Attempts To Change Sexual Orientation
Update: May 18, 2012  

According to a story in the May 19th New York Times, Robert Spitzer has written a letter to Kenneth Zucker, editor of the Archives of Sexual Behavior, in which he expresses his regrets for publishing his 2003 study of highly religious individuals who said their sexual orientation was changed by reparative therapy.

The website Truth Wins Out has published an advance copy of the letter, including the following text:

Several months ago I told you that because of my revised view of my 2001 study of reparative therapy changing sexual orientation, I was considering writing something that would acknowledge that I now judged the major critiques of the study as largely correct. After discussing my revised view of the study with Gabriel Arana, a reporter for American Prospect, and with Malcolm Ritter, an Associated Press science writer, I decided that I had to make public my current thinking about the study. Here it is.

Basic Research Question. From the beginning it was: "can some version of reparative therapy enable individuals to change their sexual orientation from homosexual to heterosexual?" Realizing that the study design made it impossible to answer this question, I suggested that the study could be viewed as answering the question, "how do individuals undergoing reparative therapy describe changes in sexual orientation?" – a not very interesting question.

The Fatal Flaw in the Study – There was no way to judge the credibility of subject reports of change in sexual orientation. I offered several (unconvincing) reasons why it was reasonable to assume that the subject's reports of change were credible and not self-deception or outright lying. But the simple fact is that there was no way to determine if the subject's accounts of change were valid.

I believe I owe the gay community an apology for my study making unproven claims of the efficacy of reparative therapy. I also apologize to any gay person who wasted time and energy undergoing some form of reparative therapy because they believed that I had proven that reparative therapy works with some "highly motivated" individuals.

Read Dr. Herek's critique of the study (published with Spitzer's original article in the Archives of Sexual Behavior in 2003).

Update: April, 2012  

An article in the April 2012 American Prospect, "My So-Called Ex-Gay Life," details author Gabriel Arana's personal experiences with reparative therapy. It also discusses his interview with Dr. Robert Spitzer, reporting that Spitzer expressed a wish to retract his 2003 Archives of Sexual Behavior paper on highly religious individuals who said their sexual orientation was changed by reparative therapy.

According to Arana's account, Spitzer said he spoke about writing a retraction to the editor of the Archives, who declined to publish it.

Numerous reports and blog posts about the Arana article subsequently appeared on the Web, many of them highlighting Spitzer's comments about retracting his paper. For example, an article in The Advocate was headlined Psychiatrist Retracts 2001 Claim That Ex-Gay Programs Can Work.

Many researchers and clinicians were puzzled by various aspects of the report about Spitzer. Was he saying that his original data were flawed, or does he now believe that his interpretation of the results was incorrect? Why would Dr. Ken Zucker, editor of the Archives, be unwilling to publish a letter or comment by Spitzer about the controversial study? And why was Spitzer disclosing his misgivings about the study indirectly through an interviewer, rather than making them public in an article he wrote himself?

Some of these questions were answered in a blog entry by Dr. Alice Dreger. In it, she reports on her conversation with Dr. Zucker about Spitzer's retraction.

If you're interested in the Spitzer paper, you'll appreciate the clarifications that Dr. Dreger provides.

Update: 2009  

In response to recent public debates about interventions intended to change individuals' sexual orientation, the American Psychological Association created a Task Force on Appropriate Therapeutic Responses to Sexual Orientation which reviewed the relevant research literature.

In 2009, the Task Force reported that it found "serious methodological problems in this area of research, such that only a few studies met the minimal standards for evaluating whether psychological treatments, such as efforts to change sexual orientation, are effective" (p. 2).

Based on its review of the studies that met these standards, the Task Force concluded that "[E]nduring change to an individual's sexual orientation is uncommon. The participants in this body of research continued to experience same-sex attractions following SOCE [sexual orientation change efforts] and did not report significant change to other-sex attractions that could be empirically validated, though some showed lessened physiological arousal to all sexual stimuli. Compelling evidence of decreased same-sex sexual behavior and of engagement in sexual behavior with the other sex was rare. Few studies provided strong evidence that any changes produced in laboratory conditions translated to daily life. Thus, the results of scientifically valid research indicate that it is unlikely that individuals will be able to reduce same-sex attractions or increase other-sex sexual attractions through SOCE" (pp. 2-3).

In addition, the Task Force found evidence to indicate that some individuals experienced harm or believed they had been harmed by these interventions. The Task Force report provides a detailed discussion of this topic and an extensive review of relevant research.

