PsychologicalReports, 2000,86,689-702.

0 Psychological Reports 2000

BELIEFS AND PRACTICES OF THERAPISTS WHO PRACTICE

SEXUAL REORIENTATION PSYCHOTHERAPY '
JOSEPH NICOLOSI A. DEAN BYRD
Nafiorzal Assonation for Research and Therapy University of Utah
of Homosexuality

RICHARD W. POTTS

Utah Valley Regional Medical Cenfer

5umrnary.-There is currently controversy regarding whether sexual reorientation

or conversion therapies are ethical and effective forms of treaunent for dissatisfied ho-
mosexually oriented people. We present the results of a survey of 206 psychothera-
pists who practice sexual conversion therapy. 187 therapists said they believed homo-
sexuality is a developmental disorder and that the 1973 decision by the American Psy-
chiatric Association to "depathologize" homosexuality was politically motivated and
unscientific. The therapists believe chat the majority of dissatisfied homosexually ori-
ented clients who seek conversion therapy benefit from it, experiencing both changes
in their sexual orientation and improved psychological functioning. We condude that
therapists who persist in providing reorientacion therapy do so because they believe it
is an effective and ethical treatment option for their clients.

The treatment of homosexuahty has a long history in the psychiatric

and psychological professions. Beginning with Sigmund Freud at the turn of
the 20th century, many chicians have attempted to help dissatisfied homo-
sexually oriented people reduce and overcome their homosexual tendencies.
Psychoanalysis, psychoanalytically oriented psychotherapy, behavioral and
cognitive therapies, and a variety of group psychotherapy approaches have
all been used for this purpose (James, 1978).
Reviews of the literature on the outcome of therapy published in the
1970s concluded that therapists have had considerable success at helping
homosexual people reduce homosexual thoughts and behaviors and increase
heterosexual interest. Rogers, Roback, McKee, and Calhoun (1976) con-
cluded "Homosexuals can be successfully treated in group psychotherapy
whether the treatment orientation is one of a change in sexual pattern of
adjustment, or whether a reduction in concomitant problems is the primary
goal" (pp. 23-24). Adams and Sturgis (1977) reported average success rates
in decreasing homosexual urges and behaviors ranging from 18% to 78%
and in increasing heterosexual urges and behaviors ranging from 8% to
71% for the behavior therapy studies they reviewed.

'Address enquiries to Joseph Nicolosi, President, National Association for Research and Ther-
apy of Homosexuality, 16633 Ventura Blvd., Suite 1340. Encino. CA 91436.
690 J. NICOLOSI, ET AL.

After reviewing a number of psychoanalytic, group, and behavioral stud-

ies, Clippinger (1974) concluded that "at least 40% of the homosexuals were
cured, and an additional 10-30% of the homosexuals were improved . . ."
(p. 22). James (1978) meta-analyzed 101 outcome studies published between
the years 1930 and 1976. She concluded that, when the results of all
research studies were combined, approximately 35% of the homosexual cli-
ents "recovered" and 27% "improved." Based on this finding, she argued
that pessimistic attitudes about the prognosis for homosexuals changing
their sexual orientation are not warranted. "Significant improvement and
even complete recovery [from a homosexual orientation] are entirely possi-
ble. . ." (James, 1978, p. 183).
Despite this reported success, by the mid-1970s treatment and research
on psychotherapy for homosexuality came to a virtual halt. The major reason
for this was the removal of homosexuality in 1973 from the Diagnostic and
Statistical ,Zlanual (DSM) by the American Psychiatric Association. In Janu-
ary, 1975, the governing body of the American Psychological Association
voted to support the American Psychiatric Association's decision, saying that
it wished to oppose discrimination against homosexuals. It also encouraged
mental health professionals to "take the lead in removing the stigma of men-
tal h e s s that has long been associated with homosexual orientations" (Con-
ger, 1975, p. 633).
Since that decision to remove homosexuahty from the DSM, profession-
als who have persisted in viewing and treating homosexuality as an abnormal
condition which can be changed have been criticized as unenlightened, prej-
udiced, homophobic, and unethical (Davison, 1976; May, 1977; Silverstein,
1977; Marmor, 1980; Bayer, 1981; Martin, 1982; Friedman, 1988; Socarides,
1988). Many professionals now believe that the only legitimate and healthy
choice for people who experience homosexual attractions is to "come out of
the closet" and become actively involved in the gay hfestyle and culture. Ef-
forts have been made to restrict access to treatments which are designed to
help people resist and overcome their homosexual tendencies (Davison,
1976; Silverstein, 1977; Marmor, 1980; Welch, 1990; Browning, Reynolds, &
Dwordin, 1991; Fassinger, 1991; Shannon & Woods, 1991; Hancock & Cer-
bone, 1993; Haldeman, 1994).
On August 14, 1997, the Council of Representatives of the American
Psychological Association adopted a resolution on "appropriate therapeutic
responses to sexual orientation" (American Psychological Association, 1997).
Following the American Psychological Association's lead, in March, 1998, the
governing council of the American Counseling Association also adopted a
resolution "On Appropriate Counsehg Responses to Sexual Orientation."
Both resolutions opposed the portrayal of homosexuality as a "mental disor-
der" and stated their support for "the dissemination of accurate information
 BELEFS. PRACTICLS IN SEXUAL REORIENTATION THERAPY 69 1

