A Lee Beckstead. Journal of Gay & Lesbian Psychotherapy, Volume 5, Issue 3-4. 2002.
Sexual reorientation therapies, commonly referred to as conversion or reparative therapies, have been developed for individuals who sense themselves to be “homosexual” and find this identity incongruent. Historically, mental-health professions have offered sexual reorientation treatments that have ranged from biological, behavioral, cognitive, and psychodynamic to religious as a means for homosexuals to develop into heterosexuals (cf. Drescher, 1998a; Haldeman, 1991, 1994; LeVay, 1996; Murphy, 1992, 1997).
Current approaches tend to utilize religious and psychodynamic principles that define homosexuality as a “condition” that results when a child does not receive sufficient love through the attachment to the same-sex parent, thereby creating an estrangement toward same-sex others. Moberly (1983), for example, theorized that a gay man is like a boy who yearns for his father’s love, which Moberly affirmed as a normal and valid need. However, her theoretical perspective is that this need becomes pathologically sexualized in its search for what she calls “same-sex completion.” She defined adult homosexuality as “fundamentally a confusion of the emotional needs of the non-adult with the physiological desires of the adult” (p. 21). According to Nicolosi (1993), the core issue for male homosexuals is their sense of feeling different and inferior from same-sex parents and peers: “It is this internal sense of incompleteness in one’s own maleness [that] is the essential foundation for homoerotic attraction” (p. 211). Female homosexuality is rarely discussed within sexual reorientation theories, although Elaine Siegel’s (1988) work is a notable exception. Current sexual reorientation treatments for both sexes tend to offer “gender lessons” and support groups whereby clients can see others of the same sex as friends rather than sexual partners. With these cognitive shifts, clients theoretically can “catch up, to conquer what the heterosexual . . . achieved years before” (Nicolosi, 1993, p. 213). For the sake of salvation, sexual reorientation programs tend to rely on the power of God and prayer to help the repentant homosexual strengthen willpower, reduce desire, and limit behavior (Ritter and O’Neill, 1989). Heterosexual marriage and children are promised, which sexual reorientation therapists consider a healthy adaptation to a heterosexual world (Nicolosi, 1991). For purposes of this article, the term, “sexual reorientation therapy” is used as an umbrella category for the entire enterprise of attempting a change in sexual orientation via therapy; the terms “conversion” and “reparative” therapy are used synonymously for those treatments that are religious in nature and utilize a gender-identity etiology.
Two dichotomized clinical and political agendas have intersected around the issue of sexual reorientation. The first agenda tries to create a method of eliminating sexual attractions to same-sex individuals and to foster a heterosexual conversion (“gay is bad”) while the second aims to promote the expression to self and others of a homosexual identity and to validate same-sex sexual and emotional relationships (“gay is good”). Corresponding with these two perspectives, institutional debates in the mental health fields have emerged that question whether to ban or further develop these treatments. The current debates parallel the historical discussions that took place during the declassification of homosexuality as a mental illness (cf. Bayer, 1981). The aim of this article is to present the two polarized perspectives of the discussions on sexual reorientation, the oversimplification felt to characterize both views, and the potential harm to clients of forcing an all-or-nothing choice to be an “out” gay or an “ex”-gay.
The Ethics of Sexual Reorientation Therapy: Self-Determination and Efficacy
Among others, two issues have emerged surrounding the ethics of sexual reorientation therapy: (a) providing clients with the opportunity to self-determine and (b) evaluating the efficacy of such interventions. On the one hand, proponents of reparative therapy believe that “non-gay” homosexual clients (Nicolosi, 1991) have the right to choose the kind of therapy they receive and the freedom to choose how to live out their sexual orientation. Supporters of this argument cite the American Psychological Association’s (APA) General Principle D of the Ethics Code (APA, 1992), which calls for “Respect for People’s Rights and Dignity” and affirms that psychologists be aware of and respect cultural and individual differences. Both religion and sexual orientation are among these differences. Furthermore, Standard 1.09 expects that “psychologists respect the rights of others to hold values, attitudes, and opinions that differ from their own” (APA, 1992, p. 1601). It is this reasoning that leads Throckmorton (1998) and Yarhouse (1998) to assert that it is unethical to force individuals who are unhappy with their same-sex attractions into accepting a lesbian, gay, or bisexual (LGB)-affirmative identity because it goes against the clients’ religious choices, diversity, and moral convictions. They argue that an “out” LGB-affirmative identity may prove too difficult for some individuals insofar as it presents a constricted range of choices that are unacceptable alternatives to leaving spouse, children, church, and community. Literature exists to support the idea that therapy can have a better outcome when therapists utilize counseling interventions that respect the principal values and goals of clients’ religion (Bergin, 1980; Worthington, 1988). For example, Koltko (1990) provided an analysis of how religious beliefs affect psychotherapy:
Religious beliefs help to form a client’s attitudes about the self and its worth, about what that self should become, and provide answers to questions such as: What forms of lifestyle are to be preferred? Which forms of human experience are pathological, which are merely normal, and which are genuinely and healthily transcendent? In brief, religious beliefs can influence every part of the personality. (p. 139)
In support of this position, McConaghy (1977) argued that individuals seeking conversion treatments should not be considered as victims of society but rather as capable of making a voluntary and knowledgeable request in accordance with their values and needs. Sturgis and Adams (1978) agreed and claimed that banning conversion therapy would indicate a failure to accurately assess and satisfy clients’ needs.
On the other side of this debate are LGB-affirmative mental health organizations and therapists who argue that so-called non-gay clients do not have the freedom to be who they are, given the homophobic and heterosexist beliefs that pervade society. The underlying premise to treat homosexuality, as stated by Spitzer (1981), is a value judgment of whether “homosexuality and heterosexuality are essentially comparable conditions, differing only in prevalence” (p. 213). However, heterosexual bias, defined by Morin (1977) as a “belief system that values heterosexuality as superior to and/or more ‘natural’ than homosexuality” (p. 629), undeniably exists. This bias is known to foster hatred, discomfort, and fear of same-sex intimacy, love, and sexuality while promoting the more conventional, heterosexual ideal. Individuals may internalize these critical, external assessments, and uncomfortable or painful emotions may become activated when encountering homosexuality. Externally, societal institutions and systems often force individuals to dissociate and fragment their lives rather than helping them consolidate and accept the possibility of living with an “out” gay identity (Coleman, 1982; Herek, 1984; Ritter and O’Neill, 1989; Drescher, 1998b). Silverstein (1972) addressed these ideological effects and how they relate to issues of self-determination and sexual reorientation:
To grow up in a family where the word “homosexual” was whispered, to play in a playground and hear the words “faggot” and “queer,” to go to church and hear of “sin” and then to college and hear of “illness,” and finally to the counseling center that promises to “cure,” is hardly to create an environment of freedom and voluntary choice. (p. 4)
Begelman (1975) insisted that the very existence of conversion therapy programs strengthens biases against homosexuality, while adding to the self-hatred of the clients seeking an alleged cure. Agreeing with these criticisms, Davison (1978) urged clinicians to conduct comprehensive assessments of clients’ social and political systems, thereby focusing “on the problems homosexuals (and others) have, rather than on the so-called problem of homosexuality” (p. 170).
