There is a certain irony which is never mentioned. The naysayers have never come out with a study whereby the therapy has been applied to a large number of conscientious patients, and found to be 100% ineffective. On the contrary, there is ample evidence of cure rates of the order of a third to a half of patients. Indeed, in a high proportion of cases, change is spontaneous. Whitehead and Whitehead devoted a whole chapter of their book, My Genes Made Me Do It (downloadable here) to both spontaneous and assisted change. Dr Spitzer, who was largely instrumental in getting homosexuality taken off the list of mental disorders, nevertheless, to his surprise, discovered that a lot of people had made successful changes. More detailed is that of Dr Phelan, who quoted 100-odd studies, some very old, some very new. I am glad I copied it when I first encountered it, because now it can generally be found on the net only minus the long list of references which gives it its value. For your information, therefore, I enclose the full review. I am sure he would not mind.
IS GAY TO STRAIGHT POSSIBLE? WHAT THE RESEARCH SHOWS
By James E. Phelan, LCSW, BCD, ICADC, Psy.D
Summary
Organizations such as the American Psychological Association have issued warnings against the use of therapies aimed at changing sexual orientation, however a vast amount of reports about change in sexual orientation from homosexual to heterosexual are documented in the literature. The outcomes of interventions, using a variety of techniques, aimed at changing sexual orientation, are vast and varied and examined in this review.
Reports about change in sexual orientation from homosexual to heterosexual began to appear in literature as early as the nineteenth century. Charcot, in 1882, published a paper entitled, “Inversion of the Genital Sense.” Charcot, already famous for his treatment of hysterics through hypnotic induction, applied the same therapeutic modality to homosexual men and reported success when "the homosexual patients became heterosexual" (Horstman, 1972, p. 5). Albert von Schrenck-Notzing (1892) also recounted a case of treatment success using suggestion and hypnosis therapies. Prince (1898) reported treatment of sexual paraphilias, including homosexuality, and stated that 70% were essentially improved or cured (Fine, 1987).
Psychoanalysis
The field of psychoanalysis manifested many reports. Freud suggested that a homosexual could change his or her orientation if desired (Freud, 1951). According to Fordham (1935), Jung helped a male homosexual change his sexual orientation through dream analysis and the break down of the negative child-mother bond, which had intensified his sexuality.
Following in the tradition of Freud, Gordon (1930) reported a case where his homosexual patient made a heterosexual adjustment. Stekel (1930) reported 3 cases of complete cure using psychoanalysis after a 1-year follow-up. Anna Freud (1949, 1952) referred to 4 cases that she claimed led to complete heterosexual orientation.
London and Caprio (1950) reported successful psychoanalysis with two men who reported becoming heterosexual. After 18 years of treating lesbian women, Caprio (1954) reported that many patients who resolved former childhood conflicts were restored to complete heterosexuality.
Citing his 30 years of practice during which he successfully concluded analysis of one hundred homosexual men, Bergler (1956) reported a 33% cure rate; these patients were able to function heterosexually, whereas, prior to treatment, they were exclusively homosexual. Ellis (1956) showed distinct changes in orientation with 11 out of 40 of his patients, or 28%, while 48% showed considerable improvement. Eidelberg (1956) claimed that 2 out of 5 cases were successful after a 3-year follow-up.
An unpublished report by the Central Fact-Gathering Committee of the American Psychoanalytic Association in 1956 was one of the first surveys that compiled results of treatment. Of those who completed treatment, eight were cured and 13 were improved. Another 16, who did not complete treatment, were also considered improved. In all reported cures, follow-up communications indicated full heterosexual role and functioning (Socarides, 1978).
In their study, Curran and Parr (1957) demonstrated one subject who completely changed in orientation and five who made a change toward heterosexuality. In Berg and Allen’s (1958) work, three out of ten homosexual males showed successful treatment in terms of the diminution of homosexual interest and actions. Hadfield (1958, 1966) reported a 53% treatment success rate after a 30-year follow-up.
Robertiello (1959) gave a report about a lesbian woman who became aware of unconscious memories after analysis with free association and dream interpretation. This awareness led to an oedipal resolution, whereby she arrived at a heterosexual adjustment. After a two-year follow-up, she maintained her heterosexual identity. Beukenkamp (1960) treated a male subject with group psychoanalysis, which resulted in the subject's reorientation to heterosexuality in both behavior and experiences. Monroe and Enelow (1960) treated four men using psychoanalytic methods, and after a five-year follow-up, found all of them heterosexually oriented.
