Misconceptions about the Sexual Identity Therapy framework

In the “reporting” by Gay City News regarding the now-cancelled APA symposium, a claim was made about the Sexual Identity Therapy framework. The symposium, approved by the APA program committee 7 months ago, was to include a presentation of this framework and related issues which would have allowed for questions and discussion.
The GCN said I am an advocate for sexual identity therapy and described it this way:
“Sexual Identity Therapy,” which he [Throckmorton] says he has successfully applied to help patients “alter homosexual feelings or behaviors” and live their lives “heterosexually” with “only very few weak instances of homosexual attraction.”
This is false. The article attributes to me claims about SIT I have never made. In fact, the SIT framework says this:

Prior to outlining the recommendations, let us define what they are not. They are not sexual reorientation therapy protocols in disguise.

The SIT framework, first contemplated formally in 2005, does not advance any means to do what the GCN article references (“alter homosexual feelings or behavior”), nor do they provide any reference for their assertion. Putting these phrases in quotes makes it appear that I have been quoted in reference to SIT when in fact that is not true. The SIT framework provides an ethical set of guidelines for therapists and clients pursuing a variety of goals but does not prescribe any specific goals. Some clients may wish to alter their sexual behavior but SIT does not prescribe this end unless it is the objective of an individual client.
The article said that there is no research support for the SIT framework and while it is true that we have no outcome studies as yet. It is misleading to portray it as being without research foundation. A review of the SIT framework will demonstrate that we have taken into account current research regarding sexual orientation, sexual identity and specify that clients should be informed about the positions of professional associations regarding homosexuality.
Those wishing to characterize the framework should read it first. Those with specific questions or criticisms, please alert either Mark Yarhouse or me.

36 thoughts on “Misconceptions about the Sexual Identity Therapy framework”

  1. Warren: I have noticed that on your blog, you frequently complain about “misconceptions” regarding your SIT guidelines. I wonder… Why do you suppose there are so many misconceptions? Is it just thst people don’t want to understand, that they are deliberately misrepresenting you, that they assume you are still connected to reparative therapists, quacks and crackpots — or could it be that you are just not doing a very good job of explaining them?

  2. Perhaps you should shift your focus to toughening the Human Sexuality education requirements in your state.

  3. Warren, Wow! Your school must have really sucked if you had “no class in sexual identity or orientation issues in school.” Who did they think you would be treating? Crash test dummies? Human sexuality courses were required towards my Master’s degree and ongoing, continuing education on human sexuality is also required to renew my license.
    What I am saying is that I don’t think your SIT guidelines are needed since all therapists are bound by personal and professional ethics to treat each patient with dignity and respect. You still haven’t convince me that YOUR guidelines are needed.

  4. It is still a specialized topic. And I’m sorry – unless you have practice in it (such as dealing with suicidal patients who are particular in their issues and treatment approaches) then these guidelines are a good idea – because those who are needing to resolve conflict need specialized treatment that doesn’t always move the client towards accepting homosexuality.
    You missed the point. the point was – when you are directly asked about yourself you speak with certainty. How does a person measure that certainty? You can only go with what the client says. In other words, I take you on your word. Over time, that may change as the client explores more thoughts and options. And that is for the client to find without pushing or pulling from the therapist. And for those who think homosexuality is religiously acceptable and their client does not – then I warn you – beware of your biases. It is easy to convince yourself that you are totally right and what is right for you is right for your client. If you fail to explore other opinions and options for treatment then you fail your clients. That is not ethical. I interviewed a few counselors (drs, mfts, etc…) most were – before anything came out of my mouth about my own opinion on the matter – saying things like – I work with gay people – it is perfectly acceptable to live as a lesbian. Sorry. The majority of counselors need more training on the issue and I think the SIT guidelines are a good start.

  5. Then perhaps we need no guidelines, Michael.
    I had no class in sexual identity or orientation issues in school. I was blessed to have an advisor in my MA program who specialized in these areas and I learned a lot via supervision with him but these issues are not regularly discussed in grad school.
    From what I hear from our undergrads who go on to grad school, the situation is not much different now.

