A longitudinal study of attempted religiously mediated sexual orientation change.
ABSTRACT The authors conducted a quasi-experimental longitudinal study spanning 6-7 years examining attempted religiously mediated sexual orientation change from homosexual orientation to heterosexual orientation. An initial sample was formed of 72 men and 26 women who were involved in a variety of Christian ministries, with measures of sexual attraction, infatuation and fantasy, and composite measures of sexual orientation and psychological distress, administered longitudinally. Evidence from the study suggested that change of homosexual orientation appears possible for some and that psychological distress did not increase on average as a result of the involvement in the change process. The authors explore methodological limitations circumscribing generalizability of the findings and alternative explanations of the findings, such as sexual identity change or adjustment.
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ABSTRACT: This commentary highlights current policy issues affecting lesbian, gay, bisexual, transgender, and queer (LGBTQ) people in the US with implications for mental and behavioral health care and social work services. These issues include conversion or reparative therapies, especially for young people, and conscience clauses that may exempt some students and practitioners from serving LGBTQ people and their families. While not a “policy” per se, emerging knowledge about health disparities that affect LGBTQ people will also be summarized because of its relevance to practice; many of these concern mental health and behavioral health. Finally, some resources for making health care organizations more responsive to the needs of LGBT people are identified.Clinical Social Work Journal 09/2013; 41(3). · 0.27 Impact Factor
Conference Paper: 美國婚姻平等法運動與基督教群體間的推手過招[Show abstract] [Hide abstract]
ABSTRACT: 同性婚姻是一個開創新類型家庭的社會革命。它顛覆了傳統婚姻觀，也企圖改變相關的法律制度。因為它同時點燃了期盼與憤怒，在美國，同性婚姻已成了社會分歧的爭議。基督宗教對婚姻的認知，一向左右著美國立法權規範婚姻的法律制定。因此這個文化翻轉也牽動著基督宗教社群內部倫理論述的調整，以及對外的政治參與。本文聚焦在同性婚姻支持者如何將合法化的訴求置於婚姻平等的歷史框架裡，並把現今正在進行的論戰連結到已被社會認定的「異族通婚」之歷史公案。社會歷史的進展與基督宗教的論述轉化也以相似的型態，在「同性婚姻」的論戰裡重演了一次。在經文證明、自然推論和重組詮釋的循環裡，基督宗教的左右兩翼在美國社會面對巨大變遷時，同時帶來了穩定與創新的能量。本文的分析將從社會歷史的角度，探討「婚姻平等」的框架如何成功的為同性婚姻支持者設定了一個有利的戰場，把少數人的權益轉變為多數人的關懷。最後，筆者就同性婚姻法與基督宗教立場在美國未來可能的走勢提出看法。「從基督教精神看性別平等法制—比較法的觀點」研討會, Taichung, Taiwan; 12/2011
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ABSTRACT: Abstract This study reports the results of a comprehensive online survey of 1,612 current or former members of the Church of Jesus Christ of Latter-day Saints (LDS) many of whom engaged in psychotherapy in an effort to cope with (understand, accept, or change) their same-sex attractions. Data obtained from written and quantitative responses showed that therapy was initiated over a very wide age range and continued for many years. However, counseling was largely ineffective; less than 4% reported any modification of core same-sex erotic attraction. Moreover, 42% reported that their change-oriented therapy was "not at all effective," and 37% found it to be moderately to severely harmful. In contrast, affirming psychotherapeutic strategies were often found to be beneficial in reducing depression, increasing self-esteem, and improving family and other relationships. Our data suggest that the very low likelihood of a modification of sexual orientation and the ambiguous nature of any such change should be important considerations for highly religious sexual minority individuals considering reorientation therapy.Journal of Sex and Marital Therapy 05/2014; · 1.27 Impact Factor
Ex-Gays?: An Extended Longitudinal Study of
Attempted Religiously Mediated Change in Sexual Orientation
Stanton L. Jones (Wheaton College) and Mark A. Yarhouse (Regent University)
In Byrd, Dean (Symposium Chair), August 9, 2009, “Sexual Orientation and Faith Tradition—A Test of the Leona
Tyler Principle,” American Psychological Association Convention, Toronto, Canada
For many years the Public Affairs website of the American Psychological Association stated: “Can therapy
change sexual orientation? No. . . . [H]omosexuality is not an illness. It does not require treatment and is not
changeable” (American Psychological Association, 2005). This absolute assertion that sexual orientation is
immutable is notable in light of the dozens of older published studies suggesting significant change by some
through psychotherapy or religiously-mediated methods (Jones & Yarhouse, 2007, p. 77ff). Claims like that of the
American Psychiatric Association that “[T]here is no published scientific evidence supporting the efficacy of
‘reparative therapy’ as a treatment to change one’s sexual orientation” (American Psychiatric Association, 2005)
are questionable in light of such studies.
