My Journey Away from Reparative Therapy

Over the past few weeks, I have written about the Nashville Statement. In doing so, I realized that many readers here haven’t followed this blogclass2
since the beginning (2005) and aren’t aware of my work in the area of sexual identity. In fact, I would say a significant number of readers came along in 2014 when I wrote about Mars Hill Church.
On Saturday, Yahoo News published a profile of my work by Senior Political Correspondent Jon Ward. In the well written piece, Jon focused on my prior support for sexual orientation change efforts. However, he also connected the dots from that work to my opposition to Uganda’s Anti-Homosexuality Bill and later opposition to Christian nationalism and megachurch exploitation. I appreciate Jon’s careful attention to the nuances in the story.
If you are interested in more information about how I went from being a supporter of reorientation therapy to being a vocal opponent and how that journey connects to current interests, I encourage you to go read Jon’s profile.

Reparative Therapy Pioneer Joseph Nicolosi, Dead at 70

NIcolosi
Joseph Nicolosi

I was saddened just now to read in the Daily Beast that Joe Nicolosi died suddenly early this morning.  The Beast cited the Facebook page of Nicolosi’s clinic, the Thomas Aquinas Psychological Clinic in Encino, CA for the news. According to the note, posted earlier this afternoon:

We are deeply saddened and shocked to announce the death of Dr. Joseph Nicolosi yesterday in California from complications from the flu.

My condolences to his wife Linda and son Joseph, Jr.
The illness must have come upon him quickly; I know someone who spoke to him just recently. As always, he was vigorously defending his ideas.
We disagreed about a great many things, but I can say to his credit that he cared deeply about his family, his work, and his clients.
Nicolosi was the co-founder with Charles Socarides and Ben Kaufman of the National Association for the Research and Therapy of Homosexuality (NARTH) in 1992. Along with Focus on the Family and Exodus International, NARTH was a third of the ex-gay movement’s trinity. Nicolosi spoke frequently at Exodus conferences and was for many years the featured speaker at Focus on the Family’s Love Won Out traveling ex-gay conference.
Nicolosi adapted psychoanalytic ideas from Elizabeth Moberly and others to promote what he considered to be a therapeutic approach to sexual orientation change. He was most interested in the formation of male homosexuality and believed distant fathers and overbearing mothers together created a family triad which greatly increased the chances that a male child would become gay. Even as neurological and family studies called his work into question, Nicolosi defended his ideas via media appearances and his organization NARTH. At his death, Nicolosi was in the middle of a research project with psychologist Carolyn Pela.
In response to reports of harm from Nicolosi’s theories and practice, many gay rights advocates made ending reparative therapy a prime objective. Currently, five states, DC and several cities have banned reparative therapy for minors.
This evening Nicolosi’s wife Linda released a statement on the clinic Facebook page.

Calling All Former Participants in Studies of Sexual Orientation Change Efforts

Writing on Tuesday about Joseph Nicolosi’s new reparative therapy study got me thinking about the other studies of sexual orientation change efforts which have come and gone. I know a few participants in the Spitzer, Shidlo and Schroeder, Jones and Yarhouse studies who once told researchers they had changed orientation but now identify as gay. I suspect some have stayed about the same as they were when they participated in the research. It would be interesting to find out if there are any patterns in experience since those studies were published.
With that in mind, I am calling for subjects in any of the studies designed to assess sexual reorientation to contact me. If you participated in the Spitzer, Shidlo and Schroeder, Jones and Yarhouse, or any study which asked if you had changed orientation (including my 2005 study), please contact me at this email (SOCEFollowup@gmail.com). Those interested don’t have to reveal their identities at first and feel free to write with any questions about this effort.
It seems pretty clear to me that some erosion in the percentage of people claiming change has occurred since Exodus International shut down. Several former leaders in Exodus have recently come out as gay and there may be others who participated in studies from that era who have gone in a different direction. While this isn’t exact science, it may help to shed some light on the long term experience of those who once claimed to have changed orientation.
 

