This week, the American Psychological Association published an extensive report regarding Appropriate Therapeutic Responses to Sexual Orientation. The New York Times summed up the findings pretty succinctly in their article Wednesday:
The American Psychological Association declared Wednesday that mental health professionals should not tell gay clients they can become straight through therapy or other treatments.
In addition, the APA adopted a pointed resolution in response to the research. The resolution says a lot, but I think the following are the three most important points:
BE IT FURTHER RESOLVED, That the American Psychological Association concludes that there is insufficient evidence to support the use of psychological interventions to change sexual orientation;
BE IT FURTHER RESOLVED, That 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;
BE IT FURTHER RESOLVED, That the American Psychological Association concludes that the benefits reported by participants in sexual orientation change efforts can be gained through approaches that do not attempt to change sexual orientation;
You can read the full report (PDF) yourself on the APA’s website. The intent of this post is to provide a digest of the report’s findings as laid out in the Executive Summary. I’m going to blog as I read from the Executive Summary and include highlights of the findings. I had considered blogging the 100 pages of the rest of the report, but that does not seem as helpful. I hope this condensed form will help make the important findings of the study more accessible to you. I will be citing page numbers so that you can easily retrieve this information in the future. As always, all emphases (green) is mine.
Minority Stress (p. 1-2)
One of the first points addressed in the study is that sexual minorities are subject to minority stress. This means that the prejudice and discrimination people who are non-heterosexual experience is similar to other minorities, and the APA works toward affirmative interventions with a multicultural competence. So, people who experience minority stress because of age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, or socioeconomic status should be treated in a way to help them feel positive about their identity.
We see this multiculturally competent and affirmative approach as grounded in an acceptance of the following scientific facts:
• Same-sex sexual attractions, behavior, and orientations per se are normal and positive variants of human sexuality—in other words, they do not indicate either mental or developmental disorders.
• Homosexuality and bisexuality are stigmatized, and this stigma can have a variety of negative consequences (e.g., minority stress) throughout the life span.
• Same-sex sexual attractions and behavior occur in the context of a variety of sexual orientations and sexual orientation identities, and for some, sexual orientation identity (i.e., individual or group membership and affiliation, self-labeling) is fluid or has an indefinite outcome.
• Gay men, lesbians, and bisexual individuals form stable, committed relationships and families that are equivalent to heterosexual relationships and families in essential respects.
• Some individuals choose to live their lives in accordance with personal or religious values (e.g., telic congruence).
SOCE (Sexual Orientation Change Efforts) (p. 2-3)
The main goal of the study was to address three questions regarding sexual orientation change efforts (SOCE):
• Are sexual orientation change efforts (SOCE) effective at changing sexual orientation?
• Are SOCE harmful?
• Are there any additional benefits that can be reasonably attributed to SOCE?
To this end, they reviewed 83 peer-reviewed studies from 1960-2007, most of which had been conducted before 1978. Unfortunately, a LOT of this research had methodological problems. Many of the older studies did not isolate and control factors as in proper experimentation, and “none of the recent research (1999-2007) meets methodological standards that permit conclusions regarding efficacy or safety.” The few studies that were conducted appropriately were qualitative, and are thus informative, but not conclusive.
Given the limited amount of methodologically sound research, claims that recent SOCE is effective are not supported.
Of the “high-quality” evidence, the studies available 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 signicant change other-sex attractions that could be empirically validated, though some showed lessened physiological arousal to all sexual stimuli.
There was also evidence to indicate individuals experienced harm from SOCE, including “loss of sexual feeling, depression, suicidality, and anxiety.” High drop rates from SOCE were also seen as an indicator that individuals thought the treatments were harmful.
Individuals Who Seek SOCE (p. 3)
While the research did not say much about SOCE, it had a lot to offer about the people who seek SOCE. They are mostly adult White males who “consider religion to be an extremely important part of their lives and participate in traditional or conservative faiths (e.g., The Church of Jesus Christ of Latter-Day Saints, evangelical Christianity, and Orthodox Judaism).” Almost all of the studies come from convenience samples because the participants were recruited by the groups endorsing SOCE.
Some participants reported benefits from SOCE, such as reduction of isolation (finding a sense of community), alterations in how problems are viewed (having others with whom they could identify), and stress reduction. BUT:
The research literature indicates that the benefits of SOCE mutual support groups are not unique and can be provided within an affirmative and multiculturally competent framework…
Recent studies did not distinguish between orientation and orientation identity. Some individuals modified how they identify, but their orientation did not actually change.
Children and Adolescents (p. 4)
Here are a few key findings from the research on children and adolescents:
- “There is no research demonstrating that providing SOCE to children or adolescents has an impact on adult sexual orientation.”
- “The few studies of children with gender identity disorder found no evidence that psychotherapy provided to those children had an impact on adult sexual orientation.”
- “There is currently no evidence that teaching or reinforcing stereotyped gender-normative behavior in childhood or adolescence can alter sexual orientation.”
- Of inpatient facilities that offer coercive treatment, “many do not present accurate scientific information regarding same-sex sexual orientations to youths and families, are excessively fear-based, and have the potential to increase sexual stigma” and “they potentially violate current practice guidelines by not providing treatment in the least-restrictive setting possible, by not protecting client autonomy, and by ignoring current scientific information on sexual orientation.”
Key Findings (p. 4-5)
• Our systematic review of the early research found that enduring change to an individual’s sexual orientation was unlikely.
• Our review of the scholarly literature on individuals distressed by their sexual orientation indicated that clients perceived a benefit when offered interventions that emphasize acceptance, support, and recognition of important values and concerns.
• Studies indicate that experiences of felt stigma—such as self-stigma, shame, isolation and rejection from relationships and valued communities, lack of emotional support and accurate information, and conflicts between multiple identities and between values and attractions—played a role in creating distress in individuals. Many religious individuals’ desired to live their lives in a manner consistent with their values (telic congruence); however, telic congruence based on stigma and shame is unlikely to result in psychological well-being.
I think that last point is super important. Basically, not all beliefs are compatible with psychological well-being.
In the case of children and their families:
Research indicates that family interventions that reduce rejection and increase acceptance of their child and adolescent are helpful. Licensed mental health providers (LMHP) can provide to parents who are concerned or distressed by their child’s sexual orientation accurate information about sexual orientation and sexual orientation identity and can offer anticipatory guidance and psychotherapy that support family reconciliation (e.g., communication, understanding, and empathy) and maintenance of the child’s total health and well-being.
Another important finding was in regards to social support for young people. Schools and communities should promote acceptance and safety.
For those with conflicting religious beliefs, it is important for pyschologists to recognize the importance of faith to that individual as well as the science of sexual orietnation.
The other information in the executive summary relates to psychologists’ code of conducts and training, as well as recommendations for future research and APA policy.
I hope this digest was helpful! Obviously, the rest of the report is chock full of research findings, which I encourage others to pursue if you have interest in these issues or if they have relevance to you, your experiences, or your work.