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Initial empirical and clinical findings
concerning the change process for ex-gays. Professional Psychology:
Research and Practice, 33, 242-248.
Throckmorton, W. (2002a)
ABSTRACT
Despite the controversy surrounding sexual reorientation, there
are only a few published empirical reports concerning the experiences of
ex-gays. Summarizing these reports, this article describes the role of religious
variables in the change process. Some kind of change appears to occur for many
who identify themselves as ex-gay. Although sexual orientation is not an easily
defined or measured phenomenon, change over time is not theoretically unfounded
or empirically unprecedented. Many of the individuals who report efforts to
become ex-gay feel that the efforts were helpful, and a small percentage feel
the efforts were harmful.
INTRODUCTION
Ex-gay is a term that often provokes extreme reactions. Many view the
term as a misnomer, connoting an impossible situation ( Ross,
1977 ; Schreier, 1998 ). For instance, the recently
issued Guidelines for Psychotherapy With Lesbian, Gay, and Bisexual Clients
do not mention issues in working with ex-gays and imply becoming one might
be impossible ( American Psychological Association [APA], 2000
). Other clinicians, however, seem interested in exploring the possibility
that people might be able to change sexual orientation ( Spitzer,
2000 ; Throckmorton, 1998 ). A dispassionate response to
the concept of ex-gay is rare. 1
Pattison and Pattison (1980 , p. 1553) introduced the term
ex-gay to the professional literature; they defined it to mean someone
who had "experienced a basic change in sexual orientation from exclusive
homosexuality to exclusive heterosexuality." Over the past 20 years, as a gay
male/lesbian affirming movement has grown, a parallel group of individuals who
identify themselves as ex-gay has developed. Recently, ex-gay leader href="#c47">Worthen (2000) wrote the following:
What does ex-gay mean? It is a statement of fact: I am no longer the
same. God has changed me, He is changing me, and He most certainly will continue
to change me.... At New Hope Ministry, we do not attempt to make heterosexuals
out of homosexuals. Rather, we attempt to change a person's identity, the way a
person looks at himself. We encourage the former gay to drop the label
homosexual from his life. However, we do not ask him to become dishonest about
his struggle with homosexuality. He is a Christian who has a homosexual problem,
rather than a homosexual who believes in Christ Jesus. (pp. 1, 3)
Thus, ex-gay refers both to people who have
changed and also to people who are in the process of changing their lesbian or
gay male identity–as a by-product of religious observance. For the purpose of
this review, I consider the term ex-gay to refer to an individual who
experiences same-gender sexual attraction but who has changed or desires to
modify sexual arousal due to religious motivation.
Ex-gays are often associated with ministry organizations of various faiths.
For instance, Exodus International is one of the largest Christian
organizations, and it provides referrals to member agencies and organizations.
Exodus's Web site offers the following description: CPYRTHLD="OTHER">
Exodus is a nonprofit, interdenominational Christian organization promoting
the message of "freedom from homosexuality through the power of Jesus Christ."
Since 1976, Exodus International North America has grown to include over 100
local ministries in the USA and Canada. We are also linked with other Exodus
world regions outside of North America, totalling [ sic ] over 135
ministries in 17 countries. (2000)
Other faiths also have ministries to ex-gays. For instance, JONAH is a Jewish
organization that "intends to deal with homosexual issues in a manner consistent
with Jewish principles as set forth in the Torah" ( Rosenbluth,
2000 , p. 7). The organization is "geared to assist homosexual men and women
seeking to change their sexual orientation" ( Rosenbluth, 2000
, p. 7).
Do Ex-Gay Ministries Help People Change Sexual Orientation?
