New Study on Sexual Orientation Change Efforts
August 23, 2018
by Andrè Van Mol, MD
States are rushing to ban change therapy for unwanted same-sex attraction and gender identity conflicts (though over 20 have refused), with California aiming to make anything like it (and then some) prosecutable consumer fraud. Activists often conflate stories of alleged torture and shaming from non-professional “therapy” sources as evidence against licensed professionals offering change counseling. Modern sexual orientation change efforts (SOCE)—pejoratively labeled “conversion therapy”—means counseling. Change counseling is talk, just talk. Reparative therapists (a 1990s term) have long condemned aversive methods (electric shocks, cold baths, etc.) as unethical and ineffective. Even the Southern Poverty Law Center May 2016 hit piece “Quacks” confirmed that neither “electric shock” nor other “aversion therapy” is used in change therapy. The Rhode Island ACLU opposes “conversion therapy” but also opposes legislative bans. A recent newspaper editorial asserted that states should not be banning desired change therapy any more than also-controversial alternative-complementary medicine practices. A gay-identified columnist shares that concern and opposes bans as ideological overreach.
Amid the fray, a new study on SOCE titled “Effects of Therapy on Religious Men Who Have Unwanted Same-Sex Attraction” was published on July 23. In a brief introduction to SOCE history, the authors note the irony in the 2009 American Psychological Association report advising against change therapy due to an alleged lack of methodologically rigorous research proving it safe or effective, that then recommended gay-affirmative therapy, which lacks the same validation of safety and efficacy. They added that the “research community ignores all the positive study results from the dozens of SOCE studies done over the past several decades,” while giving a pass to gay-affirmative therapy with the same deficiencies.
In citing other studies supportive of SOCE—including a 2009 NARTH literature review—they bring up adversarial studies such as the 2002 Shidlo and Schroeder survey (initially recruited for SOCE dissatisfaction with predictable results) and the 2015 study by Dehlin et al. As for the latter, Christopher Rosik notes that the authors were known anti-SOCE gay advocates, so pro-change groups refused to participate (e.g. the former Evergreen Int’l) or were not invited (e.g. NARTH), thus further skewing results. Also, their five-point rating scale had a non-neutral midpoint (“not effective”) and combined two qualities—effectiveness and harmfulness—rather than rating them separately. Both studies have been referred to as anti-SOCE advocacy research. The current study authors state “many informal groups supporting SOCE now decline research participation because of past experiences with unethical practices by researchers.”
This new “Effects of Therapy...” study selected measurement points the APA report mentioned as possibilities of harm: “Consequently, null hypotheses worth testing were: (1) SOCE is ineffective, (2) it produces more harm than help, (3) most reasons for therapy are cultural/family pressure, and (4) SOCE is much less effective and more harmful than therapies on completely different unwanted problems.” Now that would be some study. The authors took it on.
The researchers surveyed 125 men at least 18 years old “with active lay religious belief” (thus no priests) who had or currently engaged various avenues of SOCE. 97 percent had professional therapy and 86 percent some manner of less formal group support.
The survey tool used retrospective memory to answer 88 multiple-choice questions from previously published studies, thus nothing they made up for convenience. Most “had heterosexual shifts in sexual attraction, sexual identity and behavior with large statistical effect sizes, similarly moderate-to-marked decreases in suicidality, depression, substance abuse, and increases in social functioning and self-esteem.” “Harmful effects were none to slight” and “effect size[s], were comparable with those for conventional psychotherapy for unrelated mental health issues.”
Reasons given for entering SOCE included religious (No. 1 at 64 percent) and strengthening an existing marriage (12 percent), but family pressure came in fourth (3.2 percent), counter to APA objection (3) listed above.
Of the 125 men in the survey, 68 percent claimed “much reduction in their same-sex attraction and behavior” and “an increase in their opposite-sex attraction and behavior.” There was a 56 percent decrease in those claiming predominant homosexual attraction, a 43 percent decrease in those with predominant homosexual identity, a 12-fold increase in those claiming mostly heterosexual attraction and a 2.5-fold increase in those reporting mostly heterosexual identity. Changes were generally noted in homosexual (decrease) and heterosexual (increase) frequency of fantasy, desire for intimacy, kissing and sex.
The therapies participants rated most helpful were “weekend gender-affirming retreats” (26.4 percent), counselors (13.6 percent), and psychologists (12.8 percent). The techniques considered particularly helpful were “developing nonerotic relationships with same-sex peers, mentors, family members, and friends” (87 percent); “understanding better the causes of your homosexuality and your emotional needs and issues” (83 percent); “meditation and spiritual work” (83 percent); “exploring linkages between your childhood and family experiences and your same-sex attraction or behavior” (78 percent); and “learning to maintain appropriate boundaries” (76 percent).” Participants reported the most harmful techniques were “going to the gym” (16 percent), “imagining getting AIDS” (13.6 percent), “stopping homosexual thoughts” (12.8 percent), and “abstaining from masturbation” (10.4 percent).
As for comorbid problems, the authors stated, “Participants reported improvements (with large effect sizes) in self-esteem and social functioning, and similarly decreases in suicidality, substance abuse, depression, and self-harm.” Only five reported negative self-esteem effects, and overall negative impact replies on various mental health issues were slight. About 70 percent of participants reported only benefitting from therapy.
The criticism of the absence of a control group was addressed. Simply put, they find it unethical to assign to a years-long non-treatment control group people with unwanted attractions, depression and suicidality.
The study found that counseling for people with undesired same-sex attraction demonstrated rates of effectiveness and harmfulness that compared favorably to general psychotherapy for other unwanted issues. The authors asserted that the freedom to chose SOCE was both “an issue of basic civil rights” and “should be considered fundamental to client autonomy and self-determination.”
They closed the article with a bang: “Given the results of this survey, the current recommendation by the American Psychological Association (2008) that ‘ethical practitioners refrain from attempts to change individuals’ sexual orientation’ is itself unethical, at least for lay religious men.” There is yet another such study due for publication in the near future.