Holding therapy and the Sexual Identity Therapy Framework

In light of the Exodus statement regarding the techniques displayed by Richard Cohen in the media, I thought it good to point out that the sexual identity therapy framework specifically identifies “holding therapy” as being inappropriate. From the framework:

Therapists should maintain professional boundaries in the therapeutic relationship. Therapists should follow ethical guidelines of their profession in conducting sexual identity therapy. Some approaches to sexual reorientation may blend appropriate therapeutic boundaries and are discouraged (e.g., Cohen, 2000). For instance, therapists should not engage in dual relationships with clients or provide physical touch or nurturance to clients. Therapists may supervise or oversee the client’s involvement in physical contact with others of the client’s choosing (friend, family member) during sessions only if the client has given consent. Clients should not be expected to become physically close to other clients in a group therapy situation. Therapists should not refer clients to retreats, support groups or interventions requiring boundary violations as a condition of participation.

Clearly, at times, family sessions involve hugging and the like, but the therapist should not participate. Especially troubling is the paternalism of this arrangement. Clients seeing the therapist as a parent figure should worked through, not encouraged. While we do not specifically discourage emotive techniques (beating pillows and screaming), we might consider whether we should add something to this effect – if for no other reason, to manage liability risk exposure. I have mentioned Genesis & Associates before as a negative example of how good intentions can go very wrong. Indeed, people who feel positive about an alternative technique at the time can later feel quite damaged by it. Specifically, a former Genesis & Associates client reported to CBS News in 2004 that she was damaged by therapists she formerly lauded on the 1995 documentary Divided Memories. In that CBS News report, the techniques were described that led to Ms. Diament’s dissatisfaction with her Genesis experience:

Carol says Mansmann prescribed two controversial treatments. One was “rage therapy” which included beating pillows while screaming. The other, “detachment therapy.” Mansmann urged Carol to move out of her home, away from her family. (italics mine)

To be fair, I suspect the detachment caused as much or more harm than the rage therapy. However, the rage therapy set up her willingness to believe that she was mistreated as a child and then to detach from her family. In hindsight, the “therapy” led to harmful results she was not able to anticipate.

In our guidelines, we do discourage therapists who have apriori determined the “root reasons” for same-sex attraction. Such emotive techniques as a given cannot be consistent with our guidelines since they are predicated on the notion that all same-sex attraction is a response to historical trauma or relational wounding.

UPDATE: 4/4/07 – I received an email from Richard Cohen this evening taking exception to my characterization of his work. Here is the email, which I indicated that I would include here to allow him to describe his work.

Dear Warren,

If you’re going to reference my work, here is the correct statement and my position:

Holding is not done by the therapist or by ministry leaders. It is to be done by OSA (Opposite-Sex Attracted) mentors, ideally the individual’s parent.

For clarification, this is stated clearly in Coming Out Straight on page 203, and in Chapters Ten and Twelve. I highly suggest you read the book and those chapters to better understand this issue.


Richard Cohen, M.A.


International Healing Foundation

I recall asking Richard in an email about two weeks before his CNN appearance if he held his clients and he said he did not. Then he shows up on CNN holding one of his clients. Where was the mentor? Past clients have said he does indeed hold them so I think it is up in the air. I am also referring in this post to the whole approach which is promise change based on a faulty view of homosexuality in general. It is not hard to see how boundaries bent can become boundaries broken.

23 thoughts on “Holding therapy and the Sexual Identity Therapy Framework”

  1. Lynn David said: “It just struck me that the opposite of being gay is not ex-gay….” You are so right. Any reasonable, honest person knows that the opposite of gay is “straight” or “heterosexual” — and ex-gay has never meant that.

  2. It just struck me that the opposite of being gay is not ex-gay…. the true opposite is indeed being miserably unhappy about who you are.

    And that is the behind the entirety of the socio-political underpinnings of the ex-gay/change philosophy. It is not that any certain percentage of persons of homosexual orientation might be able to change. The point for the ex-gay ministries/ministerial therapies is that they be able to have access to those who might change their orientation (for however short a period).