Research in which the term ex-gay is used is sparse. I could locate
only 11 reports in the professional literature or under review for publication
concerning individuals involved in ex-gay ministries. The extent and degree of
impact, positive or negative, of these ministries is currently impossible to
gauge. Other authors have provided anecdotal accounts of individuals harmed or
disillusioned as a result of their involvement in ex-gay ministries ( href="#c5">Bennett, 1998 ; Haldeman, 1994 , href="#c16">1999 ; Human Rights Campaign, 2000; href="#c21">Martin, 1984 ; Stein, 1996 ). href="#c38">Shidlo and Schroeder (2000) made a more rigorous study of those
who report harm from ex-gay or change efforts. However, these results have yet
to be peer reviewed and are not generally available. Specifically, these results
are not studies of ex-gays but perhaps of "ex-ex-gays," although they noted that
approximately 3% of their sample felt that change was successful.
To limit the scope of this article, I do not consider sexual reorientation
therapies in depth. Such therapies often have objectives similar to those of
ex-gay ministries, which is to assist clients who desire an alteration of sexual
orientation. However, volunteer counselors often staff ex-gay ministries, as
opposed to licensed clinicians who conduct reorientation counseling. href="#c7">Clippenger (1974) , Adams and Sturgis (1977) ,
Nicolosi (1991) , Yarhouse (1998a) , and
Throckmorton (1998) have offered reviews of reorientation
therapies that conclude with guidelines for ethical use of such approaches. href="#c1">Acosta (1975) , Haldeman (1994) , href="#c21">Martin (1984) , Stein (1996) , and href="#c43">Tozer and McClanahan (1999) have provided critical reviews of
this literature that yield ethical and clinical cautions against reorientation
procedures.
This review does not answer the controversial question, Do ex-gay ministries
help people change sexual orientation? There are at least two reasons for this.
First, sexual orientation is a concept that is difficult to define and measure (
Gonsoriek, Sell, & Weinrich, 1995 ). Being gay, lesbian,
bisexual, or straight means different things to different people. Some lay
people (and researchers) define sexual orientation by behaviors, others
consider impulses and fantasies, and others consider some combination of these.
Self-report is the most common means of assessing sexual orientation, with all
of the limitations known for this assessment method. Moreover, there is no
consensus of a direct, physical means of assessing sexual orientation. Gonsoriek
et al. did not abandon the concept of sexual orientation, but they concluded
that "given such significant measurement problems, one could conclude there is
serious doubt whether sexual orientation is a valid concept at all" (p. 46).
A second and related problem is the controversy between those holding
essentialist and social constructionist views of sexual orientation ( href="#c9">DeLamater & Hyde, 1998 ). Essentialist theorists view sexual
orientation as an immutable, inherent trait, whereas social constructionists see
sexual orientation as arising from self-reflection in the context of culture.
Essentialists often separate sexual orientation from sexual identity and assume
the actuality of distinct categories of sexuality (e.g., gay, bisexual,
straight), whereas sexual identity is one's more conscious self-identification.
As such, essentialists are not likely to trust self-reported change as
sufficient to establish proof of sexual orientation change ( href="#c14">Gonsoriek et al., 1995 ). Many constructionists, however, see
the lesbian, gay, and bisexual (LGB) identities emerging recently in history (
Richardson, 1993 ). Constructionists place great value on the
narratives of those who claim change in the experience of sexual orientation.
The practical implication of this discussion is that one's presupposition
concerning sexual orientation may influence how one views the data concerning
change. Essentialist theorists (and therapists) may assume that change reported
in the literature is simply change in sexual identification, whereas
constructionists may be more inclined to view change data as evidence of the
socially constructed nature of sexual orientation ( Richardson,
1993 ).
Religious belief is frequently cited as a motivation for seeking sexual
reorientation ( Haldeman, 1994 ; Yarhouse,
1998a ). However, this motivation is only recently receiving research and
clinical attention. Prior to 1974, there were numerous reports of clinical
efforts to reorient sexual orientation ( Bergin, 1969 ; href="#c46">Wolpe, 1973 ), but only a few mentioned the reasons given by
research participants for the desire to change (e.g., McCrady,
1973 ). Contemporary practitioners might be caught off guard by religiously
motivated requests to modify sexual orientation as well, given the prevailing
view that sexual orientation is highly resistant to change ( APA,
1997 ). Although the reports in this article do not provide proof that
sexual orientation changes through religious mediation, they do invite mental
health professionals and the public to be cautious in assuming that we fully
understand the potential and limitations for human change.
