Spontaneous change compared to therapeutically mediated change

Something has been bothering me, running around in my head since I did the brief series of posts on Dean Byrd’s review of LDS book, In Quiet Desperation (here, here and here).

In their review of Ty Mansfield’s book, Byrd et al make this statement:

The book inadvertently limits the power of the Atonement in the lives of people who struggle with homosexual attraction. As professionals with many combined years of practice in treating those with unwanted homosexual attraction, we have witnessed changes in the lives of many of these individuals, and the epiphanies have been many.

Like all emotional challenges, the outcome data has ranges of success. What is clear is that when the same standard applied to treatment outcomes of similarly situated difficulties is applied to the treatment outcomes of those with unwanted homosexuality, the results are remarkably similar. There is much in the professional treatment protocols that are compatible with the restored gospel. Appropriate professional help along with the healing powers of the gospel have repeatedly convinced us that there is no struggle for which the Atonement is not sufficient.

There are several things that bother me about these two paragraphs, but for now I want to focus on this sentence:

What is clear is that when the same standard applied to treatment outcomes of similarly situated difficulties is applied to the treatment outcomes of those with unwanted homosexuality, the results are remarkably similar.

Despite a claim of clarity, nothing is particularly clear to me about treatment outcomes for “unwanted homosexuality.” It is not clear to me what other conditions are “similarly situated” in comparison to same-sex attraction. This was not explained.

However, my thoughts about outcomes ran to the studies reported in the NARTH literature review of sexual reorientation, the Jones and Yarhouse study and the usual reparative therapy contention that change results were along a continuum – one-third dramatically changed, one-third somewhat changed and one-third not changed. However, whatever numbers one likes, one cannot put it in context without a control or comparison situation. Another term for this in this context is spontaneous remission. Don’t some people change in various ways for reasons unrelated to therapy?

Certainly that is the case for other situations which are the proper focus of therapy. Note this abstract for a study of improvement rated by patients at a community mental health center in Utah.

It was hypothesized that outpatient psychotherapy in a mental health center would result in an improvement rate of 65% or more, a spontaneous remission rate of 36% or less, and a difference of at least 29% from gain in improvement due to therapy. The analysis of 201 follow-up questionnaires supported all three hypothesis. A five-year follow-up questionnaire provided evidence for external validity in the form of a correlation between original improvement rate and subsequent need for outpatient treatment and inpatient treatment. The results were interpreted as being significant evidence for the efficacy of psychotherapy and for the validity of self-report method of measuring improvement and spontaneous remission.

Note that the rate of improvement was significantly higher than expected based on a spontaneous improvement rate of 36% or less. The authors had reasons to predict this rate and took it into account when assessing the meaning of a 65% improvement rate overall. 

My point is not to compare sexual reorientation to mental health improvement near Salt Lake City, Utah. However, I want to raise the issue that considering spontaneous improvement is important when one is communicating the meaning of changes reported without a control group. There are a couple of studies which have looked at spontaneous change, although none would be directly comparable to any current studies of sexual reorientation. Diamond found spontaneous change in her study of 100 women. In 2005, Kinnish, Strassburg and Turner reported varying levels of sexual orientation flexibility in the Archives of Sexual Behavior. Their report found that 19% of men and 17% of women in their sample moved in a heterosexual direction (from gay to bisexual,  or bisexual to straight — none went from exclusively gay to exclusively straight). In 2003, Dickson, Paul and Herbison reported spontaneous change in a New Zealand cohort. The chart of movement can be viewed here. Note that 5 of 15 went from some same-sex attraction to only heterosexual attraction and none from “major attraction to the same sex” to straight.  

While these studies are suggestive, they cannot be directly compared to existing studies of sexual reorientation.  However, the fact that some men with some same-sex attraction and many women might shift spontaneously should be taken into account when thinking about the role of therapy in mediating sexual orientation change.

