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The Doctor’s Word

Dr. Rekers often defended his treatment of Kirk by saying that Kirk had been independently evaluated by other psychologists throughout his childhood, and that those evaluations confirmed Rekers’s success. Problems surface when we only have the doctor's word for it.

Jim Burroway

June 8th, 2011

When Dr. Robert Stoller established the Gender Identity Clinic at UCLA in 1963,1 it quickly became one of the nation’s premiere facilities trying to cure or prevent homosexuality and transgender identities. The clinic’s stature was due not only to the top researchers that he drew to his enterprise, but to Stoller himself, whose own reputation in sexual research made such successful recruitment possible.

Dr. Stoller had been trained as a psychoanalyst, the particular branch of psychology founded upon Sigmund Freud’s theories involving the unconscious mind, repression, the Oedipal complex and penis envy, and so on. But by 1968, when he published the groundbreaking book Sex and Gender, Stoller challenged several key Freudian theories, including the belief that all humans were, by nature, bisexual. And like many who became involved with behavioral therapy techniques, Stoller became disillusioned with the unscientific practices that prevailed in psychoanalytic research. Instead of relying on observable, empirical and measurable evidence to form, test and modify a hypothesis — which is the very definition of the Scientific Method — Psychoanalytic research relied too heavily on narrative case reports to confirm already prevailing psychoanalytic theories, an approach which was inherently subjective, unmeasurable, and unrepeatable. Stoller’s 1986 paper in the Journal of the American Psychoanalytic Association challenged psychoanalysts to imagine how different their case reports would be if patients played a greater role in the publication process. “We would do better ethically and scientifically if throughout the process of writing and publication, we let our patients review our reports of them,”2 he began, before laying out the chief problem with the prevailing practice which leaves us with only the doctor’s word for what happened.

Not yet responsive to the philosophers of science, we accepted each other’s skimpy, undocumented accounts as reliable evidence. We had — still have — much at stake: pride, including our scientific pretensions, as against humbling candor.

… Anticipating the discussion below on psychoanalysis as science, let me underline that the editing process that produces anyone’s case presentation is so much the product of the author’s intentions and can be for the reader so invisible a process that we are euphemistic to refer to our written reports as containing “data,” “observations,” “facts.”

Stoller proposed sharing with the patient the process of selecting and editing quotes from thousands of hours’ worth of transcripts. He had, by then, invited some his own patents to help out with some of his publications, and what he learned from that experience was profound:

Patients’ sense of what happens in treatment (for instance, an interpretation’s value) is our constant concern, but our literature has not dealt head-on with the idea that patients’ opinions can be as much or more right than ours. We have settled this latter issue silently, and perhaps cruelly, with presentations whose foregone conclusions support us. Pick up any issue of a psychoanalytic journal — 50 years old or today’s — and read at random a clinical description. The report is so much the analyst’s version and the writing style applied to the clinical story so free of uncertainty, whether the writer’s version of the story is the right one or not, that we automatically accept the description as reality. Try this exercise: read each word as if you were skeptical, and see if the description cures your skepticism. Do you find evidence for the author’s saying that the patient was “extremely” this or “hardly” that; that such-and-such was a pathologic defense while something else was a healthy sublimation; that the analysis revealed that … ; that, as the author declares, it was unquestionably the case that … ; that the patient’s response to the described interpretation was the response the author reports to us? You will sense, beyond the innumerable declarative statements that produce a sense of factuality, an ambiance — a rhetoric — in which the author’s position is the fixed point in the universe, serving as baseline truth. If you doubt this, then accept my challenge: show your patients your descriptions of them. The failure to do so contributes to the defensively authoritarian tone sensed by people — not all enemies — outside analysis.


Stoller’s criticism was directed toward psychoanalysts, but he may as well have admonished behavioral therapists and other psychologists, including his own colleagues at UCLA. Particularly when George Rekers and his mentor, Ivar Lovaas, wrote this about four-year-old Kirk Murphy in their seminal 1974 paper:

When we first saw him, the extent of his feminine identification was so profound (his mannerisms, gestures, fantasies, flirtations, etc., as shown in his “swishing” around the home and clinic, fully dressed as a woman with long dress, wig, nail polish, high screechy voice, slovenly seductive eyes) that it suggested irreversible neurological and biochemical determinants.3

I immediately thought of that passage when I came across Stoller’s admonition to his fellow psychoanalysts. Many professionals who commented on Kirk’s case over the years were drawn to that passage, and it invoked a lot of commentary. Some were skeptical, but most saw it as evidence of how profound a change Rekers’s therapy had on “Kraig.” In either case, everyone who read it had an opinion about Kirk’s diagnosis and treatment, and all the while his own mother was left out of the discussion. For the longest time, Kaytee didn’t even know anything had been written about him. In fact, that was one of her complaints about her experience at UCLA: she often said that she was never given any written documentation describing how her son was doing.

And so it was time, I thought, for Kaytee to finally have the opportunity to add her own perspective to the twenty papers, book chapters and books that Rekers wrote during his career. But despite my having sent Kaytee all of the papers Rekers wrote about her son in November, by last January she still hadn’t been able to bring herself to read any of them.

