Thursday, 6 August 2009

Reparative therapy for homosexuality

The American Psychological Association has adopted a resolution that mental health professionals should not tell clients that they can change their sexual orientation through therapy or other treatments following a lengthy task force report on the subject.

British bodies have yet to adopt such measures despite the fact that therapists here in the UK are making such claims and attempting to 'cure' people. An article in BMC Psychiatry found that 17% of practitioners surveyed had assisted at least one client/patient to reduce or change their homosexual feelings, most commonly (66%) by counselling.

One member of the British Psychological Society interviewed by The Guardian said: 'Although homosexual feelings are usual in people, their physical expression, and being a person's only way of having sexual relations is problematic. The physical act for male homosexuals is physically damaging and is the main reason in this country for AIDS/HIV. It is also perverse'.

The main reason people feel the need to change their sexual orientation is religion. Religious responses to homosexuality cover the whole spectrum, from tolerance to fear and loathing of the God Hates Fags variety found at Westboro Baptist Church in America. It is generally believers from the more hard-line and evangelical groups who feel the need to change themselves - or who are pressured to do so, but not exclusively so.

The treatment is often called 'reparative therapy'. Reparation means making amends (as a losing side is forced to do after a war) or repairing. Neither of which implies anything other than homosexuals are wrong or broken.

One of the apparently moderate approaches in this country is that of the True Freedom Trust. They accept that homosexuality is not a wilful choice and class it along with any other sex outside of marriage (sinful).

However, they also say that 'ongoing change in all areas of our lives is possible through the work of the Holy Spirit within. Counselling and therapy are one (sic) of the tools God uses in this process (...) although we do not see it as our aim to 'cure' homosexuality. We do not believe a sexual relationship is essential for a meaningful life. We therefore seek to foster positive attitudes to singleness in the church'.

So it doesn't matter how nature made you as long as you do nothing about it. But should you want to change, therapy is recommended. And the implication is that you should want to change if you want to stay within the faith community.

The Christian Medical Fellowship, who will be familiar to readers of my earlier posts as a group with an interesting relationship with the truth, also appear to take this moderate approach.

They admit that 'genetics may contribute in some way. But this does not mean that those individuals are unable to exercise choice.' Like the TFT, they are promoting celibacy.

For both organisations, faith trumps nature. The CMF says: 'we need to protect the individual's right to bring his or her feelings and behaviour into line with his or her religious and moral values, rather than the other way around (...) This right should be defended even when it means learning to live with sexual feelings that the individual may not value and may not wish to nurture (...) Questions about the divine intervention for the ordering of human relationships are theological and ethical issues, for which science and psychiatry have no answers'.

This last sentence would imply that God made people gay in the first place.

Even this vague stab at a moderate tone is undermined elsewhere on their site where it says that 'Homosexual acts are dangerous' and 'Monogamous homosexuals are extremely rare'. Which is much more in keeping with their general tone.

The Church Times has a section on homosexuality which appears to take a balanced view of evidence but, like other apparently moderate groups, they take refuge in the fact that there is no hard and fast scientific evidence for a single cause for homosexuality and conclude that: 'Unfortunately, this means that empirical evidence can be used rather like biblical texts to argue that homosexuality is a normal variant on the spectrum of sexual orientation, a biological abnormality, a moral/immoral choice, or whatever else.' They do not appear to understand the word 'empirical'.

In one way, these more temperate responses are more dangerous. The out and out ranters are easy to spot, caricature and contend with. It is the apparently liberal, tolerant and caring groups who are more likely to attract young people confused about their sexuality. Even though they are apparently accepting of everyone's nature and even, to a degree, of genetics, human sexuality is (once again) something inherently bestial and sinful to be conquered and quelled. Their attitude is really just a thinly veiled version of 'Love the sinner, hate the sin'.

Celibacy is unnatural (in the sense that our instinct is to reproduce, not in a judgemental sense). Enforced celibacy, or abstinence as religious groups often call it, as a condition of acceptance by a community, is not healthy either when it is practised or when it fails. It's a fix that ignores and denies human nature (again). If there were truly nothing wrong with being gay, there would be no need to promote battening down natural instincts or seeking therapy, however caring the terms used.

