Two Important Papers - Ten Years On

Back at the start of the “noughties” two papers were published that explored issues around Sexual Orientation Change Efforts (SOCE). The first, by Robert Spitzer who was part of the Task Force on the APA that removed homosexuality from the DSM was finally published in 2003, but was researched earlier. The second by Shidlo and Schroeder was released in 2002 and sees its tenth anniversary this year.

Spitzer’s paper has recently been in the news as he has sought to distance himself from his original conclusion. It’s interesting to note that many of the criticisms raised by Spitzer now about his conclusions then were highlighted a decade ago by activists such as Daniel Gonzalez, who has recently published a re-edited version of his original film looking at the Spitzer study. It’s worth ten minutes or so of your time watching what Gonzalez had to say then in the light of what Spitzer has said now.

We can summarise Gonzalez’s criticism as follows,

  • Spitzer’s sample is not truly random as it was gathered by purposefully advertising for people who wished to feedback mainly positive experiences of SOCE
  • Given that the research is happening at a point in time after the events being examined, there is the potential for retrospective “wishful thinking” or “false recall”. Survey members might misreport what happened to them and how they felt about it either by basic human error or wilful self-deception.
  • The surveys were undertaken by phone interview and there was little ability for the researchers to interact with the participants and try to discern where participants were giving answers that might be false

These are, let’s be fair, completely fair criticisms. Originally hailed as a survey that “proved” SOCE works, the reality is that such a paper simply proves that some people who participated in SOCE believed it worked. Ultimately there was, in the words of Spitzer himself, ” no way to judge the credibility of subject reports of change in sexual orientation”.

All well and good. It is reasonable for critics to demand that ex-gay organisations no longer use Spitzer’s work to “prove” that gay people can change. The paper simply doesn’t prove that – it only proves that some people self-report that they change.

Got that? Let’s move on.

2002 saw the release of Shidlo and Schroeder’s paper on the harm of SOCE, entitled “Changing Sexual Orientation: A Consumers’ Report”. Ten years later it is heralded by many as the definitive piece of work on the subject, cited by many professional organisations in their position papers on Reparative Therapy. For example, the UKCP references this paper, and this paper alone, in its public stance on the issue.

What did Shidlo and Scroeder report? They surveyed 202 people who had been through some form of SOCE (20 of which were women) and they asked them to report whether their therapy had helped or harmed them (or both). The results were interesting. Of the 168 who reported SOCE resulting in “failure”, 157 (so over 93%) reported some form of harm from the therapy. Of the 31 who were “successful”, 9 (29%) reported some harm.

At the same time however, both groups were also asked if the therapy had helped in anyway. 100% of the “successful” group said yes, but interestingly 81 of the “failures” (48%) also reported some form of help from the therapy they had undertaken.

Aggregated, 38% of all those who responded said that SOCE had just led to harm, 14% just to help and 46% both help and harm. Even amongst those for whom SOCE was a failure, barely half (85) were bold enough to say that they hadn’t had any benefits from the therapy and it had been harmful.

So what we are left with when we examine S&S carefully is a survey where even amongst those who said that SOCE only half said it was just a waste of time and harmful. Over 60% of the whole sample found that engaging in SOCE had brought some benefit to them.

It’s worth stopping for a moment at this point and reflecting on same key points from the S&S methodology. Key factors in their approach were,

  • Specifically seeking out people who had experienced harm from SOCE. They ran adverts in gay magazines that asked for those who had experienced harm to get in touch
  • Participants were asked to think back to three separate points in time (before, during and after therapy) and report how they had felt
  • “Harm” was self-reported – standard psychological community measures of distress were not used, instead participants engaged in a telephone interview where they were asked to talk through their experience of SOCE.

Now, at this point you might be suddenly wanting to scroll up the page to have another look at Daniel Gonzalez’s list of criticisms of Spitzer’s study. To save you the time, I’ll just provide a table right here so you can compare the two methodologies.

