Reparative therapy

Reparative therapy (also called conversion therapy and reorientation therapy) refers to methods aimed at eliminating same-sex sexual desires. Many techniques have been tried, including behavior modification, aversion therapy, psychoanalysis, prayer, and religious counseling. Reparative therapy is closely associated with the "ex-gay" movement, which is more explicitly religious. Ex-gay groups tend to focus primarily on adopting an "ex-gay identity" and avoiding same-sex sexual activity, and secondarily (or sometimes not at all) on changing the underlying orientation.

The medical and scientific consensus is that reparative therapy is not effective and is potentially harmful. No mainstream medical organization endorses reparative therapy and many have expressed concerns over the ethics and assumptions surrounding its practice. The mainstream view is that sexual orientation is unchangeable, and that attempts to do so are often damaging to the person's well-being.

Since the 1990s, the reparative therapy and ex-gay phenomena have appeared in the news with relative frequency. Reparative therapists characterize the movement as offering the possibility of a choice to gay men and women who are discontented with their lifestyle. LGBT rights supporters characterize the phenomenon as "the Christian Right [having] repackage[d] its anti-gay campaign in kinder, gentler terms. Instead of simply denouncing homosexuals as morally and socially corrupt, the Christian Right has now shifted to a strategy of emphasizing... the ex-gay movement. Behind this mask of compassion, however, the goal, remains the same: to roll back legal protections for lesbian, gay, bisexual and transgender people..."

History and doctrine


Scientific research into sexual orientation began in earnest in the 1950s. At that time, LGBT people largely remained in the closet and homosexuality was listed as a mental disorder in the APA's Diagnostic and Statistical Manual of Mental Disorders. In 1957, Evelyn Hooker published The Adjustment of the Male Overt Homosexual, finding that "homosexuals were not inherently abnormal and that there was no difference between homosexual and heterosexual men in terms of pathology." In 1969, the Stonewall riots gave birth to the gay rights movement and increased the visibility of LGBT people. In 1973, the APA declassified homosexuality as a mental disorder; in 1974 the ABA endorsed the Model Penal Code, including its decriminalization of consensual adult homosexual acts; in 1981 the WHO removed homosexuality from its list of mental illnesses.

Against this backdrop of increased visibility and understanding, opposition movements arose taking the view that homosexuality is in fact a mental disorder and is changeable. Old (and today largely unused) conversion techniques included electroconvulsive therapy, administration of Metrazol to induce convulsions, and nausea-inducing drugs.

In 1968, Charles Socarides (1922-2005) developed a psychoanalytic theory which interpreted same-sex desires as an illness arising from a conflict between the id and the ego. The conflict usually arose from an early age in "a female-dominated environment wherein the father was absent, weak, detached or sadistic." Ironically, Socarides' son Richard Socarides is openly gay and was Bill Clinton's Senior Advisor for Public Liaison for gay and lesbian issues.

Starting in 1976, Exodus International began referring people to religious ministries that attempted to change their subjects' sexual orientations. The Exodus ministries begin from the Christian perspective that same-sex relations are a sin. They believe that same-sex attraction is caused by environmental factors including "poor family dynamics, a rift in the father-son or mother-daughter relationship growing up, feelings of being an outsider among one's peers during childhood and adolescence, and instances of sexual abuse/incest." Exodus calls subjects "strugglers." Today Exodus is the most visible ex-gay organization, occasionally taking out full-page newspaper ads or renting billboards.

The label reparative originates from 1983 when Elizabeth Moberly, a research psychologist, coined the term reparative drive to refer to male homosexuality itself, interpreting same-sex male desires as attempts to repair for a lacked connection between father and son during childhood. She encouraged same-sex bonding with both mentors and peer relationships as a way of stopping same-sex sexual attraction.

In a 1991 book Joseph Nicolosi argued "[e]ach one of us, man and woman alike, is driven by the power of romantic love. These infatuations gain their power from the unconscious drive to become a complete human being. In heterosexuals, it is the drive to bring together the male-female polarity through the longing for the other-than me. But in homosexuals, it is the attempt to fulfill a deficit in wholeness of one’s original gender." This book has been criticized as "a religious treatise on homosexuality thinly disguised as a scientific document. In the new religious cum scientific paradigm, mental health is defined as conformity to traditional values and norms.

