JOURNAL OF HUMAN SEXUALITY (Volume 1) What Research Shows: NARTH’s Response to the APA Claims on Homosexuality A Report of the Scientific Advisory Committee of the National Association for Research and Therapy of Homosexuality James E. Phelan Neil Whitehead Philip M. Sutton 2009 Journal of Human Sexuality Editorial Offices: The Crane Building, 307 West 200 South—Suite 3001, Salt Lake City, UT 84101 Telephone: 1-888-364-4744; Email: [email protected]; Web: http://www.narth.com Editorial Board Editor Philip M. Sutton, Ph.D., South Bend, Indiana Associate Editors George A. Rekers, Ph.D., ABPP, University of South Carolina School of Medicine James E. Phelan, M.S.W., Columbus, Ohio Neil Whitehead, Ph.D., Whitehead Associates, Lower Hutt, New Zealand David Wood, Ph.D., Elburn, Illinois Managing Editor: David C. Pruden, M.S. National Association for Research and Therapy of Homosexuality 16633 Ventura Blvd.—Suite 1340, Encino, CA 91436 Email: [email protected]; Web: http://www.narth.com Board of Directors Julie Harren Hamilton, Ph.D., President A. Dean Byrd, Ph.D., M.B.A., M.P.H., Immediate Past President Arthur A. Goldberg, J.D., Secretary Treasurer Marc Dillworth, Psy.D. Benjamin Kaufman, M.D. Joseph Nicolosi, Ph.D. Mary Beth Patton, M.S. George A. Rekers, Ph.D., M.B.A. Philip M. Sutton, Ph.D. David C. Pruden, M.S., Vice President of Operations Journal of Human Sexuality is an academic peer-reviewed journal, an official publication of the National Association for Research and Therapy of Homosexuality (NARTH). © Copyright 2009, by the National Association for Research and Therapy of Homosexuality. All rights reserved. Written permission to reprint articles or reproduce materials from this journal for publication, use in the classroom, research, and other scholarly purposes must be requested from [email protected]. NARTH reserves the right to deny permission at its sole discretion. Requests for copies of this journal should be addressed to the National Association for Research and Therapy of Homosexuality, 307 West 200 South—Suite 3001, Salt Lake City, UT 84101, or can be or- dered by phone at 1-888-364-4744 or online at http://www.narth.com Acknowledgements Joseph Nicolosi, Ph.D., was serving as president of the National Association for Research and Therapy of Homosexuality when the idea for this journal was conceived. Without his countless hours of guid- ance and years of service to NARTH, this journal and many other important projects never would have come to fruition. David C. Pruden, M.S., was the project director for the journal. Under his leadership, the cover was designed, the contents were edited, the writing by the various authors was merged into a meaningful whole, and the journal was published. Finally, the NARTH staff has provided and continues to provide outstanding direction and service to our members every day. Without Kim Niquette, Joan Mackenzie, Eric Graham, and Frank York, none of our activities would have been possible. Background This document was prepared in response to certain statements and resolutions of the American Psychological Association (APA) that are inaccurate and not grounded in science, in direct violation of the APA’s own “Leona Tyler Principle” (Fowler, 1993; Tyler 1969). As members of NARTH’s Scientific Advisory Committee, we feel obligated to inform both the scientific and lay communities about the plethora of studies that lead to a singular conclusion: Homosexuality is not innate, immutable, or without significant risk to medical, psychological, and relational health. We wrote a reasonably comprehensive, historical review of more than 100 years of clinical and research literature. The literature we reviewed includes older, less methodologically sophisticated stud- ies as well as more recent, representative, and methodologically rigorous studies. We acknowledge in advance the methodological limitations of the earlier studies, but include them because these earlier reports for the most part met acceptable research and publication standards at the time they were writ- ten, and because their conclusions are supported by the most current, methodologically sound studies available. We are aware that there will be those in both the public and private domains who will disagree and take issue with our presentation of specific reports or studies. Research by its very nature invites verifica- tion, critique, commentary and interpretation, as well as a willingness to see the overall picture portrayed by many decades of empirical research, clinical studies, and experiential evidence. Overall, we believe this monograph offers convincing evidence that there is hope and help for those men and women who find their unwanted homosexual attractions to be distressing. In a spirit of cli- ent