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.

Sexual identity: APA sexual orientation task force report – Analysis

(First posted August 5, 2009)
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.

Sexual Identity Therapy Framework resources

Peter LaBarbera today reprints Laurie Higgins critique of an article by Mark Yarhouse regarding the application of our sexual identity therapy framework (SITF). I am aware he does not mean to promote the framework but his articles have increased my emails about the framework and requests for referrals to therapists who practice in that manner. I refer them to the registry of practitioners who claim to use the SITF at the Institute for the Study of Sexual Identity. However, a quick look will confirm that many areas of the country are unrepresented there. This area clearly needs to be developed.

Those affiliated with ISSI include people working in several graduate programs in counseling and we aware of other programs who inform students about the SITF. By far, the largest organization that offers information regarding the SITF is the American Association of Christian Counselors. Mark and I presented a preconference workshop at the 2007 AACC conference titled, Introduction and Clinical Application of the Sexual Identity Therapy Guidelines.”  A 3 CD set of that workshop is available on the AACC website. In 2008, Mark presented the SITF at the AACC West Region conference. A audio of that workshop is also available on the AACC website.

The website supporting the SITF is www.sitframework.com. There we have posted articles consistent with the SITF and a list of presentations regarding it. On YouTube, there is a two part demonstration of how I worked with BBC reporter David Akinsanya in 2005. Akinsanya had just left Love in Action early because he felt it did not fit him and his values. This interview was conducted in 2005 as the SITF was being developed. 

Wall Street Journal reporter has followed the development of the SITF with a 2007 article in the LA Times and then a 2009 piece in the Wall Street Journal. Wikipedia has an entry on the SITF. The APA’s 2009 sexual orientation task force cited the SITF favorably as a means for clients to therapeutically explore their options.

Much needs to be done to develop the model and describe how existing models are applied with it. Between us, Mark and I have trained several hundred mental health and ministry professionals in the model and look forward to providing more opportunities for supervision and training.

Lifesitenews article: An exercise in confirmation bias

Yesterday, Lifesitenews published an article complaining about me. Many of the complains are recycled from Peter LaBarbera’s website and a OneNewsNow article. I addressed those criticisms here and here. Mark Yarhouse also did so on the SIT Framework website. Beyond rehashing LaBarbera’s issues, I think the article reflects poorly on Lifesitenews. Let’s start with their characterization of how my peers have been reacting to my work. Reporter Matthew Hoffman wrote:

Throckmorton’s defection from the ex-gay movement has been met with condemnation by Evangelicals. “Though he works for an evangelical institution, Pennsylvania-based Grove City College, which advertises itself on faith-based websites as ‘authentically Christian,’ Warren promotes a new, morally neutral paradigm on homosexuality that affirms people’s ‘Sexual Identity’ according to their feelings (and comfort level with same),” laments Peter LaBarbera of Americans For Truth About Homosexuality (AFTAH).

Evangelicals? Let’s count how many condemning evangelicals are quoted by LSN. If you count Michael Glatze, two people are quoted as complaining about my views, the other one being Peter LaBarbera. My reason for hedging on Glatze is that he began his ex-gay journey as a member of the LDS church and is listed as an “Executive Assistant” at the Buddhist inspired Shambhala Mountain Center in Colorado, which, according to an article written by Glatze in 2009, is a welcoming place for gays and lesbians.

Rather than reporting some broad evangelical condemnation of my work, the article repeats the criticisms of Peter LaBarbera. I noted to Mr. Hoffman when I declined his interview (more about that shortly), that I am on the National Advisory Board for the American Association of Christian Counselors (as is Mark Yarhouse) and that they paid Mark and me to present a half-day workshop at the 2007 conference on how to apply the sexual identity therapy framework. By any definition, the AACC would be considered an evangelical organization. Mr. Hoffman says that I am under fire from evangelicals and yet only quotes one, maybe two. At the same time, he ignored evidence that my views are promoted within a much larger, more mainstream evangelical organization (not to mention several others he could have consulted).

As an aside, it is curious that Mr. LaBarbera has not included the AACC in his crusade. The AACC still promotes the SITF via the tapes they sell of the pre-conference workshop. The SITF was featured in the AACC magazine in 2007 via an invited article by Mark Yarhouse. Perhaps, the AACC will be next.

