Dale's Web Pages — ONE OUT OF TWO

CHANGE OF SEXUAL ORIENTATION — REVIEW OF THE LITERATURE

By NARTH

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8) OPPOSITION TO THERAPEUTIC CHANGE

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Barrett, R., Barzan, R. (1996) Spiritual experiences of gay men and lesbians. Counseling and Values. 41: 4 - 15.

RELIGION: "...assisting gay and lesbians to step away from external religious authority may challenge the counselor's own acceptance of religious teachings."(8)

"most counselors will benefit from a model that help them understand the difference between spiritual and religious authority." (8)

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Begelman, D.(1975) Ethical and legal issues of behavior modification (in Hersen, M., Eisler, R., Miller, P (ed) Progress in Behavior Modification NY: Academic.

ETHICS: The efforts of behavior therapists to reorient homosexuals to heterosexuals by their very existence constitute a significant causal element in reinforcing the social doctrine that homosexuality is bad. Indeed, the point of the activist protest that behavior therapists contribute significantly to preventing the exercise of any real option in decision-making about sexual identity, by further strengthening the prejudice that homosexuality is a "problem behavior," since treatment may be offered for it. As a consequence of this therapeutic stance, as well as a wider system of social and attitudinal pressures, homosexuals tend to seek treatment for being homosexuals."

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Begelman, D. (1977) Homosexuality and the ethics of behavioral intervention. Journal of Homosexuality. 2, 3: 213 - 218.

ETHICS: "My recommendation that behavior therapists consider abandoning the administration of sexual reorientation techniques is based on the following considerations. 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. I realize this is a serious charge, especially in relation to therapists sensitive to the abstract issues involved. But I believe the charge is valid, even when therapists administer these techniques out of concern for the alleviation of client distress, in contrast to harboring traditional biases against homosexuality. The recommendation is not based on any abstract disagreement with the principle that clients have a right to seek aid in reducing their anxiety or upset. But it does take cognizance of the fact that the homosexual person who seeks treatment does so most of the time because he has been forced into adopting a conventional and prejudicial view of his behavior. On what ethical basis, it may be asked, are we obliged to desert the client in favor of allegiance to an abstract set of considerations." (217)

DISORDER: "... investigators have also argued that since recent studies reveal homosexuals do no worse than heterosexual subjects on such measures, there is no evidence to confirm that homosexuality is a disorder. However, such studies actually have no bearing on the issue at hand. At best, they only confirm the hypothesis that homosexual persons are not as crazy as many have hitherto believed, not that homosexuality is not a disorder. If a poor showing on independent measures of adjustment confirms the hypotheses under investigation, wouldn't a reverse finding confirm the hypotheses that heterosexuality is disorder? The answer is it wouldn't. The question "is Heterosexuality a disorder? It is not an empirically determinable one; it is a senseless one. Homosexuality has not been classified as a 'mental illness' on the basis of presumptions about a showing on measures of adjustment. It has been so categorized because it is perceived as significant departure from acceptable standards of conduct in the areas of sexual behavior... Coming to regard homosexuality as simply another life-style in contrast to a disorder is merely to expand the criteria for a concept of acceptable behavior. This is not equivalent to learning something new about homosexuality; it is more akin to judging it differently, while in possession of the same old facts." (218)

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Blair, R. (1972) Etiological and Treatment Literature on Homosexuality. NY: National Task Force on Student Personnel Services and Homosexuality.

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Blair, R. (1982) Ex-Gay. NY: Homosexual Community Counseling Center.

RELIGION: In studying the Ex-Gay movement he found that although many of these practitioners publicly promise change, they privately acknowledge that celibacy is the realistic goal to which gay men and lesbians must aspire. He further characterizes many religious conversionists as individuals deeply troubled about their own sexual orientation, or whose own sexual conversion is incomplete. Blair reports a host of problems with such counselors, including the sexual abuse of client.

"Since leaving the 'ex-gay' movement Evans [a former member of an ex-gay ministry] writes: 'I have met other born-again Christians who have accepted their homosexuality as I have, as our natural way of life. We have dedicated this to the Lord...Instead of trying to reject or suppress this portion of myself, I must present my entire being, including my homosexuality, as a loving sacrifice to God.'"

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Bohan, J. (1996) Psychology and Sexual Orientation: Coming to Terms. NY: Routledge.

HETEROSEXISM: "...contemporary theory has undertaken to theorize heterosexuality itself, to ask what are the assumptions that underlie it, what is the origin of the hostility toward LGB identity, and what is the impact on human experience of the privileging of heterosexuality." (33)

RELIGION: "Religious beliefs and strongly held political ideologies are examples of values. This function might explain the correlation between psychological heterosexism and conservative political beliefs, as well as the relation to religiosity, especially a commitment to conservative religious institutions whose teachings about homophilia are extremely negative. Indeed, the religious arguments for homonegativity is arguably the most powerful force in contemporary social movements to limit gay rights. Also, the frequent finding that homonegativity is correlated with other forms of prejudice may be explicable from this perspective. The cohesiveness of these attitudes suggests that they serve an important function for the individual"

"Homonegative attitudes of this sort may change if the individual recognizes a conflict between this value and another value... attitudes might change if a revered authority, such as a member of the clergy or a biblical scholar, were to present a more positive view of LGB experience, still grounded in religious teaching." (p. 58)

"Diminishing anti-LGB prejudice and discrimination will require institutional as well as individual change.

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Cabaj, R. (1988) Homosexuality and Neurosis. Journal of Homosexuality. 15, 1/2: 13 - 24

CHOICE: "If the patient is truly dissatisfied [with being gay], once the evaluation is completed, he must be clearly advised of the difficulties involved in attempting to change one's sexual orientation and the unlikelihood that any such attempt would be successful. Better use of therapy would be to help the patent accept his orientation and explore his fears of and resistance to being homosexual. If the patient insists, a referral to a sensitive therapist willing to work on changing orientation may be in order, but only if such a therapist is objective, and not biased against homosexuality, and can help the patient accept homosexuality if change is not possible."

CHILDHOOD: It will be a relief for some patients to learn that there is no evidence that parental upbringing plays a role in sexual orientation development, but such information may serve to cut short the anger being expressed toward their parents in the therapy, anger that may really be tied to other parent-child issues. The probably role of genetics and biological and biochemical factors in utero may serve to confuse some patients and obscure the target of anger if the patient resents his or her orientation. ... the patient may see the therapist (one of the targets) as being too accepting and objective, and as avoiding or dismissing the patient's feelings. The common wish to blame someone or something for a perceived problem, whether it be sexual orientation or failed relationships, may help obscure the poor self-esteem of the patient, which is only intensified by internal homophobia."

ALCOHOLISM: 'The illness of alcoholism must always be considered in evaluating the gay patient, especially since alcoholism causes depression, anxiety, phobias, and social isolation -- common complaints for seeking psychotherapy.'

SEXUAL ADDICTION: "Many gay men find themselves locked into sexual promiscuity and may wish to change for health reasons, or in order to establish an intimate relationship. Such obsessive-compulsive behavior can be treated by traditional means, but group therapy seems to be particularly useful."

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Coleman, E. (1978) Toward a new model of treatment of homosexuality: A review. Journal of Homosexuality. 3, 4: 345 - 357.

ABSTRACT: A review of the literature of outcome studies in the psychoanalytic or behavioral treatment of homosexuality reveals limited results when "heterosexual shift" is the goal. Recently, however, a growing body of empirical knowledge has accumulated that challenges the illness or maladaptive model of homosexuality. Consequently, a new model has been emerging that is designed to assist homosexuals to recognize, accept, and value their sexual identity and to help them adjust to this identity in a predominantly heterosexual society. Unfortunately, only a few studies exist that examine the results of this new approach.

ETHICS: "... to offer a cure to homosexuals who request a change in their sexual orientation is, in my opinion unethical. There is evidence, as reviewed in this paper, that therapists can help individuals change their behavior for a period of time. The question remains whether it is beneficial for clients to change their behavior to something that is inconsistent or incongruent with their sexual orientation. In most cases, I would say not... Exploring heterosexual behavior should always be available as a treatment goal, but it should never be viewed as denying or changing sexual orientation." (355)

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Coleman, E. (1982) Changing approaches to the treatment of homosexuality: A review (in Paul, W., Weinrich, J., Gonsiorek, J., Hotvedt, M.(eds) Homosexuality: Social, Psychological and Biological Issues. The Final Report of the Society for the Psychological Study of Social Issues Task Force of Sexual Orientation. Beverly Hills CA: Sage.) 81 - 88.

ETHICS: "... therapists should enlist the aid of clients to combat the social system that has been responsible for unjustifiably creating their negative self-image. It is unethical and morally questionable to offer a 'cure' to homosexuals who request a change in their sexual orientation."

CHOICE: "There is the problem clients who simply will not accept treatment that is based on improving homosexual functioning. Therapists such as Freund (1977) have thought that for these clients counseling toward heterosexual adjustment is acceptable as a "second-best choice."... This treatment approach should be offered cautiously. Clients must explore their reasons for wanting such goals. They must understand the meaning and significance of their decision to act in a way that is incongruent with their sexual orientation. they must understand the external forces that affect their decision to do so. The danger with this approach is that in helping clients increase their sexual repertoire to include heterosexual activity this may lead to the feeling that their basic sexual orientation is not acceptable or tolerated. This would lead to the same sense of failure that is generated by attempts to "cure" individuals of their homosexuality."

ETHICS: "It is naive to think that we are, can, or should be value-free agents. We cannot continue to participate in society's unfair discrimination against homosexuality. There has been and should continue to be more emphasis in treatment of homosexuals on assisting them to recognize and accept their sexual identity, to improve interpersonal and intersocial functioning, and to help them value this identity in a predominantly heterosexual society."

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Coleman, E. (1982) Developmental stages of the coming-out process (in Paul, W., Weinrich, J., Gonsiorek, J., Hotvedt, M.(eds) Homosexuality: Social, Psychological and Biological Issues. The Final Report of the Society for the Psychological Study of Social Issues Task Force of Sexual Orientation. Beverly Hills CA: Sage.) 149 - 157.

SUICIDE: "The conflict of this stage is resolved in several ways. Some individuals decide to commit suicide. Others hid their true sexual identity from themselves and others and continue to suffer from chronic low-grade depression."

PROMISCUITY: "When gay men and lesbians finally give themselves permission to become sexual with members of their own sex, there is naturally a surge of interest and intrigue... This natural and essential social and sexual experimentation can be viewed as promiscuous behavior."

CASE: David, 20-year-old college student, out of the closet for two years, spent every weekend in gay bars and baths, was depressed. "He began to doubt whether anyone was interested in him for other than for sex." He saw his behavior as "immature and sinful." Therapist encourages him to explore and experiment. "I think it is a mistake to push people to form long-term committed relationships at this point. I remember as an adolescent that I was always told to play the field."

