by James Fox, LPC, LPC/S

James Fox is a straight licensed psychotherapist in private practice in Upstate South Carolina.  He is also a 1994 graduate of Bob Jones University.

My first exposure to “reparative therapy” (RT) was many years ago in graduate school, when I bought one of the optional texts for the course Sexuality Counseling.   The book was Joseph Nicolosi’s Reparative Therapy of Male Homosexuality.  Essentially, reparative therapy (also known as “conversion therapy”) is intended to change a person’s sexual orientation from non-straight to straight.  It seemed strange to me, even those many years ago, that reparation was necessary for a “condition” not considered pathology by the then current Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR).  Since then, I have encountered the concept of treating homosexuality as though it were disordered behavior many times in a variety of contexts.  For this article, I will address some of the specific claims made by proponents of reparative therapies, present my professional evaluation of the merits or demerits of the prevailing arguments for those therapies, and summarize the consensus position on those therapies in the broader field of clinical mental health

Chalk it up to Paulk

To begin, let’s consider an April 16, 2015, Facebook post by Restored Hope Network’s executive director, Anne Paulk, on that organization’s Facebook page.

Ms. Paulk is the ex-wife of former Exodus International board chairman, John Paulk, a now openly gay man who has issued a public apology for his own part in propagating what he considers the false belief that one’s sexual orientation can be changed (Alan Chambers, former Exodus International President has also done so).  Below, I am going to address several assertions that Ms. Paulk makes in that Facebook post from April 16.

Assertion number one:  “Conversion therapy [essentially a synonym for RT] is standard “talk therapy” and is not “quackery.”

In short, no, it is not, and yes, it is!  RT is not recognized by the American Psychological Association, the American Counseling Association, the American Psychiatric Association, or the National Association of Social Workers as a bona fide treatment model.  If for no other reason, sexual orientation other than being straight is not considered a disorder by any of those organizations.  Here is a statement by the American Psychiatric Association:

“The potential risks of ‘reparative therapy’ are great, including depression, anxiety and self-destructive behavior, since therapist alignment with societal prejudices against homosexuality may reinforce self-hatred already experienced by the patient.”

It is hard to deny something is quackery and insist it is industry standard, when every major professional mental health association in the country denounces it and claims it may actually do harm.

Assertion number two:  “It is not electroshock, ice baths, water boarding or any such ‘technique…’” In other words, it’s humane.  

There is a repletion of examples of RT being rendered in present day in shocking fashion.  One such example is that detailed by H. Adam Ackley, Ph. D., a transgender and intersex individual in a recent article for the Huffington Post.  In his case, RT included invasive medical and biological interventions that nearly took his life.

To find other examples, all one need do is search “reparative therapy” on YouTube, and s/he will find endless videos of people giving firsthand witness of atrocious interventions including exactly what Anne Paulk denies:  electro-shock, ice interventions, masturbatory/aversion “treatment,” and on and on it goes.  Also, let us not miss the fact that telling someone that who s/he is is unacceptable, sinful, or deviant may not necessarily include objectionable medical or biological interventions, but does constitute psychological violence.  The American Psychiatric Association, in 2009, reported that LGBT teens that experienced negative feedback from their families were nine times more likely to attempt suicide, six times more vulnerable to major depression, and three times more likely to use drugs.  Perhaps, the reason that some RT proponents see their approach as normative is that they may see any intervention, regardless of what it entails, as less of a problem than being gay.  They seem to see being gay as the ultimate evil, so any intervention is justifiable.

Assertion number three:  RT involves “looking at and ministering to underlying soul wounds or relational deficits…”

That is doubletalk.  Telling someone that they are not okay the way they were made and were created with “deficits” by nature inflicts “soul wounds.” That is not “ministering” at all.  I suppose the Spanish Inquisition purported to minister, too.

Assertion number four:  It is not about theology or religion.  

