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Therapists defend gay conversion counseling: 'You can't say gay once, gay always'

Joseph Nicolosi of Encino, Calif. has been practicing sexual orientation change therapy for 25 years.
Joseph Nicolosi of Encino, Calif. has been practicing sexual orientation change therapy for 25

They’ve been dismissed as quacks, homophobes and in denial, but therapists who counsel patients on shedding their gay feelings insist that their work is needed.

“If a person wants to be gay, and thinks he is gay, then that’s perfectly fine,” said Joseph Nicolosi, who founded a so-called "reparative" therapy practice in Encino, Calif. “I want to be available for those who want to change.”

In recent months, Nicolosi and his colleagues have come under fire for their position that people can diminish gay feelings through therapy, a process referred to as "sexual orientation change effort" by the American Psychological Association.

  • Last week, four men who underwent conversion therapy sued their New Jersey provider, saying they were shamed and falsely led to believe they could be “cured” of being gay. 
  • In California, Governor Jerry Brown signed a law that bans the use of sexual orientation change effort on minors. The ban, supposed to take effect on Jan. 1, was put on hold by a judge Monday, but only for three California therapists who challenged the law.
  • Psychiatrist Robert Spitzer, a leader in psychiatry in the 20th century, apologized in May for publishing an article saying that conversion therapy was possible for motivated patients. Exodus International, a nonprofit for ex-gay Christians, came out weeks later saying they don’t recommend “therapies that make changing sexual orientation a main focus.”

But Nicolosi, who has been in practice for 25 years and who coined the term "reparative," stands firm: “We need to understand there’s a lot of mystery about human sexuality. You can’t say gay once, gay always.” 

Conversion therapy draws on Sigmund Freud’s theory that all people are born bisexual and that some become gay because of their upbringing, which he wrote about in Three Essays on the Theory of Sexuality. Many therapists offered some form of sexual orientation change therapy until around 1973, when homosexuality was removed from the psychiatric guide to mental disorders, according to the American Psychological Association.

In a 2009 resolution, the association stated that therapists who persist with such therapies appeared to be part of the broader “conservative political movements that have supported the stigmatization of homosexuality on political or religious grounds.”

Psychology can acknowledge different viewpoints, the resolution says, but such therapies contradict rigorous studies. “Belief in the hope of sexual orientation change followed by the failure of the treatment was identified as a significant cause of distress and negative self-image.”   

Related: Four men sue New Jersey organization over ‘gay conversion therapy’

David Pickup, a licensed therapist in Glendale, Calif. who trained with Nicolosi, went through sexual orientation change therapy in his early 30s. Pickup, 56, believes he was attracted to men because he was molested several times by a high school student when he was five. He describes himself as a “typically religious, conservative guy."

David Pickup, a
David Pickup, aRich Pedroncelli / AP file

“I had challenges with homosexual feelings but never identified being gay for me was innate or inborn,” he said. “I never lived the gay lifestyle. I just had sexual experiences.”

Pickup is quick to differentiate himself from those who practice aversion therapy, which tries to eliminate a behavior or desire by associating it with pain. Those who were sued in New Jersey were accused of shaming patients and forcing them to strip off their clothes in group sessions. 

“I can say this: I don’t do oranges therapy, and I don’t do naked therapy,” Pickup said. (In the New Jersey lawsuit, one of the young men said oranges were used to represent testicles.) Rather, he said, his practice is focused on talk therapy and working through a client's issues.  

Pickup is not married. “I’m still looking,” he said. His friends are straight, for the most part, he said, although he remains close to a gay man from his past. He said they are like brothers, even though they disagree on matters of sexuality.

Both Nicolosi and Pickup belong to NARTH -- National Association for Research and Therapy of Homosexuality -- which includes about 350 therapists, according to its vice president, David Pruden. Unlike Nicolosi and Pickup, Pruden said most of those therapists have just a few gay clients within a larger practice.

“People get the idea that someone comes in and we say, ‘How do you feel about that?’ and then, ‘We’re going to fix that,’” Pruden said. “You really don’t. What you really do is treat them like any other client that is distressed about anything, and you work on distress.”

Through talk therapy, he said, some clients say their same-sex attractions are diminished.

Most of Nicolosi's clients are men from conservative, religious backgrounds, he said. About 40 percent are teens, and about half of them, sent by their parents, say they don’t want to change or are confused.

“We say, fine, you want to be gay, but are you curious in understanding why you’re gay?” Nicolosi said.

Nicolosi's theory is that men are attracted to other men because of how they were raised. He bases this notion on conversations he had early in his career with gay men.

“As I listened to these men, I started to hear common themes of their childhood,” Nicolosi said. “Overinvolved, intrusive mother, distanced, detached or hostile father, so that the boy did not bond with the father. That became the foundation of the understanding. I looked into the literature. I saw that there was an entire tradition of psychoanalytic understanding.”

So why not accept that his patients might be gay?

Knowing the reason for their same-sex attraction is consoling to patients, Nicolosi said. “They’re no longer weirdos or perverts or degenerates or whatever. Now they realize that their same-sex attraction is an attempt to repair a sense of not belonging to men.”

On his website, Nicolosi has transcribed some of these conversations. In many, the men describe wanting a “normal life.”

One man, married 31 years, told Nicolosi: “I wanted what most everybody wants — I wanted family, security. I wanted to grow old together with somebody that I was committed to. I wanted children, a house, a job, and a picket fence, all of those things — the American dream. And I couldn’t have that with homosexuality.”

In some places, gay couples can enjoy much of what Opp desired: Same-sex marriage is legal in nine states, and same-sex couples can adopt children together in all U.S. states except Mississippi and Utah. 

“Gay marriage doesn’t cut it for this clientele,” Nicolosi said. “They want a woman. They want a male-female relationship. They don’t want to be living with a guy in a marriage. That’s too radical for them.”

Some patients take years to feel less gay; others never do, he said.

“Some can walk away and say they have no homosexual attraction, period,” he said. “That’s rather rare. A lot of them say, ‘My homosexuality comes up rarely and not really strongly. It’s something that I can dismiss.’”

NARTH’s Pruden said fewer patients are seeking to change their sexual orientation these days because society has become more accepting.

“Once people felt less shamed – and I think that’s really positive – there was less a feeling that they couldn’t talk about it,” Pruden said. But those who do want to minimize those feelings, Pruden said, “deserve to have their needs met as well.”

“To say to them, we’re not willing to walk alongside you in your journey feels to me as cruel as the other extremes we used to be at, when people were hurt for saying, ‘I’m gay, and I’m OK with that,’” Pruden said. “In a sense it’s a pro-choice movement – people should have the right to deal with this.”

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