  6. Mary, you said: “SIT guidelines are a good idea. It helps focus on the client and not the therapist’s biases.”
    Decent therapists don’t need SIT guidelines to keep their focus on the client. That’s just good therapy — for any sort of client. Therapists already have — or should have — a sense of what is truthful scientifically — what is helpful and ethical — and a respect (they call it “unconditional positive regard”) for the client they are treating.
    These are “guidelines” that decent therapists already know and follow. If therapists need SIT to remind them to be respectful of a client’s beliefs and values and not force their own biases, maybe they should go back to school or find another profession.

  7. Mary,
    We’re getting way off on a tangent here – All I was saying is something that Warren confirmed – and that it is in all cases, including SIT, a good therapist has a responsibility to perform a good assessment in order to truly help a client live according to their values.
    There is never any certainty in anything – that doesn’t mean a good assessment isn’t warranted or shouldn’t be performed.

  8. We got on the subject to prove that when a person says they KNOW themsleves – that it is subjective and can be challenged at every point in our lives. By asking you – you state you have had enough experience to know yourself. I beg to differ. It is the age old question – how much of our thoughts are our own free will and how much has been shaped by our surroundings?
    Sounds to me like a lot of what you think is the same old rhetoric that gets put into the media. You might say the same about me.
    Who is to know and how can we truly assess that and be certain?

  9. Yes it will Mary – if the therapist is good and does a good assessment and helps the client either affirm that their values are their own or belong to someone or something else.

  10. Jayhuck,
    Then don’t you think that will also happen for someone else in therapy?

  11. Maybe this will be a better answer – because I am self-aware enough now, thankfully, to know what my values really are. I can honestly say though there was a time in my life when I THOUGHT I knew what my values were, but those values were really those of others.
    Its not just something I one day knew – it was a long process of self-discovery.

  12. I’m not quite sure I understand how we got onto a subject about me when what I was talking about is what a good therapist does when assessing a client.

  13. Mary,
    Because I know what my values are. There was a time when I did now – I lived for other people and what they wanted for me. I’m sure you understand that.

  14. Jayhuck,
    I am asking you – how do YOU know that what you are thinking is really what YOU want and not the suggestion of your peers?

  15. Mary,
    People do all kinds of things – sometimes with good motivations and intentions and sometimes not – it is the job of any good therapist or even healthcare worker at times to assess where the client is coming from. No good therapist simply does what a client asks without such an assessment.

  16. No Mary, that’s not what I mean – not sure how to make it more clear – perhaps Warren’s post will. I’m talking about doing assessment – something any therapist worth his/her salt would do.
    First of all, this arena is not the only one where such judgments are made.
    I am fully aware of this, but I wasn’t clear how you handled this specifically with SIT. Some of what you said clears that up a bit. Thank you. I wasn’t really looking for an example of where SIT helped someone come out so much as how you would actually get to the point you were comfortable believing that a client’s driving force was indeed THEIR OWN values.

  17. I’m not clear on what you mean – can you elaborate more. Sounds like you are saying that you know what you think but others do not know what they think. Is that right?

  18. First of all, this arena is not the only one where such judgments are made. Clients ask questions a lot about how to raise kids, whether divorce is indicated, and 101 value related questions. So therapists have to do this frequently.
    So counselors ask straight out, why are you here? What do you hope to accomplish? Why is this a problem for you? What could make the conflict disappear? If a miracle happened, how would you know it did? Who else would notice? If so and so was ok with homosexuality, would you be? If your church believed homosexuality was ok, would that change your views? If you thought you could have happy relationships, would that influence you? Solution focused therapy has a bunch of these kind of questions that help focus in on what people really want.
    I was on the Michelangelo Signorile show sometime back and a caller said she was the wife of a female former client of mine. The client said I helped her do this valuing process and she eventually resolved her conflict in favor of coming out. She is now happy in her relationship to her lesbian partner. I consider that a success under the framework of SIT.

  19. Mary,
    Its a fine line. As I said above, I realize that my/our values are developed with the help of others, but that is different than saying my values ARE those of others. Does that make sense? A good therapist is going to have to do some good assessment to determine if the client is indeed doing this because they are trying to align their lives with their values, or if they are simply doing it because others want them to or told them to.

