Reparative therapy

Reparative therapy, or conversion therapy, is any of several voluntary techniques that are aimed at changing a person's sexual orientation from homosexuality to heterosexuality. Their efficacy has not been established.

Controversy

Reparative therapy can be divided into two categories: secular and religious. Secular reparative therapy seeks to distance itself from religion and morality, basing itself on object relations theory and empirical studies in gender identity.

In general, one's position on reparative therapy will be determined by one's position on the cause of homosexuality: Is it genetic or environmental? Nevertheless, it is to be noted that there exists general scientific consensus that sexual orientation is generally unchangeable in adults, though this consenus and the cause for that immutability are disputed.

Sexual orientation is defined as an individual's amorous desires, but it also refers to his feelings and self-concept, all of which might not remain static over a lifetime. Attempts have been made to measure this change, for example, by the Klein Sexual Orientation Grid. Since feelings, self-concept and preference can change over time, the belief that this change might be consciously ellicited with the aid of therapy arises. As well, it is known that, historically and in some other cultures, homosexuality was widely practiced (e.g., Greeks), but not to the exclusion of heterosexuality. Sexologist Alfred Kinsey also showed that, even in the modern age, "[e]xclusive preferences of behavior, heterosexual or homosexual, come only with experience, or as the result of social pressures which tend to force an individual into an exclusive pattern of one or the other sort."

Supporters of reparative therapy believe that homosexuality is not a fixed sexual orientation but an emotional disorder which a person can change. This viewpoint has not only a moral, but an historical basis. In the words of 1

There are anecdotal reports of successful conversions, total reversions, and partially successful conversions (in which the subjects still had some homosexual feelings/attractions). Reparative therapists say this variability in success should not be viewed as a therapeutic failure, for, in the words of Otto Weininger

"[T]he rudiment of homosexuality, in however weak a form, exists in every human being.... There is no friendship between men that has not an element of sexuality in it, however little accentuated it may be in the nature of the friendship, and however painful the idea of the sexual element would be. But it is enough to remember that there can be no friendship unless there has been some attraction to draw the men together."3

Rather, reparative therapists assert, this illustrates the crux of the theory: man's alienation from and perceived rejection by men, leading to a quest for bonding and fulfillment, oftentimes in inappropriate and dysfunctional manners, such as compulsive sexual gratification - the need to possess the perceived manhood of the object of desire. Dr. Nicolosi elaborates:

"The basic premise of reparative therapy is that the majority of clients (approximately 90%, in my experience) suffer from a syndrome of male gender-identity deficit. It is this internal sense of incompleteness in one's own maleness which is the essential foundation for homoerotic attraction. The causal rule of reparative therapy is "Gender identity determines sexual orientation." We eroticize what we are not identified with. The focus of treatment therefore is the full development of the client's masculine gender identity."4

This theory is, however, unsubstantiated by empirical evidence, although it's dynamic is clearly in evidence in the gay scene, where it is most desirable to have had a large number of masculine lovers.

Opponents of reparative therapy maintain that homosexuality is a fixed sexual orientation, and (partly on this basis) they argue that it should not be repathologized as a mental disorder. Why homosexuality should remain so rigidly fixed for life, while it is known that sexual preference, feelings and self-concept can shift over a lifetime, is unclear. Should this rigidity turn out to one day become proven fact, then one would have to ask: Why can a heterosexual preference evolve into a homosexual one, but a homosexual preference or self-concept can never evolve at all?

To this date, however, there are no outcome studies with sufficient scientific rigor to determine conclusively either the actual efficacy or harm of reparative treatments. That is: apart from anecdotal evidence, there is no scientific evidence that reparative therapy does anything.

History

Conversion therapy is not a new idea and, in fact, harkens back to the start of psychology itself. Researchers such as Irving Bieber, Lawrence Hatterer and Sigmund Freud believed that homosexuality could be 'cured' through a variety of techniques, including "aversion therapy, nausea producing drugs, castration, electric shock, brain surgery, cures' arose from the redefinition of homosexuality as a medical illness from the former view that it was a sinful choice. The Stanford Encyclopedia of Philosophy states:

"[T]he rise in the prestige of medicine resulted in part from the increasing ability of science to account for natural phenomena on the basis of mechanistic causation. The application of this viewpoint to humans led to accounts of sexuality as innate or biologically driven. The voluntarism of the medieval understanding of sodomy, that sodomites chose sin, gave way to the modern notion of homosexuality as a deep, unchosen characteristic of persons, regardless of whether they act upon that orientation. The idea of a 'latent sodomite' would not have made sense, yet under this new view it does make sense to speak of a person as a ?latent homosexual?."2

Modern reparative therapy is a re-reading of this early psychological research and stems from the clinical work and theories of Elizabeth Moberly, a British Christian theologian. In her book, 'defensive detachment emotionally isolates him from other males, and from his own masculinity.4

The finding on inadequate gender identification and its result is shared by Stoller, Marmor and Bieber, who express their:

"conviction that it is necessary for all human beings to complete the separation-individuation of early childhood in order to establish gender identity. Failure to do so results in a deficit in masculinity for boys, with a corresponding intensification and continuation of the primary feminine identification with the mother, thus begins the course toward homosexual development."5

Proponents

There are organizations, such as Exodus International, NARTH and the International Healing Foundation, which advocate the idea that sexual orientation is not fixed by genetic factors and support the belief that reparative therapy is genuine.

