Tag: david pickup

Reparative therapy and confirmation bias: Langer & Abelson’s 1974 study of clinical bias

Recently, I have been examining the possible role of confirmation bias in the attributions of reparative therapists.  In this post, I look at a classic study of how theoretical persuasion associates with clinical judgment.

Ellen Langer’s and Robert Abelson’s 1974 study* on clinical judgment is an important caution to clinicians about the role of preconceived ideas on diagnosis and attributions about patients. The abstract for the study is presented here:

The effect of labels on clinicians’ judgments was assessed in a 2 X 2 factorial design. Clinicians representing two different schools of thought, behavioral and analytic, viewed a single videotaped interview between a man who had recently applied for a new job and one of the authors. Half of each group was told that the interviewee was a “job applicant,” while the remaining half was told that he was a “patient.” At the end of the videotape, all clinicians were asked to complete a questionnaire evaluating the interviewee. The interviewee was described as fairly well adjusted by the behavioral therapists regardless of the label supplied. This was not the case, however, for the more traditional therapists. When the interviewee was labeled “patient,” he was described as significantly more disturbed than he was when he was labeled “job applicant.”

In addition to ratings of pathology, the authors recorded some of the descriptions of the interview by therapists who were told the interviewee was a job applicant and those who were told he was a patient. The differences are striking. Behavior therapists did not differ much but the psychoanalytic therapists described the job applicants as well adjusted but the same interviewee, when labeled as a patient, was labeled as disturbed. Note these differences from Langer and Abelson’s discussion of their study.

In the study just described, all of the subjects saw the same videotaped interview. Yet when asked to describe the interviewee, the behavior therapists said he was “realistic”; “unassertive”; “fairly sincere, enthusiastic, attractive appearance”; “pleasant, easy manner of speaking”; “relatively bright, but unable to assert himself”; “appeared responsible in interview.” The analytic therapists who saw a job applicant called him “attractive and conventional looking”; “candid and innovative”; “ordinary, straightforward”; “upstanding, middle-class-citizen type, but more like a hard hat”; “probably of lower or blue-collar class origins”; “middle-class protestant ethic orientation; fairly open-— somewhat ingenious.” The analytic therapists that saw a patient described him as a “tight, defensive person . . . conflict over homosexuality”; “dependent, passive-aggressive”; “frightened of his own aggressive impulses”; “fairly bright, but tries to seem brighter than he is … impulsivity shows through his rigidity”; “passive, dependent type”; “considerable hostility, repressed or channeled.”

Note the dramatic differences in descriptions. The same person who was described as well adjusted by analysts who thought they were watching a person applying for a job was described in pathological terms when they thought they were watching a patient being interviewed. Note that an attribution of homosexuality was made by at least one of the analytic therapists.

When reparative therapists say they are not biased when examining the histories of their same-sex attracted patients, I am highly skeptical.

Langer and Abelson describe the potential problem with making attributions based on patient labeling:

In practical terms, the labeling bias may have unfortunate consequences whatever the specific details of its operation. Once an individual enters a therapist’s office for consultation, he has labeled himself “patient.” From the very start of the session, the orientation of the conversation may be quite negative. The patient discusses all the negative things he said, did, thought, and felt. The therapist then discusses or thinks about what is wrong with the patient’s behavior, cognitions and feelings. The therapist’s negative expectations in turn may affect the patient’s view of his own difficulties, thereby possibly locking the interaction into a self-fulfilling gloomy prophecy.

It is not hard to see how a client presenting with “unwanted same-sex attraction” could end up in the kind of self-fulfilling prophecy described by Langer and Abelson. Since reparative therapists believe homosexuality is invariably caused by “gender wounds” early in life, no small amount of effort will be spent to find evidence of them, whether or not they exist.

*Langer, E.J.; & Abelson, R.P. (1974).A patient by any other name . . . : Clinician group difference in labeling bias.Journal of Consulting and Clinical Psychology.42(1), 4-9.

