Article on reorientation therapy... is it crap?

[TXlib]

My conservative acquaintance just sent me this article. I have long felt, due to conversations with homosexual friends that homosexuality is hard-wired, and that you can't choose your sexual orientation. I have no knowledge in psychological matters, so I don't know if this article has any basis in reality, anyway. Who is this doctor, Robert L. Spitzer, anyway? Is he considered a "champion of gay activism", as the article claims?

I have highlighted in red two key pieces of information that make me doubt the study: the small sample size (200), and the fact that the sample was not random, but they all came forward as volunteers, thus introducing a huge self-selection bias. Does anybody see any other major problems with the article, or might there be some truth to it?

---

Spitzer Study Just Published:
Evidence Found for Effectiveness of
Reorientation Therapy

By Roy Waller and Linda A. Nicolosi

The results of a study conducted by Dr. Robert L. Spitzer have just been published in the Archives of Sexual Behavior, Vol. 32, No. 5, October 2003, pp. 403-417.

Spitzer's findings challenge the widely-held assumption that a homosexual orientation is "who one is" -- an intrinsic part of a person's identity that can never be changed.

The study has attracted particularly attention because its author, a prominent psychiatrist, is viewed as a historic champion of gay activism. Spitzer played a pivotal role in 1973 in removing homosexuality from the psychiatric manual of mental disorders.

Testing the hypothesis that a predominantly homosexual orientation will, in some individuals, respond to therapy were some 200 respondents of both genders (143 males, 57 females) who reported changes from homosexual to heterosexual orientation lasting 5 years or more. The study's structured telephone interviews assessed a number of aspects same-sex attraction, with the year prior to the interview used as the comparative base.

In order to be accepted into the 16-month study, the 247 original responders had to meet two criteria. First, they had to have had a predominantly homosexual attraction for many years, including the year before starting therapy (at least 60 on a scale of sexual attraction, with 0 as exclusively heterosexual and 100 exclusively homosexual). Second, after therapy they had to have experienced a change of no less than 10 points, lasting at least 5 years, toward the heterosexual end of the scale of sexual attraction.

Although examples of "complete" change in orientation were not common, the majority of participants did report change from a predominantly or exclusively homosexual orientation before therapy to a predominantly or exclusively heterosexual orientation in the past year as a result of reparative therapy.

These results would seem to contradict the position statements of the major mental health organizations in the United States, which claim there is no scientific basis for believing psychotherapy effective in addressing same-sex attraction. Yet Spitzer reports evidence of change in both sexes, although female participants reported significantly more change than did male participants.

The statistical and demographic details of the respondents include the following:

• The study did not seek a random sample of reorientation therapy clients; the subjects chosen were volunteers.
  
• Average ages: men, 42, women, 44.
  
• Marital status at time of interview: 76% men were married as were 47% of the female respondents. 21% of the males and 18% of the females were married before beginning therapy.
  
• 95% were Caucasian and 76% were college graduates.
  
• 84% resided in the United States, the remaining 16% lived in Europe.
  
• 97% were of a Christian background, 3% were Jewish, with an overwhelming 93% of all participants stating that religion was either "extremely" or "very" important in their lives.
  
• 19% of the participants were mental health professionals or directors of ex-gay ministries.
  
• 41% reported that they had, at some time prior to the therapy, been "openly gay." Over a third of the participants (males 37%, females 35%) reported that at one time, they had had seriously contemplated suicide due to dissatisfaction with their unwanted attractions. 78% had publicly spoken in favor of efforts to change homosexual orientation.
  

Employing a 45-minute telephone interview of 114 closed end questions, each requiring either a yes/no answer or calling for a scaled rating of between 1 and 10, Spitzer's study focused on the following areas: sexual attraction, sexual self-identification, severity of discomfort with homosexual feelings, frequency of gay sexual activity, frequency of desiring a same-sex romantic relationship, frequency of daydreaming of or desiring homosexual activity, percentage of masturbation episodes featuring homosexual fantasies, percentage of such episodes with heterosexual fantasizing, and frequency of exposure to homosexually-oriented pornographic materials.

In addition, participants were asked to react to a series of possible reasons for desiring change from homosexual orientation to heterosexuality as well as being asked to assess their marital relationships.

