Currently, there are two approaches to the provision of psychotherapeutic assistance to homosexual ego-dystonics (those homosexuals who reject their sexual orientation). In accordance with the first, they should be adapted to the orientation of their own sexual desire and help them adapt to life in a society with heterosexual standards. This is the so-called supportive or gay affirmative therapy (English affirm - to affirm, confirm). The second approach (conversion, sexually reorienting, reparative, differentiating therapy) is aimed at helping homosexual men and women change their sexual orientation. The first of these approaches is based on the assertion that homosexuality is not a mental disorder. It is reflected in ICD – 10 and DSM – IV.

In our opinion, as well as the opinion of leading clinical and forensic sexologists of Ukraine and Russia (V.V. Krishtal, G.S. Vasilchenko, A.M. Svyadoshch, S.S. Libikh, A.A. Tkachenko), homosexuality should be attributed to disorders of sexual preference (paraphilia) [1, 2]. The same opinion is shared by many professionals in the USA and, in particular, members of the National Association for Research and Therapy of Homosexuality; NARTH created in 1992 [3]. Of interest is the opinion on this issue of professor-psychiatrist Yu. V. Popov - deputy. Director for Research, Head of the Department of Adolescent Psychiatry, St. Petersburg Psychoneurological Institute named after V. M. Bekhterev, which was not mentioned in our previous publications on the problem under discussion. He notes that “in addition to moral, social, legal norms, the framework of which is very relative and can even significantly differ from one another in different countries, ethnic groups and religions, it’s quite right to speak of a biological norm. In our opinion, the key criterion for any definition of a biological norm or pathology (apparently, this is true for all living things) should be the answer to the question whether these or those changes contribute to the survival and reproduction of the species or not. If we consider in this aspect any representatives of the so-called sexual minorities, then they all go beyond the biological norm ”[4].

It should be noted that the non-recognition of homosexuality as a sexual norm is also reflected in the clinical manual “Models for the diagnosis and treatment of mental and behavioral disorders” edited by V. N. Krasnov, I. Ya. Gurovich [5], which was approved by 6 on August 1999. Order No. 311 of the Ministry of Health of the Russian Federation [6]. It reflects the position of the Federal Scientific and Methodological Center for Medical Sexology and Sexopathology (Moscow) on this issue. The same views are held at the Department of Sexology and Medical Psychology of the Kharkov Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine [7].

Currently, the medical community and society as a whole are trying to impose the idea that sexually reorienting therapy should be prohibited, firstly, because healthy people cannot be treated, such as homosexuals, and, secondly, because it may not be effective. At the congress of the American Psychiatric Association (APA) in 1994, it was planned to submit to delegates the document "An official statement on psychiatric treatment aimed at changing sexual orientation", which has already been approved by the board of trustees of the association. The resolution, in particular, stated: "The American Psychiatric Association does not support any psychiatric treatment based on the psychiatrist's belief that homosexuality is a mental disorder or that aims to change a person’s sexual orientation." This statement was to become an official condemnation of reparative (conversion) therapy as an unethical practice. However, NARTH, with the help of the Christian organization Focus on the Family, sent letters to members of the association protesting against the "violation of the first amendment." The protesters had posters with slogans like "APA is not GAYPA." As a result, due to the lack of clarity of some of the wordings, the adoption of this statement was delayed, which NARTH and Exodus International consider [8] to be their victory.

It should be noted that Exodus International is an interfaith Christian organization with 85 branches in 35 states, which, in particular, is working to develop heterosexual desire, and if this does not work out, help homosexuals to refrain from sexual contacts with representatives of their gender. To this end, religious instruction is provided, combined with group counseling. The efforts focus on childhood injuries, which, according to the theorists of this movement, are the cause of homosexuality (absence of a mother or father, sexual harassment, cruelty of parents). It was reported that in 30% of cases, this work yields positive results [9]. Later (in 2008) a number of publications appeared on the Internet informing that American psychologists Stan Jones and Mark Yarhaus conducted a study among 98 members of this organization, with whom work was carried out to change their unwanted homosexual orientation. According to them, positive results were 38%. The researchers assured that the conversion effects did not lead to any adverse mental consequences for all 98 people, which contradicts the installation of opponents of these effects, who claim that they are harmful to the human psyche.