about sexual orientation, and mental health, and appropriate interventions

in order to counteract bias that is based in ignorance or unfounded beliefs
about sexual orientation" (American Psychological Association, August 14,
1997).
What is less widely known is that the original versions of both resolu-
tions opposed and censured mental health professionals who practice sexual
reorientation or conversion therapy (Stern, 1998; Throckrnorton, 1998).
However, following debate and protests from some members of the govern-
ing bodes of the American Psychological Association and American Counsel-
ing Association, both resolutions were revised and did not outlaw conver-
sion therapies. Although some mental health professionals have haded these
resolutions as an important step in that du-ection (e.g., Herek, 1997, The
APA resolution on appropriate therapeutic responses to sexual orientation: a
comment by Gregory M. Herek, Pb.D. [On-line] Available: http://psycholo-
gy.ucdavis,edu/rainbow/hdresolution97~comment.html), others have point-
ed out that they allow for "the full range of ethical and appropriate thera-
peutic approaches" (Stern, 1998, p. 3), including conversion therapies.
Although many mental health professionals who disapprove of conver-
sion therapies have made their views known (e.g., Davison, 1976; Silverstein,
1977; Marmor, 1980; Welch, 1990; Browning, e/ a/., 1991; Fassinger, 1991;
Shannon & Woods, 1991; Hancock & Cerbone, 1993; Haldeman, 1994),
much less has been published about the beliefs and practices of conversion
therapists regarding such therapies and their effects. '-we were interested in
understandmg their views. Why do conversion therapists provide conversion
therapy to clients who request it in the face of so much opposition from
professional groups? What are their views of homosexuahty? How effective
do they believe is conversion therapy? What types of changes do they per-
ceive their clients make?
The purpose of this article was to report the results of a survey about
the beliefs and practices of therapists of various training who practice sexual
conversion therapy. The results of our survey may be helpful to psychothera-
pists and mental health professionals who are seekmg to examine carefully
the varied viewpoints about what constitutes an appropriate therapeutic re-
sponse to homosexuality. Our findmgs may give insight into why some ther-
apists persist in providing conversion therapy to clients in the face of intense
professional opposition to this practice. The survey also gives insight into
the potential outcomes of conversion therapy from the perspective of these
psychotherapists.

'A complete bibliography of these studies is available on request Erom J. Nicolosi.

