Ego-dystonic sexual orientation
Encyclopedia
Ego-dystonic sexual orientation is an ego-dystonic condition characterized by having a sexual orientation
or an attraction that is at odds with one's idealized self-image, causing anxiety
and a desire to change one's orientation or become more comfortable with one's sexual orientation.
(WHO) lists ego-dystonic sexual orientation in the ICD-10
, as a disorder of sexual development and orientation. The WHO diagnosis covers when gender identity or sexual orientation is clear, yet a patient has another behavioural or psychological disorder which makes that patient want to change it. The diagnostic manual notes that a sexual orientation is not a disorder in itself.
The diagnostic category of "ego-dystonic homosexuality" was removed from the American Psychiatric Association
's DSM
in 1987 (with the publication of the DSM-III-R), but still potentially remains in the DSM-IV under the category of "sexual disorder not otherwise specified" including "persistent and marked distress about one’s sexual orientation”.
The Medical Council of India uses the WHO classification of ego-dystonic sexual orientation. The Chinese Classification and Diagnostic Criteria of Mental Disorders includes ego-dystonic homosexuality. The American Psychological Association
has officially opposed the category of ego-dystonic homosexuality since 1987.
The WHO notes that for codes under F66: "Sexual orientation by itself is not to be regarded as a disorder."
This is often a result of unfavorable and intolerant attitudes of the society or a conflict between sexual urges and religious belief systems.
, sexual behaviour, or helping a client become more comfortable with their sexual orientation and behaviours. Human rights groups have accused some countries of performing these treatments on egosyntonic
homosexuals. One survey suggested that viewing the same-sex activities as compulsive facilitated commitment to a mixed-orientation marriage
and to monogamy
. Treatment may include sexual orientation change efforts
or treatment to alleviate the stress. In addition, some people seek non-professional methods, such as religious counselling or attendance in an ex-gay
group.
helps LGB people to examine and accept their sexual orientation
and related sexual relationships. Psychologists understand that homosexuality
and bisexuality
are not indicative of mental illness. Psychologists are encouraged to recognize how their attitudes and knowledge about homosexual and bisexual issues may be relevant to assessment and treatment and seek consultation or make appropriate referrals when indicated. Psychologists strive to understand the ways in which social stigmatization (i.e., prejudice, discrimination, and violence) poses risks to the mental health and well-being of homosexual and bisexual clients. Psychologists strive to understand how inaccurate or prejudicial views of homosexuality or bisexuality may affect the client’s presentation in treatment and the therapeutic process. Douglas Haldeman has argued that for individuals who seek therapy because of frustration surrounding "seemingly irreconcilable internal differences" between "their sexual and religious selves... neither a gay-affirmative nor a conversion therapy approach [may be] indicated," and that "[just as] therapists in the religious world [should] refrain from pathologizing their LGB clients... so, too, should gay-affirmative practitioners refrain from overtly or subtly devaluing those who espouse conservative religious identities." Data suggest that clients generally judge therapists who do not respect religiously-based identity outcomes to be unhelpful.
, marginalization, and isolation. They focus on helping a person with ego-dystonic sexual orientation accept their sexual orientation.
develop through life, and psychotherapy
, support group
s, and life events can influence identity development; similarly, self-awareness, self-conception, and identity may evolve during treatment. Psychotherapy
, support group
s, and life events can change sexual orientation identity (private and public identification, and group belonging), but not actual sexual orientation, emotional adjustment (self-stigma and shame reduction), and personal beliefs, values and norms (change of religious and moral belief, behaviour and motivation). The APA has stated that sexual orientation
develops across a person’s lifetime".
Gender Wholeness Therapy was designed by an ex-gay Licensed Professional Counselor
, David Matheson. "The emphasis in Mr. Matheson's counselling is on helping men — all his clients are male — develop 'gender wholeness' by addressing emotional issues and building healthy connections with other men. He [says] he believe[s] that help[s] reduce homosexual desires.
