Insurances DO pay for Reparative Therapy!
by Joe Kort, MSW
I was recently asked how psychotherapists get paid for providing Reparative Therapy (RT) if most mental health organizations have identified it as an unethical and harmful form of treatment.
The way these therapists and treatment centers get around this is by using a diagnosis known as Sexual Disorder Not Otherwise Specified (302.9). This is in the DSM IV which is the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition in the mental health field. These therapists also use depression and anxiety disorder diagnoses which insurance companies will pay for.
In other words, if a client comes in and want to “change” from gay to straight many therapists would say this person is “depressed” or “anxious” and give them codes for those mood disorders. Insurances rarely check to see what is contributing to the depression they simply want to know what they are paying for and monitor the depressive symptoms.
In terms of Sexual Disorder NOS, this diagnosis applies to the following individuals according to the DSM IV:
1) Marked feelings of inadequacy concerning sexual performance or other traits related to self-imposed standards of masculinity or femininity.
2) Distress about a pattern of repeated sexual relationships involoving a succession of lovers who are experienced by the individual only as things to be used.
3) Persistent and marked distress about sexual orientation.
So you can see that number three would cover those who do Reparative Therapy. The Sexual Disorder NOS diagnosis is in the DSM IV for those gays and lesbians who are closeted and struggling with coming out. It is used wrongly by those doing RT for those trying to “behave as heterosexuals”
It would be great to see a group of folks start challenging insurance companies demanding that they get more information on what Sexual Disorder NOS is being treated for.
Sadly, these RT’s could still use depression and anxiety disorders claiming that these folks need RT because their orientation is causing them their mood disturbances.
In truth as most understand that it is not the sexual orientation that is causing them distress but rather what is “done to them” regarding their homosexuality. Reparative Therapists simply continue the homophobic and heterosexist acts on these poor people and make a living from it.
Joe Kort
“In truth as most understand that it is not the sexual orientation that is causing them distress but rather what is “done to them” regarding their homosexuality. Reparative Therapists simply continue the homophobic and heterosexist acts on these poor people and make a living from it.”
Give me the empirical data that supports this construct of “internalized homophobia.” I want to see studies involving non-random samples with controls. In short, I want to see statistical data, if possible.
Second, give me a list of peer reviewed articles that show the efficacy of Gay-Affirming-Therapy. I expect to see controls, as well as a large random sample used. I also expect to see the study replicated in other peer reviewed journals, done by none-gay researchers who do not purport to be crusaders of the gay agenda.
Thank you very much.
“Sadly, these RT’s could still use depression and anxiety disorders claiming that these folks need RT because their orientation is causing them their mood disturbances.”
The funny thing, Joe, I’ve been seeing an MFT therapist in Boston who purportedly gives Re-orientation therapy. On my way out of his office I ran into a lesbian couple. They said that they were going to see my therapist, who was going to help them with their parenting skills (they were happily married, and had adopted children).
The world appears to be more than this black and white narrow view of “heroes” vs. “villains,” of evil re-orientation therapists forcing people into therapy.
“Second, give me a list of peer reviewed articles that show the efficacy of Gay-Affirming-Therapy. I expect to see controls, as well as a large random sample used. I also expect to see the study replicated in other peer reviewed journals, done by none-gay researchers who do not purport to be crusaders of the gay agenda.”
I have a better question, find me a study by a GAY researcher that supports reparative therapy. Afterall, if orientation is a litmus test for the validity of research done it shouldn’t be one sided and as far as I know all the pro reparative therapy studies have been done by heterosexuals.
Hi Joe,
You decided to evade my question but that’s find. I will answer yours. Realize I’m not trying to be malicious, or combative. Rather, I only want intellectual discussion. Your credentials indicate that you are more than capable of such. Don’t disappoint me.
