Blog Theme: Sexual Identity Therapy – Interview with Mark Yarhouse

I released the advocacy film “I Do Exist” in July 2004. It was supposed to be a documentary style account of five former gays who had become straight through religious means. I showed the film at a conference of change therapists in November of that same year to great fanfare. It was shown all over the world, but ultimately it was not an accurate portrayal of reality for at least 4 of the participants. Gradually over the next couple of years, I became aware of that and stopped selling the video in early 2007.

My experience with “I Do Exist” drove me back to the research on change and sexual orientation. After realizing that I had been moving in the wrong direction with my earlier claims, I  became a critic of reparative therapy. I chronicled that change on this blog from the beginning in July 2005. All of the posts on reparative therapy and sexual orientation change efforts in general would take hours to review. That story is summarized in this Yahoo News account by Jon Ward.

However, I did not simply criticize change therapy, I wanted to find an alternative for people who struggled morally with their sexual orientation. In 2005, I began a process of developing a framework to help guide therapists who worked with religious clients conflicted by their sexual orientation. Right away, I asked Mark Yarhouse to collaborate. By 2006, we came out with the sexual identity therapy framework. Mark and I discuss that story in this interview.

Of the two of us, Mark has been the prolific writer and researcher. His book Sexual Identity and Faith contains applications of the SIT framework and I recommend it for that purpose. I have multiple posts about the framework on the blog and those can be found here.

In addition to talking over our work together, Mark describes his more recent work with Revoice and gender identity. Thanks to Mark for taking time to reminisce.

Dr. Mark Yarhouse is a clinical psychologist who specializes in conflicts tied to religious identity and sexual and gender identity. He assists people who are navigating the complex relationship between their sexual or gender identity and Christian faith. He is the Dr. Arthur P. and Mrs. Jean May Rech Professor of Psychology at Wheaton College, where he runs the Sexual and Gender Identity (SGI) Institute. He is an award-winning teacher and researcher. He was a past participant with the Ethics and Public Policy Center think tank in Washington, DC, and he was named Senior Fellow with the Council of Christian Colleges and Universities to conduct a study of students navigating sexual identity concerns at Christian colleges and universities. He has been a consultant to the National Institute of Corrections to address issues facing sexual minorities in corrections, and he was part of a consensus panel from the American Psychological Association on sexual orientation and gender identity change efforts that convened to provide input to the Substance Abuse and Mental Health Services Administration in Washington, DC.  He is currently the Chair of the task force on LGBT issues for Division 36 (Psychology of Religion and Spirituality) of the American Psychological Association. He was also invited to write the featured white paper on sexual identity for the Christ on Campus Initiative edited by Don Carson for The Gospel Coalition.

He has published over 80 peer-reviewed journal articles and book chapters and is author or co-author of several books, including Understanding Sexual Identity: A Resource for Youth Ministers and Understanding Gender Dysphoria: Navigating Transgender Issues in a Changing Culture. His most recent books are Sexual Identity & Faith and Costly Obedience: Listening to and Learning from Celibate Gay Christians. (this is the book where the celibacy research is reported)

Coming Soon: Interview with Mark Yarhouse

On Tuesday July 21, I will publish an interview with Mark Yarhouse, professor at Wheaton College. Mark and I are authors of the sexual identity therapy framework which became an alternative for religious gay clients.

Mark and I will discuss the history of our work together going back to our opposition to a ban on reorientation therapy to our focus on sexual identity therapy. We also talk about Mark’s more recent work in gender identity.

I asked Mark about a relatively new group on the scene helping people navigate sexual identity concerns – Revoice. In that context, he described research into the effects of celibacy. Here is an excerpt of that conversation.

I hope you will revisit the blog on Tuesday to catch the full interview with Mark.

You can see all posts about these interviews by clicking this link.

Also subscribe to my Psychvideos Youtube channel where I am posting them.

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 ([email protected]). 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.
 

Interview with Mark Yarhouse on SAMHSA Report Calling for an End to Sexual Orientation Change Efforts for Minors

On October 15, I linked to a report published by SAMHSA which called for an end to sexual orientation change efforts for LGBT minors. At the time, I wrote:

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.

