Tag: sexual orientation

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.

1984 Press Conference: Ronald Reagan opposed discrimination against gays

In a post earlier today, I referenced a Baltimore Sun article where Democrat Presidential nominee Walter Mondale said he heard President Ronald Reagan speak against discrimination against gays. I found a transcript of that June 14, 1984 press conference in the Reagan archives which supports Mondale’s statement. Here is the brief answer to a reporter’s question about gay rights in employment:

Employment Rights for Homosexuals

Q. Mr. President, there is a move afoot in the Congress that has the support of many of the Democratic Presidential candidates to change the Federal civil rights law to prohibit job discrimination against homosexuals. Is that something that you would favor?

The President. Now, I was so — you’re going to have to start again here for — first few words. I missed them. I was so confused about three of you — —

Q. There’s a measure before the Congress to change the Federal civil rights law to specifically prohibit job discrimination against homosexuals. Is that something that you would favor?

The President. Well, I just have to say I am opposed to discrimination, period. Now — —

Q. Well, would you support the measure, Mr. President?

The President. What?

Q. Will you support that measure, putting it into — —

The President. I want to see — I want to see what else they have there.

A few months later, Mondale told a Tupelo, MS crowd that he held essentially the same position as Reagan.

But the issue arose last Thursday when Mondale was asked at a Tupelo, Miss., appearance, why he supported “perversions” such as “gay rights.”

He answered: “I saw Reagan on a news conference a couple of months ago and someone said that about homosexuals.

He said, I wouldn’t discriminate against them.

That’s my position.

Does that draw a distinction between us?”

Reagan’s words in 1984 are consistent with his actions in 1978, opposing discrimination in CA by campaigning against the Briggs Initiative. When Reagan said that he wanted to see what else was in the bill referenced by the reporter, it seems clear that he was unfamiliar with the specific piece of legislation. However, on the broader question, Reagan expressed opposition to discrimination based on sexual orientation. Will those who now seek congruence with Reagan’s policies follow his lead?

UN restores reference to sexual orientation in violence policy – UPDATED

UPDATE: Paul Canning has this story from all angles. He has the vote changes listed and notes that 47 countries switched votes from the last time this issue came up.

His summary demonstrates the striking changes in votes from the first time around when sexual orientation was removed as a basis for condemning executions.

This means that 23 nations changed their vote to yes, 15 didn’t vote no and nine more abstained – 47 in total went in a positive direction. This is a quarter of the UN membership.

  • One third of African countries changed their vote positively, including Rwanda and Angola voting yes. 
  • Almost the whole of the Caribbean changed their vote positively, including Jamaica.

In the debate at the UN the most moving contribution was from the Rwandan delegate who said that a group does not need to be “legally defined” to be targeted for massacres and referenced his countries experience. “We can’t continue to hide our heads in the sand” he said.”These people have a right to life.”

“These people have a right to life,” said the Rwandan delegate. Will this sentiment spread to neighboring nations, including Uganda? We shall see…

This just in from Reuters…

The United States succeeded on Tuesday in getting the United Nations to restore a reference to killings due to sexual orientation that had been deleted from a resolution condemning unjustified executions.

Western delegations were disappointed last month when the U.N. General Assembly’s human rights committee approved an Arab and African proposal to cut the reference to slayings due to sexual orientation from a resolution on extrajudicial, summary and arbitrary executions.

The committee’s move also had outraged human rights activists and groups that lobby for gay rights. Philippe Bolopion of Human Rights Watch (HRW) said at the time that it was a “step backwards” and “extremely disappointing.”

The 192-nation General Assembly approved a U.S. amendment to the resolution that restored the reference to sexual orientation with 93 votes in favor, 55 against and 27 abstentions. The amended resolution was then adopted with 122 yes votes, none against and 59 abstentions.

The main opposition to the U.S. amendment came from Muslim and African nations, which had led the push to delete the reference to sexual preference from the resolution last month.

