Moving beyond a systematic review of sexual reorientation therapy.

A recently published article in the Journal of Marital and Family Therapy (JMF7) may be of interest to social work practitioners. The article, "A Systematic Review of the Research Base on Sexual Reorientation Therapies" (Serovich et al., 2008), raises some serious concerns that are relevant to social work clinicians and educators and have recently been debated in the pages of Social Work (Hodge, 2007; Melendez & LaSala, 2006). The JMFT article is a systematic review of 28 empirical research studies examining the topic of sexual reorientation therapy. The article provides an introductory description of sexual reorientation therapy, a brief review of the literature, and then a review of the literature in terms of methodology, results, and ethical issues. The authors conclude that "scientific rigor in these studies is lacking" (Serovich et al., 2008, p. 235) and that "if sexual reorientation therapies are to be fully accepted and embraced as valid, two other important issues need to be addressed" (p. 236). The two issues spoken of are (1) the reversibility of reorientation therapy and (2) the validity of such an intervention when there is no strong empirical data suggesting its effectiveness. The concern I have with this article's conclusions, and its implications for clinical social work practice, is that it promotes an overall validation of sexual reorientation therapy as an intervention that remains to be adequately tested. A systematic review of an intervention confirms the notion that such an intervention is potentially useful. However, this particular intervention is not only not useful--it has been deemed inappropriate and dangerous. A recent publication by the American Psychological Association--in collaboration with the American Academy of Pediatrics, the National Education Association, and 10 other well-respected professional organizations--clearly stated that sexual orientation conversion therapy efforts "have serious potential to harm young people" (Just the Facts Coalition, 2008, p. 5), the authors noting that "several mental health professional organizations have issued public statements about the dangers of this approach" (p. 6). The American Psychiatric Association (2000) issued a position statement on sexual reorientation therapies that reaffirmed that "homosexuality is not a diagnosable mental disorder" (p. 1) and recognized the moral and political forces at play in the promotion of reparative sexual reorientation therapies (for a full commentary on these culture wars, see "Peer Commentaries on Spitzer," 2003). If being lesbian or gay is not unhealthy or dysfunctional, there is no need to "repair" or "reorient" lesbian and gay individuals. As readers of JMFT are, typically, very interested in addressing issues of marital conflict and infidelity, it is understandable that Serovich et al.'s (2008) article places the issue of same-sex desires in the context of couples and family therapy. However, marital instability and infidelity plague heterosexual and homosexual relationships alike. It is also critical to recognize that sexual-orientation issues that arise within the realm of heterosexual marital problems may not be a direct result of one partner coming out as lesbian or gay but, rather, of the cultural stigma and cultural oppression attached to being lesbian or gay. This phenomenon is, in this way, similar to the high suicide rate among lesbian, gay, and bisexual (LGB) teenagers, which is not directly attributable to being gay or lesbian but is mediated by victimization. When harassment is statistically controlled for, the rate of gay teenage suicide and other health risk behaviors decreases to a level comparable to that found among heterosexual peers (Bontempo & D'Augelli, 2002). Historically, the dissolution of heterosexual marriages over the issue of unrecognized sexual orientation might have been prevented by full societal--and, thus, individual--acceptance of same-sex orientation earlier on. …