In 1992, Nicolosi, Socarides, and Benjamin Kaufman founded NARTH, currently the most prominent reparative therapy organization.

The shadow of Freud and the psychoanalytic basis of Moberly's, Nicolosi's, and Socarides' theories have helped earn psychoanalysis "its present mythic status as an implacable foe of lesbian and gay identities." This status continues even though many psychoanalysts have repudiated the anti-gay bias within the field and both the American Psychoanalytic Association and the American Academy of Psychoanalysis have issued non-discrimination statements.

Today, the movement tends to characterize itself as offering the possibility of a choice for gay men and women who are unsatisfied with their sexual orientation. There is often an emphasis on minimizing and not acting on same-sex attractions, rather than eliminating them outright. This has received much support, both ideological and financial, from some religious conservatives. John Paulk, formerly of Focus on the Family, said "As the church, we must continue to speak out boldly against the radical homosexual agenda while we minister to those who are trapped in this lifestyle... it is compassionate to warn about the dangers of homosexuality in order to spare individuals the heartache and grief of that behavior. At the same time, we must always remember that many turn to homosexuality precisely because they have experienced rejection from the people closest to them. The church must not compound that rejection, but rather be an oasis of grace, healing and hope."

Techniques
Techniques used by reparative therapists and ex-gay groups roughly fall into three categories, depending on the practitioner's theoretical view of sexual orientation: behavior modification techniques, psychoanalytic techniques, and religious techniques.

Practitioners who view same-sex orientations as resulting from learned behavior may adopt behavioral modification techniques. These may include masturbatory reconditioning, visualization, and social skills training. The most radical involve aversion therapy such as electroconvulsive therapy. Documented cases include electric shocks being administered to patients' genitalia, "sometimes paired with disturbing images, including a bowl of feces and pictures of Kaposi's Sarcoma lesions." Incidences of these kinds have been reported as recently as 1992. In another case therapists used plethysmography, which uses electric sensors attached to a person's genitals to measure sexual arousal, was used, in conjunction with shock therapy, to electrically shock the patient's penis when he became sexually aroused by same-sex images. One residential adolescents treatment center used sedation, isolation, physical restraints, hypnosis, and "hold therapy," in which a girl was held down while staff members screamed at her until she admitted that she was hurting her family by being a lesbian. It is unknown to what extent these methods are used today.

Nicolosi and Socarides are the lead representatives of the view that same-sex desires are a form of arrested psychosexual development, resulting from "an incomplete bond and resultant identification with the same-sex parent, which is then symbolically repaired in psychotherapy." Their corresponding psychoanalysis-based intervention plans involve conditioning a man to a traditional masculine gender role. He should "(1) participate in sports activities, (2) avoid activities considered of interest to homosexuals, such art museums, opera, symphonies, (3) avoid women unless it is for romantic contact, (4) increase time spent with heterosexual men in order to learn to mimic heterosexual male ways of walking, talking, and interacting with other heterosexual men, (5) Attend church and join a men’s church group, (6) attend reparative therapy group to discuss progress, or slips back into homosexuality, (7) become more assertive with women through flirting and dating, (8) begin heterosexual dating, (9) engage in heterosexual intercourse, (10) enter into heterosexual marriage, and (11) father children."

Finally, ex-gay ministries use religious and spiritual methods designed to either change the individual's sexual orientation, or give him or her the willpower not to act on same-sex desires. This often involves prayer and religious counseling. "[T]his modality is thought to be one of the most common for individuals seeking to change their sexual orientation."

The actual practices used by organizations and their members often fall into a cross section of these categories. For instance, Love in Action hosts workshops on "child development, gender roles, and personal sexuality," one-on-one Biblical guidance, "a structured environment help[ing] establish new routines and healthy patterns of behavior", "challenging written assignments and interactive projects," "family involvement to improve communication... and to facilitate marital reconciliation," and "hiking, camping, canoeing, and rafting."

