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?
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.
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