When I declined the interview, I pointed out to Mr. Hoffman that the National Association for the Research and Therapy of Homosexuality (NARTH) also claims to value client self-determination. I sent Mr. Hoffman a link to my recent post, “Is NARTH the next target?” which notes that Joseph Nicolosi says, on the NARTH website, that he provides gay affirmative therapy to some of his clients. NARTH is mentioned favorably at least 46 times on Peter LaBarbera’s website. I also sent a link to a YouTube video where Dr. Nicolosi says this about his practice:

The therapeutic approach is always positive. In fact, to be honest with you we never tell our clients not to have homosexual activity. If they want to do it, let them do it. It’s up to them. Our job is to help them understand what they learned from it. When a client comes in to me and says, ‘I had gay sex last night.’ My only question to him is, ‘What was going on with you just before you decided to act out? What was your psychological state of mind that made you want…?’ That’s where the lesson is. So we don’t tell clients not to act out. They can act out, but every time they do act out, it’s an opportunity to learn something about themselves.

Given that Mr. Hoffman mentions my movement away from NARTH’s emphasis on reorientation, it would have reasonable and responsible for him to mention that NARTH holds to a view of client self-determination that is arguably more permissive than my own. For instance, in the SITF, if a client seeks celibacy or monogamy, we advocate working with clients to avoid contexts which could elicit undesired behavior.

Mr. Hoffman is correct that I changed my mind about an interview with him, but failed to completely describe the circumstances, saying

After agreeing to an email interview with LifeSiteNews, Dr. Throckmorton refused to answer the questions submitted, claiming they were “slanted.” The questions sent to Dr. Throckmorton, are available at this link.

In fact, I declined his original request. After thinking it over, I asked to see the questions he wanted to ask. I did not agree to an interview although he may have thought that I did since I asked to see the questions. Once I read the questions, which he posted, I decided there was little chance for a fair representation of my views. For instance, I asked Mr. Hoffman how he formed this question (#3 in his list):

3. In a recent article you defended the thesis that sexual orientation is biologically determined in the womb, by hormonal deficiencies. Do you now believe that homosexual orientation is immutable?

I wrote to ask where I “defended the thesis that sexual orientation is biologically determined in the womb, by hormonal deficiencies.” He then wrote back citing this article in Uganda’s The Independent and quoted this section:

However, we do not know this to be the case. Most researchers around the world agree that there is no consensus about the causes of any given person’s sexual orientation. While it seems unlikely that there is one biological or genetic cause for all homosexuals, there are data which suggest that genetic and hormonal factors during pre-natal development have some impact on our desires, in different ways for different people.

In the email, Mr. Hoffman explained:

Perhaps I overstated your position slightly. You are suggesting

apparently that hormonal and genetic factors in the womb contribute to the phenomenon. Please consider my question amended to that effect.

I believe he did more than slightly overstate my position. His original question slanted my plainly stated views. That was enough for me to stick with my decision not to do an interview.

Currently, LSN is lamenting exclusion from a mainstream Catholic news source, Zenit. I know nothing of the specific issues but it relates to criticisms of LSN’s reporting. I can say after this experience, that I will not accept what I read there at face value. Perhaps in the zeal to promote a certain point of view, LSN’s reporting is skewed in a manner which concerns more mainstream outlets. Here are some tips. If you are going to advance a thesis, call it an op-ed, don’t present it as news. If you make a generalization about a trend or a group, interview more than one person from the group you are characterizing. If you want to have sources trust you, then do not slant or misrepresent their views. Follow up on aspects of a story that may lead you away from your preconceived ideas – avoid confirmation bias.

The value of self-determination in counseling

In response to the recent attacks on the sexual identity therapy framework, a supportive reader contacted me with a story of one of her experiences in counseling. I do know the person and can confirm the accuracy of the situation. Why should therapists avoid imposing their beliefs on clients? Read and see what you think.

As someone who has been in counseling, I enormously appreciate your emphasis on self-determination.  As you wrote the other day, any therapist can force any views at any patient. When I was in grad school, I had just started with a female therapist.  She was given plenty of information about my Christian beliefs and how it was important to operate within that for me to succeed.  And then within 5 weeks (before I quit), she sent me to the library to read a book that was essentially how to be a lesbian. And then she basically told me that if I’d just go and have sex with someone that I wouldn’t have problems with it anymore.  And then I quit.  Why is respecting beliefs a better way? I really had a hard time with that, because she tried to force me out of my beliefs.  And it was awful.  I had a hard time trusting any therapist after that.

