The Illustrated Manual Of Sex Therapy

Conversion therapy , sometimes called reparative therapy or reorientation therapy , is one type of sexual orientation change effort that attempts to change the sexual orientation of a person from homosexual or bisexual to heterosexual, which have been a source of intense political controversy in the United States and numerous other countries. The American Psychiatric Association states that political and moral debates over the integration of gays and lesbians into the mainstream of American society have obscured scientific data about changing sexual orientation "by calling into question the motives and even the character of individuals on both sides of the issue." The most high-profile contemporary advocates of conversion therapy tend to be conservative Christian groups and other religious organizations. The main organization advocating secular forms of conversion therapy is the National Association for Research and Therapy of Homosexuality (NARTH).

The American Psychological Association defines conversion therapy as therapy aimed at changing sexual orientation. The American Psychiatric Association states that conversion therapy is a type of psychiatric treatment "based upon the assumption that homosexuality per se is a mental disorder or based upon the a priori assumption that a patient should change his/her sexual homosexual orientation." Psychologist Douglas Haldeman writes that conversion therapy comprises efforts by mental health professionals and pastoral care providers to convert lesbians and gay men to heterosexuality, that techniques include psychoanalysis, group therapy, aversive conditioning involving electric shock or nausea-inducing drugs, sex therapy, reparative therapy, and involvement in ex-gay ministries such as Exodus International, and that claims of its effectiveness are unsupported by empirical evidence.

Mainstream American medical and scientific organizations have expressed concern over conversion therapy and consider it potentially harmful. The advancement of conversion therapy may cause social harm by disseminating inaccurate views about sexual orientation. The ethics guidelines of major mental health organizations in the United States vary from cautionary statements about the safety, effectiveness, and dangers of prejudice associated with conversion therapy (American Psychological Association), to recommendations that ethical practitioners refrain from practicing conversion therapy (American Psychiatric Association) or from referring patients to those who do (American Counseling Association).

Terminology

The American Psychological Association in 2008 defined conversion therapy and reparative therapy as “therapy aimed at changing sexual orientation.“ The American Psychiatric Association considers conversion therapy and reparative therapy to be forms of "psychiatric treatment...based upon the assumption that homosexuality per se is a mental disorder or based upon the a priori assumption that a patient should change his/her sexual homosexual orientation." There is disagreement over which methods the term reparative therapy applies to and whether it should be used. GLAAD states that the term implies that homosexuality is a disorder and should be avoided, a view also held by some psychologists and sociologists. Jack Drescher writes in Psychoanalytic Therapy and the Gay Man that properly speaking reparative therapy applies only to the approach developed by Elizabeth Moberly and Joseph Nicolosi. Robert Spitzer in 2003 used reparative therapy to refer to "...any help from a mental health professional or an ex-gay ministry for the purpose of changing sexual orientation".

The Just the Facts Coalition, consisting of the American Academy of Pediatrics, American Association of School Administrators, American Counseling Association, American Federation of Teachers, American Psychological Association, American School Counselor Association, American School Health Association, Interfaith Alliance Foundation, National Association of School Psychologists, National Association of Secondary School Principals, National Association of Social Workers, National Education Association, and the School Social Work Association of America, in 2008 released Just the Facts About Sexual Orientation and Youth . This statement defines sexual orientation conversion therapy as “counseling and psychotherapy to attempt to eliminate individuals‘ sexual desire for members of their own sex”, and also defines sexual orientation conversion therapy and reparative therapy as “counselling and psychotherapy aimed at eliminating or suppressing homosexuality”. It distinguishes sexual orientation conversion therapy from ex-gay ministry and transformational ministry , defining the latter as "religious groups that use religion to attempt to eliminate those desires."

The American Psychological Association in 2009 released Appropriate Therapeutic Responses to Sexual Orientation , which defines sexual orientation change efforts (SOCE) as "methods that aim to change a same-sex sexual orientation (e.g., behavioral techniques, psychoanalytic techniques, medical approaches, religious and spiritual approaches) to heterosexual, regardless of whether mental health professionals or lay individuals (including religious professionals, religious leaders, social groups, and other lay networks, such as self-help groups) are involved."

History

Overview

Legal scholar Kenji Yoshino argues that the history of conversion therapy can be divided broadly into three phases: an early Freudian period, a period of mainstream approval of conversion therapy during a time when the mental health establishment became the "primary superintendent" of sexuality, and a post-Stonewall period wherein the mainstream medical profession disavowed conversion therapy.

During the earliest parts of psychoanalytic history, analysts granted that homosexuality was non-pathological in certain cases, and the ethical question of whether it ought to be changed was discussed. By the 1920s psychoanalysts assumed that homosexuality was pathological and that attempts to treat it were appropriate, although psychoanalytic opinion about changing homosexuality was largely pessimistic. Those forms of homosexuality that were considered perversions were usually held to be uncurable. Psychoanalysts‘ tolerant statements about homosexuality arose from recognition of the difficulty of achieving change. Beginning in the 1930s and continuing for roughly twenty years, major changes occurred in how psychoanalysts viewed homosexuality, which involved a shift in the rhetoric of psychoanalysts, some of whom felt free to ridicule and abuse their gay patients.

Europe

Sigmund Freud

Main article: Sigmund Freud's views about homosexuality

Sigmund Freud was a physician and the founder of psychoanalysis. Freud stated that homosexuality could sometimes be removed through hypnotic suggestion, and was influenced by Eugen Steinach, a Viennese endocrinologist who transplanted testicles from straight men into gay men in attempts to change their sexual orientation, stating that his research had “thrown a strong light on the organic determinants of homo-eroticism”. Freud cautioned that Steinach's operations would not necessarily make possible a therapy that could be generally applied, arguing that such transplant procedures would be effective in changing homosexuality in men only in cases in which it was strongly associated with physical characteristics typical of women, and that probably no similar therapy could be applied to lesbianism. In fact Steinach’s method was doomed to failure because the immune system rejects transplanted glands, and was eventually exposed as ineffective and often harmful.

Freud‘s main discussion of female homosexuality was the 1920 paper “The Psychogenesis of a Case of Homosexuality in a Woman“, which described his analysis of a young woman who had entered therapy because her parents were concerned that she was a lesbian. Her father wanted this condition changed. In Freud‘s view, the prognosis was unfavourable because of the circumstances under which she entered therapy, and because homosexuality was not an illness or neurotic conflict. Freud wrote that changing homosexuality was difficult and possible only under unusually favourable conditions, observing that “in general to undertake to convert a fully developed homosexual into a heterosexual does not offer much more prospect of success than the reverse.” Success meant making heterosexual feeling possible, not eliminating homosexual feelings.

Gay people could seldom be convinced that heterosexual sex would provide them with the same pleasure they derived from homosexual sex. Patients often wanted to become heterosexual for reasons Freud considered superficial, including fear of social disapproval, an insufficient motive for change. Some might have no real desire to become heterosexual, seeking treatment only to convince themselves that they had done everything possible to change, leaving them free to return to homosexuality after the failure they expected. Freud therefore told the parents only that he was prepared to study their daughter to determine what effects therapy might have. He eventually broke off the treatment entirely because of what he saw as her hostility to men.

In 1935, Freud wrote to a mother

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