To return to the APA ruling, the lengthy report it is based on looks at the efficacy of therapy for 'curing' homosexuals and converting them back to the straight and narrow.

'Contrary to claims of sexual orientation change advocates and practitioners, there is insufficient evidence to support the use of psychological interventions to change sexual orientation' said Judith M Glassgold, chair of the task force behind the report.

'At most, certain studies suggested that some individuals learned how to ignore or not act on their homosexual attractions. Yet, these studies did not indicate for whom this was possible, how long it lasted or its long-term mental health effects. Also, this result was much less likely to be true for people who started out only attracted to people of the same sex".

As well as pointing out the flawed methodology of studies purporting to show the efficacy of 'cures', the APA was also concerned about mischaracterizing homosexuality as a mental disorder. Or perhaps more accurately the re-characterizing as this was the medical position in the past. It was not until the 70s that American practitioners agreed to remove it from the list of mental disorders.

The fact that it is acceptable for practitioners in a position of trust to take on vulnerable people, make promises they cannot keep according to the evidence and, by attempting a cure in the first place, tell these vulnerable people that there is something deeply wrong with them, is shameful, especially when the clients/patients are not adults but young people forced to attend by their families.

There is a freedom of conscience and expression issue here. It is a right to believe and express any point of view that does not go as far as inciting violence. If your religion tells you that homosexuality is wrong, then that is what you may say. A practitioner may see themselves trying to cure lesbians, gays and bisexuals as an act of Christian charity.

However, when the person expressing and acting on a belief is a professional dealing with vulnerable people, there must be guidelines. Doctors are allowed a conscience clause that exempts them from acting against their religion - for example, they are allowed not to recommend a patient for an abortion or the morning after pill. But they must refer the patient immediately to another doctor who will.

Therapists who believe that homosexuality (or the physical expression of it) is wrong should be given a similar exemption and the obligation to refer should be imposed on them, rather than allowing them to offer treatment that has no evidential basis and potential risks of harm. They are supposed to be scientists, after all (at least, some of them).

The Wellcome Trust has launched a website to examine attempts at cures, which it warns may well be damaging. The site is an excellent resource for links to research and first-hand testimonies of gay people.

The National Secular Society has written to both the Royal College of Psychiatry and the British Psychological Society calling on them to adopt the same position as the APA. The RCP has responded that: 'The college takes very seriously the call by the National Secular Society to issue broader guidance to our members and will look into the issue further.'

Dr Petra Boynton has also covered this subject in her very fine blog and is calling on her colleagues to petition the RCP, BPS and BMA.

Should you be interested in the Biblical teachings on homosexuality that such attitudes are based on, Romans 1:26-7 is the only place where lesbianism is condemned along with male homosexuality and Leviticus 18:22 is the most cited reference.

UPDATED 2 OCTOBER 2012: Britain's biggest professional body for psychotherapists, the British Association for Counselling and Psychotherapy, has finally ruled that reparative therapy is unethical. It has written to nearly 30,000 members that it 'opposes any psychological treatment such as 'reparative' or 'conversion' therapy which is based upon the assumption that homosexuality is a mental disorder, or based on the premise that the client/patient should change his/her sexuality". BACP recognises World Health Organisation policy that so-called therapies can cause severe harm to mental and physical health.

The BACP guideline change follows a case in which Christian psychotherapist, Lesley Pilkington, was struck off the members' list for offering conversion therapy to an undercover journalist. Her appeal was turned down in May this year.

The other main professional body for British psychotherapists, the UK Council for Psychotherapy, issued similar guidance to members in early 2010, shortly after the Pilkington case emerged.

However,anyone can legally call themselves a psychotherapist or a counsellor. In 2007 the (Labour) government announced plans for statutory regulation to prevent this but the Department for Health has since dropped the plan.


  1. Tessera

    Thanks for this – I found the post while looking up stuff on True Freedom Trust.

