This is a draft of an article that is looking for a home. Dr. Cummings related his experience in private practice working personally with an estimated 2,000 plus gay clients. The HMO (Kaiser-Permanente) where he was Chief of Mental Health used their experience with between 15,000 and 16,000 gay and lesbian people to form policies that were implemented while he was there. He discloses this information here in print for the first time. Having interviewed Dr. Cummings, I understand better why he is an enthusiastic supporter of our sexual identity therapy framework.
Therapists at Kaiser developed means to help clients pursue their values and desires in an informed manner. â€œOver time, we were able to identify within 4 or 5 sessions which clients were likely to pursue change and which ones were not.â€ Cummings learned that clients most likely to change attractions either had a strong, internalized value system which contradicted homosexual behavior or they developed a homosexual adaptation through a childhood of abusive life experiences. Those with no prior heterosexual inclination and those with a longer history of same-sex attraction were not as likely to develop heterosexual adaptation.
NOTE: 3/8/07 – Inexplicably, a NARTH writer has plagiarized my interview with Dr. Cummings. It is here on the NARTH site and contains quotes that are verbatim from my article.
3/9/07 – Dave Pruden has written to say that the article has been removed. No explanation was given. Dave apologized for this but he said he does not know who is responsible.
25 thoughts on “Sexual identity therapy: An interview with Dr. Nicholas Cummings”
You seem to have difficulty understanding how anyone who is gay/lesbian could have a happy life…so I thought I would put myself out there and share mine.
I am a young academic with a tenure-track position at a liberal arts school in the northeast…I have a solid job, partner benefits, and live with a beautiful young professional woman who works in patent law. I couldn’t be more in love. We’ve been smitten with each other since meeting, and have a wonderful life – we work out every morning together at the gym, often bike to work into the city, are members of a local church, have a dog and a place in an amazing loft – and spend our leisure time traveling both here and abroad.
I live a life absolutely blessed. Ivan, I can only wish you were this fortunate…and pray that everyone can experience the life that I have…even if just for a moment. I thank God for my health, my life, my love, and for making me exactly who I am.
I think your last post, while poignant, may have missed my point. Anyhow, I don’t think it’s worth it for me to go over again.
To Ivan who said: “I mean I accept you are satisfied, if you say you are, and that as a gay man, youâ€™re psychologically well-adjusted like any heterosexual man.”
Well, I wouldn’t quite put it that way. I know lots of straight men who are are not particularly well-adjusted psychologically. What I mean is that I am happy with my work, my family, my lover, my hobbies, my church. Somedays are rougher than others, but that’s true of everyone. Sexual orientation does not determine one’s happiness or level of psychological adjustment.
All I mean is that I no longer feel bad about being gay. I accept that I am, just as a straight man might accept that he is straight.
What offends me and angers me is NOT that someone might question whether or not I am “truly happy” — as I have said, I have my highs and my lows just as every human being does. What DOES offend and anger me are questions about “cause” from people who believe my sexuality is some sort of a disease that needs to be cured, or that I am demon possessed or not as “healthy” or “moral” as straights.
I angers me that I have been fired from two jobs — simply for being gay. It angers me that I was beaten and stabbed in the back my gang members who hated “faggots”. It angers me that these same gang members murdered my best friend for being gay. It offends me when a bullhorn toting “Christian” yells obscenities at my Mom as we walked into the Municipal Auditorium to hear the Gay Men’s Chorus do a Christmas concert. But you asking me if I am “truly happy” — that I can live with.
Eddy: I am not making “scientific” claims about anyone else’s sexuality. I was only reporting my own experience of my earliest sexual awareness. In first grade, I had very strong romantic, emotional and physical crushes on other boys. These feelings were definitely sexual as well as emotional. I didn’t “mis-interpret them as sexual”. They were sexual and I looked forward to any opportunity to “play army with Tommy”. An erection is difficult to “mis-interpret”. YES with males, NO with females.
