CHANGE OF SEXUAL ORIENTATION
A REVIEW OF THE LITERATURE
By: Dale O’Leary

Is it possible for therapy to produce a change in sexual orientation? Is such therapy ethical? C.A. Tripp in a 1971 debate with Lawrence Hatterer insisted that "there is not a single recorded instance of a change in homosexual orientation which has been validated by outside judges or testing." Tripp claimed to have treated patients supposed cured by other therapists, who came to him because they do not want to disappoint their previous therapists. Tripp's statement has been widely quoted, but the full text of the debate reveals Tripp was offered clinical evidence of change by Hatterer. Hatterer's book published in 1970 contains extensive case material drawn from tape recorded sessions and follow-up information. Dr.Warren Throckmorton, who has reviewed the literature, sums up the evidence:"Narrowly, the question to be addressed is: Do conversion therapy techniques work to change unwanted sexual arousal? I submit that the case against conversion therapy requires opponents to demonstrate that no clients have benefited from such procedures or that any benefits are too costly in some objective way to be pursued even if they work. The available evidence supports the observation of many counselors -- which many individuals with same-gender sexual orientation have been able to change through a variety of counseling approaches."This report contains numerous reports of change of orientation and this list is by no means exhaustive. The material is sufficient to demonstrate that change is possible and that many forms of therapy -- including some that are no longer used -- have produced change. Some therapists appear to be more successful than others. The reports of change are well documented, backed up by case histories, extensive follow-up, and autobiographical material.The surveys and analyses of collected data provide evidence that approximately 30% of those who enter therapy and persist can expect to experience a change of orientation. Even taking the extreme position that change applies only to an individual who was in behavior, attraction, and fantasy exclusively homosexual for a significant period of adult life and became exclusively and permanently heterosexual in behavior, attraction, and fantasy, it is clear that such persons do exist. The prognosis is more positive for those who had heterosexual experiences. Given the make-up of the human brain and the power of habit, occasional homosexual attraction experienced in times of stress for a number years after the cessation of homosexual behavior should not be surprising. Ex-Gay ministries counsel members that full freedom may take years.Behavior modification techniques for eliminating homosexual behavior and attraction have largely been abandoned; nonetheless the numerous reports of their use from 1946 to 1976 points to the desire of homosexual men to rid themselves of unwanted thoughts and behaviors. These men appear willing to try anything. The fact that some succeeded may be attributed to their desire for change, their willingness to seek help, the effect of revealing to the therapist of the nature of the problem, and the confidence of the therapist that change is possible. In some cases, it may be that a man, who believed that he was incapable of being excited by women, was surprised to discover that his body was capable of heterosexual arousal and that this helped to overcome a phobia-rooted homosexuality.It is also worthy of note that a number of studies contain reports on clients who entered therapy seeking help for other problems for whom the change of sexual orientation was an unexpected outcome. There is also evidence that change occurs spontaneously.References to autobiographical accounts of religiously medicated change have been included in this report. While this type of change has not received extensive scientific study, many of those claiming religiously mediated change have testified publicly and their claims can be documented.None of these studies claim that every person who seeks change will succeed. Given the reported failure rates, one would expect to find a large group of homosexuals who were dissatisfied with therapy. These could be the source of Tripp's anecdotal evidence.

CRITICS OF CHANGE: The critics of therapy claim that studies report only changes of behavior and that the underlying "orientation" or sexual attractions remain untouched. This is simply untrue. Many of the therapists query clients about homosexual attractions and fantasy. And many therapists do not consider a person fully "changed" unless the attractions and fantasies were also exclusively heterosexual.The opponents of change have criticized the studies which claim to document change on the grounds that the rely on the testimony of therapists. However in 1998, when a large group men and women who were once homosexuality attracted or active publicly announced that they are "ex-gay," their testimony was derisively dismissed. Homosexual activists pressured networks to refuse to air commercials containing "exgay" testimonies. The "exgays" were accused of never being really homosexual or of "suppressing" their gayness. The intensity of the reaction against ex-gays suggests that those who "accept" their homosexuality feel threatened by the possibility of change.Section 8 of this report contains quotes from writers who oppose therapy for change. A number of these writers admit that change is possible, but condemn therapy even when the client wants change because the availability of therapy oppresses homosexuals who don't want to change. According to Begelman (1977), who condemns therapy for change as unethical:"Administering these programs means reinforcing the social belief system about homosexuality. The meaning of the act of providing reorientation services is yet another element in a causal nexus of oppression."Therapists who view homosexuality as a normal variety of sexual orientation insist that there is no "excess" psychopathology among homosexuals and then discuss at length the psychological problems associated with "internalized homophobia," a condition, which, according to them, effects most homosexuals. Those who normalize homosexual orientation, usually also normalize sexual promiscuity and extreme sexual practices since homosexuals routinely engage in these behaviors. There is the overwhelming evidence that during early childhood homosexual men had negative relationships with their fathers and that their mothers who did not support their masculine identity development. This forces homosexual activists, like Gerald Davison(1982), to argue such childhood experiences don't cause with excess pathology because they are part of the histories of homosexuals and homosexuality is normal. By this reasoning Davison dismisses the accumulated research of developmental psychologists and the pain of the children.

