Reparative
Therapy:
The
Dangers of Anti-LGBT Therapy Models
Jared
Smith
University
of Dayton
The Problem
People whom
fall under the lesbian, gay, bisexual, transgender (LGBT) umbrella have
frequently been subjected to harassment and discrimination both historically
and globally. Examples of discrimination which occur here in the US include the
deprivation of basic rights to marry, adopt, hold employment, or shelter (HRC,
2014). In many other countries, it is a fight for the right to live against
threats of imprisonment, death, or attack by roving vigilante squads as seen in
recent documentaries Hunted: The War
Against the Gays in Russia HBO Films (2014) and God Loves Uganda First Run Films (2013). The LGBT are an oppressed
and misunderstood people and so it should come to no surprise that this
discrimination permeates into all areas of society, including the mental health
field. A 2014 Huffington Post article by Alissa Scheller reveals that in 48
states, it is currently legal to perform unethical reparative therapies to try to
change the sexual orientations of LGBT individuals. These practices are often
barbaric, non-empirically based, and have a high tendency towards negative
health and well-being outcomes for those who undergo treatment. The purpose of
this paper is to look into the history and practices of anti-gay reparative
therapies, to assess them for empirical validity and to evaluate outcomes of
the individuals whom undergo these therapies on individual, societal, and
global levels.
What is an Anti-Gay Therapy Model?
The process
of therapy has its roots in Freudian psychoanalysis and, unfortunately, it is
also here that we see the roots of anti-gay practices in therapy. It should be noted that both Freud and Ellis
both felt that homosexuality should not be considered a pathology. In
particular, Freud felt that all people were innately bisexual and that life
events and parental bonding patterns determined later sexuality. In 1935, Freud wrote the following on the
topic of homosexuality:
"Homosexuality
is assuredly no advantage, but it is nothing to be ashamed of, no vice, no
degradation, it cannot be classified as an illness; we consider it to be a
variation of the sexual function produced by a certain arrest of sexual
development. Many highly respectable individuals of ancient and modern times
have been homosexuals, several of the greatest men among them (Plato,
Michelangelo, Leonardo da Vinci, etc.). It is a great injustice to persecute
homosexuality as a crime, and cruelty too”.
Unfortunately future psychoanalytical therapists did not take heed of
Freud’s beliefs and homosexuality became highly pathologized within the
therapeutic community. Psychoanalysis is
actually where the term “reparative therapy” was first used to describe the
process of attempting to change homosexual persons into heterosexual persons.
As with many psychoanalytical practices, these beliefs have been highly
scrutinized by the current mental health community for being empirically
untestable and inconsistent from person to person. The term reparative therapy
has also been applied to a few behavioral practices, specifically those of aversion/conversion
therapy. This treatment which became
popular in the 60’s was rooted in behaviorist practices and involved trying to
reprogram the mind of homosexuals to disdain homosexuality by associating it
with unpleasantness. This aversion
treatment was often followed by a conversion phase in which clinicians tried to
also get clients to associate pleasure, happiness or success with heterosexual
encounters.
Psychoanalysis and behaviorist therapy models are the two main schools
of reparative therapy for the treatment of homosexuality; however, this is far
from an exhaustive list of reparative therapy models. Other classes of
treatment – many of which are faith-based Christian models – exist and are
equally non-empirically supported. Although the APA officially removed
homosexuality from the list of mental disorders in 1973, many of these
practices are still legal and practiced today.
Procedures
Involved in Anti-gay Therapy
It is difficult to say with any certainty what the
exhaustive list of treatment procedures for LGBT individuals undergoing
reparative therapy would look like as many organizations which partake in
anti-gay therapies do not allow for the greater scientific community to observe
and assess their processes. However, due
to anecdotal evidence and known past practices, we can piece together some of
the treatments, many of which, though not in common practice today, are extreme
and horrific.
As discussed previously, many interventions were
psychoanalytic or behaviorist in nature.
Through the process of psychoanalysis, searching the unconscious was
utilized as an historical treatment for homosexuality. Dependent upon the clinician’s
ability to look into the unconscious portions of the client’s mind and evaluate
the client’s parental relationships, a clinician would use this information to
attempt to find the root cause of homosexuality and then change the client into
a heterosexual. Hypnotism was sometimes in
conjunction with psychoanalysis (Freund, 1977).
On the behavioral side of things, conditioning to avert from
homosexual attraction was commonplace in behavioral interventions. One rather extreme practice involved
administering electrical shocks (either in the form of ECT or in the form of
genital shocks) to clients while simultaneously exposing them to homoerotic
imagery. Similar treatments were done
with chemical interventions, during which clinicians would show homoerotic
imagery to clients following a dosage of medications used to induce violent illness.
