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Reparative therapy and the power of an explanation

April 12, 2012 By 56 Comments

Yesterday, I posted a link to an article titled “My So-called Ex-gay Life” from the website of the American Prospect and written by Gabriel Arana. In that post, I focused on psychiatrist Robert Spitzer’s desire to retract his 2001 study of ex-gays. I also reported on my brief exchange with Bob about his study and his current views on sexual orientation.

Today, I want to comment about Arana’s description of Narth co-founder Joseph Nicolosi. Arana summarizes his three year therapy episode with Nicolosi which ended with Nicolosi’s prognosis to Arana’s parents that their son would never enter the gay lifestyle:

Late into my last year of high school, Nicolosi had a final conversation with my parents and told them that the treatment had been a success. “Your son will never enter the gay lifestyle,” he assured them.

I once had an experience with Nicolosi which is similar to what happened with Arana and his parents. I was in a meeting with several psychologists, including Nicolosi, debating the merits of his theory of paternal deficit as the sole cause for adult male homosexuality. I presented the basics of a clinical case involving a young adult who consulted me about his distress over his same-sex attractions. The young man told me that he came out to his father because he was closer to his father than to his mother. In addition, there were other indications of paternal warmth and closeness that I mentioned in the presentation. In the midst of some discussion over the case, Nicolosi abruptly interrupted me and said, “He’ll be fine. He’s not gay.” Nicolosi then explained that a boy like that who has such a close relationship with his father could not possibly remain attracted to the same sex. In fact, the young man did remain attracted to the same sex, although he did not come out as gay at that point. The only follow up I ever heard was that he had determined to live a celibate life. That case was presented as an illustration of other cases with the same basic narrative — gay men with close warm relationships with their fathers.

Nicolosi’s theoretical statements reveal the most obvious confirmation bias. Despite the fact that Nicolosi has been exposed to evidence which would invalidate his narrow theory, he persists in holding on. Witness what he said to Arana:

What about people who don’t fit his model? “After almost 30 years of work, I can say to you that I’ve never met a single homosexual who’s had a loving and respectful relationship with his father,” he says. I had heard it all before.

He said the same thing in the meeting where I introduced cases of gay males who had a loving and respectful relationship with their fathers. However, in the face of the disconfirming evidence, he simply changed the rules – those men weren’t gay, they couldn’t be because they were close to their dads. Even though the clients were attracted to the same sex; according to Nicolosi, they would not continue with those attractions because of their closeness to their dads.

Arana articulates well how different explanatory narratives can become inculcated into an identity. Arana describes how he perceived the therapeutic narrative:

[Read more...]

Filed Under: ex-gay, NARTH, Professional issues, psychology, Religion and sexuality, reparative therapy, sexual orientation Tagged With: , , ,

Robert Spitzer Retracts 2001 Ex-gay Study

April 11, 2012 By 27 Comments

Psychiatrist Bob Spitzer, author of a 2001 ex-gay study, told American Prospect journalist, Gabriel Arana, that he wants to retract his study:

Spitzer was growing tired and asked how many more questions I had. Nothing, I responded, unless you have something to add.

He did. Would I print a retraction of his 2001 study, “so I don’t have to worry about it anymore”?

Knowing this article was coming, I talked last evening with Bob and asked him what he would like to do about his study. He confirmed to me that he has regret for what he now considers to be errant interpretations of the reports of his study participants. He told me that he had “second thoughts about his study” and he now believes “his conclusions don’t hold water.” He added that he now believes that the criticisms of the study expressed in the 2003 Archives of Sexual Behavior issue are “more true to the data” than his conclusions were.

He told me that he had expressed these thoughts to Ken Zucker, editor of the Archives of Sexual Behavior several months ago. He wondered aloud to Dr. Zucker if there was some obligation to say the critics were right and that the study should be withdrawn. Although Spitzer said he did not recall Zucker’s exact reply, he did not feel encouraged to withdraw the paper. The Prospect article also references the issue of a formal retraction:

I asked about the criticisms leveled at him. “In retrospect, I have to admit I think the critiques are largely correct,” he said. “The findings can be considered evidence for what those who have undergone ex-gay therapy say about it, but nothing more.” He said he spoke with the editor of the Archives of Sexual Behavior about writing a retraction, but the editor declined. (Repeated attempts to contact the journal went unanswered.)