Some of the findings of the Spitzer study, particularly regarding motivations for change, included:

• The majority of respondents (85% male, 70% female) did not find the homosexual lifestyle to be emotionally satisfying. 79% of both genders said homosexuality conflicted with their religious beliefs, with 67% of men and 35% of women stated that gay life was an obstacle to their desires either to marry or remain married.
  
• Although all of the participants had been sexually attracted to members of the same sex, a certain percentage (males 13%, females 4%) had never actually experienced consensual homosexual sex. More of the male respondents (34%) than females (2%) had engaged in homosexual sex with more than 50 different partners during their lifetime. Further, more of the men than women (53% to 33%) had never engaged in consensual heterosexual sex before the therapy effort.
  
• Dr. Spitzer said the data collected showed that, following therapy, many of the participants experienced a marked increase in both the frequency and satisfaction of heterosexual activity, while those in marital relationships noted more emotional fulfillment between their spouses and themselves.
  

As for completely reorienting from homosexual to heterosexual, most respondents indicated that they still occasionally struggled with unwanted attractions--in fact, only 11% of the men and 37% of the women reported complete change. Nevertheless this study, Spitzer concludes, "clearly goes beyond anecdotal information and provides evidence that reparative therapy is sometimes successful."

Spitzer acknowledges the difficulty of assessing how many gay men and women in the general population would actually desire reparative therapy if they knew of its availability; many people, he notes, are evidently content with a gay identity and have no desire to change.

Is reorientation therapy harmful? For the participants in our study, Spitzer notes, there was no evidence of harm. "To the contrary," he says, "they reported that it was helpful in a variety of ways beyond changing sexual orientation itself." And because his study found considerable benefit and no harm, Spitzer said, the American Psychiatric Association should stop applying a double standard in its discouragement of reorientation therapy, while actively encouraging gay-affirmative therapy to confirm and solidify a gay identity.

Furthermore, Spitzer wrote in his conclusion, "the mental health professionals should stop moving in the direction of banning therapy that has, as a goal, a change in sexual orientation. Many patients, provided with informed consent about the possibility that they will be disappointed if the therapy does not succeed, can make a rational choice to work toward developing their heterosexual potential and minimizing their unwanted homosexual attractions."

Is reorientation therapy chosen only by clients who are driven by guilt--that is, what's popularly known as "homophobia"? To the contrary, Spitzer concludes. In fact, "the ability to make such a choice should be considered fundamental to client autonomy and self-determination."

Copyright © NARTH. All Rights Reserved. </copyright.html>
Updated: 7 October 2003

---

[AntiCoup2K4]

1. If I remember correctly

The 2 "ex gay" founders of Exodus ministries had to resign from the group when they fell in love - with each other. And I believe there was another one of these "cured" homosexuals who was seen in a DC gay bar. I remember seeing this Nicolosi person on Pat Robertsons show a while back. She makes "Dr" Laura look sane by comparison.

[alexwcovington]

2. This doesn't seem like the best sample...

...to be making conclusions from.

I think that homosexuality is a choice... but the question is much more complex than just a matter of choice or biology.

[Rowdyboy]

3. Certainly I well remember deciding to be a tiny, despised minority

It was a lovely spring day in 1968 (I was 14) and I thought to myself, do I want to be normal, or a queer, hidden from family, loathed in the workplace, unable to have basic human rights offered to heterosexuals. I think I'll just be gay!

Maybe someday I can even be beaten and hung from a fence to suffer and die like Matthew Shepherd! Sounds cool to me! :eyes:

[alexwcovington]

7. I'm not being morally judgemental

There's no need to berate the concept that human behaviour is governed by choice. The whole point of a lot of the struggles these days is getting people to accept the ability of other people to make choices.

I'm not trying to be offensive here.

[Bertha Venation]

10. sexual orientation is not about behavior

"There's no need to berate the concept that human behaviour is governed by choice."

I don't. And yes: human behavior is largely governed by choice.

But sexual orientation is not about behavior.

Consider: I'm left-handed, but I can choose to use my right hand, i.e., exhibit right-handed behavior. But to what end? I'd spill my food all over the place and no one would be able to read my writing.

