What does the scholarly research say about whether conversion therapy can alter sexual orientation without causing harm?

CT Bans Map

Overview:  We identified 47 peer-reviewed studies that that met our criteria for adding to knowledge about whether conversion therapy (CT) can alter sexual orientation without causing harm. Thirteen of those studies included primary research. Of those, 12 concluded that CT is ineffective and/or harmful, finding links to depression, suicidality, anxiety, social isolation and decreased capacity for intimacy. Only one study concluded that sexual orientation change efforts could succeed—although only in a minority of its participants, and the study has several limitations: its entire sample self-identified as religious and it is based on self-reports, which can be biased and unreliable. The remaining 34 studies do not make an empirical determination about whether CT can alter sexual orientation but may offer useful observations to help guide practitioners who treat LGB patients.

The research on conversion therapy is limited by the difficulty of empirically assessing a person’s sexual orientation. All of the studies we identified rely on self-reports, and those who wish to change their sexual orientation enough to seek therapeutic intervention may be inclined toward a bias in assessing or reporting their own attractions. Most of the studies lacked control groups, and none used nationally representative probability samples. Many researchers sympathetic to conversion therapy do not actually assess changes in sexual orientation or arousal patterns, but in behavior, which is not a true gauge of orientation. Some subjects who claimed movement from gay to straight are actually more accurately described as bisexual, but were not initially coded as such. Many of these studies sample exclusively religious populations, and so their conclusions generally reflect more about religious self-identifications than any indication that sexual orientation can genuinely change. Some researchers found success in depressing same-sex arousal—often with the use of severe techniques—but often that did not translate into increased heterosexual arousal or ability to sustain a satisfying opposite-sex sexual relationship.

Such limitations do not mean there is no useful research on conversion therapy. For instance, among the research we include here under “of interest to practitioners” are several ethical discussions of how to approach therapy with patients reporting dissatisfaction with their sexual orientation. Additionally, a direct examination of the research may help visitors to this site assess for themselves how persuasive claims are that sexual orientation can be changed.

However, after reviewing the research, we concluded that there is no credible evidence that sexual orientation can be changed through therapeutic intervention. Most accounts of such change are akin to instances of “faith healing.” There is also powerful evidence that trying to change a person’s sexual orientation can be extremely harmful. Taken together, the overwhelming consensus among psychologists and psychiatrists who have studied conversion therapy or treated patients who are struggling with their sexual orientation is that therapeutic intervention cannot change sexual orientation, a position echoed by all major professional organizations in the field, including the American Psychological Association whose substantial 2009 report is available here. For a printer-friendly PDF of this Overview report, click here.

Below are 12 studies concluding that CT is ineffective and/or harmful.

Click here to jump to the 1 study concluding that CT can be effective. Click here to jump to the 34 studies that do not make an empirical determination about whether CT can alter sexual orientation but that may be useful to practitioners with LGB patients.

Click on any thumbnail to view its abstract; click below each thumbnail to visit the source website, which links to studies where available.

Beckstead, A. L., & Morrow, S. L. (2004). Mormon clients’ experiences of conversion therapy: The need for a new treatment approach. The Counseling Psychologist, 32(5), 651-690.

Perspectives were gathered of 50 Mormon individuals who had undergone counseling to change their sexual orientation. The data were analyzed using the constant comparative method and participant verification, thereby developing a grounded theory. A model emerged that depicted participants’ intrapersonal and interpersonal motivations for seeking conversion or “reparative” therapy, their perceived benefits and harms of such interventions, and the factors that facilitated self-acceptance and consolidation of a positive self-identity. Based on these descriptions, this study provides the foundation for a broader-based treatment approach (besides one focused solely on changing sexual orientation or adopting a lesbian, gay, or bisexual identity), which is designed to produce individualized congruent solutions for religiously conflicted, same-sex-attracted clients.

Borowich, A. (2008). Failed reparative therapy of orthodox Jewish homosexuals. Journal of Gay & Lesbian Mental Health, 12(3), 167-177.

Abstract: The author is an Orthodox Jewish psychiatrist who, at the time of this presentation, had spent thirty-six years in the general practice of psychiatry, primarily among the broad spectrum of Orthodox Jewish patients. As a part of this general practice, the author encountered a number of Orthodox patients with homosexual attractions who desired to change their orientation. Since the author’s initial results seemed encouraging as he found that all of his patients moved at least one point towards heterosexuality on the Kinsey scale, he began accepting more referrals to achieve significant change in homosexual orientation.

The author’s therapeutic goals, at the time, were to counteract the homosexual patient’s self-loathing; provide a warm, hopeful and accepting therapeutic environment; explain that human approaches to sexuality were variable and not monolithic and provide alternatives to a gay community lifestyle. The author believed a nurturing relationship with a straight male therapist, who understood the person’s religious sensibilities and feelings, might help detoxify corrosive masculine influences of the past and provide some role-modeling for future identification.

The author describes several long-term cases in which he treated Orthodox Jewish patients who wished to be rid of their homosexual feelings and attractions. All of the author’s male homosexual patients in intensive therapy moved at least one point on the Kinsey scale towards heterosexuality. However, that movement was not unidirectional. Reversions occurred in response to stressful events of various sorts—at times compromising an intact and extensive nuclear family and leading to catastrophic results. In contrast to the men, the author found it virtually impossible to achieve significant movement toward heterosexuality with homosexual women. The author believes more was accomplished when there was no direct expectation that change in sexual orientation be the specific goal. In those cases, sexual reorientation happened as a result of organic change as a part of a successful therapy for mutually agreed emotional problems.