New Sexual Reorientation Study Off to a Shaky Start; Michael Bailey's Brain Scan Offer is Still Good

After the closing of Exodus International, the wind went out of the sexual reorientation sails. In June of last year, former ex-gay organization Exodus International leader Alan Chambers said the movement was “gasping for air.”
However, a quiet breeze may be blowing still as demonstrated by a study being conducted by one of the luminaries of reparative therapy, Joseph Nicolosi and relative newcomer Carolyn Pela.  Nicolosi and Pela summarized their preliminary findings at a meeting of the Christian Association for Psychological Studies a year ago. Nicolosi described the study on his website:

Dr. Pela described the study as being longitudinal with a within-group repeated-measures design.  Their dependent variable was psychotherapy as conducted at Dr. Nicolosi’s Thomas Aquinas Psychological Clinic.  The independent variables were (1) well-being as operationalized by the Outcome Questionnaire 45 (OQ-45.2), a highly respected measure of psychotherapy process and outcome, and (2) separately assessed dimensions of sexual orientation, namely, thoughts, desires, behavior, and identity.  Data collected to date involved 102 male psychotherapy clients who presented with ambivalence, discomfort, or distress regarding their SSA.  Eighty-one participants had been involved in the study long enough to have well-being assessed and data on change were available from 56 participants at the time of the CAPS presentation.

I am pretty sure the dependent and independent variables are reversed in his description. The independent variable is what is manipulated in an experiment and the dependent variable is a measure of results (see this brief explanation). That problem aside, what did they find?

Findings from preliminary data collected over a 12 month period indicated statistically significant reductions in distress and improvements in well-being, significant movement toward heterosexual identity, and significant increases in heterosexual thoughts and desires with accompanying significant decreases in homosexual thoughts and desires.  Effect sizes for these changes were generally in the moderate range, which suggests they are robust and not likely to be statistical artifacts.  The findings did not discover significant change in heterosexual or homosexual kissing or sexual activity.  These findings appear to have been the result of very low base rates in these behaviors among study participants leading to floor effects and a subsequent lack of change, as it is not possible to change a behavior in which participants are not engaging.

To summarize, the participants were thinking straighter but not doing anything about it.
To me, this result is understandable. If one is in treatment with the stated goal to think more about heterosexual outcomes, then there would be strong motivation to produce those experiences when asked. However, the test for any actual change will be when therapy is over and the regular rehearsal of such ideas isn’t happening. The difference between process changes (how a client feels during therapy) and outcome changes (what remains after therapy is over) is often great. Reorientation therapy studies are filled with people who said they had changed during the study but then felt differently months or years later. Thus, follow up must be a key component of any therapy study.
It should be pointed out that this study isn’t a true experiment since there is no control group. There isn’t a way to test for the effect of the passing of time. Spontaneous fluidity has been reported and it isn’t clear without a control group that psychotherapy is responsible for any change that is reported (or to what degree the therapy is responsible). Without a long term follow up and a control group, this study won’t provide much more information than we already have.
Finally, if Nicoloso and Pela truly want a potent and believable pre and post measurement, they should take Northwestern University professor Michael Bailey’s offer to conduct brain scans of the participants. Some years ago, Bailey informed Nicolosi that he could bring his patients to the lab to test their automatic responses to erotic cues. Nicolosi never took him up on the offer. I recently asked Bailey if the offer was still good. He answered in the affirmative. Pre (or even mid) treatment scans compared with post-treatment scans would help to offset the lack of a control group.
 

People Can Change Becomes Brothers on a Road Less Traveled

Several years after the collapse of Exodus International, now comes sexual orientation change group People Can Change to say they are changing focus from change of orientation to a focus on living congruently with traditional religious teaching on sexuality. My prior posts on People Can Change and their flagship program Journey into Manhood can be view by clicking the links.
I wasn’t a fan of the program when it was People Can Change. I doubt this will improve things much although I can say it gets closer to a more honest presentation of what is possible. In any case, if the procedures and processes haven’t changed, then I am still not a fan.