Empirical Reports Concerning Religiously Mediated Change
Qualitative Research Wolkomir (1996)
.
Wolkomir used a qualitative research design to study a group of 5 gay male
Christians attending a Metropolitan Community Church (MCC) as well as a group of
5 ex-gay men meeting in a conservative church. The ex-gay group was an Exodus
International affiliate group. Wolkomir was interested in how the participants
transformed what was once "a stigmatized identity into a moral one." She found
that both groups felt stigma and moral shame from the culture and the church
because of their same-sex attractions, and the participants in both groups were
observed using their group involvement as a means of transforming a stigmatized
identity into an acceptable one. In the case of the MCC group, the pastor
conveyed that God loves the members as they are, without the need for change. On
the other hand, the ex-gay leaders stressed God's love but also "normalized"
homosexuality by saying it is no worse than any other sin. For instance, having
same-sex attraction is no worse for the ex-gay group than being intoxicated, a
state which many otherwise moral people have experienced.
In addition to the reinterpreting of previously stigmatized aspects of
identity, the institutional support of the church and the social interaction of
the group format emerge as supports to identity change. Each group meets with
the blessing of a church structure that supports the new identity of its
members. In the meetings, Wolkomir (1996) observed the
participants discussing the creation of a moral identity. This interaction
rehearsed and deepened the meaning of the new identity. For both groups, the
processes are similar, but the identity outcomes are quite different. For the
former gay men and lesbians, the ex-gay label is evidence of a higher
moral identity. For the MCC group, their status as children of God is evidence
of that moral identity. Because the aim of Wolkomir's work was not to document
reorientation, no follow-up data were recorded nor was any mention made of the
outcomes of the men in the study. Robinson (1998) .
Robinson analyzed interviews with 7 men who believed that their sexual
orientation had changed. These men were affiliated with Evergreen, a ministry of
the Church of Jesus Christ of Latter Day Saints. The participants experienced
histories of same-sex attraction and behavior and at one time considered
themselves to be gay. At the time of the interviews, each participant was
heterosexually married and had engaged in no same-sex sexual behavior for at
least the year prior to the study. In his analysis of the interviews, Robinson
found nine components that he believed were associated with change for all of
the participants. The participants shared common patterns of cognition and
emotional sensitivity, as well as a spiritual transformation. After change, the
participants no longer felt troubled by the following experiences: feeling
different from or rejected by heterosexual men, emotional attraction to men,
sexual attraction to men, negative self-appraisal based on having had same-sex
desire, social isolation, or compulsive sexual thoughts and behaviors. Finally,
participants no longer interpreted their prior same-sex attractions as requiring
them to identify themselves as gay.
Many of Robinson's (1998) participants referred to href="#c23">Moberly's (1983) book concerning a new Christian approach to
same-gender attraction as being catalytic in the process of change. Moberly
posited that same-sex attraction is an inherently unsatisfying means of meeting
a legitimate human need for same-sex love and affiliation. If same-sex relations
within the family are thwarted in some way, then a person may attempt to repair
the deficit in a search for same-gender relationships. In homosexuality,
according to Moberly, these legitimate yearnings are eroticized, yielding
same-sex sexual attraction. The object of counseling or ministry is to repair
this same-sex emotional need via intimate nonsexual same-sex relations.
What do the participants of Robinson's (1998) research
tell us regarding this theory? According to Robinson, participants attributed
change to the reparative theory but did not actually change in accord with it.
