In some cases, the answer may be yes. "In many societies/cultures expression of sexuality out [of line] with cultural norms can cause huge distress," one therapist wrote in response to the British survey. "Given the balance between biological and developmental determinants of sexuality it is valid for an individual to value his cultural norms and to try and reduce the distress caused by transgressing these." Maybe the therapist should question those norms. Maybe the client should be told that his distress is a symptom of cultural ignorance and injustice—and that changing his orientation would be even harder than changing society.
But what do you do when the distress is rooted in the client's deeply held values? One therapist, answering the survey, said it might be OK to help a patient try to modify her feelings if she wanted to stay married. Another argued that the "client ultimately knows best and may have deep religious beliefs that influence them enormously." A third wrote that if the patient "had a strong faith, then working to help the person accept their feelings but manage them appropriately may be the best approach if [the] person felt they would lose God and therefore their life was not worth living."
Would you tell such a patient that her understanding of God is wrong? Are you sure her attraction to women is more fundamental than her religious beliefs? Is peace with the lesbian part of her sexuality worth the destruction of her family or her faith? And most important: Do you think you can answer these questions without knowing more about her?
Michael King, the professor who led the British study, tries to do just that. When gay people seek therapeutic escape, he argues, "Mental health practitioners and society at large must help them to confront prejudice in themselves and in others."
Help them confront prejudice in themselves? Isn't that just the substitution of one inner war, one purification quest, for another?
Sometimes, the substitution makes sense. When the patient is clearly gay, and when his discomfort with homosexuality isn't fundamental to his personality, it's logical to target the discomfort. But not every case is that simple. A friend once told me she was "primarily wired toward women." She was my girlfriend for the next year and a half. Another friend told me he couldn't countenance homosexuality because he was "obliged to believe it's a mortal sin." He came out of the closet a year later, but he never left Christianity or conservatism. Another friend lived as a gay man for years, then carried on a multiyear, monogamous relationship with a woman, then went back to the gay life.
"The evidence shows that you cannot change sexual orientation," says King. But on the margins, I've seen it happen.
That's the thing about therapy: It's about real people, and they don't necessarily fit your grand theory or mine. Conservative evangelists are arrogant and wrong to assume that therapy can alter a patient's sexuality. Don't repeat their mistake by insisting that it can't.