from NARTH - APA Highlights

Response to the APA's "Report of the American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation" (2009)

By N.E. Whitehead, Ph.D.

Summary: This paper asserts that the APA's labeling of homosexuality as "normal" is a value judgment which, contrary to the task force's assertion, does not come from science.

The task force failed to convey an understanding of the vast body of intellectual history on the causes of homosexuality.

Further, because the causes of homosexuality are clearly so individualistic, the sociological surveys studied by the task force could not capture them. Individual case studies would have been far more revelatory, yet the task force report ignored them.

The alternative approach to dealing with homosexually oriented clients--gay-affirmative therapy--is advocated by the APA committee, yet this approach remains relatively untried, and should demand an even higher standard of proof than that which is required for the traditional therapies that the task force rejects.

"Normal" is a Values-Laden Term, Not a Scientific Term

There are many professionals who believe that several of APA's basic positions on homosexuality are scientifically untenable, and have believed this for 30 years and more - specifically, both the alleged normality of the condition, and the alleged lack of accompanying pathology.

The most basic bit of philosophical sleight-of-hand in the report is its claim that homosexuality has been proven normal. But as a practicing scientist, I am well aware that this statement of normality is a value judgment, and when wrongly presented as a scientific statement of fact, it transforms science into a sort of religion. Further, this claim is used as a means of advocating for the ethical normality of acting on one's homosexual attractions.

If the statement, "homosexuality is normal" means that homosexuality occurs often in society, one could not dispute it, for surveys show that it is fairly widespread. But to use the value-word "normal" to describe it on that basis requires an untenable leap of faith. Anyone in introductory philosophy classes learns that it is a logical fallacy to say that because something is, it is therefore right (or wrong), healthy (or unhealthy). This is referred to as the is/ought fallacy -- i.e., just because something "is," does not mean that it "ought to be."

Science can only say that some things are right or "normal" when it has been paired with a religious or philosophical ideology. Therefore statements about the normality or abnormality of homosexuality cannot come from science, but from politics. When the APA implies that the concept of ethical normality comes from science, it is attaching a false authority to its pronouncements.

Standards of Proof

Therapists have been offering therapies to help homosexuals for many decades. However the task force now demands a standard of proof of effectiveness for sexual-reorientation therapy which is impossibly high and is not required of other therapies.

The success rates of various therapies for addiction, for example, are similar to those for sexual-reorientation therapy, but addiction therapies are never attacked on the grounds that they have not been subjected to the impossibly rigorous tests proposed for therapy for homosexuals.

The only rigorous survey to test the effectiveness of sexual-reorientation therapy would be a longitudinal comparison of groups that received "treatment" versus "no treatment." But since clients usually present with many co-morbid problems, particularly suicidality, mood disorders and substance abuse, the "no treatment" option would not be ethical. This means, therefore, that a rigorous test of reorientation therapy would be impossible.

The task force's insistence on such high standards of proof for sexual-reorientation therapies is so highly selective that its motives must be suspected of being merely political, which would be reprehensible in an organization which claims to be science-based.

Would the committee recommend that therapy for obesity, drugs or alcoholism not be attempted because they have a high recidivism rate? The ethical position must surely be that anything that may work should be tried, though with appropriate safeguards and with appropriate informed consent.

Given the task force's stated standards of therapeutic efficacy, the same research standards must be applied to testing gay-affirmative therapy -- i.e., therapy which affirms the client's homosexuality as good, equivalent to heterosexuality, and intrinsic to the client's nature. In fact, even higher standards must be demanded because this therapeutic approach is largely untried, compared with the wealth of experience gained over many decades for traditional sexual-reorientation therapies. In fact, some common sense is needed, for traditional therapies which at least advocate same-sex sexual abstinence, will ultimately save many gay men's lives. On the other hand, gay-affirmative therapy, which allows or encourages expression of an intense sexuality which often causes premature death, should have to meet extremely high standards of proof to be declared "safe."

Spontaneous Change in Attraction

The authors did not adequately review the significant body of literature that show that spontaneous change in sexual attractions does indeed take place. This has been well-known since the time of Kinsey, who, like other researchers, reported many such cases of change. Approximately 3% of the heterosexual population once believed they were homosexual or bisexual. We know that significant change in attraction takes place in both directions on the heterosexual-bisexual-homosexual continuum (Kinnish, Strassberg, & Turner, 2005). If spontaneous change takes place, surely therapeutically assisted change has an even better chance of success.

Misinterpreted Research, Ignorance of Intellectual History

The APA report contains a serious misinterpretation of the intellectual history of research into homosexuality. Following a common and completely mistaken thread, they assert that the work of Bell, et al. (Bell, Weinberg, & Hammersmith, 1981) and their successors showed that no family factor has any effect on the genesis of homosexuality.