Gender-affirmative therapy has been described by A. Dean Byrd
as follows: "The basic premise of gender-affirmative therapy is that social and emotional variables affect gender identity which, in turn, determines sexual orientation. The work of the therapist is to help people understand their gender development. Subsequently, such individuals are able to make choices that are consistent with their value system. The focus of therapy is to help clients fully develop their masculine or feminine identity".
Several organizations have started retreats led by coaches aimed at helping participants diminish same-sex desires. These retreats tend to use a variety of techniques. Journey into Manhood, put on by People Can Change
, uses "a wide variety of large-group, small-group and individual exercises, from journaling to visualizations (or guided imagery) to group sharing and intensive emotional-release work." Weekends put on by Adventure in Manhood support "healthy bonding with men, through masculine activity, teamwork, and socialization." Though not specific to gay men, several gay men attended the New Warrior Training Adventure, a weekend put on by Mankind Project
, which is a "process of initiation and self-examination that is designed to catalyse the development of a healthy and mature masculine self." Joe Dallas
, a prominent ex-gay, leads a monthly five-day men's retreat on sexual purity titled, Every Man's Battle.
For some ex-gay groups, choosing not to act on one's same-sex desires counts as a success whereas conversion therapists tend to understand success in terms of reducing or eliminating those desires. For example, some ex-gays in mixed-orientation marriage
s acknowledge that their sexual attractions remain primarily homosexual, but seek to make their marriages work regardless. Ex-gay advocates sometimes compare adopting the label "ex-gay" to the coming out
process." Some conservative Christian
political and social lobbying groups such as Focus on the Family
, the Family Research Council
, and the American Family Association
actively promote to their constituencies the accounts of change of both conversion therapies and ex-gay groups.
Some ex-gay organizations follow the tenets of a specific religion, while others try to encompass a more general spirituality. Although most ex-gay organizations were started by American evangelical Christians, there are now ex-gay organizations in other parts of the world and for Catholics, Mormons
, Jews
and Muslims. According to Douglas Haldeman, "This modality is thought to be one of the most common for individuals seeking to change their sexual orientation." Ex-gay ministries typically are staffed by volunteer counselors, unlike reorientation counselling, which is conducted by licensed clinicians.
Ex-gay groups use several different techniques. Love in Action
hosts workshops on "child development, gender roles, and personal sexuality," one-on-one Biblical guidance, "a structured environment help[ing] establish new routines and healthy patterns of behaviour", "challenging written assignments and interactive projects," "family involvement to improve communication... and to facilitate marital reconciliation," and "hiking, camping, canoeing, and rafting." Exodus International
considers reparative therapy to be a useful tool, but not a necessary one. Evergreen International does not advocate or discourage particular therapies and states that "therapy will likely not be a cure in the sense of erasing all homosexual feelings."
Robert L. Spitzer
reported in 2003 that individuals who reported experiencing a change in sexual orientation had felt depressed or even suicidal prior to treatment "precisely because they had previously thought there was no hope for them, and they had 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." Spitzer's study, however, is widely considered disreputable in the therapeutic and mental-health community. The American Psychiatric Association
enumerated many flaws in Spitzer's methods and analysis, and an American Psychological Association
task force likewise scrutinized Spitzer's work and found it seriously flawed. A member of the association sponsoring the journal Archives of Sexual Behavior
resigned in protest of Spitzer's paper being published therein. The degree to which Spitzer's claims were treated as authoritative by news media has been examined and found problematic.
Several therapies have been established, including:
. Some churches publish specific instructions to clergy on how to minister to gay and lesbian people. These include Ministry to Persons with a Homosexual Inclination
, produced by the Roman Catholic Church
, and God Loveth His Children
, produced by The Church of Jesus Christ of Latter-day Saints. In 1994, a church in the Presbyterian Church (USA)
held a conference entitled “The Path to Freedom: Exploring healing for the Homosexual.” The APA encourages religious leaders to recognize that it is outside their role to adjudicate empirical scientific issues in psychology.
