It’s been three decades since homosexuality was declassified as a mental disorder, removed as such from the Diagnostic and Statistical Manual of Mental Disorders in 1973 by the American Psychiatric Association, a step that was two years later lauded and echoed by the American Psychological Association and two years after that by the National Association of Social Workers. Since then, those organizations, as well as the American Medical Association and a host of other professional bodies, have publicly and consistently rejected the notion that sexual orientation is a characteristic that’s determined by personal choice and have worked to destigmatize homosexuality.

According to the American Psychological Association, evidence suggests that a person’s sexual orientation is significantly influenced by biological factors and that it emerges early in life. The organization’s position is stated bluntly on its Web site: “The reality is that homosexuality is not an illness. It does not require treatment and is not changeable.”

Nevertheless, while that prestigious institution, like most respected organizations, boasts an “if it ain’t broke, don’t fix it” attitude, there remains a vocal movement insisting that homosexuality is a disorder that requires repair or eradication. It’s a fire fueled to a large degree by religious and political agendas and fanned by the recent social debate over same-sex marriages and civil unions, the personal revelations of New Jersey Governor James McGreevey, and the “values” preoccupation in the recent state and national political contests.

Explains Daphne Stevens, PhD, LCSW, an adjunct faculty member at Valdosta State University School of Social Work, “The current interest in ‘converting’ homosexuals appears to be a reflection of the current political and social mores that support homophobia.” This, she observes, is not new. “Our attitudes about what is pathological and what is normal are always affected by the zeitgeist of the culture.”

Disorder of Maladaption?
Proponents of this movement support a brand of therapy variously known as reparative or conversion therapy, which seeks to alter sexual orientation. They commonly trace homosexuality to developmental disorders or attachment anomalies. A strong proponent of reparative therapy and one of only several mental health professional organizations to support the practice is the National Association for Research and Therapy of Homosexuality (NARTH), a nonprofit educational organization founded in 1992 and describing itself as “dedicated to the research, therapy, and prevention of homosexuality.”

NARTH’s 1,000 members are therapists who believe homosexuality is a condition that can be treated. Its president, Joseph Nicolosi, PhD, a clinical psychologist, supports reparative therapy as a tool for clients “with a dissatisfaction with the same-sex attraction and the hope of developing their heterosexual response.”

The organization, he explains, “sees the male homosexual condition as rooted in a failure to bond with the father, and the homosexual attraction a conflict between the desire to connect with the masculine and a fear of connecting. It’s what we call anticipatory shame. The child was not supported by his parents in his early masculine strivings, and as an adult, he is now in conflict with his normal desire to connect with other males. The boy who grows up homosexual was often born with an unusually sensitive temperament. This is the identifiable biological element—‘gender atypicality’—that can predispose some children to homosexuality. While the boy’s parents may have successfully raised their other sons to be heterosexual, this one particular son needed the males in his life to actively elicit his masculine gender identity—and somewhere along the way, there was a failure in this regard.”

An essential feature of the therapy, continues Nicolosi, is helping clients develop intimacy, but not sexual intimacy, with other men. “What we do is get them to feel their feelings that precede homosexual feelings, and what precedes their homosexual desire is a feeling of masculine inadequacy about themselves.”

Nicolosi focuses on gay men because he specializes in male homosexuality and rarely works with lesbians. According to NARTH Publications Director Linda Nicolosi, other NARTH therapists, such as Janelle Hallman, MFCC, do work with lesbians. (See the NARTH Web site for articles at www.narth.com.)

At NARTH, says Joseph Nicolosi, “we don’t see homosexuality so much as a disorder but as a maladaption for certain individuals. It’s not working for them.” It further stands in the way of the fulfillment of certain goals, such as marrying and having a family. The members of NARTH are not unanimous, however, about whether homosexuality is a disorder if it causes no conflict for the homosexual individual.

“That depends on who you talk to in NARTH,” Joseph Nicolosi responds. “There’s a variety of views among our members, but my own perspective is that it’s a maladaption.” As to whether this is true, he says, “the burden of proof is on the people who say that it’s normal and natural.” As evidence for his stance, he points to anatomy. “The male body is designed for a woman’s body, and a woman’s body is a designed for a male’s body. The bodies are complementary and the burden of proof would lie on those people who say that the activity of two men who have sex is as normal as the sexual activity of a man and a woman.”

Clients and Identity
The vast majority of NARTH’s clients are individuals who are not gay-identified, “which is to say that they have homosexual feelings and may engage in homosexual activity but they do not self-label as gay,” Joseph Nicolosi explains, adding that NARTH views the label of gay as acceptance of a social-political identity that’s embraced with acceptance and often pride. “We make a distinction between homosexual, which is a description of sexual orientation, and gay, which is a social-political identity with which our clients do not identify.” Less common, he adds, NARTH clients are gay-identified. “They accept their homosexuality, but we deal with other issues.”