Both of these arguments, which lead to the prohibition of conversion therapy (homosexuality is the norm, conversion therapy is ineffective), are untenable. In this regard, it is advisable to report that the exclusion of homosexuality from the list of mental disorders DSM occurred as follows. On December 15, 1973, the first vote of the Bureau of the American Psychiatric Association took place, at which 13 of its 15 members voted to exclude homosexuality from the register of mental disorders. This caused a protest from a number of experts who, for a referendum on this issue, collected the necessary 200 signatures. In April 1974, a vote took place at which out of a little over 10 thousand 5854 ballots confirmed the decision of the presidium. However, 3810 did not recognize him. This story was called an “epistemological scandal” on the grounds that resolving a “purely scientific” issue by voting for the history of science is a unique case [10].

In connection with the attempts to depatologize homosexuality, the famous Russian forensic sexologist Professor A. A. Tkachenko [11] notes that the decision of the American Psychiatric Association “was inspired by the pressure of the militant homophilic movement”, and “the definition worked out in these conditions, which are essentially extreme, (incidentally, largely reproduced in the ICD-10) partly contradicts the principles of medical diagnosis, if only because it excludes cases accompanied by mental suffering given by anosognosia. " The author also reports that this decision “was impossible without a revision of the fundamental concepts of psychiatry, in particular, the definition of mental disorder per se”. The named solution, in fact, is a categorical statement of the a priori “normality” of homosexual behavior.

Analyzing the fact that the American Psychiatric Association of Homosexuality was removed from the diagnostic classification, RV Bayer [12] claims that it was not due to scientific research, but was an ideological action caused by the influence of time. In this regard, it is advisable to provide information reported by Kristl R. Wonhold [13]. He notes that in order to understand the actions of the APA, you need to go back to the political situation of the 60-70-s. Then all traditional values ​​and beliefs were called into question. It was a time of rebellion against any authorities. In this atmosphere, a small group of radical American homosexuals launched a political campaign to recognize homosexuality as a normal alternative way of life. “I am blue and happy with it,” was their main slogan. They managed to win the committee that reviewed the DSM.

In a short hearing that preceded the decision, orthodox psychiatrists were accused of "Freudian bias." In 1963, the New York Medical Academy instructed its Public Health Committee to prepare a report on homosexuality, which concluded that homosexuality is indeed a disorder, and homosexuality is an individual with emotional disabilities, incapable of forming normal heterosexual relationship. In addition, the report said that some homosexuals “go beyond a purely defensive position and begin to prove that such a deviation is a desirable, noble and preferred lifestyle.” In 1970, the leaders of the homosexual faction in the APA planned "systematic actions aimed at disrupting the annual meetings of the APA." They defended their legitimacy on the grounds that the APA supposedly represents “psychiatry as a social institution”, and not as a sphere of scientific interests of professionals.

The tactics adopted turned out to be effective and in 1971, yielding to the pressure exerted on them, the organizers of the next APA conference agreed to create a commission not on homosexuality, but from homosexuals. The chairman of the program was warned that if the composition of the commission is not approved, then the meetings of all sections will be disrupted by the activists of the "gay". However, despite agreeing to allow homosexuals themselves to discuss the composition of the commission at the 1971 conference, the gay activists in Washington decided that they should deal another blow to psychiatry, since a "too smooth transition" would deprive the movement of its main weapon - riot threats. An appeal to the Gay Liberation Front followed, calling for a demonstration in May 1971. Together with the front leadership, a strategy for organizing the riots was carefully developed. On May 3, 1971, protesting psychiatrists broke into a meeting of elected representatives of their profession. They grabbed the microphone and handed it to an outside activist who proclaimed: “Psychiatry is a hostile entity. Psychiatry is waging a relentless war of extermination against us. You can consider this a declaration of war against you ... We completely deny your authority over us. "

