Wednesday, February 27, 2008

I may not be good at very much, but one thing I can do is write.

I turned in the first 16 pages of my thesis last week and got them back last night. I was really scared to look at my grade; this paper is notoriously graded very hard and the school wants you to be able to use it for grad school, so they put a lot of pressure on you to write a good one.

Well, I got a 94, which according to my professor, is quite good, as it's pretty rare to even reward on A on this draft of the paper to begin with. So I was quite pleased, and my professor had a lot of good things to say.

Lucky for you, if you want to read the paper, you can do so now! This is the Intro, Background, and the presentation of the 2 sides to the controversy. Before the paper is done, I will a critical analysis of both arguments, interviews, and a moral reasoning argument to support my ultimate opinion on the matter.

My paper is on conversion therapy, or, "ex-gay" reparative therapy. Enjoy!


In 1948, Alfred Kinsey estimated that at least 10% of the male population was exclusively homosexual for at least three years of their adult lives (qtd. in Haldeman 221). While no data of that sort exists today, many people estimate that number is probably still accurate, or, if anything, a little low. Gay rights and visibility have increased tremendously just in the last twenty years, and societal acceptance is at a level never seen before. Even among evangelical Christians, typically the most socially conservative group of people in the nation, 80% of people under 30 say that “anti-homosexual” describes Christianity, and that 76% oppose gay marriage, as opposed to 81% of those over 30 (Barna).

In 2004, however, in one day, over eleven states voted to constitutionally ban same-sex marriage (Reid), and hate crimes against gay and lesbian individuals actually increased between 2005 and 2006 (FBI). And despite marriage or a civil-union equivalent being legal in ten states, the United States is still a very divided country when it comes to gay and lesbian individuals.

Conversion therapy, as we know it today, is the attempt, generally through psychoanalysis, to convert homosexually identified individuals, both male and female, into heterosexually identified individuals (Johnston and Jenkins 62). It is also known as ex-gay reparative therapy (Throckmorton 4), and, sometimes, as “transformational ministry” (American Psychological Association 3). It is a process that has existed since roughly the end of the 19th century, when the term “homosexual” was first coined by Hungarian writer Karl Maria Kerbeny, ironically, in a pamphlet arguing for the civil rights of those who engaged in homosexual acts (Murphy 501). The primary crux for the defense of conversion therapy, particularly today, is that homosexuality is a freely chosen personality quirk, subject to the whim of suggestion or a disordered condition (Haldeman 260). Individuals may not realize that they have chosen it, arising as it does, so the suggestion goes, from a form of arrested psychosexual development (Haldeman 260). Many proponents of conversion therapy attribute this arrested development to an incomplete bond with the appropriate same-sex parent, and seek out relationships with individuals of the same gender in an attempt to recreate and stabilize that broken, or incomplete, bond (Haldeman 260). The underlying factor in this pronouncement is that the root causes of homosexuality are known, and that it is an undesirable “condition” or state in which to exist (Morrow and Beckstead 643). In conversion therapy, homosexuality is narrowly defined as little more than a series, or pattern, of behaviors, and rarely takes into account a client’s inner life, or chooses to blatantly disregard it (Haldeman 261). A number of individuals having completed conversion therapy reported continuing having homosexual fantasies, but not acting on them, thereby legitimately claiming a heterosexual identity (Haldeman 261). In theory, conversion therapy helps a client manage his or her homoerotic fantasies in order to live in, and maintain, a functioning heterosexual lifestyle (Haldeman 261). Barring an inability to control these fantasies or live heterosexually, celibacy is most often the recommended and desired outcome (Haldeman 224). At best, 38% of overall conversion therapy clients end up with “solid heterosexual shifts,” which also represent, typically, an adjustment in life, not a complete “metamorphosis” (Haldeman 223). Some of even this small number may be ambiguous, however, as further studies have shown that the greatest success came to those clients whose sexual lives and behavior already contained significant heteroerotic content, thus making them much more likely to be defined as bisexual as opposed to completely heterosexual (Haldeman 221). A commonly used metaphor is one of the drug abuser: after treatment, an ex-user may still sometimes crave drugs, but as long as he or she doesn’t actually use any, then the individual is still an “ex” drug user, despite the cravings (Beckstead 93).

