Talk:Sexual orientation change efforts/Dumping Ground

Sexual orientation change efforts (SOCE) are methods that aim to change a same-sex sexual orientation. They may include behavioral techniques, psychoanalytic techniques, medical approaches, religious and spiritual approaches.

History
The first attempts to classify homosexuality as a disease were made by the fledgling European sexologist movement in the late 19th century. In 1886 noted sexologist Richard von Krafft-Ebing listed homosexuality along with 200 other case studies of deviant sexual practices in his definitive work, Psychopathia Sexualis. Krafft-Ebing proposed that homosexuality was caused by either "congenital [during birth] inversion" or an "acquired inversion". In the last two decades of the 19th century, a different view began to predominate in medical and psychiatric circles, judging such behavior as indicative of a type of person with a defined and relatively stable sexual orientation. In the late 19th and early 20th centuries, pathological models of homosexuality were standard. Several methods have been attempted, including aversion therapy, lobotomy/leucotomy, narcotherapy, electro-convulsive therapy, hormone therapy, hypnotherapy, surgical castration and chemical castration, but have been largely abandoned.

In 1992, the World Health Organization replaced its categorization of homosexuality as a mental illness with the diagnosis of ego-dystonic homosexuality. The UK Government followed suit in 1994, followed by the Ministry of Health in Russian Federation in 1999 and the Chinese Society of Psychiatry in 2001. The trustees of the American Psychiatric Association (APA) had previously voted unanimously to remove homosexuality as a disorder from the Sexual Deviancy section of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-II in 1973. This decision was officially confirmed by a small majority (58%) of the general APA membership in 1974, who voted to replace the diagnosis with a milder category of "sexual orientation disturbance", which was then replaced in the DSM-III with "ego-dystonic homosexuality" which, in 1986, was deleted from the DSM-III-R. The APA now classifies persistent and marked distress about one's sexual orientation under Sexual Disorders Not Otherwise Specified. Therapists who offer change therapy argue clients should have the right to self-determination.

Conversion therapy
The American Psychological Association defines conversion therapy or reparative therapy as therapy aimed at changing sexual orientation. The American Psychiatric Association states that conversion therapy or reparative therapy is a type of psychiatric treatment "based upon the assumption that homosexuality per se is a mental disorder or based upon the a priori assumption that a patient should change his/her sexual homosexual orientation." Psychologist Douglas Haldeman writes that conversion therapy comprises efforts by mental health professionals and pastoral care providers to convert lesbians and gay men to heterosexuality, and that techniques include psychoanalysis, group therapy, aversive conditioning involving electric shock or nausea-inducing drugs, sex therapy, reparative therapy, and involvement in ex-gay ministries such as Exodus International.

The ethics guidelines of major U.S. mental health organizations vary from cautionary statements about the safety, effectiveness, and dangers of prejudice associated with conversion therapy (American Psychological Association) to recommending that ethical practitioners refrain from using conversion therapy (American Psychiatric Association) or referring patients to others who do (American Counseling Association). It may be harmful if the client is egosyntonic and does not wish to change their sexual orientation.

Behavior Modification
Aversion therapy uses associate negative stimuli with homoerotic pictures and positive stimuli with heteroerotic pictures. A series of 1966 experiments showed promise, and the practice became popular, but it fell out of practice after the reports were shown to be flawed. Since 1994, the American Psychological Association has declared that aversion therapy is a dangerous practice that does not work, but it is still in use in some countries.

Syntonic therapy
Syntonic therapy, a method developed by Robert Kronemeyer, was based partly on the work of Wilhelm Reich.

Kroneyemer was also influenced by Arthur Janov's primal therapy, observing that, "To the extent that I have an affinity with the spirit of another therapy, it must be for Arthur Janov's primal." Kronemeyer agreed with Janov that, "...the homosexual act is not essentially a sexual one but is based upon the denial of real sexuality; it is, through sex, the acting out symbolically of a need for love." However, Kronemeyer criticised Janov's methods for over-relying upon catharsis, stating that it was not the only important part of therapy. Kronemeyer also stated that patients should be allowed to continue in their neurotic crutches until their defenses were strong enough for them to abandon them voluntarily since not doing so was inhumane, that primal therapy was excessively expensive, and that many of the patients who screamed did so only to please their therapists. Kronemeyer contrasted his idea of cure with Janov's, stating that while Janov regarded it as the emergence of a primal person, he regarded it as the integration of all aspects of a person, including body, emotions, mind, and spirit.