  20. Jayhuck,
    I’d like to know – how do you know your own values are not influenced by society or some institution?

  21. Or, worded differently:
    How do you determine that a client’s values are indeed THEIR values, and not simply those of other people or institutions? I ask this with the understanding that other people are influential in helping a client develop his/her value system – but when it comes to therapy such as this, I believe the therapist would have to be able to determine if the client is indeed doing this for themself, or if the driving factor is another person or group of people. I would think this would greatly impact the outcome.

  22. Warren,
    If you did address this then I missed it. It is really the only thing that I am uncertain about when it comes to SIT. I would like to know two things:
    1) What sort of assessment, if any, do you do?
    2) If you find that the motivation behind his desire to “change” or live within his values is a bad one, what do you do next?
    I think there is a misconception out there that you simply do WHATEVER it is a client wants, and I know that is not the case – in ANY kind of responsible therapeutic relationship.

  23. I am pretty sure I have addressed that before but I am curious what kind of assessment you would find sufficient. I could answer and then we could get into another all-values-are-societal loop.

  24. Warren,
    I am still curious what you would do about a client who comes in asking for your help but who may be doing so without the best of motivations. What sort of assessment do you perform in order to ensure that the client’s wishes are founded on their own values and not the values of another influential person, individual or even socity, or do you merely do WHATEVER the client wants without any such assessment? I am still unclear about this regarding SIT and I have yet to read something of yours that clears this up.

  25. Just like guidelines for counseling suicidal patients are needed, or people coming out of drug addiction, so the SIT guidelines are a good idea. It helps focus on the client and not the therapist’s biases. And in addition – it would be a good guideline for those in ministry role to follow such guidelines.

  26. To put it simply: I withdrew my support because I had given it in haste — without completely looking into who else might be “signing on” and what their past and present affiliations, agendas and motivations might be.

  27. No. I mean that my support of your SIT guidelines (which I support in general priinciple but which I no longer think are needed) might be seen by others as support for some of your past affiliations (namely NARTH0 and your support of questionable individuals (namely Highley)
    I am also very concerned that others, perhaps not you, may have signed on to the guidelines in a sidewya attempt — a first step — towards getting the APA to soften its stance that gayness is not ilness. I am very worried about guilt by association.
    I want to stay MILES away from any person who has been a member of or has supported NARTH. YOU may not support rreparative therapy — but can you be sure that other SIT endrosers don’t? I did not want to be used by any anti-gay persons or groups to further their agendas, I think current professional and ethivcal guidelines are enough. The only people who seem to be sturggling with this are you guys. Answer my question: why are they needed? Convince me.

  28. Michael – “some sort of reparative therapy.”
    What does that mean? What you are implying is fantastical. You are implying that I write articles criticizing reparative drive theory and therapy, make statements in the framework about informed consent, in opposition to one size fits all explanations, etc. when secretly I am pursuing a strategy for making the very approach I criticize acceptable.
    Very strange way to do things.
    If by “some sort of reparative therapy” you mean helping people clarify their values, beliefs and live in harmony with them, then I am not sure where we go from there…

  29. And to be really honest, I started having some serious doubts about you. I can still agree with the general principles I stated without endorsiing you or your guidelines So take out the references to your guidelines. Now, my thoughts should read:
    “I heartily support … informed consent, accurate information and individualized assessment and treatment, a shift in the focus of therapy away from the emphasis on cause and change of sexual orientation. Instead, therapists should concentrate on what good therapy ought to be, namely; helping clients to clarify their own goals, values and beliefs and to live in harmony with them.”
    But that it what all good therapists are called to do, what they are required to do by the ethical and professional guidelines that govern their profession — I really don’t see the need for SIT guidelines and cannot at this point give my endorsement. More and more, I see this effort as a backdoor attempt to gain some sort of APA support for some sort of reparative therapy.

  30. Warren: I agree with the general principles of SIT — but withdrew my support because some really questionable folks had signed on as endorsers. I also believe that existing guidelines for ethical behavior by therapists are anough.

