1978 Vol. o 6 ns Noi n 1, and C Zical Psychology 170—1 Not Can but Ought: The Treatment of Homosexuality Gerald C. Davison State University of New York at Stony Brook My earlier proposal to terminate change-of-orientation programs rests on moral not empirical grounds. Arguments based on whether therapists can or cannot alter sexual preferences are irrelevant. Therapists, moreover, have no abstract responsibility to accede to requests from clients for certain types of treatment; we work within a host of personal, conceptual, and even legal constraints. Ther- apists are characterized better as secular priests than as professionals applying ethically neutral techniques. Therapists should attend to large-scale social and political factors in their clients' lives as conscientiously as they attend to intra- psychic and interpersonal variables; our students should study philosophy and politics as well as learning theory and research design. Finally, to urge that therapists desist from sex reorientation programs is not tantamount to exhorting them not to see homosexuals in therapy; indeed, renouncing these widely used programs can help professionals focus on the problems homosexuals (and others) have, rather than_ on the so-called problem of homosexuality. I am grateful for the invitation to respond to Sturgis and Adams ' (1978) critique of my pro- posals to terminate change-of-orientation pro- grams for homosexuals (Davison, 1976). Given the cultural biases against homosexual- ity, it is problematic to assert that people who ask for change of orientation are expressing a "free wish." We have been remiss in examining why people request certain kinds of treatment (cf. Silverstein, Note 1). Some of the misunderstanding of my position may stem from a confusion in levels of discourse. Even though I am prepared to argue that indi- viduals can benefit from a renunciation of change-of-orienta-tion programs, my proposals are more properly viewed as institutional in nature (Rap- paport, 1977), that is, as concerned with societal– ethical constraints on human behavior within a framework that is more broad than that familiar to most psychotherapists. Certain issues are bet- ter discussed at one level than at another. I believe the issue of therapy for homosexuality should be addressed at an institutional level. Let me turn now to some of the specific points raised in the critique of Sturgis and Adams I wish to thank David A. Begelman for his com- ments on an earlier draft of this paper. Requests for reprints should be sent to Gerald C. Davison, Department of Psychology, State Uni- versity of New York at Stony Brook, Stony Brook, New York 11794. (1978). They are entirely correct to claim that my arguments are based on sociopolitical factors rather than on empirical considerations. They have properly grasped the thrust of my 1976 article, but I do not share their displeasure at my being moved by ethical rather than empirical concerns. What they fail to understand is that the issues we are dealing with as therapists are, in deed, philosophical–ethical ones, and these moral considerations transcend research considerations. To discourse on the empirical level, as they do very well, is simply to misperceive the essence of the issue. Their critique is irrelevant to my article. Those who continue to offer change-of-orienta- tion treatment to homosexuals do not have a monopoly on sensitivity to clients' rights. I do not believe that the issue can be settled by argu- ing, as they do, that a therapist has some sort of abstract responsibility to satisfy a client's ex- pressed needs. It is not that simple. As Begelman (1975) has pointed out, therapists constrain themselves in many ways when clients ask for certain kinds of help. There is a host of client requests that therapists do not honor. In fact, the courts (cf. Kaimowitz v. Michigan Depart- ment of Mental Health, 1973) are becoming in- volved in denying the "voluntary" requests of pa- tients for certain types of treatment. Requests alone have never been a sufficient criterion for providing therapy. Clients, moreover, make certain requests of Copyright 1978 by the American Psychological Association, Inc. All rights of reproduction in any form reserved. 170