In response to the Task Force report, the APA passed a 2009 resolution that stated, in part, "the American Psychological Association concludes that there is insufficient evidence to support the use of psychological interventions to change sexual orientation" and "the American Psychological Association concludes that the benefits reported by participants in sexual orientation change efforts can be gained through approaches that do not attempt to change sexual orientation."

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"Reparative therapy."

The mass media and the Web are filled with claims these days from religious conservatives, orthodox psychoanalysts, anti-gay organizations, and even a professional football player claiming that people with a homosexual orientation not only can become heterosexual, but also should do so.

However, claims by the Family Research Council, Charles Socarides, Joseph Nicolosi, and others of "successful" conversions through reparative therapy are filled with methodological ambiguities and questionable results (for reviews, see Haldeman, 1991, 1994; see also Haldeman's 1999 review paper is available on the web in HTML and Adobe Acrobat (PDF) format). They are also ethically suspect. [Bibliographic references are on a different web page]

In many of these behavior-change techniques, "success" has been defined as suppression of homoerotic response or mere display of physiological ability to engage in heterosexual intercourse. Neither outcome is the same as adopting the complex set of attractions and feelings that constitute sexual orientation.

Many interventions aimed at changing sexual orientation have succeeded only in reducing or eliminating homosexual behavior rather than in creating or increasing heterosexual attractions. They have, in effect, deprived individuals of their capacity for sexual response to others. These "therapies" have often exposed their victims to electric shocks or nausea-producing drugs while showing them pictures of same-sex nudes (such techniques appear to be less common today than in the past).

Another problem in many published reports of "successful" conversion therapies is that the participants' initial sexual orientation was never adequately assessed. Many bisexuals have been mislabeled as homosexuals with the consequence that the "successes" reported for the conversions actually have occurred among bisexuals who were highly motivated to adopt a heterosexual behavior pattern.

The extent to which people have actually changed their behavior – even within the confines of these inadequate operational definitions – often has not been systematically assessed. Instead, only self reports of patients or therapists' subjective impressions have been available. More rigorous objective assessments (e.g., behavioral indicators over an extended period of time) have been lacking (Coleman, 1982; Haldeman, 1991, 1994; Martin, 1984).1

Some psychoanalysts claim to have conducted empirical research demonstrating that their "therapies" are able to change gay people into heterosexuals. Their studies have multiple flaws, including a lack of safeguards against bias and a lack of control groups. Rather than having patients evaluated by an independent third party who is unaware of which patients received the "reparative therapy," these studies are simply compilations of self-reports from psychoanalysts who are attempting to change their patients' sexual orientation (and who are highly motivated to report "success").

And even if we accept these studies' claim that change has occurred, they do not provide any evidence that such change resulted from a particular therapy. Individuals who changed might well have done so anyway, even without therapy.

The 2001 APA Convention Papers











  Furor Erupts Over Study On Sexual Orientation, an article by Ken Hausman in the APA's Psychiatric News (July 6, 2001)


Claims about the "success" of conversion therapies have appeared mainly in the mass media and on the World Wide Web, rather than in high-quality, peer-reviewed scientific journals. A 2000 paper by Joseph Nicolosi and his colleagues was published in Psychological Reports. Psychological Reports is also the major outlet for Paul Cameron, the discredited antigay psychologist. As detailed elsewhere on this site, Psychological Reports has very low prestige among researchers and a low rejection rate. In addition, unlike other psychological journals, it charges its authors a fee to publish their papers.

However, in May of 2001, two papers on the topic of conversion therapies were presented at the American Psychiatric Association's annual convention. One paper, by Dr. Robert Spitzer, reported findings from 45-minute telephone interviews with 143 men and 57 women who had sought help to change their sexual orientation. He found that 66 percent of the men and 44 percent of the women had achieved "good heterosexual functioning" and he attributed this to the interventions.

The Spitzer study was immediately criticized on several grounds. For example, the sample consisted predominantly of activists recruited from "ex-gay" and anti-gay organizations. About two thirds were referred to Spitzer by so-called "ex-gay ministries," such as Exodus, or by the National Association for Research and Therapy of Homosexuality (NARTH). Of those who participated, 78 percent had spoken publicly in favor of efforts to convert homosexuals to heterosexuality.

This is a potential weakness of the study because activists are highly motivated to report that they successfully changed their sexual orientation. Consequently, they may present an inaccurate impression of themselves to researchers. Dr. Spitzer took the activists' testimonials at face value, with no checks on the reliability or validity of their self-reports. In his relatively brief interviews with them, Dr. Spitzer may not have been able to detect factual errors or misstatements – intentional or inadvertent – by the activists.

