Discover article on sexual orientation change and the APA report

Discover magazine has an online article out today which covers the APA report, NARTH and the Jones and Yarhouse study.

Here are some excerpts:

Joseph Nicolosi, a psychologist in Encino, Calif., says he can rid adults, teens, and even children of homosexuality. For nearly 30 years, he has offered a “psychodynamic” form of reparative therapy for people—mostly men—seeking to change their sexual orientation.

“If [a patient] can accept his bodily homoerotic experience while staying connected to the therapist,” he wrote in “The Paradox of Self-Acceptance,” “the sexual feeling soon transforms into something else: the recognition of deeper, pain-generated emotional needs which have nothing to do with sexuality.”

He cites the following case: A 43-year-old married accountant was recalling another man that he had seen at the airport while on a business trip. “This had awakened his sexual fantasies and dreams. I asked him to hold onto that image and observe his bodily sensations while staying connected to me. As he did, he felt an intense sexual longing. But as he followed that fantasy through an imaginary sexual scenario, quite unexpectedly, he then experienced an embodied shift to sadness, longing, and emptiness. In tears, he spoke of his sense of deep unworthiness. ‘I would just love him to be my friend! He’s the kind of guy that I always wanted to be close to. How much I just want to be friends with a guy like him.'”

This describes an aspect of the approach advocated in Nicolosi’s new book, Shame and Attachment Loss. People I have seen who have been through this approach describe it as being a chase for making sense of what they eventually come to see as an automatic reaction in search of a justification. Having said that, perhaps this gives some men a greater sense of control over their automatic impulses.

The center of this so-called “reparative therapy” is the National Association for Research and Therapy of Homosexuality (NARTH). Its membership—around 1,100 people, according to current NARTH president Julie Harren Hamilton—is dwarfed by the APA’s 150,000 members.

Treatments follow from the assertion that homosexuality is not an innate trait, but rather a result of childhood trauma and lack of attachment to members of the same sex.

“The treatment is different for men and women,” Nicolosi, one of NARTH’s former presidents, told DISCOVER. “The principles are the same—we find that for the lesbian, there is a traumatic attachment loss with the mother, and for the males it’s a traumatic attachment loss with the fathers. We believe the male homosexual should work with a male therapist, and the lesbian should work with a woman.”

It is always difficult to know who Nicolosi is referring to when he says, “we.” Is he referring to NARTH or those who are reparative therapists, or the royal we, referring to himself? However, Hamilton seems to distance NARTH from the singular approach used by Nicolosi when she says:

These treatments take on several approaches. “Psychological care for individuals with unwanted homosexual attractions includes a variety of approaches. There are many paths that lead into and out of homosexuality,” NARTH president Julie Harren Hamilton wrote DISCOVER in an email. “Therapists who assist clients with unwanted homosexual attractions vary in their…methods, [which include] object relations, interpersonal therapy, cognitive-behavioral therapy, family therapy, and many others.”

This would be a welcome departure for NARTH and Hamilton. On her video Homosexuality 101, she lays out the typical reparative drive explanation as the most common pathway. If NARTH truly wants to move away from the singular cause, it should make it clear what other pathways they view as possible.

Then the article turns to the Jones and Yarhouse study.

SOCE advocates have done studies in recent years to try and show that their efforts are working. One of the more influential among sexuality-change advocates was a study by two professors at Christian colleges: Mark Yarhouse, a psychology professor at Regent University, and Stanton Jones, provost and professor of psychology at Wheaton College.

The six-year study started with 98 subjects, most of whom were white, male, and religious—92 percent identified themselves as “born again.” All of the treatments were provided by Exodus International. Of the 61 who provided data in all six years, 14 of them—23 percent—reported that they had successfully converted to heterosexuality “in some form or another,” according to Jones. Meanwhile, 18 subjects—30 percent—reported that they had dis-identified as homosexuals and were now “chaste,” meaning no overt sexual activity at all. The results were based entirely on self-reported surveys.

I think Judith Glassgold’s assessment of the study was too harsh when she said:

The study was dismissed by the APA task force on multiple grounds, and held as an example of the systematic scientific problems of SOCE today. “Everything was wrong with that study,” Glassgold says. “[Yarhouse and Stanton] chose the wrong statistics to evaluate, they violated statistical laws, and they didn’t have a control group—just a small sample of people recruited from religious groups. They followed the individuals over a couple of years, but didn’t specify that the subjects should only try one intervention at a time, so they tried many at the same time. So we aren’t sure which, if any, intervention was causal.”

