Things that make you go, hmmmm….

Check out this story of “change.”

Case Report

The patient, a 57-year-old right-handed man, sustained his first cerebral vascular accident in the right middle cerebral artery region at the age of 45, which resulted in right-sided hemiparesis that resolved completely within 3 months. He continued to run his private business successfully while living with his mother.

The patient lost his father in early childhood. There was no evidence of an emotional or conduct disorder during school years, and the patient eventually obtained his university degree. He continued to manage his successful practice until he sustained the second cerebral vascular accident in the left middle cerebral artery region at age 53.

The patient became aware of his homosexual orientation in his early teens and had several gay partners. He suffered a major depressive episode at age 26 that resolved within a few months. He also had a diagnosis of excessive harmful use of alcohol, but there was no evidence of dependence.

The patient started complaining of his changed personality and heterosexual orientation 6 months after his second stroke. At the same time he complained of excessive mood swings and changed interests. He became preoccupied with photography and had a successful photographic exhibition a year after his second stroke. His sexual orientation remained heterosexual 4 years following the second stroke, and he preferred to describe himself as bisexual because of his previous homosexual orientation.

Discussion

The mechanism by which a person acquires his sexual orientation is complex and ranges from pure psychological theories to more complex biological concepts. Our patient was aware of his homosexual orientation beginning in his early teens. He always enjoyed his gay relationships and had had at some point a live-in partner. He grew up with an absent father and had a strong bond with his mother. He went back to live with his mother after separating from his partner 4 years before his first stroke. It is unlikely that his psychological reaction to his first and/or second stroke could explain his altered sexual orientation, and his sexuality was accepted by his social network and family members.

Taking into consideration the interval between his first and second stroke, it is likely that an organic process within the left middle cerebral artery region is the cause of his altered sexual orientation.

The sexual needs of patients suffering from a brain injury are centered on hyper- and hyposexuality rather than altered sexual orientation. The alteration of sexual orientation raises serious challenges to patients and their care. It may be essential to address the issue of sexual orientation in assessing patient needs following brain injury in addition to other possible behavioral changes that might be encountered.

This is one of those head-scratchers that make you wonder what role “the middle cerebral artery region” plays in sexuality. I have had no chance to look into this but wanted post it due to the nature of the report.

Filed under: Research news, sexual orientation by Warren - 12 Comments →

This article about brain plasticity by Neil and Briar Whitehead posted on Anglican Mainstream caught my attention for several reasons. Some relate to classes I teach but for this post, I am interested in discussion surrounding the main reason the Whiteheads wrote about neuroscience: sexual reorientation.

I have a few questions.

Sex and gender researchers working in the belief that the brain and its functions were more less set, believed they might find evidence that homosexuality was hard-wired in the brain. They looked for signs that parts of the brain used in sexual activity were different in homosexuals and heterosexuals, that, for example parts of a homosexual male brain might be more like a woman’s.

Almost without exception these numerous studies produced contradictory conclusions, and were not replicable. Although gay activism sought to use some of these findings to argue homosexuality was biologically ingrained, the most that can be said scientifically about them is that IF any differences exist they are probably the result of homosexual behavior rather than the cause of it. But it is clear now that no-one is stuck with the type of brain they were born with. Our assumption now should be, change is possible in many behaviors – sexual orientation not excluded – and extraordinary effort will produce extraordinary change.

I don’t agree with this assessment of the state of research. We are on the beginning edge of research regarding sexual orientation differences in the brain and some of those differences seem striking. The work of Savic in particular has found some differences in gay and straight males in areas of the brain which may or may not be modified by experience. This study was just last year; there has not been time to publish replications. What research do the Whiteheads refer to here? This is an ongoing process which the Whiteheads describe as though the research program was in some mature state with many contradictory studies. I believe this is a extremely premature statement:

the most that can be said scientifically about them is that IF any differences exist they are probably the result of homosexual behavior rather than the cause of it.