That therapist should have made a referral. Apparently, the value conflict was so great that the therapist apparently was not able to get past it. Therapists are not machines and have strong beliefs about many things so when the conflict is great, referral is indicated. The sexual identity therapy framework allows for such referrals while at the same time requiring respect for clients and their values.

Is NARTH the next target?

As I noted yesterday, Peter LaBarbera of American for Truth About Homosexuality doesn’t like the sexual identity therapy framework, saying

As you can see above, Throckmorton’s and Regent University’s Mark Yarhouse’s “Sexual Identity Therapy” model grants the possibility that some clients may come to embrace a positive “gay identity” that “modifies” their religious beliefs in such a way as to “allow integration of same-sex eroticism within their valued identity.”

If he is consistent, he will need to expand his crusade to include an organization and therapist he often cites approvingly. On the AFTAH website, the National Association for Research and Therapy of Homosexuality is referenced at least 46 times (e.g., here). However, on the NARTH website, co-founder of NARTH, Joe Nicolosi says that gay affirming counseling should be available.

The developmental model we suggest must deeply resonate with the men we work with, or they will (rightfully) leave our office and pursue a different therapeutic approach. We explain that our position differs from the American Psychological Association, which sees homosexuality and heterosexuality as equivalent, and along the way, we encourage them to clarify and re-clarify the direction of their identity commitment. Gay-affirmative therapy should, of course, be available for any such client.

A few gay-identified clients do decide to stay with us. Out of respect for diversity and autonomy, I affirm them in their right to define themselves as they wish, and I accept them in their gay self-label.

Nicolosi affirms these clients in “their right to define themselves as they wish,” and he accepts “them in their gay self-label.” Of course, here Nicolosi is speaking as a professional therapist and as such acknowledges that such affirmations come from a respect for autonomy. There is little difference between these options and the options LaBarbera criticizes in his article on the SITF.

There are many problems with LaBarbera’s recent crusade. One, highlighted by this post, is that his critiques of the SITF are devoid of any proper context. The SITF is intended for mental health professionals and professional relationships with clients of all ideologies. Pastors and ministry workers follow a more directive line in keeping with the teachings of their faith. Will NARTH now become a target since they support acceptance of some clients “in their gay self-label” and affirmation of “them in their right to define themselves as they wish?”

Losing my religion? That’s news to me…

UPDATE 2: Is NARTH the next target for Peter LaBarbera? Since NARTH’s website also allows for client self-determination regarding goals and objectives, they are the next logical target. Also, Dr. Nicolosi, co-founder of NARTH does not discourage homosexual behavior in his clients.

UPDATE: Jim Brown at ONN published a follow up article to the one which is the subject of this post.

Dr. Warren Throckmorton of Grove City College says he has not lost faith in God’s ability to change people who are struggling with homosexuality, but believes most of those people are not likely to experience a “diminishment” in same-sex attraction.

“To say that because it appears from the research that change is infrequent in attractions doesn’t mean I’ve lost my faith in God’s ability to change people,” he states.

…………………………

In an article from OneNewsNow this morning, Peter LaBarbera says that I have lost my “faith in God’s ability to change people.”

Strange that no one asked me what I thought about this. OneNewsNow did not ask me what I think of change. LaBarbera paraphrases something I did not say and they printed it. If you were doing an article about someone, wouldn’t you make an effort to get that person’s views? (UPDATE: I am glad to report that OneNewsNow reporter Jim Brown just called and did seek my perspective)

Regular readers of the blog will understand the difference between the change and congruence paradigms of sexual identity ministry. The change paradigm seeks change of orientation as a goal and a standard of success. Some who hold to this paradigm believe that such change is an indicator of spiritual growth and what is known in Christian theology as “sanctification” – i.e., becoming holy and without sin.

On the other hand, the congruence paradigm seeks alignment with one’s understanding of Christian teaching. Change in the direction of essential attractions is viewed as infrequent and may actually be better describe as better behavioral control. A smaller subset of those people may change their attractions in a more dramatic and abrupt manner. This latter experience may be more common among women than men. Whether it happens or not is not deemed important to the objective of congruence. An assumption is that essential human desires are not likely to change much in this life and so the objective is to align behavior and will to Christian teachings.

The congruence paradigm defines change in ideological terms with meaningful cognitive and behavioral implications. Being converted to Christianity or experiencing a recommitment to one’s faith is a profound change and from the perspective of my Christian tradition is the most important kind of change.

