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Sexual Orientation Change Efforts Through Psychotherapy for LGBQ Individuals Affiliated With the Church of Jesus Christ of Latter-day Saints

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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.
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Sexual Orientation Change Efforts
Through Psychotherapy for LGBQ
Individuals Affiliated With the Church of
Jesus Christ of Latter-day Saints
Kate Bradshawa, John P. Dehlinb, Katherine A. Crowellc, Renee V.
Galliherb & William S. Bradshawd
a English Department, Dartmouth College, Hanover, New Hampshire,
USA
b Department of Psychology, Utah State University, Logan, Utah, USA
c Department of Psychology, Pacific Lutheran University, Tacoma,
Washington, USA
d Department of Microbiology and Molecular Biology, Brigham Young
University, Provo, Utah, USA
Accepted author version posted online: 09 May 2014.Published
online: 13 Jun 2014.
To cite this article: Kate Bradshaw, John P. Dehlin, Katherine A. Crowell, Renee V. Galliher & William
S. Bradshaw (2014): Sexual Orientation Change Efforts Through Psychotherapy for LGBQ Individuals
Affiliated With the Church of Jesus Christ of Latter-day Saints, Journal of Sex & Marital Therapy, DOI:
10.1080/0092623X.2014.915907
To link to this article: http://dx.doi.org/10.1080/0092623X.2014.915907
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JOURNAL OF SEX & MARITAL THERAPY, 0(0), 1–22, 2014
Copyright C
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ISSN: 0092-623X print / 1521-0715 online
DOI: 10.1080/0092623X.2014.915907
Sexual Orientation Change Efforts Through Psychotherapy
for LGBQ Individuals Affiliated With the Church of Jesus
Christ of Latter-day Saints
Kate Bradshaw
English Department, Dartmouth College, Hanover, New Hampshire, USA
John P. Dehlin
Department of Psychology, Utah State University, Logan, Utah, USA
Katherine A. Crowell
Department of Psychology, Pacific Lutheran University, Tacoma, Washington, USA
Renee V. Galliher
Department of Psychology, Utah State University, Logan, Utah, USA
William S. Bradshaw
Department of Microbiology and Molecular Biology, Brigham Young University, Provo,
Utah, USA
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, many of whom engaged in psychotherapy to cope
with (i.e., 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. Results 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.
Affirmative psychotherapy is the predominant modern stance in serving lesbian, gay, bisexual,
or questioning (LGBQ) individuals (Chung, Szymanski, & Markle, 2012), an approach that is
Address correspondence to William S. Bradshaw, Department of Microbiology and Molecular Biology, Brigham
Young University, Provo, UT 84602, USA. E-mail: groverclan@q.com
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2BRADSHAW ET AL.
based on increasing awareness in psychology and the broader culture of the substantial strains
such individuals experience in their heteronormative contexts. Psychotherapy that focuses on
fostering self-acceptance and increasing a sense of empowerment for such persons (e.g., Butler,
2010; Ross, Doctor, Dimito, Kuehl, & Armstrong, 2007) is strongly supported by most major
mental health organizations (e.g., American Medical Association, 2011; American Psychological
Association, 2011; National Association of Social Workers, 2012).
An older, more controversial approach promoted sexual orientation change. A recent review
outlines the challenge of verifying change and provides recommendations for offering beneficial
therapeutic assistance when it is not forthcoming (Beckstead, 2012). Evidence suggests that
programs aimed at altering orientation lack evidence for effectiveness and may produce harmful
outcomes (e.g., American Psychological Association, 2012; Just the Facts Coalition, 2008).
The Pan American Health Organization (2012) recently issued a position statement (“Cures”
For An Illness That Does Not Exist) concluding that “purported therapies aimed at changing
sexual orientation lack medical justification and are ethically unacceptable” (p. 1). Nevertheless,
reparative therapy advocates continue to promote its use (National Association for Research and
Therapy of Homosexuality, 2009, 2012a), tout claims of success (Dahle et al., 2009; Nicolosi,
Byrd, & Potts, 2000), and repudiate evidence to the contrary (Jones, Rosik, Williams, & Byrd,
2010).
In a recent defense of reorientation therapy, Jones (2012) identified what he described as “false
beliefs” (p. 3) espoused by opponents of reparative or conversion therapies: the assumption that
same-sex relationships are equivalent to heterosexual marriages in all important characteristics,
that being gay is just as healthy as being heterosexual, and that sexual orientation is not a willful
choice. Proponents of reorientation therapy thus strongly discount biological evidence (LeVay,
2011), and espouse instead social or psychological explanations, those assumed to have the
greatest probability of being reversed through therapeutic efforts (Abbott & Byrd, 2009; Dahle
et al., 2009; Jones, 2012; National Association for Research and Therapy of Homosexuality,
2010).
The line of reasoning that emerges begins with the assertion that LGBQ individuals are
intrinsically inferior to those who are heterosexual—an opposite-sex orientation being the only
natural and therefore legitimate human state. This view is often defended on religious grounds and
is based (for Christians) on a Biblical literalism that condemns same-sex behavior as a reflection
of disapproval by deity. Tozer and Hayes (2004) showed that many individuals who hold religion
as a central organizing principle in their lives, and who are orthodox in their denominations,
have a propensity to seek conversion therapy, which is driven by accompanying internalized
homonegativity. In this perspective, a transition to heterosexuality is not only warranted but also
required.
Proponents of reorientation therapy must deal with the professional consensus that evidence for
meaningful change is lacking (American Psychological Association Task Force on Appropriate
Therapeutic Responses to Sexual Orientation, 2009). They counter by asserting bias on the
part of members of the American Psychological Association Task Force, contending that the
standards used in reviewing the published literature were artificially elevated and unreasonable,
and arguing that if studies claiming change are flawed by methodological inadequacies, then
so are those studies claiming that therapy may have harmful consequences (Jones et al., 2010).
Spitzer (2003), whose work was widely cited as evidence that change is a valid outcome for
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SEXUAL ORIENTATION CHANGE EFFORTS 3
some individuals, has repudiated his claims and now takes the position that the self-reports of
his participants were not sufficient indications of actual alterations in sexual orientation (Arana,
2012; Spitzer, 2012).
Psychotherapy Among LGBQ Latter-day Saints
Members of the Church of Jesus Christ of Latter-day Saints (LDS; also known as Mormon)
who identify as having a same-sex attraction constitute an ideal population in which to in-
vestigate orientation change efforts. In this denomination, theology, a hierarchical institutional
organization, and uniform instruction come together to strongly promote a traditional hetero-
sexual expectation. The nuclear family headed by married male and female parents, both now
and in the life to come, is at the heart of Mormon doctrine (First Presidency and Council of
the Twelve Apostles of the Church of Jesus Christ of Latter-day Saints, 1995). Messages from
ecclesiastical leaders are disseminated worldwide from semiannual General Conferences, in offi-
cial church magazines, and from letters read in every local congregation. Instructional materials
produced in hundreds of languages for auxiliary organizations (for children, youth, and adult
men and women) reinforce the heterosexual family-centered emphasis in the religion. As a re-
sult, LDS members who are LGBQ face intense internal conflict related to integration of their
religious and sexual identities (Dahl & Galliher, 2012; Dehlin, Galliher, Bradshaw, & Crowell,
in press), which is manifested for many in concentrated, dedicated efforts to change their sexual
orientation.
Even though the LDS Church does not formally endorse any particular therapeutic approach for
unwanted same-sex attraction (Oaks & Wickman, 2006), it has supported Evergreen International,
a lay organization committed to helping people “who want to diminish same-sex attractions
and overcome homosexual behavior” (Evergreen International, 2010). This was also the earlier
perspective taken by LDS Family Services, the support agency to which many LDS ecclesiastical
leaders refer LGBQ church members (LDS Social Services, 1995). LDS Family Services no
longer promotes sexual orientation change, but it focuses more broadly on therapeutic outcomes
that permit individuals to maintain full fellowship in the church. Most nonofficial publications on
the subject of homosexuality directed at LDS readers promote sexual reorientation. For example,
Abbott and Byrd (2009, p. 3) advocated using the term sexual preference instead of sexual
orientation, given that the former “implies both choice and change,” and argued that “change
is achievable, though difficult” (p. 76). Robinson (2009) claimed that orientation change can
occur through recognition that homosexuality is a cultural construct. Byrd (2009) reiterated his
contention that “some people can and do change” (p. 168; but see the criticisms by Bradshaw,
2011). Scharman (2009) echoed the view that “real and lasting change” (p. 210) has been achieved
through counseling and spiritual means. These observations suggest that LDS members who are
LGBQ would provide an ideal population in which to assess the outcomes of therapist-assisted
sexual orientation change efforts.
