Behav. Ra. & Therapy, 1970. Vol. 8. pp. 93 to 95. Pergamon Prc.u.

Printed in England
Preliminary report on a new aversion therapy for male homosexuals
(Received 15 J uly 1969)
As Rachman and Teasdale (1969) have pointed out, current aversion therapies are in a striking dilemma:
The effect of aversive procedures depends largely on the intensity of the noxious stimulus (cf. Solomon,
1964). On the other hand, this variable can only be handled within narrow limitations, for ethical reasons.
One hope for the future to resolve this problem appears in the first encouraging results with Covert Sen-
sitization (Cautela and Wisocki, 1968; Ashem and Donner, 1968), but the obvious shortcomings of this
method are the uncontrollable parameters of the administered covert stimuli.
Seeking new ways for solving the intensity dilemma it is promising to shift the perspective of
thinking about that problem: Not the i&en&y of the aversive stimulus per se, but the incompatibility of
the response the aversive stimulus elicits with the undesirable (e.g. homosexual) response must be the
very target of an aversion procedure (cf. Lazarus, 1968). Structuring the problem in this way eventually
leads us to the use of effective aversive stimuli which are more tolerable for the patient.
Behavioral analysis in male homosexuals reveals that the crucial point for them is feeling sexually
attracted by certain visual stimuli while seeing potential male partners. Therefore, aversion treatment
has to focus on neutralizing the erotic appetite elicited by these stimuli. A pilot study with four homo-
sexuals trying out a variety of aversive stimuli in a covert presentation led us to the hypothesis that this
visual-aesthetic stimulus dimension is not only the most salient but also a very vulnerable one, with regard
to sexual arousal. Therefore, we have designed a therapeutic experiment with the following steps in each
trial :
(a)
@)
Cc)
(4
63
m
The patient is asked to concentrate on a colour slide showing a very attractive naked man (as CS).
As soon as he is feeling some sexual arousal, he says mhm. At this moment, a colour slide
showing nauseous running sores (as the UCS) is projected (from a second projector) on the naked
man.
The patient concentrates on those regions of the body which are now covered with the sores.
As soon as sexual arousal has ceased and eventually been replaced by some sort of disgust, he
again signals. Five seconds later the therapist terminates the projection of the two contaminated
pictures.
Now a colour slide showing an attractive woman is projected, functioning as a relief stimulus
which the patient is asked to concentrate on, while deeply relaxing.
As soon as he is feeling sexually aroused, he signals. Only ten seconds after this signal the pro-
jection of the heterosexual stimulus is terminated. If the patient cannot indicate some sort of
erotic feelings, the picture is moved away after one minute of exposure.
Until now we have used 15 various pairs of pictures. The slides showing the sores are exchanged
randomly in order to avoid habituation to the aversive stimulus. Mean number of trials per session is
30. We usually conduct one session per week.
Similar to an assessment procedure described by Barlow, Leitenberg and Agras (1969), we use a five
step scale (from 0 to 4) for a self-rating of sexual arousal. Out of the 15 male and the 15 female slides,
the patient has to rate quickly a standard sample of each ten male and female coloured pictures separately,
after each session.
Admittedly, at this stage the carried out procedure is a rough one, but it allows further refinement
in order to increase resistance to extinction, and the measurement of some further parameters. The ideal
assessment would be Freunds plethysmography (1967). The intention of our pilot study was to examine
whether this procedure will work at all.
First results with two homosexual patients are very encouraging. In the figure below the total scores
of ratings of each ten male and female pictures after each aversion session are presented:
Both patients, very well motivated to be cured (it is with these cases that an aversion therapy is most
promising) reported a switching on of the sores in imagination, when they were led into temptation.
By this measure they could neutralize the erotic attraction in such situations.
93
94 CASE HISTORIES AND SHORTER COM~MUXICATI0N.S
Patient A, a 22-year-old student, is already much improved after eight aversion sessions. He now
has a happy relationship with a suitable girl. Before treatment he had two sexual contacts per month,
on the average, with a friend, lasting for five years and vety disturbing temptations while walking in the
street. Since the first aversion session he has had no homosexual contacts in spite of continuing the friend-
ship. Since approximately the sixth session, the temptations have ceased completely. The improvement
has lasted for two months since the termination of aversion treatment, without the slightest indication of
relapse.
Patient B, a 40-year-old man, has a far stronger homosexual habit than patient A: his homosexual
history has a duration of about 25 years, with one sexual contact every week, and about 700 various
partners. Nevertheless, during treatment (which is continuing), his monthly rate of homosexual contacts
has already decreased from 4 to 3 (baseline measure has recorded 4 months). Moreover, since aversion
sessions have begun, his heterosexual phantasies during orgasm have increased from 0 to 2 per month,
leading to increasing satisfaction for him. (The importance of phantasy data in conditioning sexual habits
has been demonstrated by Evans 1968). He has increased his efforts to find a woman, whom he would
like to marry.
We have chosen a classical conditioning procedure because of a number of theoretical reasons Rachman
and Teasdale (1969) have discussed, e.g. showing that in Feldmans and MacCullochs well-known
avoidance conditioning procedure (1965) the classical conditioning elements are probably responsible for
the favourable results. Apart from this aspect it seems unsuitable to choose avoidance responses as a
target of therapy in homosexuals, because these responses could eventually interfere with professional
activities, for instance. This would not be the case if we neutralize only the specific homosexual stimulus
dimension.
Finally, we should not forget that therapy for homosexuals, who themselves wish to be treated, can
only be of durable success if we complete the treatment by adapting them heterosexually (cf. Cautela and
Wisocki, 1968; Freund, 1965; Kockott, 1969).
Institute of Psychology, KARL H. MANDEL
Clinical Department,
University of Munich,
Munich, Germany
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CASE HISTORIES AND SHORTER COMMUNICATIONS 95
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