On the other hand, when my daughter was in Kindergarten, she was already telling me about boys she thought were “cute” or “nice”. She didn’t “misinterpret her feelings as sexual” any more than I did. We both just felt what we felt. My attractions have remained constant over time and so have hers. I’m gay. She’s straight — and I will be the proud Dad who gets to give her away to a wonderful Christian man this April.
I appreciate your comments about how we ought to talk more scientifically…how you were relentless with Ivan about the word ‘satisfactory’. Now, it’s your turn.
I’ve read at least 3 references to sexual direction before the age of reason (about yourself, about your daughter). I want clarification.
What was the sexual nature of your feelings at age 5 or 6 that you brought up in another recent thread? What was the sexual nature of your daughters feelings at age 6 or 7 that you also used to try to make that point? I’m not trying to get explicit here but I do believe you are inserting a controversial and unproven premise into the discussions. Therefore, I need clarification re the sexual direction feelings that you attribute to yourself and your daughter at those ages.
How can I be sure that you both don’t fit into my theory of childhood feelings and attractions being reinterpreted as sexual? (I believe they are both RE-intepreted and MIS-interpreted.) Please elaborate for the benefit of our scientific understanding.
NickC said: “No one Iâ€™ve met personally has ever changed orientation or stopped being aware of himself as gay no matter how long or successfully he was married or otherwise adapted.”
In the more than 30 years since we started EXODUS, neither have I. I think such a person may actually exist — but it’s kinda like trying to get a good picture of Bigfoot.
I don’t mean I need clarification. I mean I accept you are satisfied, if you say you are, and tht as a gay man, you’re psychologically well-adjusted like any heterosexual man. I also suspect you’d be offended if I tried to work out if you were *really* happy as a gay man. If I began to nitpick your words, to find out if you were *genuinely* and *really* happy, you’d be offended and angry. As you said in your own post, perhaps when you say you’re a satisfied gay man livign a gay life, perhaps your example is applicable here: “â€œIâ€™m satisfied, Doc, just leave the railroad spike in my foot and give me something for the painâ€¦â€” You see, what you say doens’t need to be clear. I don’t need to clarify your happiness. I can’t possibly clarify your emotions, if you feel them to be true. They are yours, and you own them. Don’t forget your own comment to Dr. Throckmorton where you got annoyed that anyone who asked the question “What causes homosexuality?” asked it with prejudice, that there was something psychologically wrong with homosexuality. With that in mind, these kinds of things seem to annoy you. You’d like people to take you at your word that your a psychologically normal gay person. Yes?
I don’t mean I need clarification. I mean I accept you are satisfied, if you say you are, and tht as a gay man, you’re psychologically well-adjusted like any heterosexual man. I also suspect you’d be offended if I tried to work out if you were *really* happy as a gay man. If I began to nitpick your words, to find out if you were *genuinely* and *really* happy, you’d be offended and angry. As you said in your own post, perhaps when you say you’re a satisfied gay man livign a gay life, perhaps your example is applicable here: “â€œIâ€™m satisfied, Doc, just leave the railroad spike in my foot and give me something for the painâ€¦â€” You see, what you say doens’t need to be clear. I don’t need to clarify your happiness. I can’t possibly clarify your emotions, if you feel them to be true. They are yours, and you own them. Don’t forget your own comment to Dr. throckmorotn where you got annoyed that anyone who asked the question “What causes homosexuality?” asked it with prejudice, that there was something psychologically wrong with homosexuality. With that in mind, these kinds of things seem to annoy you. You’d like people to take you at your word that your a psychologically normal gay person. Yes?
Follow up on Timothy Kincaid’s comments above:
I’m going to be repeating points I’ve made many times in postings here, but maybe I keep repeating myself to help clarify my own thinking.
1) Many homosexuals (I have no idea what percentage) are able to adapt quite well to a heterosexual lifestyle, including loving, sexually fulfilling heterosexual marriage. The motivation does not have to be religious–my partner had a very successful 14 year marriage based solely on the business he and his wife ran together. Homosexuals have been adapting in this way, largely due to social and religious pressure, for as far back as we know. It’s certainly nothing new to ex-gay ministries or value-oriented therapy.