Those who criticize sexual reorientation therapy also argue that changing one’s sexual orientation is not possible and that attempting such a change may cause harm (Haldeman, 1991, 1994; LeVay, 1996; Martin, 1984; Murphy, 1992, 1997; Stein, 1996). Many have asked what exactly is the basis for conducting sexual reorientation therapy if homosexuality is no longer considered pathological or a mental disorder (Tozer and McClanahan, 1999). After presenting what he calls the “inadequate and questionable science” of conversion treatments, Haldeman (1991) pointed out that mental health providers who use such interventions “commit consumer fraud, as this damaging practice simply does not work” (pp. 150, 160).
In line with the latter reasoning, on August 14, 1997 the American Psychological Association passed that a resolution based on its ethics code, that affirmed six basic principles concerning treatments to alter sexual orientation. The resolution supported the “dissemination of accurate information about sexual orientation, and mental health, and appropriate interventions in order to counteract bias that is based in ignorance or unfounded beliefs about sexual orientation” (APA, 1998, p. 934). In essence, the resolution requires a full discussion by the therapist of the client’s potential for happiness as a gay, lesbian, or bisexual individual and communication that no scientific evidence exists that conversion treatments work. The American Psychiatric Association (2000) elaborated on its earlier stance that homosexuality is not a mental illness and recommended that practitioners refrain from using sexual reorientation interventions until these treatment modalities are placed under empirical scrutiny to assess risks versus benefits and long-term outcomes. Other mental-health provider associations such as the American Medical Association, American Academy of Pediatrics, American Counseling Association, and the National Association of Social Workers have made similarly strong policy statements against sexual reorientation therapy.
The “Gay is Bad” Agenda: “Change is Possible”
Despite current LGB-affirmative stances, individuals continue to seek out– and a subset of therapists continues to offer–sexual reorientation therapy. “Ex-gay” ministries became visible to the public’s eye from July 13 to July 20, 1998 when a series of “ex-gay” advertisements appeared in national newspapers, including The Los Angeles Times, The New York Times, USA Today, The Washington Post, and The Washington Times. These full-page advertisements were sponsored by 18 religiously conservative organizations, including the Christian Coalition and the Family Research Council. The text of these advertisements included the messages that “the truth may hurt before it can heal, but change is possible” and “if you really love someone, you’ll tell them the truth . . . that homosexuals can change” (“We’re Standing,” 1998, p. A11). Anne and John Paulk (Paulk, 1998) became a “poster couple” for the “ex-gay movement” when they appeared in these ads, testifying of their happy marriage, their freedom from a homosexual past, and the possibility that anyone could change her or his sexual orientation. Similarly, Exodus International, one of the largest ex-gay organizations, promoted the need for and effectiveness of conversion treatments:
Exodus upholds heterosexuality as God’s creative intent for humanity, and subsequently views homosexual expression as outside God’s will. Exodus cites homosexual tendencies as one of many disorders that beset fallen humanity. Choosing to resolve these tendencies through homosexual behavior, taking on a homosexual identity, and involvement in the homosexual lifestyle is considered destructive, as it distorts God’s intent for the individual and is thus sinful. Instead, Christ offers a healing alternative to those with homosexual tendencies. Exodus upholds redemption for the homosexual person as the process whereby sin’s power is broken, and the individual is freed to know and experience true identity as discovered in Christ and His Church. That process entails the freedom to grow into heterosexuality. (Exodus International, n.d., para. 2-3)
Although many testify of the possibility of changing one’s sexual orientation (e.g., Dallas, 1991; Nicolosi, Potts, and Byrd, 2000a, b; Socarides, 1995), no definitive statement exists explaining what clients, therapists, or researchers consider change to be in sexual reorientation outcome studies. Stein (1996) remarked that clients and therapists may have different goals in mind when using conversion principles, such as extinguishing homosexual fantasies or behaviors, replacing homosexual behaviors with heterosexual relationships, or altering the fundamental sexual orientation. Freund (1960) noted early on that the “major criterion of success appears to be a change in the sexual behaviour of the patient; a homosexual is regarded as cured when he [or she] gives up homosexual practices and succeeds in initiating heterosexual conduct” (p. 315). Other outcome goals may include learning to cope with the periodic intrusion of homosexual attractions, reducing behaviors and thoughts enough to live by one’s religious and moral standards, or living with celibacy. Nicolosi (1991) proposed that reparative therapy
. . . can do much to improve a man’s way of relating to other men and to strengthen masculine identification. As a result of their treatment, many men have been supported in their desired commitment to celibacy, while others have been able to progress to the goal of heterosexual marriage. (p. xviii)
Based on clinical experience, Birk (1980) noted that most individuals who identify as homosexual before treatment continue to have some homosexual feelings, fantasies, and interests after treatment. However, Yarhouse (1998) emphasized that same-sex attractions should be expected after treatment, similar to recovered drug abusers who still have “cravings” and experience residual effects. Regardless of the disputable analogy that homosexuality is similar to a drug addition, the lack of uniformity around outcome goals is lumped together and “change in sexual behavior or in the gender of one’s primary partner may not indicate any change in underlying sexual desire at all” (Stein, 1996, p. 530).