Dehlin, J. P., Galliher, R. V., Bradshaw, W. S., Hyde, D. C., & Crowell, K. A. (2014). Sexual orientation change efforts among current or former LDS church members. Journal of Counseling Psychology. Advance online publication.

This study examined sexual orientation change efforts (SOCE) by 1,612 individuals who are current or former members of the Church of Jesus Christ of Latter-day Saints (LDS). Data were obtained through a comprehensive online survey from both quantitative items and open-ended written responses. A minimum of 73% of men and 43% of women in this sample attempted sexual orientation change, usually through multiple methods and across many years (on average). Developmental factors associated with attempts at sexual orientation change included higher levels of early religious orthodoxy (for all) and less supportive families and communities (for men only). Among women, those who identified as lesbian and who reported higher Kinsey attraction scores were more likely to have sought change. Of the 9 different methods surveyed, private and religious change methods (compared with therapist-led or group-based efforts) were the most common, started earlier, exercised for longer periods, and reported to be the most damaging and least effective. When sexual orientation change was identified as a goal, reported effectiveness was lower for almost all of the methods. While some beneficial SOCE outcomes (such as acceptance of same-sex attractions and reduction in depression and anxiety) were reported, the overall results support the conclusion that sexual orientation is highly resistant to explicit attempts at change and that SOCE are overwhelmingly reported to be either ineffective or damaging by participants.

Fjelstrom, J. (2013). Sexual orientation change efforts and the search for authenticity. Journal of Homosexuality, 60(6), 801-827.

This article is based on structured interviews of a sample of 15 former participants in sexual orientation change efforts (SOCE), who currently identify as gay or lesbian. The primary research question for this study was, “What was the experience of self-identified gay men and lesbians who went through some type of SOCE and eventually asserted themselves as gay or lesbian?” The research concludes that participants sometimes identified as heterosexual during SOCE, but never changed their underlying homosexual orientation, and that suppression, disconnection, and a sense of inauthenticity were significant phenomena of this process.

Flentje, A., Heck, N. C., & Cochran, B. N. (2013). Sexual reorientation therapy interventions: perspectives of ex-ex-gay individuals. Journal of Gay & Lesbian Mental Health, 17(3), 256-277.

While the topic of sexual reorientation therapy, that is, therapy intended to change one’s sexual orientation from lesbian, gay, or bisexual (LGB) to heterosexual, is not a new one, there is renewed interest in reorientation therapy. While most of the debate surrounding this controversial practice has focused on whether or not it should be banned, relatively few studies exist that detail what the process of reorientation therapy entails. The purpose of this investigation was to find out more about the typical modalities and interventions of reorientation therapy. Participants were 38 individuals who had gone through at least one episode of reorientation therapy and later reclaimed a LGB identity (113 total episodes). Participants’ open-ended responses to questions about their therapy experiences were coded into broader themes, and participants selected from a list of possible treatment methods that were used in their most recent intervention experience. Results indicated that frequently used reorientation interventions had a strong emphasis on religious practices, often included negative messages about LGB individuals, and had a greater emphasis on change than on validation techniques. Some participants recounted practices that are inconsistent with the ethical guidelines for mental health professionals. Implications for policy and practice are discussed.

Haldeman, D. C. (2001). Therapeutic antidotes: Helping gay and bisexual men recover from conversion therapy. Journal of Gay and Lesbian Psychotherapy, 5(3/4), 117-130.

Studies of sexual orientation conversion therapies have focused on the efficacy, or lack thereof, of treatments designed to change sexual orientation. Recently, given the typically low success rate achieved in most conversion therapy studies, some researchers have examined the potential for such treatments to harm patients. It is the author’s impression, after twenty years’ clinical work with individuals who have undergone some form of conversion therapy, that these treatments can indeed be harmful. This article identifies the various problems commonly presented by patients following an unsuccessful therapeutic attempt to change sexual orientation. Such problems include poor self-esteem and depression, social withdrawal, and sexual dysfunction. Case material illustrates these concerns, and therapeutic approaches to address them are suggested. Directions for future study are identified.

Jones, M., Botsko, M., & Gorman, B. (2003). Predictors of psychotherapeutic benefit of lesbian, gay, and bisexual clients: the effects of sexual orientation matching and other factors. Psychotherapy: Theory, Research, Practice, Training, 40(4), 289-301.

Predictors of the level of benefit derived from nearly 2,000 psychotherapy episodes reported by a nationwide, nonprobability sample of 600 lesbian, gay, and bisexual clients were analyzed using ordinary least squares regression, corrected by generalized-estimating-equation (GEE) procedures for lack of independence in the data. Among the positive predictors of benefit are the following: the year the episode began; the number of sessions in the episode; the client’s identifying him- or herself as gay, lesbian, or bisexual at the beginning of the episode and being unconflicted about it; and having a therapist who is female, gay, or lesbian or who trained as a social worker or a psychologist. Negative predictors include having a therapist who is an analyst, who uses reparative therapy, or who violates sexual boundaries.

Maccio, E. (2011). Self-reported sexual orientation and identity before and after sexual reorientation therapy. Journal of Gay & Lesbian Mental Health, 15(3), 242-259.

Researchers disagree on whether sexual reorientation (i.e., conversion or reparative) therapy (SRT) can change sexual orientation. Much of the recent research relies on participants from a particular religious denomination or from SRT organizations. This study recruited participants from SRT organizations and from gay-affirming ones. In this cross-sectional study, 37 former SRT participants reported no statistically significant differences in sexual orientation and sexual identity from before SRT participation to the time of their participation in this study. Practitioners with clients struggling with their sexual orientation or identity must be informed of SRT alternatives, including person-centered and gay-affirmative approaches.

