Spitzer's also been quoted in 'Homosexuality and Hope' and, as one of the clinicians who pioneered the 1973 removal of ('ego-syntonic') homosexuality from the DSM, he's been widely portrayed in Christian Right press as a dangerously liberal psychiatrist who had 'come to his senses'.
In fact, his research is - as Spitzer himself readily acknowledges - not quite as idealogy-shattering as it's been painted:
Some conservative commentators therefore argue that he has "changed his mind." This is not true -- Dr. Spitzer remains of the view that homosexuality is not an illness, and believes that "conversion" therapies might work, at best, for only a small minority of GLBT people (he has estimated around 3%).
It is important to understand what Spitzer was trying to establish: he was not trying to determine yet again whether "conversion" therapy can work for everyone (to which the answer is clearly "no") -- to the contrary, he wanted to test whether it can be ruled out as something that never works for anybody. His answer to that very limited question also is "no" -- based on a highly selective look at a small number of people who were the most likely of anyone to report favorable results from treatment.
Spitzer studied 200 individuals (143 men and 57 women) who claimed to have achieved a change lasting five years or more. Most of his subjects were identified by "ex-gay" ministries and therapists -- groups and doctors who have a vested interest in "proving" that change is effective, and who therefore would forward the strongest candidates they could find.
Even with this very select group of persons that "ex-gay" ministries and therapists thought were most likely to substantiate their claims, Spitzer found the following:
71% of the men and 37% of the women reported that they still had significant homosexual feelings.
34% of the men, and 56% of the women, had failed to achieve "good" heterosexual "functioning" (defined to include heterosexual relations at least once a month without the assistance of homosexual fantasies more than 20% of the time).
Spitzer's subjects included many "bisexual" persons -- nearly 30% reported that they were having heterosexual relations "regularly" (and others assumedly were having them less often) at the time they began therapy.
So what about the small number of people who seem to have made real progress? Here the question turns on whether Spitzer's study is reliable, or whether its methodological flaws were fatal. Spitzer's methodology has been criticized on numerous grounds. In addition to the sample bias noted above, Spitzer based his findings simply on 45-minute telephone interviews -- so the subjects did not have any anonymity that might help them candidly report unfavorable outcomes; Spitzer could not assess their credibility face-to-face; and the findings were based entirely on the subjects' self-report (rather than, e.g., physiological measures of arousal), which research has shown is often very misleading. In addition, Spitzer's study has not been subject to any peer review or other normal professional tests of validity. Some therefore believe that the study merits no credit at all.
What is perhaps most noteworthy is what Robert Spitzer says about his own work:
* In describing the study for CNN (May 9, 2001), Spitzer stated that "Our sample was self-selected from people who already claimed they had made some change. We don't know how common that kind of change is. . . . I'm not saying that this can be easily done, or that most homosexuals who want to change can make this kind of change. I suspect it's quite unusual."
* In an editorial to the Wall Street Journal (May 23, 2001), Spitzer stated that "Some homosexuals appear able to change self-identity and behavior, but not arousal or fantasies; others can change only self-identity; and only a very few, I suspect, can substantially change all four. . . . In fact, I suspect the vast majority of gay people would be unable to alter by much a firmly established homosexual orientation."
* Spitzer told the Advocate (July 17, 2001) that "the kinds of changes my subjects reported are highly unlikely to be available to the vast majority" of GLBT people, and that only "a small minority" -- perhaps 3% -- might have a "malleable" sexual orientation. He also charged in that interview that his research was being "twisted by the Christian right."
In short, Spitzer looked at the strongest cases proponents of "change" therapies could put forward, found decidedly mixed outcomes (including some reports of "success" that undoubtedly would have disappeared under more rigorous study methodologies), and concluded that perhaps 3% of GLBT people can achieve sufficient "change" to function heterosexually at least once a month without fantasizing about a same-sex partner more than 20% of the time.
Spitzer's findings have been debated further here. |