People Can Change‘ is Changing Its Name
International Fellowship for Men Who Put Faith and Values Before Homosexual Attractions  Takes on a New Identity as It Marks Its 100th ‘Journey Into Manhood’ Weekend Program
Contact: Rich Wyler, Founder and Executive Director, Brothers, Road, 434-227-9346,richwyler@brothersroad.org
CHARLOTTESVILLE, Va., Oct. 4, 2016 /Christian Newswire/ — A high-profile non-profit organization that provides peer- support programs primarily for men who experience same-sex attractions – but who chose not to live gay lives or to identify as gay – is changing its name.
Known since its 2000 founding as People Can Change, the international non-profit is renaming and rebranding itself as an interfaith fellowship called Brothers on a Road Less Traveled – or Brothers Road for short. Its website is moving fromwww.peoplecanchange.com to www.brothersroad.org. Its new self-descriptor: “Men supporting each other in addressing our same-sex attractions in affirming ways that align with our faith, values, morals and life goals.”
This change also reflects an important acknowledgement of what has long been the reality of its mission and membership – that it is largely a religious community supporting members of a wide range of faith traditions, including Christians of all denominations, religious Jews, Muslims and others.
The group is best known for its experiential weekend intensives called Journey Into Manhood. In fact, this past weekend in Texas the organization concluded its 100th three-day Journey Into Manhood event. Since the first “JiM” weekend in Maryland in January 2002, the group has now presented Journey Into Manhood 100 times in 11 U.S. states and in England, Poland and Israel.
Some 2,500 men from 45 U.S. states and more than 40 countries have participated over the past 15 years. Participants range in age from 18 into their 60s, although the average age is about 36. About a third are already married to women. Participants attend primarily in an effort to make peace with themselves and their sexuality, to minimize their eroticization of other men to the extent possible, and to bring their sexual behavior and feelings more in line with their morals, values and life goals.
“Our new name, Brothers on a Road Less Traveled, better communicates who we are and what we’re really about,” explained Rich Wyler, founder and executive director.
“The word ‘Brothers’ emphasizes our vital need for authentic brotherhood, community and acceptance as we seek to meet our same-sex bonding needs through deep platonic friendships rather than sexual relationships,” Wyler said. “The phrase ‘on a Road’ emphasizes that this is a life journey-a new way of living, not a quick-fix. And the words ‘Less Traveled’ recognize and honor the reality that we are a minority within the larger gay minority.”
The reference to a road less traveled comes from the 1916 Robert Frost poem, The Road Not Taken, in which the writer encounters two equally valid choices but concludes, “Two roads diverged in a wood, and I, I took the one less traveled by, and that has made all the difference.”
“Experiencing deep internal conflict over same-sex attractions can feel for many of us like standing at that crossroads where two roads diverge,” Wyler said, “Do you follow society’s gay-affirming path, or do you take a more faith-affirming road that acknowledges the reality of same-sex attractions but addresses those needs through platonic brotherly love rather than sexual relationships?”
Wyler emphasizes that the newly renamed organization is not backing away from the personal, lived experience of so many of its participants who have, in fact, seen profoundly positive changes in their self-esteem, thought lives, relationships and behaviors. Many have seen their same-sex sexual attractions diminish over the years or have seen sexual or romantic interests in the opposite sex develop or increase. These kinds of shifts are not universal, Wyler says, but they’re not unusual either.
Based near Charlottesville, Virginia, Brothers on a Road Less Traveled is an interfaith fellowship serving members of numerous religions. It is run as a virtual organization with no physical offices and no full-time employees, but with volunteers, contractors, supporters, participants and donors across the world.
The Brothers Road community offers eight to 10 inner-healing and personal-growth weekend intensives a year in the U.S., Europe and Israel, as well as online groups and webinars and in-person support groups and reunion retreats in some locations. It also offers a weekend program for wives of men who experience same-sex attractions or sex addictions, called “A Wife’s Healing Journey”-including one coming up Dec. 2-4 in the Nashville, Tennessee area.

Former Ex-Gay Leader Alan Chambers Says Ex-Gay Movement Is Gasping for Air

In a massive report by Mark Potok and available on the Southern Poverty Law Center website, former president of Exodus International Alan Chambers answers a question from Mark Potok about the future of ex-gay ministry. When Exodus was open for business, it was the largest organization dedicated to sexual reorientation.
Potok’s question is followed by Chambers’ answer.

What do you feel is the future of the ex-gay movement here and abroad?
I honestly believe it is gasping for air. I don’t believe there will ever again be an organization with the size or scope of Exodus International.
My hope is, as I stated very clearly during my closing speech at the Exodus conference in 2013, that every ministry focused on changing orientation will close. I do not believe the ministries or churches that seek to serve people who choose to be celibate are a danger unless they place conditions or qualifications on God’s love.
There will never be a consensus on science or Scripture or politics or much of anything for that matter, but we can seek to unite around the gospel of grace and love and peace. That is a life changing and revolutionary paradigm.