Hmmmm.  Robert Spitzer, an oft-cited researcher by RT therapists, admitted that in his most famous study that looked at 200 structured interviews, 93% of the subjects who sought out RT were motivated to do so out of religious belief.  Another article I read to prepare for this piece noted that 90%+ of RT advocates are Fundamentalist Christians.  After claiming that RT is not about religion or theology, in the very same post Ms. Paulk makes the following statements:

We are a coalition of ministries, pastors, and professional counselors across the United States.

We primarily offer Christian discipleship.

We are inter-denominational and hold to the authority of the Bible, which unites all [emphasis mine] of our diverse leaders [I encourage you to read “diverse” judiciously.].

Most [of our leaders] are pastoral counselors.

Were it not for our design as men and women in the image of God, testified by our biological design, God’s clear Word throughout Scripture defining homosexual behavior as sin, and such feelings as temptation, I suppose you could go there.

What the holy heck! Oh, but dear folk, it’s not religiously motivated. More doubletalk.

Assertion number five:  She espouses the argument that since most Fundamentalist Christians disagree with every major professional association in the United States on RT, then her Fundamentalist opinion must be right.

Say what? Here’s Ms. Paulk in her own words:

Who then is the emperor with no clothes? Is it not the wise of the world? We are seen as the small, the weak, the foolish by the world, but God has chosen this small, weak and foolish body to confound the wise.

We are definitely “confounded,” no doubt.  More doubletalk.  Essentially, all of the Country’s experts in their fields are repudiated by a few “foolish” people trying to impose their religious wills on the rest of us.  Unbelievable.  Does that sound like unmitigated arrogance, or is it just me? In case I have not succeeded in bringing Ms. Paulk’s assertions into question, let me note one more observation from her Facebook post.  She seems to claim that Eye Movement Desensitization and Reprocessing (EMDR) has no empirical evidence, and there is no scientific study to show its efficacy.  She is correct that there is not a study out there.  There are, in fact, at least 100 such studies in at least 12 different languages.  She makes it difficult for thinking people to take her seriously.

 

Other Names and Movements Behind RT

Freud:  Non-religious proponents of RT are almost exclusively Freudian.  

Sigmund Freud himself eventually saw homosexuality as a normal variant in human sexuality.  However, his psychosexual theory of human development has influenced many modern-day RT practitioners and theorists.  It is noteworthy that psychodynamic (Freudian) theory is exactly that:  a theory.  It is not empirical science as conceptualized in modern behavioral medicine.  Here is how Freudianism has informed RT and its practice.  I took the following citation from a Wikipedia article that I think reflects accurately how Freudianism connects with RT.

In classical Freudian psychoanalytic theory, a child’s identification with the same-sex parent is the successful resolution of the Oedipus complex and of the Electra complex. This is a key psychological experience that is necessary for the development of a mature sexual role and identity. Sigmund Freud further proposed that boys and girls experience the complexes differently: boys in a form of castration anxiety, girls in a form of penis envy; and that unsuccessful resolution of the complexes might lead to neurosis, pedophilia, and homosexuality. Men and women who are fixated in the Oedipal and Electra stages of their psychosexual development might be considered “mother-fixated” and “father-fixated”. In adult life this can lead to a choice of a sexual partner who resembles one’s parent.

When RT therapists talk about relational deficits, they are usually referring to some brand of repackaged and reapplied classic Freudian/Psychodynamic theory as cited above.  As I scoured my brain to identify one Psychodynamic therapist from the hundreds of psychotherapists I have met, I couldn’t remember a single one.  That is how out of date and out of vogue classic Freudianism is today.  Secular RT advocates are usually motivated by their theoretical orientation as Psychodynamic theorists, not by science.  Psychodynamic theory is taught in psychological theory courses almost solely as a way to trace the evolutionary history of clinical mental health over the last 150 years, and nothing more.  All that to say that, if RT’s main non-religious adherents are Freudian, that’s not saying much to support it, not much at all.

Nicolosi:  Joseph Nicolosi wrote the most referenced book promoting RT recently published (if 1991 is considered recent).