Research Questions
This study reports selected results from an online survey of a large sample of LGBQ individuals
who are or had previously been affiliated with the LDS Church. We have reported elsewhere the
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4BRADSHAW ET AL.
sexual orientation change efforts of this population broadly across nine different interventions
(including private, religious, professional, and informal group approaches; Dehlin, Galliher,
Bradshaw, Hyde, & Crowell, 2014) but focus in detail here on data relevant to psychotherapy.
We addressed the following research questions:
1. What were the psychotherapy experiences of same-sex oriented LDS individuals? How
frequent was change identified as an explicit goal? What were the positive and negative
outcomes?
2. As a result of psychotherapeutic change efforts, how many reported an alteration in their
core erotic attractions, and what was the qualitative nature of such change?
METHOD
Participants
The complete sample consisted of 1,612 persons who took part in an online survey and met
eligibility requirements: (a) 18 years of age, (b) a history of same-sex attraction, (c) a history of
LDS Church membership, and (d) completion of a majority of survey items. Twenty-three persons
who failed to meet criteria were excluded. The mean age of participants was 36.9 years (SD =
12.58) and 24.1% (n=387) were women. The majority identified as White (n=1,544; 95.3%)
and resided in the United States (n=1,515; 94%). The U.S. geographical distribution of the
sample (all but two states were represented) closely mapped the LDS population in the country
(MormonHaven, n.d.). Most participants were highly educated (n=1,002, 62.2%, reported
college degrees or graduate/professional degrees). The percentage of participants in various
income brackets was almost identical to the estimate for the LDS population in the United States
(Pew Forum, 2011).
The subsample for the present study comprised 898 individuals (56%; 197 women and 700
men) who indicated they had engaged in psychotherapy (“talk therapy with a licensed mental
health professional in an attempt to understand, cope with, or change your sexual orientation”).
Of the 898 psychotherapy participants, 30 did not respond to a group of secondary questions
(e.g., age of onset of therapy, duration, goals of therapy), resulting in a reduced data set of 672
men and 194 women for primary analyses related to psychotherapy processes and outcomes.
Because some items were not relevant for some participants (e.g., a participant had not had
a particular psychotherapy experience being assessed), there is slight variation in sample size
across analyses. Additional demographic characteristics for the psychotherapy subsample of n=
898 are reported in Table 1. Women were more likely than men were to report sexual orientation
labels that denoted sexual fluidity (e.g., bisexual, queer, pansexual), whereas men were more
likely to report sexual orientation labels that denoted strong attraction to only one sex (e.g., gay,
heterosexual), χ2(7, n=878) =64.09, p<.001. Women also reported both greater variability
and more mid-scale scores (indicating bisexuality) than did men for all Kinsey scales: sexual
behavior–women M=3.70, SD =1.97; men M=4.63, SD =1.92, t(855) =–5.85, p<.001;
sexual attraction–women M=4.33, SD =1.63; men M=5.18, SD =1.25, t(866) =–7.72, p<
.001; sexual identity–women M=4.42, SD =1.98; men M=4.93, SD =1.88, t(845) =–3.17, p=
.002.
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SEXUAL ORIENTATION CHANGE EFFORTS 5
TABLE 1
Demographic Characteristics of the Psychotherapy Subsample at the Time of Survey Completion
Men (n=700) Women (n=197)
n%n%
Age (years), M(SD) 38.8 (12.66) 35.0 (11.06)
Sexual orientation
Lesbian 116 58.9
Gay 576 82.2 6 3.0
Bisexual 68 9.7 46 23.4
Heterosexual 28 4.0 10 5.1
Attracted to same sex 15 2.1 0 0
Other 13 1.9 19 9.6
Kinsey Scale scores, M(SD)
Behavior 4.63 (1.93) 3.75 (2.00)
Attraction 5.18 (1.25) 4.36 (1.65)
Identity 4.93 (1.88) 4.48 (2.00)
Marital status
Single 285 41.5 69 37.7
Heterosexual marriage 114 16.6 20 10.9
Legal same-sex relationship 96 14.0 23 12.6
Committed, nonlegal
same-sex relationship
148 21.5 58 31.7
Divorced or separated 44 6.4 13 7.1
LDS Church status
Active 206 30.8 36 18.8
Inactive 209 31.3 78 40.8
Disfellowshipped 31 4.6 5 2.6
Excommunicated 60 9.0 9 4.7
Resigned 162 24.2 63 33.0
LDS =Latter-day Saints.
Measures
The survey, titled “Exploration of Experiences of and Resources for Same-Sex Attracted Latter-
day Saints,” contained 149 items and took participants, on average, more than 1 hr to com-
plete. The larger survey contained a number of measures of psychosocial well-being and sexual
identity–related minority stress that were not used in this study. Items developed by the authors,
on the basis of a careful review of the literature, assessed sexual identity developmental his-
tory; ratings of sexual attraction, behavior, and identity using the Kinsey 7-point rating scales
(i.e., 0 =exclusively heterosexual to 6 =exclusively homosexual); past and present attitudes
about LGBQ issues; childhood history (including abuse); perceptions about the causes of ho-
mosexuality; personal religious experiences relative to sexual orientation; and experience in and
affiliation with the LDS Church. An analysis of missing data for the descriptive and psychosocial
variables used in this study (sex, age, relationship status, LDS Church status, sexual orienta-
tion, Kinsey scores) revealed that 242 of the 899 cases (26.9%) contained at least some missing
data, and 344 of the 10,788 fields overall (3.2%) were left blank. Because previous attempts to
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6BRADSHAW ET AL.
use multiple imputation analyses with these data generally failed to change statistical signifi-
cance levels (Dehlin, Galliher, Crowell, Hyde, & Bradshaw, 2014), the original data have been
maintained.
Most relevant for the present study, participants were asked to complete an in-depth exploration
of nine intervention efforts that they might have undertaken in an effort to “understand, cope
with, or change same-sex attraction.” These interventions appeared in the following order in
the survey: individual effort, personal righteousness, psychotherapy, psychiatry, group therapy,
retreats, support groups, ecclesiastical counseling, and family therapy. The present study focused
narrowly on the experiences of participants who reported that they had engaged in psychotherapy
(psychotherapy, third in that list). In addition to their involvement in psychotherapy, these persons
reported being engaged in an average of 3.7 additional interventions.
Individuals who reported prior involvement in psychotherapy were directed to a second set of
items assessing the following details:
1. Age when first beginning therapy
2. Duration of therapy
3. An indication of goals and relevant issues going into therapy (i.e., depression, anx-
iety, eating, family, friends, partner, work/school, anger, or substance abuse, and
change/acceptance/ understanding of their sexuality)
4. An indication of what issues were actually addressed during the course of therapy (same
options as in the previous item)
5. A rating of the overall effectiveness of psychotherapy using a scale from 1 (highly
effective)to5(severely harmful)
6. The opportunity to provide a written narrative in which to describe their experiences in
detail; the length and content of these responses seem to reflect that the survey was a
needed cathartic release for many
Procedures
This study was approved by the Institutional Review Board of Utah State University. Following
guidelines established for internet research (Michalak & Szabo, 1998), it was administered online
and was advertised on a number of websites and globally through an Associated Press news
story and several online news sources (e.g., KSL.com, an LDS Church-owned site). Among the
participants, 21% indicated that they heard about the study through online and print publications
(e.g., Huffington Post,Salt Lake Tribune). An equal number reported that they learned of the
study through LDS-affiliated LGBT support organizations (e.g., http://affirmation.org, http://
northstarlds.org, http://mormonstories.org, http:// LDS Family Fellowship.org) covering a full
spectrum of religious and political views. Only one group, Evergreen International, refused
invitations to advertise it. Another 5% learned of the study from nonreligious LGBT support
organizations (e.g., Equality Utah, Salt Lake City Pride Center), and 47% indicated they had been
recruited through word of mouth, e-mail, or social media. The survey was available online from
July 12 through September 29, 2011. Participants provided informed consent and certified that
they had taken the survey only once.