Given that reparative theory predicts that change in same-sex attractions comes
as same-sex bonding needs are met in nonsexual relationships, one might expect
that the men in Robinson's study would report this factor to be the primary
agent of change. However, they consistently do not. Instead, the change seems
primarily related to adopting a new interpretive schema or framework concerning
the causes and implications of their same-sex attraction. href="#c32">Robinson (1998) noted that "the participants in this study often
reported that at least the initial change they experienced occurred very rapidly
and before any significant effort had been made in forming close same-sex
relationships. Some participants even reported that they had made little effort
to meet unmet same-sex intimacy needs" (p. 186). Change for them resulted
largely from "understanding" the nature of their same-sex attraction.
Even if the conceptual framework is inaccurate, simply having an explanation
and a hope for change were deemed powerful catalysts for change. href="#c32">Robinson (1998) viewed the reinterpretation finding as
supporting a constructionist perspective concerning sexual orientation. He noted
that many of his participants initially held an essentialist view of sexual
orientation (i.e., that sexual orientation was a fixed, unalterable trait). What
seemed to promote change was a perspective shift generated by href="#c23">Moberly's (1983) theories. The participants then constructed
their sexual orientation as changeable and found their experience of sexuality
changing as a result. The other factors identified by Robinson were then
supportive of this basic paradigmatic shift. Robinson concluded that perhaps the
most important aspect of his findings was that some kind of change is possible.
Ponticelli (1996 , 1999 ).
Ponticelli provided a look into the workings of Exodus International. In this
study, she attempted to extend our theoretical understanding of identity
transformation while maintaining the integrity of human agency in varying
contexts. As a participant-observer, she conducted her research during the 1992
and 1994 Exodus annual conferences. She interviewed 15 women and read
testimonies of 12 women who were involved in the Exodus International ministry.
She found that the process of becoming identified as an ex-lesbian closely
paralleled social psychological findings concerning religious conversion.
Ponticelli (1999) identified five factors instrumental to
the formation of an ex-lesbian identity. Set in the theoretical background of
identity construction and religious conversion, she noted that ex-lesbians adopt
a new universe of discourse, reconstruct their personal biographies more in
keeping with an ex-lesbian identity, adopt a new explanatory model for important
issues in life, accept their new ex-lesbian role, and develop emotional ties to
others of like mind. The Exodus ex-gay ministry seems to promote these factors
through a variety of behaviors. For instance, giving testimony or telling one's
personal story is an aspect of recreating a perspective that helps the
ex-lesbian identity make sense. The employment of a new universe of discourse
allows the new ex-lesbian identity to be described in a manner consistent with
that of others in the social group. Giving testimony allows the ex-lesbian to
demonstrate an acceptance of the role of being "saved" or "healed." href="#c30">Ponticelli (1999) noted that role acceptance has been identified
as an indicator of conversion. She also asserted that the development of strong
emotional bonds with other converts is essential to the success of the
ex-lesbian. In her qualitative account, she wrote that "Exodus's never-ending
love, support, and acceptance often angered me, but at the same time carried a
certain pleasantness in contrast to memories of my childhood" ( href="#c29">Ponticelli, 1996 , p. 198). Thus, for Ponticelli's participants,
a combination of a new and compelling schema concerning sexuality,
reinterpretation of one's past according to that schema, and social support seem
to lead to the construction of a change in sexual identity. Survey
Research Pattison and Pattison (1980) .
Pattison and Pattison interviewed 11 men who claimed to have changed sexual
orientation as a result of participation in an ex-gay ministry. All of the men
had identified themselves as "gay" by age 15. Nine gave themselves a Kinsey
rating of 6 ( exclusively homosexual ), with one rating a 5 and the other
a 4. 2 Postchange, 5 of the men rated
themselves as exclusively heterosexual, with 3 having a Kinsey rating of 1 and 3
having a rating of 2. Three of the 11 participants reported no homosexual
fantasies, behavior, or impulses. Although some of the men reported homosexual
fantasies postchange, Pattison and Pattison did not interpret this finding as
evidence that the men had not changed. Rather, they wrote that their data
"suggest the gradual development of a rejection of the homosexual object choice
as an increased cathexis of the heterosexual object is developed" ( href="#c28">Pattison & Pattison, 1980 , p. 1555). Thus, the basic shift
was assumed, but the implications continued to develop at different rates for
each individual.
