Holding therapy and the Sexual Identity Therapy Framework

In light of the Exodus statement regarding the techniques displayed by Richard Cohen in the media, I thought it good to point out that the sexual identity therapy framework specifically identifies “holding therapy” as being inappropriate. From the framework:

Therapists should maintain professional boundaries in the therapeutic relationship. Therapists should follow ethical guidelines of their profession in conducting sexual identity therapy. Some approaches to sexual reorientation may blend appropriate therapeutic boundaries and are discouraged (e.g., Cohen, 2000). For instance, therapists should not engage in dual relationships with clients or provide physical touch or nurturance to clients. Therapists may supervise or oversee the client’s involvement in physical contact with others of the client’s choosing (friend, family member) during sessions only if the client has given consent. Clients should not be expected to become physically close to other clients in a group therapy situation. Therapists should not refer clients to retreats, support groups or interventions requiring boundary violations as a condition of participation.

Clearly, at times, family sessions involve hugging and the like, but the therapist should not participate. Especially troubling is the paternalism of this arrangement. Clients seeing the therapist as a parent figure should worked through, not encouraged. While we do not specifically discourage emotive techniques (beating pillows and screaming), we might consider whether we should add something to this effect – if for no other reason, to manage liability risk exposure. I have mentioned Genesis & Associates before as a negative example of how good intentions can go very wrong. Indeed, people who feel positive about an alternative technique at the time can later feel quite damaged by it. Specifically, a former Genesis & Associates client reported to CBS News in 2004 that she was damaged by therapists she formerly lauded on the 1995 documentary Divided Memories. In that CBS News report, the techniques were described that led to Ms. Diament’s dissatisfaction with her Genesis experience:

Carol says Mansmann prescribed two controversial treatments. One was “rage therapy” which included beating pillows while screaming. The other, “detachment therapy.” Mansmann urged Carol to move out of her home, away from her family. (italics mine)

To be fair, I suspect the detachment caused as much or more harm than the rage therapy. However, the rage therapy set up her willingness to believe that she was mistreated as a child and then to detach from her family. In hindsight, the “therapy” led to harmful results she was not able to anticipate.

In our guidelines, we do discourage therapists who have apriori determined the “root reasons” for same-sex attraction. Such emotive techniques as a given cannot be consistent with our guidelines since they are predicated on the notion that all same-sex attraction is a response to historical trauma or relational wounding.

UPDATE: 4/4/07 – I received an email from Richard Cohen this evening taking exception to my characterization of his work. Here is the email, which I indicated that I would include here to allow him to describe his work.

Dear Warren,

If you’re going to reference my work, here is the correct statement and my position:

Holding is not done by the therapist or by ministry leaders. It is to be done by OSA (Opposite-Sex Attracted) mentors, ideally the individual’s parent.

For clarification, this is stated clearly in Coming Out Straight on page 203, and in Chapters Ten and Twelve. I highly suggest you read the book and those chapters to better understand this issue.

Richard

Richard Cohen, M.A.

Director

International Healing Foundation

I recall asking Richard in an email about two weeks before his CNN appearance if he held his clients and he said he did not. Then he shows up on CNN holding one of his clients. Where was the mentor? Past clients have said he does indeed hold them so I think it is up in the air. I am also referring in this post to the whole approach which is promise change based on a faulty view of homosexuality in general. It is not hard to see how boundaries bent can become boundaries broken.

Montel Williams, Dr. Salzer and Abomination

During the Montel Williams Show called Homosexuality…Can it be cured?, Dr. Alicia Salzer said in response to Alan Chambers:

…science has shown us that 96% of people cannot change and along the way, absorb an enormous amount of self-loathing, a lot of confusion, a lot of family conflict, so I know the harm.

Surprised that she would make this dogmatic statement, I contacted the show to ask how she arrived at the 96% figure. The producer Melissa Borusso called to say Dr. Salzer relied on the 2002 study by Ariel Shidlo and Michael Schroeder, titled “Changing Sexual Orientation: A Consumer’s Report” published in the APA journal Professional Psychology: Research and Practice. I am quite familiar with this research. I presented along side Drs. Shidlo and Schroeder at the 2000 APA convention in Washington DC, where they Shidlo & Schroedermade their results public in a symposium titled “Gays, ex-gays, and ex-ex-gays: Examining key religious, ethical and diversity issues.” The symposium was organized by Mark Yarhouse and also included a presentation by Doug Haldeman. The Shidlo and Schroeder study is valuable in that it provides documentation that some efforts to reorient sexuality may have harmful outcomes for some people.

