A couple of readers asked me to comment on Nick Cummings USA Today column on reorientation therapy. With some caution, I think it would be good to do so.
First I want to say that I have always liked and admired Nick. His work in managed behavioral health care was pioneering. In the 1980s, Nick promoted the idea that excellent clinical services could save businesses a lot of money and actually expand access to therapy. He was correct and helped create modern managed behavioral healthcare, which is essentially the dominant system today. In addition to the new business strategies that Nick’s company (American Biodyne) innovated, Nick was/is a gifted clinician and trainer. I learned a lot from Nick about therapy as a Biodyne clinician in the mid-1980s. I will always be grateful for his influence on me at that time.
Nick is an admirable gentleman in many ways. He seems to be indestructible and maintains an ambitious and rigorous schedule into his older age. He also reads and studies Greek (another area of common interest) and has developed a cooperative program with China that is helping to shape their behavioral health system.
Having declared a sincere admiration for Nick, I have to add that we disagree about his recent push to defend reorientation therapy as a modality. Nick is an endorser of the Sexual Identity Therapy Framework and I have heard him promote the ideals we support. Thus, I know that any person who sought change therapy from him would not get the usual reparative therapy explanations for homosexuality, nor would religion be used as a coercive tool. In other words, I don’t believe Nick wishes to defend any and all approaches to change therapy; I think he wishes to defend the right of clients to arrange their lives and seek help to do it. However, it is dismaying that his defense comes in the context of the JONAH’s court case. Much of what is done in the name of reorientation cannot be defended.
One area Nick and I disagree about is how much to emphasize the role and importance of bisexuality. Nick once told me that clients who had no prior heterosexual experience were not successful in changing orientation and so over time, the Kaiser-Permanente therapists discouraged orientation change for those clients. To me, this suggests that many of those “changed” clients were bisexuals who found ways to live with or minimize their same-sex attractions. Furthermore, to my knowledge, no one was discussing “spousosexuals” from 1959-1979. Some men and women are generally attracted to the same sex but spontaneously fall in love with one person of the opposite sex. Some of those successes could easily have been people who had the potential for that kind of fluidity. Another problem with relying on Nick’s data is that follow up was lacking for many of the clients. Nick is aware that some of his clients remained changed, but he does not have systematic data on the population.
If all reorientation therapists were like Nick, I doubt we would have the conflict and polarization we have seen over the past decade or so. I also doubt there is anybody currently vocally defending reorientation who practices as Nick did. Current reorientation therapists blame parenting and masculinity deficits for same-sex attraction, some of them put people through emotionally taxing and empirically questionable human potential exercises, still others attempt to coerce people with religion. My impression is that Nick and his crew did none of that. Certainly, in all of my dealings with American Biodyne, no one ever suggested any of that. The emphasis was always on helping the client find strategies to enhance mental health and live in accord with their aspirations.
Nick’s closing paragraph makes me think that he believes that there are some, perhaps many, therapists who work empirically and ethically with “fully informed persons.” This is where we disagree. The way reorientation is practiced as I have seen it and heard it described at various conferences and by various therapists in my travels during the last decade or so gives me no confidence that he is right this time.
Given those concerns, I continue to support the APA’s distinction between sexual orientation and sexual orientation identity; the former being durable once established and the latter being more subject to modification. I am skeptical there are many current reorientation therapists fully inform their clients about that distinction.