So this accusation that I have lost my “faith in God’s ability to change people” is flat wrong. It also ignores the body of my work and efforts to bring evangelical concerns to the professions. I have been working to make the professional bodies aware that religious identity is powerful and for many evangelicals so vital that it overwhelms all other considerations. The chair of the recent American Psychological Association task force on sexual orientation acknowledged this in an interview with the Wall Street Journal:

“We’re not trying to encourage people to become ‘ex-gay,'” said Judith Glassgold, who chaired the APA’s task force on the issue. “But we have to acknowledge that, for some people, religious identity is such an important part of their lives, it may transcend everything else.”

Earlier today I posted a more detailed rebuttal to attacks on the sexual identity therapy framework. Co-author Mark Yarhouse also posted today on the same subject.

On the application of the sexual identity therapy framework: An answer to critics

Recently a brief portion of the sexual identity therapy framework was attacked by Peter LaBarbera. More broadly, his criticism challenges Christians in counseling: Should a counselor who is Christian insist that clients conform to the counselor’s beliefs?

LaBarbera argues that Christians in counseling should suspend neutrality and require their clients to conform to what the counselor believes. In my view, this confuses the roles of professional counselor versus pastor, respectively.  

He faults the SITF because he says counselors who practice in line with it must affirm behaviors with which they disagree. However, he misreads the intent of the SITF, and in violation of professional ethics, urges professional counselors to act as pastors. If professional counselors acted in this manner then there would be no restraints on ideological coercion from counselors. Here I respond to his contentions and point out the proper application of the SITF. 

The portion in question is here (The entire framework can be read here):

The guidelines do not stigmatize same-sex eroticism or traditional values and attitudes. The emergence of a gay identity for persons struggling with value conflicts is a possibility envisioned by the recommendations. In addition, the recommendations recognize, as do many gay and lesbian commentators, that some people who have erotic attraction to the same-sex experience excruciating conflict that cannot be resolved through the development of a GLB identity (Haldeman, 2002). Thus, for instance, some religious individuals will determine that their religious identity is the preferred organizing principle for them, even if it means choosing to live with sexual feelings they do not value. Conversely, some religious individuals will determine that their religious beliefs may become modified to allow integration of same-sex eroticism within their valued identity. We seek to provide therapy recommendations that respect these options.

First, it is important to understand that the SITF applies to professional counseling and psychotherapy and not to ministry or pastoral counseling. Often when people seek a professionally trained counselor with a graduate degree, they seek an unbiased relationship to discuss their conflicting values and feelings. This neutral stance is provided out of respect for clients’ status as a free moral agent. This, I believe, is a God-given freedom and must be respected, even when the outcome is a choice which is contrary to the beliefs of the counselor. Recently, Saddleback Church pastor, Rick Warren, said it this way: 

The freedom to make moral choices is endowed by God. Since God gives us that freedom, we must protect it for all, even when we disagree with their choices. 

Consistent with this Christian view of persons, all health care codes of ethics require basic respect for the moral autonomy of clients/patients. For instance, the ethics principles of the American Medical Association as applied to psychiatrists state:

The psychiatrist should diligently guard against exploiting information furnished by the patient and should not use the unique position of power afforded him/her by the psychotherapeutic situation to influence the patient in any way not directly relevant to the treatment goals.

Health care providers can exert significant influence over patients and due to the power differential must take special care not to act coercively. This duty falls to all health care providers, Christian and non-Christian alike.

In addition, the American Counseling Association code of ethics reads:

Counselors are aware of their own values, attitudes, beliefs, and behaviors and avoid imposing values that are inconsistent with counseling goals. Counselors respect the diversity of clients, trainees, and research participants.

These ethics codes apply to health and mental health care providers who enter into professional contracts with clients, may be receiving reimbursement for services from third party or government payers, and are often regulated by state certifying agencies. In other words, these relationships are regulated by several state and federal laws which require sensitivity to activities which could be coercive and damaging to clients of all belief systems. Christians who are professionally trained and credentialed are not exempt from these considerations because they of their religious beliefs and loyalties. The sexual identity therapy framework was written with this professional audience in mind.

In the ethics codes and the SITF, there is provision for counselors who cannot take a neutral stance. As noted in the SITF, sensitive referral is an option:

The need for referral can arise for reasons involving therapeutic capability and value conflicts. Therapists who rarely conduct sexual identity therapy may find their knowledge and skill base challenged by the needs of some clients.