Anyways,
Douglas Haldeman is a gay man, an activist for gay causes. Still, he has conceded that–
“not all supporters of conversion therapy seek to interfere in the lives and freedoms of gay people, or…are out to do us harm. Rather…there is a religious basis from which these people are operating, not malicious, but rather in the service of their own religious beliefs….This is not to say that I endorse these beliefs or share them myself; but neither do I endorse the prospect that we, as gay scholars and activists, should interefere with people’s choices.” (1)
Out of respect for personal autonomy, Haldeman grants that the client with strong religious convictions therefore has the right to pursue change:
“A corollary issue for many is a sense of religious or spiritual identity that is sometimes as deeply felt as is sexual orientation. For some it is easier, and less emotionally disruptive, to contemplate changing sexual orientation, than to disengage from a religious way of life that is seen as completely central to the individual’s sense of self and purpose.” (2)
Therefore, Dr. Haldeman says, such therapy is not necessarily harmful or unethical:
“There appear to be many dissatisfied homosexually- oriented individuals who seek psychological guidance or spiritual intervention to achieve a goal they identify as a change in sexual orientation… some…particularly those who have experienced less invasive styles of conversion therapy, seem not to have been affected adversely.”
Not everyone is out to get you. Let those who want to pursue change, pursue change.
Not all re-orientation therapists are out to deprive your people of rights. Only go after those who have made a public agenda out of doing it.
Avoid this black and white, victim-villain mentality.
Further, the concept of the depressed gay teenager has been shown to be a myth by recent research–read the book “The New Gay Teenager” by Cornell University’s Dr. Savin-Williams (who is homosexual himself).
Chris
–
Sources:
(1) From a paper presented by Douglas Haldeman at a symposium entitled “Gays, Ex-Gays, Ex-Ex-Gays–Examining Key Religious, Ethical, and Diversity Issues,” American Psychological Association Annual Meeting, August 7th, 2000, Washington, D.C.
(2) Ibid.
A couple things, first, I’m not Joe Kort. Second, Douglas Haldeman says here “there is no credible scientific evidence that suggests sexual orientation can be changed.” Haldeman supports the right of individuals to choose reparative therapy if they wish. That’s not the same thing as supporting it.
Support seems to imply that you believe it is a beneficial method that you recommend to people, Haldeman clearly doesn’t feel that way, just that for SOME people it MAY not do any harm.
Just because something may not be harmful to all people does not mean it is necessarily beneficial or effective. An example might be a simple sugar pill. Sure, it might help some people to feel better psychologically speaking, but would it be as effective as a drug for whatever problem an individual might be having? I don’t think so.
Lastly, the idea that somehow one book removes decades of scientific studies on depression is improbable.
Chris,
If this RT does not believe that “all” homosexuality is bad than that is wonderful. However, the literature from RT pretty much all agree that is no such thing as a true, self-affirming gay or lesbian.
G-d Bless your therapist.
And if you can point me to a book on RT that believes that for those living gay affirmative lives are living normative lives for them and that for some is a need for RT I would like to read it.
I have never found any such book. They all claim that all homosexuality is pathological and negative.
It is not that I think that all RT themselves are bad. However, using what I know is the basis for RT by Michael Cohen, Nicolosi and the others is that they believe “all homosexuality is pathological and bad” and there is no such thing as someone gay or lesbian.
I would love to read differently.
WarmlyChris,
If this RT does not believe that “all” homosexuality is bad than that is wonderful. However, the literature from RT pretty much all agree that is no such thing as a true, self-affirming gay or lesbian.
G-d Bless your therapist.
And if you can point me to a book on RT that believes that for those living gay affirmative lives are living normative lives for them and that for some is a need for RT I would like to read it.
I have never found any such book. They all claim that all homosexuality is pathological and negative.
It is not that I think that all RT themselves are bad. However, using what I know is the basis for RT by Michael Cohen, Nicolosi and the others is that they believe “all homosexuality is pathological and bad” and there is no such thing as someone gay or lesbian.
I would love to read differently.
Warmly
I would also love to see a study done of those who are straight (heterosexual) turned gay successfully. That type of study would be a valuable contribution I believe.
Warmly, Joe Kort
“Haldeman supports the right of individuals to choose reparative therapy if they wish. That’s not the same thing as supporting it.”
Dear anonymous, the above is what it boils down to.