I. Bieber et al. (1962), in a nine-year study of homosexual men, used an analyst team of seventy-seven members and provided information on two patient samples consisting of 106 homosexuals who undertook psychoanalysis. The results found that 29 out of 106, or 27% of those completing treatment, became exclusively heterosexual. I. Bieber (1967) found in a five-year follow-up that 15 out of 20 subjects, who they kept in contact with, remained exclusively heterosexual. After seven years, this success rate remained consistent (I. Bieber, 1969). The subjects were followed for as long as twenty years, and treatment success, defined by exclusive heterosexuality, was still confirmed (I. Bieber & T. B. Bieber, 1979).
Coates (1962) treated 33 males and reported an outcome in which 15% of the men resolved homosexual activity as a result of psychoanalytic intervention. Ovesey, Gaylin, and Hedin (1963) successfully treated three men and followed them as long as seven years, reporting that all of them remained heterosexual. Cappon (1965) reported a 50% treatment success rate for males, and 30% for females. Mayerson and Lief (1965) reported that 47% of their nineteen patients who had been in treatment were functioning heterosexuals after a follow-up with a mean time of four and a half years.
Mintz (1966) claimed to have successfully treated two out of ten patients during an eight-year period. Kaye et al.’s (1967) report of a research committee documented that 50% of homosexual women in treatment could be helped by the use of psychoanalysis. They also found that 56% of exclusive homosexual women treated made a shift to heterosexuality.
Socarides (1968) cited a 50% success rate in the psychoanalytical-based conversion treatment of homosexuals. Ten years later, treatment success was still supported; twenty out of forty-four patients (44%) treated by psychoanalysis had developed to full heterosexual functioning, having no homosexual thoughts, behaviors, or fantasies (Socarides, 1978).
Jacobi (1969) referred to 60 patients who were treated, in which six of them made a definite transformation to heterosexuality. While working with twelve homosexual women, Siegel (1988) found that more than half of them became fully heterosexual.
Berger (1994) described two cases of treatment success: One case “resulted in the patient marrying and fathering three children and living a heterosexually fulfilling and enjoyable life” (p. 255). The other was a "successful long-term psychodynamic psychotherapy treatment [which] helped relieve the patient of his original presenting symptoms and enabled him to become comfortably and consistently heterosexual" (p. 255).
Finally, a survey of 285 anonymous members of the American Psychoanalytic Association, conducted by MacIntosh (1994), revealed that out of 1,215 homosexual patients analyzed by those members, 23% changed from homosexual to heterosexual, and 84% of the total group received significant therapeutic benefits.
Behavioral Therapy
Behavioral-based therapies have not only been used to treat ego-dystonic homosexuality, those with unwanted same-sex attraction, but are also used to treat a variety of sexual conditions, such as impotence, frigidity, voyeurism, exhibitionism, transvestism, fetishism, and others (Rachman, 1961). Davison and Wilson (1973) rated over two hundred behavioral therapists and found a mean of 60% who claimed success in treating homosexuality.
By use of adaptational therapy, a 40-year-old man who practiced homosexuality for 22 years was successfully treated; he ceased his homosexual behavior, married, and stated that he was completely cured (Poe, 1952). Albert Ellis (1959) by use of Rational-Emotive Therapy (RET), which he made famous, reported a patient changed to heterosexuality after a three-year follow-up. Shealy (1972) reported another patient changed from homosexuality to heterosexuality by use of RET.
Despite problematic behavioral intervention, Freund (1960) reported that 26% of his patients treated, who were exclusively homosexual, reached heterosexual adaptation. Stevenson and Wolpe (1960), by use of assertiveness training, reported treatment success of two homosexuals, which led to their establishment of heterosexuality. Treatment success was also confirmed at a four-year follow-up. Schmidt, Castell, and Brown’s (1965) treatment outcome, after assessment by independent raters, found 30% of the study's exclusive homosexuals had changed to heterosexuals. Serban (1968) reported treatment of 25 homosexuals using existential therapeutic approaches. He conducted a case review and concluded that after his subjects’ erotic perceptions were changed, so did the subjects’ sexual orientations.