Mental health practitioners can incorporate religion into therapy by "integrating aspects of the psychology of religion into their work, including by obtaining a thorough assessment of clients’ spiritual and religious beliefs, religious identity and motivations, and spiritual functioning; improving positive religious coping; and exploring the intersection of religious and sexual orientation identities." Researchers have found that for some clients, identity conflicts can be reduced by reading religious texts to help clients increase self-authority and focus less on negative messages about homosexuality. Researchers also found that clients made further progress if they came to believe that regardless of their sexual orientation, God still loves and accepts them.
Alternatively, gay and lesbian people may decide to seek out minority-affirming religious groups, or change churches to those that affirm LGBT people.
Sexual orientation
Sexual orientation describes a pattern of emotional, romantic, or sexual attractions to the opposite sex, the same sex, both, or neither, and the genders that accompany them. By the convention of organized researchers, these attractions are subsumed under heterosexuality, homosexuality,...
or an attraction that is at odds with one's idealized self-image, causing anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
and a desire to change one's orientation or become more comfortable with one's sexual orientation.
Classifications
The World Health OrganizationWorld Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
(WHO) lists ego-dystonic sexual orientation in the ICD-10
ICD-10
The International Statistical Classification of Diseases and Related Health Problems, 10th Revision is a medical classification list for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases, as maintained by the...
, as a disorder of sexual development and orientation. The WHO diagnosis covers when gender identity or sexual orientation is clear, yet a patient has another behavioural or psychological disorder which makes that patient want to change it. The diagnostic manual notes that a sexual orientation is not a disorder in itself.
The diagnostic category of "ego-dystonic homosexuality" was removed from the American Psychiatric Association
American Psychiatric Association
The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...
's DSM
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...
in 1987 (with the publication of the DSM-III-R), but still potentially remains in the DSM-IV under the category of "sexual disorder not otherwise specified" including "persistent and marked distress about one’s sexual orientation”.
The Medical Council of India uses the WHO classification of ego-dystonic sexual orientation. The Chinese Classification and Diagnostic Criteria of Mental Disorders includes ego-dystonic homosexuality. The American Psychological Association
American Psychological Association
The American Psychological Association is the largest scientific and professional organization of psychologists in the United States. It is the world's largest association of psychologists with around 154,000 members including scientists, educators, clinicians, consultants and students. The APA...
has officially opposed the category of ego-dystonic homosexuality since 1987.
Diagnosis
When the WHO removed the diagnosis of homosexuality as a mental disorder in ICD-10, it included the diagnosis of ego-dystonic sexual orientation under "Psychological and behavioural disorders associated with sexual development and orientation". The WHO's ICD.10 diagnoses Ego-dystonic sexual orientation thus:The gender identity or sexual preference (heterosexual, homosexual, bisexual, or prepubertalPedophiliaAs a medical diagnosis, pedophilia is defined as a psychiatric disorder in adults or late adolescents typically characterized by a primary or exclusive sexual interest in prepubescent children...
) is not in doubt, but the individual wishes it were different because of associated psychological and behavioural disorders, and may seek treatment in order to change it.
The WHO notes that for codes under F66: "Sexual orientation by itself is not to be regarded as a disorder."
This is often a result of unfavorable and intolerant attitudes of the society or a conflict between sexual urges and religious belief systems.
Treatments
There are many ways a person may go about receiving therapy for ego-dystonic sexual orientation associated with homosexuality. There is no known therapy for other types of ego-dystonic sexual orientations. Therapy can be aimed at changing sexual orientationSexual orientation
Sexual orientation describes a pattern of emotional, romantic, or sexual attractions to the opposite sex, the same sex, both, or neither, and the genders that accompany them. By the convention of organized researchers, these attractions are subsumed under heterosexuality, homosexuality,...
