LDS Reparative Therapy Studies

Gary Horstmanshoff,Ph.D., DATE 2/10/2012

A major theme among Mormon-homosexual studies is concerning reparative therapy.^[1] What benefits and what changes results from this form of therapy? What harms come from this type of therapy? How successful is it compared to other forms of therapy? What other therapy options exist for those who are unable to accept a gay identity?

Much controversy has been created by reparative therapy within the psychotherapy and social work community. The American Psychological Association's most recent statement (2010)^[2] discourages but does not prohibit sexual orientation change therapy and encourages mental health professionals to avoid misrepresenting the efficacy of such therapy (cf. Dehlin). It also condemns religious discrimination and advocates for respect for a client's religiosity.

This review of studies on LDS reparative therapy is split into three sections. First, we provide a general overview of three studies that consider those who are "converts" to reparative therapy (Beckstead, 1999; Byrd-Chamberlain, & Robinson). These studies consider individuals who have benefited from reparative therapy and changed in their sexual urges and behavior. A detailed review is given of each of these three studies.

Second, we look at one study that considers "non-converted" respondents - those who have tried reparative therapy and are ultimately not satisfied with that form of therapy (Beckstead, 2001a). This fourth study also provides a comparison between his converted (1999) and non-converted (2001a) data to understand different trajectories of these two groups. Finally, the results of two quantitative studies (Schow & Dehlin), one qualitative study (Goodwill), and some overall conclusion about research on LDS reparative therapies are discussed.

Reparative Therapy: The Converts

Two dissertation studies (Beckstead 1999, and Robinson) and a study reported on in a published article (Byrd-Chamberlain) have considered samples made exclusively of those who feel they have benefited from and changed their behavior and undesired, same-sex attractions through reparative therapy. Although these three researchers represent differing views as to the ultimate value of reparative therapy, the results of all three studies were amazingly similar and repeated the same themes - providing validity for all three studies. Comparing the results of these studies provides a good idea of what is meant by change and what are common themes among those who struggle long-term to resist a gay or lesbian identity. This section briefly summarizes commonalities across these three studies before giving a detailed review of each of them separately.

Beckstead's master thesis gives a detailed description of themes in the stories of 18 men and two women who reported to have changed through reparative therapy, and the general process they underwent to get there. With the intent of helping other therapist understand the process of reparative therapy and what is meant by change, Robinson likewise gives detailed descriptions of themes in the stories of seven heterosexually married men who represent themselves as success stories after undergoing reparative therapy. Finally, in hopes of helping others who might be struggling, Byrd & Chamberlain give a much briefer description of themes from interviews with four men and two women made progress undergoing reparative therapy.

Robinson's most surprising finding was that it wasn't the methods recommended by reparative theory, but rather just becoming aware of the theory, that resulted in the most change in his participants. Reparative therapy does not predict that change would occur due to hearing about the theory but rather from repairing relationships with parents and developing masculinity traits. The primary impact of hearing the theory of reparative therapy is also highlighted in both Beckstead (1999) and Byrd-Chamberlain studies.

Learning about this theory relieved a huge burden in three ways. First, individuals who suffered low self-esteem and blamed themselves and God now felt they had validity for the fact that they had not chosen their unwanted attractions. Second, the theory provided a rationality that they could relate to in one way or another. Third, the theory gave them hope that there might be a way to overcome their attractions by correcting these deficits. Although not changing an individual's orientation, just the awareness that it was not their fault and the hope for potential change provided a huge relief that allowed the men to change how they looked at homosexuality and gave them new incentives to change their behaviors.

