Spitzer Study Published:
Evidence Found for Effectiveness of
Reorientation Therapy

By Roy Waller and Linda A. Nicolosi

The results of a study conducted by Dr. Robert L. Spitzer have just been published in the Archives of Sexual Behavior, Vol. 32, No. 5, October 2003, pp. 403-417.

Spitzer's findings challenge the widely-held assumption that a homosexual orientation is "who one is" -- an intrinsic part of a person's identity that can never be changed.

The study has attracted particularly attention because its author, a prominent psychiatrist, is viewed as a historic champion of gay activism. Spitzer played a pivotal role in 1973 in removing homosexuality from the psychiatric manual of mental disorders.

Testing the hypothesis that a predominantly homosexual orientation will, in some individuals, respond to therapy were some 200 respondents of both genders (143 males, 57 females) who reported changes from homosexual to heterosexual orientation lasting 5 years or more. The study's structured telephone interviews assessed a number of aspects same-sex attraction, with the year prior to the interview used as the comparative base.

In order to be accepted into the 16-month study, the 247 original responders had to meet two criteria. First, they had to have had a predominantly homosexual attraction for many years, including the year before starting therapy (at least 60 on a scale of sexual attraction, with 0 as exclusively heterosexual and 100 exclusively homosexual). Second, after therapy they had to have experienced a change of no less than 10 points, lasting at least 5 years, toward the heterosexual end of the scale of sexual attraction.

Although examples of "complete" change in orientation were not common, the majority of participants did report change from a predominantly or exclusively homosexual orientation before therapy to a predominantly or exclusively heterosexual orientation in the past year as a result of reparative therapy.

These results would seem to contradict the position statements of the major mental health organizations in the United States, which claim there is no scientific basis for believing psychotherapy effective in addressing same-sex attraction. Yet Spitzer reports evidence of change in both sexes, although female participants reported significantly more change than did male participants.

The statistical and demographic details of the respondents include the following:

Employing a 45-minute telephone interview of 114 closed end questions, each requiring either a yes/no answer or calling for a scaled rating of between 1 and 10, Spitzer's study focused on the following areas: sexual attraction, sexual self-identification, severity of discomfort with homosexual feelings, frequency of gay sexual activity, frequency of desiring a same-sex romantic relationship, frequency of daydreaming of or desiring homosexual activity, percentage of masturbation episodes featuring homosexual fantasies, percentage of such episodes with heterosexual fantasizing, and frequency of exposure to homosexually-oriented pornographic materials.

In addition, participants were asked to react to a series of possible reasons for desiring change from homosexual orientation to heterosexuality as well as being asked to assess their marital relationships.

Some of the findings of the Spitzer study, particularly regarding motivations for change, included:

As for completely reorienting from homosexual to heterosexual, most respondents indicated that they still occasionally struggled with unwanted attractions--in fact, only 11% of the men and 37% of the women reported complete change. Nevertheless this study, Spitzer concludes, "clearly goes beyond anecdotal information and provides evidence that reparative therapy is sometimes successful."

Spitzer acknowledges the difficulty of assessing how many gay men and women in the general population would actually desire reparative therapy if they knew of its availability; many people, he notes, are evidently content with a gay identity and have no desire to change.

Is reorientation therapy harmful? For the participants in our study, Spitzer notes, there was no evidence of harm. "To the contrary," he says, "they reported that it was helpful in a variety of ways beyond changing sexual orientation itself." And because his study found considerable benefit and no harm, Spitzer said, the American Psychiatric Association should stop applying a double standard in its discouragement of reorientation therapy, while actively encouraging gay-affirmative therapy to confirm and solidify a gay identity.

Furthermore, Spitzer wrote in his conclusion, "the mental health professionals should stop moving in the direction of banning therapy that has, as a goal, a change in sexual orientation. Many patients, provided with informed consent about the possibility that they will be disappointed if the therapy does not succeed, can make a rational choice to work toward developing their heterosexual potential and minimizing their unwanted homosexual attractions."

Is reorientation therapy chosen only by clients who are driven by guilt--that is, what's popularly known as "homophobia"? To the contrary, Spitzer concludes. In fact, "the ability to make such a choice should be considered fundamental to client autonomy and self-determination."

http://www.narth.com/docs/evidencefound.html

Can Some Gay Men and Lesbians Change Their Sexual Orientation? 200 Participants Reporting a Change from Homosexual to Heterosexual Orientation

Research Summary:
Robert L. Spitzer
Can Some Gay Men and Lesbians Change Their Sexual Orientation? 200 Participants Reporting a Change from Homosexual to Heterosexual Orientation

Author and Source:

Robert L. Spitzer
Presentation at the American Psychiatric Association Annual Convention. New Orleans, May 9, 2001. Note.
Subsequently published in Archives of Sexual Behavior, 32(5), 403-417, October 2003.