The Dickson study is intriguing in that the results can be interpreted as supporting the existence of different types of homosexual orientation. About their results, the authors note in the abstract:

These findings show that much same-sex attraction is not exclusive and is unstable in early adulthood, especially among women. The proportion of women reporting some same-sex attraction in New Zealand is high compared both to men, and to women in the UK and US. These observations, along with the variation with education, are consistent with a large role for the social environment in the acknowledgement of same-sex attraction. The smaller group with major same-sex attraction, which changed less over time, and did not differ by education, is consistent with a basic biological dimension to sexual attraction. Overall these findings argue against any single explanation for homosexual attraction.

To me, this is a reasonable hypothesis. I believe there are multiple pathways to adult sexual orientation and for some, apparently the social context means more than for others. Also, for some the trait may continue to shift around through life with changing circumstances, yet for others, not at all.

UPDATE: In an odd attack piece, the gay website Queerty reads this post (actually the Crosswalk version) as a kind of strange defense of change therapies or change of orientation in general.  A commenter named Timothy (is it our Timothy?) gets the point, but whoever writes for them and the commenters thus far over there are clueless.

36 thoughts on “Spontaneous change compared to therapeutically mediated change”

  1. Hey, Michael. I very much enjoyed our conversation, too. Yes, let’s both tend the whole garden.

    Folks, I just want to say that Michael and I have realized that there is a right and a wrong way to engage each other in this or any other forum, and we had a pleasant talk about a host of things near and dear to our hearts. The garden allusion here is to a wonderful devotional reading Michael shared with me.

    We have agreed the quest for the exclusively gay-to-straight male can be put on a shelf, at least for our purposes here.

  2. Debbie, just got through talking to you by phone. Totally enjoyed it! I will take your advice, and focus on “tending the garden” instead of “chipping away at the rock.” 🙂

  3. Temptation and orientation aren’t just ‘different words for the same thing’ though. ‘Temptation’ is normally viewed as coming at the spirit from the outside (the world, the flesh, the devil) while ‘orientation’ is normally viewed as coming from within (God-given created status). ‘Temptation’ is incidental. It might be a lot of recurring incidents but it is incidental. ‘Orientation’ suggests that it is who you are.

  4. Sorry, typos. I meant to type:

    You guys call the same sex attraction “temptation” — and admit it’s lifelong. Since I do not believe gayness is sin, I think of the SSA as “orientation” — and also believe is it lifelong.

  5. Thanks, my thinking can be “entrenched”. As I hope you know, I do not mean to be contrary — or to impose some sort of standard that everyone must accept their gayness or be completely clear of it.

    You guys call the same sex attractrion “temptation” — and admit it’s lifelong. Since I do not believe gayness is sin, I think of the SSA as “reorientation” — and also believe is it lifelong.

    As I have said many times, I don’t think SSA beomes OSA for men. I think some SSA men may shift somewhat towards some OSA — but that they are not “straight” in the common sense of that word.

    I do believe that SSA men can and do change many OTHER things — identity, lifestyle, behavior, attitudes, beliefs, etc. in ways that are profound and life-changing for them. Warren has referred to this process as “reframe and resist”, not “remove and reorient”.

    It would be very cool, I suppose, if someone actualy DID make the complete change I am talking about — but if they are at peace in their walk with the Lord, more power to them!

    I have no axe to grind with them — it’s the organizations who continue to boldly exclaim “YOU DON’T HAVE TO BE GAY!!!” without adding “but you probably do remain SSA, not OSA”. In others words, “You don’t have to be gay but your attractions probably do…”

    I see the terms “gay” and “exclusively SSA” as synonyms. I know “you guys” see “gay” as meaning something else. So one can still be “exclusivley SSA’ and not be “gay”. To me, it’s a distinction withou a difference.

    I have said before that “can gays change?” depends on what you mean by “gay” and what you mean by “change”. If “gay” is an identity and lifestyle, then of course gays can change. If we are talking about the attractions to one gender or the other, I stand my ground. Gay men do not seem to become straight men.

    If Jesus Christ appeared to you today and said, “Michael, you’re gay and here’s why. Deal with it, but trust me to move you somewhere closer to wholeness,” would that matter?

    In a way Debbie, He has. Of courtse it matters! He knows I am gay. Only He knows what “caused” it. I do trust Him to bring me closer to wholeness as he promised us. You and just define “wholeness” differently.