What does change refer to in these studies? Because sexual orientation was considered a social construction or not overtly recognized in the Robinson and Byrd-Chamberlain studies, it was not change sexual orientation that was the primary focus of these studies. Change reflected in all three studies is more nuanced. Following are aspects of change listed in these three studies:

• All three studies recognized that men with poor masculine gender identities were able to improve this through playing basketball and doing other masculine activities.
• Many who lacked healthy interpersonal skills were able to build successful, non-sexual friendships with other same-sex individuals.
• Through group support individuals were able to gain validation and solidarity with others who struggled with same-sex attractions like themselves. Their self-esteem increased by seeing that they were not abnormal and realizing that others had similar issues.
• Most of the men the participants in these studies had "acted out" and were involved in anonymous sex encounters and other undesired sexual behaviors, although most were heterosexually married at the time. They were able to learn to control their unwanted sexual behavior and limit sex to their spouse.
• As many of the men had acted sexually outside of marriage, their change also involved reconnecting and recommitting to heterosexual relationships with their wives. For those who still found it difficult to have heterosexual sex, there was agreement to maintain a friendship, emotional relationship for the sake of their marriage and children.
• After many years of struggling to control things themselves, some felt a transcendent, spiritual experience after they had done all they knew how and then turned over their struggle to God.
• They found meaning in the life-long struggling process such as rewards in the next life and deeper empathy and spirituality, which they wouldn't have had without this struggle.

All of these areas represent change that the participants in these studies reported, however no examples were given of men that had life-long same-sex attractions who had reversed their orientation and now replaced these attractions with strong opposite sex sexual desires and passions that hadn't been there before. Beckstead notes that the social construction in these studies involves not sexual orientation change but rather sexual orientation identity change. Individuals were able to change their identities to match their belief systems and to learn to control their sexual behaviors and their level of sex drive in order to follow their religious and moral beliefs.

Following is a more thorough review of each of these studies alphabetically by the author's name. After considering studies of those supportive of reparative therapy, we will subsequently consider a study considering those who are unsatisfied with their reparative therapy.

Beckstead, Arvel Lee. 1999. "Gay is not me": Seeking congruence through sexual reorientation therapy. Master's thesis, Department of Educational Psychology, University of Utah: Salt Lake City, Utah. See also journal article: Beckstead, A. Lee. 2001b. Cures versus choices: Agendas in sexual reorientation therapy. Journal of Gay & Lesbian Psychotherapy, 5, 87-115.

This detailed study of 20 individuals (233pp) who reported successful outcomes from reparative therapy primarily considered three questions:

• Motivating factors for seeking reparative therapy
• The process each individual underwent to create lasting change
• The benefits and harms of this type of therapy.

This study involved analysis of interviews with 18 men and 2 women who all underwent and were "converts" to therapy for sexual reorientation or change therapy. Nine of them attended the support group called Evergreen between 1-7 years. Individual therapy ranged from 4 months to 20 years. All participants were Caucasian. Their ages ranged from 25-60 years and the average age was 40 years old. Fourteen of the men were married, 1 was engaged, and 5 were single. All were currently LDS.

Self-reported sexual orientation varied considerably: 2 exclusively heterosexual, 6 predominantly heterosexual, 3 bisexual, 2 predominantly homosexual, and 7 others referred to themselves variously as: heterosexual with a homosexual problem; same-sex attracted; attracted to men but happy sex with wife; 90-95% heterosexual with homosexual past; a daughter of God who feels a physical, emotional, romantic, sexual, etc., attraction to women; in feelings of attraction, almost exclusively homosexual-in behavior exclusively heterosexual; and "myself".

In this extensive study 17 themes are discussed with numerous examples within each: first discovery of same sex attraction, motivating factors for identity development, the cycle of incongruence, coping with the incongruence, finding hope after the bottom, the theory - it all makes sense now, feelings congruent with heterosexuality, being-doing difference, congruence in heterosexual gender identity, coping with same-sex attraction, relapse, surrendering to God, same-sex attraction as a none-issue, experiences of success, cures versus choices, a very long process, and two lives becoming congruent-whole.

