ANALYSIS OF DR. SPITZER'S STUDY OF REPARATIVE THERAPY
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Professional organizations and conversion therapy:
Various professional organizations, including the American Academy of
Pediatrics, American Psychiatric Association, American Psychological
Association, and the National Association of Social Workers have
stated that
a person's sexual orientation cannot be changed by reparative therapy. 1,2
The one exception is the very small group: National Association for Research
and Therapy of Homosexuality (NARTH). NARTHwas founded in 1992 as a "non-profit, educational organization dedicated
to the research, therapy and prevention of homosexuality." It currently consists of "more than 1,000 mental-health
professionals." -- fewer than 1% of the therapists who belong to either of the APA's.
3,4 NARTH
strongly advocates the use of reparative therapy, believing it to be very
effective and safe. They regard homosexual behavior as a treatable
disorder.
The American Academy of Pediatrics, American Counseling Association, American Association of School
Administrators, American Federation of Teachers, American Psychological Association, American School Health Association, Interfaith Alliance Foundation, National Association of School
Psychologists, National Association of Social Workers, and National Education Association
have
formed the "Just the Facts Coalition." In 1999, they developed and endorsed "Just
the Facts About Sexual Orientation & Youth: A Primer for Principals, Educators
and School Personnel." It includes a number of quotations from major
professional organizations expressing concern about reparative therapy and other methods of
attempting to change an individual's sexual orientation. One example is the
American Academy of Pediatrics, which stated: "Therapy directed specifically
at changing sexual orientation is contraindicated, since it can provoke guilt
and anxiety while having little or no potential for achieving changes in
orientation." 5
Background of Dr. Spitzer's study:
Dr. Robert Spitzer is a Professor
of Psychiatry at Columbia University. During his three decades of
psychiatric research, he has specialized in the topic of human
sexual orientation. In 1973, he was one of the members of the American Psychiatric
Association who was instrumental in removing homosexuality from their list of mental
illnesses. The APA was the first major mental-health agency to do so.
For their annual conference in 2000-MAY, the American Psychiatric
Association had scheduled a
panel discussion to debate whether there is any hard evidence that an
adult's sexual orientation can be altered
through reparative therapy. Dr. Robert Spitzer was scheduled to be the moderator. Two psychiatrists
withdrew from the panel, stating that the topic is too politically
charged to permit scientific discussion. The debate was then
cancelled. According to the APA: "The doctors who were to
debate on the topic decided there was not enough scientific
information to have a proper debate. They felt that any debate would
turn into a political debate and not a true scientific debate. While
there is information on reorientation therapy, there have been no
controlled research studies." 6 Dr.
Spitzer said: "I think we ought to be able to talk about
anything in a dispassionate way." Referring to the
speakers who dropped out, he said, "I think they [the
psychiatrists who withdrew] felt that to even debate it was to
legitimize the topic and they felt that since the groups that they
regard as their enemy were kind of salivating over having the debate,
they didn't want it."
Exodus International, a Fundamentalist Christian group who tries to help gays
and lesbians change their sexual behavior, protested the cancellation. Their
national board chairman, John Paulk of Colorado Springs, CO, said: "I'm here
as one representative for a virtually unseen but sizable population. I once
lived as a gay man, but now I'm heterosexual, something the American Psychiatric
Association says does not exist." 10 It is notable that he did not say that he was once gay; he said that he "lived as a
gay man." We have a hunch that he has
had a bisexual orientation during all of his adult life, engaging first in
homosexual behavior, and more recently in heterosexual behavior.
At the time of the proposed debate,
Dr. Spitzer suspected that an adult's sexual orientation is fixed. He said: "There is no documentary evidence showing someone’s sexual
preference can be changed by therapy.
The term "sexual preference" is
normally only meaningful when used to refer to persons with a
bisexual orientation -- adults who are attracted to both men and women.
Bisexuals are
often attracted to one gender more that the other. They can thus be described as
having a "preference." who The vast majority of adults have
either a heterosexual or homosexual orientation. They are attracted to only one
gender, and thus cannot accurately be said to have a "preference." Dr.
Spitzer appears to have used the term here in place of the more generally used
term "sexual orientation."
He continued: "There is only anecdotal evidence, mostly
from the therapists themselves, claiming that what they do works. That’s not
very scientific. On the other hand, there’s no scientific evidence to show
that this is impossible...It hasn’t been studied."
Before the scheduled debate, Dr. Spitzer had decided to conduct a study of "ex-gays" and "ex-lesbians," These are individuals
who:
Had once identified themselves as homosexuals.
