Insufficient evidence to support sexual orientation change efforts

Mental health professionals should avoid telling clients they can change their sexual orientation through therapy or other treatments, according to a resolution adopted by the APA's Council of Representatives on Aug. 5 during APA's 2009 Annual Convention.

The resolution was based on the recommendation of the APA Task Force on Appropriate Therapeutic Responses to Sexual Orientation, which reviewed decades of research and found insufficient evidence that such treatments work.

Instead of telling clients that they can change, therapists should help them find ways to become more comfortable with their sexual orientation, the resolution states. It also advises parents and guardians to avoid treatments that portray homosexuality as a mental illness or developmental disorder.

Beginning in February 2007, the six-member task force reviewed and updated APA's 1997 resolution on the issue. The group first examined 83 peer-reviewed articles published between 1960 and 1978, according to task force chair Judith Glassgold, PsyD, a former president of Div. 44 (Society for the Psychological Study of Lesbian, Gay, Bisexual and Transgender Issues), with more than 20 years of experience working with clients struggling with their sexual orientation.

The task force found numerous methodological problems with much of the so-called change therapy research published to date. Only a few studies were well designed, and only one of the older studies assessed treatment outcomes in comparison to an untreated control group. The task force then examined studies conducted in the last 10 years and found that due to methodological problems, most failed to show that reported changes were caused by treatment rather than other factors, Glassgold said. For instance, recent studies lacked representative samples of people seeking to change their sexual orientation and instead used convenience samples such as participants recruited through the Internet or religious programs specifically organized to help people seeking to change their orientation, she said.

A few older studies suggested that some people can learn to ignore or limit their same-sex attractions, but that was unlikely to be the case for those individuals who were initially attracted only to their own sex.

The task force also drew a distinction between sexual orientation and sexual orientation identity, said Glassgold, noting that some people who are attracted to members of their own sex choose to identify themselves as heterosexuals.

"There really is no evidence that orientation can change, [or that you can change] who you're attracted to or who you fall in love with," she said.

In addition, some participants in sexual orientation change efforts reported an exacerbation of distress and depression when such efforts failed, she said.

The task force also looked at how therapists can help people who are distressed by their sexual orientation in ways that do not attempt to change that orientation. Despite growing social acceptance of homosexuality, some people, particularly men from an evangelical or fundamentalist faith tradition, can't reconcile their sexual orientation with their religious beliefs, Glassgold said. Therapists can help by teaching such clients active coping skills, reconciling religious and sexual orientation identities and helping them develop social support networks so they feel less isolated, she said.

When working with clients who want to change their sexual orientation, practitioners need to acknowledge and explore the stigma and bigotry still experienced by gay, lesbian, bisexual and transgender people, Glassgold said.

The task force also found that coercive approaches to change teens' sexual orientation—particularly involuntary residential programs—are "contrary to current clinical and professional standards," she said. And parents should avoid programs that claim to prevent adult homosexuality by teaching gender conformity since there is no evidence for the effectiveness of such programs.

"It's really important for practitioners to try to increase parental acceptance of their children and encourage families to love their children despite any outcome of a child's identity …. There is evidence that parental rejection increases mental health problems in children," Glassgold said.

Warren Throckmorton, PhD, an associate professor of psychology and fellow at the Center for Vision and Values at Grove City College in Grove City, Pa., described the task force's work as a "well-done effort."

"I felt the treatment of religion was very respectful, and in doing so, it created space for clients of conservative religious faith to explore the reality of their sexual orientation, while maintaining their faith commitments," said Throckmorton, who researches sexual orientation and homosexuality and writes about such issues from a Christian perspective.

Julie Harren Hamilton, PhD, president of the National Association for Research and Therapy of Homosexuality (NARTH), said she appreciated what she described as the task force's recognition that clients have a right to self-determination, and its respect for religious diversity. But she disagreed with the task force's main conclusions, and charged that the task force was composed only of members opposed to sexual orientation change efforts.

"We believe that if the task force had been more neutral in their approach, they could have arrived at only one conclusion, that homosexuality is not invariably fixed in all people, that some people can and do change," she said.