This posed a dilemma. This was her son we were talking about, but she was central to the discussion. Having lost her son to suicide, I was reluctant to open old wounds. And yet, part of the task of this investigation was to understand the differences between Rekers’s description of “Kraig” and the real Kirk Murphy. And if Rekers wasn’t going to take up Stoller’s challenge — “show your patients your description of them” — it was left to me to do it.

It was a strange situation, asking yourself whether a mother should hear what her own son’s doctor wrote about him, even after she complained that nobody at UCLA would level with her. But after overcoming a great deal of trepidation, I finally read that passage to her. There was an uncomfortable pause on the other end of the phone, and I immediately wondered if I had committed a terrible mistake.

But finally she responded: “That is a damned boldfaced lie, pardon my French.” She paused again, as though she could scarcely believe what she heard. “I can’t believe he made up all that crap.” The more she thought about it, the more incredulous she became. “Where would he even have gotten a wig? Or a dress that would fit him? Oh, that makes me so angry. What a creep!”


Scientific Pretensions In An Authoritarian Tone
Garbage in, garbage out. That’s a maxim for any system designed to measure a given phenomenon. Behavioral Therapy was intended to correct the shortcomings of psychoanalysis by insisting on sticking to measurable, observable behaviors rather than the murky world of dream interpretation and childhood memories. But behaviorists, it turns out, are no more immune to self-confirming biases and faulty diagnosis than the psychoanalysts they criticized, even if they were able to conjure the charts, numbers and “observable behaviors” to confirm their own prevailing hypotheses.

From 1974 to 1987, virtually everything anyone would know about “Kraig,” George Rekers’s pseudonym for Kirk, came from Rekers’s pen.4 Throughout the 1970s and 1980s, Kirk’s case became a landmark case history among behavioral therapists trying to change their clients’ sexual orientation, and it was Rekers and Lovaas’s 1974 paper describing swishy, flirtatious and slovenly seductive “Kraig” which became the “data” that therapists relied on to evaluate the case. Lawrence Newman, also of UCLA, writing in the American Journal of Psychiatry, hailed “Kraig’s” case as demonstrating “the dramatic results that can be achieved … with a behavioral approach,” and that with parental cooperation “therapeutic change may occur with extraordinary speed.”5 Behavior therapy textbooks for practitioners and college students quickly picked up the theme. A 1977 clinical textbook devoted four pages to a detailed description of “Kraig’s” case,6 and a 1979 textbook lauded Rekers’s “pioneer[ing] behavioral approaches.”7 Another textbook marveled at the efficiency of Rekers’s methods, calling them “intriguing in the promise they hold for maximizing the services which can be rendered by the relatively few professionally trained therapists.”08 Another 1980 clinical handbook called Rekers’s results “quite promising in terms of possible preventive intervention in the early stages of gender-identity conflict.”09

Diagnostic criteria were proposed10 and criticized,11 ethical issues surrounding Kirk’s care were raised12 and countered,13 and protests even broke out on UCLA’s campus14 -– all with Kirk’s case playing an important role in those developments. By the 1980’s, “Kraig” was showing up in undergraduate college textbooks. A 1981 textbook described Rekers’s work with “Kraig” as “probably the most widely known work in childhood gender problems,”15 and a 1982 textbook devoted an entire sidebar to “Kraig’s” case.16 All of this was in addition to the chapters that Rekers himself was invited to contribute to nearly a dozen clinical textbooks written for pediatricians and mental health professionals.17

Enthusiasm extended beyond behavioral therapists. Mike Marlow, writing in a journal for school guidance counselors, cited “Kraig’s” case in particular and informed his readers that “[o]ne promising treatment procedure has been the development of behavior modification techniques to shape sex-typed behaviors by George Rekers and his colleagues. … Response cost procedures (based on token economies) and verbal prompts have as well been effectively introduced in modifying feminine mannerisms.”18 By 1980, one researcher noted that the 1974 Rekers and Lovaas paper which first presented Kirk’s case had been cited so many times that it had “the potential to be (a) citation classic in the near future.”19 In 1999, Rekers was still caught up in that enthusiasm himself, boasting that his breakthroughs with Kirk and other children opened the doors “for preventing homosexual orientation in males, if applied extensively in the population.”20

What Data? What Long-Term Follow-up?
What makes this acclaim so remarkable is that it occurred despite the lack of independent verification of Kirk’s progress following his treatment at UCLA. Rekers often wrote that other independent investigators performed follow-up evaluations on Kirk and confirmed that he was “normal,” but Rekers’s supporting evidence for those claims were remarkably thin. Soon after the Murphy family moved to Montana, UCLA flew them back to Los Angeles for a follow-up examination. But for those who were interested in learning about a long-term follow-up to the landmark case, published results were scare. For example, here is Rekers’s first description of that follow-up evaluation:

An additional follow-up evaluation was conducted three and a half years after the treatment by an independent clinical psychologist who again interviewed the boy and the family members and administered the complete battery of psychological tests. The boy was found to have normal gender identity and emotional, social, and academic adjustment.21

For more than a decade, those two sentences were all that anyone was allowed to know about “Kraig” at age nine.22 There’s no hint of who administered the “complete battery of psychological tests,” and more importantly, Rekers doesn’t say what the tests consisted of or what Kirk’s scores were.23 And most tellingly, that passage did not make its appearance in a peer-reviewed journal. Instead, it appeared in a chapter Rekers wrote for a clinical handbook which was not subject to peer review. But with this tidbit published somewhere, Rekers was able to point to this source in his future writings to claim that Kirk had been independently evaluated without providing a comprehensive peer-reviewed report on the results of those evaluations.