    The number of people that they can change, not necessarily any percentage increase but simply the number that might change (for however short a time), is dependant upon the absolute number which may be shamed enough by societal and relgious pressures. The religous/faith-based pressure has always been there in society.

    The political pressure which ex-gay groups tacitly approve is now necessary in that egalitarian society which Christianity envisioned. Thus democracy then is no longer that means to an egalitarian society through the implementation of personal rights, but that means by which to impart societal pressure. All of which is meant to shame the individual into not accepting himself. Thus the numbers may be increased (for however short a period) even though their percentage of success may decline.

  3. Thank you for that article, Nick. Sixth Grade has certainly changed since my time. A story like that makes the struggle worth it, and makes the world feel like a better place.

    And it probably ruined Regina Grigg’s day!

  4. There’s a story in today’s New York Times that speaks eloquently to these unending discussions on the best way to deal with “unwanted same sex attraction.” I was at first going to call the story remarkable, but as I think about it, it shouldn’t really be particularly remarkable. Just a quiet, touching account of a young boy who was deeply unhappy about his homosexual feelings until he came out and discovered acceptance by his family, friends, and available support groups for gay youth.

    (I’m pasting the link here, but it’s a long and awkward one, so if it doesnt’ work, just visit the NYT home page and look for the story. Registration required.)


    What would have happened if Zach’s family, instead of reacting to his identity with simple love and approval, had shipped him off to a Love in Action or ex-gay therapist? How much additional turmoil and depression would he have endured if he spent his adolescense battling his own sexual feelings as “unwanted attractions”?

    Instead, because he did find a welcoming community, he has grown up as a confident, successful young man, far less focused on his gay identity than on his school activities and friends.

    That’s why I have a difficult time with the Dr Throckmortons and Karen Booths and others who keep seeking new (or resurrect old) therapeutic approaches for gay “strugglers.” I don’t think you will ever find any therapy that produces as much mental health as honesty and self-acceptance.

    In other words, coming out really is the best therapy for unwanted same sex attractions.

  5. Ivan – I have no idea about percentages. If Dr. Nicolosi’s numbers are accurate, maybe a third of those who want to change? But it would be a guess.

    Warren, you do have a wicked sense of humor 🙂

  6. Boo – Thanks Boo, that’s the nicest thing you’ve ever said to me 🙂

    Ivan – I have no idea about percentages. If Dr. Nicolosi’s numbers are accurate, maybe a third of those who want to change? But it would be a guess.

    RE: therapist’s oversight. Perhaps that is a authoritarian way of stating it. What we mean is that if a therapist and client think some kind of physical containment is needed – lets say if the client is dealing with grief or other powerful emotions, and that client wants a friend or family member there – then the therapist may (not must or should) participate and not run afoul of the framework.

  7. Garlic works.

    Okay. Garlic doesn’t cure my attractions to other men necessarily, but it does seem to have a signiciant impact on their attractions toward me.

  8. My question is regarding a statement in the Sexual Identity Therapy Framework which says:

    “Therapists may supervise or oversee the client’s involvement in physical contact with others of the client’s choosing (friend, family member) during sessions only if the client has given consent.”

    Why would the therapist serve in this role or capacity? As a therapist, I have never and would never “oversee” or “supervise” an adults physical contact with someone during sessions….I may “take note of” these, but the terms described seem a bit too regressive to me, not allowing clients (and disempowering them) to work through in insight or self-direct their own actions.

    In the framework of sexual identity therapy, I cannot think of a scenario which would require such oversight as a helpful or therapeutic method…nor can I think that this would be appropriate in any capacity in sexual identity work. It seems belittling…I don’t “oversee” a person who self-injures, or individuals in abusive relationships (due to later retribution, etc..) and individuals are responsible for their own changes of behavior through insight…if they choose to change.

    Interactions with the therapist, however, are usually commented on as a therapeutic rapport builds. I agree that there should be no physical contact – hugging, etc..as I believe there should not be in any therapy session.

