Sexual identity therapy and neutrality, Part one

Continuing the discussion about sexual identity therapy, I want to contrast our framework with both gay affirming and reparative therapies on the dimension of value neutrality in two posts. As a springboard for my thoughts, I want to quote from an article by Joseph Nicolosi on the NARTH website called, “Why I Am Not A Neutral Therapist.” He led with this explanation:

A Christian psychologist contacted me to discuss reorientation therapy for SSA men. Hoping to find a politically “safe” compromise with the APA, he was anxious to avoid value judgments and remain noncommittal about homosexuality. The solution, he thought, would be a simple behavior modification program. Speaking from my 25 years of experience in this field, I told him I found his approach naïve and ultimately unworkable.

Then he adds:

“Furthermore, why should I refuse to discuss philosophical issues with clients,” I told him, “when gay-affirmative therapists are working very hard as boosters of their philosophy? They tell clients that same-sex feelings are ‘sacred.’ They push them to revolutionize society’s and the church’s attitudes. Any client’s conviction that heterosexuality is the norm will be redefined by the therapist as a ‘psychological illness — homophobia.'”

“The fact is, neutrality fails for clinicians on both sides of this issue,” I told the psychologist. “Clinicians like you and me, who believe that humanity was designed for heterosexuality, must speak up about our philosophy. These men with unwanted SSA want boosters, allies, advocates, as they claim their masculine identity — someone who believes in them and stands strongly at their side.”

Dr. Nicolosi parallels his disclosure of reparative drive theory as an ideology to what he believes gay affirming therapists do with clients but from an opposing perspective. After all, if it is ethical for gay affirming therapists to promote homosexuality as a moral good, then why shouldn’t reparative therapists promote heterosexuality as God’s design?

Before I discuss this further, one might question whether gay affirming therapists or therapists in general really have a worldview on the matter. I cannot go into this exhaustively but a statement from the APA’s Clinton Anderson from a recent AP article by David Crary suggests there are favored and disfavored religious views on matters gay. Speaking about religious views which are at odds with homosexual behavior, Dr. Anderson said:

“We cannot take into account what are fundamentally negative religious perceptions of homosexuality — they don’t fit into our worldview,” Anderson said.

So can therapists be neutral?

In my view, not all therapists can practice in a neutral manner. In our sexual identity therapy framework, we have clear guidance which allows for referrals when value conflicts impair what therapy has to offer a client. In other situations, the role of the therapist is to assist clients clarify their own perspectives and work toward congruence. For clients who do not know what they believe, it can be very valuable for the therapist to refrain from imposing a religious worldview or stigmatizing conservative religious views.

Some people want a non-neutral therapist on either side of the worldview spectrum. Perhaps they would not be happy with sexual identity therapy. My investigations into this arena suggest that retrospective assessments of therapist helpfulness are associated with therapists not attempting to impose a contrary value position on to the client. And so, I continue to believe that SIT occupies a niche that offers something not available in ideologically-driven approaches. For those who are still figuring things out or have not felt successful with other approaches, our framework could provide something different.

Part two will explore where the sexual identity therapist isn’t neutral.

25 thoughts on “Sexual identity therapy and neutrality, Part one”

  1. LOL! Jayhuck, I DID answer your question on neutrality…just not in THIS thread. My bad. It seems we’ve had about 10 threads with recent comments and the side bar only links to five. Anyway, rather than theorize on neutrality as an outsider, I thought it best to let the particpants speak for themselves. See my post in the “APA Sexual Identity Therapy Symposium” thread.

    Regarding my ‘assumptions’. You’re raised similar questions challenging SIT before and Warren and others have made it quite clear that is for people who find themselves conflicted–so, yes, I’m assuming you know that it isn’t for ‘happy gay people’. Some time back, I seem to recall that you said you followed the links to the SIT framework, etc. and read them. So, again, I assumed that you knew the framework never called it a ‘disease’. If that’s making assumptions, I’ll gladly ‘own it’.

    Regarding my challenge to read past blogs and to google the definitions. I do apologize for a slightly snarky tone when writing that but, seriously, a number of us have been discussing these terms off and on for months…you included. We’ve actually been having some genuine communication while you’re somehow stuck on Chapter 1. That’s why I’m suggesting you google your way to the clinical definitions. (I tried it myself before suggesting it to you the first time! Your answers actually come up in the first page of results. I was ‘there’ in less than 5 minutes and I rarely google.)

