How often does sexual orientation modification occur?

I wanted to clarify an earlier post about the experience of Nicholas Cummings at Kaiser-Permanente. This revised article suggests a 13.4% rate of change for homosexuals who sought sexual reorientation from Kaiser therapists in the 1960s-1980s.

Dr. Cummings estimates as many as 16,000 clients sought therapy due to dissatisfaction with their sexuality during that period and that 67% reached a good outcome (meaning they either achieved a heterosexual adjustment or affirmed a gay identity). Of those, 20% were assessed as having redirected their sexuality toward a heterosexual adaptation, yielding a figure of 13.4% for the entire group. There were many more homosexual clients who sought therapy for the usual reasons people do and these people are not included in the numbers above.

The article is still draft at this point but I thought it might make for some good discussion.

21 thoughts on “How often does sexual orientation modification occur?”

  1. I think a very basic question that needs to be answered is one of operational definition. What exactly is considered to be “change” or “adjustment?” Have these understandings changed over the span of time of this data?

    So many problems with this…where to start?

  2. I guess the question remains…how “relative” is all this change? Are there certain aspects to it that can’t possibly be measured scientifically? If so, what then? While I don’t reccomend anyone getting married to “marie antoinette”, I will say that I’d not trade my own experiences and am able to find “joy” within the “change” I’ve been afforded by having been in such a marriage. yes, this is all a bit “tongue in cheek”…but I’m serious as well.

    love and grace,


  3. That’s a good comment Tim Kincaid.

    I immediately think of “gay” episcopal bishop Gene Robinson of New Hampshire, whose ordination is at the center of the currently fracturing Anglican church.

    Bishop Robinson participated in some amount of reorientation therapy, with some obvious success — having been “happily married” to a woman for 12 years, and fathering 2 children (i think that’s correct) with her.

    Then, 12 years later, he split up his family, settled down with a man, and proceeded to split up his church.

    I can only scratch my head, when asked “is he gay? is he straight? is he bisexual? whatever he is, or was, did he change over the course of time?” There’s more than enough factual evidence to answer YES to all of these questions. The only answer that seems to hold any weight at all is the answer he would give for himself.

    For all we know, he might be Marie Antoinette. Maybe someone should ask him… 😉

  4. I’m a bit hesitant to write this as I’m certain I’ll be misunderstood… but, nonetheless…

    To those of us who see the dialog of reorientation within the context of its emphasis among those who use it for political machination, we care greatly about how “real” a shift in orientation may be. However to others, including some who seek a change, it may be less important that there be a “real” change than that there be some identity that results in a manageable life.

    Take, as illustration, another possible situation where there could be a disparity between “reality” and perception. Suppose, for example, that a person was convinced that they were Marie Antoinette. And suppose that this adoption of this identity was the only way this person could withstand an otherwise miserable existence.

    Now some might say that it is in that patient’s best interest to face reality, she’s simply NOT Marie Antionette. Others might say so what, who cares about whether this person is or is not who they think they are… what matters is this person’s well being, and a delusion may be preferable to the reality if there is an adequate support system and no one is hurt. A good argument could be made either way.

    I’m not suggesting that sexual identity is nothing more than delusion. Nor am I suggesting that it is an indication of mental illness if one thinks that one’s sexual orientation has changed. I’m simply suggesting that in the case of individuals, the “realness” of change may be less important than the identity of change.

    Of course, that’s not the whole story. The reasons why realness may matter is because it impacts others. When this identity is used to make claims of “real” change for political purposes, then the personal is no longer primary. Identity and values, while adequate for the individual, cannot ethically be used as a shield for political claims.

    And then there are the issues of potential spouses. Identity change may well serve a person for life, but if it doesn’t then it’s small consolation for those who bought into someone else’s identity.

    When politicians are told that the individual actually is Marie Antoinette and they should vote accordingly, or when a potential spouse is told that he will be afforded the priveleges of marrying nobility, then the question comes back: just how real is that person’s identity.

  5. NickC beat me to the question I had about trying to follow-up with any of these patients. Maybe you could get funding to do a follow-up. I know that is data I’d be interested in seeing.

  6. I want to clarify my question about aversion therapy since I don’t want it to be seen as an attack. As I understand it, aversion therapy was one of many different types of therapies through the 1960’s; less so in the ’70’s.

    Because of the specialized equipment and medical facilities required to do it, I don’t think the prevalence was high, but when we’re talking numbers of the 13% range, I think it’s important. And since Kaisar-Premanente has been a large health care provider, it’s concievable that they may have had such facilities for clients who requested it.

    Whis is a second point I want to make. Most case reports that I’ve read describing aversion therapy involved clients who requested such therapy. While it may have occured in mental instititions and other non-voluntary settings, those case reports don’t appear to have been written about much in this country. (South Africa, for example, is another matter altogether)

    Today, we see it as unethical. I’m not one to retroactively apply today’s standards to treatments which were considered legitimate 40 years ago. We learn with time, fortunately.

  7. So Dr. Cunningham is also a NickC? No relationship, I assure you.

    Another question to ask him: Does Kaiser Permanente have any records that would allow for analysis of the long-term outcomes for this group of clients? After five to ten years or longer, was there any difference in how satisfied/successful the various groups of clients remained.