I can reveal that I had an informal role by providing information to the SPLC attorneys in the JONAH case. I know that makes me a heretic in the minds of some on the religious right. I also shopped at Target last night.
The problem is not with people following their religious beliefs about sexual behavior, even if it means celibacy from homosexuality. The problem is the misguided, discredited belief that parental failings cause homosexuality and the resultant “therapies” which follow from such beliefs. If you have the stomach to read through Potok’s report, you will read some bizarre things done in the name of sexual reorientation. You can also read this post for a brief account.
For all my posts on reparative therapy (get a beverage and some snacks), click here.

Information and Misinformation on Gender Dysphoria from Wallbuilders and the American College of Pediatricians, Part One

Tuesday on Wallbuilders Live, Dr. Michelle Cretella represented tiny pediatric breakaway group the American College of Pediatricians. She briefly discussed the organization’s position paper on responding to gender identity issues. In doing so, she said something which caught my irony sensor. It also occurred to me, as it repeatedly has in the discussion of gender dysphoria, how difficult it is to avoid taking extreme positions.
Listen to her response to a question from host Rick Green about how much harm gender dysphoria is causing.

I want to address two claims that came up in this segment. In this post, I address the claim that 80% of gender dysphoric children will accept their biological sex with therapy. In a future post, I will write about the claim about suicide rates.
Cretella says:

They’re [advocates for transgender children] cooperating with, at least, mental confusion.  You know, initially, we know that there is psychiatric literature that shows if you work with these children one on one and with their families, the vast majority, over 80% will come to accept their biological sex after puberty before adulthood. So yes, to put these children to reaffirm their confused thinking, to put them on puberty blockers, and then cross-sex hormones to make them quote unquote the other gender, you are permanently sterilizing children. It’s insanity.

Cretella is correct that persistence rates are low (gender dysphoria continuing into adulthood) among gender dysphoric children, but this is not the case with adolescents who remain gender dysphoric or those who experience it with an adolescent onset. In their paper, ACP uses the American Psychiatric Association’s DSM-V as an authority. The section of the DSM-V cited by ACP supports the claim about persistence but does not fully support Cretella’s claim about the role of therapy.

Rates of persistence of gender dysphoria from childhood into adolescence or adulthood vary. In natal males, persistence has ranged from 2.2% to 30%. In natal females, persistence has ranged from 12% to 50%. Persistence of gender dysphoria is modestly correlated with dimensional measures of severity ascertained at the time of a childhood baseline assessment. In one sample of natal males, lower socioeconomic background was also modestly correlated with persistence. It is unclear if particular therapeutic approaches to gender dysphoria in children are related to rates of long-term persistence. Extant follow-up samples consisted of children receiving no formal therapeutic intervention or receiving therapeutic interventions of various types, ranging from active efforts to reduce gender dysphoria to a more neutral, “watchful waiting” approach. It is unclear if children “encouraged” or supported to live socially in the desired gender will show higher rates of persistence, since such children have not yet been followed longitudinally in a systematic manner. For both natal male and female children showing persistence, almost all are sexually attracted to individuals of their natal sex. For natal male children whose gender dysphoria does not persist, the majority are androphilic (sexually attracted to males) and often self-identify as gay or homosexual (ranging from 63% to 100%). In natal female children whose gender dysphoria does not persist, the percentage who are gynephilic (sexually attracted to females) and self-identify as lesbian is lower (ranging from 32% to 50%). (APA, DSM-V, p. 455)

To the DSM-V, I can add the description of persistence developed by the World Professional Association for Transgender Health (WPATH) in their standards of care.