I'm gay, but I can choose to have sex with men, i.e., exhibit heterosexual behavior. But to what end? I would be going completely against my own nature. Not to mention that I would be miserable, on innumerable levels, during the act, and the man would probably not enjoy himself (unless he were a monster).

I can choose a behavior, but would not choose one that is against my nature.

Do you see?

[Rowdyboy]

29. Sorry, thats just a hot button issue with me

The logical response is, "When did you decide to be hetero?" Like you had any choice or could be anything other than what you are. People use the falsehood that homosexuality is a "choice" to justify their hatred and discrimination.

As to the original thread, I really don't believe many gays I've known could change their orientation. Maybe for a short period of time, on the surface, but eventually the real persona will bleed through.

[Gildor Inglorion]

30. Bless your heart, you have no IDEA how offensive you're being...

living in North Dakota *shudder* is a choice. Sexual orientation is NOT.

[Bertha Venation]

33. I don't know about anyone else who replied to this thread, but

I'm kind of disappointed that Alex hasn't replied to any of us. :shrug:

[Bertha Venation]

12. I remember when I chose, too.

I'm sure we all do.

Note: continuing Rowdy's sarcasm. Sometimes sarcasm is the only way to get the point across.

[Iris]

20. So if homosexuality is a choice, then

are all of us straight people choosing to be heterosexual? And if we are, then what is determining that this is the standard behaviour? Society?

And if society chooses for us, then what do you make of the portion of our society that enjoys women "choosing" to be with other women in a way that is titillating to others? If this becomes more and more accepted by the media and "society," does that then mean it is ok to choose "lesbianism" but not "queerness"?

[Mrs. Venation]

31. When Did You Choose Your Orientation?

If you did choose it, could you now choose differently?

[Bertha Venation]

4. Spitzer himself decried the RW spin on his study.

This SPIN is crap, and NARTH is a well known right wing nut bag orgainzation -- gay haters all.

[TXlib]

11. Do you have a link?

Do you have a link where Spitzer decried this spin? I'd like to pass it on to my acquaintance.

[Bertha Venation]

13. let me check around

gimme a few minutes

[Bertha Venation]

19. here's what I've found, it's not exactly what you need, though

http://www.religioustolerance.org/hom_spit.htm

http://www.newdirection.ca/research/spitzer.htm That's a report of the study itself -- I'd like to say it's THE study but I can't be sure, don't have time to read it thoroughly. But it's on a "no-you-don't-have-to-be-gay---no-one-really-is!" site.

I'll keep looking as I have time

[David__77]

5. If you see the name "Nicolosi," then it's CRAP.

They're with a fundamentalist group. "NARTH" is repudiated by the entire psychiatric community and is little more than an adjunct of the well-funded fundamentalist political groups. They're like a "flat earth society," if you will...

[TXlib]

14. Can you provide a link where NARTH is repudiated?

I'd like to pass it on to him.

When arguing with him, I can't just assert that Spitzer decried the RW spin on his study, or that NARTH is repudiated by the entire psychiatric community -- he's going to want to see a link to a credible site that backs my assertion up. Otherwise, all I've got is hot air.

[Duncan Grant]

34. Here's what you need TXlib (everyone please check this out).

I doubt that your 'friend' will be satisfied by any evidence that contridicts his intrinsic beliefs. Here are a few places to begin:

http://www.psych.org/public_info/HOMOSE~1.cfm

snip

<<There are a few reports in the literature of efforts to use psychotherapeutic and counseling techniques to treat persons troubled by their homosexuality who desire to become heterosexual; however, results have not been conclusive, nor have they been replicated. There is no evidence that any treatment can change a homosexual person's deep seated sexual feelings for others of the same sex.

Clinical experience suggests that any person who seeks conversion therapy may be doing so because of social bias that has resulted in internalized homophobia, and that gay men and lesbians who have accepted their sexual orientation positively are better adjusted than those who have not done so.>> (emphasis added)

http://www.apa.org/pubinfo/answers.html

snip

<<Some therapists who undertake so-called conversion therapy report that they have been able to change their clients' sexual orientation from homosexual to heterosexual. Close scrutiny of these reports however show several factors that cast doubt on their claims. For example, many of the claims come from organizations with an ideological perspective which condemns homosexuality. Furthermore, their claims are poorly documented. For example, treatment outcome is not followed and reported overtime as would be the standard to test the validity of any mental health intervention.>> (emphasis added)


:grr: :nuke: on edit: deleted my own self-rightous rant about homophobia here at DU.