What evidence has been demonstrated that sexual behavior can make these differences? I would like to know what studies have contradicted the Savic research and other studies which demonstrate brain differences, not just in symmetry but responses to sweat, serotonin and visual cues.

The Whiteheads then discuss brain training, noting that musicians and cab drivers have enlarged areas of the brain which are used for the specific tasks used frequently. They then leap to sex.

Monkey experiments have shown that artificial exercise of three digits on the hand increases the area of the brain asso­ciated with those fingers and decreases the other regions proportionately.(1) Violinists have a grossly enlarged area of the brain devoted to the fingers of their left hands. Those who learn a juggling routine for three months produce observable small changes in the small-scale structure of the brain, and these changes reverse when they stop.(3)

London taxi drivers have an enlarged area of the brain dealing with navigation. Is this innate? No. London bus drivers on set routes did not have this enlarged area, and on retirement of the taxi drivers, the brain area involved diminished.(6) Taxi-drivers were not born that way, but developed the brain area through huge amounts of navigation and learning, and only maintained it through constant use. We change our brains at the micro-level through the way we exercise, and anything we do repetitively espe­cially if associated with pleasure (e.g.) sexual activity. So, if brain scientists did find real differences between the brains of homosexuals and heterosexuals, this was probably the result of different sexual behaviors, not the cause of them.

Do we have any research that demonstrates brain areas which enlarge based on frequent sex? Or straight sex or gay sex? I know of none and the Whiteheads offer none but this appears to be what they are suggesting. They also suggest that gay and straight sex might bulk up different brain areas thus reflecting activity rather than causing it. I know of no research which indicates different brain areas for sexual arousal. This study by Safron et al seems to provide evidence against such an idea.

Now here is where stand up comics should get some material.

Doidge sums up the extraordinary plasticity of the brain with the words, Use it or lose it. (Or, for those trying to drop an unwanted behavior, Don’t use it, and you’ll lose it.)

Even if part of the brain is strongly associated with a particular sexuality it should be possible to change it. Stopping a sexual activity and avoiding stimulation of that brain region, and plunging into some other intense brain activity for months would lead to a diminishing of the intensity of that sexual response. Months is about the timescale of first significant change. That can be true for learning a musical instrument too!

Doidge’s conclusion about sexuality is that “Human libido is not a hardwired invariable biological urge, but can be curiously fickle, easily altered by our psychology and the history of our sexual encounters.” and “It’s a use-it-or-lose-it brain, even where sexual desire and love are concerned.” This would apply both to same-sex attraction and opposite-sex attraction.

If we train hard enough, an activity can become automatic and we pay it less conscious attention. That is particularly true of playing a musical instrument. Many of the basic techniques like chords, scales and arpeggios, are so deeply learnt that we don’t think about the details and indeed can’t if the music is fast. Details of driving, throwing a ball, reading, even tying shoelaces don’t and often can’t demand full attention. Anything we do often, we often end up doing automatically. In the same way it can seem that sexual orientation is so deeply embedded that it is innate. But, really, it is no more innate than any complex skill we have worked at to the point where we can do it without thinking e.g. seemingly automatic placement of left-hand fingers on guitar strings to produce a C chord.

Hey, what did you do this summer? Well, I learned to play the…

Changing sexual orientation is like learning to play a musical instrument? Should we have straight lessons? Community colleges could offer them in their continuing education departments. New slogan: “We put the adult in adult development!”

I apparently will need to get this book by Doidge. Whitehead doesn’t offer any of the research Doidge relies on for his startling new discovery about music instruments and sex. I wonder if there are any such studies. Whatever techniques Doidge is aware of, perhaps he ought to share them with Exodus since the changes reported by Jones and Yarhouse do not seem to reflect this new found brain plasticity. (I made this modification here because I have since learned that Doidge does not advocate any techniques of orientation change.).

I suspect this passage in the Whitehead article is deeply insulting to many ex-gays and ex-ex-gays alike (New reparative therapy slogans: “Just train it!” “You’ve got to train it to gain it”). How many such persons have essentially followed this approach: don’t use and you’ll lose it. However, they didn’t lose it.