For the method of coding written responses see the Online Appendix and Note, Figure 1.
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SEXUAL ORIENTATION CHANGE EFFORTS 7
0
5
10
15
20
25
30
35
Percentage
Males Females
No Change Change Undetermined
FIGURE 1 Assessment of sexual orientation change efforts. Narratives relating 720 participants’ sexual orientation
change efforts in psychotherapy were cataloged using the following criteria: (a) an explicit statement that no change
occurred; (b) a statement that a goal of orientation change had been replaced by a goal of acceptance; (c) that a change
had not occurred was inferred using additional information besides the narrative; (d) a statement that change had not
occurred was retrieved from narratives directed at other interventions; (e) a statement to the effect that the decision
that orientation could or should not be changed was made before therapy began; (f) an indication of some modification
of sexual orientation; (g) sexual orientation was not addressed by the client or therapist during counseling; and (h)
information inadequate to make a decision relative to orientation change. Participants included 566 men, 152 women,
and 2 did not declare their sex.
RESULTS
Sexual Identity Development and Religious Histories
Table 2 reports the average age at which men and women reported a number of sexual development
milestones. All sex differences were statistically significant (tvalues range from 2.12 to 7.52; p
values ranged from .034 to .001), with men achieving all developmental milestones at a younger
age than women. Milestone values were dependent on the current age of the participants; in the
cohort of those ages 18–29 years, the average times for telling someone else and self-labeling, in
both sexes, were 3–5 years earlier than for the entire group.
Of participants, 84.9% were born in an LDS family, while the remainder converted to the
LDS faith. All participants had been baptized in the LDS Church, but only 26.9% reported
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8BRADSHAW ET AL.
TABLE 2
Milestones in Sexual Identity Development
Age
Men Women
When did you first . . . MSDMSD
Sense a difference (feeling, attitudes, behavior) between yourself and others of
your same age and biological sex that you now attribute to your same-sex
sexual orientation?
8.81 3.9 11.00 6.2
Realize you were attracted romantically or sexually to persons of the same sex? 12.74 4.6 15.91 7.0
Have a same-sex romantic or sexual experience? 18.15 8.4 21.61 8.1
Tell someone of your same-sex attraction? 21.96 8.0 23.38 8.8
Label yourself gay, lesbian, bisexual, transgendered, questioning, queer, or
another label you have chosen for yourself?
22.28 8.6 24.51 8.8
currently attending church regularly. Of the participants, 45% resided in Utah at the time of
survey completion, relevant because of the possible effect on orthodoxy and religious practice of
residency in the state where the Church is headquartered.
Description of Psychotherapy Experiences
The age of onset of psychotherapy for men and women was similar, with a mean age for men of
25.13 years (SD =9.09 years) and for women of 24.34 years (SD =9.42 years), t(855) =−1.06,
p=.291. The average time spent in psychotherapy was 4.3 years (SD =5.6 years) for men
and 5.0 years (SD =6.1 years) for women, t(849) =1.59, p=.112. Length of psychotherapy
ranged from less than 1 month to 30 years, and about 15% of clients engaged in therapy for 10
to 30 years. The distributions for both onset and duration of therapy were skewed dramatically to
older ages and longer periods, indicating the persistence of homosexuality as an unresolved issue
for many.
Participants replied to the broad question, “How effective was this experience in meeting your
goals?” on a 5-point scale ranging from 1 (very effective)to5(severely harmful). On average,
participants described psychotherapy as “moderately effective,” although men reported higher
(less effective) scores (M=2.40, SD =1.12) than women (M=2.06, SD =0.96), t(852) =–3.81,
p<.001. About 38% (n=266) of men and 27% (n=52) of women reported therapy as not
effective or harmful (scores of 3–5). Table 3 more explicitly presents an evaluation of therapy de-
rived from four different approaches or models. Average ratings indicated that participants viewed
counselors who worked with individuals to clarify their own values and goals without setting
an agenda for either change or acceptance as most helpful. Both men and women rated efforts
aimed at orientation change with average scores greater than 3.0. Said differently, 80% of those
whose therapy focused on sexual orientation change efforts evaluated the experience as either
“not at all effective” (42%), “moderately harmful” (21%), or “severely harmful” (16%). Aversion
therapy, the practice of using aversive conditioning techniques to explicitly alter same-sex attrac-
tion, was viewed as the most harmful. Tests of gender differences were nonsignificant, with the
exception of evaluations of aversion therapy. Men described aversive conditioning techniques as
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SEXUAL ORIENTATION CHANGE EFFORTS 9
TABLE 3
Broad Descriptions of Goals and Outcomes of Psychotherapy Related to Sexual Orientation
Men Women
Therapist emphasis MSD n MSD n t df p
Change 3.25 1.08 393 3.40 1.10 63 <1.0 454 ns
Acceptance 1.74 0.92 317 1.63 0.84 103 1.05 418 ns
Client choice 1.58 0.87 416 1.56 0.97 131 <1.0 545 ns
Aversion 4.33 0.87 73 3.60 1.31 20 2.96 91 .004
Men Women
A priori goals Actually worked on A priori goals Actually worked on
Psychotherapy goals n%n%n%n%%
Change 387 57.6 330 49.1 47 24.2 37 19.1 19.1
Accept 178 26.5 219 32.6 50 25.8 64 33.0 33.0
Understand 247 36.8 255 37.9 65 33.5 71 36.6 36.6
Note. The survey question was “If you have participated in formal therapy or counseling, please identify any of the
following models of counseling (philosophy, ideology, conceptual framework) that was adopted by your counselor/s.
Using the scale below, please rate your experience of the model’s overall effectiveness in meeting your therapy goals: 0
=not applicable, 1 =highly effective, 2 =moderately effective, 3 =not at all effective, 4 =moderately harmful, and 5
=severely harmful.
significantly more harmful than did women. Sample sizes for these analyses varied, since only
participants who had engaged in therapy from a particular approach would respond to that specific
item.
Exploratory correlational analyses were conducted to assess for relations among therapy effec-
tiveness ratings and sexual development histories, religious variables, and therapy characteristics.
Correlations between the overall therapy effectiveness rating score and sexual development mile-
stones described in Table 2 were all very small (all rs<.10) or between therapy effectiveness
and therapy duration (r=.06) or age of onset (r=.15). However, current LDS affiliation was
linked to ratings of therapy effectiveness. Those no longer affiliated (i.e., excommunicated, dis-
fellowshipped, or resigned) were more likely than those who were still affiliated (i.e., active or
inactive in the church) to describe their therapy experiences as “severely harmful,” χ2(N=841,
df =8) =24.93, p=.02.
Participants selected from a list, all their a priori goals for therapy, as well as the concerns
that were actually addressed. The choices included depression, anxiety, family/peer/work issues,
anger problems, eating problems, and others. The most common issues worked on in therapy that
were not explicitly related to sexual orientation were depression (56.2%), anxiety (43.0%), and
family concerns (35.2%). Change, accept, or explore/understand were the three goals relative
to sexual orientation. Table 3 shows the number of men and women who selected change,
acceptance, and understanding as goals for therapy. Men (58%) were more likely than women
(24%) were to report that they entered therapy with the goal of sexual orientation change, χ2(n
=860, df =1) =67.88, p<.001, =.281, and to report that they actually worked on sexual
orientation change in therapy, χ2(n=868, df =1) =56.82, p<.001, =.256; men –n=330;
women –n=37. However, 80% of the total psychotherapy cohort (n=898) explicitly marked
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10 BRADSHAW ET AL.
change as a goal in one of the interventions in which they engaged, or indicated efforts to change
or pressure from their social contexts to change (e.g., from parents or ecclesiastical leaders) in
their written narratives. There were no significant sex differences in the proportions of men and
women who endorsed acceptance and understanding as goals for therapy. Also, the proportion
of participants who endorsed change as an a priori goal for therapy was larger for both men
and women than the proportion who endorsed change as an actual therapy activity, while the
reverse pattern was true for the goal of acceptance. This suggests that a number of participants
experienced a goal shift—from change to acceptance—as they engaged in therapy.