This was what I’m getting at. Even if he has his own subjective opinions on RT, the fact that he supports the view that it may be right for some people is what I’m getting at. Also is his distinction between sexual and religious orientation. For some, religious orientation is felt to be more core to an individual than his sexual orientation. This is an important point, as there are therapists out there who would rather have a person ignore his religious orientation and embrace fully his sexual orientation. For these individuals, RT may be a better alternative than gay-affirming-therapy. I whole-heartedly agree with Dr. Haldeman here, and I hope you do as well.
An analogy: I don’t believe that Prozac and psychiatry is the answer to life’s problems (no I’m not Tom Cruise in disguise), but I support those who need it. Nor will I advocate to make prozac illegal, as gay activists tried to do with reparative therapy a few years back. I kind of got the impression that Joe supported this sort of thing, which raised a red flag.
And this is to Joe: I know of two re-orientation therapists who also do gay-affirming work IF that is what their patients want. Like Anne Heche, they go both ways. I could give you their names and contact info if you want, in private. Though I don’t know if that would change your thinking, and it would probably be a waste of my time anyways.
By the way, you still haven’t answered my ORIGINAL question regarding peer reviewed, scientific, objective research regarding the efficacy of GAT (gay affirming therapy).
That question still stands. I withhold all future discussion until that question is addressed.
Warmly,
Chris
Chris,
I, too, help those with homosexual orientation to live heterosexually if that is what they choose for religious and other reasons which prevent them from accepting their sexual and romantic orientation.
I do not–I repeat do not–offer them false hope that their sexual and romantic orientation will change because it will not. They absolutely can live a life of heterosexuality if they choose. I help them do so with integrity. I help them relieve themselves of any shame for having a homosexual orientation.
However you are right I will never believe that someone can go from gay to straight just as I do not believe that someone can go from straight to gay. It is simply not possible.
As for your other question regarding peer reviewed, scientific, objective research regarding the efficacy of GAT (gay affirming therapy) I do not know of any but I will seek it out as that is a very good question.
The peer reviewed, scientific, objective research regarding the efficacy of reparative therapy–which exists–has many holes and recidivism within it.
Unfortunately studies tend to reflect the judgments of those who perform them no matter how hard you try to eliminate them.
What I wish is that therapists and others would allow those who wish to live as openly gay and lesbian live their lives free of discrimination and from the belief that their homosexuality is a pathology.
At the same time allow those who wish to live heterosexually while still knowing they inherently are homosexual live that way as well.
Honestly Chris you sound as though you have not done much reading in the reparative therapy literature. It is riddled with homophobic and heterosexist statements with constant gay bashing saying repeatedly that homosexuality is never okay.
Warmly, Joe Kort
Joe, more accurately I think most of the literature doesn’t deny the existence of happy, functioning gay people, rather it denies the existence of gay people entirely. Certainly that’s the position of the Love in Action cabal.
I’m not sure why there is the double-standard for mental health codes. Insurance companies regularly deny ICD9 codes that are too generic (NOS codes, etc.), and it usually requires an appeal with clinical notes (or re-filing with the correct codes) to get those codes paid. I say this with years of experience doing billing for family practices. Of course physicians typically use codes like those because they are too lazy to look up the correct codes. I can’t imagine that mental health is any different–laziness is a human trait, not an MD trait. How is it on other NOS codes? Is it just this one that regularly gets paid?
I wish my reparartive therapist, Joe Nicolosi, would have figured out a way to get my insurance to pay for it. It would have saved me a lot of money.
Hi Joe,
Thanks for your willingness to engage in a nice, non-combative intellectual conversation. It means a lot to me, for real.
“The peer reviewed, scientific, objective research regarding the efficacy of reparative therapy–which exists–has many holes and recidivism within it.”
