A number of developmental models have been proposed by certain therapists, who suggest that homosexuality may be connected with a lack of bonding to the same-sex parent. In response to this, many churches and secular therapists, particularly in the United States but also in Britain, began offering ‘ex-gay’ courses to help people move through and beyond, as they saw it, the emotional and relational wounds that were a factor in homosexuality.

Living Out does not support efforts to change people's sexual orientation, and we explain why in this article. This post is about whether these treatments are harmful and/or effective, or not. (For a brief discussion of claims regarding the causes of homosexuality see Ed Shaw’s article: Why are some people same-sex attracted? and this review of academic studies on the causes of sexual orientation).

Are ‘ex-gay therapies harmful?

There has been a huge amount of criticism of what we will call, for want of a better term, ‘ex-gay’ therapies. Many have argued both that such therapy does not work and indeed harms the clients who undertake it. A paper by Ariel Shidlo and Michael Schroeder in 2002 interviewed a number of those who had undergone such therapy, to find out about their experiences and whether it had been harmful. They reported that many of the participants had not experienced orientation change and felt wounded by the process. This paper was taken by some as clear evidence that ‘ex-gay’ or ‘reparative’ therapy didn’t work, but as Shidlo and Schroeder themselves pointed out, that conclusion couldn’t be drawn from the paper:

‘The data presented in this article do not provide information on the incidence and the prevalence of failure, success, harm, help, or ethical violations in conversion therapy.’ 1

But there was also a problem with Shidlo and Schroeder’s paper itself. They set out to recruit participants who felt that they had been harmed by their therapy. This is the statistical equivalent of conducting a political opinion poll by only interviewing people in the headquarters of the Labour party. And Shidlo and Schroeder also didn’t qualify the harm reported in any way – they accepted a self-report of harm without using any standard forms of measurement.

Do ‘ex-gay’ therapies work?

Shidlo and Schroeder’s research did not look at the probability of change, merely whether some people did report such change. However, this challenge was picked up by Stanton Jones and Mark Yarhouse, who carried out a longitudinal study of those going through reparative therapy to see whether they could answer such a question.

Jones and Yarhouse’s research is available on their website, and it’s an interesting read.2 For the first time ever, researchers garnered information from participants in reparative therapy, not just after the therapy had been completed but from the very start. In this way they could track how participants felt about what was going on, and use psychotherapy industry standard measures to assess not only whether sexual orientation had changed, but also whether there was any psychological harm to the participants from their participation in the programmes.

The first result they observed was that there was on average a small recordable orientation shift in those who participated, but that it wasn’t significant. However, for those who began the therapy self-reporting as almost exclusively homosexual in their attractions, there was a more noticeable shift in orientation that was significant. This seemed to indicate that therapy was successful at helping those who had exclusive homosexuality to develop some heterosexual feelings, but that it didn’t provide anything like a ‘gay to straight’ outcome.

We should note that at this time, sexual orientation was usually measured on a single bi-polar scale between exclusively homosexual and exclusively heterosexual (the so-called Kinsey Scale). But when participants were asked to measure homosexual attraction and heterosexual attraction on separate scales (i.e., not in relation to each other) then the change was more substantial. For the whole population there was a significant reduction in homosexual attraction. The more pronounced a participant’s homosexual orientation was to begin with, the more pronounced the reduction in their homosexual attraction. However, there was no significant increase in heterosexual attraction, even though on average participants did record some increase.

Jones and Yarhouse also asked participants to report what they felt the results of the therapy were. Over two-thirds of the participants reported that they felt they had seen a positive desired change in their sexual orientation, in that they felt that they were now able to live a chaste life, or that they were positive about continuing in therapy. Only 1 in 8 of the participants reported that they had rejected the premise of the therapy and were definitely gay, or that they were confused about their sexual identity.

Summary of Jones and Yarhouse’s findings

A finding which was very significant, and which overthrew all the previous criticisms of ‘ex-gay’ therapy, was that there was a significant decrease in the distress reported by participants, using psychotherapy industry standard measures. That is, not only was there no clinical evidence that reparative therapy caused harm, but there was evidence that it was of benefit to the participants in lessening their distress. Added to that, as we have said, there was a significant reduction in homosexual attractions for some participants, even if it wasn’t matched by a corresponding increase in heterosexual attractions.

Interpreting Jones and Yarhouse’s findings

Finally, Jones and Yarhouse looked at the issue of how best to describe the positive results they had seen. 3 It is worth quoting what they say in full:

‘There is also the question of sexual identity change versus sexual orientation change. Recent theoretical and empirical work on sexual identity among religious sexual minorities suggests that attributions and meaning are critical in the decision to integrate same-sex attractions into a gay identity or the decision to dis-identify with a gay identity and the persons and institutions that support a gay identity. In light of the role of attributions and meaning in sexual identity labelling, is it possible that some of what is reported in this study as change of orientation is more accurately understood as change in sexual identity? […]These findings go against the common argument that change of orientation is gradual and occurs over an extended period of time. Some may see these results as reflecting not a change in sexual orientation for most participants who reported such change, but rather a change in sexual identity. Such a change might result from how one thinks of oneself and labels one’s sexual preferences (that is, attributions and meaning-making). This might also explain to some why the Truly Gay subpopulation showed more dramatic change, as their shift was away from a more pronounced gay identity. Such a departure may have been measured as a greater movement away from something that had previously been more salient to them.

It is possible that this data reflects both persons who experienced a more powerful change in orientation as well as persons who experienced a change in sexual identity. The shift itself appeared to be consolidated and sustained over time for those who reported a successful outcome. […] It certainly appears from this data that the process is complex and multifaceted.’