 J. NICOLOSI, ET AL.

METHOD
We asked the therapists who participated in the survey to share their
experiences about a variety of issues includmg (1) whether they think con-
version therapy is helpful to their clients, (2) what types of changes in sexual
orientation their clients have reported through participation in conversion
therapy, ( 3 ) what types of emotional and psychological changes their clients
have reported through participation in conversion therapy, (4) how they ap-
proach conversion therapy, and ( 5 ) what are their beliefs about hornosexual-
ity. By surveying as many therapists who provide conversion therapy as we
could, the present survey of even a small number of therapists with varied
training would allow us to find out more about the beliefs and practices of
therapists who actually practice conversion therapy. Our goal was not to sur-
vey all psychotherapists or to draw conclusions about the attitudes of thera-
pists, in general, regarding conversion therapy. It was simply to find out
more about the beliefs and experiences of a group of psychotherapists who
practice conversion therapy.
Survey Description
The first page of the survey explained the purpose of the survey and
also stated that "participation in this study is completely voluntary and anon-
ymous. You may choose not to participate, and you have the right to refuse
to answer any question." The survey also contained instructions to mail the
completed survey directly to J. Nicolosi.
In the 77 questions therapists were asked to provide (1) background
and demographic information, (2) information about their own past and cur-
rent sexual orientation, ( 3 ) information about their professional training and
credentials, (4) description of their approach to conversion therapy, ( 5 ) their
beliefs about the etiology and treatment of homosexuahty, and (6) their per-
ceptions regarding the changes their clients have reported with regards to
their sexual orientation and psychological functioning. In making the ratings
about their clients' functioning, therapists were asked to recall and compare
their clients' functioning at the time they entered therapy with their func-
tioning after completion of treatment. The therapists' ratings of clients' func-
tioning were made on 7-point scales. Therapists were also asked five open-
ended questions about their feelings about and approach to conversion ther-
apy. '

'It is impossible to report 4U of the data we obtained in this survey and so we report only
those data that are nlost ~elevantto the topic. A summary of other findings of this survey and
another survey of over SO0 conversion therapy clients is available on request from J. Nicolosi.
A book which provider 3 decailed report of the results of boch surveys is currently in prepara-
tion.
 BELIEFS. PRACTICES IN SEXUAL REORIENTATION THERAPY

Procedure
Because sexual conversion therapy is currently so controversial in the
mental health professions, therapists who continue to provide it are often re-
luctant to disclose this to professional colleagues. Thus, many of them are
part of a "hidden population" who are difficult to identLfy and survey. Be-
cause of the difficulties associated with locating conversion therapists, we
were forced to rely heavily on word of mouth to recruit therapists.
During 1996 the first author sent copies of the survey to conversion
therapists he knew throughout the United States. H e asked these therapists
to pass out copies of the survey to other therapists they knew who practiced
conversion therapy. These therapists were also asked to give surveys to ther-
apists they knew. Some therapists were also contacted at ex-gay ministry
groups, e.g., Courage, Exodus International, Evergreen International. Adver-
tisements were also placed in newsletters of these organizations and an-
nounced at their conferences. AU potential respondents were assured that
their anonymity and confidentiahty would be safeguarded. They were in-
structed not to write their names on the surveys. Therapists mailed the com-
pleted surveys directly to J. Nicolosi.
Statistical Analysi~
Basic descriptive statistics, i.e., means, medians, frequencies, percent-
ages, were computed to describe the characteristics of the therapists. Chi-
squared tests and paired t tests were used to examine the therapists' retro-
spective perceptions of the frequency of the participants' homosexual behav-
iors as well as whether it seemed their psychological, interpersonal, and spiri-
tual well-being changed.
We also quahtatively analyzed the therapists' written responses to the
open-ended questions using the constant comparison method (Erlandson,
Harris, Shpper, & Allen, 1993). First, each written response was typed and
coded. This yielded 104 pages of responses. The second step was emergent
category designation. During this step, a Ph.D. psychologist (not one of the
authors) took the units of data from Step 1 and sorted them into categories
or themes.
Therapists
Two hundred and six therapists returned the s u r v e y . V n e hundred
and sixty-one (77%) were men and 49 (23%) were women. Fifty-one (25%)
of the therapists were chical social workers, 42 (20%) were psychologists,
24 (12%) were psychoanalysts, 22 (11%) were marriage and family thera-

'The numbers d o not always add up to 206 because not all participants responded to every
question.
694 J. NICOLOSI, ET AL.