No one made any objection. Then the activists of these actions appeared in the APA Committee on Terminology. "Its chairman suggested that perhaps homosexual behavior is not a sign of mental disorder and that this new approach to the problem must necessarily be reflected in the Handbook of Diagnostics and Statistics." When in the 1973 year the Committee met in an official meeting on this issue, a pre-worked out decision was adopted behind closed doors (see above).

F. M. Mondimore [8] as follows describes the events preceding the adoption of this decision. The author reports that the exclusion of homosexuality from the category of disorders was greatly facilitated by the struggle of individuals with same-sex orientation for civil rights. 27 On June 1969 in Greenwich Village (NY), a homosexual uprising was triggered by a morale police raid on Stonewall Inn's gay bar on Christopher Street. It lasted all night, and the next night gays gathered in the streets again, where they insulted passing policemen, threw stones at them, and set fires. On the second day of the uprising, four hundred policemen already fought with more than two thousand homosexuals. Since that time, which is considered the beginning of the struggle of gay people for civil rights, this movement, inspired by the examples of the movement for their civil rights of blacks and the movement against the war in Vietnam, has been aggressive and at times confrontational in nature. The result of this struggle, in particular, was the cessation of police raids on gay bars. “Encouraged by their success in the fight against police harassment, members of the gay rights movement turned their efforts against another historical adversary - psychiatry. In 1970, gay activists broke into the annual meeting of the American Psychiatric Association and foiled a speech by Irving Bieber on homosexuality, calling him a “son of a bitch” in the presence of his shocked colleagues. A wave of protests has forced gay psychiatrists to advocate the exclusion of homosexuality from the official list of mental illness ”[8].

At the first stage, the APA decided that in the future the diagnosis of “homosexuality” should be applied only in cases of “ego-dystonic” homosexuality, that is, in cases where the homosexual orientation led to the “visible suffering” of the patient. If the patient accepted his sexual orientation, now it was considered unacceptable to diagnose him as “homosexual,” that is, the subjective criterion replaced the objective assessment of specialists. At the second stage, the words “homosexuality” and “homosexuality” were completely removed from the DSM, as this diagnosis was recognized as “discriminatory” [13].

D. Davis, C. Neal [14] describe the dynamics of terminology related to homosexuality as follows. They note that in 1973, perse homosexuality was excluded from the list of mental disorders by the American Psychiatric Association, but in 1980 it reappeared on this list under the name “ego-dystonic homosexuality”. However, this concept was removed from the list of mental disorders during the revision of DSM-III in 1987. Instead, the concept of “unspecified disorder” appeared, meaning “persistent and pronounced state of distress associated with experiencing one’s sexual orientation.”

The ICD-10 notes that homosexual and bisexual orientations are not per se regarded as disorders. Moreover, the F66.1 (ego-dystonic sexual orientation) code is noteworthy, which reflects a situation where gender or sexual preference is not in doubt, but the individual wants them to be different due to additional psychological or behavioral disorders, and may seek treatment to change them. In the context of the fact that homosexual orientation in the classification under consideration is not considered a pathology in itself, the desire to get rid of this orientation, in fact, can be regarded as the presence of some kind of abnormality [7].

However, Christian R. Wonhold [13] notes that in 1973, as at present, there were no scientific arguments and clinical evidence that would justify such a change in position regarding homosexuality (recognition as normal).

In 1978, five years after the APA decided to exclude “homosexuality” from the DSM, a vote was taken among 10000 American psychiatrists who are members of this association. 68% of the doctors who filled out and returned the questionnaire still considered homosexuality a disorder [13]. It is also reported that the results of an international survey among psychiatrists about their attitude towards homosexuality showed that the vast majority of them see homosexuality as deviant behavior, although it was excluded from the list of mental disorders [15].