One such documented case (West, 1968) resulted in deaths due to clients’
suffocating to death in their own vomit during apomorphine based aversion
therapy.
If these techniques sound a little extreme, consider the
surgical alternative treatments which included genital mutilation and
castration for the purpose of changing sexual drives (Bremer, 1959) or the
surgical transplant of heterosexual men’s testicle cells into homosexual men’s
testicles (Schmidt 1984; Wolff 1986).
Often times, androgen therapy was also commonplace alongside these
practices to try to improve masculinity (Tennent, Bancroft and Cass, 1974).
Even more extreme surgical interventions in the past have included brain
surgeries – including the implantation of lead into the brain (Heath, 1972) –
and cerebral ablation (brain lesioning) (Schmidt and Schorsch, 1981; Rieber and
Sigusch, 1979).
The last class of treatments is that of religious affiliated
individuals. Many of these treatments have been described as using
“shame-based” techniques and the threat of damnation to treat homosexuality. It
has been significantly more difficult to affirm what therapeutic techniques are
still in use for the purpose of sexual reorientation. In looking for modern
conversion therapy, a Gawker article reviewing an exposé of the practices of
Dr. Jerry Mungadze whom uses “Right Brain Therapy” and “Color Therapy” to aide
in sexual reorientation was unveiled.
The video portrays a consultation with the doctor during which he has
the client color in a picture of the brain with crayons. Upon finishing the picture, the doctor uses
the colored picture as a “natural MRI” to diagnose pathology. Coincidentally,
this becomes a challenge as color therapist, Dr. Mungadze is colorblind. In an
attempt to find more mainstream practices which may still be in use, the National Association for Research &
Therapy of Homosexuality (NARTH) institute practice guidelines were
consulted as well as the main NARTH website.
Neither of these mentioned specific interventions; however, they did
mention that models can be often cognitive, or psychodynamic in nature.
Results of Interventions
The aforementioned practices associated with gay conversion
therapy could be considered worthwhile if they resulted in improved client
well-being, and successful orientation change for individuals unhappy with
their LGBT orientation. Unfortunately, this
is not the case. The highest claim for
successful conversion therapy has been about 27%, not accounting for drop-out
and using a sample which contained bisexual individuals. In his article “The
Religious Conversion of Homosexuality,” Silverstein (2003) offers pre and post
reparative therapy data and indicates that 83% of men whom undergo
reorientation therapy are unsuccessful. Often times, the few success stories
which exist fall apart upon deeper probing. In many cases, these individuals
have changed their sexual conduct patterns rather than actually changing their
sexual orientation. A similar pre and post data collection was discussed in the
article “Self-Reported Sexual Orientation” in which Maccio (2011) found that
before treatment, 45.9% of subjects identified as gay or lesbian. In the follow up post treatment data
collection, over 70% identified their current orientation as gay or lesbian.
In contrast to the dazzling results bolstered by reparative
therapy comes a long list of negative side effects which accompany treatment:
- Decrease in overall sexual arousal (Haldeman, 1991)
- Long-term sexual dysfunction, lowered self-esteem, loss of
family and religiosity,
-Elevated depression and anxiety (Haldeman, 1994, 1999)
- Phobic anxiety of
attractive men, increased suicidality, increased aggression and hostility, severe depression, engagement in
emotionally unsatisfying relationships (Bancroft, 1969).
-Elevated self-hatred,
heightened denial, emotional turmoil, increased depression, increased
suicidality, anger towards parents, decreased spiritual satisfaction (Beckstead
and Morrow, 2004).
-Distorted perceptions of homosexuality (Cianciotto &
Cahill, 2006)
-Paranoia resulting
from feelings of inadequate gender role expression (Cianciatto & Cahill,
2006; Drescher, 2006; Shidlo & Schroeder, 2003).
One study in particular (Shidlo & Schroeder, 2003) found
11 cases of attempted suicide following conversion therapy. Of the 11 whom attempted, only three
individuals had a history of suicide attempts, an increase of over 72%.
An Ethical Dilemma
The article “Nursing Implications in the Application of
Conversion Therapies on gay, lesbian, bisexual and transgender clients,” Blackwell
(2008) includes an excerpt from the APA regarding their official stance on
homosexuality:
“The American
Psychological Association:
opposes portrayals
of lesbian, gay, and bisexual youth and adults as mentally ill due to their
sexual orientation and supports the dissemination of accurate information about
sexual orientation, and mental health, and appropriate interventions in order
to counteract bias that is based in ignorance or unfounded beliefs about sexual
orientation. (American Psychological Association, 1999, p. 6)”
The article continues by mentioning
a 1999 collaborative effort of both the American Psychological Association and
the American Psychiatric Association in conjunction with the American Academy
of Pediatrics, the American Counseling Association, the American Association of
School Administrators, the American Federation of Teachers, the American School
Health Association, National Association for School Psychologists, the National
Association of Social Workers, the Interfaith Alliance Foundation, and the
National Education Association. This movement involved massive psychoeducational
movement on sexual orientation and contained information stating that
conversion therapy for sexual reorientation was based on outdated theories and
modalities and had been rejected by all major health organizations and mental
health professions.