Sometimes clients come to therapy because they’re being coerced by someone else, explains Joseph Nicolosi. “A wife may force her husband into therapy once it’s revealed that he’s dealing with homosexuality, or an adolescent might be brought in by his parents because they found out that he’s dabbling in gay Web sites.” That, however, he says, would never be the foundation for any therapy. “Eventually, the only way the therapy is going to work is if the client sees the reason for himself. This has to make sense for him.”

Although practitioners of conversion therapy suggest otherwise, the American Psychological Association insists that claims of success with reparative therapy are dubious. Because they often stem from organizations with an inherent bias against homosexuality, their ethical bases have been called into question.

“What I find particularly telling is that the people who believe that you can change are the ones who think you should change,” says Ron Schlitter, deputy executive director of Parents, Families, and Friends of Lesbians and Gays (PFLAG). “The science is not there to support reparative therapy, and when you dig a little deeper, you realize that there’s a lot of ideology and politics involved with this idea that change not only is possible, but that sexual orientation or homosexual orientation in particular is some kind of choice. It’s a damaging lie that is wrong on so many levels, yet it’s continually repeated as if somehow that’s going to make it true.”

What’s considered successful eradication of homoerotic response by reparative therapists is discredited by those who contest it as mere suppression of feeling or behavior. Study participants have not been rigorously selected or contrasted with control groups, some suggest, nor, they say, has bias in the studies been controlled. Reported positive outcomes, critics contend, have not been well-documented and are not supported by sound, peer-reviewed, longitudinal studies—the gold standard of validation for any therapeutic approach.

Finally, many who dispute the validity of reparative therapy note that claims of positive outcomes have often been reported in publications with minimal credibility, and those few that have emerged in prestigious publications have quickly been met with vigorous criticism.

Professional Support
NARTH has gained support from the former president of the American Psychological Association, Robert Perloff, PhD, who was the keynote speaker at the annual NARTH Conference last November. Perloff’s lecture, titled “Free to Choose,” began by emphasizing the importance of client self-determination, a cornerstone value of all mental health professions. Said Perloff, “I am here as the champion of one’s right to choose… It is my fervent belief that freedom of choice should govern one’s sexual orientation… If homosexuals choose to transform their sexuality into heterosexuality, that resolve and decision is theirs and theirs alone, and should not be tampered with by any special interest group—including the gay community…”

In support of NARTH’s mission statement, Perloff concluded, “The individual’s right for self-determination of sexuality—or sexual autonomy—is, I am happy to see, inherent in NARTH’s position statement: ‘NARTH respects each client’s dignity, autonomy, and free agency… Every individual has the right to claim a gay identity, or to develop [his or her] heterosexual potential. The right to seek therapy to change one’s sexual adaptation is considered self-evident and inalienable.’”

Noting that he was a fellow of the American Psychological Association’s Lesbian and Gay division, Perloff reiterated his support for gay and lesbian issues. However, he vigorously declared his opposition to the efforts of the gay community within the American Psychological Association to prevent psychotherapists from accepting clients who wished to develop their heterosexual potential.

To support the value of reparative therapy and demonstrate positive outcomes, Joseph Nicolosi points to the findings of research studies suggesting that sexual orientation could be changed. He emphasizes in particular the research of Robert Spitzer, MD, a Columbia University psychiatrist, who presented the findings of one study to the American Psychiatric Association’s annual convention. The study and the dissemination of its findings at so prestigious an organization have been frequently touted as evidence and support for reparative therapy.

The American Psychiatric Association, however, renounced the study, disputed its findings, and reiterated its position that there’s no basis for reparative therapy and that the practice can, in fact, be harmful.

Linda Nicolosi adds, “I think both sides in this issue need to frankly admit that matters of sexuality are fundamentally ethical-philosophical issues; thus, there can never be a purely ‘scientific’ answer that will settle the question, ‘Is homosexuality a mental illness?’ Both sides need to learn to tolerate each other as legitimate expressions of intellectual diversity within the mental health profession.”

“The political agenda has eclipsed the fundamental right of individuals to seek treatment that they want,” says Joseph Nicolosi. “This kind of therapy should be available for individuals who want to explore their heterosexual potential and who want to diminish something that’s dissatisfying to them. They’ve been told by other therapists that the solution to their problem is to work through their homophobia and to learn to accept and enjoy their homosexuality, but that is not a sufficient answer for certain individuals, either because of their value system, world view, philosophy, religion, or personal desires. Those individuals should be given a chance to explore this alternative therapy,” he concludes.

Criticism
Critics refute these beliefs, suggesting that the practice of reparative therapy is a form of discrimination that’s based on faulty premises—chiefly that homosexuality is an illness—and they warn of its dangers and potentially destructive consequences. The therapy, explains Tina B. Tessina, PhD, psychotherapist and author of It Ends With You: Grow Up and Out of Dysfunction and Gay Relationships: How to Find Them, How to Improve Them, How to Make Them Last, has been responsible for a lot of pain. “It starts from the premise that being gay, lesbian, or bisexual is wrong to begin with, and therefore strengthens the victims’ internal homophobia, self-hatred, and dysfunction.” When, she asks, “will people get that this is a dysfunctional, unscientific, untherapeutic, and even un-Christian idea?”

