Sexual identity: Thoughts on the status of the reorientation wars

(First posted on August 12, 2009)

So now that the dust has started to settle from the APA convention in Toronto, let’s review the status of the Reorientation Wars.

Does therapy change orientation?

In anticipation of the APA’s report, NARTH fired an opening salvo with their paper (What Research Shows…). Perhaps sensing, incorrectly as it turns out, that the APA would advocate a ban on reorientation therapy, NARTH tossed every positive reference to change they could find into the paper. They noted problems in defining sexual orientation but did little to distinguish the various definitions and their meaning in the many studies they cited. They concluded, of course, that therapy can change orientation.

The APA on the other hand, differentiated sexual orientation and sexual orientation identity. Sexual orientation for them is the biological responsiveness to one gender or both. According to their literature review, the evidence that therapy can change orientation is not sufficient to permit therapists to inform clients that therapy can change their orientation. However, sexual orientation identity (i.e., self-labeling) may shift and be responsive to a variety of factors, including religious mediation.

It seems to me that what NARTH is calling sexual orientation includes the APA’s sexual orientation identity. While this statement risks taking us into the “all or nothing” dead end discussion about change, I do not mean that one must change completely for change to be important and psychologically relevant. I suggest instead that what many studies measure is how people see themselves, even if their sexual responsiveness (orientation) has only shifted by a degree (e.g., an average of less than a point on the Kinsey scale in the Jones and Yarhouse study). Jones and Yarhouse suggest as much in their recent paper when they write:

There is also the question of sexual identity change versus sexual orientation change (see Worthington & Reynolds, 2009). Recent theoretical (e.g., Yarhouse, 2001) and empirical (e.g., Beckstead & Morrow, 2004; Yarhouse & Tan, 2004; Yarhouse, Tan & Pawlowski, 2005; Wolkomir, 2006) work on sexual identity among religious sexual minorities suggests that attributions and meaning are critical in the decision to integrate same-sex attractions into a gay identity or the decision to dis-identify with a gay identity and the persons and institutions that support a gay identity. In light of the role of attributions and meaning in sexual identity labeling, is it possible that some of what is reported in this study as change of orientation is more accurately understood as change in sexual identity?

I believe the answer to their question is that it is not only possible but probable that change in sexual identity is what is being reported. The distinction between orientation and identity (or attraction and identity as we often describe it here) is key, in my view, in order for us to understand the experience of those who say they have changed while at the same time experiencing same-sex attraction. I also believe that men and women are different and their change may be different. Women seem to describe less exclusivity than men. Fluidity may be more likely with complete shifts described. I think we need to accommodate atypical experiences such as men and women who completely shift for a time and then shift back. Whatever the pattern, I hope we can agree that sexual attraction patterns may be one thing while meaning making aspects may lead two people with the same attraction pattern to identity in disparate ways.

Is sexual reorientation harmful or beneficial?

NARTH says reorientation might harm some people but that for the most part it is not harmful. The APA says existing studies are not good enough to allow conclusions. Point for the APA here. All we can say is that some people report harm and some people report benefit. The APA notes that the benefits can occur in programs which promote congruence with religious faith. This is clear and the Jones and Yarhouse study demonstrate that health status improves modestly for those who remained in the study. However, I would say we do not yet know much about what the potent or beneficial elements of those programs are. The APA report identified some of those elements.

Homosexuality and pathology

NARTH says homosexuals have more pathology than any other group of similar size. The APA says homosexuality is normal. By this they mean that homosexuality is not a developmental disorder or indicator of a mental disorder. The two recent reports go off in different directions but some observations can be made.

The NARTH report spends lots of time reporting on greater levels of mental health and health problems among homosexuals as compared to heterosexuals. The APA report does not do this. However, I believe the point regarding different levels of symptoms would be stipulated by the APA. However, the APA raises the minority stress model as responsible for many difficulties faced by non-heterosexual people. The NARTH report discounts the role of stigma.

I doubt the APA would dispute the health status data for another reason: greater group pathology does not mean inherent disorder. The APA’s position is not that gays have equal health outcomes but rather that the unequal health outcomes do not imply inherent pathology – that SSA is not inherently the result of pathological development. This is of course in great contrast to the reparative therapists. Joseph Nicolosi says that the only way you get SSA is to traumatize a child.

