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from What do clinical studies say?
Journal Articles Support the
Reparative-Therapy Treatment Option
Two recent journal articles by Mark Yarhouse of Regent University in Virginia make a strong
case for the ethics of reparative-type therapies as a treatment option. The first appeared in
Psychotherapy (vol. 35, Summer 1998, no. 2, pp. 234-259), and is entitles "When Clients Seek Treatment for
Same-Sex Attraction: Ethical Issues in the 'Right to Choose' Debate."
The second appeared in The American Journal of Family
Therapy, 26:321-330, 1998, and is entitled, "When Families Present with Concerns about an Adolescent's Experience of Same-Sex Attraction."
In the Psychotherapy article, Dr. Yarhouse affirms the ethicality of conversion-type therapies.
"Psychologists have an ethical responsibility to allow individuals to pursue treatment aimed at
curbing experiences of same-sex attraction or modifying same-sex behaviors," he says, "not only because
it affirms the clients' right to dignity, autonomy and agency, as persons presumed capable of
freely choosing among treatment modalities and behavior, but also because it demonstrates regard
for diversity."
When the Therapist Overrides the Client's Convictions
He discusses the gay-advocacy position that the only acceptable treatment is gay-affirmative
therapy. Gay-affirmative therapy holds that a client's unwillingness to accept his homosexuality is
inevitably the result of internalized homophobia, and thus is a belief which is not freely chosen;
therefore, clients are said not to have the right
to choose sexual-reorientation treatment. In rebuttal,
Dr. Yarhouse cites Ethical Standard 1:09 of the A.P.A., 1992, p. 1601, that psychologists are to
be "aware of cultural, individual, and role differences, including those due toreligion." He says
that when psychologists "override the values" of their clients, they are assuming that sexual diversity
is to be respected, but religious diversity is of lesser value. Some therapists, he says, actually
encourage their homosexual clients to abandon
their religious tradition in favor of a generalized
"spirituality."
Dr. Yarhouse says that in working with homosexual clients, a more sophisticated
consent-to-treat form is required, and he suggests particular subjects which that consent form should cover.
The Critique: "No One Ever Changes"
Critics of reparative-type therapies cite the lack of clear evidence that such therapy is effective.
"The dearth of controlled outcome studiesdoes not disprove the success of treatment," Dr.
Yarhouse notes. He criticizes those researchers who insist that an ex-gay man who still struggles with
occasional temptations is not, in fact, changed. "Continued struggles with same-sex arousal may
be expected residual effects from years of homosexual fantasy and behavior. Psychologists
certainly refrain from decrying chemical-dependency programs because someone experiences cravings
following treatment."
When a client decides to pursue gay-affirmative therapy, he says, he should be aware of those
factors associated with a gay lifestyle--increased rates of depressive symptomology, alcohol and drug
use, suicidal ideation, and widespread use of sexual practices which increase the risk of physical
harm and disease (for which he cites the 1994 book, The Social Organization of Sexuality in reference).
Acknowledging a client's right to choose sexual-reorientation treatment "affirms their right
to dignity, autonomy, and agency, as persons presumed capable of freely choosing among
treatment modalities and behavior," as well as the client's right to his own cultural and religious values.
Dr. Yarhouse's second article, "When Families Present with Concerns about an Adolescent's
Same Sex Attraction," similarly stresses the importance of respecting the client's cultural and
religious values. He states that no one theory, in and of itself (biological or psychological) can
completely explain the origins of homosexual attraction, but that both do have some empirical support.
He questions the ethicality of the gay-affirmative approach, which aims to change the client's
attitudes and values about homosexuality, and says it borders on using the professional relationship
to further the therapist's own interests. Instead, he advises using a comprehensive type of
informed consent which fully advises the client of all his options. If religious or social values are central to
the family's concerns and in clear conflict with those of the therapist--or the therapist believes he
may ultimately attempt to impose his own values on the client--then the therapist should refer him out
to a like-minded clinician.
Dr. Yarhouse can be contacted at Regent University, School of Counseling and Human
Services, 1000 Regent University Drive, Virginia Beach, VA 23464.
Updated: 8 February 2008
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