Initially, reparative therapy was welcomed by many 'Ex-Gay' and homosexual Christian groups who saw it as a means of reconciling their beliefs with their sexuality and as a way of gaining greater acceptance in their respective churches or ministries.

Lately, it has been adopted by much larger, mainstream secular and religious groups, particularly in the USA. Many in these mainstream groups see it as a kinder way of approaching the 'homosexual problem'. It has also been used by some of these groups to influence public opinion and sway legislators "from supporting equal rights, domestic partnership and hate crime legislation."

Reparative therapists claim that the psychological community has submitted to political forces, harming people while witholding treatment for their illness... homosexuality.

Opponents

There are people and groups who oppose these therapies, usually on the grounds that there is little scientific evidence that the techniques work. There is also opposition from the those who espouse the cultural argument that homosexuality is not immoral or harmful to the individual or society.

The difficulty with the claim that the scientific evidence for change does not exist is that many studies indicate that while change is not a universal phenomena, for some percentage of individuals who orient toward homosexuality, some orientation change does occur. For instance, Ben Newman's discusses 48 studies of homosexuality with regard to the question, "Is change possible?" Every study listed included some evidence of a heterosexual shift in subjects' sexual orientation, and some count as "success" an increase in heterosexual daydreams unaccompanied by any lessening of the number of homosexual acts. The 48 include studies by partisan groups such as NARTH, and many are old and are methodologically dated, which is to be expected, as the political pressures by gay rights groups are such that any attempt at testing and study are quashed by the APA and other governing bodies.

Those who are convinced that homosexuality is caused by genetic factors may view conversion therapy not only as an impotent, but a potentially damaging, pseudoscience. They attempt to present it as a manifestation of religious fundamentalism and intolerance of minorities, but prefer to ignore the fact that those afflicted with unwanted and intrusive homosexual thoughts seek the help voluntarily.

Both the theory and practice have come under heavy criticism from gay rights groups, the American Psychiatric Association, the American Academy of Pediatrics, the American Medical Association, the American Psychological Association, the American Counseling Association, and the National Association of Social Workers, the Royal College of Nursing and other organizations.

The American Psychiatric Association (APA) concluded in 1973 that homosexuality is not a mental illness and states that there are no scientifically rigorous studies to indicate the actual "efficacy or harm of 'reparative' treatments" and that "reparative" therapists have yet to produce "any rigorous scientific research to substantiate their claims of cure." The APA position statement on reparative therapy states that "recent publicized efforts to repathologize homosexuality by claiming that it can be cured are often guided not by rigorous scientific or psychiatric research, but sometimes by religious and political forces opposed to full civil rights for gay men and lesbians." The APA position statement ends with a recommendation to ethical practitioners to "refrain from attempts to change individuals' sexual orientation, keeping in mind the medical dictum to first, do no harm."

"...sexual orientation is not a choice and cannot be altered. Groups who try to change the sexual orientation of people through so-called 'conversion therapy' are misguided and run the risk of causing a great deal of psychological harm..." Raymond Fowler, executive director, American Psychological Association.

"If an individual is comfortable with his or her homosexuality, it is not the role of the therapist to convince the client otherwise. If one's feelings are egodystonic and there is a desire to talk about changing, that is an acceptable choice and a psychologist may participate if he or she desires." Ray Fowler, PhD, CEO, American Psychological Association. (From the Utah Psychologist, Winter, 1998, p. 11.)

Techniques

Reparative therapy relies primarily on analysis and counselling and recognizes and promotes good and healthy male bonding as an essential adjunct to successful healing. Some religious individuals may express that the power of prayer and of reading scripture, as forms of guidance and self-reflection, ought never to be underestimated; however they cannot be considered a part of therapy per se. There are also others who are not religious who see the value in turning to higher values and a search for meaning in their quest for recovery. Whether aversion therapy and fasting are used by any contemporary practitioners remains unclear. They are certainly not mentioned by Dr. Joseph Nicolosi, who is the author of the primary manual on Reparative Therapy.

The Bigger Picture

Although same-sex sex acts seem (both to reparative therapists and others) to contravene human anatomical structure and design, a propensity for an emotional bisexuality would seem to exit, as is evidenced by the male need for