    I am wondering if Warren could explain a bit more about his thoughts in the opening statements made in the sexual identity therapy framework about oversight, etc……when it might be necessary, etc…

    I admit, I might be missing something here….

  9. Timothy asked: “Would it be ethical for a doctor to prescibe all of his patients with the same medicine under the assumption that they were all suffering from wounds?” The answer, of course, is no.

    But too often religious and non-religious healers alike tend to make the mistake. The old adage seems to be true: “When the only tool you have is a hammer, you tend to see every problem as a nail.”

    Warren mentioned that he is compiling a “list of strange things said in the name of reorientation.” It must be a pretty big list by now! Are chile peppers on your list of proposed cures for gayness?

  10. Clearly, at times, family sessions involve hugging and the like, but the therapist should not participate.

    Awwww… but Warren, you just look so cuddly!

  11. Timothy, I think I mostly agree with you, except for assumption number 6.

    In the model I witnessed, I don’t think a causal relationship between SSA and specific wounding was assumed (and maybe my previous posts in general haven’t helped clarify that.) I would probably phrase it, “therefore same-sex attractions are a sin THAT MAY BE EFFECTED by wounding that is retained as memory that can be healed.” I didn’t experience the model as being as rigid and universalist as you describe. But I’ll keep your warnings in mind.

  12. Karen,

    You probably weren’t looking for my input on this… but, nonetheless here it is:

    I was raised in a pentecostal environment and do believe in the working of the Holy Spirit and in divine revelation and intervention in our lives. That being said, however, I’ve also seen some very very nutty stuff attributed to the Holy Spirit that would have best been attributed to someone wanting to be perceived as used by God. In my experience, a huge percentage of “I have a word for you from God” was not inspired by anything greater than self-rightousness and self-glorification.

    So I would caution you to be careful that you do not design a system that encourages and rewards those who tell others what “God has told them”. I would suspect that such a situation would be begging for abuse.

    Secondly, it appears to me that your plan would make the following assumptions:

    1. same-sex attractions are sinful

    2. all sin comes from the Fall

    3. sin causes wounding

    4. wounding stays with us in the form of memory (whether or not recalled)

    5. wounded memories can be healed

    6. therefore same-sex attractions are a sin caused by wounding that is retained as memory that can be healed

    But I really think that there is no evidence to support this notion (actual events resulting in wounding) as a universal truth and much to suggest that this is not the case in all circumstances.

    And regardless of faith in The Truth, healing is really only of value when it works. If there are no wounded memories to heal, then it isn’t of much value to declare that The Truth says there are memories. Going too far in the direction of faith over reality begins to sound a lot like Christian Science.

    Suppose, for a moment, that only a third of those you experience actually have wounds as some source of their same-sex attraction. Should then they subscribe to this process as a healing for their same-sex attraction?

    Would it be ethical for a doctor to prescibe all of his patients with the same medicine under the assumption that they were all suffering from wounds? That which might save the life of some would kill others.

    I would suggest that you reconsider your base assumptions and allow that perhaps some same-sex attracted persons are not so because of some wounded memories. Even if someone says that the Holy Spirit told them so.

  13. BTW – I’m not trying to advocate for the prayer model approach, but to understand the differences between them and Dr. T’s guidelines. When I make referrals, I want to be able to do that with as much information as possible.

  14. Warren – at the one week-long workshop I attended at the seminary, the professor claimed it was different than theophostic, though I don’t know enough yet about either to be able to confirm that.

    As I observed the model firsthand, the counselor (or caregiver) did no direct prompting of the prayer imagery. And yes, though the divine revelation part was assumed, it was described and directed by the “pray-ee.” (Though I realize even questions from caregivers can subtly introduce their personal agenda.)

    I think there is the potential for abuse in any model – whether faith-based or theraputic. But I won’t dismiss charismatic prayer approaches out of hand because I’ve met several people who have been helped immensely by them. (And I personally experienced a form of Inner Healing Prayer in the early 80s that was key to helping me deal with some of my issues with my parents.)