The Whiteheads then suggest that male and female differences are largely due to experience after birth:

Male and female behavior – let alone ho­mosexuality and heterosexuality – is apparently not hardwired into the brain at birth. In fact, only one quar­ter of the brain is formed in a new-born child; the rest is developed through learning and experience (environ­mental input). We can be confident that whatever male/female differences exist in adult brains (and, no doubt, more will be found at some stage), they will be largely shaped by learning and behavior.

I think researchers in hormones might quarrel with this. I am aware of a recent study which found associations between fetal testosterone levels and sex-typed behavior at age 8.5. Testosterone has an organizing function in the brain prenatally but it is unclear whether it does at or before puberty. There is way too much unknown I believe, for dogmatism here. As with the rest of the claims, I would like to see this research much more than studies about driving and music.

The Whiteheads conclude:

Anatomy is not destiny; change is always possible. The brain is plastic and is in a constant state of change. Indeed the question is rather: what change is not possible?

Well, at the end, an idea is all we have. Essentially, the Whiteheads suggest that because brain plasticity has been associated with driving, musical training and regaining use of motor function, it should be true of sexual orientation change as well. As noted, there are some problems with his facts and no direct evidence for the hyperbolic title of this article.

UPDATE: My comments above about Norman Doidge’s book were made prior to reviewing it. I have since been able to read through parts of it and believe it is a valuable contribution for a lay audience. He does not offer techniques of sexual reorientation nor does he liken orientation change to learning a musical instrument. Neil and Briar Whitehead make those far-fetched connections, not Dr. Doidge. My reaction to the book was solely based on the selective quotations from the Whiteheads. I am sorry if anyone made an impression regarding Doidge’s book based on this post. Readers are encouraged to read the related posts linked below.

Related Posts:

NARTH authors again mislead readers: More on brain plasticity and sexual orientation

My Genes Made Me Do It and brain plasticity

Filed under: NARTH, Research news, sexual orientation by Warren - 143 Comments →

Yesterday, I was on WHYY out of Philadelphia for an interview with Judith Glassgold, chair of the recently released APA Task Force report. Marty Moss-Coane is the host of Radio Times, a show broadcast over NPR as well as locally on WHYY.

You can listen to the interview here. It is long (about an hour) but the long format allowed us to unpack the report and some of the clinical issues involved.

Among other points, Dr. Glassgold affirmed my understanding and analysis of the APA task force report and the value it has for people working within a sexual identity therapy framework. There is much more of interest so if you groove on this topic, this is a good interview without pressure to create sound bites.

Filed under: Media and society, Professional issues, Religion and sexuality, Research news, mental health, psychology, reparative therapy, sexual identity, sexual identity therapy, sexual orientation by Warren - 2 Comments →

In the category of “Old Business.”

On July 23, I asked blog readers what the phrase “new scientific research” meant.

Here is what some of you said:

New: Recently reported (not in media for more than 3 months)
Scientific: Can document measuring criteria, tested, revealing a need to do further research
Research: Primary Data

If it’s new, it’s not a review of past literature.

Data that hasn’t been reported before.

Not -
A literature review
A meta-analysis
A re-analysis of data that has been previously been reported with a different analysis.

Study with new data…Not a literature review. Not a review to undermine the own viewpoints with no diversity view.

That’s what I think too. Therefore I was surprised to see NARTH headline their recent press release for the summary paper, “What Research Shows…” as

New Scientific Research Refutes Unsubstantiated Claims Regarding Homosexuality

The problem is that there is no new scientific research in the paper. The paper itself is not new scientific research but rather a collection of prior studies.

I asked NARTH leaders about the decision to call their paper “new scientific research.” I did learn in the process that the NARTH Governing Board had reviewed the press release and title and approved it. When I pressed about why the paper was called “new scientific research,” NARTH past-president Dean Byrd then wrote to me twice say that he did not have time to answer the question.