Brief Description:

Spitzer did telephone interviews of 200 subjects who claim to have changed their sexual orientation from homosexual to heterosexual.

Stated Goal of Study:

Spitzer's goal in carrying out this research was to "study the self-reported experiences of individuals who claim to have achieved a change from homosexual to heterosexual attraction that has lasted at least five years".

Stated Definition of Change:

Spitzer clearly defined terms throughout his study, including "homosexual indicators" and "good heterosexual functioning" (see "Summary of Results", below).

Actual Change (based on the criteria as defined in the full paper, and focusing on subjects who were initially exclusively or predominantly homosexual):

Change in Heterosexual Behaviour (commenced for 20 subjects)
Change in Heterosexual Attraction (commenced for the same 20 subjects)

Description of Method:

Spitzer recruited subjects from ex-gay ministries, NARTH, former therapists and other sources. To be included in the study, subjects had to meet the following criteria:

·         "Predominantly homosexual attraction (at least 60, 0-100 scale) prior to a specific effort to change attraction to heterosexual"

·         "Goal of functioning heterosexually"

·         "After change effort, some change in sexual attraction (at least 10, on 0-100 subjective self report scale) beginning at least 5 years prior to interview".

Of the initial 274 subjects, 74 were excluded due to not adequately meeting the entry criteria. Of the 200 eligible study subjects, 143 were male and 57 were female. 43% were from ex-gay ministries, 23% were from NARTH, 9% were referred by former therapists, and 25% came from other sources. He then did extensive telephone interviews (112 closed-ended and 9 open-ended questions), tape-recording some of the interviews.

Summary of Results:

1.      Spitzer assessed changes in sexual orientation measures between the 12 months before subjects began their effort to change, and the 12 months prior to the interview. These questions pertained to sexual attraction, lustful thoughts about the same-sex, same-sex and opposite-sex masturbatory fantasies, use of pornography, yearning for romantic emotional intimacy with the same sex, frequency of heterosexual and homosexual sex, etc. Here are some of the results:

2.      Change in sexual attraction: Spitzer used a 0-100 scale where 0 is no sexual attraction to the same sex and 100 is exclusive attraction to the same sex. Average (or mean) sexual attraction for before and after is as follows:

Changes in Average Sexual Attraction
(100 = only attracted to the same sex,
0 = only attracted to the opposite sex)

 

12 months before effort to change

 

12 months prior to interview

Male Subjects

91

23

Female Subjects

88

8

This shows an overall movement from high same-sex attraction to high or relatively high opposite-sex attraction.

3.      Homosexual Indicators in the 12 Months Prior to the Interview: These indicators are same-sex attraction, sexual orientation identity, same-sex lustful thoughts, yearning for romantic emotional intimacy, same-sex masturbatory fantasies, same-sex thoughts during heterosexual sex, gay pornography, homosexual behaviour, and being bothered by homosexual feelings.

 

No or only minimal homosexual indicators

 

No homosexual indicators

 

Male Subjects

29%

11%

Female Subjects

63%

37%

4.      No homosexual indicators means exactly that: results of 0, never and no. "No or only minimal homosexual indicators" means that the answers to the items considered homosexual indicators must be 10 or less (items that use a 0 - 100 scale), "a few times a year" or never.

5.      This is significant considering that all subjects in the study were at least 60 on the 0-100 (0= heterosexual, 100= homosexual) sexual attraction scale before the effort to change and that their average "before" sexual attraction was 91 for male and 88 for female subjects.

6.      Good Heterosexual Functioning
The following five items had to be true in order for a subject to be considered to have "good heterosexual functioning":

o        was in a loving heterosexual relationship in the last year

o        satisfaction from the emotional relationship with their partner is 7 or more (scale of 1-10)

o        heterosexual sex at least a few times a month

o        the physical satisfaction from sex with their partner is at least 7 (scale of 1-10)

o        they never, or rarely, have same-sex thoughts while having sex with their partner. "Rarely" was defined as no more than 15% of heterosexual sex occasions.

In the year before starting therapy, none of the females and only 3 of the males satisfied the criteria for Good Heterosexual Functioning. In contrast, 66% (n=94) of the male subjects and 44% (n=25) of the female subjects had good heterosexual functioning in the 12 months prior to the interview.

7.      Good Heterosexual Functioning for Those who Were Extreme on Homosexual Indicators

Of the 200 subjects, 27 males and 6 females were considered extreme on combined homosexual indicators. For them, the following was true:

o        No opposite-sex attraction as a teenager or in the year before the change effort

o        Never heterosexual sex with excitement

o        No heterosexual fantasies during masturbation in the 12 months prior to change effort

o        Attraction was 95 or greater (scale of 1-100; 100 = exclusively homosexual).


They could probably be classified as exclusively or predominantly homosexual before change.

