Robert Spitzer's study supporting "ex-gay therapy" revisited

On the day that it is being reported that Robert Spitzer has disavowed his own study supporting ex-gay therapy, here is an edited excerpt from my article "The Case Against Reorientation Treatment" (2005) critiquing his much quoted study:

Because Spitzer’s research is cherished by the pro-reorientation camp as the one true work of science that supports their views, I have taken the trouble to go through it with a fine tooth comb. In his introduction Spitzer mentions the standard claims of bias against reorientation.  He insists that, contrary to common belief, research in support of the efficacy of reparative therapy does exist, and then proceeds to cite all the pseudo-scientific research mentioned earlier in this article.  His research doesn’t avoid the usual methodological pitfalls.  He tells us of “Announcements aimed at recruiting participants [that] requested individuals who had sustained some change in homosexual orientation for at least 5 years.”  So not only were they self-selected, but all those for whom re-orientation had failed had been sifted out in advance.  They were poorly defined: they had to be “predominantly homosexual” (self-report, scored on a scale of 0-100) and to have experienced a change (in the direction of heterosexuality) of at least 10 points on the scale. 

And a few more interesting facts: “These criteria were designed to identify individuals who reported at least some minimal change in sexual attraction, not merely a change in overt homosexual behavior or self-identity as “gay” or “straight.” It should be noted that individuals who satisfied these criteria were not excluded from the study if they had had homosexual sex during or following therapy.”  If the individual is still having homosexual sex then what exactly constitutes “success”?  “Forty-three percent of the 200 participants learned about the study from ex-gay religious ministries and 23% from the National Association for Research and Therapy of Homosexuality”.  The rest were either recruited by their therapists or by other participants.  The type of therapy participants received was not standardised and therefore varied wildly from psychological to pastoral counselling.  Major methodological flaws are the recruitment of people who may be motivated towards self-deception (e.g. from ex-gay religious ministries) or even towards giving false information (out of a misguided sense of loyalty towards those who had tried to help them and who were also the ones urging them to participate in the study) and the lack of objective corroboration of the claims that have led to their selection in the first place. 

“On all measures, the year prior to the therapy was compared to the year before the interview” – again, we see usage of the unreliable retrospective self-assessment.  Spitzer admits that “Reports of complete change were uncommon”.  An insightful statement of his encapsulates many of the psychological mechanisms that give rise to the dismissal of the subjective techniques used in such research: “Are the participants’ self-reports of change, by-and large, credible or are they biased because of self-deception, exaggeration, or even lying? This critical issue deserves careful examination in light of the participants’ and their spouses’ high motivation to provide data supporting the value of efforts to change sexual orientation.”  This is immediately followed by: “Again, it is impossible to be sure, but comparing the actual results to the results that might be expected if such systematic bias were present suggests (at least to the author) that, by and-large, this is not the case.”  This, of course is pure speculation based on nothing more than a hunch.  He suggests that the presence of a bias would lead to a much higher reported change of sexual orientation.  And why exactly is that?  Is bias equally distributed?  You can’t determine or even estimate the effect of an unmeasured factor.  

He concludes: “Thus, there is evidence that change in sexual orientation following some form of reparative therapy does occur in some gay men and lesbians.”  It is important to note that “To recruit the 200 participants, it was necessary to repeatedly send notices of the study over a 16-month period to a large number of participants who had undergone some form of reparative therapy. This suggests that the marked change in sexual orientation reported by almost all of the study subjects may be a rare or uncommon outcome of reparative therapy.” And: “The participants in the study all believed that the changes they experienced were due primarily to their therapy.  However, the lack of a control group leaves the issue of causality open.” 