Independent evidence for Kirk’s follow-up at age 15 is even worse. Its first mention appeared in Rekers’s Shaping Your Child’s Sexual Identity in 1982. That’s not even a textbook geared toward clinicians; it’s a paperback marketed to conservative Christian parents. Rekers wrote:

Finally, when Craig was fifteen years old, I arranged for another clinical psychologist to do a follow-up evaluation of Craig’s sexual identity and general psychological adjustment. This psychologist reported that Craig was indistinguishable from any other normal teenage boy. He reported that Craig was developing normal masculine roles, had a normal male identity, had normal aspirations for growing up to be married and have a family, and was well-adjusted as a teen-age boy in general.24

But at least here we have a clue as to who may have performed that evaluation. Buried in a footnote, Rekers wrote, “I express my appreciation to Drs. Larry N. Ferguson and Alexander C. Rosen for their independent evaluations.” By 1979, Ferguson was working as a research psychologist at Logos Research Institute,25 a conservative religious-based think tank that Rekers had founded in 1975.26 With Rekers as his employer, Ferguson’s participation in such an evaluation could not be seen as independent. As for Rosen, he had been Rekers’s longstanding colleague at UCLA: the two of them co-wrote at least fourteen papers — including three defending the kind of treatment Kirk received at UCLA against growing criticism.27 Rosen may not have been as personally invested in Kirk’s reported outcome as Rekers, but he was certainly invested in UCLA’s reputation.

But the bigger problem is this: Rekers alone presented their findings and thanked them in a footnote — all in a paperback book for the general public. Neither Rosen nor Ferguson published their findings under their own authorship (in a court of law, Rekers’s description of their findings would be dismissed as hearsay), and their data was therefore never subjected to an independent peer-review. And as before, we don’t have any descriptions of the evaluation methods, nor do we see any of the data which is supposed to support Rekers’s conclusion. Trust me, Rekers may have well have written. This is all you need to know.

But here’s the real rub: even if Rekers had sent a truly independent team to evaluate Kirk at fifteen, and even if those independent evaluators had administered a battery of standardized tests and structured interviews, they still may have come away with the impression that Kirk “was developing normal masculine roles.” Remember what Kirk was trained to do at a very young age: he was trained to sublimate whatever he was feeling inside and to hide it from the outside world. He repeated his mantra over and over — ” I can’t act that way or people will know that I’m different” — as he walked a worn path in the family’s back yard in Montana with his favorite stick. They trained him in how to act and how to present himself, and they trained him well. They just didn’t make him straight.

And besides all that, think of what Kirk was experiencing when he was fifteen and undergoing this evaluation: his family was disintegrating, his mother had suffered a nervous breakdown, and he was bearing the burden of holding everything together financially and mentally. The last thing he needed was a bunch of doctors from Los Angeles making things more unbearable with the possibility of more “treatment.” And he certainly couldn’t take on the added burden of letting his family and doctors down after all everyone had been through. If he were to reveal himself as a “failure,” then it would reflect not only on him but everyone else. When someone wants to hide the things that are distressing him, there’s no standardized psychological test in the world that can reliably reveal it. And so the charade continued: Kirk was fine, and the treatment was a success. And it is very possible that Kirk himself may have facilitated to that charade. Everything he learned was about making other people happy with him for they way they wanted him to be.

The Doctor’s Word, Contradicted
It wouldn’t be until 1987 when a truly independent account of how Kirk was doing became available. That’s when Dr. Richard Green published excerpts of his interviews with Kirk and his parents in Sissy Boy Syndrome.28 Green used the pseudonym of “Kyle” for Kirk, and acknowledged Rekers as “Kyle’s” therapist. (He also tied “Kyle” to Rekers’s “Kraig” directly via a footnote referencing the 1974 Rekers and Lovaas paper describing Kirk.) Green had traveled to Montana to interview Kirk and his mother when Kirk was seventeen. During those interviews, Kirk refused to acknowledge any homosexual feelings or fantasies. Kirk did admit to homosexual experiences with a male cousin, but he chalked that up to experimentation and said that the thought of it disgusted him. When asked his opinion of homosexuality, Kirk responded, “I think that it’s sort of really gross.” He added, “You have them who are into leather and stuff like that. I mean, I think that is really sick, and I think that maybe they should be put away.”29 But otherwise, he talked far more about girls than anything else.

But things changed the following year. After Kirk turned eighteen and graduated from high school, Green flew Kirk to Boston for another round of interviews. Maybe it was because Kirk was away from the turmoil at home, maybe it was because Kirk was enjoying his vacation in Boston, or maybe it was because Kirk had grown more comfortable with Dr. Green, it’s hard to say. But it was during those later interviews that he reluctantly revealed that he was still attracted to men, that he was deeply conflicted over his sexual attractions, and that he tried to kill himself the year before after an anonymous sexual encounter with another man.

