The governors of California and New Jersey have recently signed bills into law that violate First Amendment protections of freedom of speech and freedom of religion. These new laws ban licensed counselors from engaging in talk therapies that reduce the level of same-sex attractions in minors for whom such reduction is a personal goal. Strikingly, these bills apply to all minors except those who wish to change their sex ("gender identity") altogether, via hormones and surgery. Legislators in New York, Massachusetts, and Pennsylvania are pushing for similar talk-therapy bans. Such legislation usurps the rights of parents and children to seek counseling that conforms to their values. They are also based on faulty premises.
When signing these bills, Governor Jerry Brown dismissed sexual orientation modification as "quackery," and Governor Chris Christie said that "people are born gay." Both these statements ignore empirical evidence that, for many teenagers, sexual orientation is unstable and malleable. The most comprehensive study of sexuality to date, the 1992 National Health and Social Life Survey, found that, without any intervention whatsoever, three out of four boys who think they are gay at sixteen don't think they are gay by the age of twenty-five.
The University of North Carolina's National Longitudinal Study of Adolescent Health surveyed 10,000 teenagers and found that the vast majority of sixteen-year olds who reported only same-sex sexual attractions reported only opposite-sex sexual attractions one year later.* Because these surveys produced such unexpected results, similar studies were soon replicated all over the Western world. The outcomes were almost identical, with population-based samples now reaching into the hundreds of thousands.
Nicholas Cummings, a former president of the American Psychological Association, writes that "contending that all same-sex attraction is immutable is a distortion of reality." As chief psychologist for Kaiser Permanente in San Francisco, Cummings oversaw hundreds of patients who were successful in changing their sexual orientations. Cummings was selective in recommending therapeutic change only to those who were highly motivated to change and who were clinically assessed as having a high probability of success.
The vast majority of Cummings's gay and lesbian patients didn't want to change their sexual orientations, and Cummings offered them therapy to attain happier and more stable homosexual lifestyles. Dr. Cummings writes, "Attempting to characterize all sexual reorientation therapy as 'unethical' violates patient choice." Instead, Cummings believes that lawmakers should respect a patient's inalienable right to self-determination.
For the last two decades, many cultural conservatives have been troubled by the way in which mainstream psychologists and psychiatrists have been pushing teenagers to prematurely identify themselves as gay, and they have been seeking out therapists with more traditionalist perspectives on sexuality.
In 1998, Stanford Professor Dr. James Lock published a controversial article in the American Journal of Psychotherapy entitled "Treatment of Homophobia in a Gay Male Adolescent." The subject of this article was a fourteen-year-old boy (J.) who was deeply conflicted about his sexuality. Lock reports that J.'s mother "doted on him and clearly had difficulty limiting him." J.'s father was distant from the entire family, but especially from J. Although J. was troubled by his inability to make male friends and to play team sports, Dr. Lock made no effort to help integrate J. into normal, age-appropriate social activities.
Instead, Dr. Lock quickly diagnosed J. as having a problem with "internalized homophobia," and he worked to set J. on a path to gay self-acceptance. He encouraged J. to join a gay support group, which left J. feeling acutely depressed. At the age of sixteen, J. began having sexual encounters with a man in his late twenties, after which J. felt "empty, unhappy, dissociated." Dr. Lock interpreted these encounters as J.'s way of "avoiding real relationships." He also cited homophobia as a reason for J.'s starkly negative reaction to these encounters. Dr. Lock advised therapists to work with "homophobic" gay teenagers (1) by helping gay teens to explore sexual fantasies through films, books, and magazines, and (2) by supporting appropriate exploration of same-sex romantic and sexual interactions.
Dissatisfied with gay-affirmative therapeutic models, clinical psychologist Joseph Nicolosi began to offer talk-only "reparative" therapy to help build up a heterosexual identity in sexually-conflicted teenagers. Nicolosi believes that homosexual feelings are, in many cases, a result of childhood sexual abuse, dysfunctional parenting, and the failure of boys to form adequate friendships with other boys.
One of Nicolosi's clients, Dave, had been molested by an uncle between the ages of eight and eleven. Dave's parents divorced when he was twelve, and Dave lived with his mother and his stepdad. Although Dave felt same-sex attractions, he did not want to live his life as a gay man because of his devout Christian faith. Dave sought out a therapist who shared his values. Dr. Nicolosi, who is Catholic, worked with Dave's pastor and youth pastor to help him develop healthy male friendships.
Dave went away to a church summer camp and joined the church's basketball team. Although Dave is not athletic, his counselor encouraged him to push himself past his discouragement and persist in his involvement in sports. The church's recreation center became for Dave a refuge from some of the tensions at home. In counseling, Dave came to see that his stepfather was capable of giving him some of the male affirmation he craved.
Patients who benefit from reparative therapy report that they enhanced their gender identities; learned how to integrate with peers at school; and found solutions that were in keeping with their beliefs. Critics of reparative therapy feel that they were misinformed about realistic outcomes and misled with unsubstantiated theories. They felt pressure to be heterosexual, and they blamed themselves for not changing.