Because there is no proof of causality, we cannot attribute any of the changes to the treatment.  Any change reported could be the result of the strong Christian beliefs of individual participants, or other factors that had not been taken into consideration.  Even the most enthusiastic, anxious-to-convert population is likely to return to homosexuality after some time, and only in a small number of cases did participants actually report maintaining heterosexual orientation over time. It is impossible to confirm that even those reporting heterosexuality had in fact changed their orientation or even their behaviour.  It is impossible not to wonder why those approached were so reluctant to participate.  You would expect someone who had undergone a “cure” of any kind to be enthusiastic about it and to want to “spread the word” through helping with related research.

Spitzer then says: “It probably is the case that reparative therapy rarely, if ever, results in heterosexual arousal that is as intense as a person who never had same sex attractions. However, advocates of reparative therapy do not make that claim. One would not judge a psychosocial treatment for a sexual dysfunction as a failure if it did not result in sexual function indistinguishable from that of individuals who never had experienced such a disorder.” But homosexuality is not a “sexual dysfunction”.  This has strong implications for reorientation treatment: what is the ethical justification for trying to destroy someone’s natural (and therefore strong) sexual desire and replacing it with something that is not quite the real thing?  Why is it justified for a therapist to cause psychological damage to someone in this context but not in any other context?  Homosexuality is not a sexual dysfunction (such as paedophilia or any other form of sexual non-consensual aggression) and as such, there is no justification for it to be treated in a similar way.

Spitzer claims that “The findings of this study have implications for clinical practice. First, it questions the current conventional view that desire for therapy to change sexual orientation is always succumbing to societal pressure and irrational internalized homophobia. For some individuals, changing sexual orientation can be a rational, self-directed goal.”  On what evidence does he base that?  This is not supported by any facts or valid data gathered in his research.  He continues: “Second, it suggests that the mental health professionals should stop moving in the direction of banning therapy that has as a goal a change in sexual orientation.  Many patients, provided with informed consent about the possibility that they will be disappointed if the therapy does not succeed, can make a rational choice to work toward developing their heterosexual potential and minimizing their unwanted homosexual attractions.”  The APA and the many other bodies that oppose this therapy, do so after careful consideration and in order to protect the public from unethical treatment and likely psychological damage.  But above all, it is difficult to comprehend what motivates someone to promote a treatment that has never been proven to be effective.

L porn - Real pleasure in front of the camera

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When geeks are gay: the closet of stereotypes

It's hard to escape stereotypes. We think we're immune, we think we can spot them and avoid them, but they keep coming at us from every direction. They don't just damage us indirectly by influencing how others see us - they damage the way we see ourselves and influence the way we act.

Stereotypes can be particularly harmful to those still coming to terms with their sexuality. I see this again and again in my practice. You see, if you want others to believe you're gay, you shouldn't be too masculine, shouldn't look like you've dressed in the dark, and should definitely not spend most of your time fixing any one of the numerous broken down cars that litter your backyard. Unless, of course, you enjoy the idea that every terror filled time you utter "I'm gay" to someone, it will be met with the words "You're kidding!" A reaction like that can be devastating to someone who is struggling with doubts, yet has finally come up with the courage to share his inner truth with another soul, be it a family member, a friend, or even himself. A client of mine described to me how it feels: "It makes me mad. Like, why the hell would I kid around about something like this? People think they know what a gay man looks like and behaves like and I don't fit that. I'm large, non-feminine, married, a father, I like cars, guns, and, as far as they knew, women. So, yeah, I don't really fit the stereotype."

Stereotypes can push us back into a closet of sorts, kicking and screaming. Stereotypes make those who don't fit preconceived ideas - what we should look like, how we should behave, how we should feel - just plain invisible to the outside world. It erases the "misfits" and leaves behind only those who conform to a narrow set of parameters. So do we have to conform to limiting and misguided ideas of what we should be like in order to gain acceptance for who we are? This is far from healthy. We can end up internalising what we hear until it becomes our "truth". We use it to push ourselves back into a closet of everything we're not, we force ourselves to behave in a way that simply isn't us.

