Wall Street Journal covers APA task force report and sexual identity therapy

The Wall Street Journal’s Stephanie Simon has captured well the application of the APA task force sexual orientation report in an article out this morning. Of course I would say that…

The men who seek help from evangelical counselor Warren Throckmorton often are deeply distressed. They have prayed, read Scripture, even married, but they haven’t been able to shake sexual attractions to other men — impulses they believe to be immoral.

Dr. Throckmorton is a psychology professor at a Christian college in Pennsylvania and past president of the American Mental Health Counselors Association. He specializes in working with clients conflicted about their sexual identity.

The first thing he tells them is this: Your attractions aren’t a sign of mental illness or a punishment for insufficient faith. He tells them that he cannot turn them straight.

But he also tells them they don’t have to be gay.

For many years, Dr. Throckmorton felt he was breaking a professional taboo by telling his clients they could construct satisfying lives by, in effect, shunting their sexuality to the side, even if that meant living celibately. That ran against the trend in counseling toward “gay affirming” therapy — encouraging clients to embrace their sexuality.

But in a striking departure, the American Psychological Association said Wednesday that it is ethical — and can be beneficial — for counselors to help some clients reject gay or lesbian attractions.

The APA is the largest association of psychologists world-wide, with 150,000 members. The association plans to promote the new approach to sexuality with YouTube videos, speeches to schools and churches, and presentations to Christian counselors.

According to new APA guidelines, the therapist must make clear that homosexuality doesn’t signal a mental or emotional disorder. The counselor must advise clients that gay men and women can lead happy and healthy lives, and emphasize that there is no evidence therapy can change sexual orientation.

But if the client still believes that affirming his same-sex attractions would be sinful or destructive to his faith, psychologists can help him construct an identity that rejects the power of those attractions, the APA says. That might require living celibately, learning to deflect sexual impulses or framing a life of struggle as an opportunity to grow closer to God.

While the report doesn’t use my exact words (e.g., I don’t say ‘you don’t have to be gay’), she does catch important aspects of the APA report and the stance I use within the sexual identity therapy framework. Furthermore, I don’t show the video at the same time in the same order of things to clients and then they make a decision about their direction. I do however, do extensive informed consent and answer lots of questions which involves videos and slides to answer. Thanks for Michael Bailey for those vids.

This report captures the essence of the novel findings in the APA report in contrast to the AP report which continues to present a polarized picture. For sure, as long as the dialogue around change is important to people, we keep talking past each other. However, when you look at what both sides actually claim, they are not that far apart. According to the AP report, Jones and Yarhouse are going to report over half of 61 subjects either changed or are celibate. Whatever the percentage, it is clear that change cannot be promised to clients as a predictable function of therapy or ministry. We should be able to agree about that and then place emphasis on belief and value congruence. From there, see what happens.

I will have other posts on the media reaction and additional analysis…

APA sexual orientation task force report: Analysis

Earlier today, the American Psychological Association governing board received the report of the Task Force on Appropriate Therapeutic Response to Sexual Orientation. The report and press release were embargoed until now. With this post, I want to comment on the paper and recommendations made by the Task Force.

Generally, I believe the paper to be a high quality report of the evidence regarding sexual orientation and therapy. The authors of the paper (see this post for the new release which contains authorship information) provide a very helpful discussion of the professional literature on sexual orientation change efforts (SOCE), potential benefits and harm and the role of religion and values in sexual orientation identity exploration. Before I get to a more detailed look at highlights, I want to note an important statement from the APA press release made by Task Force Chair, Judith Glassgold:

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.

Dr. Glassgold here describes sexual identity therapy. In fact, as I will point out, the SIT framework is referred to positively throughout the paper. Whereas some evangelicals may be troubled by the negative view of sexual reorientation in this report, there is much here that clarifies important aspects of work in this field. The paper is long (130 pages) and so one post cannot capture all that is important. I want to start with what for me are the high spots, beginning with the abstract:

The American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation conducted a systematic review of the peer-reviewed journal literature on sexual orientation change efforts (SOCE) and concluded that efforts to change sexual orientation are unlikely to be successful and involve some risk of harm, contrary to the claims of SOCE practitioners and advocates. Even though the research and clinical literature demonstrate that same-sex sexual and romantic attractions, feelings, and behaviors are normal and positive variations of human sexuality, regardless of sexual orientation identity, the task force concluded that the population that undergoes SOCE tends to have strongly conservative religious views that lead them to seek to change their sexual orientation. Thus, the appropriate application of affirmative therapeutic interventions for those who seek SOCE involves therapist acceptance, support, and understanding of clients and the facilitation of clients’ active coping, social support, and identity exploration and development, without imposing a specific sexual orientation identity outcome. (p. v)

While the paper takes a dim view of change efforts, the authors indicate that attempts to change have been viewed as helpful by some and harmful by others. This is a fair reading of the research. Given these assessments of the research, the stance the APA recommends is to provide supportive psychotherapy without imposing an identity outcome on the client. To get to this view, the authors review change literature, literature on outcomes and research regarding religion and sexual orientation. I want to briefly recap each section.