[dsc]

35. Thank you

It has been a crappy day to be gay in the Lounge. You did good.

[Duncan Grant]

36. Hi dsc! You're very welcome.

:wow: You can say that again. :shrug: :wtf:

Best to you friend! :hi:

[dsc]

37. and best to you.

Ironicly I retreated here due to being called vile names in the primary forum. Then today occured. Being a gay Dean supporter here is awfully tough on more than on occasion.

[Duncan Grant]

42. You can say that again, too!

;)

[Ediacara]

40. not just the the psych community repudiating NARTH

But the American Medical Association, American Psychological Association, American Psychiatric Association, and the American Association of Pediatrics have firm positions against homosexual curing.

Their reasons range from it's massively harmful to patients to it just plain doesn't work.

[Bossy Monkey]

6. Copyrighted. You have to edit, then provide link, which is here:

http://www.narth.com/docs/evidencefound.html

As to the article, in a nutshell, it's horseshit, for the reasons you mention, along with "...with an overwhelming 93% of all participants stating that religion was either "extremely" or "very" important in their lives."

[TXlib]

15. Thanks

He sent the article to me as text in an email, which is why I didn't post a link.

[salvorhardin]

8. Junk science

Note: I am not a homosexual, so I might be talking out of my arse here. Any homosexuals that want to call B.S. on my post, please do. It took me many years to get over the homophobia (and racism!) that was taught me growing up in a small rural predominantly white community and I still have to fight against it to this day.

The problem is that conservatives can't accept the fact that some people are attracted to the same sex and as always view the world in black and white terms.

As far as whether sexuality is genetically or environmentally determined or a simple matter of choice, the truth is that like most things involving humans, there is no single determining cause. Just as with obesity, there are genetic, biological*, psychological, societal** and environmental factors altogether influencing homosexuality.

Unlike obesity, homosexuality does *not* affect one's health, although the way one practices homosexual sex can. On the other hand, being stupid about the way one practices heterosexual sex can too. The only reason HIV is not as prevalent in the hetero population as it is among homosexuals is precisely because historical societal intolerance of homosexuality marginalizes homosexuals and forces them underground. If homosexuality was openly accepted I think you would see a large reduction in behaviors which lead to the spread of HIV.

Neither do I think that one must be one or the other; hetero or homo. Again, I think what we have seen is that with all human behaviors there is a continuum on which they lie. While some people may lie at either the extreme hetero or the extreme homo end of the curve, I think the vast majority of people fall somewhere close to the median favoring one side or the other.

I hope I've made sense here.

* I prefer to distinguish between biological and genetic influences. While one could say that they're both biological and that it's needless nitpicking, I see genetic influences being determined at conception and biological influences as being contemporary and perhaps malleable.

** More semantics. I see societal influences in the sociological sense as being an agglomeration of environmental influences. The environmental influences being more close to home; e.g. one's family and friends.

[VelmaD]

9. It was based on a PHONE SURVEY

It's complete garbage. And junk science to boot.

If he really wanted to know if "therapy" worked he'd pull them in for face-to-face interviews and then hook 'em up and show 'em porn and gauge the physical reaction. There's no other way to determine the truth about someone's level of attraction to the opposite or same sex. Asking them "are you still gay?" is a sure-fire way to get them to lie.

[TXlib]

16. Very good point, Velma. Thanks!

Heh... hook 'em up to a tumescence meter!

I just may use your post verbatim in my next reply to him, if you don't mind.

[VelmaD]

21. Go for it

There's an equivalent to the "tumescence meter" that they can use on women as well to determine level of arousal. Do NOT ask me why I know that. ;)

[Snow]

28. I'll tell you, Velma, I do a lot of studies using phone surveys

and that technique in itself is not enough to damn a piece of research - you can do phone surveys right. However, your point that this information can only be gathered under, so to speak, lab conditions, is very well taken. What you've got is an invalid survey instrument. Anyway, what concerned me more was the composition of the sample:

-snip-
Marital status at time of interview: 76% men were married as were 47% of the female respondents. 21% of the males and 18% of the females were married before beginning therapy.
-snip-
So did they get married as a result of the treatment or were they married at the time of enrollment? If the latter, this is a very unrepresentative group of homosexuals.

