from Clinical/Therapeutic Issues

To the Editor:

One of today's most controversial topics involves the interest particularly of clinical psychologists. It is the problem of whether and how to treat people who--for whatever their reasons--find their own homosexual impulses to be distressing.

If at one time mental-health clinicians felt enjoined to convince every patient to embrace heterosexuality, now the situation is in some cases reversed. Clinicians are under pressure to encourage homosexuality. Aside from further controversy as to the origins and personal significance to a patient of having homosexual impulses, this practical problem is bothersome.

We seem to be devoted in so many ways, as a profession, to helping people to find their own answers. It feels odd to me to take a firm stand to impose our own values on a patient, and to be inflexible about what the meanings of the behavior are to the particular patient.

While I applaud APA's backing the preservation of civil rights for all people, I deplore a tendency to put any human behavior beyond the scope of scientific investigation. Somehow, this has happened with homosexuality, with fallout that constrains clinicians. I was glad to see at least one careful and scholarly journal prove willing to publish new, decently designed studies even on so controversial a matter as homosexuality happens to be at this time.

Psychological Reports, a respected, peer-reviewed journal, published a two-part study on homosexuality and treatment in May and June of this year. The first part was based on reports of therapists who treated people who had stated that they wanted to be heterosexual (sometimes among other reasons for entering into therapy).

I was especially interested in the second study, an anonymous survey of former patients who reported that they sought help to become heterosexual--or at least not actively homosexual--because they were unhappy being homosexual. The authors acknowledged the design difficulties in this kind of research, but they apparently tried to make as objective a survey as they could.

Eight hundred and eighty-two persons returned the survey. The mean time that had elapsed since they were in therapy was six years. Roughly a third of the respondents described themselves as having been exclusively homosexual before deciding to enter into therapy. The most interesting findings to me were from these respondents. A quarter of them entered into therapy with a conversion therapist, the rest with various therapists across the spectrum of mental health specialists. Their average age when they completed the survey was 29.9 years. Their average length of time in therapy was 3.4 years (median: 2 years).

My interest in their self-reports rests on the fact that they all entered into therapy because they wanted to become heterosexual. I think it matters that this was an old enough cohort to have experienced a good deal of living homosexually first, and in the present climate. It was not surprising that most of them reported they now considered themselves to be heterosexual, according to their stated goal. What particularly drew my attention was that under circumstances of anonymity that made it easy to complain, only 7% of the total number of participants who received conversion therapy said that they were doing worse psychologically, interpersonally, or spiritually. This is in keeping with MacIntosh's (1985) finding that 85% of the patients he learned about who treated by psychoanalysts experienced a significant increase in their sense of well-being, whether or not they remained homosexual.

I am not trumpeting that there are absolute truths in these publications. The authors of the study in Psychological Reports are themselves very cautious in interpreting the significance of what they publish. Nonetheless, it is heartening to see that some people in the field are beginning to try to explore this fraught subject with open minds.

--Johanna Krout Tabin, Ph.D., ABPP