That the medical and psychological establishment has not only provided no intrinsic properties to identify homosexuality as a pathology, but has outright renounced the idea that it is any more than another diversity on the broad human spectrum of diversities, means little to those who practice and preach conversion therapies (Haldeman 225). The primary objections to conversion therapy rest on the fact that homosexuality has been judged not to be an illness, and that it reinforces a prejudiced view of homosexuality among individuals and society at large (Haldeman 225). In fact, leading conversion therapists have more often than not been rabid activists in courthouses across the country in arguing against any laws either decriminalizing sex between same-gendered people, or granting protections to gay and lesbian individuals (Shidlo and Schroeder 250-251). Most importantly, it is necessary to look at the motives of those providing conversion therapy, and the motives of those seeking it. 26% of the individuals entering conversion therapy do so at the behest of their therapist (Shidlo and Schroeder 252). Typically, these individuals seek treatment to help cope with feelings of depression, guilt and anxiety related to their sexual orientation, but are not explicitly looking to change that orientation (Shidlo and Schroeder 252). Many teenagers and young adults attending religious-based universities tell stories of being forced into conversion therapy or face expulsion or termination of financial aid (Shidlo and Schroeder 252). For that other 74%, however, many simply feel that a homosexual identity is incongruent with the lifestyle they wish to live, and it provides an unacceptable alternative to a spouse, family and church (Beckstead 89). Proponents of conversion therapy view it as just another choice in the plethora of self-determined choices individuals can now make through therapy or psychoanalysis.

In 1997, after two years of in-depth study, the American Psychological Association passed a resolution condemning the use of conversion therapy, due to the fear that clients may request such a therapy due to “societal ignorance and prejudice about same gender sexual orientation,” and “family or social coercion,” and that such therapies were misguided and damaging (qtd. in Throckmorton 3). The American Counseling Association followed suit in 1998, passing a similar resolution with a companion resolution supporting same-sex marriage (Throckmorton 3). But are the resolutions themselves misguided? Despite scant evidence of its efficacy, and its threat of even further damage upon already impressionable or sensitive clients, should the American Psychological Association continue its condemnation of conversion therapy, since many people do request it, and that some people claim to have benefited from it?

Practiced since the late 19-th century, conversion therapy has always been controversial, especially in doctors’ and therapists’ choices of methods. Treating homosexuality as a pathology to be done away with, some methods have been extreme, such as physical abuse, castration, male hormone treatments, and lobotomies (Murphy 513). Mostly, though, therapies have sought simply to create behavioral changes in an attempt to control or sublimate same-sex attraction (Murphy 502). Exercise and outdoor activities were frequently prescribed, as were physical activities (such as excessive bicycle riding) that could exhaust an individual and leave him no energy to pursue sexual liaisons (Murphy 502). Others suggested visiting brothels, or for a man to be locked away alone with a woman for a week or more in order for her to help the man discover the pleasures a woman and her body have to offer (Murphy 503). Still others, however, saw marriage as the key component missing in a young man’s life who was struggling with same-sex desires; a virtuous woman, as opposed to a prostitute, was the real solution (Murphy 503). In more contemporary circles, though, homosexuality is less likely to be treated as pathology than simply as a misguided lifestyle, and that conversion therapy is simply one more choice a client has in his or her treatment options (Gonsiorek, 2004).

The history of addressing conversion therapy has basically been divided into two main disciplines going all the way back to Freud – that of psychology and that of social work (Johnston and Jenkins, 2006). While the psychological field has had its share of both supporters of conversion therapy (those who argue that it is successful as well as ethical) and its opponents (those who argue that conversion therapy has no “empirical base of efficacy,” that it is impossible to change one’s sexual orientation, and the continued use of conversion therapy fosters further prejudice and discrimination in society), the social work field has remained largely quiet (Johnston and Jenkins, 2006). Social work has a long history of ambivalence towards gay and lesbian individuals, and according to Johnston and Jenkins, most social workers have been socialized in a “heterosexist society” (2006).

Now provided almost entirely by religious organizations, conversion therapy often promotes a loss of faith as the only alternative to their particular theology (Gonsiorek, 2004). If living fully, and learning to integrate all aspects of one’s personality into a healthy lifestyle is the ultimate goal of therapy and psychoanalysis, isn’t conversion therapy really doing more harm than good, even among clients who request it (Haldeman 263)?