This study has been widely criticized ( Haldeman, 1994 ;
Krajeski, 1981 ; Stein, 1996 ). Many have
noted the small, nonrandom sample size, missing detail in the description of
participant change, seemingly inconsistent descriptions of participants' sexual
orientation status, and the biases of the authors toward viewing the
participants as having changed. Pattison (1981) replied to
some of these criticisms in a letter to the editor of the American Journal of
Psychiatry . He noted that the criticisms of his report often assumed that
the authors intended it as a formal psychotherapy research outcome study.
Rather, as he stated in the original conclusions section ( href="#c28">Pattison & Pattison, 1980 , p. 1560), he considered the
report to be an instance of "folk healing." The participants had viewed
themselves as changed, and the Pattisons had documented that some kind of change
had occurred from the participant's frame of reference.
Although it is not clear from the data presented in Pattison
and Pattison's (1980) study that the participants did, in fact, change
sexual orientation, the report does shed some light on processes that might
catalyze individuals in their attempt to sustain identity change. href="#c27">Pattison (1981) cited Frank's (1973 , p. 853)
observation that "folk therapy proceeds from the explicit assumption of an
ideological frame of reference." The participants had made an ideological
commitment that involved a reorganization of behavior, cognition, emotional
responsiveness, and social interaction over time. Implicit in their ideological
commitment to one set of beliefs was a rejection of another set of beliefs.
Thus, although this value position is offensive to some, adopting such a
position seemed for these persons to be associated with maintaining a desired
reorganization of their lives. Nicolosi, Byrd, and Potts
(2000) .
Nicolosi et al. reported the results of a large survey of individuals who had
tried sexual reorientation. Surveys were distributed to therapists, ex-gay
groups, and ex-gay conferences (e.g., Exodus International). Two factors warrant
serious consideration of this study. First, its large sample size (882) made it
the largest survey of its kind. Second, the characteristics of the sample
closely fit our definition of ex-gay . Recruits were drawn from ex-gay
ministry groups and conferences, and 96% of the total sample responded that
religion was very important to them. According to the report, 216 respondents
had participated in reorientation therapy with a professional therapist only,
229 received counseling from both a professional therapist and a pastoral
counselor, 223 received assistance from a pastoral counselor only, and 156
received assistance from friends, family, and/or ex-gay ministries. The
remaining participants received assistance from some other combination of
interventions. Unfortunately, outcomes were not broken down by type of
intervention. The clearest presentation of results involved 318 respondents who
rated themselves as exclusively homosexual prior to entering reorientation
efforts. The respondents were asked to rate their sexual orientation before and
after change efforts. Posttherapy, 11.6% of the respondents rated themselves as
unchanged, 11.3% as almost entirely homosexual, 24.2% as more homosexual than
heterosexual, 6.9% as equally homosexual and heterosexual, 11.6% as more
heterosexual than homosexual, 16.7% as almost entirely heterosexual, and 17.6%
as exclusively heterosexual. Thus, 22. 9% reported no change, 42.7% reported
some changes, and 34.3% reported much change.
As a group, respondents rated their therapy or change experience as being
helpful on a range of variables, including self-acceptance, trust of the
opposite sex, self-esteem, emotional stability, relationship with God, and
depression. However, Nicolosi et al. (2000) also noted that
7.1% of survey respondents said that they were doing worse after intervention
than before. Concerning these results, the authors noted that "conversion
therapy is not appropriate for all clients. Clients who have decided they wish
to affirm a gay identity could feel shamed and emotionally hurt if therapists
attempted to impose conversion therapy on them" ( Nicolosi et
al., 2000 , p. 1084).