Efficacy of change efforts

The Task Force reviewed 83 studies that met basic standards for inclusion. They were not impressed with the methodological rigor of the body of research. Their conclusion:

Thus, the results of scientifically valid research indicate that it is unlikely that individuals will be able to reduce same-sex attractions or increase other-sex sexual attractions through SOCE. (p. 3)

Safety of change efforts

The Task Force provided a cautious and nuanced response to the question of harm or benefit from SOCE. I believe they are on target here. Some people report harm and some report benefit but there are no studies which allow conclusions about likelihood of either outcome for any given person. About safety, the press release notes:

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.

Religion and change efforts

One of the highlights of the report is the discussion of religion and sexual orientation. The authors are to be commended for their balanced and thoughtful approach. I especially like the discussion surrounding the concepts of “organismic congruence” and “telic congruence.” On page 18, the paper summarizes these concepts well:

The conflict between psychology and traditional faiths may have its roots in different philosophical viewpoints. Some religions give priority to telic congruence (i.e., living consistently within one’s valuative goals) (W. Hathaway, personal communication, June 30, 2008; cf. Richards & Bergin, 2005). Some authors propose that for adherents of these religions, religious perspectives and values should be integrated into the goals of psychotherapy (Richards & Bergin, 2005; Throckmorton & Yarhouse, 2006). Affirmative and multicultural models of LGB psychology give priority to organismic congruence (i.e., living with a sense of wholeness in one’s experiential self (W. Hathaway, personal communication, June 30, 2008; cf. Gonsiorek, 2004; Malyon, 1982). This perspective gives priority to the unfolding of developmental processes, including self-awareness and personal identity.

This difference in worldviews can impact psychotherapy. For instance, individuals who have strong religious beliefs can experience tensions and conflicts between their ideal self and beliefs and their sexual and affectional needs and desires (Beckstead & Morrow, 2004; D. F. Morrow, 2003). The different worldviews would approach psychotherapy for these individuals from dissimilar perspectives: The telic strategy would prioritize values (Rosik, 2003; Yarhouse & Burkett, 2002), whereas the organismic approach would give priority to the development of self-awareness and identity (Beckstead & Israel, 2007; Gonsiorek, 2004; Haldeman, 2004). It is important to note that the organismic worldview can be congruent with and respectful of religion (Beckstead & Israel, 2007; Glassgold, 2008; Gonsiorek, 2004; Haldeman, 2004; Mark, 2008), and the telic worldview can be aware of sexual stigma and respectful of sexual orientation (Throckmorton & Yarhouse, 2006; Tan, 2008; Yarhouse, 2008). Understanding this philosophical difference may improve the dialogue between these two perspectives represented in the literature, as it refocuses the debate not on one group’s perceived rejection of homosexuals or the other group’s perceived minimization of religious viewpoints but on philosophical differences that extend beyond this particular subject matter. However, some of the differences between these philosophical assumptions may be difficult to bridge.

On this blog, we have frequently grappled with these differences. Many such discussions have sides talking past each other because different views of congruence are assumed to be determinative. In this CNN clip about the Task Force, Psychiatrist McCommon and I came to about the same conclusion regarding congruence.

There are different assumptions about what best constitutes the answer to the question: ‘who am I?’ This paper nicely addresses these assumptions and acknowledges that people who are deeply committed to a non-gay-affirming religious position may stay same-sex attracted but not identify as gay. As the paper notes, this is an acceptable alternative.

Clinical approaches

The authors consider the role of therapy and ministries groups as aspects of SOCE. What they say about support groups is interesting.

These effects are similar to those provided by mutual support groups for a range of problems, and the positive benefits reported by participants in SOCE, such as reduction of isolation, alterations in how problems are viewed, and stress reduction, are consistent with the findings of the general mutual support group literature. The research literature indicates that the benefits of SOCE mutual support groups are not unique and can be provided within an affirmative and multiculturally competent framework, which can mitigate the harmful aspects of SOCE by addressing sexual stigma while understanding the importance of religion and social needs. (p. 3)

In a nutshell, support groups can have benefit when the singular focus is not change of orientation. Our conversations here regarding the change versus congruence model is relevant. I think the kind of changes that are most common are ideological and behavioral. And when I say behavioral, I mean both cessation of unwanted behavior and also less preoccupation with seeking harmful sexual behavior. I think some people feel they have moved on the Kinsey scale because they have better self-control regarding same-sex behavior. These are good and important telic changes but they don’t represent the kinds of changes which reflect dramatic organismic shifts. Orthodox Christianity does not require organismic changes in order to pursue spiritual development.