Until the early 1980’s, conversion therapy was primarily a quiet, underground phenomenon, practiced behind closed doors and away from prying eyes and ears. Elizabeth Moberly, a British theologian, is largely responsible for the resurgence of what she dubbed “reparative” therapy by starting up the National Association for Research and Therapy of Homosexuality (NARTH), which offered a “new ray of hope” for curing homosexuality (Johnston and Jenkins, 2006). To date, NARTH is the only professional mental health organization in the world that preaches homosexuality as a disorder and that change is possible through pure self-determination (Johnston and Jenkins, 2006).

Exodus International, an umbrella organization of multiple ex-gay ministries, including Parents and Friends of Ex-Gays (P-FOX), and Love in Action, first came to major public prominence in the late 1990’s when they ran full-page ads for a full week in national newspapers such as The New York Times, The Los Angeles Times, USA Today, The Washington Post, and The Washington Times (Beckstead 91-92). These ads were sponsored by over 18 religiously conservative organizations like the Christian Coalition and Focus on the Family, and promoted homosexuality as a “disorder” and that a “homosexual lifestyle” was a lie and tantamount to imprisonment and spiritual death (Beckstead 92).

But why, opponents of conversion therapy argue, must individuals choose either to be “out” as a gay or lesbian, or be religious (Miville and Ferguson, 2004)? According to psychoanalytic theory, a gay or lesbian individual is considered “healthy” if he or she is able to renounce stigmatized notions and stereotypes of a gay or lesbian lifestyle, and live a full and fulfilling life (Miville and Ferguson, 2004). But if a person is uncomfortable with their same-sex attraction, or finds it incompatible with their religious lifestyle, can they still be mentally healthy by actively choosing to renounce their same-sex attracted identity (Miville and Ferguson, 2004)? Proponents of conversion therapy view the American Psychological Association’s condemnation as an “attempt to limit the choice of gays and lesbians who want to change” and that it disregards a therapist’s obligation to “respect the dignity and wishes of all clients” (Schroeder and Shidlo 132).

In the following two sections, I will more closely examine each sides’ arguments both for and against conversion therapy, and its potential impact, both positive and negative, on its clients and consumers.

Conversion therapy is not viewed by the majority of psychologists and clients as a legitimate solution to the complexity of managing multiple, and often incongruent, identities (Phillips 773). While it’s true that sexuality can be, and often is, remarkably fluid and salient throughout many peoples’ lives, research does not support the notion that any one individual can legitimately convert their core sexual orientation or that same-sex attraction is abnormal or presents a maladjusted development (Phillips 773).

Alfred Shidlo and Michael Schroeder are two psychologists working in independent practice in New York City, and at the Columbia Center for Gay, Lesbian, and Bisexual Mental Health of Columbia Presbyterian Medical Center, and at the Albert Einstein College of Medicine, respectively.

Both doctors have argued aggressively against the use of conversion therapy; they argue that despite the lack of scientific or empirical data proving the harmfulness of conversion therapy, the opposition it has generated from mental health organizations and the American Psychiatric Association speak for themselves (249). In 1998, the APA released a statement condemning the use of conversion therapy, arguing not only that it was ineffective, but that it prays on the most vulnerable among the gay and lesbian population:

The potential risks of reparative therapy are great, including depression, anxiety and self-destructive behavior, since therapist alignment with societal prejudices against homosexuality may reinforce self-hatred already experienced by the patient. Many patients who have undergone reparative therapy relate that they were inaccurately told that homosexuals are lonely, unhappy individuals who never achieve acceptance or satisfaction. The possibility that the person might achieve happiness and satisfying interpersonal relationships as a gay man or lesbian is not presented, nor are alternative approaches to dealing with the side effects of societal stigmatization discussed.

Shidlo and Schroeder’s landmark 2002 study on the results and satisfaction or dissatisfaction of various consumers of conversion therapy was telling: more than half of the people to whom they spoke reported suffering from depressed feelings resulting from the therapy (254). Some said this was because they were told that their sexuality was a choice (and believed it); others blamed it on their failure to change or when they experienced a resurgence of same-sex desire after completing therapy; still others spoke of suicidal ideation, and one female participant even likened her therapy to having been killed; another female claimed that even years after completing conversion therapy, the process was so traumatic that she hasn’t been able to even step foot inside a church again; three respondents had actually attempted suicide during the conversion therapy process (254).