Back in my online psychotherapy practice, I'm talking to a guy who knows he's gay but is terrified of "living the gay life". I ask him what he's scared of. He tells me that all the gay relationships he's seen, have had at least one very effeminate man. It's neither what he wants from a partner, nor what he's about, so how can he be gay? Everything he "knows" about what it's like to be gay, comes from the movies, TV and other media that are available where he lives (which is as far from New York, London or Amsterdam as you can get). I tell him to find out what it's really like from some real life gays and suggest the internet. He's a lot happier in our next session. He tells me, "As it was put to me, it's like hanging out with your best friend, with sex." He adds, "Somebody who plays video games and can hold a decent conversation, who likes some of the same things and has a penis? That sounds awesome!"


And what perpetuates all these damaging stereotypes? Much of it is down to the way LGBT people are portrayed in popular culture. There are too few role models to do justice to the huge variety in personalities, styles, likes and dislikes, that makes up the multi-faceted LGBT community. Nothing beyond a few narrow stereotypes is reflected. We are reduced to handful of extremes, sometimes even turned into a freak show, our existence sensationalised into the outrageous and the shocking. Yes, we can be all of the above and there's absolutely nothing wrong with that, but we do boring too. This is so important for many people to know when they're trying to find out who they are, or even when they can't help who they are but fear it will lead to rejection. It's intimidating to feel that you have to pick from a limited set of options in order to be counted as LGBT. It can make some people feel that maybe it's not who they are, and others that they're "not good enough" LGBTs. It reduces our identity to nothing more than our sexuality, whereas in reality we have complex identities just like everyone else, which is true of all minorities. Many people I see in my practice are confronted with these issues. When older people come to me for help because they're still trying to come to terms with their sexuality, I'm likely to find the same stereotypes standing in their way. Families refuse to believe that they are really gay because they're "not like that". As the doubts seep in, I have seen people start to wonder whether they're wrong about themselves. After all, they're not "like that". In extreme cases, they even suppress the sexual attraction they feel, but, mostly, they just feel they don't belong and exclude themselves.

You'd think that, by now, we would be seeing a greater maturity in society where everyone would accept that even LGBTs come in all shapes and sizes, good and bad, politically correct or not. You wouldn't think that we would still be waiting for all colours of the rainbow to mean exactly that. If society claims to accept us as normal, then why isn't that depicted in that most accessible mirror of our daily lives: popular media? Do it for kids growing up thinking - or knowing - they might be LGBT, wanting the reassurance of seeing others like them, rounded characters in real life or fiction. Do it to give kids role models that feel right, that feel truly like them no matter who they are, in a way that feels comfortable to try out. Do it also for those hovering on the fringes of the LGBT community, hesitating, feeling left out and out of kilter. Do it to show everyone out there that we're here - the ones you see and the ones you refuse to see. We're everywhere, so you had better get used to it. And don't be so sure that the geek you're talking to couldn't possible be gay.

Bisexual Men Exist, Revisited

And here's something I wrote earlier: Bisexual Men Exist, Revisited.  This is my most recent column for my Bi Social Network, Bi Life with Ronete Cohen.  It's about the Rosenthal study that proves once and for all that bisexual patterns of attraction in men do exist. (If you want to read of all it, you'll have to join Bi Social Network.)

The Flat Earth Society - bigotry in the name of god

As strange as it may seem, the Flat Earth Society is very much alive and well. Wherever we look, there are people who obstinately ignore what science and fact is telling them and holding on to ludicrous views. When it comes to real flat-earthers, we can simply giggle as we watch them, imprisoned in their own narrow world, too scared to fall off the edge to really go anywhere.

But the ones I'm talking about are dragging us all into their self-imposed prison of ignorance. The modern day equivalent - a united front of ex-gay movement fanatics, anti-same-sex marriage advocates, opponents of anti-LGBT bullying programs and sex education at schools, etc. - stick to their ignorant views despite the science, despite a huge body of evidence that proves the contrary. Many of them don't just ignore what others know, they ignore what they know deep inside.