Further adding to the ambiguity of whether a “cure” exists for homosexuality, self-reports of sexual reorientation have not been consistent with objective data. For example, Conrad and Wincze (1976) found that physiological arousal measurements did not support the positive reports of those who had participated in sexual reorientation behavioral therapy. Freund (1960) discovered, using data from phallometric assessments, that the descriptions of clients’ successes of sexual reorientation were imprecise and involved contradictions with follow-up investigations, “which throws doubts on the diagnosis either before or after treatment” (p. 315). To date, no rigorous and definitive efficacy studies have been performed identifying what can be changed regarding sexual orientation, and the discussion of sexual reorientation therapy remains polarized.
“Gay is Not Me”: Experiences of Those Who Describe the Benefits of Conversion Therapy
To bring more understanding to this subject, this article’s author (Beckstead, 1999) recorded and analyzed the perspectives of 20 individuals (2 women, 18 men) who had undergone counseling to change their homosexual orientation. Qualitative methods were used to develop a grounded theory (Glaser and Strauss, 1967) and theoretical framework that was based on participants’ individual interviews, journal writings, and a focus-group discussion. These individuals were selected to participate in the study because they self-identified as proponents of sexual reorientation therapy and reported that they had become “exclusively heterosexual” or experienced other successful outcomes due to such treatments. This sample represented a subset of a larger research sample (5 women, 45 men) that included both the proponent sample and individuals who had underwent conversion treatments but self-identified with an “out” LGB identity and reported being harmed by or opposed to such therapy (Beckstead, 2001). The two research samples could be identified as either “converted” or “nonconverted” to the ideology of conversion therapy. The research sample as a whole was limited to those individuals who were European-American and members of the Church of Jesus Christ of Latter-day Saints (LDS or Mormons).
According to LDS doctrine, the highest blessings are reserved for those who fulfill the moral obligations of the LDS church, and significant doctrines declare that homosexuality is not a part of God’s plan (Doctrine and Covenants, 1981). That is, “everlasting joy” and “exaltation to Godhood” depend on a heterosexual family. The LDS church has in the last decade offered an acceptance of and leniency toward individuals who have same-sex attraction, as long as they do not “indulge” in the “perverted acts” of homosexual behavior (Oaks, 1995). Brzezinski (2000), in her research regarding same-sex attracted Mormons, articulated the “process and pain of identity development when faced with the disparity between same-sex orientation and religion” (p. iv). This strong religious climate affected the lives of the participants in this study as well, and their stories reflected their struggle. The present study, therefore, provided not only a description of the experiences of seeking sexual reorientation via therapy during a highly politicized debate, but it also supplied a unique analysis of the experiences of homosexual individuals who have a strong religious background. A summary of the results from this study follows to highlight participants’ needs before treatment, how they met these needs via conversion therapy, and their agenda to let others know of the benefits of self-determination.
Disease Model: A Need for a “Cure”
All participants in the “converted” sample emphasized that their religious identities remained central to their core identity. As one participant, Robert, remarked:
The thought of living a gay lifestyle … never crossed my mind. It was never an option to me. My upbringing in the church, my belief system, was so much a part of who I was. That’s who I was. The sexual orientation was peripheral and if the sexual orientation was not in harmony, then something had to give and I decided, almost subconsciously at that point, that I was not going to be homosexual.
In addition to this “peripheral” positioning of their sexuality, every participant had distinct, negatively critical and polarized images of what it would mean for them to “be gay”–perceiving severe limitations of what their lives would be like if they were to consider themselves homosexual. They discussed how they developed these beliefs from personal experiences, stories from others who had lived “the gay lifestyle,” and statistics about the dangerousness of being gay. Overall, their attitudes about the lives of gays, bisexuals, and lesbians were derived from a stereotypical view that to be gay would involve a life of promiscuity, distrust, cruising, disease, selfishness, loneliness, and emptiness. As stated by Matt, “Whatever discomfort I might feel trying to conform to a heterosexual lifestyle would be far more preferable [than living a gay lifestyle] … The gay lifestyle could not promise commitment with the integrity and devotion that such commitment can foster.” Russ also commented that “being gay” was not the optimal choice:
I don’t think it lends itself to the optimal development of a person whether that is mentally, socially, morally, [or] physically. There’s a good deal greater health risk I think associated with the gay lifestyle, in terms of contracting diseases. I think that it’s not optimal and therefore if you really pursue our own interest as a society, we wouldn’t reward or condone it.
Many participants claimed that their homosexuality was equal to an internal “dis-ease,” such as diabetes, bulimia, asthma, and cancer. For example, Shannon felt “afflicted” by his same-sex attractions and wished he did not have this “insidious, insidious, horrific, terrible, plague.” He continued by saying:
I wouldn’t wish this on anybody. I would rather have cancer. That’s how I look at it honestly. I have said this many times because cancer doesn’t affect my eternal progression … Theoretically, I can be cut off from my wife and be cut off from God … So this is much worse than any kind of disease that I could ever have.
Another participant, Jason, who wrote books about the benefits of conversion therapy and used the pseudonym of Jason Park, also viewed being gay as spiritually, emotionally, and physically dangerous. In one book, he used inaccurate statistics that claim that “less than 2% of the gay population survives to age sixty-five” (Park, 1997, p. 131). Despite these strong, disapproving statements, participants also described experiencing a degree of pleasure or passion due to their same-sex attractions. Clint seemed to sum up these conflicting experiences by stating, “I see it as a sad lifestyle, although it has some elements that I find appealing. Is that an honest answer?”
Participants emphasized that the generally accepted concept of “internalized homophobia” was not the primary motive for not wanting to be gay. They indicated that the essential reason that compelled them to change their sexuality was a spiritual need to conform to what they felt to be true. For example, John insisted, “No, the pain was not inflicted by my religion’s or by society’s intolerance of homosexuality, but by my own soul’s sense of dissonance; being gay did not bring harmony to me in my life.” Like other participants, Rex provided examples of how he felt that “something seemed missing” in his life because of his homosexual actions. Doug, who no longer practiced the doctrines of the LDS church, emphasized that he believed his reason not to be gay came from an internal sense of what is right and wrong:
The thing I think I need to drive home is that I had no external pressure to change. All of it had been long gone by the time I got involved in reparative therapy, and I did it because I wanted to…. [Being gay] just feels funny to me. It’s not what I want, you know, and the standard gay Nazi response is “Well, this is internalized homophobia.” Maybe, but maybe not, you know. That’s a cop-out. But there is something deep that has nothing to do with religion, family, or anything else that if I just calm down, mellow out, there is something that just feels weird about me being gay . . . There’s something just weird internally to me about setting up a household with his-and-his towels.