Related:

 

 

Reparative therapy and confirmation bias: An illustration

One of the biggest problems I have with reparative therapy is the self-fulfilling nature of the approach. Reparative therapists assume that the existence of same-sex attraction means a person has suffered gender based trauma during a specific period of childhood.

Reparative therapist David Pickup has commented on another post that straight men may have wounds but, from his point of view, they are not as deep as those which haunt gay men. In other words, if a straight man says he was traumatized in the same way, the reparative therapist’s answer is that the trauma wasn’t deep enough to trigger the reparative drive leading to same-sex attraction. If the gay man says he does not recall any such trauma, then the reparative drive theory posits that the gay man has repressed it and needs to uncover it. It seems to me the powerful effects of confirmation bias are at work.

The assumptions necessary to work as a reparative therapist remind me of the assumptions often associated with the repressed memory movement. Especially during the decade of the 1990s, many therapists assumed that negative moods such as depression or relational problems were due to childhood abuse of some kind that had been forgotten via the defense mechanism of repression. Some therapists harbored a belief that clients who could not remember trauma from the past were in a state of denial. This belief  led some therapists to repeatedly ask about recollections of trauma and hold out the possibility to their clients that they were simply unable to remember.

By questioning the mechanism of repression, I am not questioning the reality of gender based trauma. I am not questioning that some gay people had very impoverished childhoods. Of course that is true. But so did many straight people. In his recent comment, Mr. Pickup proposed that gay people have experienced deeper trauma than straight people experienced. This seems circular to me. How can you tell which experiences are worse? As far as I can tell, the way reparative therapists answer this question iss by knowing the sexual orientation of the client. Straight people have deep wounds; gay people, by definition according to the reparative approach, have deeper wounds.

As an illustration of how clients can adapt themselves to the theories of their therapists, I offer the experience of Carol Diament. Ms. Diament initially thought she would not need to detach from her family, as the other clients at Genesis Associates did. However, after awhile, “memories of abuse came up” and she detached from her parents (over three years), husband and even small children (at least 8 months and maybe longer).

Eventually Carol got away from Genesis, sought another therapist and came to realize that her memories were reconstructed with the help of her therapists at Genesis. By then, the damage was done. She had lost years of her life and had even lost her immediate family.

The clip is just over nine minutes long, but I hope you will watch it all the way through. Then, I hope you will discuss this and let me know what you think. Am I seeing a parallel with reparative theory that is valid or not?

Over the years, I have worked with many clients, gay and straight, who have experience significant trauma with parents. However, I have not been able to differentiate them based on the severity of their experiences. Furthermore, I know and have worked with many gay men and women who recall no deep trauma relating to their parents or peers. I also know gay men who experienced trauma after they came out to their parents because of the tension surrounding homosexuality. However, prior to the disclosure, the relationship was on par with any comparable straight person’s home life.

I also want to be clear that I am not closed to the possibility that certain childhood experiences could influence some people to question sexuality and engage in same-sex behaviors. In addition, some experiences of abuse are associated with risky sexual behavior of all kinds. Therapy, even reparative therapy, might help such people. However, I think these scenarios represent only a portion (probably very small) of the total gay and bisexual population.

NARTH at odds with Exodus over reparative therapy

Historically, the National Association for the Research and Therapy (NARTH) has considered Exodus an ally in the social discussion of sexual orientation change efforts. Until recently, Exodus sold reparative therapy books in their bookstore but recently removed them. Also, Alan Chambers recently told an audience at the Gay Christian Network conference that

The majority of people that I have met, and I would say the majority meaning 99.9% of them have not experienced a change in their orientation or have gotten to a place where they could say that they could  never be tempted or are not tempted in some way or experience some level of same-sex attraction.

