Category: APA

Press release: APA Task Force on Appropriate Therapeutic Responses to Sexual Orientation Report

The APA released the report from the Task Force on Appropriate Therapeutic Responses to Sexual Orientation today. This post is the APA press release, I also have an analysis of the report and another post coming with press reports.

APA PRESS RELEASE

August 5, 2009

Contact: Kim Mills

(202) 336-6048 until Aug. 5

(416) 585-3800 – Aug. 5-9

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INSUFFICIENT EVIDENCE THAT SEXUAL ORIENTATION CHANGE EFFORTS WORK, SAYS APA

Practitioners Should Avoid Telling Clients They Can Change from Gay to Straight

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TORONTO—The American Psychological Association adopted a resolution Wednesday stating that mental health professionals should avoid telling clients that they can change their sexual orientation through therapy or other treatments.

The “Resolution on Appropriate Affirmative Responses to Sexual Orientation Distress and Change Efforts” also advises that parents, guardians, young people and their families avoid sexual orientation treatments that portray homosexuality as a mental illness or developmental disorder and instead seek psychotherapy, social support and educational services “that provide accurate information on sexual orientation and sexuality, increase family and school support and reduce rejection of sexual minority youth.”

The approval, by APA’s governing Council of Representatives, came at APA’s annual convention, during which a task force presented a report that in part examined the efficacy of so-called “reparative therapy,” or sexual orientation change efforts (SOCE).

“Contrary to claims of sexual orientation change advocates and practitioners, there is insufficient evidence to support the use of psychological interventions to change sexual orientation,” said Judith M. Glassgold, PsyD, chair of the task force. “Scientifically rigorous older studies in this area found that sexual orientation was unlikely to change due to efforts designed for this purpose. Contrary to the claims of SOCE practitioners and advocates, recent research studies do not provide evidence of sexual orientation change as the research methods are inadequate to determine the effectiveness of these interventions.” Glassgold added: “At most, certain studies suggested that some individuals learned how to ignore or not act on their homosexual attractions. Yet, these studies did not indicate for whom this was possible, how long it lasted or its long-term mental health effects. Also, this result was much less likely to be true for people who started out only attracted to people of the same sex.”

Based on this review, the task force recommended that mental health professionals avoid misrepresenting the efficacy of sexual orientation change efforts when providing assistance to people distressed about their own or others’ sexual orientation.

APA appointed the six-member Task Force on Appropriate Therapeutic Responses to Sexual Orientation in 2007 to review and update APA’s 1997 resolution, “Appropriate Therapeutic Responses to Sexual Orientation,” and to generate a report. APA was concerned about ongoing efforts to promote the notion that sexual orientation can be changed through psychotherapy or approaches that mischaracterize homosexuality as a mental disorder.

The task force examined the peer-reviewed journal articles in English from 1960 to 2007, which included 83 studies. Most of the studies were conducted before 1978, and only a few had been conducted in the last 10 years. The group also reviewed the recent literature on the psychology of sexual orientation.

“Unfortunately, much of the research in the area of sexual orientation change contains serious design flaws,” Glassgold said. “Few studies could be considered methodologically sound and none systematically evaluated potential harms.”

As to the issue of possible harm, the task force was unable to reach any conclusion regarding the efficacy or safety of any of the recent studies of SOCE: “There are no methodologically sound studies of recent SOCE that would enable the task force to make a definitive statement about whether or not recent SOCE is safe or harmful and for whom,” according to the report.

“Without such information, psychologists cannot predict the impact of these treatments and need to be very cautious, given that some qualitative research suggests the potential for harm,” Glassgold said. “Practitioners can assist clients through therapies that do not attempt to change sexual orientation, but rather involve acceptance, support and identity exploration and development without imposing a specific identity outcome.”

As part of its report, the task force identified that some clients seeking to change their sexual orientation may be in distress because of a conflict between their sexual orientation and religious beliefs. The task force recommended that licensed mental health care providers treating such clients help them “explore possible life paths that address the reality of their sexual orientation, reduce the stigma associated with homosexuality, respect the client’s religious beliefs, and consider possibilities for a religiously and spiritually meaningful and rewarding life.”

