Sunday, January 30, 2011




As I write (25th January 2010) Mrs Lesley Pilkington, a British Association for Counselling and Psychotherapy (BACP) registered and accredited psychotherapist, is facing a disciplinary hearing for offering counselling to someone who approached her at a conference claiming to want help to overcome unwanted homosexual feelings. This hearing is currently suspended because of accusations of witness intimidation towards one of Mrs Pilkington’s expert witnesses. The person who brought the complaint is Mr Patrick Strudwick. Mr Strudwick approached Mrs Pilkington under a false name and rather than wanting to overcome unwanted feelings of same sex attraction he aimed to expose those people who practice what the American Psychological Association (APsyA) defines as sexual orientation change efforts (SOCE). Mr Strudwick also approached a psychiatrist and told him the same story only to attempt to get the doctor suspended by the General Medical Council. The account of this attempt to expose practitioners in the field of SOCEs was published in the Guardian, and was followed up by an article in the Independent and the launch of a Facebook group entitled Stop Conversion Therapies or SCOTT where war was declared on those who offer help to those who wish to overcome unwanted homosexual feelings.

It is surprising, in the light of the hearing, to realise that the BACP has no specific position on whether SOCEs are ethical or not. This is even though an article published in the October 2009 edition of the BACP magazine Therapy Today which relied heavily on the opinion of Prof Michael King, on University College London and founder of the Gay and Lesbian Mental Health Special Interest Group at the Royal College of Psychiatrists (RCPsy) to state that SOCEs do not work. This lack of specific statement also puts the BACP at odds with the British Psychological Society (BPS), the United Kingdom Council for Psychotherapy (UKCP), and the RCPsy which all state that SOCEs are unethical. The validity of these statements, though, is open to debate and are also of questionable ethics. defines psychotherapy as the treatment of mental and emotional disorders through the use of psychological techniques designed to encourage communication of conflicts and insight into problems, with the goal being relief of symptoms, changes in behavior leading to improved social and vocational functioning, and personality growth. What this definition misses is that in psychotherapy from all psychological schools, as in counseling, it is the client who dictates what path they want to take. It is up to the client whether they choose to deal with an issue and how they deal with it. Well, in every situation except sexuality. Because of politically correct pressure and the misuse of research it is now acceptable to ignore the needs and wishes of the client to take them down a path of affirmation and acceptance of unwanted feelings. This situation is compounded in the statements that are reported as being from the BPS and RCPsych which actually come from the Psychologies of Sexuality section of the BPS, a body that also promotes the normality of polyamory, BDSM and other paraphilia, and the Gay and Lesbian Mental Health Special Interest Group. This is akin to having an alcoholic who is happy with their drinking habits condemning Alcoholics Anonymous. As such we should recognize that the statements from these special interest groups are those of people who want to defend their own lifestyle choice. This comment is not to say that people choose to have homosexual feelings, but that these groups often consist of and support those who have made lifestyle choices about how they are going to live with their homosexual feelings.


Putting aside the biased views of the BPS and RCPsych groups we need to face the unethical use of research and assumptions that underpin the condemnation of SOCEs. The first assumption is that homosexuality is natural. This is seen in the article concerning Mrs Pilkington’s hearing in the Church Times of January 21st 2001 where Patrick Strudwick likens homosexuality to race and implies that just as we would not try and help someone of African descent to become white we should not try and help homosexuals become straight. The major problem with this position is that there is no evidence for homosexuality being natural. While there have been many attempts to try and prove that people are born gay not one of these experiments has been replicated. In fact major doubts have been raised about the validity of the research. In the case of Le Vay’s research into the difference of the size of the hypothalamus in homosexual and heterosexual males, the editor of Science magazine in the edition that Le Vay’s research was reported stated that it was not known whether homosexuality was caused by or the cause of the differences in the brain. As the findings of the research have not been replicated we are no closer to an answer.


With the research by Dean Hamer we are on even less solid ground. The statistical test used by Hamer and his research team was devised by Neil Risch, professor in human genetics at the University of CaliforniaSan Francisco, who said of this research that the statistical requirements for this test were not met by Hamer and his team. In fact the level of Hamer’s research was questionable Hamer was investigated by the Office of Research Integrity at the Department of Health and Human Services.

This lack of scientific evidence has led people as diverse as Peter Tatchell of Outrage, and Francis S Collins, ex-director of the Human Genome Project and Director of the National Institutes of Health in Maryland (a Barak Obama appointment) to state that there is no credible scientific evidence for homosexuality being inborn.