CASE: Gary 35-year-old graduate student referred after serious suicide attempt after first long-term lover cheated on him and then left. Had been through bar and bath scene.

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Conlin, D., Smith, J. (1982) Group psychotherapy for gay men (in Gonsiorek (ed) Homosexuality and Psychotherapy. NY: Haworth) 105 - 112.

INTERNALIZED HOMOPHOBIA: "None of the group members has requested a change of sexual orientation; all, however, have been either disturbed by or in conflict with their homosexual feelings, and have been socially inhibited as a consequence of their internalized homophobia."

DISORDERS: "In our experience in working with both mixed and all-gay groups, we have found that mixed groups can be useful to the homosexual patient who is already functioning at a high level of self-acceptance and adaptation as a gay person, and presents with problems unrelated to sexual orientation, such as anxiety or depressive disorders." (107)

CASES: Mr. A. in group "was able to admit and accept his own bitterness, alienation, and distance from his family, who rejected him."

Mr. B. problem with alcohol.

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Corbett, K. (1993) The mystery of homosexuality. Psychoanalytic Psychotherapy. 10, 3: 345 - 357.

ABSTRACT: I contend that male homosexuality is a differently structured masculinity, not a stimulated femininity ... the gay man's gender identity is distinguished by his experience of passivity in relation to another man.

FATHER: "I have found that passive longings seen from the fact that a homosexual boy's choice of love object is modeled on his father, leading to the boys wish to have his erogenous zones touched or filled by the father. The fantasy of being loved by a the father is essentially an expression of passive longing."

"Gay men frequently harbor the belief that their experience of masculinity is flawed, especially in comparison to normative heterosexual masculinity. Recognizing the inherent dilemma in such experience, a gay male patient of mine commented, "There was this sense of otherness. You know, not being the norm -- the normal boy'."

"I have found that my gay male patients feel that their fathers did not comprehend their early gender experience . This lack of comprehension is often experienced by the son as signaling the father's disappointment. Without exception, my gay male patients present themselves as having disappointed the parents, with greater emphasis generally placed on the disappointment of their fathers; they were not the sons their fathers wished for."

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Davison, G. (1974) Behavior therapy and homosexuality: A critical perspective. Behavior Therapy. 5: 16 - 28.

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Davison, G. (1976) Homosexuality: The ethical challenge. Journal of Consulting and Clinical Psychology. 44:157 - 162.

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Davison, G. (1982) Politics, ethics and therapy for homosexuality. (in Gonsiorek, J. Homosexuality and psychotherapy. NY Haworth Press) 89 - 96.

FAMILY: "... in the Bieber study... there is also a major logical error in reasoning -- namely, that one has demonstrated pathology of homosexuality by showing that male homosexuals have child-rearing experiences that are different from those of male heterosexuals. One cannot attach a pathogenic label to a pattern of child rearing unless one a prior labels the adult behavior patter as pathological. For example, Bieber et al. found that what they called a "close-binding intimate mother" was present much more often in the life histories of the analytic male homosexual patients than among the heterosexual controls. But what is wrong with such a mother unless you happen to find her in the background of people whose current behavior you judge beforehand to be pathological? Moreover, even when an emotional disorder is identified in a homosexual, it could be argued that the problem is due to the extreme duress under which the person has to live in a society that asserts that homosexuals are "queer" and that actively oppresses them."

ETHICS: "... even if one were to demonstrate that a particular sexual preference could be modified by a negative learning experience, there remains the question of how relevant these data are to the ethical question of whether one should engage in such behavior changes regimens. The simple truth is that data on efficacy are quite irrelevant. Even if we could effect certain changes, there is still the more important question of whether we should. I believe we should not."

"Change of orientation therapy programs should be eliminated. Their availability only confirms professional and societal biases against homosexuality, despite seemingly progressive rhetoric about its normality.... Viewing therapists as contemporary society's secular priests rather than as value-neutral technicians will sensitize professionals and laypeople alike to large-scale social, political, and moral influences in human behavior."

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Davison, G. (1991) Constructionism and morality in therapy for homosexuality (in Gonsiorek, J., Weinrich (ed) Homosexuality: Research implications for public policy. Newbury Park CA: Sage) 137 - 148.

ETHICS: "... how can therapists honestly speak of nonprejudice when they participate in therapy regimens that by their very existence -- and regardless of their efficacy -- would seem to condone the current societal prejudice and perhaps also impede social?"

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Edwards, R. (1996) Can sexual orientation change with therapy? APA Monitor. 27:49.

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Garnets, L., Hancock, K., Cochran, C., Goodchilds, J., Peplau, L. (1991) Issues in the psychotherapy with lesbians and gay men. American Psychologist. 46, 964 - 972.

ABSTRACT: "In 1984, a task force of the American Psychological Association (APA) Committee on Lesbian and Gay Concerns was charged with investigation bias in psychotherapy with lesbians and gay men. The task force surveyed a large and diverse sample of psychologists (2,544 of whom completed a questionnaire) to elicit information about specific instances of respondent-defined biased and sensitive psychotherapy practice. Open-ended responses were used to separately identify major themes and biased and sensitive practice and to illustrate each with concrete examples. Results suggest that psychologists vary widely in their adherence to a standard of unbiased practice with gay men and lesbians. To bring individual practice into accord with APA policy will require continued and expanded effort to educate practitioners about sexual orientation."

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Gittings, B. (1973) Gay, Proud, Healthy. Philadelphia PA: Gay Activists Alliance.

GENOCIDE: "While much of psychiatry seems unaware of this, it is felt with growing resentment and bitterness by the homosexual community who increasingly see psychiatry as THE major enemy in a battle against deeply rooted societal prejudice, and see psychiatrists as singularly insensitive and obtuse to the destruction which they are wreaking upon homosexuals... The homosexual community looks upon efforts to change homosexuals to heterosexuality, or to mold younger, supposedly malleable homosexuals into heterosexuality.. as an assault upon our people comparable in its way to genocide."

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Gonsiorek, J. (1982a) Introduction (in Paul, W., Weinrich, J., Gonsiorek, J., Hotvedt, M.(eds) Homosexuality: Social, Psychological and Biological Issues. The Final Report of the Society for the Psychological Study of Social Issues Task Force of Sexual Orientation. Beverly Hills CA: Sage.)

DISORDER: "Therefore, if other studies find that some homosexuals are disturbed, the proper conclusion is that they are disturbed for reasons other than sexual orientation, or perhaps for reasons in conjunction with sexual orientation; but it cannot be maintained that sexual orientation per se and psychological adjustment are related."(65)

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Gonsiorek, J. (1982b) Results of psychological testing on homosexual populations. (in Paul, W., Weinrich, J., Gonsiorek, J., Hotvedt, M.(eds) Homosexuality: Social, Psychological and Biological Issues. The Final Report of the Society for the Psychological Study of Social Issues Task Force of Sexual Orientation. Beverly Hills CA: Sage.)

DISORDER: "... in this chapter I intend to demonstrate that a careful examination of psychological test data can not only answer the important question of whether homosexuality per se is a sign of mental illness or psychological disturbance."

FAMILY: "... much of the psychoanalytic theorizing about the causes of homosexuality focuses on certain family patterns which are alleged to predispose a child toward homosexuality... Whether or not one believes these theories of causality of homosexuality (and this topic is heatedly debated, with no apparent winner in sight), there is an implication in much of this research that since such a pattern is alleged to be more frequent in families of homosexuals, this is evidence that homosexuality per se is disturbed because such family patterns are indicative of psychological disturbance. On the face of it, this reasoning may sound plausible. In reality, however, such reasoning is circular. The veracity of theories which hold that certain family patterns are pathological are very much in question. When 'differences' are found, this is alleged to be evidence in favor of the theory. But the existence of difference does not explain what those differences mean." (71)

"... if a group with allegedly disturbed family pattern also scored in a disturbed range on these measures, there world be strong evidence for both a conclusion of greater disturbance in the group and for one's favorite theory."

"Given the immature state of the behavioral sciences, it is not sufficient or even reasonable to assert that because one's favorite theory would lead to a conclusion that family pattern x means disturbance, therefore individuals with family pattern x are more disturbed." (72)

DISORDER: "Does the statement that homosexuality per se is not a sign of psychological disturbance mean that there are no disturbed homosexuals. Absolutely not. It means that the proportion, or base rate, of disturbed individuals in homosexual and heterosexual populations is roughly equivalent." (73)

RESEARCH: "The vast majority of the studies to be reviewed in this chapter are flawed in that they sample from particular, as opposed to general, segments of homosexual populations."

"Despite all these problems, a clear and consistent pattern emerges from studies on homosexuals using psychological testing. Homosexuality in and of itself is unrelated to psychological disturbance or maladjustment." (74)

INTERNALIZED HOMOPHOBIA: "Further, if there are some reasons (one being increased levels of external stress) to believe that certain measures of disturbances may be higher in certain homosexual populations. This also can be congruent with a conclusion that homosexuality in itself is not an indicator of psychological disturbance, because if homosexuals as a group are subject to more environmental stress, then a proper comparison group may not be heterosexual in general, but heterosexuals with roughly equivalent environmental stress."

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Gonsiorek, J. (1982c) The use of diagnostic concepts in working with gay and lesbian populations. (in Homosexuality and Psychotherapy. NY: Haworth Press)

DISORDERS: "When a clinical practitioner is faced with a gay or lesbian client who may be giving indications of severe depression, thought disorder, persistent characterological problems, neuropsychogical impairment, etc., in addition to or instead of issues related to societal oppression, coming out, etc. (which may at times fit reasonably well with the anti-diagnostic mode) anti-diagnostic views are not only less than helpful, but their sole application may constitute incompetence or malpractice."

"...this paper makes certain assumptions. First that homosexuality per se is unrelated to psychopathology and psychological adjustment."(Gonsiorek 1977, 1982b)

"There are a number of clinical conditions in which individuals at times manifest homosexual behavior or concerns, and the client may therefore appear to be coming out or having a sexual identity crisis when in reality, these behaviors or concerns are part of serious psychopatholoy. On the other hand, the coming out process in itself can produce in some individuals considerable psychiatric symptomatology reminiscent of serious underlying psychopathology; but in fact, such pathology does not exist and the individual is having a particularly difficult time coming to terms with his or her sexuality. Finally, the coming out process may serve as a precipitating event for some individuals who do have severe underlying problems; that is both may be present."

PARANOIA: "Stoller's view (1968) view, which suggests that any major threat to one's core sexual identity may elicit paranoid defenses is probably a more useful statement of any linkage between paranoia and homosexuality."

"Paranoia and other florid reactions of a sexual identity crisis in a genuinely homosexual person are more likely to be partially, or at times completely, reality-based."