With these self-concepts of being diseased, damned, and in need of change, all participants sought help from their religion.
Religion’s Agendas and Responses
Although participants’ church leaders tended to provide support, many participants discussed their frustration with the leaders’ responses. Muriel, for example, pointed out, “Some just plain have no clue.” Dan commented on his disappointment:
One thing that was very difficult for me to understand was why my [church] leaders couldn’t get any inspiration for me. I understood why I might not be able to get answers; I wasn’t worthy to. But why not my leaders? These were spiritual men. Weren’t there any answers?
Several participants stated that they were threatened by their church leaders to leave their gay relationships or be excommunicated. Shannon verbalized the treatment from his church officials in this manner: “I’ve learned that people want to beat you into submission, or emotionally even.” Forrest related that his experience of going through a church disciplinary council left him distrustful of church leaders:
I had previously asked for support from bishops in dealing with the pain and grief that I was going through associated with being gay and a member of the church. Three bishops and my stake president told me they didn’t want to hear about it. When I confessed my wrongdoing, they couldn’t decide what the next course of action would be and they left me in limbo for about a month. That, combined with their breaking a confidence and other events, left me feeling extremely depressed and unwanted.
Discussing the meeting he had with an official in the LDS church, Robert said, “He told me that this millstone would soon be taken off my neck. Little did he know.”
LGB-Affirmative Therapists’ Agendas and Responses: “Gay is Good”
Participants turned to many forms of therapy to resolve their conflicts. Therapists who proposed that participants should “come out” and leave their religion were described as unable to understand the complexities of participants’ dilemma. Jason’s dialogue with his first counselor seems to articulate the frustrations expressed by all participants:
I tried to explain the conflict to her between religion, my personal values, [and my same-sex attractions] . . . and she just kind of said, “Well, I don’t see what your problem is. Just pick one.” She didn’t seem much help. She just didn’t quite get it.
Jacob provided an example of how his therapist unintentionally pointed out the losses that Jacob would have if he chose to identify and live his life as a gay man:
I went down in my mind this path of finding a lover, leaving my wife, and losing everything I loved, which was my wife and my family and my church and my God, my relationship with Him, and not finding any real happiness in that relationship in my mind because by that point I had known other people who had been in these relationships and they were fleeting.
Barnaby agreed, “I couldn’t see leaving all that behind.”
The Need for More Choices
Because of the high stakes involved of losing family, friends, community, religious support, and eventually “eternal exaltation,” participants felt that “being gay” was not a valid choice for them and asked for more options than having to be “that way.” For example, Barnaby stated:
What I don’t like is the idea that it’s inevitable. That someone grows up and suddenly they are 12 years old and they see a guy and they like his butt, you know, and suddenly they are gay. I don’t like that.
Ace, who was struggling to get out of a lesbian relationship during data collection, wrote about her conflicts with her options:
It tears me in two. I don’t believe I have a choice. I’m supposed to be the good little Mormon wife–being faithful and virtuous. But that’s wrong–of course I have a choice (we always have choices, don’t we?) and the choice I’ve been making for the past several months is not the choice that I should be making.
Participants adopted a variety of coping strategies to eliminate or cope with homosexual feelings. These strategies included (a) intrapsychic defense mechanisms; (b) sexual and relational solutions; (c) emotional coping; (d) hiding; (e) religious solutions; and (f) escape, release, and suicide. These strategies varied in their effectiveness but were unable to eradicate participants’ attractions. Attempting suicide was seen as the only solution for 8 participants. Dan, for example, wrote, “I felt like I couldn’t continue to live in such pain. My alternatives seemed to be either to end my life or to straighten my life out.” Similar to other participants, Paul wanted to destroy the homosexual self he could not live with:
I really felt that that guy was out of control and was being controlled by circumstances and his body, and I wanted to be controlled by a higher power . . . I was majorly heading downhill and that’s when I was contemplating getting rid of the guy I didn’t like.
Sexual Reorientation Therapy: “The Last Option”
Participants’ distress intensified around their sexual, religious, social, and spiritual conflicts and their coping strategies became more maladaptive until they hit what they described as an emotional “bottom” that compelled them to seek out a therapy that would resolve their conflicts. In addition to the emotional distress, 4 participants reported that they sought conversion treatments after they were convicted of public sexual activities. Richard described his motivation for therapy in this way:
I entered therapy in a complete state of crisis. My life was out of control. I had put my family at severe risk of being torn apart, losing my marriage and my children. After 14 years, I could no longer manage the double life of addict [sic] and churchgoing family man. I felt I had no choice but to enter therapy.
Kent wrote about the consequences that he experienced for being “totally out of control”:
Suddenly I saw a picture of my own marriage falling apart . . . if I stayed on the path I had started down again. It upset me, bad. I literally went and locked myself in the bathroom and covered my mouth while I sobbed for grief over what I had been doing again. …I really didn’t know how to deal with this, and that’s when I got involved with reparative therapy.
Converting to the Agenda of Reparative Therapists
For participants in this study, sexual reorientation therapy seemed to represent the best coping strategy to self-determine and find a solution that would be congruent with their religious and societal values. It was, as Jacob emphasized, a therapy that would “go the way [these participants] wanted to go.” Accordingly, participants stated that sexual reorientation therapists and support groups accepted them as heterosexuals and provided causal theories and interventions to replace previously distressful self-concepts with more acceptable labels and skills. For example, participants described experiencing relief and hope after learning from reparative therapy principles that all heterosexuals have same-sex needs for emotional closeness and that participants did not have to eliminate these needs, only the sexualizing of these needs. Paul explained:
I started getting some books. I think that’s where I started getting major change for me. I was finally getting some literature that was helping me understand what I was dealing with…. Then I had something to pin some hopes on.
Because of these etiological theories, participants stated that they were able to connect their childhood neglect and gender inferiority to the cause of their homosexual feelings and behaviors. As Matthew wrote, conversion therapy “ended up identifying root causes of depression and feelings of inadequacy that gave rise to the same-sex attraction, or at least to its acute stages.” Participants overall valued and were converted to these etiological theories that seemed to provide them with a reason “outside of them” of why they acted homosexual, rather than the belief that they were inherently or genetically homosexual. This seemed congruent with their need to believe that “being gay” was not a part of them.