Had attempted to change their sexual orientation by:
They regard a homosexual as a person who has sex with others of the same
gender. That is, their definition is based on a person's behavior. This differs
from the definition of "homosexual" by most therapists, human
sexuality researchers, religious liberals, gays and lesbians. These latter groups define a homosexual as a person who
is sexually attracted only to members of the same gender -- whether these
feelings are acted upon or not.
They rarely refer to bisexuals -- persons who are attracted to both men
and women. They generally lump them together with gays and lesbians or with
heterosexuals, depending upon their behavior at the time.
A person with a bisexual orientation who enters therapy and makes a decision to
confine their sexual relationship(s) to members of the opposite gender are
considered to have "left the homosexual lifestyle," to have become "ex-gays" or
"ex-lesbians," and to have become heterosexual. They are
counted as success stories by
reparative therapists or transformational ministries. Non-Evangelicals would
suggest that the individuals are still bisexual; their orientation has
remained unchanged.
A person with a homosexual orientation who decides to become celibate is
also considered a victory for reparative therapy or a transformation ministry;
they have become an "ex."
Again, non-Evangelicals would suggest that the individuals have not changed
their orientation, which remains homosexual. They
are simply celibate homosexuals.
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About the study:
According to Parul Varnell of the Chicago Free Press, "Spitzer
admits that he had 'great difficulty' finding people who claimed to have
changed their orientation from gay to straight. Ex-gay groups regularly
claim to know of 'thousands' of people who have 'changed' or 'left
homosexuality.' But after searching for nearly a year and a half, Spitzer
could only find 274 possibilities." 8
Dr. Robert
Spitzer finally studied 143 "ex-gays" and 57 "ex-lesbians" who had reported
that they had become "straight." During 45 minute telephone interviews
with each subject, they were
asked 60 questions about their "feelings and behavior before and
after their efforts to change orientation. They discussed their motives
for change; their strategies, which included counseling, support groups,
prayer and mentoring; and their current relationships with the opposite
sex".7
Dr. Spitzer
reported:
"Some people can and do change. Like most psychiatrists, I
thought that homosexual behavior could only be resisted, and that no one
could really change their sexual orientation. I now believe this to be
false." 17
That 86% of the men and 63% of the
female subjects
emerged from therapy still having
feelings of attraction to persons of the same-sex. That is, after
therapy they are bisexuals, not heterosexuals.
That sixteen (11%) of the men and
21 (37%) of the women report that they now have a heterosexual orientation.
It is not known how many of these had entered therapy as bisexuals and
how many had been homosexuals.
That 66% of the males and 44% of the females had arrived at "good heterosexual functioning."
According to Cnn.com, that term is defined as having been "in
a sustained, loving heterosexual relationship within the past year,
getting enough satisfaction from the emotional relationship with their
partner to rate at least seven on a 10-point scale, having satisfying
heterosexual sex at least monthly and never or rarely thinking of
somebody of the same sex during heterosexual sex."
"Of the 112 men (out of the total 143) who
acknowledged that they masturbated, more than half (56 percent) said
they used homosexual fantasies some of the time and about one-third (31
percent) said they seldom had opposite-sex masturbation fantasies."
8
Of the 200 subjects,
86 had been referred to Dr. Spitzer by conservative Christian
groups specializing in converting homosexuals.
NARTH referred 46 subjects. Some other sources provided 68.
It is apparent that the individuals that Dr. Spitzer interviewed were
hand-selected from a very large group of persons who had either a
homosexual or a bisexual orientation. Those who had been unable to change
their sexual behavior would not have become subjects in the study.
There are more than 1,000 professional therapists who belong to NARTH.
Assume that the average member has treated 50 clients a year for the
past five years. That means that there are over 250,000 clients from
which NARTH could select subjects for this study. Assuming that
reparative therapy had a "cure" rate of 0.02% then
NARTH would have been able to provide the approximately 50 "successful"
clients to this study. But a cure rate of 0.02% can
be expressed as a failure rate of 99.98% -- not a promising
form of therapy! If one considers the anecdotal accounts of gays
and lesbians who have committed suicide after failed reparative therapy,
then it becomes even less attractive.
Dr. Spitzer
reported his findings at a meeting of the American Psychiatric
Association on 2001-MAY-9.
In later interviews, Dr. Spitzer said:
"Our sample was self-selected from people who already claimed
they had made some change. We don't know how common that kind of change
is. . . . I'm not saying that this can be easily done, or that most
homosexuals who want to change can make this kind of change. I suspect
it's quite unusual." 13
"I suspect the vast majority of gay people would be unable to
alter by much a firmly established homosexual orientation."
