The Jones and Yarhouse study: What does it mean?

Let me begin by saying that I endorsed the book, Ex-Gays, A Longitudinal Study of Religiously Mediated Change in Sexual Orientation, by Stanton Jones and Mark Yarhouse which contained the first report of their longitudinal study. Since the publication of the book, Jones and Yarhouse have released results of their final follow up, first in 2009 at the annual convention of the American Psychological Association, and then most recently in the Journal of Sex and Marital Therapy. With the follow up, I believe the study remains an important investigation into the interplay of religion, sexual orientation and personal identity. I give them credit for the perseverance required to explore a topic which is highly controversial and to report their findings in detail.
Since the release of the peer-reviewed article, socially conservative groups have described the study as proof that gays can change orientation. For instance, the American Family Association’s Bryan Fischer, one of the worst offenders, claims that the study proves gays can change and that they weren’t born gay. Also, Citizenlink, an affiliate of Focus on the Family reported:

Of the 98 subjects, more than half were reported as successful; 23 percent reported a complete change in orientation after six years. Also, 20 percent reported giving up the struggle to change.

This claim is misleading. Jones and Yarhouse did not report “complete change in orientation.” Instead they cautioned against misinterpreting their findings by saying

These results do not prove that categorical change in sexual orientation is possible for everyone or anyone, but rather that meaningful shifts along a continuum that constitute real changes appear possible for some. The results do not prove that no one is harmed by the attempt to change, but rather that the attempt does not appear to be harmful on average or inherently harmful. The authors urge caution in projecting success rates from these findings, as they are likely overly optimistic estimates of anticipated success. Further, it was clear that “conversion” to heterosexual adaptation was a complex phenomenon.

Regarding the changes reported by their participants, the authors offer two related explanations. One is that some of the participants changed sexual orientation to some degree and the other is that the participants changed their sexual identity. Sexual identity involves placing more emphasis on behavioral conformity to prohibitions on homosexual behavior as a means of self definition. For the Exodus participants, less temptation to engage in homosexual behavior might be taken as a signal that orientation has changed, thus allowing a different attribution about their sexuality than once believed. The authors raise these two possibilities in the abstract for the most recent paper:

The authors conducted a quasi-experimental longitudinal study spanning 6–7 years examining attempted religiously mediated sexual orientation change from homosexual orientation to heterosexual orientation. An initial sample was formed of 72 men and 26 women who were involved in a variety of Christian ministries, with measures of sexual attraction, infatuation and fantasy, and composite measures of sexual orientation and psychological distress, administered longitudinally. Evidence from the study suggested that change of homosexual orientation appears possible for some and that psychological distress did not increase on average as a result of the involvement in the change process. The authors explore methodological limitations circumscribing generalizability of the findings and alternative explanations of the findings, such as sexual identity change or adjustment.