    Obviously, some of us will expect that long term, the clients who embraced heterosexual adaptation might have had a higher level of dissatisfaction. But perhaps that isn’t true at all. It seems to me that if an organization as large as Kaiser Permanente can actually identify a population of this size, there’s an opportunity here for follow up research that would establish some objective answers to the questions we constantly debate.

  8. “yes I have worked with clients in this way, although this is a relatively infrequent given the clientele I normally see.”

    Do you mean to say your numbers are higher because of you clientele? In what way?

    Also, among those 90% who see you for sexuality issues, what percentage of that 90% achieved a heterosexual functioning, and what a gay orientation or celibacy? And yes Michael, we can discuss the term “heterosexual functioning” if you’d like 🙂

  9. Michael – Good points. I think a good follow up might be to ask Dr. Cummings to describe some cases.

    Please be aware of the context for this piece: I am not a reparative therapist. I believe people change various dimensions of their inner world and some of these change are relatively durable as long as their beliefs and environment remains consistent. Sexual adjustment is not in a vacuum. I honestly am not personally invested in any number except to be faithful to my own clinical experience and the experience of other therapists and clients who have experienced something powerful in their lives.

    I intend to pose some of these questions to Nick and I appreciate the discussion. I do not want to present this as a defense of reorientation but rather sexual identity work — people can live by their values, so much so that important aspects of their sexuality may shift in some cases.

  10. Dr. Throckmorton, I am not questioning Dr. Cummings’ character. But “credibility and integrity” are not data and a heterosexual “adaptation” is not heterosexuality. Under tremendous social, familial, social, legal and religious pressure, gay men have made such “adaptations” for centuries.

    It’s all still very undefined. How many of the 13.4% were bisexual and how many of those who “adapted” still had strong same sex attractions and/or still acted on their gay feelings?

  11. These are very helpful comments. I will edit the column to make it clearer that these are estimates. Part of my desire to get this out is to have additional corroboration. For me, personally, Nick Cummings’ word can be taken to the bank. I cannot say enough about his credibility and integrity. He and I both know that others will be skeptical — which I fully understand, especially from those who do not know Nick or know of his work.

    He is fine with these estimates being quoted.

    In answer to Ivan, yes I have worked with clients in this way, although this is a relatively infrequent given the clientele I normally see.

    As I said in the article, Nick’s recollections are consistent with my experience. For me, the numbers will be a bit higher because I have a very selective group of clients. Also how change is defined will impact the numbers. I hope to post on this subject in the near future. My satisfaction percentage is consistently above 90 percent, meaning that whatever happens with sexuality, 9 of 10 clients historically have been happy with their experience and would refer a friend.

    I cannot answer whether all the people I have seen are still adjusting the way they did at the time they stopped counseling. There are a handful that keep in touch and have seen even more change after the passing of time. Others have not seen much change and some have abandoned the pursuit of change.

  12. It sounds like an interesting article. However, it seems odd that its taken 20 years for Dr. Cummings and Kaisers’ gay treatment information to surface publicly (at least it’s the first I’ve heard of it). Has Dr. Cummings kept patient files and figures from as long as 40 years ago or are these stats simply his own rough estimate (it seems coincidental that 67% is nearly equivalent to 2/3rds)? Does he intend his quoted number to be taken literally or were these off-hand estimates?

    Calculating 13.4% makes the figures sound like a real quantative study was conducted rather than one person’s perception of events 20-40 years ago. Even if the data Dr. Cummings has is only his personal estimates, it would be nice if he could identify some of the 600 psychotherapists who would be willing to support his observations.

  13. Although I am plased with his non-dogmatic stance, once again words and phrases that are loaded with emotional power are left undefined.

    ” Those with no prior heterosexual inclination and those with a longer history of same-sex attraction were not as likely to develop heterosexual adaptation.”

    In other words, the gays remained gay in their orientation while strongly (religiously) motivated bisexuals were more likely to find some shifting of the attractions — at least to the extent that their “adaptation” was “satisfactory”.

    “…likely to develop heterosexual adaptation.” This is an odd use of words. The phrase reminds me of one Elizabeth Moberly was very fond of using: “they are able to choose heterosexual relating…” Why not just say they became straight and no longer had gay attractions? Because they did not.

    It’s the issue of words again. Making a “satisfactory heterosexual ajustment” or “choosing heterosexual relating” are NOT the same as being heterosexual. I don’t think we should call this a “modification or sexual orientation.”

  14. From the article:

    Those with no prior heterosexual inclination and those with a longer history of same-sex attraction were not as likely to develop heterosexual adaptation.

    So, a good indicator for turning from homosexuality to heterosexuality is… bisexuality?

  15. Since this was the period of 1960-1980, a very important variable would be what types of therapy were used on these patients. There was quite a lot of aversion therapy going on in those days.

  16. Please be careful with numbers like “13.4”. Remember that the product of two numbers is only as accurate as the least specific of the two multipliers (or some such rule from eighth grade math).

    Since two-thirds and 20% are probably not meant to be understood as 66.7% and 20.0%, the product of the two is probably not 13.4% at all but instead “around 13%”.

  17. 2 questions for you:

    1. Have you ever helped a person experiencing homosexual attractions to adopt a gay identity, and then helped him/her to adjust to it?

    2. In your experience, among highly motivated patients, what do you think is a good estimation for change? What does your clinical experience tell you?

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