Methodology Spitzer 2003 Shidlo and Schroeder 2002
Sample selection Advertised for those wanting to report success of SOCE Advertised for those wanting to report failure of SOCE
Recall of Events Asked participants to recall events from SOCE and to self-report current perspective on those events Asked participants to recall events from SOCE and to self-report current perspective on those events
Method of Interview Telephone Interview Telephone Interview
Measure of Success / Harm Self-reported understanding of outcome Self-reported understanding of outcome

OK….

It strikes me that advocates of S&S 2002 cannot be logically consistent if they (quite rightly) reject Spitzer 2003 on the basis of it’s methodology and then quote Shidlo and Schroeder 2002 on the subject of harm. If Spitzer’s methodology was flawed for only seeking participants who wanted to report success of SOCE, for asking them to recall events in the past which they might either falsely recall because of the passage of time OR because they wilfully wanted to misrepresent the truth of the outcome of therapy and for using only a telephone interview, then Shidlo and Schroeder’s methodology is equally so. One cannot reject one of the basis of methodology without rejecting the other.

Thoughts?

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  • nojam75

    Interesting comparison of the two studies.  
    Both studies’ sampling biases make the skewed statistical analysis somewhat irrelevant.  Regardless of the percentages, I hope we can agree that one person harmed by a therapy is too many. 

    Ultimately, the burden of proof that SOCE methods are safe and effective therapies are on SOCE promoters since sexual orientation is not considered an illness.  Sadly, the SOCE industry’s reluctance to study the safety and effective of their controversial and experimental treatments seems to indicate that they intentions are about promoting a fundamentalist religious/philosophical agenda rather than actually helping clients.  

    • http://www.peter-ould.net Peter Ould

      Almost,

      i) As much as the burden of proof is on SOCE advocates to *prove* that it works, one cannot say that it *doesn’t* work until you have proved that statement by testing your hypothesis (in this case that SOCE don’t work).
      ii) You are mistaken if you believe that SOCE advocates are unwilling to explore these issues. The Jones and Yarhouse study deliberately set out to explore issues like this and they reported on them.
      iii) If one person harmed by a therapy is too much and you want to ban all such therapies (that cause harm) on that basis, you’d put 99% of therapists out of business.

      • nowconcerned

        I think the key point in nojam75’s post is ‘since sexual orientation isn’t considered an illness’.  

        I think therapy is like any other medicine – you have to weigh up the side effects against the benefits and decide if it’s worth it.  Somebody on a documentary programme made the point recently that the greatest benefit of therapy is that you come to the conclusion that you can sort out your problems yourself better than anyone else!  Doctors kind of remind me of charismatic healers – you go to them with one demon/problem and discover 10 you didn’t know you had LOL.

        Back to the point.  I think it’s interesting that even those that reported harm also reported some benefit.  Not so often advertised by anti-ex-gay activists.  However, if there’s no illness to be cured, what do we even mean by positive change?

  • http://randythomas.co/ Randy Thomas

    Very good Peter. I participated in both a Spitzer and Shidlo study and the only difference is that I could tell Shidlo’s questions were very biased. I couldn’t tell where Spitzer angle was coming from. Great post Peter.

  • nowconcerned

    Hi Randy.  Without giving away any personal details you’d rather keep to yourself, I’d be interested to know, would you advise anybody to go through SOCE?  I’m slightly intrigued that you answered both an advert for those who’d experienced change and an advert looking for help debunking ‘homophobic’ therapy.  You can tell me to mind my own bees wax.

    • http://randythomas.co/ Randy Thomas

      Honestly, I talked with Shidlo back in the late 90’s. I was asked by some gay activists to do the interview with him, I wasn’t aware of the negative adverts at the time of my interview. At several points in the interview I know he was frustrated with me when I said things along the lines of I felt nothing but benefit from the support groups I was a part of.