Furthermore, with a religious belief in Satan’s role to tempt these individuals continually with “amoral” thoughts, participants seemed assured that they did not have to feel distressed about being attracted to same-sex others, as Jason explained in his book:
Temptation is not identity. Just because you are tempted by homosexual feelings, it does not mean you are a homosexual. Satan may continue to tempt you with things from your past, although you have left them behind . . . Some men also try to compare sexual experiences with men with the sexual experiences they have had with their wives. This is an unfair and unnecessary comparison. Since illicit sex with a man is counterfeit love, Satan is anxious for it to be intense and seem fulfilling. But like illegal drugs, it produces an abnormal high that does not last. (Park, 1997, pp. 117, 185-186)
Given these reparative therapy and religious models, participants were not punished if they had behavioral and cognitive relapses but were treated as addicts who were in recovery and seeking treatment. This shift in identity from sinner to penitent seemed relieving to participants. Overall, their same-sex (emotional) attractions, which were once considered as “unnatural,” became reframed for participants as universal, heterosexual, and nothing to eliminate.
Experiences of Success
Along with the positive outcomes of relief, hope, and acceptance, the overall therapeutic benefits described by the 20 participants in this sample were (a) developing secure, same-sex, emotional relationships; (b) increasing gender identity congruence; and (c) decreasing homosexual behaviors and thoughts. These positive experiences seemed to resolve their previously distressful emotions and identities of being (a) “lost and alone,” (b) a “sissy or tomboy,” and (c) a “fag, dyke, or pervert.”
Universality (Yalom, 1985) seemed to be a curative factor for participants who developmentally had felt “lost and alone” and had the opportunity to participate in a conversion support group. One such group was Evergreen, a support group for same-sex attracted, LDS individuals that offered participants the assurance “that individuals can overcome homosexual behavior and can diminish same-sex attraction and is committed to assisting individuals who wish to do so” (Evergreen International, n.d., para. 1). At the time of data collection, 9 participants were members of Evergreen and 16 of the 20 had been involved in such activities. These groups were described by Jason as “a nonsexual ‘gay’ community” (Park, 1997, p. 80) and were for many the most important part of therapy. Jim expressed the essential nature of his support group in fulfilling his emotional distress:
Evergreen was extremely helpful, but not with what we proposed it to do. Therapy is interesting for the theories it proposes, but the help I got from Evergreen has been the associations and friendships I’ve made. I’ve talked with 200 men, 50 intimately. That has been helpful. Therapy and counseling and all that–I wish I had the money back.
Shannon captured the overall feel of Evergreen with these words: “You’re not bad, I love you, let’s progress together.” Overall, participants described benefits of receiving validation, normalization, added resources of information and accountability, and opportunities to be authentic and develop relational styles.
Participants described their treatments as focusing on feelings, labels, and behaviors of growing up a “sissy or tomboy,” because of their therapists’ belief that a gender-identity deficit was the “cause” of homosexuality. For the male participants, a program of learning and playing sports was incorporated into their treatment. Doug explained this process as an “emotional transformation” and an “identity change.” Muriel also described a maturing into her true gender identity through therapy:
I am a very active dreamer at night … In my relationship dreams, I wasn’t always the same gender. Sometimes I was a boy with a girlfriend, sometimes a girl with a girlfriend, and sometimes a girl with a boyfriend and sometimes I wasn’t even sure what gender I was or who I was. This would really distress me in the morning and I would feel confused and upset throughout the day … But I have noticed in the past year that I don’t dream of myself as the guy anymore … Perhaps my true identity is becoming more instilled inside me.
Overall, this focus on gender roles and gender-group membership seemed to develop for participants a new sense of belonging, self-efficacy, and acceptance.
In addition to these benefits, participants reported shifts in their previous identity of experiencing themselves as “fags, dykes, or perverts.” These shifts seemed to occur because they reframed their sexual fantasies as emotional needs, learned strategies to manage their attractions by decreasing the frequency that they sexualized same-sex individual, and discontinued homosexual sexual behaviors through relapse-prevention techniques. Bruce, for instance, explained his process of coping with same-sex attractions:
Ask yourself, “What is it you really want? Do you want to have sex? Do you want a friend? Where are you going with this? …I realized that my perspective was changing a little bit where at first I would be walking across campus and I would see a good-looking guy and start sexualizing, to where I was like, “You know, I wonder if I could be his friend. I wonder if we could really be friends.” And it just kind of changed my focus . . . And again, it’s still my choice if I want to sexualize it. Yes, I could still be aroused, but it’s not necessarily what I want to do.
Another way participants seemed to cope with the dissonance of having same-sex attractions and not being gay was in making a distinction between being homosexual and doing homosexual. That is, a person only is lesbian, bisexual, or gay if she or he continues to do homosexual acts. The importance of the dichotomy of being and doing lies in the possibility that participants did not need to accept a homosexual label or orientation. As Jacob reasoned,
How come someone who is living in a marriage relationship can have adulterous feelings and they’re not labeled as adulterer: “You are an adulterer. You have adulterous feelings. You will always be an adulterer.” (Laughs) … I just couldn’t accept those labels.
To embrace the idea that “gay is not me,” participants needed to abstain from homosexual behaviors and fantasies, as Doug stated: “The only thing that defines the difference between homosexual and heterosexual is behavior. I mean, if I’m sitting next to my straight buddy, the only difference between him and me is behavior.” LDS church leaders also distinguished between “being” and “doing” when considering the repentance of members. For example, a prominent LDS church official, Oaks (1995), asserted, “We should note that the words homosexual, lesbian, and gay are adjectives to describe particular thoughts, feelings, or behaviors. We should refrain from using these words as nouns to identify particular conditions or specific persons” (p. 9). Similarly, John, who married approximately five months after our interview, explained,
My sexual orientation is heterosexual. I am not what I would say cured. I believe that any kind of addictive behavior creates patterns in the brain that take a long time to change, whether it’s drinking or taking drugs or whatever. I had established a pattern….I feel now like I’m a heterosexual who has not been [hetero]sexually active.
As an outcome of therapy, many participants reported that their “homosexual problems” had ceased to be an issue in their lives. Paul exemplified this with his comment: “It’s so nice to be at peace….I don’t feel controlled by it, and I carry on other stuff in my life now.” Achieving control over how to live their lives seemed to provide a sense of empowerment, as stated by Rex: “I came to understand that I have a choice as to how I behave. Before therapy, I was frightened. After therapy, I am confident and able to recognize my choices and choose according to what I feel is right.” Participants referred to this increased self-understanding and self-acceptance as finding “wholeness” and congruence. For example, Jim described his progress as
…a maturing process of becoming more accepting of life, more accepting of who you are, and more powerful in your ability to get what you want, see what you want, have a clear vision, and achieve a certain calmness of who you are.