Uganda: Committee Chair describes Anti-Homosexuality Bill timetable

This morning I spoke with Stephen Tashobya, the chair of the Ugandan Parliament’s Legal and Affairs committee. This committee has jurisdiction over the Anti-Homosexuality Bill. I asked Hon. Tashobya if he had any current plan for action on the AHB. He told me that the Parliament was currently preoccupied with the upcoming Christmas break and then the elections. About the AHB, he said, “So I suppose I can say it will come up after elections which is the 18th of February.”

He said he did not promise that the bill would be next in line, but said

Ideally, what we are trying to do is to ensure that we clear all the bills that are before the committee before the end of this Parliament in May. I am not in a position to say we are going to handle it in this time framework, but we are trying to get out all of the bills by the end of May, including that one [the AHB].

Mr. Tashobya confirmed that if the bill is not considered during this Parliament, then a new bill would need to be tabled in the next one. He then outlined the procedure he envisioned for the bill.

What I can say is that there is special interest in that bill, both for and against and we are mindful of the interest in that bill. We are looking first of all in the context of the Parliament and the public interest, we are trying to see how we can handle it. We shall have public hearings, where all come and give their views and finally the committee report will take into account those views we are receiving from the public.

Mr. Tashobya said that the committee report would be presented then to the Parliament as a whole and discussed prior to a second and third reading. Often the required second and third reading occurs on the same day, followed by the vote, also on that same day. If passed, the bill is sent on to President Museveni. At that point, Museveni could do nothing and allow the bill to become law or he could send it back to Parliament if there were elements he did not like. However, according to Mr. Tashobya, that would be “unusual” saying, “In the life of this Parliament, he has not sent a bill back.”

For opponents of the AHB, it appears that the public opportunity to speak out will be in a relatively short window in the public hearings convened by the Legal and Parliamentary Committee sometime between late February and early May.

SPLC myth #4: Homosexuals don’t live nearly as long as heterosexuals

As anticipated, the groups identified by the Southern Poverty Law Center as “hate groups” have reacted with defensive distraction. Instead of responding directly to the charges made by the SPLC, they have organized a significant effort to change the subject. Called Start Debating/Stop Hating, the website   consists of endorsements from some prominent conservative activists, politicians and ministers. The website also asks visitors to sign a petition which reads:

“We, the undersigned, stand in solidarity with Family Research Council, American Family Association, Concerned Women of America, National Organization for Marriage, Liberty Counsel and other pro-family organizations that are working to protect and promote natural marriage and family. We support the vigorous but responsible exercise of the First Amendment rights of free speech and religious liberty that are the birthright of all Americans.”

That sounds fine until you realize that the SPLC did not place groups on the list because they favored “natural marriage and family.” There are other unlisted organizations (e.g., Focus on the Family, Alliance Defense Fund) which clearly and publicly oppose gay marriage.  The SPLC clearly stated reasons why the new groups, including the FRC and the AFA were listed. The issue is a systematic effort to vilify gays, such as this gem from American Family Association’s Bryan Fischer:

Homosexuality gave us Adolph Hitler, and homosexuals in the military gave us the Brown Shirts, the Nazi war machine and six million dead Jews. Gays in the military is an experiment that has been tried and found disastrously and tragically wanting. Maybe it’s time for Congress to learn a lesson from history.

That is SPLC myth #5. For this post, I am going to look at myth #4 which focuses on the claim that gays don’t live as long as straights. I have addressed this before extensively and so I am only going to point out again that the groups and their defenders are changing the subject instead of addressing actual problems in the information they present to their constituents.

A recent case in point is a column by Bryan Fischer of the AFA where he did exactly what the SPLC complained about in myth #4. Watch:

While drugs have been found to mitigate the damage done by HIV, there is no cure. Once someone contracts it, he has it for life, a life often tragically shortened by between eight and 20 years, according to the International Journal of Epidemiology.

