Nick Cummings USA Today Article on Reorientation Therapy

A couple of readers asked me to comment on Nick Cummings USA Today column on reorientation therapy. With some caution, I think it would be good to do so.
First I want to say that I have always liked and admired Nick. His work in managed behavioral health care was pioneering. In the 1980s, Nick promoted the idea that excellent clinical services could save businesses a lot of money and actually expand access to therapy. He was correct and helped create modern managed behavioral healthcare, which is essentially the dominant system today. In addition to the new business strategies that Nick’s company (American Biodyne) innovated, Nick was/is a gifted clinician and trainer. I learned a lot from Nick about therapy as a Biodyne clinician in the mid-1980s. I will always be grateful for his influence on me at that time.
Nick is an admirable gentleman in many ways. He seems to be indestructible and maintains an ambitious and rigorous schedule into his older age. He also reads and studies Greek (another area of common interest) and has developed a cooperative program with China that is helping to shape their behavioral health system.
Having declared a sincere admiration for Nick, I have to add that we disagree about his recent push to defend reorientation therapy as a modality. Nick is an endorser of the Sexual Identity Therapy Framework and I have heard him promote the ideals we support.  Thus, I know that any person who sought change therapy from him would not get the usual reparative therapy explanations for homosexuality, nor would religion be used as a coercive tool. In other words, I don’t believe Nick wishes to defend any and all approaches to change therapy; I think he wishes to defend the right of clients to arrange their lives and seek help to do it. However, it is dismaying that his defense comes in the context of  the JONAH’s court case. Much of what is done in the name of reorientation cannot be defended.
One area Nick and I disagree about is how much to emphasize the role and importance of bisexuality. Nick once told me that clients who had no prior heterosexual experience were not successful in changing orientation and so over time, the Kaiser-Permanente therapists discouraged orientation change for those clients. To me, this suggests that many of those “changed” clients were bisexuals who found ways to live with or minimize their same-sex attractions. Furthermore, to my knowledge, no one was discussing “spousosexuals” from 1959-1979. Some men and women are generally attracted to the same sex but spontaneously fall in love with one person of the opposite sex. Some of those successes could easily have been people who had the potential for that kind of fluidity. Another problem with relying on Nick’s data is that follow up was lacking for many of the clients. Nick is aware that some of his clients remained changed, but he does not have systematic data on the population.
If all reorientation therapists were like Nick, I doubt we would have the conflict and polarization we have seen over the past decade or so. I also doubt there is anybody currently vocally defending reorientation who practices as Nick did. Current reorientation therapists blame parenting and masculinity deficits for same-sex attraction, some of them put people through emotionally taxing and empirically questionable human potential exercises, still others attempt to coerce people with religion. My impression is that Nick and his crew did none of that. Certainly, in all of my dealings with American Biodyne, no one ever suggested any of that. The emphasis was always on helping the client find strategies to enhance mental health and live in accord with their aspirations.
Nick’s closing paragraph makes me think that he believes that there are some, perhaps many, therapists who work empirically and ethically with “fully informed persons.” This is where we disagree. The way reorientation is practiced as I have seen it and heard it described at various conferences and by various therapists in my travels during the last decade or so gives me no confidence that he is right this time.
Given those concerns, I continue to support the APA’s distinction between sexual orientation and sexual orientation identity; the former being durable once established and the latter being more subject to modification. I am skeptical there are many current reorientation therapists fully inform their clients about that distinction.

American Psychiatric Association’s DSM 5 draft is now available for review

The draft of the APA Diagnostic and Statistical Manual, 5th edition is now available for review and comment.  

A Message from the DSM-5 Task Force Chairs

Dear Reader,

Welcome to the DSM-5 Development Web site.  This site provides information culminated from over 10 years of revision activities, made possible thanks to the generous dedication of more than 600 global experts in the field of mental health. 

The DSM-5 Task Force and Work Group members are working to develop criteria for diagnoses that not only reflect new advances in the science and conceptualization of mental disorders, but also reflect the needs of our patients. We encourage you to delve into the wealth of information contained within this site to become familiar with some of the advancements in scientific and clinical knowledge that will assist in making diagnoses more accurate, valid, and clinically useful.  We also hope that this knowledge will pave the way for further research in these important areas. 

Your input, whether you are a clinician, a researcher, an administrator, or a person/family member affected by a mental disorder, is important to us.  We thank you for taking part in this historic process and look forward to receiving your feedback. 

David J. Kupfer, M.D., DSM-5 Task Force Chair

Darrel A. Regier, M.D., M.P.H., DSM-5 Task Force Vice-Chair

Sure to be controversial, the Task Force will accept comments until April 20. I will accept comments starting now and never ending…

APA Monitor on the APA sexual orientation and therapy report

The current American Psychological Association Monitor briefly reports on the August report from the Task Force on Appropriate Therapeutic Responses to Sexual Orientation. Not much new here for regular readers of the blog. The big news in my view was the treatment of religion which did not get as much coverage as the discouragement of change therapies.

The article ends with quotes from NARTH’s Julie Hamilton and me.

