ABCT Apologizes for Past Support of Gay Conversion Therapy

It's 2022, and the Association for Behavioral and Cognitive Therapies (ABCT) has just issued a belated apology because two of their past Presidents published papers on “aversion therapies” for “converting” gay and transgender individuals to the socially prescribed norms of sexuality and gender identity. 

Well, they didn't actually say this, nor did they name the prominent and distinguished clinical psychologists who authored these papers. Although these luminaries signed on to the mea culpa, there was no direct admission of the harm caused by these ill-advised practices. Instead, the document focused on “the courageous and historic role that some of our members have played in advancing SGM [sexual and gender minority] rights and mental health (e.g., Drs. Charles Silverstein and Gerald Davison).” 

Which is great and all.

But. 

This covert history has been hiding in plain sight for 50 years, and I'm surprised the reckoning hasn't come any earlier. I'm not a clinician, nor am I in the field of cognitive behavior therapy research. But in 2013 I wrote a post on Dr. David H. Barlow and Aversion Therapy for Gays. Dr. Barlow had received a prestigious award for his contributions to clinical psychology, which are indeed extensive. But he was also an author on papers that examined aversion therapy in gay men (Barlow et al., 1969; Barlow, 1973; Barlow et al., 1975; Herman et al., 1974; Barlow et al., 1975; Hayes et al., 1983) and exorcism for transsexualism (Barlow et al., 1977). Dr. Barlow and Dr. Steven C. Hayes were Past Presidents of ABCT in 1978-1979 and 1997-1998, respectively. Hayes subsequently developed Acceptance and Commitment Therapy (ACT) and Barlow is known for his work on the treatment of anxiety disorders.

Sorry Seems to Be the Hardest Word

I first learned about the ABCT apology on Twitter, via Lorenzo Lorenzo-Luaces, PhD (@lluaces) and Aaron Fisher (aaronjfisher).

ABCT Apology for Behavior Therapy’s Contribution to the Development and Practice of Sexual Orientation and Gender Identity and Expression Change Efforts

The ABCT Board of Directors and past leadership have released an apology for behavior therapy’s contributions to the development and practice of sexual orientation and gender identity and expression change efforts [SOGIECEs].

More details are in the Full Apology PDF.

...[ABCT] apologizes for our historic role in the development and use of so-called “conversion therapies,” practices that have caused untold harm to members of the sexual and gender minority (SGM) community for over 50 years. To this day, publications written by ABCT members – including members in prominent leadership roles – are used by anti-SGM activists to justify their ongoing use of these damaging so-called “therapies.” ABCT deeply regrets behavior therapists’ role in the creation, study, and use of these practices, and recognizes and accepts responsibility for the ways in which both our actions and inactions have harmed SGM people. ABCT recognizes it is time for us to document our history and legacy and say that we are truly sorry.¹

But documentation of this history and legacy is rather sketchy... Without naming names, the Apology cited the recent review of Capriotti and Donaldson (2022), which in turn asked “Why don’t behavior analysts do something?” about retracting the unethical paper of Rekers and Lovaas (1974). The conversion therapy work of Barlow and Hayes was mentioned here as well. 

 

I wrote to Barlow in 2013 to ask him about this early research on SGM people.²  I didn't really expect an answer, especially since I'm an obscure anonymous blogger. Nonetheless, I wanted to give him the opportunity to respond before I posted about his work.

Dear Dr. Barlow,

Congratulations on your receipt of the 2012 James McKeen Cattell Fellow Award from the APS for your distinguished contributions to the field.

I am a blogger writing a post about past treatments for homosexuality and came across references to your early work on aversion therapy in gay men, which I found unfortunate.

I wondered whether you had a statement about that work in light of contemporary views of homosexuality, or whether you had issued such a statement in the past.

Thank you very much for your time.

