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Reparative therapy (also called conversion therapy and reorientation therapy) refers to methods aimed at eliminating same-sex sexual desires. A large number of techniques have been tried, including systems of rewards and punishments, psychoanalysis, bible reading, and bioenergetics.[1] Reparative therapy is closely associated with the "ex-gay" movement, which is more explicitly religious. The medical and scientific consensus is that reparative therapy is not effective and is potentially harmful.[2] No mainstream medical organization endorses reparative therapy and many have expressed concerns over the ethics and motivations surrounding its practice. The mainstream view is that sexual orientation is unchangeable, and that attempts to do so are often damaging to the person's well-being.[2]
History and doctrineImage:Charles Socarides.jpg The late Charles Socarides, a conversion therapist. Scientific research into sexual orientation began in earnest in the 1950s. At that time, LGBT people largely remained in the closet and homosexuality was listed as a mental disorder in the APA's Diagnostic and Statistical Manual of Mental Disorders. In 1957, Evelyn Hooker published The Adjustment of the Male Overt Homosexual, finding that "homosexuals were not inherently abnormal and that there was no difference between homosexual and heterosexual men in terms of pathology."[5] In 1969, the Stonewall riots gave birth to the gay rights movement and increased the visibility of LGBT people. In 1973, the APA declassified homosexuality as a mental disorder; in 1974 the ABA endorsed the Model Penal Code, including its decriminalization of consensual adult homosexual acts; in 1981 the WHO removed homosexuality from its list of mental illnesses. Against this backdrop of increased visibility and understanding, opposition movements arose taking the view that homosexuality is in fact a mental disorder and is changeable.[2] Old (and today largely unused) conversion techniques included electroconvulsive therapy[6], administration of Metrazol to induce convulsions[7], and nausea-inducing drugs.[8] Starting in 1976, Exodus International began referring people to religious ministries that attempted to change their subjects' sexual orientations. The Exodus ministries begin from the Christian perspective that same-sex relations are a sin.[9] They believe that same-sex attraction is caused by environmental factors including "poor family dynamics, a rift in the father-son or mother-daughter relationship growing up, feelings of being an outsider among one's peers during childhood and adolescence, and instances of sexual abuse/incest."[10] Exodus calls subjects "strugglers." Today Exodus is the most visible ex-gay organization, occasionally taking out full-page newspaper ads or renting billboards.
Socarides held that all men have a need for camaraderie and bonding, and that same-sex sexual attractions can be stopped by fulfilling these needs. Socarides distinguished between the innate emotional need for same-sex bonding and its dysfunctional expressions, and tried to correct the latter. Socarides saw homosexuality as a result of pre-oedipal (toddler) trauma or deficit that resulted not only in a homosexual orientation, but also in a personality disorder.[12] Elizabeth Moberly, a research psychologist, coined the term "reparative drive,"[13] to refer to homosexuality itself, as if it were an attempt to repair emotional deficits. She encourages same-sex bonding with both mentors and peer relationships as a way of stopping same-sex sexual attraction.[14] Lecturer Richard Cohen calls same-sex sexual attraction "same-sex attachment disorder." He sees "male bonding" as being very similar to same-sex sexual desire, but lacking a sexual element. Today, the movement tends to characterize itself as offering the possibility of a choice for gay men and women who are unsatisfied with their sexual orientation. There is often an emphasis on minimizing and not acting on same-sex attractions, rather than eliminating them outright.[3] This has received much support, both ideological and financial, from some religious conservatives. John Paulk, formerly of Focus on the Family, said "As the church, we must continue to speak out boldly against the radical homosexual agenda while we minister to those who are trapped in this lifestyle... it is compassionate to warn about the dangers of homosexuality in order to spare individuals the heartache and grief of that behavior. At the same time, we must always remember that many turn to homosexuality precisely because they have experienced rejection from the people closest to them. The church must not compound that rejection, but rather be an oasis of grace, healing and hope."[15] Techniques
In 1997, the American Psychological Association Council of Representatives issued a statement outlining principles to be followed in treatments to alter sexual orientation. They emphasized that homosexuality should not be portrayed as a mental disorder and any discriminatory practices should not be condoned. Psychologists should obtain consent before giving treatment to alter sexual orientation and respect their patient’s right to self-determination and autonomy. [16] Reparative therapists focus on individual and group counseling: Techniques used by Love in Action include workshops on "child development, gender roles, and personal sexuality," one-on-one Biblical guidance, "a structured environment help[ing] establish new routines and healthy patterns of behavior", "challenging written assignments and interactive projects," "family involvement to improve communication... and to facilitate marital reconciliation," and "hiking, camping, canoeing, and rafting."