However, when I asked Zucker via email about his stance, he told me that Bob had not submitted anything for review, but he is free to submit a letter to the Editor or other communication expressing regret and his current views. The ball is in Bob’s court. My guess is that Bob will take him up on that offer.

There is much else to consider in this article which I will get to later today.  The material and personal experience with Joseph Nicolosi is well worth reading.

Filed Under: ex-gay, Professional issues, sexual orientation Tagged With: , , , ,

Reparative therapy and confirmation bias: Langer & Abelson’s 1974 study of clinical bias

February 2, 2012 By 20 Comments

Recently, I have been examining the possible role of confirmation bias in the attributions of reparative therapists.  In this post, I look at a classic study of how theoretical persuasion associates with clinical judgment.

Ellen Langer’s and Robert Abelson’s 1974 study* on clinical judgment is an important caution to clinicians about the role of preconceived ideas on diagnosis and attributions about patients. The abstract for the study is presented here:

The effect of labels on clinicians’ judgments was assessed in a 2 X 2 factorial design. Clinicians representing two different schools of thought, behavioral and analytic, viewed a single videotaped interview between a man who had recently applied for a new job and one of the authors. Half of each group was told that the interviewee was a “job applicant,” while the remaining half was told that he was a “patient.” At the end of the videotape, all clinicians were asked to complete a questionnaire evaluating the interviewee. The interviewee was described as fairly well adjusted by the behavioral therapists regardless of the label supplied. This was not the case, however, for the more traditional therapists. When the interviewee was labeled “patient,” he was described as significantly more disturbed than he was when he was labeled ”job applicant.”

In addition to ratings of pathology, the authors recorded some of the descriptions of the interview by therapists who were told the interviewee was a job applicant and those who were told he was a patient. The differences are striking. Behavior therapists did not differ much but the psychoanalytic therapists described the job applicants as well adjusted but the same interviewee, when labeled as a patient, was labeled as disturbed. Note these differences from Langer and Abelson’s discussion of their study.

In the study just described, all of the subjects saw the same videotaped interview. Yet when asked to describe the interviewee, the behavior therapists said he was “realistic”; ”unassertive”; “fairly sincere, enthusiastic, attractive appearance”; “pleasant, easy manner of speaking”; “relatively bright, but unable to assert himself”; “appeared responsible in interview.” The analytic therapists who saw a job applicant called him “attractive and conventional looking”; “candid and innovative”; “ordinary, straightforward”; ”upstanding, middle-class-citizen type, but more like a hard hat”; “probably of lower or blue-collar class origins”; “middle-class protestant ethic orientation; fairly open-— somewhat ingenious.” The analytic therapists that saw a patient described him as a “tight, defensive person . . . conflict over homosexuality”; ”dependent, passive-aggressive”; ”frightened of his own aggressive impulses”; ”fairly bright, but tries to seem brighter than he is … impulsivity shows through his rigidity”; “passive, dependent type”; “considerable hostility, repressed or channeled.”

Note the dramatic differences in descriptions. The same person who was described as well adjusted by analysts who thought they were watching a person applying for a job was described in pathological terms when they thought they were watching a patient being interviewed. Note that an attribution of homosexuality was made by at least one of the analytic therapists.

When reparative therapists say they are not biased when examining the histories of their same-sex attracted patients, I am highly skeptical.

Langer and Abelson describe the potential problem with making attributions based on patient labeling:

In practical terms, the labeling bias may have unfortunate consequences whatever the specific details of its operation. Once an individual enters a therapist’s office for consultation, he has labeled himself “patient.” From the very start of the session, the orientation of the conversation may be quite negative. The patient discusses all the negative things he said, did, thought, and felt. The therapist then discusses or thinks about what is wrong with the patient’s behavior, cognitions and feelings. The therapist’s negative expectations in turn may affect the patient’s view of his own difficulties, thereby possibly locking the interaction into a self-fulfilling gloomy prophecy.

It is not hard to see how a client presenting with “unwanted same-sex attraction” could end up in the kind of self-fulfilling prophecy described by Langer and Abelson. Since reparative therapists believe homosexuality is invariably caused by “gender wounds” early in life, no small amount of effort will be spent to find evidence of them, whether or not they exist.