SCHIZOPHRENIA: "Some gay/lesbian affirmative therapists do an enormous disservice to their clients who are gay or lesbian and schizophrenic by minimizing or ignoring the client's schizophrenia." Some therapists "interpret aspects of schizophrenia (such as interpersonal awkwardness; chronic lack of desire, pleasure deficit; disordered thought process; pervasive ambivalence; etc. as signs of 'not really accepting one's gayness.' They may then pressure or shame such client into moving beyond their capabilities. This can be genuinely damaging, particularly if done in a group therapy setting where group members mimic the therapists and provide considerable pressure. Some years ago, this author had to hospitalize one such individual who became psychotic and suicidal as a result of such pressure in a coming out group."

BORDERLINE: "At time, the person having a sexual identity crisis may appear floridly disturbed and "borderline-ish" than a true borderline personality in crisis."

"The processes of coming out are often profound and may shake an individual to his or her core. This alone may account for the production of florid symptoms."

"...some individuals with obsessional or counter phobic personality features may experience a flooding when coming to terms with same-sex feelings."

"...the development of borderline appearing personality features is response to repeated anonymous sexual behavior...A gay man begins to frequent back-room bars, baths, public restrooms, parks or other public places for anonymous sex. He, on occasion, does have anonymous sex, which may be reinforcing and perceived as a boost to self-esteem. On another level, it may elicit a variety of guilt and sef-recrimination responses if the individual has beliefs that sexuality, or same-sex activity, or some forms of sexual activity in which he has been engaging in are immoral, improper... both the thrill of success at sexual conquest and the negative feelings may become even more highly charged.... One way of handling this situation is via splitting operations. The result in these individuals is an overlay of borderline-appearing personality functions on a variety of pre-existing personality styles."

"...such disease-orientated writers have described lesbian relationships as a pathological interaction between two individuals with borderline features, if not actual borderline personalities."

NARCISSISM: "...narcissistic-appearing overlay...The appearance of these individuals may be one of extreme narcissism, shallowness and almost complete immersion of the personality in the changing whirlwinds of high fashion, the latest chic, or the 'right' social circles."

DISORDER: "...these overlays may be tenacious or even become permanent aspects of personality. Some victims may be scarred psychologically with the marks of social oppression of homosexuality."

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Gonsiorek, J. (1982d) Organizational and staff problems in gay/lesbian mental health agencies. (in Homosexuality and Psychotherapy. NY: Haworth) 193 - 208.

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Gonsiorek, J. (1991) The empirical basis for the demise of the illness model of homosexuality (in Gonsiorek, J., Weinrich, J. (ed) Homosexuality: Research Implications for Public Policy. Newbury Park CA: Sage) 115 - 136.

FAMILY: The model of pathological homosexuality is rejected. Rejects the theories of family dysfunction as a cause of homosexuality.

RESEARCH: Researcher bias, as well as methodological inadequacies characterize studies supporting the illness model. Hooker (1957) referenced.

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Gonsiorek, J., Sell, R., Weinrich, J. (1995) Definition and measurement of sexual orientation. Suicide and Life Threatening Behavior. 25( sup) : 40 - 51.

ABSTRACT: "Critically examines how sexual orientations (SO) are measured and defined. The conceptualization problems of homosexuality are highlighted along with the role played by cultural factors. Measurements of SO include in-depth interviews, survey and cross-cultural studies, which face problems of self-disclosure risks. Physiological measures, like plethysmyograph, also have limitations with involuntary Ss. The commonly used measurement, verbal self-report, faces limitations like Ss having to accurately appraise themselves. The limitation of current conceptualizations of SO is lack of research on change over time. Caution is raised against measurement concerns with adolescents are made, a specific measurement strategy, applicable at a number of different levels are described."

CHANGE: "Perhaps the most dramatic limitations of current conceptualizations is change over time. There is essentially no research on the longitudinal stability of sexual orientation over the adult life span."

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Green, R. (1988) The immutability of (homo) sexual orientation: Behavioral science implications for a constitutional (legal) analysis. The Journal of Psychiatry and Law. 16: 537- 573.

ABSTRACT: "The Supreme Court ruled in Bowers v Hardwick that there is no fundamental right under a substantive due process analysis to engage in homosexual behavior. Therefore, the remaining constitutional route to protecting homosexuals against discrimination is the equal protection clause of the fourteenth amendment. For the highest level of protection there, a class of persons must be declared "suspect." To so qualify, the class should demonstrate, Inter alia, that the trait for which it is stigmatized is immutable. Growing research evidence exists for an innate origin of homosexuality. More importantly, whatever its origins, the low rate of sexual reorientation, via psychiatric intervention satisfies the concept of immutability. The Court's criteria are met for applying the strictest of scrutiny to laws that discriminate against homosexuals."

CHILDHOOD: Green uses results of a longitudinal study of 64 boys with extensive cross-gender behavior to argue for "the very early and essentially irreversible establishment of sexual orientation in the male."

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Haldeman, C., (1991) Conversion therapy for gay men and lesbians: A scientific examination. (in Gonsiorek, J., Weinrich, J. (ed) Homosexuality: Research Implications for Public Policy. Newbury Park CA: Sage) 149 -160.

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

ABSTRACT: "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." (p.211)

CHANGE: "The categories homosexual, heterosexual, and bisexual, conceived by many researchers as fixed and dichotomous, are in reality very fluid... Essentially, the fixed, behavior-based model of sexual orientation assumed by almost all conversion therapists may be invalid. For individuals, sexual orientation is a variable construct subject to changes in erotic and affectional preferences, as well as changes in social values and political philosophy that may ebb and flow throughout life."

RELIGION: "Fundamentalist Christian conversion programs hold enormous symbolic power over many people. Possibly exacerbating the harm to naive, shame-ridden counselees, these programs operate under the formidable auspices of the Christian church...."

DISORDER; "Were there properties intrinsic to homosexuality that make it a pathological condition, we would be able to observe and measure them directly. In reality, however, there exists a wide literature indicating just the opposite: that gay men and lesbians do not differ significantly from heterosexual men and women on measure of psychological stability, social or vocational adjustment, or capacity for decision making." (p.225)

RELIGION: "Such programs seek to divest the individual of his or her 'sinful' feelings or at least to make the pursuit of a heterosexual or celibate lifestyle possible. their theoretical base is founded on interpretations of scripture that condemn homosexual behavior, their often unspecified treatment methods rely on prayer, and their outcomes are generally limited to testimonials. Nonetheless, these programs bear some passing examinations because of the tremendous psychological impact they have on the many unhappy gay men and lesbians who seek their services and because of some psychologists' willingness to refer to them. Lastly, many such programs have been associated with significant ethical problems."

"Gay men who are most likely to be inclined toward doctrinaire religious practice are also likely to have lower self-concepts, to see homosexuality as more sinful, feel a greater sense of apprehension about negative responses from others, and are more depressed in general. (Weinberg & Williams, 1974) Such individuals make vulnerable targets for the 'ex-gay" ministries, as they are know. Fundamentalist Christian groups, such as Homosexuals Anonymous, Metanoia Ministries, Love in Action, Exodus International, and EXIT of Melodyland are the most visible purveyors of conversion therapy. The workings of these groups are well documented by Blair (1982) who states that, although many of these practitioners publicly promise change, they privately acknowledge that celibacy is the realistic goal to which gay men and lesbians must aspire. He further characterizes many religious conversionists as individuals deeply troubled about their own sexual orientation, or whose own sexual conversion is incomplete. Blair reports a host of problems with such counselors, including the sexual abuse of client."(p.224)

FATHER: "Nicolosi... cites numerous studies that suggest that gay men have greater frequencies of disrupted bonds with their fathers, as well as a host of psychological concerns, such as assertion problems. These observations are used to justify a pathological assessment of homosexuality. The error in such reasoning is that the conclusion has preceded the data. There may be cause to examine the potentially harmful impact of a detached father and his effect on the individual's self-concept or capacity for intimacy, but why should a detached father be selected as the key player in causing homosexuality unless an a priori decision about the pathological nature of homosexuality has been made and unless he is being investigated as the cause? This perspective is not consistent with the available data, nor does it explain the millions of heterosexual men who come from backgrounds similar to those of gay men, or for that matter, those gay men with strong father-son relationships. Nicolosi does not support his hypothesis or his treatment methods with any empirical data." (223)

RESEARCH: "APA "fact sheet of Reparative Therapy" opens with the following statement: 'No scientific evidence exists to support the effectiveness of any of the conversion therapies that try to change sexual orientation.' A review of the literature makes it obvious why this statement is made."

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Hammersmith, S. Weinberg, M. (1973) Homosexual identity: Commitment, adjustment, and significant other. Sociometry. 36, 1: 56 - 79.

"... the young homosexual experiences guilt and shame, anxiety, depression and feelings of worthlessness, but that he is largely relieved of these feelings when he 'accepts' his homosexuality."

"The person who defines himself as homosexual may still regret the identity. The homosexual may resign himself to his homosexuality as a fact of life and yet feel that he would really rather be "a homosexual."

"... having 'settled into' a homosexual identity -- leads to better psychological adjustment as indicated by a more stable, positive self-image, fewer anxiety symptoms, and less depression. In addition, one model proposes that support of his homosexual identity by significant others positively influences the homosexual's commitment to that identity."

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Harry, J. (1985) Sexual orientation as destiny. Journal of Homosexuality. 10, 3/4: 111 - 123.

CHILDHOOD: "My theses are that sexual orientation is (1) best defined in terms of attitudes or preferences rather than sexual behavior; (2) largely immutable during adult life; and (3) established at least as early as childhood."

"The evidence indicates that the basis for sexual orientation, if not the orientation itself, is established by early childhood. The evidence for this is the repeated finding that, as children, homosexuals of both sexes were far more likely than heterosexuals to be gender nonconformists or cross gendered.

CHANGE: I believe that my review of the evidence indicates that sexual orientation is immensely resistant to change, that it is established early in life, and that most of the evidence suggesting flexibility pertains only to sexual behavior.

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Hencken, J. (1982) Homosexuality and psychoanalysis: Toward a mutual understanding. (in Paul, W., Weinrich, J., Gonsiorek, J., Hotvedt, M.(eds) Homosexuality: Social, Psychological and Biological Issues. The Final Report of the Society for the Psychological Study of Social Issues Task Force of Sexual Orientation. Beverly Hills CA: Sage.) 121 -148.

FAMILY: "There is another way to view the information about a person's childhood one acquires in the psychoanalytic situation. This approach emphasizes not the search for causes in the past, but rather understanding of the ways in which people make psychological use of their childhood experiences in the current way they see their lives... In short , the emphasis in this approach is on psychological significance or meaning, rather than on causes."

"Moreover, the model presupposes that there was only one form of mature, adult personality -- the heterosexual 'genital character.'"

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Herek, G. (1991a) Myths about sexual orientation: A lawyer's guide to social science research. Law & Sexuality. 1: 133 - 172.