I wonder what specific reports you are referring to. Please don’t mention the Spitzer study, as I’ve discussed that to death. There have been thousands of studies over the past 80 years that seem to show that some type of change is possible. I admit, some of these studies were poorly done, but some other ones were quite remarkable, as they were done by gay-supportive scientists. For instance, a prominent behaviorist, Joseph Wolpe (who was gay supportive and believed that change was impossible) did a study which highlighted how one of his patients experienced spontaneous change of sexual orientation. The orientation change in question happened by accident, even after the patient was told that it was impossible for him to change. There was a 5 year follow up on the patient which confirmed that the change was sustained. That is only one of many studies which have been conveniently swept under the rug.
Most of these studies show that orientation can (to differing degrees of course) for some people over time.
But what these studies DON’T establish, conclusively, is whether or not intentional therapy can cause the change. To date, nobody really knows if those who changed changed because of the therapy, or in spite of the therapy. Check out
https://www.bbc.co.uk/dna/h2g2/A543818
Here, the authors deny that RT works, but at the same time, they do NOT deny that orientation may change over time, as a result of natural life changes.
“At the same time allow those who wish to live heterosexually while still knowing they inherently are homosexual live that way as well.”
This statement with its essentialist/reductionist seems to deny the fluidity in sexuality, particularly in women’s. You ought to look at a study done by Lisa Diamond (who is a member of APA’s gay/lesbian division) which shows just how fluid a woman’s sexuality really is. I believe you can find the study on any of the online research databases.
Best wishes,
Chris
PS: By the way, it would appear that no long term, objective data has been done to conclusively determine the efficacy of GAT. Also, anecdotally, some people who seek out RT were people who first sought out GAT, and felt that it hurt them, and de-valued their religious beliefs. This in fact, is one of the things which Dr. Haldeman discussed as being detrimental to someone’s mental health.
Chris,I’m not going to dwell on Spitzer either — for me his NARTH-approved study is as convincing as those late night adverts for “ab-blasters” etc. I do note that Spitzer spent 16 months finding 200 people to interview, despite raiding the claimed lists of “hundreds of thousands” available to Exodus. And most could be described as “professional ex-gays” making a living out of selling their claims. That makes one pause.However, be careful using Wolpe as an example. The ONE client had debilitating social phobia, combined with a (IMO) disturbed view of sexuality. The treatment was for his social phobia, and that appeared successful. Having been released from that cage, the client began exploring his sexuality. He did report enjoying heterosexual relationships, and wasn’t pursuing homosexual contacts (note: the deliberate use of those two words). There is no info. available as to whether he continued to be sexually attracted to men, although refraining from behaviour. My own reading is that the treatment for social phobia simply released the true sexuality of a previously very repressed man. As it turned out, at least part of that was a capacity to enjoy heterosexual relationships.Such a situation does not apply to the vast majority of gay men. It says more about the effect of sexual repression than about “changing orientation”.As for the rest — well, of course. Many people are perfectly capable of enjoying sexual relationships with both sexes. Simply because they wish to pursue one over the other, at some point in time, says absolutely nothing about changing sexual orientation.I know that it’s often claimed that there are “thousands of studies” over the “past 80 years”; but would you mind pointing me toward one instead of simply claiming they exist? I’d be happy to review the work for you.I’ve yet to find one that doesn’t:1) have a limited view of what sexuality is etc2) lump bisexuals in with homosexuals3) has any outside verification4) was conducted over more time than the period of therapy5) wasn’t written by a therapist blowing their own trumpet6) neglect to mention how many failures they had, or what happened to those people.As for GAT: it has (at least) a strong basis in a fairly ordinary concept. Nearly all gay men and women pass through a period — albeit brief or not particularly troubling — of reconciling their sexuality with outside expectations, most of them negative and learned prior to any awareness of your own sexuality. This process is so well described I’m not going to repeat it here. Most of us do it using our own resources within; some individuals need outside reassurance, hence GAT.Unlike RT, GAT is designed to follow and support that normal development pathway of gay people — in many ways it is simply a treatment for a phobia, and is not an attempt to influence sexual orientation. Whether someone wishes to avail themself of that is another issue.
I still cannot figure out why people need “therapy” to change.
They should just change their behavior.
As far as I can tell, these “change” operations are nothing more than money making operations for the “change” artists. I sincerely do not understand why, if the people involved, want to “change,” they don’t just change.