The reporter is a little sloppy here referring to Yarhouse and Stanton (Jones, I assume; a little later someone named Miller is named without a first name or introduction) and does not interview another person to provide another perspective. I think if anything the Jones and Yarhouse study is not very positive for sexual reorientation. Flaws aside, it does not help those who want to promote change as the proper focus of therapy or ministry.

There is a historical review of some of the behavioral sexual reorientation methods that might be new to some readers. The article notes that the polarization continues between NARTH and the APA. However, the article failed to really grasp the important news from the APA report, i.e., the respectful and appropriate treatment of religion as a diversity variable and the interface with client self-determination.

Jones and Yarhouse Exodus study follow up

This morning at the American Psychological Association annual convention, Stanton Jones and Mark Yarhouse are presenting their Time 6 and final follow up to the study of Exodus participants seeking change of orientation. The paper is titled, Ex Gays? An Extended Longitudinal Study of Attempted Religiously Mediated Change in Sexual Orientation. They are presenting these data as a part of a APA symposium titled Sexual Orientation and Faith Tradition Symposium chaired by Dean Byrd.

You can review the paper in full so I will only highlight a few points in the post.

The paper begins by recounting the skepticism toward change evinced by the professional mental health associations. Then, they note an important limit and hypotheses of the study:

Our study addresses the generic questions of whether sexual orientation is changeable, and whether the attempt is intrinsically harmful, by focusing only on the religiously mediated approaches to change; this is not a study of professional psychotherapy. Our hypotheses for this study were taken directly from the prevailing professional wisdom: We hypothesized 1) sexual orientation is not changeable, and 2) the attempt to change is likely harmful. We already cited the American Psychological Association’s (2005) claim that sexual orientation “is not changeable.” Regarding harm, our study was framed in light of the American Psychiatric Association’s (1998) claim that the “potential risks of ‘reparative therapy’ are great, including depression, anxiety and self-destructive behavior.” The tools of scientific study are ideally suited to investigate empirically such strong, even absolute claims.

I bolded the statement about the study not being an examination of psychotherapy because I predict that NARTH affiliated therapists and various religious conservative groups will not clearly communicate this point when messaging the results of this study. Despite the fact that Christian self-help groups are different than therapy as practiced by many psychodynamic therapists, I suspect some therapists will hope the public does not catch the distinction.

Now for some results. Retention is sure to be an issue as this study is discussed:

Retention. We began with 98 subjects at T1. Our sample eroded to 73 at T3, a retention rate of 74.5%. This retention rate compares favorably to that of respected longitudinal studies. 63 subjects were interviewed or categorized at T6, for a T1 to T6 6 to 7 year retention of 64%.

Kinsey scale changes:

Table 1

This table shows the shifts in Kinsey scale scores (7 is exclusively homosexual with 1 being exclusively heterosexual). You can see that the shifts on average were about a point on the scale – less than one for the entire group and more than one for the group which were deemed more gay identified at the beginning. Although statistically significant, this would not on average take the group to the straight side of the continuum but rather by considered bisexual by most observers.

They also used the Shively-DeCecco scale which asks participants to rand both same-sex attraction and opposite-sex attraction. As you can see below, the change reflected in the Kinsey moves was due to reductions in SSA and not increases in OSA.

Table 2

Regarding categorical self-assessments, Jones and Yarhouse report modest shifts.

Table 5

Regarding these changes, Jones and Yarhouse say:

Several results are particularly notable. Despite a smaller N for the T6 sample than at T3, we found growth in absolute size in the two Exodus “success” outcome groups moving from row 1 to row 3: Conversion cases grew from 11 to 14 and Chastity cases from 17 to 18. But the group that grew the most in absolute and proportional terms was Failure: Gay Identity which doubled in absolute size from 6 to 12. The percentage of those showing stability of outcome T3 to T6 (row 4) is greatest in columns 1 and 6: the Success: Conversion (73%) and Failure: Gay Identity (67%) categories, with slightly less in the Success: Chastity category (53%). Of the one subject each that shifted from the Success: Conversion and Failure: Gay Identity categories from T3 to T6, each moved to the Continuing category at T6. The largest absolute shift from T3 to T6 of those who participated in the T6 interview was a T3 Success: Chastity case that became a Failure: Gay Identity case; next largest was a Non-Response case at T3 that became a Success: Conversion case.