But this assumption is quite wrong, as discussed in the successful replication of Bell et al.'s work by Van Wyk and Geist (Van Wyk & Geist, 1984). The paths to adult homosexuality that Bell et al. found, accounted for 30% of the variance, which is a good and significant result by the standards of sociological surveys. This unequivocally means that social factors as a whole are significant in homosexual development. (But other factors are also involved, since less than half the variance is accounted for). However Bell et al also found that any individual path or sequence, although statistically significant, had a very small effect size (in today's terminology). No individual path is the dominant one, as amply confirmed by much other research. Nor will exposure of individuals to any known factor cause more than a very small proportion to become homosexual. This shows clearly that there are a large number of individualistic reactions and social-factor paths to the end point of adult homosexuality. It also means that sociological surveys of homosexuality have a strong chance of not accurately portraying the truth of each individual life.

The problem here is a confusion between a sociological viewpoint and a clinical one (Whitehead, 1996). Sociological surveys give the mean figure for a group of people, but inevitably must ignore individual particularities. Sociologists have a tendency to make incorrect claims about individuals based on sociological surveys which hide individual differences. Conversely, a clinician may gain accurate insights about individuals from in-depth interviews; however, he may have a tendency to make sweeping generalizations about the general population based on his limited client sample, which may or may not be representative of the population as a whole.

If One Identical Twin Has Same-Sex Attraction,
The Co-Twin Overwhelmingly Does Not

The consistent outcome of extensive twin studies, (Hershberger, 1997), (Bailey, Dunne, & Martin, 2000), (Kendler, Thornton, Gilman, & Kessler, 2000; Bearman & Bruckner, 2002), (Santtila et al., 2008), (Langstrom, Rahman, Carlstrom, & Lichtenstein, 2008) is that there is a combined dominant cause of homosexuality, but it is in the class of individual, non-shared experience (or more probably, different reactions to the same experiences). This is exemplified by the fact that if one identical twin has same sex-attraction, the co-twin overwhelmingly does not. No shared factor--social or genetic-- is predominant.

Since science establishes that individual experience is primary, criticisms of the methodological weaknesses of surveys are a pointless counsel of perfection. Therapies, and individual experiences, are so varied that it is most impressive there is any coherence at all in the overall picture captured by these surveys. Reports of change are more striking when they are in the form of individual stories, and it is those stories which are most important in understanding the reality of change.

Because in any therapy, some clients do not change, some change a little, and some change a lot, testing whether change is real or possible (which is the point at issue here) should not use the average of a sociological survey (which will only show a small or even non-significant change), but the reality/or otherwise of the greatest change which occurred for any individual in the group. This is an illustration of what change is potentially possible. Looking closely at the factors involved, skilled therapists then learn how to improve their therapy.

Client satisfaction is a crucial factor in this. It is a valid therapeutic endpoint. The account by the client is paramount. If the client is satisfied with what he/she sees as change, that is change for them.

It may be of theoretical interest to cross-question clients very deeply to understand the characteristics of their sexual-orientation change, but our experience is that the current politically driven skepticism which would drive the inquiry would be unfairly intense. The most intense questioning seems to come from those who have not changed their sexuality, who now label themselves as gay (as do the majority of the members of the APA task force), and who then project their own experience onto the population at large.

Interestingly, the task force treats the sociological survey as the overwhelmingly important methodology for their investigation. Given the fact that their organization (APA) is psychological, not sociological, and would normally put primary emphasis on the clinical story, this fact is astounding. The sociological approach is not their primary expertise, and in this case, it is greatly misapplied.

"Stress from Minority Status"
Has Very Little Empirical Support

The authors of the report mention "minority stress" as an explanation for the higher level of mental-health problems found among homosexual and bisexual individuals, but they did not mention that the work of Sandfort et al. (Sandfort, Bakker, Schellevis, & Vanwesenbeeck, 2009) found that another factor--differences in coping style--accounted for all the variance in mental health in their homosexual subjects, leaving no room for minority stress. Nor did the task force mention the literature which failed to find much influence of minority stress when searched for.

Nor did they mention the important epidemiological work which found, in gay-friendly countries such as the Netherlands (Sandfort, de Graaf, Bijl, & Schnabel, 2001) and New Zealand (Fergusson, Horwood, & Beautrais, 1999) that mental-health problem prevalence for gays and lesbians was about the same as in the USA (Herrell et al., 1999). Much subsequent work has confirmed these studies, which suggest that factors other than minority stress are likely behind the higher level of mental-health disorders in gays.

The authors of the APA report might reflect that traditional sexual-reorientation therapies have existed for at least 35 years, in various forms, in spite of a remarkably hostile social and professional climate. In general, neither therapists nor clients have found these therapies so unrewarding that they have abandoned the project. This kind of "real-life sociological experiment" means that traditional-therapy participants are likely about as satisfied as clients and therapists in other established therapeutic fields.

Reference List

1. APA Task Force on Appropriate Therapeutic Responses to Sexual Orientation. (2009). APA Task Force on Appropriate Therapeutic Responses to Sexual Orientation, Washington, DC.