WHYY interview with Judith Glassgold about APA task force report

Yesterday, I was on WHYY out of Philadelphia for an interview with Judith Glassgold, chair of the recently released APA Task Force report. Marty Moss-Coane is the host of Radio Times, a show broadcast over NPR as well as locally on WHYY.

You can listen to the interview here. It is long (about an hour) but the long format allowed us to unpack the report and some of the clinical issues involved.

Among other points, Dr. Glassgold affirmed my understanding and analysis of the APA task force report and the value it has for people working within a sexual identity therapy framework. There is much more of interest so if you groove on this topic, this is a good interview without pressure to create sound bites.

New Scientific Research revisited

In the category of “Old Business.”

On July 23, I asked blog readers what the phrase “new scientific research” meant.

Here is what some of you said:

New: Recently reported (not in media for more than 3 months)

Scientific: Can document measuring criteria, tested, revealing a need to do further research

Research: Primary Data

If it’s new, it’s not a review of past literature.

Data that hasn’t been reported before.

Not –

A literature review

A meta-analysis

A re-analysis of data that has been previously been reported with a different analysis.

Study with new data…Not a literature review. Not a review to undermine the own viewpoints with no diversity view.

That’s what I think too. Therefore I was surprised to see NARTH headline their recent press release for the summary paper, “What Research Shows…” as

New Scientific Research Refutes Unsubstantiated Claims Regarding Homosexuality

The problem is that there is no new scientific research in the paper. The paper itself is not new scientific research but rather a collection of prior studies.

I asked NARTH leaders about the decision to call their paper “new scientific research.” I did learn in the process that the NARTH Governing Board had reviewed the press release and title and approved it. When I pressed about why the paper was called “new scientific research,” NARTH past-president Dean Byrd then wrote to me twice say that he did not have time to answer the question.

Not-for-profit co-ops may replace public option in health care reform

The Associated Press has a good summary of the political landscape on healthcare reform today.

During the 1993 Clinton Health Care debates, co-ops were floated as an option. While this may seem like a compromise, such co-ops are not a panacea. I might support them if the amount of administrative costs were capped and they were not allowed to lobby legislators (think about Fannie Mae and Freddie Mac).

Such an option could get us closer to public health clinics where health care would be free or dramatically low in cost. Co-ops should be open to such an arrangement since such care can be coordinated well and the incentive is good care and not profit margin.

However, I maintain that unless tort reform is on the table, it matters little whether we have non-profits or insurance companies or the government. Physicians will still practice defensively and run up costs. Don’t hear me say tort reform will fix the system but without it, I doubt the current fixes will help as much.

Health care reform controversy comes to Grove City

Yesterday, Grove City got involved.

Americans for Prosperity rolled through town collecting signatures on a petition opposing more government control of health care.

I wrote about the visit at World Magazine, just up today. Actually, I wrote the article sitting in the Four Star Pizza. They’re all wireless and tasty in there.

gc

Unpaid protester

GC crowd

People waiting to sign the petition

AFP Bus

Americans for Prosperity bus

World Magazine on the APA sexual orientation task force report

Alisa Harris at World Magazine has a web only article out today discussing the APA task force report. I am quoted along with David Pruden at NARTH. There are a couple of points in the NARTH information that are incorrect.

Psychologist Warren Throckmorton once met a woman who was in a lifelong lesbian relationship and suddenly, with no prefaced desire to leave her lesbian lifestyle, fell in love with a guy at work. She left her lesbian partner and married the man.

The American Psychological Association just published a report on whether therapists can make this change happen. In examining change therapy, which claims that people with homosexual desires can switch to heterosexual desires, the report says there is insufficient evidence that the therapies work.

This kind of story is a good argument for control groups if you really want to rule out spontaneous change from the claims that therapy produced it. If this woman and others I know like her were in therapy, perhaps they would have attributed the change to the therapy.

