Gay Rights, Patient Rights: The Implications of Sexual Orientation Conversion Therapy

Therapies designed to change sexual orientation have come under increasing scrutiny from the profession and the public. The proposition that sexual orientation can be changed therapeutically is widely questioned, and there is concern that such therapies reinforce social devaluation of homosexuality and bisexuality. At the same time, conservative religious individuals wish to seek treatment appropriate to them, which may include attempting to change or control sexual orientation. The ethical questions and clinical and social implications of this complex issue are discussed. Guidance to practitioners interested in this issue is offered, including references to policies of the American Psychological Association. When homosexuality was declassified as a treatable mental disorder nearly 30 years ago, it was assumed by many that the popularity of treatments intended to change sexual orientation would come to an end. At that time, treatments intended to change homosexual orientation, known as sexual orientation conversion therapy, were discounted by organized psychology and psychiatry as the last vestiges of an antiquated, prejudicial view of homosexuality. Although conversion therapies are marginalized in mainstream mental health organizations, they are experiencing a “renaissance” of sorts at present. There are several reasons for this. First and foremost, despite the dramatic changes in the ways that lesbians, gay men, and bisexual (LGB) men and women are viewed culturally, there remains a segment of society that rejects the notion that an LGB orientation is a normal variant of human sexuality. Some proponents of conversion therapies portray homosexuality as freely chosen and changeable, which appeals to those who would limit civil rights protections for LGB individuals. This position was reinforced by a high-profile advertising campaign designed to persuade ambivalent gay male and lesbian individuals that their unwanted homoerotic feelings can be changed (Haldeman, 1999). There is another aspect, however, to the continuing discussion about the therapeutic modifications of sexual orientation having to do with individuals’ religious and spiritual identities. The major mainstream mental health organizations have all issued policy statements affirming that homosexuality is not a mental disorder and disavowing treatments based upon this premise. Diversity in religious expression is also supported by organized mental health. So what of the individual whose religious beliefs are at odds with an LGB orientation? Should practitioners always view such individuals as having simply internalized homophobic doctrine and therefore limit access to the treatment that may facilitate an adaptation to a more ego-syntonic style of living on the basis of religious beliefs? How are the rights to treatment of such individuals supported without negating the gay-affirmative stance of organized mental health and endorsing homophobic treatments? These are the difficult questions around which the discourse on sexual orientation conversion therapy has lately centered and which the present discussion will attempt to address.