Honest Sex Science

Some people can change their sexual orientation with the help of therapy. So said Robert Spitzer—“considered by some to be the father of modern psychiatry,” in the New York Times’ description—in his (in)famous 2003 study in the Archives of Sexual Behavior, appropriately titled “Can Some Gay Men and Lesbians Change Their Sexual Orientation?”

Spitzer addressed this question by conducting structured telephone interviews with two hundred individuals recruited specifically for their self-reported success at orientation change years after they had gone through some form of psychological therapy. He concluded that “there is evidence that change in sexual orientation following some form of reparative therapy does occur in some gay men and lesbians.”

He has now recanted his study. “I believe I owe the gay community an apology for my study making unproven claims of the efficacy of reparative therapy,” he concluded in a published letter to the editor of the Archives, further apologizing to anyone who had “wasted time and energy undergoing some form of reparative therapy” because they believed him. It was, declared the editors of the New York Times, the “welcome end of a pseudotheory.” Our recent study and his are the only two peer-reviewed studies of orientation change published in mainstream scientific journals in the last two decades. Should we follow Spitzer with a recantation of our work?

We don’t think so. We concluded, like Spitzer, based on our findings, that some people can experience meaningful change in sexual orientation. Published in 2011 in the Journal of Sex and Marital Therapy, our study, “A Longitudinal Study of Attempted Religiously Mediated Sexual Orientation Change,” included several significant improvements over Spitzer’s methodology.

Most notably, instead of gathering recollections about change many years after the fact, a method regarded as vulnerable to self-deception and bias, we gathered data on individuals annually as they went through the process of attempting to change. In addition to administering the type of structured interview used by Spitzer, we repeatedly administered standardized psychological inventories and measures widely regarded as valid over the six- to seven-year period of the study, urging participants to tell the truth about their experience.

We studied a population of ninety-eight men and women who used the Christian ministry group Exodus to assist their change effort. As a group, our participants manifested significant shifts away from homosexual attraction and, to a lesser degree, toward heterosexual attraction.

About one third of the final participants abandoned their attempt to change, with many embracing a homosexual identity. About one third embraced sexual abstinence rather than a homosexual identity. About one fourth had moved away from a predominantly homosexual orientation and reported having satisfactory heterosexual relationships. One participant claimed at first to be a “success” story but later repudiated his report and embraced a homosexual identity, while another had given up on change but later claimed to have successfully changed his orientation to heterosexuality.

In light of the common claim that attempts to change sexual orientation are often profoundly harmful, we administered at every assessment a standardized measure of psychological distress. Distress did not increase with continuing commitment to the process, and few subjects reported extreme levels of distress, suggesting that distress and harm are not inherent in the attempt to change sexual orientation. To be sure, harm may indeed occur when incompetent or inhumane methods are utilized, or when vulnerable minors are treated unprofessionally. On the whole, however, our evidence suggests that some people experience meaningful shifts in sexual orientation and that the attempt to change is not intrinsically or necessarily harmful.

Of course, studies of such complex issues always suffer from limitations. Five hundred subjects would have been better than ninety-eight; following them for twenty years would have been better than six to seven. We cannot claim that our ninety-eight individuals represent all individuals who want to change sexual orientation, or even everyone who seeks change through Exodus’ programs. And our study is limited by the conceptual ambiguities of measuring sexual orientation: Psychologists disagree strongly about how exactly to construe the meaning of the terms heterosexual and homosexual and how best to quantify the complex and shifting nature of sexual attraction and experience. But the reports of change still appear striking and meaningful.

Why are we not inclined to follow Spitzer in his recantation? It is important to note, first, that Spitzer has apologized for the study but his data remain. There is an enormous difference between changing one’s interpretation of scientific data, even through apology or recantation, and removing the data from the scientific canon by a retraction.