Feldman, MacCulloch, and Orford (1971) reported follow-up results on research, done between the years of 1963-1965, with sixty-three male homosexual patients. They reported that 29% of the patients who had no prior heterosexual experience had changed. Change was indicated by the cessation of homosexual behavior, only occasional homosexual fantasies or attractions, and strong heterosexual fantasy, behavior, or both. Van den Aardweg (1971) related that nine out of twenty patients treated using exaggeration therapy were completely cured, meaning no homosexual fantasies or behaviors were reported.
Barlow and Agras (1973) found a 30% decrease of homosexual behavior in patients up to six months in follow-up, utilizing the flooding technique. Using avoidance conditioning, classical conditioning, and backward conditioning, McConaghy and Barr (1973) found one-fourth of their patients ceased homosexual behavior after a 1-year follow-up. Freeman and Meyer (1975) used behavioral approaches and reported a 78% successful treatment rate in patients who were exclusively homosexual after an eighteen-month follow-up.
Pradhan, Ayyer, and Bagadia (1982) demonstrated that by utilizing behavioral modification techniques, eight out of thirteen male homosexuals showed a shift to heterosexual adaptation that was maintained during a six-month and one-year follow-up. Van den Aardweg (1986a, 1986b) reported treating over one hundred homosexuals using cognitive approaches, and found that one-third of them had been radically changed in heterosexual adaptation.
Finally, the level of success in decreasing homosexuality claimed by behavioral therapists, is essentially a third or more in reported cases (Birk, Huddleston, Miller, & Cohler, 1971; Bancraft, 1974). As stated previously, a high percentage of behavioral therapists surveyed said that they were successful when they had a goal of helping patients achieve heterosexual shifts (Davison & Wilson, 1973).
Group Therapy
Group therapy is another modality that has shown treatment success. Eliasberg (1954) presented an account of group therapy with twelve homosexuals and found three members who were able to experience a shift from homosexuality to heterosexuality. Hadden (1958) reported that he treated three homosexual subjects where one experienced a shift to heterosexual adjustment. Smith and Basin (1959) treated two men in group therapy and noted one as having had marked improvement while the other sought heterosexual adjustment.
According to Litman (1961), a homosexual man was reported to have changed his sexual orientation facilitated by group therapy. Hadden (1966), after treating thirty-two homosexuals in group therapy, reported a 38% success rate in which subjects progressed to an exclusively heterosexual pattern of adjustment. Birk, Miller, and Cohler (1970) also reported a similar success rate of 33% and claimed significant improvements in a number of cases.
T. Bieber (1971) related over a 40% success rate by use of group therapy. Hadden (1971) confirmed a one-third success rate. Pittman and DeYoung (1971) expressed that two out of six, or one-third, of homosexuals treated received maximum benefit and established the goal of heterosexuality.
Truax and Tourney (1971) related that group treatment of thirty patients, compared to twenty untreated controls, increased heterosexual orientation, decreased homosexual preoccupation, reduced neurotic symptomatology, improved social relations, and increased insight into the causes and implications of homosexuality. Birk (1974) reported a 38% success rate after a six-year period from a sample of twenty-six subjects. Birk (1980) reported that ten out of fourteen, or 71% of men in treatment for over two and a half years, and who were exclusively homosexual prior to treatment, were heterosexually adjusted and married at follow-up.
Group therapy combined with other therapies has shown various treatment successes over a ten-year period (Ross & Mendelsohn, 1958; Finny, 1960; Buki, 1964; Mintz, 1966; and Miller, Bradley, Gross, & Wood, 1968). Like behavioral therapy reports, group therapy reports tend to reveal a treatment success rate of one-third or more of cases making a shift in orientation.
Sex Therapy
Sex therapists have shown success at treating homosexuality. Alfred C. Kinsey reported treatment of more then eighty homosexual men who had made satisfactory heterosexual adaptation (Pomeroy, 1972). In Masters and Johnson's (1979) treatment of ninety homosexuals, a 28.4% failure rate was reported after a six-year follow-up (Schwartz & Johnson, 1984). Masters and Johnson chose to report failure rates to avoid vague concepts of success. Although the failure rate was not equated in terms of success rate, it seemed valid to compare the success of their work with those reported in other studies dealing with change of orientation, according to Diamant (1987).