Analysis of Open-Ended Descriptions Related to Change
Effectiveness ratings were subject to important limitations. Many individuals had engaged in
multiple therapy efforts (at different times and with different therapists), which were not dif-
ferentiated in their overall rating scores. Our reading of the open-ended responses that ac-
companied the majority of the ratings demonstrated that the focus of what was or was not
effective varied widely among individuals. Some applied the score narrowly to sexual orienta-
tion change efforts. Others took a broader view of the beneficial or harmful aspects of therapy
overall.
A direct assessment of whether core sexual attraction was amenable to change through psy-
chotherapy was made by examining the content of the written descriptions provided by 83% of
the psychotherapy subsample (n=720). Each narrative was categorized using the coding scheme
described in the Online Appendix. The results are reported in Figure 1. Overall, 13.2% (n=
95) of the written reports were indeterminate, either because sexual orientation had not been
addressed during therapy or the reports did not contain sufficient information. The distribution
patterns for men and women were similar. However, a chi-square analysis revealed that although
men and women were equally unlikely to report sexual orientation change, men were more likely
than chance to explicitly state that no change occurred, and women were more likely to provide
indirect or indeterminate responses, χ2(7, n=718) =21.68, p=.003, V=.174. Overall, these
data showed that, across both sexes, where a determination could be made (n=624), 96.5%
indicated that a change in core sexual attraction had not occurred.
Details about the 22 individuals (4 women, 18 men) who indicated some modification of their
same-sex attraction are provided in Table 4. For both men and women, average age was in the early
40s but exhibited a wide range. Therapy was initiated on average in the early 20s and lasted (on
average) for many years. Mean duration of therapy was skewed upward for both men and women
by three participants whose therapy lasted 20 or more years. Most men (n=14) were married,
but all women were divorced or single. Therapy was given a positive average rating by both men
and women. Only four self-identified as being gay, and the remainder reported being bisexual,
having a same-sex attraction, or being heterosexual. The average Kinsey Scale score for attraction
for these 22 participants was at the midpoint of the scale. A two-point lower average score for
identity (vs. attraction) appears to reveal their reluctance regarding a homosexual designation.
Note that the standard used for accepting a “change” outcome was not stringent. In addition, the
comments included results other than an actual alteration of core same-sex attraction. Examples
included “. . . seeing that these temptations and thoughts do not define who I am” and “. . . a
decrease in my negative reaction to my same gender attraction.
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TABLE 4
Individuals Reporting Orientation Change
Kinsey scale Age when Duration of Therapy Current
Age Sexual Marital therapy started therapy effectiveness Narrative association with
Sex (years) orientation Behavior Attraction Identity status (years) (years) rating description LDS Church
Female 54 Heterosexual 5 5 0 Single 19 35 1 “While the
same-sex
attraction is still
stronger than
heterosexual
attractions, the
frequency and
intensity and
duration of those
attractions have
lessened.”
Active
Female 51 Bisexual 4 3 Divorced 46 1 2 “I feel like I have
been forgiven for
my sexual
behavior. I think
ofasamesex
relationship
every day but I
don’t act on it.”
Active
Female 31 Bisexual 1 2 2 Divorced 30 .2 2 “The chemistry
[SSA]
diminished and
eventually, I was
able to feel
attraction to men
again.”
Inactive
(Continued on next page)
11
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TABLE 4
Individuals Reporting Orientation Change
Kinsey scale Age when Duration of Therapy Current
Age Sexual Marital therapy started therapy effectiveness Narrative association with
Sex (years) orientation Behavior Attraction Identity status (years) (years) rating description LDS Church
Female 24 Heterosexual 0 3 0 Single 22 2 2 “My attraction to
women hasn’t
completely gone
away. But it has
improved
significantly.
Often times I
will go days
without thinking
about another
woman or the
fact that I am
attracted to
women.”
Active
Male 66 Bisexual 4 4 0 Married 58 9 1 “SSA attractions
have definitely
lessened but are
not difficult to
understand and
not act upon
them.”
Active
Male 58 Bisexual 2 4 1 Married 18 6 2 “Same sex
attraction
diminished, but
never went
away.
Active
12
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Male 57 Heterosexual 1 3 1 Married 20 20 1 “I have experienced
a significant
reduction in SSA
feelings.”
Active
Male 57 Bisexual 2 5 0 Married 35 3 2 “improved
relationship with
wife and
decreased
homosexual
activity.”
A
Male 53 Gay 6 4 5 Single 26 4 2 “I started
experiencing a
change and
control when I
attended support
groups.”
Excommunicated
Male 52 Gay 2 5 1 Married 16 20 1 “God has brought
about a mighty
change in my
heart that I have
no desire to be
sexual with
men.”
Active
Male 48 Gay 0 4 0 Married 29 1.5 2 “same-gender
attraction
diminished
substantially, and
heterosexual
attraction to
fianc´
ee/spouse
increased
significantly.
Active
(Continued on next page)
13
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TABLE 4
Individuals Reporting Orientation Change(Continued)
Kinsey scale Age when Duration of Therapy Current
Age Sexual Marital therapy started therapy effectiveness Narrative association with
Sex (years) orientation Behavior Attraction Identity status (years) (years) rating description LDS Church
Male 42 Heterosexual 0 1 0 Married 24 2 1 “My SSA is
dramatically
diminished and
different from
when I started. “
A
Male 41 Bisexual 2 1 0 Married 40 3 1 “helps me to change
some of how I feel
and the attractions
that I have.
Active
Male 37 Bisexual 2 3 Married 33 4 2 “[being true to my
wife] has driven
me to abstain from
sexual
relationships
outside of
marriage.”
Excommunicated
Male 36 Heterosexual 3 Married 26 .5 2 “everything changed
in very impossible
ways.”
A
Male 36 Heterosexual 0 1 0 Married 17 5 2 “relapses
[cross-dressing]
generally occurred
less and less
frequently until it
was finally in the
past.”
Active
14
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Male 31 Heterosexual 1 2 0 Married 22 6 1 “support me in my
journey of
change.”
Active
Male 29 Heterosexual 0 4 0 Married 26 3 1 “I am more attracted
to my wife and
have healthier
relationships with
heterosexual men.”
A
Male 29 Heterosexual 0 4 0 Single 26 2 1 “I have felt so much
strength from God
to control myself.”
Active
Male 28 Heterosexual 0 1 0 Married 18 2 1 “helpful in
overcoming my
behaviors and
seeing that these
temptations and
thoughts do not
define who I am.”
Active
Male 25 Same-sex
attraction
7 4 4 Single 20 5 1 “received much help
. . . working on my
same-sex
attraction.”
A
Male 22 Gay 7 4 5 Single 22 .6 1 “It has largely helped
me to increase my
attraction toward
women and
decrease my
negative reaction
to my same gender
attraction.”
Active
Male
aver-
age
42.5 2.1 3.2 1.1 26.4 5.4 1.4
Female
aver-
age
40.0 2.5 3.3 0.7 29.2 10.0 1.8
Note. SSA =same-sex attraction. LDS =Latter-day Saints Church. On the Kinsey scale, 7 =asexual. On the therapy effectiveness rating, 1 =highly effective and
2=moderately effective. For current association with LDS Church, A=active but with policy or doctrinal reservations or reduced private devotion.
15
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16 BRADSHAW ET AL.
Broad Beneficial and Detrimental Psychotherapy Outcomes
Our review of the written comments regarding psychotherapeutic experience documented a broad
range of potential benefits and harms ancillary to the goal of orientation change (Table 5). It is our
view that many participants welcomed this opportunity to share important, sometimes intimate,
details of their experience. Comments relative to psychotherapy averaged 68 words, but a number
were 300–500 words in length. Many found therapy to be a helpful, even life-saving experience.
To be able to talk to a knowledgeable professional about a very private concern was salutary.
Others reported improved relationships with family or other close associates. Of particular interest
was the large number of individuals who reported decreased levels of depression and anxiety and
improved feelings of self-worth. These outcomes were often linked to having accepted same-sex
attraction and explored ways to cope with or accommodate that reality. Consider the words of
one individual: “I learned to love myself because I was gay. To celebrate my uniqueness and what
I could bring to the world that was special.