    BTW: when searching for two or more words that you want to find as a pair or group always put quotes around the set i.e. “sexual identity” or “gender identity”; that’ll focus your results. (LOL! I want to ASSUME that you know that already but couldn’t take the chance that you didn’t. I wish I knew how to link but, alas, I barely know how to follow links.)

    Another BTW: these two terms are NOT like ‘ex-gay’; these terms originated in the psychological community not a church or ministry and have definitions that are a bit more precise albeit wordier.

  2. Everyone is probably going to have their own definition anyway.


    I think your statement above is the perfect answer.

  3. Eddy,

    To be honest, I did not know that – but thanks for making a whole lot of assumptions.

    Instead of me spending hours and hours researching this topic, is there anyone who can give me – besides Eddy – a very brief definition of Sexual Identity and Gender Identification. If these terms are anything like Ex-Gay, Everyone is probably going to have their own definition anyway.

  4. You’ve recently asked “what do you mean by ‘sexual identity’ anyway?”. Today you ask “what is ‘gender identification’ anyway?”. A search of the blog archives will lead you to previous discussions on those topics; a google search will lead you to pages and pages of resources on either topic. My suggestion: you go read what’s been said here in the past, check out the links google takes you to and find current definitions. Then, if you still have questions about the meaning of either term, come back with the portion of the definition that you don’t understand and I’ll (we’ll) help you with that.

    Yeah, Jayhuck, we’re not suggesting required SIT therapy for happy gay people. But you know that. Nowhere in the SIT framework is homosexuality ever called a ‘disease’. But you know that as well.

  5. Eddy,

    I think you and I agree here, but we are only talking about neutrality regarding those people who might have a problem with their religion and their orientation, right? I think we’d have to agree that therapy for gay people outside of this would have to assume that gay people are happy, and operate from the reality that it is not a disease!

  6. Eddy,

    What in the world is “gender identification”? I ask that only because so much of what we associate with gender is actually socialized. I really don’t understand what you mean by that. Any clarification you can give would definitely be appreciated 😉

  7. Thanks, Timothy.

    LOL. One of my ‘large family dysfunctions’ is feeling guilty when I feel I’ve talked too much…but, other times, I know I can’t really say what I want without elaborating. Sometimes, here, I worry that my words will be misconstrued or taken out of context…and it only makes me get wordier. I swear I wrestle with these communication issues MORE than I wrestle with anything else in my life. Currently, communicating effectively and losing weight are THE major issues in my life. Seems I’m making a bit of progress in both areas.

  8. Part two–

    I don’t believe that SIT needs to be exclusive to people with religious conflicts regarding homosexuality but I concede that there would likely be a higher percentage from this group.

    Even believing as I do, I don’t want to be restricted to a minister or ex-gay organization for my support or therapy when needed. Neutrality is my chief reason. I don’t want someone judging me for considering the possibility that I might be wrong in my beliefs. Neither do I want someone ‘pushing’ the opposing beliefs on me. I see tremendous therapeutic value in neutrality.

    I also see tremendous value in being able to discuss related issues without ‘walking on eggs’ and ‘tripping the buttons’ of my therapist.

    I’ve mentioned before that I have six brothers. We are all short but I am the ‘runt of the litter’. I envision a minister or ex-gay program weaving connections between that and my homosexuality that may or may not exist. I honestly believe I’d waste far less time with a professional (and neutral) therapist. We’d likely spend more time discussing family dynamics–and how to survive them–than on how these relationships may have helped foster a gay identity. LOL! Perhaps that’s why I’m always trying to ‘cut through the bull’ and ‘stay on track’. I don’t want the easy to spout off pat answers and retorts…I’ve had plenty of those. I want to look BEYOND those and see what there is to learn both about myself and the world around me.

  9. JAG,

    Towards the end of my time in the ministry, I was no longer as sure of everything I once believed. I recognized that it was one thing to ‘walk the walk’ I felt God called me to but I wasn’t comfortable projecting that onto anyone else.

    So, I’d explore what the client believed, why they believed it and how strongly. When I discovered that a client wasn’t sure about the what and the why, I’d actually encourage them to sample affirming or pro-gay churches or ministries. More than once I challenged them with “What if I’m wrong? What if we’re wrong?”

    In those circumstances where someone would be compelled (by family, friends, spouse or church) to come see me ‘to get fixed’, I’d strike a deal. “What’s bothering you right now? Let’s talk about that. We can keep meeting until either you feel I can no longer help you or until I feel that.”

