New Study on Reparative Therapies
by Robert L. Spitzer, M.D.

Robert L. Spitzer, M.D., is Professor of Psychiatry and Chief of
Biometrics Research Department at the New York State Psychiatric
Institute in New York City, USA. He has achieved international
recognition as an authority in psychiatric assessment and the
classification of mental disorders.

Dr. Spitzer was at the center of the 1973 American Psychiatric
Association's (APA) decision to remove homosexuality from its list of
mental disorders, the DSM (Diagnostic and Statistical Manual).
Talking to former homosexuals at the 1999 APA annual meeting resulted in
Dr. Spitzer's new interest in studying the effectiveness of sexual
reorientation therapies.

"Like most psychiatrists," said Dr. Spitzer, "I thought that homosexual
behavior could be resisted, but sexual orientation could not be changed.
I now believe that's untrue - some people can and do change."
In his new study announced May 9, 2001 at the annual meeting of the
American Psychiatric Association, Dr. Robert L. Spitzer released the
evidence for his conclusions. The print of his presentation is
courtesy of Dr. Spitzer:

This is a more accurate title for my talk: 200 Subjects Who Claim to
Have Changed Their Sexual Orientation from Homosexual to Heterosexual.

Sexual orientation refers to a sustained sexual attraction, sexual
fantasy, desire for a romantic, emotionally intimate relationship and
sexual behavior with excitement, directed primarily to the same or
opposite sex.

Sexual orientation is multidimensional and each component is on a
continuum.

There is a professional consensus that homosexual behavior can be
resisted, renounced or relabeled. However, homosexual orientation can
never be changed.

I certainly shared this viewpoint, so how did Bob Spitzer, who played a
central role in eliminating homosexuality as a mental disorder from
DSM-II in 1973, come to have doubts about this consensus? The answer is
that at the 1999 APA annual meeting in Washington I talked to several
people who were picketing the meeting and claiming that, contrary to a
recent APA position statement, change of sexual orientation was possible
and should not be discouraged and that they, personally had changed from
homosexual to heterosexual. I started to wonder, could it be that some
homosexuals could actually change their sexual orientation? After much
thought, and realizing that previous studies claiming that such change
was possible had all kinds of methodological flaws, I concluded that my
curiosity would only be satisfied if I conducted a study of my own.

The basic idea is simple. Study the self-reported experiences of
individuals who claim to have achieved a change from homosexual to
heterosexual attraction that has lasted at least five years.

The basic study questions would be…
Can one find a substantial number of such individuals?
If yes, how often is such change accompanied by changes in other
homosexual indicators?
Are there gender differences?

With the help of Dr. Richard C. Friedman, I developed a structured
telephone interview so that it would be absolutely clear to others how
we assessed our subjects. We were surprised to realize that previous
sexual orientation questionnaires and measures were quite inadequate in
that they usually focused on a single variable of sexual attraction or
identity, so that we had to largely develop our own questions and
response categories.
We kept revising the interview schedule during a pilot study of 40
individuals who had been referred to us as potential subjects.
During this developmental phase we asked questions such as: "What kind
of help did you receive?" "What were you like before (change effort)?"
"How are you different now?" "What aspects of your homosexuality
remain?"

We developed specific questions for these key homosexual indicators.
Sexual attraction during a one year period on a subjective scale that
goes from 100 (exclusively homosexual) to 0 (exclusively heterosexual).
The subject picks any number from 100 to 0.
Lustful thoughts or daydreaming about having sex with the same sex -
from never, a few times a year, a few times a month, a few times and
week and every day in a one year period.
Same sex fantasies during masturbation - the percent of occasions of
masturbating
Same sex fantasies during heterosexual sex - the percent of occasions of
sex.
Yearning for romantic emotional intimacy - again, from never to nearly
every day.
Homosexual behavior with excitement.

The final study interview, which I personally administered to all
subjects, took about 45 minutes. I entered data directly into a Data
Entry SPSS program as the interview progressed.

There are 112 closed ended questions with fixed response categories, and
9 open ended questions in which I directly entered the subject's answer.

Audio recordings of about a third of the subjects can be reviewed by
other researchers and the entire study data set is also available.