Likewise, Exodus International members recommend, for example, that a subject who finds him or herself attracted to someone of the same sex should "immediately look around for someone of the opposite sex... and start searching for the beauty in that person"; a subject should disentangling sexual desire from the desire for affection or affirmation; and a subject should repent and confess his or her sins. Other reported techniques include having the men play basketball and football, and having the women learn how to manicure their fingernails and wear makeup. In another, therapists placed the two genders together in a "misogyny training course" and had the women apologize to the men for the feminist movement because it had "created so many unattractive women that, of course, gay men would turn away from them."



Lecturer Richard Cohen, whose recent television appearances have sparked controversy, holds male patients in his lap with the patient curled into the fetal position. NARTH opposes such "holding" techniques. He also advocates bioenergetics methods involving slamming a pillow with a tennis racket while shouting "Mom! Why did you do that to me?" (Videoclip of Cohen's techniques via YouTube.)

New Age therapies are also employed by reparative therapists, including EMDR, buddha therapy, and chiropractic adjustments. Some have tried "beauty therapy," during which butch lesbians are given "a beautiful and professionally coiffured hairstyle, taught to use cosmetics, and taught to wear the most elegant feminine styles to bring out the charm and beauty in their bodies."

Distinguishing between the reparative therapy and ex-gay movements
The reparative therapy movement is different from the ex-gay movement, but the two are closely linked and there is no consistent distinction drawn between them in the literature. Very roughly, reparative therapists tend to use secular approaches to changing sexual orientation while ex-gay organizations focus on using religion to adopt an "ex-gay identity" to either eliminate same-sex desires or to will oneself not to act on them. Ex-gay organizations such as Exodus International often consider reparative therapy to be a useful tool, but not a necessary one.

For some ex-gay groups, merely choosing not to act on one's same-sex desires counts as a "success" whereas reparative therapists tend to understand success in terms of actually reducing or eliminating those desires. For example, some ex-gays in opposite-sex marriages acknowledge that their sexual attractions remain primarily homosexual, but seek to make their marriages work regardless. The mere act of adopting the label "ex-gay" is seen as a narrative device whereby "individuals us[e] language as the primary tool to not only express identity but also create and transform it." Ex-gays try to analogize this to the coming out process.

Mainstream medical view on changing sexual orientation
The medical and scientific consensus is that reparative therapy is not effective and is potentially harmful. No mainstream medical organization endorses reparative therapy and many have expressed concerns over the ethics and motivations surrounding its practice. The mainstream view is that sexual orientation is unchangeable, and that attempts to do so are often damaging to the person's well-being.

These organizations include the American Psychiatric Association, the American Psychological Association, the American Counseling Association, the National Association of Social Workers, the American Academy of Pediatrics, the American Association of School Administrators, the American Federation of Teachers, the National Association of School Psychologists, and the National Education Association. The ethics guidelines of these organizations discourage, and sometimes prohibit, its practice. The American Psychiatric Association opposes any treatment that is “based upon the assumption that homosexuality per se is a mental disorder or based upon the a priori assumption that the patient should change his/her sexual homosexual orientation.”

United States Surgeon General David Satcher issued a 2001 report urging tolerance for gays and lesbians and maintaining that "there is no valid scientific evidence that sexual orientation can be changed." A survey of the American Psychological Association indicated their view that reparative therapy is a discredited therapy.

There is debate on reparative therapy within the professional literature. Douglas Haldeman considers reparative therapy to be pseudoscientific.

Reparative therapists believe that sexual orientation is changeable and they cite anecdotal evidence of conversions. The American Psychiatric Association stated that success stories and harm stories are anecdotal, and that “there are no scientifically rigorous outcome studies to determine either the actual efficacy or harm of "reparative" treatments.” It called for more scientific research to determine the risks and benefits involved, and until such research is available, recommended that "ethical practitioners refrain from attempts to change individuals' sexual orientation." Major medical organizations and others reject the anecdotal evidence offered by reparative therapists and ex-gay groups for reasons including:


 * results are not published in peer-reviewed journals, but tend to be released to the mass media and the Internet (see Science by press conference);
 * random samples of subjects are not used and results are reliant upon the subjects' own self-reported outcomes or on the therapist's own evaluations which may be subject to social desirability bias;
 * evidence is gathered over short periods of time and there is little follow-up data to determine rates of relapse over the long-term;
 * the evidence does not demonstrate a change in sexual orientation, but merely a reduction in same-sex behavior;
 * the evidence does not take into consideration that subjects may be bisexual and may have simply been convinced to restrict their sexual activity to the opposite sex;
 * reparative therapists falsely assume that homosexuality is negative or unhealthy, and thus that change is desirable;
 * reparative therapists' research focuses on gay men almost exclusively and rarely includes lesbians.

