological evidence indicates that a person can reinforce the strength of those same-sex attractions by choosing to participate in repeated homosexual behavior.) Having same-sex attractions is not the same as a “lifestyle.” A gay lifestyle is a choice to act on same-sex attractions. Having same-sex attractions is not morally wrong in themselves. But I think Andrew would agree, at least, that an HIV-positive man who performs an insertive sexual act upon another man is choosing to perform an immoral act. A person (without a severe mental impairment such as psychosis) can choose whether or not to act on same-sex attractions through homosexual behavior.
In the context of the information shared in the references to this blog and in the above two websites, I think you will see that there is a great deal of psychological research and clinical experience behind my statement, “In all my years being a clinical psychologist, many teens and adults with same-sex sexual attractions have come to me asking for help to become heterosexual. But no one with heterosexual attractions has ever come asking my help to become develop a homosexual lifestyle!!!”
Finally, it is not true that I am a “member of the Family Research Council” as Andrew implied. However, it is true that I was the founding Chairman/CEO of the Family Research Council, along with a governing board that included professors of psychiatry at Harvard University Medical School and Duke University Medical School. We founded this organization to provide academic research findings to the public and to interested governmental bodies.
I invited Andrew’s further reflection on these matters, and I thank him for his comments.
References
American Medical Association. (2005). International Statistical Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM, AMA Physician, 2005). Chicago: American Medical Association.
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Arlington, VA: American Psychiatric Association.
Appelbaum PS, Lidz CW, Meisel A 1987. “Informed Consent: Legal Theory and Clinical Practice.” New York. Oxford University Press.
Byrd, A. D. & Nicolosi, J. (2002). A meta-analytic review of treatment of homosexuality. Psychological Reports, 90, 139-152.
Corey, Gerald, Corey, Marianne Schneider, and Callahan, Patrick (2007). Issues and Ethics in the Helping Professions (7th ed.). Belmont, CA: Thomson Brooks/Cole.
Jones, Stanton L. & Yarhouse, Mark A. (2007). Ex-gays?: A Longitudinal Study of Religiously Mediated Change in Sexual Orientation. Downers Grove, IL: IVP Academic.
Koenig, H., & Pritchett, J. (1998). Religion and psychotherapy. In H. Koenig (Ed.), Handbook of religion and mental health (pp. 323-336). San Diego, CA: Academic Press.
Schwartz HI, Roth LH 1989. “Informed Consent and Competency in Psychiatric Practice.” In Tasman A, Hares RE, Frances AJ (eds) Review of Psychiatry Vol. 8. Washington DC. American Psychiatric Press, Inc. 409-31
Shaeffer, K. W., Nottebaum, L., Smith, P., Dech, K., & Krawczyk, J. (1999). Religiously-motivated sexual orientation change: a follow-up study. Journal of Psychology and Theology, 27, 329-337.
Sperry, Len (2007). The Ethical and Professional Practice of Counseling and Psychotherapy. Boston, MA: Pearson Education.
Spitzer, R. L. (2003). Can some gay men and lesbians change their sexual orientation? 200 participants reporting a change from homosexual to heterosexual orientation. Archives of Sexual Behavior, 32, 403-417.
Steere, D. (1997). Spiritual presence in psychotherapy: A guide for caregivers. New York: Brunner/Mazel.
World Health Organization. (2007). International Statistical Classification of Diseases and Related Health Problems,10th Revision Version for 2007. Available at www.who.int/classifications/apps/icd/icd10online/. Accessed March 20, 2008.
I’d be interested in you, the reader’s comments on this issue, as well as in Andrew’s reaction to my reply. E-mail your questions to: teensextoday@ProfessorGeorge.com or just write to me on my blog. If we post your question, we can keep it anonymous if you so request. Count on me to be logical, ethical, and scientific in my answers.
–Professor George
© Copyright, 2008, Professor George LLC
George A. Rekers, Ph.D., FAACP, Distinguished Professor of Neuropsychiatry and Behavioral Science Emeritus, University of South Carolina School of Medicine
www.ProfessorGeorge.com
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