Schroeder, M., & Shidlo, A. (2002). Ethical issues in sexual orientation conversion therapies: An empirical study of consumers. Journal of Gay and Lesbian Psychotherapy, 5(3/4), 131-166.

This study uses interviews with 150 consumers of sexual orientation conversion therapies to identify critical incidents of poor practice and ethical violations. We found that some licensed conversion therapists may be practicing in a manner inconsistent with the APA Ethics Code, similar professional codes, and recent guidelines on treatment of lesbians and gay men. Areas of ethical violations identified include: informed consent, confidentiality, coercion, pre-termination counseling, and provision of referrals after treatment failure.

Shidlo, A., & Schroeder, M. (2002). Changing sexual orientation: A consumer’s report. Professional Psychology: Research and Practice, 33(3), 249-259.

What motivates individuals to pursue conversion therapy and ex-gay groups? How do they perceive its harmfulness and helpfulness? In this study, 202 consumers of sexual orientation conversion interventions were interviewed to answer these questions. The results indicated that a majority failed to change sexual orientation, and many reported that they associated harm with conversion interventions. A minority reported feeling helped, although not necessarily with their original goal of changing sexual orientation. A developmental model that describes the various pathways of individuals who attempt to change their sexual orientation is presented. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Smith, G., Bartlett, A. & King, M. (2004). Treatments of homosexuality in Britain since 1950—an oral history: The experience of patients. British Medical Journal, 328(7437), 427-429.

Objectives: To investigate the circumstances since the 1950s in which people who were attracted to members of the same sex received treatments to change their sexual orientation, the referral pathway and the process of therapy, and its aftermath.

Design: A nationwide study based on qualitative interviews.

Participants: 29 people who had received treatments to change their sexual orientation in the United Kingdom and two relatives of former patients.

Results: Most participants had been distressed by their attraction to their own sex and people in whom they confided thought they needed treatment. Although some participants chose to undergo treatments instead of imprisonment or were encouraged through some form of medical coercion, most were responding to complex personal and social pressures that discouraged any expression of their sexuality. While many participants found happiness in same sex relationships after their treatment, most were left feeling emotionally distressed to some degree.

Conclusion: The definition of same sex attraction as an illness and the development of treatments to eradicate such attraction have had a negative long term impact on individuals.

Weiss, E. M., Morehouse, J., Yeager, T., & Berry, T. (2010). A qualitative study of ex-gay and ex-ex-gay experiences. Journal of Gay & Lesbian Mental Health, 14(4), 291-319.

Some individuals attempt to change their sexual orientation to resolve conflict between sexual orientation and religious belief. The psychological and social experiences of individuals attempting such change are not well documented scientifically. This study used qualitative methodology to explore the psychological and social experiences of individuals as they attempt to change their orientation. The findings support and extend existing research and suggest that there may be important differences in religious outlook between those who persist in trying to change and those who go on to affirm a homosexual identity.

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Below is 1 study concluding that CT can be effective.

Click here to jump up to studies concluding that CT is ineffective and/or harmful. Click here to jump down to studies that do not make an empirical determination about whether CT can alter sexual orientation but that may be useful to practitioners with LGB patients.

Click on any thumbnail to view its abstract; click below each thumbnail to visit the source website, which links to studies where available.

Nicolosi, J., Byrd, A. D., & Potts, R. W. (2000). Retrospective self-reports of changes in homosexual orientation: A consumer survey of conversion therapy clients. Psychological Reports, 86, 1071-1088.

We present the results of a survey of 882 dissatisfied homosexual people whom we queried about their beliefs regarding conversion therapy and the possibility of change in sexual orientation. There were 70 closed-ended questions on the survey and 5 open-ended ones. Of the 882 participants, 726 of them reported that they had received conversion therapy from a professional therapist or a pastoral counselor. Of the participants 779 or 89.7% viewed themselves as “more homosexual than heterosexual,” “almost exclusively homosexual,” or “exclusively homosexual” in their orientation before receiving conversion therapy or making self-help efforts to change. After receiving therapy or engaging in self-help, 305 (35.1%) of the participants continued to view their orientation in this manner. As a group, the participants reported large and statistically significant reductions in the frequency of their homosexual thoughts and fantasies that they attributed to conversion therapy or self-help. They also reported large improvements in their psychological, interpersonal, and spiritual well-being. These responses cannot, for several reasons, be generalized beyond the present sample, but the attitudes and ideas are useful in developing testable hypotheses for further research.

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Below are 34 studies that do not make an empirical determination about whether CT can alter sexual orientation but that may be useful to practitioners with LGB patients.

Click here to jump up to studies concluding that CT is ineffective and/or harmful. Click here to jump up to the study concluding that CT can be effective.

Click on any thumbnail to view its abstract; click below each thumbnail to visit the source website, which links to studies where available.

Beckstead, A. L. (2012). Can we change sexual orientation? Archives of Sexual Behavior, 41(1), 121-134.

The self-reports of individuals who claim that they have changed their sexual orientation are either dismissed as false or relied upon to promote sexual orientation change efforts. However, these reactions do not capture the complexity of the sexual reorientation phenomenon. This article provides an overview regarding the promise and effort of sexual reorientation and how this knowledge may inform our current understanding of human sexuality. Specifically, a brief history is given of the interventions used to change attractions to same-sex adults and the assumptions underlying these efforts. Information will be given regarding which conclusions can be derived from sexual reorientation studies. The limitations of these studies will be explained to strengthen future research. Hypotheses will be presented regarding the motivations and needs of those distressed by a same-sex erotic orientation and the impact that the hope of sexual reorientation may have for family members, religious leaders, and policy makers. A multivariate model of sexuality and sexual orientation, including scales of attraction and aversion, will be proposed based upon current understanding of sexuality and the distinctions found in sexual reorientation research. In the end, a therapeutic framework will be highlighted that may be used (and researched) to help those distressed by their sexual orientation.