Most germane to our principal hypothesis that change of sexual orientation is not possible, 53% of the T6 sample of 61 cases that self-categorized (row 3) did so as some version of success, either as Success: Conversion (23%) or Success: Chastity (30%). At T6, 25% of the sample self-categorized as an Exodus failure (Confused or Gay Identity).

In my view, this means of description confuses success with change. Over half did describe some version of success but that is not the same as over half describing sexual orientation change. I will be interested to see how this is reported in the press.

The changes reported here are significant and no doubt welcomed by the people involved. However, they are not the types of changes which I suspect the various mental health groups mean by “sexual orientation change.” Whatever happened to the participants in this study, they do not appear to have gone from gay to straight — in the sense that people who have always been straight are straight. They have gone from gay to less gay and a bit more straight. I do not mean to suggest that this is not important information; it is. But I am wondering if anyone at APA would dispute the within category changes reported here. I am going to ask and will report what I learn.

Jones and Yarhouse seem to be aware that the results can be understood as a change in identity and not orientation. They write:

There is also the question of sexual identity change versus sexual orientation change (see Worthington & Reynolds, 2009). Recent theoretical (e.g., Yarhouse, 2001) and empirical (e.g., Beckstead & Morrow, 2004; Yarhouse & Tan, 2004; Yarhouse, Tan & Pawlowski, 2005; Wolkomir, 2006) work on sexual identity among religious sexual minorities suggests that attributions and meaning are critical in the decision to integrate same-sex attractions into a gay identity or the decision to dis-identify with a gay identity and the persons and institutions that support a gay identity. In light of the role of attributions and meaning in sexual identity labeling, is it possible that some of what is reported in this study as change of orientation is more accurately understood as change in sexual identity?

The entire section on identity and orientation in the discussion section of the paper is good reading. Finally, in light of the APA task force report, I wonder if the discussion section of the Jones and Yarhouse paper could be revisited. The APA report, while skeptical of categorical change, did not take a strong stance regarding harm. Actually, the APA report and the Jones and Yarhouse paper agree on the inconclusive nature of the evidence on that question.

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 conference opens today in Denver, CO

Amidst the inevitable protests, the annual conference of the National Association for Research and Therapy of Homosexuality opens today in Denver, CO with the theme, “Sound Scientific Research: In a time of universal deceit, telling the truth is a revolutionary act.” For NARTH, this would be a worthy objective.
Given the theme, one would expect a program with research presentations which support their reparative theory positions. Not so. A review of the program reveals no such sessions. NARTH’s approach to research is on display with their new “fact sheet’ on female homosexuality. My review of it is here and here.
Those looking for actual research regarding homosexuality would do well to consult primary sources among researchers. Those looking for an evangelical approach to matters of sexual identity would do better to avoid the NARTH conference and seek assistance from the Institute for the Study of Sexual Identity.

Spreading some love to fellow travelers and bloggers

I am not a very consistent blogroller. Up to now, my list of links has been an after thought. I am not sure I will stay on top of things but I have added some new ones.
I want to mention four of the new links. First, go visit John Shore’s blog – Suddenly Christian. John is a winsome, funny, prolific and lately, controversial Evangelical writer who produces some entertaining and thoughtful posts. John is an adult convert to Christianity who brings a fresh and sometimes uncomfortable perspective to the Evangelical world.
The Marin Foundation is the brainchild of Andrew Marin. Not a blogger – yet – Marin seeks to do research and build bridges between religious and LGBT communities with an ambitious mission and set of values. He may in the middle enough to bother some people on either extreme, but this is where he believes he should be. He is currently writing a book about his views.
Wayne Jacobsen is on a roll. He published the NY Times #1 best seller, The Shack recently and it has changed his life. His blog is a bridgebuilding effort, which is a natural outgrowth of his work with Bridgebuilders. Wayne was a catalyst behind the First Amendment Center Guidelines on Sexual Orientation in schools. I have been a friendly acquaintance of Wayne via a meeting at Grove City College through mutual friends about three years ago.
It has taken me too long to put up a link to Mark Yarhouse’s Institute for the Study of Sexual Identity. The front page reads like a blog although without comments. Mark work on narrative sexual identity therapy was featured in a recent American Journal of Family Therapy article and is referenced at the ISSI site.
Enjoy!