Sexual Identity Therapy Framework to Be Reviewed

I posted this to the SIT Blog and I hope other bloggers post this on their blogs.  

News Release 

Sexual Identity Therapy Framework to Be Reviewed

The Sexual Identity Therapy Framework, authored by Warren Throckmorton and Mark Yarhouse, will be reviewed in 2008 for possible revision. Proposed as a means to help counselors work with clients who experience value conflict surrounding homosexual attractions, the Framework is endorsed by Nicholas Cummings, the father of managed behavioral healthcare and Robert Spitzer, the architect of modern psychiatric diagnosis. The framework respects diversity of sexual orientation and religious practice and anticipates a planned review of sexual orientation counseling which will be reported by the American Psychological Association in 2008.

“We believe this area of counseling practice is changing rapidly and we want to be sensitive to how therapists and consumers of sexual identity therapy feel the framework helps or hinder excellent outcomes. We want to hear from professionals and consumers alike,” said Dr. Throckmorton.

The authors are asking for public and professional comment on the Framework though the end of February, 2008.

Interested persons can download and review the Framework at http://www.sexualidentity.blogspot.com. One may leave comment there or send extended comments to Warren Throckmorton at ewthrockmorton@gcc.edu and/or Mark Yarhouse at markyar@regent.edu. Therapists interested in a registry of therapists who adhere to the Framework should visit, http://www.sexualidentityinstitute.org.

Selected endorsements:

I have reviewed the sexual identity framework written by Warren Throckmorton and Mark Yarhouse. This framework provides a very necessary outline to help therapists address the important concerns of clients who are in conflict over their homosexual attractions. The work of Drs. Throckmorton and Yarhouse transcend polarized debates about whether gays can change their sexual orientation. Rather, this framework helps therapists work with clients to craft solutions tailored to their individual situations and personal beliefs and values. I support this framework and hope it is widely implemented.

Robert L. Spitzer, M.D., is Professor of Psychiatry, Columbia University, New York State Psychiatric Institute, New York City, NY. Dr. Spitzer was Chairman of the committee that developed the Diagnostic and Statistical Manual of Mental and Emotional Disorders, 3rd Edition and 3rd Edition (Revised).

Drs. Throckmorton and Yarhouse have brilliantly resolved contention in psychotherapy by providing the field with unbiased guidelines that are responsive to scientific evidence, are sensitive to professional practice, and which restore patient determination in choosing his/her goals in psychotherapy.

Dr. Nicholas Cummings, PhD, ScD is Distinguished Chair in Psychology, University of Nevada, Reno. Dr. Cummings is the President of the Foundation for Behavioral Health and Chairman of the Nicholas & Dorothy Cummings Foundation, Inc. He was the founding CEO of American Biodyne (now Magellan Behavioral Care). He is also the former President of the American Psychological Association. Dr. Cummings was the founder of the four campuses of the California School of Professional Psychology, the National Academies of Practice, and the American Managed Behavioral Healthcare Association. He was the former Executive Director of the Mental Research Institute. Dr. Cummings is the co-editor with Rogers Wright of Destructive Trends in Mental Health.

One point I am considering is to discourage referral to NWTA and I-groups as a means of changing orientation. While no outcome studies have been done on this point, it seems clear that such referrals do nothing on average to change orientation. We welcome feedback and suggestions.

Year in review: Top Ten Stories from 2007

Since it was so much fun last year, I decided to compile a top ten list of stories of the year on the blog. Since I am the only voter, the list is subjective and regular readers might arrange them differently or think I should have included another story over one of these. The stories are arranged in the order of the interest they seemed to create here on the blog and elsewhere.

1. APA Task Force on sexual orientation – I first reported here that the APA had convened a task force to review APA policy regarding therapeutic responses to sexual orientation. Initial information released from the APA noted that gay advocacy groups sought assistance from the APA in order to negatively evaluate efforts to change sexual orientation. The charge also involves therapeutic responses to individuals who wish to alter behavioral expression of their sexuality. The issue was the subject of a CNN segment involving yours truly, an Associated Press article and was the subject of several posts on the blog. A large coalition of religious groups and interested individuals wrote the APA regarding the religious aspects of the committee’s charge. Efforts to further regulate orientation change efforts spilled over to other professions, notably, the American Academy of Physician Assistants. The APA Task Force will likely be featured as a top story again since the report is expected to be released sometime in 2008.