pists, 19 (9%) were psychiatrists, 14 (7%) were pastoral counselors, and 34

(17%) were some other professional specialty, e.g., professional counselors.
One hundred and seventy-one (81%) of the therapists were licensed. One
hundred and fourteen (55%) stated they supervise other therapists in a for-
mal setting.
Eighty-nine (39%) of the therapists said that at one time in their life
they had experienced sexual-identity confusion. Fifty-five (26.7%) of the
therapists reported that at one time they perceived their own sexual orienta-
tion as partly homosexual. Thirty-eight (18.4%) of the therapists reported
that they continue to view their sexual orientation as partly homosexual al-
though most of these say they now view themselves as "almost entirely het-
erosexual."
In regards to their professional practices, the average length of time
since the therapists received their professional degrees was 19 years and the
majority of therapists had been in practice for over 10 years. One hundred
and fifty-one of the therapists said that "less than 20%" of their practice in-
volves clients seelung treatment of unwanted homosexuality, and another 21
(10%) said approximately 20% of their clientele seek therapy for this rea-
son. Only 19 (9%) of the therapists said 90% or more of their clientele seek
therapy for the purpose of changing their sexual orientation. One hundred
and nineteen (57%) of the therapists said the percentage of their clients seek-
ing conversion therapy has stayed about the same during the past five years,
66 (32%) said they have had an increase in such clients, and 23 (11%) a de-
crease. One hundred and thirty-one (64%) of the therapists said they pre-
dominantly treat male homosexuals, 56 (27%) treat an equal number of male
and female homosexuals, and 20 (20%) predominantly treat female homo-
sexuals.
In terms of the number of homosexual clients treated, 84 (41%) of the
therapists said they have treated fewer than 10 male homosexual clients, 72
(35%) said they have treated between 10 to 50 male clients, 28 (14%) have
treated between 50 to 100 male clients, and 22 (10%) have treated over 100
male clients. One hundred and forty-one (69%) of the therapists said they
have treated fewer than 10 female homosexual clients, 43 (21%) have treat-
ed between 10 to 50 female clients, and 20 (9%) have treated more than 50
female clients.
With respect to their approach to conversion therapy, 72 (34%) of the
therapists stated they "always treat clients from a rehgious/spiritual context"
43 (21%) they never do, and 94 (45%) said'it depends on the client. One
hundred and seventy-five (85%) of the therapists said they do most of their
conversion therapy in individual sessions, 9 (4%) said mostly in group ses-
sions, and 23 (11%) said they use equally often individual and group ses-
sions. Sixty-three (30%) of the therapists reported that the average duration
 BELIEFS, PRACTICES IN SEXUAL REORIENTATION THEFW'Y 695

of weekly individual therapy for male homosexual d e n t s is "less than one

year," 62 (30%) said it is "one to two years," 26 (13%) said it is "two to
three years," and 38 (18%) said it is more than three years. Seventy-three
(35%) therapists said that the average duration of weekly individual therapy
for female homosexual clients is "less than one year," 42 (20%) said it is
"one to two years," 20 (10%) said it is "two to three years," and 23 (10%)
said it is more than three years.
RESULTS
Therapists' Beliefs About Homosexuality
Table 1 summarizes the therapists' stated beliefs about the etiology and
treatment of homosexuality. Most of the therapists believe that homosexual-
ity is a developmental and a gender-identity problem and that childhood sex-
ual abuse can contribute to the development of homosexuality. The majority
of therapists also view the 1973 decision by the American Psychiatric Associ-
ation to remove homosexuahty from the DSM, and efforts to dscredit the
treatment of unwanted homosexuality, as politically motivated and nonscien-
tific. Not surprisingly, the majority of therapists agreed that it is possible for
homosexual people to change to a heterosexual orientation, although most
also indcated that not all d e n t s are capable of changing. Approximately
37% of the therapists believe that treatment cannot be successful without
reference to rehgious or spiritual issues, but the majority beheved this was
not essential. Over 63% of the therapists said they believe it can be helpful
to bring prayer into the therapeutic setting.
TherapistsJ Reports of Their Perceptions of Clients' Changes in Sexual
Orientation
With regard to the global changes in clients' homosexual thoughts, feel-
ings, and behaviors, 38 (18%) of the therapists reported that "more than
90%" of their male homosexual clients had described a "significant decrease
in unwanted homosexual thoughts, feehgs, and behaviors" during therapy,
19 (9%) said "81% to 90%" of their male clients had reported such
changes, 38 (18%) said "61% to 80%" of their male d e n t s had, and 39
(19%) said that "41% to 60%" of their male clients had. Twenty-two
(11%) of the therapists said that "less than 10%" of their male clients had
described such changes.
Twenty-six (13%) of the therapists recalled that "more than 90%" of
their female homosexual clients had reported a "significant decrease in un-
wanted homosexual thoughts, feelings, and behaviors" during therapy, 18
(9%) said "81% to 90%" of their female clients had described such changes,
15 (7%) said "61% to 80%" of their female clients had, and 27 (13%) said
that "41% to 60%" of their female clients had. Twenty-five (12%) of the
 J. NICOLOSI, ET AL.

