Guy walks into a shrink's office. Says he's gay and wants to be straight. Shrink says, "OK, I'll help."
Don't wait for the punch line. There isn't one, because this isn't a joke. It's a true story. And it's a common one, according to a British study just published in BMC Psychiatry. Researchers contacted more than 1,800 mental health professionals to find out whether they would ever try to change a client's sexual orientation. Of the 1,328 practitioners who responded, one in six admitted to having helped at least one patient attempt to alter homosexual feelings. The total number of such cases reported by the respondents was 413. That's nearly one case for every three therapists.
The study's authors find this disturbing. Treatment to change homosexuality has proved ineffective and often unsafe, they argue. Therefore, therapists shouldn't try it.
If only life were that simple.
In the big picture, the authors are right. Homosexuality isn't a sin or mental illness. It needs no cure. In most cases, it's deeply ingrained and probably inborn. If you try to change your sexual orientation, you're more likely to end up at war with yourself than at peace. For these reasons, any systematic program to turn gay people straight, such as "reparative therapy," is futile and dangerous.
But therapy isn't about the big picture. It's about lots of little pictures: the worlds unique to each of us. You and I may have the same sexual orientation, but our lives are very different. You know nothing of my family, my religion, or my community. You don't even know how straight or gay I am. If I tell my therapist that I'd rather try to modify my feelings than give up my faith or my marriage, who are you to second-guess her or me?
In the British study, the therapists who admitted to collaborating in such cases weren't anti-gay. "A very small number of those advocating intervention in this area had discernibly negative views about the same sex relationships," the authors report. But for most intervention advocates, "The qualitative data suggest that they made therapeutic decisions based on privileging client/patient choice where there was a wish to avoid the impact of negative social attitudes to same sex relationships."
The therapists also distinguished between clear-cut and borderline homosexuality. "I am sure there are cases of bisexuality or sexual ambivalence where counseling could be offered to motivated individuals," one respondent wrote. Another argued that "some clients/patients are unsure of whether they are really homosexual—particularly young adults under 25." A third ventured, "Some bisexual individuals may wish to choose an orientation that is comfortable for them and their lifestyle choices for example. This is a therapeutic issue to explore and support if that is their wish."
The idea of heterosexuality as a valid "lifestyle choice" turns the argument for sexual acceptance on its head. If a patient prefers to adjust his orientation to family or cultural circumstances, rather than the other way around, should the therapist challenge him?