Category: psychology

A new test of orthodoxy

Yesterday, the information arm of the American Family Association, OneNewsNow published an article about my views on change of sexual orientation.  The information on the matter came from Peter LaBarbera who said

“But in the last few years, he’s basically become a pro-gay advocate who discredits the idea of change for most homosexuals,” LaBarbera explains. “He grants the idea that they can change, but he says change is very rare.
“So effectively, Warren Throckmorton has become a very useful advocate for the homosexual side because he can claim to be an evangelical and yet he’s undermining scriptural truth.”

As I understand this argument, I am wrong to claim to be an evangelical because I believe that categorical change in sexual attractions, especially for men, is rare. In addition such a belief is in itself “pro-homosexual advocacy.”
LaBarbera adds that

Christians know people can leave the lifestyle, and that through Christ, many thousands have. So he says Throckmorton’s message — that change is near impossible — is contrary to Christian thinking.

Here we have a test of orthodoxy – something that must be believed in order to be considered a Christian. In my tradition, faith in the redeeming mission of Christ is the test of faith. However, in the new orthodoxy of some in the Christian right, one must believe certain things about gays in order to be consider a Christian.
On the points raised by the ONN article, I observe that LaBarbera conflates behavior and inclination. He says I don’t think people can “leave the lifestyle” because I think categorical change of sexual attractions is rare and complex. While his description of behavior change is crude and stereotypical, I disagree with his assessment of me. I do believe that people change their behavior. They do so for a variety of reasons but in the context of this controversy, some do in order to seek conformity to their religious beliefs. That this happens is not in doubt by any researcher, pro-gay or not, that I know. The APA in their 2009 Task Force report acknowledged this and even noted that finding congruence can lead to certain positive outcomes.
However, gay and bisexual people who change their behavior infrequently lose their same-sex attractions, no matter how earnestly they pray. In my work as well as other studies, heterosexually married gay and lesbian people do not demonstrate change in attractions on average, even as they demonstrate devotion to their marriages. My critics can keep on criticizing but they have not been able to address the evidence which does not cut in their favor.
If I need to apologize for something, it is that I misled evangelicals for several years on the matter of sexual orientation. I did not intend to do so. When I made the documentary I Do Exist, I really believed the stories told. I know the people making the video did as well. I believed my clients; I believed people who told me they changed completely. In hindsight, I acknowledge that my work was complicated by the culture war. I now think the culture war is a significant stumbling block for the church.
From that time, there are a handful of people who continue to say they have changed in a comprehensive way. Many however, have acknowledged that their attractions have shifted within a range but have not really changed from one category to another. My view is that these stories are all interesting and that I desire to take people where they are and just work out a way that helps them live with integrity.
Who knows, maybe I will shift my views in different ways in the future. However, I hope it will be in response to evidence, not in order to fit into a man made definition of orthodoxy. In the mean time, I invite critics to simply deal with the evidence.

The Jones and Yarhouse study: What does it mean?

Let me begin by saying that I endorsed the book, Ex-Gays, A Longitudinal Study of Religiously Mediated Change in Sexual Orientation, by Stanton Jones and Mark Yarhouse which contained the first report of their longitudinal study. Since the publication of the book, Jones and Yarhouse have released results of their final follow up, first in 2009 at the annual convention of the American Psychological Association, and then most recently in the Journal of Sex and Marital Therapy. With the follow up, I believe the study remains an important investigation into the interplay of religion, sexual orientation and personal identity. I give them credit for the perseverance required to explore a topic which is highly controversial and to report their findings in detail.

Since the release of the peer-reviewed article, socially conservative groups have described the study as proof that gays can change orientation. For instance, the American Family Association’s Bryan Fischer, one of the worst offenders, claims that the study proves gays can change and that they weren’t born gay. Also, Citizenlink, an affiliate of Focus on the Family reported:

Of the 98 subjects, more than half were reported as successful; 23 percent reported a complete change in orientation after six years. Also, 20 percent reported giving up the struggle to change.

This claim is misleading. Jones and Yarhouse did not report “complete change in orientation.” Instead they cautioned against misinterpreting their findings by saying

These results do not prove that categorical change in sexual orientation is possible for everyone or anyone, but rather that meaningful shifts along a continuum that constitute real changes appear possible for some. The results do not prove that no one is harmed by the attempt to change, but rather that the attempt does not appear to be harmful on average or inherently harmful. The authors urge caution in projecting success rates from these findings, as they are likely overly optimistic estimates of anticipated success. Further, it was clear that “conversion” to heterosexual adaptation was a complex phenomenon.