Joseph Nicolosi (Joseph Nicolosi) in the Diagnosis Policy section of his book Reparative Therapy of Male Homosexuality. A new clinical approach ”[16] convincingly proved the scientific groundlessness of such a serious action. He notes that virtually no new psychological or sociological research justifies this change ... This is a policy that has stopped professional dialogue. Militant gay defenders ... caused apathy and confusion in American society. Gay activists insist that accepting homosexual as a person cannot happen without the approval of homosexuality. ”

As for the ICD, the decision to remove homosexual orientation from the list of mental disorders of this classification was made by a margin of one vote.

It should be noted that homosexuality is not only in itself a pathology in the sphere of drives. According to special studies, mental disorders in homosexuals (gays and lesbians) are much more common than in heterosexuals. Representative national studies conducted on large samples of homosexually and heterosexually behaving individuals have found that most of the first individuals throughout life (time-time) suffer from one or more mental disorders.

A large representative study was carried out in the Netherlands [17]. This is a random sample of 7076 men and women aged 18 to 64 years, which was examined to determine the prevalence of affective (emotional) and anxiety disorders, as well as drug dependence throughout life and in the last 12 months. After the exclusion of those persons who have not had sexual intercourse in the last 12 months (1043 people), and those who did not answer all the questions (35 people), 5998 people remained. (2878 men and 31220 women). Among men surveyed, 2,8% of people had same-sex relationships, and among women examined, 1,4%.

An analysis of the differences between heterosexuals and homosexuals was carried out, which showed that both throughout life and in the last 12 months, homosexual men had much more mental disorders (affective, including depression, and anxiety) compared to heterosexual men. Homosexual men also had a stronger alcohol dependence. Lesbians differed from heterosexual women in a greater susceptibility to depression, as well as higher alcohol and drug addiction. In particular, it was found that most homosexually behaving men (56,1%) and women (67,4%) suffer from one or more mental disorders throughout their lives, while most heterosexually behaving men (58,6%) and women (60,9 %) throughout life did not have any mental disorder.

In the study of this contingent, it was also shown that homosexuality is associated with suicidality. The study evaluated differences in signs of suicide between homosexual and heterosexual men and women. The authors concluded that even in a country with a relatively tolerant attitude towards homosexuality, homosexual men are much more at risk of suicidal behavior than heterosexual men. This could not be explained by their higher mental incidence. In women, such an explicit dependence was not revealed [18].

In the United States, a study was conducted of many thousands of Americans aimed at studying the risk of mental disorders among individuals who had sexual relations with partners of the same gender `[19]. Respondents were asked about the number of women and men with whom they had sexual intercourse over the past 5 years. 2,1% of men and 1,5% of women reported having contacts with one or more sexual partners of the same gender in the last 5 years. It was revealed that these respondents in the last 12 months. there was a higher prevalence of anxiety disorders, mood disorders, disorders associated with the use of psychoactive substances, as well as suicidal thoughts and plans, than those who came into contact only with people of the opposite sex. The authors concluded that homosexual orientation, determined by the presence of a same-sex sexual partner, is associated with a general increase in the risk of the above disorders, as well as suicidality. They noted that further research was needed to examine the reasons underlying this association.

In the Netherlands, a study has been conducted on the relationship between sexual orientation referral for psychiatric care [20]. The authors point to the current assumption that homosexuals and bisexuals are less likely to seek medical help than heterosexuals because they trust the healthcare system less. The purpose of the study was to study the differences in the appeal for this assistance, as well as the degree of trust in health authorities depending on their sexual orientation. A random sample of patients (9684 people) who applied to general practitioners was examined. It was found that the state of health was worse in homosexual men and women compared with heterosexual ones. No sexual orientation differences in trust in the health system were identified. Homosexual men were more often treated for mental and somatic health problems than heterosexual men, and lesbians and bisexual women were more often treated for mental problems than heterosexual women. It is noted that the higher frequency of seeking medical help from homosexuals and bisexuals compared to heterosexuals can only partially be explained by differences in their state of health. In order to better understand the results obtained, it is necessary to have data on a predisposition to seeking medical help from homosexual and bisexual men and women.