In his book Reparative Therapy of Male Homosexuality, he takes a lot from Freud, but his work is worth mentioning separately, since it is currently used in some Christian-leaning graduate and post-graduate schools.  Dr. Nicolosi suggests that gay attraction “may be rooted in a need for acceptance, approval, of affection from males, or may reflect his loneliness, boredom, or simple curiosity.” My response is “so what?” Plenty straight men are driven for the same acceptance or approval, loneliness, boredom, and curiosity from women, but we don’t call it pathology or suggest those straight men need therapy.  He says further, “He [the gay man] may engage in same-sex behavior for adventure, money, peer pressure; or to express hostility against male peers, or general rebellion.” Again, why not apply the same standard to straight men? Nicolosi also claims that RT increases “self-acceptance” and “compassion.” How, I ask? How? You mean telling a guy he’s second-rate material because he likes boys instead of girls and is naturally interested in penises instead of vaginas makes him feel better about himself?  Here is a Nicolosi quote that flies directly in the face of all those professional associations I referenced earlier that assert that being gay is not a sickness:

“As part of his discernment process, the client deserves to know the long-term medical and emotional liabilities associated with a gay lifestyle, including the maladaptive behavioral patterns…”

What medical and emotional liabilities I pray? What maladaptive behavioral patterns? Nicolosi also puts forward the ol’ “unnatural” argument.  Let’s allow him to speak in his own words again:

“The belief that humanity is designed for heterosexuality has been shaped by age-old religious and cultural forces, which must be respected as a welcome aspect of intellectual diversity….  Natural-law philosophy says this view derives from mankind’s collective, intuitive knowledge; a sort of natural, instinctive conscience.  This would explain why so many people—even the non-religious—sense that a gay identity is a false construct.”

Obviously, for a straight person, gay sexuality is unnatural.  But for a gay person, it is the most natural thing in the world.  Furthermore, I’m less interested in “religious and cultural” forces and “philosophy” than I am in cold, hard science. Nicolosi is fond of referring to “same-sex attraction.” RT is not just about changing a behavior or  “attraction”; it’s about robbing a person of his/her entire identity.  Being LGBTQ+ cannot be dressed down to sexual behavior or “same-sex attraction” only.  One’s sexuality is inseparably attached to his/her identity as a human being, his/her sense of how to connect to the rest of the world, and his/her way to relate to other people.  RT attempts to impose an identity upon people who would define themselves very differently.  Such an imposition is, as I said earlier, emotional and psychological violence.  Calling it “therapy” doesn’t make it any less violent.  Take what the Ninth Circuit had to say in a 1997 case.  The court called sexual orientation conversion efforts upon an individual “mental and physical torture.”  It ruled that “human rights laws cannot be sidestepped by simply couching actions that torture mentally or physically in benevolent terms such as ‘curing’ or ‘treating’ victims.” For a diagram of Nicolosi’s basic assumptions about gay men, see Appendix A.

Spitzer:  Although Robert Spitzer once championed the effectiveness of sexual orientation conversion efforts to The Washington Post, he later  retracted those claims.

In 2012 he apologized to the LGBT community for making unproven claims about the effectiveness of RT, calling it “my only professional regret.” Spitzer has also requested that NARTH (National Association for Research and Therapy of Homosexuality) and Focus on the Family stop citing his earlier writing in support of RT.

Stories

My first experience with RT was in the mid-nineties.  I was an associate pastor at an IFB (Independent Fundamental Baptist) church whose senior pastor was my friend John Smith*.  What I did not know at the time was that John is gay.   What I also did not know is that John had worked with Jim Binney (a Fundamentalist counselor serving mostly Christian leaders), who apparently had attempted to address John’s sexual orientation on several different occasions.  While pastoring, John (as rumor has it) had an affair with a man in the church.  This was not the first time, but it was John’s last gay relationship as a pastor.  Following the affair, John, the father of three including a toddler, left the church, eventually got divorced from his wife, and went through a very dark time.  His multiple gay relationships over the years had a high cost to his family, the churches he pastored, and him personally.  There was a vast wasteland of human casualties left in the wake.  A lot of people got hurt.  Finally, John came to terms with his sexual orientation and is now in a long-term committed gay relationship.  Had he and others not believed he could change his orientation, those casualties could have been averted.  His children would not have endured a nasty divorce.  His churches would not have been upended.  His own identity and self-esteem would not have gone through the ringer.  Jim Binney had offered really bad advice.  Had John trusted what he knew about himself, his life would have taken a much different course.  Fortunately, God has redeemed all of that mess, and John is happy and whole.