Bright, C. (2004). Deconstructing reparative therapy: an examination of the processes involved when attempting to change sexual orientation. Clinical Social Work Journal, 32(4), 471-481.

Reparative therapy is a process through which reparative therapists believe they can and should make heterosexuals out of homosexuals. At the present time, most professional regulating bodies have banned the use of reparative therapy. In addition, reparative therapy is not supported by any reliable quantitative or qualitative studies. In spite of the lack of empirical substantiation, reparative therapists continue to practice, arguing that prior quantitative studies, as well as client self-determination, validate their methods. With a knowledge base originally grounded in psychoanalytic theory, current applications of reparative therapy cross not only scientific and psychological, but also social, political, and religious boundaries. The current trend promoting reparative therapy occurs through the conglomeration of the social, political, and religious dimensions of organizations that champion the cause of creating former homosexuals. Persons who identify as former homosexuals espouse the saving graces of a mixture of reparative therapy with various forms of religious counseling, on occasion offered by faith-based providers. The purpose of this paper is shed new light on the process and theory behind reparative therapy. This paper will attempt to provide social work clinicians with the knowledge necessary to understand and formulate an informed opinion about the use of reparative therapy for homosexuality.

Cates, J. A. (2007). Identity in crisis: Spirituality and homosexuality in adolescence. Child and Adolescent Social Work Journal, 24(4), 369-383.

Adolescents experiencing same-sex attraction are increasingly comfortable identifying themselves as gay/lesbian/bisexual. For at least a minority of these youth, that identification conflicts with their spiritual values, and they or their families seek conversion therapy. The efficacy of conversion and ethics of conversion therapy for same-sex orientation stirs significant debate. The complexities of an approach to same-sex issues with adults multiply when the client is an adolescent. This article uses three adolescent case studies to examine issues of identity, ethics, confidentiality, social expectations, and therapist role.

Cramer, R. J., Golom, F. D., LoPresto, C. T., & Kirkley, S. M. (2008). Weighing the evidence: Empirical assessment and ethical implications of conversion therapy. Ethics and Behavior, 18(1), 93-114.

The American Psychological Association’s (APA’s) as well as other professional organizations’ (e.g., American Psychiatric Association) removal of homosexuality as a mental disorder represented a paradigmatic shift in thinking about sexual orientation. Since then, APA (2000) disseminated guidelines for working with lesbian, gay, and bisexual (LGB) clients, and a variety of scholars and researchers alike have advocated affirmative therapeutic interventions with LGB individuals. Despite these efforts, the controversy over treating individuals with LGB orientations using nonaffirmative techniques continues. In this discussion, the limited evidence regarding the efficacy and effects of conversion therapy is surveyed, particularly in the context of empirically supported treatment criteria summarized by Division 12 (clinical psychology) of the APA. Authors then consider the resulting ethical considerations in performing conversion therapy and propose alternative uses of affirmative therapy on the basis of ethical standards defined by APA. Finally, options for treating LGB individuals who are coming to terms with their sexual orientations are discussed.

Creek, S. J., & Dunn, J. L. (2012). “Be ye transformed”: the sexual storytelling of ex-gay participants.  Sociological Focus, 45(4), 306-319.

The ex-gay movement in the United States has, for the last three decades, argued that there can be “freedom from homosexuality.” We draw from eighteen in-depth, semi-structured interviews with individuals seeking help from an ex-gay ministry for same-sex attractions. We argue that the testimonies that “ex-gays” or “strugglers” we spoke with represent a distinct genre of story, what Kenneth Plummer would call a “sexual story,” such as, for example, lesbian and gay coming out narratives. We find that elements of each type of narrative are flexible and culturally resonant across subcultures, demonstrating the creativity with which social movements and individuals construct and reconstruct themselves.

Drescher, J. (1998). I’m your handyman: A history of reparative therapies. Journal of Homosexuality, 36(1), 19-42.

Reparative therapy has come to generically define talking cures that claim to change an individual’s homosexual orientation to a heterosexual one. Although other treatment modalities have also promised to “cure” homosexuality, the history of reparative therapies has become inexorably linked with that of psychoanalysis. This paper reviews the history and theoretical assumptions of psychoanalytically-oriented practitioners, beginning with Freud’s juvenilization of gay people to the later analysts who pathologized and attempted to change same-sex attractions. The evolution of reparative therapists from medically concerned practitioners into antigay political activists is also discussed. The evolution of one branch of psychoanalytic theory into an antihomosexual political movement illustrates the permeability of boundaries between clinical issues and political ones. In their open support of antigay legislation, reparative therapists have moved from the traditional psychoanalytic center and have been embraced by conservative religious and political forces opposed to homosexuality. In doing so, they have apparently adopted religious organizational practices themselves, preaching dogma and stifling dissent. The increasing marginalization of reparative therapists from the psychoanalytic mainstream illustrates how psychoanalysis per se is neither gay-affirming nor condemning, although psychoanalytic practitioners may fall into either of these categories.

Drescher, J. (2002). Ethical concerns raised when patients seek to change same-sex attractions. Journal of Gay & Lesbian Psychotherapy, 5(3/4), 181-204.