*Langer, E.J.; & Abelson, R.P. (1974).A patient by any other name . . . : Clinician group difference in labeling bias.Journal of Consulting and Clinical Psychology.42(1), 4-9.

Related:

 

 

Filed Under: NARTH, Professional issues, reparative therapy, sexual identity, sexual orientation Tagged With: , , ,

Reparative therapy and confirmation bias: An illustration

January 31, 2012 By 38 Comments

One of the biggest problems I have with reparative therapy is the self-fulfilling nature of the approach. Reparative therapists assume that the existence of same-sex attraction means a person has suffered gender based trauma during a specific period of childhood.

Reparative therapist David Pickup has commented on another post that straight men may have wounds but, from his point of view, they are not as deep as those which haunt gay men. In other words, if a straight man says he was traumatized in the same way, the reparative therapist’s answer is that the trauma wasn’t deep enough to trigger the reparative drive leading to same-sex attraction. If the gay man says he does not recall any such trauma, then the reparative drive theory posits that the gay man has repressed it and needs to uncover it. It seems to me the powerful effects of confirmation bias are at work.

The assumptions necessary to work as a reparative therapist remind me of the assumptions often associated with the repressed memory movement. Especially during the decade of the 1990s, many therapists assumed that negative moods such as depression or relational problems were due to childhood abuse of some kind that had been forgotten via the defense mechanism of repression. Some therapists harbored a belief that clients who could not remember trauma from the past were in a state of denial. This belief  led some therapists to repeatedly ask about recollections of trauma and hold out the possibility to their clients that they were simply unable to remember.

By questioning the mechanism of repression, I am not questioning the reality of gender based trauma. I am not questioning that some gay people had very impoverished childhoods. Of course that is true. But so did many straight people. In his recent comment, Mr. Pickup proposed that gay people have experienced deeper trauma than straight people experienced. This seems circular to me. How can you tell which experiences are worse? As far as I can tell, the way reparative therapists answer this question iss by knowing the sexual orientation of the client. Straight people have deep wounds; gay people, by definition according to the reparative approach, have deeper wounds.

As an illustration of how clients can adapt themselves to the theories of their therapists, I offer the experience of Carol Diament. Ms. Diament initially thought she would not need to detach from her family, as the other clients at Genesis Associates did. However, after awhile, “memories of abuse came up” and she detached from her parents (over three years), husband and even small children (at least 8 months and maybe longer).

Eventually Carol got away from Genesis, sought another therapist and came to realize that her memories were reconstructed with the help of her therapists at Genesis. By then, the damage was done. She had lost years of her life and had even lost her immediate family.

The clip is just over nine minutes long, but I hope you will watch it all the way through. Then, I hope you will discuss this and let me know what you think. Am I seeing a parallel with reparative theory that is valid or not?

Over the years, I have worked with many clients, gay and straight, who have experience significant trauma with parents. However, I have not been able to differentiate them based on the severity of their experiences. Furthermore, I know and have worked with many gay men and women who recall no deep trauma relating to their parents or peers. I also know gay men who experienced trauma after they came out to their parents because of the tension surrounding homosexuality. However, prior to the disclosure, the relationship was on par with any comparable straight person’s home life.

I also want to be clear that I am not closed to the possibility that certain childhood experiences could influence some people to question sexuality and engage in same-sex behaviors. In addition, some experiences of abuse are associated with risky sexual behavior of all kinds. Therapy, even reparative therapy, might help such people. However, I think these scenarios represent only a portion (probably very small) of the total gay and bisexual population.

Filed Under: NARTH, Professional issues, psychology, reparative therapy, sexual orientation Tagged With: , , , ,

NARTH issues statement on sexual orientation change

January 29, 2012 By 38 Comments

Apparently in response to Alan Chambers’ candor about sexual orientation change, the National Association for the Research and Therapy of Homosexuality issued a clarification of what that organization means by change.