This though has not stopped books being published that state that people are born gay. One is the book “Nature’s Choice” based on a series of talks presented to and sponsored by the pro-gay organisation parents and Friends of Lesbians and Gays. Another is Born Gay by Wilson and Rahman. This latter book by Glenn Wilson, visiting professor of psychology at Gresham College, London and Qazi Rahman, lecturer in psychobiology at the University of East London, claims that homosexuality is 30% genetic and 70% the influence of abnormal levels of hormones in the womb. This claim is not supported by the research into identical twins which reports an average covalence (where one twin is homosexual the other twin also being homosexual) of around 7%. Amongst the research that produces this statistic is a 1993 research paper by Prof Michael King of University College London who stated that the discordance in homosexuality amongst homosexual twins showed that genetics was not the cause of homosexuality. As the founder of the Gay and Lesbian Mental Health special interest group Dr King is not happy to be reminded of this research.


The second assumption is that homosexuality is more common that it actually is. The figure quoted by the pro-gay movement is 1 in 10. This is based on the Sexuality and the Adult Male and Sexuality and the Adult Female papers from the team headed up by Alfred Kinsey, an expert in the gall wasp. By adding together the claims of the research that 1 in 7 of the male population and 1 in 13 of the female population are “gay” pro-gay advocated in the 1970s came up with the false 1 in 10 figure. In the 1980s and 90s it was noticed that the spread of AIDS in the homosexual community was not as vast as anticipated. This led to the Kinsey Institute for Human Sexuality relooking at the research done and doing more research, a process that led to a major revision of the statistic for how common male homosexuality is from 1 in 7 to 1 in 33. With the female homosexual population the statistic went from around 10% to under 3% of the population.


The next assumption behind the statement that SOCEs are unethical is the false belief that sexuality is fixed. Put simply the claim is once gay always gay. This though is not supported by personal testimony and the elasticity of human sexuality, especially those who once identified as gay becoming straight, has been the basis of a blog post by Peter Tatchell and the gay man about town column in the free London paper The Metro. This phenomenon is not new as even Alfred Kinsey reported that people who he had interviewed and were, according to his scale, homosexual were now heterosexual. The reality from interviews undertaken across the globe, from New Zealand to the USA is that sexuality, and in particular female sexuality, is elastic – a phenomenon that has led to the label of LUG (lesbian until graduation) being applied to many middle class females who experiment with same sex relationships while at university.


The fourth assumption is that SOCEs are dangerous. This claim is based on very little evidence with one document being at the forefront of this claim. In the 1990s Michael Schroder and Ariel Shidlo were approached by the pro-gay lobby to do research into “reparative therapy”. This was advertised in the gay press and in gay bars with the words “Recording the Harm.” As such the research by Shildo and Schroder fails the test of proper research as it actually stated the outcome they wanted. Even so, because of the testimonies concerning SOCEs that were helpful the authors changed the title of their research to “Sexual Conversion Therapy: Ethical, Clinical and Research Perspectives”. This was also co-authored by Jack Drescher, a major critic of the ex-gay movement who has attacked, without proper reference to the research, research by Robert Spitzer and others that claim that SOCEs can help people. Unlike practitioners of SOCE, Drescher was interviewed by the APsyA’s committee that looked at SOCEs. This paper by Schildo and Schroder is the only peer reviewed paper that claims that SOCEs do harm. According to Warren Throckmorton, who is not a fan of SOCEs and has been critical of those who practice this form of therapy. “Shidlo and Schroeder advertised on the Internet and other places, specifically looking for people who felt harmed by attempts to change sexual orientation” he also states “In 2002, I presented a paper on ex-gay ministries in an APA symposium with Shidlo and Schroeder and offered to look at their data to examine the counselling factors that may have led to the unfavourable outcomes. I have yet to hear from them.” Here is an offer to look at the counselling methods spoken of in Shildo and Schroder’s report to see why the harm was done but there has been no response. I can also find no evidence that the research by Shildo and Schroder has been subject to statistical checks such as a scalability matrix. Again this raises the question of whether this research is suitable for use by groups such as the UKCP for creating an ethical statement.