, sexual behaviour, or helping a client become more comfortable with their sexual orientation and behaviours. Human rights groups have accused some countries of performing these treatments on egosyntonic
Egosyntonic
Egosyntonic is a psychological term referring to behaviors, values, feelings that are in harmony with or acceptable to the needs and goals of the ego, or consistent with one's ideal self-image....
homosexuals. One survey suggested that viewing the same-sex activities as compulsive facilitated commitment to a mixed-orientation marriage
Mixed-orientation marriage
A mixed-orientation marriage is a marriage in which one of the partners is heterosexual and the other is bisexual or homosexual.- Motivations:Some cite spiritual reasons for getting married...
and to monogamy
Monogamy
Monogamy /Gr. μονός+γάμος - one+marriage/ a form of marriage in which an individual has only one spouse at any one time. In current usage monogamy often refers to having one sexual partner irrespective of marriage or reproduction...
. Treatment may include sexual orientation change efforts
Sexual orientation change efforts
Sexual orientation change efforts are methods that aim to eliminate a same-sex sexual orientation. They may include behavioral techniques, cognitive behavioral techniques , psychoanalytic techniques, medical approaches, religious and spiritual approaches.The longstanding consensus of the...
or treatment to alleviate the stress. In addition, some people seek non-professional methods, such as religious counselling or attendance in an ex-gay
Ex-gay
The ex-gay movement consists of people and organizations that seek to get people to refrain from entering or pursuing same-sex relationships, to eliminate homosexual desires, to develop heterosexual desires, or to enter into a heterosexual relationship...
group.
LGB affirming
Gay affirmative psychotherapyGay affirmative psychotherapy
Gay affirmative psychotherapy is a form of psychotherapy for gay and lesbian clients which encourages them to accept their sexual orientation, and does not attempt to change them to heterosexual, or to eliminate or diminish same-sex desires and behaviors. The American Psychological Association ...
helps LGB people to examine and accept their sexual orientation
Sexual orientation
Sexual orientation describes a pattern of emotional, romantic, or sexual attractions to the opposite sex, the same sex, both, or neither, and the genders that accompany them. By the convention of organized researchers, these attractions are subsumed under heterosexuality, homosexuality,...
and related sexual relationships. Psychologists understand that homosexuality
Homosexuality
Homosexuality is romantic or sexual attraction or behavior between members of the same sex or gender. As a sexual orientation, homosexuality refers to "an enduring pattern of or disposition to experience sexual, affectional, or romantic attractions" primarily or exclusively to people of the same...
and bisexuality
Bisexuality
Bisexuality is sexual behavior or an orientation involving physical or romantic attraction to both males and females, especially with regard to men and women. It is one of the three main classifications of sexual orientation, along with a heterosexual and a homosexual orientation, all a part of the...
are not indicative of mental illness. Psychologists are encouraged to recognize how their attitudes and knowledge about homosexual and bisexual issues may be relevant to assessment and treatment and seek consultation or make appropriate referrals when indicated. Psychologists strive to understand the ways in which social stigmatization (i.e., prejudice, discrimination, and violence) poses risks to the mental health and well-being of homosexual and bisexual clients. Psychologists strive to understand how inaccurate or prejudicial views of homosexuality or bisexuality may affect the client’s presentation in treatment and the therapeutic process. Douglas Haldeman has argued that for individuals who seek therapy because of frustration surrounding "seemingly irreconcilable internal differences" between "their sexual and religious selves... neither a gay-affirmative nor a conversion therapy approach [may be] indicated," and that "[just as] therapists in the religious world [should] refrain from pathologizing their LGB clients... so, too, should gay-affirmative practitioners refrain from overtly or subtly devaluing those who espouse conservative religious identities." Data suggest that clients generally judge therapists who do not respect religiously-based identity outcomes to be unhelpful.
LGB support groups
LGB groups help counteract and buffer Minority StressMinority stress
Minority stress describes chronically high levels of stress faced by members of stigmatized minority groups. It may be caused by a number of factors, including poor social support and low socioeconomic status, but the most well understood causes of minority stress are interpersonal prejudice and...
, marginalization, and isolation. They focus on helping a person with ego-dystonic sexual orientation accept their sexual orientation.
Disidentify with LGB
A task force commissioned by the APA found that religious identity and sexual orientation identitySexual orientation identity
Sexual orientation identity describes how persons identify their own sexuality. In addition, they may choose not to identify their sexual orientation, or dis-identify with a sexual orientation.This may or may not relate to their actual sexual orientation...
develop through life, and psychotherapy
Psychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...