  31. Michael – Here is what you once said about the SIT framework:

    I heartily support the sexual identity therapy guidelines, including informed consent, accurate information and individualized assessment and treatment. I particularly appreciate that these guidelines shift the focus of therapy away from the emphasis on cause and change of sexual orientation. Instead, the focus is where all good therapy ought to be, namely; helping clients to clarify their own goals, values and beliefs and to live in harmony with them.

    Now since then, you have asked that I not use this statement in promotional material and I have honored that. However, at one time, you not only understood the need for them but had a favorable reaction. Nothing much has changed. Good therapy would do what the SIT Framework advocates but on the social conservative side, I am pretty sure, in the sexual identity arena, such therapy may be rare. And I am not sure among therapists who do not even want me to speak at a professional meeting, but I do wonder what they do with SSA evangelicals who do not affirm homosexuality. If these groups would talk about those people and include them in their written statements and guidelines, we might know. However, where are these cases in the guidelines of the ACA, and the APAs?
    Here is what other endorsers say:

    Robert Spitzer, MD
    I have reviewed the sexual identity framework written by Warren Throckmorton and Mark Yarhouse. This framework provides a very necessary outline to help therapists address the important concerns of clients who are in conflict over their homosexual attractions. The work of Drs. Throckmorton and Yarhouse transcend polarized debates about whether gays can change their sexual orientation. Rather, this framework helps therapists work with clients to craft solutions tailored to their individual situations and personal beliefs and values. I support this framework and hope it is widely implemented.
    Robert L. Spitzer, M.D., Professor of Psychiatry, Columbia University, New York State Psychiatric Institute, New York City, NY. Co-editor of the Diagnostic and Statistical Manual of Mental and Emotional Disorders, 3rd Edition and 3rd Edition (Revised).
    Nicholas Cummings, PhD, ScD
    Drs. Throckmorton and Yarhouse have brilliantly resolved contention in psychotherapy by providing the field with unbiased guidelines that are responsive to scientific evidence, are sensitive to professional practice, and which restore patient determination in choosing his/her goals in psychotherapy.
    Dr. Nicholas Cummings, PhD, ScD is Distinguished Professor in Psychology, University of Nevada, Reno. Dr. Cummings is the President of the Foundation for Behavioral Health and Chairman of the Nicholas & Dorothy Cummings Foundation, Inc. Considered the father of managed behavioral healthcare, he was the founding CEO of American Biodyne (MedCo/Merck, then Merit, now Magellan Behavioral Care). He is also the former President of the American Psychological Association. Dr. Cummings was the founder of the four campuses of the California School of Professional Psychology, the National Academies of Practice, the American Managed Behavioral Healthcare Association, and the National Council of Professional Schools of Psychology. He was also the Chief Psychologist (Retired) at Kaiser Permanente. He was the former Executive Director of the Mental Research Institute. Dr. Cummings is the author of: The Essence of Psychotherapy; Integrated Behavioral Healthcare; Clinical Strategies for Becoming a Master Psychotherapist; Evidence-Based Adjunctive Treatments and co-editor with Rogers Wright of the recent book Destructive Trends in Mental Health.

  32. Warren: Could you please respond to the questions above? I am strugging to understand why SIT guidelines are needed.

  33. I really think the problem is your past association with NARTH — which does teach that gayness is illness and that orientation can/should be changed — and which has quite a list of quacks, extremists and weirdos attached to it. I think that stigma will always be attached to your name and your work — whether that is fair or not. It’s a credibility problem.
    Question: Is SIT really nececssary? Aren’t therapists already bound by certain standards of ethical and professional behavior — to treat patients with compassion and human diginity? To do no harm? To not mis-represent the scientific data? To not promise that which cannot be delievered? To provide services only within the scope of their education, training, experience and licensure? To respect a client’s personal/religious values? Why is SIT needed? Can you make a compelling case — one that will overshadow your past affiliation with and support of NARTH?

  34. Boo – What a great idea. Our problem is that we did not have a naming contest. Probably, our opponents really just feel left out. It is a little cumbersome to say “sexual identity not reparative therapy framework” though. We need something a little shorter.

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