The next assumption is that SOCEs are ineffective. This is the claim produced by the APsyA’s committee convened to look specifically at this issue. As reported in the US secular press, this committee was noted for its absence of involvement by practitioners of SOCEs. I have previously mentioned Dr Warren Throckmorton. Dr Throckmorton is the pioneer of an alternative to SOCEs entitled Sexual Identity Therapy (SIT), which aims to allow the beliefs of the individual to find congruence or agreement with their sexual feelings. This is not then a form of SOCE as SIT does not attempt to change sexual feelings. Neither is it gay affirmative as it does not seek to affirm the sexuality of the client. Unlike SOCEs though SIT has no peer reviewed research into its safety, or effectiveness. It is interesting to note that Dr Throckmorton claims not to be dealing with egodystonic sexuality. He states “I want to make it clear that SIT does not "treat" "ego-dystonic" homosexuality because it is not a disorder to be treated. We conceptualize people as experiencing conflicts involving their sexuality and other values or beliefs which they believe to be at odds. We help people clarify their values and beliefs and make plans to live in accord with those. I think any presentation of our model should make it clear that we do not view same-sex attraction per se as a disorder or indicator of a disorder.” This though is a false claim. If we look at the International Classification of Diseases (ICD) 10 Classification of Behavioural and Mental Diseases F66.1 Egodystonic Sexuality is defined as “The gender identity or sexual preference is not in doubt but the individual wishes it were different because of associated psychological and behavioural disorders and may seek treatment in order to change it.” It would appear the Dr Throckmorton is only referring to the lack of definition for Egodystonic Sexuality in the American Psychiatric Associations (APsychA) Diagnostically Statistical Manual 4th edition – revised and ignores the global use of the World Health Organisations manual.


Unlike SIT, gay affirmative therapy (GAT) and the anti-SOCE claims there is a growing body of research that shows the effectiveness and safety of SOCEs. In 2009 Mike Yarhouse and Stanton Jones presented a paper on religious forms of SOCEs to the APsyA, the same year the anti-SOCE statement was released. This was a longitudinal study, which is carried out over a long period of time, and showed the SOCEs are no more harmful and no less effective than psychological interventions for eating disorders, drug addiction or any other neurosis. In 2001 Robert Spitzer produced a research paper that carried testimonies of successful treatment through SOCEs. This paper is of importance as Prof Spitzer was one of the psychiatrists who led the push to have homosexuality removed from the classification of mental disorders. Spitzer recognised that there were problems with the research, but claimed that they were no worse than any other piece of psychological or psychiatric research. After a battle to get his research published, that included threats from members of the Gay and Lesbian special interest groups in the American psychiatric and psychological associations to destroy his career, Spitzer managed to get his paper published in a peer reviewed journal. This paper was accompanied by responses by a wide ranging of psychiatrist and psychologists – including Jack Drescher – that questioned Spitzer's professionalism and track record as a researcher. This was in spite of the recognition of Spitzer as a leading research psychiatrist and his role in heading up the publication of the Diagnostic Statistical Manual (DSM) IV in 1994 and the text revision of 2000. One psychiatrist, who like Spitzer believed homosexuality to be inborn, applied the Guttman Scalability Matrix (or Guttman Reliability Matrix) to Spitzer’s research – something that there is no evidence for the Shildo and Schroder paper or SIT having gone through – and stated that the research met the statistical criteria for research of this type. Excluding PhD research by people like Katarn, the documents published by Narth and others in the peer reviewed Journal of Human Sexuality, we have one piece of research that is peer reviewed, presented to the American Psychological Association, and is longitudinal and another that has been subjected by leading psychiatrists to checks and balances and both of which have shown SOCEs to be as safe and effective as other psychological interventions.


This leads us onto the final issue, and that is the standard of research. In science there are two types of research. The first is qualitative. This includes the use of double blind studies into medicine where two groups exist, a control and the study group. The control group is given a placebo while the study group is given the drug. The double blind come in that neither the control or study group, nor those distributing the drug/placebo know who is getting what. These studies are also long term, or longitudinal. The other type of research is quantitative and is based on the number of interviews. Put simply the more people that experience something the more likely it is to be true.


By the nature of what is being studied it is almost impossible to do qualitative research concerning psychological interventions. As they are talking therapies a placebo is not something that can easily be created. Also, because of ethical issues, it is often not possible to create a control group. If the therapy is to help people with a specific learning difficulty, bulimia or a psychological neurosis it is often deemed unethical, by bodies such as the APsyA, BPS, RCPsych, UKCP, BACP, APsychA and other professional bodies to have a group that is not receiving the treatment. Many of the psychological interventions provided on the NHS, including the Cognitive Behavioural Therapy being offered for many conditions through the Increasing Access to Psychological Therapies (IAPT) strategy are based on non-qualitative research. Critics of SOCE, such as Prof King, know this but are calling for SOCEs to be measured by a different standard to other psychological interventions.


In conclusion, if we look at the full picture around SOCEs the position by the UKCP that reparative or conversion therapies are unethical is without foundation. Rather than being based on the best for the client it is based on capitulating to pressure from the pro-gay lobby. The problem is that, unless groups like the UKCP, are willing to stand up to the threats and intimidation received by people like Mrs Pilkington and look at the evidence properly the situation will not change and those who want help will continue to be left stranded. 

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