Since the American Psychiatric Association removed homosexuality from its diagnostic manual in 1973, mainstream mental health organizations have maintained that an individual’s sexual orientation should be respected. Reparative therapists, however, argue that homosexuality is always a symptom of mental illness which should be treated. They have further argued that all therapists have an ethical responsibility to refer individuals with antihomosexual religious beliefs to reparative therapists in order to change their sexual identities.

This paper argues that such recommendations are unwise because they are derived from a misleadingly narrow reading of ethical guidelines. Rather than an issue regarding ethical patient care, this argument is a reflection of the culture wars surrounding homosexuality. This paper places those struggles in historical context. It examines reparative therapists’ pathologizing of and attempts to “cure” or change same sex attractions. Reparative therapists insist on social and traditional gender conformity as a therapeutic goal, and in doing so operate from an essentialist view of antihomosexual morality. Reparative therapies rely upon gender stereotyping that disrespects a patient’s same-sex attractions. Furthermore, as some reparative therapists actively support political activities opposed to granting civil rights to lesbians and gay men, these activities raise ethical issues relevant to the entire psychotherapeutic endeavor. Inevitably, the decision about what social status to accord homosexuality is a moral and ethical issue affecting all patients and clinicians.

Drescher, J. (2015). Can sexual orientation be changed? Journal of Gay & Lesbian Mental Health, 19(1), 84-93.

This paper was presented at a 2013 conference at the United Nations Church Center in New York City. The conference, “Selling the Promise of Change: International Health and Policy Consequences of Sexual Orientation Change Efforts (SOCE),” was sponsored by the NGO Committee on Human Rights and the NGO Committee on HIV/AIDS. The paper begins with a review of the history of mental health attitudes toward homosexuality from the 19th century to the present. This is followed by a discussion of how SOCE shifted from a clinical debate to a culture war issue. The paper then reviews some research issues raised by the Spitzer (2003) study, some of the problematic clinical and ethical issues raised by efforts to change sexual orientation, and concludes with a summary of the position statements of the American Psychiatric Association and American Psychological Association.

Ford, J. G. (2002). Healing homosexuals: a psychologist’s journey through the ex-gay movement and the pseudo-science of reparative therapy. Journal of Gay & Lesbian Psychotherapy, 5(3/4), 69-86.

Reparative therapy has become a generic term for any process that purports to facilitate a shift from homosexual orientation to heterosexual orientation. The author shares his own process as a survivor and former practitioner of reparative therapy. The religious mind-set and presuppositions that support reparative therapy are explored. The history of the grass roots ex-gay movement and the political ramifications associated with claims of healing are exposed. The author concludes that the pseudo-scientific claims of reparative therapy are suspect and warns of the risks and potential harm associated with these experimental therapies.

Forstein, M. (2002). Overview of ethical and research issues in sexual orientation therapy. Journal of Gay & Lesbian Psychotherapy, 5(3/4), 167-179.

Attempts to change sexual orientation have evolved primarily out of moral and pathological beliefs about homosexuality, rather than out of neutral curiosity about the fluidity of human erotic desire. History is replete with violent examples of antihomosexual bias being purveyed in the guise of “medical cure” of what was considered a psychosexual arrested development. Research into the efficacy and desirability of changing sexual orientation has been marred by biased researchers and inadequate research principles and designs. Ethically, there are many questions raised concerning the behavior of therapists who try to change their patients’ sexual orientation. Issues about research and ethical guidelines about therapy to change sexual orientation are addressed.

Gonsiorek, J. C. (2004). Reflections from the conversion therapy battlefield. The Counseling Psychologist, 32, 750–759.

Despite the efforts to resolve the decades-long controversy surrounding therapeutic attempts to change homosexual to heterosexual orientation (“conversion” or “reparative” therapy), it shows no signs of abating. A new trend is seen to emerge in this area, that of integrative solutions to conflicts between sexual orientation and religious belief. This article will briefly review how the controversy about therapeutic attempts to change sexual orientation arrived at this point of integrative solutions and will outline what I believe are assumptions underlying these nascent integrative solutions. The article will focus on how this controversy poses challenges and risks for psychology as a method of scientific inquiry and as a profession. Some efforts being done in this field, offer creative points of departure in the best traditions of psychology’s respect for diversity and concern for professionalism in practice for the challenges of working with religiously conservative clients who are nonheterosexual. I strongly suspect, however, that these efforts will have little effect on conversion therapists’ reckless disregard for client welfare and professional practice standards in their single-minded pursuit of enforcing religious orthodoxy and laying a claim to scientific respectability in the process. Avoiding polarization is a worthy goal but not at any price. The risks in the conversion therapy controversy are high, and psychology’s integrity as an independent profession and as science is at stake.

Haldeman, D. C. (1994). The practice and ethics of sexual orientation conversion therapy. Journal of Consulting and Clinical Psychology, 62(2), 221-227.

Sexual orientation conversion therapy was the treatment of choice when homosexuality was thought to be an illness. Despite the declassification of homosexuality as a mental illness, efforts to sexually reorient lesbians and gay men continue. The construct of sexual orientation is examined, as well as what constitutes its change. The literature in psychotherapeutic and religious conversion therapies is reviewed, showing no evidence indicating that such treatments are effective in their intended purpose. A need for empirical data on the potentially harmful effects of such treatments is established. Ethical considerations relative to the ongoing stigmatizing effects of conversion therapies are presented. The need to develop more complex models for conceptualizing sexual orientation is discussed, as well as the need to provide treatments to gay men and lesbians that are consonant with psychology’s stance on homosexuality.

Haldeman, D. C. (2002). Gay rights, patient rights: The implications of sexual orientation conversion therapy. Professional Psychology: Research and Practice, 33(3), 260-264.