CHANGE: "Myth #3: Being homosexual is a choice that can be changed. The questions of whether sexual orientations are inborn or acquired and, if the latter, whether they are immutable or changeable, have aroused considerable controversy. some arguments for societal acceptance of lesbians and gay men have been based on the notion that homosexuality is an innate condition over which an individual has no choice. Writing as parents of gay children, for example, Griffin, Wirth, and Wirth described their own initial concerns that they might have caused their children's homosexuality. They argued for a biological explanation of homosexuality partly because: 'our society will accept gayness only if the vast majority of its citizens see it as a naturally occurring event. If most people understand that a certain percentage of society will be gay no matter what their family background is, or what their sexual experiences were, then gay people have a better chance of living lives free from fears of retaliation.'

"Perhaps agreeing with Griffin and others' equation of 'natural' and 'innate,' Americans who believe that homosexuality 'is something that people are born with' are more likely to have accepting attitudes of gay people than are those who believe it is an acquired characteristic or a personal preference."

"Given the current lack of knowledge about why some individuals develop a heterosexual orientation while others become homosexual, most social and behavioral scientists share Money's view that sexuality is shaped through a complex interaction of biological, psychological, and social forces. The relative importance of each, however, remains a topic of dispute."

"Even for the relatively small number of gay people who wish to become heterosexual, the many failures of so-called 'conversion' therapies indicate that, once established, sexual orientation is highly resistant to change."

"As recently as January of 1990, Dr. Bryant Welch, Executive Director for Professional Practice of the American Psychological Association, stated that "no scientific evidence exists to support the effectiveness of any of the conversion therapies that try to change one's sexual orientation' and that 'research findings suggest that efforts to 'repair' homosexuals are nothing more than social prejudice garbed in psychological accouterments.'"

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Herron, W., Kinter, T., Sollinger, I., Trubowitz, J. (1982) Psychoanalytic psychotherapy for homosexual clients: New concepts. (in Gonsiorek Homosexuality and Psychotherapy. NY: Haworth)

CHANGE: "Although a few psychoanalysts report success in his regard, their work gives no proof of absolute or eternal absence of all homosexual interests, desires and thoughts in their 'changed' patients."

"The majority psychoanalytic position, however, remains at variance with the APA decision... the reigning psychoanalytic attitude continues to be that homosexuality is a developmental disturbance to be resolved by conversion to heterosexuality."

"We view psychoanalysis as a developmental psychology with therapeutic applications that enable the patient to learn to make life choices based upon self-understanding. We believe sexual orientation to be one of these learned decisions, a decision based on constitutional and experiential occurrences."

"Changing a person's sexual behavior from homosexual to heterosexual might be accomplished by working with a potential already present, but this would not really change the person's preference. While it may appear that psychoanalysis can change a person's sexual orientation, in truth this is a limited accomplishment that happens only occasionally and even then is of questionable duration."

CASE STUDIES: Describe the "various derivations and uses of homosexuality. All these people were experiencing problems they regarded as connected to their homosexuality, although not all saw their sexual orientation as a major source of concern."

Client 1: "He identified most strongly with his mother and appeared to feel he was restoring symbiosis through homosexual acts... He was extremely anxious, intermittently depressed with suicidal ideation, and filled with rage toward the world."

Client 2: Bisexual "His rather narcissistic orientation interferes with his comprehension of how his wife and lover feel about him and how they feel about his behavior towards them. The narcissism, rather than the homosexuality, has become the focal problem of his therapy."

Client 3: Interested primarily in autoerotic sex. Domineering mother and sister and passive ineffectual father.

Client 4: Female suffered considerable rejection by her father. Angry and assertive.

Client 5: Feared intercourse with men. Lesbianism as a quest to regain the image of her lost mother.

Client 6: Priest, outwardly angry father, feels enhanced only be a sexual encounter with an attractive man.

Client 7: Priest, father passive and frightened, feels excessive guilt about sexual desires "Through therapy he has begun to realize that leaving the priesthood would allow him to pursue a homosexual life-style more freely."

"Our belief that all sexual behavior can serve a variety of purposes includes the conviction that homosexuality can be a 'healthy' sexual orientation."

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Hetrick, E., Stein, T. (1984) Ego-dystonic homosexuality: A developmental view. (in Innovations in Psychotherapy with Homosexuals. Washington DC: APA)

RELIGION: "... a child raised in a religiously orthodox family may have emotional and psychological difficulties reconciling religious and sexual identities."

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Hooberman, R. (1979) Psychological androgyny, feminine gender identity, and self-esteem in homosexual and heterosexual males. The Journal of Sex Research. 15, 4: 306 - 315.

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Hooker, E., Ziemba-Davis, M. (1990) Epilogue.(in McWhirter (ed) Homosexuality/ Heterosexuality) 400 - 402.

KINSEY: "I ... owe a great debt of gratitude to Alfred Kinsey without whom I would have had neither the courage to pose my questions nor the knowledge to frame them in the manner in which I did."

"In conclusion, we would like to note one other contribution of Dr. Kinsey: his validation of the many different variant of sexual orientation. Kinsey was very explicit in stating that, for example, homosexuality was a valid or as " normal" as heterosexuality for the individuals involved.

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Hopcke, R. ( 1990) Dorothy and her friends. Quadrant. 22, 2: 65 - 77.

HETEROSEXISM: "Patriarchal values identify particular personal characteristics as exclusively male or female, and assign social roles largely in terms of gender; in general, the characteristics and roles assigned to men are valued over those assigned to women."

"A heterosexist culture views heterosexuality as the only normal, and therefore acceptable, means of fulfilling human relationships. Accordingly all other forms of sexual relationship are considered either subordinate to or perversions of heterosexual relationships. The primacy of heterosexuality over same-sex or inter-sex relationships enjoys wide support from nearly every important cultural institution -- and has a long but by no means monolithic history."

HOMOPHOBIA: "Unlike heterosexuals, gay people have no model of self-image or relationship in the culture at large to support a growing awareness of their homosexuality. This lack of external cultural supports for their sexual and emotional development creates a peculiar and frequently destructive psychosocial vacuum for gay people, who often have a difficult time acknowledging their gay feelings and identity. Until quite recently, what seemed to be manifestations of pathology within homosexually oriented persons were understood as characteristics of homosexuality per se, rather than unfortunate adaptive responses to the fierce prejudice, horror, and hatred shown to homosexuality in Western society. By removing 'homosexuality' from their list of mental disorders in 1973, and in the latest revision eliminated even "ego-dystonic homosexuality" as a mental disorder, the American Psychiatric Association has at last acknowledged that social hatred, rather than same-sex love, is the true elements of pathology in gay people's lives.

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Isay, R., Friedman, R. (1989) Toward a further understanding of homosexual men Journal of the American Psychoanalytic Association.

NARCISSISM: "Homosexuality may be considered a specific form of narcissism. clinical evidence provides evidence that homosexual object choice should not be taken as evidence of pathological narcissism, however. I propose that we take as their unique differentiating characteristic the conscious persistent choice of members of the same sex as objects of love or desire.

CHANGE: Isay suggests that "at some point in every intensive therapy, every gay patient expresses unhappiness and dissatisfaction with his homosexuality." It is important to treat this dissatisfaction analytically rather than accept it at face value.

"With psychotherapy, the irrational aspects of the wish to become heterosexual emerged."

"One reason previous therapy had failed was the expressed desire to give up homosexuality (agreed with by a well intentioned therapist) functioned in service of masochism." .

BORDERLINE: "...homosexuality in any form, as far as we know, is not associated with any syndrome of psychopathology more than any other. .. The absence of such research to date is important since clinicians who see "borderline homosexuals" may assume a causal relation between the two conditions. In the case of individual borderline patients such causal relations may indeed exist. For example, the perception of a homosexual identity may be a symptom of identity diffusion in a borderline patient. In this type of situation it is not the homosexual identity per se that is pathological, but rather, a patient who suffers from a global character pathology uses the homosexual identity in a pathological manner.

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Isay, R. (1985) On the analytic therapy of homosexual men. Psychoanalytic Study of the Child. 40:235 -254.

ABSTRACT: "Defines a homosexual as a person who has a predominant erotic preference (expressed in fantasy), usually for a long period of time, for other s of the same sex. It is suggested, on the basis of clinical experience, that efforts to change sexual orientation in analysis may cause symptomatic depression and, in some cases, severe social problems later in life. It is posited that the analyst's internalized social values interfere with the proper conduct of an analysis by causing the analyst to be unable to convey an appropriate positive regard for his/her patient or to maintain therapeutic neutrality. Five case examples are presented to illustrate this position and the emotional and social consequences of the attempted and seemingly successful change from homosexuality to heterosexuality."

ANTI-CHANGE: Reorientation therapy can cause symptomatic depression and social problems later in life by contributing to an already damaged self-esteem.

"I believe it is likely that observations of successful conversion of "homosexual" patients to heterosexuality over an indefinite or extended period of time are, in fact, due to successful suppression of the homosexual component in men who have a strong bisexual orientation." (p.251)

CASE: 47 year old married man with 2 daughters, who had completed analysis in his late 20's. Previously an active homosexual life and a passionate love. Still had homosexual fantasy although he was content with his conventional life.

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Isay, R. (1990) Psychoanalytic theory and therapy of gay men. (in McWhirter, D. (ed) Homosexuality/Heterosexuality. NY: Oxford.) 283 - 306.

CASE: Defensive homosexuality in heterosexuals. Charles became increasingly aware during the course of his analysis of sadistic and spiteful rage toward her and toward other women because of frustrated sexual longings and the feeling of being demeaned by her."

CHILDHOOD: "Every gay man I have seen reports that beginning at age 3 or 4 he experienced that he was "different" from his peers. This feeling is described as having been more sensitive, crying more easily, having his feelings hurt more readily, having more aesthetic interests, and being lies aggressive than others of such age. Such differences make children feel like outsiders in relation to peers and often to family as well." "In my much smaller clinical sample I have found that many of the same characteristics described in these studies of effeminate boys, except for the cross-dressing , are recollected in gay men whom I do not consider to have gender identity disorders, that is, they experience and perceive themselves as men not women. Nor have I observed any qualitative distinction in the early experience described by those men who as adults are more conventionally masculine in appearance and those whose behavior appears are more androgynous or feminine." (301)

DISORDER: "...there are homosexuals who are sadistic, masochistic, narcissistic, depressed, borderline, or psychotic, that is, who run the spectrum of psychological disturbances. Those men who are gay and have such psychological disturbances dynamically resemble their heterosexual counterparts more closely than they do each other.

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Jensen, J. (1999) A Psychiatrist's Response to the Latter Day Saints Social Services National Affirmation Annual Conference.

REVIEW: LDS Social Services document "Understanding and Helping Individuals with Homosexual Problems"

LDS SS document "... unqualified and unjustified use of concepts steeped more in the prejudices of Western tradition which date back to the turn of century than in modern social or psychological sciences."