  6. Sure, Michael. We should give the blog readers the benefit of a summary, though. And then be done with it. You know I believe that you love the Lord, though we have theological differences. You have lived as a gay man for a long time. So, your thinking is entrenched in ways that mine never was.

  7. Debbie, would you be willing to chat off line? I want to answer all of your questions. We come from two such divergent viewpoints that I am having trouble typing it all out.

  8. I am saying that I do not believe that gay men turn into straight men – that exclusively SSA males becomes exclusively OSA males.

    Can we just let Michael have his belief here? I know this Johnny One Note thing drives some of us nuts, but what concerns me more is why, Michael, you insist on there being such an individual as an exclusively SSA male turned exclusively OSA. What if such a thing were really not possible? What would it prove for you? Would it give you the elusive peace to accept yourself you have apparently never found?

    If Jesus Christ appeared to you today and said, “Michael, you’re gay and here’s why. Deal with it, but trust me to move you somewhere closer to wholeness,” would that matter? In reality, he has said that through the whole of God’s Word.

    Why must you insist on this one path — exclusive heterosexuality — for SSA men? What person who has worked, prayed and rested in Jesus’ arms to overcome any problem or sin in life never again identifies with or is tempted by that very thing? Who ever becomes completely whole in the eyes of the world? You are setting up a false construct meant to except gays from the truth that applies to all humanity, and it invalidates the debate.

  9. This is much like my search for the ‘truly monogamous’ gay couple…the ones that have no other sex partners and never did.

  10. Debbie and Mary:

    Not mis-representing anthing. I am not saying that “gays can’t change” anything about their lives or that some gays don’t change some things to some degree. I know gays can and do change many things about their lives. I have never said they don’t.

    I am not talking about you. If you tell me you were once exclusively SSA and are now exclusively OSA, I would believe you. I am not talking about women.

    I am saying that I do not believe that gay men turn into straight men — that exclusively SSA males becomes exclusively OSA males.

    It’s not “nit-picking”. It’s a fact. I have never men one. Not one. Ever. Period. When I do, I will print a very PUBLIC apology. Not saying that Bigfoot doesn’t exist — just that we haven’t caught one yet.

  11. Thank Freud, postmodern theologians and the Devil — not necessarily in that order — for this endless debate and witless nitpicking over whether or not people can change.

  12. Michael,

    You are so easy! What you did is just prove that those who did not change are willing to misrepresent the whole group. Because as we can prove right here and now is that

    1) You went on to live as a gay man

    2) A commenter here still has SSA and decided to live a life congruent with his beliefs, and

    3) Some people (that would be me) change

    Michael: you have proVEN THAT THERE ARE GAY PEOPLE WHO ARE MISREPRESENTING THE TRUTH. You did it right here.

    As well, someone like me will also be here to say that people change. Yes, people do change from gay to straight. And there are gay people who don’t want the truth to get out.

  13. Mary. I go down this road and will continue to do so in case there are new readers here who read “gays can change” and wrongly assume that means from gay to straight. Consider me a product disclaimer. 🙂

  14. Mary–

    I also considered a number of responses to Michael’s question(s)…I also wondered ‘how many times do we go down this road’. The answer is that we choose by our responses whether we’re going to go down that road or not. I know it’s difficult but you don’t HAVE to engage. Michael’s questions don’t HAVE to be answered. They can stand as unique rhetorical questions…unique in the sense that one side will focus on the labels and categories as expressed in ‘From what to what?’…and the other side, that rejects the rigid labels, will see ‘dramatic change’ in a context without boxes and labels. If you simply let them stand as rhetorical, Michael has been able to give voice to his opinion on that aspect of the topic but the conversation doesn’t have to shift to focus there.

  15. Michael,

    Here we go again. How many times do we go down this road? Change means something different to everyone since this is a very personal journey. I think the only way you are going to define that is by asking each individual. And I highly doubt they are going to come out and answer your questions. Many folks just work on this issue and then quietly go back to living their life. Some will live as gay, some will live with persistent SSA feelings and in congruence with their beliefs, some will change completely.