However, the Shidlo and Schroeder study cannot provide a basis for Dr. Salzer’s claim made before a national audience. In fact, Drs. Shidlo and Schroeder were very clear about this in their research report, saying:

The data presented in this article do not provide information on the incidence and the prevalence of failure, success, harm, help, or ethical violations in conversion therapy. (italics in the original, p. 250).

Exactly. Probability of change cannot be gleaned from this study. The cautious rendering of the research would be that some people report being harmed and some people report benefit from efforts to modify aspects of their sexuality. At present, we do not know with precision how likely either outcome is to occur for anyone.

After hearing from the Montel folks that Dr. Salzer relied on Shidlo and Schroeder for this authoritative sounding figure of 96%, I remembered seeing how she arrived at this figure in her video, Abomination: Homosexuality and the Ex-Gay Movement. First, the stage is set with on-screen appearances from Dr. David Scasta and Dr. Robert Spitzer. Dr. Scasta describes how the scientific community reviews data to come to a consensus about an issue and then says, “what’s been coming out of the consensus is that much of the data coming out of the Christian right groups is really not scientific.” Now I do not completely disagree with this statement because the 30% figure that is often used is an educated guess based on clinical experience of certain reparative therapists as well as research on methods that are not used frequently (e.g., aversive conditioning) or widely (traditional psychoanalysis) in the present. Also, it is not clear that all studies or therapists use the same definition of change or success. However, lack of knowledge does not mean that number is incorrect, it means we don’t know.

Successful

Following Dr. Scasta is Dr. Spitzer who says, “The people who do this therapy claim that about a third make a substantial change in behavior and feelings, I very much doubt that that happens.” Bob has been on the record with this point before.

If the film had stopped there or simply said, we do not know how frequently change occurs, I would not be writing this post. However, following the introduction of doubt about the numbers offered by “the Christian right,” Dr. Salzer’s video segues to Dr. Ariel Shidlo and a description of his 2002 report.

We decided to do research on the effects of conversion therapy, because at the time there wasn’t a lot of scientific data about it. We interviewed 202 people who had undergone conversion therapy. Only 13% of those had felt the therapy had been a success. When we took a closer look at that 13% we found some very interesting things.

fourpercent

With this prelude, Ariel Shidlo describes his study with Michael Schroeder. Recall that Shidlo and Schroeder said their report does not provide data that could address prevalence of harm or benefit, and yet the video spent much time reviewing prevalence of different outcomes. While the film does not say what Dr. Salzer said on Montel, it does provide numbers that appear to be authoritative, especially in the context of disparaging estimates attributed to the “Christian right.”

FailedFirst, Dr. Shidlo notes that 13% of the participants said they benefitted from their therapy experiences. From there, Dr. Shidlo partitions the 13% into those who were still struggling, single and celebate and finally, the 4% of their group who viewed themselves as heterosexual. The video depicts an 87% failure rate. On the Montel show, Dr. Salzer moves the failure rate to 96%.

In my opinion, the Montel Show should retract Dr. Salzer’s statement and I have asked them to do so. While I recognize there are problems with how research is used by the ex-gay movement, the Montel quote is also a significant misuse of research by a psychiatrist and in then to a lesser degree by an association of psychiatrists via the Abomination video as well.

Note: All graphics are from the video Abomination: Homosexuality and the Ex-gay Movement

UPDATE: An op-ed on this subject is posted on DrThrockmorton.com.

Exodus makes public statement regarding Richard Cohen

This statement was posted this afternoon on the Exodus International website:

Statement on Richard Cohen

Exodus International does not endorse the work of Richard Cohen or the methods utilized in his practice. Some of the techniques Mr. Cohen employs could be detrimental to an individual’s understanding of healthy relational boundaries and disruptive to the psychological and emotional development of men and women seeking clinical counsel and aid.

UPDATE: Alan Chambers has resigned from the PFOX (Parents & Friends of Ex-gays and Gays) board.

Richard Cohen responds to critics; apologizes for Daily Show

I just received this email from Richard Cohen, published here with permission:

March 22, 2007

International Healing Foundation

Tel. (301) 805-6111

Greetings,

I would like to address the questions that some friends have expressed in regard to some of the media appearances I’ve done recently, including Jimmy Kimmel Live, Paula Zahn Now, The Montel Show, and this week’s Jon Stewart’s The Daily Show on Comedy Central.

I’ve chosen to do interviews on shows such as these in an effort to reach people who would normally never hear our message. Some of these shows have mocked me and this work. Most times though, the interviews on these and other shows have turned out in our favor. I have had wonderful opportunities to get the truth out clearly and have seen many people respond because of these interviews, seeking out healing and change through various PATH (Positive Alternatives To Homosexuality) organizations.