Kronemeyer rejected some earlier methods that were used in attempts to change homosexuality, including lobotomy, electroshock treatment, and Aesthetic Realism.

Coaches
Coaches do not have to have a medical license, and only "coach" participants in their work to change sexual orientation. One of the largest organizations is the International Healing Foundation, whose motto is "Changing From Gay To Straight Is Possible." They provide classes for people trying to change their orientation, as well as training for those trying to help. Higher Path Life Coaching is another organization started by ex-gay Rich Wyler centered in the Virginia area.

One of the more well-known coaches is Richard Cohen, founder of the International Healing Foundation. His television appearances have sparked controversy. He holds male patients in his lap with the patient curled into the fetal position, and also advocates bioenergetic methods involving slamming a pillow with a tennis racket while shouting "Mom! Why did you do this to me?"

Bioenergetics
Bioenergetics is a therapeutic technique developed by Alexander Lowen and John Pierrakos, who were students of Wilhelm Reich. It has been used to attempt to convert gay people to heterosexuality by Richard Cohen, who has been called one of America's leading practitioners of conversion therapy. Cohen holds male patients in his lap with the patient curled into the fetal position, and also advocates methods involving shouting or slamming a pillow with a tennis racket.

Ex-gay groups
A task force commissioned by the APA found that ex-gay groups act like support groups, in that they help counteract and buffer minority stress, marginalization, and isolation.

Most ex-gay groups focus on abstaining from homosexual relationships rather than a complete sexual orientation change from homosexual to heterosexual. Exodus International believe reparative therapy can be a beneficial tool. Evergreen International teaches that it is unlikely therapy can erase all homosexual feelings, and does not advocate any particular form of therapy.

Effects of SOCE
The American Psychological Association, the American Psychiatric Association, and the National Association of Social Workers state that "Sexual orientation has proved to be generally impervious to interventions intended to change it, which are sometimes referred to as 'reparative therapy'”. In 2009, an APA task force reported: "Given the limited amount of methodologically sound research, claims that recent SOCE (sexual orientation change effort) is effective are not supported. We concluded that the early high-quality evidence is the best basis for predicting what would be the outcome of valid interventions. These studies show that enduring change to an individual’s sexual orientation is uncommon. The participants in this body of research continued to experience same-sex attractions following SOCE and did not report significant change to other-sex attractions that could be empirically validated." They also reported that "given the limited amount of methodologically sound research, we cannot draw a conclusion regarding whether recent forms of SOCE are or are not effective."

One of the reasons is that there are no randomized clinical trials to validate claims of effectiveness. Without these, it is impossible to determine whether the reported changes were caused by therapy, or by another factor such as will power. The Royal College of Psychiatrists and United States Surgeon General David Satcher and American Psychological Associations have all concluded that there is insufficient evidence that sexual orientation can be changed.

Benefits and harms
Participants have reported both harm and benefit from such efforts, but no casual relationship has been determined between either the benefit or the harm. The American Psychiatric Association has stated that "anecdotal reports of "cures" are counterbalanced by anecdotal claims of psychological harm". and cautions that “[t]he potential risks of ‘reparative therapy’ are great, including depression, anxiety and self-destructive behavior.” 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". They determined that the benefits reported by SOCE could be achieved through other methods.

Position of professional organizations on SOCE
The World Health Organization's ICD-10, which is widely used internationally outside of North America (where DSM-IV-TR is used), states that "sexual orientation by itself is not to be regarded as a disorder". It lists ego-dystonic sexual orientation as a disorder instead, the diagnosis for which is when "the gender identity or sexual preference (heterosexual, homosexual, bisexual, or prepubertal) 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 APA dropped ego-dystonic homosexuality from the DSM-IV in 1987 and opposes the diagnosis of either homosexuality or ego-dystonic homosexuality as any type of disorder.