  16. As professionals with many combined years of practice in treating those with unwanted homosexual attraction, we have witnessed changes in the lives of many of these individuals, and the epiphanies have been many.

    Once again, it all depends on what you mean by “change”. To “witness changes in the lives of many” is not the same thing as going from gay to straight.

    The 2005, Kinnish, Strassburg and Turner report found that 19% of men and 17% of women in their sample moved in a heterosexual direction (from gay to bisexual, or bisexual to straight — none went from exclusively gay to exclusively straight).

    The 2003, Dickson, Paul and Herbison reported … “that 5 of 15 went from some same-sex attraction to only heterosexual attraction and none from ”major attraction to the same sex” to straight.

    Once again, women seem to be more flexible than men in sexual attraction, bisexuals more flexible than homosexuals, etc. Nothing new there.

    Warren noted that: “…change results were along a continuum – one-third dramatically changed, one-third somewhat changed and one-third not changed” — did anyone define “dramatically changed”? Dramatically changed how? From what to what?

  17. Sorry, the embedded video of Dr. Lisa Diamond didn’t come through. Lisa caught a glimpse of “spontaneous” change in some of her papers. Sorry for the confusion.

  18. Debbie Thurman ~ Sep 22, 2009 at 6:35 pm

    I’m having difficulty in understanding what you are saying here.

    No you’re not.

    [sigh]

    I really wasn’t sure what your point was and was asking for clarification. But at this point perhaps its best that we do not discover or discuss the meaning of your comment.

  19. Hey—why didn’t that turn into a smiley face? Is it the lack of a space after the final letter of ‘influence’?

  20. I also found the comments from Dickson abstract to be of interest. I’d be interested in more studies that examine what influence social environment (and, of course, media influence:-) ) can have on sexual identity or orientation.

  21. I really can’t help but think a lot of these social stats on sexual behavior, sexual identification are kinetic and adjusting through time and cultural shifts. For example, when we document something 20 years ago – trying to compare that to today’s cultural or “social contructs” we have a different picture of how people view themselves and their place in society.

    If we look at sexual habits and trends over the last few decades we can see patterns just among heterosexuals. I would assume that this has as much to do with a person’s perspective of themselves as does trends in homosexuality and “change” or re-orientation. I think people really do and can change sexual habits and patterns as time moves on. No big deal – until it becomes a political battle for rights and privileges etc …. Then we make it something entirely different. An inborn orientation that is fixed. I understnad the logic of going down that path to gain personal rights etc… but it just does not seem to fit the data especially where women are concerned.

  22. I dunno. They are finding more and more about the brain activity and addiction to the pleasure senses with gambling, hoarding etc… sex included.

  23. @ Warren,

    These numbers seem higher than the reorientation numbers…

    These numbers have to do with behaviors…not sensations. Unfair comparison.

  24. Offhand, I can think of two ‘natural’ reasons why the gambling numbers are higher than reorientation.

    1) The gambling impulse is not wired into that biological mechanism we call ‘the sex drive’. (Whether gay, straight or celibate…there’s the drive itself to contend with.) If memories of sexual sensation are all gay, when the drive speaks up…that’s all the person has to work with. Further, if they’re not sure what non-lustful heterosexuality is, they’ll resist going therevia masturbation or otherwise. (LOL. I’ve posed questions about that dilemma a few times…to no avail.)

    2) The gambling impulse does not have a horde of naysayers questioning whether you should really quit or not…it doesn’t have people telling you you’ll likely go crazy if you try to quit… questioning your very sanity and ridiculing your ‘rigid religious beliefs’…it doesn’t have ‘growing numbers’ coming out in support of the behavior. What might the possible impact of these demotivators be? (Even after all these years, I have good-meaning friends and family members who tell me they think they’ve found a good man for me. I’ve questioned them about this asking if I seem to be unhappy or unfulfilled..’No…everyone should have someone…who will look after you when you’re older?’…that was the most recent. The most common is something a number of readers here will find unimaginable…that I’m so witty, funny, fun-loving, hard-working and intelligent…that I’m depriving someone of the joy of having me.)