An important difference between gender dysphoric children and adolescents is in the proportion for whom dysphoria persists into adulthood. Gender dysphoria during childhood does not inevitably continue into adulthood.V Rather, in follow-up studies of prepubertal children (mainly boys) who were referred to clinics for assessment of gender dysphoria, the dysphoria persisted into adulthood for only 6–23% of children (Cohen-Kettenis, 2001; Zucker & Bradley, 1995). Boys in these studies were more likely to identify as gay in adulthood than as transgender (Green, 1987; Money & Russo, 1979; Zucker & Bradley, 1995; Zuger, 1984). Newer studies, also including girls, showed a 12–27% persistence rate of gender dysphoria into adulthood (Drummond, Bradley, Peterson-Badali, & Zucker, 2008; Wallien & Cohen-Kettenis, 2008).
In contrast, the persistence of gender dysphoria into adulthood appears to be much higher for adolescents. No formal prospective studies exist. However, in a follow-up study of 70 adolescents who were diagnosed with gender dysphoria and given puberty-suppressing hormones, all continued with actual sex reassignment, beginning with feminizing/masculinizing hormone therapy (de Vries, Steensma, Doreleijers, & Cohen-Kettenis, 2010).
Another difference between gender dysphoric children and adolescents is in the sex ratios for each age group. In clinically referred, gender dysphoric children under age 12, the male/female ratio ranges from 6:1 to 3:1 (Zucker, 2004). In clinically referred, gender dysphoric adolescents older than age 12, the male/female ratio is close to 1:1 (Cohen-Kettenis & Pfäfflin, 2003). (WPATH, p. 11).

The irony of Cretella’s confidence in psychiatric intervention relates to the expulsion from ACP membership of George Rekers who was infamous for his own personal decline and his discredited treatment approach to what was then called gender identity disorder. In fact, we don’t know the role, if any, therapy plays in influencing the current persistence rates. While there is reason to think parental permission to transition in childhood might increase the persistence rates, there isn’t sufficient research to say for sure.
After listening to Cretella and reading the ACP paper, I wonder what the ACP recommends for the 10-20% of people with gender dysphoria persisting into the late teens. Do they favor reassignment for those persons? They focus on the data which make their point but don’t seem to have an answer for the rest of the people involved.
Another problem with ACP’s confidence in psychiatric interventions for gender dysphoria is that they also oppose a frequent end point in the trajectory of many gender dysphoric children: homosexuality (see image at the end of the post). One of the reasons George Rekers tried to re-orient gender dysphoria was to prevent homosexuality. Furthermore, one of the prime objectives of reparative therapists like Joseph Nicolosi is to prevent homosexuality via the alteration of parenting behaviors toward gender nonconforming children. ACP should stop pretending to sympathize with gender dysphoric children when they also write letters to school personnel promoting reparative change therapy for gay people.
Summary
Cretella is right that studies of gender dysphoric children (mostly with boys) find low rates of persistence of gender dysphoria into adulthood. However, she should have distinguished between prepubescent children and teens. The outcomes for these two groups do not appear to be the same. No doubt her listeners will not make that distinction.
Cretella was wrong to invoke psychiatric treatment as the reason for low persistence rates. If anything, some treatments have been shown to be harmful in some cases while others may not be harmful but may not cause a reduction in gender dysphoria. From her presentation, one could get the impression that advocates for gender dysphoric children know these treatments work but are motivated to undermine the natural family and therefore withhold appropriate medical care. While there is strong disagreement among experts and some advocates might oppose traditional families, it is simply not true that gender dysphoria could be easily treated if only activists would get out of the way.
Another important factor is that the treatment advocated by Cretella and the ACP is an outdated, discredited, psychoanalytically based approach which has not shown success. Even among those in the mainstream who are skeptical of puberty blocking drugs, the treatments advocated by ACP are rejected.
Gender Dysphoria After Childhood
The following image comes from a 2012 study by Devita Singh on gender dysphoric boys. Note the columns titled “sexual orientation in fantasy” and “sexual orientation in behavior.” By far, the most common end point for gender dysphoric children across studies is some level of same sex attraction. Gay advocates have in the past confided to me that they are ambivalent about supporting interruption of puberty because such interventions may interfere with a natural homosexual outcome. Please see this common sense article by Michael Bailey and Eric Vilain on the dilemma many parents of gender dysphoric children face.
Singh table