    We always had lots to discuss and work on outside the notion of sin. My perspective was that we could work on compulsive behaviors, positive self-image, gender identification, ego strength until they got to the point where they could make their own decision from a position of personal strength. Of the local affirming or pro-gay Christian groups, there was only one that I would not refer to.

    LOL! I don’t know when the day came when I realized I was neither God nor judge but I was comfortable providing what help I could and then leaving the rest up to them and God.

    I assumed, after meeting Warren online and familiarizing myself with SIT, that an actual professional therapist could provide more adequate assistance and be more adept at neutrality. LOL! I think I’ve got more to say but it seems that two of my closest online friends have dropped at least a dozen e-mails on me since I started this. Later.

  10. Dr. Throckmorton,

    I am not sure if this is on topic or not –

    Do psychologists/therapists have to take any kind of oath regarding their intention toward their clients or otherwise before they begin practicing? If so, what is it? I know medical doctors have to but wasn’t sure about psychologists.

  11. Eddy –

    “I don’t believe that SIT therapy implies that an individual has religious conficts surrounding their orientation. It only implies that they are having SOME form of sexual identity conflict and that they desire a ‘neutral zone’ where they can work through them with professional guidance and support.”

    In word, I think you are correct Eddy…however, for as much discussion as I’ve heard around Christian therapists and SI therapy when individuals wish to align their orientation to a more heterosexual model, I have not heard any discussion of the SI therapist issues, procedures and difficulties in helping a christian client who may want to align their orientation to being an openly gay/lesbian person that might be acceptable in their faith (like in a reconciling ministry). To me, that seems hardly neutral.

    If Warren might do us the favor of discussing more about the experience of helping a lesbian Christian client through the coming out process, developing a relationship and raising a family – and coping with the difficulties that she may face with opposing beliefs – then, I’d be more inclined to say that SIT is neutral.

    I haven’t seen that discussion. I hope that it is coming though…I’d love to see the discussion of the gay/lesbian christian client among Christian psychologists being discussed. It’s a real vacancy right now.

    What are your thoughts, Eddy? Warren?

  12. What does sexual identity mean? All these terms are so incredibly confusing to me. Its like the term ex-gay – there is no one definition for it, and I get a different one depending upon the ex-gay or ex-ex gay person I talk to.

    Is sexual identity therapy specifically targeted to gay people? Is it Reparative Therapy with another name? I’m guessing that the vast majority of people seeking this therapy have religion as a reason – directly or indirectly.

  13. I don’t believe that SIT therapy implies that an individual has religious conficts surrounding their orientation. It only implies that they are having SOME form of sexual identity conflict and that they desire a ‘neutral zone’ where they can work through them with professional guidance and support. Warren, please correct me if I’ve got that wrong.

    Timothy, how’s this? The ‘rules of Exodus’ presented by JAG were NOT the rules of Exodus but actually belonged to one of its more prominent affiliates for its inner-city live-in program. The rules were NOT designed as therapy, as JAG suggested, but rather to reduce occasions for temptation in that program.

  14. Eddy,

    Those rules were not those of ONE live-in Exodus-affiliated live-in program. No, they are the rules of THE Exodus-affiliated live-in program.

    LIA is not just some obsure affiliate.

  15. Correct me if I’m wrong, but we are just talking about gay people who come in with religious conflicts surrounding their orientation, right? We aren’t talking about the majority of gay people who see therapists for other things????

  16. Eddy,

    I’m not completely certain I understand exactly how neutrality would be implemented in a counseling setting where the client has a problem being gay – but…… Clients should fully understand that science says that being gay is NOT a disease and most gay people do not seek therapy. That people can and do live long and happy lives as openly gay people. That there are millions of gay people who ARE religious and ok with their orientation – They should also understand that the vast majority of people who have a problem with homosexuality are those whose religion tends to be more conservative.

    We have to try and keep a separation between science and religion here. I’m not saying that we don’t respect and treat those people who want to suppress or otherwise re-direct their orientation, but we can’t suppress what science and reality say to do that either.

  17. The rules cited by JAG above are NOT Exodus rules. I believe there are well over 100 local ministries affiliated with Exodus. From what I know, those sound like the rules that ONE of the ministries set up for people involved in their ‘live-in program’. The rules were not intended to be a method of therapy or healing; they were to ‘prevent a stumbling block’ to others in the program.