NARTH of course is skeptical:

The panel surveyed 83 peer-reviewed studies, most of which occurred before 1978 and had methodological flaws, according to the panel. But the 138-page report left out certain key studies by Jones and Yarhouse, Karten, and Spitzer, said Pruden, adding that there was no minority report and a lack of ideological diversity on the task force. In a response to the APA report, NARTH argued that “homosexuality is more fluid than fixed” and that there’s substantial evidence someone can change his sexual orientation.

This comes from the NARTH press release in response to the APA report:

NARTH appreciates that the APA stressed the importance of faith and religious diversity. Unfortunately, however, the report reflects a very strong confirmation bias; that is, the task force reflected virtually no ideological diversity. No APA member who offers reorientation therapy was allowed to join the task force. In fact, one can make the case that every member of the task force can be classified as an activist. They selected and interpreted studies that fit within their innate and immutable view. For example, they omitted the Jones and Yarhouse study, the Karten study, and only gave cursory attention to the Spitzer study. Had the task force been more neutral in their approach, they could have arrived at only one conclusion: homosexuality is not invariable fixed in all people, and some people can and do change, not just in terms of behavior and identity but in core features of sexual orientation such as fantasy and attractions.

At least one problem here is that the task force report did consider Jones and Yarhouse, Karten and Spitzer. I would have preferred that the criticisms of the Jones and Yarhouse study would have been considered in a different manner (not in a footnote) but I do not think the outcome would have been much different given the APA distinction between orientation and identity.

On the claims of omission, a quick search of the APA report demonstrates how misleading the NARTH press release is. The Jones & Yarhouse study is referenced 17 times, Karten’s dissertation is mentioned three times, and Spitzer’s study is referenced 19 times.

I was glad Ms. Harris included the following:

The idea that people develop homosexual tendencies because of sexual abuse or distant parents is “one of the easiest theories to falsify,” he argues. “There are many gay people who have perfectly fine relationships with their parents and are not sexually abused.” Instead of telling his gay clients that they can become straight, Throckmorton helps them figure out how they want to live and then helps them get there.

Thoughts on the status of the Reorientation Wars

So now that the dust has started to settle from the APA convention in Toronto, let’s review the status of the Reorientation Wars.

Does therapy change orientation?

In anticipation of the APA’s report, NARTH fired an opening salvo with their paper (What Research Shows…). Perhaps sensing, incorrectly as it turns out, that the APA would advocate a ban on reorientation therapy, NARTH tossed every positive reference to change they could find into the paper. They noted problems in defining sexual orientation but did little to distinguish the various definitions and their meaning in the many studies they cited. They concluded, of course, that therapy can change orientation.

The APA on the other hand, differentiated sexual orientation and sexual orientation identity. Sexual orientation for them is the biological responsiveness to one gender or both. According to their literature review, the evidence that therapy can change orientation is not sufficient to permit therapists to inform clients that therapy can change their orientation. However, sexual orientation identity (i.e., self-labeling) may shift and be responsive to a variety of factors, including religious mediation.

It seems to me that what NARTH is calling sexual orientation includes the APA’s sexual orientation identity. While this statement risks taking us into the “all or nothing” dead end discussion about change, I do not mean that one must change completely for change to be important and psychologically relevant. I suggest instead that what many studies measure is how people see themselves, even if their sexual responsiveness (orientation) has only shifted by a degree (e.g., an average of less than a point on the Kinsey scale in the Jones and Yarhouse study). Jones and Yarhouse suggest as much in their recent paper when they write:

There is also the question of sexual identity change versus sexual orientation change (see Worthington & Reynolds, 2009). Recent theoretical (e.g., Yarhouse, 2001) and empirical (e.g., Beckstead & Morrow, 2004; Yarhouse & Tan, 2004; Yarhouse, Tan & Pawlowski, 2005; Wolkomir, 2006) work on sexual identity among religious sexual minorities suggests that attributions and meaning are critical in the decision to integrate same-sex attractions into a gay identity or the decision to dis-identify with a gay identity and the persons and institutions that support a gay identity. In light of the role of attributions and meaning in sexual identity labeling, is it possible that some of what is reported in this study as change of orientation is more accurately understood as change in sexual identity?