With respect to the last point, one commentator argues that the reason for the focus on gay men is more political than medical. He argues that conservative and rigidly defined gender roles are the core value system used by reparative therapists, and that male sexuality, with its emphasis on masculine and patriarchal hierarchies, is seen as more important and valuable than female sexuality.

Peer-reviewed research
A 2002 peer-reviewed study by Dr. Ariel Shidlo and Dr. Michael Schroeder found that 88% of participants failed to achieve a sustained change in their sexual behaviour and 3% reported changing their orientation to heterosexual. The remainder reported either losing all sexual drive or struggling to remain celibate, with no change in attraction. Schroeder said many of the participants who failed felt a sense of shame. Many had gone through reparative therapy programs over the course of many years. Their study sample included both participants connected with reparative therapy advocates, as well as participants recruited through the Internet. Of the 8 respondents (out of a sample of 202) who reported a change in sexual orientation, 7 were employed in paid or unpaid roles as ex-gay counselors or group leaders, something which has led many to question whether even this small "success" rate is in fact reliable.

In 2001, Dr. Robert Spitzer, who was involved in the original declassification of homosexuality as a mental disorder, presented a paper on reparative therapy at the APA annual convention. He reported that 66% of the men and 44% of the women he sampled had achieved "good heterosexual functioning" through interventions. This paper was widely reported by proponents of reparative therapy as evidence of success of the therapy, and as the first step towards official acceptance and the legitimisation of reparative therapy.

The APA immediately issued an official disavowal of the paper, noting that it had not been peer-reviewed and bluntly stating that "There is no published scientific evidence supporting the efficacy of reparative therapy as a treatment to change one's sexual orientation." Two years later, Spitzer published the paper in the Archives of Sexual Behavior. The publication decision sparked controversy and one sponsoring member resigned in protest. The paper has been criticized on various grounds, including using non-random sampling and poor criteria for "success". Critics argue that it relied upon samples selected by reparative therapists themselves (86 participants were handpicked by ex-gay organizations), that proper random samplings were not used, that small samplings were used, that the subjects appeared to be ex-gay advocates who may have been biased in favor of reparative therapies, that 60% of the subjects had previously reported being bisexual, and that no follow-up study had been carried out to acertain long-term conversion.

Spitzer himself played down the results of his own paper; upon being asked about the 200 patient sample after 16 months, and the percentage of people who might succeed, Spitzer said that it took almost a year and a half to only find 200 willing individuals, and therefore, the number of homosexuals who could successfully become heterosexual was likely to be "pretty low". He also conceded that the study's participants were "unusually religious."

Potential harms
Mainstream medical bodies state that reparative therapy can be harmful because it exploits guilt and anxiety, thereby damaging self-esteem and leading to depression and even suicide. The American Psychiatric Association states that 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 a patient." There is evidence that rates of depression, anxiety, alcohol and drug abuse and suicidal feelings are roughly doubled in those who undergo reparative therapy. Michael Bussee, founder of Exodus International, reports that "One man slashed his genitals with a razor and poured Drano on his wounds," and that another man impulsively underwent an incomplete sex-change operation because he believed his sexual desires might receive divine approval were he biologically a woman. Psychology Today states: "'The danger is that some individuals are going to end up feeling that in some important way their life is a lie and a sham,' observes Christopher Wallis, M.D., a member of the American Psychoanalytic Association's committee on issues of homosexuality. The consequences can be devastating. Terry Norman, [a professional counselor], says 'orientational repression' sometimes leads to drug and alcohol abuse, workaholism and compulsive sex. There also have been reports of people killing themselves, or attempting to, after failing to convert. 'After hearing the categorical promises that these programs work, what do people conclude when they do these things and it doesn't work for them?' asks Norman. 'That God doesn't bless them, that they really are pieces of trash that pollute the Earth.'"