Warren Throckmorton, PhD, an associate professor of psychology and fellow at the Center for Vision and Values at Grove City College in Grove City, Pa., described the task force’s work as a “well-done effort.”  

“I felt the treatment of religion was very respectful, and in doing so, it created space for clients of conservative religious faith to explore the reality of their sexual orientation, while maintaining their faith commitments,” said Throckmorton, who researches sexual orientation and homosexuality and writes about such issues from a Christian perspective.

Julie Harren Hamilton, PhD, president of the National Association for Research and Therapy of Homosexuality (NARTH), said she appreciated what she described as the task force’s recognition that clients have a right to self-determination, and its respect for religious diversity. But she disagreed with the task force’s main conclusions, and charged that the task force was composed only of members opposed to sexual orientation change efforts. 

“We believe that if the task force had been more neutral in their approach, they could have arrived at only one conclusion, that homosexuality is not invariably fixed in all people, that some people can and do change,” she said.

 Some people may change something but there is little evidence which would allow more than guesses about what the potent elements in any such change might be. The NARTH review found that all kinds of approaches reported some degree of change. Can they all be right? In such a situation, a more plausible guess might be that there was some common element of the clients and/or the therapy that could be involved. And as Jones and Yarhouse suggested in the discussion section of their APA report, perhaps sexual identity is a better concept to consider when discussing categorical change. If someone shifts a Kinsey point or two, one might feel satisfied with this and justified in considering themselves to have changed.

As I have noted, the distance between opposing views may be narrowing significantly.

The APA report and the sexual identity therapy framework

The recent American Psychological Association task force report on sexual orientation and psychotherapy included several positive references to the SITF. I have archived those on the SITF website and am providing two here with brief commentary.

The abstract of the sexual identity therapy framework (SITF) says

Sexual identity conflicts are among the most difficult faced by individuals in our society and raise important clinical, ethical and conceptual problems for mental health professionals. We present a framework and recommendations for practice with clients who experience these conflicts and desire therapeutic support for resolution. These recommendations provide conceptual and empirical support for clinical interventions leading to sexual identity outcomes that respect client personal values, religious beliefs and sexual attractions. Four stages of sexual identity therapy are presented incorporating assessment, advanced informed consent, psychotherapy and sexual identity synthesis. The guidelines presented support the resolution of identity conflicts in ways that preserve client autonomy and professional commitments to diversity.

 

I think the APA report and the SITF are compatible in many important ways.  They both recognize the difference between attractions, behavior and identity. They both recognize that informed consent is critical and that client may seek congruence with other aspects of personality, other than sexual desire, a distinction made in this segment from page 18 of the APA report: Continue reading “The APA report and the sexual identity therapy framework”

The persistent rumor that the APA wants people to change churches

I addressed it here and now here but it continues.

This morning I read an article on the website of the National Catholic Register by Father Benedict Groeschel, host of Sunday Night Live on EWTN (Catholic network). Father Groeschel is laboring under a significant misunderstanding of the APA report when he writes:

On top of all that, in an almost bizarre ignoring of the purposes of his own discipline, one of the members of the task force that composed the report claimed that people who belong to religions that expect celibacy from the unmarried and monogamy from the married but find such expectations too difficult or onerous should simply change to a religion which requires less of them.

I should say I am pretty sure this is misinformation. I don’t know if a member of the task force speaking for him or herself might have said people should switch churches. I have not been able to find a quote to this effect. However, I do know the APA denied this intent and the APA report does not support the idea that a church switch would be promoted as some kind of easy way out for its own sake. Any switching would be done for reasons based in belief change and could go either direction – from gay affirming to non-affirming or vice versa.

How did Father Groeschel become misinformed? A familiar suspect appears later in the article.

It is necessary to register a strong objection to this recent statement. For valid and reasonable information I suggest the writings of an outstanding researcher and therapist in this area, Dr. Joseph Nicolosi, who has long been the inspiration behind the National Association for Research and Therapy for Homosexuality.

Recently, he was quoted in this newspaper pointing out that research used by homosexual activists shows that public opinion regarding homosexuality will change if people believe it is genetic. “To the extent people are not responsible,” said Nicolosi, “their behavior will be tolerated.” (See “Scientists Outing ‘Gay Gene’ Myth,” July 26-Aug. 8.)

More information regarding NARTH and Nicolosi’s work can be found at NARTH.com and JosephNicolosi.com.

I would strongly suggest that Register readers register their protest with the American Psychological Association for what amounts to an abuse of research and demand that the APA distance itself from this pseudoscientific presentation. For those interested, the website for the APA is APA.org.

I actually hope Register readers do contact the APA. When the APA responds that these charges are off the mark and refers people to the actual report, people will find they have been misled.

Guest blogging tomorrow at US News and World Report

Just a head’s up to watch for the tomorrow’s God and Country Blog at US News and World Report. Yours truly will have an article about the recent APA task force report and the contention that the APA advocates that conflicted people just switch churches if they can’t work out the conflict.

Check out the week’s other guest authors and thanks to host Dan Gilgoff for the opportunity.

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.