“In other words,” Glassgold said, “we recommend that psychologists be completely honest about the likelihood of sexual orientation change, and that they help clients explore their assumptions and goals with respect to both religion and sexuality.”

A copy of the task force report may be obtained from APA’s Public Affairs Office or at http://www.apa.org/pi/lgbc/publications/therapeutic-response.pdf.

Members of the APA Task Force on Appropriate Therapeutic Responses to Sexual Orientation:

Judith M. Glassgold, PsyD, Rutgers University – Chair

Lee Beckstead, PhD

Jack Drescher, MD

Beverly Greene, PhD, St. John’s University

Robin Lin Miller, PhD, Michigan State University

Roger L. Worthington, PhD, University of Missouri

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States and is the world’s largest association of psychologists. APA’s membership includes more than 150,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare.

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WorldNetDaily suddenly finds year old NARTH article newsworthy

A reader emailed me to say that the American Psychological Association had recently changed the official view on homosexuality causation to endorse an environmental set of causes. The prompt for the email was this article from WorldNetDaily: “‘Gay’ gene claim suddenly vanishes”
To arrive at this startling conclusion, the WND writer, Rob Unruh quotes an article published more than a year ago from NARTH titled, “APA’s New Pamphlet On Homosexuality De-emphasizes The Biological Argument, Supports A Client’s Right To Self-Determination.”
In the article, Dean Byrd notes that the APA document shifts emphasis on causes to a more nuanced and complex view. Byrd cites this quote:

“There is no consensus among scientists about the exact reasons that an individual develops a heterosexual, bisexual, gay or lesbian orientation. Although much research has examined the possible genetic, hormonal, developmental, social, and cultural influences on sexual orientation, no findings have emerged that permit scientists to conclude that sexual orientation is determined by any particular factor or factors. Many think that nature and nurture both play complex roles…”

However, oddly, Byrd leaves this last phrase from the APA website out of his quote:

…most people experience little or no sense of choice about their sexual orientation.

Also in the APA paper, reparative therapy is discussed. The APA says
What about therapy intended to change sexual orientation from gay to straight?

All major national mental health organizations have officially expressed concerns about therapies promoted to modify sexual orientation. To date, there has been no scientifically adequate research to show that therapy aimed at changing sexual orientation (sometimes called reparative or conversion therapy) is safe or effective. Furthermore, it seems likely that the promotion of change therapies reinforces stereotypes and contributes to a negative climate for lesbian, gay, and bisexual persons. This appears to be especially likely for lesbian, gay, and bisexual individuals who grow up in more conservative religious settings.
Helpful responses of a therapist treating an individual who is troubled about her or his same-sex attractions include helping that person actively cope with social prejudices against homosexuality, successfully resolve issues associated with and resulting from internal conflicts, and actively lead a happy and satisfying life. Mental health professional organizations call on their members to respect a person’s (client’s) right to self-determination; be sensitive to the client’s race, culture, ethnicity, age, gender, gender identity, sexual orientation, religion, socioeconomic status, language, and disability status when working with that client; and eliminate biases based on these factors.

From these paragraphs expressing concern, Byrd pulls out this sentence to portray a greater openness to change therapy than is warranted:

“Mental health organizations call on their members to respect a person’s [client’s] right to self-determination.”

I blogged about this article last year when it came out, commending the APA for their nuanced account of the research to that point. I think NARTH should do what the APA did a year ago and issue a statement about environmental causes. Then I wondered:

…when NARTH would make an APA-like statement about theorized environmental factors such as child abuse and same-sex parenting deficits. What if NARTH acknowledged “what most scientists have long known: that a bio-psycho-social model of causation best fits the data?” Wouldn’t there be a need for a statement cautioning readers of their materials that evidence for parenting playing a large or determining role is meager? Paralleling Dr. Byrd’s assessment of the APA pamphlet, shouldn’t NARTH say with italics, “There is no homogenic family. There is no simple familial pathway to homosexuality.”…
I wrote Dean and asked him about NARTH’s stance. He answered for himself by saying,

I think that the bio-psycho-social model of causation makes it clear that there is neither a simple biological or environmental pathway to homosexuality.