, support group
Support group
In a support group, members provide each other with various types of help, usually nonprofessional and nonmaterial, for a particular shared, usually burdensome, characteristic...
s, and life events can influence identity development; similarly, self-awareness, self-conception, and identity may evolve during treatment. Psychotherapy
Psychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...
, support group
Support group
In a support group, members provide each other with various types of help, usually nonprofessional and nonmaterial, for a particular shared, usually burdensome, characteristic...
s, and life events can change sexual orientation identity (private and public identification, and group belonging), but not actual sexual orientation, emotional adjustment (self-stigma and shame reduction), and personal beliefs, values and norms (change of religious and moral belief, behaviour and motivation). The APA has stated that sexual orientation
Sexual orientation
Sexual orientation describes a pattern of emotional, romantic, or sexual attractions to the opposite sex, the same sex, both, or neither, and the genders that accompany them. By the convention of organized researchers, these attractions are subsumed under heterosexuality, homosexuality,...
develops across a person’s lifetime".
Gender Wholeness Therapy was designed by an ex-gay Licensed Professional Counselor
Licensed Professional Counselor
Licensed professional counselor is a licensure for mental health professionals. The exact title varies by state, but the other most frequently used title is licensed mental health counselor . Several U.S. states, including Illinois, Maine, and Tennessee, have implemented a two-tier system whereby...
, David Matheson. "The emphasis in Mr. Matheson's counselling is on helping men — all his clients are male — develop 'gender wholeness' by addressing emotional issues and building healthy connections with other men. He [says] he believe[s] that help[s] reduce homosexual desires.
Gender-affirmative therapy has been described by A. Dean Byrd
A. Dean Byrd
Albert Dean Byrd is a former president of the National Association for Research & Therapy of Homosexuality , a research organization that advocates sexual orientation change efforts . He is a psychologist who focuses on SOCE, and has written on the topic...
as follows: "The basic premise of gender-affirmative therapy is that social and emotional variables affect gender identity which, in turn, determines sexual orientation. The work of the therapist is to help people understand their gender development. Subsequently, such individuals are able to make choices that are consistent with their value system. The focus of therapy is to help clients fully develop their masculine or feminine identity".
Several organizations have started retreats led by coaches aimed at helping participants diminish same-sex desires. These retreats tend to use a variety of techniques. Journey into Manhood, put on by People Can Change
People Can Change
People Can Change is an American nonprofit organization supporting men wishing to reduce or eliminate their same-sex desires. The organization hosts weekend retreats for these men...
, uses "a wide variety of large-group, small-group and individual exercises, from journaling to visualizations (or guided imagery) to group sharing and intensive emotional-release work." Weekends put on by Adventure in Manhood support "healthy bonding with men, through masculine activity, teamwork, and socialization." Though not specific to gay men, several gay men attended the New Warrior Training Adventure, a weekend put on by Mankind Project
Mankind Project
ManKind Project is a non-profit, educational organization, with the stated purpose to "support men in leading meaningful lives of integrity, accountability, responsibility, and emotional intelligence."...
, which is a "process of initiation and self-examination that is designed to catalyse the development of a healthy and mature masculine self." Joe Dallas
Joe Dallas
Joe Dallas is a prominent figure in the ministry for sexual addiction recovery and reparative therapy.-Biography:Joe Dallas is founder of Genesis Counseling which specializes in "sexual addiction recovery and homosexuality.." Dallas is the keynote speaker at one of the monthly weekend retreats on...
, a prominent ex-gay, leads a monthly five-day men's retreat on sexual purity titled, Every Man's Battle.