DM Fergusson et al. [21] reported a twenty-year longitudinal study of a cohort of 1265 children born in New Zealand. 2,8% of them were homosexuals based on their sexual orientation or sexual partnerships. Data were collected on the frequency of mental disorders in individuals from 14 years to 21 years. Homosexuals had a significantly higher prevalence of major depression, generalized anxiety disorder, behavior disorders, nicotine addiction, other substance abuse and / or addiction, multiple disorders, suicidal ideation, and suicidal attempts. Some of the results were as follows: 78,6% of homosexuals compared to 38,2% of heterosexuals had two or more mental disorders; 71,4% of homosexuals compared to 38,2% of heterosexuals experienced major depression; 67,9% of homosexuals compared to 28% of heterosexuals reported suicidal ideation; 32,1% of homosexuals compared to 7,1% of heterosexuals reported suicidal attempts. It was found that adolescents with homosexual romantic relationships have a significantly higher suicide rate.

ST Russell, M. Joyner [22] reported on data from a nationally representative study of the general population of US teens. 5685 teenage boys and 6254 teenage girls were examined. Homosexual romantic relationships “were reported by 1,1% of boys (n = 62) and 2,0% of girls (n = 125)” (Joyner, 2001). The following was revealed: suicide attempts had 2,45 times higher chances among boys with a homosexual orientation than among heterosexual boys; suicide attempts were 2,48 times more likely among girls with a homosexual orientation than among heterosexual girls.

King et al. [23] studied 13706 academic publications between January 1966 and April 2005. One or more of the four methodological quality criteria needed to be included in the meta-analysis met at least 28 of them: sampling from the general population instead of the selected group, random sampling, 60% or higher frequency of participation, the sample size is equal to or larger than 100 people. A meta-analysis of these top-quality 28 studies reported a total of 214344 heterosexual and 11971 homosexual subjects.

As a result, it was found that homosexuals have mental disorders more often than heterosexuals. So, in particular, it was found that, compared with heterosexual men, homosexuals throughout life (lifetime prevalence) have the following:

2,58 times increased risk of depression;

4,28 times the increased risk of suicide attempts;

2,30 times increased risk of intentional self-harm.

Parallel comparison of the prevalence of mental disorders in the last 12 months. (12-month prevalence) revealed that homosexual men have:

1,88 times increased risk of anxiety disorders;

2,41 times the increased risk of drug addiction.

King et al. [16] also found that compared to heterosexual women, homosexuals throughout life (lifetime prevalence) have:

2,05 times increased risk of depression;

1,82 times the increased risk of suicide attempts.

Parallel comparison of the prevalence of mental disorders in the last 12 months. (12-month prevalence) revealed that homosexual women have:

4,00 times the increased risk of alcoholism;

3,50 times increased risk of drug addiction;

3,42 times the increased risk of any mental and behavioral disorder caused by substance use.

A lower level of adaptation of homosexual men is evidenced by the study of quality of life (QOL) in the above contingent of Dutch men [24]. Homosexual men, but not women, differed from heterosexual men in various indicators of QOL. One of the main factors that negatively affected QOL in homosexual men was their lower level of self-esteem. It is noted that the lack of a relationship between sexual orientation and the quality of life in women suggests that this relationship is mediated by other factors.

J. Nicolosi, L. E. Nicolosi [25] report that often the responsibility for a higher level of mental problems among homosexuals (men and women) is blamed on their oppressive society. Although the authors note that there is a certain amount of truth in this statement, it is not possible to explain the current situation by the influence of this factor alone. One study found a higher level of psychological problems among homosexuals and in those countries where homosexuality is favorably treated (Netherlands, Denmark), and where the attitude towards it is disapproving [26].