Participants reported three primary benefits from reparative therapy:

• Help in developing healthy same-sex emotional (non-sexual) relationships
• Decreased homosexual behavior
• Increased gender identity congruence (e.g. masculine identity for the men)

Five background factors created a need for change:

• Commitment to LDS religious society
• Heterosexual society norms
• Negative "gay" society stereotypes
• Family influences
• Their soul's sense of dissonance

These five background factors lead to more immediate motivations to resolve incongruence in emotions and identities. The first motivational conflict was the intense highs and lows experienced when engaging in homosexual thoughts and activities. Emotional highs from passion, pleasure, romance, sensuality, and intimacy, followed by negative emotions of panic, worry, disgust, self-hatred, frustration, depression, desperation, embarrassment, worthlessness, and humiliation generated tensions that needed to be resolved. The second motivational conflict was a growing dissonance between two incompatible identities: two lives that can't come together. Many of the participants began living a double-life that generated energy in need of resolution.

Twenty-four different coping strategies for dealing with incongruent identities are identified and discussed under six topics:

1. Sexual-relational solutions: sexual addictions (masturbation, pornography, voyeurism, promiscuity, and exhibitionism), self-induced aversion therapy, avoiding romantic and erotic relationships, attempting sexual intercourse with a woman, getting married, accepting a gay identity while separating from religious identity, and celibacy
2. Emotional coping: shutting off emotions, approval seeking dependence, hostility to others
3. Escape or release: fantasy world, alcohol use, suicide
4. Hiding: hiding or remaining silent, discriminating against gays-lesbians, becoming vigilant and suspicious of others, gaining weight and eating
5. Religious solutions: being the "good" child" through church activities and callings, constant prayers
6. Classic defense mechanisms: compartmentalizing, denial of one's homosexual attractions, repression and suppression, perfectionism or obsessiveness, rationalizing

Under the final theme - a very long process - Beckstead summarized five stages in this process: incongruence-dissonance, discovery-experimentation-immersion, realizing there's more to life, spiritual surrender-commitment, and working it out. Participants in this study emphasized the key transition represented by discovery of the theory behind reparative therapy independent of actually applying the interventions recommended by the theory (cf. Robinson's study).

As mentioned, Beckstead's primary finding which is consistent with other studies of change is that it is sexual orientation identity, not sexual orientation, which seems to be socially constructed and changes over time. Sexual orientation identity is secondary to religious-spiritual identity for these individuals who are willing to sacrifice sexual desires for religious rewards. Faithful enduring to the end and obedience is more important than gratifying same sex desires for the majority of these individuals.

Byrd, A. Dean, & Chamberlain, Mark D. 1993. Dealing with issues of homosexuality: A qualitative study of six Mormons. Issues in Religion and Psychotherapy,^[3] 19 (1), 47-89. Reprinted as chapter 10 in the book edited by Daniel K. Judd, Religion, Mental Health and the Latter-Day Saints (1999: Religious Studies Center Specialized Monograph Series, v. 14).

Byrd and Chamberlain presented a study of six individuals, four men and two women, referred primarily by LDS Family Services therapists. The goal of this study was to assist those struggling against same-sex attraction by identifying common issues in coping experiences of these individuals. The participants in this study ranged in age from 22-53 years. They resided in Salt Lake and Utah counties. All participants had graduated from high school. These individuals had been in change therapy from 6 months to 4 years. Three of the four men were participating in a Saturday sports program at the time.

Unlike the other two dissertations discussed in this section, this article is much shorter (36 pages) and did not give biographical information about each of the six individuals or references which participant made which of the quotes cited in the study.

The article was primarily divided into two sections. The first discussed themes emphasizing challenges and struggles. The second emphasized developmental or transitional themes in their efforts to cope.

