Moving beyond a systematic review of sexual reorientation therapy.

Dessel, Adrienne

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.

It is also problematic that Serovich et al. (2008) refer to people who "may not engage or wish to engage in same-sex behavior, but ... still identify as not heterosexual based on their partner preferences or emotional attraction" (p. 234). It is a well-accepted fact that sexual relations are a healthy part of any long-term monogamous relationship, heterosexual or homosexual. To conclude that lesbian or gay people may identify as such without engaging in same-sex relations is to reaffirm the seriously problematic position that many antigay groups hold--"to love the sinner but hate the sin" (Bassett et al., 2005, p. 18)--or the notion that is it acceptable to be lesbian or gay as long as you do not "practice it." Proponents of such same-sex celibacy do not allow for the same rights and pleasures (that is, public displays of affection, private legal sexual relations) that are socially and culturally granted to heterosexual couples.

Finally, there are between 1 and 9 million children living in LGB families, and over 7 million LGB parents with dependent children in the United States (Kosciw & Diaz, 2008; Stacey & Biblarz, 2001).These families are raising healthy children who fare no worse in their emotional, cognitive, social, or sexual functioning than do their peers raised in heterosexual homes (Perrin, 2002). In fact, children raised in lesbian homes exhibit more tolerance of diversity and more nurturing behavior toward younger children (Stacey & Biblarz, 2001;Tasker, 1999). Again, it is the lack of education and the social stigmatization that creates negative environments for these children (Kosciw & Diaz, 2008).

Although I support work that attempts to shed light on the fallacy of sexual reorientation therapy as a purported mental health intervention, the ethical issues, fluid nature of the development of sexual orientation, and social stigmatization involved cannot be given nearly enough weight in an article of this length. These are the key issues that need to be understood by therapists and other mental health professionals, such as social workers, who are working with LGB youths, adults, and families. Social workers are obligated by the profession's Code of Ethics to end oppression of all groups and held to the standard that they "should not permit their private conduct to interfere with their ability to fulfill their professional responsibilities" (NASW, 2000, Standard 4.03). I would encourage Serovich et al. (2008) to step out a bit further and challenge the fundamentally homophobic and heterosexist nature of our culture (Kullasepp, 2007; Lind, 2004; Silverschanz, Cortina, Konik, & Magley, 2008). More realistic frameworks for understanding human sexuality include the extent of bisexuality (Rodriguez Rust, 2000) and the concept of "relational orientation" rather than sexual orientation (Greenfield, 2005). Clinical social workers who work in the marital and family therapy realm need to pay close attention to the cultural and social factors overlying notions of "mental health" and "mental illness" and consider how best to tackle the damaging effects of prejudice and oppression on psychosocial functioning.

Original manuscript received July 27, 2009

Final revision received August 3, 2009

Accepted August 6, 2009

REFERENCES

American Psychiatric Association. (2000). Therapies focused on attempts to change sexual orientation (reparative or conversion therapies) [Position statement]. Retrieved from http://archive.psych.org/edu/other_res/lib_archives/ archives/200001.pdf

Bassett, R, van Nikkelen-Kuyper, M., Johnson, D., Miller, A., Carter, A, & Grimm,J. (2005). Being a good neighbor: Can students come to value homosexual persons? Journal of Psychology and Theology, 33, 17-26.

Bontempo, D., & D'Augelli, A. (2002). Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths' health risk behavior. Journal of Adolescent Health, 30, 364-374.

Greenfield, D. (2005). Shifting from sexual orientation to relational orientation: A discursive move with theoretical and pedagogical benefits. Equity & Excellence in Education, 38, 309-319.

Hodge, D. R. (2007). Learning to hear each others' voice: A response to Melendez and LaSala [Points & Viewpoints]. Social Work, 52, 365-374.

Just the Facts Coalition. (2008).Just the facts about sexual orientation and youth: A primer for principals, educators, and school personnel. Retrieved from www.apa.org/pi/lgbc/publications/justthefacts.html

Kosciw, J., & Diaz, E. M. (2008). Involved, invisible, ignored: The experiences of lesbian, gay, bisexual and transgender parents and their children in our nation's K-12 schools. New York: Gay, Lesbian and Straight Education Network.

Kullasepp, K. (2007).Affective guidance of sexual identity construction: The intra-psychological level in the service of culture. Integrative Psychological and Behavioral Science, 41,272-284.

Lind, A. (2004). Legislating the family: Heterosexist bias in social welfare policy frameworks. Journal of Sociology and Social Welfare, 3 I(4), 21-35.

Melendez, M. R, & LaSala, M. C. (2006).Who's oppressing whom? Homosexuality, Christianity, and social work [Points &Viewpoints]. Social Work, 51, 371-377.

National Association of Social Workers. (2000). Code of ethics. Retrieved from http://www.socialworkers.org/ pubs/Code/code.asp

Peer commentaries on Spitzer. (2003). Archives of Sexual Behavior, 32, 419-468.

Perrin, E. (2002). Technical report: Coparent or second-parent adoption by same-sex parents. Pediatrics, 109, 341-343.

Rodriguez 1Lust, R (2000). Bisexuality in the United States: A social science reader. New York: Columbia University Press.

Serovich, J., Craft, S., Toviessi, R, Gangamma, R., McDowell, T., & Grafsky, E. (2008).A systematic review of the research base on sexual reorientation therapies. Journal of Marital and Family Therapy, 34, 227-238.

Silverschanz, P., Cortina, L., Konik, J., & Magley, V. (2008). Slurs, snubs, and queer jokes: Incidence and impact Of heterosexist harassment in academia. Sex Roles, 58, 179-191.

Stacey, J., & Biblarz, T. (2001). (How) does the sexual orientation of parents matter? American Sociological Review, 66, 159-183.

Tasker, E (1999). Children in lesbian-led families: A review. Clinical Child Psychology and Psychiatry, 4, 153-166.

Adrienne Dessel, PhD, LMSW, is associate co-director, The Program on Intergroup Relations, University of Michigan, 1214 South University Avenue, Amt Arbor, MI 48104; e-mail: adessel@umich.edu.