I believe the answer to their question is that it is not only possible but probable that change in sexual identity is what is being reported. The distinction between orientation and identity (or attraction and identity as we often describe it here) is key, in my view, in order for us to understand the experience of those who say they have changed while at the same time experiencing same-sex attraction. I also believe that men and women are different and their change may be different. Women seem to describe less exclusivity than men. Fluidity may be more likely with complete shifts described. I think we need to accommodate atypical experiences such as men and women who completely shift for a time and then shift back. Whatever the pattern, I hope we can agree that sexual attraction patterns may be one thing while meaning making aspects may lead two people with the same attraction pattern to identity in disparate ways.

Is sexual reorientation harmful or beneficial?

NARTH says reorientation might harm some people but that for the most part it is not harmful. The APA says existing studies are not good enough to allow conclusions. Point for the APA here. All we can say is that some people report harm and some people report benefit. The APA notes that the benefits can occur in programs which promote congruence with religious faith. This is clear and the Jones and Yarhouse study demonstrate that health status improves modestly for those who remained in the study. However, I would say we do not yet know much about what the potent or beneficial elements of those programs are. The APA report identified some of those elements.

Homosexuality and pathology

NARTH says homosexuals have more pathology than any other group of similar size. The APA says homosexuality is normal. By this they mean that homosexuality is not a developmental disorder or indicator of a mental disorder. The two recent reports go off in different directions but some observations can be made.

The NARTH report spends lots of time reporting on greater levels of mental health and health problems among homosexuals as compared to heterosexuals. The APA report does not do this. However, I believe the point regarding different levels of symptoms would be stipulated by the APA. However, the APA raises the minority stress model as responsible for many difficulties faced by non-heterosexual people. The NARTH report discounts the role of stigma.

I doubt the APA would dispute the health status data for another reason: greater group pathology does not mean inherent disorder. The APA’s position is not that gays have equal health outcomes but rather that the unequal health outcomes do not imply inherent pathology – that SSA is not inherently the result of pathological development. This is of course in great contrast to the reparative therapists. Joseph Nicolosi says that the only way you get SSA is to traumatize a child.

The reparative impulse to find trauma behind every gay person is misguided I believe, conceptually and for sure empirically. Women have greater levels of mental health problems than men but we would not consider women inherently disordered. NARTH has chosen some good studies to cite in the section of their paper which relates to health status (as well as some really bad and irrelevant ones). However, I don’t think it really gets them where they want to go.

And where do they want to go? This is clear from their press release complaining about the APA task force report. They state:

Further, if some clients are dissatisfied with the therapeutic outcome [of reorientation therapy], as in therapy for other issues, the possibility for dissatisfaction appears to be outweighed by the potential gains. The possibility of dissatisfaction also seems insignificant when compared to the substantial medical, emotional, and physical risks associated with homosexual behavior.

NARTH would suggest that these medical and emotional risks, along with the incongruity of homosexual behavior with the personal and religious values of many people will continue to be the motivation for some individuals to seek assistance for their unwanted homosexual attraction.

According to NARTH, gays ought to seek reorientation therapy because being gay is a risky life, full of health and mental health disadvantages. Their hypothesis is implied but hard to miss: reduce the SSA and reduce the health risks. The assumption appears to be that ex-gays will have better health outcomes than gays. One problem with this line of thinking is that there is no empirical evidence for it and some evidence against it.*

One researcher quoted in the NARTH paper regarding health risks was New Zealand’s David Fergusson. Dr. Fergusson has done significant work in this field. I asked him to look at the section of the NARTH paper in which his work was quoted. Here is a statement he provided about it:

While the NARTH statement provides a comprehensive and accurate analysis of the linkages between sexual orientation and mental health, the paper falls far short of demonstrating that homosexuality should be classified as a psychiatric disorder that may be resolved by appropriate therapy. To demonstrate this thesis requires an in depth understanding of the biological and social pathways that explain the linkages between homosexual orientation and mental health. At present we lack that understanding. Furthermore it is potentially misleading to treat what may be a correlate of mental disorder as though it were a disorder in its own right.