This week’s interview on The Daily Show was difficult. It took place in my home and office, and was the most degrading experience I’ve had in the media. I unknowingly allowed myself to be manipulated and coerced by the producer and the host. I take full responsibility for this mistake. I have learned since my interview with The Daily Show that this program treats most of the experts they interview the same way they treated me: taking bits and pieces of the interview, re-edit it out of order, and make the interviewee appear foolish.

Happily, regular Daily Show viewers—which I am not—are in on the gag and know that this is the way the show generates laughs. I have learned well from this experience to better research future interview opportunities and to be more discerning about the offers that I accept, and what therapeutic approaches I demonstrate on the air. I sincerely apologize if my decision to be on this and other interview programs has caused you any hurt or harm. Please forgive me.

Over the past seventeen years with the International Healing Foundation, I have been able to assist hundreds of men and women with unwanted same-sex attraction (SSA) realize their dreams of a heterosexual life. With all my heart, I want to help the general public understand that no one is born with same-sex attractions (SSA), and that change is possible.

There are still so many people caught in the lies of the “gay myth.” It grieves God’s heart to see His children in such situations. It hurts me too, having lived a “gay life,” and knowing the wonderful possibility of healing that truly exists, and the freedom that may be experienced when someone comes out straight. We must get our message out as often as possible. Lives are [at]stake. Lives can be changed forever.

Changing our cultural understanding about SSA and the possibility of change takes a lot of time, and a lot of skill in reaching out to major media outlets, with a well-crafted message. I am not a public relations expert and very much need the help of one. I have had to handle the media on my own. I realize now that this needs to be changed.

If you can contribute financial resources toward funding public relations and media strategizing, so we can launch a positive campaign to promote the truth about SSA and the possibility of change, please contact me. I/we need and appreciate your help in this urgent matter. I know that we can impact our culture in a positive way. However, we simply need the training and funding to accomplish this life-saving goal.

I am in this for life. Twenty years ago God called me to do this work, and I have been faithful. I will not cease. I will not sit down. I will continue to work for the freedom of all men and women who experience same-sex attractions and their loving families.

Thank you for your understanding, your prayers, and your support.

Many blessings,

Richard

Richard Cohen, M.A.

Director

International Healing Foundation

P.O. Box 901

Bowie, MD 20718

Tel (301) 805-6111

Fax (301) 805-5155

www.ComingOutStraight.com

www.GayChildrenStraightParents.com

Certified Sexual Reorientation Coach

In Richard Cohen’s most recent media performance, he mentioned that he is a certified sexual reorientation coach. I looked this up on his website and learned that Richard is the lead certifier and, at present, probably the only CSRC in the world. That may soon change however, as the training program to become a CSRC begins this month and is open to “counselors, clergy, coaches and ministry leaders.” Becoming a CSRC involves the following:

The Counselor’s Training Program is for therapists, coaches, clergy, and ministry leaders who wish to assist those dealing with unwanted same-sex attraction (SSA). Training includes:

• Evaluating and developing a treatment plan for clients

• Four stages of healing unwanted same-sex attraction (SSA)

• Cognitive and inner child approaches to healing

• Creating affirmations for healing gender identity

• Psychodynamic/Therapeutic techniques for greater healing:

Focusing / Voice Dialogue / Bioenergetics / Psychodrama /

Family Constellations / Holding & Healthy Touch

• Assisting clients in establishing healthy friendships and mentors

• Understanding the meaning of sexual fantasies and masturbation

• Working with families: Attachment Therapy

• Strategies for family interventions and relational healing

• Preparing SSA men and women for dating

• Taking care of the therapist, preventing burn out

The total costs for the four weekends is $1400. It is not mentioned on the website, but I suppose the cost of the tennis raquet is not included in the fee. Pillows are probably included. I suspect a lighter version of this training will be offered for those who want to be an Assistant Coach.

It is clear that no one holding the CSRC “credential” could meet the sexual identity therapy guidelines. We developed the guidelines to help the public discriminate among approaches and we specifically discourage Cohen’s methods. The public needs some way to know what they are getting themselves into. In a reverse manner, the CSRC may actually serve a purpose. If a directory of CSRCs ever comes out, I will buy it so I can know who to avoid.

UPDATE: The term “certified sexual reorientation coach” has disappeared from Richard Cohen’s website. It is here in a Google cache for awhile. Mr. Cohen has responded to the fallout from his Daily Show performance which I will post soon.

