1. Spitzer and Reparative Therapy: Responses by Helena M. Carlson and Lisa M. Diamond Presentation Constructed by Will Brown

2. Reparative Therapy Reparative Therapy: Psychotherapy with the goal of homosexuals changing their sexual orientation to heterosexuality. Most clinicians won’t offer this treatment to their clients Thought to encourage self-loathing and thoughts that homosexuality is a sickness that needs treatment Very few offer reparative therapy Some churches offer therapy and support Exodus International has “Ex-gay” ministries

3. Reparative Therapists Reparative therapists see mostly men as their clients and find that their male patients failed to develop a strong gender identification The goal of therapy is to help alleviate these males of their confusion about maleness Estimates of success after therapy: 1/3 of patients develop heterosexual feelings 1/3 of patients experience diminished homosexual feelings 1/3 of patients remain essentially unchanged Most major mental health associations have released statements regarding ineffectiveness and potential harm from treatment.

4. Spitzer’s Study There were few to zero reputable approaches and studies on the efficacy of reparative therapy and Spitzer wanted to conduct a study that could produce reliable results His hypothesis: “Some individuals whose sexual orientation is predominately homosexual can become predominately heterosexual following some sort of reparative therapy (which can take the form of psychotherapy, counseling, or participation in an ex-gay ministry program” Study involves interviewing individuals whose orientation was predominately homosexual and who have now been predominately heterosexual for a period of at least five years due to some form of reparative therapy. The New York Psychiatric Institute Institutional Review Board approved the study protocol.

5. Participants Participants were recruited from announcements looking for individuals who had sustained a change in homosexual orientation for at least five years. Had to meet two criteria before being selected 1. Predominate homosexual attraction for many years prior to study, at least a 60 on a scale of sexual attraction. 2. A change of at least 10 points on scale towards heterosexuality after therapy, lasting at least five years Of 247 recruited, 200 met criteria for study. 143 males and 57 females

6. Participant’s Background Mean Age Men: 42 and Women: 44 Marriage 76% of men and 47% of women were married at some point through therapy. 21% of men and 18% of women were married before therapy. Religion 81% Protestant, 8% Catholic, 8% Mormon, and 3% Jewish 93% reported that religion was “extremely” or “very” important in their lives 95% Caucasian 76% College educated Over 1/3 considered suicide because of their homosexuality

7. Spitzer’s Evaluation of Participant’s Heterosexuality If having heterosexual sex: Frequency of sex? Emotional satisfaction of heterosexual relationship? Physical satisfaction with heterosexual sex? “Good Heterosexual Functioning” has five criteria: 1. Within last year, participant was in a heterosexual relationship and considered it “loving.” 2. Overall satisfaction with emotional relationship with their lover. At least a 7 on scale from 1-10 (10 being very best). 3. Heterosexual sex with partner at least a few times a month 4. Physical satisfaction with heterosexual sex. At least a 7 on same 1-10 scale. 5. During no more than 15% of heterosexual sex occasions thinks of homosexual sex.

8. Results Participants were presented with 11 possible reasons for wanting to change sexuality and asked to rate the importance of each reason from “not at all” to “extremely important.” Of 11 reasons to change sexual orientation the most popular responses were: The individual did not find life as a gay man or lesbian emotionally satisfying Conflicts between their same sex feelings and behavior and the tenets of their religion A desire to get married or stay married

9. Results: Effective Therapy 47% reported that seeing a mental health professional was the most or only helpful form of therapy 90% reported using more than one type of therapy Most effective topics in therapy Talking over childhood experiences and examining why they were experiencing homosexual feelings Successful methods of translating learning to life Connecting childhood or family experiences with homosexual feelings Creating non-sexual same sex relationships (through support groups) Thought stopping and avoiding “tempting” situations Developing a loving relationship with member of opposite sex

10. Results: “Good Heterosexual Functioning” Pre-therapy 2.1% of males and none of the women qualified Post-therapy 56% of males and 44% of the women qualified 87% felt more masculine (males) or more feminine (females) 93% developing intimate nonsexual relationships with others of same sex. Higher frequency of heterosexual sex, more emotional satisfaction with spouse, and more physical satisfaction with heterosexual sex.

11. Spitzer’s Pros of His Study This study was far more detailed in questioning than past studies Larger sample size Evaluation process was well documented No indication of interviewer coding bias All interviews and data set are available for review

12. Spitzer’s Cons of His Study Interviewer was author and had vested interested in study Study relied exclusively on self report Study relied on accuracy and lack of a bias of the participants memory of their thoughts and feelings of a time period of up to 12 years.

13. Summary Spitzer believes it is possible for gays or lesbians to undergo a change in their sexual orientation Participants of study felt that they experienced a change from a predominately homosexual orientation to a predominately heterosexual one following reparative therapy Study relies strongly on the self-examination of the participants, but data does not suggest that their was a significant bias in their responses.

14. Helena M. Carlson’s Response Potential Bias in Spitzer’s Study No consent form was administered and interviewer knew the participants. Confidentiality was not ensured to participants and doubt is placed on the truth of the participants’ responses because they may fear they are not protected. In emotionally-laden issues, individuals may not want their true feelings know, especially if their feelings differ from the socially accepted practices of their community. Homosexuality is discouraged (to say the least) in religious communities. Phone interviews were conducted by Spitzer alone Raises the question of interviewer bias A heavy burden is placed on the participants memory Average time span of 12 years from therapy to interview

15. Helena M. Carlson’s Response Problems With Spitzer’s Sample Spitzer’s sample comprised of white, protestant, middle class, middle aged men and women Hardly a diverse sample of gay men and women

16. Helena M. Carlson’s Response Problems with Spitzer’s Execution of Study Diverse range of counseling was all considered reparative therapy Practice of health professionals and church support groups differ widely and without distinguishing the differences it is confusing which method of counseling each participant participated in. The sexual attraction scale used in the study was made for the study On the scale from 0-100, a 100 was considered extremely homosexual while a 0 was considered extremely heterosexual, and any score over 20 was considered homosexual. Therefore an individual who scored 25 would be considered similarly to an individual who scored 100.

17. Helena M. Carlson’s Response All of the former reasons are valid enough for study to be considered invalid and results be disregarded as a valid discussion on the effectiveness of reparative therapy

18. Lisa M. Diamond’s Response What is Sexual Orientation? By never effectively providing a concrete definition of what sexual orientation is, Spitzer cannot truly say what he successfully curved in respect to his participants’ sexual desires. Spitzer reduces the complex idea of sexual orientation to, as Kinsey defined it (1948) “… Sheep and goats,” in that he never acknowledges complexities of sexual desires.

19. Lisa M. Diamond’s Response What is Sexual Desire? Spitzer claims that his participant’s sexual desires were curved, but never defines what sexual desires truly are. Spitzer also makes two reductionist assumptions about the experiences that count as sexual desires. 1) That these experiences are fairly uniform from person to person 2) That we all “Know them when we feel them”

20. Lisa M. Diamond’s Response What was Actually Repaired? Because neither sexual orientation or sexual desires were actually defined in Spitzer’s study, it is hard to truly acknowledge what was “repaired” through the therapies.