Participants reported, however, that their sense of peace and contentment did not indicate a change in sexual orientation but a change in self-acceptance, self-identity, focus, and behavioral patterns. No substantial or generalized heterosexual arousal was reported, and participants were not able to modify their tendency to be attracted erotically to their same sex. Yet, these same participants continued to self-identify as heterosexual. That is, as they became converted to the reparative therapy model that defined them as heterosexuals and as they decreased their homosexual behaviors, participants could label themselves “resolved” of their homosexuality. This treatment outcome seemed to involve attitudinal shifts in what identity they could apply to themselves and what they could do within that identity. Their self-concepts seemed to develop into more acceptable ones, congruent with their values and needs. Overall, a change in how to define sexual identity seemed to occur rather than a direct change in sexual orientation. If anything, participants in this study may have reoriented toward asexuality (i.e., an absence of fantasies for either sex) rather than toward heterosexuality (e.g., Storms, 1980).
Participants’ Agenda: Sharing Their Stories
Many participants mentioned the importance of sharing their stories of success to provide hope for other “strugglers.” For example, John expressed in an Evergreen conference, “For a long time I thought change was possible for others, but not for me. I now know that change is far more difficult than any discussion can define, but that it is possible, and it is a choice–the most difficult choice I have ever made.” The need to let others know that more options exist than identifying as gay, bisexual, or lesbian, to have these options available to explore, and then have the right to choose which options to live were recurring themes as participants talked about their agendas for participating in the study. As Jacob stated, “I think there needs to be studies that show that reparative therapy works.” Matthew wanted to share his “growth process . . . to give others hope for change in society that says change is neither possible nor desirable.” Robert conveyed, “There is so much to the contrary that reparative therapy doesn’t work or that, you know, it’s a forced thing, that people are uptight or whatever. I want to increase the truth that change is available.”
In an addition to their desires to share their successful experiences, participants expressed concern and even anger during their interviews because they believed they were being silenced or oppressed by the mental health organizations’ resolutions against sexual reorientation therapy. For example, Barnaby related, “I think that is a form of abuse. I really do because you’re denying someone the opportunity to look at an option … That is very oppressive.” Richard also expressed his feelings on this subject:
I am angry at the gay culture that perpetuates the lie that no one can ever change and if someone is gay, then the only mentally healthy thing to do is indulge all sexual urges indiscriminately. I am angry with the psychological professionals for adopting the gay agenda, perpetuating that lie, and abandoning men like me for whom change is by far the most emotionally healthy alternative.
Russ talked extensively about his opinions of the 1997 American Psychological Association resolution:
I think their decisions are largely political, whether there are any good studies that address the real issues. It is so politically incorrect to do any research that may even suggest that homosexuality should be in some cases open to remediation. It’s just so politically incorrect that very few people are willing to look honestly at the question . . . Just like anything else, there are risks that the therapy might not have the desired outcome. There are no guarantees, and the fact that there are no guarantees have been skewed and twisted by the gay community, the gay agenda, to the point that the absence of guarantee makes an honest attempt at therapy suspect…. It’s just ridiculous in my mind that that mental health agency has largely abrogated its responsibility when it comes to providing options for people who seek to exercise their right to self-determination.
Doug also stated his concerns and reasons for participating in this research:
My big fear is that politically the whole idea of change, the potential of change, the possibility of change, gets snuffed out for political reasons to that you can’t even talk about it anymore. . . . The person at the end of the food chain gets forgotten and the question of what I want, and how I want, and when I want becomes irrelevant. So I guess I am here to stand up and be counted.
Jim stated his own need to investigate this subject: “There’s not much science in it at all, science has dropped out. It’s become political…a push for a desired outcome. My agenda is to advance the cause of science.” In sum, Doug discussed the need of more research to “cure” homosexuality:
Just because somebody that has asthma isn’t evil that doesn’t mean that you should start silencing any research . . . or any discussion or any possibility of curing or changing asthma. . . . Right now there’s really not a cure for cancer. Is it unfair for a doctor to say, “We’ll see what we can do or we’ll look to see what we can find?”
The Danger in Hoping for a “Cure”
One reason for participants to hope for a “cure” may have come from their religious background and belief in miracles (e.g., “with God, nothing is impossible”). Former president of the LDS Church, Spencer W. Kimball (1969), testified that such change was possible:
After consideration of the evil aspects, the ugliness and prevalence of the evil of homosexuality, the glorious thing to remember is that it is curable and forgivable . . . It is forgivable if totally abandoned and if the repentance is sincere and absolute. Certainly it can be overcome, for there are numerous happy people who were once involved in its clutches and who have since completely transformed their lives. Therefore, to those who say that this practice or any other evil is incurable, I respond: “How can you say the door cannot be opened until your knuckles are bloody, till your head is bruised, till your muscles are sore? It can be done.” (p. 82)
However, promising that God and sexual reorientation therapy “will set you free” from homosexuality was not congruent with the findings of this study, at least not in these simplistic terms. Participants discussed a more complex explanation for their changes and discussed needing to alter their initial hopes. For example, Bruce stated,
I’ll probably never be cured. …I believe that men are always attracted to men, you know, it may not be sexual attraction and make them aroused or something, but if I have good friendships and I can maintain those friendships in an emotional closeness that I need with men and have a wife and kids and a family, then I will be very satisfied, you know, and feel good about my life and then to me that will be success.
In Muriel’s words, one can find both a sense of acceptance of her same-sex attractions as well as a hope of a “cure” for them:
I think if your goal is to totally change the way you feel, then you may be in for a lifetime battle … I guess my therapy goal has been to gain light and truth . . . to know how to handle my feelings of same-sex attraction without getting overwhelmed and feeling hopeless. And I believe that in time–not by ignorance–like [my therapist] taught me, that when we know who we are, then we naturally become that … And if there are parts of us that need to be “repaired,” the Spirit will fix them.