NARTH is widely known for championing a view of homosexuality that requires some kind of trauma as a causal factor. In point of fact, SSA can occur without bad parenting or abuse. Shouldn’t NARTH follow the APA’s lead and issue an official statement such as suggested above?
UPDATE: OneNewsNow and AFTAH have joined the echo chamber.
The ONN account begins:

The attempt to prove that homosexuality is determined biologically has been dealt a knockout punch. An American Psychological Association publication includes an admission that there’s no homosexual “gene” — meaning it’s not likely that homosexuals are born that way.

I wonder if NARTH will correct this misunderstanding of the APA’s publication. In fact, no knockout punch has been delivered to any theory, except perhaps for those dogmatic views that stress one pathway. Let’s see leaving aside extreme biological determinism, who else gets a knockout punch here? The APA statement cuts both ways but NARTH, and the people quoted in this report only want to see it go one way.
The APA (over a year ago) handled the research with integrity. When will NARTH and related groups do the same?

Year in review: Top ten stories of 2008

As in year’s past, I have enjoyed reviewing the posts from the year and coming up with the top ten stories.

1. Cancelation of the American Psychiatric Association symposium – Amidst threat of protests, the APA pressed to halt a scheduled symposium dedicated to sexual identity therapy and religious affiliation. Whipped up by a factually inaccurate article in the Gay City News, gay activists persuaded the APA leadership to pressure symposium organizers to pull the program. Gay City News later ran a correction.

2. The other APA, the American Psychological Association, released a task force report on abortion and mental health consequences. Basing their conclusions on only one study, the APA surprised no one by claiming abortion had no more adverse impact on mental health than carrying a child to delivery. I revealed here that the APA had secretly formed this task force after a series of research reports in late 2005 found links between abortion and adverse mental health consequences for some women. New research confirms that concern is warranted.

3. Golden Rule Pledge – In the wake of Sally Kern saying homosexuality was a greater threat to the nation than terrorism, I initiated the Golden Rule Pledge which took place surrounding the Day of Silence and the Day of Truth. Many conservative groups were calling for Christian students to stay home. This did not strike me as an effective faith-centered response. The Golden Rule Pledge generated some controversy as well as approval by a small group of evangelicals (e.g., Bob Stith) and gay leaders (e.g., Eliza Byard). Some students taking part in the various events were positively impacted by their experience.

4. Exodus considers new direction for ministry – At a leadership training workshop early in 2008, Wendy Gritter proposed a new paradigm for sexual identity ministry. Her presentation was provocative in the sense that it generated much discussion and consideration, especially among readers here. It remains to be seen if Exodus will continue to move away from a change/reparative therapy focus to a fidelity/congruence ministry focus.

5. New research clarifies sexual orienatation causal factors – A twin study and a study of brain symmetry, both from Sweden and a large U.S. study shed some light on causal factors in sexual orientation.

6. Letter to the American Counseling Association requesting clarification of its policies concerning counseling same-sex attracted evangelicals. Co-signed by over 600 counselors (many of whom were referred by the American Association of Christian Counselors), I wrote a letter to the ACA requesting clarification regarding how counselors should work with evangelicals who do not wish to affirm homosexual behavior. The current policy is confusing and gives no guidance in such cases. Then President Brian Canfield replied affirming the clients self-determination in such cases. He referred the matter back to the ACA ethics committee. To date, that committee has not responded.

7. Paul Cameron’s work resurfaces and then is refuted – Insure.com resurrected Paul Cameron’s work in an article on their website about gay lifespans. The article was later altered to reflect more on HIV/AIDS than on homosexual orientation. Later this year, Morten Frisch produced a study which directly addressed Cameron’s methods.

8. Mankind Project unravels – This year I posted often regarding the Mankind Project and New Warriors Training Adventure. Recently, I reported that MKP is in some financial and organizational disarray.