Beyond harms caused to individual people, there is a broad concern in the mental health community that the advancement of reparative therapy itself causes social harm by disseminating inaccurate views about sexual orientation and the ability of LGB people to lead happy, health lives. "To attempt to 'cure' is to reinforce bigotry."

Ethics guidelines
The American Psychological Association opposes practicing reparative therapy, but its ethics guidelines do not explicitly prohibit it; rather, they caution that any psychologist attempting to change someone's sexual orientation must, among other things, eliminate the effects of biases about sexual orientation on one's practice and avoiding making deceptive claims about the scientific basis for reparative therapy. The ethics guidelines of the American Psychiatric Association and the American Counseling Association adopt a stronger stance and recommend that ethical practitioners avoid using reparative therapy or referring clients to people who do use it. NARTH supports these guidelines and "advises its members to provide psychological care in a professional, ethical manner which is consistent with the codes of ethics of the national mental health organizations and state licensing boards."

Some commentators, recommending a hard stand against the practice, have found reparative therapy inconsistent with a psychologist's ethical duties because “it is more ethical to let a client continue to struggle honestly with her or his identity than to collude, even peripherally, with a practice that is discriminatory, oppressive, and ultimately ineffective in its own stated ends."  They argue that clients who request it do so out of social pressure and internalized homophobia, pointing to evidence that rates of depression, anxiety, alcohol and drug abuse and suicidal feelings are roughly doubled in those who undergo reparative therapy.

Even where professional ethics guidelines do not explicitly forbid reparative therapy, there still are a number of potential clashes, as reported in another paper by Schroeder and Shidlo (see above) in particular on four particular issues: first, patients should not be pressured into therapy (many reparative therapists and those who approach them have strong religious views, and pressure is often placed on counsellees from that standpoint). Secondly, the therapist should not provide misleading information about the success rates of any treatment (the success rates claimed by groups such as Exodus International and NARTH are not substantiated by outside studies). Thirdly, the therapist should be prepared to provide alternative courses of treatment to those who were not progressing, or to refer them to counsellors or therapists offering alternative treatments. This often did not happen. Fourthly, the counsellor/therapist would be expected to refrain from direct criticism of the relevant professional associations.

Self-determination argument
Reparative therapists focus on patient self-determination when discussing whether reparative therapy should be available, citing the APA's code of ethics, which states "Psychologists respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self-determination." Mark Yarhouse writes "[p]sychologists have an ethical responsibility to allow individuals to pursue treatment aimed at curbing experiences of same-sex attraction or modifying same-sex behaviors, not only because it affirms the client's rights 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." Yarhouse and Throckmorton argue that the procedure should be available out of respect for a patient’s values system and because they find evidence that it can be effective.

One commentator responds that that refusing to endorse a procedure that "has been deemed unethical and potentially harmful by most medical and nearly every professional psychotherapy regulating body cannot be justifiably identified as prohibiting client self-determination."

Ethics guidelines with respect to ex-gay groups
"Unlike many organizations and individuals who offer counseling and mental health treatment services, the majority of ex-gay programs market themselves as religious ministries and are therefore not governed or overseen by professional associations, licensing boards, state departments of health or other bureaucracies." The applicability of professional ethics guidelines to ex-gay organizations is, thus, unclear.

Reasons why people seek to change sexual orientation
Some LGB people are unhappy with their sexuality for a variety reasons, including religious or personal beliefs, the desire for a traditional family, shame, rejection (actual or feared), or a general dissatisfaction with the contemporary gay lifestyle. However, Psychology Today states: "Just who tries to change? Not the average gay man or woman. Would-be converts, say psychologists, typically come from deeply authoritarian backgrounds where homosexuality is branded immoral or a sin, while others are married and cannot reconcile their family commitments with their erotic desires."

The American Psychological Association states that harassment and abuse, as well as pressure from family, peers, and religious groups ignorant about and prejudiced against homosexuality, may cause high levels of emotional stress for lesbians, gays, and bisexuals. These pressures may lead people to feel forced into attempting to change their sexual orientation. Other researchers have found that social pressure plays a key role in a person's desire to change his or her sexuality. In one extreme case, an Exodus member attempted to recruit lesbians by going to lesbian bars or hangouts posing as a lesbian, flirting with women, exchanging phone numbers, and eventually having sex with women for the purpose of getting close to lesbians to convert them to heterosexuality.