The danger in the acknowledgment that a “cure” may be possible is that it may lead an individual into a “failure” mind set. Hopes of experiencing heterosexual attractions and eradicating homosexual attractions may turn into disappointments. One participant wrote, for instance: “The truth is that I’m really struggling again with the pornography thing, which is extremely discouraging to me at this point.” This participant had mentioned several times earlier in his journal and to others that he was “cured” of his homosexuality but discussed later how he felt defeated because he was not attracted to women and continued to experience homosexual arousal. In addition, all participants described their “conversion” as a long-term process that was often painful. These long-term hopes for a “cure” or resolution, along with continued “relapses,” may be misunderstood as so-called weaknesses of the individual rather than the ineffectiveness of treatments and what is possible to change. That is, individuals who attempt sexual reorientation and fail in experiencing themselves as heterosexual may believe (or their family and church members may believe) that they have not tried hard enough or were not motivated enough. Individuals may internalize their continual failures, and any lack of progress may contribute to self-loathing, lowered self-esteem, and hopelessness. Those clients for whom reparative therapy is not the answer may realize this far too late after their long, painful process gets drawn out.
Clinical, Research, and Political Implications
A subset of same-sex attracted individuals exists who seem to get lost in the polarized debate regarding whether a homosexual can or should become heterosexual. Should same-sex attracted clients in conflict be placed in reparative therapy or provided with an LGB-affirmative stance? Which therapy modality would be more effective and ethical in providing these clients with a healthier and happier lifestyle? Participants in this study suggested that reparative therapy was necessary and effective for them because it provided more options. However, the “nonconverted” participants from the larger research sample (Beckstead, 2001) described many harms from such therapy. Ethically, it is important to develop theories, research, selection criteria, and interventions that will resolve the conflicts with which these individuals struggle. Overall, providing a space for these clients to explore their ambivalence, misinformation, and complex choices may be the most healing factor. Brzezinski (2000) suggested that this safe space provides clients with the sense of freedom to look at all the options before them regarding the integration of their sexuality into their interpersonal and cultural contexts. One may hope that all LGB-affirmative and reparative therapists would support clients in making their own choices about how to prioritize the dimensions of their lives. However, as participants in this study suggested, some counselors still work from an extreme and biased perspective. The following clinical issues seem essential until a broader based treatment plan is developed that allows clients to explore issues from a variety of perspectives.
How Results May Be Useful for LGB-Affirmative Therapists
Participants stated that they needed more workable alternatives than the ones to which LGB-affirmative therapists seemed to espouse. All participants stated that identifying as “gay” was not a valid option for them, because they were unable to deviate from their religious convictions, life circumstances, and values. Haldeman (1996) pointed out that therapists will more than likely be ineffective if they impose contrary value systems on their clients. In general, LGB-affirmative therapists may need to evaluate their heterophobic biases when helping their clients explore options, such as managing the difficult adaptation to a heterosexual lifestyle (Isay, 1998).
Many aspects of conversion therapy discussed as positive by participants may be incorporated into the work of LGB-affirmative therapists. The effective therapeutic variables suggested in this study were finding peace and reconciliation with the identities of being “lost and alone” and labeled a “fag, dyke, or pervert,” and a “sissy or tomboy.” Changing maladaptive defense strategies and forming secure and intimate relationships were also important therapy issues for these participants as they learned to manage their attractions. At least seven clinical issues were prominent for participants in their satisfaction with their social, spiritual, sexual, and gender identities. These salient issues may transfer to all types of therapies and include (a) working within clients’ religious values and relational needs; (b) exploring a range of options and creating workable alternatives; (c) enhancing self-esteem, self-acceptance, and self-control; (d) breaking compulsive cycles and replacing ineffective coping mechanisms; (e) enhancing honesty, authenticity, and assertiveness within relationships; (f) increasing gender identity congruence; and (g) utilizing support groups to decrease the individual’s sense of isolation. Above all, the goal for clinicians may be to facilitate positive self-identifications, regardless of sexual orientation (Morin, 1977).
How Results May Be Useful for Sexual Reorientation Therapists
Four clinical issues were highlighted, based on participants’ perspectives, which could have an impact upon the work of sexual reorientation therapists. These issues include (a) being clear about therapeutic goals and outcome possibilities, (b) being clear about the limitations of sexual reorientation theories and interventions, (c) exploring the effects of homophobia and heterosexism internalized by and acting upon their same-sex attracted clients, and (d) exploring clients’ rigid ways of defining self, gender, spirituality, homosexuality, heterosexuality, and relationships.
Many individuals entering reparative therapy may do so in the hope that such therapy will eradicate their attractions toward same-sex others and increase heterosexual attractions. As previously stated, a successful therapeutic outcome for participants was more complex than “leaving homosexuality.” Clients seeking a status of “ex-gay” or heterosexual must be informed that they may always be susceptible to same-sex sexual desires and that their change process may entail a very long and sometimes painful process.
The limitations of reparative therapy theories and interventions involve making causal interpretations from studies that are correlational, not causal, to confirm their hypotheses about the etiology of homosexuality and how to “repair” it. An alternative hypothesis of their theories could be that a so-called gender-identity deficit develops from the child feeling separate from same-sex peers and adults and not being able to participate in important social developmental lessons because of her or his inherent homosexuality and attractions to peers. Hirschfeld (1914) suggested early on that the poor father-son relationship could result from “masculine” fathers not knowing how to relate to or what to do with a homosexual son’s femininity or difference. In this “chicken or the egg” argument, reparative therapists ignore the possibility of alternative hypotheses by inferring the cause of sexual orientation using gender-identity data. Freund (1974) emphasized that a feminine gender identity was not a necessary condition for the development of male homosexuality, and vice versa: “The relationship between these two anomalies is either a relationship between their casual factors, or the presence of one of the two anomalies enhances the probability of the acquisition of the other” (p. 59). To test these hypotheses, Freund and Blanchard (1983) conducted three separate studies and found a consistent pattern of results that suggested that the emotionally distant relationships of fathers and gay sons relate to the sons’ atypical childhood gender identity (or observed gender-role behavior) rather than to the sons’ sexual attraction to males. Additionally, Storms (1980) tested whether a sex-role or erotic orientation determines sexual orientation. The results of Storms’ study suggested that participants did not differ significantly on measures of masculinity and femininity; that is, sexual orientation did not necessarily involve sex roles but depended on sexual fantasies and desires. Furthermore, studies of non-clinical populations have failed to find associations between family patterns and the development of any particular sexual orientation (Siegelman, 1981; Bell, Weinberg, and Hammersmith, 1981).