RELIGION: "In order for LDS Social Services to "offer a reparative therapy approach which assumes that homosexual behavior can be changed," they had to leave the mainstream of the mental health professions and shop around for anyone whose own prejudices match those of "the church" no matter how unjustified, antiquated, unscientific, ineffective, harmful and unethical their belief and practices may be. This unfortunate collision has compromised the scientific integrity of LDS Social Services and -- by extension -- the LDS Church; a retreated, closed, propagandistic and anxiety- maintained position which is untenable for a people whose prominent motto is 'the glory of God is intelligence.'"

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Johnsgard, K., Schumacher, R. (1970) The experience of intimacy in group psychotherapy with male homosexuals. Psychotherapy: Theory, Research, & Practice. 7: 173 - 176.

Group therapy for male homosexuals which emphasized truth, openness, expression of feelings and intimacy.

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Koertge, N. (1990) Constructing concepts of sexuality: A philosophical commentary. (in McWhirter (ed) Homosexuality/Heterosexuality. NY: Oxford.

CONSTRUCTIONISM: "If sexuality is largely constituted by belief systems, why aren't sexual orientations more labile? Shouldn't I just be able to think myself into a new sexual category? Yet psychoanalysts, experts in the talking "cure" are remarkably unsuccessful in changing the preferences even of clients who really want to change. ..Artemis Moonglow, a so-called political lesbian reminds us, some people do appear to think their way into a new form of sexual life."

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Kus, R. (1985) Stages of coming out; An ethnographic approach. Western Journal of Nursing Research. 7, 2: 177 - 198.

COMING OUT: "...'coming out' is defined as: that process by which a gay individual identifies self as gay, changes any previously held negative notions of gays or homosexuality, accepts being gay as a positive state of being, and acts on the assumption that being gay is a positive state of being.

CASE: "But I can never view the heterosexual portion of our society without some, and probably a fair amount of distrust. I do not, and never will, really trust the straight world, And I don't know why I should..."

CHILDHOOD: "... gay children grow up thinking they are straight persons. Thus unlike racial and ethnic minorities, gay have not had the opportunity of several years of childhood to learn adequately what being a minority in America means. Also, gays do not have gay parents and a host of gay relatives after whom to model themselves' there is no anticipatory socialization process for the gay child. Therefore, upon learning one is gay, overwhelming feelings of aloneness can, and most often do, occur."

"in retrospect, I've always been gay. I always knew that as a child I was somehow "different" from other people.

In the accounts of gay men, there is often seen what Reid (1973) calls "The Best Little Boy in the World" syndrome, characterized by a childhood of high achievement, heightened sensitivity to adult expectations with accompanying model performance, politeness, and non-commitment to the usual "rough-and-tumble" activities often seen in boys. ..Lesbians on the other hand, often recount what I call a 'Rubyfruit Jungle (Brown 1973) type of childhood characterized by sports, and bucking of traditionally "feminine" trappings of dress and behavior." (183)

CHANGE: "... many gays in Stage 1 report not wanting to be gay."

DISORDER: "Some of the common health problems in this stage -- as reported by my informants and the literature -- include severe guilt and diminished self-esteem, stress and its physical manifestations (such as ulcers, a sense of overwhelming aloneness leading to loneliness, inability to focus on academic learning and other tasks at hand, and depression. Suicidal ideation, estimated to have occurred in 40% of the gay population (Jay & Young 1979, p. 728) often is experienced at this stage. Likewise, a pattern of drinking may begin here that can lead to alcoholism, perhaps the most severe and widespread health problem in both the gay and lesbian population. Finally, in rare instances, the gay man may experience an actual acute psychotic episode.

RELIGION: "...one must remember that this century has produced such antigay crusaders as Hitler, Stalin, Bryant, and Falwell, and such antigay movements as Nazism, the Klan, and the "Moral Majority."

PROMISCUITY: "...gay men are often uncomfortable with what they initially define as 'promiscuity' in the gay community. "

"...sexually transmitted disease (STD) is often seen in this stage especially among gay men. (187)

DRUGS: "...during eight years of practicing in acute psychiatric settings as a nurse therapist, I have seen many gay clients (almost all men) who overdose, are depressed, and are filled with a sense of hopelessness.

SCHIZOPHRENIA: "It is highly likely, for example, that the schizophrenic patient saying 'I am gay' is not gay at all. It is possible that the gay client accepts being gay as a positive life force yet is depressed for other reasons."

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Lawson, R. (1987) Scandal in the Adventist-funded program to heal homosexuals: Failure, sexual exploitation, official silence, and attempts to rehabilitate the exploiter and his methods. Paper presented at the annual convention of the American Sociological Association Chicago IL . June.

Investigation of Colin Cooks' Quest ministry, charges that Cook engaged in sexual relations with some clients.

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Lief, H., Kaplan, S. (1986) Ego-dystonic homosexuality. Journal of Sex and Marital Therapy. 12, 4: 259 - 266.

DISORDER: DSM-III diagnosis of Ego-dystonic homosexuality: a) heterosexual arousal is absent or weak; b) a pattern of homosexual arousal is a persistence source of distress and unwanted;

CASE: Homosexually active man, tried to give up homosexuality when mentor "gave the patient paternal interest and affection that he had never received from his own father." Patient had severe depression, apathy, emotional detachment, and suicidal impulses. Therapy helped him accept homosexual impulses and lifestyle.

CHOICE: "The patient coming in with a dysphoria over his or her homosexual feelings, fantasies or behavior must be give the choice of working through the homophobia or the heterophobia. With the first choice, treatment is directed toward decreasing shame over the homosexual orientation and integrating the patients social role and personal identity."

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Martin, A. (1984) The emperor's new clothes: Modern attempts to change sexual orientation. (in Stein, T, Hetrick, E. Innovations in psychotherapy with homosexuals. Washington DC: American Psychiatric Press) 24 -57.

RELIGION: "... the patient told that success depends on his or her "motivation" and "choice." In other words, in both therapy and religion, success or failure becomes the responsibility of the patient/believer. Unfortunately, clinicians pay little attention to the tactic's potential for negative outcomes in therapy, particularly for those already burdened with societally induced guilt and shame."

CHANGE: "Leaving aside for the moment the very important observation that there is no an iota of evidence to support the simplistic notion that because one can perform heterosexually or homosexuality under certain restricted conditions one can choose one's sexual orientation, what does it mean when the client, convinced that the choice is his or hers, either suffers a "treatment reversal" or never succeeds?"

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May, E. (1977) Discussion of: recent trends and new developments in the treatment of homosexuality" by James J. Hinrichsen and Martin Katahn. Psychotherapy: Theory, Research and Practice. 14, 1: 18 - 20.

Review of literature on therapy supporting a homosexual adjustment - 1971 to 1976. Critical of Hinrichsen & Katahn who ignored this trend.

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Maylon, A. (1982) Psychotherapeutic implications of internalized homophobia in gay men. Journal of Homosexuality. 7, 2/3: 59 -70.

HOMOPHOBIA: "Since homophobic beliefs are a ubiquitous aspect of contemporary social mores and cultural attitudes, the socialization of the incipient homosexual individual nearly always involves an internalization of the mythology and opprobrium which characterize current social attitudes toward homosexuality." (60)

"Other aspects of ego development may continue, but the rejection of homosexual proclivities truncates the process of total identity formation."

"This theoretical disposition regards homosexuality as a non-pathological human potential.... gay-affirming approaches to psychotherapy consider oppression and ant-homosexual attitudes to be just two of many factors that influence the process of personality formation and psychological adaptation."

INTERNALIZED HOMOPHOBIA: "Conscious attitudes are rather easily modified. Repressed anti-homosexual material, however, is much more difficult to apprehend and change. The derivatives, elaborations, and developmental consequences of introjected homophobia are as pernicious as the original internalized attitudes. Therefore, an important goal of this stage of psychotherapy is to illuminate the many complex secondary and tertiary adaptations which are abstractions of homophobia; for example, low self-esteem, lack of psychological congruity and integration, overly embellished and ossified defense, problems with intimacy, and a particular vulnerability to depression."

"The initial awareness of more-than-incidental homosexual promptings usually has profound psychological implications. It is nearly always accompanied by feelings of intense anxiety, despair, and intrapsychic conflict. This affective response brings about a dramatic potentiation of suppressive defenses. Conflict over burgeoning homosexual awareness also activates the process of stimulus generalizations. This augments a gradual stigmatization of all intense affective phenomena (Clark 1977), prompting an even more profound elaboration of the already established defensive motif (suppression, denial, and over -compensation). This, in turn, leads to an inhibition and compartmentalization of all eroticized impulses. This psychological fragmentation of sexual and affectional proclivities interferes with the developmental process; that is, an integrated and positive identity cannot be established so long as eroticized desires and capacities are repugnant and constantly, estranged. In the absence of identity consolidation, further development cannot take adequate advantage of maturation of more differentiated and complex psychological and interpersonal capacities. Thus, one of the more significant outcomes of homophobic bias is an arrest of the developmental process. The other major consequence is the contamination of self-concept."(p.66)

"... the therapist's unconditional acceptance of homoerotic capacities is a necessary countervalence for earlier anti-homosexual cultural conditioning."

"Anti-homosexual attitudes (both exogenous and internalized), masculine sex-role stereotypy and conditioning, insufficient eroticized and affectional pre-intimacy involvements with other males, and relative unavailability of models of male intimacy, all interfere with the development of the capacity for long-term and mutually satisfying love relationships among gay men." (p.67)

RELIGION: "Traditions such as the nuclear family, orthodox, religious beliefs, rigid sex-role models, and conservative morality are not relevant reference points for most adult gay males in search of personal meaning and integrity."(p.68)

HOMOPHOBIA: "Gay-affirmative therapy uses traditional psychotherapeutic methods but proceeds from a non-traditional perspective. This approach regards homophobia, as opposed to homosexuality, as a major pathological variable in the development of certain symptomatic conditions among gay men." (p.69)

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McConaghy, N. (1987) Heterosexuality/homosexuality: Dichotomy or continuum? Archives of Sexual Behavior. 16, 5: 411 - 423.

ABSTRACT: "A recent reanalysis (Van Wyk and Geist (1984) Psychosocial development of heterosexual, bisexual, and homosexual behavior. Archives of Sexual Behavior. 13: 505 -544.) of Kinsey's data rejected his conclusion that heterosexuality and homosexuality were a continuum."

KINSEY: "The findings of the present study support Kinsey's concept of a heterosexual-homosexual continuum with a significant percentage of the population aware of a homosexual component, rather than Van Wyk and Geist's interpretation of the Kinsey data, that heterosexuality and homosexuality are polar extremes with only a small minority aware of homosexuality."

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

HETEROSEXISM: "There would be no reorientation techniques where there no interpretation that homoeroticism is an inferior state, an interpretation that in many ways continues to be medically defined, criminally enforced, socially sanctioned, and religiously justified. And it is in this moral interpretation, more than in the reigning medical theory of the day, that all programs of sexual reorientation have their common origins and justifications."(520)

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Neisen, J. 1993) Healing from cultural victimization: Recovery from shame due to heterosexism. Journal of Gay and Lesbian Psychotherapy. 2, 1: 49.