Therapists who find themselves disappointed by a client’s choices or who even attempt to dissuade a client from pursuing a particular integrative course should secure consultation and consider referral. Moreover, if a therapist’s value position or professional identity (e.g., gay affirming, conservative Christian) is in conflict with the client’s preferred direction, the referral to a more suitable mental professional may be indicated (Haldeman, 2004). Therapists considering referral must take care to consider the therapeutic alliance and any institutional difficulties which might occur due to the referral. Referral may generate charges of discrimination and trigger legal or clinical liability exposure in certain cases (Hermann & Herlihy, 2006). When referral seems clinically appropriate, legal counsel and consultation with one’s liability insurer should be considered.

Akin to the conscience clauses for medical and pharmacy professionals, the referral option acknowledges that counselors may not be able to work against their deeply held beliefs and commitments in their professional work.

Those who believe Christian counselors should be free to take a more pastoral role and direct clients should consider an implication of that perspective. Consider the case of a Christian client who seeks counseling with a moral conflict from a non-Christian counselor. Under the current codes of ethics, the counselor must be sensitive to the client’s faith. However, if coercion and imposition were permitted, then the counselor would be on safe ground to recruit the client away from Christianity and to another faith or no faith.

Much of my work in recent years has been to persuade the professions that respect for religious liberty requires that the professions respect the choices of religious clients. In the area of sexual identity, this means that clients who do not affirm same-sex behavior can be supported to live in accord with their conscience. In August 2009, the American Psychological Association released a task force report which supported such religious clients.

Consistent with respect to conscience and professional ethics, Wheaton College Provost, Stanton Jones, endorsed the SITF, saying:

Throckmorton and Yarhouse have advanced a masterful synthesis of best practice in the confusing and troubled area of sexual orientation, sexual identity, and personal values.  No one should be forced toward a resolution of personal identity that violates their personal conscience; our commitment to being guided by the findings of scientific inquiry and respect for client autonomy and religious freedom should lead us toward empowering individuals to make informed choices about their lives. These guidelines are consistent with the ethical principles of the major mental health professional organizations and are superior to any other existing guidelines for practice in this area. 

In contrast, ministers are able and expected to operate with a more directive stance. Religious leaders are expected to lead and guide according to their understanding of their faith system. When people seek help from them, they expect such guidance. Often people seek the services of both counselors and clergy and each has a role to play in working toward resolution.

To sum up, the SITF is written as a guide to professionals who operate in a legal environment which is open to people of all faiths and no faith. Mr. LaBarbera’s stance confuses roles and if applied to professional Christian therapists across the board would expose them to significant liability.

UPDATE: My friend and co-author, Mark Yarhouse, weighs in on this discussion on his blog. His treatment of this issue is more detailed than mine and well worth the read.

The APA report and the sexual identity therapy framework

The recent American Psychological Association task force report on sexual orientation and psychotherapy included several positive references to the SITF. I have archived those on the SITF website and am providing two here with brief commentary.

The abstract of the sexual identity therapy framework (SITF) says

Sexual identity conflicts are among the most difficult faced by individuals in our society and raise important clinical, ethical and conceptual problems for mental health professionals. We present a framework and recommendations for practice with clients who experience these conflicts and desire therapeutic support for resolution. These recommendations provide conceptual and empirical support for clinical interventions leading to sexual identity outcomes that respect client personal values, religious beliefs and sexual attractions. Four stages of sexual identity therapy are presented incorporating assessment, advanced informed consent, psychotherapy and sexual identity synthesis. The guidelines presented support the resolution of identity conflicts in ways that preserve client autonomy and professional commitments to diversity.

 

I think the APA report and the SITF are compatible in many important ways.  They both recognize the difference between attractions, behavior and identity. They both recognize that informed consent is critical and that client may seek congruence with other aspects of personality, other than sexual desire, a distinction made in this segment from page 18 of the APA report: Continue reading “The APA report and the sexual identity therapy framework”

New SIT Framework website and list

Late Friday afternoon might not be the best time to post this but…

I want to announce the new Sexual Identity Therapy Framework website and invite people to join the SIT Framework list serv.

Here is the listserv portal:

Click to join sexualidentitytherapy

The discussions will be geared primarily to mental health professionals but interested ministry leaders and others may find them to be of value. There may be some overlap with the blog but there will be unique material as well.