As noted in this study, individuals who are trying to cope by seeking reasons for their homosexuality may tend to believe that reparative therapy hypotheses are proven facts. These leaps of causation may be misleading when participants who are seeking information have the possibility of being misinformed and believing that they are basing their judgments on science. Reparative therapists need to consider more sophisticated distinctions between sexual orientation, gender identity, and sexuality, and how these issues interact with attachment issues within relationships.
A consistent finding in this study was that participants held perceptions that were similar to reparative therapists that LGB relationships are “brief and very volatile, with much fighting, arguing, making-up again, and continual disappointments” (Nicolosi, 1991, p. 110). Participants stated they did not want to have these types of relationships and believed, as does Nicolosi, that gay relationships “almost never possess the mature elements of quiet consistency, trust, mutual dependency, and sexual fidelity characteristic of highly functioning heterosexual marriages” (p. 110). The stance of “gay is not me” seemed grounded in these pejorative stereotypes. This view is not consistent with well-established, empirical evidence that indicates that homosexuality per se is not an unhappy or unhealthy state of being (Gonsiorek, 1991) and that gay and lesbian relationships can be meaningful and stable (Peplau, 1993). In addition, the statistics that participants used to support their views of homosexuality as “dangerous” were referenced from studies by Cameron (1993), which have been discredited as fraudulent. Herek (1998), for example, detailed the statistical and validity errors of the Cameron group studies and noted their “substantial impact . . . to promote stigma and to foster unfounded stereotypes of lesbians and gay men as predatory, dangerous, and diseased” (p. 247). Ego-dystonic, same-sex attracted clients may forget that homosexuality does not represent a personality or lifestyle; it represents a sexual orientation (Morin, 1977). “Addictive” and “promiscuous” sexual behaviors may have unhealthy aspects, such as those experienced by some participants. However, it would be more accurate to remove the words “gay lifestyle” from one’s terminology and use words such as compulsiveness, maladaptive coping, and substance abuse, in addition to issues of commitment and intimacy, with which all humans are faced, not just gay men, lesbians, and bisexual women or men.
As Murphy (1997) noted, “patients may unwittingly absorb the therapist’s views on sexual orientation without due reflection” (p. 93). Therefore, biases that reflect issues of internalized homophobia and heterosexism must be explored between therapists and their clients within the sexual reorientation therapy setting. Therapists must also consider fully with clients the benefits and disadvantages of adapting to a range of heterosexual and homosexual lifestyles. To facilitate this exploration, introductions to role models of all perspectives may be helpful in dispelling stereotypes and empowering clients in their decision process.
Research Implications
Those conducting investigations into the efficacy of sexual reorientation must take into consideration the questionable reliability and self-presentational biases of surveys based on self-report (Leary, 1994; Schlenker and Weigold, 1992). Participants who identified as heterosexual in this study would more than likely have done so on surveys that ask similar questions regarding outcome change. Questionnaires that do not explore the meanings of participants’ definitions of sexual orientations and reports of change may not only be meaningless due to oversimplification, but also misleading if they perpetuate an ideology that gays, lesbians, and bisexuals can and should be heterosexual. Individuals who are seeking a “cure” for themselves, family members, or friends may be susceptible to the imprecise messages of so-called ex-gays and of conversion therapists. Unbiased and objective data, such as psycho-physiological data from sexual arousal assessments, are needed to corroborate self-report findings and understand what type of change is possible in sexual reorientation.
Although participants in the present study expressed satisfaction with their experiences in conversion therapy, several repeated an important theme that more understanding and research are needed. In terms of defining the therapy, participants stated that even the name “reparative therapy” was problematic. One participant argued, “We are using the wrong words, asking the wrong questions, and approaching it so narrowly…. We’ve watched a lot of guys. It’s not working. Now what else can we do?” Consequently, more empirical studies must be designed that examine the efficacy of both LGB-positive and conversion therapies. Researchers who investigate issues of sexual orientation are encouraged to be explicit about their values and distinguish their advocacy behaviors from their research behaviors.
Political Implications
Although it is important to recognize the legitimacy of the choices and self-defined successes made by participants in this study, this stance is not the same as condoning reparative therapy. As a result of conducting this study, it became apparent that some elements of conversion therapy are very effective at facilitating self-acceptance and self-identity, and some are not. The aspects of reparative therapy that work seem to be those components found in all meaningful therapy: providing normalization, support, reframing, workable solutions, and empowerment. The ineffective and harmful aspects of this therapy seem to be the misrepresentation of treatment outcomes, reinforcement of negative stereotypes, and internalization of treatment failure. Information is also needed regarding the spouses of those who marry “ex-gay” individuals. However, participants in this study indicated that LGB-affirmative therapy would not have been helpful for them. Therefore, working from a broader perspective may allow for accurate labels of sexual orientation without the added stigma, assumptions, or forced identifications. A treatment plan is necessary that is flexible and unbiased enough to help clients explore all options available, not one that pushes one agenda over another.
Overarching this finding is the author’s belief that the bigger political and societal picture gets missed in the debate between reparative and LGB-affirmative therapists, as well as between ex-gays and gays. Religion also plays a role in this debate due to its imposed penalties and powerful influence to dictate members’ attitudes and behaviors. These groups confront each other with divergent value systems, expect one another to conform, and then angrily disagree with any opposition. With this, the channels of communication, understanding, and connection get shut down. Recognition must be made between these groups that psychology may not be able to change the doctrines of religion and that religion may not be able to change the intentions of LGB-affirmative clinicians and researchers. Nevertheless, seeking dialogue toward a common ground that draws upon the strengths of each divergent viewpoint seems more productive than debating. In bridging this gap, changes can be made in the acceptance, honesty, and understanding of all groups and the creation of a forum for all voices to be heard and respected. Without this dialogue, these groups may miss the more important societal goal that it is not really about changing sexual orientation but ceasing the intolerance, discrimination, and separation that exist in society.
In summary, much variability exists in the way individuals adapt and live out their sexuality and spirituality in their social contexts. Rather than a polarization between a gay identity and a heterosexual identity and a need to label people as one way or the other, space must be created to embrace this variability and explore the many facets of our human identities. The ideal society for all seems to be a place where individuals can be “who they are” and be valued for it.