Twice in my career, I have encountered patients whose first stop was an affiliated “ministry” of the former Exodus International near Greenville, South Carolina.  By the time the patients got to me, they had been guilted and shamed until they no longer liked themselves.  They were profoundly depressed.  They not only distrusted their sexuality, but they distrusted themselves, period.  One of them was the child of Fundamentalist parents (He is a pastor’s son) who had insisted he go to RT.  After giving that a shot and being emotionally beaten up by the counselor in the process, he ditched his faith, because he had come to believe that he couldn’t be who God made him to be while at the same time being a follower of Jesus.  He hated himself.  He hated God.  He hated his parents.  He was way in over his head in self-destructive behavior.  Had he been allowed to embrace his own sexual identity and orientation, none of that would have happened.  Now, thankfully, years later, the guy is actively involved in a Christian church, in a happy, fulfilling gay relationship, and in a restored relationship with his parents.   But he still carries deep scars.

Recently, I sat on a panel at a BJUnity event to discuss Matthew Vines’ book God and the Gay Christian.  On the panel with me was a gay man and a lesbian woman.  I listened as they excruciatingly told stories of how they were required by religious authority figures to undergo “counseling” intended to help them become straight.  One of my fellow-panelists spoke of a dark time of self-loathing because the change from gay to straight just wasn’t happening.  I heard talk of rejection, judgment, isolation… and suicidality as a result.  Though this dear one has moved forward from his “counseling” experience, he also carries scars and still suffers fallout. Over the last several years, many RT victims have written their stories and submitted them to BJUnity.  Every story is unique.  But what is the same in all the stories I have read is the wounding and scarring from the rejection and trauma they experienced because they are LGBTQ+.  Much of that wounding and scarring was perpetrated by reparative/conversion therapy or counseling.  To see a visual representation of the wounding many of our LGBTQ+ friends go through, please refer to Appendix B.

In an American Prospect article by former Joseph Nicolosi client Gabriel Arana documenting his experiences with RT, we read:

“When my father and I first sat down, Nicolosi explained what he meant by ‘cure.’ Although I might never feel a spark of excitement when I saw a woman walking down the street, as I progressed in therapy, my homosexual attractions would diminish. I might have lingering thoughts about men, but they would no longer control me…

…[after years in therapy with Nicolosi] Nicolosi’s ideas did more than haunt me. The first two years of college, they were the basis for how I saw myself: a leper with no hope of a cure. I stayed in the closet but had sexual encounters with classmates nonetheless. I became increasingly depressed but didn’t go to mental-health counseling for fear that a well-meaning therapist would inform my parents… I slept in 20-minute spurts for two nights, consumed with despair. I eyed the prescription bottles on my dresser with anxious excitement. I had reached a point at which I feared myself more than what would happen if I were gay.”

 

My Observations and Conclusions About RT as a Veteran Therapist

Reparative “therapy” is pseudo-therapy based on pseudo-science and religious beliefs.  The overwhelming majority of the mental health community denounces it.  In large part, it is denounced because it is designed to treat a condition that is not pathology, but rather a normal variant in human sexuality.  In addition, sexual orientation is presumed by scientists across many disciplines to be fixed and determined by nature not nurture. RT practices wholesale confirmation bias.  It seizes onto anything (including Robert Spitzer’s work that even Spitzer himself has renounced as faulty research) that seems to support its belief that sexual orientation is a choice and can be changed. The depression, anxiety, and identity disturbances that frequently afflict LGBTQ+ individuals are not due to their sexual orientation at all but due to their experiences of rejection, emotional abuse, and condemnation by RT therapists, non-affirming families, judgmental religious leaders, and peer groups (reference Appendix B).