Flat earthers claim that you can pray away the gay, that you can "cure" people with what they call therapy (but that few therapists would recognise as such, more often than not administered by someone who isn't a therapist at all). They ignore the fact that the American Psychological Association (APA) and all other reputable professional organisations (as distinguished from discredited pseudo scientific propaganda organs) who have not only researched and examined the issue, but truly understand humans, condemn this treatment in no uncertain terms. They ignore the fact that they say that homosexuality isn't an illness and it is therefore unethical and pointless to try and "cure" it, and that it is likely to cause harm to try and do so. They are not dissuaded by the evidence, which even they can see, that they don't seem to be "curing" anyone. They are not dissuaded by the evidence, even when a not insubstantial number of them know deep down inside that they themselves are gay. They shout "the earth is flat" at the top of their voices until they are caught with their pants down with yet another male escort they picked up through the internet. They ignore the huge number of ex-ex-gays, among them founders and leaders of the movement, who not only admit that they pretended to no longer be gay, but apologised for all the terrible harm they have done to the people who were bullied by the church and their environment into changing or facing eternal damnation. They claim to be motivated by the love of god, yet they manage to turn a blind eye to those who have been harmed and even committed suicide as a result of this atrocity. They continue regardless. Because the earth is flat and that's it.

Flat earthers claim that same-sex marriage harms children. The APA says the opposite is true and they should know, because they are guided by facts and by a deep, professional knowledge and understanding of people and families. Not allowing same-sex marriage harms the support network that the children of same-sex couples have and makes them unequal to (and subsequently more vulnerable than) the children of opposite sex parents. It disadvantages them financially and also interferes with legal and other rights both parents would have regarding the children and each other. Same-sex marriage doesn't harm children, it helps them. But the flat earthers keep on fighting it on the grounds that it will means the end of the family and civilisation as we know it. Because the earth it flat and that's it.

Flat earther oppose sex-education. They advocate abstinence as the only choice. The facts and figures show that the US states where abstinence is taught have the highest rates of sexually transmitted diseases (STDs) and teenage pregnancies. Countries where real sex-education is the norm have low levels of STDs and pregnancies among teenagers. Yet they keep on saying that teaching abstinence works and sex-education is bad. Because the earth is flat and that's it.

Flat earthers say Don't Ask Don't Tell worked. Facts say that DADT lost the US army many many vital soldiers, in particular Arab speakers, a relatively rare and much needed specialisation. They say they'll reinstate it. Because the earth is flat and that's it.

Recent research shows that the way people read the bible is tied to their fellow worshippers' level of education. Judging by the exponential growth in the number of flat earthers and the way they seem to be wherever you look nowadays, more vocal than ever, it's time to get worried about what kind of education church members are getting. This spread of ignorance is truly breathtaking: the inability to absorb facts and knowledge, to understand basic scientific concepts such as empirical evidence, or even to accept that you can't know everything about everything and that sometimes it's clever to admit the limits of your knowledge and to listen to those who have made it their job to know. When you remember that flat earthers want to teach Creationism and Intelligent (sic) Design in science classes, it all makes sense - or not. And it becomes truly scary, because they are trying to spread their ignorance to everyone else.

Belief in god is a personal thing. Christian Sharia law is as unacceptable as its Muslim equivalent, but it's creeping into our lives. Religion - or rather a very fundamentalist and hate-filled version of it - is being forced down all our throats. Religion is a highly personal view of the world that should stay inside the walls of the church or the synagogue or the mosque. Ignorance and hate-filled views shouldn't determine public policy. The state is there to protect us all in the same way, whatever our views. How we are protected should be determined by expert knowledge, not prejudice. Even the children of the members of the most bigoted churches, even the members themselves, deserve the same protection that we all receive. If they are gay, they shouldn't be bullied and abused for it. If they need real facts about sex, they should be allowed access to them. If they fall in love with a member of the same sex, they should be allowed to marry. The earth isn't flat and you can't fall off the edges. Church stops once you exit its doors. You can carry it with you, inside you, but that's as far as it goes.