    Anyway, I believe that when you add these two factors to the mix of normal temptation, times of stress–and challenges to self-image, you can tip the scales.

  25. Eddy – Byrd et al may have indeed been referring to addictions or problematic behavioral concerns. Here is an outcome study of gambling:

    The Iowa Gambling Treatment Program (IGTP) amassed participant data for gamblers and concerned others of gamblers over 4 years (1997–2001). Data collection opportunities included: (1) crisis contacts, (2) placement screening, (3) admission, (4) treatment services, (5) discharge, and (6) follow-up. Among followed gamblers, 74% of treatment completers, 49% of substantial treatment completers, and 36% of dropouts and referrals were abstaining from gambling at 6-month follow-up. The reduction in dollars lost to gambling was similar; 85% of treatment completers, 88% of substantial treatment completers, and 65% of others reduced their dollars lost per week. Although more extensive follow-up efforts are needed to properly evaluate the effectiveness of the IGTP, these results suggest that the IGTP shows promise.

    I like what the first few paragraphs of this study say about outcome research. When does a pound of anecdote yield an ounce of truth? That is a keeper and illustrates nicely the predicament we are in when trying to discuss reorientation. We clearly have several tons of anecdotes.

    Why is it important to study and evaluate treatment outcomes? The first principle of medical ethics is to do no harm. This maxim exists because the best of intentions can lead to treatment efforts that inadvertently and unintentionally stimulate adverse consequences. A similar and equally simple premise dictates the need for program evaluation: despite the best of intentions, unless a program is evaluated, we do not know whether it is producing positive, neutral, or negative results. It is easy to assume that the outcome of a gambling treatment program will be obvious and straightforward; people frequently use anecdotal information to support the value of treatment programs. However, we must ask, ‘‘When does a pound of anecdote yield an ounce of truth?’’

    These numbers seem higher than the reorientation numbers…

  26. Just as the Church has a hard time focusing on and talking about its bugaboos — porn, sexual promiscuity and adultery, sexual abuse, wife-bashing, gambling and chemical dependencies — so the gay community is hard-pressed to address its peculiarities and human failings, from the unmentionable in polite company to the same stuff the rest of the world deals with (see above list).

    Debbie,

    I’m having difficulty in understanding what you are saying here. Could you clarify?

  27. Just as the Church has a hard time focusing on and talking about its bugaboos — porn, sexual promiscuity and adultery, sexual abuse, wife-bashing, gambling and chemical dependencies — so the gay community is hard-pressed to address its peculiarities and human failings, from the unmentionable in polite company to the same stuff the rest of the world deals with (see above list).

    Oh, and cover all of the above with a blanket of depression and anxiety, which we are much more open about addressing these days. Pick your poison of choice. Like me, you can simply neglect to mention the dirty, little secrets to your therapist or — God forbid — your pastor or best friend for years, while you are getting help for “depression.”

  28. Warren–

    What is clear is that when the same standard applied to treatment outcomes of similarly situated difficulties is applied to the treatment outcomes of those with unwanted homosexuality, the results are remarkably similar.

    When you consider that this sentence was sandwiched between talk about Atonement and Gospel remedies, my hunch is that ‘similarly situated difficulties’ probably refers to that other LDS–Life Dominating Sin. I think they were trying to avoid some landmines by not specifically mentioning the ‘difficulties’ because most of them are seen as ‘addictive behaviors’. While homosexuality is not an addictive behavior, it does (or can) share the distinction of being ‘life dominating’.

    In this sense it can be seen and treated similarly to smoking, overeating, gambling, drinking to excess…and expectations ought to be the same. (Code for: just as people with these difficulties experience an occasional hankering for the old behavior, the same should be expected for those with unwanted homosexuality…just as times of personal stress or challenges to the basic sense of self worth provoke renewed and/or intensified desires for the old behavior, the same is likely for those with unwanted homosexuality.) Success ought to be measured by the self-control, in the learning and personal growth, in the lessening of the dominion of the unwanted behavior and/or desires.

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