Hypnosis
As reported earlier, Charcot, in 1882, applied hypnotic induction to homosexual men and reported success in that "the homosexual patients became heterosexual" (Horstman, 1972, p. 5). Albert von Schrenck-Notzing (1892) had similar findings (Fine, 1987). Cafiso (1983) related success in treating a homosexual man by strengthening his ego through hypnosis. This result corresponds with the positive reports of hypnosis from Regardie (1949), Alexander (1967), and Roper (1967).
Other Interventions
Whitener and Nikelly (1962) related that thirty homosexual college students in treatment showed good results, that is they became more masculine identified and became attracted to females. The Braaten and Darling (1965) study, also conducted on college students, showed that out of 76 male homosexuals treated in a college setting, 29% moved toward a heterosexual reorientation.
Dr. Nicholas Cummings is a past president of the American Psychological Association. During his twenty years as Chief of Mental Health at Kaiser-Permanente Health Maintenance Organization (1959-1979) in San Francisco, he saw over 2,000 patients with same-sex attraction, his staff saw another 16,000, and he reported a 27% reorientation rate (Cummings, 2007).
Spontaneous Change
Wolpe's (1969) patient, who was in treatment for assertiveness training, reported a spontaneous shift to heterosexual behavior, even when the focus was not on changing it. Fluker (1976), a medical doctor treating gay-identified men for sexually transmitted diseases (not homosexuality), learned from one of his patients, who was not in conversion therapy, that he no longer had homosexual inclinations and was happily married to a woman. Cameron and Crawford (1985) discovered that 2% of their random sample of 170 claimed they had once been homosexual, which was not reportedly due to any intervention.
Nichols' (1988) study mentioned a client who had spontaneously developed heterosexual interests and transformed from a bisexual to a heterosexual in mid-life. Shechter (1992) reported spontaneous change in a male client who had been in psychoanalysis (not for treatment of homosexuality).
Michael, Gagnon, Laumann, and Kolata (1994) found that based on a national survey, some people even change their sexual orientation without psychotherapy. Even without intervention, studies have shown that sexual orientation is not a unitary, one-dimensional construct (Weinrich & Klein, 2002).
Ex-Gay or Religiously Mediated Therapies
Christians view recovery from homosexuality to have taken place as early as biblical times, citing, "… and this is what some of you (homosexuals) were" (1 Corinthians 6:11, New International Version, emphasis added). Robinson (1998) reported on the interviews with seven men from Evergreen International, a ministry affiliated with the Church of Jesus Christ of Latter Day Saints (LDS). Robinson associated “change” of the subjects with nine components, one was that they adopted a new interpretive framework concerning the causes and implications of their same-sex attraction, and another was that they no longer identified themselves as gay.
Successful change of eleven homosexual men while they participated in a Pentecostal fellowship was reported by Pattison and Pattison (1980). On post measures, five of the eleven participants reported no homosexual fantasies, behaviors, or impulses. Mesmer (1992) surveyed more than one hundred people participating in ex-gay ministries who had reported leaving the homosexual lifestyle and found 41% of them had achieved complete heterosexual orientation.
Schaeffer, Hyde, Kroencke, McCormick, and Nottebaum (2000) surveyed 248 men and women at an Exodus International Annual Conference to determine if they were experiencing success in changing their sexual orientation and found a statistically significant effect based on changes over time. Exodus International is an umbrella organization of Christian ministries helping those with unwanted same-sex attraction. In a follow-up study of one hundred and forty of the original participants, Schaeffer, Nottebaum, Smith, Dech, and Krawczyk (1999) found that 61% of the male and 71% of the female participants had maintained abstinence from any same gender sexual contact in the past year of the study. Twenty-nine percent of this sample indicated that they had changed their sexual orientation (0 on the Kinsey scale) in the past year of the study, and 65% said they were in the process of change.
Assemblies of Persons Claiming Sexual Orientation Can Be Changed
Ex-gays have collectively stood up to be counted. On May 22, 1994, in Philadelphia, for the first time in history, the American Psychiatric Association was protested against, not by pro-gay activists, but by a group of ex-gays claiming that they had been cured and that cure was possible for others (Davis, 1994). This was repeated at their 2000 convention in Chicago (Gorner, 2000), and again at the 2006 American Psychological Association Convention in New Orleans (Foust, 2006).
Meta-Analyses
Clippinger's (1974) meta-analysis of the treatment results of homosexuality demonstrated that out of 785 homosexuals treated, 307 (40%) were cured or had at least made some heterosexual shift.
