Tuesday, March 31, 2009

Research Worth Reading

A report out of the UK gives some promising news, or is it depressing. I'm not sure.

The authors surveyed 1,328 shrinks of various sorts about how they would deal with a client whose main goal was to change from lesbian, gay, or bisexual into a heterosexual.
Only 55 (4%) said that they would help an LGB person try to become straight.

I don't know if it's promising that so few (UK) psychiatrists and therapists would help someone try to change their sexual orientation, or depressing that so many would.
It gets more depressing when you read on to discover that an additional 10% would try to refer the prospective client to someone else who would be willing to help them try to change.

This comes 52 years after the British Wolfenden Report concluded that "none of our medical witnesses were able ... to provide any reference in the medical literature to a complete change".

I think the most interesting part of the report, though, is the justifications that the shrinks who said they would try to help someone change their sexual orientation gave.
Although they reported a wide range of justifications, I want to focus on the idea of promoting patient autonomy. A quick sample of these follow:

“We have a responsibility to assist our patients with self-determination.”

“It is up to the person themselves to decide which direction to go in. I am just the sounding board for them to make their own decisions.”

“Client ultimately knows best and may have deep religious beliefs that influence them enormously.”

“(the) client is ‘the expert’ and I deal with their realities rather than mine.”

“People should be given the opportunity to choose to redirect their sexual feelings depending on their circumstances. For example the homosexual man I helped to become heterosexual came from a working class background where it was completely unacceptable to deviate from the norm. It was extremely important to him to be accepted by that community.”

The dilemma for me is that I'm a big proponent of autonomy and self-determination; that health care providers should spend more time helping people get where they want to go, and less time telling them where to go.
So, on the one hand, I agree with this (small minority) of shrinks that patient autonomy is a very strong ethic that should not be violated.

Any yet, I wonder how many of these shrinks would be such strong defenders of patient autonomy when presented with someone who wanted to become lesbian or gay? How many would assist someone who wanted to develop the ability to see through walls? Or who felt that their life would be so much better if they were just three inches taller?
Would these shrinks be such forceful advocates of patient autonomy when a person wants help to live as the gender they feel they are, not the body they were born into?

I believe the kindest thing to do would be to explain that the change they are trying to undertake is not possible, but perhaps it is better to humor someone's interest in trying to change their orientation long enough to develop a deeper therapeutic relationship that can begin to help them find more realistic ways to live in their bodies, in their minds, and in their communities in a more harmonious fashion.

Hmmm. Certainly has me confused about what the "right" thing to do is.

Annie Bartlett, Glenn Smith, Michael King. (2009). The response of mental health professionals to clients seeking help to change or redirect same-sex sexual orientation. BMC Psychiatry 9:11. http://www.biomedcentral.com/1471-244X/9/11

Report of the Committee on Homosexual Offences and Prostitution. (1957). Her Majesty's Stationary Office, London.

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