Kirk’s interview in Boston also reveals why earlier follow-up evaluations may have missed the fact that Kirk was still attracted to men. Kirk defended his parents’ decision to send him to UCLA, saying if he hadn’t gone he’d be a “total basket case.” He acknowledged that going to UCLA caused more psychological conflict in him “because of the way my parents handled it.” He went on: “Well, I felt really ashamed, and I didn’t want anybody to know, and when the research guys would come to check on me, I didn’t want anybody to see me with them. Maybe that wasn’t my parents’ fault, it’s just — people don’t really understand.” When Green commended Kyle for his honesty with a very difficult series of admissions, Kyle responded, “I thought you would be mad. … [B]ecause the whole purpose of everything you did, I thought, was to keep me from being like that. I thought you would be disappointed.”30

Green departed from Rekers’s assessment of “Kyle” by determining that “Kyle” was bisexual.31 and he expressed some very strong doubts about Rekers’s therapeutic methods. He also noticed Rekers’s paperbacks written for parents, books in which Rekers dropped his scientific authoritarian tone in exchange for that of a preacher and moralist. That didn’t sit well with Green:

I have even more difficulty with the moralistic basis that has recently been revealed behind Rekers’s attempts to “treat” these children. That basis is described in his books, Shaping Your Child’s Sexual Identity (1982) and Growing Up Straight (1982). The goal of treatment is to promote” real masculinity, which should be affirmed in every young man in order to prevent them from being strongly tempted by the sexual perversions” (Rekers, 1982[a]), 112). Homosexuality is “an unfortunate perversion” and a manifestation of “promiscuous and perverted sexual behavior” (1982[a], 85). Rekers states that “persons afflicted with these abnormal sexual conditions have historically realized that their sexual conduct is … a sinful yielding to temptation” and that “homosexuality has been sold to the unwary public as a right between consenting adults” (1982[a], 87-88).32

Green clearly saw that Rekers no longer held any pretense of scientific impartiality. And having denounced Rekers’s books, it’s all the more remarkable to see Green citing the very same book he denounced earlier to describe Kirk’s independent evaluations:

Two years after treatment ended, Kyle was described as “indistinguishable from any other boy in terms of gender-related behaviors” (Rekers and Lovaas, 1974, 186). At age nine, Kyle was described as having “a normal male sexual identity” (Rekers, 1982[a], 138). At fifteen he was described as “indistinguishable from any other normal teen-age boy … developing normal masculine roles, [with] a normal male identity [and] normal aspirations for growing up to be married and have a family” (139).33

To be fair, Green was far from the only one to repeat Rekers’s claims. It is, after all, a standard practice among doctors to accept other doctors at their word. Others, like Green, challenged the ethics of Rekers’s treatment program, but very few challenged his results. All that changed with Green’s Sissy Boy Syndrome, when those who were paying attention to “Kraig’s” case got their first truly independent look at how that four-year-old boy turned out. By getting eighteen-year-old Kirk to open up to him after resisting the year before, Green was able to demolished Rekers’s claims that Kirk was straight. Kirk’s case, along with several others presented in Green’s book, now demonstrated “[t]he apparent powerlessness of treatment to interrupt the progression from ‘feminine’ boy to homosexual or bisexual man.”34

For Rekers’s part, he never referenced or acknowledged Green’s evaluations of “Kyle” in Sissy Boy Syndrome. Rekers would cite Kirk’s case three more times after 1987,35 but as far as he was concerned, “Kraig” was not attracted to men, he was not deeply conflicted over his sexual attractions, and he did not try to kill himself after an anonymous sexual encounter with another man. When CNN tracked him down this year to try to get a comment from him, Rekers protested, “Two independent psychologists with me had evaluated him and said he was better adjusted after treatment, so it wasn’t my opinion.”35 Their lack of independence aside, even now Rekers regard’s “Kraig’s” independent evaluations as ending long before Sissy Boy Syndrome and nothing more needs to be said.

Notes:

1. Bryant, Karl Edward. “The politics of pathology and the making of Gender Identity Disorder.” Unpublished doctoral dissertation, University of California at Santa Barbara (September 2007): 73. [BACK]

2. Stoller, Robert J. “Patients’ responses to their own case reports.” Journal of the American Psychoanalytic Association 36, no. 2 (April 1988): 371-391. [BACK]

3. Rekers, George A.; Lovaas, O. Ivar. “Behavioral treatment of deviant sex-role behaviors in a male child.” Journal of Applied Behavior Analysis 7, no. 2 (Summer 1974): 173-190. [BACK]

4. Kirk’s case was first introduced in Rekers’s unpublished doctoral dissertation in 1972, followed by a paper Rekers wrote with Dr. Ivar Lovaas that was published in the Journal of Applied Behavior Analysis in 1974. Kirk is described either by name (as “Kraig” or “Craig”) or by other clearly identifiable information (usually by his age with a reference to either Rekers’ doctoral thesis or the 1974 Rekers & Lovaas paper) in the following papers, chapters and books:

Rekers, George A. “Pathological sex-role development in boys: Behavioral Treatment and Assessment.” Unpublished doctoral dissertation, University of California at Los Angeles. (1972).

Rekers, George A.; Lovaas, O. Ivar. “Behavioral treatment of deviant sex-role behaviors in a male child.” Journal of Applied Behavior Analysis 7, no. 2 (Summer 1974): 173-190. This is the first published description of Kirk’s treatment at UCLA.

Rekers, George A. “Stimulus control over sex-typed play in cross-gender identified boys.” Journal of Experimental Child Psychology 20, no. 1 (August 1975): 136-148.

