Early in my training, a wise mentor told me that, "psychotherapy doesn't aim to change anyone." Although, as a young psychiatrist, I found that disappointing, what I now realize is that psychotherapy, or even psychoanalysis, doesn't change people's basic personalities, inborn temperaments, tendencies, preferences, attractions and identities. The work of therapy has to do with helping people fully understand and accept -- not change -- who they are, and that includes sexual orientation and gender identity. That is not to say that psychotherapy cannot greatly improve people's lives. However that improvement comes from a more adaptive, flexible, integrated and lively response to one's self, from a gradual maturation of one's relationships with self and others, not from a place of fear or judgment directed towards the self. When a therapist is unwilling to accept their patients as they are regardless of their own opinions, which they ought to keep private, they may influence their patients to change in a predetermined direction. However such changes are temporary and superficial at best, and at worst lead patients down a path of shame and denial.
History is ripe with unsuccessful attempts by the medical establishment to convert sexual orientation. Psychoanalysts also tried for decades to change people's sexual orientation and failed. These efforts only resulted in patients lying about their sexual orientation or adopting a "heteronormative" (the view that heterosexuality is the normal or preferred sexual orientation) front that never became authentic (see Becoming Gay: The Journey to Self-Acceptance by Richard Isay and Jane Isay's Opinion piece in the New York Times "Keeping Marital Secrets Closeted"). The growing understanding and research on gender and sexuality as well as the experience of psychoanalysts such as Richard Isay has lead the American Psychoanalytic Association to finally change its position in 2012 culminating in a position statement opposing reparative therapies. Given this history and the powerful discrimination and societal/family pressures to comply with gender and sexual norms that are still operative today, people likely would have changed their sexual orientation and/or gender identity if they could.
Reading over the National Alliance for Reparative Therapy's (NARTH) website, I am struck by the concrete, simplistic and outdated interpretation of psychoanalytic theories and studies on genetics and human sexuality. On that site, Neil Whitehead argues that gender identity and sexuality are fluid and therefore not biologically determined, or as he says " not set in concrete." Is there a single human characteristic, personality trait, value, motivation or urge that is ever set in stone? Since when is the mind either 100 percent nature or 100 percent nurture? The point is not that gender identity or sexual preference are 100 percent biological, or don't have any societal influence; the point is that they have a strong biological component and thus more than other facets of identity and personality are very hard to modify in any meaningful way. Nor is it clear how such change would promote personal integrity and health given that sexual orientation and gender identity are not mental disorders.
Sometimes gay adults who follow a religious tradition that condemns homosexuality will want to engage in activities that help them to hold on to their religious beliefs and to continue belonging to their chosen community. I recently watched a fascinating documentary on Vice about a conversion "therapy" camp. In it adult men participated in a theater group enacting the story of Jack and the Beanstalk, replete with phallic references, carrying pouches full of seeds around their necks. It was certainly campy. These men appeared to have found a way to belong and to be around peers in a culture that does not accept them. People should feel free to engage in religious conversion to help them stay closeted if they so chose, the issue at hand is that such attempts have nothing to do with psychotherapy.
Any therapy that has a fixed outcome as its goal, based on a narrowly defined value judgment, betrays the basic tenets of psychotherapy. One such tenet that NARTH chooses to ignore is neutrality. Neutrality means remaining impartial to our patients' conflicts, and not having a decided view about what our patients should choose, so that they may be able to find their own path in life. After all, it is the patient that has to live with the consequences, not the therapist. Reparative therapists claim that they prioritize their patients' goals over their own. However, by having already arrived at a decision that homosexuality and trans or queer gender identities are abnormal, they foreclose the possibility that their patients may eventually be able to lead healthy lives as gay or transgender people. As mental health professionals we all have a responsibility to make sure that gay, lesbian, bisexual, transgender and gender queer individuals who are struggling with their identity and/or with society's response to them, as well as their families, are educated about their options, have access to real psychotherapeutic treatment and are not further traumatized and stigmatized by sham therapies.
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