Mainstream health organizations critical of attempts to change sexual orientation include the American Medical Association, American Psychiatric Association, the American Psychological Association, the American Counseling Association, the National Association of Social Workers, the American Academy of Pediatrics, the American Association of School Administrators, the American Federation of Teachers, the National Association of School Psychologists, the American Academy of Physician Assistants, and the National Education Association.

Self-determination
The American Psychological Association's code of conduct states: "Psychologists respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self-determination," but also: "Psychologists are aware that special safeguards may be necessary to protect the rights and welfare of persons or communities whose vulnerabilities impair autonomous decision making." Gerald Koocher, president of the APA, stated: "In a full multifaceted therapeutic relationship, the therapist has every duty to respond to patient choice and to help patients achieve their goals.... BUT... [First,] therapists must determine whether patients understand that their motives may arise purely from the social pressures of a homophobic environment.... [and second,] patients must understand that [treatments to modify sexual orientation] lack a validated scientific foundation and may prove psychologically harmful." The American Counseling Association says that "it is of primary importance to respect a client's autonomy to request a referral for a service not offered by a counselor." No one should be forced to attempt to change their sexual orientation against their will, including children being forced by their parents. Clients with an egosyntonic sexual orientation can feel shamed and emotionally hurt if therapists attempted to change their sexual orientation against their consent.

Supporters of SOCE focus on patient self-determination when discussing whether therapy should be available. Mark Yarhouse, of Pat Robertson's Regent University, wrote that "psychologists have an ethical responsibility to allow individuals to pursue treatment aimed at curbing experiences of same-sex attraction or modifying same-sex behaviors, not only because it affirms the client's rights to dignity, autonomy, and agency, as persons presumed capable of freely choosing among treatment modalities and behavior, but also because it demonstrates regard for diversity." Yarhouse and Throckmorton, of the private Christian school Grove City College, argue that the procedure should be available out of respect for a patient’s values system and because they find evidence that it can be effective. Douglas Haldeman similarly argues for a client's right to access to therapy if requested from a fully informed position: "For some, religious identity is so important that it is more realistic to consider changing sexual orientation than abandoning one's religion of origin... and if there are those who seek to resolve the conflict between sexual orientation and spirituality with conversion therapy, they must not be discouraged."

In response to Yarhouse's paper, Jack Drescher argued that "any putative ethical obligation to refer a patient for reparative therapy is outweighed by a stronger ethical obligation to keep patients away from mental health practitioners who engage in questionable clinical practices." Chuck Bright wrote that refusing to endorse a procedure that "has been deemed unethical and potentially harmful by most medical and nearly every professional psychotherapy regulating body cannot be justifiably identified as prohibiting client self-determination." Some commentators, recommending a hard stand against the practice, have found therapy inconsistent with a psychologist's ethical duties because "it is more ethical to let a client continue to struggle honestly with her or his identity than to collude, even peripherally, with a practice that is discriminatory, oppressive, and ultimately ineffective in its own stated ends." They argue that clients who request it do so out of social pressure and internalized homophobia, pointing to evidence that rates of depression, anxiety, alcohol and drug abuse and suicidal feelings are roughly doubled in those who undergo therapy.

Disclosure
Medical organizations view homosexuality as a normal variant of human sexuality and do not allow therapists to portray homosexuality as a mental disorder or as abnormal.

The American Counseling Association says that a counselor attempting to change the sexual orientation "must define the techniques/procedures as 'unproven' or 'developing' and explain the potential risks and ethical considerations of using such techniques/procedures and take steps to protect clients from possible harm." The counselor must also provide complete information about the treatment, offer referrals to gay-affirmative counselors, discuss the right of clients, understand the client's request within a cultural context, and only practice within their level of expertise.

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". Therapists may not portray LGBT people as mentally ill due to their sexual orientation and accurately give information about sexual orientation, mental health, and appropriate interventions.