When we attempted to recruit possible subjects we merely asked for
individuals who had sustained some change in homosexual orientation for
at least five years. However, the actual entry criteria were more
restrictive. To be accepted into the study it was necessary for the
subject in the interview to report: Predominantly homo-sexual
attraction…
We use the phrase "change effort" rather than therapy, since some of the
changes involved specific efforts, such as involvement in a mentoring
relationship with a heterosexual, that the subjects usually did not
regard as therapy.
The individual had to have the goal of functioning heterosexually.
It was also necessary, that after the change effort, there be a change
of at least 10 points on our sexual attraction scale. 10 points is an
arbitrary minimal change but at least reflects the subject's assessment
that there has been some change in the object of sexual attraction.

In order to obtain 200 study subjects, which turned out to be 143 men
and 57 women, we interviewed 274 potential subjects that we found, with
great difficulty over a period of 16 months.
74 subjects were excluded, most commonly because there was a change in
behavior and self-identity, but no change in sexual attraction, or the
individual was not predominantly homosexual, or the change was less than
5 years duration.

Our 200 subjects were primarily recruited from ExGay religious
ministries that offer a variety of programs to help homosexuals who want
to overcome their homo-sexual feelings.
And from NARTH, the National Association for Research and Therapy of
Homosexuality, a group of mental health clinicians and lay people who
by and large regard homosexuality as a treatable developmental disorder.
The "Other" was largely other subjects, therapists who do sexual
reorientation Rx , as well as responses to notices of the study on the
radio and in newspaper advertisements.
The referral source, by various means, got in contact with potential
subjects who then called my office to arrange for an interview.

About 90% of subjects reported using more than one kind of change
effort. The slide presents the answer to the question, "Which was most
helpful?"
The mental health professional was most commonly a psychologist (23%),or
pastoral counselor (12%). Rarely a psychiatrist (3%).
"Other" included repeated meeting with a heterosexual role model, often
refer-red to as "mentoring," self help books or what some subjects
called "spiritual work" - meaning changing one's relationship with God.

When results for males and females are very similar, the result for the
total sample of 143 men and 57 women is shown.
About three quarters of the men and half of the women were currently
hetero-sexually married.
About a fifth of the subjects were married before the change effort and
often reported that homosexual behavior or attraction threatened their
marriage.
Most were Caucasian and had completed college.

Most subjects were Protestant.
The vast majority said religion is "extremely" or "very" important in
their lives. Many nonreligious therapists that we sought referrals from
were reluctant to get in touch with former patients. This may, in part,
account for the unusually high proportion of our sample that was very
religious.
The great majority of subjects had publicly spoken in favor of efforts
to change homosexual orientation. Indeed, the primary motivation for
participating in the study for almost all subjects was their interest in
providing evidence, from their own experience, that homosexuality can
be changed and to offer hope to others.

Why did the subjects want to change? These were the most commonly
reported answers.
Gay life-style not emotionally satisfying…Usually this referred to
widespread promiscuity, stormy, painful relationships, often with
extreme jealousy.
Religious conflict…
Desire to get or be able to stay married, particularly for the men.

Here is the average time line - almost identical for men and women.
There was, of course, great individual variability. The onset of sexual
arousal to same sex was about 12 years. About 18 years later is the
beginning of the change effort that they found helpful (often preceded
by one or more change efforts that were not helpful..including, often,
therapists who told them they had no choice but to accept their
homosexuality). After two years into the change effort, they begin to
feel different sexually. The vast majority of subjects reported this
change as being gradual, and often starting with diminution of
homosexual feelings and gradual emerging or intensification of
heterosexual feelings. Three years later, after about five years of the
change effort, it ends for 78% of the subjects. The remaining 12% report
that the change effort continues up to the present time, usually
referring to continuing to at-tend an ExGay support group or having a
life-long struggle with the underlying issues that they believe caused
their homosexuality.

How homosexual were these subjects before the change effort? First, how
often did they have same sex attraction as a teenager?
We use red for males, and pink for females.
To make the main points, in this slide as in many other slides, we show
the extremes.
Many "often" or "very often" had same sex attraction as teenagers.

In contrast, most subjects as teenagers "never" or only "rarely" had any
opposite sex attraction, particularly the male subjects.