Moving from ministry to clinical worlds, the application seems obvious to me. And perhaps it seems obvious since I have been advocating for this stance for several years now. The client sets the value direction and the outcome is not imposed.

In our review of the research and clinical literature, we found that the appropriate application of affirmative therapeutic interventions for adults presenting with a desire to change their sexual orientation has been grounded in a client-centered approach (e.g., Astramovich, 2003; Bartoli & Gillem, 2008; Beckstead & Israel, 2007, Buchanan et al., 2001; Drescher, 1998a; Glassgold; 2008; Gonsiorek; 2004; Haldeman, 2004, Lasser & Gottlieb, 2004; Mark, 2008; Ritter & O’Neill, 1989, 1995; Tan, 2008; Throckmorton & Yarhouse, 2006; Yarhouse & Tan, 2005a; and Yarhouse, 2008). (P.55)

It is heartening to see the SIT framework referenced here (and elsewhere in the APA paper) as one “appropriate application of affirmative therapeutic interventions.” In general, I think the APA strategies and the SIT framework are quite compatible.

Bottom line: The APA report will likely be quite influential for years to come. They call for more research on SOCE and a cautious, and I think accurate, interpretation of the research on reorientation. I believe the therapeutic strategies called for are akin to the SIT framework and clarifies nicely the appropriate stance of therapists. The report also respects the place of religion in identity development and exploration. These issues were not clear prior to this report.

In additional posts, I will deal with various aspects of the paper as well as media coverage. The press release is here and here on the APA website.

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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Sexual identity therapy: A blast from the past

In light of conversations on the Exodus-PFOX thread, I thought it might be good to review a past mainstream media article that brought SIT more into the mainstream conversation.

The LA Times article now titled “Approaching agreement in debate over homosexuality” by Stephanie Simon (now with the Wall Street Journal) was published on June 18, 2007 with the title, “New ground in debate on ‘curing’ gays.”

The article begins with some familiar ground to this blog:

Alan Chambers directs Exodus International, widely described as the nation’s largest ex-gay ministry. But when he addresses the group’s Freedom Conference at Concordia University in Irvine this month, Chambers won’t celebrate successful “ex-gays.”

Truth is, he’s not sure he’s ever met one.

With years of therapy, Chambers says, he has mostly conquered his own attraction to men; he’s a husband and a father, and he identifies as straight. But lately, he’s come to resent the term “ex-gay”: It’s too neat, implying a clean break with the past, when he still struggles at times with homosexual temptation. “By no means would we ever say change can be sudden or complete,” Chambers said.

His personal denunciation of the term “ex-gay” — his organization has yet to follow suit — is just one example of shifting ground in the polarizing debate on homosexuality.

I am not sure if I am correct, but I think Alan later nuanced the remarks about not knowing ex-gays, but I do think he has made efforts including the recent article regarding Bryce Faulkner, to paint an accurate picture of his personal situation.

This article brought to a wide audience conversations that we have been having here for quite awhile — and continue to have. The ex-gay conversation is a recurring one here. Some newer readers may want to review this post (Ex-ex-gay?) and this one ( What does change mean?) and this one (Acceptance and Commitment Therapy).

The LA Times article quoted several people who approved of the framework, including commenter Michael Bussee.

“Something’s happening. And I think it’s very positive,” agreed Michael Bussee, who founded Exodus in 1976, only to fall in love with another man — a fellow ex-gay counselor.

Now a licensed family therapist in Riverside, Bussee regularly speaks out against ex-gay therapies and is scheduled to address the Ex-Gay Survivor’s Conference at UC Irvine at the end of the month.

But Bussee put aside his protest agenda recently to endorse new guidelines to sexual identity therapy, co-written by two professors at conservative Christian colleges.

Other notable folks gave a thumbs-up to the framework as well.

He and other gay activists — along with major mental-health associations — still reject therapy aimed at “liberating” or “curing” gays. But Bussee is willing to acknowledge potential in therapy that does not promise change but instead offers patients help in managing their desires and modifying their behavior to match their religious values — even if that means a life of celibacy.

“It’s about helping clients accept that they have these same-sex attractions and then allowing them the space, free from bias, to choose how they want to act,” said Lee Beckstead, a gay psychologist in Salt Lake City who uses this approach.

The guidelines for this type of therapy — written by Warren Throckmorton of Grove City College and Mark Yarhouse of Regent University — have been endorsed by representatives on both the left and right. The list includes the provost of a conservative evangelical college and the psychiatrist whose gay-rights advocacy in the 1970s got homosexuality removed from the official medical list of mental disorders.