One reparative therapist has argued that there is also social pressure not to enter reparative therapy.

Reaction by reparative therapists
Reparative therapists generally respond to the mainstream medical view with two main points. First, they argue that the mainstream medical view (from the 1973 declassification of homosexuality as a mental disorder to the current opposition to reparative therapy) is the result of political beliefs and lobbying. Second, they argue that there is no scientific data conclusively showing that reparative therapy does not work.

Robert Perloff charged that APA is "too politically correct, too bureaucratic, too obeisant to special interests." He stated that APA’s view of Conversion therapy is "all wrong. First, the data are not fully in yet. Second, if the client wants a change, listen to the client. Third, you're barring research."

Reparative therapy/ex-gays as a means to shape the LGBT rights debate
Social conservatives sometimes use possibility of conversion therapy to argue against LGBT rights legislation and LGBT acceptance in general. The argument is that if sexual orientation is changeable, then remaining gay or lesbian is a mere choice and therefore does not warrant the legal protections and social acceptance afforded to others who are protected on the basis of age, race, gender, disability, etc. This pattern of reasoning has seen some results: for example, LGBT students at religious universities have been expelled because they refused to be "cured."

Gay rights supporters argue that "the Christian Right has seized the political opportunity offered by the ex-gay movement to repackage its anti-gay campaign in kinder, gentler terms. Instead of simply denouncing homosexuals as morally and socially corrupt, the Christian Right has now shifted to a strategy of emphasizing personal salvation for homosexuals — through the ex-gay movement. Behind this mask of compassion, however, the goal, remains the same: to roll back legal protections for lesbian, gay, bisexual and transgender people..." Mental health organizations hold that conversion attempts are caused by, and reinforce, negative attitudes and mistaken beliefs about homosexuality.

Scandals involving minors
One of the most controversial aspects of reparative therapy has been the focus on gay teenagers, including occasions where teenagers have been forcibly treated in ex-gay camps. A 2006 report has outlined evidence that ex-gay and reparative therapy groups are increasingly focusing on youth. Several legal researchers have responded to these events by arguing that parents who force their children into aggressive reparative therapy programs are committing child abuse under various state statutes.

One early case involved Lyn Duff, a lesbian from Pasadena, CA, who was taken by force from her grandparents home and placed in Rivendell of Utah, a residential treatment center near Salt Lake City. Duff's placement was paid for by the State of California through special education funds on the basis of her diagnosis with "Gender Identity Disorder". Her treatment reportedly included shock therapy, aversion therapy, psychotropic drugs, hypnosis, and behavioral counseling (for instance, being told to wear dresses and make up, etc.). Duff spent 178 days in Rivendell before escaping and, with the help of the National Center for Youth Law, the National Center for Lesbian Rights and Legal Services for Children, initiating legal action against the facility and her mother. In 1993, Duff's therapist at Rivendell, R. Mark Hinckley, left Rivendell to start Turnabout, a similar camp to treat gay youth in Salt Lake City.

In Tennessee in 1995, a 16-year-old gay male sought legal emancipation from his parents because they were forcing him to attend reorientation counseling with a Memphis psychologist. They intended to send him to either Love in Action, or another similar program. The Memphis Circuit Court judge agreed that the boy would be harmed by this treatment and indicated that he would sign the emancipation order. In a settlement agreement, the parents abandoned their plans to send the boy to treatment. The doctor in the case lost his license to practice as a psychologist, due to alleged ethics violations.

In 2005, 16-year-old Zachary Stark posted on his blog protesting his parents' decision to send him to an ex-gay camp. In 2006, 17-year old DJ Butler was driven to the same camp in handcuffs. The camp, run by Love in Action ministries, was subsequently shut down when Tennessee authorities discovered that unlicensed staff had been administering prescription drugs to the patients.