Three themes represented problematic areas described by those interviewed:

• Confusion, guilt, and discouragement by initial feelings of homosexual attraction
• Negative perceptions of God and the church
• Problem relationships with others

Four transitions and developmental themes emerged as individuals attempted to address the previous negative problems:

• Developing intimacy through sharing with others: the importance of disclosure
• Dramatic transition due to new knowledge or understanding
• Changing relationship with God
• Changing gender and sexuality issues

Participants who had seen themselves as different compared to other men and had withdrawn from social interactions learned how to engage in healthy, non-sexual relationships with others of the same sex. Participants benefited from being more honest and by self-disclosing their own struggles. The theories underlying reparative therapy gave individuals hope and a new way to view their struggles (cf. Robinson). Participants who had blamed God for their condition were able to reframe their views to see God as loving. They improved self-confidence and self-esteem by developing gender-congruent abilities and identities. They also were able to meet non-sexual (social-emotional) needs with others of the same sex and thereby feel a healthier balance and diminished intensity in their sexual attractions. These themes repeat the same basic story that was found in the two other dissertations.

To help individuals struggling with homosexuality issues, the authors feel the following seven points need to be emphasized:

• Non-sexual issues (e.g. interpersonal skills, developing better gender congruence, etc.) need to be emphasized
• Acceptance and love by those trying to help (e.g. family, church leaders, therapists) is more important than their knowledge
• Avoidance and secretiveness are obstacles to progress
• Those wishing to help should not emphasize authority, power, hierarchy, but rather emphasize love, equality, and reciprocity.
• Be alert to real suicide possibilities
• Rather than becoming something or someone new, participants in the study found ways to integrate their identity in unexpected ways.
• An individual's life is determined by the choices they make and how they choose to respond to their same-sex attractions.

Robinson, Jeffrey R. 1998. Understanding the meanings of change for married LDS men with histories of homosexual activities. Ph.D. dissertation, Department of Marriage and Family Therapy, Brigham Young University: Provo, Utah.

This dissertation (343pp) considers narratives of seven men who are in heterosexual marriages and active LDS members who claimed to have changed and overcome their homosexuality to some degree. The men interviewed met three criteria:

• A history of extensive homosexual attraction and behavior
• Currently in committed, monogamous heterosexual marriages which they considered successful for at least the last year
• Reported having changed or overcome homosexual desires and behaviors

The fundamental purpose of this study was to provide helpful information for those in clinical practice working with men with unwanted homosexual desires. The goal was to obtain a rich and detailed description of the process and meaning of change from interviews with those who felt they had successfully achieved this.

Participants in this study were all Caucasian men in their 20s to late 40s. They all lived along the Wasatch front in Utah and had been heterosexually married for at least two years, several for over 10 years. Participants were referred to throughout the study by participant numbers rather than by name.

Unfortunately the information about number of years married, presence of children, quality of their marriage, or motivational factors involving family issues were not specifically discussed in this study. Two men (Participants #1 and 5) mention fear of loosing their families and children as a primary motivation factor in their process. Unmarried men in their situation may feel an opposite motivation due to stigma attached to unmarried, middle-aged men in the LDS culture.

The seven men had previously read frequently referred and in their interviews to theories Elizabeth Moberly's (1983) theory of reparative therapy, and to a lesser degree similar theories of Konrad (1987) & Nicolosi (1991).^[4]

Comparing the detailed narratives of these seven men, Robinson discusses nine themes reported in each of the interviews:

1. Common traits include emotional sensitivity, intellectual introspection and wanted to be right.
2. Feeling different or rejected by other men.
3. Experienced non-sexual attraction to other men.
4. Experienced sexual attraction to other men.
5. Interpretation and reinterpretation of homosexual desires.
6. Negative Self-Appraisal.
7. Isolation.
8. Compulsive sexual behaviors and obsessive thoughts.
9. Religiosity and spiritual transformation.

The most surprising finding and a key for Robinson was that it wasn't Moberly's (1983) prescribed interventions which brought the most immediate, profound, and predicted results, but rather just hearing about the theory of change. The theory gave participants a causal explanation that absolved them of blame (re-defining what it meant to be homosexual or to have homosexual desires), interventions to try, and hope for future. This same finding was mentioned in the other two studies of LDS strugglers as well.