How many individuals did the subject have homosexual sex before the
change effort?
A small proportion, even smaller for the females, had resisted
homosexual impulses and never had homosexual sex.
As expected, a sizable proportion of men had had sex with a large number
of men.

53% of the males, and 33% of the females, had never had consensual
heterosexual sex.

We assessed change in sexual orientation indicators by comparing the 12
months before the change effort - which we will refer to as "Before" -
with the past 12 months before the interview - which we will refer to as
"After."

The next group of slides, on various indicators, contrasts BEFORE, with
AFTER.
First, mean sexual attraction scores for males and females. Remember,
100 is exclusively same sex, and 0 is exclusively opposite sex, BEFORE
and AFTER.
Both males and females, on average, BEFORE, are in the very high
homosexual range. AFTER, on average, they are in the high heterosexual
range, even more so for the females.
Here, as in most of the remaining slides, note that the females often
BEFORE are similar or less extreme on homosexual indicators, and AFTER
are always more heterosexual than the males.

How many reported sexual attraction as exclusively homosexual before?
Almost half in males and females.
AFTER, 17% of the men, and considerably more of the females, 55%, report
a score of 0, exclusively heterosexual.

Looking with lust at same sex or daydreaming about having sex with same
sex, at least a few times a month.
This was the case for almost all subjects BEFORE, and for only a much
smaller number AFTER, especially for the females.

Yearning for romantic emotional involvement with same sex, at least a
few times a month.
Extremely common BEFORE, very unusual, AFTER.

Almost all of the 138 men and 50 women who BEFORE masturbated, had same
sex masturbatory fantasies on 20% or more masturbatory occasions.

This was far less common in the 112 men and 39 women who masturbated
AFTER, particularly for the women.

Opposite sex masturbatory fantasies, without making an effort to have
such fantasies, among those who masturbated was unusual BEFORE, and
quite common AFTER.

What proportion of subjects, AFTER, had absolutely none of these
homosexual indicators - e.g., 0 on the sexual attraction scale and
"never" on the lustful thoughts scale. That would exclude someone who,
for example reported 5 on the sexual attraction scale and a few times a
year a same sex lustful thought. This - what we regard as an unrealistic
criterion of absolutely no indicators, was the case for only 11% of the
men, and a much larger proportion of the women, 37%.
We made a less stringent criterion which we call Only Minimal Homosexual
indicators. For this we allow scores of 0 to 10 on variables that use a
0 to 100 scale and allow a frequency of "a few times a year" on
frequency variables. Now this applies to 29% of the males and 63% of
the females.

How often were the subjects able to achieve their goal of good
heterosexual functioning? We defined this as requiring:
Last year in a loving heterosexual relationship. Satisfaction from the
emotional relationship with their partner, at least 7+ (1-10 scale
where 10 is as good as it can be, and 1 is as bad as it can be).
Heterosexual sex at least monthly.
Physical satisfaction from heterosexual sex at least 7+ (the same 1-10
scale).
Never or rarely (<20%) think of same sex during heterosexual sex.
This was the case for 66% of the males and 44% of the females. Many
female subjects said they had dated and been sexually aroused but the
relationship did not end in marriage.

We expected that Good Heterosexual Functioning would not be achieved as
often in subjects who before the change effort were extreme on
homosexual indicators. We defined this as:
No teenage opposite sex attraction
Never had heterosexual sex
Before: no heterosexual masturbatory fantasies
Before: attraction 95+ (homosexual)
We report the results for the 33 males who were in this group. There
were too few females, only 5, to report.
In these 33 males, good heterosexual functioning was achieved by 67% of
these subjects, much to our surprise.

56 subjects had regular heterosexual sex both BEFORE and AFTER, in
almost all cases with the same person, their spouse.
We looked at three variables. Satisfying emotional relationship (7+ on
the 1 bad as it can be, -10 good as it can be scale) which went from 25%
to 98%,
Sex physically satisfying (7+ on the 1-10 scale) which went from 43 to
100%.
Finally, often (20+%) during sex think of same sex, which went from 52
to 6%.
These AFTER values are very similar to the values for these three
variables on the 81 subjects having regular heterosexual sex AFTER but
who had not had regular heterosexual sex BEFORE.