The claim that conversion therapy cannot be effective is also erroneous. This is evidenced by a number of data. Results (J. Nicolosi et al., 2000) of the first specially planned large-scale study of the effectiveness of conversion therapy (examined 882 people, average age - 38 years, 96% - people for whom religion or spirituality is very important, 78% - men, average duration treatment (about 3,5 years) indicate that 45% of those who considered themselves to be exclusively homosexual, changed their sexual orientation to completely heterosexual or became more heterosexual than homosexual [9]

It is interesting to note that Columbia University professor RL Spitzer, responsible for the American Classification of Mental Illness (DSM), who once decided to exclude homosexuality from the list of mental disorders, made a statement that the results of reorientation therapy for homosexuals in many ways encouraging. Moreover, in 2003, the journal Archives of Sexual Behavior published the results of his research project to test the hypothesis that, in some individuals, the prevailing homosexual orientation may change as a result of therapy. This hypothesis was confirmed by a survey of 200 people of both sexes (143 men, 57 women) [27].

Respondents reported changes in the direction from homosexual to heterosexual, which persisted for 5 years or more. The subjects interviewed were volunteers, the average age of men was 42, women - 44. During the interview, 76% of men and 47% of women were married (before starting therapy, respectively, 21% and 18%), 95% of the respondents were white, 76% graduated from college, 84% lived in the USA, and 16% - in Europe. 97% had Christian roots, and 3% were Jewish. The vast majority of respondents (93%) stated that religion was very important in their lives. 41% of the people surveyed said that for some time before treatment they were openly gay (“openly gay”). More than a third of those surveyed (37% of men and 35% of women) admitted that at one time they seriously thought about suicide because of their unwanted attraction. 78% spoke out in favor of efforts to change their homosexual orientation.

An 45 minute telephone interview including 114 targeted questions was used to evaluate the changes achieved as a result of therapy. The RL Spitzer study focused on the following aspects: sexual attractiveness, sexual self-identification, severity of discomfort due to homosexual feelings, the frequency of homosexual activity, the frequency of desire for homosexual activity and the desire to have it, the percentage of masturbation episodes accompanied by homosexual fantasies , the percentage of such episodes with heterosexual fantasies and the frequency of exposure I am homosexually oriented pornographic material.

As a result of this study, it was found that although cases of a “complete” change in orientation were recorded only in 11% of men and 37% of women, the majority of respondents reported a change from the predominant or exclusively homosexual orientation that occurred before treatment to the predominant heterosexual orientation as a result of reparative (conversion) therapy. Although it is reported that these changes are evident in both sexes, women still had significantly more. The data obtained revealed that after treatment, many of the respondents noted a clear increase in heterosexual activity and increased satisfaction with it. Individuals who were married indicated greater mutual emotional satisfaction in the marriage [27].

Thinking about the results, RL Spitzer asks herself if the reorientation therapy is harmful. And he himself, answering him, claims that there is no such evidence regarding the participants in his research. Moreover, in his opinion, based on the findings, this study found significant benefits to such treatment, including in areas not related to sexual orientation. Based on this, RL Spitzer notes that the American Psychiatric Association should stop applying the double standard in its attitude to reorientation therapy, which it considers harmful and ineffective, and to gay affirmative therapy, which supports and strengthens gay identity, which it fully approves of. In addition, in conclusion, RL Spitzer emphasized that mental health professionals should abandon their recommended treatment prohibition, which aims to change sexual orientation. He also noted that many patients who have information about a possible failure when trying to change their sexual orientation, on the basis of consent, can make a rational choice regarding work towards developing their heterosexual potential and reducing their unwanted homosexual attraction [27].