Filed under: NARTH, Professional issues, Religion and sexuality, Research news, reparative therapy, sexual orientation by Warren - 9 Comments →

The Wall Street Journal’s Stephanie Simon has captured well the application of the APA task force sexual orientation report in an article out this morning. Of course I would say that…

The men who seek help from evangelical counselor Warren Throckmorton often are deeply distressed. They have prayed, read Scripture, even married, but they haven’t been able to shake sexual attractions to other men — impulses they believe to be immoral.

Dr. Throckmorton is a psychology professor at a Christian college in Pennsylvania and past president of the American Mental Health Counselors Association. He specializes in working with clients conflicted about their sexual identity.

The first thing he tells them is this: Your attractions aren’t a sign of mental illness or a punishment for insufficient faith. He tells them that he cannot turn them straight.

But he also tells them they don’t have to be gay.

For many years, Dr. Throckmorton felt he was breaking a professional taboo by telling his clients they could construct satisfying lives by, in effect, shunting their sexuality to the side, even if that meant living celibately. That ran against the trend in counseling toward “gay affirming” therapy — encouraging clients to embrace their sexuality.

But in a striking departure, the American Psychological Association said Wednesday that it is ethical — and can be beneficial — for counselors to help some clients reject gay or lesbian attractions.

The APA is the largest association of psychologists world-wide, with 150,000 members. The association plans to promote the new approach to sexuality with YouTube videos, speeches to schools and churches, and presentations to Christian counselors.

According to new APA guidelines, the therapist must make clear that homosexuality doesn’t signal a mental or emotional disorder. The counselor must advise clients that gay men and women can lead happy and healthy lives, and emphasize that there is no evidence therapy can change sexual orientation.

But if the client still believes that affirming his same-sex attractions would be sinful or destructive to his faith, psychologists can help him construct an identity that rejects the power of those attractions, the APA says. That might require living celibately, learning to deflect sexual impulses or framing a life of struggle as an opportunity to grow closer to God.

While the report doesn’t use my exact words (e.g., I don’t say ‘you don’t have to be gay’), she does catch important aspects of the APA report and the stance I use within the sexual identity therapy framework. Furthermore, I don’t show the video at the same time in the same order of things to clients and then they make a decision about their direction. I do however, do extensive informed consent and answer lots of questions which involves videos and slides to answer. Thanks for Michael Bailey for those vids.

This report captures the essence of the novel findings in the APA report in contrast to the AP report which continues to present a polarized picture. For sure, as long as the dialogue around change is important to people, we keep talking past each other. However, when you look at what both sides actually claim, they are not that far apart. According to the AP report, Jones and Yarhouse are going to report over half of 61 subjects either changed or are celibate. Whatever the percentage, it is clear that change cannot be promised to clients as a predictable function of therapy or ministry. We should be able to agree about that and then place emphasis on belief and value congruence. From there, see what happens.

I will have other posts on the media reaction and additional analysis…

Filed under: APA, Exodus International, Media and society, Professional issues, Religion, Religion and sexuality, Research news, ex-ex-gay, ex-gay, mental health, psychology, reparative therapy, sexual identity, sexual identity therapy, sexual orientation by Warren - 194 Comments →

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.

Filed under: APA, Breaking news, Exodus International, NARTH, Professional issues, Religion and sexuality, Research news, ex-gay, health, mental health, psychology, reparative therapy, sexual identity, sexual identity therapy, sexual orientation by Warren - 119 Comments →

The APA released the report from the Task Force on Appropriate Therapeutic Responses to Sexual Orientation today. This post is the APA press release, I also have an analysis of the report and another post coming with press reports.

APA PRESS RELEASE

August 5, 2009
Contact: Kim Mills
(202) 336-6048 until Aug. 5
(416) 585-3800 – Aug. 5-9

——————————————————————————–

INSUFFICIENT EVIDENCE THAT SEXUAL ORIENTATION CHANGE EFFORTS WORK, SAYS APA
Practitioners Should Avoid Telling Clients They Can Change from Gay to Straight

——————————————————————————–

TORONTO—The American Psychological Association adopted a resolution Wednesday stating that mental health professionals should avoid telling clients that they can change their sexual orientation through therapy or other treatments.