For some participants, psychotherapy was clearly unrewarding. As a general rule, however,
experiences of harm or iatrogenic distress were much less frequent than reports of benefit. The
most salient examples of detrimental effects of therapy were the loss of self-esteem and loss of
religious faith associated with the failure to realize the promise extended by some therapists that
sexual orientation would change as a function of dedicated efforts in therapy.
We explored some things in regards to my family dynamics that were helpful. The idea, however,
was that those relationships contributed to my homosexuality and I dealt with some unhelpful anger
along the way, too. It was also another unsuccessful attempt to be straight. Failure to change while
getting professional help was hard to accept.
I attempted to “change” myself through righteous behaviors. However, when the attractions remained
despite how often I prayed, read scriptures, served others, attended church meetings, or was obedient,
I became more depressed and felt more distant from God and others.
DISCUSSION
Descriptions of Psychotherapy Related to Sexual Orientation
The data reported here suggest that reversing a nonheterosexual orientation is likely a major em-
phasis for those who experience same-sex attraction in the LDS community. Of our psychotherapy
cohort, 80% described sexual orientation change efforts as a central feature of their therapy-related
experiences, extending over a heterogeneous spectrum of private and professional approaches.
The average length of time spent in psychotherapy for those in our sample was 4.3 years for
men and 5.0 years for women. It is clear that many individuals were dealing with significant
issues associated with homosexuality that were not yielding to quick solutions. Consistent with
our findings, other reports have shown that LGBQ individuals tend to engage in psychotherapy
for longer periods than do their heterosexual counterparts (Liddle, 1997).
Entering therapy in the early- to mid-20s is consistent with classical developmental theory
(Erikson, 1968). In general, this is a stage characterized by the need to develop a sense of self
and personal identity and also by religious questioning, exacerbated almost certainly for LGBQ
persons in a highly religious context. Many of our participants reported coming out to others
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SEXUAL ORIENTATION CHANGE EFFORTS 17
TABLE 5
Benefits and Detriments of Psychotherapeutic Sexual Orientation Change Efforts, as Reported in
Open-Ended Narratives
Benefit Detriment
Nature of outcome Description n% Description n%
Overall outcome Positive, helpful 109 9.8 Not effective 102 9.1
Significance Life-saving 12 1.1 Felt worse after 29 2.6
Disclosure Helped to talk to someone 44 3.9
Orientation
change
Some change occurred 22 2.0 Same-sex attraction did
not change
119 10.7
Understand, accept 125 11.2
Cope with lack of change 25 2.2
Helped in coming out 17 1.5
Self-worth Improved self-esteem 98 8.8 Damaged, harmful 33 3.0
Same-sex
attraction and
faith
Helped to reconcile 13 1.2 Lost faith 10 0.9
Family Improved relationships 60 5.4 Worsened relationships 7 0.6
Depression and
anxiety
Decreased 80 7.2 Increased 7 0.6
Suicide Avoid 15 1.3 Attempted 4 0.4
Child abuse issues Helped 22 2.0
Masculinity Helped with body image 10 0.9
Masturbation and
porn
Reduced 14 1.2
Sexual intimacy Helped 6 0.5
Therapy efficacy Waste of time and
money
20 1.8
Therapy cost Lacked money for
therapy
70.6
Therapist Compassionate 3 0.3 Inept, untrustworthy 23 2.1
Reluctant to target
same-sex attraction
13 1.2
Sexually attracted to140.4
Client
commitment
Resisted help, pretended 32 2.9
Miscellaneous216 1.4
Narrative Insufficient information
to code
25 2.2
Note. The written narratives of 720 psychotherapeutic clients (80% of those whom provided some details about the
counseling they received) were coded as to the perceived outcomes of the experience. Many participants reported efforts
with multiple therapists. Responses for the several outcomes (an average of 1.6 for each report) across all therapists are
reported. The average effectiveness rating of these persons was 2.41. An additional 134 persons (15%) reported an average
effectiveness rating of 2.17 but did not include a comment.
1Or became highly dependent upon.
2Included fewer than five reports each of issues such as cross-dressing, sex addiction, eating disorders, general heath,
and specific mental illnesses.
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18 BRADSHAW ET AL.
and self-identifying as nonheterosexual at this time (Table 2). Some gay LDS men divulge their
orientation to ecclesiastical leaders in preparation for 2-year missionary service at 19 years of
age (women at 21 years of age). During the mission, it may become clear that personal efforts
at righteousness do not reduce same-sex attractions. Subsequently, the pressure to marry appears
to increase the conflict between their sexuality and following an orthodox LDS trajectory. Thus,
many of this age turn to professionals for help. In addition, a significant number of our participants
first sought assistance at ages 30 through 60 years, undoubtedly reflecting the need to resolve the
culturally induced personal and religious tensions that persist for some people.
However, even the most optimistic expressions of “change” did not claim that same-sex
attractions and opposite-sex aversions had been eliminated and replaced by strictly positive
heterosexual romantic feelings. Rather, because “the feelings don’t go away,” some sort of
accommodation had been achieved. This included redefining one’s sexual self (Worthington,
2004) to reduce the effect of minority stress and internalized homonegativity (Tozer & Hayes,
2004). In contrast, 42% reported that their change oriented therapy was “not at all effective” and
an additional 37% described it as moderately or severely harmful. Our results appear at the same
time as the demise of the religious ministry of Exodus International (Huffington Post, 2013),
and the admission of its president, Alan Chambers, that “. . . 99.9% [of our clients] have not
experienced a change in their orientation . . .” (Throckmorton, 2012).
Our data showed that an accommodation is most probable for those who identify as bisexual.
Most who claimed change indicated some capacity for arousal by both sexes, including self-
identified heterosexuals who positioned themselves in the middle of the Kinsey Scale. These
were the people most likely to attempt heterosexual marriage; the 14 married men in this group
had been married an average of 17 years. One recent study reported that married men are more
likely than single men to feel that change has occurred during sexual orientation change efforts
(Karten & Wade, 2010).
Limitations
We consider here factors relative to the validity and generalizability of our results. Over 1,600
participants represented a very significant response (compare other sexual orientation change
efforts reports: Exodus International programs [Jones & Yarhouse, 2011; n=98] or Spitzer [2003;
n=200]). Further, the demographic characteristics of the participants suggest that our survey
successfully reached the broad target population. The age of onset of same-sex attraction was
similar to that reported by others (McClintock & Herdt, 1996). Active, inactive, and former LDS
Church members were represented about equally. Women, however, were underrepresented. Data
from national prevalence analyses suggests that bisexuals may also have been under-represented.
The ratio of gay to bisexual men in the U.S. is estimated at 1.5:1, while there are two to three times
more bisexual women than are lesbians (Gates, 2011). In our sample, the male ratio was about
4.5:1, and the female ratio was close to 1:1. Bisexual LDS members may not have enrolled because
they maintain church activity and remain closeted (Dehlin, Galliher, Crowell, & Bradshaw, 2014).
Our data show that inactive and disaffected LDS were 1.7 times more likely than the committed
and active to be “out.” If closeted individuals were underrepresented, their numbers were still
sufficient to accurately represent their sexual orientation change efforts experience. It is also
unlikely that larger numbers of persons in this particular circumstance would be disposed to
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SEXUAL ORIENTATION CHANGE EFFORTS 19
volunteer information of the sort reported here, if approached through any other methodological
design.
Last, we acknowledge that the psychotherapy experiences and presenting problems of our
participants varied immensely, a fact that we see as both a strength and a limitation. From our data,
we know that therapeutic efforts aimed at both change and acceptance were common (Table 3), as
were issues related to depression and anxiety. Lacking information about the diagnostic profiles of
our participants or the specific therapeutic techniques employed, our ability to discuss what works
and what does not work in therapy with LGBQ LDS is limited. However, given the variability
inherent in these “real world” therapy experiences, we view the powerful and consistent findings
with regard to sexual orientation change efforts outcomes as even more compelling.