Sincerely,
The Neurocritic

Then a reader (Jordon) commented on my post in 2015, saying Barlow wrote back when he was asked about aversion therapy. Barlow sent a forthcoming book chapter from his 2016 retrospective, The Neurotic Paradox, Volume 1: Progress in Understanding and Treating Anxiety and Related Disorders. A sort-of not-really apology appeared on p. 6-7:

But it was also during this time [late 60s-early 70s] that I undertook what has come to be from my own personal point of view the most regrettable initiative in my clinical research career. Specifically ... I began treating and evaluating the effects of [covert sensitization]  treatment in individuals with what came to be called paraphilias but what was then called sexual deviation (Barlow, 1974a). While our focus was mostly on pedophilia (e.g. Barlow, Leitenberg, & Agras, 1969), the aggressive behavior of rapists (e.g. Abel, Barlow, Blanchard, & Guild, 1977), and other paraphilias (e.g. Hayes, Brownell, & Barlow, 1978), included in this series of studies were participants presenting with same-sex arousal patterns with consenting adults. (e.g., Barlow, Leitenberg, & Agras, 1969). At that time homosexuality was considered a disorder in all systems of nosology and, under extreme pressures from society and the associated stigma, these individuals sought out treatment; so very few clinicians even gave it a second thought. But by the mid-1970s several individuals began questioning these treatment goals.

 

These practices were “embedded in the continually shifting landscape of cultural values and mores” and homosexuality wasn't de-pathologized until “later in the decade” of the 1970s [it was actually 1973] and “most of the work was on paraphilias” [but many papers were on attempted conversion of gay men and transgender women (who were called male transsexuals)]. Most importantly, Barlow did not acknowledge the harm inflicted on the recipients of his treatments.

Besides the bizarre exorcism in a transsexual article, three more papers described covert modeling procedures and a “therapeutic package” to change the gender identity of transgender youth and young women (Barlow et al., 1973, 1979; Hay et al., 1981). Given the Increasing Criminalization of Gender-Affirming Care for Transgender Youth in many Southern states, it's critical for all psychological organizations to disown past practices used to justify such discriminatory and inhumane treatment.

 

What else should I be?
All apologies
What else could I say?
Everyone is gay

--Nirvana

Footnotes

¹ One of the action items is that disclaimers will be added to SOGIECE papers previously published in ABCT journals. My initial search turned up only one. Barlow DH (1973). Increasing heterosexual responsiveness in the treatment of sexual deviation: A review of the clinical and experimental evidence. Behavior Therapy 4:655-671

² The SGM terminology was unfamiliar to me before now. I also wondered whether the acronym SOGIECE was real, but apparently it is.

 

ADDENDUM (June 12 2022): Dr. Hayes has issued a personal apology for his role in conversion therapy. Also, he has published on ACT to lessen the impact of internalized homophobia (which is quite common in LGBTQ+ persons, as I know from personal experience).

Yadavaia JE, Hayes SC. (2012). Acceptance and commitment therapy for self-stigma around sexual orientation: A multiple baseline evaluation. Cognitive and behavioral practice 19(4):545-59.

 

Bibliography
(refs discussed in Dr. David H. Barlow and Aversion Therapy for Gays)

Barlow DH (1973). Increasing heterosexual responsiveness in the treatment of sexual deviation: A review of the clinical and experimental evidence. Behavior Therapy 4:655-671.

Barlow DH, Abel GG, & Blanchard EB (1977). Gender identity change in a transsexual: an exorcism. Archives of sexual behavior, 6 (5), 387-95. PMID: 921523

Although the prevention of transsexualism is the ideal, work in this area has been fraught with ethical problems, and data on the possibility of prevention, or even what to prevent, are not available...

Barlow DH, Agras WS, & Leitenberg H (1972). The contribution of therapeutic instruction of covert sensitization. Behaviour research and therapy, 10 (4), 411-5. PMID: 4637499

Barlow DH, Agras WS, Abel GG, Blanchard EB, Young LD. (1975). Biofeedback and reinforcement to increase heterosexual arousal in homosexuals. Behav Res Ther. 13:45-50.

The patient descriptions are distressing, e.g. a boy raped by a male relative: “The first S was a 15-yr-old male who had engaged in homosexual behavior for 4 yr after being seduced [sic] by an uncle.”