Smoking will cut six to seven years from the lifespan of the smoker, meaning a cigarette habit is less dangerous to human health and longevity than gay sex.

Given the reference, I assume he is referring to the 1997 study by Hogg et al in the International Journal of Epidemiology which found the following:

In a major Canadian centre, life expectancy at age 20 years for gay and bisexual men is 8 to 20 years less than for all men.

Does Mr. Fischer have a get-off-the-hate-list-free card because he cited a peer reviewed journal? Those who really want to support these groups might be inclined to stop right there and cease their investigation of the question. Indeed, that is what the American College of Pediatricians do on their Facts About Youth website. They say:

The only epidemiological study to date on the life span of gay men concluded that gay and bisexual men lose up to 20 years of life expectancy.

I have pointed out to the people who put that website together that Hogg et al is not the “only epidemiological study to date on the life span of gay men” but they have not changed their website. In any case, the point is that people who count on these organizations for accurate information would not get it by trusting them and reading their claims.

The Hogg et al study was conducted using data from 1987 – 1992 when AIDS claimed many lives. In 2001, Hogg et al countered the incorrect use of their study – the same study that Bryan Fischer and ACPED cites as current information – by noting that life expectancy had improved significantly, saying:

In contrast, if we were to repeat this analysis today the life expectancy of gay and bisexual men would be greatly improved. Deaths from HIV infection have declined dramatically in this population since 1996. As we have previously reported there has been a threefold decrease in mortality in Vancouver as well as in other parts of British Columbia.

This is not reported on the ACPED site nor is it referred to by Bryan Fischer. Why not? If these groups were interested in presenting accurate information in debating and not hating, then why not present the whole picture?

However, there is more. A more recent 2008 studyby Danish epidemiologist Morten Frisch and statistician Henrik Brønnum-Hansen found that the trajectory of gay mortality is improving there to the point where, according to these researchers,

Despite recent marked reduction in mortality among gay men, Danish men and women in same-sex marriages still have mortality rates that exceed those of the general population. The excess mortality is restricted to the first few years after a marriage, presumably reflecting preexisting illness at the time of marriage. Although further study is needed, the claims of drastically increased overall mortality in gay men and lesbians appear unjustified.

The authors found that mortality improved dramatically with the introduction of antiretroviral treatments and while the mortality rates were still not as favorable for gays and lesbians, they were not compatible with the claims of a 20 year difference. Indeed, the Danish researchers found that the mortality picture of married GLB people is improving over time.

More research needs to be done and these studies need replication but the accurate picture is that life span differences are not dramatic and are not comparable to those produced by smoking. If anything, the mortality picture is improving substantially, not declining. If this new effort from the FRC is supposed to be about debate and dialogue then, please discuss this.

Here is a question:

Why haven’t the groups (or their supporters) singled out by the SPLC disclosed the update provided by Hogg et al in 2001 or the study by Frisch and Brønnum-Hansen in 2008?

Regarding mortality, the truth is more in line with what Hogg et al noted in their 2001 update:

It is essential to note that the life expectancy of any population is a descriptive and not a prescriptive mesaure. Death is a product of the way a person lives and what physical and environmental hazards he or she faces everyday. It cannot be attributed solely to their sexual orientation or any other ethnic or social factor. If estimates of an individual gay and bisexual man’s risk of death is truly needed for legal or other purposes, then people making these estimates should use the same actuarial tables that are used for all other males in that population. Gay and bisexual men are included in the construction of official population-based tables and therefore these tables for all males are the appropriate ones to be used.

In addition to avoiding information inconsistent with their premise, the groups identified by the SPLC often use the information they do disclose in an incorrect manner.  If these groups want to debate, then I suggest they use all of the information available and they use it in accord with accepted scientific standards. For instance, generalizing from Hogg et al in 1997 to all gay people everywhere in 2010 is improper and can easily lead to charges of purposeful negative stereotyping. Instead of changing the subject, I would like to see these groups change the way they defend their views.