TABLE 1
CONVERSION
THERAPISTS'
BELIEFS
ABOUTETIOLOGY
AND TREATMENT
O F HOMOSFXUALITY

Survey Question Response Opuons" M SD

1 2 3 4
I believe homosexuality is a developmental disorder.
I beheve male homosexuality to be a gender-identity
problem.
I believe a homosexual orientation can be learned
throu h childhood sexual abuse by an older homo-
sexu9
I believe that the 1973 A P A decision which depathol-
o ized homosexuality was political and nonscien-
tific.
I believe present attempts to discredit treatment of
unwanted homosexuality are politically mouvated
and nonscientific.
A homosexual client in therapy may be capable of
change to a heterosexual orientation.
Nor all clients are capable of sexual orientation
change.-
Sometimes it is best not to attempt sexual orientation
change for a particular client.
My efforts to treat a client for unwanted homosexual-
ity have resulted in harm.
It is helpful to bring prayer into the therapeucit set-
-
ting. 70 50 21 48 2.4
Treatment success can be accomplished only with reli-
gious or spiritual reference. 21 53 60 65 2.9
*l =strongly agree, 2 =somewhat agree, 3 = somewhat disagree, 4 =strongly disagree.

therapists indicated that "less than 10%" of their female clients had report-
ed such changes. Based on feedback from clients about how long their
changes in sexual orientation have lasted, 53 (34%) of the therapists recalled
they knew of clients whose changes had endured over 20 years, 27 (17%)
knew of changes that had endured 11 to 20 years, and 23 (15%) knew of
changes that had endured 7 to 10 years.
Therapists' Recall of Clients' Changes in Functioning
Assuming these ratings based on retrospective recall may be considered
valid, Table 2 summarizes therapists' memory of the sexual, psychological,
and interpersonal changes described by their clients as a result of conversion
therapy. The magnitude of change reported by these therapists was quite
large as shown by the range of 1 to 3 standard deviation units. While these
represent both statistically and chically significant change (Larnbert & Ber-
gin, 1994), it is at least reasonable to note that the higher ratings indicate
better functioning so these therapists recalled their clients were doing much
better psychologically, interpersonally, and sexually after conversion therapy.
The qualitative analysis of the therapists' retrospective responses to the
 BELIEFS, PRACTICES IN SEXUAL REORIENTATION THERAPY 697

open-ended questions yielded several major themes. First, the therapists

clearly agreed that conversion therapy helped the clients cope better with
and reduce their homosexual tendencies. Many of these therapists viewed
homosexual behavior as an addction and remarked that their clients seemed
relieved to feel more in control and less consumed by homosexual preoccu-
pations. Second, many therapists stated that conversion therapy had helped
their clients grow in self-esteem, self-understanding, and self-acceptance.
Others emphasized that therapy had not only helped their clients reduce ho-
mosexual tendencies, but it had helped the clients heal emotionally and psy-
chologically.

TABLE 2
THERAPISTS'
BEL~EFSABOUTSEXUAL,PSYCHOLOGICAL,
AND ~NTERPERSONAL
CHANGES RECALLED
FORT H E I R
CONVERSION
THERAPYCUENTS
Variable N Beforet Aftert f*
M SD M SD
Self-acceptance
Self-understanding
Trust of Opposite Sex
Personal Power
Self.esteem
Satisfy~n~ Kelauonships
Emc~c~onal Srability
Spirituality
Relationship With Church
Relationship With God
Relationship With Family
Depression
Frequency of Homosexual Thoughts
Intensity of Homosexual Thoughts
Fre uency of Masturbation (With
F?omosexual Fantasies)
Fre uency of Homosexual Behavior
4ith a Pamer
Receptivity to Marriage
Receptivity to Heterosexual Dating
< ,001. tTherapists retrospective1 rated the11cl~ents'sexual orientation and behavior becore
;k clients entered therapy or sou hYt to change and after therapy or efforts to change Racing
fi
scale was a 7-point Llkert scale =very often, very poor, very severe, or very Incense; 7 =
never, none, or very good). Higher mean scores "After" compared to "Before" recalled by che
therapists reflect improvement, e.g., more self-esteem, less depression.