Robinson emphasized that the chief factor initiating the change process was the reinterpretation of their struggle (Theme #5). This was motivated by their religiosity and culminated in a spiritual transformation (Theme #9). Sexual attraction (Theme #4) was the central defining issue such that the nine themes are in a roughly developmental order.

Robinson identifies three personality characteristics as evident among these seven men: emotional sensitivity, intellectual introspection, and a strong desire to be right. Are these characteristics typical of the kind of individual who ultimately can not accept a gay-identity or are these characteristics due to struggling against the dominant society for years with very little generalized validation or understanding? In the case of the former, it may provide a profile to help when considering what type of therapy would be best to help a Mormon-homosexual struggler.

In the closing discussion, Robinson explains his view that sexual orientation is socially constructed. He does this for the explicit reason that sexual orientation implies a fairly unchangeable condition. As he is ultimately an advocate for change, discussing sexual orientation would undermine his and his clients' desired goal.

Although not discussed explicitly, it is evident from quotations that heterosexual attractions varied across these seven men. One participant (#3) indicated that he had always thoroughly enjoyed sex with his wife and it was only when marital sex decreased and conflict increased that he began looking for homosexual connections outside of marriage, while another (#2) said that marital intimacy with his wife had been difficult. The other five men appear in the range between those two as they were able to enjoy sex with their wives but felt a stronger draw to male sexuality and were not generally sexually attracted to women other than their wives. None of these men appear to have developed frequent, passionate sensual attractions to heterosexual women outside their wives as might be expected if their underlying sexual orientations had significantly changed.

Participants also differed in the degree to which they had engaged sexually with other men, although this was not overtly discussed in any real detail. Two of the men (Participants #1 & #6) had never engaged sexually with another man while other men described frequently acting out in anonymous sex encounters while heterosexually married.

The narratives of these men included frequent projection of positive things that had happened to them to God and negative things to Satan. They talked a lot about the battleground between good and evil.

Change for these men involved learning how to develop healthy non-sexual relationships with other men, developing a strong sense of their own masculinity, learning to control their extramarital behaviors and being more committed to their marriages, and developing a healthier self-esteem and a more positive view of God. Spiritual rebirth was an ultimate part of the process for some of the men who felt they had done everything they knew how to change and it was only after that they let go and turned it over to God that they felt a spiritual transformation that God had not forsaken them and they could now put it in God's hands.

Reparative Therapy: The Non-Converted

Only one qualitative study primarily focused on those who had tried reparative therapy and had been unsatisfied with the ultimate outcome (Beckstead's second study and dissertation, 2001a). Beckstead expected to find a different trajectory and themes with this second group compared to his first study of those who were converted to change therapy, but found to the contrary that the same basic themes and process emerged for this group as had been discussed in his prior study. The main difference between the two groups was in the ultimate decision that was made. The participants in this second study made the decision to reject the view of reparative therapy and to accept an affirming view towards their homosexual identity. Following is a more detailed summary and review of this study.

Beckstead, Arvell Lee. 2001a. The process towards self-acceptance and self-identity of individuals who underwent sexual reorientation therapy. Ph.D. dissertation, Department of Educational Psychology, University of Utah: Salt Lake City, Utah. See also: Beckstead, A. Lee, & Morrow, Susan L. 2004. Mormon clients' experiences of conversion therapy: The need for a new treatment approach. The Counseling Psychologist, 32, 651-690. See also: Beckstead, A. Lee. 2003. Understanding the self-reports of reparative therapy "successes." Archives of Sexual Behavior, 32, 419-468.

The first half of this study considers a detailed analysis of interviews with 20 men and two women who had unsuccessfully attempted reparative therapy. The analysis also considered perspectives of eight additional individuals who participated in focus-groups discussing the results of these studies. During the latter part of the dissertation comparisons are made with individuals from the first study (1999), making a total of 50 participants in this study, 45 men and five women.