International views
In China, Western psychiatry and psychology were imported during a "Westernization Movement" in the late 19th century. At that time, the West viewed homosexuality as a mental disorder, and that became the prevailing view in China as well. During this period, homosexual sexual behavior was grounds for persecution, a marked change from the attitude of general (but not total) acceptance found in pre-19th-century China. These views lasted throughout the 1970s, despite changed theoretical models of sexuality orientation in the West, during a period when the Chinese government held a "closed-door" policy on information about human sexuality. After 1980, information became more available, and views began to change. In 2000 and under pressure from both the APAs and the ACA, the Chinese Classification of Mental Disorders (CCMD-III) declassified homosexuality, but added a diagnosis resembling ego-dystonic sexual orientation. Attempts to change sexual orientation are rare in China.

In India, psychiatry and psychology scholars have "preserved an almost complete silence on the subject of homosexuality". One paper discusses behavior modification methods used to treat the sexual orientation of thirteen gay patients. They use the WHO classification of egodystonic sexual orientation, but the People's Union for Civil Liberties reports that doctors will often diagnosis the patient as egodystonic even if the patient really is egosyntonic.

In Italy, little research has been conducted in the mental health community on homosexuality. Early work tended to describe homosexuality as a pathology or a developmental arrest. More recently, attitudes have begun to change: "with a lag of about ten years, Italy has followed ... the attitudes of American mental health professions toward homosexuality".

In Germany, the psychiatry, psychology, and sexology establishment from the early 20th century viewed homosexuality as pathological. However, following the increased visibility of the homosexual community during the AIDS epidemic of the late 1980s and the declassification of homosexuality as a mental disorder in the ICD-10, non-pathological, rather than pathological, models of homosexuality became mainstream.

Japan's psychiatric body removed homosexuality from its list of psychiatric disorders in 1995.

In Norway, a country known for its strong LGBT rights legislation, the shift from a pathological to non-pathological understanding of homosexuality began in the 1970s, following the APA's declassification in 1973. In 2000, the General Assembly of the Norwegian Psychiatric Association overwhelmingly voted for the following position statement on sexual orientation change therapy: Homosexuality is no disorder or illness, and can therefore not be subject to treatment. A ‘treatment’ with the only aim of changing sexual orientation from homosexual to heterosexual must be regarded as ethical malpractice, and has no place in the health system.

Political debate
Changing sexual orientation has become highly politicized, and the ensuing debates "have obscured the scientific data by calling into question the motives and even the character of individuals on both sides of the issue."

Individuals who feel therapy has been helpful have felt oppressed by LGBT activists opposed to SOCE. Randy Thomas, a leader of Exodus International, has said "As a former homosexual, when I was involved in the 1980s promoting the gay agenda, our only focus was to seek tolerance, whereas today's political activism has moved from true tolerance into political domination and power. It's an amazing thing to watch a group that said they were oppressed become oppressors." Gay psychiatrist David Scasta organised a panel to discuss the matter at an American Psychiatric Association convention, but cancelled it after criticism by gay activists. Not all gay people are opposed to people trying to change their sexual orientation. Camille Paglia, a lesbian writer, wrote in her book Tramps and Vamps, "Is the gay identity so fragile that it cannot bear the thought that some people may not wish to be gay? Sexuality is highly fluid and reversals are theoretically possible."

The National Gay and Lesbian Task Force has described the recent support for sexual orientation change efforts as "the Christian Right repackag[ing] its anti-gay campaign in kinder, gentler terms. Instead of simply denouncing homosexuals as morally and socially corrupt, the Christian Right has now shifted to a strategy of emphasizing ... the ex-gay movement. Behind this mask of compassion, however, the goal remains the same: to roll back legal protections for lesbian, gay, bisexual and transgender people ..."

Psychologist John Gonsiorek called the position espoused by the Christian right hypocritical. He wrote "some conservative Christian institutions actively foster social conditions to maximize distress for such clients about their sexual orientations, and these institutions simultaneously promote conversion therapy as the solution to this distress." Prominent ex-gay Joe Dallas, while opposing homosexual sex, called Christians to repent of their hostility toward homosexuals and reach out to them: "I find to this day that there is a certain wrath Christians often express towards this sin that they do not express towards other sins - both sexual and non-sexual. And that's a problem. It's an imbalance."