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The Dubious Ethics and Efficacy of Conversion Therapy

The practice has been dismissed as improper for more than two decades.
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(Photo: Katie Brady/Flickr)

(Photo: Katie Brady/Flickr)

The widely discredited practice of “conversion therapy,” in which a therapist or counselor attempts to change a patient’s sexual orientation, was condemned at the highest level of government Wednesday night when President Obama endorsed a petition that calls for banning the practice for minors.

“The overwhelming scientific evidence demonstrates that conversion therapy, especially when it is practiced on young people, is neither medically nor ethically appropriate and can cause substantial harm,” senior advisor Valerie Jarrett writes in an official statement.

If that sounds like old news, a search of the academic literature finds that indeed it is. The American Psychiatric Association removed homosexuality from its Diagnostic and Statistical Manual of Mental Disorders in 1973. Two years later, it urged all mental health professionals to “to take the lead” in reducing the stigma associated with homosexuality—a goal that obviously runs counter to the notion of “converting” someone from gay to straight.

A chapter in prominent psychologist Douglas Haledman's 1991 book made a clear case that such therapeutic practices need to be relegated to history.

A survey of 762 therapists found that "those who believe in the ethics and/or practice conversion therapy report statistically higher levels of negative beliefs of lesbian, gay, and bisexual individuals."

“Psychological ethics mandate that mental health professionals subscribe to methods that support human dignity and are effective in their stated purpose. Conversion therapy qualifies as neither,” he wrote. “There is no evidence from any of the studies reviewed here to suggest that sexual orientation can be changed.”

Actually, one study published in 2003 (long after Haldeman’s essay) did provide some tentative evidence that such therapy could in fact work. After interviewing 200 people who reported the process shifted their sexual orientation to some degree, Dr. Robert Spitzer concluded that “there is evidence that change in sexual orientation following some form of reparative therapy does occur in some gay men and lesbians.”

Those findings were somewhat fuzzy, however: Spitzer noted that “Reports of complete change were uncommon,” and women “reported significantly more change” than men.

Ten years later, Spitzer wrote a letter to the editor of the same journal that had published the study, the Archives of Sexual Behavior, conceding that his research was fatally flawed, since “there was no valid way to determine if the participants’ accounts of change were valid.”

“I believe I owe the gay community an apology,” he wrote, expressing remorse “to any gay person who wasted time and energy undergoing some form of reparative therapy because they believed that I had proven that reparative therapy works with some ‘highly motivated’ individuals.”

Who seeks out such treatment, anyway? A 2004 study found that “Individuals with same-sex attractions who saw religion as a central organizing principle of their lives tended to view conversion therapy as a viable option."

"Additionally, individuals who held an intrinsic orientation to religion tended to possess internalized homo-negative attitudes," wrote Penn State researchers Erinn Tozer and Jeffrey Hayes. “The negative messages one internalizes about being attracted to someone of the same sex are critical components of considering conversion therapy.”

It's not hard to put two and two together: When you're constantly being told that your urges are sinful (a position of many, but far from all, churches), and your religion is too important a part of your identity to consider abandoning, conversion therapy starts to look like a viable option.

OK, but who are the therapists who participate in this practice, in spite of the lack of evidence supporting it? A paper published this past January in the Journal of Marital and Family Therapy found the answer: ignorant ones, basically.

A survey of 762 marriage and family therapists found that “those who believe in the ethics and/or practice conversion therapy report statistically higher levels of negative beliefs of lesbian, gay, and bisexual individuals, and lower levels of clinical competence working with lesbian, gay, and bisexual clients.”

“We found that male therapists and those who had not worked with lesbian, gay, and bisexual clients were more likely to believe in and practice conversion therapy,” added the research team led by Christi McGeorge of North Dakota State University. That study called for the American Association of Marriage and Family Therapists “to provide greater education and clearer policies” regarding this practice.

Therapists are not performing conversion therapy on minors in California or New Jersey—at least not legally. California banned the practice in 2012, and New Jersey followed the following year. Legal challenges to the ban on First Amendment grounds were dismissed by the Ninth Circuit Court of Appeals, which stated that the states “may regulate mental health treatment.”

Given the low probability of action by Congress, it’s now up to other states to use that power and face this issue.

Findings is a daily column by Pacific Standard staff writer Tom Jacobs, who scours the psychological-research journals to discover new insights into human behavior, ranging from the origins of our political beliefs to the cultivation of creativity.