Three primary research questions were asked concerning those who were no longer advocates for reparative therapy:

• What background, process, and experiences distinguished these individuals from the 20 who remained advocates of reparative therapy?
• What does the model of their experiences look like?
• How did they move from reorientation to acceptance of a gay identity?

Of the primary individuals in this group (N=22), 12 were divorced and 5 had children. Current relationship status consisted in 1 married, 8 in same-sex relationships, and 13 single. Ages ranged from 20-52 with an average age of 35 years. Sexual identities were as follows: 12 self-identified as exclusively homosexual, 1 as between exclusively homosexual and predominantly homosexual, 1 as predominantly homosexual, 2 as bisexual, and the other six participants used a self-label: 1 openly gay/queer, 2 gay, 1 exclusively gay, 1 fabulously gay, 1 exclusively myself.

Twelve of the participants participated with the Evergreen support group and three had been involved with the Exodus support group. Those who had attended Evergreen participated from 2 months to 9 years with an average of 1 ½ years activity in the group. Length of time in working with an individual reparative therapist varied from 3 weeks to 20 years with an average of 3 ½ years. Time since they had stopped conversion therapy ranged from 2 months to 12 years with an average of 4 years.

The eight participants in focus groups included three who were heterosexually married and one divorced (4 had children), two in same-sex relationships, and three were single. Ages ranged from 28-53 with an average of 40.5 years old. Self-identified sexual orientation identities included: two bisexual, two gay, one truly lesbian, one heterosexual with still some struggle though vastly improved and continuing to improve, one homosexually oriented, and one predominantly heterosexual. These individuals ranged in their involvement in change therapy from 4 months to 11 years with an average of 4.5 years. Time away from therapy included up to 13 years, although some were still receiving therapy at the time.

An overview of the process showed eleven transitional themes, the first five of which were also discussed in his first study:

1. Becoming aware of attraction and "differences"
2. Influenced by motivating factors to change
3. Coping with incongruent identities and emotions
4. Hitting bottom: internal and external conflict
5. Experiencing sexual reorientation therapies
6. Gaining a different perspective and becoming disillusioned
7. Developing self-acceptance
8. Consolidating an identity
9. Finding and making choices
10. Struggling still with internal and external conflicts
11. Experiencing success

Twenty-nine coping strategies were identified under six categories, similar to Beckstead's (1999) first study:

• Intra-psychic, mostly unconscious defense mechanisms: compartmentalizing, denial, repression/suppression, distraction, rationalizing
• Sexual-relational solutions: cruising-voyeurism, masturbation, avoiding activities, avoiding/leaving same-sex relationships, prostitute, dating opposite sex, getting married, celibacy
• Emotional coping: cutting off all emotions, believing in miracles, self-control
• Hiding: hiding or remaining silent, dishonest and keeping secrets
• Religious solutions: Being the "good" child, proving worthiness through self-sacrifice, going on LDS mission, constant prayers, and belief in Satan's role.
• Escape, release, and suicide

Many of the participants felt a need for conversion therapy as a stepping stone or launching pad for coming-out. Participants reported both positive and negative aspects of reparative therapy they experienced:

What deciding factors led these individuals to stop wanting to identify as or become heterosexual? Some came to a conclusion that attempts to change their sexual orientation were not working. They did not see progress among others in therapy. Some found gay/lesbian relationships to be emotionally rewarding and sexually committed. Many did not want to be associated with the negative stereotypes of the ex-gays: promiscuous, dishonest, unhappy, unable to think on their own, or stuck. They felt that if it works for others great, but they came to a decision that it wasn't for them.

