Conversion therapy (also known as reparative therapy, reorientation therapy, or transformational therapy) has been generally understood to have as its chief goal the cessation or changing of individuals’ same-sex attraction and sexual behavior and the adoption of opposite-sex attraction and sexual behavior. Proponents and practitioners of conversion therapy base the rationale for such intervention on medical, moral, or religious traditions that regard homosexuality and homosexual behaviors as unnatural, psychopathological, or morally transgressive.
However, since the 1970s, mainstream mental health organizations (American Psychiatric Association, American Psychological Association) have adopted nosology and policy that reject the idea that homosexual individuals are mentally unhealthy simply because of their sexual orientation. Beginning in the late 1950s, scientific research such as that generated by Evelyn Hooker clearly demonstrated that homosexuals do not suffer any greater frequency of psychopathology than heterosexuals and that common psychodiagnostic tests cannot identify or effectively discriminate between homosexuals and heterosexuals.
In addition, the American Psychiatric Association, American Psychological Association, American Academy of Pediatrics, American Counseling Association, and National Association of Social Workers have all adopted professional positions that oppose conversion therapy, citing as problematic its portrayal of homosexuals as abnormal, its almost exclusive focus on changing homosexual men while ignoring lesbian women, a lack of scientific support for its effectiveness, questionable ethics underlying such interventions, and the iatrogenic dangers (depression, anxiety, and other disorders) inherent in trying to persuade homosexual individuals that they are “ill” or in need of a “cure.”
What Is Conversion Therapy?
Conversion therapy encompasses a range of techniques and approaches; many distinctions among them are dependent upon the underlying philosophy of the practitioner. Early psychological techniques of conversion therapy focused on long-term, classical psychoanalysis that sought to uncover and provide corrective emotional experiences for theorized Oedipal traumas thought to have arrested sexual development and caused homosexuality. Other approaches have utilized behavioral techniques, seeking to condition an aversion in homosexual individuals to same-sex activities by pairing homoerotic stimuli with unpleasant experiences (electroshock, anxiety, nausea). Some approaches take the form of verbal therapy or counseling, focusing on thoughts, feelings, and behaviors associated with homosexuality and teaching avoidance of these experiences.
Conversion therapy based upon religious traditions often relies on practitioners utilizing interpretations of religious doctrine or texts that forbid and condemn homosexuality; such practitioners seek to help homosexual individuals correct or cease sexual behavior that is found outside what is acceptable according to these doctrines. Such transformational ministries and “ex-gay” ministries (e.g., Exodus International) focus upon homosexuals’ inner turmoil as they attempt to reconcile their chosen religious or spiritual belief systems with their homosexuality.
Many proponents of conversion therapies hold the position that if a homosexual views his or her sexual orientation as unhealthy or as being against personally held beliefs and wishes to convert to heterosexuality (or at least stop same-sex sexual practices), that person has a right to such self-determination and a right to seek treatment to achieve that goal. However, research on sexual identity development suggests that because of societal heterosexism and the inculcation of antihomosexual and proheterosexual attitudes into our society, it is a part of normal identity development for homosexual persons to experience a strong sense of confusion, fear, doubt, denial, stigma, and even self-hate surrounding their homosexual attractions. If “coming out” (the process of fully realizing and accepting one’s homosexuality) is met with supportive and positive social reactions, this initial difficult phase of identity development can give way to a healthy self-concept and positive self-identification as a homosexual.
Does Conversion Therapy Work?
No program of peer-reviewed research published in mainstream scholarly journals shows that conversion therapy is effective. Those studies that have been conducted are often plagued by sampling problems that make drawing conclusions very difficult. For example, if an investigator examines the efficacy of conversion therapy with a sample of bisexual men (who have sex with persons of both the same and opposite sex), the ability of the men in this study to cease having sex with men for a period of time may be very different than would be found in a study where conversion therapy was provided to men who were strictly gay. As well, operationalization of what constitutes an “effective” outcome has been difficult. For example, the cessation of engagement in same-sex sexual relations is often considered a measure of “successful” conversion therapy; however, it is highly unlikely that behavioral cessation has also fundamentally changed the actual homosexual orientation of clients, who still emotionally and sexually desire same-sex persons and attitudinally think of themselves as homosexual. This latter state of affairs is anecdotally reported by “ex-gays” who have received conversion therapy. Many either have chosen to remain without sexual partners or have tried to forge heterosexual partnerships in an effort to resist their homosexual orientation and desires. Even though same-sex sexual relations have stopped, and heterosexual sexual relations begun, such “ex-gay” clients report still thinking of themselves as gay and desiring same-sex relations; they simply do not allow themselves to have them.
Most scholars have arrived at the consensus that although some homosexual or bisexual persons may be able to resist engaging in sex with same-sex partners, the alteration or transformation of homosexuality into heterosexuality is an extremely unlikely (and probably unhealthy) event and that an individual’s sexual orientation is a relatively stable characteristic.
What about Homosexuals Who Want to Be Heterosexual?
Most mental health professionals accept the idea that it is the very rare individual who does not undergo some discomfort and period of adjustment upon the realization of being homosexual. Because values and models set heterosexuality as the norm in our society, and because these expectations are internalized, it is consequently difficult for persons finding themselves falling outside the norm to feel comfortable with possessing a nonmajority sexual orientation.
Many mainstream clinicians who encounter a gay or lesbian client who voices a desire to change his or her sexual orientation would first ensure that such a client is not simply in the midst of a typical phase of self-doubt and fear. In addition to these reactions arising from internalized homophobia, such clients may have also encountered highly critical or even hostile social reactions when sharing with others the fact they are homosexual, thereby heightening their concerns over their homosexuality. At a societal level, media messages and conversations about the erosion of gay rights, the push to make gay partnerships illegal and to deny gay partners health insurance, and reports of hate crimes (including murder) perpetrated against gay men and lesbian women would also add up to create a reasonable level of distress, anxiety, and confusion. Finally, as aforementioned, contextual and cultural variables (racial/ethnic, religious/spiritual, intrafamilial) would need to be assessed before arriving at a conclusion that the client is making an informed and healthy decision.
Homosexuality and same-sex sexual attraction is not a mental illness, disorder, or pathology. Therefore, not only is the need for psychological treatment or counseling not supported or indicated, but self-reports from persons undergoing conversion therapies demonstrate that such treatments may bring harm to clients. No case can be built that justifies conversion therapy as judged by the ethical standards of major mental health organizations. Finally, there is no documented empirical research that demonstrates the efficacy or effectiveness of conversion therapy; in fact, almost all evidence of successful outcomes come from anecdotal or single source reports (e.g., therapist or client impressions) without corroborating or longitudinal evidence of stable and true change of sexual orientation or a healthy adjustment to a nonsexual lifestyle or a self-imposed heterosexual partnering.
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