Rekers, George A.; Lovaas, O. Ivar. “Treatment of deviant sex-role behaviors.” Chapter 25 in M. Franks & G.T. Wilson (eds.) Annual Review of Behavior Therapy: Research and Practice, Vol 3 (New York: Bruner/Mazal, 1975): 553-579. This is a reprint of the Rekers & Lovaas (1974) paper.

Rekers, Geroge A.; Lovaas, O. Ivar. “Behavioral treatment of deviant sex-role behaviors.” Chapter 38 in Gerald R. Patterson, et al. (eds.) Behavior Change 1974: An Aldine Annual on Psychotherapy, Counseling, and Behavior Modificaiton (Chicago: Aldine, 1975): 385-401. This is a reprint of the Rekers & Lovaas (1974) paper.

Rekers, George A.; Yates, Cindy E. “Sex-typed play in feminoid boys versus normal boys and girls.” Journal of Abnormal Child Psychology 4 no. 1 (March 1976): 1-8.

Rekers, George A. “Assessment and treatment of childhood gender problems.” Chapter 7 in Benjamin B. Lahey & Alan E. Kazdon (eds.) Advances in Clinical Child Psychology, Vol. 1 (New York: Plenum Press, 1977): 267-306.

Rekers, George A. “Atypical gender development and psychosocial adjustment.” Journal of Applied Behavior Analysis 10, no. 3 (Autumn 1977): 559-571.

Rekers, George A.; Rosen, Alexander C.; Lovaas, O. Ivar; Bentler, Peter M. “Sex-role stereotypy and professional intervention for childhood gender disturbances.” Professional Psychology 9, no. 1 (February 1978): 127-136.

Rekers, George A. “Sexual problems: Behavior modification.” Chapter 17 in Benjamin B. Wolman, James Egan, and Alan O. Ross (eds.) Handbook of Treatment of Mental Disorders in Childhood and Adolescence (Englewood Cliffs, NJ: Prentice-Hall, 1978): 268-296.

Rekers, George A.; Crandall, Barbara F.; Rosen, Alexander C.; Bentler, Peter M. “Genetic and physical studies of male children with psychological gender disturbances.” Psychological Medicine 9, no. 2 (May 1979): 373-375. “Kraig”/”Craig” is not mentioned by name, but the authors include in their study of  “12 consecutive referrals to the first author’s clinical research programme”, “one who had one undescended testicle.” Later in the same paper, the subject with the undescended testicle was identified as the boy reported in Rekers & Lovaas, 1974.

Rekers, George A. “Sex-role behavior change: Intrasubject studies of boyhood gender disturbance.” Journal of Psychology 103, no. 2 (November 1979): 255-269. “Kraig”/”Craig” is not mentioned by name, but is instead referred to as “a five-year-old cross-gender identified boy,” with a reference to Rekers & Lovaas, 1974.

Rekers, George A.; Lovaas, O. Ivar. “Case report #2 on cross-gender identification.” In Charles E. Schaefer and Howard L. Millman (eds.) How to Help Children with Common Problems (New York: Plume Books, 1981): 389-390.

Braun, Michael; Rekers, George Alan. <em>The Christian In an Age of Sexual Eclipse: A Defense Without Apology </em>(Wheaton, IL: Tyndale House, 1981). Kirk is identified as “Craig” throughout the book.

Braun, Michael; Rekers, George Alan. The Christian In an Age of Sexual Eclipse: A Defense Without Apology (Wheaton, IL: Tyndale House, 1981). Kirk is identified as “Craig” throughout the book.

Rekers, George A. Shaping Your Child’s Sexual Identity (Grand Rapids, MI: Baker Book House, 1982). Kirk is identified as “Craig” throughout the book.

Rekers, George A. Growing Up Straight: What Every Family Should Know About Homosexuality (Chicago: Moody Press, 1982): 76. “Kraig”/”Craig” is not mentioned by name, but is instead referred to as “a four-year-old son” who “pretended he was the mother virtually every time he played house, with a reference to Rekers & Lovaas, 1974.

Rekers, George A. “Play therapy with cross-gender identified children.” In Charles E. Schaefer and Kevin J. O’Connor (eds.) Handbook of Play Therapy (New York: John Wiley & Sons, 1983): 369-385.

Rekers, George A. “Gender identity problems.” Chapter 16 in Philip H. Borstein and Alan E. Kazdin (eds.) Handbook of Clinical Behavior Therapy with Children (Homewood, IL: Dorsey Press, 1985): 658-699. “Kraig”/”Craig” is not mentioned by name, but is instead referred to as “a four year old boy” with a reference to Rekers & Lovaas, 1974 (see pages 686-7).

Rekers, George A.; Kilgus, Mark; Rosen, Alexander C. “Long-term effects of treatment for Gender Identity Disorder.” Journal of Psychology and Human Sexuality 3, no. 2 (1990): 121-153. “Kraig”/”Craig” is not mentioned by name, but is instead referred to as “a four year old boy” with a reference to Rekers & Lovaas, 1974 (see page 149).

Rekers, George A.; Kilgus, Mark D. “Differential diagnosis and rationale for treatment of gender identity disorders and transvestism.” Chapter 12 in George A. Rekers (ed.) Handbook of Child and Adolescent Sexual Problems (New York: Lexington Books, 1995): 255-271. Kirk is identified as “Craig.”

