Reparative therapy & transformational ministries

An analysis of Dr. Spitzer's study

Sponsored link.

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 an adult's sexual orientation cannot be changed by reparative therapy. _1,2

A very small group disagrees: National Association for Research and Therapy of Homosexuality (NARTH). It was 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 number of 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 mental disorder.

"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 (APA) 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. [Palk may not actually be an ex-gay; he was spotted in "Mr. P's," a gay bar in Washington DC some months later.] ₂₂

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. "

Author's note: 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."  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: either engaging in reparative therapy with a therapist, or through spiritual counseling from a conservative Christian transformational ministry.
	Now consider themselves to be heterosexual.

All or almost all of the people referred to Dr. Spitzer are evangelical Christians.

Definitions of terms:

Since essentially all "ex-gays" and "ex-lesbians" are conservative Christians, they generally use the same definitions of words as do fundamentalist and other evangelical Christians. That is:

	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.

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 have a bisexual orientation. We suspect that all or essentially all were also bisexual when they entered therapy. Unfortunately, their initial sexual orientation is unknown; we suspect but cannot prove that most or all were bisexual.
	That sixteen (11%) of the men and 21 (37%) of the women report that they now are heterosexual. 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 to make the total of 200. 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 been involved 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

Unfortunately, these statements were lost in a sea of media accounts that emphasized that change is possible.

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." The implication is that the vast majority of people who try reparative therapy or transformational ministry and fail to change their sexual orientation were lazy; they just didn't try hard enough. The CNN report also implies that the study showed that people can change their sexual orientation. There is no evidence that any of the 200 subjects were able to do that; all might have been bisexuals in the past and remained bisexuals at the time of the study.
	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 either inaccurate or 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:

There are at least four fatal flaws in the study, any one of which seriously weakens the validity of the study, in our opinion:

1. All or almost all of the 200 subjects interviewed were referred by reparative therapists or by Christian transformational ministries. Apparently all or almost all of the clients were evangelical Christians. Thus:

   	They probably would have defined "homosexuality" in terms of behavior, not orientation.
   	Any results would not necessarily be representative of non-evangelicals.

2. Dr. Spitzer seems to have asked the subjects whether they rated themselves as "homosexual" before therapy. Being conservative Christians, they probably would have answered this question in terms of their behavior, not their sexual orientation. Dr. Spitzer did not include "bisexuality" as an option. "Spitzer told Extra! he did not include a category for bisexuality in his study 'because there's no accepted definition of what bisexuality is'." Thus it is not known what percentage of the 200 subjects initially had a homosexual orientation, and what percentage had a bisexual orientation. The difference between the two groups is massive. It is much easier to confine ones relationships to members of the opposite sex if one is sexually attracted to such persons. We suspect that most of the subjects had a bisexual orientation and had previously engaged in at least some homosexual activity. After therapy, we suspect that they remained bisexual, chosen to confine relationships with members of the opposite sex, and feel that they have successfully developed such relationship. Others had a homosexual orientation, still have that orientation, and are celibate.
3. 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, and were heavily motivated to show that transformational ministry and reparative therapy worked.

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 thousands or tens of thousands of other gays, bisexuals  and lesbians who were seeking change. Yet, Dr. Spitzer was only able to find 200 potential subjects for his study in all of America. This alone indicates that reparative therapy is almost always a failure.

Presentation of studies to the APA:

Although the panel discussion at the 2000-MAY annual conference of the American Psychiatric Association never materialized, two studies were presented at the APA's 2001-MAY-09 meeting:

Dr. Robert Spitzer presented a paper described above and titled: "200 Subjects Who Claim to Have Changed Their Sexual Orientation from Homosexual to Heterosexual."