Richard Cohen on the The Daily Show

It’s like deju vu all over again. Wanna be a CSRC? I kept wondering when Donnie Davies was going to appear.

UPDATE: 3/22/07 Randy Thomas of Exodus weighs in on the Daily Show appearance. The comments on his posts are interesting as well.

Also, You Tube has taken the video down as a result of their dispute with Viacom over copyrighted content.

Accurate public statements: A Montel post-mortem

Since last Thursday’s Montel Williams Show, I have called show producers and emailed the show several times asking them for research to support a statement made by psychiatrist Alicia Salzer in reference first to Alan Chambers’ story and then to change therapies in general. She said:

This is marketing; this is not science: Science has shown us that 96% of people cannot change and along the way, absorb an enormous amount of self-loathing, a lot of confusion, a lot of family conflict, so I know the harm.”

I am completely aware that harmful things have been done and continue to be done in the name of reparative therapy, but Salzer’s statement about a rate of change cannot be supported. The closest thing to a study that might yield a 4% change rate is Shidlo and Schroeder’s qualitative study of those who said they were harmed by some type of effort to change. This was not a study that could test hypotheses about rate of change for any population. At present, science cannot say much about such change, and “it” surely cannot say what Dr. Salzer did. As noted, I have repeatedly contacted the Montel show about this statement with no response.

All mental health professionals are bound to make tentative statements about research findings and to take care to separate opinion from “science.” Consider this statement from the physician code of ethics:

Section 7

A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.

1. Psychiatrists should foster the cooperation of those legitimately concerned with the medical, psychological, social, and legal aspects of mental health and illness. Psychiatrists are encouraged to serve society by advising and consulting with the executive, legislative, and judiciary branches of the government. A psychiatrist should clarify whether he/ she speaks as an individual or as a representative of an organization. Furthermore, psychiatrists should avoid cloaking their public statements with the authority of the profession (e.g., “Psychiatrists know that…”).

I feel pretty sure that Dr. Salzer believes she is acting to better community and public health. However, I do not believe exaggeration is the way to accomplish this end.

UPDATE: 3/20/07 – I received a call from Melissa Borusso, producer of the Montel Show. She left a voice mail saying that, as suspected, Dr. Salzer was relying on the study of Shidlo and Schroeder for her statistics.

So if I went on national television and said that science has shown us that 66% of gay males and 44% of lesbians can achieve good heterosexual functioning through reorientation therapy (from Spitzer’s study), what do you think the reaction would be? Would there be a You Tube video up denouncing my misuse of research? I would hope so…

Freud on homosexuality: Letter to a mother

Commenters on recent posts have mentioned Freud’s views of homosexuality. I am looking for an easy link to the section in Three Essays on the Theory of Sexuality where he discussed homosexuality. In the mean time, I thought I would post his letter to a woman who wrote him about her homosexual son.

Dear Mrs. X (April 9, 1935)

I gather from your letter that your son is a homosexual. I am most impressed by the fact that you do not mention this term yourself in your information about him. May I question you, why do you avoid it? Homosexuality is assuredly no advantage, but it is nothing to be ashamed of, no vice, no degradation, it cannot be classified as an illness; we consider it to be a variation of the sexual function produced by certain arrest of sexual development. Many highly respectable individuals of ancient and modern times have been homosexuals, several of the greatest among them (Plato, Michelangelo, Leonardo da Vinci, etc.). It is a great injustice to persecute homosexuality as a crime, and cruelty too. If you do not believe me, read the books of Havelock Ellis.

By asking me if I can help, you mean, I suppose, if I can abolish homosexuality and make normal heterosexuality take its place. The answer is, in a general way, we cannot promise to achieve it. In a certain number of cases we succeed in developing the blighted germs of heterosexual tendencies which are present in every homosexual, in the majority of cases it is no more possible. It is a question of the quality and the age of the individual. The result of the treatment cannot be predicted.

What analysis can do for your son runs in a different line. If he is unhappy, neurotic, torn by conflicts, inhibited in his social life, analysis may bring him harmony, peace of mind, full efficiency, whether he remains a homosexual or gets changed. If you make up your mind that he should have analysis with me (I don’t expect you will!!) he has to come over to Vienna. I have no intention of leaving here. However, don’t neglect to give me your answer.

Sincerely yours with kind wishes,

Freud

P.S. I did not find it difficult to read your handwriting. Hope you will not find my writing and my English a harder task.

Source:

Freud, Sigmund, “Letter to an American mother”, American Journal of Psychiatry, 107 (1951): p. 787.

Pictures of the original letter are here and here.