March 27th, 2009
Annie Bartlett, Glenn Smith, Michael King. “The response of mental health professionals to clients seeking help to change or redirect same-sex sexual orientation.” BMC Psychiatry (March 26, 2009): in press. Pre-release article available here (free registration required). Assigned DOI: 10.1186/1471-244X-9-11.
There have been remarkably few studies on attempts the change sexual orientation in clinical settings. There’s very little evidence that such attempts are effective, and there is some evidence that these attempts may be harmful to many clients who seek change. A recent study from the U.K. has looked at the issue and came to some surprising results.
According to the study, only about 4% of British therapists reported that they themselves would attempt to change a client’s sexual orientation if the client asked for such therapy. But in a surprising finding, another 10% said they would refer their client to another therapist to help them change their sexual feelings. And 17% — about one in six — reported that they had assisted at least one client to reduce his or her same sex attractions.
The study is based on a survey conducted in 2002-2003. The questionnaire was sent to 1848 practitioners, of which 1328 completed responses were returned, resulting in a remarkably high response rate of 72%. Participants were a geographically distributed random sample based on their membership in the following professional organizations:
BACP members were most likely to counsel clients to accept their sexuality and least likely to assist clients to change. Psychiatrists were most likely to refer other colleagues who might help clients to adjust to their sexuality.
The first question of the survey asked therapists how they would manage a client seeking to change their sexual attractions. The responses were:
The “other” category is surprisingly large. There’s no insight into what those respondents might have in mind in this particular survey.
The 222 (17%) therapists who had tried to reduce or change their clients same-sex attractions reported treating at least 413 clients. (The structure of the survey only permitted examining up to five clients per therapist.) These therapists were asked about their clients reasons for wanting to change:
These therapists reported very little follow-up after treatment. In 117 (28%) cases, there was no follow-up. In the remainder, the medial follow-up period was only eight months. Citing the American Psychiatric Association’s opposition to conversion therapy, the authors conclude:
Thus, it is hard either to understand or recommend the actions of the one in six psychotherapists, counsellors and psychiatrists who undertook these treatments. The qualitative data suggest that they made therapeutic decisions based on privileging client/patient choice where there was a wish to avoid the impact of negative social attitudes to same sex relationships. They appeared to take little account of the potential harm of applying treatments with no evidence for efficacy. Furthermore, the commonest reason for the referral was confusion about sexual orientation rather than an expressed desire to change it. It is well known that confusion is both a feature of a developmental trajectory, often part of the “coming out” story, and a common reason for seeking help. It appears unlikely that therapists were responding straightforwardly to the demands of patients as direct requests for change were very rarely reported.
Speaking to The Independent, Prof. Michael King was much more blunt:
He said: “There is very little evidence to show that attempting to treat a person’s homosexual feelings is effective and in fact it can actually be harmful.
“So it is surprising that a significant minority of practitioners still offer this help to their clients.”
He went on: “The best approach is to help people adjust to their situation, to value them as people and show them that there is nothing whatever pathological about their sexual orientation.
“Both mental health practitioners and society at large must help them to confront prejudice in themselves and in others.”
The study was conducted by Dr. Annie Bartlett (St. George’s, University of London), Dr. Glenn Smith (Royal Holloway, University of London) and Prof. Michael King (University College London Medical School). Together, they established the web site TreatmentsHomosexuality.org.uk, which Prof. King introduced in a BTB guest post last September. That web site seeks oral history contributions in written, audio, or video form from former clients and therapists who participated in sexual reorientation therapies.
This study is an outgrowth of previous papers that the three have published on clinical attempts to change homosexuality. The British Medical Journal in 2004 published two papers which were oral histories of treatments since the 1950’s. Dr. Smith’s paper focused on the experience of patients, and Prof. King’s paper focused on the experience of professionals. Dr. Smith found that “The definition of same sex attraction as an illness and the development of treatments to eradicate such attraction have had a negative long term impact on individuals.” And Prof. King observed that:
With hindsight, professionals realised that they had not appreciated the influence of social context on sexual behaviour. Most now regarded same sex attraction as compatible with psychological health, although a small minority considered that the option to try to become heterosexual should still be available to patients who desire it.
Social and political assumptions sometimes lie at the heart of what we regard as mental pathology and serve as a warning for future practice.
In 1999, Prof. King and Dr. Bartlett published a historical overview of treatments of homosexuality in the British Journal of Psychiatry. That overview included accounts of electric shock and other forms of aversion therapy, which some therapiests continued to defend into the early 1980’s. They stated in their concluding remarks:
In December 1997, in documents released by the British government under a 30-year rule, it was revealed that ministerial approval was given for experiments in aversion therapy on gay men. Even today, criticism of the ‘treatment’ of gay men is regarded as mere political correctness. Few other psychiatric labels have led to such pain and disarray. This peculiar history has exposed the conservative social bias inherent in psychiatry and psychology, damaged the lives of gay men and lesbians, and provided grounds for discrimination.
…Mental health professionals in Britain should be aware of the mistakes of the past. Only in that way can we prevent future excesses and heal the gulf between gay and lesbian patients and their psychiatrists.
It appears that a surprising number of mental health professionals have not yet learned from the mistakes of the past.
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Part 4: It Depends On How The Meaning of the Word "Change" Changes
Part 5: A Candid Explanation For "Change"
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