ABSTRACT: The author draws parallels between the painful effects of sexual/physical abuse and heterosexism. Heterosexism is defined as a form of cultural victimization that oppresses gay/lesbian/bisexual person. Heterosexism stymies individual growth and development just as individuals who have been sexual/physically abused struggle with the painful effects of their own victimization. Recognizing heterosexism as a form of victimization and abuse, the parallels between the effects of sexual/physical abuse and heterosexism become more clear. A paradigm based on the healing process for individuals who have been sexually/ physically abused can also be used with individuals who have been culturally victimized. The utility of the paradigm is in providing helping professionals and their gay/lesbian/bisexual clients a means to articulate (1) how heterosexism is abusive, (2) the painful consequences of victimization, and (3) the healing process.

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Nelson, J. (1982) Religious and moral issues in working with homosexual clients.(in Gonsiorek, J. Homosexuality and Psychotherapy. NY: Haworth) 163

ABSTRACT: "While strict moral and religious neutrality in psychotherapy is problematic at best, the therapist working with homosexual clients particularly needs clarity about her or his own moral and religious assumptions, together with a knowledge of the Judeo-Christian tradition on the subject. This article examines the biblical evidence and current theological arguments about homosexuality. Christianity as an incarnational faith is a sex-affirming religion, with positive resources for lesbian and gay men. An analysis of homophobia concludes, maintaining the position that the church as a whole will benefit great from the liberation of gay men and lesbians from oppression."

"I consider 'homosexuality' an abstraction. There is no such thing as 'homosexuality' per se."

RELIGION: "...my own conviction ... that homosexuality is a Christianly valid orientation; that homosexual genital expression should be guided by the same general ethical criteria as are appropriate for heterosexual expression, though with sensitivity to the special situation of an oppressed minority... "

PROMISCUITY: "Given the realities of social oppression, it is insensitive and unfair to judge gay men and lesbians by a heterosexual ideal of the monogamous relationship. ... that other sexual encounters and experiences can have elements of genuine good in them even while falling short of the optimum remains an open possibility."

"For the gay male or lesbian couple who intend a covenant of indefinite duration, will 'fidelity' always mean 'genital exclusivity'? Some such couples (as is true of some heterosexual couples) have explored relationship that admit the possibility of sexual intimacy with secondary partners. For these couples 'infidelity' does not have a simple biological meaning (sex with someone other than the permanent partner). Rather, infidelity means the rupture of the bonds of faithfulness, trust, honesty, and commitment between to the partners well-being and growth, a commitment to the primacy of this covenant over any other relationship. While there are undoubted risks for such a course of action, and while the weight of Christian tradition is on the side of sexual exclusivity, there are also risks when a couple's relationship becomes marked by possessiveness."

HOMOPHOBIA: "In a word, churches and society both desperately need release from homophobia, that irrational fear of same-sex orientation and expression."

"While some resistance to homosexuality is, to be sure based upon calm and reasoned religious belief... undoubtedly much is based upon unreasoned, ill-understood emotional reactions."

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Pillard, R. ( 1982) Psychotherapeutic treatment for the invisible minority. (in Paul, W., Weinrich, J., Gonsiorek, J., Hotvedt, M.(eds) Homosexuality: Social, Psychological and Biological Issues. The Final Report of the Society for the Psychological Study of Social Issues Task Force of Sexual Orientation. Beverly Hills CA: Sage) 99

CHANGE: "The conviction of therapists that treatment causes a change in sexual orientation sometimes comes not from studies of outcome but from intimate participation in process -- that is, the observation that a shift in patient dynamics followed some technical maneuver or the recovery of a repressed memory or the overcoming of a resistance."

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Reece, R. (1982) Group treatment of sexual dysfunction in gay men. (in Paul, W., Weinrich, J., Gonsiorek, J., Hotvedt, M.(eds) Homosexuality: Social, Psychological and Biological Issues. The Final Report of the Society for the Psychological Study of Social Issues Task Force of Sexual Orientation. Beverly Hills CA: Sage) 113 -

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Reiter, L. (1989) Sexual orientation, sexual identity, and the question of choice. Clinical Social Work Journal. 17, 2: 140.

ABSTRACT: "Sexual orientation, determined early in life, may or may not match sexual identity, which can change over time. Starting with a review of some definitions of homosexuality in the literature, the author offers a definition that differentiates between orientation and identity. She goes on to describe several possible routes from gay orientation to gay identity, explains discrepancies, acknowledges the potential threat to subjective identity when sexual identity shifts, and argues that identity, not orientation, is open to choice. Two case examples illustrate some of these points."

CHANGE: Regards sexual orientation as immutable, but admits that there is change.

"Free will does indeed allow choice in lifestyle and the identities people construct. Sexual orientation, determined very early in life, is an enduring and essential psychological reality, transcending choice."

CASE: Alice, 32-year old with a history of sexual child abuse. "Her parents' willingness to maintain a relationship with (the abuser) was a source of rage for Alice." She had a very of heterosexual intercourse and childbirth. A recovering alcoholic and drug addict. Ex-Catholic. Heterosexual fantasy. Self-identified as lesbian.

Alan, gay-identified, late 20s, "who remembers always feeling different and flawed and not fitting in with the other children for whose company he longed. Besides homosexual affairs, he has had pleasurable sexual experiences with women and occasional sexual fantasies about women. Has considered the possibility of marriage and fatherhood feels that as a gay man he has the freedom to choose a heterosexual lifestyle.

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Rich, A. (1980) Compulsory heterosexuality and lesbian experience. Signs. 5: 631 - 660.

HETEROSEXISM: Opposes the normativeness of heterosexuality and compulsory heterosexuality.

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Richardson, D. (1987) Recent challenges to traditional assumptions about homosexuality: Some implications for practice. Journal of Homosexuality. 13, 4: 1 -12.

ABSTRACT: "Discusses recent theoretical inquiry into homosexuality that is challenging the traditionally held view that people have an essential sexuality that is either homosexual or heterosexual, which remains fixed and unchanging throughout their lives. Clinical implications of these recent developments are addressed in particular, the suggestion that the homosexual as a certain type of person is an invention. The therapeutic value and difficulties associated with an acknowledgment that sexual preference and identity may change over time are considered. Goals are considered with regard to the person who seeks professional help in changing from a homosexual to a heterosexual orientation."

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Rochlin, M. (1982) Sexual orientation of therapist and therapeutic effectiveness with gay clients.(in Paul, W., Weinrich, J., Gonsiorek, J., Hotvedt, M.(eds) Homosexuality: Social, Psychological and Biological Issues. The Final Report of the Society for the Psychological Study of Social Issues Task Force of Sexual Orientation. Beverly Hills CA: Sage) 21 -

ROLE MODELS: "It is widely recognized that lesbians and gay men are generally deprived of positive gay role models in their natural development, that such role models are growth-enhancing... without the availability of gay adults who are decent, accomplished and fulfilled human beings as role models," it is not possible to escape ... oppressive self-hatred and impoverishment."

"Now I could be one of the living models for young gay people I wished I could have found in my own youth."

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Ross, M. (1978) The relationship of perceived societal hostility, conformity, and psychological adjustment in homosexual males. Journal of Homosexuality. 4, 2: 157

ABSTRACT: The present study examined the relationship between the perception by homosexual males of positive or negative societal reaction to homosexuality (PSR), their degree of conformity to heterosexual norms, and their degree of psychological adjustment. In this study respondents with high PSR were those who perceived negative societal reaction to homosexuality. Respondents with low PSR were those who perceived positive societal reaction. The study differentiated between the effects of putative societal reaction and actual societal reaction and was based on a three-group sample of homosexual men who (a) were, (b) had been, or (c) had never been heterosexually married. Findings showed that putative societal reaction was a critical variable producing conformity and psychological maladjustment in homosexual males.

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Rothblum, E. ( 1994) Introduction to the special section: Mental health of lesbians and gay men. Journal of Consulting and Clinical Psychotherapy. 62, 2;

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Rothblum, E. (1994) "I only read about myself on bathroom walls": The need for research on the mental health of lesbians and gay men. Journal of Consulting and Clinical Psychotherapy. 62, 2; 213 - 226.

SURVEY: "A survey of 2,500 members of the American Psychiatric Association (Time 1978 as cited by Marmor 1980 ) found that the majority of members considered homosexuality pathological and also perceived homosexual to be less happy, and less capable of mature and loving relationships than heterosexuals."

CHOICE: "In general, lesbians tend to view sexual orientation as a political choice, whereas gay men are more likely to have an essentialist perspective. ... For example, Chapman and Brannock (1987) found than 63% of the lesbians in their survey stated that they had chosen to be lesbians, 28% felt they had no choice, and 11% did not know way they were lesbians."

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Russell, A., Winkler, R. (1977) Evaluation of assertive training and homosexual guidance service groups designed to improve homosexual functions. Journal of Consulting and Clinical Psychology. 45, 1: 1 - 15.

The four subjects who showed marked improvement on the behavioral measures described themselves on entering their group as being aware of their oppression as homosexuals in society and were at the point of taking some more positive action about this.

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Schramski, T., Giovando, K.(1993) Sexual orientation, social interest, and exemplary practice. Individual Psychology. 49, 2: 199 -

DISORDER: "Homosexuality, per se, implies no impairment in judgment, stability, reliability, or general social or vocational capabilities. Further, the American Psychological Association urges all mental health professionals to take the lead in removing the stigma of mental illness that has long been associated with homosexual orientation." (APA 1975)

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Schreier, B. (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.

REVIEW: Literature on change - highly critical and dismissive of studies supporting change. Response to Throckmorton article in same issue.

RELIGION: "Throckmorton is critical about an article by Wolpe (1973) where Wolpe chose to offer religious reorientation rather than sexual reorientation. Perhaps instead of sexual reorientation, individuals could seek religious reorientation to any number of major U.S. religions that are affirming of people with same-sex orientations.... Not all religions are judgmental and condemning. Advocating for sexual reorientation while being critical of religious reorientation again demonstrates nothing more than bias." (308)

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Schwartz, D. (1993) Heterophilia - the love that dare not speak its aim: Commentary on Trop and Stolorow's "Defense analys in self psychology: A developmental view. Psychohanalytic Dialogues. 3, 4: 543 - 652.

Their paper exemplifies two interrelated phenomena seen in psychoanalysis (1) the unarticulated belief in a particular sexual ideology, which I call "heterophilia," and (2) the explicit belief that psychoanalysis is, or should be, free of ideology and politics. In what follows I try to show how heterophilia, the overvaluing of intimate relations between different-sexed partners, manifests itself in Trop and Stolorow's case report and how it tends to immunize their ideological commitments against articulation and scrutiny. Moreover, I will try to show that as an artifact of heterophilia, same-sex desire is necessarily denigrated."

BEHAVIOR: "For young gay men contending with societal oppression and superego anxieties, anonymous and uncomplicated sexual encounters may constitute a kind of tooth-cutting experience that allays anxiety for the pursuit of deeper kinds of intimacy later."
 