[17][18] Techniques recommended by Exodus International include: a subject who finds him or herself attracted to someone of the same sex should "immediately look around for someone of the opposite sex... and start searching for the beauty in that person"; a subject should disentangling sexual desire from the desire for affection or affirmation; and a subject should repent and confess his or her sins.[19] Techniques recommended by NARTH include: seeking non-sexual male relationships, experimenting with more traditional male activities, reliving the pain of being different, and working on "Oedipal, enmeshment, and early abandonment" issues.[20] Image:Cohensholding.jpg Richard Cohen demonstrating his "holding" technique to Paula Zahn on CNN. Lecturer Richard Cohen tries to identify subliminal emotional needs behind same-sex desires and attempts to replace them with non-sexual means of expression, usually by encouraging the subject to form a non-sexual, emotional bond with another adult of the same gender. This is supposed to substitute for the bond between the client and their same-sex parent which therapists allege did not properly form during childhood. For example, Cohen might hold a male patient in his lap with the patient curled into the fetal position.[21] Cohen also advocates what he calls "bioenergetics," which involves hitting a pillow with a tennis racket while shouting "Why did you do that to me?" (Videoclip of Cohen's techniques via YouTube.) Work by David A. Matheson[22] has been used extensively by Evergreen International[23] and is the foundation for People Can Change[24]. His techniques focus on "men changing need to feel masculine and bond with other men," "getting out of the false self and facing real feelings in open relationships," "having those relationships, experiences, and opportunities that strengthen, nurture, and lead to joy and personal satisfaction," and "letting go of everything that prevents change from happening and letting in the things that restore growth processes." New Age therapies are also employed by reparative therapists, including EMDR, buddha therapy, and chiropractic adjustments.[25] Particularly controversial (and probably largely outdated) techniques include electroconvulsive therapy[26] and aversion therapy. Documented cases include electric shocks being administered to patients' genitalia, "sometimes paired with disturbing images, including a bowl of feces and pictures of Kaposi's Sarcoma lesions." The most recent reported incidences of these kinds of aversion therapy were in 1992.[27] Mainstream medical view of reparative therapyThe consensus among mainstream medical organizations is that sexual orientation is unchangeable. The American Psychological Association states:
Major organizations that do not support reparative therapy and are concerned about its potential for harm include the American Psychiatric Association, the American Psychological Association, the American Counseling Association, the National Association of Social Workers, the American Academy of Pediatrics, the American Association of School Administrators, the American Federation of Teachers, the National Association of School Psychologists, and the National Education Association. [2] The ethics guidelines of these organizations discourage, and sometimes prohibit, its practice.[29] The American Psychiatric Association opposes any treatment that is “based upon the assumption that homosexuality per se is a mental disorder or based upon the a priori assumption that the patient should change his/her sexual homosexual orientation.”[30] United States Surgeon General David Satcher issued a 2001 report urging tolerance for gays and lesbians and maintaining that "there is no valid scientific evidence that sexual orientation can be changed." [31]. Researchers such as Haldeman (1999:3) consider reparative therapy to be pseudoscientific. Scientific research on reparative therapyThe medical consensus is that sexual orientation is unchangeable.[2] For example, the American Academy of Pediatrics says, "Therapy directed specifically at changing sexual orientation is contraindicated, since it can provoke guilt and anxiety while having little or no potential for achieving changes in orientation." [32]. According to Norcross et al (2006) a delphi poll survey of the American Psychological Association (101 respondents) indicated their view that reparative therapy is a discredited therapy.[33] The American Psychiatric Association states that success stories and harm stories are anecdotal, and that “there are no scientifically rigorous outcome studies to determine either the actual efficacy or harm of "reparative" treatments.”[30] It calls for more scientific research to determine the risks and benefits involved. Until such research is available, it recommends that "ethical practitioners refrain from attempts to change individuals' sexual orientation."[30] Reparative therapists believe that sexual orientation is changeable and they cite anecdotal evidence of conversions. ajor medical organizations and others reject this anecdotal evidence for many reasons, including[34][35]:
Shidlo and Schroeder studyA 2002 peer-reviewed study by Dr. Ariel Shidlo and Dr. Michael Schroeder found that 88% of participants failed to achieve a sustained change in their sexual behaviour and 3% reported changing their orientation to heterosexual. The remainder reported either losing all sexual drive or struggling to remain celibate, with no change in attraction. Schroeder said many of the participants who failed felt a sense of shame. Many had gone through reparative therapy programs over the course of many years. Their study sample included both participants connected with reparative therapy advocates, as well as participants recruited through the Internet. Of the 8 respondents (out of a sample of 202) who reported a change in sexual orientation, 7 were employed in paid or unpaid roles as ex-gay counselors or group leaders, something which has led many to question whether even this small "success" rate is in fact reliable. [27][36] Spitzer studyIn May 2001, Dr. Robert Spitzer, who was involved in the original declassification of homosexuality as a mental disorder, presented a paper on reparative therapy at the APA annual convention. He reported that 66% of the men and 44% of the women he sampled had achieved "good heterosexual functioning" through interventions.[37] This paper was widely reported by proponents of reparative therapy as evidence of success of the therapy, and as the first step towards official acceptance and the legitimisation of reparative therapy. The APA immediately issued an official disavowal of the paper, noting that it had not been peer-reviewed and bluntly stating that "There is no published scientific evidence supporting the efficacy of reparative therapy as a treatment to change one's sexual orientation."[34] Two years later, Spitzer published the paper in the Archives of Sexual Behavior. The publication decision sparked controversy and one sponsoring member resigned in protest. The paper has been criticized on various grounds, including using non-random sampling and poor criteria for "success". Critics argue that it relied upon samples selected by reparative therapists themselves (86 participants were handpicked by ex-gay organizations), that proper random samplings were not used, that small samplings were used, that the subjects appeared to be ex-gay advocates who may have been biased in favor of reparative therapies, that 60% of the subjects had previously reported being bisexual, and that no follow-up study had been carried out to acertain long-term conversion.[38][34] Spitzer himself played down the results of his own paper; upon being asked about the 200 patient sample after 16 months, and the percentage of people who might succeed, Spitzer said that it took almost a year and a half to only find 200 willing individuals, and therefore, the number of homosexuals who could successfully become heterosexual was likely to be "pretty low". He also conceded that the study's participants were "unusually religious." Potential harmsMainstream medical bodies state that reparative therapy can be harmful because it exploits guilt and anxiety, thereby damaging self-esteem and leading to depression and even suicide.[39][40] There is evidence that rates of depression, anxiety, alcohol and drug abuse and suicidal feelings are roughly doubled in those who undergo reparative therapy.[41] Ethics issuesThe ethics code of the American Psychological Association does not prohibit the practice, but instead lists strict guidelines for its members to follow. These include eliminating the effects of biases about sexual orientation on one's practice and avoiding making deceptive claims about the scientific basis for reparative therapy.[16] The ethics guidelines of the American Psychiatric Association and the American Counseling Association adopt a stronger stance and recommend that ethical practitioners avoid using reparative therapy or referring clients to people who do use it.[42][30] Some commentators, recommending a hard stand against the practice, have found reparative therapy inconsistent with a psychologist's ethical duties because “it is more ethical to let a client continue to struggle honestly with her or his identity than to collude, even peripherally, with a practice that is discriminatory, oppressive, and ultimately ineffective in its own stated ends."[43] They argue that clients who request it do so out of social pressure and internalized homophobia, pointing to evidence that rates of depression, anxiety, alcohol and drug abuse and suicidal feelings are roughly doubled in those who undergo reparative therapy.[41] Mark Yarhouse, a prominent proponent of reparative therapy, takes the opposing view that "[p]sychologists have an ethical responsibility to allow individuals to pursue treatment aimed at curbing experiences of same-sex attraction or modifying same-sex behaviors, not only because it affirms the client's rights to dignity, autonomy, and agency, as persons presumed capable of freely choosing among treatment modalities and behavior, but also because it demonstrates regard for diversity."[44] Yarhouse and Warren Throckmorton, another prominent reparative therapy advocate, argue that the procedure should be available out of respect for a patient’s values system and because they find evidence that it can be effective. [45] Even where professional ethical guidelines do not explicitly forbid reparative therapy, there still are a number of potential clashes, as reported in another paper by Schroeder and Shidlo (see above) in particular on four particular issues: first, patients should not be pressured into therapy (many reparative therapists and those who approach them have strong religious views, and pressure is often placed on counsellees from that standpoint). Secondly, the therapist should not provide misleading information about the success rates of any treatment (the success rates claimed by groups such as Exodus International and NARTH are not substantiated by outside studies). Thirdly, the therapist should be prepared to provide alternative courses of treatment to those who were not progressing, or to refer them to counsellors or therapists offering alternative treatments. This often did not happen. Fourthly, the counsellor/therapist would be expected to refrain from direct criticism of the relevant professional associations. Reasons why people seek to change sexual orientationPeople may seek out reparative therapy for many reasons, including religious or personal beliefs, the desire for a traditional family, shame, rejection (actual or feared), fear of STIs, or a general dissatisfaction with the contemporary gay lifestyle.