Catholic theologian Joshua Gonnerman warns that the "offer of orientation change can be an . . . idol in which all of one's hope is placed" and that "the failure to change sexual orientations can easily shatter someone who placed her hope in heterosexuality." Gonnerman reminds us that chastity is the sexual ethic that the church demands, not heterosexual functioning.
Wanting to protect clients from false hopes of change that may never happen, Warren Throckmorton, who won an award in 2002 for supporting reparative therapy, helped develop a new framework for managing sexual identity conflicts called sexual identity therapy (SIT). SIT creates therapeutic space for the self-acceptance of clients who are unable or unwilling to change their sexual orientations. It also guards against the simplistic misconception that all gay people did not bond with their parents or were sexually abused.
According to Throckmorton, our sexual preferences are not hard-wired but rather a result of temperament, environment, and life experiences. In therapy, Throckmorton helps clients distinguish between identity (chosen self) and attractions (feeling). "Feelings and desires are not standards or commands," Throckmorton writes, "they are reactions to whatever environment we find ourselves. Feelings often change as we change our environments and make commitments to chosen values."
However, sometimes feelings do not change. In these cases, we must decide whether or not we want to act in accord with our beliefs. For some clients this will mean choosing to be celibate; others will modify or abandon traditionalist religious beliefs.
Unfortunately, the subtleties of these Christian approaches to therapy are lost in the drama of legislative hearings. At the three-hour hearing in Trenton that preceded the vote to ban conversion therapy, lead witness James "Brielle" Goldani testified that in 1997 he had been sent by his parents to a religious camp in Ohio run by the Assemblies of God Church called "True Directions." Goldani said that he was subjected to electroshock therapy and nausea-inducing IV injections to cure him of homosexuality.
In the wake of the hearing, Ohio's Secretary of State and Attorney General launched investigations, and they found that no such camp called True Directions ever existed in Ohio. The Assemblies of God had never heard of True Directions and would never have sanctioned such barbarism.
Goldani's horror story was lifted from a 1999 film titled "But I'm a Cheerleader," starring RuPaul. In the film, the parents of the main character send their daughter to a "conversion therapy" camp called True Directions where she receives the kind of treatment that Goldani describes. Unfortunately, it is quite common for proponents of bans on conversion therapy to circulate urban legends like "True Directions" to vilify therapists and pastors who disagree with them.
Lesbian cultural critic Camille Paglia writes, "Responsible scholarship is impossible when rational discourse is being policed by storm troopers . . . who have the absolutism of all fanatics." Paglia believes that it is a perfectly worthy aim to help gays function heterosexually, if they so wish. Paglia asks, "Is gay identity so fragile that it cannot bear the thought that some people may not wish to be gay?"
It is unclear how people of faith will resolve the internal debates about pastoral care for teenagers with same-sex attractions, but sweeping bans on all therapeutic efforts to reduce homosexual feelings in teenagers will have a chilling effect on religious counseling and set a dangerous precedent for psychotherapy of all kinds.
The bans will certainly make clinicians reluctant to work with teens to explore a range of sexual and gender identity issues for fear of legal ramifications. Indeed, we may be entering a strange new era in which therapists can freely help teenagers manage heterosexual attractions and behaviors but are fearful of helping teenagers manage homosexual attractions and behaviors.
In response to the therapy bans, the American Academy of Christian Counselors wrote: "What does alarm us is the blatant disregard for faith values and the unnecessary restrictions that will be placed on clients and their families." A teenager like Dave will no longer have the option of seeking out a counselor who shares his goals for himself. He will, instead, be stuck with a therapist who will be fearful of pursuing ethical treatments that run afoul of the law. Or Dave may seek treatment from an unlicensed, untrained counselor. For teenagers who are trying to balance the demands of their faith with the demands of their sexuality, this will certainly make their journey to adulthood even more difficult and lonely.
The bans on talk therapy have consequences for the freedoms of speech and religion of all Americans. The Ninth Circuit Court of Appeals was only able to uphold this ban in California by defining one-on-one counseling as "conduct" rather than "speech." The court held that talk-only sexual re-orientation therapy is more like administering electroshock treatments than communicating a message.
Paul Sherman and Robert McNamara, who represent the Institute for Justice, warn that if "speech" can be relabeled "conduct" in this way, then governments can begin regulating teachers who engage in the "conduct" of instructing, actors who engage in the "conduct" of entertaining, and consultants who engage in the "conduct" of strategizing. "Whatever one's view of the merits or evils of 'reparative' talk therapy," McNamara and Sherman write, "it consists entirely of spoken communication," and this should bring it within the scope of First Amendment protection. The Ninth Circuit's ruling represents a radical break from the American tradition of protecting unpopular speech that offends the sensibilities of a powerful interest group.
*An earlier version of this essay incorrectly identified a study as being that of the Center for Disease Control and Prevention's 2007 report, Adolescent Health in the United States. The correct study is the University of North Carolina's National Longitudinal Study of Adolescent Health.