Summary and Implications for Counseling and LDS Communities
To our knowledge, this study is the largest published analysis of therapist-assisted sexual orien-
tation change efforts among LDS members. An early small-scale effort (4 male and 2 female
participants), was aimed at identifying for therapists the issues facing LDS persons with un-
wanted homosexual attraction (LDS Family Services; Byrd & Chamberlain, 1993). In another
qualitative study, seven men reported that reinterpreting their homosexual desires enabled them
to maintain a successful heterosexual marriage (Robinson, 1998). An analysis of 136 persons
(85% male) in the LDS LGBQ support group Affirmation suggested the unlikelihood of change
(Schow, 1994). Horlacher and Horstmanshoff (2011) described the relation between sexuality
and religiosity (including sexual orientation change efforts) on the basis of an online longitudinal
study (2003–2007) conducted with 174 highly religious Mormons. From extensive interviews
with 50 LDS participants in reparative therapy (with equal representation of positive and negative
perceptions about counseling), Beckstead and Morrow (2004) concluded that sexual identity, not
orientation, was a changeable variable, and they identified helpful outcomes that were possible
through the therapeutic process.
The weight of empirical data to the contrary, belief in the possibility of sexual orientation
change persists—in society at large, in the LDS community (Dehlin, Galliher, Bradshaw, Hyde,
& Crowell, 2014), and among the small group of academics (Rosik, Jones, & Byrd, 2012)
who continue to challenge professional consensus (Hancock, Gock, & Haldeman, 2012). While
sharing some relevant doctrines with other religious groups (e.g., free will, repentance, grace),
LDS members may be strongly resistant to the immutability of same-sex attraction because of
faith in divinely mediated miracles, the sentiment that authority may be more trustworthy than
science, and a tradition that any challenge can be overcome with sufficient effort (e.g., Eldridge,
1994). Or, “ . . . successful treatment of unwanted homosexuality is more likely to result from
a combination of secular counseling and religious faith” (Abbott & Byrd, 2009, pp. 76–77).
That therapeutic approach views homosexuality as a social perturbation of normal development,
and thus reversible. This model requires a parallel disregard for the large body of evidence
demonstrating a biological origin for sexual orientation (Byrd, 2009; National Association for
Research and Therapy of Homosexuality, 2010, 2012b).
For adherents to this line of reasoning, the claim of a successful sexual orientation change by a
few individuals is sufficient to generalize to the population at large. The clear evidence, however, is
that dutiful long-term psychotherapeutic efforts to change are not successful and carry significant
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20 BRADSHAW ET AL.
potential for serious harm, and that LGBQ LDS members find greater satisfaction in counseling
approaches that result in acceptance or accommodation.
SUPPLEMENTAL MATERIAL
Supplemental material (Online Appendix) for this article is available at www.tandfonline.com/
usmt.
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... any modification of sexual orientation (e.g. Bradshaw et al., 2015;Dehlin et al., 2015;Maccio, 2011). For example, in the largest survey of its kind Dehlin et al (2015) found that only one respondent out of 1,019 (0.1%) who had undergone sexual orientation change efforts subsequently identified as 'heterosexual'. ...
... Nicolosi, Byrd & Potts, 2000b) appear to report more benefits than those that use other recruitment methods (e.g. Bradshaw et al., 2015). The benefits reported include: ...
... A growing number of studies are finding that exposure to conversion therapies is associated with multiple indicators of poor health (Blosnich et al., 2020;Dehlin et al., 2015;Meanley et al., 2020;Ryan et al., 2018;Salway et al., 2020;Turban, et al., 2020) for both sexual orientation and gender identity change efforts. A wide range of harms have also been reported within surveys and in qualitative research with those who have undergone sexual orientation change efforts (APA, 2009a;Beckstead, 2002;Beckstead & Morrow, 2004;Bradshaw et al., 2015;Fjelstrom, 2013;Flentje, Heck & Cochran, 2014;Mikulak, 2020;Van Zyl, Nel & Govender, 2017;Weiss et al., 2010). A previous systematic review concluded that there was evidence (largely in the form of qualitative studies) that some individuals perceive they have been harmed by conversion therapy but that methodological limitations precluded definitive conclusions (APA, 2009a) 31 . ...
Article
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The aim of this research was to improve understanding of the practice and to address the following four research questions: 1. What forms does conversion therapy take? 2. Who experiences conversion therapy and why? 3. What are the outcomes of conversion therapy? 4. What measures have been taken to end conversion therapy around the world? In order to answer Questions 1-3, a rapid evidence assessment was conducted examining research published from January 2000 to June 2020. Forty-six published studies were identified. Most of the evidence identified was specifically focused on conversion therapy aimed at changing sexual orientation, with only five articles that specifically addressed conversion therapy to change gender identity. A qualitative study was also conducted to gather evidence on the experiences of people in the UK who had undergone conversion therapy. Thirty individuals were interviewed (16 men, 12 women, 2 non-binary persons) who had experienced sexual orientation change efforts (24), gender identity change efforts (3) or both (3). To answer Question 4, an additional search of the grey literature was conducted to identify measures taken around the world to end conversion therapy. Modern forms of conversion therapy appear to largely take the form of talking therapies and spiritual interventions. There is evidence that these forms of conversion therapy can be harmful but there is no robust evidence that identifies whether certain techniques or practices used by conversion therapists are more or less harmful than others. The evidence base is larger for sexual orientation change efforts than for gender identity change efforts. A growing number of legal jurisdictions are legislating to restrict conversion therapy. The scope of such laws varies and due to many legislative measures being relatively recent there is little evidence on what are the most effective policies for ending conversion therapy.
... Similarly, those who use GICE are seeking to change individuals with a marginalized gender identity (e.g., transgender, nonbinary, genderqueer, etc.) into having a cisgender identity (Turban et al., 2020). SOCE and GICE are ineffective and associated with harmful outcomes, such as increased depression, anxiety, suicidal ideation, and suicidal attempts (Blosnich et al., 2020;Bradshaw et al., 2015;Higbee et al., 2020;Przeworski et al., 2020;Turban et al., 2019Turban et al., , 2020. Although states, counties, and cities within the United States and some professional mental health organizations have begun to ban the practice of SOCE with minors, these practices continue to occur (Heiden-Rootes et al., 2021;Gamboni et al., 2018). ...
... One of the core goals of any ethical code, AAMFT's included, is to "do no harm" in clinical practice. Our findings and many previous studies demonstrate the significant harmful effects of SOCE and GICE (e.g., Blosnich et al., 2020;Bradshaw et al., 2015;Higbee et al., 2020;Przeworski et al., 2020;Turban et al., 2019Turban et al., , 2020. When practices that are decidedly harmful and potentially deadly are allowed to continue, a confusing and conflicting message is sent about who we are and our legitimacy as a profession. ...
... Only nonreligious GICE was associated with severe psychological distress and analyses stratified on racial groups found Black individuals showed increased odds of binge alcohol consumption when exposed to nonreligious change efforts while White individuals showed decreased odds with both nonreligious and religious GICE. Our hope is that this study along with the other studies (e.g., Blosnich et al., 2020;Bradshaw et al., 2015;Higbee et al., 2020;Przeworski et al., 2020;Turban et al., 2019Turban et al., , 2020 on the harmful impacts of GICE will finally spur all mental health associations and licensure boards to fully ban this practice and be a catalyst for legislative bodies to criminalize these practices with both adults and minors. When GICE is no longer practiced anywhere then another important step for transgender and nonbinary equality will finally be reached. ...
Article
Gender identity change efforts (GICE) and sexual orientation change efforts (SOCE) continue to be practiced by mental health professionals and religious organizations. It is frequently sought out by families who are rejecting loved ones with marginalized sexual orientations and gender identities. This study explored the impact of religious and nonreligious GICE on the mental health of transgender and nonbinary adults through a secondary data analysis of the U.S. Transgender Survey. Results found that both nonreligious and religious GICE were associated with increased odds of suicidal ideation and attempts. Only nonreligious GICE was associated with severe psychological distress. Black individuals showed increased odds of binge alcohol consumption when exposed to nonreligious change efforts, while White individuals showed decreased odds with both nonreligious and religious GICE. This study supports ethical and legal bans on GICE.