In 2004, the sensation was the appearance at the NARTH conference of the former president of the American Psychological Association, Dr. Robert Perloff, a world-famous scientist. The paradox is that in the past he himself was a member of the commission of this association on sexual minorities. Speaking at the conference, R. Perlov announced his support for those therapists who respect the client’s beliefs and offer him conversion therapy when it reflects his wishes. He expressed his “fervent conviction that freedom of choice should govern sexual orientation ... If homosexuals want to transform their sexuality into heterosexual, then this is their own decision, and no interested group, including the gay community, should intervene ... There is a person’s right to self-determination sexuality. "

Characterizing his approval of the NARTH position, R. Perlov emphasized that “NARTH respects the opinion of each client, his autonomy and free will ... each individual has the right to declare his rights to a gay identity or develop his heterosexual potential. The right to be treated to change sexual orientation is considered self-evident and inalienable. ” He noted that he fully subscribes to this NARTH position. Dr. Perlov also reported an increasing number of studies that contradict a popular view in the US that changing sexual orientation is impossible. Noting that the number of positive responses to conversion therapy has been increasing in recent years, he urged therapists to get acquainted with the work of NARTH, and described the attempts of gay lobbyists to silence or criticize these facts as “irresponsible, reactionary and far-fetched” [28, 29].

It should be emphasized that the problem of the possibility of using conversion therapy and its effectiveness is highly politicized. This was reflected in the statements according to which this type of treatment should be put on a par with attempts to change the racial or national identity of blacks, people of "Caucasian nationality" and Jews. Thus, those who believe that it is possible to change the sexual orientation of homosexuals are trying to stigmatize, putting them on a par with racists, anti-Semites and, in general, with all kinds of xenophobes. However, such attempts cannot be considered adequate, since the question of the normality or usefulness of a race or nationality and getting rid of signs of racial and national identity cannot be raised because of its complete absurdity. Through such stigmatization, conversion therapy advocates want to be intimidated by the possibility of being in an extremely uncomfortable position.

At the end of August 2006, there was a message about the sensational statement by the president of the American Psychological Association, Dr. Herald P. Koocher, which he made in the same month. According to his statements, he broke with the position that this association has long held against the “periodical therapy” of homosexuals. Mr. Cooker noted that the association will support psychological therapy for those individuals who experience an undesirable homosexual attraction. Speaking with psychology doctor Joseph Nicolosi, who was then president, at the annual meeting of the American Psychological Association in New Orleans, he said that the association "does not conflict with psychologists who help those who are concerned about unwanted homosexual attraction." He also emphasized that, given the patient’s autonomy / independence and respect for his choice, the code of ethics of the association, of course, would include psychological treatment for those who want to get rid of homosexual attraction.

The American Psychological Association has long been hostile to the work of NARTH, attributing attempts to change the sexual orientation of homosexuals to their discrimination. Commenting on this statement, Dr. Dean Byrd, a psychologist at NARTH, who at one time was its president, noted that in fact the opinion expressed by Dr. Cooker is today identical to the position of NARTH. He also expressed hope that a fruitful dialogue between the two associations could begin on this very important issue [30].

In this regard, it should be noted, in particular, that in the journal of the American Psychological Association “Psychotherapy: Theory, Research, Practice, Training” (“Psychotherapy: Theory, Research, Practice, Training”) an article was published in 2002, in which it was suggested that sexually reorienting (conversion) therapy, taking into account the value orientations of the individual, can be ethical and effective [31].

However, it should be noted that, despite the innovative statement by the president of the American Psychological Association, there is no agreement among its members regarding the conversion therapy of homosexuals, the purpose of which is to change the orientation of sexual desire from homosexual homosexual. So, on 29 on August 2006, the Cybercast News Service news agency announced a statement by a representative of this association who said that there was no scientific justification for such therapy, and it was not justified [according to 30].

In this regard, the statement of Clinton Anderson, director of the American Psychological Association Office of Lesbian, Gay and Bisexual Concerns, which needs to be understood and discussed, is of great interest. . According to him, he does not argue that “homosexuality leaves some people”, and does not think that anyone will be against the idea of ​​an opportunity to change. After all, it is known that heterosexuals can become gays and lesbians. Therefore, it seems reasonable that some gays and lesbians could become heterosexuals. The problem is not whether sexual orientation can change, but whether therapy can change it [according to 32].