autonomy, self-determination, and diversity, NARTH strongly supports the freedom and rights of individuals to seek psychological care for unwanted homosexual attractions and the rights of licensed professionals to provide that care. Contents Introduction 5 Three Claims by the APA 7 I. Response to APA Claim: There Has Been No Conclusive or Convincing Evidence That Sexual Orientation May Be Changed Through Reorientation Therapy 9 Definition and Measurement of “Change” 9 Recent Reports of Assisted Sexual Reorientation 12 Table 1. Compilation and Overall Average Outcome of Recent Surveys of Reorientation Therapy Consumers 15 Historical Review of Documented Success in Sexual Reorientation 19 Pre-Freudian Hypnosis 19 Psychoanalysis 19 Behavior and Cognitive Therapies 24 Group Therapies 27 Hypnosis 28 Sex Therapies 28 Pharmacological Interventions 28 Religiously-Mediated Reorientation 29 Spontaneous Reorientation 30 Other Interventions 31 Anecdotal Accounts of Sexual Reorientation 31 Assemblies of Persons Reporting That Sexual Orientation Can Be Changed 32 Meta-Analyses 32 General Commentaries Supportive of the Possibility of Sexual Reorientation 33 General Commentaries Critical of the Possibility of Sexual Reorientation 35 Limitations of the Reorientation Literature 36 Conclusion 38 II. Response to APA Claim: Efforts to Change Sexual Orientation Are Harmful and Can Lead to Greater Self-Hatred, Depression, and Other Self-Destructive Behaviors 41 Reports of the Harmfulness of Efforts to Change Sexual Orientation 42 Suicidality 42 Greater Homophobia 43 Figure 1. Belief in Genetics as a Source of SSA 43 Figure 2. Gallup Poll: People With SSA Born That Way? 44 Figure 3. Should SSA People Have Equal Access? 44 Reports of the Helpfulness of Efforts to Change Sexual Orientation 45 Avoidance of Even Greater Harm 47 Principles for Ethical Therapy 49 Conclusion 50 III. Response to APA Claim: There Is No Greater Pathology in the Homosexual Population Than in the General Population 53 Higher Levels of Mental Health Problems 53 Risk Comparisons for Men 57 Risk Comparisons for Women 57 Discussion of Specific Areas of Medical and Mental Health Risk 57 Substance Abuse 57 Alcohol 57 Drug Use 59 Summary of Substance Abuse Among Homosexuals 60 Undue Risk-Taking, Particularly With Life or Health 60 HIV/AIDS Risk 60 Homosexual Women and HIV/AIDS 65 Summary of HIV/AIDS Risk 66 Sexually Transmitted Diseases/Health Risks 66 Analingus 68 Suicide 68 Suicide among homosexual youth 69 Romantic relationship difficulties 70 Self-hatred and depression 70 Substance abuse 71 Discrimination 71 Summary regarding suicide rates 72 Psychological Maladjustment Studies 72 Minnesota Multiphasic Personality Inventory (MMPI) 73 MMPI MF (masculinity/femininity) Scale 73 California Psychological Inventory (CPI) 73 Personality Factor Questionnaire (16PF) 74 Gough’s Adjective Checklist 74 Other Tests 74 Summary of Psychological Maladjustment Studies 74 Journal of Human Sexuality 1:2 Mental Health and Psychological Disorders 75 Results from the U.S. National Lesbian Health Care Survey and Canadian Surveys 75 Anxiety and Depression 75 Eating Disorders and Standards of Attractiveness 76 Psychiatric Disorders 77 Summary of Research on Mental Health and Psychological Disorders 79 Interpersonal Relationships 80 Summary of Interpersonal Relationships 81 Promiscuity as a New Social Norm 81 Sexual Addiction and Coercion 83 Sexual Addiction 83 Rape/Sexual Coercion 84 Molestation 84 Violence 85 Adjustment Problems for Homosexual Youth 86 Sexuality 86 Scat and Water Sports 86 Fisting 86 Other Unconventional Sex Practices 86 Conclusion 87 Summary Bullets 87 IV. Responses from the APA to NARTH 89 Psychological Perspectives on Lesbian and Gay Male Experiences (Garnets & Kimmel, 1993) 89 Homosexuality: Research Implications for Public Policy (Gonsiorek & Weinrich, 1991) 89 Addendum: Sexual Orientation and Mental Health: What the Behavioral Sciences Know About Sexual Orientation and Why It Matters (Gonsiorek, 2006) 90 Summary Narrative 93 References 95 Journal of Human Sexuality 1:3 Introduction In the policy statement Resolution on Appropriate Therapeutic Responses to Sexual Orientation (DeLeon, 1998), the American Psychological Association (APA) voiced its concern about “the eth- ics, efficacy, benefits, and potential for harm of therapies that seek to reduce or eliminate same-gender sexual orientation.” The statement also indicates that “some gay, lesbian, bisexual and questioning indi- viduals [are] . at risk for presenting for ‘conversion’ treatment.” A decade later, the APA continues to voice these concerns. (Here and below, quotations in bold are for emphasis, while quotes in italics are present in the original.) In Answers to Your Questions for a Better Understanding of Sexual Orientation