Dr. Spitzer's study also appears to suffer from some of the same methodological flaws as the published studies discussed above. For example, only a minority of the participants (about 40%) were exclusively attracted to partners of the same sex before they attempted to change. As noted above, including bisexuals in studies evaluating the outcomes of conversion therapies tends to inflate the proportion of "successes."

Dr. Spitzer did not claim that his findings could be generalized to the gay and lesbian population at large. Indeed, he was quoted in the New York Times as saying that, despite the findings from his study, the number of homosexuals who could successfully become heterosexual was likely to be "pretty low." He also conceded that participants in his study were "unusually religious" and were not necessarily representative of most gay men and lesbians in the United States.

The second APA paper, presented by Dr. Ariel Shidlo and Dr. Michael Schroeder, reported findings from a study of 202 homosexuals who were recruited through the Internet and direct mailings to groups advocating conversion therapy. Most of the participants (178, or 88%) reported that efforts to change their sexual orientation had failed. Only 6 (3%) achieved what the researchers considered a heterosexual shift. Drs. Shidlo and Schroeder also reported that many respondents were harmed by the attempt to change.


An Analogy  

To better appreciate the potential flaws in Dr. Spitzer's study, consider an analogous situation.

Suppose a pharmaceutical company claims that a new vitamin supplement can change left-handed people to right-handers. Mainstream medical organizations express their opposition to the vitamin, saying that it causes harm to many people who use it, and noting that there is no reason for left-handed people to try to change.

To test the drug company's claim, a researcher conducts brief telephone interviews with people who have used the product. He recruits most of his research participants from a list (provided by the drug company) of individuals who claim to have used the vitamin and have given public testimonials on behalf of the drug company. Many of those people say that they tried the vitamin because they felt miserable as left-handers in a right-handed world, and that they are now functioning as right-handers (although many report occasional thoughts about using their left hand).

The researcher's data consist entirely of the one-time telephone interviews. He does no follow-up interviews to assess the consistency of the users' stories. Nor does he conduct face-to-face assessments with standardized measures to assess whether the vitamin users have actually become right-handed. Meanwhile, another research team reports data from a different study, in which they found that the vitamin supplement did not change most left-handers to right-handers, and that many people who tried the vitamin suffered serious negative side effects.

In such a situation, we would want to ask several questions. How reliable are the reports of vitamin users who were recruited through the drug company? What about the many people who were harmed by the vitamin? Why is it important for left-handers to become right-handed in the first place?

We can raise similar questions about Dr. Spitzer's study.

  • How reliable are the reports of people recruited through Exodus and NARTH?
  • For those who did change, how do we know that they would not have changed their sexual orientation anyway, even without some form of therapy?
  • What about the many people who have been harmed by conversion therapies?
  • Why is it important for gay men and lesbians to become heterosexual in the first place? Doesn't the real problem lie in society's hostility toward people who are homosexual or bisexual?

Indeed, even if conversion therapies could be shown to change sexual orientation in a small number of cases, there are strong arguments that doing so is unethical. For example, Dr. Gerald Davison (1991), a former president of the Association for the Advancement of Behavior Therapy, argued that change-of-orientation programs are ethically improper, and that their availability only confirms professional and societal biases against homosexuality.

The Mainstream Position



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  For more than a quarter-century, the major professional associations of mental health practitioners and researchers in the United States have recognized that homosexuality is not a mental illness. They are highly critical of attempts to change sexual orientation.

The American Psychiatric Association's official web site notes that: "There is no published scientific evidence supporting the efficacy of 'reparative therapy' as a treatment to change one’s sexual orientation, nor is it included in the APA's Task Force Report, Treatments of Psychiatric Disorders. More importantly, altering sexual orientation is not an appropriate goal of psychiatric treatment. Some may seek conversion to heterosexuality because of the difficulties that they encounter as a member of a stigmatized group. Clinical experience indicates that those who have integrated their sexual orientation into a positive sense of self function at a healthier psychological level than those who have not. 'Gay affirmative psychotherapy' may be helpful in the coming out process, fostering a positive psychological development and overcoming the effects of stigmatization. A position statement adopted by the Board in December 1998 said: The American Psychiatric Association opposes any psychiatric treatment, such as 'reparative' or 'conversion' therapy, which is based upon the assumption that homosexuality per se is a mental disorder, or based upon a prior assumption that the patient should change his/ her homosexual orientation.'"

