Reparative Therapy: What the Facts Really Are
As far back as 1990, Dr. Bryant Welch, Executive Director of the American Psychological Association stated, “Research findings suggest that efforts to repair homosexuals (sic) are nothing more than social prejudice garbed in psychological accoutrements.” Since then, mainstream medical and psychological health associations have taken unequivocal stances against what is called conversion, reparative, and reorientations therapies due to lack of evidence to support positive impact and the plethora of evidence documenting harm. These organizations include: American Academy of Child & Adolescent Psychiatry, American Academy of Family Physicians, American Academy of Nursing, American Academy of Pediatrics, American Association of Marriage & Family Therapy, American College of Physicians, American Counseling Association, American Medical Association, American Medical Student Association, American Psychiatric Association, American Psychoanalytic Association, American Psychological Association, American School Counselor Association, American School health Association, National Association of Social Workers, the Pan American Health Organization, and others.
These organizations, who represent the majority of U.S. medical and psychological health professionals have taken this stance not because of political positioning, but because, as the American Psychological Association (2007) noted:
APA affirms that same-sex sexual and romantic attractions, feelings, and behaviors are normal and positive variations of human sexuality regardless of sexual orientation identity;
APA reaffirms its position that homosexuality per se is not a mental disorder and opposes portrayals of sexual minority youths and adults as mentally ill due to their sexual orientation;
APA concludes there is insufficient evidence to support the use of psychological interventions to change sexual orientation;
APA encourages mental health professionals to avoid misrepresenting the efficacy of sexual orientation change efforts by promoting or promising change when providing assistance to individuals distressed by their own or others’ sexual orientation;
APA 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.
These organizations have taken stances validating the inherent worth, dignity, and validity of sexual/affectional orientation due to the lack of conclusive empirical evidence that supports that one sexual/affectional orientation is less or more mentally and physically healthy. In fact, the data is so consistent, these organizations had no other choice but to take these stances to uphold their own foundations of evidence-based decision making. Those that continue to advocate for reorientation continue to perpetuate the reductionist, bipolarity construct of sexual/affectional orientation that current science and service left behind 50 years ago when the APA declassified homosexuality as a mental health concern.
The faculty assumptions imbued into the claims of reorientation are numerous and include:
- Sexual/affectional orientation is behavior that can be changed. This approach ignores copious evidence which connotes the multimodality of sexual/affectional orientation. Additionally, current conceptualizations include sexual/affectional orientation as having the components of identity connected to it.
- Sexual/affectional orientation is only something LGBQ people have. Sexual/affectional orientation is something heterosexual people have as well, but ironically is not seen as something open to reorientation.
- Religion condemns LGBQ orientation. Religion is a choice and perhaps reorientation could be for religious choice, re-orienting to the major U.S religions that support LGBQ orientations: American Baptist Church; Disciples of Christ; Episcopal Church; Metropolitan Community Church; Presbyterian Church, USA; Reform Judaism; Society of Friends; Unitarian Universalist Church; Buddhism, United Church of Christ, Congregational, and many others. People who are LGBQ have not abdicated religion to those who would seek to change them and many organized religions agree.
- Research supports reorientation therapy. There is bottomless research denoting the bad science of these “studies” and their sufficiency of methodological, participant selection, statistical analyses, and outcome measure problems. Also, unethical behavior, sexual abuse, deception, and theological malpractice are rife throughout this literature. The confines of here do not allow for detailing all of this research, though objective reviews can be found from infinitely wide sources including everything from the Minnesota Department of Health to the Government of the United Kingdom.
- Heterosexuality is the Standard. A mainstay assertion is that people who are LGBQ are undeveloped, regressed, and fixated and thus need changing due to an inability to have mature relationships. It is a specious argument that when people who are LGBQ have problems with relationships, it is due to their sexual/affectional orientation and when people who are Straight have relationships, it is not.
- Reorientation Therapies Only Help. Reorientationists consistently produce data that only indicates that their actions help. The very idea that treatment cannot cause harm is a dangerous and unethical position for any psychologist. Once again, there is a bottomless set of studies demonstrating first-person accounts of the harmful impact of these therapies. These range between them being destructive to them being, at the very best, unable to produce what they proport.
These are a few of the many faculty assumptions that undergird this movement. The leading national organizations who represent the majority of U.S. licensed medical and psychological providers, clearly state that as there is no illness, there is no cure. Prohibitions against such practices, which cannot sufficiently document positive outcomes over risk for harm, exist in 27 states+ D.C. and this number grows annually. It is time, as it is with all medical and mental health matters, to listen to the evidence and move on from practices which rest on bias, poor science, historical limitations, and societal prejudice.
This article was written by Barry Schreier, Ph.D., in collaboration with the Public Education Committee of the Iowa Psychological Association.
We are in a time of significant legislative challenge focused on Iowa citizens who are transgender/non-binary (TGNB). Recent changes to Iowa law include, amongst several actions, prohibiting youth who are TGNB from accessing gender affirming medical care. This creates challenges for psychologists who work with youth who are TGNB and their family and friends.