Although this report seems to provide support for the idea that therapy
and/or ex-gay ministries provide reorientation with limited negative side
effects for some persons, some limitations should be noted. Although true of all
such studies, the sampling method affords little or no opportunity to verify the
identity of the respondents. The quality of the interventions received by the
respondents cannot be confirmed. The survey used did not define sexual
orientation or related terms such as "exclusively homosexual," and the survey
did not ask respondents to assess various aspects of sexual orientation, such as
fantasies, attractions, and behaviors before and after change, so exact
assessment of the degree of change is not exactly known. Furthermore, the sample
is not a random sample of gay individuals but rather of a subset of persons who
voluntarily sought out sexual orientation change intervention. Although these
results do not confirm that sexual orientation changes, the results can be
viewed as a broad assessment of self-identity change. Apparently, quite a few
respondents saw themselves as gay at one time, but at the time of the survey
they saw themselves as predominantly straight. Schaeffer and colleagues.
Schaeffer and colleagues provided three studies of ex-gay ministry
participants. These studies all surveyed Exodus International participants ( href="#c26">Nottebaum, Schaeffer, Rood, & Leffler, 2000 ; href="#c35">Schaeffer, Hyde, Kroencke, McCormick, & Nottebaum, 2000 ; href="#c36">Schaeffer, Nottebaum, Smith, Dech, & Krawczyk, 1999 ).
Schaeffer et al. (2000) surveyed 184 men and 64 women who
were attempting to change sexual orientation with the assistance of an Exodus
International ministry and found that Exodus participants were significantly
more heterosexually oriented at the time of the study than they remembered being
at age 18. The changes reported were positively associated with religious
motivation to change and positive mental health.
In a follow-up study of 140 of the original participants, href="#c36">Schaeffer et al. (1999) found that nearly 61% of the male and
71% of the female participants had abstained from any sexual same-sex contact in
the past year. Of those 140 participants, 65% were in the process of changing
sexual orientation, with 29% indicating that they had already changed sexual
orientation in the last year. Of the remaining 8 participants, 2 indicated that
they were no longer attempting reorientation, and 6 were unsure concerning
continuation. The researchers also compared participants who rated themselves
exclusively (Kinsey 6) or almost exclusively homosexual (Kinsey 5) at age 18,
with a bisexual group rating themselves 2, 3, or 4 on the Kinsey scale at age
18. Analysis revealed that the reported current reorientation success of the
homosexual group ( n = 86) was not significantly different from that of
the bisexual group ( n = 40). The homosexual group actually reported
better behavioral success than the bisexual group ( Schaeffer et
al., 1999 ). Finally, the researchers again found that change was positively
associated with religious motivation and emotional well-being.
Nottebaum et al. (2000) extended these two studies by
comparing 105 participants who accepted a gay male/lesbian identity with a
matched sample of Exodus participants who were attempting to change their sexual
orientation for primarily religious reasons. Sexual orientation currently and at
age 18 were examined, along with the role of emotional well-being, therapy,
religion, and childhood experiences. Although the two groups did not differ
concerning sexual orientation at age 18 (both reported similar same-sex
identities), the Exodus group reported more current heterosexual identification.
Although both groups reported good mental health, the gay male/lesbian group
reported better mental health in comparison to the Exodus group. The Exodus
group was more religious in the traditional sense. For instance, 98.7% of the
Exodus group was reared in homes where same-sex attraction and behavior were
considered morally wrong, compared with 66.7% of the gay/lesbian group.
Nottebaum et al. (2000) asked participants if they had
good relationships with their mothers and fathers while growing up. The gay
male/lesbian participants described a significantly better relationship with
parents than did the Exodus group. The Exodus men especially disagreed with the
question. At least two broad possibilities exist to help clarify this finding.