There’s an extraordinarily high rate of failure of these therapies, explains Stevens, and, she says, there’s a significant risk of suicidal behavior or suicide among individuals who’ve gone through such attempts at conversion. Because they often are blame-oriented, she adds—blaming the client for their “choice” or the parents for behavior resulting in homosexuality, “they can be very damaging not only to clients but their families as well, as any kind of therapy that’s blaming and moralistic can be.”

The concepts behind conversion therapy, she says, spring from a conservative religious standpoint that sees homosexuality as a choice and suggests that there’s something wrong in individuals who make that choice. Stevens, who insists that homosexuality isn’t a matter of morals or mental illness, says she’s never seen a gay or lesbian person “converted” to a heterosexual orientation and rejects the notion that sexual orientation is a matter of choice. “I’ve never seen a gay or lesbian person choose to be gay or lesbian,” says Stevens. “It’s too awful and painful. There are so many prejudices against them in this culture.”

According to Stevens, it’s one thing if a client comes to a therapist and asks for help to live as a heterosexual. “That would be something to explore and to honor in a client, but that’s quite different from what is usually meant by conversion or reparative therapy, which is more often when the therapist or social worker believes homosexuality is wrong and that it arises in reaction to an unavailable father or an overbearing mother.”

This therapy, she suggests, is very punitive and pathologizing and thus is outside the bounds of professional practice. “The traditional values of social workers have no place for pathologizing our clients. We draw on their strengths and honor their wishes.”

Social workers, suggests Schlitter, should take steps to be as informed as possible on this issue. “People have legitimate questions as they sort through what’s real and what is not, and there are resources out there for self-education. Social workers are going to be dealing with people whose lives are the wreckage of this kind of thing,” he explains.

Social Work’s Role?
While some maintain that social workers can and should perform reparative therapy, Roy Gilbert-Higginson, PhD, MSW, deputy director of field and policy at PFLAG, says, “My take as a social worker is that the social work code of ethics prohibits me from getting involved in reparative therapy. The code puts you in the position of starting where your client is and of not doing anything that is going to harm the client. It would be a transgression on the part of a social worker to practice such therapy.”

Schlitter, Gilbert-Higginson, and Stevens believe the role of social workers is to help people who’ve been damaged by such therapy. “We have people come to us who are ashamed, embarrassed, and they’re trying to put back the pieces of what was a very tortured life in some ways that’s now perhaps in even worse shape because of what they’ve gone through.”

According to Gilbert-Higginson, “Anybody that’s in counseling who’s ever come into contact with someone who’s been in reparative therapy deals with the wreckage of reparative therapy.” The therapy, he insists, isn’t reparative, but rather is destructive. “It doesn’t do anything to resolve the person’s basic problem—it papers over the cracks. A person who’s going to a psychologist or any other kind of counseling and saying they’re unhappy about their homosexuality needs guidance on what is the root of their unhappiness, not to be converted. And that’s the basic problem with reparative therapy.”

Social workers, Schlitter says, need to understand why people with sincere personal motives think reparative therapy might be something they want to try for themselves and help direct them to the kinds of resources or support they might need as they try to explore what their lives are about.

Adds Gilbert-Higginson, “The social worker’s role is to help clients get to a place where they’re comfortable with themselves, and for the client coming into therapy because of a problem with their sexual orientation, that could be that they’re comfortable with being a homosexual or comfortable being a heterosexual. The question must be open going into therapy. If you’re going into reparative therapy with the declared intent of ‘curing’ your homosexuality, the openness is missing and the element of choice is gone.”

Stevens is loathe to criticize the work of other mental health professionals, yet she’s adamant that licensed professionals are obligated to support their clients and need to be alert to professional practices that seem to be unethical or harmful and respond appropriately. It’s also crucial, she says, to help clients who’ve had negative therapeutic experiences and help them work through the aspects of any kind of therapy that might be harmful or painful.

“Social work as a discipline requires that we respect individual differences and serve as advocates for our clients,” she says. “To try to ‘convert’ a homosexual violates this principle.”

— Kate Jackson is a staff writer for Social Work Today.

For more information on this issue, visit the following Web sites:

American Psychological Association
www.apa.org

Parents, Families, and Friends of Lesbians and Gays
www.pflag.org

The National Association for Research and Therapy of Homosexuality
www.narth.com

The coalition is comprised of the American Academy of Pediatrics, the American Counseling Association, the American Association of School Administrators, the American Federation of Teachers, the American Psychological Association, the American School Health Association, the Interfaith Alliance Foundation, the National Association of School Psychologists, the National Association of Social Workers, and the National Education Association. The work provides a thorough history and assessment of the reparative therapy movement and resources for therapists and educators.

To learn more, visit the Just the Facts Web site at www.apa.org/pi/lgbc/publications/justthefacts.html.