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from Clinical/Therapeutic Issues
Ethical Issues in Psychotherapy
The following letter-to-the-editor was
addressed to the American Psychological
Association's Monitor. Dr. Tabin discusses ethical
issues underlying treatment, and mentions the
NARTH studies published in Psychological
Reports.
To the Editor:
One of today's most controversial topics involves
the interest particularly of clinical
psychologists. It is the problem of whether and
how to treat people who--for whatever their
reasons--find their own homosexual impulses to be
distressing.
If at one time mental-health clinicians felt
enjoined to convince every patient to embrace
heterosexuality, now the situation is in some
cases reversed. Clinicians are under pressure to
encourage homosexuality. Aside from further
controversy as to the origins and personal
significance to a patient of having homosexual
impulses, this practical problem is bothersome.
We seem to be devoted in so many ways, as a
profession, to helping people to find their own
answers. It feels odd to me to take a firm stand
to impose our own values on a patient, and to be
inflexible about what the meanings of the behavior
are to the particular patient.
While I applaud APA's backing the preservation of
civil rights for all people, I deplore a tendency
to put any human behavior beyond the scope of
scientific investigation. Somehow, this has
happened with homosexuality, with fallout that
constrains clinicians. I was glad to see at least
one careful and scholarly journal prove willing to
publish new, decently designed studies even on so
controversial a matter as homosexuality happens to
be at this time.
Psychological Reports, a respected, peer-reviewed
journal, published a two-part study on
homosexuality and treatment in May and June of
this year. The first part was based on reports of
therapists who treated people who had stated that
they wanted to be heterosexual (sometimes among
other reasons for entering into therapy).
I was especially interested in the second study,
an anonymous survey of former patients who
reported that they sought help to become
heterosexual--or at least not actively
homosexual--because they were unhappy being
homosexual. The authors acknowledged the design
difficulties in this kind of research, but they
apparently tried to make as objective a survey as
they could.
Eight hundred and eighty-two persons returned the
survey. The mean time that had elapsed since
they were in therapy was six years. Roughly a
third of the respondents described themselves as
having been exclusively homosexual before deciding
to enter into therapy. The most interesting
findings to me were from these respondents. A
quarter of them entered into therapy with a
conversion therapist, the rest with various
therapists across the spectrum of mental health
specialists. Their average age when they
completed the survey was 29.9 years. Their
average length of time in therapy was 3.4 years
(median: 2 years).
My interest in their self-reports rests on the
fact that they all entered into therapy because
they wanted to become heterosexual. I think it
matters that this was an old enough cohort to have
experienced a good deal of living homosexually
first, and in the present climate. It was not
surprising that most of them reported they now
considered themselves to be heterosexual,
according to their stated goal. What
particularly drew my attention was that under
circumstances of anonymity that made it easy to
complain, only 7% of the total number of
participants who received conversion therapy said
that they were doing worse psychologically,
interpersonally, or spiritually. This is in
keeping with MacIntosh's (1985) finding that 85%
of the patients he learned about who treated by
psychoanalysts experienced a significant increase
in their sense of well-being, whether or not they
remained homosexual.
I am not trumpeting that there are absolute truths
in these publications. The authors of the study in
Psychological Reports are themselves very cautious
in interpreting the significance of what they
publish. Nonetheless, it is heartening to see that
some people in the field are beginning to try to
explore this fraught subject with open minds.
--Johanna Krout Tabin, Ph.D., ABPP
Updated: 8 February 2008
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