Top Ten Posts in 2015

The ten top posts during 2015 are as follows with the most popular first:
1. Open Letter to Gateway Church Pastor Robert Morris from a Former Member of Mars Hill Church – This was posted on November 2, 2014 but remained popular throughout 2015. Driscoll recently joined Jimmy Evans as a director to form The Trinity Church in Phoenix.
2. Former Chief Financial Officer at Turning Point Claims David Jeremiah Used Questionable Methods to Secure a Spot on Best Seller Lists – This story about David Jeremiah’s questionable tactics from a former insider was a scoop but not one which stuck to Jeremiah like  a similar scandal did to Mark Driscoll.
3. Hillsong’s Brian Houston Interviewed Mark and Grace Driscoll After All (VIDEO) (AUDIO) – First, he said he would interview Driscoll, then he said he wouldn’t, then Brian Houston aired an interview with Mark and Grace Driscoll. It was great theatre but didn’t draw good reviews from former Mars Hill leavers.
4. A major study of child abuse and homosexuality revisited – This post from 2009 is one of the most popular articles in the history of the blog. In it, I demonstrate a key mistake in a journal article often used to link homosexuality and child abuse.
5. Southern Baptists Say Enough to Perry Noble and NewSpring Church – I am surprised that this post got so much attention.
6. Gospel for Asia Faces Allegations of Misconduct; GFA Board Investigation Found No Wrongdoing – The GFA story received the most attention from me this year.
7. Pastor of Willow Creek Presbyterian Says Church Reaction to Hiring Tullian Tchividjian is “Overwhelmingly Positive” – I briefly covered Tullian Tchividjian’s comeback as a development minister at a PCA church in FL.
8. A Few Thoughts on The Village Church Controversy – Village Church’s leadership apologized for their response to a young woman who sought a divorce from her husband who had admitted having child porn.
9. Hillsong Founder Brian Houston Issues Statement On Mark Driscoll at the Hillsong 2015 Conference – Mark Driscoll’s return to the spotlight garnered much reader attention.
10. Gospel for Asia’s K.P. Yohannan and the Ring Kissing Ritual – While the financial scandals were of interest to readers, this article ranked higher than the money problems.
To fully capture activity on the blog, one should consider the Gospel for Asia scandals (Patheos considered my coverage as a part of one of their top ten Evangelical stories of 2015).
It has been a good year and I thank my readers and those who support the blog with their comments and regular visits.

New SAMHSA Report Calls for End to Change Therapy for LGBT Youth

I may have more to say about this report in the coming days, hopefully with some commentary from Mark Yarhouse, but for now, I am going to link to it.
Ending Conversion Therapy: Supporting and Affirming LGBTQ Youth was released today by the Substance Abuse and Mental Health Services Administration. The report recommends the end of change therapies for minors via professional advocacy and legal strategies.
Mark Yarhouse, co-author with me of the Sexual Identity Therapy framework and professor at Regent University, was an evangelical presence on the panel of experts who produced the consensus statements.
The most controversial parts of the report, in my opinion, deal with gender identity. I think most therapists now understand that sexual orientation is durable and rarely, if ever, changes dramatically as the result of change therapy. However, the recommendations on gender identity are more controversial. Despite the use of the word consensus, I question whether there is a consensus among professionals of all ideologies about how to respond therapeutically to youth dealing with stress over gender expression.
As for the goal of ending change therapy for youth, I am a supporter. Despite years of research and effort, no safe, effective and ethical approach to sexual orientation change has emerged. The very few people who still claim effectiveness are small operations with no research of their own methods. The anecdotes of harm are convincing and the candid admissions of people like Alan Chambers that the change they claimed didn’t happen is enough to cause significant skepticism. My own professional experience researching change efforts in clients and research participants informs me that any claimed change is unlikely to be lasting or complete. The biological research, while not conclusive, supports a very early establishment of sexual desires (especially for males). The available options for attempting change are often bizarre and carry potential to create psychological problems. Thus, limiting these efforts in a free society to adults seems like a reasonable professional position.
 

Southern Baptist Seminary Leaders Reject Reparative Therapy

Let me just say that I opposed reparative therapy before it was cool to oppose it.
Yesterday, Al Mohler and others articulated their position against reparative therapy, also known as sexual orientation change efforts.
Atlantic has an article on Alan Chambers’ new book and chronicles the demise of the ex-gay movement from Alan’s point of view.
Essentially, Mohler and colleagues believe changing orientation is not the Christian goal. Rather, avoidance of same-sex sexual relations is the objective in the narrow sense, and more broadly, pursuit of a spiritual life is what Christians should seek. Some same-sex attracted people are bisexual and others sometimes fall in love cross-orientation to form a mixed orientation marriage.
Although it is dated, I have a page on reparative therapy which demonstrates my approach to the issues in the professional sense.