[46] The American Psychological Association states that harassment and abuse, as well as pressure from family, peers, and religious groups ignorant about and prejudiced against homosexuality, may cause high levels of emotional stress for lesbians, gays, and bisexuals. These pressures may lead people to feel forced into attempting to change their sexual orientation.[16] Other researchers have found that social pressure plays a key role in a person's desire to change his or her sexuality.[41][47] One reparative therapist has argued that there is also social pressure not to enter reparative therapy.[48]. Reaction by reparative therapistsReparative therapists generally respond to the mainstream medical view with two main points. First, they argue that the mainstream medical view (from the 1973 declassification of homosexuality as a mental disorder to the current opposition to reparative therapy) is the result of political beliefs and lobbying. Second, they argue that there is no scientific data conclusively showing that reparative therapy does not work. Controversies, criticisms, and scandalsReparative therapy as a means of shaping the LGBT rights debateSocial conservatives sometimes use possibility of conversion therapy to argue against LGBT rights legislation and LGBT acceptance in general. The argument is that if sexual orientation is changeable, then remaining gay or lesbian is a mere choice and does not warrant the legal protections and social acceptance afforded to women and minorities. Critics argue that "the Christian Right has seized the political opportunity offered by the ex-gay movement to repackage its anti-gay campaign in kinder, gentler terms. Instead of simply denouncing homosexuals as morally and socially corrupt, the Christian Right has now shifted to a strategy of emphasizing personal salvation for homosexuals — through the ex-gay movement. Behind this mask of compassion, however, the goal, remains the same: to roll back legal protections for lesbian, gay, bisexual and transgender people..."[4] The mainstream medical view is that conversion attempts are caused by, and reinforce, negative attitudes and mistaken beliefs about homosexuality.[2] Scandals involving minorsOne of the most controversial aspects of reparative therapy has been the focus on gay teenagers, including occasions where teenagers have been forcibly treated in ex-gay camps. For example, in Tennessee in 1995, a 16-year-old gay male sought emancipation from his parents because they were forcing him to attend reorientation counseling with a Memphis psychologist. They intended to send him to either Love in Action, or another similar program. The Memphis Circuit Court judge agreed that the boy would be harmed by this treatment and indicated that he would sign the emancipation order. In a settlement agreement, the parents abandoned their plans to send the boy to treatment. The doctor in the case lost his license to practice as a psychologist, due to alleged ethics violations.[49] In 2005, 16-year-old Zachary Stark posted on his blog protesting his parents' decision to send him to an ex-gay camp. In 2006, 17-year old DJ Butler was driven to the same camp in handcuffs.[50] The camp, run by Love in Action ministries, was subsequently shut down when Tennessee authorities discovered that unlicensed staff had been administering prescription drugs to the patients.[51] A 2006 report from the National Gay & Lesbian Task Force has outlined evidence that reparative therapists are increasingly focusing on the young.[52] Relapses and ex-ex-gays
Image:00sep29Paulk.jpg Ex-gay John Paulk leaving a gay bar. (Photograph by Wayne Besen.)
Financial and political motivationsOpponents argue that many reparative therapists may become involved for personal financial gain. They note that participants in conversion therapies frequently have to pay for the treatment they receive, as is true of any psychiatric treatment. It has also been noted that the organizations that sponsor ex-gay ministries, like Focus on the Family, use anti-gay political campaigns to generate funds but provide relatively few resources to their reparative therapy wings.[54] TerminologyThe practice is alternatively called "conversion therapy."[52] Those outside the movement may reject the label "reparative," as it presupposes that same-sex attraction is something which can or should be "repaired." Opposition from gay rights and religious groupsMainstream gay rights organizations and some religious organizations oppose reparative therapies, including the National Gay and Lesbian Task Force, The Interfaith Alliance, New Ways Ministries and People for the American Way. Reparative therapy and ex-gays in popular cultureReparative therapy and the ex-gay phenomenon occasionally appear in popular culture, usually in a satirical or skeptical context. In 1999, Universal released But I'm a Cheerleader a black comedy about a high school cheerleader who is sent to an ex-gay camp. Macaulay Culkin starred in Saved! (2004) a major motion picture comedy featuring one high school student trying to "straighten out" another. A 2007 South Park episode Cartman Sucks satirized reparative therapy and ex-gay camps. Reparative therapy was derided on Penn and Teller's television show Bullshit!.[55] Reparative therapist Richard Cohen was satirically interviewed by Jason Jones in a segment for the March 19, 2007 episode of The Daily Show. Cohen later apologized for this appearance.[56] See alsoReferences
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