E. C. James (1978) concluded that when the results of all research studies up until that time were combined, approximately 35% of the homosexual clients recovered, 27% improved, and 37% did not recover or improve. Based on this finding, she concluded that pessimistic attitudes about the prognosis for homosexuals changing their sexual orientation are not warranted, saying: “Significant improvement and even complete recovery [from a homosexual orientation] are entirely possible …” (p. 183).
Goetze (1997) brought together seventeen studies and found a total of 44 subjects, who were exclusively or predominately homosexual, experienced a shift of some sort to heterosexual adjustment.
Jones and Yarhouse (2000) used meta-analysis to review thirty studies conducted between the years of 1954-1994. Of the 327 subjects from all the studies, 108, or 33%, of them were reported to have made at least some heterosexual shift.
Surveys of Consumers
Nicolosi, Byrd, and Potts (2000), with large efforts from the National Association for Research and Therapy of Homosexuality (NARTH), retrospectively surveyed 882 dissatisfied homosexuals with a seventy-item, client-answered scale. After receiving therapy or engaging in self-help, 20%-30% of the participants said they shifted from a homosexual orientation to an exclusively or almost exclusively heterosexual orientation. Of the 318 who identified as exclusively homosexual before treatment, 56 or 17.6% reported that they viewed themselves as exclusively heterosexual at the time of the study.
Shidlo and Schroeder (2002) interviewed 182 men and 20 women, who were consumers of sexual orientation conversion interventions, to find out how they perceived its harmfulness and helpfulness. The researchers recruited participants by advertising on openly gay and lesbian websites, in e-mail lists and newspapers, and via direct mailings to gay and ex-gay organizations. The researchers originally called for participants who failed and were “harmed” by change therapies. Of the two hundred and two participants, one hundred and seventy-six were considered as having failed conversion therapy, twenty-six as having been successful, twelve still struggling in that they reported "slips" or some incidences of homosexuality, six were not still struggling with same-sex attractions, in that they were managing them, and eight were termed to be in a "heterosexual shift period" (p. 253), in which they were rated as three or less on the seven-point Kinsey scale; they were self-labeled as heterosexual, they reported having heterosexual behaviors and being in a heterosexual relationship, and they denied homosexual behavior.
Spitzer (2003), from Columbia University, interviewed 200 subjects, who had participated in sexual reorientation processes, by using a telephonic sexual orientation interview consisting of 114 closed-ended questions. Prior to intervention, 46% of the males and 42% of the females reported exclusive same-sex attraction. After intervention, 17% of the males and 54% of the females reported exclusive opposite-sex attraction. By way of his findings, Spitzer stated, "Thus, there is evidence that change in sexual orientation following some form of reparative therapy does occur in some gay men and lesbians" (p. 403).
Karten's (2006) dissertation examined the sexual reorientation efforts of 117 dissatisfied same-sex attracted men who had undergone some type of intervention to change orientation. Using a seven-point sexual self-identity scale with one indicating exclusive homosexuality and seven indicating exclusive heterosexuality, he found that, on average, at the onset of intervention, men reported a mean score of 2.57 (2 = almost entirely homosexual; 3 = more homosexual than heterosexual), and at the time of the study (after intervention), he reported a mean score of 4.81 (4 = equally homosexual and heterosexual; 5 = more heterosexual than homosexual). The shift was statistically significant.
Conclusion
Numerous reports about change in sexual orientation from homosexual to heterosexual have been documented in the literature using a variety of therapies as detailed above. This documentation debunks the claim by some that there is no evidence of change. The outcomes of interventions aimed at changing sexual orientation are vast and varied.
Without significant evidence, the American Psychological Association has made public releases in warning against the use of therapies aimed at changing sexual orientation (American Psychological Association, 1997). Because of public pressures by such groups, a shift in the treatment of homosexuality has evolved from amelioration to acceptance and normalization.
Author: James E. Phelan, LCSW, BCD, ICADC, Psy.D. is a Licensed Clinical Social Worker, Board Certified Diplomate in Clinical Social Work, Internationally Certified Alcohol and Drug Counselor, and holds a doctorate in psychology. He is an addictions therapist for the Department of Veteran’s Affairs and is in private practice. Tel (614) 571-7093 / Email: jpmphelan@sbcglobal.net.
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