Two psychotherapists from New York City, Ariel Shidlo and Michael Schroeder, discussed:  "... 202 randomly recruited subjects who had tried to change their sexual orientation through therapy. 88 percent failed completely, while 9 percent considered themselves successful but were celibate or still struggling with same-sex behavioral "slips"; only six people (3 percent) were actually successful." "Additionally, Shidlo and Schroeder found that a great number of their subjects suffered 'significant harm' due to instances in which reparative therapists appeared 'not to be practicing in a manner consistent with the APA Ethics Code'--encouraging patients to remember childhood abuse as the 'cause' of their homosexuality when no such abuse occurred; insisting that lesbians and gays can never live happy, healthy or monogamous lives; or practicing coercion (for example, students at religious universities were sometimes required to attend conversion therapy in order to graduate or receive financial aid." 23

An article in Wikipedia speculated:

"Of the 8 respondents (out of a sample of 202) who reported a change in sexual orientation, 7 were employed in paid or unpaid roles as 'ex-gay' counselors or group leaders, something which has led many to question whether even this small 'success' rate is in fact reliable." ₂₄

This study also has deficiencies. The subjects were self-selected, and thus may not represent the experiences of all gays, lesbians, and bisexual

Needless to say, Dr. Spitzer's study received essentially all of the media attention.

Author's note:

I am personally enraged at the irresponsibility of the large professional mental health organizations. I believe that it is close to depraved indifference. The organizations have not had a good record with 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 a few thousand therapists conducting reparative therapy. There are many dozens of fundamentalist or other evangelical 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. It is deeply flawed as described above.

There are anecdotal stories of suicide attempts following failure of reparative therapy. There is still no 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 2009, 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.

1. "Answers to your questions about sexual orientation and homosexuality," American Psychological Association, at: http://helping.apa.org/daily/answers.html 
2. Doug Nave, "Organizations of US Mental Health Professionals are unanimous," at: http://www.covenantnetwork.org/chgther.html
3. The National Association for Research and Therapy of Homosexuality (NARTH) has a home page at: http://www.narth.com/
4. As of 2001-JAN, NARTH can be reached at: 16633 Ventura Boulevard, Suite 1340, Encino, CA 91436-1801. Phone: (818) 789-4440. Fax: (805) 373-5084
5. "Just the Facts About Sexual Orientation & Youth: A Primer for Principals, Educators and School Personnel," at: http://www.apa.org/pi/lgbc/publications/
6. APA response copied from a reader's Email
7. Ethan Campbell, "Score one for politics," Boundless Webzine, at: http://www.boundless.org/2000/features/
8. Paul Varnell, "Those Not Very 'Ex' Gays," Chicago Free Press. 2001-MAY-16. Online at: http://www.indegayforum.org/articles/varnell65.html
9. See our essay on Christian practices in the U.S.
10. Psychiatrists cancel gay debate," Associated Press, 2000-MAY-18, at: http://cobrand.salon.com/news/wire/
11. Queer Resource Directory has an ex-gay section at: http://abacus.oxy.edu/qrd/www/rrr/exgay.html 
12. Doug Nave, "Organizations of US Mental Health Professionals are unanimous," at: http://www.covenantnetwork.org/chgther.html
13. CNN, 2001-MAY-9. Cited in Reference 12.
14. Wall Street Journal, 2001-MAY-23. Cited in Reference 12.
15. Advocate, 2001-JUL-17. Cited in Reference 12.
16. Barbara Pogue, "My Brother's Keepte - Part II," Lone Star Citizen, 2001-SEP issue. Online at Focus on the Family, at: http://www.family.org/cforum/
17. Pete Winn, "A life-changing study," Focus on the Family, at: http://www.family.org/cforum/
18. "Spitzer study is news but doesn't make the news," Family Research Council, at: http://www.frc.org/get/
19. " 'Some Gays Change," prominent Psychiatrist Says," Press release, Exodus International, at: http://www.exodusnorthamerica.org/
20. 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/
21. Jack Drescher, "Letter from the American Psychiatric Association to the Finnish Parliament," 2001-SEP-23, at: http://www.finnqueer.net/
22. Joel Lawson, "Ex-gay leader confronted in gay bar," Southern Voice, 2000-SEP-21, at: http://psychology.ucdavis.edu/
23. Jennifer L. Pozner, "Controversy, not credibility. A study of 'gay change' with the results media were looking for," Extra! magazine, 2001-SEP/OCT.
24. Reparative Therapy," Wikipedia, at: http://en.wikipedia.org/

Other information sources used:

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.
	Stuart Shepard, "Ex-gays protest APA," Focus on the Family, at: http://www.family.org/

Copyright © 2002 to 2009 by Ontario Consultants on Religious Tolerance
Originally written: 2002-FEB-16
Latest update and review: 2009-FEB-24
Author: B.A. Robinson

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