The really important thing evident in Professor Michael King's survey published this week in my view, is the fact that it points to a significant sub-group of individuals who are unhappy about their sexuality, and willing to look for professional help in working out this important aspect of their lives. Sadly, they are not likely to get this help, except from a few marginalised professionals. The concerning thing is it looks like the majority of psychologists, therapists and psychiatrists have little empathy for their concerns. If they get involved, after all, aren't they going to be accused of quackery? - essentially defined as wanting to change people's sexual orientation.
I'm sure he is correct in his concern that whatever support is given to this group, is responsible and the therapy modalities evidence-based. I'm afraid if he thinks the the helpful modalities are all 'talking' therapies, he is mistaken - in my view. One thing to be sure, its doubtful that any UK therapist is offering 'Conversion' therapy - I don't even know anyone offering 'Reparative' therapy, (all therapy is reparative I thought?). They may be offering 'gender-affirming' therapy, and I would guess that a significant part of that approach is around 'action' rather than 'talking'.
Another really important outcome of this survey is Professor King's intimation that it is possible that the numbers of health care professionals captured in the group he refers to, is likely to be understated. Its doubtful that many counselling practitioners would feel confident of talking about the support they offer -not because they have anything to hide, but because if they do they'll probably get into trouble. So if they can't talk about it, are they ever going to look for funding to research the area?
I also think Professor King's paper is dogmatic on the question of 'evidence' relating to whether or not 'change' can and does take place. He's surely not doubting that change takes place since most people know that it changes with or without (and inspite) of therapy or ministry - all of which argues that sexuality isn't necessarily fixed, but fluid. Not since 1973 when homosexuality was removed (by APA president at the time Robert Spitzer and his colleagues), has there been much public money spent on researching this area (except by ‘Special Interest Groups’ within the APA and RCP in the UK).
Earlier research by Spitzer (two video's available) is important, although he himself acknowledged its limitations. He called (a while back) for more empirical work to be done. Yarhouse and Jones (2008) seem to have offered an example of a prospective study in response, although once again the sample is small. King argues this isn't reliable evidence because it isn't a 'randomised clinical trial'. Will Professor King get such trials, (or the subjects for such trials) especially when the subjects of such studies are likely to be ridiculed as "complying with their internalised homophobia" or in some may being less than authentic because they don't want to express homosexual feelings. Perhaps other kinds of research methodologies need to be considered since after all, we're not dealing with a mental illness. Tanya Erzan's Critical Ethnography might be helpful as one such example. I just don't think we know enough yet to make such dogmatic claims - in either direction.
In the end the argument comes down to whether or not being "Gay" (a social-political identity) and having issues with homosexuality (feelings and/or behaviour) is the same thing. The issue is, if we conflate the two, we are likely to take Professor King's apparent argument that 'change' is impossible or unnecessary. If we don't see them as necessarily the same thing, then how could we defend mental health workers failing to support people who want to self-determine their own sexual identity and practices, and still be equitable? Even the APA is cautious now in insisting that there is a simple biological pathway to homosexuality, and calls on mental health organisations and professions to guard individuals' rights to self determination of sexuality. I don’t see the same caution reflect in this paper.
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