Regarding the changes reported by their participants, the authors offer two related explanations. One is that some of the participants changed sexual orientation to some degree and the other is that the participants changed their sexual identity. Sexual identity involves placing more emphasis on behavioral conformity to prohibitions on homosexual behavior as a means of self definition. For the Exodus participants, less temptation to engage in homosexual behavior might be taken as a signal that orientation has changed, thus allowing a different attribution about their sexuality than once believed. The authors raise these two possibilities in the abstract for the most recent paper:

The authors conducted a quasi-experimental longitudinal study spanning 6–7 years examining attempted religiously mediated sexual orientation change from homosexual orientation to heterosexual orientation. An initial sample was formed of 72 men and 26 women who were involved in a variety of Christian ministries, with measures of sexual attraction, infatuation and fantasy, and composite measures of sexual orientation and psychological distress, administered longitudinally. Evidence from the study suggested that change of homosexual orientation appears possible for some and that psychological distress did not increase on average as a result of the involvement in the change process. The authors explore methodological limitations circumscribing generalizability of the findings and alternative explanations of the findings, such as sexual identity change or adjustment.

As I read all of the literature, including my own work, I first want to disagree with the way that Citizenlink characterized the results as “complete change.” That is not at all what Jones and Yarhouse reported. Considering the dichotomy proposed by Jones and Yarhouse — change in orientation or identity – I lean toward their alternative explanation – “sexual identity change or adjustment.”  However, I believe the discussion of what their results mean needs to be broadened beyond those two possibilities. In addition to considering orientation and identity as important constructs, I believe there are other ways to account for the changes Jones and Yarhouse report which are not sufficiently addressed in their published accounts.  First, I want to make some observations about the study which influence my opinions about what the results mean.

First, and most basically, the Jones and Yarhouse study did not examine in any systematic way the efficacy of reparative therapy or any other kind of psychological therapy as a means of altering sexual orientation. The participants in the study were involved in religiously based support groups which primarily had as a goal to reinforce a traditional moral view of sexuality. Clearly, the participants hoped they would change and engaged in various religious interventions to assist that end. However, the study did not assess the role of professional therapy and cannot legitimately be used to say such therapies work.

Second, there were quite a few dropouts six to seven years into the study. While true of all longitudinal studies, the final percentages being reported should also take into account the distinct possibility that many if not most of the drop outs were not successful in their efforts to change. The study began with 98 participants and ended up with 65 who were followed up for six to seven years. Some reported that they were healed of homosexuality and just didn’t want to participate, while others said they were gay and stopped trying to change. I don’t know for sure what the dropouts mean but the fact that so many failed to complete the study needs to be a part of any discussion.

Third, ratings from men and women were combined. Given the low number of people involved I understand why this was done but the practice may inflate the assessments of change for the group. It has become well accepted that the sexuality of women is more fluid than for men. A few women experiencing large shifts could influence the group averages. Continue reading “The Jones and Yarhouse study: What does it mean?”

NARTH is not primarily composed of mental health professionals

Last week, the Family Research Council promoted the annual conference of the National Association for the Research and Therapy of Homosexuality, touting the group as “one of the best sources of information about homosexuality.” In the description of NARTH, the FRC claimed that NARTH is “primarily composed of psychiatrists, psychologists, and other professional therapists and counselors who offer ‘sexual reorientation therapy’ to help people overcome unwanted same-sex attractions.”
However, this is not accurate. NARTH is not composed primarily of mental health professionals. Actually, according to NARTH’s operations director, David Pruden, only about 250 of NARTH’s approximately 1000 members are mental health professionals. Furthermore, some of those 250 members who have mental health degrees are academics who write about sexuality but do not provide sexual reorientation therapy. Thus, the lion’s share of NARTH’s members consist of lay people, ministers, and activists who have an interest in the materials provided by NARTH but are not scientists or therapists.
By comparison, the American Psychological Association has 150,000 members. All mental health groups are by far much larger than NARTH. I suspect most, if not all, state chapters of these groups are larger than NARTH.
The influence of NARTH comes from the fact that religiously conservative groups like FRC recommend the organization and refer to it as a counterpart to the established organizations. However, in the mental health marketplace, NARTH is not attracting members or supporters. Given the fact that 75% of the members have no professional or scientific credentials, it seems more accurate to consider NARTH to be an advocacy group with some like-minded mental health professionals as members, rather than a scientific group.
This impression is reinforced by the fact that two prime speakers at next week’s convention in Phoenix are not scientists at all, but anti-gay activists. Sharon Slater will speak in a session about her work with United Nations’ countries, especially in Africa and the Middle East, which aims to keep laws on the books criminalizing homosexuality. Then, following Slater, will be Michael Brown who is a minister. Read this post for more about these individuals.
RELATED: What if NARTH was a scientific organization?