-snip-
95% were Caucasian and 76% were college graduates.
-snip-
95% were Caucasian?? Where do these people live?

-snip-
84% resided in the United States, the remaining 16% lived in Europe.
-snip-
And what kind of recruitment strategy pulls in study subjects from Europe? Were they native English speakers? Was the survey instrument validated in their language if they were not? These are sensitive, culturally loaded questions, and should not be used with someone who's not a native speaker.

They could have saved themselves a bit by describing their sampling frame, ie the population from which the volunteers ummmm, volunteered.

Finally, the sample size is probably okay to detect the difference they're after, except that they split it by gender - and it's unbalanced! So, what was probably an adequately powered sample to begin with lost that power by stratifying on gender. Basic error #43.

[VelmaD]

32. Point well taken

For some topics a phone survey can work if it's done right. Just realized that I did imply that phone surveys were always junk science and I didn't mean it quite that way.

I think your points about gender and the native language of the respondents were dead on too. Neat to meet other folks on the board who are interested in research.

[dsc]

17. I am ashamed to say

that I actually gave a lot of thought to doing this therapy when I was in college. To the credit of the place they made clear their low sucess rate (around 5%). My parent's insurance, who was covering me at the time, refused to pay for it. They said it was not proven to be effective. Given the massive cost of the therapy I decided not to do it. So I was saved by the parsimony of the insurance company.

I am not proud of this fact but I did consider it. Maybe the numbers have improved since (we are talking about the late 80's in my case) but I highly doubt they have gotten that much better.

[Iris]

22. don't be ashamed

As another person posted earlier, realizing you are gay is probably pretty scarey.

[dsc]

24. thanks

I was just desperate for anything which would work.

[Iris]

25. I think that's totally understandable.

I'll bet the pressure is even worse for teenagers and twentysomethings today.

[dsc]

26. It appears to be getting better

I am a substitute teacher and have seen a decent amount of evidence that it is getting better for people now. But it still is a personal thing. Some parents are better than others. Some kids more fragile than others. No amount of over all improvment will make those factors unimportant.

[Iris]

27. that's good to hear

[HuckleB]

39. Three percent is the highest number I've seen by a legitimate study.

[dsc]

41. I had figured the 5% had to be accurate as who would have made up that

number. Who knew? I no longer have the brosures so I can't look it up now.

[Bill McBlueState]

18. this is interesting:

"Marital status at time of interview: 76% men were married as were 47% of the female respondents. 21% of the males and 18% of the females were married before beginning therapy."

So a large number of the respondents got married as a result of the "therapy." Once a respondent gets married, he or she is going to be *highly unwilling* to consider the possibility that he or she is still gay. That admission is going to make the recent choice to marry someone of the other sex seem pretty bad. The author should come back and ask these people again in five or ten years.

[jpgray]

23. There are no clear divisions on human behavior

Doubtless there are some small percentage of gays who are a little confused and perhaps straight. I know for sure there are analogues of that in the straight community--straight guys who are a little confused and perhaps gay.

This doesn't mean that all gays or even any sizable minority can or should be 'reoriented'. As for double standards, the APA should also have a program to 'deorient' straight people who have the same problem in reverse. :D

[HuckleB]

38. One organization supports "Reparative Therapy": NARTH, the publisher...

of this junk science. NARTH's inability to show its work as anything but trash is quite famous. This appears to be very similar to other so-called NARTH studies, which do not pass the muster of peer review.

The following groups have determined "Reparative Therapy" to be unethical, with a dramatically high failure rate. Further, tt results in long-term damage to many clients.

American Academy of Pediatrics
American Counseling Association
American Federation of Teachers
American Medical Association
American Psychiatric Association
American Psychological Association
National Association of School Psychologists
National Association of Social Workers
National Association of Secondary School Principals
National Education Association

I've discussed this issue ad nauseum with Freepers on the 'Net. Logic and science means nothing to them, so don't worry about trying to show opposing research (There is plenty. Just hit a med school/health science library). It won't matter. The principles of good science mean nothing in the twisted world of the NARTHians.