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Shidlo, A. (1994) Internalized homophobia: Conceptual and empirical issues.(in Greens, B., Herek, G. Lesbian and Gay Psychology Thousand Oaks CA8/4/99 Sage.)176 - 205.

HETEROSEXISM: "... prejudicial attitudes toward gay persons can be a vehicle for expressing cultural or religious values. Other terms such as homonegativism provides a more neutral and inclusive designation for the total universe of negative attitudes toward homosexuality."

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Silverstein, C. (1972) Behavior Modification and the Gay community. Paper presented at the annual convention of the Association for Advancement of Behavior Therapy. NY. Oct.

RELIGION: "To suggest that a person comes voluntarily to change his sexual orientation is to ignore the powerful environmental stress, oppression if you will, that has been telling him for years that he should change... What brings them into counseling is guilt, shame, and the loneliness that comes from their secret. If you really wish to help them freely choose, I suggest you first desensitize them to their guilt. Allow them to dissolve the shame about their desires and actions and to feel comfortable with their sexuality. After that, let them choose, but not before."

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Sleek, S. (1997) Concerns about conversion therapy. APA Monitor. October. 28:16

ANTI-CHANGE: Quotes Linda Garnet, Chair of APA's Board for Advancement of Psychology in the Public Interest who stated that reorientation therapies "feed upon society's prejudice towards gays and may exacerbate a client's problems with poor self-esteem, shame, and guilt."

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Smith, J.(1988) Psychopathology, homosexuality, and homophobia. Journal of Homosexuality. 59

RELIGION: "Irrational prejudice against homosexuality has been a feature of Judeo-Christain culture for millennia, waning and waxing in intensity from amused but derogatory tolerance to outright genocide."

GENOCIDE: "... all parents wish their children to be happy and to resemble themselves, and if it were possible to prevent homosexual adjustment (not to mention transsexualism) most parents would welcome the intervention. On the other hand, this raises ethical issues along the lines of other "Final Solutions" to minority problems."

FAILURE: "... there is no unanimity of opinion either as to what is one to do with the patient who presents with the wish to change his or her sexual orientation. ...These patients do present with psychopathology, but their psychopathology is not their homosexual thoughts, feelings, and behaviors, but rather their internalized and self-directed homophobia which impairs self-acceptance and the establishment of adaptive and sexually fulfilling lifestyles in the context of minority sexual orientation. My therapeutic approach to this concern is to teach the patient to redefine his or her problem, and eventually to promote an ego-syntonic state through individual and small group psychotherapy. At times a impasses is reached and therapy must be discontinued, but it should be remembered that, as with all developmental issues, time and nature are on the side of the maturational process, and even an unsuccessful conclusion to therapy may plant the seed for future growth in a healthy direction."

"Many homosexually adjusted persons who have integrated successfully into mature adults have acquired superior coping skills as a consequence of having worked through the burdens of internalized homophobia and social stigmatization. It may be for this reason that there appears to be an over-representation of homosexually adjusted persons in caregiving occupations and professions."

PEDOPHILIA: "Pedophilia may be a cultural label rather than anything inherently medical or psychiatric."

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Stein, T., Cohen, C. (1994) Psychotherapy with gay men and lesbians: An examination of homophobia, coming out and identity. (in Stein, T, Hetrick, E. Innovations in psychotherapy with homosexuals. Washington DC: American Psychiatric Press)

HOMOPHOBIA: "The refusal by a psychotherapist to accept that homosexuality is a normal variation of human behavior must at this point be viewed as an absolute barrier to working with gay men and lesbians in psychotherapy."

"The effects of societal pressure to be heterosexual have often been to inculcate a basic mistrust or hatred for one's sexual and interpersonal identity when it is homosexual. A therapist who further encourages renunciation or denial of the homosexual feelings may destructively reinforce the patient's own internalized homophobia." (62)
 

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Stolorow, R., Trop, J. (1993) "Defense analysis in self psychology: A developmental view." Reply Psychoanalytic Dialogues. 3, 4: 653 - 656.

POLITICAL: "They all seem to feel that it is now politically incorrect to publish a case in which the patient, during analysis, chose a heterosexual path over a homosexual (or, more accurately, a largely asexual one.)... All three commentators seem to hold, as an ideal for every analysis, the fullest exploration of all possibilities for sexual expression irrespective of whether the patient wishes to do this or not."

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Tripp, C. (1975) The Homosexual Matrix. NY: McGraw-Hill.

CHANGE: "There are no known "cures" for homosexuality, nor are any likely, since the phenomena which comprise it are not illnesses in the first place. Of course, the issue does not end here. Smoking and drinking are not illnesses either, but they can be stamped out by various means. With these and other considerations in mind, the Kinsey Research made a concerted effort over a period of years to find and evaluate the histories of people whose sex lives had changed either during or following therapy of any kind. None was ever found. Several psychoanalysts who were friends of the Research promised to send particular patients they were proud of having "cured" but none of these was ever forthcoming. After Kinsey's death and to this day, Wardell Pomeroy (a longtime member of the research and now a New York psychotherapist) has maintained a standing offer to administer the Kinsey Research battery to any person a therapist might send, and thus possibly validate a case of changed homosexuality. This offer has never had any "takers" except for one remarkable instance."

"A New York psychiatrist who for a number of years has headed a large psychoanalytic research program on homosexuality -- a man who has written an important book on the subject in which various percentages of changed cases were reported -- did indeed make a definite commitment to exemplify these results. After several delays of several weeks each, the psychiatrist finally confessed to Pomeroy that he had only one case which he thought would qualify but that, unfortunately, he was on such terms with the patient he did not feel free to call him up. One possible case? -- then what about his 358-page book claiming from 19 to 50 per cent cures? (Bieber 1962) Whether or not it qualifies as an outright misrepresentation is, in part, a matter of definition. The psychiatrist did not actually say in his much-quoted book that he, personally, had cured anybody, no did he claim to have actually seen or personally examined anybody else's successful results. There were numerous implications of a firsthand knowledge, to be sure (along with elaborate statistical citations) but legalistically speaking, the psychiatrist was, and is, in the clear. No doubt he was clear. No doubt he was clear in his own mind too -- fully believing both what other psychiatrists reported and what he himself was able to make these reports. In all this, he takes his place in a long tradition for this brand of reporting. Over the years there have been literally dozens of second-party accounts of "cured" homosexuality. Life the footprints of the Loch Ness monster, they very often appear, but without the presence of the elusive beast."

"The efforts of the Kinsey Research to find people whose sexual response had changed as a result of therapy did manage to turn up a few instances worthy of mention, and in a few of these, the person was quite proud of the "progress" he or she had made. But on close examination all examples quickly failed to qualify. In most, it was a matter of sheer suppression -- "I used to be a lesbian, but now I turn away when temptation knocks." Others were slightly more complicated, often involving a man's fantasizing males during heterosexual intercourse, and the like. Once when Kinsey was in Philadelphia, a man phoned him at his hotel to say he had heard they were interested in people whose homosexuality had been changed by therapy, as his had been. Kinsey immediately arranged to take his history. The man explained that he had once been a very active homosexual but that, thanks to therapy, "I have now cut out all that and don't even think of men -- except when I masturbate."

"Actually, it is quite surprising that the Kinsey Researchers did not find any instances of people whose sexual responses were altered during therapy (and it surprised them too). One would expect changes to occasionally occur by accident, if nothing else. There are always a few people who are free to enter or to leave homosexual involvements by virtue of the fact that their preferences are not yet clearly defined. Others have clear-cut preferences which remain somewhat flexible due to a lack of aversion -reactions to their implied opposites; these individuals sometimes move back and forth across the heterosexual-homosexual line as a result of particularly good or bad experiences they have with members of either sex."

"But, of course, the average therapist knows nothing of all this background. He does not realize that validated changes in homosexuality are nowhere to be found. And he certainly does not know that the most prestigious literature on the subject is all second-party reporting at best (if, indeed, it is not from still further back in some armchair). On the contrary he finds himself surrounded by colleagues and by published accounts suggesting that such changes are feasible and are actually being made. Not infrequently he feels almost a professional obligation to be able to see what others see (something of any Emperor's New Clothes situation) and to be able to match their results, quite aside from the extent to which his attitudes may press in the same direction."

"Thus there are a great many therapists -- including those who are wise enough to avoid the word cure, and would not be fooled by the man from Philadelphia either -- who feel the urge to launch major efforts to suppress and to change homosexual behavior. Their outlook and their level of sophistication vary considerably. More than a few have the notion that if they can get a patient to try out heterosexuality, he will "lose his fear of it", come to like it, and in that case the homosexuality will automatically disappear (shades, once again, of a "blocked" heterosexuality). Other know better than this, but nevertheless persistently aim at essentially the same target. In their view, the only really bad thing about homosexuality is its exclusivity, that it supposedly cuts a person off from general society and from the conventional experiences of hearth and home. In both of these positions, and in all graduations between them, the patient's marriage to a partner he cares about is considered the major breakthrough. (How interesting it is -- and how alarming -- that the risks and comforts of the spouse are never mentioned; the massive literature on how to alter homosexuality contains not a word on his or her behalf.)" (p.238)

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Troiden, R. (1988) Homosexual identity development. Journal of Adolescent Health Care. 9: 105 - 113.

CHILDHOOD: Majority of homosexuals felt different as children.

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Weinberg, M., Williams, C. (1974) Male Homosexuals. NY: Oxford UP.

RELIGION: "...respondents who attribute the most importance to religion are more worried about exposure of their homosexuality, more concerned with passing, and less known about than homosexuals for whom religious is not important at all." (253)

"... holding religiosity constant... among those who regard religion as very important, those who perceive homosexuality as more in violation of religion score lower in stability of self-concept (and in the United States, self acceptance) and higher in depression than do those who do not perceive such a violation."

"... we have suggested that the etiology of both the normal stage of unease with a homosexual orientation as well as dissatisfactions that more clearly need professional intervention result from society's stigmatization of the homosexually oriented."

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Weinberg, T. ( 1978) On "doing" and "being" gay: Sexual behavior and homosexual male self-identity. Journal of Homosexuality. 4: 2: 143 - 156.

CASE: "This respondent's first 'gay' sexual experience, then, was not his first sexual experience with another male. It took the presence of what Strauss (1959) calls a "coach" to redefine his sexual activities and his own sexual identity as homosexual."

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9) RESPONSES TO CRITICS OF THERAPY

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Bieber, I. (1976) A discussion of "Homosexuality: The ethical challenge." Journal of Consulting and Clinical Psychology. 44, 2: 163 -166.

Response to Davison (1976)

ETHICS: "Davison's thesis is simple is assumes that homosexuality is a normal sexual mode in the wide spectrum of human sexuality and that the psychological problems noted among homosexuals directly derive from societal prejudices. He suggests, therefore, that it is unethical for clinicians to cooperate with homosexuals who wish to change their sexual direction."