Therapies designed to change sexual orientation have come under increasing scrutiny from the profession and the public. The proposition that sexual orientation can be changed therapeutically is widely questioned, and there is concern that such therapies reinforce social devaluation of homosexuality and bisexuality. At the same time, conservative religious individuals wish to seek treatment appropriate to them, which may include attempting to change or control sexual orientation. The ethical questions and clinical and social implications of this complex issue are discussed. Guidance to practitioners interested in this issue is offered, including references to policies of the American Psychological Association.

Haldeman, D. C. (2004). When sexual and religious orientation collide: Considerations in working with conflicted same-sex attracted male clients. The Counseling Psychologist, 32(5), 691-715.

The debate among scholars and gay activists and religious/political activists about the appropriateness and efficacy of conversion therapy has left out a number of individuals for whom neither gay-affirmative nor conversion therapy may be indicated. The present discussion, through the use of case material, offers considerations for the practitioner who seeks to assist same-sex attracted male clients in the integration of their conflicting religious and sexual selves. Issues of attachment, social and family considerations, religious and spiritual factors, and developing familiarity with the gay community are considered. Ethical considerations of treatment are discussed.

Halpert, S. C. (2000). “If it ain’t broke, don’t fix it”: Ethical considerations regarding conversion therapies. International Journal of Sexuality and Gender Studies, 5(1), 19–35.

Despite the unanimous adoption of a position statement by the American Psychiatric Association objecting to reparative therapy in December 1998, the decision was not without its critics. The current work examines the ethical considerations regarding “conversion” or “reparative therapies” in light of the extensive psychological literature documenting the societal stigma (homophobia and heterosexism) suffered by lesbian and gay individuals. Overall, there are two major concerns regarding conversion therapy, namely its ethical inappropriateness, and lack of empirical evidence supporting its efficacy. The author argues that no professional health associations support reparative therapy, homosexuality per se is not an illness and does not require treatment, and, the mental health profession must acknowledge its own role in the oppression of homosexual individuals.

Hein, L. C., & Matthews, A. K. (2010). Reparative therapy: the adolescent, the psych nurse, and the issues. Journal of Child and Adolescent Psychiatric Nursing, 23(1), 29-35.

TOPIC: Reparative therapy aims to modify the sexual orientation of lesbian, gay, and bisexual (LGB) people into that of heterosexuals. Although denounced as harmful by most professional organizations, these treatments continue-youth may be particularly vulnerable to the negative consequences.
PURPOSE: The purpose of this article is to discuss reparative therapies, the potential harm LGB youth may experience, clinical and practice issues for psychiatric nurses, and the ethical issues surrounding nurse involvement in reparative therapy.
CONCLUSIONS: Reparative therapy for adolescents raises important clinical and ethical issues for psychiatric nursing. Further discussion of nurse involvement in these treatments is needed.

Lasser, J. S., & Gottlieb, M. C. (2004). Treating patients distressed regarding their sexual orientation: Clinical and ethical alternatives. Professional Psychology: Research and Practice, 35(2), 194-200.

Homosexuality and bisexuality have not been considered psychopathologies for many years, and recent research has suggested a wide variety of etiological considerations, many biologically based, to account for same-sex desire. Nevertheless, many patients still present with questions and distress regarding their sexual orientation. The authors address the question of how practitioners may manage these situations. To this end, the authors briefly review the background of the relevant issues, make various assumptions, consider therapists’ values, and present 4 alternatives available to practitioners who may be confronted with this situation. Each alternative is discussed with regard to its relevant ethical issues and clinical implications.

Lingiardi, V., Nardelli, N., & Drescher, J. (2015). New Italian lesbian, gay and bisexual psychotherapy guidelines: A review. International Review of Psychiatry, 27(5), 405-415.

Although homosexuality was depathologized in the last century and the majority of mental health professionals consider it to be a normal variant of human sexuality, some psychologists and psychiatrists still have negative attitudes toward lesbian, gay and bisexual (LGB) clients. Sometimes they provide interventions aimed at changing sexual orientation through ‘reparative’ or ‘conversion’ therapies. At other times their interventions are influenced by anti-gay prejudices or simply by lack of knowledge about sexual minorities. This paper argues for the need for appropriate treatment guidelines aimed at providing bias-free, respectful, and effective interventions given that Italian health associations have delayed providing them. Some of the main guidelines recently approved by the Consiglio Nazionale dell’Ordine degli Psicologi (National Council of the Italian Association of Psychologists) are presented. Issues addressed include differences between gender and sexual orientation, minority stress, including perceived stigma and internalized stigma, homophobic bullying, coming out, and resilience. Respectful listening to LGB and questioning clients, affirming their identities and fostering a sense of resilience are essential requirements for all mental health professionals wishing to provide effective interventions in a society where sexual minorities are subjected to discrimination throughout their entire life cycle.

Lingiardi, V., Nardelli, N., & Tripodi, E. (2015). Reparative attitudes of Italian psychologists toward lesbian and gay clients: Theoretical, clinical, and social implications. Professional Psychology: Research and Practice, 46(2), 132-139.

Many mental health professionals still consider homosexuality to be a mental disturbance. These professionals often practice interventions that aim to change or “repair” homosexuality. Even when these “reparative” interventions are required by the client her/himself, the interventions minimize the role of internalized homophobia and promote ineffective and harmful therapeutic practices. This report aims to study this “reparative attitude” (RA) through the use of an Internet-based questionnaire that was administered anonymously to Italian licensed psychologists (n 3,135). The analysis of the frequencies showed that RA affected 58% of the participants. In addition, RA was predicted by variables representing demographic, sociocultural and professional characteristics, as well as by some theoretical assumptions about homosexuality. This study highlighted the need to improve the theoretical preparation of mental health professionals. The study also contributed to the development of the first Italian guidelines for providing counseling and psychotherapy to lesbian, gay, and bisexual clients.