I asked Alan Chambers about the reason for the removal of the reparative therapy books and he told me that Exodus wants to be clear that Christian discipleship is how they want to be known. He also said that he has respect for reparative therapy observations but added

The reason I removed RT books from Exodus Books is because I don’t agree with using this research as a means to say that “this” is how homosexuality always develops, “this” is the primary means in which to deal with it and this is “the” outcome you can expect.  Too, Exodus, as a whole, is not a scientific or psychological organization…we are a discipleship ministry and that is where I think our strength is and energy should be focused.

Apparently, these developments are troubling to NARTH leaders. One of them, David Pickup, recently penned an article at the Anglican Mainstream in defense of reparative therapy.  He wrote the article in direct response to the comments by Alan Chambers, noted above. Pickup writes:

Authentic Reparative Therapy really works. It works to help men change their sexual orientation, naturally dissipate their homoerotic feelings, and maximize their heterosexual potential.

However, there is evidence from the Exodus ministry that could be signaling an unawareness of this important message. Exodus has indicated a significant change in their views and policies as evidenced by the remarks of Exodus President Alan Chambers at the Gay Christian Network Conference last week. The official commentary on the peter-ould.net website has brought this to our attention. I believe their interpretation of Alan Chamber’s remarks is correct.

Chambers’ remarks essentially indicate that:

1. Exodus will no longer indicate or specifically claim that change from Gay to 100% straight is possible for anyone except for a few rare cases.

2. Exodus has apologized and will continue to do so for making these unrealistic claims, which they now believe have contributed toward misinformation, hurtfulness and homophobia.

3. Exodus will work to achieve a deeper understanding of the truth of homosexuality, which will allow them to minister more effectively and compassionately to those dealing with homosexuality.

Pickup then says something that will leave Exodus and NARTH watchers in disbelief.

In my experience, Exodus has, quite unintentionally for the last 20 years, failed to understand and effectively deal with the actual root causes of homosexuality and what leads to authentic change. I laud their willingness to admit their naiveté’, but I do not see anything so far that indicates they now truly understand the psychological, developmentally-based causes of homosexuality or what produces real change.

According to Pickup, not only is Exodus clueless now, they have been for 20 years. I imagine that will come as a shock to those in Exodus who have been given talks straight out the reparative playbook for all those years.

Pickup then offers his slant on why change in orientation should be recognized even if a same-sex attracted person is still same-sex attracted after they say they have changed.

(Parenthetically, let me state it is important that we recognize that just because a man might feel occasional sexual attractions towards men does NOT mean significant and real change has not occurred. Let’s take other challenges common to many people: depression or anxiety for instance. How many people who have successfully dealt with these issues are 100% changed so that they are not susceptible to later feelings of depression or anxiety? Can a therapist guarantee a client will never have those feelings again? Of course not. The same is true for homosexuality. Real change has occurred; however, no apologies should be made if much successful change has occurred even though homosexual feelings occasionally surface.)

I asked Alan Chambers what he meant by saying “99.9” don’t change and he said:

I cannot speak for others who say that temptation or attraction don’t equal orientation.  As a layman with regards to that issue, I tend to link them all together and that is where that 99.9%, non-scientifc/anecdotal/experiential statement comes from.

So what does it matter if some same-sex attraction remains? Doesn’t even a little shift deserve the word change attached to it? Alan seems to want to extract himself from this semantic debate by sticking to experience – the vast majority of people he knows retain attractions to the same sex. Pickup wants to explain that away by making sexual attraction analogous to depression or anxiety. Since he sees same-sex attraction as a disorder which stems from childhood wounds, that may work for him, but it won’t work for those who do not see it that way.

One problem here is political. NARTH wants to be able to say SSA people have changed if they experience a reduction in awareness of SSA and perhaps an experience of opposite sex attraction. This is a kind of change and if left in the therapeutic context, I would not quarrel too much with this (except to say that I don’t agree with the kind of techniques often used to push people this way). However, NARTH does not stay in the therapeutic context. They provide support for political groups who want change to mean complete change from gay to straight. Change is such a volatile concept because a modicum of change in the therapeutic setting is then exaggerated in the political and legal settings to argue against same-sex attraction as something intrinsic to the vast majority of people who experience it.