The “Resolution on Appropriate Affirmative Responses to Sexual Orientation Distress and Change Efforts” also advises that parents, guardians, young people and their families avoid sexual orientation treatments that portray homosexuality as a mental illness or developmental disorder and instead seek psychotherapy, social support and educational services “that provide accurate information on sexual orientation and sexuality, increase family and school support and reduce rejection of sexual minority youth.”

The approval, by APA’s governing Council of Representatives, came at APA’s annual convention, during which a task force presented a report that in part examined the efficacy of so-called “reparative therapy,” or sexual orientation change efforts (SOCE).

“Contrary to claims of sexual orientation change advocates and practitioners, there is insufficient evidence to support the use of psychological interventions to change sexual orientation,” said Judith M. Glassgold, PsyD, chair of the task force. “Scientifically rigorous older studies in this area found that sexual orientation was unlikely to change due to efforts designed for this purpose. Contrary to the claims of SOCE practitioners and advocates, recent research studies do not provide evidence of sexual orientation change as the research methods are inadequate to determine the effectiveness of these interventions.” Glassgold added: “At most, certain studies suggested that some individuals learned how to ignore or not act on their homosexual attractions. Yet, these studies did not indicate for whom this was possible, how long it lasted or its long-term mental health effects. Also, this result was much less likely to be true for people who started out only attracted to people of the same sex.”

Based on this review, the task force recommended that mental health professionals avoid misrepresenting the efficacy of sexual orientation change efforts when providing assistance to people distressed about their own or others’ sexual orientation.

APA appointed the six-member Task Force on Appropriate Therapeutic Responses to Sexual Orientation in 2007 to review and update APA’s 1997 resolution, “Appropriate Therapeutic Responses to Sexual Orientation,” and to generate a report. APA was concerned about ongoing efforts to promote the notion that sexual orientation can be changed through psychotherapy or approaches that mischaracterize homosexuality as a mental disorder.

The task force examined the peer-reviewed journal articles in English from 1960 to 2007, which included 83 studies. Most of the studies were conducted before 1978, and only a few had been conducted in the last 10 years. The group also reviewed the recent literature on the psychology of sexual orientation.

“Unfortunately, much of the research in the area of sexual orientation change contains serious design flaws,” Glassgold said. “Few studies could be considered methodologically sound and none systematically evaluated potential harms.”

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.

“Without such information, psychologists cannot predict the impact of these treatments and need to be very cautious, given that some qualitative research suggests the potential for harm,” Glassgold said. “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.”

As part of its report, the task force identified that some clients seeking to change their sexual orientation may be in distress because of a conflict between their sexual orientation and religious beliefs. The task force recommended that licensed mental health care providers treating such clients help them “explore possible life paths that address the reality of their sexual orientation, reduce the stigma associated with homosexuality, respect the client’s religious beliefs, and consider possibilities for a religiously and spiritually meaningful and rewarding life.”

“In other words,” Glassgold said, “we recommend that psychologists be completely honest about the likelihood of sexual orientation change, and that they help clients explore their assumptions and goals with respect to both religion and sexuality.”

A copy of the task force report may be obtained from APA’s Public Affairs Office or at http://www.apa.org/pi/lgbc/publications/therapeutic-response.pdf.

Members of the APA Task Force on Appropriate Therapeutic Responses to Sexual Orientation:

Judith M. Glassgold, PsyD, Rutgers University – Chair
Lee Beckstead, PhD
Jack Drescher, MD
Beverly Greene, PhD, St. John’s University
Robin Lin Miller, PhD, Michigan State University
Roger L. Worthington, PhD, University of Missouri

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States and is the world’s largest association of psychologists. APA’s membership includes more than 150,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare.

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