17 of these 27 men and 3 of these 6 women had good heterosexual functioning (as defined above) in the 12 months prior to the interview. More would need to be known about their current (viz., 12 months before the interview) same-sex attractions, fantasies, and behaviours in order to determine where they rate on a Kinsey-type scale of sexuality.

Thus, 20 people who were extreme on combined homosexual indicators before change, now have good heterosexual functioning. This at the least is a change in heterosexual behaviour (namely, they began being involved in heterosexual sexual behaviour) and a change in heterosexual attraction.

8.      Changes in subjects having regular heterosexual sex before and after
Changes in the 56 Subjects who were having heterosexual sex regularly both before starting their effort to change, and in the 12 months prior to the interview (essentially, most of these subjects were married and stayed married).

Changes for the 56 Subjects who regularly had heterosexual sex

 

12 months before effort to change

 

12 months prior to interview

Satisfying emotional relationship with opposite-sex partner
(7+ on scale of 1-10)

25%

98%

Sex with opposite-sex partner is physically satisfying
(7+ on scale of 1-10)

41%

100%

Often think of the same sex while having sex with opposite-sex partner
(20% or more of the time)

55%

6%

Considering that many subjects (67% of males, 35% of females) said that staying or getting married was important, these changes in heterosexual functioning are significant for the individuals involved.

As well, only 3 of these reported Good Heterosexual Functioning prior to starting therapy. For the year prior to the interview, 47 of these 56 participants reported Good Heterosexual Functioning.

9.      Depression: It is often said that those who try to change their sexual orientation become very depressed as a result. That was not the case for the subjects of this study. There was in fact a marked decline in depression after their effort to change:

 

12 months before effort to change

 

12 months prior to interview

Male Subjects

43%

1%

Female Subjects

47%

4%

10.  There were many other results, related to changes in specific aspects of behaviour and attraction, etc., which will not be discussed here.

More data will be reviewed here after Dr. Spitzer's research is officially published.

Particular Strengths:

1.      Good sample size.

2.      Many questions dealt with the subjects' longer-term sexual history. These included sexual arousal as a teenager by the opposite sex and by the same sex, number of people with whom one had homosexual sex, the number of years that regular homosexual sex took place, parallel questions regarding heterosexual sex, how often one thought about the same sex while having heterosexual intercourse, etc.

Limitations and Shortcomings:

1.      Independent or external verification of the answers given is not possible, as the changes were self-reported. One could potentially have asked subjects' spouses, if applicable, questions about sexual activity and about their perception of their partner's satisfaction, etc. For those subjects who had been in therapy, one could potentially have asked the therapists to confirm, refute, or cast in doubt the changes that their clients were reporting.
Spitzer acknowledged that the subjects could have been lying or exaggerating, but also said that there were clear reasons not to dismiss their claims. These included the "complexity and range of change reported", the subjects' "ability to provide detailed descriptions", and the "gradual nature of change".

2.      Not a random sample nor a controlled study. Also, 78% of the subjects had spoken or written publicly in favour of efforts to change. The results can therefore not be applied to same-sex-attracted people in general, nor is one able to determine the effectiveness of different types of therapy. Dr. Spitzer had neither of these as his goals in doing this research, and they do not affect the validity of the results.

Reviewed and Critiqued In:

Multiple reviews are part of "Peer Commentaries on Spitzer (2003)", in Archives of Sexual Behavior, 32(5), 419-468, October 2003.

Our summary and commentary on these peer reviews is now available.

Additional:

The section on "Common Objections Raised about Dr. Spitzer's Study" has been made into a Separate Article.

Footnotes

Unless otherwise noted, all quotations in this review are from the PowerPoint presentation. Data is from or adapted from the PowerPoint presentation or SPSS-generated reports from the original data, as provided by Dr. Spitzer, and from the final paper as published. The questionnaire forms were also examined.
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The introductory pages provide a clear explanation of the categories and definitions used throughout the reviews. As well as giving general information about each study reviewed, each review focuses on changes made by those who were exclusively or predominantly homosexual before change.
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Combined Homosexual Indicators: Spitzer does not use this specific term. We have added the word "combined" to make it clearer that this is a combination of homosexual indicators in the past 12 months and of indicators in the longer-term sexual history.
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The criteria that subjects must be married is chosen not because marriage is a magical indicator, but because additional information was available for married subjects: frequency of heterosexual sex, emotional and physical satisfaction from heterosexual sex, and frequency homosexual fantasies during heterosexual intercourse.
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http://www.newdirection.ca/research/spitzer.htm

Introduction

That "homosexuals can't change" is a common idea in our culture. We hear about it on the news and read about it in textbooks. But is this idea true? Is a change of sexual orientation really impossible for homosexual persons? Or might some who truly desire to change, be able to experience real change in their sexual orientation?