Third, many of the therapists stated that clients' religious and spiritual
beliefs had played a crucial role in h e a h g and change from homosexuality.
A substantial minority of the therapists expressed the belief that spiritual re-
sources and influences are essential in the treatment of homosexuahty.
Fourth, quite a few therapists mentioned that they do not beheve conversion
698 J. NICOLOSI, ET AL.

therapy is appropriate for all clients and pointed out that they refer gay cli-
ents for gay affirmative therapy. They emphasized the importance of respect-
ing clients' values and not imposing a therapeutic approach on them that
does not lit these, whether that is conversion or gay affirmative therapy.
Fifth, also expressed was their belief that, even though their clients have not
chosen to have homosexual tendencies, homosexuality is not "inborn" and
can be changed. Sixth, some of the therapists expressed outrage at col-
leagues and professional organizations who attempt to deny dssatisfied ho-
mosexually oriented people an opportunity to seek conversion therapy.
D~scussro~
This study was self-report and retrospective in nature, which places lim-
itations on the conclusions that can be drawn. Because we d d not randomly
select these therapists from the entire population of psychotherapists, we can-
not generalize to all therapists or even to all therapists who practice conver-
sion therapy. Nevertheless, the survey gives considerable insight into the be-
liefs and practices of a group of conversion therapists.
The finding that most of the surveyed therapists believe that the 1973
decision to remove homosexu&ty from the DSM was politically rather than
scientifically motivated was of interest. The decision to remove homosexual-
ity from the DSM was made after leaders and members of the American Psy-
chiatric Association had endured several years of intense political pressure
and disruptive lobbying efforts by mhtant gay activist groups (Socarides,
1978, 1988; Bayer, 1981). Socarides and others have characterized the deci-
sion as politically motivated and argued that it conflicted with a large body
of chical and scientific evidence (Bayer, 1981; Socarides, 1988; Nicolosi,
1991). Most of the conversion therapists we surveyed continue to hold this
view.
The findmg that these conversion therapists believe that homosexuality
is a developmental disorder was also of interest in light of controversy about
this issue. Believing that homosexuality is a disorder does not mean that
these therapists necessarily believe that gay and lesbian people have higher
general rates of mental illness or psychopathology than do heterosexual peo-
ple, although some mental health professionals have argued this may be the
case (e.g., Socarides, 1995). It simply means that they believe that homosex-
u&ty is an abnormal variation of human sexual orientation, that is, a devel-
opmental disorder that apparently is caused by a complex interaction of a
variety of familial (e.g., distant relationship with father), social (e.g., rejection
by childhood same-sex peers), traumatic (e.g., childhood sexual abuse by an
older male), personality (e.g., gentle, nonaggressive), and biological factors
(Nicolosi, 1991; Byne & Parsons, 1993; Socarides, 1995; Satinover, 1996).
The finding that the therapists we surveyed belteve that conversion ther-
 BELIEFS, PRACTICES IN SEXUAL REORIENTATION THERAPY 699

apy helps clients minimize and overcome their homosexual tendencies was
not surprising. If conversion therapists did not believe that they were help-
ing clients reduce their homosexual tendencies, undoubtedly they would not
continue to offer such services. Not only did these therapists perceive that
many of their clients had made significant changes in sexual orientation and
redictions in the frequencies and intensity o f homosexual behaviors and
thoughts, they also reported that their clients had made large and significant
improvements in interpersonal and psychological functioning. They also re-
ported that they believe (based on what clients have told them) that such
changes are long lasting. These findings are consistent with MacIntosh's sur-
vey (1994) of 285 psychoanalysts who reported having analyzed 1,215 homo-
sexual patients. The therapists in MacIntosh's survey reported that 23% of
their patients changed from homosexuality to heterosexu&ty and that 85%
of their patients experienced a significant increase in their overall well-being.
The finding that the majority of the conversion therapists beheve that
conversion therapy is not appropriate for all homosexually oriented people
underscores a sentiment that was often expressed in the therapists' qualita-
tive responses. Most of them beheve thar people have the right to pursue a
gay lifestyle if they so desire and thar psychotherapists should not attempt to
impose conversion therapy on them. In this sense these therapists are not
against "gay rights." What they say they are against are therapists who at-
tempt to impose gay affirmative therapy on people who would prefer to
make efforts to reduce and overcome unwanted homosexual tendencies.
The finding that a significant number of the conversion therapists be-
lieve that spiritual issues and prayer are an important or essential part of
successfd treatment is of interest. Some mental health professionals have
marginalized religious motivations for wanting to change a client's sexual
orientation (e.g., Haldeman, 1994). Some of the conversion therapists we sur-
veyed shared their belief chat, if clients seek conversion therapy for religious
reasons, they should respect their clients' value choices rather than l a b e h g
such beliefs as homophobic and attempting to impose an alien, i.e., gay affir-
mative, framework of values upon them (Donaldson, 1998; Yarhouse, 1998).
Most of the conversion therapists in this study appeared to be open and re-
spectful toward rebgious and spiritual motivations and resources for change
and viewed it as an ethical obligation to respect the religious aspects of their
clients' diversity (American Psychological Association, 1992; Shafranske,
1996; kchards & Bergin, 1997, 2000).
A significant minority (26.7%) of the therapists in this study had made
their own personal choice earlier in their lives to leave the gay Mestyle, and
they are now making efforts to help other dissatisfied homosexual people do
so. Interestingly, 18.4% of these therapists continue to view their sexual ori-
entation as partly homosexual. This finding raises the question of how con-
700 J. NICOLOSI, ET AL.

