Same-Sex Attraction, Behavior & Transgender Feelings: Variations on normal.

There's nothing about GLBT orientation by itself that requires psychotherapy. As noted below almost all psychiatrists and psychologists, and other behavioral scientists now believe that such feelings and behaviors are variants of "normal". That is, GLBT people can be and usually are as normal and healthy as heterosexual persons. They are as able to have long, healthy relationships and live lives as happy as heterosexual people. Most health care professionals also believe that if only societies and their religions would have equal respect and esteem for GLBT people as they do those who have more common feelings, attractions, behaviors, or appearances, GLBT people would have no greater need for psychotherapy than heterosexuals.

"Clinical experience suggests that any person who seeks conversion therapy may be doing so because of social bias that has resulted in internalized homophobia, and that gay men and lesbians who have accepted their sexual orientation positively are better adjusted than those who have not done so."

- American Psychiatric Association

Uses for psychotherapy: There are at least several reasons why GLBT people might reasonably want and seek psychotherapy. GLBT people have the same reasons as anyone else to be troubled and feel the need for psychotherapy: grief over the death of a loved one, fear about changing careers, and so forth. But besides, those universal issues, some GLBT people, especially in the early years of recognizing that their interests are different, may feel confused or unsure about their feelings and experiences and want professional help to understand what's going on and what to do. Others may be troubled by their feelings, attractions and sexual behaviors and want to somehow stop feeling or acting they way they do - to better fit in with the majority - thinking that these attractions and behaviors past and present can be fixed, like a medical condition.

Is GLBT sexual minority status a problem? Most people who have same-sex attractions or who have had sex with others of the same sex don't see these feelings and behaviors as problems, nor do they wish they were heterosexual. In one study, only 15% of gay adolescents and adults had not achieved a sense of "positive" identity; 85% were proud or at peace with being gay. In his book, "Familiar Faces; Hidden Lives" Dr. Howard Brown notes three reasons why some same-sex oriented people have felt that their "condition" (same-sex attraction and homosexual behavior) was a problem: First, some (certainly not all) religions have condemned homosexuality as immoral and have refused them the recognition and services provided to heterosexual members; second, some societies have passed laws prohibiting homosexual behaviors and some of these are still "on the books"; and third, some systems of medicine have made homosexuality a diagnosis to be treated. Of these three areas of possible difficulty for homosexuals, Dr. Brown believed making homosexuality a diagnosis, presumably based on science, was the most damaging.

Religious/legal issues: Organized religions vary in their beliefs about sexual diversity: Some believe as Unitarian minister Don Fielding does that "Homosexuality is simply a form of sexual expression: sex more desired with a member of one's own gender than the opposite one. That's all it is - nothing more and nothing less. It can be as loving as heterosexuality is. There is no wrong form of human affection." Or, as author Ann Thompson Cook does, that "each of us really is made in God's image, even when some of us don't look or act in ways that match the conventional view of male or female." The Vatican and fundamentalist religious groups, however, currently interpret the Bible in more proscriptive ways. Many people of faith probably believe something between those positions. But, according to respected historians, some religions which currently condemn homosexuality, (e.g., The Vatican) did not uniformly condemn it in the past, since in the history of the Catholic church, records of marriage ceremonies for same-sex couples can be found (see John Boswell's book, "Christianity, Social Tolerance, and Homosexuality"). In 2003, the US Supreme Court ruled that consensual sex between people of the same sex is legal, overturning all state laws to the contrary. So, religious prohibitions are inconsistent, and legal ones have now begun to fall in the USA.

Medical/psychotherapy issues around homosexuality: Since 1973, the overwhelming consensus of medical and psychological experts in the Western World has been that homosexuality is a normal variant of human sexuality, and does not represent a disease to be treated. Being gay, lesbian, or bisexual can be perfectly healthy - requiring no change or medical or psychological treatment. Yet, with disapproval of homosexuality so prevalent in some societies, it is not surprising that when people in these cultures become aware of their attractions, or when they have homosexual sex - they may feel troubled. When severe, these feelings have sometimes been called "homosexual panic." Frequently, in the past more often than today, same-sex attractions and behavior first emerge in people already in heterosexual relationships, with a spouse and children, making them harder to hide and often more problematic.

A desire for psychotherapy to explore feelings and behaviors which are perceived by the self and by significant others as problems should be supported and encouraged. But, given the likelihood that some people, including professional therapists, in some religious and social situations will condemn homosexual feelings and behaviors, it is important for the individual with such feelings to seek help from professionals who can be non-judgmental, and who can be as supportive of homosexual as of heterosexual feelings and behaviors.