Text of the 1997 resolution









The American Psychiatric Association's Position Statements on conversion therapy are posted on their web site.


At its meeting in August, 1997, the Council of Representatives of the American Psychological Association overwhelmingly approved a resolution affirming its longtime position that homosexuality is not a disorder and raising serious questions about so-called reparative therapies. In particular, the APA resolution raised the question of whether it is ethically possible for a psychologist to conduct conversion therapy with individuals who are not capable of informed consent, including minors.

In 1998, at its December 11-12 meeting, the American Psychiatric Association Board of Trustees unanimously endorsed a position statement opposing reparative therapy. According to the 1998 position statement:

"The potential risks of 'reparative therapy' are great, including depression, anxiety and self-destructive behavior, since therapist alignment with societal prejudices against homosexuality may reinforce self-hatred already experienced by the patient."

"Many patients who have undergone 'reparative therapy' relate that they were inaccurately told that homosexuals are lonely, unhappy individuals who never achieve acceptance or satisfaction."

"The possibility that the person might achieve happiness and satisfying interpersonal relationships as a gay man or lesbian is not presented, nor are alternative approaches to dealing with the effects of societal stigmatization discussed."

"Therefore, the American Psychiatric Association opposes any psychiatric treatment, such as 'reparative' or 'conversion' therapy which is based upon the assumption that homosexuality per se is a mental disorder or based upon a prior assumption that the patient should change his/her homosexual orientation. The American Psychiatric Association recognizes that in the course of ongoing psychiatric treatment, there may be appropriate clinical indications for attempting to change sexual behaviors."

In Summary  

In summary, scientific data are lacking to show that behavior modification techniques effectively change individuals' sexual orientations from homosexual to heterosexual. The relatively small number of attempts that have been adequately documented appear to have been largely unsuccessful.

Does this mean that no one ever changes his or her orientation from homosexual to heterosexual through the use of such techniques? Not necessarily. It is possible that some individuals who enter such therapies eventually make such a change, although there is no evidence for a cause-and-effect relationship. Those people might have changed their sexual orientation without the therapy.

However, so-called reparative therapy techniques – premised on the assumption that homosexuality is a form of psychopathology – appear to do much more harm than good. And even if conversion therapies were shown to be successful in more than a relative handful of cases, they would remain ethically questionable.

The mainstream view in psychology and psychiatry is that people who are troubled about their homosexual orientation have internalized society's prejudice against homosexuality, and that the appropriate task of a therapist is to help them to overcome those prejudices and to lead a happy and satisfying life as a gay man or lesbian.


  1. Claims by religious organizations to have changed homosexuals to heterosexuals generally have not been documented in such a way as to permit their critical evaluation. For more discussion of them, see Haldeman (1991, 1994). (return to text)
    Dr. Herek's critique of the Spitzer study (which was one of several published in the Archives of Sexual Behavior in 2003) can be read elsewhere on this web site.
    Background paper on reparative therapy Download a background paper on "reparative therapy" by Professor Herek, which contains much of the information from this web page. (Requires Adobe Acrobat reader, version 5, which can be downloaded free of charge).
    Dr. Herek's comments on the APA Resolution on "Reparative Therapy"
  Facts About Homosexuality and Mental Health
  Facts About Changing Sexual Orientation
  Facts About Homosexuality and Child Molestation
  Bibliography for Facts About Sexual Orientation
  Other Relevant Links (will open in a separate browser window)
Paulks on Newsweek cover   "Ex-Gay Leader Confronted In Gay Bar" from the Southern Voice (September 23, 2000).
John Paulk, "a prominent ex-gay leader once featured as 'going straight' on the cover of Newsweek magazine, was confronted and photographed" patronizing a gay bar in Washington, D.C. According to the Exodus web site (currently inactive), he subsequently was removed as Chairman of the Board of Exodus North America.
  Calculated Compassion: How the Ex-Gay Movement Serves the Right's Attack on Democracy (Political Research Associates)
  Answers to Your Questions About Sexual Orientation and Homosexuality (American Psychological Association)
  Gay and Lesbian Issues (American Psychiatric Association)
Crowd ad   Copies of print advertisements about "reparative therapy" (July, 1998)
  The Pseudo-Science Of Sexual Orientation Conversion Therapy by Douglas Haldeman, Ph.D.
  The Ex Files: Not Your Usual Gays by Mark E. Pietrzyk
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