9. Debunking of false claims about Sarah Palin’s record on support for social programs – I had lots of fun tracking down several false claims made about Sarah Palin during the election. Her opponents willfully distorted her real record to paint her as a hypocrite. I learned much more about Alaska’s state budget than I ever wanted to know but found that most claims of program cuts were actually raises in funding which not quite as much as the agencies requested. However, overall funding for such programs increased.

10. During the stretch run of the election, I became quite interested in various aspects of the race. As noted above, I spent some time examining claims surround Sarah Palin’s record. I also did a series on President-elect Obama’s record on housing, including an interview with one of Barack Obama’s former constituents.

I know, I know, number 10 is an understatement. (Exhibit A)

Happy New Year!

Abortion and mental health disorders: New study finds relationship

A new study published online today finds varying degress of connection between induced abortion and later mental health problems. The article, published by the Journal of Psychiatric Research, used the National Comorbidity Study, a large representative sample of people carried out in the early 1990s. Here is the abstract:

The purpose of this study was to examine associations between abortion history and a wide range of anxiety (panic disorder, panic attacks, PTSD, Agoraphobia), mood (bipolar disorder, mania, major depression), and substance abuse disorders (alcohol and drug abuse and dependence) using a nationally representative US sample, the national comorbidity survey. Abortion was found to be related to an increased risk for a variety of mental health problems (panic attacks, panic disorder, agoraphobia, PTSD, bipolar disorder, major depression with and without hierarchy), and substance abuse disorders after statistical controls were instituted for a wide range of personal, situational, and demographic variables. Calculation of population attributable risks indicated that abortion was implicated in between 4.3% and 16.6% of the incidence of these disorders. Future research is needed to identify mediating mechanisms linking abortion to various disorders and to understand individual difference factors associated with vulnerability to developing a particular mental health problem after abortion.

In the discussion section, the authors believe that abortion contributes to the effect independent of other factors.

What is most notable in this study is that abortion contributed significant independent effects to numerous mental health problems above and beyond a variety of other traumatizing and stressful life experiences. The strongest effects based on the attributable risks indicated that abortion is responsible for more than 10% of the population incidence of alcohol dependence, alcohol abuse, drug dependence, panic disorder, agoraphobia, and bipolar disorder in the population. Lower percentages were identified for 6 additional diagnoses.

Given the multidetermination of mental health disorders, these risks should be taken into account, especially those in double figures.
I believe another significant abortion and mental health study is due out next week as well.
The reference is: Coleman PK et al., Induced abortion and anxiety, mood, and substance abuse disorders: Isolating, Journal of Psychiatric Research (2008), doi:10.1016/j.jpsychires.2008.10.009

Psychiatric Bulletin publishes David Fergusson editorial on mental health and abortion

I posted extensively on the APA Task Force on Mental Health and Abortion in August, including comments from New Zealand researcher David Fergusson. This month, the Psychiatric Bulletin published an editorial by Dr. Fergusson.
The editorial supports the recent Royal College of Psychiatrists’ statement regarding abortion and mental health.
Fergusson’s editorial notes the contrast between a RCP statements in 1994 and 2008. The 1994 view was that no relationship existed between abortion and mental health. Currently, the RCP cautions about the possible effects and suggests post-abortion counseling.
Fergusson notes that such debates are important, especially in the UK since mental health concerns are offered as the major reason a woman is granted an abortion. If mental health status is not improved, or may be worsened, the effects of abortion have major relevance to policy.
He concludes:

It is unlikely that these problems of evidence, uncertainty and the law will be resolved by further medicolegal debates between pro-life and pro-choice advocates. What is required is a well-designed, well-funded and, above all, impartial programme of research into the mental health risks, benefits and consequences of abortion. The recent Royal College of Psychiatrists’ statement makes an important contribution to this process by highlighting the real uncertainties that exist in the current evidence on abortion and mental health.

It is hard for me to read this in any other way but as a critical contrast to the recent APA report.