FAMILY: "In most cases, the mother was indeed overly close, inappropriately intimate with her son, intrusive, overprotective, and demasculinizing, but the most striking of our findings was the consistency of a seriously disturbed father-son relationship. In not one homosexual case could the father's attitude be described as affectionate or even reasonably constructive. Mostly, the fathers were reported as detached, and/or openly hostile or "never there." Children perceive detachment as hostility, which in fact it is. One is not unremittingly detached from a love object. These sons emerged from the paternal influence hating and fearing their father on the one hand and deeply yearning for paternal affection on the other."

FATHER: "If one were to choose any single criterion on which to base a prognosis for change, it is the degree of pathology of the father-son relationship. Where some positive elements exist there is comparatively less existing pathology and the prognosis for change is more encouraging."

"Since 1962, I have examined about 850 male homosexuals in psychiatric consultation. ... I also examined about 50 pairs of parents whose sons were homosexual. This sizable sample of parents and sons confirmed our research findings. In not a single case was there a good father-son relationship. In general, the parents' relationship with each other was also poor. Mothers tended to be complainingly dissatisfied with their husbands and openly preferred their son to their spouse."

CHANGE: "The goal [of therapy] is to resolve as much of a patient's psychopathology as can be accomplished. When irrational beliefs and idea systems that distort interpersonal relationships are clarified and corrected, significant changes in various areas of personality and behavior occur." (p.166)

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Throckmorton, W. (1996) Efforts to modify sexual orientation: A review of outcome literature and ethical issues. Journal of Mental Health and Counseling. 20, 4: 283 -305.

RELIGION: Throckmorton is critical of those who pressure homosexual clients to change their religious beliefs."For instance, Barrett and Barzan (1996) in their article concerning spiritual and the gay experience, suggest that "assisting gay and lesbians to step away from external religious authority may challenge the counselor's own acceptance of religious teachings."(p.8) According to Barrett and Barzan (1996), "most counselors will benefit from a model that help them understand the difference between spiritual and religious authority." (p.8)

Wolpe (1973) candidly reports on this tension in his work with a gay client in the 1950s. He described the case of a 32-year-old male who had never experienced sexual attraction or relations with women. The man had "formed a succession of attachments to men with whom he had sexual relations." (p.258) However, he also felt such relations were against his religious belief causing severe anxiety. Wolpe chose to attempt to minimize his religious objections via giving him a book to read. While the client felt some guilt reduction, he still wished to "overcome his homosexuality" (Wolpe, 1973, p.259)Wolpe refused on the basis of a belief in the genetic basis for homosexuality. The client continued in assertiveness training, however, which resulted in significant reduction in anxiety and improvement in job performance. After several months, the man reported to Wolpe that he had become unable to have sex with men and was feeling attracted to a woman. Through the next year, he became sexually active with women and finally married. After a 3-year follow-up, Wolpe described the client's heterosexual sex life as "in every way satisfactory" (p.261).

"Since religion is one of the client attributes that mental health counselors are ethically bound to respect, counselors should take great care in advising those clients dissatisfied with same-gender sexual orientation due to their religious beliefs. To accommodate such clients counselors should develop expertise in methods of sexual reorientation or develop appropriate referral resources." (p. 301)

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Tripp, C. Hatterer, L. (1971) Can homosexuals change with Psychotherapy? Sexual Behavior. 1, 4: 42 - 49.

Excerpts from a transcribed discussion:

CHANGE: Dr. T. "I know Dr. Hatterer believes he has 'cured' homosexuals; similar claims have often been made. I have never seen a major change in any adult's sexual response, although patients on other therapists' 'cure' list (not yet Dr. Hatterer's) often come to me and to other therapists I know because they do not want to 'disappoint' their first doctor. In any event, there is not a single recorded instance of a change in homosexual orientation which has been validated by outside judges or testing. Kinsey wasn't able to find one. And neither Dr. Pomeroy nor I have been able to find such a patient. We would be happy to have one from Dr. Hatterer.

Dr. H. "I have 'cured' many homosexuals, Dr. Tripp. Dr. Pomeroy or any other researcher may examine my work because it is all documented on 10 years of tape recordings. Many of these 'cured' (I prefer to use the word 'changed') patients have married, had families and live happy lives. It is a destructive myth that 'once a homosexual, always a homosexual." It has made and will make millions more committed homosexuals. What is more, not only have I but many other reputable psychiatrists (Dr. Samuel B. Hadden, Dr. Lionel Ovesey, Dr. Charles Socarides, Dr. Harold Lief, Dr. Irving Bieber, and others) have reported their successful treatments of the treatable homosexual.

Dr. Tripp. There is quite a misunderstanding here as to what constitutes fundamental change...

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DISORDER: Dr. H. I have treated numerous young men who were supposedly disturbed by their 'homosexuality.' But I do not look upon homosexuality as an entity. Rather it is a common symptom which appears in many individuals in response to innumerable, dissimilar situations.

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PROMISCUITY: Dr. T. But I know of many, many homosexual couples who do stay together for ten, twenty, and many more years. They evidence quite the same mutual concern for each other's well-being found in warm and stable marriages.

Dr. H. Your experience is very different from mine. The homosexuals I have seen were in the main disgusted with the brevity of their relationships, disgusted by how they squandered their time, interfered with their work, dispensed with their integrity , and sacrificed hopes of an enduring relationship and family life by their driven pursuit of homosexual sex partners.

--

Dr. T... I have a sample of 32 couples who have been together more than twenty-five years.

Dr. H. Are they still together sexually?

Dr. T. Yes, but not usually exclusively.

Dr. H. I have seen men who lived together for periods of five or seven years, but rarely for twenty. And those who do stay together generally allow each other a lot of freedom sexually, or they will both invite a third party in for sex relations. The sexual involvement declines or disappears.

Dr. T. Yes, that is often the case and it seems to work very well.

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Dr. T. All sexual arrangements work. Homosexuality especially works because it has very minor differences from heterosexuality; the overlap is tremendous and the differences are essentially trivial. But all sexual patterns work. Sadomasochistic relationships work, transvestitism works, even transsexualism for those individuals who manage to achieve the bodily changes they want.

Dr. H. I would strongly suggest Dr. Tripp examine in greater depth his word works' when applied to all those situations he refers to. I believe he confuses it with 'survive' Obviously millions of men practicing homosexuality are productive at work and would report some periods of sexual happiness with their partners either in or out of sustained relationships.

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Dr. T. Let me get your reactions to a situation that we who do therapy with homosexuals have often heard about. There are about five or six Turkish baths in New York City that are frequented exclusively by persons who want to engage in homosexual acts. There used to be one near the train station that was a "commuters' bath' in that many of the customers were married men stopped off before they went home. They were primarily heterosexual, but engaged in this sporadically. If their lives were happy and well managed, would you say they were necessarily neurotic? Incidentally, many patients report that these men want to be passive in anal intercourse.

Dr. H. That's a big if. In order to answer the question it would be necessary to investigate what was happening with these men and their wives at home. You are right that such men want to be 'serviced by males or summit to them. But why? What and who drives them to such practices.

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Dr. T.... To see 'humiliations' and 'sadism ' in the picture is quite unwarranted. Nor do labels of 'abnormal' help... From my point of view, there is no indication that fundamental changes in anybody's sex life are ever wrought by therapy, nor would they be particularly desirable anyway. A person's best sexual orientation is the one that helps him get the most out of himself, spontaneously. Killing off his guilt and his childish expectation that conformity is the road to heaven but tend to give him confidence and the energy to make a much smoother social integration... Since homosexuality is an alternate orientation and not a disease, 'cure' is patently impossible. What passes for 'cure' is surface symptom suppression or outright avoidance.

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CHANGE: Dr. H. You define cure in one way; I define it in another. I see the patients sexual life in the context of his entire life style.

I had a patient recently who has had a rather extensive homosexual history . He's married now and having seven heterosexual orgasms a week. He has occasional homosexual fantasies when under pressure or stress, which has nothing to do with his homosexual responsiveness but rather with his neurotic use of homosexual sex.

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Richardson, D. (1993) Recent challenges to traditional assumptions about homosexuality: Some implications for practice.(in Garnets, L., Kimmel, D. Psychological Perspectives on Lesbian Gay Males Experiences. NY: Columbia.) 117 -129.

This article challenges the idea of sexual orientation as unchangeable, while supporting the idea that homosexuality is a positive choice, and responses to Silverstein, Davidson and other writers quoted above.

Excerpts from the article.

CHANGE: "During the last decade there has been a change in professional attitudes toward homosexuality reflected in the development of new models of treatment. Rather than offering a cure the aim is to help homosexuals adjust positively to their orientation. Such attitudinal change on the part of the practitioners has not, in the main, questioned the fundamental assumptions of theories that seek to explain homosexuality. Recent theoretical inquiry into homosexuality, however, has done this, posing an important challenge to the traditionally held view that people have an essential sexuality that is either homosexual or heterosexual and that remains fixed and unchanged throughout their lives. This paper addresses some of the more important clinical implications of these recent developments, in particular, the suggestion that 'the homosexual' as a certain type of person is an 'invention.' In addition, the therapeutic value and difficulties associated with an acknowledgment that sexual preference and identity may change over time are considered. Finally, there is a consideration of what the goals should be in the case of the person who seeks professional help in changing from a homosexual to a heterosexual orientation."

"The notion of the 'homosexual' is, Plummer (1981) suggested an 'invention': it is a categorization specific to certain societies and particular historical periods. On this basis it is not possible to make a direct comparison between 'homosexuality' in present day Western society with 'homosexuality' in different cultures and historical periods..."

"As a limited number of studies have shown (e.g. Pattison and Pattison 1980; Ponse 1978) despite the widespread belief that sexual 'orientation' is a permanent characteristic, individuals may undergo one or more redefinitions of sexual identity during their life time.

"Once homosexuality is defined with a society as a way of being people will frequently reconstruct their past in keeping with their present identification as homosexual (Richardson 1981). This may take the form of their saying 'I must have really been gay all along," it being a case of their 'real' selves having been 'suppressed' until they identified themselves as homosexual. This process of reconstruction may still occur even when it runs counter to a previous identification as heterosexual and a prior absence of homosexual attraction."

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Plummer, K.(1981) Going gay: Identities, life cycles and life styles in the male gay world (in Hart, J., Richardson, D. (ed) The theory and Practices of Homosexuality.. London: Routledge) 93 - 110.

Ponse, B. (1978) Identities in the Lesbian World: The Social Construction of Self. Westport CT: Greenwood Press

    Richardson, D. (1981) Lesbian Identities ( in Hart, J., Richardson, D. (ed) The theory and Practices of Homosexuality.. London: Routledge) 111 - 124.

Richardson, D. (1984) The dilemma of essentiality in homosexual theory. Journal of Homosexuality. 9, 2/3: 79 - 90.

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From Dale's Disk, change5.rtf — Jan. 2000
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