By Damien W. Riggs MAPS, Associate Professor, Department of Social Work and Social Planning, Flinders University, Australian Research Council Future Fellow, and Treasurer, APS Gay and Lesbian Issues Interest Group

Fifteen years ago the APS followed the APA in releasing a position statement about the potentially harmful effects of engaging in forms of psychological practice that attempt to change a person’s sexual orientation. Given the lack of empirical evidence about such practice at the time, the position statements by both the APS and APA were in effect moral statements: they emphasised that homosexuality was not a disorder, and thus claiming to ‘treat’ it was unwarranted.

Over the fifteen years since these position statements were released, some psychologists and other allied health professionals have continued to offer services commonly referred to as ‘reparative therapies’. These therapies use behavioral techniques aimed at reducing the likelihood of engaging in unwanted behaviours, such as intimacy with partners of the same gender. Importantly, these therapies do not per se claim to change an individual’s attractions, but rather their willingness to act upon their attractions.

Concurrently, a considerable body of research assessing the efficacy of reparative therapies has emerged that almost unilaterally indicates that reparative therapies indeed do nothing to change an individual’s attractions, and actually may often do very little to change an individual’s behaviour.

Further, an important finding from this body of research is that for many people reparative therapies can be damaging. These therapies often rely upon negative messages about homosexuality and bisexuality, which may contribute to the shame and stigma that many lesbians, gay men, and bisexual people experience. Shaming an individual, as a therapeutic approach, is likely to result in poor mental health outcomes such as depression and low self-efficacy.

A striking example from the literature appears in the case of a journal article published by Spitzer (2003). Drawing on a sample of 200 people who reported same gender attractions and who had undertaken reparative therapy, Spitzer suggested that change in terms of behaviours was achieved to some degree by a majority of the sample, though this was more likely for women than men. In 2012, however, Spitzer denounced his own findings (Arana, 2012), suggesting that the research question (“Can some version of reparative therapy enable individuals to change their sexual orientation from homosexual to heterosexual?”) could not have been answered by the data collected.

This year, given the lack of evidence in support of reparative therapy, and the potentially harmful effects arising from it, the APS developed a new position statement that reflects the evidence base. This document draws on the APS Code of Ethics and strongly asserts that reparative therapies not only fail to meet the criteria of evidence-based practice, but they may also be counter to the Code of Ethics.

This new position incorporates the previous moral position i.e., that homosexuality is not a disorder and thus should not be treated as such, and strongly denounces the use of any therapy that attempts to change a person’s sexual orientation due to lack of any clinical evidence demonstrating the effectiveness of such an approach. In so doing, the new position statement alerts psychologists to the potential harm reparative therapies can cause.

The position statement further suggests that reparative therapies are not in line with the standards expected of Australian psychologists. This point about standards is important given the outcomes of recent legal cases in the United States where those subjected to reparative therapies have sued and won cases against clinicians who engage in such therapies (see Stern 2015). Practising without an evidence base leaves clinicians vulnerable to charges of unethical practice and indeed potential litigation.

The position statement concludes with the APS advocating for the use of evidence-based strategies to alleviate distress that do not include attempts at changing sexual orientation, but rather include challenging negative stereotypes, seeking social support, and self-acceptance, among others.

In sum, the APS is proud to be taking the lead in ensuring that its ethical standards and positions reflect the latest evidence. This brings the APS in line with other professional organisations who have made similar statements about reparative therapies, and indeed positions the APS at the forefront of such statements within the discipline of psychology.

 

References

InPsych October 2015