2) The ability to adapt to a heterosexual lifestyle and establish a marriage does not constitute a “change” in basic sexual orientation. I am not a social scientist and have not conducted research on this topic, so I can only speak of what I’ve seen among the many people I’ve met in both ex-gay ministries and now in an openly gay life. No one I’ve met personally has ever changed orientation or stopped being aware of himself as gay no matter how long or successfully he was married or otherwise adapted.
I do not deny the possibility that some people actually do experience changes in orientation. I’m simply saying that successful adaptation to a heterosexual life does not equal “change” in that sense.
3) When a person’s basic orientation remains unchanged, heterosexual adaptation may not remain successful long term. People go through many other changes over their lives, and the convictions or circumstances that motivate a successful adaptation often change with them. Religious beliefs may shift or modify; children grow up and cease to be the focus of a marriage; shared interests may fade. These changes are challenging enough for any marriage, but they are greatly intensified when one partner has a strong homosexual orientation. So even a seemingly successful adaptation carries (I believe) a higher-than-normal risk of a bitter divorce or other traumatic upheaval later in life.
Due to my own experience with the ups and downs of adaptation over the long haul, I remain very skeptical of recommending this approach to anyone.
Timothy, when did Spitzer say 1-2% of all gays could possibly change? All I’ve ever read was him saying it was rare.
Based on the testimonials and other things I’ve read about Exodus (and NARTH etc.) it seems the group of gay men they tend to target (effeminate, promiscous/sex addicts) are the type of men Kaiser claims were least likely to change. Hopefully there are other readers who may have more detailed info on who Exodus clients are and can correct me if I’ve got the wrong impression.
Granted they also seem to have strong religous beliefs against being gay which Kaiser says is an indicator of being able to change.
IVAN asked: “Can I nitpick and ask about all the nunaces in your language and explanations when you write how you life a happy gay life? No. You say you are happy.”
On the contrary, please “nitpick” anything that is not clear to you. I do not expect you to take me on face value with undefined terms. If there is something you want clarified, I will be very happy to do that.
By the way, I haven’t said I live a “happy gay life”. Like everyone, gay or straight, some things are happy and some are not. Being gay has not been easy. I have accepted that fact that I am gay, that’s all. I am no longer ashamed of it or worried that God will reject me because of it. I no longer believe that I have to be straight or celibate. For me, that’s a “satisfactory” outcome. I just wish people (especially “ex-gays”) would be more careful about the words they use.
In the final analysis, happiness has little to do with being gay — and a LOT to do with how one lives one’s life.
Exhibit 1 – Dr. Spitzer saying that 1 or 2 percent (definitely less than 10%) of all gay people could reorient.
Exhibit 2 – Dr. Cummings saying that maybe 17%, or thereabouts of those gay people who found their orientation to be psychologically challenging, could change their orientation. This may not be that far from what Spitzer is saying – remember these are different populations. If we assume that Cummings’ maybe 25% of the gay population would seek therapy for their orientation (a very high estimate in my guess) then the numbers are in the Spitzer ballpark.
Exhibit 3 – Ex-gay groups like LIFE, claiming that all can change.
Exhibit 4 – Gay groups like HRC, claiming that none can change.
I think that the Drs. in 1 and 2 completely discredit 3 and cast doubt on 4 (depending on what is meant by change).
My opinion is: a small number of gay people (a few percent of the total gay population) are able to construct lives that are – for all practical external purposes – identical to heterosexual lives. They may be able to completely change their attractions or, alternately, be able to so sublimate their same-sex attractions that their lives do not cause discontent with their values. If they do retain any same-sex attractions, these are not significant enough to impede their happiness.
I also think that there are some who appear to fit the category who are not in actuality content or for whom time will cause a shift in priorities. We’ve seen this many times and, indeed, some who post here at one point would have been a success by Cummings’ standards but eventually were not. However, I hesitate to suggest that this is true for ALL of those claiming success. I’m still open to some genuine shift in orientation.