Fergusson also told me that one would need to develop studies to demonstrate that any changes in orientation associate with improvements in health status. The Jones and Yarhouse study provide some very general assessment but many potential confounds are uncontrolled. For instance, it is not possible to say that the modest shifts on the Kinsey scale were responsible for the shifts in health status. These folks were quite religious and religion is associated with enhanced health status. I suspect religious gays have a better health status than non-religious gays, on average. The point is we do not have evidence that sexual orientation status per se is what leads to the differences in health status.

While I am on the subject of health status, I need to mention that there are other factors which NARTH ignored. One, gender non-conformity is strongly correlated with adult homosexuality and is also associated with poorer mental health. Two, homosexuals report higher levels of sexual victimization which is also associated with higher levels of mental health problems. And, three, no one can discount the possibility that biological factors which associate with the development of homosexuality may also influence the development of emotional problems (i.e., in the same way women are more likely to report depression than men).

So where are we? I hope we have a larger middle and smaller numbers of people at the opinion extremes. People on both sides can agree that erotic responsiveness is extremely durable for men and perhaps less so for women, but behavior and self-identity reflection is alterable. People on both sides agree that conclusions about benefit and harm are not possible in any general sense. Also, I hope we can agree that full informed consent should be conducted prior to engaging in counseling. Regarding health status, both sides can agree that homosexuals have higher levels of problems but there is little agreement about what the differences mean.

Those on the far sides of the continuum will continue to argue that change is possible or change is impossible, and/or that reorientation is always harmful or never harmful and/or that health status difference mean something vital or irrelevant about inherent pathology.

The wars will continue but perhaps fewer people will be engaged in them; now is the time rather to reason together.

*Nottebaum, L. J., Schaeffer, K. W., Rood, J., & Leffler, D. (2000). Sexual orientation—A comparison study. Manuscript submitted for publication. (Available from Kim Schaeffer, Department of Psychology, Point Loma Nazarene University, 3900 Lomaland Drive, San Diego, CA 92106) – In this study, the authors found that mental health was better among the gay sample than the Exodus sample.

Love Won Out transitions to Exodus International

This just in…

The Associated Press has a story on topic…

Focus on the Family’s conference on homosexuality joins Exodus’ expanding church outreach

Orlando, FL. — Focus on the Family’s Love Won Out conference on homosexuality will be moving to Exodus International starting November, the longtime allies announced today. The move is a logical step not only for both organizations, but also for a movement that has educated and equipped Christians for decades about the reality that unwanted same-sex attractions can be overcome.

Exodus is making church education a priority effort. Recently, Exodus announced it was merging with outreach ministries of the Presbyterian and Reformed faith communities as well as The United Methodist Church. Those new partnerships will focus on equipping churches with a biblical perspective of sexuality and gender – efforts critical in continuing the original mission of the Love Won Out conference.

“Exodus is thrilled with this opportunity as the Love Won Out conference is a natural fit in our ongoing efforts to share the hope we’ve found,” said Alan Chambers, President of Exodus International. “Love Won Out has been and will continue to be a powerful event dedicated to helping the global Christian church better understand and more effectively reflect biblical truth and Christ-like compassion to a hurting world.”

Focus on the Family launched Love Won Out in 1998 to educate and equip Christians on how to respond to the issue of homosexuality in a biblical way, and has traveled to more than 50 cities worldwide with its message of truth and grace. The conference has always featured Exodus speakers and highlighted Exodus member ministries.

“There is no one better equipped to take over the operation of Love Won Out than Alan and his team,” said Focus on the Family’s Melissa Fryrear, a Love Won Out speaker and host for more than six years. “They have been with us since the beginning. They have stood alongside us in sharing the hope that, with Christ, transformation is possible for those unhappy with same-sex attractions. And we will stand alongside them as they continue to share that message as the organizer of Love Won Out.”