As I read all of the literature, including my own work, I first want to disagree with the way that Citizenlink characterized the results as “complete change.” That is not at all what Jones and Yarhouse reported. Considering the dichotomy proposed by Jones and Yarhouse — change in orientation or identity – I lean toward their alternative explanation – “sexual identity change or adjustment.”  However, I believe the discussion of what their results mean needs to be broadened beyond those two possibilities. In addition to considering orientation and identity as important constructs, I believe there are other ways to account for the changes Jones and Yarhouse report which are not sufficiently addressed in their published accounts.  First, I want to make some observations about the study which influence my opinions about what the results mean.
First, and most basically, the Jones and Yarhouse study did not examine in any systematic way the efficacy of reparative therapy or any other kind of psychological therapy as a means of altering sexual orientation. The participants in the study were involved in religiously based support groups which primarily had as a goal to reinforce a traditional moral view of sexuality. Clearly, the participants hoped they would change and engaged in various religious interventions to assist that end. However, the study did not assess the role of professional therapy and cannot legitimately be used to say such therapies work.
Second, there were quite a few dropouts six to seven years into the study. While true of all longitudinal studies, the final percentages being reported should also take into account the distinct possibility that many if not most of the drop outs were not successful in their efforts to change. The study began with 98 participants and ended up with 65 who were followed up for six to seven years. Some reported that they were healed of homosexuality and just didn’t want to participate, while others said they were gay and stopped trying to change. I don’t know for sure what the dropouts mean but the fact that so many failed to complete the study needs to be a part of any discussion.
Third, ratings from men and women were combined. Given the low number of people involved I understand why this was done but the practice may inflate the assessments of change for the group. It has become well accepted that the sexuality of women is more fluid than for men. A few women experiencing large shifts could influence the group averages.
Fourth, the nature of the change reported requires examination. Jones and Yarhouse reported that 23% of the participants remaining in the study labeled their experience as “conversion” from a homosexual orientation to a heterosexual one. However, let’s look at how the authors described the starting point for this group of changers on average. On a seven point scale with seven being completely homosexuality, the group averaged a 5.09 rating which Jones and Yarhouse described in their book as “’largely homosexual, but more than incidental heterosexual’ attraction.” At the third assessment of sexual attraction, the authors reported that the rating had dropped to 1.55. This group rated themselves as having moved toward the heterosexual side of the continuum. On the Kinsey scale used to assess the attractions, the average score fell between the “exclusively heterosexual” and “largely heterosexual, but incidental homosexual” ratings. An alternative way of describing the outcome is that the participants went from one end of the bisexual spectrum to the other. On average, the group rating indicated both heterosexual and homosexual attractions at the beginning, middle and end of the study.
Jones and Yarhouse helpfully supplied descriptions of the change provided by the participants in their book which was completed after about three years into the study. To me, these descriptions describe changes in sexual identity more than categorical changes in sexual orientation. There were five examples given of people in the change group. Two men said they were still attracted to the same sex, one man and one woman described themselves as heterosexual without elaboration and one of the examples in the change category recanted his reports of change and said he was gay.
As noted two participants said they were changed but continued with same-sex attractions. There self-descriptions provide insight into what they mean by change.  One participant said: “I am a heterosexual, yet I continue to suffer from some degree of sexual brokenness an unwanted sexual attraction to men.” Another said, “I would define myself to be primarily heterosexual by definition of who I have sexual activity with, with latent, sporadic homosexual lust. I don’t desire sexual contact as much as I did last year; I think that a vibrant sexual relationship with my wife has contributed to that.”
Whatever else is true, it is hard for me to see these situations as categorical (gay to straight) changes. The changes were certainly perceived to be beneficial but if words have any meaning, these descriptions cannot be considered as a “complete change in orientation.” The participants views of themselves and their behavior have changed but they continue to disclose attraction to the same sex in the way that a bisexual person might do.
These observations lead me to consider other explanations for the study results. For instance, I think bisexuality is a significant and generally overlooked conceptual issue for ex-gay studies. People who are attracted to both sexes may shift in their self-attributions based on current relationship, and personal beliefs about how they ought to regard themselves. These people may seem to shift within a basically bisexual orientation.
I also think that some men and women (more so women in my view), can develop attractions for specific opposite sex attachments without altering their essential orientation. Some people in mixed orientation marriages report that they remain generally attracted to the same sex but have fallen in love with a person of the opposite sex. The sexual relationship is legitimate and intense but the attraction to the opposite sex partner does not generalize to other members of the opposite sex.
Women seem to have less aversion to cross orientation relationships and behavior. One study of twins found that two-thirds of women would be open to lesbian relationships if the relationship could remain secret versus one-third of men who were not completely averse to potential same sex behavior. Lisa Diamond’s work on sexual fluidity in women raises the possibility that for some fluidity is a dimension of their particular sexual orientation. In other words, some people might be more naturally flexible in their attractions without any interventions. I know people like that. It is possible that some of the changes reported by Exodus participants would have taken place without any intervention. Some studies have reported spontaneous changes in attraction without intervention. Without a baseline rate of flexibility (control group), one cannot know what the changes reported by Jones and Yarhouse mean. Looking at the few studies which have examined lifespan shifts, I am skeptical that the 23% change rate reported by Jones and Yarhouse indicates religious interventions had much to do with change in attractions. I think those interventions probably had a lot to do with behavioral alignment with beliefs in chastity and fidelity.
I see nothing in the Jones and Yarhouse study that is inconsistent with seeing the participants as shifting within a bisexual continuum, developing cross orientation relationships and/or demonstrating naturalistic changes. In fact, I think the study supports these explanations more solidly than viewing the changes as categorical shifts in sexual orientation. Furthermore, without a baseline of naturalistic change and the separation of results by sex, I am not clear what to make of the reported rate of change. Actually, I don’t think anyone should use it in any normative manner.
To me, the study is valuable because it provides a look into the experience of people trying to make sense out of their lives and how they can live with what seems like a contradiction. Some find certain cognitive changes lead to less pressure to engage in behavior they believe to be wrong. Others don’t experience a reduction in such pressure but decide to refrain from acting on those desires. To me, the more interesting aspect of the study is the different ways people engage in self-attribution in response to the givens of their lives.
 
Additional point: Mark Yarhouse is co-author with me of the Sexual Identity Therapy Framework. I believe it is important to note that change of orientation is not an objective we promote as an aspect of the framework. Popular but accurate accounts of the application of the SIT Framework can be found in a 2009 Wall Street Journal article by Stephanie Simon and an article by Mimi Swartz in the New York Times Magazine (June 16, 2011, see especially page 5 to the end).