... The AAMFT code of ethics states MFTs should not discriminate, however MFTs are not prohibited by the code from recommending, referring for or providing sexual orientation change efforts (SOCE), also known as conversion therapy. Extensive research has been conducted and shown that SOCE is not effective at changing sexual orientation (Haldeman et al., 2019;Ryan et al., 2020;Serovich et al., 2008) and that in fact it causes depression, suicidality, internalized homophobia, decreased self-esteem and other negative outcomes (Bradshaw et al., 2014;Haldeman, 2002;Shidlo & Schroeder, 2002). Although other professions have prohibitions against SOCE (Gamboni et al., 2018), AAMFT has not prohibited this harmful practice. ...
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The purpose of this article is to educate Marriage and Family Therapists about the history of the profession and to call attention to the troubling history of eugenics as it pertains to current ethical practice. The eugenics movement sought to increase the marriage and reproduction of healthy, white people, while implementing a system of institutionalization and sterilization to deter the reproduction of people of color, people with disabilities, and anyone determined to be “undesirable” by eugenicists. The helping professions, including Marriage and Family Therapy arose during the years when this took place, and contributed to the implementation of eugenics in a variety of ways. Founders of the field of Marriage and Family Therapy, including eugenicist Paul Popenoe, also known as the father of marriage counseling, played a key role in linking eugenics ideals and practices with Marriage and Family Therapy. While other professions, and indeed other organizations of all types, have worked to understand their participation in the promotion of eugenics ideals, and have issued apologies along with commitments to function ethically in the future, Marriage and Family Therapy has yet to do so. This article is a call to reckon with our history, to understand it, to educate and to practice ethically in the future.
... Nevertheless, a substantial body of literature has provided empirical evidence for the low efficacy of SOCE (American Psychological Association, 2000;Bradshaw et al., 2015;Maccio, 2010). A recent systematic review by Przeworski and colleagues (2021) clearly showed that SOCE are not efficacious in altering sexual orientation. ...
Article
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Introduction While accumulating evidence shows that sexual orientation change efforts (SOCE) are harmful and ineffective, SOCE is still highly prevalent in some regions where homosexuality is heavily stigmatized. This study investigated the experiences, motivations, and impacts of SOCE among sexual minorities in Hong Kong and examined the mediating role of sexual identity distress in the relationship between SOCE and mental health. Methods A total of 219 sexual minority individuals completed a questionnaire on SOCE in 2020–2021. They were asked to report their experiences, motivations, perceived effectiveness, benefits, and harms of SOCE. They were also assessed on sexual identity distress, depressive and anxiety symptoms, and suicidality. Results Religious beliefs and interpersonal concerns were the primary motivations for SOCE. Participants who had experienced SOCE showed significantly higher levels of internalized homonegativity, identity uncertainty, and difficult process than their counterparts who had not experienced SOCE. They were also at a greater risk of developing depressive symptoms and suicidal ideation. Such discrepancy in mental health could be explained by heightened levels of sexual identity distress experienced by individuals who had experienced SOCE. Conclusions This study was the first to characterize the experiences and impacts of SOCE in Hong Kong and provided empirical evidence for the role of sexual identity distress as a key mechanism mediating the relationship between SOCE and mental health. Policy Implications The study concludes with recommendations for legislation, psychological interventions, and public education in Hong Kong to reduce the prevalence and negative impacts of SOCE.
... However, reparative interventions may focus on changing the behavior rather than the innate orientation itself. Many sexual orientation reparative therapies conducted in history have indeed been reported to be based on faulty assumptions, not effective, and probably doing harm to such individuals (Haldeman, 1994;Bradshaw et al., 2015). ...
Article
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According to the neuro-hormonal theory, sexual orientation in humans develops in the womb under the influence of sex hormones. In this article, we review the evidence from basic research on the possible role of neurotransmitters on influencing sexual orientation. We show that pharmacological or genetically induced changes in neurotransmitter systems during development might, by hormone-mediated structural and functional brain changes, result in alterations in sexual preference in animal models. We propose that in humans this mechanism may contribute to the relationship between non-heterosexual orientation and increased prevalence of neuropsychiatric disorders. Data to support this idea are reviewed. We suggest that altered neurotransmitter levels during development will increase the chance for both non-heterosexual differentiation of the brain and neuropsychiatric disorders. This possibility may have clinical implications, because medication given to a pregnant woman may, in this way, alter brain development of the fetus in a permanent way.
Article
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Sexual orientation change efforts (SOCEs) signify activities designed to change or reduce homosexual orientation. Recent studies have claimed that such therapies increase suicide risk by showing positive associations between SOCE and lifetime suicidality, without excluding behavior that pre-dated SOCE. In this way, Blosnich et al.’s (2020) recent analysis of a national probability sample of 1518 sexual minority persons concluded that SOCE “may compound or create…suicidal ideation and suicide attempts” but after correcting for pre-existing suicidality, SOCE was not positively associated with any form of suicidality. For suicidal ideation, Blosnich et al. reported an adjusted odds ratio (AOR) of 1.92 (95% CI 1.01–3.64); the corrected AOR was .44 (.20–.94). For suicide planning, Blosnich et al.’s AOR was 1.75 (1.01–3.06); corrected was .60 (.32–1.14). For suicide attempts, Blosnich et al.’s AOR was 1.75 (.99–3.08); corrected was .74 (.36–1.43). Undergoing SOCE after expressing suicidal behavior reduced subsequent suicide attempts from 72 to 80%, compared to those not undergoing SOCE, when SOCE followed a prior expression of suicidal ideation (AOR .17, .05–.55), planning (AOR .13, .04–.45) or intention (AOR .10, .03–.30); however, SOCE following an initial suicide attempt did not significantly reduce further attempts. By violating the principle that a cause cannot occur after an effect, Blosnich et al. misstated the correct conclusion. Experiencing SOCE does not result in higher suicidality, as they claim, and may sharply reduce subsequent suicide attempts. Restrictions on SOCE will not reduce suicidal risk among sexual minorities and may deprive them of an important resource for reducing suicide attempts.
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We report here some of the results from an online survey of 1612 LGBTQ members and former members of the Church of Jesus Christ of Latter-day Saints (CJCLDS, Mormon). The data permitted an exploration of diversity—individual similarities and differences within and between the sexes. Men and women were compared with respect to sexual identity self-labeling and behavior (i.e., identity development, disclosure, activity), orientation change efforts, marital relationships, and psychosocial health—these variables in the context of their religious lives. More women than men self-identified in the bisexual range of the sexual attraction continuum. Both men and women had engaged in extensive effort to change their sexual orientation. Only about 4% of the respondents claimed that those efforts had been successful, and the claims were for outcomes other than an alteration in erotic feeling. In general, only those who identified as bisexual reported success in maintaining a mixed-orientation marriage and continuing activity in the church. For both men and women, measures of psychosocial and sexual health were higher for those in same-sex relationships and those disaffiliated from the church.
Article
Background. Sullins, Rosik, and Santero (2021) evaluated a convenience sample of 125 men who had undergone sexual orientation change efforts (SOCE) and they made their data available for independent analysis. Methods: Data from Sullins et al. (2021) were reanalyzed in ten new ways. Several new typologies and variables were created. Paired sample t-tests, correlations, regression analyses, repeated measures analyses with time x group interactions, and chi-square tests were used to evaluate ten novel hypotheses. Results: Using parametric statistics, we found similar results to Sullins et al. (2021) where they had used nonparametric statistics. Regression analyses found that lower initial SSI and higher SSB predicted more change. Using a new typology for marital status, it was found that those who became engaged/got married during SOCE had the largest gains in OSB compared to other categories of marital status. Using the typology of change, it was found that some men who became stronger for SSA, SSI, and SSB nevertheless reported high levels of helpfulness for SOCE. Harms from SOCE seem to be minimal compared to the positives reported for young adults. SOCE effectiveness did not appear to change with time since therapy, lending less support to a recall bias argument. Congruence between SSA and SSI, may, in some cases, reduce the apparent effectiveness of SOCE Conclusion: While the sample’s results cannot be generalized outside of highly religious men with initially higher levels of SSA and SSB than SSI, these results differ from many contemporary assertions that SOCE cannot ever be effective and is inherently harmful, or that SSA is inherently immutable. Therefore, calls to ban SOCE legally appear to be founded upon incomplete or inaccurate data and thus premature, while more higher quality research is yet needed regarding SOCE.
