April 16, 1999

The statement of the Board of Trustees reported in the January 5 article titled "APA Maintains Reparative Therapy Not Effective" is so marked with unwarranted conclusions that it calls out for correction as a matter not only of scientific accuracy but of public health information. The homosexual patient, his family, and the worldwide psychiatric community should not be misled by sociopolitical activism within our organization. The obligatory homosexual is a victim of certain early developmental conflicts that have left him with a disturbance in his gender-defined sexual identity, the core of his disorder.

1. Reparative therapy is a descriptive phrase offering hope to many where previously there was only despair. Its meaning is to "repair the damage" unfortunately inflicted in early childhood and open the road to possible heterosexual functioning. It is an eclectic psychiatric treatment involving psychoanalytically oriented psychotherapy, individual psychoanalysis, group therapy, and supportive therapy. "Religious conversion" is not one of its methods.



2. That reparative therapy has "no efficacy" in "changing someone's sexual orientation" is completely false and misleading. There are dozens of psychoanalytic reports that support the efficacy of treatment. They are well known and quite extensive, and are presented in my chapter "On advances in the psychoanalytic theory of male homosexuality" in The Sexual Deviations, Third Edition, edited by Ismond Rosen, Oxford University Press, (1996).



3. That psychoanalytic psychotherapy is "destructive" is completely false. We proceed with correct empathy for the patient's feelings, ever mindful of the need for gratification through homosexual acts, sympathetic in tone, manner, and voice, and thereby diminish guilt and other associated anxieties.



4. While APA removed homosexuality from DSM as a disorder in 1973, the appropriateness of therapy is to be found in our opinion in ICD-10 F66.1 Diagnosis: "Psychological and Behavioral Disorders Associated with Sexual Development and Orientation," as well as in our DSM as Sexual Disorder, Not Otherwise Classified 302.90: "persistent and marked distress about one's sexual orientation."



5. Our therapeutic position is not based on "a priori" assumption that a patient should change his or her homosexual orientation. No decision about the course of treatment is made before thorough diagnostic clinical interviews with the patient. We therefore welcome the statement of the APA Board of Trustees (strongly objected to by gay activists within our Association), which "recognizes that in the course of ongoing psychiatric treatment there may be appropriate clinical indications for attempting to change sexual behaviors."

The professional freedom to treat homosexuals is furthermore protected in a resolution passed unanimously by the American Psychoanalytic Association in May 1993:

1. "Scientific issues should be researched, discussed, and debated in a scientific atmosphere of free and open exploration. Threats to disrupt scientific meetings, intimidation of clinical researchers, and sexual politics [emphasis our own] have no place in our continuing attempts to understand human sexual behavior."



2. "The contract entered into by analyst and analysand is a private one. Once embarked in a treatment, the goals are the concern of the patient and analyst only, and these goals may be changed and clarified as treatment progresses."

Charles W. Socarides, M.D.
New York, N.Y.

Abraham Freedman, M.D.
Philadelphia, Pa.

C. Downing Tait, M.D.
Atlanta, Ga.

Benjamin Kaufman, M.D.
Sacramento, Calif.

Harold M. Voth, M.D.
Topeka, Kan.