    I was particularly interested by your comments related to the seemingly liberal stance taken by some religious organisations. At heart of much of what initially sounds ‘liberal’ is often an implicit presumption that homosexuals are in some ways flawed creatures in need of the wisdom and ministration of Ma-Ma Church. It’s a nice way of being nasty.

    In the mid-80s I was young Evangelical Christian (tho’ I never did master the smile...). It was during a time when I was hoping to marry a woman whom I loved very much and thought it would be best to get some professional help regarding issues with my sexuality. So I schlepped over to Liverpool to meet with the then director of True Freedom Trust (TFT), Martin Hallett.

    I continued to have written contact with the organisation for several years. TFT suffered a setback when Martin’s side kick, an ‘ex-gay’ who was a counsellor with the organisation, who had married and had two children (a success story!) then found he still needed the odd weekend in Cockermouth and the marriage failed and success turned to an uncomfortable embarrassment – not to mention four wounded lives.

    By this time I had left the Evangelical fold and had become a member of a monastic community. A little phenomenon I began to notice while a novice monk was that people used to write me very frank letters – often telling me things that were perhaps best said to a spiritual director rather than a twenty-six year old novice, who didn’t know his arse from his elbow. One of these came from someone I had got to know through TFT. At the time he was rather a favourite speaker on matters of sexuality – his views were conservative with a dash of (conditional) love and acceptance (cf. your own wise words!!). He wrote to me one April telling me of his time speaking at Spring Harvest (this is an Evangelical jamboree I have been lucky enough never to attend). His topic was ‘Wholeness in Christ’ and how homosexuals, in a loving church, could achieve this while at the same time remaining celibate (he was himself, so he kept telling everyone (esp. himself!) an example of this). However in his letter to me, he told how he felt such a fraud standing in front of thousands of people saying this, when he was at the time under the care of a doctor and taking medication for depression.

    This last story perhaps suggests homosexual ‘reparation’ is more ideological than a reality. It is not unlike the Creationist vs. Evolution argument and is rooted in the fact that science has, by the use of empiricism, suggested that the world is far far older than Genesis would have us believe and therefore it becomes repugnant to certain Christians because it undermines the validity of the Bible. And if this bit of the Bible is undermined, what else is valid? In truth this smearing of evolution stems from problems certain Christians have with their faith, rather than anything evolution says or implies about creation. Homosexuality appears to fulfil a similar role. If there are acceptable variants of sexuality then the Bible could just have got that bit wrong – and if so what else? In addition gays fulfil a needy service is that their ‘morality’ can be challenged without the need to challenge the morality of the rest of the church. It is a means of being virtuous without the inconvenience (if you’re straight) of challenging yourself too much.

    In my late 30s I decided, after a mainly celibate life, that I should just accept I’m gay and get on with it. I met my partner some time a few months later and seven years later we’re still together and I am happier than I have ever been in my life (and rathr irritatingly friends (not least some wiser Evangelical friends) and colleagues note how I am a much nicer person to be around!). My acceptance of myself was indeed reparation of the errors and conceit endemic in religious belief.

    Must get on, but a good post.


  2. Phelim McIntyre6 July 2011 at 09:16

    Tess - your blog does not seem to follow science when looking at the biology of homosexuality. According to research where one pair of identical twins is gay there is only a 13% chance that the other will be gay (a 25% chance when bi-sexuality is taken into account). Le Vay's gay brain results have not been found on repeating the experiment - even by Le Vay. Neither has the research by Dean Hamer into a gay gene been replicted, again Hamer is one of the scientists who has failed to replicate his own reseacrh.

    To add insult to injury, where there is no research into the effectiveness or safety of so called "Gay Affirmative Therapies" to treat "Internalised Homophobia" there are growing numbers of studies on the safety and effectiveness of sexual orientation change efforts. These were dismissed as "unscientific" by a panel made up of psychologists who either in gay relationships or openly pro-gay and hostile the ex-gay movement, yet the research they dismissed was carried out to the same rigerous standards as other studies into the use of CBT in those with eating disorders, schizophrenia and psychotheraputic interventions and other issues. If they dismiss one then they must dismiss all of them, leaving psychotherapy and counselling no research that they can trust.

  3. Fantastic reply Phelim McIntyre!!!