version therapists define "change" or "success" in therapy. Our findings sug-

gest that improvements in psychological and social functioning, along with
reductions in homosexual tendencies (but not complete elunination of these
tendencies), are viewed by conversion therapists as indicators of successful
outcomes. In another survey of clients who have experienced conversion
therapy, we found that clients also view change and success in this manner
(Nicolosi, Byrd, & Potts, in press). These conversion therapy clients consid-
ered therapy effective because it helped them function better emotionally
and socially and reduced the intensity and frequency of their homosexual
thoughts and desires, even though it may not have completely e h i n a t e d
these tendencies (Nicolosi, et al., in press).
Conclusions
Despite the relatively undefined group of therapists surveyed, analysis
of their responses allows considerable insight into why the conversion thera-
pists we surveyed continue to practice conversion therapy in the face of
controversy and opposition. The majority reject currently p r e v a h g views of
homosexuality; namely, that it is genetically determined or "inborn," a nor-
mal variation of human sexual orientation, and immutable or unchangeable.
Lnstead, they hold to the view that homosexuality is a combination of "na-
ture" and "nurture," a developmental disorder, and subject to change. Al-
though these views are unpopular and not widely accepted in the "main-
stream" mental health professions, these therapists believe that there is con-
siderable theoretical and empirical support for their views. It appears the
conversion therapists in our survey hold to their views because they believe
that such views are ethically and scientifically warranted.
Standard 1.09 of the ethics code of the American Psychological Associa-
tion states that "In their work-related activities, psychologists respect the
rights of others to hold values, attitudes, and opinions that differ from their
own" (American Psychological Association, 1992, Standard 1.09). In light of
the resolutions recently passed by mental health organizations about appro-
priate therapeutic responses to sexual orientation and the efforts by some
professionals to oppose and censure conversion therapists, it seems impor-
cant to ask whether Standard 1.09 should apply in this controversial domain
of practice. We think that it should and hope that the leaders and members
of the American Psychological Association, American Psychiatric Association,
and American Counseling Association will honor their own ethical prin-
ciples. In doing so, mental health professionals would preserve the rights of
all homosexually oriented people, gay or dissatisfied, religious or nonreli-
gious, to choose and pursue their own values and lifestyle.
The interesting data based on a small number of therapists recruited
variously requires emphasis on more research in this domain. National sur-
 BELIEFS, PRACTICES I N SEXUAL REORIENTATION THERAPY 701

veys of mental health professionals are needed to find out what percentage
remain open to conversion therapy as a treatment option for dissatisfied ho-
mosexually oriented people as well as to find out what percentage actually
provide conversion therapy. Ouccome studies of conversion therapies are
greatly needed to provide additional documentation about the current de-
scription of benefits as well as the situations in which such therapies may be
harmful (Lambert & Bergin, 1994). Studies need to be designed to clardy
the various ways therapists actually conduct conversion therapy and what
may be the most effective components of treatment. Although the current
political clunate in American society and the mainstream mental health pro-
fessions provides little incentive for such research, we are hopeful that coura-
geous researchers d conduct such studies.
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Accepted March 27, 2000.

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