Pickup then lectures Exodus about theology and calls on them to align closer with reparative therapists.

If Chambers and Exodus do want to truly understand the nature of homosexuality, then they should be open to understanding the psychological underpinnings of these issues and start to recommending qualified therapists who are experts at facilitating significant change. If not, then Exodus will fall into deeper controversy than they are in already. They will be reduced to the myopic ministry of simply helping people to deal with their homosexuality through behavioral changes, which, by the way, reflects the American Psychological Association’s belief about Reparative Therapy: that real change is not possible and people may be helped only in the sense of conforming their behavior to reflect their religious beliefs. In short, Exodus will eventually lose even more effectiveness and begin to flounder.

Pickup even claims that reparative therapy is biblical:

Generally, many Exodus members cannot or will not see that Reparative Therapy is reflective of sound biblical principles. They do not understand shame and its role in the etiology of homosexuality. Not knowing this has led to the unintentional shaming of many same-sex attracted individuals for years, and has actually impeded their progress!

So Exodus has been part of the problem all these years?! I have been to several Exodus conferences over the years, and I can say they work hard not to shame people. The only sessions where I heard any shaming take place was in the sessions where reparative therapists told their audiences that the reason they were SSA was because their fathers didn’t love them and their mothers were smother mothers.

After chastising Exodus for shaming people, he engages in the practice by blaming parents and indicting parents and churches for causing the gay.

Many people of faith do not understand the root causes of homosexuality, which are primarily experienced in childhood. If they did understand, they would have to deal with the truth that they may have contributed to the development of their child’s homosexuality by not supplying enough of their emotional and identity formation needs. In general, parents find it very hard to believe how their child’s upbringing could possibly have been so injurious to them since they loved their child so much. However, loving a child and giving the child the love he needs can be two entirely different things. Parents and churches often find this idea to be unbelievable.

All I can say to Pickup’s last sentence there is: if only. If it were true that evangelicals were more skeptical of these ideas, then I believe Exodus would have changed the tune a long time ago. If only evangelicals were more skeptical, we would not be in such a polarized society where Christianity is synonymous with anti-gay.

As if a few anecdotes prove anything, Pickup closes by citing come quotes he says come from satisfied change customers.

“This is really hard work, but when I focus on healing the pain of what I didn’t get from my father or my friends, something in me heals. Then when I get my male needs met, the SSA just goes away by itself.”

“I really feel more attracted to women now. I want to love a woman and have a family.”

“I still have shame issues, and I once in a while feel attracted to a man, but I know how to work on that and feel affirmed by other men now.” I see myself as a man like other men, and the sexual attractions just sort of go away.”

“This affirmation work and the needs I’m getting filled feels a lot better than sex with a guy.”

I have no doubt that healing from real wounds in life can be beneficial emotionally and it can also lead to a better sense of self-control. So when people who are sexually compulsive find some way to understand themselves better, they can resist whatever pressures push them to risky behavior. However, as Alan Chambers recently noted, such benefit infrequently leads to an elimination of same-sex attraction.

Now if four quotes are sufficient for Mr. Pickup, I will end with four statements from my clients about reparative therapy and their experience.

Our therapist told us after taking our money that there was nothing he could do for us because our family didn’t fit the typical family for a homosexual. He even said that our son would grow out of it because we didn’t fit the mold. (He didn’t grow out of it)

I quit going to Journey into Manhood because it just didn’t last. After a weekend, I did lose some of the same-sex attraction but it always came back. I went to a support group, and saw a reparative therapist and it just didn’t change.

When we took our son to the reparative therapist, he told us that same-sex attraction invariably arises due to a broken relationship with me, his father, and a mother who compensates for this. We were devastated; the man said he was describing our family but he was wrong. My son and I have always been close.

You know, I used to want to change my attractions. I felt like a failure when I saw a hot guy. But the last 3 years have been awesome, I don’t have to pretend or anything. I am who I am and that is an SSA man who loves his wife and kids.