First, the gay men and lesbians who decided to change had childhood experiences
different from those who identified themselves as gay (and who continued with
that identification). Perhaps those who seek reorientation really do demonstrate
a childhood pattern similar to the one predicted by ex-gay theorists href="#c23">Moberly (1983) and Nicolosi (1991) . Perhaps,
however, those gay men and lesbians who did not seek change experienced more
satisfying childhood relationships. If this hypothesis could be supported by
additional empirical work, then perhaps reparative theory may only describe
those gay men and lesbians who are significantly distressed by their sexual
feelings. Another perspective is that each group interpreted their experiences
in keeping with the theory of causation of same-sex feelings most acceptable to
them. Given that many Exodus groups assert a specific reparative theoretical
view of causation, the participants in Exodus could experience a need to
reinterpret their experiences through this theoretical framework. Additionally,
the report of the gay male and lesbian sample may then have been a
better-than-actual representation to avoid fitting the traditional stereotype.
Spitzer.
Spitzer (2001) has provided the most recent and possibly
the most controversial study. Spitzer's objective was to examine the extent to
which a sample of self-labeled ex-gays had been successful in changing sexual
orientation across a variety of self-report indicators. He surveyed 200
participants (143 men and 57 women) by telephone. The criterion for being in the
sample was that the participants had been successfully involved in a sustained
effort of at least 5 years' duration to change their sexual orientation. Spitzer
examined self-reports of sexual attraction, sexual thoughts, same-sex fantasies
during sexual activity, emotional attachments, and same-sex sexual behavior. On
all dimensions, the year prior to the interview was compared with recollection
of the year prior to the efforts to change.
The sample was well-educated and quite religious. Seventy-six percent of the
participants had completed an undergraduate education, and 93% said religion is
"extremely" or "very important" to them. Most participants were Protestant
Christian (81%). The two most common reasons for seeking change were that living
as a gay man or lesbian was no longer satisfying (81%) and that same-sex
behavior was at odds with the participant's religion (79%).
Concerning extreme change in same-sex sexual attraction, href="#c40">Spitzer (2001) reported that 46% of the men and 42% of the women
assessed themselves as exclusively homosexual in the year prior to change.
Regarding postchange efforts, 17% of his sample of men and 54% of the women
reported exclusively heterosexual attraction. There were changes on other
dimensions as well. During the year prior to initiating change, 99% of the male
sample and 88% of the female sample affirmed that they had same-sex sexual
fantasies, whereas after they experienced change, only 32% of the men and 5% of
the women reported the same type of fantasies. A desire for emotional
involvement with same-sex individuals went from 78% of the men and 81% of the
women to 8% of the men and 4% of the women postchange ( Spitzer,
2001 ). Spitzer concluded that the majority of participants made substantial
changes from predominantly or exclusively homosexual to a predominant
heterosexual adjustment. Although he noted that complete change was uncommon, he
further reported that most of those who made lesser changes felt that those
changes were beneficial.
This study was widely reported in the popular media ( Duin,
2001 ). Although presented at the American Psychiatric Association's annual
meeting in May 2001, the study has yet to be peer reviewed. However, the results
that have been made available by Spitzer are consistent with the research
results reported above. Some people do make changes of some kind, and religious
mediation seems to energize and maintain those changes.
Implications and Applications
So what should mental health professionals do when presented with clients who
request sexual reorientation or who are in distress over sexual orientation? In
my view, the uncertainties that surround this topic argue for a careful response
from clinicians and theorists on this issue. For instance, clients who request
sexual reorientation could be informed that multiple views exist and multiple
courses have been pursued with a variety of outcomes ( Hart, 1984
). The following guidelines are distilled from Throckmorton
(1998) , Yarhouse (1998a , 1998b ),
and Shidlo & Schroeder (2000) .
Informed consent undergirds all the recommendations for dealing with ex-gay
issues in practice. Practitioners should do a standard clinical assessment, with
the usual attention to the client's competence to give consent and the
therapist's nonbiased disclosure of information. Further, therapists should
document that clients understand the information presented and that the
decisions to seek interventions are voluntary ( Dsubanko-Obermayr
& Baumann, 1998 ).
