The Edge continues “My ex-gay life” series: Dissecting reparative therapy

The Edge’s David Foucher continues his series regarding all things ex-gay with an article today regarding reparative therapy. There are extensive and interesting quotes from Joseph Nicolosi, Clinton Anderson, Jack Drescher, Robert Jay-Green, yours truly and others.

There are a number of quotes that caught my eye. This one from Robert Jay-Green left me scratching my head:

“All these theories are all promulgated by the ex-gay people,” he points out. “They have this theory that distant fathers and overly-close mothers cause homosexuality. Well, that’s been disproved. The research shows that there is no similarities in the pattern of family development in kids who grow up to be lesbian or gay versus kids who grow up to be straight.”

I don’t think that is want he wanted to say. I think he meant no differences.

In fact, there are some differences but they are only of modest effect statistically speaking. In fact, as we have noted here, gay psychotherapist, Joe Kort thinks there are some family dynamics that can lead to homosexual behavior. He believes this homosexual behavior for these actually and essentially straight people can be changed when they get appropriate psychotherapy.

Dr. Nicolosi lays out the core of reparative therapy. As he describes, it is not compatible with the sexual identity therapy framework:

“[Success] occurs by their understanding the causes of their same-sex attraction,” Nicolosi explains. “We call it the three A’s: attention, affection, approval. These are underlying emotional needs that were not fulfilled by their same-sex parent – the father for the male homosexual and the mother for the lesbian.

“There are two jobs [for the patient],” he continues. “The first task is about the past, and the other is about the present. The past aspect is facing the reality that they did not get this love, making it very clear and conscious, and then going through a grief process. They have to grieve that their father never did and never will love them the way they need to be loved – to the extent they need it. And what that does is free them up from the illusion that they are going to get it somehow either by that father or by somebody else of the same sex.”

According to Nicolosi, the next challenge is to replace that need with an emotional connection in their present.

“[They need to] get those needs met thought a relationship with other men,” he says. “The focus is not on not having gay sex… it’s putting the emphasis on making deep emotional attachments. And we have seen that when these men make deep emotional attachments to other men, their sexual interest diminishes.”

While for people who did have problems with parents, there can be some value in acceptance and grieving. However, presenting this scenario to clients as a general explanation for all attractions to the same sex is not consistent with the sexual identity therapy framework. As I noted in this Edge article, I do not believe the research support is there. Thus, we cannot tell clients we know something we don’t know, but rather theorize.

Queer theories for the straight guise

Now that’s a title with more than a double meaning.

Recently readers sent two websites to me to review. As I did I was struck by a similar reaction which I will explain shortly. The websites are Homosexuality 101 and Joe Kort’s new blog Straight Guise.

Let me take the second one first. Briefly:

Straight Guise will explore the many reasons men have sex with other men, only some of which have anything to do with homosexuality or bisexuality.

In a nutshell, he proposes that anytime someone says they have changed from gay to straight, if they are telling the truth, they were never really gay in the first place. He says:

If there are any success stories by someone practicing RT [reparative therapy] or helping someone stop same sex attractions, the individual was not gay from the start. In other words those who state they have helped someone go from gay to straight or be relieved or same sex attraction are simply describing someone who is heterosexual who may have been acting out homosexual behavior having nothing to do with their sexual orientation.

He lists a variety of ways that straight men can through trauma or emotional trouble come to a homosexual orientation. He sounds reparative in his descriptions of a couple of straight guise scenarios. For instance, he says abused men can reenact their abuse through gay sex and offers a very interesting case in point.

However, the most reparative scenario of all is…

Father Hunger: These are heterosexual men who crave affection and attention from their fathers and seek sex with men as a way of getting that male nurturance and acceptance.

In reading, one must keep in mind that Joe is explaining straights who act gay not gays who are really gay. So in the universe of father hungry men, I guess one might see gays who have father hunger who are really gay, straights with father hunger who are really straight but act gay, and straights with father hunger who are really straight. I wonder if there are real gays who have father hunger who act straight. Maybe they have mother hunger. Are bisexuals just hungry? The glass is half empty? What about lesbians? We’ll get to them in a minute (they always have to wait).

Speaking of father hungry gays, Julie Harren’s video Homosexuality 101 provides a quick course in reparative drive theory and at least for men, the hypothesis that perceptions of a disconnect with dad lead to homosexual behavior. Ironically, on at least the father hungry male, Mr. Kort and Dr. Harren may agree that such a father-deficient developmental history can lead to homosexual behavior. The difference of course is that Joe believes he is explaining a type of gay-acting straight man and Julie believes she is explaining almost all gay men.