On what basis has immutability been asserted in light of prior published research claiming such change?
Anecdotes of failed change (by “ex-ex-gays”) have contributed to pessimism about the possibility of real change.
The dismissal of past research as rooted in homophobic bias has served as an effective ad hominem argument that
has undermined the credibility of this research. Further, there has been a steady decline of such published studies in
the last several decades as the professional political climate has made such research professionally threatening,
research funding and other support for such research has evaporated, and as the mental health professions have
increasingly accepted various sexual orientations.
The methodological rigor of this older research also has been challenged. The public affairs website of the
American Psychological Association (2005) long stated that “claims [of orientation change] are poorly
documented. For example, treatment outcome is not followed and reported over time as would be the standard to
test the validity of any mental health intervention.” Beyond the lack of longitudinal follow up, prior studies have
been criticized for utilizing obscure or idiosyncratic measures of sexual orientation change, for relying on therapist
ratings rather than hearing directly and objectively from the subjects themselves, and for utilizing reports from
memory of past feelings rather than sampling subjects prospectively. The present study was designed to address
those weaknesses of previous studies by studying attempted change longitudinally and prospectively via
standardized self-report measures . In some important ways, our study resembles the respected decade-long study
by Lisa Diamond (2007; 2008) of a group of 89 non-heterosexual women. Where our study differs from hers most
distinctly was that her sample was not seeking deliberate change in their experience of sexual attraction (though
some did report significant change), while our sample all sought such change.
There are two sets of methods employed today by those seeking change in sexual orientation: One set of
methods involves professional psychotherapy. These methods are often called reorientation or conversion therapies.
Independently, there are religious ministries of various kinds that use a combination of spiritual and psychological
methods to seek orientation change. Our study addresses the generic questions of whether sexual orientation is
changeable, and whether the attempt is intrinsically harmful, by focusing only on the religiously mediated
approaches to change; this is not a study of professional psychotherapy. Our hypotheses for this study were taken
directly from the prevailing professional wisdom: We hypothesized 1) sexual orientation is not changeable, and 2)
the attempt to change is likely harmful. We already cited the American Psychological Association’s (2005) claim
that sexual orientation “is not changeable.” Regarding harm, our study was framed in light of the American
Psychiatric Association’s (1998) claim that the “potential risks of ‘reparative therapy’ are great, including
depression, anxiety and self-destructive behavior.” The tools of scientific study are ideally suited to investigate
empirically such strong, even absolute claims.
We studied a group of men and women seeking sexual orientation change through a religious ministry
organization called Exodus. Exodus International (2007) is a worldwide, interdenominational, “Christian
organization dedicated to equipping and uniting agencies and individuals to effectively communicate the message
of freedom from homosexuality.” It is the largest umbrella organization for Christian ministries to people
experiencing unwanted sexual attraction or sexual identity concerns. Exodus seeks to articulate a Christian
perspective that neither rejects homosexual persons nor embraces “gay” identity as an acceptable norm. Exodus-
affiliated ministries seek to help individuals troubled by their sexual orientation to achieve “freedom from
homosexuality through the power of Jesus Christ” (Exodus, 2007).
Ex-Gays? APA 2009
The methods used to seek change are diverse. Most Exodus-affiliated ministry groups rely on small groups
as the primary intervention setting, and the typical methods of intervention are worship, prayer, education and
discussion. Some Exodus groups have structured curricula, while others are more unstructured. A variety of
additional services are provided through specific groups, including residential programs; seminars; individual,
couple and family therapy; support groups for family members; and written materials. Success is defined differently
by different programs. Some focus primarily on one’s relationship with God and others, including freedom from
codependence in relationships. Other programs define success in behavioral terms, including what it means to
achieve celibacy and chastity, while others are concerned with change of thoughts, fantasies and feelings which are
seen as leading to change of sexual orientation. The motives behind the various ministries are grounded in the
traditional Christian moral teaching disapproving of homosexual conduct.
Funding for this study was provided by two grants from Exodus; we accepted this funding pledging that we
would report publicly the results of our outcome study regardless of how encouraging or embarrassing Exodus
might find those results. Further, we would also disclose that we share roughly the same basic set of religious
commitments as articulated by Exodus, but do not regard that as constituting bias. Researchers in this area often
have “positions” on any number of value issues of relevance to their research, and yet competently execute their
methodologies and honestly report their findings (Jones & Yarhouse, 2007).
