Whenever I discuss transgender medical or therapeutic treatments here at the Ex-Gay Watch, I always seem to go back to the Harry Benjamin Standards Of Care. Like or hate this document (and the GID diagnosis), what the document does is provide criteria for determining if one has a condition that falls under the document’s purview; it provides a general outline of what medical and psychological treatments are appropriate for transsexuals; and it lists timelines and benchmarks for when particular treatments are considered appropriate.

Many medical and mental health conditions have standards of care — evidence-based clinical practice guidelines. There are standards of care for everything from treating ingrown toenails to managing Alzheimer’s disease; from treating acute dental trauma to treating bipolar disorders.

The National Guideline Clearinghouse™ maintains a public resource for many of these guidelines.

Not too surprisingly, there are no entries in the National Guideline Clearinghouse™ for Same Sex Attraction Disorder (SSAD) — no evidence-based clinical practice guidelines listed there for how to conduct conversion therapies for a SSAD (or any other named disorder relating to treatment of homosexuality or unwanted homosexual propensities) diagnosis.

National Association For Research & Therapy Of Homosexuality (NARTH) indicates this about its function:

NARTH’s function is to provide psychological understanding of the cause, treatment and behavior patterns associated with homosexuality, within the boundaries of a civil public dialogue.

After reading the organization’s function one might think that the organization would maintain an evidence-based clinical practice guideline for treating unwanted homosexual propensities. Yet, if one searches the NARTH website, one finds they have no published standard of care for SSAD, or standard of care for any other titled disorder relating to treatment of homosexuality or unwanted homosexual propensities.

There are books on how to treat homosexuality with conversion therapies [i.e. Changing Homosexuality in the Male and Reparative Therapy of Male Homosexuality: A New Clinical Approach, etc.); the Catholic Medical Association has published Homosexuality and Hope; Statement of the Catholic Medical Association which has a section entitled Treatment; and ethical considerations relating to unwanted homosexual feelings have been discussed at NARTH and generated by the American Association of Christian Counselors (AACC). None of these are standards of care.

The American Psychological Association states in it’s position paper Therapies Focused on Attempts to Change Sexual Orientation (Reparative or Conversion Therapies):

The validity, efficacy and ethics of clinical attempts to change an individual’s sexual orientation have been challenged. To date, there are no scientifically rigorous outcome studies to determine either the actual efficacy or harm of “reparative” treatments. There is sparse scientific data about selection criteria, risks versus benefits of the treatment, and long-term outcomes of “reparative” therapies. The literature consists of anecdotal reports of individuals who have claim ed to change, people who claim that attempts to change were harmful to them, and others who claimed to have changed and then later recanted those claims.

Although there is little scientific data about the patients who have undergone these treatments, it is still possible to evaluate the theories, which rationalize the conduct of “reparative” and conversion therapies. Firstly, they are at odds with the scientific position of the American Psychiatric Association which has maintained, since 1973, that homosexuality per se, is not a mental disorder. The theories of “reparative” therapists define homosexuality as either a developmental arrest, a severe form of psychopathology, or some combination of both. In recent years, noted practitioners of “reparative” therapy have openly integrated older psychoanalytic theories that pathologies homosexuality with traditional religious beliefs condemning homosexuality.

The earliest scientific criticisms of the early theories and religious beliefs informing “reparative” or conversion therapies came primarily from sexology researchers. Later, criticisms emerged from psychoanalytic sources as well. There has also been an increasing body of religious thought arguing against traditional, biblical interpretations that condemn homosexuality and which underlie religious types of “reparative” therapy.

Validating the APA contention that noted practitioners of “reparative” therapy have openly integrated older psychoanalytic theories that pathologies homosexuality with traditional religious beliefs condemning homosexuality, the document Giving Pastoral Care; Addressing Gender Issues is found on the NARTH website. This document lists Understanding Root causes & issues and Biblical & Practical applications in it’s table of contents.

Also validating the APA contention is NARTH’s status as a signatory member of Positive Alternatives To Homosexuality (PATH). The organization describes itself as follows:

PATH is a non-profit coalition of organizations that help people with unwanted same-sex attractions (SSA) realize their personal goals for change — whether by developing their innate heterosexual potential or by embracing a lifestyle as a single, non-sexually active man or woman.

Besides NARTH, PATH’s signatory members include Courage (Catholic), Evergreen International (Latter-day Saint), Exodus International (Christian), and JONAH: Jews Offering New Alternatives to Homosexuality (Jewish).

So what treatments are PATH’s signatory organizations advocating for patients it identifies as having unwanted same sex attractions? Without standards of care for SSAD (or any other named disorder relating to treatment of homosexuality or unwanted homosexual propensities), one can draw the conclusion that its treatments (that are referred to as conversion therapies) can include just about any clinical or non-clinical practice or procedure, and can be practiced by just about anyone.

For example, a conversion therapist can be someone like Jerry Leach (of Reality Resources, another PATH signatory organization), whose qualifications are described as follows:

Jerry is an accredited member of the American Association of Christian Counselors, an ordained Christian Minister, and a participating Member Ministry of Exodus North America.

He does have a Master’s of Divinity Degree and is a duly ordained Christian minister and is registered in Kentucky as a Limited Liability Corporation (LLC).

He is not a state licensed or board certified psychologist.

And, “appropriate” therapies may be said to include the practices of unlicensed psychotherapist Richard Cohen, who engages is a “bioenergetics” (demonstrated on CNN as Cohen striking a pillow with a tennis racket in lieu of striking Cohen’s overbearing mother) and “holding therapy” (which has the therapist cradling adult patients to simulate the father’s love the patient didn’t feel he or she received as a child).

It would seem a fairly significant concern that organizations like NARTH and Exodus International have protested the 1973 removal of homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (DSM), and yet the National Association For Research & Therapy Of Homosexuality doesn’t have an evidence-based clinical practice guideline at the ready should their goal of re-disordering homosexuality actually come to pass.

If SSAD (or any other named disorder relating to treatment of homosexuality or unwanted homosexual propensities) were a real healthcare or mental health condition, would just any minister or unlicensed psychotherapist be able to practice the condition’s treatment? Would ministries unlicensed to provide mental health services be able to sign up in a coalition of organizations as competent practitioners of appropriate therapies? Would the treatments — in this condition’s case called conversion therapies — be so nebulously defined as to not even remotely resemble a set of evidence-based clinical practices?

Perhaps there are no standards of care for SSAD because SSAD is a made-up name for a made-up condition. If NARTH considers SSAD — by that name or any other name by which they want to label this “condition” — as a one that requires treatment, perhaps they should publish standards of care for it. Otherwise, it’s hard to take their stated function of providing “psychological understanding of the cause, treatment and behavior patterns associated with homosexuality” as a serious description of their function.

Michael Airhart and David Roberts contributed to this article.

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