I believe it is possible that Pickup’s clients find an adjustment that suits them. However, the mischief starts when reparative therapists generalize those experiences to gay people as a group.

I am sure it obvious that I think Chambers is much more on the right track than Pickup. Although Exodus continues to refer to reparative therapists and there are member ministries that are quite reparative in their approach, I think a move toward honesty about what people can expect is valuable.

Mankind Project clarifies stance on reparative therapy

Within the last day or so, Mankind Project members received an email from Executive Director, Carl Griesser with an alert to a new feature on the MKP website.

…the next time you visit www.MKP.org you will find a rainbow flag with the word Friendly superimposed as a navigation button linked directly to a slightly modified version of the reparative therapy statement. The Executive Committee and our IT Team believe this is an effective way of indicating our welcoming attitude to all men, while making the statement easily accessible to the public.

Click on the link and you will find the following article titled Sexual Orientation & the Mankind Project:

· The ManKind Project creates trainings and circles in which men are invited to discover their deepest truths.
· We welcome men of all sexual orientations: gay, straight, and bisexual, as well as those who identify as having unwanted same sex attraction, to do their own work as they define it, to respect the identity and value of others, and to take responsibility for the impact their words and behaviors have on others.
· We support each man in pursuing his path to deeper authenticity. We do not provide therapy nor endorse any particular therapy, including reparative therapy. Any group or organization that states or implies otherwise does so without our permission.
· We do not, and will not, attempt to change a man’s sexual orientation.
· We stand firm in support of gay and bisexual men. We support men who believe that homosexuality is a normal part of the spectrum of human sexuality and of mature masculinity.
· We will not tolerate proselytizing for any religion or belief and do not tolerate discrimination on our trainings or in our communities. We support our training and community leaders in identifying and challenging discriminatory language and behavior.

I provided a link to this statement in a previous post. Essentially, some reparative therapy clients/therapists were recommending the New Warriors Training Adventure to same-sex attracted men as a means of enhancing their sense of masculinity. Reparative therapists believe male same-sex attraction derives from a sense of distrust of men and a disconnection from natural masculinity. Via the reparative drive, he sexualizes his desire for masculine closeness and seeks homosexual relationships. Get a man feeling all masculine and his SSA disappears. Perhaps one of the clearest statements of this hypothesis and the proposed remedy is David Pickup’s the Workout program.
Mr. Pickup recommends the New Warriors Training Adventure and notes on his website that he serves as training coordinator of the Los Angeles branch of the Mankind Project. This is the branch which hosted Joseph Nicolosi, Narth co-founder and father of reparative therapy, at a training session in 2005. This session was quite controversial and eventually led to the MKP statement.
The email to MKPers provided this rationale for the new rainbow link:

Men,
As many of you are aware, the Project Council approved a Position Statement on Reparative Therapy in February 2007. Based on initial text prepared by Jim Mitchell, I prepared a statement which was then revised by a group of gay, bi, and straight men, and men who identify as having Unwanted Same Sex Attraction (USSA). We decided that it was necessary to take this stand because many men were being referred to the NWTA by reparative therapists and groups who had little or no experience with MKP (as well as by some reparative therapists and USSA men who had been through the training.) It was our intention to clarify for ourselves and for these men what they can expect if they attend our trainings. I sent the statement to the reparative therapists and groups I knew about, and have continued to do so when I learn of others. I asked organizations which implied on their websites that MKP offered or supported reparative therapy to remove such statements and any links to our website. Some complied with the request, though not all.

I got a chuckle out of this sentence: “It was our intention to clarify for ourselves and for these men what they can expect if they attend our trainings” since the MKP is so secretive about what men can expect. In any case, I believe it is valuable for MKP to indicate to men that they do not adhere to the masculinity enhancement model of reparative therapy for men who might be encouraged by reparative organizations/practitioners to seek NWTA for that purpose.