The reparative impulse to find trauma behind every gay person is misguided I believe, conceptually and for sure empirically. Women have greater levels of mental health problems than men but we would not consider women inherently disordered. NARTH has chosen some good studies to cite in the section of their paper which relates to health status (as well as some really bad and irrelevant ones). However, I don’t think it really gets them where they want to go.

And where do they want to go? This is clear from their press release complaining about the APA task force report. They state:

Further, if some clients are dissatisfied with the therapeutic outcome [of reorientation therapy], as in therapy for other issues, the possibility for dissatisfaction appears to be outweighed by the potential gains. The possibility of dissatisfaction also seems insignificant when compared to the substantial medical, emotional, and physical risks associated with homosexual behavior.

NARTH would suggest that these medical and emotional risks, along with the incongruity of homosexual behavior with the personal and religious values of many people will continue to be the motivation for some individuals to seek assistance for their unwanted homosexual attraction.

According to NARTH, gays ought to seek reorientation therapy because being gay is a risky life, full of health and mental health disadvantages. Their hypothesis is implied but hard to miss: reduce the SSA and reduce the health risks. The assumption appears to be that ex-gays will have better health outcomes than gays. One problem with this line of thinking is that there is no empirical evidence for it and some evidence against it.*

One researcher quoted in the NARTH paper regarding health risks was New Zealand’s David Fergusson. Dr. Fergusson has done significant work in this field. I asked him to look at the section of the NARTH paper in which his work was quoted. Here is a statement he provided about it:

While the NARTH statement provides a comprehensive and accurate analysis of the linkages between sexual orientation and mental health, the paper falls far short of demonstrating that homosexuality should be classified as a psychiatric disorder that may be resolved by appropriate therapy. To demonstrate this thesis requires an in depth understanding of the biological and social pathways that explain the linkages between homosexual orientation and mental health. At present we lack that understanding. Furthermore it is potentially misleading to treat what may be a correlate of mental disorder as though it were a disorder in its own right.

Fergusson also told me that one would need to develop studies to demonstrate that any changes in orientation associate with improvements in health status. The Jones and Yarhouse study provide some very general assessment but many potential confounds are uncontrolled. For instance, it is not possible to say that the modest shifts on the Kinsey scale were responsible for the shifts in health status. These folks were quite religious and religion is associated with enhanced health status. I suspect religious gays have a better health status than non-religious gays, on average. The point is we do not have evidence that sexual orientation status per se is what leads to the differences in health status.

While I am on the subject of health status, I need to mention that there are other factors which NARTH ignored. One, gender non-conformity is strongly correlated with adult homosexuality and is also associated with poorer mental health. Two, homosexuals report higher levels of sexual victimization which is also associated with higher levels of mental health problems. And, three, no one can discount the possibility that biological factors which associate with the development of homosexuality may also influence the development of emotional problems (i.e., in the same way women are more likely to report depression than men).

So where are we? I hope we have a larger middle and smaller numbers of people at the opinion extremes. People on both sides can agree that erotic responsiveness is extremely durable for men and perhaps less so for women, but behavior and self-identity reflection is alterable. People on both sides agree that conclusions about benefit and harm are not possible in any general sense. Also, I hope we can agree that full informed consent should be conducted prior to engaging in counseling. Regarding health status, both sides can agree that homosexuals have higher levels of problems but there is little agreement about what the differences mean.

Those on the far sides of the continuum will continue to argue that change is possible or change is impossible, and/or that reorientation is always harmful or never harmful and/or that health status difference mean something vital or irrelevant about inherent pathology.

The wars will continue but perhaps fewer people will be engaged in them; now is the time rather to reason together.

*Nottebaum, L. J., Schaeffer, K. W., Rood, J., & Leffler, D. (2000). Sexual orientation—A comparison study. Manuscript submitted for publication. (Available from Kim Schaeffer, Department of Psychology, Point Loma Nazarene University, 3900 Lomaland Drive, San Diego, CA 92106) – In this study, the authors found that mental health was better among the gay sample than the Exodus sample.

(Note: Social psychologist David Myers referred to this post in an op-ed on the APA task force printed in the Wall Street Journal.)

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  • Teresa

    Can someone here answer this question for me?

    Is the essential psychological view of NARTH the following:

    ‘Homosexuality’ is a psychiatric illness and never should have been removed from DSM-II … although, they may not publicly state this?

    Dr. Charles Socarides was an opponent of the removal of homosexuality as a mental disorder; and, was and is considered by NARTH very favorably.

  • DAVE G

    Has anyone determined the specifics of “harm” reported by failed clients? That is, other than loss of friends among the gay community, and lack of a supportive community among ex-gays or non-gays.