We conducted a prospective, longitudinal study of individuals seeking sexual orientation change using
respected self-report measures of sexual orientation and of psychological distress. This is the most rigorous
longitudinal methodology ever applied to this question of sexual orientation change and possible resulting harm.
This is a naturalistic, quasi-experimental study following subjects pursuing change via methods available in their
community, and hence we had no capacity to standardize or otherwise control intervention methods, and our ability
to establish rigorous standards for timing of assessments was limited. Use of this quasi-experimental method
maximizes external validity while necessarily compromising certain aspects of internal validity and rigor. Such a
quasi-experimental methodology is adequate to address the stark hypotheses of the study, it does not allow,
however, for rigorous examination of more sophisticated hypotheses such as predictors or probabilities of change,
or differential effectiveness of change strategies.
Over half of our sample completed their Time 1 assessment when they had been involved in their specific
Exodus ministry for less than a year; these individuals are denoted as “Phase 1” subjects in this study. Because of
the challenges we faced in building a large enough subject sample, we enrolled a second group of subjects into the
study, those who had been involved in Exodus for one to three years when they were first assessed for our study
(denoted Phase 2 subjects). Because enrollment of subjects for the Time 1 assessment involved a challenging
process of managing contact with 16 Exodus ministries around the U.S., the time delay between T1 and T2 varied
from as short as 8 months to as long as 24 months. The gaps between subsequent assessments were more
standardized, approximating a 12 month period between assessments. Thus, the total elapsed time between T1 and
T6 varied from 6 to 7 years.
T1 assessments were conducted as face-to-face interviews, with many crucial measures administered as
paper-and-pencil “Self-Administered Questionnaires” and mailed to our research office without interviewers seeing
the responses according to best practices standards (following Laumann, et al, 1994). We switched entirely to
phone interviews and Self-Administered Questionnaires by the T3 assessment because of increasing subject
Previous studies of change have been criticized for using unvalidated and/or idiosyncratic measures of
sexual orientation. While a valid concern, this criticism also presumes two things that are highly problematic: 1)
that a stable consensus exists around a single definition of sexual orientation, and 2) that there exists a consensus
about reliable and valid ways to assess it. There is no such consensus definition of sexual orientation, and no
accepted, singular method to assess it. We will report here on the results that emerge from our use of two scales.
First, we used the seven point self-report Kinsey scale (1948), originally scaled from 0, exclusively
heterosexual, through 3, equally heterosexual and homosexual, to 6, exclusively homosexual (we shifted the scaling
to a seven point scale from 1, exclusively heterosexual, to 7, exclusively homosexual). We report two variations of
the Kinsey: 1) the Kinsey 1-item was the original version asking subjects to describe the population of individuals
with which one had had sexual relations (behavior), and 2) a Kinsey Expanded scale that is the average of four
Kinsey ratings of behavior, sexual attraction, emotional/romantic attraction, and fantasy.
Second, we used the Shively and DeCecco (1977) scale, which is based on conceiving heterosexual and
homosexual attraction to be separate and orthogonal (rather than on a single continuum as for the Kinsey scale).
Ex-Gays? APA 2009
Thus, the Shively and DeCecco scale is composed of four questions that ask for a five-point rating of physical
sexual attraction to men and separately to women, and of emotional attraction to men and separately to women. The
result is separate ratings (from 1, none, to 5, exclusively) for homosexual and heterosexual orientation.
To test our hypothesis that the attempt to change sexual orientation would result in increased psychological
distress, we used a respected measure of subjective distress, the 90-item Symptom Check List-90-Revised (SCL-
90-R; Derogatis, 1994). We took as our hypothesis that scores on the SCL-90-R should show significant movement
toward worsened functioning or psychological status as a result of Exodus involvement. The SCL-90-R is a strong
measure for longitudinal use in both research and clinical settings (Derogatis, 2000; Ambrose, Button, & Ormrod,
1998; Bruce & Arnett, 2008). We will report here on the SCL-90-R’s Global Severity Index (GSI), a reliable
composite measure of the number of symptoms and intensity of distress.
Retention. We began with 98 subjects at T1. Our sample eroded to 73 at T3, a retention rate of 74.5%. This
retention rate compares favorably to that of respected longitudinal studies.
63 subjects were interviewed or categorized at T6, for a T1 to T6 6 to 7 year retention of 64%.