I also said I hoped to have commentary from Mark. Today, I have an interview with him on his committee experience and his views of the consensus. Mark is professor of psychology at Regent University and Director of the Institute for the Study of Sexual Identity. He is co-author with me of the Sexual Identity Therapy Framework, which is a model for ethically and effectively helping clients with distress surrounding their sexual orientation and religious beliefs. For more on SITF, see the website which supports the framework. This will be cross–posted there.
This interview comes amid a bit of a controversy involving Mark and a speaking engagement in Canada. I hope those who assume they know Mark’s views will also read this and the SITF.

Warren Throckmorton: In general, what was your experience like being on the consensus committee? Did you feel the rest of the committee members took religious concerns seriously?
Mark Yarhouse: Overall, it was a good experience. I am always grateful for the opportunity to engage with others around complex issues, to learn from other experts, and to share from my own lines of research. We reviewed existing research and past policy statements, as well as shared from our professional experience working with children, adolescents, and families. In answer to your question about religious concerns, I think committee members wanted to take religious concerns seriously, although the primary focus was the well-being of minors who are navigating sexual identity and gender identity. As you know all too well, the beliefs and values of religious families are important considerations when working with families whose teen may be navigating gender identity or sexual identity concerns. In any case, my experience was that other committee members were interested in the experiences I’ve had – and others had – working with conventionally religious families.
WT: Even though the sexual identity therapy framework (SITF) wasn’t mentioned or cited, do you feel the report is supportive of the approach we take in the framework?
MY: Yes, I think so. We had the opportunity to review many documents, including the SITF and the 2009 APA task force report on appropriate therapeutic responses to sexual orientation, which, as you know, cited the SITF favorably. The kind of practice we saw as helpful would emphasize identity exploration without an a priori fixed outcome. I think the framework does that in the area of sexual identity. However, the framework does not address in much detail working with minors, and that may be something we consider if we offer a revision in the future.
WT: Do you have any comments, reservations about the consensus reported in the paper?
MY: As the SAMHSA report notes, we decided at the outset that we would define consensus as a reasonably high percentage of agreement rather than unanimous consensus. We all agreed to that, but that meant that what counted as consensus in at least a few occasions was not reflecting unanimity. We worked hard for unanimity in all cases, but that did not always happen. I at times found myself in disagreement with some of the wording, for example, but the threshold for consensus was met in those instances, and I understood and respected that process.
WT:It seems to me that the consensus surrounding sexual orientation is more settled than gender identity. How do you see that?
MY: There are fewer professional debates about sexual orientation, which likely reflects the consensus you are referring to. There seem to be more professional discussions about a range of clinical options with gender dysphoria. However, I was impressed by how little research is published on minors – particularly efforts to achieve congruence between gender identity and biological sex.  I was under the impression that more studies of higher quality had been published in some areas, and as the committee looked at them together, we found them lacking. Also, while research was one consideration, we drew on other sources, too, such as committee members’ professional experience and prior reports. In any case, I would have preferred to frame and word various aspects of the consensus report differently, but again that in some cases goes back to what counted as consensus. Without going into too much detail, you could imagine someone favoring the language of  ‘insufficient evidence’ in discussions of effectiveness and harm, to reflect how little published research is available in a given area of inquiry. Other topics, such as how to conceptualize sexual and gender identities and expressions in a diverse and pluralistic culture raise important philosophical and theological questions that were beyond the scope of the discussion.
WT: In general, do you support the recommendations of the paper (or asked another way). Is there anything in the recommendations you have concerns about?
MY: It is important to distinguish the consensus statement from the SAMHSA report. I did provide feedback on portions of the SAMHSA report, especially around family, community, and religious considerations, but it was written by designated persons from that agency. I think it reflects a little more regard for conventionally religious persons and families and provides for more resources than otherwise may have been available. But many committee members provided input and suggestions, and I imagine the author of the report had to balance various considerations in putting together the final document.
As far as concerns, I indicated at the outset that I did not think the government should be involved in legislating around the complexities of clinical practice in these two areas. I prefer to see government support the regulatory bodies that provide oversight to mental health professions in a given jurisdiction. I shared more of my thoughts on that in an interview with First Things. My opinion has not changed on that matter.

The Jones and Yarhouse study: What does it mean?

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

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

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

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

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

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

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

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

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

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

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