Issued January 27, the statement reads in full:

Current discussions of homosexual sexual orientation change are unavoidably occurring within a sociopolitical climate that makes nonpartisan scientific inquiry of this subject very difficult.  In light of this reality, a few considerations are crucial for accurately understanding the sometimes contradictory opinions regarding the possibility of sexual orientation change.   First and foremost, it is important to recognize that how change is conceptualized has vast implications for our thinking about change.  Some of the more ardent proponents and opponents of homosexual sexual orientation change may view change in strictly categorical terms, where change is an all-or-nothing experience.  Proponents and opponents with this view differ only in the direction of their desired outcome.  Proponents of change understood in categorical terms may view a homosexual sexual orientation as a lifestyle choice that merely needs to be renounced. Opponents who take this viewpoint, on the other hand, may conceive of sexual orientation as essentially hard wired and simply not modifiable.  NARTH does not support either of these perspectives.

NARTH believes that much of the expressed pessimism regarding sexual orientation change is a consequence of individuals intentionally or inadvertently adopting a categorical conceptualization of change. When change is viewed in absolute terms, then any future experience of same-sex attraction (or any other challenge), however fleeting or diminished, is considered a refutation of change. Such assertions likely reflect an underlying categorical view of change, probably grounded in an essentialist view of homosexual sexual orientation that assumes same-sex attractions are the natural and immutable essence of a person.  What needs to be remembered is that the de-legitimizing of change solely on the basis of a categorical view of change is virtually unparalleled for any challenge in the psychiatric literature.  For example, applying a categorical standard for change would mean that any subsequent reappearance of depressive mood following treatment for depression should be viewed as an invalidation of significant and genuine change, no matter how infrequently depressive symptoms reoccur or how diminished in intensity they are if subsequently re-experienced.  Similar arguments could be made for any number of conditions, including grief, alcoholism, or marital distress.  The point is not to equate these conditions with homosexuality, but rather to highlight the inconsistency of applying the categorical standard only to reported changes in unwanted same-sex attractions.

Rather than pigeonholing homosexual sexual orientation change into categorical terms, NARTH believes that it is far more helpful and accurate to conceptualize such change as occurring on a continuum.  This is in fact how sexual orientation is defined in most modern research, starting with the well known Kinsey scales, even as subsequent findings pertinent to change are often described in categorical terms. NARTH affirms that some individuals who seek care for unwanted same-sex attractions do report categorical change of sexual orientation.  Moreover, NARTH acknowledges that others have reported no change. However, the experience of NARTH clinicians suggests that the majority of individuals who report unwanted same-sex attractions and pursue psychological care will be best served by conceptualizing change as occurring on a continuum, with many being able to achieve sustained shifts in the direction and intensity of their sexual attractions, fantasy, and arousal that they consider to be satisfying and meaningful. NARTH believes that a profound disservice is done to those with unwanted same-sex attractions by characterizing such shifts in sexual attractions as a denial of their authentic (and gay) personhood or a change in identity labeling alone.  Attempts to invalidate all reports of such shifts by presuming they are not grounded in actual experience insults the integrity of these individuals and posits wishful thinking on an untenably massive scale.

Finally, it also needs to be observed that reports on the potential for sexual orientation change may be unduly pessimistic based on the confounding factor of type of intervention.  Most of the recent research on homosexual sexual orientation change has focused on religiously mediated outcomes which may differ significantly from outcomes derived through professional psychological care.  It is not unreasonable to anticipate that the probability of change would be greater with informed psychotherapeutic care, although definitive answers to this question await further research.  NARTH remains highly interested in conducting such research, pursuant only to the acquisition of sufficient funding.

To summarize, then, those who are  highly pessimistic regarding change in sexual orientation appear to have assumed a categorical view of change, which is neither in keeping with how sexual orientation has been defined in the literature nor with how change is conceptualized for nearly all other psychological challenges.  NARTH believes that viewing change as occurring on a continuum is a preferable therapeutic approach and more likely to create realistic expectancies among consumers of change-oriented intervention.  With this in mind, NARTH remains committed to protecting the rights of clients with unwanted same-sex attractions to pursue change as well as the rights of clinicians to provide such psychological care.

I hope to post something on this Monday or Tuesday; but for now here is NARTH’s official word on the subject of orientation change. Discuss…

Filed Under: NARTH, Professional issues, reparative therapy, sexual orientation Tagged With: , ,
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