A Systematic Review of the Research Base on Sexual Reorientation Therapies
Serovich, Julianne M., Craft, Shonda M., Toviessi, Paula, Gangamma, Rashmi, McDowell, Tiffany, Grafsky, Erika L., Journal of Marital and Family Therapy
In the past few years, members of the AAMFT, like members of other professional groups, have engaged in a discourse as to the necessity and effectiveness of sexual reorientation therapies. The purpose of this article is to review, critique, and synthesize the scientific rigor of the literature base underpinning sexual reorientation therapy research. Using a systematic narrative analysis approach, 28 empirically based, peer-reviewed articles meeting eligibility criteria were coded for sample characteristics and demographics as well as numerous methodology descriptors. Results indicate the literature base is full of omissions which threaten the validity of interpreting available data.
Prior to the removal of homosexuality as a mental disorder from the Diagnostic and Statistical Manual of Mental Disorders (American Psychological Association, 1987), the clinical literature base was replete with studies of therapies aimed at changing sexual orientation based on behavior modification or aversive conditioning procedures. Gradually, however, such studies were discontinued for ethical and legal reasons. With homosexuality depathologized, therapeutic interventions have been developed that are more affirmative of a same-sex orientation (Zucker, 2003).
In contrast, some researchers and therapists have maintained that sexual orientation can be changed and have described techniques that collectively have been considered "reparative therapy" or "conversion therapy" (Nicolosi, 1991; Socarides & Kaufman, 1994). Based on a psychoanalytic interpretation of homosexual behavior, Nicolosi (1991) suggested that the pathological sexualization was in need of "repairing," thus the term "reparative" therapy (Morrow & Beckstead, 2004). Reparative therapy, as a program of psychotherapy, attempts to "cure" homosexuals by transforming them into heterosexuals (Hicks, 1999). These therapies can include a myriad of techniques including prayer, religious conversion, and individual or group counseling. In contrast, aversion therapies are techniques which share the same goal but are behavioral in nature, such as shock therapy. Traditional methods of aversion techniques have been termed "cruel" (Haldeman, 2002) and would not pass current Institutional Review Board Standards for acceptable research practices. For the purposes of this article, the term "sexual reorientation" will be utilized as an umbrella term to describe therapies which are either aversive (behavioral) or reparative (psychosocial). Many believe that these therapies should be available (e.g., Rosik, 2003), while others claim they are unnecessary and harmful (e.g., Green, 2003).
Some authors suggest that it is important to consider religious and spiritual orientations while deciding to recommend or not recommend sexual reorientation therapies (Yarhouse & Throckmorton, 2002). This is predicated on the notion that, while sexual orientation may be primarily biological, sexual behaviors are volitional and subject to moral evaluation (Stein, 1996). Some researchers and therapists believe that reorientation therapies may be warranted when an individual's sexual orientation is in conflict with his or her religious beliefs. Several guidelines have been suggested for clinicians to help those individuals who express dissatisfaction with their sexual orientation (Throckmorton, 2002; Yarhouse & Throckmorton, 2002).
Other studies have identified negative consequences of sexual reorientation therapies. For example, Shidlo and Schroeder (2002) noted that a majority of those who sought reparative therapies perceived psychological harm in the form of depression, suicidal ideation and attempts, social and interpersonal harm, loss of social support, and spiritual harm as a direct result of these interventions. Haldeman (2002) also noted typical negative outcomes of reparative therapies that include chronic depression, low self-esteem, difficulty sustaining relationships, and sexual dysfunction. …