The editor of the Archives of Sexual Behavior, Kenneth Zucker, rightly noted this distinction in an interview with Psychology Today and published Spitzer’s letter under the title “Spitzer Reassesses His 2003 Study” rather than retracting the study. He also made clear that Spitzer’s article underwent multiple rounds of careful, professional peer review, contrary to reports in the New York Times.

Second, the core of Spitzer’s change of heart: his loss of confidence that “the participants’ reports of change were credible and not self-deception or outright lying.” Embellishing Spitzer’s words, the Times reporter Benedict Carey explains that “simply asking people whether they have changed is no evidence at all of real change. People lie, to themselves and others. They continually change their stories, to suit their needs and moods.”

Is self-report trustworthy? Much of psychology and medicine is premised on the validity of self-report. We depend on people to tell the truth about their depression, their headaches, their delusions, their nausea. Even some sophisticated brain-imaging studies depend on the validity of people’s self-report about what they are thinking as their brains are being imaged. It would be the foolish physician who forbade patients to speak and only looked for “verifiable measures.”

The critics themselves assume that self-reporting can be trusted. They accept without independent verification the self-reports of those who say they did not change their sexual orientation and those who claim they were harmed by the attempt.

In a review of efforts to change sexual orientation, an American Psychological Association task force in 2009 insisted on rigorous experimental standards for evidence in support of the possibility of changing sexual orientation but accepted uncritically subjects’ reports that trying to change their sexual orientation resulted in high levels of harm. The report, “Appropriate Therapeutic Responses to Sexual Orientation,” even recommended “gay affirmative therapy” despite its acknowledging that no rigorous empirical evidence supports that approach’s efficacy or safety.

We do not believe that reports of change can be summarily dismissed. We also are concerned about how Spitzer’s recantation is being interpreted. His apology is being treated as evidence that sexual orientation “cannot be changed,” as he himself insisted in a recent interview. But if a researcher concludes that his study cannot prove that successful change is possible, that study cannot prove that change is impossible either. It is one thing for Spitzer to admit to having growing doubts about his own study’s design, but it is quite another to declare that orientation cannot change.

Perhaps he was drawing upon broader evidence, as did the position statement released within weeks of Spitzer’s apology by the Pan American Health Organization, stating that sexual orientation “cannot be changed” and citing the 2009 American Psychological Association task force. That task force, however, in fact concluded only that if we consider as relevant evidence only studies that use the most tightly defined methods (thus omitting any psychological-intervention methods that defy tight procedural specification), then there is insufficient evidence to establish that sexual orientation can be reliably changed.

By these restrictive standards, there is an absence of compelling evidence. But we must be cautious about what the absence of such evidence means. The lack of such narrow kinds of evidence does not mean that we know that sexual orientation “cannot be changed.” Ignorance does not yield absolute conclusions.

Much of the science surrounding sexual orientation in general and efforts to change sexual orientation in particular is yet inconclusive. Some may be able to change their sexual orientation to a degree, but many, perhaps the majority, cannot and will not. People may be harmed when practitioners, professional or religious, do not properly protect human welfare, but harm does not appear inevitable.

Scientific caution, not premature closure, is in order in interpreting even these limited conclusions. We believe, for instance, that meaningful change in sexual orientation away from exclusive homosexuality toward heterosexuality is less frequent, on average, than the general proportions that occurred in our study population as described earlier. We express this caution based on our sense that our research population was not fully representative of all who initially contact Exodus for help but rather tended to draw those with greater motivation and resources and so were more likely to change.

But change sometimes occurs. It has long been rumored that after the papal session in which he delivered his forced recantation of his hypothesis that the earth moves about the sun, Galileo muttered, “And yet it moves.” There are people who say, “And yet I have changed,” including participants in Spitzer’s and our studies. We ought to listen.

Stanton L. Jones is provost of Wheaton College, and Mark A. Yarhouse is Rosemarie Scotti Hughes Chair of Christian Thought in Mental Health Practice at Regent University. Their work can be found at exgaystudy.com.