Rekers, George A; Oram, Kimberly Barnett. “Child and adolescent therapy for precursors to adulthood homosexual attractions.” In Julie Harren Hamilton & Philip J. Henry (eds.) Handbook of Therapy for Unwanted Homosexual Attractions: A Guide to Treatment (Self-published via Xulon Press, 2009): 302. Kirk is identified as “Craig.” [BACK]

5. Newman, Lawrence E. “Treatment for the parents of feminine boys.” American Journal of Psychiatry 113, no. 6 (June 1976): 683-687. [BACK]

6. Gambril, Eileen D. Behavior Modification: Handbook of Assessment, Intervention, and Evaluation (San Francisco: Jossey-Bass Publishers, 1977): 988-991. [BACK]

7. Redd, William H.; Porterfield, Albert L.; Anderson, Barbara L. Behavior Modification: Behavioral Approaches to Human Problems (New York: Random House, 1979): 334. [BACK]

8. Ross, Alan O. “Behavioral Therapy With Children.” Chapter 15 in Sol. L. Garfield and Allen E. Bergin (eds.) Handbook of Psychotherapy and Behavior Change: An Empirical Analysis (New York: John Wiley & Sons, 1978): 591-620. [BACK]

9. Brownell, Kelly D.; Barlow, David H. “The behavioral treatment of sexual deviation.” Chapter 10 in Alan Goldstein & Elba B. Foa (eds.) Handbook of Behavioral Interventions: A Clinical Guide (New York: John Wiley & Sons, 1980): 604-671. [BACK]

10. Rosen, Alexander C.; Rekers, George A.; Friar, Linda Rogers. “Theoretical and diagnostic issues in child gender disturbances.” Journal of Sex Research 13, no. 2 (May 1977): 89-103. [BACK]

11.Wolfe, Barry E. “Behavioral treatment of childhood gender disorders: A conceptual and empirical critique.” Behavior Modification 3, no. 4 (October 1979): 550-575.

Zucker, Kenneth J. “Childhood gender disturbance: Diagnostic issues.” Journal of the American Academy of Child Psychiatry 21, no. 3 (May 1982): 274-280.

Zucker, Kenneth J. “Cross-gender-identified children.” Chapter 4 in Betty W. Steiner (ed.) Gender Dysphoria: Development, Research, Management (New York: Plenum, 1985): 75-174. This chapter includes an extensive review of Rekers’s diagnostic and treatment claims, pointing out several inconsistencies and offering alternative explanations of findings. [BACK]

12. Morin, Stephen F. “Heterosexual bias in psychological research on lesbianism and male homosexuality.” American Psychologist 32, no. 8 (August 1977): 629-637.

Morin, Stephen F.; Schultz, Stephen J. “The gay movement and the rights of children.” Journal of Social Issues 34, no. 2 (Spring 1978): 137-148.

Nordyke, Nancy S.; Baer, Donald M.; Etzel, Barbara C.; LeBlanc, Judith M. “Implications of the stereotyping and modification of sex role.” Journal of Applied Behavior Analysis 10, no. 3 (Fall 1977): 553-557.

Winkler, R.C. “What types of sex-role behavior should behavior modifiers promote?” Journal of Applied Behavior Analysis 10, no. 3 (Fall 1977): 549-552.

Wolfe, Barry E. “Behavioral treatment of childhood gender disorders: A conceptual and empirical critique.” Behavior Modification 3, no. 4 (October 1979): 550-575. [BACK]

13. Rekers, George A. “Atypical gender development and psychosocial adjustment.” Journal of Applied Behavior Analysis 10, no. 3 (Fall 1977): 559-571.

Rosen, Alexander C.; Rekers, George A.; Bentler, Peter M. “Ethical issues in the treatment of children.” Journal of Social Issues 34, no. 2 (Spring 1978): 122-136.

Rekers, George A. “A priori values and research on homosexuality.” American Psychologist 33, no. 5 (May 1978): 510-512. [BACK]

14. Rorvik, David Michael. “The Gender Enforcers: Seeing to it the boys will be boys.” Rolling Stone (October 9, 1975): 53ff. [BACK]

15. Kauffman, James M. Characteristics of Children’s Behavioral Disorders (2nd ed) (Columbus, OH: Charles E. Merrill Publishing Co., 1981): 257. [BACK]

16. Gelfand, Donna M.; Jenson, William R.; Drew, Clifford J. Understanding Child Behavior Disorders (New York: Holt Rinehart and Winston, 1982): 14. [BACK]

17. Rekers. George A. “Assessment and treatment of childhood gender problems.” Chapter 7 in B.B. Lahey and A.E. Kazdin (eds.), Advances in Clinical Child Psychology, Vol. I (New York: Plenum, 1977): 267-306.

Rekers, George A. “Sexual problems: Behavior modification.” Chapter 17 in B.B. Wolman (ed.), Handbook of Treatment of Mental Disorders in Childhood and Adolescence (Englewood Cliffs, NJ: Prentice-Hall, 1978): 268-296.

Rekers, Geroge A. “Psychosexual and gender problems.” Chapter 11 in Eric J. Mash & Leif G. Terdal (eds.) Behavioral Assessment of Childhood Disorders (New York: Guilford Press, 1981): 483-526.