It was a long process for both groups. Beckstead's surprising finding was that both groups of individuals shared the same developmental process rather than showing two separate processes. Even after diverging in their choice of identities and commitments, in their separate spheres they followed similar processes of finding self-acceptance and consolidating their identities. Beckstead identifies common themes that help both participants who accept and reject a gay identity to facilitate self-acceptance as follows:

• Meeting others like themselves and finding a place to belong
• Rejecting labels and outside validation
• Finding one's value
• Accepting one's same-sex attractions: letting go
• Adopting/living by one's ethics: making choices
• Becoming comfortable with one's gender role
• Participating on other forms of therapy
• Finding family and peer acceptance

Similarly he discusses themes that help to consolidate ones identity whether that involved accepting or rejecting a gay-affirming identity:

• Defining "gay": being versus doing
• Defining sexual relationships in differing ways: sin/Satan's role, sense of adolescence, falling in love & connectedness, non-issue of attractions
• Wanting to be heterosexual or not
• Adopting labels: same-sex-attracted, gay, or denying a label
• Expanding one's category of self: not just about sex anymore
• Redefining spirituality

Both groups continued to struggle but felt they had made considerable progress. He concludes that although reparative therapy may be beneficial in some areas, its foundation has potential for great harm. He recognizes that not everyone can accept gay-affirming therapy initially. He proposes a broader plan of therapy that has as a goal the most benefit from the least harm and congruent solutions. Individuals who may not be open to the recommended gay-affirmative therapy, rather than being vulnerable to the harmful aspects of reparative therapy could instead be referred to gender-affirmative therapy, positive psychological therapy (cf. Seligman & Csikszentmihalyi, 2000), or therapy aimed at overcoming depression, building self-esteem, and confidence. His studies show that decisions to accept a gay identity may not be optimal for everyone, but much good can come from other therapies that are not seen as aversive to ones religious beliefs while at the same time, not promoting invalidated theories that can cause further harm (i.e. reparative therapies).

Discussion

Although the researchers of these studies have differing opinions as to the value of reparative therapy, all four studies showed very similar results. The stories of the participants in all four studies consistently repeated the same themes. In this section we consider what three other LDS-homosexual studies have to say about change-therapy and end with some general observations about this topic. More about these three studies and bibliographic information is found in a review of eleven Mormon-homosexual studies.

Three Other LDS-Homosexual Studies. Two quantitative studies provide a beginning to understanding the frequency of success reported by LDS participants in this form of therapy. Ron Schow's 1994 affirmation survey of 136 individuals (20 women, average age 37 years, age range 18-66 years) showed that 82% of those who filled out the survey attempted to change their sexual orientation. Eighty-three participants underwent counseling with ecclesiastical leaders, 50 went to LDS social services for help. Eighty-four percent of those who reported on their experience with change therapy experienced no change at all.

Dehlin's Utah State University internet study is still in the process of being analyzed. By far it is the largest study that has been done. It asked participants (N=1635, 24% women) to evaluate several different change therapies they may have experienced and the effectiveness of these attempts. Participants include both converts and non-converts to reparative methods. In his study 65% of participants attempted to change their orientation. Of those, 35% (N=659) used formal therapy. Only 20% of these (N=102) reported that their therapy was effective while the remaining 80% felt it was either ineffective or harmful. Those who participated in a gay-affirming therapy (N=659) showed the opposite pattern with only 13% finding it harmful or having no effect while the remaining 88% found it effective.

Goodwill's quantitative study, discussed in more detail elsewhere, provides a different view of reparative therapy. Unlike the studies discussed so far, Goodwill studied five men with LDS backgrounds who chose not to go through change therapy or participate in support groups like Evergreen. What characteristics or differences might such individuals show compared to the more clinical samples? What is their view towards change therapies? Although having limited experience with change therapy, these individuals expressed strong opinions about reparative therapy.