Ex-gay organizations
For some ex-gay groups, choosing not to act on one's same-sex desires counts as a success whereas conversion therapists tend to understand success in terms of reducing or eliminating those desires. For example, some ex-gays in mixed-orientation marriage
Mixed-orientation marriage
A mixed-orientation marriage is a marriage in which one of the partners is heterosexual and the other is bisexual or homosexual.- Motivations:Some cite spiritual reasons for getting married...
s acknowledge that their sexual attractions remain primarily homosexual, but seek to make their marriages work regardless. Ex-gay advocates sometimes compare adopting the label "ex-gay" to the coming out
Coming out
Coming out is a figure of speech for lesbian, gay, bisexual, and transgender people's disclosure of their sexual orientation and/or gender identity....
process." Some conservative Christian
Christian right
Christian right is a term used predominantly in the United States to describe "right-wing" Christian political groups that are characterized by their strong support of socially conservative policies...
political and social lobbying groups such as Focus on the Family
Focus on the Family
Focus on the Family is an American evangelical Christian tax-exempt non-profit organization founded in 1977 by psychologist James Dobson, and is based in Colorado Springs, Colorado. Focus on the Family is one of a number of evangelical parachurch organizations that rose to prominence in the 1980s...
, the Family Research Council
Family Research Council
The Family Research Council is a conservative or right-wing Christian group and lobbying organization formed in the United States in 1981 by James Dobson. It was fully incorporated in 1983...
, and the American Family Association
American Family Association
The American Family Association is a 501 non-profit organization that promotes conservative Christian values, such as opposition to same-sex marriage, pornography, and abortion, as well as other public policy goals such as deregulation of the oil industry and lobbying against the Employee Free...
actively promote to their constituencies the accounts of change of both conversion therapies and ex-gay groups.
Some ex-gay organizations follow the tenets of a specific religion, while others try to encompass a more general spirituality. Although most ex-gay organizations were started by American evangelical Christians, there are now ex-gay organizations in other parts of the world and for Catholics, Mormons
Mormons
The Mormons are a religious and cultural group related to Mormonism, a religion started by Joseph Smith during the American Second Great Awakening. A vast majority of Mormons are members of The Church of Jesus Christ of Latter-day Saints while a minority are members of other independent churches....
, Jews
Jews
The Jews , also known as the Jewish people, are a nation and ethnoreligious group originating in the Israelites or Hebrews of the Ancient Near East. The Jewish ethnicity, nationality, and religion are strongly interrelated, as Judaism is the traditional faith of the Jewish nation...
and Muslims. According to Douglas Haldeman, "This modality is thought to be one of the most common for individuals seeking to change their sexual orientation." Ex-gay ministries typically are staffed by volunteer counselors, unlike reorientation counselling, which is conducted by licensed clinicians.
Ex-gay groups use several different techniques. Love in Action
Love In Action
Love In Action is an ex-gay, Christian ministry founded in 1973 by Frank Worthen, John Evans, and Kent Philpott. The program was originally founded in Marin County, California, just north of San Francisco.-History:...
hosts workshops on "child development, gender roles, and personal sexuality," one-on-one Biblical guidance, "a structured environment help[ing] establish new routines and healthy patterns of behaviour", "challenging written assignments and interactive projects," "family involvement to improve communication... and to facilitate marital reconciliation," and "hiking, camping, canoeing, and rafting." Exodus International
Exodus International
Exodus International is a non-profit, interdenominational ex-gay Christian organization founded by Michael Bussee, Gary Cooper, Frank Worthen, Ron Dennis, and Greg Reid...
considers reparative therapy to be a useful tool, but not a necessary one. Evergreen International does not advocate or discourage particular therapies and states that "therapy will likely not be a cure in the sense of erasing all homosexual feelings."