2. The sexual identity therapy framework – The SIT framework was the subject of national news stories and identified by Stephanie Simon of the LA Times as an important component of changes in therapy for those in conflict over sexual identity. I did numerous posts on the framework in an attempt to distinguish it from other approaches. Mark Yarhouse and I presented aspects of the framework at the American Psychological Association convention, the American Association of Christian Counselors World Conference and other local conferences. A revision of the framework and several high level presentations are slated for 2008. 

3. The release of the Exodus outcomes study by Stanton Jones and Mark Yarhouse – After months of speculation, Stanton Jones and Mark Yarhouse released the results of their longitudinal study of Exodus International participants at the AACC conference in September.  Although the study garnered little national media attention, many blogs, (including this one), and the gay and religiously based news services thoroughly covered the study. With additional data to be collected and reported, this story will most likely reappear in 2008.   

4. Donnie Davies – For a short time in January and February, blogosphere was captivated by the “Rev. Davies” and the “The Bible Says” music video. In a kind of “Where’s Waldo” cyber hunt, numerous bloggers were eager to crack the case and learn find out who Donnie Davies was, where was he hiding, and to learn if his act for real. I did 11 posts on the subject and became acquaited via email with Joey Oglesby, the actor behind the spoof. We even wondered if Mr. Oglesby and Rev. Davies were twins separated at birth because of their uncanny resemblance. Will Donnie do an anniversary reunion tour in January? Stay tuned.

5. The Cameron Eastern Psychological Association presentation – In March, Paul and Kirk Cameron released a series of news spots claiming that data from Canada, Norway and Denmark supported their contention that gays die between 20-30 younger than straights. In reviewing their study, first presented as a poster session at the Eastern Psychological Association annual meeting, I disputed key assumptions underlying their claims. In addition, Danish epidemiologist, Morten Frisch reviewed the study here on the blog finding it inadequate. Paul and Kirk Cameron provided rebuttals to criticisms and a nine-part series resulted.

6. New Warriors Training Adventure and the Mankind Project – A post regarding the suicide of Michael Scinto in an October issue of the Houston Press led to a series of posts about the Mankind Project and New Warriors Training Adventure. I received numerous emails from men who attest to benefit and those who believe NWTA was harmful and coercive. One irony about NWTA is that public proponents of reparative therapy and gay affirmative therapy both recommend NWTA to clients to enhance masculinity. Reparative therapists believe NWTA may lead to reduced same-sex attraction and gay therapists believe NWTA can enhance security in a gay identity. I remain curious about the mechanisms inherent in NWTA and other such programs to effect either benefit or harm. With the Scinto trial schedule for later in 2008, this story will remain of interest through the next year.

7. Montel Williams show on reparative therapy – The Montel Williams show purporting to examine reparative therapy was a lightning rod for controversy. On the show, psychiatrist Alicia Salzar falsely claimed that science has shown that 96% of people attempting to change orientation cannot do so and experience harm. Her claim was based on a study, the authors of which acknowledged cannot be used to make such a claim. The unwillingness of the show to retract the statement led to a ethics complaint against Dr. Salzar, filed by Exodus International. 

8. Pro-life/abortion related stories – The most viewed post on the blog consisted of an interview with Grove City College colleague and historian Paul Kengor regarding the religious beliefs of Hillary Clinton.  Other such interviews have been immensely popular with readers as well. Another APA task force, this one on abortion and mental health issues, stimulated grassroots activism, reported here in November. 

9. Emergence of the ex-ex-gay movement – At this year’s Exodus conference, a group of people once involved in ex-gay efforts had a parallel conference to discuss their efforts to recover from their experiences. Perhaps, the newest ex-ex-gay, James Stabile is a 19 year old young man from Dallas who encountered evangelists from the Heartland World Ministry Church in early September. Recorded on film and broadcast on the Christian Broadcasting Network, it appeared that Mr. Stabile was dramatically converted and even reported change in homosexuality. Later it was learned that Mr. Stabile had not changed and was back home with his parents after a stay at ex-gay residential program, Pure Life Ministry.