Barlow DH, Leitenberg H, & Agras WS (1969). Experimental control of sexual deviation through manipulation of the noxious scene in covert sensitization. Journal of abnormal psychology, 74 (5), 597-601. PMID: 5349402

Hayes SC, Brownell KD, & Barlow DH (1983). Heterosocial-skills training and covert sensitization. Effects on social skills and sexual arousal in sexual deviants. Behaviour research and therapy, 21 (4), 383-92, PMID: 6138027

Herman SH, Barlow DH, Agras WS. (1974). An experimental analysis of exposure to "explicit" heterosexual stimuli as an effective variable in changing arousal patterns of homosexuals. Behav Res Ther. 12:335-45.

Additional References

Barlow DH, Abel GG, Blanchard EB. (1979). Gender identity change in transsexuals: Follow-up and replications. Archives of General Psychiatry 36(9):1001-7.

Barlow DH, Agras WS. (1973). FADING TO INCREASE HETEROSEXUAL RESPONSIVENESS IN HOMOSEXUALS. Journal of Applied Behavior Analysis. 6(3):355-66.

“Heterosexual responsiveness, measured by penile responses and reports of behavior, was strengthened in three homosexuals through a fading procedure [slides of nude females superimposed on slides of nude males.]. ... The results suggest that fading was responsible for altering stimulus control of sexual arousal and that aversive techniques may not be necessary in the treatment of sexual deviation.” [well that's a relief...]

Barlow DH, Hayes SC, Nelson RO, Steele DL, Meeler ME, Mills JR. (1979). Sex role motor behavior: A behavioral checklist. Behavioral Assessment. 1:119-38. [I could not find a copy of this; however, the items appear in Hayes et al. 1984].  Examples:

• Firm Wrist Action Versus Limp Wrist Action.
• Hand(s) in Pocket. 
• Frequent or Exaggerated Hand or Arm Movements.

Barlow DH, Reynolds EJ, Agras WS. (1973). Gender identity change in a transsexual. Archives of General Psychiatry 28(4):569-76.

Brownell KD, Hayes SC, Barlow DH. (1977). Patterns of appropriate and deviant sexual arousal: the behavioral treatment of multiple sexual deviations. Journal of Consulting and Clinical Psychology 45(6):1144.

• one cis-male cross-dresser into BDSM (among the rapists, pedophiles, and exhibitionists) listened to arousing scenarios followed by humiliating consequences while his penile circumference was measured.
  
• no gay or trans subjects here, but other papers have used the D word (“deviant”).

Hay WM, Barlow DH, Hay LR. (1981). Treatment of stereotypic cross-gender motor behavior using covert modeling in a boy with gender identity confusion. Journal of consulting and clinical psychology 49(3):388.

Hayes SC, Nelson RO, Steele DL, Meeler ME, Barlow DH. (1984). Instructional control of sex-related motor behavior in extremely masculine or feminine adults. Sex Roles 11(3):315-31.

Leonard SR, Hayes SC. (1983). Sexual fantasy alternation. Journal of behavior therapy and experimental psychiatry. 14(3):241-9.

• four bisexual men (three white, one black) who were “confused” about their sexual orientation
• but only the black man was medicated (with a potent antipsychotic)
  

“Subject 3 was a 32 yr old, black, married, blue collar worker and father of five. His heterosexual history was extensive. He reported a 3 yr history of homosexual activity ocurring during drinking episodes. At the time of referral and throughout the study, he received medication (Thorazine 25 mg daily) from a physician at the referring agency.”

 

I have THOUGHTS. Some on how some therapy orientations get a pass in criticism but more on ABCT having a statement signed by its presidents when at least two (Barlow and Hayes) have published papers on behavioral modification of sexuality https://t.co/1JdyaN6YEq

— Lorenzo Lorenzo-Luaces, PhD (@lluaces) June 9, 2022

 

While I applaud @ABCTNOW's proactivity and (relative) transparency, this letter fails to name two current high-profile members: David Barlow and Steven Hayes. Encouraging readers to 'educate themselves' falls short of the work this letter intends to do.https://t.co/f6Wuv6ObUu

— Aaron Fisher (@aaronjfisher) June 9, 2022

 

Thank you for your belated apology. If I may humbly ask, why did it take so long, when members of the LGBTQ+ community have been seeking such acknowledgments for years? https://t.co/UISL0haq

— The Neurocritic (@neurocritic) June 9, 2022