Joseph Nicolosi commented on this statement as follows: “Those of us who have struggled so long for the APA (the American Psychological Association) to recognize the possibility of change appreciate Mr. Anderson’s concession, especially because he is the chairman of the APA gay and lesbian section. But we don’t understand why he thinks that change cannot happen in the therapeutic office. ” Dr. Nicolosi also noted that Anderson would like to receive an explanation regarding the factor that supposedly exists in the therapeutic office and blocks the transformation of sexual orientation. According to J. Nicolosi, the processes occurring during therapy create more favorable conditions for such a transformation and exceed the opportunities that exist outside the office [according to 32].

The removal of homosexuality from the category of pathology was accompanied by inhibition of his research and became a significant factor hindering his treatment. This fact also hindered professional communication of specialists on this issue. The lull in the research was not due to any new scientific evidence showing that homosexuality is a normal and healthy version of human sexuality. Rather, it has become more fashionable not to discuss this [16].

J. Nicolosi also cites two humanitarian reasons that have played a role in the exclusion of homosexuality from the list of mental disorders. The first of these is that psychiatry hoped to eliminate social discrimination by removing the stigma of the disease attributed to homosexual people [12, 33]. We proceeded from the fact that by continuing to diagnose homosexuality, we will strengthen the prejudice of society and the pain of homosexual people.

The second reason, according to the cited author, was that psychiatrists are not able to clearly identify the psychodynamic causes of homosexuality, and therefore, to develop its successful therapy. The cure rate was low, and for those studies that reported conversion therapy was successful (the percentage of clients converted to heterosexuality ranged from 15% to 30%), there was a question whether the results were preserved for a long time. However, the success or failure of therapy should not be criteria for determining the norm. Otherwise, we are talking about logic, according to which, if something cannot be repaired, then it is not broken. This or that disorder cannot be denied only because of the lack of an effective remedy for its treatment [16].

The rejection of conversion therapy for homosexuals, based on the exclusion of homosexuality from the category of pathology, has led to the fact that discrimination has begun on those of them whose social and moral values ​​reject their homosexuality. “We forgot about those homosexuals who, due to a different vision of personal integrity, want to change with the help of psychotherapy. Unfortunately, these men were assigned to the category of victims of psychological depression (depression), and not to the courageous men, what they are, men who are committed to a true / genuine vision ... It is most detrimental that the client himself is discouraged, as a professional to whom he seeks help, tells him that this is not a problem, and that he should accept it. This circumstance demoralizes the client and makes his struggle to overcome homosexuality much more difficult ”[16, p. 12 – 13].

Some people, notes J. Nicolosi [16], define a person, focusing only on his behavior. However, clients undergoing his therapy perceive their homosexual orientation and behavior as foreign to their true nature. For these men, values, ethics and traditions determine their identity to a greater extent than sexual feelings. Sexual behavior, the author emphasizes, is only one aspect of a person’s identity, which is constantly deepening, growing and even changing through its relationship with others.

In conclusion, he notes that psychological science should take responsibility in deciding whether the gay lifestyle is healthy and their identity is normal, and psychologists should continue to study the causes of homosexuality and improve its treatment. The author does not believe that a gay lifestyle can be healthy, and a homosexual identity is completely ego-synthonic [16].

It should be noted that conversion effects are carried out, in particular, using hypnosis, autogenous training, psychoanalysis, behavioral (behavioral), cognitive, group therapy and religiously oriented influences. In recent years, the technique of desensitization and processing with eye movements (DPDG) [34] developed by Francis Shapiro [35] has been used for this purpose.

G. S. Kocharyan

Kharkov Medical Academy of Postgraduate Education

Key words: unwanted homosexual orientation, psychotherapy, two approaches.

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