In Kramer, Golom, LoPresto, and Kirkley (2008), the APA
ethical code is matched up with the tenants of conversion therapy in the
following table:
The table illustrates 16 different
ethical violations posed by the use of conversion therapy for the use of sexual
reorientation.
Similarly, conversion therapy also does not stack well against
the American Counseling Association’s (ACA) ethical code. The ACA 2014 code of ethics shows at least
six instances in which the use of conversion therapy would be considered
unethical. Beginning with section A “The
Counseling Relationship” there are two instances. Section A.4.a says that
counselors must act to avoid harming their clients. Yet in the results section, we clearly see
that harm was a very common byproduct of the conversion therapy process, cited
as causing emotional turmoil, and increasing aggression, depression and
suicidality. Section A.4.b “Personal Values” states that counselors are aware
of, and avoid imposing their personal values on clients. However, when the greater scientific
community has expressed that this model of therapy is harmful and the
pathologizing of homosexuality is a non-ethical practice, to continue to utilize
such methods against an ethical code seems like a value loaded action. Clearly these practitioners hold a personal
stance that homosexuality is a treatable illness, and despite their entire
professional community disagreeing with them, they insist upon keeping their
flawed belief system and applying it to the clients. In section C.1 “Knowledge and Compliance of
Standards” it says counselors have a responsibility to read, understand, and
follow the ACA code of ethics. By the virtue
of practicing outside of the code of ethics, as conversion therapists do, they
are in direct violation of the code of ethics.
Section C.5 “Non-Discrimination” states that counselors do not engage in
or endorse discrimination based on gender identity or sexual orientation. Therefore, having a therapeutic viewpoint
that homosexuality is wrong, an illness, etc. is an inherent violation of
ethics even before practicing on clients. In C.7a, we see that counselors must
have practices grounded in theory and empiricism. From an empirical sense, it has been
repeatedly shown that conversion therapy is a harmful and non-productive
treatment; ergo, it is not grounded in solid theory or practice and has no empirical
data to advocate its use. Finally, in
C.7.c “Harmful Practices” we see that it is unethical for counselors to use
practices which evidence suggests are harmful even if the client requests such
a treatment. Therefore, despite encountering clients whom want to receive
anti-gay therapy, utilizing such a therapy is still unethical because of its
long documented history of eventual harm to the client. Administering anti-gay therapy to a person
seeking to change their sexual orientation would be similar to helping an
anorexic person lose weight. While it may
be in line with the clients’ goals, the goals themselves are not in the best
interest of the client’s overall well-being as evidenced by eventual harm to
(at minimum) the client’s physical health.
By contrast, NARTH’s ethical guidelines also state that harm
should be avoided and reduced; however, they characterize suicidality and other
symptoms as an expected result of therapy and call for the management of these
symptoms. While this may be seen as a responsible
and transparent approach to the methods used, a more ethical and responsible
alternative may be utilizing methods which do not knowingly incite suicidality
in clients.
A Brighter Future
Non-professionals
with their own agenda will probably always exist in mental health professions.
Due to their charisma, they may always be able to draw a clientele and prey upon
the insecurities of others. That is why
it is our job as scientifically literate professionals and members of a
professional community to minimize the damage that these people can cause to
others and our profession. Most
professional organizations have taken the first step already by barring anti-gay
therapy models; however, I believe the fight has not been taken far enough. There
should be stricter policies in place, such as voiding of licensure and barring
people from practicing again for utilizing such practices. Furthermore, these
practices should have legal ramifications as well. In 48 states, these dangerous practices are
still legal! It is our job as professionals to be bringing these issues to the
forefront. Counselors should also
familiarize ourselves with strength-based and affirmation centered models which
have been shown to improve the lives of people struggling with their LGBT
statuses. As with any other minority population, counselors should train in the
particular life challenges LGBT individuals face and do their best to be there
for them both as professionals and as community allies advocating for fair and
equal treatment.
Disclosure: The writer of this paper
Jared A Smith, a master’s student at the University of Dayton, is a member of
the LGBT community (bisexual) as well as a member of various pro-lgbt rights
community and activist groups.
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