She also has some thoughts about lesbians. Above the others, I was pretty stunned at the description of one type of lesbian. She says, “somewhere, maybe very early on, maybe even in infancy there was a break in the relationship with the mother.” As examples, she says that maybe the infant-lesbian-to-be was hospitalized or the mother was hospitalized or suffered depression, but whatever it was, something happened to impact the relationship at a critical period. In infancy? She then says, the mom and daughter may have gone on to have a pretty good relationship. If that is true, then how do you “fix” such a thing? Sounds like an argument for a critical period to me where once set, the picture cannot be altered. I doubt that is what she intended.

What is striking to me about both of these efforts is the how little research can be offered in support. These are theories but they are presented as fact. Joe offers some interesting and I think compelling vignettes and I am quite sure Julie could do so as well. In fact, they probably would look very similar working with a male client who had abuse or father deficits in the background. Both would likely work toward insight and provide support for the client’s values (as would I). However, they both begin with different presuppositions: Joe believes a priori that anyone who changes in some fashion was never gay and Julie assumes that the same-sex attracted person is not really gay but off-track developmentally. One point of this post is that clients may have similar therapeutic courses and outcomes working with therapists with very different worldviews.

Troubling to me about these theories is that they are not readily falsifiable. How can we tell who is correct here? Joe simply says, if you changed you weren’t gay (even if you thought you were) and reparative drive theory asserts that if you’re gay you had a disruption in your parenting (whether you know it or not).

Now for some discussion. Would we limit/ban either of these therapists from conducting their work based on their theories/methods and if so, why and if not, why not? Does Joe get a pass because even though he does the same thing as Julie, he says he is actually returning a person to his “true sexual orientation?” Would Julie say the same thing?

There may be a part two to this topic…

Geneticist Francis Collins comments on Narth article

Exgaywatch is reporting an email exchange with geneticist Francis Collins of Human Genome Project fame. In it, Dr. Collins reacts to a NARTH article describing his views of on causes of homosexuality. You should read both the article on the NARTH website by Dr. Dean Byrd and then the response by Dr. Collins to get the context. I am going to reproduce Dr. Collins email to David Roberts at EGW:

It troubles me greatly to learn that anything I have written would cause anguish for you or others who are seeking answers to the basis of homosexuality. The words quoted by NARTH all come from the Appendix to my book “The Language of God” (pp. 260-263), but have been juxtaposed in a way that suggests a somewhat different conclusion that I intended. I would urge anyone who is concerned about the meaning to refer back to the original text.

The evidence we have at present strongly supports the proposition that there are hereditary factors in male homosexuality — the observation that an identical twin of a male homosexual has approximately a 20% likelihood of also being gay points to this conclusion, since that is 10 times the population incidence. But the fact that the answer is not 100% also suggests that other factors besides DNA must be involved. That certainly doesn’t imply, however, that those other undefined factors are inherently alterable.

Your note indicated that your real interest is in the truth. And this is about all that we really know. No one has yet identified an actual gene that contributes to the hereditary component (the reports about a gene on the X chromosome from the 1990s have not held up), but it is likely that such genes will be found in the next few years.

This is a very clear picture of the current research that I agree with. This is what should be presented by all concerned when describing the research to clients, activist audiences, in churches and in the media.

Ex-wife of ex-ex-gay speaks about reorientation therapy experiences

Pam Ferguson, also known to many as Willful Grace, describes her experiences with her ex-husband’s reparative therapy in a post at ExGayWatch.

Her descriptions of some of the things done in the name of sexual reorientation make me cringe. I continue to believe those who support a patient’s right to pursue sexual reorientation should be more zealous to root out such practices. I appreciate Pam’s decision to share and encourage others to do so here in response.

I think the entire post is worth reading but here is one excerpt:

The therapist, who was always in stocking feet, would often rub his foot on Tdub’s [her nickname for her ex-husband] leg (This occurred in couples session; I witnessed this.) I found this a bit awkward and, assuming it went on in his individual sessions, I asked Tdub about it. He admitted that it made him feel awkward at first but that he’d gotten used to it and it was just a part of the therapist’s “way”. He later went on to mention that the therapist sort of played the role of a father figure and was teaching them lessons about safe and affirming male touch.

Note to the movement: The whole therapist-as-a-father-figure thing has got to go, and the sooner the better.

Sexual identity therapy: Is neutrality a bad thing?

Last year, I wrote an article for my website called I Am Not a Reparative Therapist. In that article, I indicated that one of my problems with reparative therapy, as I understood it, was that the therapist promoted reparative drive theory to clients as the singular source of same-sex attractions.