There are at least three places we can look for answers. There are the stories of those who claim to have experienced change. There are the statements made by psychiatrists and psychologists.1 And there are the actual research studies which claim to provide evidence for change.

It is these research studies, published in scientific journals and books, which this paper examines and summarizes. Our purpose is to clarify what evidence exists for changes from homosexuality to heterosexuality.

Through our review of the literature, we have found evidence for real change of sexual orientation. It is important to be clear that the possibility of change and the fact that some people have changed does not mean that all people can change, want to change or should change. It simply means that an individual who desires to change may find it possible to do so.

[Table of Contents]

What Does "Change" Mean?

When some people hear the word "change," they only think of a person who is 100% gay becoming 100% straight.

In this paper, we are looking for various kinds and degrees of change.

  1. We are interested in change that happens in all areas of a person's sexuality. An example would be a woman who was formerly exclusively homosexual. She now no longer has homosexual behaviour, fantasies and attractions. Instead, she identifies herself as heterosexual, and has heterosexual behaviour and attractions.
  2. We are also interested in changes that happen in one area of a person's sexuality. One example would be an exclusively homosexual man who is now also sexually involved with women. However, he is not strongly attracted to women, nor does he fantasize about them. As well, his homosexual behaviour, attractions and self-identity have not changed.
  3. Change can be an increase of something. A woman who was only occasionally attracted to other women, might find the frequency of those attractions increasing. Or, it can be a decrease. A man who was very sexually active, may decrease his sexual activity.
  4. Change can also mean acquiring something one has not had before. A lesbian woman may find herself acquiring a sexual attraction to men. And it can mean eliminating, or no longer having, something which one used to have.

[Table of Contents]

Categories of Change

We will use four specific categories and two broader categories. The specific categories are behaviour, attraction, fantasy and self-identification. The first three of these are divided into two areas: homosexual and heterosexual. In each specific category, change can mean increasing, decreasing, acquiring or eliminating. For the category of self-identification, a change means using a different term to identify one's sexuality. The two broader categories are "full sexual orientation shift" and "partial sexual orientation shift."

Behaviour:

Any sexual contact or interaction between two or more people. This ranges from dating to mutual masturbation to full sexual involvement. It might be with an anonymous partner, or an acquaintance, or in the context of a longer relationship. For our purposes, sexual contact with a prostitute or other anonymous partner shall not constitute a change in behaviour unless it occurs repeatedly over a longer period of time. For example, a homosexual man who goes out and has sex once with a female prostitute can not be said to have "increased his heterosexual behaviour."

·         Change in Homosexual Behaviour

·         Change in Heterosexual Behaviour

Attraction:

The attraction (sexual and/or emotional) which a person has, to the same sex and/or the opposite sex. Does a person experience sexual desire for men, women, or both? To whom is a person primarily attracted at emotional and sexual levels?

·         Change in Homosexual Attractions

·         Change in Heterosexual Attractions

Fantasy:

The fantasies and daydreams that a person has. The content of these is usually, but not always, sexual in nature.

·         Change in Homosexual Fantasy

·         Change in Heterosexual Fantasy

Self-Identification:

The term(s) a person uses to refer to his or her sexuality. In everyday language, a person may say, "I'm a lesbian," or "I'm straight." We use the terms homosexual, heterosexual and bisexual.

·         Change in Self-Identification

Sexual Orientation Shift

"Sexual orientation shift" refers to a significant shift or movement in one's sexuality. For our purposes, the starting point for the following two categories will always be exclusive or predominant homosexuality.

Full Sexual Orientation Shift:

This means a complete shift, or change, from homosexuality to heterosexuality. Simply adding some heterosexual behaviour to one's homosexuality is not enough. Change is necessary in behaviour, attraction, and fantasy. Homosexual behaviour, attractions and fantasy are eliminated. Heterosexual behaviour, attractions and sometimes fantasy take their place. The person's identification of himself or herself will usually change from homosexual to heterosexual.
To be considered a full sexual orientation shift for the purposes of this paper, a person who was Kinsey 6 (exclusively homosexual) or Kinsey 5 (predominantly homosexual) must end up as Kinsey 0 (exclusively heterosexual). See the section "Standard Formats and Categories" for more detail on the Kinsey scale.

Partial Sexual Orientation Shift:

In a full shift in sexual orientation, a person who was exclusively or predominantly homosexual ends up being exclusively heterosexual.
In a partial shift, the person ends up with heterosexual attractions and desires, but with some degree of homosexuality remaining.2 For some, there may only be occasional homosexual fantasies; for others, there may be significant homosexual attraction. The key is that there has been change, and that a person is truly attracted to the opposite sex. We will use this term only when a person who was exclusively or predominantly homosexual:

·         is now attracted to the opposite sex;

·         is now involved in heterosexual behaviour3;

·