    I’ve always found the specific name brands amusing. I have assumed that the live-in facility was near a vibrant gay community that had a peculiar affinity for those brands.

  18. “I hope the APA develops guidance sensitive to religious perspectives but we will continue advocating for it even if they do not.”

    The “guidance” should be…if you want a religious perspective, seek your minister. It is not the place of the APA to promote or attempt therapies that are not proven to be effective, and have been reported by some to be damaging. Shouldn’t we, as psychologists, be literature-driven? If you want to go to “straight camp,” go…but don’t expect a well-informed person to endorse that nonsense.

    For example, one of the rules listed on the “refuge program rules” for Exodus states that:

    “”The clients may not wear Abercrombie and Fitch or Calvin Klein brand clothing, undergarments, or accessories.

    Men: Shirts are to be worn at all times, even while sleeping. T-shirts without sleeves are not permitted at any time,

    whether worn as an outer garment or an undergarment. This includes ³muscle shirts² or other tank-tops. Bikini-style underwear is prohibited.

    Women: Bras must be worn at all times, except while sleeping. Thong-style underwear is prohibited.

    This is just silly. If my client takes off his Calvin Klein bikini underwear, I don’t think research has yet proven that this will help make him straight.

    My point? The “religious perspective” that you want them to value is often not as well-informed as Warren can be (at times)…and opens the door for crap like this to take place, offering hope and scamming well-intentioned and desparate clientele.

    It should be shut down.

  19. Dr Throckmorton, is SIT neutral? Is it practiced by therapists of varying views on sexuality? It just seems like most people would find it hard to be neutral.

    Sorry, I should read up on what SIT is all about. (I’ve downloaded the pdf file)

    How well received has this been in professional and public circles?

  20. I’m sure, being human, that therapists will run into obstacles from time to time that will test their neutrality. I’m hoping that, more often than not, they will surmount the hurdle and proceed with their ‘best effort at neutrality’. I’m also hoping that therapists, who may differ markedly in their views on religion, the Bible, and sexuality, will recognize the ‘niche’ that SIT addresses…and will hop on board themselves.

    (I EXPECT to hear the religious views of my pastor or church counselor. The opposite is true with a convential therapist. If they’re really good, I shouldn’t have a clue when we’re through IF they believe or WHAT they believe. LOL! I’m the one paying for the session(s), we ought to be talking about what I believe and how that’s playing out in my everyday life.)

    And I think some of us might need to lose the picture of a SIT therapist being nothing but a SIT therapist. I dream of a Yellow Pages Ad for a psychologist where SIT therapy is just one of ten areas they specialize in.

    By the way, is it redundant to say ‘SIT therapy’ or ‘SIT therapist’? Feels like “What’s your soup du jour today?”

  21. Lynn David – I don’t know exactly what he meant although “fundamentally negative religious perceptions of homosexuality” sure sounds like a reference to traditional church teaching to me.

    Anonymous – No, wasn’t me. I hope the APA develops guidance sensitive to religious perspectives but we will continue advocating for it even if they do not. Our approach was not developed to curry favor with any group or compromise on anything. It is simply our best assessment of ethical practice and where the science is at this point.

  22. Dr. T, were you that psychologist that contacted Dr. Nicolosi with your APA plan?

  23. Warren wrote: “….if it is ethical for gay affirming therapists to promote homosexuality as a moral good, then why shouldn’t reparative therapists promote heterosexuality as God’s design?

    ….one might question whether gay affirming therapists or therapists in general really have a worldview on the matter. …. suggests there are favored and disfavored religious views on matters gay.

    My last therapist was about as neutral as anyone could be. It was at a time in my life when I finally accepted that I was gay and had just moved back to my hometown area, so this acceptance of mine was a bit of an issue. She was pointing out despite being small, my hometown had a good-sized gay community which I could get to know (unBiblically) and at the same time she was encouraging me to speak with my Roman Catholic parish priest about my concerns and values as held by the Church. Can’t be much more neutral than her approach, though she would be considered a “gay-affirming therapist.”

    As for Anderson’s missive, “We cannot take into account what are fundamentally negative religious perceptions of homosexuality — they don’t fit into our worldview.” What does he mean when he speaks of a “worldview?” What do you think he means? If it is nothing more than the idea that having a homosexual orientation is not indicative of any mental defect, then where does that leave a therapist’s perogative to affirm a client’s religiously formed values which derride his homosexuality (sexual orientation not the behavior)?

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