Sample characteristics. At Time 1 our sample included 72 men and 26 women. They are highly educated,
with 56.1% having finished college and 26.5% having completed some graduate training. They reported a high
level of religious involvement, with 50% attending religious services weekly or nearly every week, and 36.7%
attending more than once a week. When asked “Would you say you have been ‘born again?’” 91.8% said yes.
Minimum age for inclusion in this study was 18, but the youngest subject was 21 at T1. The average age was 37.50
years old. This average was older than we had expected, and its significance should be underscored. There is an
unflattering caricature that Exodus groups appeal primarily to young, naïve, confused and sexually inexperienced
individuals. Such individuals might also be expected to have more optimistic possibilities for sexual orientation
change, with older, more sexually experienced persons having more pessimistic expectations for change. This
sample was older than the caricature, and more sexually experienced.
Among the 72 male subjects, only 16.7% had not had sex with another man as an adult, and one-third of the
male sample had had sex with 30 or more other males. About half of the men had never had sex with a woman, and
overall the experience of the male sample of sex with women was considerably less than their experience with male
partners. Of the 25 women who gave us meaningful data, only 8% had not had sex with another woman as an adult;
80% of the female sample, had had sex with one to nine other females. The women were less sexually experienced
with men than with women; 28% had never had sex with a man.
Two subpopulations. We report our analyses on the experimental population as a whole, but also
conducted every analysis on two subpopulations. First, we designated as the Phase 1 subpopulation the 57 subjects
(out of the total 98 at T1) who had been in the change process for less than one year at the T1 assessment. These
were the individuals who best met our standards for making the study truly prospective by starting our assessments
with them as early as possible in the change process. We expected that the results of change would be somewhat
less positive in this group, as individuals experiencing difficulty with change would be likely to get frustrated or
discouraged early on and drop out.
The second subpopulation was formed to address a frequent criticism of claims of sexual orientation
change that anyone who really has changed must not have really been “truly gay” to start with, but rather to have
been bisexual. To examine this claim, we developed a set of empirical markers to define a “Truly Gay”
subpopulation. These subjects scored above the scale midpoint at T1 for measures of homosexual attraction, and for
homosexual behavior in the past, and for having previously embraced full homosexual or gay identity. We expected
that the results of change for the Truly Gay subpopulation would be less positive, as these individuals would be
those more stable in their sexual orientation.
Quantitative analysis of sexual orientation outcomes. We report mostly simple t-tests and Cohen d
estimates of effect size. We have heard some criticism of our prior report (Jones & Yarhouse, 2007) for failure to
report more sophisticated statistical analyses (such as regression analyses) of these data. We do not believe such
analyses appropriate for these data given the quasi-experimental nature of the study with less control over timing of
assessments. We believe the design of the study and our statistical analyses to be adequate to address the core
hypotheses. The design is not adequate for more nuanced research questions about exactly how such change comes
about. This latter question would require a more tightly controlled study.
In simplifying this study for verbal presentation, we report only the T1 to T6 findings for some of our
quantitative measures. To aid in the interpretation of these findings, we have adopted the convention of reporting
mean differences and thus the Cohen d effect sizes with a positive valence when the shift is in the direction of less
Ex-Gays? APA 2009
homosexual orientation or more heterosexual orientation, or in the case of SCL scores when the shift is toward less
psychological distress. In contrast, mean differences are reported with a negative valence (-) when the shift is in the
direction of more homosexual orientation or less heterosexual orientation, or in the case of SCL scores when the
shift is toward more psychological distress.
Looking at the Kinsey scores in Table 1, for the whole population we see that the T1 to T6 comparisons for
both Kinsey variables were significant and of moderate effect size indicating average movement away from
homosexual orientation. For the Phase 1 or rigorously prospective subpopulation, these comparisons did not attain
significance. For the Truly Gay subpopulation, the T1 to T6 comparisons were significant and of moderate effect
size indicating average movement away from homosexual orientation. The changes reported here for the whole
population and the Truly Gay subpopulation appear to be respectably large changes compared to other studies of,
for instance, drug effects or the results of psychotherapies. These effect sizes assume considerably more
significance in light of the fact that we are reporting change on a dimension of human functioning that is supposed
to be immutable.