RELIGION AND THERAPY: If therapy for change is declared unethical or illegal, persons whose religion opposes all sexual activity outside traditional marriage would be denied their right to receive therapy consistent with their faith. It is interesting to note that a number of those who oppose therapy to change sexual orientation, support therapists who try to change their clients' religious beliefs. This includes encouraging therapists to tell their clients that Christian teaching permits homosexual activity. James Nelson, a professor of Christian Ethics at United Theological Seminary of the Twin Cities MN, is among those who supports telling clients that Christianity doesn't consider homosexual sexual activity, including non-monogamous activity, sinful.It appears inconsistent for a society which supports a client's right to controversial therapies, such as sex change operations, extensive plastic surgery, and reproductive technologies, to deny clients who desire a change of sexual orientation access to therapies known to be effective.Currently individuals seeking change are forced to contact a shrinking pool of therapists willing to take on this work or to seek religiously mediated change through support group membership. Those who are not interested in adopting a religious world view may feel uncomfortable in a religiously based ex-gay ministry. For example, Homosexuals Anonymous adopts some of the traditions of AA, but combines these with an explicitly Christian world view. Alan Medinger, an exgay and leader of the religion-based Regeneration Ministries, has expressed concern for non-Christian homosexuals seeking help. He is concerned that those who are not religious currently have no support groups available to them. On the other hand those who wish to be free from homosexual behavior for religious reasons feel abandoned by the mental health profession.

The public and homosexuals have a right to know that successful change is possible. Homosexuals, who desire treatment, have the right to the best treatment available.This report contains information on and excerpts from articles, books, and studies on treatment for homosexuality -- including those opposed to treatment. Not all the studies contain positive results. A wide variety of treatments and theoretical approaches are represented. Some of the authors have changed their point of view on treatment. The information on change has been arranged in the following manner.1) Reviews of the literature on therapy and change - Some of these are written by therapists who include their own experience and case material.2) Surveys and meta-analysis of studies - Most of the studies included in the meta-analysis are referenced individually. It should be noted that a number of studies appear in several meta-analyses.3) Reports from therapists who treated homosexual clients with some form of individual psychotherapy. It should be noted that a number of theoretical approaches are employed. In some cases change of orientation was not the therapist's or client's goal. Extensive case histories and client/therapist exchanges are included in a number of the articles and books in this section.4) Reports from therapists who treated homosexual clients with some form of group therapy. -- Group therapy was sometimes combined with individual therapy or behavior modification. Some groups involve only homosexuals, in other cases homosexuals are included in heterogeneous groups.5) Studies in which some form of behavior modification therapy was the primary treatment method -- It should be noted that most of these therapies were short term, although some employed "booster sessions." Most of the methods employed are considered by the pro-gay activists to be degrading and inhumane. Many psychotherapists consider these techniques to be superficial, leaving untouched the underlying problems. Those associated with ex-gay ministries find many of the methods and goals to be morally unacceptable.6) Reports of religiously mediated change, including studies and autobiographical material -- Celibacy and marriage are both viewed as acceptable outcomes.7) Reports of spontaneous or adventitious change of sexual orientation. -- Various studies of sexuality suggest that some persons engage in exclusive homosexuality during adolescents and early adulthood and then move on to exclusive heterosexuality. Change of orientation has occurred when no change was sought or expected.8) Articles by persons who oppose therapy with the goal of change or believe that change is impossible -- These articles focus on the psychological effects of therapy on those who fail to achieve their goal and on those who do not want such therapy.9) Responses to critics of change10) Recent articles on the subject.
Within each grouping the sources are arranged alphabetically by author. Additional works by the same author are included since many of the authors discussed the same cases in a number of articles and books.

It should be noted that each author has his own definition of improvement and/or change.The subtitles in capital letters are provided to help the reader find information on specific topics. Material in quotations marks are quoted directed from the original source. Page numbers are in parentheses at the end of the quotation.This is a work in progress. At this date, not all of the original articles have been found and reviewed and not all the bibliographic information is complete. The incomplete information has been included as a guide to those who may wish to do more research. Those articles or books which have been reviewed and are in the Irving Bieber Memorial Library East Coast are marked with @ in the bibliography.

Mrs. Dale O'Leary is author of The Gender Agenda and worked with Dr. Robert Spitzer on his landmark 2003 study. He asked her to review the last 50 years of literature on homosexuality and document all peer-reviewed studies that prove re-orientation therapy never works. She found many claims to that effect, but not a single peer-reviewed study proving that claim. Her entire report is 115 pages long, and she is willing to e-mail it to those who are interested. She will allow me to post her e-mail address once she re-locates.