“What appeals to me is that it moves away from the total polarization” common in the field, said Dr. Robert Spitzer, the psychiatrist.

“For many years, mental-health professionals have taken the view that since homosexuality is not a mental disorder, any attempt to change sexual orientation is unwise,” said Spitzer, a Columbia University professor.

Some therapies are widely considered dangerous, and some rely on discredited psychological theories. “But for healthcare professionals to tell someone they don’t have the right to make an effort to bring their actions into harmony with their values is hubris,” Spitzer said.

Just over two years later, we continue to discuss very similar concerns and the tension remains.

Activists on both sides caution that the rapprochement only goes so far.

Critics of Exodus note the group still sponsors speakers who attribute homosexuality to bad parenting and assert that gays and lesbians live short, unhappy lives.

And though Chambers has disavowed the term “ex-gay,” his group’s ads give the distinct impression that it’s possible to leave homosexuality completely behind.

Haven’t we just been discussing this topic?

The article concludes with a reference to the APA Sexual Orientation Task Force.

The American Psychological Assn. set up a task force this spring to revise the group’s policy on sexual orientation therapy. The current policy is a decade old and fairly vague; it states that homosexuality is not a disorder and that therapists can’t make false claims about their treatments.

The new policy, due early next year, must help psychologists uphold two ethical principles as they work with patients unhappy about their sexuality: “Respect for the autonomy and dignity of the patient, and a duty to do no harm,” said Clinton Anderson, the association’s director for lesbian, gay and bisexual concerns. “It’s a balancing act.”

In fact, the Task Force will report soon, in August, sometime during the APA convention. Stay tuned…

Although we will soon migrate the website, more on the SIT Framework is now here.

NARTH releases journal

The National Association for the Research and Therapy of Homosexuality recently released a journal.

PRESS RELEASE

For Immediate Release

June 10, 2009

Contact: David Pruden

Phone: (888) 364-4744

E-mail: [email protected]

New Scientific Research Refutes Unsubstantiated Claims Regarding Homosexuality

Encino, CA- A new report in this month’s edition of the peer-reviewed Journal of Human Sexuality finds that sexual orientation is not immutable and that psychological care for individuals with unwanted homosexual attractions is beneficial and poses no significant risk of harm. The study, What Research Shows: NARTH’s Response to the American Psychological Associations Claims on Homosexuality, examines over 100 years of professional and scientific literature as well as over 600 reports from clinicians, researchers, and former clients principally published in professional and peer-reviewed journals.

This research, assembled over a period of eighteen months by three of the leading academics and therapists in the field and under the direction of the NARTH Scientific Advisory Committee directly refutes unsubstantiated claims made by some factions of the American Psychological Association and several other professional mental health organizations. The study, conducted by the National Association for Research and Therapy of Homosexuality, a network of professionals dedicated to upholding the rights of men and women dealing with unwanted homosexual attraction to receive effective psychological care, confirms the results of a 2007 longitudinal study conducted by researchers Stanton L. Jones and Mark Yarhouse that found that religiously mediated sexual orientation change is possible for some individuals and does not cause psychological harm on average.

“This research is a significant milestone when it comes to the scientific debate over the issue of homosexuality,” said NARTH president Dr. Julie Hamilton. “It also confirms what we have seen evidenced in hundreds of individuals who have benefited from the help of NARTH therapists. We believe that every person should have the right to independently determine their own course in life and for many that involves seeking counseling options that affirm their personal beliefs.”

In addition to What Research Shows, a collection of peer-reviewed scholarly and professional papers entitled Understanding, Preventing, and Treating Sexual Identity Confusion in Children and Adolescents, will be published in Volume II of the Journal of Human Sexuality.

Requests for copies or for a more detailed summary of the inaugural issue of the journal should be addressed to: Journal of Human Sexuality • 307 West 200 South, Suite 3001 • Salt Lake City, UT 84101. The journal can also be ordered by phone at 1-888-364-4744 or online at www.narth.com. A PDF summary of the journal may be downloaded at www.narth.com.

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NARTH is a professional, scientific organization that offers hope to those who struggle with unwanted homosexuality. As an organization, it disseminates educational information, conducts and collects scientific research, promotes effective therapeutic treatment, and provides referrals to those who seek assistance. NARTH upholds the rights of individuals with unwanted homosexual attraction to receive effective psychological care and the right of professionals to offer that care.

I have a copy of the report heading my way and will review it later this summer. For now, it is worth pointing out that there is no new research in the response to the APA, rather it is a review of literature. If the paper “confirms the results” of Jones and Yarhouse, does that mean that NARTH will scale back the claims about change to the 15% found by those authors? That result would require a change in rhetoric from NARTH leaders when on the stump.

In any event, this paper and the journal as an effort is likely a response to the APA Task Force which will probably report in August at the APA annual meeting.