sexual identity therapy – Page 2

Reparative Therapy Makeover Continues: JONAH Responds to SPLC Suit

A group called Freedom of Conscience Defense Fund has taken on the defense of Jews Offering New Alternatives to Healing (JONAH) against a suit filed by the Southern Poverty Law Center. The SPLC complaint alleges that JONAH violated New Jersey’s consumer fraud law by promising sexual reorientation to clients without success. The complaint is here.

It is very discouraging to see the JONAH complaint framed as a freedom of conscience case. As the complaint outlines, the techniques alleged by the plaintiffs have been discredited within the mainstream mental health community and as such should be confronted. Please see this post on the “oranges therapy” and this one on the use of nudity by JONAH counselors.

Furthermore, it is misleading for JONAH to describe what it does in the following manner:

For over twelve years, JONAH has helped hundreds of people live the lives that they want, consistent with their personal values. JONAH’s mission is to give all people the opportunity to explore their internal conflicts around sexuality and other values in a caring, non-judgmental environment.

As I have noted elsewhere, reparative therapists are beginning to use the language of the sexual identity therapy framework to describe what they do. However, reparative therapy is inconsistent with the SIT Framework.

Sexual Identity Therapy is Not Reparative Therapy

I have had to make this case several times over the years but the defensive posture of reparative therapists of late makes it necessary to do it again. As more people are coming against reparative drive theory, reparative therapists are softening and in some cases altering their rhetoric regarding what they believe and what they do. Note my posts here and here.

In a NBC News article last Wednesday, NARTH’s Executive Secretary David Pruden defends reparative therapy with a line of reasoning that doesn’t sound half bad. He says

“Once people felt less shamed – and I think that’s really positive – there was less a feeling that they couldn’t talk about it,” Pruden said. But those who do want to minimize those feelings, Pruden said, “deserve to have their needs met as well.”

“To say to them, we’re not willing to walk alongside you in your journey feels to me as cruel as the other extremes we used to be at, when people were hurt for saying, ‘I’m gay, and I’m OK with that,’” Pruden said. “In a sense it’s a pro-choice movement – people should have the right to deal with this.”

Walking along side someone in a journey and acknowledging a client’s right to deal with conflict surrounding sexuality seems reasonable and fair. However, that stance is not what is under attack in legislatures and court rooms around the country. If all reparative therapists did was support clients in exploration of their beliefs and values about their sexual orientation, then they would not be experiencing the scrutiny they are now.

What Pruden describes in this brief interview (and to be fair, he may have said more about change therapy that the reporter did not include) is similar to what Mark Yarhouse and I promote in the sexual identity therapy framework. We walk along side people who are struggling with conflicts involving their sexuality and moral beliefs. We do not offer change interventions and in fact stress that we do not see orientation change as the aim of the SITF. I indicate to clients that the evidence does not support efforts to change orientation. I respect the rights of people to make behavioral choices in line with what they believe to be right and work with people to move in a moral direction they believe in. However, reparative therapists do so much more than that.

Check out what Joseph Nicolosi believes about homosexuality as stated in the NBC article. He gives the usual reparative narrative about weak fathers and overbearing mothers being the culprit and then to those who don’t want to take his therapy he says:

“We say, fine, you want to be gay, but are you curious in understanding why you’re gay?” Nicolosi said.

Reparative therapists think they know why people are gay and their interventions of building masculinity with journeys into manhood, complete with holding therapy, sports training, etc., are what attracts the ire of opponents. The reparative therapists have a hammer and to them every gay person is a nail. The reparative therapists on the Dr. Oz show last week seemed oblivious to the message being delivered by the reparative drive theory. Reparative therapy begins with the assumption that gays are disordered and in need of some kind of treatment to cure the underlying psychological damage which may (they don’t all promise that the proper therapy leads to complete change) then lead to a lessening of attraction to the same sex. They compare being homosexual to being an addict, depressed or some other malady.

Walking along side someone does not require what reparative therapists do. Working with someone to work out an adjustment involving religious morality and sexual behavior does not require a belief that same-sex attraction is a disorder or the result of deficient families.

Let’s keep things straight, reparative therapy is one thing and sexual identity therapy is another.