One of the biggest problems facing individuals seeking conversion therapy seems to be a lack of overall information regarding sexuality and informed consent (Schroeder and Shidlo 132). The APA ethics code instructs “psychologists…not to make false or deceptive statements concerning…the scientific or clinical basis for…their services” (APA, 1992, Standard 3.03(a), p. 1604; Schroeder and Shidlo 140). Most participants were told by their therapists or counselors that homosexuality was a psychological disorder; that homosexuality does not actually exist; or that gay lives are inherently unhappy (Schroeder and Shidlo 141).

A large part of conversion therapy involves providing patently false, stereotypical and defamatory information regarding homosexuals and a “homosexual lifestyle” to those clients in therapy (Shidlo and Schroeder 255). The literature largely attempts to devalue homosexuals and their relationships as “undesirable, sick and evil” (Shidlo and Schroeder 255). Naturally, when individuals fail to change, this only exacerbates and conflates already existing feelings of internalized homophobia, self-hatred, and poor self-esteem (Shidlo and Schroeder 254).

Most people who seek conversion therapy are very religious people, often belonging to extremely conservative religions, and have suffered enormous heartache and difficulty incorporating their sexuality into their lives and into what’s expected of them by their church (Beckstead and Morrow 653). According to Tozer and Hayes, the most widely researched constructs in the psychological study of religion are the ideas of intrinsic and extrinsic attitudes (717). People who are extrinsically motivated by religion use it outwardly, to achieve things like status or social support, whereas people who are intrinsically motivated try to actually live their religion and internalize it very deeply, using it as a central organizing force in their lives (Tozer and Hayes 717). Intrinsic religiosity has been found to be a galvanizing force for prejudice against gay and lesbian individuals, and for gay and lesbian individuals themselves, seeking to change their sexual orientation (Tozer and Hayes 717).
Generally, gay and lesbian people who are very religious are far more likely to suffer from feelings of homonegativy and self-hatred than those who say that religion is unimportant (Tozer and Hayes 718). Of the majority of the people who have completed conversion therapy and reported successful or positive outcomes, the top reason cited for entering conversion therapy in the first place was the “religious nature of society” (Tozer and Hayes 718). Other reasons cited included religious guilt, rejection by the church community, and a fear of eternal damnation (Tozer and Hayes 718). A large factor in these feelings is the lack of social support felt by gay and lesbian individuals (Tozer and Hayes 719). Whereas many homosexuals seek out other homosexuals for romantic, social and emotional support, gays and lesbians for whom religion is a very important part of their lives oftentimes lack this support, and have actively shunned it (Tozer and Hayes 719). Thus, in conversion therapy, they find many like-minded individuals, and often, for the first time, find the social and emotional support, and sense of belonging or inclusiveness, missing in their previous lives (Tozer and Hayes 719).

This is not an aspect of conversion therapy to be discounted; it should also be noted, however, that “affirmative therapy” for homosexuals, which challenges oppressive stereotypes, and advocates the validity of living a fulfilling life as an openly gay or lesbian person is rarely or never presented to those seeking conversion therapy (Morrow and Beckstead, 2004). It is also true that many gay and lesbian individuals with a religious inclination feel more comfortable coming out as homosexual in a religious environment than as religiously oriented in a homosexual community (Haldeman 262). But again, with the right guidance by an experienced and non-judgmental counselor or therapist, and the seeking out of inclusive religious communities that welcome all people, this is another dilemma that can be worked on and resolved without the drastic use of conversion therapy (Haldeman 262).

John Gonsiorek of Capella University and the Minnesota School of Professional Psychology/Argosy University, suggests a more “integrative” approach to solving this dilemma (2004). Since the beginning of its visibility, the LGB (Lesbian, Gay and Bisexual) community has struggled, often unsuccessfully, to integrate spiritual life and sexuality, while most religious organizations have outright rejected any view that diverges from their orthodoxy (Gonsiorek 751). Disapproval from both communities can create severe psychological distress and be devastating for religiously-inclined struggling gays and lesbians, but perhaps a stronger focus on the “interpersonal and sociopolitical factors” at play in these peoples’ discomfort, as opposed to a direct treating of orientation or a division of sexuality and spirituality within a person’s internal framework could work wonders (Gonsiorek 752).