14
"...the kinds of changes my subjects reported are highly unlikely
to be available to the vast majority [of gays and lesbians]... "[only] a
small minority -- perhaps 3% -- might have a "malleable" sexual
orientation." He expressed a concern that his study results were
being "twisted by the Christian right." 15
He told the Washington Post in 2005 that supporters of
reparative therapy have misrepresented the results of his study.
He said:
"It bothers me to be their knight in shining armor because on
every social issue I totally disagree with the Christian right...What
they don't mention is that change is pretty rare."
He noting that the subjects of his study were not
representative of the general population because they were considerably
more religious. He calls as "totally absurd" the beliefs
that everyone is born straight and that homosexuality is a choice. 20
Responses to Dr. Spitzer's study:
In response to Dr. Spitzer's study, the APA issued a statement
affirming its position and cautioning that "there is no published
evidence supporting the efficacy of reparative therapy as a treatment to
change one's sexual orientation." Quoted in Ref. 2
Other comments were:
The then APA president, Lawrence Hartmann, a professor at Harvard
Medical School, called Spitzer's study "too flawed to publish." A
Washington Post article stated that:
"Hartmann noted the study was retrospective, that it lacked
controls or independent measurements, and was based entirely on
self-reports by people who were motivated to say they had changed
because of their affiliation with ex-gay or anti-gay groups." 20
On 2001-SEP-23, Jack Drescher, M.D., FAPA Chair
Committee on Gay, Lesbian and Bisexual Issues of the American
Psychiatric Association wrote a letter to the Finish Parliament which
discussed the Spitzer study:
"As for the scientific merits of his study, I believe it is
significantly flawed. One flaw is that the majority of subjects in
the study had one 45-minute telephone interview with Dr. Spitzer and
no follow-ups. Other than Dr. Spitzer, I can find no reputable
researcher who will agree that this is an accurate way to assess
whether a person has changed their sexuality. That point was
underscored in another study presented at the same symposium.
Schroeder and Shidlo's study (in press) found that many individuals
who claimed to have changed sexual orientation during a first
telephone interview changed their story at a second, follow-up
interview." 21
David Elliot, spokesperson for the National Gay and Lesbian
Task Force said, "The sample is terrible, totally
tainted, totally unrepresentative of the gay and lesbian community."
Psychologist Douglas Haldeman of the University of Washington
commented that there is no credible scientific evidence that
sexual orientation can be changed, "and this study doesn't
prove that either." He noted that the participants
appeared unusually skewed towards religious conservatives and
people treated by therapists "with a strong anti-gay bias."
Joan Gerry of the Gay and Lesbian Alliance Against Defamation
(GLAAD) referred to the subjects as "a self-selected sample of people
who are so troubled by their sexual orientation that they will go to any
lengths to attempt to ‘change’ it....These are people who live in a
world where gays, lesbians and bisexuals are treated like second-class
citizens."
The CNN.com report on the study claim that "some gay
people can turn straight if they really want to."
Doug Nave of Covenant Network of Presbyterians commented: "...the
subjects did not have any anonymity that might help them candidly report
unfavorable outcomes; Spitzer could not assess their credibility
face-to-face; and the findings were based entirely on the subjects'
self-report (rather than, e.g., physiological measures of arousal),
which research has shown is often very misleading. In addition,
Spitzer's study has not been subject to any peer review or other normal
professional tests of validity. Some therefore believe that the study
merits no credit at all." 12
[Actually, after peer review, Dr. Spitzer's
paper was published in the 2003-OCT issue of the Archives of Sexual
Behavior.]
Barbara Pogue of the Lone Star Citizen, wrote: "Spitzer concluded
that sexual orientation shifts are definitely possible, albeit rare,
unusual and difficult." 16
Joe Nicolosi, president of the National Association for Research
and Therapy of Homosexuality (NARTH), said that the study is "an
historic event in the history of psychiatry's understanding of
homosexuality." 17
Family Research Council, a Fundamentalist Christian group,
simply reported that: "Dr Robert Spitzer's study of 200 former
homosexuals found that change is possible... [He] found that 66 percent
of the men and 44 percent of the women had achieved 'good heterosexual
functioning.' The vast majority of the study participants reported that
they were bothered only slightly, or not at all, by unwanted homosexual
feelings." The implication is that the subjects were chosen at
random from among homosexuals who had gone through therapy, and that
most homosexuals can change their orientation. This is deceptive
reporting. 18
Family Research Council reported that the Spitzer study was
not widely reported in the media. However, Exodus International,
the largest Fundamentalist Christian umbrella group of transformational
ministries stated that: "The Spitzer study is reported in today's
issue of USA Today, The Washington Post, The New York Times, and was
released to hundreds of local newspapers by the Associated Press. The
story is also being widely reported on the World Wide Web through such
prominent news sites as foxnews.com, cbsnews.com, abcnews.go.com, and
msnbc.com. Dr. Spitzer was featured on this morning's edition of 'Good
Morning America.' " 19
ABC News interviewed Dr. Spitzer about the hazards of "change
therapy." He replied: "There's no doubt that many homosexuals
have been unsuccessful and, attempting to change, become depressed and
their life becomes worse...I'm not disputing that. What I am disputing
is that is invariably the outcome." He later told ABC news that some
of his subjects had become despondent and even depressed after having
been told "...by many mental health professionals that there was no
hope for them, they had to just learn to live with their homosexual
feelings." 19
Conclusions:
We have not been able to find any information on
the subjects' original sexual orientation. We suspect that
most or all had a bisexual orientation and had previously engaged in at least
some homosexual activity. After therapy, we suspect that they
remained bisexual, and feel that they have successfully developed a
relationship with a person of the opposite gender.