Is conversion possible? Most studies suggest that one's sexual orientation is more innate than chosen and is set at a very young age, perhaps before birth. It's likely that transsexual feelings of being born into the wrong sex are also either innate or established at a very early age. A growing number of studies suggest that sexual orientation is at least partly, if not largely, determined by genetic or other prenatal factors, with the strongest evidence for that in males. And, while some people, especially some women, do experience shifting attractions over their lifetimes, nobody really knows why that happens. Thus, one would expect that sexual orientation, including equal attraction to both sexes, may be hard to change intentionally.

Nevertheless, some mental health professionals, including physicians, psychotherapists and pastoral ministers, provide what is called "conversion", "reparative", or "ex-gay" therapy. These are formal attempts to change a person's sexual orientation - typically from homosexuality to heterosexuality - or to convince or attempt to "reprogram" them to stop engaging in same-sex behavior. These forms of therapy were more commonly in practice before the American Psychiatric Association ruled that homosexuality per se did not constitute a mental illness.

There is very little reliable evidence that such conversion therapy is effective in reversing a person's sexual orientation, and there have been reports of bad outcomes associated with attempts at conversion, including suicide. Thus, many mental health professionals now believe that it is unethical for them, even if requested, to attempt such psychotherapy. Advocates of reparative or conversion therapy cite a recently published (2003) study by Dr. Robert Spitzer (who greatly helped to remove homosexuality from the list of psychiatric diagnoses). Dr. Spitzer, studying "individuals who had sustained some change in homosexual orientation for at least 5 years", found that while complete change in sexual attraction was uncommon, some of these people did make substantial changes in sexual arousal and fantasy - not merely behavior. Furthermore, even some subjects who made a less substantial change believed that their therapy was extremely beneficial. But opponents of this kind of treatment note that about two-thirds of Dr. Spitzer's sample was recruited by so-called "ex-gay ministries." Of those who participated, the largest group of subjects (43%) came from ex-gay ministries, and 78% had spoken publicly in favor of efforts to convert homosexuals to heterosexuality. Dr. Spitzer did not study the larger set of all people who sought such therapy, only a sample of those who found it helpful. See the following website for more details: http://psychology.ucdavis.edu/rainbow/html/facts_changing.html

"Conversion" Methods: The methods used by "reparative/conversion/ex-gay" therapies include a variety of different approaches and techniques. Reparative therapy has been described by Drs. Socarides, Nicolosi, and Kaufmann, but what is used by most people seeking such therapy has not been fully characterized, to our knowledge. Some clients of these treatments have reported being subjected to electric shocks or drugs to condition them to change their same-sex orientation, forms of treatment that are generally condemned for this purpose and may no longer be in common use.

Spitzer writes that:

• conversion therapy should never be coercive;
• the fact that some highly motivated people who experience same-sex attractions and sexual behavior can reduce their unwanted feelings and behaviors should never be used to justify denial of rights to homosexuals;
• just because a person experiences same-sex orientation should not be a reason to encourage him or her to change sexual orientation;
• it is not clear that some people with same-sex orientation would be better off if they sought to change their orientation.

Of four aspects of sexuality studied, Spitzer says, "Some people appear able to change self-identity and behavior, but not [their] arousal and fantasies; some can change only self-identity; and only a very few, I suspect, can substantially change all four." Again, he studied only people who thought they'd made some change, not the potentially much larger group who sought change.

The final answer on the value of "conversion/reparative/ex-gay" therapy, if any, and its potential risks is not yet in, as the quotes below document:

• [The American Psychiatric Association] … "encourages and supports research by the National Institute of Mental Health and the academic research community to further determine "reparative" therapy's risks versus its benefits."
  -American Psychiatric Association Position Statement on Therapies Focused on Attempts to Change Sexual Orientation (2000)
  
  
• "Most of the emotional disturbance experienced by gay men and lesbians around their sexual identity is not based on physiological causes but rather is due more to a sense of alienation in an unaccepting environment. For this reason, aversion therapy is no longer recommended for gay men and lesbians. Through psychotherapy, gay men and lesbians can become comfortable with their sexual orientation and understand the societal response to it."
  -American Medical Association
  
  
• "For nearly three decades, it has been known that homosexuality is not a mental illness. Medical and mental health professionals also now know that sexual orientation is not a choice and cannot be altered. Groups who try to change the sexual orientation of people through so-called conversion therapy' are misguided and run the risk of causing a great deal of psychological harm to those they say they are trying to help."
  -American Psychological Association
  
  
• "Confusion about sexual orientation is not unusual during adolescence. Therapy directed at specifically changing sexual orientation is contraindicated, since it can provoke guilt and anxiety while having little or no potential for achieving changes in orientation."
  - American Academy of Pediatrics