Depression has been reported to be a common side effect of attempts to
change sexual orientation. This certainly was not the case for our
subjects, who were often "markedly" or "extremely" depressed BEFORE, and
rarely so depressed AFTER.

During the pilot study we noted the common ways that subjects reported
they had been helped by the change effort.
This shows how often subjects reported these ways of being helped when
asked close ended questions during the study.
…feeling more [masculine, feminine]
…developing nonsexual relations with same sex

Of course the big question is, given that these are subjects highly
motivated to provide support for the value of reorientation change
efforts, to what extent are their reports merely self deception, or
gross exaggerations? Lacking any objective evidence of change, like
penile changes while viewing opposite sex erotic stimuli, there is no
way to be certain that their reports are, by and large, accurate.
However the following reasons suggest to us that they cannot easily be
dismissed. Complexity and range of change reported. The wide range and
limited nature of the outcomes that were reported and the fact that very
few reported total change lends some credibility to their reports.
Subjects had no difficulty providing detailed answers when they were
asked to describe various outcomes, such as exactly what their opposite
sex masturbatory fantasies were. The gradual nature of the change, and
the frequent pattern of less homosexual feelings followed by more
heterosexual feelings , indicate it is not a simple made up story. The
gender differences - e.g., the greater ease with which the women
subjects were able to change, and the women's reports of often being
more heterosexual to begin with - are consistent with the literature. It
would be difficult to explain why, if no one really changed, the women
subjects would report more change than the men.

In answer to the question, "How did you translate what you learned in
the change effort to changing your feelings?" subjects reported the
following change strategies that are generally recognized in the
literature as components of effective psychotherapy efforts: Narratives
linking childhood or family experiences to sexual fee-lings. Building on
an intense emotional relationship to effect change in sexual feelings,
e.g., many men reported that they only developed heterosexual arousal
after they became intensely emotionally involved with a women. Group or
individual support, as in Exgay support groups.
Thought stopping, e.g., "when I get such thoughts, I don't go down that
route." Avoiding situations that triggered homosexual feelings.
These are techniques that are commonly considered effective in
psychotherapy, lending plausibility to their claims. We can imagine the
mechanisms by which the-se techniques might work.

We conclude that, contrary to conventional wisdom, some highly motivated
individuals, using a variety of change efforts, can make substantial
change in multiple indicators of sexual orientation and achieve good
heterosexual functioning.
Subjects that made less substantial changes still believed that such
changes were extremely beneficial.
Complete change - which is generally considered an unrealistic goal in
psychotherapy - is uncommon, particularly in male subjects.

Although therapists who do this kind of therapy claim similar results in
approximately a third of patients that they treat, the difficulty
finding subjects suggests the likelihood that the substantial changes
reported by our subjects are relatively uncommon in all individuals who
make a change effort. On the other hand, other factors, such as
reluctance of subjects to be interviewed and resistance of therapists to
contacting former clients may also have played a role in the difficulty
that we experienced in finding 200 suitable subjects. The many potential
subjects rejected from the study indicates that some individuals who
claim to have changed sexual orientation, have changed only their
identity or overt homosexual behavior. However for these individuals
such limited change was experienced as substantial improvement as it
fulfilled self-identified goals of behavioral control and a shift in
identity, even though the change was less than they had wished for.

A better way to conceptualize "sexual reorientation" is to see it as
diminishing of unwanted homosexuality and an increase in heterosexual
potential--recognizing that change for some is possible along a
multidimensional continuum

We are concerned that about the misuse of our study results.
The first is to assume that homosexual orientation is changeable for
most highly motivated individuals.
The second is to dismiss the value to some conflicted homosexuals of a
shift in sexual identity and unwanted sexual behavior, even when sexual
orientation is not substantially changed.
The third is that the study results could be used to justify coercive
treatment and the denial of civil rights to homosexuals.
I end by recalling what several subjects said spontaneously. "I have no
problem accepting that most gays have no interest in changing. I wish
they could also acknowledge that I have a right to change, and that I
have".
__________________

Reprinted From:
German Institute for Youth and Society
Deutsches Institut für Jugend und Gesellschaft
Christen in der Offensive e. V.
Postfach 1220, D-64382 Reichelsheim, Germany
Tel: 06164/9308-211, Fax: 06164/9308-30