  • ken

    Teresa# ~ Jun 16, 2011 at 1:41 pm

    “Can someone here answer this question for me?

    Is the essential psychological view of NARTH the following:

    ‘Homosexuality’ is a psychiatric illness and never should have been removed from DSM-II … although, they may not publicly state this?”

    they did publicly state this on their website years ago, don’t know if the pages are still up. And NARTH is the source of the mis-information (“no scientific research”, “it was a political decision”, “it was due to gay extremist threats against the APA” etc) about why the change was made.

  • ken

    DAVE G# ~ Jun 16, 2011 at 2:54 pm

    “Has anyone determined the specifics of “harm” reported by failed clients? That is, other than loss of friends among the gay community, and lack of a supportive community among ex-gays or non-gays.”

    Types of harm that have occurred: loss of self-esteem, loss of religious faith, anxiety, depression, in extreme cases, suicide.

    Box turtle bulletin just did a series of articles about on Kirk Murphy, who was sent to therapy to “prevent” him from becoming gay. You can read about it here:

    http://www.boxturtlebulletin.com/what-are-little-boys-made-of-main

    Also Shidlo and Schroeder documented other harm as well:

    Shidlo, Ariel; Schroeder, Michael (2002), “Changing Sexual Orientation: A Consumers’ Report”, Professional Psychology: Research and Practice 33 (3): 249

  • Richard Willmer

    I was not really aware of NARTH before I started frequenting this blog. I have to say that they sound to me like a pretty vicious bunch of thugs!

  • Richard Willmer

    From what I can see, the essential position of organizations like NARTH is to discredit and diminish a whole group of people regardless of:-

    1. their overall character

    2. their contribution to society

    3. their overall ‘moral fibre’

    4. the quality of their interpersonal relationships (sexual or otherwise)

    5. their treatment of, and effect on, others.

    This is, quite simply, madness, and utterly devoid of any genuine morality or philosophy. It is also the the thin end of a very dangerous wedge. Some NARTHians like to claim they are basing their view on ‘existentialist reality’; such claims are totally delusional if the items mentioned above are being ignored.

  • Mary

    Imagine us – still using the Kinsey scale after most if not all of his work and research has come into ethical question.

  • ken

    Mary# ~ Jun 20, 2011 at 6:32 pm

    “Imagine us – still using the Kinsey scale after most if not all of his work and research has come into ethical question.”

    Do you know of some ethical flaw with the Kinsey scale Mary? What is it?

    what ethical issues are there with Kinsey’s work? Certainly his data collection methods where flawed and it is generally unwise to site his research as authoritative (and frankly I don’t know of anyone who does, other than the occasional 10% of the pop. is gay). However, Kinsey’s real contribution wasn’t his research, rather it was that he was one of the 1st researchers (in the US) to start applying scientific methods to the study of sexuality. Which spawned other (and better) research.

  • Madison

    Yes, NARTH and NARTH members generally believe that some condition related to unwanted same sex attraction should have remained in the DSM. Nicolosi usually refers to “ego dystonic sexual orientation” which I think is a fancy term for not wanting to be gay. Its absence in the DSM makes it much more difficult to treat people and perform research on the matter which I would hope many would agree is unfortunate.

    NARTH’s overall intent is pretty simple and I would say non-controversial: to help people with unwanted same sex attraction. I think they get into trouble when needing to handle the incessant attacks from TWO, EGW, et al.

  • ken

    Madison# ~ Jun 21, 2011 at 6:55 pm

    “NARTH’s overall intent is pretty simple and I would say non-controversial: to help people with unwanted same sex attraction.”

    that sounds really nice, but it isn’t really what NARTH does.

    “I think they get into trouble when needing to handle the incessant attacks from TWO, EGW, et al.”

    No, they get into trouble because the spread false and misleading information about sexual orientation. Because they offer therapies that are not based on science, but their own prejudices about gays.

  • Teresa

    Richard stated:

    From what I can see, the essential position of organizations like NARTH is to discredit and diminish a whole group of people regardless of:-

    1. their overall character

    2. their contribution to society

    3. their overall ‘moral fibre’

    4. the quality of their interpersonal relationships (sexual or otherwise)

    5. their treatment of, and effect on, others.

    Yes, to this. :)

  • Madison

    Teresa & Richard, I don’t think that could be further from the truth. Do you really believe that or is it just the rhetoric that it looks like?


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