The fact that someone may experience “ego-dystonic” homosexuality is not reason enough to consent, even at his/her request, to help them attempt to change his/her sexual orientation.  Depressed people often loathe themselves, but that doesn’t mean we should agree with them that they suck.  People with Body Dysmorphic Disorder think their bodies are ugly and that they need plastic surgery to fix the problem.  That doesn’t mean, however, that a plastic surgeon should consent to do an unneeded surgery.  Similarly, a person who has been taught to hate him/herself because s/he isn’t straight needs a therapist who will help with accepting their natural-born sexual orientation, not a person who will agree that s/he is unacceptable as a gay person.

RT is patently harmful.  It leads to self-hatred, false belief that sexual orientation is a choice and can be changed, depression, identity disturbance, relational difficulties, erosion of self-esteem, even suicide.  Telling a person s/he is damaged goods has unintended effects.  It makes people doubt their own decision making, question their own motives, and open themselves up to being abused by others.

RT advocates and therapists build what is essentially a Trojan horse.  They sell RT as ordinary “talk-therapy” (to quote Anne Paulk) with its roots in solid research and best-practices.  Once the LGBTQ+ person allows RT access, then what is released is religious militancy and condemnation.  It promotes itself as something it is not.

Not every person who experiences same-sex attraction is gay.  Some young people who grow up in Fundamentalist homes and churches have a lot of sexual identity confusion, due to the pathological approaches to sex in that movement.  It is common, then, for those young folks to sexualize any emotional intimacy with anyone regardless of gender.  For this reason, among others, I recommend doing some self-discovery work and experimentation during therapy, as that confusion is addressed and the individual gains better self-awareness.

There is such a thing as “father wounds.” However, those wounds can be resolved and healed regardless of one’s sexual orientation.  The assumption by RT is that a gay person who heals from “father wounds” will become heterosexual.  That is not my experience.  LGBTQ+ individuals can be psychologically and emotionally whole.   Again, being gay is not a sickness.

Gay people are exactly that: people.  They have stories, dreams, hurts, aspirations, goals, relationships, etc.  You probably know gay people, but they may not tell you they are gay if they fear you will judge them for it.  You could be an unwitting participant in their condemnation if you openly support RT.

RT is arrogant.  It says to people essentially, “Don’t trust yourself to know who you are. Trust us; we are the experts.  We know that God made you to be fulfilled as a heterosexual.  Don’t trust your feelings or beliefs.”

Good intentions do not excuse bad behavior.  Condemning people in the name of Jesus doesn’t make it right.

Therapists are fiduciaries of their clients’ trust.  Helping someone hate him/herself is abusing that trust.

Using Christianized moralisms to misguide other people teaches them that they must either chuck their Christianity or chuck their sexual orientation… and since they know they can’t change their sexual orientation, their faith often gets the axe.

*Not his real name.

Common Presenting Problems in Counseling LGBTQ+ Individuals

• Rejection by family due to sexual orientation and gender identity
• Bullying
• Gender Dysphoria
• Misinformation/Misunderstanding About Sexual Orientation and Gender Identity
• Anxiety
• Depression
• Suicidality
• Couples Issues
• Spirituality Problems
• Substance Abuse and Dependence
• Isolation and Loneliness
• False Guilt and Shame
• Anger
• Identity Confusion
• Rejection and Abandonment
• Post-Traumatic Stress Disorder (PTSD)
• Financial Problems Related to Family Ostracization
• HIV
• Reparative Therapy Coercion

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Author’s note: If you or someone you know is either in “reparative therapy,” considering it, or being coerced into it, I urge you to let my friends at BJUnity know about what’s going on, and allow them to talk with you about what you are getting yourself into and help you consider all the options available to you.  If you are hurting and feel alone, please be assured you don’t have to be alone.  Reach out.  Connect with someone who will be gentle, understanding, and supportive regardless where you might land.

Appendix A

 

Appendix B