Make It Better Now!

I'm a big fan of Dan Savage's wonderful It Gets Better initiative. It's a vital lifeline for so many young people. But why can't we Make It Better Now for LGBT youth?

Wherever I look I find more examples of life being made worse for LGBT youth. I see shockingly disproportionate levels of homeless LGBT teens. I see Don't Say Gay and No Homo Promo policies that isolate LGBT school students and, not only bar them from seeking help, but, unimaginably worse and almost beyond belief, leave them exposed to bullying by their peers and by those who are supposed to help and protect them. I see pathetically low levels of positive representation (0.6%!) of LGBT on youth TV.

What I can't understand, no matter how hard I try, is why we can't Make It Better Now. We need to demand urgent action. Why are hate groups allowed to dictate laws that are sanctioning bullying and criminal neglect of vulnerable children? Governments should be aware of the fact that in an atmosphere of hatred and bigotry, those brave LGBT youth who do dare to come out end up even more vulnerable. There needs to be a safety net for these children. And I refer to them as children because they are children! Schools should be looking out for them and noticing when things go wrong, instead of erasing their existence and bullying them too. This inclusiveness and acceptance should be legislated from above and not left to individual schools or districts/counties to decide. It's called protecting the vulnerable, protecting our children from real and present danger. There's no point crying crocodile tears over those who've faced so many closed doors that they've ended up committing suicide, if you're not going to do anything about it. This is hurting our children and even killing them. Can you imagine  something else hurting children this much and no action being taken? No, neither can I.

LGBT youth deserve to be safe, just like everyone else. We can normalise their existence both for them and for the rest of the world. It's not that complicated. All we need to do is to provide the infrastructure of support they need and the proportion of positive role models that reflects their true proportion in society. There are positive actions going on, but they are not joined up enough to reach everyone who needs help, or to prevent hate actions from hostile elements. LGBT youth are a very vulnerable group and should be a very high priority for policy makers. It's time for action, not words. Make It Better Now!

No sex please, we're British?

Okay, on a scale of 0 to World Event, this hardly makes a dent, but nevertheless it's a symptom of a wider malaise. The BBC has cut a sex scene between Captain Jack Harkness and another man from the UK screening of an episode of Torchwood. Yes, our US cousins have been deemed mature enough to view such depravity without being scarred for life, but we can't be trusted not to run riot as a result of exposure to a simulation of People Having Sex. What if we get turned on? Or, even worse: What if it puts ideas into our heads and we actually go and have sex? Perish the thought!

In case you were wondering, this episode isn't scheduled for before that famous British institute known as The Watershed (9pm: no scenes that are considered unsuitable for the eyes of children can be shown earlier than that - oh, except for the odd bit of violence and the relentless hard-sell of fast food and toys). It was scheduled for 9.20pm, a time that the BBC determines to be "too soon after the watershed". Come again? How soon after the watershed does the watershed actually come into effect?

What would happen if Captain Jack got his rocks off with a gal? The BBC are quick to defend their decision as totally non-homophobic, but puhleeze! Or, as we like to say in Blighty: pull the other one, it's got bells on. I smell a rat here, or, more accurately, the growing influence of Middle England/Daily Mail readers ranting and raving against the encroaching modern world. I have news for them: Queen Victoria is dead. Some of us actually like sex and don't find it in the least bit offensive. Not even same-sex sex. So put that in your pipe and smoke it! It's deeply offensive to most adults to have such sexual repression alive and well in this day and age and pushed down our throats (no pun intended - oh, well, maybe a little...). If you don't like it, no one is forcing you to watch it. But I do like it - and I'm not the only one - and I feel that my rights are being trampled. I've already complained to the BBC. Why don't you? You can use this form to do so.