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

Jones and Yarhouse Exodus study follow up

This morning at the American Psychological Association annual convention, Stanton Jones and Mark Yarhouse are presenting their Time 6 and final follow up to the study of Exodus participants seeking change of orientation. The paper is titled, Ex Gays? An Extended Longitudinal Study of Attempted Religiously Mediated Change in Sexual Orientation. They are presenting these data as a part of a APA symposium titled Sexual Orientation and Faith Tradition Symposium chaired by Dean Byrd.

You can review the paper in full so I will only highlight a few points in the post.

The paper begins by recounting the skepticism toward change evinced by the professional mental health associations. Then, they note an important limit and hypotheses of the study:

Our study addresses the generic questions of whether sexual orientation is changeable, and whether the attempt is intrinsically harmful, by focusing only on the religiously mediated approaches to change; this is not a study of professional psychotherapy. Our hypotheses for this study were taken directly from the prevailing professional wisdom: We hypothesized 1) sexual orientation is not changeable, and 2) the attempt to change is likely harmful. We already cited the American Psychological Association’s (2005) claim that sexual orientation “is not changeable.” Regarding harm, our study was framed in light of the American Psychiatric Association’s (1998) claim that the “potential risks of ‘reparative therapy’ are great, including depression, anxiety and self-destructive behavior.” The tools of scientific study are ideally suited to investigate empirically such strong, even absolute claims.

I bolded the statement about the study not being an examination of psychotherapy because I predict that NARTH affiliated therapists and various religious conservative groups will not clearly communicate this point when messaging the results of this study. Despite the fact that Christian self-help groups are different than therapy as practiced by many psychodynamic therapists, I suspect some therapists will hope the public does not catch the distinction.

Now for some results. Retention is sure to be an issue as this study is discussed:

Retention. We began with 98 subjects at T1. Our sample eroded to 73 at T3, a retention rate of 74.5%. This retention rate compares favorably to that of respected longitudinal studies. 63 subjects were interviewed or categorized at T6, for a T1 to T6 6 to 7 year retention of 64%.

Kinsey scale changes:

Table 1

This table shows the shifts in Kinsey scale scores (7 is exclusively homosexual with 1 being exclusively heterosexual). You can see that the shifts on average were about a point on the scale – less than one for the entire group and more than one for the group which were deemed more gay identified at the beginning. Although statistically significant, this would not on average take the group to the straight side of the continuum but rather by considered bisexual by most observers.

They also used the Shively-DeCecco scale which asks participants to rand both same-sex attraction and opposite-sex attraction. As you can see below, the change reflected in the Kinsey moves was due to reductions in SSA and not increases in OSA.

Table 2

Regarding categorical self-assessments, Jones and Yarhouse report modest shifts.

Table 5

Regarding these changes, Jones and Yarhouse say:

Several results are particularly notable. Despite a smaller N for the T6 sample than at T3, we found growth in absolute size in the two Exodus “success” outcome groups moving from row 1 to row 3: Conversion cases grew from 11 to 14 and Chastity cases from 17 to 18. But the group that grew the most in absolute and proportional terms was Failure: Gay Identity which doubled in absolute size from 6 to 12. The percentage of those showing stability of outcome T3 to T6 (row 4) is greatest in columns 1 and 6: the Success: Conversion (73%) and Failure: Gay Identity (67%) categories, with slightly less in the Success: Chastity category (53%). Of the one subject each that shifted from the Success: Conversion and Failure: Gay Identity categories from T3 to T6, each moved to the Continuing category at T6. The largest absolute shift from T3 to T6 of those who participated in the T6 interview was a T3 Success: Chastity case that became a Failure: Gay Identity case; next largest was a Non-Response case at T3 that became a Success: Conversion case.

Most germane to our principal hypothesis that change of sexual orientation is not possible, 53% of the T6 sample of 61 cases that self-categorized (row 3) did so as some version of success, either as Success: Conversion (23%) or Success: Chastity (30%). At T6, 25% of the sample self-categorized as an Exodus failure (Confused or Gay Identity).

In my view, this means of description confuses success with change. Over half did describe some version of success but that is not the same as over half describing sexual orientation change. I will be interested to see how this is reported in the press.

The changes reported here are significant and no doubt welcomed by the people involved. However, they are not the types of changes which I suspect the various mental health groups mean by “sexual orientation change.” Whatever happened to the participants in this study, they do not appear to have gone from gay to straight — in the sense that people who have always been straight are straight. They have gone from gay to less gay and a bit more straight. I do not mean to suggest that this is not important information; it is. But I am wondering if anyone at APA would dispute the within category changes reported here. I am going to ask and will report what I learn.

Jones and Yarhouse seem to be aware that the results can be understood as a change in identity and not orientation. 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?

The entire section on identity and orientation in the discussion section of the paper is good reading. Finally, in light of the APA task force report, I wonder if the discussion section of the Jones and Yarhouse paper could be revisited. The APA report, while skeptical of categorical change, did not take a strong stance regarding harm. Actually, the APA report and the Jones and Yarhouse paper agree on the inconclusive nature of the evidence on that question.