NARTH likes half of the NYT Magazine's coverage of sexual identity issues

NARTH is recommending the Glatze article but not the article by Mimi Swartz which addresses the APA position on sexual orientation change.
At least they tell readers

While the story is his own and does not necessarily represent a typical NARTH client his observations and thoughts are very interesting. They represent a perspective usually missing in the popular press on the subject of homosexuality.

Missing from the NARTH post is the perspective of the longer article of the two. Gotta go to the popular press for that.

New York Times on therapy for sexual identity concerns

The New York Times Magazine will have a lengthy print article on sexual identity concerns, especially among evangelical gays this sunday. The well-written article by Mimi Swartz is now up online at this link.
I have been away for several days and won’t be able to comment much under Sunday or Monday, but I think she did a nice job of bringing together several lines of thinking which led to the sexual identity management/therapy approach to handling sexual identity concerns. Her descriptions of the sexual identity therapy framework start about here and are woven throughout the later part of the article.
The one aspect of the piece I don’t like is the title – Living the Good Lie. We do not encourage this and in fact advocate for acceptance, even if that acceptance is not with approval. More on that when I can reflect a bit more…

Sexual identity: Thoughts on the status of the reorientation wars

(First posted on August 12, 2009)
So now that the dust has started to settle from the APA convention in Toronto, let’s review the status of the Reorientation Wars.
Does therapy change orientation?
In anticipation of the APA’s report, NARTH fired an opening salvo with their paper (What Research Shows…). Perhaps sensing, incorrectly as it turns out, that the APA would advocate a ban on reorientation therapy, NARTH tossed every positive reference to change they could find into the paper. They noted problems in defining sexual orientation but did little to distinguish the various definitions and their meaning in the many studies they cited. They concluded, of course, that therapy can change orientation.
The APA on the other hand, differentiated sexual orientation and sexual orientation identity. Sexual orientation for them is the biological responsiveness to one gender or both. According to their literature review, the evidence that therapy can change orientation is not sufficient to permit therapists to inform clients that therapy can change their orientation. However, sexual orientation identity (i.e., self-labeling) may shift and be responsive to a variety of factors, including religious mediation.
It seems to me that what NARTH is calling sexual orientation includes the APA’s sexual orientation identity. While this statement risks taking us into the “all or nothing” dead end discussion about change, I do not mean that one must change completely for change to be important and psychologically relevant. I suggest instead that what many studies measure is how people see themselves, even if their sexual responsiveness (orientation) has only shifted by a degree (e.g., an average of less than a point on the Kinsey scale in the Jones and Yarhouse study). Jones and Yarhouse suggest as much in their recent paper when 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?

I believe the answer to their question is that it is not only possible but probable that change in sexual identity is what is being reported. The distinction between orientation and identity (or attraction and identity as we often describe it here) is key, in my view, in order for us to understand the experience of those who say they have changed while at the same time experiencing same-sex attraction. I also believe that men and women are different and their change may be different. Women seem to describe less exclusivity than men. Fluidity may be more likely with complete shifts described. I think we need to accommodate atypical experiences such as men and women who completely shift for a time and then shift back. Whatever the pattern, I hope we can agree that sexual attraction patterns may be one thing while meaning making aspects may lead two people with the same attraction pattern to identity in disparate ways.
Is sexual reorientation harmful or beneficial?
NARTH says reorientation might harm some people but that for the most part it is not harmful. The APA says existing studies are not good enough to allow conclusions. Point for the APA here. All we can say is that some people report harm and some people report benefit. The APA notes that the benefits can occur in programs which promote congruence with religious faith. This is clear and the Jones and Yarhouse study demonstrate that health status improves modestly for those who remained in the study. However, I would say we do not yet know much about what the potent or beneficial elements of those programs are. The APA report identified some of those elements.
Homosexuality and pathology
NARTH says homosexuals have more pathology than any other group of similar size. The APA says homosexuality is normal. By this they mean that homosexuality is not a developmental disorder or indicator of a mental disorder. The two recent reports go off in different directions but some observations can be made.
The NARTH report spends lots of time reporting on greater levels of mental health and health problems among homosexuals as compared to heterosexuals. The APA report does not do this. However, I believe the point regarding different levels of symptoms would be stipulated by the APA. However, the APA raises the minority stress model as responsible for many difficulties faced by non-heterosexual people. The NARTH report discounts the role of stigma.
I doubt the APA would dispute the health status data for another reason: greater group pathology does not mean inherent disorder. The APA’s position is not that gays have equal health outcomes but rather that the unequal health outcomes do not imply inherent pathology – that SSA is not inherently the result of pathological development. This is of course in great contrast to the reparative therapists. Joseph Nicolosi says that the only way you get SSA is to traumatize a child.
The reparative impulse to find trauma behind every gay person is misguided I believe, conceptually and for sure empirically. Women have greater levels of mental health problems than men but we would not consider women inherently disordered. NARTH has chosen some good studies to cite in the section of their paper which relates to health status (as well as some really bad and irrelevant ones). However, I don’t think it really gets them where they want to go.
And where do they want to go? This is clear from their press release complaining about the APA task force report. They state:

Further, if some clients are dissatisfied with the therapeutic outcome [of reorientation therapy], as in therapy for other issues, the possibility for dissatisfaction appears to be outweighed by the potential gains. The possibility of dissatisfaction also seems insignificant when compared to the substantial medical, emotional, and physical risks associated with homosexual behavior.
NARTH would suggest that these medical and emotional risks, along with the incongruity of homosexual behavior with the personal and religious values of many people will continue to be the motivation for some individuals to seek assistance for their unwanted homosexual attraction.

According to NARTH, gays ought to seek reorientation therapy because being gay is a risky life, full of health and mental health disadvantages. Their hypothesis is implied but hard to miss: reduce the SSA and reduce the health risks. The assumption appears to be that ex-gays will have better health outcomes than gays. One problem with this line of thinking is that there is no empirical evidence for it and some evidence against it.*
One researcher quoted in the NARTH paper regarding health risks was New Zealand’s David Fergusson. Dr. Fergusson has done significant work in this field. I asked him to look at the section of the NARTH paper in which his work was quoted. Here is a statement he provided about it:

While the NARTH statement provides a comprehensive and accurate analysis of the linkages between sexual orientation and mental health, the paper falls far short of demonstrating that homosexuality should be classified as a psychiatric disorder that may be resolved by appropriate therapy. To demonstrate this thesis requires an in depth understanding of the biological and social pathways that explain the linkages between homosexual orientation and mental health. At present we lack that understanding. Furthermore it is potentially misleading to treat what may be a correlate of mental disorder as though it were a disorder in its own right.

Fergusson also told me that one would need to develop studies to demonstrate that any changes in orientation associate with improvements in health status. The Jones and Yarhouse study provide some very general assessment but many potential confounds are uncontrolled. For instance, it is not possible to say that the modest shifts on the Kinsey scale were responsible for the shifts in health status. These folks were quite religious and religion is associated with enhanced health status. I suspect religious gays have a better health status than non-religious gays, on average. The point is we do not have evidence that sexual orientation status per se is what leads to the differences in health status.
While I am on the subject of health status, I need to mention that there are other factors which NARTH ignored. One, gender non-conformity is strongly correlated with adult homosexuality and is also associated with poorer mental health. Two, homosexuals report higher levels of sexual victimization which is also associated with higher levels of mental health problems. And, three, no one can discount the possibility that biological factors which associate with the development of homosexuality may also influence the development of emotional problems (i.e., in the same way women are more likely to report depression than men).
So where are we? I hope we have a larger middle and smaller numbers of people at the opinion extremes. People on both sides can agree that erotic responsiveness is extremely durable for men and perhaps less so for women, but behavior and self-identity reflection is alterable. People on both sides agree that conclusions about benefit and harm are not possible in any general sense. Also, I hope we can agree that full informed consent should be conducted prior to engaging in counseling. Regarding health status, both sides can agree that homosexuals have higher levels of problems but there is little agreement about what the differences mean.
Those on the far sides of the continuum will continue to argue that change is possible or change is impossible, and/or that reorientation is always harmful or never harmful and/or that health status difference mean something vital or irrelevant about inherent pathology.
The wars will continue but perhaps fewer people will be engaged in them; now is the time rather to reason together.
*Nottebaum, L. J., Schaeffer, K. W., Rood, J., & Leffler, D. (2000). Sexual orientation—A comparison study. Manuscript submitted for publication. (Available from Kim Schaeffer, Department of Psychology, Point Loma Nazarene University, 3900 Lomaland Drive, San Diego, CA 92106) – In this study, the authors found that mental health was better among the gay sample than the Exodus sample.
(Note: Social psychologist David Myers referred to this post in an op-ed on the APA task force printed in the Wall Street Journal.)