First and foremost, in the possible working with and treating of internally-conflicted gay and lesbian clients, the therapist needs to understand the grave importance and influence of the detrimental effects of homophobia on gay and lesbian individuals (Steigerwald and Janson 57). Working with the client to challenge stereotypes and homophobic assumptions, and to begin to work in-depth with the client’s questions in a supportive environment, is the most helpful way that therapists and psychologists can help their clients find meaning in their lives and relationships (Steigerwald and Janson 57). This requires from the counselor an attitude of hope and non-judgment, and an “active stance” that perhaps it is not so much the client that needs to be changed, but the culture in which the client lives (Steigerwald and Janson 57).
On the basis of their research, Drs. Shidlo and Schroeder offer the following advice: for any client seeking conversion therapy, detailed, informed consent is essential, including acknowledging the condemnation and disapproval by the American Psychological Association, and accurate information not only about gay and lesbian lives, but about the lack of efficacy and possible harmful side effects of conversion therapy; the client should be educated about the possible and probable developmental pathways conversion therapy can lead to; and lastly, a thorough discussion should ensue between client and therapist about what, exactly, would entail “change” in the client’s life, and how he or she would define success (258).

So in light of all of this negative information and harmful effects of conversion therapy, why wouldn’t the American Psychological Association issue an outright ban on the practice? Well, as we will see in the next section, there is an active and persuasive argument for the diversity and autonomy that can be used to support those individuals seeking conversion therapy and wishing to change (Haldeman 263). The field of psychology is not in the business of legislating, but merely guiding and informing; an individual’s right to self-determination is not something the APA wishes to remove (Haldeman 263).

Proponents of conversion therapy use the same ethical guidelines constructed by the American Psychological Association (APA) to defend their position as do opponents of conversion therapy. General Principle D of the APA’s Ethic’s Code calls for “Respect for People’s Rights and Dignity” and affirms counselors, therapists and psychologists to be aware of, and respect, cultural and individual differences in values, attitudes and opinions (Beckstead 89). Proponents argue that for some people, especially those who are deeply religious, find it too difficult to live an “out” lifestyle as a gay or lesbian, and that literature has shown that counseling is far more effective when therapists utilize counseling techniques and interventions that respect and stay within the framework of the client’s principle values and goals (Beckstead 89).

Dr. Warren Throckmorton, PhD, Associate Professor of Psychology and Fellow for Psychology and Public Policy at Grove City College in Pennsylvania, has been a leading advocate of conversion therapy and the religious individual’s right to self-determination for years (DrThrockmorton). He argues that individuals who wish to “modify their patterns of sexual arousal” should be allowed to do so without judgment, that it can be carried out ethically, and help should be available to those who request such assistance (Throckmorton 5).

Had the American Counseling Association’s (ACA) resolution questioning the use of conversion therapy been expressed as pure opposition, or an outright ban, it would have had a tremendous impact on the counseling profession (Throckmorton 3). Counselors who believe that homosexuality can, or should, be modified, would be in violation of ethics codes and subject to punishment or loss of license (Throckmorton 3).