(unless, of course, you participate in an ex-gay video or ad campaign in which case you will at some point be photographed in a sling in a sex club).
I just wanted to get your reaction to some things Dr. Cummings said:
1. “…men who were quite feminine from an early age were not good candidates for change”
2. “Of the universe of gays we saw in Kaiser, 67% had good outcomes. Of those, 20% were successful in reorientation, with the remaining 80% pursuing sane, sexually responsible gay lives. The other third of our clients were not helped much at all.”
3. “The other third of our clients were not helped much at all. This was a much higher failure rate than for other problems. These people seemed to be sexually compulsive, frequently with obsessive compulsive disorder and substance addictions. There was an addictive quality to their behavior. They could not seem to go a day without sex.”
If you’re not clear what I’m asking, I’ll elaborate.
Ivan – Yes, Cummings purpose at Kaiser-Permanente HMO was to reduce medical costs through the provision of psychotherapy. Dr. Cummings was one of the first to develop and quantity the “offset effect” in psychotherapy (i.e., if you provide psychotherapy, you can reduce medical costs). With high users of medical care, therapy can dramatically lower medical expense. His interventions were developed pragmatically: what life course will lead to a mentally health (satisfied) person and thus a better immune system and lower medical utilization. For some people with significant and deeply held religious beliefs the adjustment that made sense and contributed to their overall wellbeing was to help them build on any heterosexual inclinations they had and move toward (here goes again) a valued life (a life consistent with their personal values).
Change, whether some or a little or a lot, was not quantified as a targeted “symptom” but as a an indicator that the client had achieved greater congruence.
In the contemporary era, Dr. Cummings supports our guidelines as a means to point therapy in that direction. The APA has no such guidance and although the Office of GLB Concerns has the framework, they have taken no action on it as yet.
I can only repeat what I said before. I agree with you that nuances and the meaning of specific words are important – I do not deny this, but Dr. Cummings did use the word “satisfactory”, which I assume means the patient was satisfied. Nuances are not important here if the client is satisfied. Can I nitpick and ask about all the nunaces in your language and explanations when you write how you life a happy gay life? No. You say you are happy. No need to go there. I will not nitpick at your words if you say “I am satisfied”. You follow? I dunno, maybe I am not being clear.
Nick – I emailed Dr. Cummings to ask him. I believe the group we are discussing is indeed Group 3. The 15,000-16,000 I believe are all of those who came in who made their sexual orientation known but I am unclear enough that I am clarifying this with him.
One very important question is not clear in Dr.Cumming’s remarks.
He speaks of results for the universe of 15,000 to 16,000 gay men and lesbians who came to Kaiser Permanente for therapy. Was this all gay men and lesbians, whatever problem motivated them to seek therapy? Or only gays/lesibans who were seeking help regarding their sexual orientation and/or behavior?
And does he have any idea how 15,000-16,000 compares to the total universe of gays/lesbians who had access to KP for service?
I’m thinking of how some of his conclusions are going to get quoted by other people. Warren already states, “Those who see homosexuals as invariably unhappy and disordered may take some support from his observations about a sizable minority of gay clients who were sexually compulsive.”
Consider that we could actually be talking about as many as three different groups:
1) All gays with access to Kaiser Permanente, including those who never sought therapy
2) All gays who ever sought therapy from Kaiser Permanente, even if their problems had nothing to do with sexual orientation or behavior.
3) Gays who sought therapy from Kaiser Permanente specifically regarding issues of orientation and sexual behavior.
I would not be particularly suprised if 30% of group 3) were sexually compulsive. But I think a number of people will happily seize on these numbers as “evidence” that a third of ALL gays and lesbians are sexually compulsive.
It’s not nitpicking. Word’s don’t mean whatever the person using them wants them to mean. If they did, research and conversation would become “irrelevant”. You asked why “nuances” were so important to me and I told you. You then called my questions “nitpicking”. I ask the questions because I have seen the great emotional and spriritual harm that has been done over the decades by “change” ministries that “over-promise” and “under-define”.