Rekers, George A.; Jurich, Anthony P. Development of problems of puberty and sex roles in adolescents.” Chapter 33 in C. Eugene Walker & Michael C. Roberts (eds.) Handbook of Clinical Child Psychology (New York: John Wiley and Sons, 1983): 785-812.

Rekers, George A. “Play therapy with cross-gender identified children.” Chapter 20 in Charles S. Schaefer & Kevin J. O’Connor (eds.) Handbook of Play Therapy (New York: John Wiley & Sons, 1983): 369-385.

Rekers, George A. “Ethical issues in child behavioral assessment.” Chapter 12 in Thomas H. Ollendick & Michael Hersen (eds.) Child Behavioral Assessment: Principles and Procedures (New York: Pergamon Press, 1984): 244-262.

Rekers, George A. “Gender identity problems.” Chapter 16 in Philip H. Bornstein & Alan E. Kazdin (eds.) Handbook of Clinical Behavior Therapy with Children (Homewood, IL: Dorsey Press, 1985): 658-699.

Rekers, George A. “Gender identity disorder in childhood.” In D.G. Branner (ed.) Baker Encyclopedia of Psychology and Counseling (Grand Rapids: Baker Books, 1985).

Rekers, George A. Cross-sex behavior.” Chapter 79 in Robert A. Hoekelman, et al. (eds.), Primary Pediatric Care (St, Louis: Mosby/Harcourt Health Science Co, 1987): 719-721.

Rekers, George A. “Psychosexual assessment of gender identity disorders.” In Prinz, R.J. (ed) Advances in Behavioral Assessment of Children and Families (vol 4) (Greenwich, CT: JAI Press, 1988): 33-71. [BACK]

18. Marlowe, Mike. “The assessment and treatment of gender-disturbed boys by guidance counselors.” Personnel and Guidance Journal 58, no. 2 (October 1979): 128-131. [BACK]

19. Routh, Donald K. “Child treatment citation classics.” Professional Psychology: Research and Practice 11, no. 6 (December 1980): 901-906. [BACK]

20. Rekers, George A. “The development of a homosexual orientation.” In Christopher Wolfe (ed.) Homosexuality and American Public Life (Dallas: Spence Publishing Co., 1999): 62-84. [BACK]

18. Rekers. George A. “Assessment and treatment of childhood gender problems.” Chapter 7 in B.B. Lahey and A.E. Kazdin (eds.), Advances in Clinical Child Psychology, Vol. I (New York: Plenum, 1977): 267-306.

Those two sentences were copied nearly verbatim in a chapter Rekers supplied to another clinical textbook a year later. Whenever Rekers wrote subsequently about Kirk’s follow-up at age nine, he typically referred to the two sentences in the 1978 textbook, not the 1977 textbook. However neither textbook is peer-reviewed.

Rekers, George A. “Sexual problems: Behavior modification.” Chapter 17 in Benjamin B. Wolman (ed.), Handbook of Treatment of Mental Disorders in Childhood and Adolescence (Englewood Cliffs, NJ: Prentice-Hall, 1978): 268-296. [BACK]

22. It would have taken an extraordinarily sharp eye to notice a tiny clue about Kirk’s follow-up at age nine which may have appeared in a two-and-a-half page notice that Rekers published in 1979 as a “Brief Communications” in the journal Psychological Medicine. While Psychological Medicine is a peer-reviewed journal, the Brief Communications section doesn’t undergo rigorous review. This notice sought to dispel the suspicion that feminine boys became feminine due to genetic or hormonal anomalies. One of the twelve was described as having an undescended testicle, which means he was probably Kirk. That paper indicates that Alexander Rosen and Peter Bentler, two psychologists at UCLA, conducted psychological testing on the twelve children, but according to the paper’s wording it appears that those tests were conducted on the children during their initial evaluation, not as a follow-up to treatment. And so remains unclear who may have evaluated Kirk at age nine. At any rate, this paper is problematic for another reason: the authors claimed that none of the mothers had undergone hormone treatments during pregnancy, which, if Kirk is among the twelve children evaluated in this study, makes that statement flat-out wrong. Kaytee says she underwent hormone treatment during the last two months of her pregnancy for Kirk.

Rekers, George A.; Crandall, Barbara F.; Rosen, Alexander C.; Bentler, Peter M. “Genetic and physical studies of male children with psychological gender disturbances.” Psychological Medicine 9, no. 2 (May 1979): 373-375. [BACK]

23. A tiny bit of information about Kirk’s follow-up at age nine might have dribbled out again in 1990, when Rekers, Marcus Kilgus and Alexander Rosen published a paper in the Journal of Psychology and Human Sexuality. While the authors don’t identify any of the boys studied in this paper by name or pseudonym, it is possible that Kirk may have been subject #18, assuming they rounded his four-years-eleven-month age up to 60 months. Everything else seems to match: #18 had among the lowest scores of the 29 presented for “Gender Behavior Disturbance” and “Gender Identity Disturbance” before treatment, which coincides with Rekers’s claim that Kirk’s case was the most extreme they had evaluated. The treatment program for subject #18 lasted 10 months, which also matches Kirk’s treatment duration. For subject #18, the follow-up was at 104 months of age, four months shy of nine years old. We cannot be certain whether subject #18 is Kirk, but it is a strong possibility. The paper gives an idea of the kinds of tests that were administered, and a name for the person performing the evaluation:

At the initial assessment and later at follow-up, the research participants were administered a comprehensive battery of objective and projective psychological tests (Bene-Anthony Family Relations Test, Schneidman Make-A-Picture Story Test, the Brown IT-Scale for Children, the Draw-A-Person Test, and the Wechsler Intelligence Scale for Children), behavioral assessment, and clinical interviews by a senior clinical psychologist with’ expertise in gender identity disorders (Dr. A. C. Rosen) and his supervised associates who were not involved in the treatment of the children.