      I don’t know you so I am not sure what you really need to pursue except a relationship with Christ. Plus, I would never tell you what you have to do with regard to your own sexual orientation. I am assuming you are a grown mature adult… that’s your responsibility. :) It never hurts to investigate, question and study. That’s the only advice I would give; get fully informed, stay away from the stigmatizers (on both sides) and pursue God.

      If you already know God I pray that your relationship with Him deepens. We could all use that!

      Personally, SOCE was not ever a primary goal for me. Jesus was/is. My “orientation” has changed quite a bit but I see that only as a by-product of questioning sexuality, exploring God’s creative intent for gender and how male and female bear His image uniquely as well as complementarily. Oh and also holding to a Biblical sexual ethic. Being celibate gave me the relational space I need to pursue Christ’s heart concerning sexuality with an open mind.  

      I have been in therapy for peripheral issues (PTSD) but never went to professional counseling for “re-orientation therapy” or anything like that.

      So, nutshell, I may be the interview Shidlo hated the most because if he reported me accurately I would have screwed up his stats. I will also pray for you to be given wisdom, understanding and peace as you decide on what path you should take regarding sexuality.  God bless!

      • nowconcerned

        Thanks for replying and being so honest.  I should have mentioned, I’m actually a woman.  Like you, I’ve been for therapy for general anxiety/relationship problems, but never reorientation therapy.  I can’t speak for everybody, but I think there are very few women who are 100% either direction and many women are comfortable with having sexual relations with both genders.  There’s also not the pressure to ‘perform’ because any kind of sex is much more about emotion and relationship.  For me, ‘therapy’ (if any was needed) has been being married to someone who really loves me and with whom I feel safe.  I can imagine that if I’d tried having sex when I was younger outside marriage I might have gone down the road of seeking a relationship with a woman.  I think a lot of sensitivity is required for women in long term relationships with other women as I’ve found that any suggestion that they should have sex with men is a bit like telling them you think it would be good for them to be raped.  There is such a thing as ‘conversion rape’ in Africa, which is an horrific crime (if anything should carry the death penalty, that should!).

        But I digress.  On the point of reorientation therapy, I think it might be more necessary for men as sex is a bigger problem.  However, I’m sceptical about it because when I read accounts of it (even accounts that are supposed to be positive) it sounds a bit like ‘don’t think about pink elephants’ therapy and quite self-defeating.  I don’t wake up after having a dream about a woman and think ‘oh no!  this is a disaster!  I’m sick!  I’m being influenced by the devil!’.  I think that’s an over reaction.  We’re all of us ‘disordered’ in our sexuality and relationships (to use the catholic phrase) and marriage isn’t for everybody.  It brings a lot of responsibility and you’re not free to do all the things you could have done if you were single.  I think it’s interesting that you were the fly in Shidlo’s ointment because a sexual relationship was never the major goal in the first place.

  • markadamsbrown

    Brilliant, Peter Ould!  I’ve never seen that point made before.

    Pray for poor Dr. Spitzer.  He never over-stated his conclusions from his phone survey, and yet for the last decade homosexual activists have beaten down this sick old man mercilessly, displaying an irrational rage that reminds me most of a pack of dogs attacking a sheep.

    Dr. Spitzer once wrote me that a full-blown study following up on his phone survey investigation would cost at least a million dollars.  That would be a small price to pay for the clarification it would provide, and for the joy it might offer to those who are highly motivated and willing to access the supernatural power of the Trinity.  Sadly, homosexual activists, with their unrelenting attacks on Dr. Spitzer, have made darned sure that he will never follow up on his phone survey investigation.

    Mark Adams Brown
    San Angelo, Texas
    June 4, 2012

  • nowconcerned

    Has anybody compared this comments thread to the one on mental health statistics related to abortion that Peter posted in September?  I don’t remember anybody there writing ‘I hope we can agree that one person harmed by abortion is too many’ (see first comment on this thread).  People were falling over themselves to argue that abortion wasn’t harmful in the scheme of things.  I wonder what this might tell us about the society we live in?  Any thoughts?

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