It seems to me that if a therapist begins with this theory or any one-size-fits-all theory, confirmation bias will operate to find it in the histories of clients. It also seems to me that any theory of origins, whether it be developmental or pre-natal or a combination thereof, is bound to contain much speculation due to the inadequacy of current research and the biases inherent in the therapeutic uncovering process. However, such speculation and uncovering may be quite useful in setting a context for the pursuit of valued action and may indeed lead to powerful emotional catharsis and the formation of a new way of looking at one’s self. A new perspective can be powerful, even if it is incorrect on certain objective points. E.g., some people say they have been freed of emotional bondage by resolving issues of trauma in past lives (past life regression). I do not believe they are correct but I suspect they really do feel better. This is an extreme example, of course, but it serves to illustrate that one may be objectively incorrect about the meaning of historical events but still feel relief because one has a meaningful perspective to make sense of it all. A single pathway theory can make clients and therapists feel better because it enhances a sense of certainty but I remain skeptical that single pathway theories are correct.

Having expressed skepticism about the meaning of historical events, I also believe that clients and therapists are sometimes correct in their inferences and finding the truth may or may not have real impact in the present. However, being correct in our inferences some of the time does not mean we are correct all of the time, nor does the events that ring so true for one client mean that the next client with similar issues has the same history or makes the same meaning of a similar history.

My reactions to reparative therapy as a means of addressing conflicted people are based in part on the belief that therapists should be prepared to flex from their theoretical and cognitive mindsets to address individual clients – the facts on the ground, so to speak. Perhaps, however, this is my bias showing about how therapy should be conducted. Perhaps, on the other hand, it is defensible to offer a form of therapy (e.g., cognitive-behavioral, client-centered, or gestalt) and say to the client, “Here is how I think about problems and how I work with them. If my way of working does not seem right for you then you are free to move on to another therapist.” Taking the analogy further, client-centered therapists refrain from giving advice, or making interpretations and view problems as arising due to discrepancies between a person’s real self and their idealized self. A client who wanted an active, directive therapist might be frustrated by a non-directive therapist. However, a non-directive therapist might be so wed to his viewpoint that he would need to refer clients who wanted a differing theoretical and technical perspective.

Germane to this discussion of therapy approaches, Dr. Nicolosi recently published an article on the NARTH website titled “Why I Am Not a Neutral Therapist.” This article lays out his rationale for advancing a specific theory of homosexuality and resultant therapy for those who do not feel congruent with their beliefs.

The developmental model we suggest must deeply resonate with the men we work with, or they will (rightfully) leave our office and pursue a different therapeutic approach. We explain that our position differs from the American Psychological Association, which sees homosexuality and heterosexuality as equivalent, and along the way, we encourage them to clarify and re-clarify the direction of their identity commitment. Gay-affirmative therapy should, of course, be available for any such client.

A few gay-identified clients do decide to stay with us. Out of respect for diversity and autonomy, I affirm them in their right to define themselves as they wish, and I accept them in their gay self-label.

This article addresses some of the concerns I cited in my article about reparative therapy. On one hand, it does appear that Dr. Nicolosi offers a singular explanation for homosexual attractions that clients encounter early in reparative therapy. On the other hand, Dr. Nicolosi tells clients the theory must ring true for them to proceed. And he apparently affirms some small group of gay clients. This is probably surprising news for many observers.

I continue to believe the reparative developmental model is probably not operative for all people who are same-sex attracted. And my bias is to hold all such theories loosely and indeed to think that there are many factors, both pre-natal and environmental, that lead to different outcomes for different people. I do wonder what people do if they do not believe reparative drive theory fits them. Does the insistence on the theory drive some people toward a more deterministic “born gay” view since they do not agree with the singular developmental theory of origins? Inasmuch as evangelical faith is often bound to an environmental explanation, can such determinism create more conflict with faith? These are of course open questions but I have written about this before.

From the article about therapist neutrality, it appears that Dr. Nicolosi envisions an environment where gay affirming therapists can assert their beliefs to clients and reparative therapists can likewise assert their beliefs and then let clients choose which approach they like. In contrast, the sexual identity therapy framework calls for therapists to refrain from offering preconceived ideas about causation and change but to focus instead on the realization of objectives which align with the individual values and beliefs of clients. In practice, I suspect there are times when therapists using any of three mindsets would look very similar.

I am hopeful that our framework provides therapists of all ideologies with a map to help clients determine their path. I believe our framework can be valuable in helping clients clarify which broad way may be most suitable for their individual situation.

Open Thread: Anderson Cooper’s look at Sex and Salvation

The second half of the CNN two-part series, “What is a Christian?” aired tonight and examined abstinance, homosexuality, pornography and marital sexual relationships. Given the broad scope, I will open a thread for reactions related to any topic covered by the segment.

Comment away…

Holding therapy and the Sexual Identity Therapy Framework

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

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

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

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

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

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

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

Dear Warren,

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

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

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

Richard

Richard Cohen, M.A.

Director

International Healing Foundation

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

Exodus makes public statement regarding Richard Cohen

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

Statement on Richard Cohen

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

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

Richard Cohen on the The Daily Show

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

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

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