Sexual orientation change efforts
The American Psychological Association "encourages mental health professionals to avoid misrepresenting the efficacy of sexual orientation change efforts by promoting or promising change in sexual orientation when providing assistance to individuals distressed by their own or others’ sexual orientation and concludes that the benefits reported by participants in sexual orientation change efforts can be gained through approaches that do not attempt to change sexual orientation". The APA reviewed research into the efficacy of efforts to change sexual orientation, and concluded that there was insufficient evidence to show whether these were effective or not. Participants have reported both harm and benefit from such efforts, but no causal relationship has been determined between either the benefit or the harm. According to a recent APA study, participants who reported harm generally reported "anger, anxiety, confusion, depression, grief, guilt, hopelessness, deteriorated relationships with family, loss of social support, loss of faith, poor self-image, social isolation, intimacy difficulties, intrusive imagery, suicidal ideation, self-hatred, and sexual dysfunction. These reports of perceptions of harm are countered by accounts of perceptions of relief, happiness, improved relationships with God, and perceived improvement in mental health status".Robert L. Spitzer
Robert Spitzer (psychiatrist)
Robert L. Spitzer was a major architect of the modern classification of mental disorders. He is a retired professor of psychiatry at Columbia University in New York City, United States and was on the research faculty of the Columbia University Center for Psychoanalytic Training and Research. He...
reported in 2003 that individuals who reported experiencing a change in sexual orientation had felt depressed or even suicidal prior to treatment "precisely because they had previously thought there was no hope for them, and they had 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." Spitzer's study, however, is widely considered disreputable in the therapeutic and mental-health community. The American Psychiatric Association
American Psychiatric Association
The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...
enumerated many flaws in Spitzer's methods and analysis, and an American Psychological Association
American Psychological Association
The American Psychological Association is the largest scientific and professional organization of psychologists in the United States. It is the world's largest association of psychologists with around 154,000 members including scientists, educators, clinicians, consultants and students. The APA...
task force likewise scrutinized Spitzer's work and found it seriously flawed. A member of the association sponsoring the journal Archives of Sexual Behavior
Archives of Sexual Behavior
The Archives of Sexual Behavior is a peer-reviewed academic journal in sexology. It is the official publication of the International Academy of Sex Research.- History :...
resigned in protest of Spitzer's paper being published therein. The degree to which Spitzer's claims were treated as authoritative by news media has been examined and found problematic.
Exploratory
The APA recommends that if a client wants treatment to change his sexual orientation, the therapist should explore the reasons behind the desire, without favouring any particular outcome. The therapist should neither promote nor reject the idea of celibacy, but help the client come to their own decisions by evaluating the reasons behind the patient's goals. Psychotherapy may result in one of four sexual orientation identities:- LGBLGBTLGBT is an initialism that collectively refers to "lesbian, gay, bisexual, and transgender" people. In use since the 1990s, the term "LGBT" is an adaptation of the initialism "LGB", which itself started replacing the phrase "gay community" beginning in the mid-to-late 1980s, which many within the...
identity - Heterosexual sexual orientation identity
- Dissidentifying from LGB identities (e.g., ex-gayEx-gayThe ex-gay movement consists of people and organizations that seek to get people to refrain from entering or pursuing same-sex relationships, to eliminate homosexual desires, to develop heterosexual desires, or to enter into a heterosexual relationship...
) - Not specifying an identity.
Several therapies have been established, including:
- Sexual Identity TherapySexual Identity TherapySexual Identity Therapy is a framework to "aid mental health practitioners in helping people arrive at a healthy and personally acceptable resolution of sexual identity and value conflicts." It was invented by Warren Throckmorton and Mark Yarhouse, professors at small conservative evangelical...
was designed by Warren ThrockmortonWarren ThrockmortonE. Warren Throckmorton is an associate professor of Psychology at Grove City College in Grove City, Pennsylvania. He is a former advocate of sexual orientation change efforts and the creator of the documentary I Do Exist, about people who say they have changed their sexual orientation.Throckmorton...
and Mark Yarhouse, and is endorsed by Robert L. Spitzer. Its purpose is to help patients line up their sexual identity with their beliefs and values. Therapy involves four phases: (1) assessment, (2) advanced or expanded informed consent, (3) psychotherapy, and (4) social integration of a valued sexual identity. According to a Regent UniversityRegent UniversityRegent University is a private coeducational interdenominational Christian university located in Virginia Beach, Virginia, United States. The school was founded by the American televangelist Pat Robertson in 1978 as Christian Broadcasting Network University. A satellite campus located in...
website, which describes a client's adoption of the "gay affirmative" or "integrative" therapeutic model as a clinical failure, sexual identity therapy is not a form of conversion therapy.
