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Guest post by Diana E. Moga, M.D., Ph.D.
Boy Erased, the new film about a young gay man subjected to a grueling regimen, bordering on abuse, to “convert” him to heterosexuality, is a stark reminder that despite significant civil rights gains and changing social norms, conversion therapy still exists. Conversion therapy has proven ineffective at best and harmful at worst, yet for those whose religious beliefs forbid homosexuality or who believe that being LGBTQ makes life too difficult, what is the alternative?
My treatment of a young religious woman who requested help dating men despite being attracted to women provides an example of how therapy can help those struggling with their gender or sexual identity without shaming and harm.
Despite a successful career with many friends, Hannah had never had a romantic relationship or been sexually active. In her thirties, she was concerned about her fertility and about disappointing her family if she did not marry and bear children. While she found discussing her erotic life distressing, she confided that the subject of most of her sexual fantasies were women. Yet she had convinced herself that she could be attracted to a man if she loved him enough. Her worry about being a lesbian centered on no longer fitting in with her family and religious community. She also had negative, stereotypical associations to the term, feeling that it did not fit in with her sense of identity.
While conversion therapy goes against my moral values and the positions of the American Psychoanalytic Association and the American Psychiatric Association, of which I am a member, my duty as a therapist required me to respect Hannah’s wishes. Treating Hannah and patients like her struggling with their gender and sexual identity has taught me the following:
1. What is conversion therapy?
Conversion therapies are intended to change one’s sexual orientation or gender identification. These efforts have historically ranged from outright cruel and dangerous practices such as castration, lobotomy, inducing seizures, and steroid blockers to the current behavioral and/or psychological interventions. Most conversion therapies are based on unproven theories that sexuality can be altered by strong religious belief or overcoming childhood “traumas.”
2. Will conversion therapy change same-sex attractions?
A 2009 American Psychological Association report that examined research on conversion therapy found that very few studies had an adequate design to determine efficacy and safety. The few studies that were adequate concluded that any changes in sexual orientation or behavior were rare; instead, conversion therapy caused a reduction in general arousal.
3. Is conversion therapy harmful?
Recent studies demonstrate that approximately 17% of subjects interviewed attempted suicide during or after treatment. Many participants reported feelings of depression and shame from their treatments. In addition, they experienced reduced self-esteem, social isolation, a sense of alienation, loss of community supports, complete loss of faith, decreased ability to experience intimacy, sexual dysfunction or impotence.
4. If harmful, why is conversion therapy still legal?
Historically, therapists believed there was no harm in trying to change one’s sexual orientation. While conversion therapy remains legal in states with greater political opposition to LGBTQ rights, the emergent literature has led fourteen states to ban the practice for minors.
5. I am struggling with my sexuality and/or gender identity. What kind of therapist should I seek?
- One who strives to empower you to make your own life decisions. For example, Hannah ended up making her own choices once she became more comfortable with herself as a mature woman with sexual feelings.
- Your therapist should openly and collaboratively discuss your treatment goals, including likely outcomes both with and without therapy. For instance, Hannah had severe social anxiety that interfered with her ability to form intimate connections with anyone, not just romantic partners. We agreed that we would work on her overall sense of identity, confidence and difficulties with intimacy. I was clear that I did not know whom she would end up choosing to date or marry but that without therapy, she would have difficulty being in a relationship with anyone.
- The therapist would understand that identity is complex and comprised of many layers. So, for instance, your sexual identity could be different from who arouses you sexually. Your sexual identity has to do with how you identify in the privacy of your own thoughts as well as how you choose to identify in public. If your religious or cultural identity is in conflict with your sexual identity, your therapist can help you to find a compromise that works for you. For Hannah, this meant coming to terms with identifying as bisexual in her own thoughts and enjoying her attraction to women, while continuing to present a sexual identity of a heterosexual woman to her family.
- Find a therapist who focuses on your overall psychological well-being including coping mechanisms, adaptation to reality, self-esteem, self-knowledge and acceptance as well as the ability to have satisfying relationships. This includes helping to reduce shame over sexual desire and to enhance one’s ability to cope with discrimination. Hannah realized that she felt a duty to have children in order to continue her family’s lineage and traditions. Toward that goal, she began a romantic relationship with a man who had similar values. During the course of our treatment, she also became more comfortable with sexual desires of which she had been ashamed.
Mental health professionals have an ethical duty to promote well-being and dignity for all people. Treatments based on devaluation or shaming of anyone’s sense of identity, feelings or desires do not promote dignity. Seek out psychotherapy based on neutrality and openness to empower you to be your authentic self.
About the guest author: Diana E. Moga, MD is a psychiatrist and psychoanalyst with a private practice in Manhattan. Dr. Moga received her medical degree and her doctorate in Neuroscience from the Mount Sinai School of Medicine and completed psychiatric residency and psychoanalytic training at Presbyterian Hospital/ New York State Psychiatric Institute and Columbia’s Center for Psychoanalytic Training and Research respectively. She is currently on the faculty at the center teaching psychoanalytic candidates on topics ranging from gender and sexuality, neuroscience, and psychoanalytic process and an assistant professor at Columbia University teaching psychiatric residents psychodynamic psychotherapy. She is co-chair of the committee on Gender and Sexuality at the American Psychoanalytic Association.