Article
Importance: Sexual orientation and gender identity change efforts (SOGICE), also called conversion therapy, is a discredited practice attempting to convert lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ) individuals to be heterosexual and/or cisgender. Objectives: To identify and synthesize evidence on the humanistic and economic consequences of SOGICE among LGBTQ youths in the US. Design, setting, and participants: This study, conducted from December 1, 2020, to February 15, 2021, included a systematic literature review and economic evaluation. The literature review analyzed published evidence on SOGICE among LGBTQ individuals of any age. The economic model evaluated the use of SOGICE vs no intervention, affirmative therapy vs no intervention, and affirmative therapy vs SOGICE to estimate the costs and adverse outcomes for each scenario and to assess the overall US economic burden of SOGICE. Published literature and public sources were used to estimate the number of LGBTQ youths exposed to SOGICE, the types of therapy received, and the associated adverse events (anxiety, severe psychological distress, depression, alcohol or substance abuse, suicide attempts, and fatalities). Exposures: SOGICE (licensed or religion-based practitioners) or affirmative therapy (licensed practitioners). Main outcomes and measures: Total incremental costs and quality-adjusted life-years (QALYs) vs no intervention and total economic burden of SOGICE. Results: Among 28 published studies, which included 190 695 LGBTQ individuals, 12% (range, 7%-23%) of youths experienced SOGICE, initiated at a mean age of 25 years (range, 5-58 years), with a mean (SD) duration of 26 (29) months. At least 2 types of SOGICE were administered to 43% of recipients. Relative to LGBTQ individuals who did not undergo SOGICE, recipients experienced serious psychological distress (47% vs 34%), depression (65% vs 27%), substance abuse (67% vs 50%), and attempted suicide (58% vs 39%). In the economic analysis, over a lifetime horizon with a 3% annual discount rate, the base-case model estimated additional $97 985 lifetime costs per individual, with SOGICE associated with 1.61 QALYs lost vs no intervention; affirmative therapy yielded cost savings of $40 329 with 0.93 QALYs gained vs no intervention. With an estimated 508 892 youths at risk for SOGICE in 2021, the total annual cost of SOGICE is estimated at $650.16 million (2021 US dollars), with associated harms totaling an economic burden of $9.23 billion. Conclusions and relevance: This economic evaluation study suggests that there is a high economic burden and high societal costs associated with SOGICE and identifies additional research questions regarding the roles of private and public funding in supporting this harmful practice.
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Background: Voluntary therapeutic interventions to reduce unwanted same-sex sexuality are collectively known as sexual orientation change efforts (SOCE). Currently almost all evidence addressing the contested question whether SOCE is effective or safe consists of anecdotes or very small sample qualitative studies of persons who currently identify as sexual minority and thus by definition failed to change. We conducted this study to examine the efficacy and risk outcomes for a group of SOCE participants unbiased by current sexual orientation. Methods: We examined a convenience sample of 125 men who had undergone SOCE for homosexual-to-heterosexual change in sexual attraction, identity and behavior, and for positive and negative changes in psychosocial problem domains (depression, suicidality, self-harm, self-esteem, social function, and alcohol or substance abuse). Mean change was assessed by parametric (t-test) and nonparametric (Wilcoxon sign rank test) significance tests. Results: Exposure to SOCE was associated with significant declines in same-sex attraction (from 5.7 to 4.1 on the Kinsey scale, p
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The “Guidelines for Psychological Practice With Lesbian, Gay, and Bisexual Clients” provide psychologists with (a) a frame of reference for the treatment of lesbian, gay, and bisexual clients and (b) basic information and further references in the areas of assessment, intervention, identity, relationships, diversity, education, training, and research. These practice guidelines are built upon the “Guidelines for Psychotherapy With Lesbian, Gay, and Bisexual Clients” (Division 44/Committee on Lesbian, Gay, and Bisexual Concerns Joint Task Force on Guidelines for Psychotherapy with Lesbian, Gay, and Bisexual Clients, 2000) and are consistent with the American Psychological Association (APA) “Criteria for Practice Guideline Development and Evaluation". They assist psychologists in the conduct of lesbian, gay, and bisexual affirmative practice, education, and research.
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This study examined the psychosocial correlates of following various church-based approaches for dealing with same-sex attraction, based on a large sample (1,612) of same-sex attracted current and former members of the Church of Jesus Christ of Latter-day Saints (LDS, or Mormon). Overall, this study found that biologically based views about the etiology of same-sex attraction (vs. psychosocial views), LDS church disaffiliation (vs. activity), sexual activity (vs. celibacy), and legal same-sex marriage (vs. remaining single or mixed-orientation marriage) were all associated with significantly higher levels of self-esteem and quality of life, and lower levels of internalized homophobia, sexual identity distress, and depression. The divorce rate for mixed-orientation marriages was 51% at the time of survey completion, with projections suggesting an eventual divorce rate of 69%.
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Sexuality is an important area of clients' lives yet it is often neglected, both in the consulting room and in training. This book examines issues of sexuality in a positive and affirming light and considers how sexuality-related issues can be introduced into therapy and training. The manual provides further reading, handouts for clients, self-reflective exercises and examples of training exercises for workshops and teaching. It is an essential resource for health professionals, therapists, clinicians, academics and trainers, and will support the practising therapist as well as those in training.
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We present the results of a survey of 882 dissatisfied homosexual people whom we queried about their beliefs regarding conversion therapy and the possibility of change in sexual orientation. There were 70 closed-ended questions on the survey and 5 open-ended ones. Of the 882 participants, 726 of them reported that they had received conversion therapy from a professional therapist or a pastoral counselor. Of the participants 779 or 89.7% viewed themselves as “more homosexual than heterosexual,” “almost exclusively homosexual,” or “exclusively homosexual” in their orientation before receiving conversion therapy or making self-help efforts to change. After receiving therapy or engaging in self-help, 305 (35.1%) of the participants continued to view their orientation in this manner. As a group, the participants reported large and statistically significant reductions in the frequency of their homosexual thoughts and fantasies that they attributed to conversion therapy or-self-help. They also reported large improvements in their psychological, interpersonal, and spiritual well-being. These responses cannot, for several reasons, be generalized beyond the present sample, but the attitudes and ideas are useful in developing testable hypotheses for further research.
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Individuals who experience feelings of homosexual attraction and yet maintain commitment to the LDS Church, with its strong prohibition against homosexual behavior, face a difficult challenge. Mormon counselors and psychotherapists are frequently sought out by such clients. In addition, such individuals may turn to family members, ecclesiastical leaders and friends. Fortunately, the availability of information for helping others understand and assist such individuals is increasing. This article is based on a study designed with the intention of adding to such resources. It is hoped that this account, based on the perspective of those personally dealing wi th issues of homosexuality, will assist those who seek to understand and help other such individuals.
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Executive Summary Increasing numbers of population-based surveys in the United States and across the world include questions that allow for an estimate of the size of the lesbian, gay, bisexual, and transgender (LGBT) population. This research brief discusses challenges associated with collecting better information about the LGBT community and reviews eleven recent US and international surveys that ask sexual orientation or gender identity questions. The brief concludes with estimates of the size of the LGBT population in the United States. Key findings from the research brief are as follows:  An estimated 3.5% of adults in the United States identify as lesbian, gay, or bisexual and an estimated 0.3% of adults are transgender.  This implies that there are approximately 9 million LGBT Americans, a figure roughly equivalent to the population of New Jersey.  Among adults who identify as LGB, bisexuals comprise a slight majority (1.8% compared to 1.7% who identify as lesbian or gay).  Women are substantially more likely than men to identify as bisexual. Bisexuals comprise more than half of the lesbian and bisexual population among women in eight of the nine surveys considered in the brief. Conversely, gay men comprise substantially more than half of gay and bisexual men in seven of the nine surveys.  Estimates of those who report any lifetime same-sex sexual behavior and any same-sex sexual attraction are substantially higher than estimates of those who identify as LGB. An estimated 19 million Americans (8.2%) report that they have engaged in same-sex sexual behavior and nearly 25.6 million Americans (11%) acknowledge at least some same-sex sexual attraction.  Understanding the size of the LGBT population is a critical first step to informing a host of public policy and research topics. The surveys highlighted in this report demonstrate the viability of sexual orientation and gender identity questions on large national population-based surveys. Adding these questions to more national, state, and local data sources is critical to developing research that enables a better understanding of the understudied LGBT community.