Focus on the Family’s gender team will continue its efforts tracking and analyzing homosexuality and its surrounding issues, as well as providing expert support to other Focus departments and practical help to its constituents.

Gary Schneeberger, vice president of media and public relations for the ministry, acknowledged that financial realities played a role in the conference’s transition to Exodus.

“Everyone knows these are challenging times for organizations and individuals all across the globe,” he said. “It is not an inexpensive undertaking to put on a Love Won Out event; and contrary to what our detractors say, the conferences rarely have recouped the financial investment made in them. That is a cost we have always paid because of the positive impact the events have had.

“With Exodus moving aggressively to strengthen its church outreach, though, they are the ones who ought to be shepherding Love Won Out as it continues on in its second decade. Our financial challenges have led us to recognize a strategic opportunity that makes sense independent of economic circumstances.”

Focus on the Family will continue to support the Love Won Out conference financially, and by providing speakers and marketing support. “Focus remains very committed to sharing biblical view of homosexuality,” said Fryrear. “After all, we’re still in the truth and grace business.”

Focus on the Family will lead its last Love Won Out conference in Birmingham, Ala. on Nov. 7.

The Washington Blade already has a story up about the move.

Get Religion discusses media coverage of the APA report

The Get Religion blog has two entries up today discussing media coverage of the APA sexual orientation and therapy report. The first one deals with the articles by the Associated Press, Washington Times, and Baptist Press.

The second one hearts the Wall Street Journal article by Stephanie Simon which discusses the sexual identity therapy framework and the APA report.

FYI

Cooking up an easy way to make a big impression on health care reform

How to be organized without really looking organized.

This came today:

Friend —

All throughout August, our members of Congress are back in town. Insurance companies and partisan attack groups are stirring up fear with false rumors about the President’s plan, and it’s extremely important that folks like you speak up now.

So we’ve cooked up an easy, powerful way for you to make a big impression: Office Visits for Health Reform.

All this week, OFA members like you will be stopping by local congressional offices to show our support for insurance reform. You can have a quick conversation with the local staff, tell your personal story, or even just drop off a customized flyer and say that reform matters to you.

We’ll provide everything you need: the address, phone number, and open hours for the office, information about how the health care crisis affects your state for you to drop off (with the option of adding your personal story), and a step-by-step guide for your visit.

According to our records, you live near Sen. Arlen Specter’s office in Pittsburgh, PA.

Sign up now to visit Sen. Arlen Specter’s office in Pittsburgh this week.

(Not your representative, or think there might be another office that’s easier for you to get to? Click here to find a different office.)

As you’ve probably seen in the news, special interest attack groups are stirring up partisan mobs with lies about health reform, and it’s getting ugly. Across the country, members of Congress who support reform are being shouted down, physically assaulted, hung in effigy, and receiving death threats. We can’t let extremists hijack this debate, or confuse Congress about where the people stand.

Office Visits for Health Reform are our chance to show that the vast majority of American voters know that the cost of inaction is too high to bear, and strongly support passing health reform in 2009.

Don’t worry if you’ve never done anything like this before. The congressional staff is there to listen, and your opinion as a constituent matters a lot. And if you bring a friend, you’ll have more fun and make an even greater impact.

Click below to sign up for an Office Visit for Health Reform:

http://my.barackobama.com/OfficeVisit

Wherever you live, these visits matter: Many representatives are pushing hard toward reform, and they are taking a lot of heat from special interests. They deserve our thanks and need our support to continue the fight. But those who are still putting insurance companies and partisan point-scoring ahead of their constituents must know that voters are watching — and that we expect better.

Earlier this week, the President wrote that “this is the moment our movement was built for” and asked us all to commit to join at least one event this month. This is the way to answer that call, and rise to the challenge of this moment together.

Thank you for going the extra mile when it matters the most,

Mitch

Mitch Stewart

Director

Organizing for America

When people opposed to the President’s health care reform plan show up to town hall meetings, they are minions of big insurance. When his supporters show up, they are constituents.

Please be sure to send this post to flag@whitehouse.gov