Goodwill described the exposure to change therapy and support groups of each of his study participants. Mark attended an Evergreen meeting with his wife once and by the end of the meeting he felt these were sick people. He felt sad and angry with what he had experienced. Todd read a book advocating change therapy which did not resonate with his experience (masculinity deficit and relationship problems with his father) and he felt was comedy material. Jeremy received an anonymous letter recommending Evergreen from a prior acquaintance. He wondered why the person wouldn't identify himself by name if he believed in this therapy. Bill never saw a therapist but advocated for individuals to integrate gay and Mormon aspects of themselves. John was sent to LDS social services by his stake president and felt it was disgusting and that they were destroying people instead of helping them to love themselves.

When asked what they would recommend to one who is seeking help to not act on their homosexual attractions, these five men felt individuals should have the choice to pursue that option but with some qualification. Jeremy stated that if one is miserable because they are gay, they should be allowed to try to change, but the therapist should see if it is really self-hatred that is the problem. Most of the men felt it was important for the therapist to honestly distinguish between controlling behavior and changing a sexual orientation. John clarified this by adding that individuals who act heterosexually still have feelings of attraction for men. Todd suggested that instead of taking a literal or behavioral point-of-view, a metaphorical view suggests that homosexuality is not what you do but how you feel in the deepest part of you (i.e. a part of ones self-identity).

General Observations. A commonality of the four main studies reviewed in this article is that they all involve individuals who were committed to Mormon beliefs and identity who made extensive attempts to change their sexual orientation. Such studies have been referred to as clinical studies. Traditional psychology has focused on how to help maladapted individuals as a way to improve mental health. A more recent field of positive psychology has found that successful individuals are not just individuals who are not maladapted but there is a separate psychology involving those who have positive adaptation.

One area of research that has been neglected by focusing on the maladaptive end of the spectrum is what differences would be found in the Mormon-homosexual identity conflict model if we studied those who have made positive adjustments without needing long-term therapy or support groups. Are there different personal characteristics that contrast long-term strugglers with formerly LDS committed individuals who have adjusted to a healthy, happy lifestyle without the need for reparative therapy or change support groups? Would studying such individuals provide differences to the general identity conflict model and perspectives represented by common themes in this review?

The broader review article emphasized the importance of going beyond these studies by contrasting important individual differences within this Mormon-homosexual identity conflict. Important differences to consider include comparing differences in timing of self-awareness of same-sex attractions compared to timing of first same-sex contact and the level of bisexual attraction an individual experiences.

As mentioned in the another review article here, there are at least two different variations on this identity developmental model that are important to consider. The one most reflected in these studies of change-therapy participants is more typical for men, while the one reported as more typical for women (also occurs for many men but less typical frequently) is not distinguished separately in these studies. These two different variations of LDS coming out may be referred to as the sex-first or the identity-first patterns. Those in the identity-first pattern are more interested in emotional relationships than sexual encounters, tend to be late-bloomers in recognizing their homosexual orientation, and are driven more by logic than by sex-drives in their coming-out process.

The overall message of the studies reviewed in this article is that gay-affirming therapy is not for everyone. Although the APA (American Psychological Association) does not approve of reparative therapy, religious and hetero-normative identities are more important for some than accepting their homosexual orientation. For such individuals alternatives are needed which allow respect for their religious views while not pushing them to accept a gay-identity. Such therapy can address building relations skills, improving self-esteem through gender-affirming activities, and overcoming destructive behaviors without needing to negatively stereotype those in the gay community or the religious community.^[5] For those who need a causal theory to replace reparative therapy, a similar model such as the Exotic Becomes Erotic Model^[6] provides an explanation that recognizes a gender atypical relationship to sexual orientation without blaming parents or oneself, or suggesting it is reversible.

In conclusion, it seems that the question of whether change of a sexual orientation is possible is not the question that we should be asking but rather, how we can identify those with a homosexual orientation who are unable to accept a gay-affirming identity and what types of therapy alternatives can provide the most help and least harm to such individuals. Developing a profile of such individuals can start not only by considering the traits Robinson identified and the common identity conflict pattern identified in these studies, but also by seeing how these individuals differ from characteristics typical of those who are able to make a healthy transition to a gay-affirming identity.^[7]