I asked Kaytee if she remembered Alexander Rosen. She didn’t, but there were a lot of people involved with Kirk whose names she couldn’t remember. Despite all of the tests that were reportedly performed on the boys for the study, only two numerical scores were published: a “Gender Behavior Disturbance” score and a “Gender Identity Disturbance” score. Neither of those scores appear to be based on the list of tests quoted above, but instead were based on a subjective five-point scale which purported to measure the boys’ gender behaviors and identities. The paper provides no useful information about how the scores were derived. Those scores only purported to measure gender variance, and not factors related to emotional, social, or academic adjustment. If Subject #18 is Kirk, then it is the sole data point we have about his reported “improvement” at age nine.

Rekers, George A.; Kilgus, Marcus; Rosen, Alexander C. “Long-term effects of treatment for childhood gender disturbance.” Journal of Psychology and Human Sexuality 3, no. 2 (1990): 121-153. [BACK]

24. Rekers, George A. Shaping Your Child’s Sexual Identity (Grand Rapids, MI: Baker Book House, 1982): 138-139. [BACK]

25. Rekers, George A.; Ferguson, Larry N. “Non-aversive intervention in public childhood masturbation: A case study.” Journal of Sex Research 15, no. 3 (August 1979): 213-223. [BACK]

26. Rekers, George Alan. Resume (Undated). Available online at http://www.docstoc.com/docs/8204845/GEORGE-ALAN-REKERS-PhD-MBA. [BACK]

27. Rekers, George A.; Bentler, Peter M.; Rosen, Alexander C.; Lovaas, O. Ivar. “Child gender disturbances: A clinical rationale for intervention.” Psychotherapy: Theory, Research and Practice 14, no. 1 (Spring 1977): 2-11.

Rekers, George A.; Rosen, Alexander C.; Lovaas, O. Ivar; Bentler, Peter M. “Sex-role stereotypy and professional intervention for childhood gender disturbances.” Professional Psychology 9, no. 1 (February 1978): 127-136.

Rosen, Alexander C.; Rekers, George A. Bentler, Peter M. “Ethical issues in the treatment of children.” Journal of Social Issues 34, no. 2 (Spring 1978): 122-136. [BACK]

28. Green, Richard. The “Sissy Boy Syndrome” and the Development of Homosexuality (New Haven, CT: Yale University Press, 1987): 292-318. [BACK]

29. Green, Richard. The “Sissy Boy Syndrome” and the Development of Homosexuality (New Haven, CT: Yale University Press, 1987): 306-307. [BACK]

30. Green, Richard. The “Sissy Boy Syndrome” and the Development of Homosexuality (New Haven, CT: Yale University Press, 1987): 317-318. [BACK]

31. Green, Richard. The “Sissy Boy Syndrome” and the Development of Homosexuality (New Haven, CT: Yale University Press, 1987): 261. [BACK]

32. Green, Richard. The “Sissy Boy Syndrome” and the Development of Homosexuality (New Haven, CT: Yale University Press, 1987): 262-263. [BACK]

33. Green, Richard. The “Sissy Boy Syndrome” and the Development of Homosexuality (New Haven, CT: Yale University Press, 1987): 295-296. [BACK]

34. Green, Richard. The “Sissy Boy Syndrome” and the Development of Homosexuality (New Haven, CT: Yale University Press, 1987): 318. [BACK]

35. Rekers, George A.; Kilgus, Mark; Rosen, Alexander C. “Long-term effects of treatment for Gender Identity Disorder.” Journal of Psychology and Human Sexuality 3, no. 2 (1990): 121-153. “Kraig”/”Craig” is not mentioned by name, but he is instead referred to as “a four year old boy” with a reference to Rekers & Lovaas, 1974 (see page 149).

Rekers, George A.; Kilgus, Mark D. “Differential diagnosis and rationale for treatment of gender identity disorders and transvestism.” Chapter 12 in George A. Rekers (ed.) Handbook of Child and Adolescent Sexual Problems (New York: Lexington Books, 1995): 255-271. Kirk is identified as “Craig.”

Rekers, George A; Oram, Kimberly Barnett. “Child and adolescent therapy for precursors to adulthood homosexual attractions.” In Julie Harren Hamilton & Philip J. Henry (eds.) Handbook of Therapy for Unwanted Homosexual Attractions: A Guide to Treatment (Self-published via Xulon Press, 2009): 302. Kirk is identified as “Craig.” [BACK]

36.Bronstein, Scott; Joseph, Jessi. “Therapy to change ‘feminine’ boy created a troubled man, family says.” CNN.com (June 7, 2011). Available online at http://www.cnn.com/2011/US/06/07/sissy.boy.experiment/index.html. [BACK]