Maccio, E. (2010). Influence of family, religion, and social conformity on client participation in sexual reorientation therapy. Journal of Homosexuality, 57(3), 441-458.

This study examined the likelihood of participating in sexual reorientation therapy (SRT) based on actual or expected family reactions to the disclosure of one’s same-sex sexuality, religious fundamentalism, social conformity, and several demographic variables. A sample of 52 SRT participants and 211 SRT nonparticipants who had ever identified as gay, lesbian, or bisexual completed a survey either online or in hardcopy format. Actual or expected negative family reactions, high religious fundamentalism, and identifying as spiritual significantly increased one’s odds of participating in SRT. The findings are essential for preparing practitioners in any clinical practice setting to work with clients struggling with their sexuality.

Morrow, S. L., & Beckstead, A. L. (2004). Conversion therapies for same-sex attracted clients in religious conflict: Context, predisposing factors, experiences, and implications for therapy. The Counseling Psychologist, 32, 641–650.

Despite a long history of viewing homosexuality as pathological and in need of change, the majority of mental health professions have, during the past 30 years, adopted statements that have depathologized lesbian, gay, and bisexual individuals. However, concurrent with these advances has been a rise in religious and therapeutic approaches to sexual reorientation (conversion or “reparative”) therapies. Recent scholarship highlights these controversies and the benefits and harms experienced by clients who have sought such interventions. This major contribution extends extant scholarship to include predisposing environmental and personality variables that lead same-sex attracted individuals in religious conflict to conversion therapies, an understanding of the journey to and through such therapies, and clinical implications and recommendations for working with these clients in a manner that does not contribute to further conflict.

Moss, I. (2014). Ending reparative therapy in minors: an appropriate legislative response. Family Court Review, 52(2), 316–329.

Reparative Therapy is a controversial Psychological practice designed to “cure” subjects, many of whom are minors, of their homo/bisexuality. These attempts to alter sexual orientation are not only generally met with failure, but also frequently involve the use of therapy methods that provide no medical benefit and carry a great risk of harm. Most troubling about this practice though is that for years, there have been persistent reports of Lesbian, Gay, and Bisexual (LGB) minors being forcibly subjected to this therapy by their parents. It is known that providers of Reparative Therapy, who maintain that homosexuality is a treatable mental disorder, often mislead parents about the risks of the treatment and the therapy’s likelihood of success. This Note proposes a state ban on Reparative Therapy, which would prohibit Reparative Therapy Practitioners from using psychological methodologies to attempt to alter the sexual orientation of minors. Modeled off the statutes of New Jersey and California, this ban would protect LGB minors from ineffective and harmful therapies, and do so in a way that does not violate patients, parents, or practitioners’ rights under the 1st and 14th Amendments.

Murphy, T. F. (1992). Redirecting sexual orientation: Techniques and justifications. Journal of Sex Research, 29(4), 501-523.

This essay reviews efforts to alter sexual orientation using behavioral, psychodynamic, hormonal, pharmaceutical and surgical methods. The essay also examines various justifications offered for such therapy and shows how these have changed as a pathological interpretation of homoeroticism has been abandoned. While such therapy was once justified in language of psychopathology, some current justifications for conversion therapy now treat the matter of therapy as a matter of personal choice and do not invoke the language of pathology at all. That a formal medical rejection of a psychopathological categorization of homoeroticism has not altogether eliminated efforts to redirect sexual orientation suggests that it is ultimately a moral and not medical devaluation of homoeroticism that at bottom drives continuing efforts to control and redirect sexual orientation.

Ponticelli, C. M. (1999). Crafting stories of sexual identity reconstruction. Social Psychology Quarterly, 62(2), 157-172.

This paper is an attempt to further the theoretical and methodological understanding of identity construction in general, and sexual identity construction in particular. Drawing from field research with one ex-gay ministry affiliated with Exodus International and Exodus literature, the author analyzes the process used by lesbian members to reconstruct their sexual identities. This analysis suggests that several social conditions necessary for religious conversion are also necessary for reconstruction of sexual identity. It is proposed that these general conditions also might explain broader instances of identity transformation in various contexts.

Rosik, C. H. (2003). Motivational, ethical, and epistemological foundations in the treatment of unwanted homoerotic attractions. Journal of Marital and Family Therapy, 29(1), 13-28.

A recent special section of the Journal of Marital and Family Therapy (October, 2000) focusing on the mental health needs of gay, lesbian, and bisexual individuals neglected to address the clinical needs of homosexual persons who desire to increase their heterosexual potential. This article attempts to correct this omission by outlining common motivations for pursuing change, updating the current state of knowledge regarding the effectiveness of change efforts, and providing some ethical guidelines when therapists encounter clients who present with unwanted homoerotic attraction. Finally, to assist marriage and family therapists (MFTs) in more deeply understanding divergent perspectives about reorientation treatments, an examination of the role of moral epistemology is presented and some examples of its potential influence are described. MFTs are encouraged to recognize and accept, rather than ignore or deny the valid needs of clients who seek to modify their same-sex attraction.

Schneider, M. S., Brown, L., & Glassgold, J. (2002). Implementing the resolution on appropriate therapeutic responses to sexual orientation: A guide for the perplexed. Professional Psychology: Research and Practice, 33, 265- 276.