Table 1: Kinsey Scores (scaled 1 [exclusively heterosexual] to 7 [exclusively homosexual]) for Three Populations
Whole Population (N)
1. Kinsey 1-item Time 1 to 6 (61) 5.03 4.20 0.84
2. Kinsey Expanded Time 1 to 6(62) 4.97 4.42 0.55
Phase 1 Subpopulation (N)
3. Kinsey 1-item Time 1 to 6 (29) 4.52 4.72 -0.21
4. Kinsey Expanded Time 1 to 6 (29) 4.87 4.83 0.04
Truly Gay Subpopulation (N)
5. Kinsey 1-item Time 1 to 6 (35) 5.60 4.37 1.23
6. Kinsey Expanded Time 1 to 6 (36) 5.56 4.67 0.89
The Shively and DeCecco (S-D) scale obtains separate ratings of heterosexual and homosexual orientation.
The S-D results in Table 2 indicate some average change in the direction intended by the Exodus process,
specifically, movement toward less homosexual attraction and toward more heterosexual attraction. For the whole
population, the T1 to T6 change away from homosexual attraction attained significance and moderate effect size,
while the change toward heterosexual attraction did not attain significance. Neither of the T1 to T6 changes attained
significance for the Phase 1 subpopulation. For the Truly Gay subpopulation, the T1 to T6 change away from
homosexual attraction attained significance and a large to moderate effect size, while the change toward
heterosexual attraction attained significance and a moderate effect size. Note that changes away from or the
diminishing of homosexual orientation appear of larger absolute magnitude than changes toward heterosexual
orientation. It would appear, then, that while change away from homosexual orientation is related to change toward
heterosexual orientation, the two are not identical processes.
The general picture that emerges from these data is that on a number of standardized measures of sexual
orientation, this population experienced statistically significant change away from homosexual orientation. Results
reported here for the Phase 1 subpopulation (those in the change process for less than one year at the Time 1
assessment) were nonsignificant. Our most surprising single finding, and one that is replicated over several
different measures, is that the Truly Gay subpopulation population experienced more significant change.
t score 2-
Ex-Gays? APA 2009
Table 2: Shively and DeCecco (S-D) Ratings for the Three Populations
t score 2-
Whole Population (N)
1. S-D Heterosex Time 1 to 6 (62)
2. S-D Homosex Time 1 to 6 (62)
Phase 1 Subpopulation (N)
3. S-D Heterosex Time 1 to 6 (29)
4. S-D Homosex Time 1 to 6 (29)
Truly Gay Subpopulation (N)
5. S-D Heterosex Time 1 to 6 (36)
6. S-D Homosex Time 1 to 6 (36)
Outcomes for harm. Following prevailing professional wisdom, our hypothesis was that involvement in the
orientation change process should result in worsening psychological distress outcomes on average on the SCL-90-
R. Our analysis yielded no support for this hypothesis. The global severity index or GSI did not show any
indication on average of increasing psychological distress. The results in Table 3 do manifest significant changes
for the whole and Truly Gay subpopulations, both in the moderate effect size range, and both indicating improved
Table 3: Symptom Checklist-90 (SCL-90) General Severity Index (GSI), Positive Symptom Distress Index (PSDI),
and Positive Symptom Total (PST) Scores for the Three Populations by Non-Patient Norms
Whole Population (N)
1. SCL GSI Time 1 to 6 (59) 57.86 54.22 3.64 10.04
Phase 1 Subpopulation (N)
2. SCL GSI Time 1 to 6 (27) 59.00 55.81 3.19 11.28
Truly Gay Subpopulation (N)
3. SCL GSI Time 1 to 6 (36) 58.75 53.72 5.03 10.91
We then examined a more rigorous hypothesis. Recognizing that some might hypothesize that the
increasingly good mental health of those who had embraced gay identity might be masking (by averaging out) the
decaying mental health of those seeking change, we analyzed our data again including only those subjects who
reported continuing down the path of sexual orientation change at T6 by either reporting themselves to be in one of
the two qualitative success categories or to be continuing the change process despite limited success. If the attempt
at the change process was going to be harmful, this harm should show up among those continuing to pursue change
over a period of six years or more years. Contrary to these expectations, we found no evidence of movement toward
increased distress on average as a result of Exodus involvement. Table 4 shows that the GSI scores moved toward
less distress T1 to T6, attaining significance and a moderate to small effect size.
Table 4: Symptom Checklist-90 (SCL-90) General Severity Index (GSI), Positive Symptom Distress Index (PSDI),
and Positive Symptom Total (PST) Scores for the Three “Success/Continuing” Populations by Non-Patient Norms
Mean Mean Diff.
1. SCL GSI Time 1 to 6 (40) 55.90 52.88 3.03
Time 6 Mean Std.
t score 2-tailed