Telephone interview data on behavior and practice are notoriously
unreliable. Individuals often answer questions according to what
they think others expect of them. For example:
17% of American adults say that they tithe (i.e. give 10 to
13% of their income to their church). Only 3% really do. 9
Many polls indicate that the percentage of adults who
say that they regularly attend religious services is about 40% in the U.S.,
and a little under 20% in Canada and perhaps 10% or less in Europe. But when
noses are actually counted, the true figures are about half
the stated North American figures (about 20% in the U.S. and 10% in Canada.)
On a topic as incendiary as changing one's sexual orientation,
a lack of honesty can be expected on the part of many of the participants.
This problem is even more severe in this study because so many
of the subjects were so closely associated with ex-gay or
anti-gay groups.
Assuming that the more than 1,000 therapists in NARTH each have had 50 clients
per year over the previous five years, then they have treated over 250,000
homosexuals and bisexuals with reparative therapy. Various transformational
ministries have treated other gays, bisexuals and lesbians who were
seeking change. Yet, Dr. Spitzer was only able to find 274 potential subjects
for his study in all of America. This data alone indicates that reparative
therapy is almost always a failure.
Author's note:
I am personally enraged at the irresponsibility of the large professional mental
health organizations. They have not had a good record about emerging therapies. They took little effort
in the 1980's and 1990's to curb recovered memory therapy
which generated false memories of incest, Satanic ritual abuse,
abuse in former lifetimes and abuse onboard UFOs. This experimental and untested
therapy caused the destruction of tens or hundreds of thousands of families of
origin, and probably triggered many hundreds or perhaps thousands of suicides.
Today,
there are at least a 1,000 therapists conducting reparative therapy. There are
many dozens of Fundamentalist Christian ministries also attempting to convert
clients' sexual orientation. Yet no statistically valid,
long term, peer-reviewed study in this field has ever been attempted that might
give some indication of the therapy's safety and effectiveness. Dr. Spitzer's
study was peer-reviewed and published. However, it was confined to a small
number of carefully selected subjects who were interviewed by telephone.
There are anecdotal stories of suicide attempts following failure of reparative
therapy. With the information available in 2002, there was no reliable data on the
therapy's safety and efficacy.
The situation is similar to that during the 1980s and 1990s with
recovered memory therapy (RMT) and
multiple personality disorder therapy (MPD). We now know that both were
dangerous, responsible for the destruction of tens of thousands of families,
created enormous numbers of false memories -- images of events that never
happened. They drove some clients to suicide.
In 2006, the world is still waiting for a peer reviewed study of reparative
therapy and transformational ministry therapy. If less than 1% of the millions
of dollars spent on therapy had been
directed to fund a meaningful study, then we would now be aware of the therapy's
safety and effectiveness.
References:
The following information sources were used to prepare and update the above
essay. The hyperlinks are not necessarily still active today.
Sandra G. Boodman, "Vowing to Set the World Straight: Proponents of
Reparative Therapy Say They Can Help Gay Patients Become Heterosexual.
Experts Call That a Prescription for Harm," Washington Post,
2005-AUG-16, at:
http://www.washingtonpost.com/
Jack Drescher, "Letter from the
American Psychiatric Association to the Finnish Parliament,"
2001-SEP-23, at:
http://www.finnqueer.net/
This essay was based partly on a number of information sources which are
no longer online, including:
"Ex.Ex" examines and explores "the reality of the
Ex-Gay movement." See: http://hometown.aol.com/
Randall Edwards, "Can sexual orientation change with therapy?"
APA Monitor. Online at:
http://www.apa.org/
"Study suggests some gays can go straight," CNN.com news,
2001-MAY-9, at: http://www.cnn.com/
Malcolm Ritter, "Some gays can turn straight, controversial study
suggests," Associated Press, 2001-MAY-8.