Despite its evidence of effectiveness based primarily on a shaky foundation of self-report, clients both in favor of, and against, conversion therapy who have previously been through the process, have described positive experiences with it (Beckstead and Morrow 652). Even though the majority of them ultimately rejected the process, many reported finally feeling a sense of relief and self-determination, not only in feeling better able to manage their life and emotions, but in gaining what they perceived as a better understanding of their own development (Beckstead and Morrow 652). Some described feeling relieved that they didn’t have to eliminate their same-sex desires entirely, and that they understood now that feelings would come and go and that was okay; others reported enhanced same-sex relationships without the constant specter of sex, as they learned how better to communicate, break patterns of objectification, and develop relational skills; enhanced gender identity and positive self-exploration was another positive outcome for many (Beckstead and Morrow 652).
Dr. Throckmorton makes an argument that nothing in the ACA’s code of ethics is being actively violated regarding conversion therapy (10). He offers that one does not have to believe that homosexuality is a disorder in order to be able to help a client change their orientation; one does not need to suffer from a disorder to benefit from counseling, only a discomfort, unhappiness or maladjustment (Throckmorton 10).
Dr. Joseph Nicolosi, PhD, clinical psychologist, founder of the Thomas Aquinas Psychological Clinic in Encino, California, and the president of the previously mentioned NARTH, claims in his book, A Parent’s Guide to Preventing Homosexuality, that rather than “cure,” he prefers to refer to the goal of “change,” thereby never promising a fundamental shift, but instead teaching healthy and effective coping mechanisms for dealing with unwanted and/or persistent homosexual desires (NARTH). Arguing that the majority of mental health practitioners view homosexuality as a result of the confluence of biological, social and psychological factors, Dr. Nicolosi claims that the social and psychological factors, the predominant and strongest of the three, can certainly be modified to create a more desirable outcome in a client’s life (NARTH). Furthermore, since psychiatry states that a disorder is characterized by distress and disability, he sees a lot of “subjective stress in homosexually oriented people which cannot be attributed solely to social discrimination” (NARTH). Dr. Nicolosi argues vehemently that “non-gay” homosexual clients have every right to choose their own forms of therapy and the freedom to choose how to live out their own sexual orientations (qtd. in Beckstead 89).

Though the number is relatively small, there are a handful of individuals who say that conversion therapy has been a blessing to them, and helped them take their sexuality from being a “peripheral” part of their lives (i.e., distinct, negative, shameful, and polarized ideas of what it would mean to them to “be gay”) to being a more active, healthy and heterosexually-oriented part of them (Beckstead 90). One man even claimed that whatever discomfort he might feel in trying to adopt a heterosexual lifestyle was far preferable to the idea of living a “gay lifestyle,” which he viewed as devoid of commitment and integrity (Beckstead 95). All of the participants in the study who reported positive outcomes from conversion therapy said that the fundamental reason for wanting to change their sexuality in the first place was a spiritual need to “conform to what they felt to be true” (Beckstead 95).

In his defense of conversion therapy and its methods, Dr. Throckmorton uses copious amounts of data and information that is sometimes decades old (Throckmorton 12). He argues, however, that the literature on therapeutic assistance for treating unwanted sexuality came to a halt in the 1970’s due to social and political pressure from the American Psychological Association and the American medical establishment (Throckmorton 12). The desire of thousands of people to change, however, did not halt, and to deny that service to tortured individuals does not only them, but the whole psychiatric profession, a disservice (Throckmorton 12). He submits that it is inappropriate to tell clients that they cannot be helped when their desire is to change, and that using Kinsey’s past reasoning that sexual orientation lies on a sliding scale in the first place, then that scale can be manipulated in favor of a more heterosexual outcome (Throckmorton 12).

Some therapists view the APA’s decision to condemn conversion therapy as an act based on secular principles and politics, and that religious values should not only supercede those of secularists and scientists, but that the APA’s condemnation was not based on empirical data in the first place (Schroeder and Shidlo 139). Some clients reported being told by their therapists that the APA’s decision was a perfect example of why it was so important to make sure they see a Christian psychologist, since not every psychologist is a Christian (Schroeder and Shidlo 140).

Dr. Throckmorton submits the challenge that opponents of conversion therapy must effectively demonstrate that no client has benefited from conversion therapy, and that even if they have, that some abstract cost has been too objectively great to be worth it (11). Many individuals, he concludes, have been able to change their sexual orientation, and live what they consider to be far more fulfilling, integrated and peaceful lives (11). By doing so, Dr. Throckmorton is making explicit the dilemma that opponents of conversion therapy face: the lack of efficacy and empirical data that they use to justify a condemnation can also be used by proponents in exactly the same manner. In other words, both Drs. Throckmorton and Nicolosi are saying, the burden of proof is on the opponents of therapy, and thus far, that proof has not turned up (Throckmorton 12). Furthermore, for those who have successfully (by their standards) changed orientations, the APA condemnation denigrates and trivializes their accomplishments (Throckmorton 11). As long as clients are benefiting, small though that number may be, legislation and ethics codes condemning the very therapy that the clients found useful is both judgmental and short-sighted.

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