"We are not to simply bandage the wounds of victims beneath the wheels of injustice,
we are to drive a spoke into the wheel itself." Dietrich Bonhoeffer, Letters and Papers from Prison (1943-1945)

Different and Conflicting Approaches

Three broad approaches to therapeutic support for same-sex attractions that people experience are emerging in the literature.  Here's a brief summary of these approaches:

  1. Gay-Affirmative Therapy (GAT)
  2. Sexual Identity Therapy (SIT)
  3. Change-Oriented Therapy (COT)

Rather than seeing these approaches as representing a specific theoretical orientation, it may be helpful to see that they attempt to untilise any number of psychotherapeutic themes and techniques to achieve different outcomes. Thus the differences between them has to do with the way in which clinicians bring to bear their different theoretical understandings and skills on the client's values and same-sex attractions.  There may be religious conflicts of interest, but this is not necessarily the case. Some with no-faith backgrounds experience values conflicts in respect of the same-sex attractions.

Understanding the different therapeutic goals of these approaches:

According to Rosik and Popper (2014)1

Gay Affirming Therapy (GAT):

recognizes that individuals will define sexual orientation identities in a number of ways and “is supportive of clients’ identity development without an a priori treatment goal for how clients identify or live out their sexual orientation” (APA, 2009, p. 602; see also ACA, 20133). However, as noted earlier, in theory and practice, there does appear to be a clear preference within GAT for clients to resolve conflicts between conservative religious values and sexual orientation by reassessing their religious identification and moving to an affirming religious institution (Beckstead, 2012)4. For those clients who find such religious reorientation impossible, GAT allows for sexual identity accommodation but cautions that “this is not the same as changing or even managing sexual orientation but is a treatment goal established in the service of personal integration” (APA, 2012, p. 155).

Sexual Identity Therapy (SIT):

adopts a similarly client-oriented approach to treatment goals: “In short, the recommendations do not presume outcomes for same-sex attracted clients who experience religious conflict” (Throckmorton & Yarhouse, 2006, p. 86). SIT strives to minimize stigma that could be directed at either same- sex eroticism or conservative religious values. Although SIT de-emphasizes the focus on sexual orientation and change, the approach appears willing to facilitate outcomes inclusive of a gay identity and an identity that prioritizes religious affiliation in which the possibility of change in same-sex attractions and behaviors is not dismissed out of hand (Tan & Yarhouse, 2010; Throckmorton, 20027). SIT is offered as a client-centered, identify-focused approach to addressing potential conflicts between religious values and sexual identity.

Change Oriented Therapy (COT):

acknowledges that clients should not be persuaded to pursue goals that are against their personal values. However, unlike GAT and SIT, COT affirms change in same-sex attractions and behavior as a valid goal for some clients, encouraging professionals to “respect the autonomy and right to self-determination of individuals who seek change intervention for unwanted same-sex attractions and behavior, as well as those individuals who do not desire such interventions” (NARTH, 2010, p. 208). Proponents of COT also assert that such change usually takes a significant degree of motivation, and therefore repeated reassessment of client goals over the course of therapy is highly advisable, possibly resulting in the need for a referral to an SIT or a GAT counselor.


1Rosik, Christopher and Popper, Paul (2014). "Clinical Approaches to Conflicts Between Religious Values and Same-Sex Attractions: Contrasting Gay-Affirmative, Sexual Identity, and Change-Oriented Models of Therapy" in journal of American Counselling Assocaition October 2014 Vol 59, pp 222-237.

2American Psychological Association. (2009). Report of the task force on appropriate therapeutic responses to sexual orientation. Retrieved from http://apa.org/pi/lgbt/resources/therapeutic-response.pdf

3American Counseling Association. (2013, January 13). Ethical issues related to conversion or re- parative therapy. Retrieved from http://www.counseling.org/news/updates/2013/01/16/ ethical-issues-related-to-conversion-or-reparative-therapy

4Beckstead, A. L. (2012). Can we change sexual orientation? Archives of Sexual Behavior, 41,121–134. doi:10.1007/s10508-012-9922-x

5American Psychological Association. (2012). Guidelines for psychological practice with lesbian, gay, and bisexual clients. American Psychologist, 67, 10–42. doi:10.1037/a0024659

6Throckmorton, W., & Yarhouse, M. A. (2006). Sexual identity therapy: Practice guidelines for managing sexual identity conflicts. Retrieved from http://www.drthrockmorton.com/article.asp?id=187

7Tan, E. S., & Yarhouse, M. A. (2010). Facilitating congruence between religious beliefs and sexual identity with mindfulness. Psychotherapy, 47, 500–511. doi:10.1037/a0022081

8National Association for Research and Therapy of Homosexuality. (2010). Practice guidelines for the treatment of unwanted same-sex attraction and behavior. Journal of Human Sexuality, 2, 5–65. Retrieved from http://narth.com/2011/12/narth-practice-guidelines/