    Thanks for your comments, though. They were helpful. And I hope to hear more from others as well.

  15. Karen – Sounds like theophostic to me. I am pretty uncomfortable with these approaches. As I understand them (never used them but saw it done once and have numerous 2nd hand descriptions), the Holy Spirit reveals to a counselor or ministry worker where a person is wounded and then that person is encouraged to bring an image of Jesus as healer to the imagery. In other words, revelation is imparted and assumed to be an accurate word from God. I do not personally subscribe to that belief. Further, the guidelines would not support such efforts. That the efforts are emotive is not the issue. We do not believe telling people why they have SSA, especially in that kind of environment, can be supported by evidence. Speaking personally, I do not believe it can be supported theologically — although that has nothing to do with the guidelines.

    If someone comes to believe that their affections are influenced in some way by historical events, then they can pursue that with a therapist. We however, do not believe it is appropriate to lead the witness.

  16. I have questions and comments, too, about Dr. T’s statement “Such emotive techniques as a given cannot be consistent with our guidelines since they are predicated on the notion that all same-sex attraction is a response to historical trauma or relational wounding.”

    I’m going to try to be very clear and careful here in what I write, but it’s faith based, and so if this is taking the thread off onto a “bunny trail,” feel free to ignore.

    My ministry is beginning to develop a second phase in equipping the church – moving beyond congregational education and foundations for ministry to a prayer-based model for working with hurting individuals, including those with unwanted same sex attraction.

    We have been exploring how we can adopt/adapt a model that comes out of the work of a seminary professor, who shall remain un-named. (And I have to qualify here that I have to date had very limited exposure to the model and its teaching materials.) The professor’s model itself is an amalgamation of what used to be called Inner Healing Prayer (IHP) with some other ministry approaches – Leanne Payne, Francis McNutt, etc. Products of the charismatic renewal of several decades ago, they are Holy Spirit led and deal to some extent with the healing of memories.

    The seminary model is also based on the worldview that we live in a “fallen” sinful world and that everyone is therefore wounded to greater or lesser degree by Sin. The wounding affects self-esteem, self-definition and behavioral choices. How that generalized wounding will apply to someone who is same-sex attracted will be unique to each individual and, again, revealed and guided by the person’s interaction with the Holy Spirit.

    That much I am comfortable with. (And I don’t really want to get into an argument about the overall validity of charismatic approaches.) But I’m concerned because I’ve experienced how this model played out in the life of someone I know. It led to a victimized “poor me” attitude and an incredible amount of blame-shifting to others without willingness to acknowledge or repent of (there’s that religious term again!) sinful personal choices.

    Any comments or “heads up” as we continue to consider this model?

  17. I agree with you Timothy (or is it Tim?) – also, have you ever tried tearing down old wall paper – way effective!

  18. Dr. Throckmorton,

    ***Such emotive techniques as a given cannot be consistent with our guidelines since they are predicated on the notion that all same-sex attraction is a response to historical trauma or relational wounding.***

    I realize it’s a difficult question to answer, but how would you divide up the various causes or influences to ones’ homosexual attractions?

    Also, what percentage do you think experience same-sex attractions as a response to historical trauma or relational wounding?

  19. I have been known from time to time to scream in frustration. It’s usually in traffic after a long or difficult day and the immediate following action is to look around to make sure I wasn’t heard. I’ll admit it is a way of reducing stress.

    I’ve even hit a pillow before. I just didn’t do so with a tennis racquet and name the pillow “Mother” while hitting it.

    For me the best release is going to the gym and working off the stress. Or taking a walk. Or (and this was the best I ever found) pulling weeds.

    I think there are certainly benefits to giving an outlet to frustration. But I find turning that outlet into physical violence against a substitute of a parent (or anyone) to be disturbing.

  20. I’ll add that to my list of strange things said in the name of reorientation. Maybe I should make a post about that alone.

  21. So the therapist, who kept suggesting that to make a man out of me I might leave my recently widowed mother to enlist in the US Army at the zenith of the VietNam War, wasn’t quite up to snuff?

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