I completely agree with Dr. T.:
“When a conflicted person hears change, they naturally think their attractions will go away.”
And when they don’t go away, too often “ex-gays” have been told that they didn’t try hard enough, didn’t have enough faith or weren’t “real” Christians after all. We need to be very careful how we use terms. Besides, client satisfaction is not the only (or the most important) measure of successful therapy. I can just hear a patient: “I’m satisfied, Doc, just leave the railroad spike in my foot and give me something for the pain…”
Michael and Dr. Throckmorton,
Don’t get me wrong. Nunces are important to me too, but what you’re saying isn’t relevant because Dr. Cummings wasn’t trying to define change in his client. There was no need to. The outcome was “satisfactory”, *whatever* that might have meant for his clients. The nitpicking was irrelevant – Elsewhere, maybe not.
Warren is right. The question at hand is not “can gays become straights” but “whether or not some people can successively craft a heterosexual life when there are homosexual attractions.”
I have no doubt that some can. It doesn’t make them heterosexual, but if they are happier, that’s certainly OK with me.
Ivan: The nuances mean a lot to me as well as a researcher and one who helps people resolve these conflicts. When a conflicted person hears change, they naturally think their attractions will go away. So I think we need to be realistic and cautious. However, I will not say it cannot happen because I do not know for sure and I think some have changed radically.
Regarding Cummings estimates, I would not dispute him. For one, the man’s integrity is above reproach. And for another he has more experience than anyone I know. But that is not to say that we have outcome data to substantiate the change part of this. He did while at Kaiser focus on client satisfaction and health outcomes. I believe his numbers there are likely to be very accurate (N=15000-16000). How much a person changed in Kinsey terms was not assessed so I think his work speaks mainly whether some people can successively craft a heterosexual life when there is homosexual attractions. And he is saying it has been done, although, to echo Spitzer, it was not the norm for the clients he saw.
I should also add that he is not endorsing reparative therapy or any general theory of homosexuality. In fact, he is very clear that there are multiple paths.
I agree that the most important thing is “Is the client living the kind of life he/she would like to live” — but definitions are very important — and YES, I do hold other therapies to the “high standard” of at least defining their terms. If someone says they have a “cure” for “depression”, for example, I would definitely want to know what the author means by both terms. Sloppy language is sloppy science.
For example, a hetereosexual “adaptation” is not the same as saying that the person is now heterosexual. If they are happier with their adaptation, fine. But let’s me clear what we are talking about.
For 30 years, “change” therapies used the misleading term “ex-gay” giving the impression that such folks were no longer homosexual in orienation. Today, partly due to the pressure they have recieved, Alan Chambers of EXODUS has done away with the term and Joe Dallas of EXODUS admits is doesn’t mean “ex-homosexual”.
I’m not sure why these tiny nunaces matter so much to you — “satisfactory” is the key word. I don’t know why else that should matter to a client, if his outcome was “satisfactory”. I assume what Dr. Cummings meant was that his outcome was satisfactory, i.e., he achieved his desired outcome. Not only that, but if you held any other therapy to such a high standard, almost always, it’d fail, somewhere, somehow. The question is: Is the client living the kind of life s/he desires to live?
Do you concur with everything that Dr. Cummings said, on all measures, percentages, and such?
Interesting article. This struck me: “Those with no prior heterosexual inclination and those with a longer history of same-sex attraction were not as likely to develop heterosexual adaptation.”
Notice that he didn’t say that they changed their sexual orientation — only that some were more like than others to develop a satisfactory heterosexual “adaptation”. Adaptation does not equal re-oreintation. Also, this article does not mention whether any of these clients already had bisexual attraction to begin with.
Also note that he said that in 4 or 5 sessions he could tell which were likely to “pursue” change. And those who did pursue change had some internalized religious pressue to do so. The “change” is undefined and “pursuing” heterosexuality doesn’t mean you’re straight. There are a lot of undefined terms in this interview. For example, what is “satisfactory outcome”?
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