This article provides background information and concrete examples to assist practitioners in the implementation of the American Psychological Association’s Resolution on Appropriate Therapeutic Responses to Sexual Orientation. It provides some general information about psychosocial aspects of lesbian, gay, or bisexual identities. It examines the issues surrounding the assertion that sexual orientation can be changed and the implications for practice. Vignettes, based on actual case studies, are used to illustrate how practitioners might respond appropriately to clients who are struggling with issues surrounding their sexual orientation.

Schreier, B. A. (1998). Of shoes, and ships, and sealing wax: the faulty and specious assumptions of sexual reorientation therapies. Journal of Mental Health Counseling, 20(4), 305-314.

Presents a study which examined the work of Warren Throckmorton’s assumption in his article `Efforts to Modify Sexual Orientation: A Review of Outcome Literature and Ethical Issues,’ from the same issue of the `Journal of Mental Health Counselling.’ Comments on his assumption of reorientation therapy; Different stance to Thockmorton’s article; Problems underlying reorientation therapies.

Steigerwald, F., & Janson, G. R. (2003). Conversion therapy: Ethical considerations in family counseling. The Family Journal: Counseling and Therapy for Couples and Families, 11(1), 55–59.

This article is the third and final part of a series of articles considering ethical issues in counseling with families and individuals within families with gay, lesbian, bisexual, and transsexual (GLBT) concerns. Conversion therapy and the ethical and practical considerations are explored in this third part. Emphasis is placed on the need for counselors to assess personal biases in the area of working with sexual minorities. A reflective exercise and case study are presented for personal exploration of awareness of biases and prejudice in working these populations.

Throckmorton, W. (1998). Efforts to modify sexual orientation: A review of outcome literature and ethical issues. Journal of Mental Health Counseling, 20, 283–304.

Reviews successful efforts to modify patterns of sexual arousal from psychoanalytical, behavioral, cognitive, group, and religious perspectives. Presents an ethical analysis of the American Counseling Association’s resolution expressing concerns about conversion therapy. Concludes that efforts to assist homosexuals who wish to modify their patterns of sexual arousal have been effective, can be conducted in an ethical manner, and should be available.

* This study is not based on primary, empirical research.

Throckmorton, W. (2002). Initial empirical and clinical findings concerning the change process for ex-gays. Professional Psychology: Research and Practice, 33, 242- 248.

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.

* This study is not based on primary, empirical research.

Tozer, E. E., & Hayes, J. A. (2004). Why do individuals seek conversion therapy? The role of religiosity, internalized homonegativity, and identity development. The Counseling Psychologist, 32, 716–740.

This study examined the potential influence of religiosity, sexual orientation identity development, and internalized homonegativity on the propensity to seek conversion therapy to change one’s sexual orientation. An Internet sample of 76 women and 130 men who were gay-identified, lesbian-identified, same-sex attracted, and “questioning” was studied. Results indicated that two types of religious orientations, intrinsic and quest, predicted a propensity to seek conversion therapy, although in different directions. Further more, internalized homonegativity fully mediated the relationships between religious orientation and propensity to seek conversion therapy. Additionally, there was a significant inverse relationship between sexual orientation identity development and propensity to seek conversion therapy. Implications for practice and research are discussed.

Tozer, E. E., & McClanahan, M. K. (1999). Treating the purple menace: ethical considerations of conversion therapy and affirmative alternatives. The Counseling Psychologist, 27(5), 722-742.

This article outlines the ethical considerations for sexual orientation conversion therapy for lesbian, gay, and bisexual individuals. There are numerous reasons not to acquiesce to a client’s desire to change his or her sexual orientation. There is no empirical evidence to show that conversion therapy is effective in reorienting a lesbian, gay, or bisexual person to heterosexuality. Moreover, these types of treatments perpetuate society’s stance that homosexuality is an inferior state and assume that the client’s struggle is pathological and not in reaction to the sociopolitical context in which lesbian, gay, and bisexual persons exist. Guidelines for responding to a client seeking reorientation and evaluating one’s biases regarding lesbian, gay, and bisexual orientations are presented. Future research implications are discussed.

Yarhouse, M. A. (1998). When families present with concerns about an adolescent’s experience of same-sex attraction. The American Journal of Family Therapy, 26(4), 321-330.

One of the unique challenges facing marriage and family therapists (MFTs) occurs when families present with concerns about an adolescent’s experience of same-sex attraction. When faced with this clinical scenario, MFTs may have few resources to draw on to provide treatment in a competent manner. The purpose of this article is to examine the American Association for Marital and Family Therapy’s Code of Ethics to explore ways in which MFTs can provide services within the framework of existing ethical principles and standards for accountability and professionalism. Recommendations are made with reference to the ethical principles of (a) professional competence and integrity and (b) responsibility to clients.

Yarhouse, M. A., & Throckmorton, W. (2002). Ethical issues in attempts to ban reorientation therapies. Psychotherapy: Theory, Research, Practice, Training, 39(1), 66-75.

The purpose of this article is to identify the ethical issues in efforts to ban reorientation therapies. The 3 primary arguments cited in the literature in favor of such a ban are discussed: (a) homosexuality is no longer considered a mental illness, (b) those who request change do so because of internalized homophobia, and (c) sexual orientation is immutable. The authors present 3 arguments in favor of providing reorientation and related services: (a) respect for the autonomy and self-determination of persons, (b) respect for valuative frameworks, creeds, and religious values regarding the moral status of same-sex behavior, and (c) service provision given the scientific evidence that efforts to change thoughts, behaviors, and feeling-based sexual orientation can be successful.

* This study is not based on primary, empirical research.

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