Warren Throckmorton, PhD

Of late, every time Ted Haggard speaks, he brings the issues of homosexuality, religion and psychotherapy into the national spotlight.

Stepping into this discussion is one of the most influential and innovative psychologists in the nation, Dr. Nicholas Cummings. Past president of the American Psychological Association, Dr. Cummings practiced psychotherapy in San Francisco for 44 years. In 1985, Dr. Cummings founded American Biodyne, the first managed behavioral health care company and he continues to be a leading figure in the practice of psychology.

As Chief of Mental Health with the Kaiser-Permanente Health Maintenance Organization, Dr. Cummings had oversight of 39 hospitals and nearly 600 psychotherapists. In this position, he helped develop interventions and procedures to address the full range of clients and mental health concerns, including homosexual clients.

Regarding clients with conflicts over homosexuality, Dr. Cummings estimates that he personally conducted therapy with over 2,000 such men and women in his career. Furthermore, he estimates that Kaiser-Permanente provided services to a cohort of as many as 16,000 clients who had conflicts over their sexual identity during his tenure there. In an interview, he described the approach developed at Kaiser-Permenente with clients who experienced Haggard-like conflicts over their homosexuality.

In therapy, one of the first tasks was to learn more about the client’s experience of same-sex attraction. Through his clinical experience, Cummings came to believe there are many kinds of homosexuality. He notes,

There are as many kinds of homosexuals as heterosexuals.  Homosexuality is not a unitary experience. Some gays were quite promiscuous in response to a chaotic upbringing; some had wonderful families and led quiet lives. Some were very conforming with traditional gender roles and others were not.

Regarding the intense debate over nature and nurture, Dr. Cummings believes it is a mistake to isolate one cause for all homosexuals. “We saw people with all kinds of backgrounds. Dogmatism about causes is unwarranted by current research on the subject which is complex and incomplete. Our clinical experience contradicts efforts to reduce homosexuality to one set of factors.”

Therapists at Kaiser developed means to help clients pursue their values and desires in an informed manner. “Over time, we were able to identify within 4 or 5 sessions which clients were likely to pursue change and which ones were not.” Cummings learned that clients most likely to change attractions either had a strong, internalized value system which contradicted homosexual behavior or they had come to a homosexual adaptation through a childhood of abusive life experiences. Those with no prior heterosexual inclination and those with a longer history of same-sex attraction were not as likely to develop heterosexual functioning.

Success was not measured by whether a client changed sexual orientation. In fact, the percentage of clients who changed was relatively low. He explains:

Of the universe of gays we saw in Kaiser, 67% had good outcomes. Of those, 20% were successful in reorientation, with the remaining 80% pursuing sane, sexually responsible gay lives. The other third of our clients were not helped much at all. These people seemed to be sexually compulsive, frequently with obsessive compulsive disorder and substance addictions. They could not seem to go a day without sex. We tried many things and nothing seemed to work.

Using the numbers above, roughly 13% of those in conflict over their homosexuality demonstrated a change to a heterosexual life. Cummings recalls, “I still get notes and Christmas cards from clients who are married and very appreciative of their work in therapy. I am also contacted by even more clients who thank me for helping them achieve happy, long-term gay relationships.”

Can those on all sides learn anything from Dr. Cummings’ experience? He notes:

Given the state of research, the APA should not reject the possibility that sexual orientation might be flexible for some nor should those who are opposed to homosexuality contend that all gays can or should try to change their attractions. Therapists should be prepared to work within the viewpoint of their clients, even if that means clients desire to align their sexual feelings with their deeply held beliefs.

Dr. Cummings observations match up quite well with my experience and reading of the science. We do not know enough to be dogmatic with clients or the public about what causes homosexuality or how flexible it might be for any given person. However, we can help clients live consistently with their core values and beliefs, whatever they may be. Thus, our guidance should be tentative and individually applied. It should not be surprising that a “one size fits all” approach to therapy is inappropriate in an arena where values, sexuality and personal identity intersect.


Warren Throckmorton, PhD is Associate Professor of Psychology and Fellow for Psychology and Public Policy at Grove City College. He is the co-author of the Sexual Identity Therapy Guidelines (www.sexualidentity.blogspot.com) and maintains an active blog at www.wthrockmorton.com.

Nicholas Cummings, PhD, ScD, is Distinguished Professor of Psychology at University of Nevada, Reno and past president of the American Psychological Association. He is the co-editor with Rogers Wright of Destructive Trends in Mental Health.

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