10. Richard Cohen – An early 2007 debacle on John Stewart’s Daily Show led Mr. Cohen to pledge on my blog that he would do no additional media appearances. He ended his email with a fundraising appeal. In response to this appearance, Exodus issued a statement distancing the organization from Cohen’s work, and NARTH and PFOX quietly removed references to Mr. Cohen from their websites. Cohen made something of a comeback however, with You Tube videos including his family, and a new edition of one of his books with Evangelical publisher, Intervarsity Press. Then, later, I looked into the Unification Church connections of Mr. Cohen’s assistant director and former board member, Hilde Wiemann. Both Cohen and Wiemann initially denied these connections but they were clear enough that cult expert, Steve Hassan, briefly placed the International Healing Foundation back on his list of Unification Church connected groups. Eventually, Mrs. Wiemann acknowledged, in contrast to the initial claims, that she had been involved in the church and had only recently left it. After her repudiation of Moon, Mr. Hassan then again removed the IHF from his list of Unification connected groups.    

Well, that was quite a year. I suppose one could make a case for other stories, e.g., the Omaha websites advocating violence, the quick emergence and then retreat of Michael Glatze as an ex-gay spokesman, Ted Haggard’s three week therapy, the wide stance of Larry Craig, the Surgeon General nominee James Holsinger, Stephen Bennett’s public division with Exodus, Al Mohler’s comments on biology and homosexuality, the retirement of I Do Exist, and my musical comeback and resultant #1 Internet hit.

Now cast your opinion – What would your top ten list for this blog look like for 2007?

Godspeed to all and a Happy New Year!

Heartland Church purity siege video describes sexual identity struggle

Commenter isea metaphor referred to another video featuring a gay man involved in a Purity Siege in Cedar Springs area of Dallas. This man’s story does not involve a sudden change but rather he gives a sincere description of his inner experience of struggle between his sexual desires and his beliefs and faith.

In the comment section for this video, someone, perhaps James Stabile, with the name “jmstabile88” says:

I am living proof that the people above are not changing anybody. The guy in the cowboy hat is a gay regular at Round Ups.(a gay bar in Dallas) I have been “saved by them” and have come back to my life because I am telling you what they do is they “save you” and then ditch you. I tried to be straight and, I AM STILL A FLAMER. The only other thing I would say is JESUS never 1 time says gay people are going to hell.

No matter what your religious views, you have to empathize with the young man in the video, Greg and his sincere desire to find encourage in his faith and acceptance in his struggle.

Disputed Mutability on Love Won Out

Dismuted Mutability is a blogger and a blog that I like to read. She provides insight into someone who has grappled with sexual identity issues in a refreshing and honest manner. Her last couple of posts are descriptions of her recent visit to Love Won Out in Indianapolis. Regarding her first post (general impressions), I cannot comment much. I did not attend that one and I am told there have been many changes in LWO since I attended in St Louis in February of 2006.

On change that has been made is that Joe Dallas is conducting the session “The Condition of Male Homosexuality” in place of Joe Nicolosi. I am posting here the link to DM’s review of Joe D’s talk. From DM’s review, the content has also changed, and in my view, for the better.

She begins with the good news:

IF you HAD to have a talk putting forward the standard developmental/reparative theory of male homosexuality, I don’t think you could get a much better talk than the one Dallas gave.

The rest of the post is well worth the read. I think she is very likely correct when she says:

I don’t think it’s a stretch to suggest that those who spend any time in exgay ministry or counseling are more likely to feel (or at least hope!) that developmental theories fit them.  After all, those who don’t feel they fit are likely to consider those approaches and the ministries that offer them a waste of time. For another thing, I would suggest that exgay ministries/counseling have a tendency to encourage a certain perception of one’s childhood experiences and parental relationships. Speaking personally, I know that I was coached to look at myself, my childhood, and my parents in a certain way by the exgay movement. Now, they might just be helping us to see what’s really there. Or they could be leading us to make a big deal out of all the ordinary imperfections of children and parents, and in some cases perhaps even something more unhelpful than that.  Anyway, my point is that there are excellent reasons for being skeptical of drawing conclusions about gays in general from observations of those who seek out and attend exgay ministries/counseling.  I think that being fully honest would require bringing this out clearly.

Psychoanalytic theory and the etiology of homosexuality: What does research say?

Does research support psychoanalytic explanations for homosexuality? In one recent exchange at the blog, Ex-Gay Watch, NARTH Scientific Advisory Board member, Jim Phelan advanced psychoanalytic theory with reference to a book entitled, Freud Scientifically Reappraised: Testing the theories and therapy, by Seymour Fisher and Roger Greenberg (1996). The 1996 edition is an update of their initial report in 1977. Specifically Dr. Phelan said that Fisher and Greenberg concluded that empirical research supported the Oedipally based Freudian conception of male homosexuality being derived from a distant or negative father and an overprotective mother – the so-called “classic triadic relationship.” 