Neither gay-affirmative nor ex-gay interventions should be assumed to be the
preferred approach to recommend to clients presenting with concerns over sexual
identity. Generally, gay-affirmative therapy or referral to such a practitioner
should be offered to those clients who want to adjust to and affirm a
same-gender sexual orientation. Clients who decide they want to modify same-sex
patterns of sexual arousal could consider ex-gay or reorientation therapy or
should seek referral to ex-gay ministries. Assessment should be conducted to
help clarify the strength and persistence of the client's wishes.
Practitioners can inform clients that many mental health professionals
believe same-gender sexual orientation cannot be changed but that others believe
change is possible. Clients should be informed that some mental health
professionals and researchers dispute the concept of an immutable sexual
orientation. Practitioners should explain that not all clients who participate
in gay-affirming therapy are able to find satisfaction in a gay identity and
that not all clients who seek sexual reorientation are successful. When clients
cannot decide which therapeutic course to pursue, practitioners could consider
suggesting that clients make a choice that is consistent with their values,
personal convictions, and/or religious beliefs.
A careful, respectful assessment of clients' religious orientation should be
included as an aspect of clinical judgment. Because religion is one of the
client attributes that mental health professionals are ethically bound to
respect, practitioners should take great care in advising those clients
dissatisfied with same-sex sexual orientation due to their religious beliefs.
Clearly the review above suggests that religious belief is often crucial to both
the decision to seek change and the maintenance of change. Indeed, such clients
may see their religious orientation as being more crucial than their sexual
feelings to how they organize their lives. For clients whose religious beliefs
are at odds with same-sex behaviors, ex-gay ministries may hold some value in
assisting them toward a healthy adjustment. To accommodate such clients,
practitioners could develop expertise in methods of sexual reorientation or
develop appropriate referral resources.
There are a great number of religious perspectives concerning same-sex
orientation. Practitioners should be prepared to refer clients to resources
within the client's faith tradition. For instance, for conservative Christians,
White (1995) has presented a view that attempts to harmonize
same-sex orientation with evangelical Christianity. On the other hand, href="#c8">Dallas (1996) presents a traditional conservative Christian view
of same-sex orientation that is more consistent with ex-gay interventions.
As documented by Shidlo and Schroeder (2000) , there are
some ministries and practitioners who use questionable and/or ineffective
techniques to facilitate an ex-gay adjustment. Practitioners can delicately
provide consultation to a client about such techniques without disparaging the
client's objectives of sexual reorientation. For instance, Shidlo and Schroeder
described a practitioner's directive to a client to quit taking piano lessons.
The "practitioner" asserted that playing piano was a feminine activity and
should be replaced by team sports involvement. This recommendation for favoring
"nonerotic same-sex activity" (team sports) over piano playing could have been
based on Moberly's (1983) theories as described above.
However, Robinson's (1998) findings cast doubt on the
efficacy of such interventions to effect modification of sexual desires. In
light of this article, a practitioner hearing such a recommendation could
discuss the harmful ramifications of such a course while remaining basically
respectful of the client's desire to seek an ex-gay adjustment.
Practitioners have an obligation to respect the dignity and wishes of all
clients. Practitioners should not refuse services to clients who pursue an
ex-gay course but rather should respect the diversity of choice and consider a
referral to an ex-gay ministry or practitioner.
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1
For the purpose of this article, the term gay is used broadly to
include lesbians, gay men, and bisexual men and women.
2
Kinsey ( Kinsey, Pomeroy, & Martin, 1948 ) developed a
widely used 7-point scale to describe sexual orientation as a continuous
variable. A rating of 6 indicated exclusive homosexuality, a 5 indicated more
homosexual with minimal heterosexual fantasies or behavior, and so on to zero,
indicating exclusive heterosexuality.
Correspondence may be addressed to
Warren Throckmorton, College Counseling, Grove City College, 100 Campus
Drive, Grove City, Pennsylvania, 16127.
Electronic mail may be sent to href="mailto:ewthrockmorton@gcc.edu">ewthrockmorton@gcc.edu size=-1>
Received: September 18, 2000
Revised: January 8, 2002
Accepted: January 11, 2002
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