Relapses and ex-ex-gays



 * In 1979, Exodus International's co-founder Michael Bussee and his partner Gary Cooper quit the group and held a life commitment ceremony together.
 * John Paulk left Focus on the Family after he was spotted by reporters in a Washington, D.C., gay bar. John Paulk is still married and champions the cause of the ex-gay movement.
 * In 1986, Colin Cook, founder of Homosexuals Anonymous, was discovered to be engaging in sexual acts with his patients. He claimed that the nude massages of other men should desensitize them against homosexual desires. In 1987, he was expelled from Homosexuals Anonymous for sexual activity, and in 1995 a similar scandal happened with his newly founded group FaithQuest Colorado. According to the Denver Post, Cook had engaged in phone sex, practiced long and grinding hugs, and asked patients to bring homosexual pornography to sessions so that he could help desensitize them against it.

Financial motivations
Opponents argue that many reparative therapists may become involved for personal financial gain. They note that participants in conversion therapies frequently have to pay for the treatment they receive, as is true of any psychiatric treatment. It has also been noted that the organizations that sponsor ex-gay ministries, like Focus on the Family, use anti-gay political campaigns to generate funds but provide relatively few resources to their reparative therapy wings.

Terminology
The practice is alternatively called "conversion therapy." Those outside the movement may reject the label "reparative," as it presupposes that same-sex attraction is something which can or should be repaired.

Opposition from gay rights and religious groups
Mainstream gay rights organizations and some religious organizations oppose reparative therapies, including the National Gay and Lesbian Task Force, The Interfaith Alliance, New Ways Ministries and People for the American Way.

Reparative therapy and ex-gays in popular culture
Reparative therapy and the ex-gay phenomenon occasionally appear in popular culture, usually in a satirical or skeptical context. In 1999, Universal released But I'm a Cheerleader, a black comedy about a high school cheerleader who is sent to an ex-gay camp. Macaulay Culkin starred in Saved! (2004) a major motion picture comedy featuring one high school student trying to "straighten out" another. A 2007 South Park episode Cartman Sucks satirized reparative therapy and ex-gay camps.

Reparative therapy was derided on Penn and Teller's television show Bullshit!. Reparative therapist Richard Cohen was satirically interviewed by Jason Jones in a segment for the March 19, 2007 episode of The Daily Show. Cohen later apologized for this appearance.

In 2006, Ted Haggard, former American evangelical preacher and leader of the National Association of Evangelicals resigned or was removed from all of his leadership positions after allegations of gay sex and drug abuse were made by Mike Jones, a former male prostitute. Initially Haggard denied even knowing Mike Jones, but as a media investigation proceeded he acknowledged that some allegations, such as his purchase of methamphetamine, were true. He later added "sexual immorality" to his list of confessions. After the scandal was publicized, Haggard entered three weeks of intensive counseling, overseen by four ministers. On February 6, 2007, one of those ministers stated that Haggard "is completely heterosexual."

Mainstream positions on reparative therapy

 * American Psychological Association Statement - sexual orientation is "not changeable."
 * American Counseling Association: Ethical issues related to conversion or reparative therapy - "No empirical evidence exists"
 * American Psychiatric Association Position Statement on Reparative Therapy - no "rigorous scientific research to substantiate their claims"
 * American Academy Of Paediatrics Statement - "little or no potential for achieving changes"

Reparative therapy advocates and ex-gay groups

 * National Association for Research & Therapy of Homosexuality
 * Exodus International, a Christian organization
 * The International Healing Foundation, Richard Cohen's organization.
 * Love In Action and Refuge, a Christian ministry
 * Warren Throckmorton (Personal Homepage)
 * Parents and Friends of ExGays and Gays
 * JONAH, a Jewish ex-gay group
 * True Freedom Trust, a Christian, ex-gay ministry based in the United Kingdom
 * Courage, a Catholic ex-gay group
 * Evergreen International, an LDS ex-gay group
 * People Can Change

Other

 * Donnie Davies' music video, a satirical 2007 meme. See also Donnie Davies.
 * Ex-gay watch, watchdog blog covering ex-gay and reparative therapy groups.
 * The Pseudo-science of Sexual Orientation Conversion Therapy detailed summary of the case against conversion therapy.
 * Fact sheet from UC Davis Psychology Department.
 * Wayne Besen, former spokesman of the Human Rights Campaign and outspoken critic of conversion therapy.
 * Tanya Erzen "Straight to Jesus: Sexual and Christian conversions in the ex-gay movement", article from American Sexuality Magazine.