I have expressed reservations about the psychoanalytic model before on this blog. Rereading Fisher and Greenberg refreshed my memory about why I do not believe the evidence for the theory is strong.

Regarding male homosexuality, Fisher and Greenberg said on page 139,

The post-1977 material we have reviewed concerning male homosexuality has narrowed the apparent support for Freud’s formulation in this area. Previously, we regarded the empirical data to be congruent with with Freud’s theory that male homosexuality derives from too much closeness to mother and a distant negative relationship with father. As noted, the increased pool of data available reinforces the concept of the negative father but fails to support the idea of the overly close, seductive mother…So we are left with only one of the major elements in Freud’s original formula concerning the parental vectors that are involved in moving a male child toward homosexuality. This reduction in confirmed points on the graph makes it all too easy to conjure up alternative theories of homosexuality that could incorporate the “negative father” data…There would be no need to appeal to the Oedipal image of a son competing with his father for mother’s love.

And so Fisher and Greenberg suggest that the evidence they reviewed supported a correlation between negative fathering and adult homosexuality but not the Oedipal drama surrounding mother. In addition to this limitation of psychoanalytic theory, there is no need to limit theorizing to thinking that poor fathering causes homosexual attractions in some general way for all same-sex attracted men. The empirical work is not able to specify well where the father-son relationship may have faltered. When sons recollect poor relationships with father, the questionnaires infrequently capture when the bad relationship occurred. For many men, I have spoken to and worked with, the bad relationships that are reported came after the emergence of homosexual interests, often in young adolescence. Furthermore, a sizable number of homosexual men report no such disruptions ever.

Fisher and Greenberg acknowledge the deficits in the research. Regarding early research (pre-1977), they noted:

…this entire body of literature is based on a strategy of asking adult homosexual subjects (and the adult heterosexual controls) to remember how their parents treated them during childhood. The questionnaires made such inquiries as, “Was your mother overly close to you?” “Was she intrusive?” “Was your father cold?” “Was he weak?” “Was he distant?” (p. 136).

The authors are skeptical that this strategy is sufficient to address the theoretical formulations that fathers were in fact all of the traits described. Furthermore, the authors pointed out four major methodological problems with the early research.

1. Some of the studies were based on highly selective samples (e.g., homosexuals in treatment or institutionalized for some reason).

2. The definitions of “homosexual” were in some instances so vague that one cannot distinguish whether subjects were possibly bisexual or had simply experimented on a limited basis with homosexual acts.

3. Bias was introduced into responses because some subjects were in psychoanalytic therapy and therefore had already been indoctrinated with Freud’s theory of homosexuality.

4. Few attempts were made to differentiate subjects with reference to mediating variables such as degree of integration into the homosexual community, age at which consistent homosexual behavior began, or degree of masculinity-femininity.

For me, these are crucial research issues that should make anyone very cautious in describing the body of research as supporting a conclusion. Even so, Fisher and Greenberg lent support to the observation of significant deficits in father-son relationships with male homosexual sons. Unaddressed is the issue of direction of causal relationship. Did the research identify the cause of homosexuality being poor fathering or on the other hand, can we tell whether fathers and sons were disrupted due to the emerging behavioral and sexual differences of the sons? The answer to both sides of that question is no, we can’t tell. And as Fisher and Greenberg note, with the mother dimension in serious question, the reparative/Oedipal explanation involving father is weakened. It may be that fathers are involved in cause but in some other more peripheral way (e.g., they do not support traditional heterosexual norms) or it may be that father-son relationships are strained but not with causal implications at all.

As for research regarding lesbians, the psychoanalytic notion is similar. Conflicted mother-daughter relationships are implicated, along with negative fathers. However, Fisher and Greenberg did not find support for the mother-daughter dynamic but did find a weak relationship between lesbianism and negative fathers. The same research cautions mentioned with regards to gay males applies here.

What can we conclude? Very little, in my opinion. It is inconsistent with the most charitable reading of what is not very good research to say psychoanlysis is supported as to etiology of homosexuality. In a future post, I hope to look at research since 1996.