- Group psychotherapyGroup psychotherapyGroup psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group...
uses group sessions led by a single psychologist and focuses on conflict surrounding homosexual expression.
- Context Specific Therapy was designed by Jeffrey Robinson. It does not work with any one theory of homosexuality, but uses several theoretical backgrounds according to the client's need, and is based on phenomenological research. It does not seek to change the client's orientation, but instead focuses on diminishing homosexual thoughts and behaviours. It works within the client's own view of God, noting that "individuals who are successful at overcoming homosexual problems are motivated by strong religious values".
- MAP Therapy is designed for both the individual with ego-dystonic sexual orientation and their family members. There are four main paths that clients may choose to take: (1) they can affirm an LGB identity, (2) they can foster a lifestyle of celibacy, (3) they can work on developing heterosexual attractions, or (4) they can explore their options.
Religious treatment
Some gay people have turned to pastoral carePastoral care
Pastoral care is the ministry of care and counseling provided by pastors, chaplains and other religious leaders to members of their church or congregation, or to persons of all faiths and none within institutional settings. This can range anywhere from home visitation to formal counseling provided...
. Some churches publish specific instructions to clergy on how to minister to gay and lesbian people. These include Ministry to Persons with a Homosexual Inclination
Ministry to Persons with a Homosexual Inclination
Ministry to Persons with a Homosexual Inclination is a document which was issued on November 14, 2006 by the bishops of the Roman Catholic Church...
, produced by the Roman Catholic Church
Roman Catholic Church
The Catholic Church, also known as the Roman Catholic Church, is the world's largest Christian church, with over a billion members. Led by the Pope, it defines its mission as spreading the gospel of Jesus Christ, administering the sacraments and exercising charity...
, and God Loveth His Children
God Loveth His Children
"God Loveth His Children" is a pamphlet produced by The Church of Jesus Christ of Latter-day Saints for members with homosexual attractions. It was approved in April 2007 and was announced in July 2007 through a letter to LDS Church bishops and stake presidents, and is available in 27 languages...
, produced by The Church of Jesus Christ of Latter-day Saints. In 1994, a church in the Presbyterian Church (USA)
Presbyterian Church (USA)
The Presbyterian Church , or PC, is a mainline Protestant Christian denomination in the United States. Part of the Reformed tradition, it is the largest Presbyterian denomination in the U.S...
held a conference entitled “The Path to Freedom: Exploring healing for the Homosexual.” The APA encourages religious leaders to recognize that it is outside their role to adjudicate empirical scientific issues in psychology.
Mental health practitioners can incorporate religion into therapy by "integrating aspects of the psychology of religion into their work, including by obtaining a thorough assessment of clients’ spiritual and religious beliefs, religious identity and motivations, and spiritual functioning; improving positive religious coping; and exploring the intersection of religious and sexual orientation identities." Researchers have found that for some clients, identity conflicts can be reduced by reading religious texts to help clients increase self-authority and focus less on negative messages about homosexuality. Researchers also found that clients made further progress if they came to believe that regardless of their sexual orientation, God still loves and accepts them.
Alternatively, gay and lesbian people may decide to seek out minority-affirming religious groups, or change churches to those that affirm LGBT people.
See also
- Environment and sexual orientationEnvironment and sexual orientationEnvironment and sexual orientation is research into possible environmental influences on the development of human sexual orientation. Some researchers distinguish environmental influences from hormonal influences while others include biological influences such as prenatal hormones as part of...
- Homosexuality and psychologyHomosexuality and psychologyPsychology was one of the first disciplines to study homosexuality as a discrete phenomenon. Prior to and throughout most of the 20th century, common standard psychology viewed homosexuality in terms of pathological models as a mental illness...
- Insight in psychology and psychiatry
- Internalized homophobia
- Minority StressMinority stressMinority stress describes chronically high levels of stress faced by members of stigmatized minority groups. It may be caused by a number of factors, including poor social support and low socioeconomic status, but the most well understood causes of minority stress are interpersonal prejudice and...