Bieber Study Co-Author, Cornelia Wilbur, Accused of Fabricating Case of Sybil

Sunday, Salon briefly reviewed a book by Debbie Nathan which claims to debunk the case of Sybil. Sybil, actually a young Minnesota girl named Shirley Mason, was one of the first cases of multiple personality disorder to catch the public attention. The book about the case sold 6 million copies and inspired a movie starring Sally Field.
The Salon article by Laura Miller gives enough detail to hook my inner skeptic. According to Nathan, most of the details reported in the book were fabricated, based on grueling sessions where Shirley/Sybil was under the influence of Sodium Pentothal, administered by her psychoanalyst, Cornelia Wilbur. At one point, Shirley Mason wrote Wilbur confessing that the information about lost time, and other personalities was made up to keep her therapist’s attention. Miller writes:

Nevertheless, Mason did at one point attempt to jump off Wilbur’s train, writing her doctor a long letter confessing that all the multiple-personality stuff — the lost time, the named “alters” and the grotesque tortures supposedly inflicted on Mason as a child by her supposedly psychotic mother — had all been made up. Wilbur briskly dismissed this as a “major defensive maneuver” designed to derail the “hard work” of therapy lying ahead. The pitiably vulnerable Mason soon caved.

The Salon article and the book it features would be interesting enough for a post. However, it gets more interesting. While she was involved in the invention of multiple personalities, Cornelia Wilbur was a member of the Society of Medical Psychoanalysts, along with Irving Bieber. In fact, she was a co-author of the famous “Bieber study” from which current reparative therapists derive much of their claims about the causes of male homosexuality. The Bieber authors surveyed psychoanalysts about their patients (presumably Wilbur was one of the participants as well) and reported their results in the 1962 book Homosexuality: A Psychoanalytic Study.
The Bieber study has been widely criticized, and for good reason.  First, the homosexual participants were psychoanalytic patients in analysis with doctors who already believed that homosexuality was a pathological condition. Also, the patients themselves were never interviewed. Rather, the authors surveyed the analysts to assess the histories and attitudes of their patients. The analysts had already formed the opinion that homosexuality was shaped in childhood and that is exactly what they reported as results.
So it is intriguing to read about Cornelia Wilbur’s conduct in relationship to her most celebrated case. Is it possible that her biases about homosexuality operated first in the Bieber study? While one cannot say based on the case of Sybil, I think is natural to question her part in the Bieber study as a result. This seems especially true given how open the Bieber methodology was to confirmation bias.
The Bieber study is central to reparative therapy. Whenever I have asked reparative therapists for the three best studies which they believe support reparative therapy, they always mention Bieber.
A number of studies mentioned over the years as supports for sexual reorientation change efforts have later come into disrepute. Rekers work with Kyle Murphy, and the Masters and Johnson studies are just two other prominent investigations which later have been questioned.
Additional information: The New York Time Magazine has a lengthy piece on Wilbur and the Sybil case here. This article makes it clear that the sessions with Mason took place while Wilbur was involved with the Bieber study.

NARTH Touts Jones and Yarhouse Study

I was wondering when NARTH would weigh in on the Journal of Sex and Marital Therapy publication of the Jones and Yarhouse study. Dated October, 2011, the title of the post — Change in Sexual Orientation is Possible — immediately spins the study. Here is what the press release about the Jones and Yarhouse study says:

WHEATON, Ill., Sept. 27, 2011 /Standard Newswire/ — Many professional voices proclaim that it is impossible to change homosexual orientation, and that the attempt to change is commonly and inherently harmful. Psychologists Stanton L. Jones (Wheaton College, IL) and Mark A. Yarhouse (Regent University) have just published in the respected, peer-reviewed Journal of Sex and Marital Therapy the final results of their longitudinal study of individuals seeking sexual orientation change through involvement in a variety of Christian ministries affiliated with Exodus International. The results show change to be possible for some, and the attempt not harmful on average. These results stand in tension with the supposed professional consensus; more information is available at www.exgaystudy.org.
In prior studies, in the words of the American Psychological Association, “treatment outcome is not followed and reported over time as would be the standard to test the validity of any mental health intervention.” This study assessed evolving sexual attractions and psychological distress levels of 98 individuals seeking sexual orientation change beginning early in the change process, and then followed them with five additional assessments over a total span of 6 to 7 years. The researchers used standardized, respected measures of sexual orientation and of emotional distress to test the study’s hypotheses.
Of the original 98 subjects, 61 were successfully categorized for general outcome at the last assessment. 53% were categorized as successful outcomes; specifically, 23% reported success in the form of successful “conversion” to heterosexual orientation and functioning, while an additional 30% reported stable behavioral chastity with substantive dis-identification with homosexual orientation. At the 6 year mark, 20% reported fully embracing gay identity. Modest but statistically significant changes were reported on average for decreases in homosexual orientation. The measure of psychological distress did not, on average, reflect increases in psychological distress associated with the attempt to change.
These results do not prove that categorical change in sexual orientation is possible for everyone or anyone, but rather that meaningful shifts along a continuum that constitute real changes appear possible for some. The results do not prove that no one is harmed by the attempt to change, but rather that the attempt does not appear to be harmful on average or inherently harmful. The authors urge caution in projecting success rates from these findings, as they are likely overly optimistic estimates of anticipated success. Further, it was clear that “conversion” to heterosexual adaptation was a complex phenomenon.
Jones and Yarhouse argue that implications of their findings include respect for the integrity and autonomy of persons seeking to change unwanted sexual attractions for moral, religious, or other reasons, just as we respect those who for similar reasons desire to affirm and embrace their sexual orientation. Full information should be offered to consumers about the options and their potential risks. The results also suggest that it would be premature for professional mental health organizations to invalidate efforts to change sexual orientation and unwanted same-sex erotic attractions.

Some might argue that the press release is not appropriately clear because it speaks of change of orientation in the same release as it says this:

These results do not prove that categorical change in sexual orientation is possible for everyone or anyone, but rather that meaningful shifts along a continuum that constitute real changes appear possible for some.

Most of the reviews of this study have missed this statement. Categorical change — moving from a homosexual orientation to a heterosexual one — is not what has been reported by the Jones and Yarhouse. Clearly some people reported changes which allowed them to make an attribution change to themselves – they feel more straight and so they identify with the label. However, the absolute shifts on average were modest, leading to the assessment from Jones and Yarhouse that “meaningful shifts along a continuum that constitute real changes appear possible for some.”
The NARTH article does not link to the press release and does not mention the assessment that the study does not prove categorical change to be possible for anyone. The review is not as skewed as some I have seen, but it does shade the picture.
I have a more focused post about the study planned, but for now, let me add that the concept of bisexuality is not satisfactorily addressed by the study or by reviewers. Bisexuals I have spoken to describe their lives as a series of shifts. For whatever reason, the direction of their attractions shifts with time and/or with relationships. From their point of view, they are not changing orientation when they fall in love with an opposite sex person after a period of same-sex relationships. Instead, they are flexing along a continuum, all of which is understood to be within their essential orientation.
The other group of people which I worked with are the mixed orientation couples. Some of them believe they have become straight because they have fallen in love with an opposite sex spouse. However, these folks do not plan this, nor does it appear to be subject to manipulation or ministry.
Another issue not addressed well by the study or the reviewers is the difference between men and women. Women are probably more likely to report big changes than men. However, Jones and Yarhouse have mixed groups. Separating men and women in the analyses would clarify the possibility that women change more than men.
In all, I am disappointed that the study has re-ignited the “change is possible” political machine. There is fluidity for some people in their sexual attractions, however this says very little about the experience of people who don’t experience that fluidity. Change of orientation for a small group of people is one hypothesis. However, there are other explanations. I think explanations incorporating the reality of bisexuality, cross orientation relationships, and male-female differences are also plausible. In fact, I think they are more plausible.
As an aside, the NARTH review ends with the obligatory slap at the APAs:

Unfortunately, however, the major mental-health associations appear to be moving further away from a purely scientific approach and toward one apparently directed by activists, whereby the purpose of their science does not seem to be understanding those who report change, but rather debunking, dismissing, and ignoring them.

All I can say is: takes one to know one.
NARTH does the same thing they accuse “major mental-health associations” of doing, just on the other side of the ideological perspective. The purpose of NARTH’s “science” seems to be to debunk, dismiss and ignore those who report no change. Regarding activism, NARTH is featuring anti-gay activist Michael Brown in a plenary session at this year’s conference. Brown has no scientific credentials but will be there as an activist, decrying the “homosexual agenda.”
Even more ominous is the presence of Sharon Slater at this year’s conference. Slater runs Family Watch International, a group who lobbies foreign governments at the UN and internationally to maintain laws criminalizing homosexuality. Slater uses NARTH materials in her work. Slater has no scientific credentials, she is there as an activist. I have asked NARTH but gotten no answer as to what scientific benefit Brown and Slater bring to the NARTH audience.
NARTH’s approach may not be “directed by activists.” Perhaps, it is more of a partnership.