What Jones and Yarhouse are suggesting is that what seemed to be more important in people leaving homosexuality behind was not a reduction in homosexual desires themselves but rather the way the person with these desires views themselves. This means that it is perfectly possible to experience homosexual attraction and yet not identify as ‘gay’. This is not to say that the person is now heterosexual! Part of the struggle for those who undertake such a journey is to find the appropriate language to help describe themselves when the society around them wants to pigeon-hole people as ‘gay’ or ‘straight’.

Orientation or identity change without therapy

On the subject of orientation and sexual identity change, it is also interesting that many people experience a shift in sexual attractions from homosexual to heterosexual (or vice-verse) without ever engaging in therapy or even seeking by other methods to change their orientation. In a recent paper for the Archive of Sexual Behaviour, Michael King (who is the chair of the Royal College of Psychiatrists’ Gay and Lesbian Special Interest Group and openly homosexual) and others discovered some remarkable results when they looked at the correlation between how men and women described their sexual orientation, and then alongside that gave a report of their sexual partnership status. 4 Of the almost 3,500 participants who described themselves as ‘entirely heterosexual’ or ‘mostly heterosexual’, over 20 said that their choice for sexual partner was ‘mainly same sex’ or ‘only same sex’. This constituted 0.6% of the population. However, when the same question was asked of the 44 participants who described themselves as ‘mostly homosexual’ or ‘entirely homosexual’, eight said that their choice of sexual partner was ‘only opposite sex’ or ‘more often opposite sex’. This constituted almost 20% of the group or proportionally 30 times as many as those who were heterosexual but mainly had homosexual relationships.

One explanation might be that many of those who have homosexual attractions didn’t identify as ‘gay’ or ‘lesbian’. To check this the researchers asked the same questions again, this time asking people to describe themselves as gay or lesbian rather than homosexual. This time only 1 of the 29 people who described themselves as gay or lesbian said their sexual relationships were exclusively or mainly heterosexual (approximately 3%). This seemed to suggest that around a third of those who experienced mainly or exclusively homosexual attraction did not want to describe themselves as ‘gay’ or ‘lesbian’ (a reduction from 1.2% to 0.8%).

Another significant study is the 2003 piece by Dickson, Paul and Herbison (DP&H) where, as part of a cohort study of women born 1972/1973, the researchers explored variant sexual behaviour over time. 5 One aspect of their findings is best expressed in the following diagram:

This transition matrix is fascinating. Of the 8 women who at age 21 claimed a major attraction to those of the same sex, five years later 2 of them (25%) now claimed to be exclusively heterosexual and a further 3 (37.5%) claimed to have only occasional same-sex attractions. Conversely, 3 of the 390 women (< 1%) who reported exclusive heterosexual attractions at age 21 reported major homosexual attraction at age 26, and a further 42 (just over 10%) reported some homosexual attraction.

In 2011, Mock and Eibach reported on an attempt to use a 10 year US longitudinal study data set to explore the same issues. 6 They were less interested in sexual identity/orientation transition per se and more interested in the reasons why people made such a transition, and whether specific kinds of people (e.g., based on age, marital status, educational achievement, race) were more likely to make a transition. Again, the results were very interesting. Without discussing them in detail here, this study built up a picture of a bi-polar sexual orientation spectrum with transition both ways. Crucially though, transition was far more likely from homosexual/bisexual towards another orientation than from heterosexuality towards bisexuality/homosexuality. This effect is even more pronounced amongst women than men. Homosexual women were five times more likely to make a transition in their sexual orientation then heterosexual women (compared to homosexual men being around two and a half times more likely to change then heterosexual men).

Summary

Studies of gay people who haven’t attempted to change their orientation show that even without any outside intervention many people change their sexual identity over the years. Specifically, female homosexuality seems to be much more fluid than male, and this fits in with the twin studies that suggest a much higher environmental factor for homosexuality amongst women than men.

Where people have tried to change, we see evidence that such sexual orientation change efforts may have some effect, although we still have serious concerns with making this a goal, as we explain in this article. However, certainly, the best longitudinal study we have so far indicates that there is no evidence that such therapy is psychologically damaging, even where it does not necessarily achieve the results the participant wanted and it can have other benefits such as reducing the person’s distress. At the same time, Jones and Yarhouse’s work sounds a note of caution: many of those who undertook the therapy did not see any significant change in their sexual orientation at all. The idea that ‘ex-gay ministries’ are the relevant way forward for gay or same-sex attracted Christians is therefore not supported by the hard evidence.

1. A. Shidlo and M. Schroeder, 'Changing Sexual Orientation: A Consumers' Report', Professional Psychology: Records and Practice, p.250. 
2. See also Stanton L. Jones and Mark Yarhouse, 'Ex-Gays? An Extended Longitudinal Study of Attempted Religiously Mediated Change in Sexual Orientation', Sexual Orientation and Faith Tradition Symposium.
3. Jones and Yarhouse, 'Ex-Gays?', pp.7-8.
4. J. Hayes et al., 'Prevalence of Same-Sex Behavior and Orientation in England: Results from a National Survey', Archives of Sexual Behaviour.
5. Dickson, Paul, and Herbison 'Same-Sex Attraction in a Birth Cohort: Prevalence and Persistence in Early Adulthood', Social Science and Medicine.
6. S.E. Mock and R.P. Eibach, 'Stability and Change in Sexual Orientation Identity Over a 10-Year Period in Adulthood', Archives of Sexual Behavior.