Shame and attachment loss: Going from bad to worse

Trying to keep up on the new developments in reparative therapy, I purchased NARTH’s co-founder Joseph Nicolosi’s new book, Shame and Attachment Loss: The Practical Work of Reparative Therapy. This post is not a review but more of a prep for a review. I am going to provide some excerpts and comments which may form the basis for a more formal review at a later date.

You have to get past a couple of features of Nicolosi’s writing in order to proceed. He has an annoying (to me) habit of speaking of himself in the plural (“When a man finds masculinity mysterious and exotic, and seeks it outside himself, we believe he is living in a false self…). This form reappears throughout the book. You also have to grasp the jargon being used in order to understand what he proposes (“grey zone,” “double bind,” “double loop”). In some respects, reading this book is like reading material from object relations theorists such as Masterson and Volkan. It is inside baseball to most folks who are not conversant with attachment and object relations theory.

However, this book is published by Christian publisher Intervarsity Press and makes an effort to make some of the concepts accessible to a lay and non-psychodynamic audience. To be sure, Nicolosi doesn’t leave the reader unclear about his views. Regarding homosexuality, he begins by dismissing Daryl Bem’s empirically derived theory of same-sex attraction because it does not stigmatize same-sex attraction. He then, indicates what has remained the same since his earlier books and what has changed. First, what has remained the same:

The essential principle of reparative therapy remains the same – simply stated by one client as “When a real man sees me as a real man, then I become a real man.” (p. 31)

The real man is the therapist or some other model of masculinity and then to become a real man is apparently to become straight. Simple, right?

What has changed?

Recently, reparative therapy has expanded to conceptualize homosexual attraction as more than a striving to repair gender deficits. We now see it more broadly, as a striving to repair deep self-deficits. (p.31)

Translation: If you have SSA, you are worse off than Nicolosi first believed. You are not just deficient in your sense of gender identity, but your core sense of self is a wreck too. He continues:

My longtime clinical observation suggests one repeated trend in early childhood: specifically, an accumulation of early, core emotional hurts that have led to an attachment injury. I believe that homosexuality is not only a defense against gender inferiority, but a defense against a trauma to the core self.

Beyond the previously recognized needs of same-sex identification and affirmation, we now better understand the condition as an attempt to heal an abandonment-annihilation trauma. We see homosexuality as typically an attempt to “repair” shame-afflicted longing for gender-based individuation. As such, homosexuality can be seen as a pathologic form of grieving. Adopting concepts from bereavement and grief literature, we thus turn new attention to the contributions of attachment theory and the role of shame.(p. 31-32; all italics in the original)

I suspect those adopted concepts of bereavement and grief will want to return to their original family. According to Nicolosi, men (women, what women?) are drawn to sex with men because it somehow helps them grieve the loss of attachment to important figures in their childhood, most notably the father. However, these losses are not restricted to gender concerns.

This understanding that homosexuality is a symptom of a larger issue of self-identity is supported by the almost universal complaint of clients that they feel “insecure,” “inadequate,” “a little boy in an adult world,” “out of control” and lacking relational authority. For years I have heard clients express this interpersonal powerlessness: “She upsets me, they annoy me, he doesn’t take me seriously. (p. 33)

The trauma is broader than lack of attachment to the same sex parent. He notes:

Attachment is the foundation of our self-identity. It is through the mother-child attachment that we develop our sense of self and discover who we are. Shame felt during this process of attachment and individuation subverts development of both self-identity and gender identity.

Since our clients report a core experience of not having felt “seen” by their parents for who they are, they inevitably also felt that they were not loved – at least in the deepest and most genuine sense. There is a deep perception that the parents, even though they may have been truly well-meaning, have failed to fully see, know and accept them.

Because parents are not perceived as loving them for who they are, gay men develop a “false self” to defend against the abandonment of not being truly known. Kids start doing things they think will get their parents and other people to like them but those things are not really them. When they actually move toward what they want to do, they get depressed because they fear attachment loss. This is very nearly the same concept as the “false self” and “abandonment depression” of James Masterson. Masterson is nowhere referenced in the book which is a curious oversight. I wonder if it is because Masterson writes about the same dynamics with straight people being the primary clientele.

According to Nicolosi, reparative therapy helps clients give up the false self, a feature of which is same-sex attraction, in order to experience real attachment and affirmation from “real men.” As this occurs, the homosexuality will diminish and heterosexuality will emerge.

This should be reasonably easy to test. If all of this is true, homosexuals should be unable to hold jobs, or advance in careers, or do other things which require secure object relations and attachments. And of course, this is the practical problem for the practical work of reparative therapy. Many gay, ex-gay, post-gay, and SSA people do not have lives which correspond to the predictions in this book. Nor do their lives indicate the kind of deep self-deficits which are predicted here.

This is first in a series of occasional posts on this book. Stay tuned…

Christianity Today on evangelical divide over reparative therapy

Christianity Today has an article out online today which covers familiar ground to readers here.

Written by Bobby Ross, the article notes the divisions over reparative therapy which have been accentuated by the recent APA report on sexual orientation and therapy.

No surprise here: Evangelical leaders who advocate gay reparative therapy took umbrage at a highly publicized American Psychological Association (APA) resolution that criticized such efforts.

By a 125-4 vote, the 150,000-member association’s governing council adopted a task force report in August claiming a lack of evidence that efforts to change one’s sexual orientation work.

One aspect of the 138-page resolution, however, drew praise from some Christian psychologists—and exposed a divide in the evangelical therapy community.

As we discuss here often, modest change in orientation has been reported but, in my opinion, the change paradigm for therapy and ministry is old school.

Warren Throckmorton, a counselor who believes that the Bible prohibits homosexuality, commended the task force for “clarifying the value of helping clients sort out their beliefs and work out an identity and life that fit within the clients’ beliefs.”

A one-time proponent of sexual reorientation efforts, Throckmorton said he spoke up until 2004 at conventions of the National Association for Research and Therapy of Homosexuality (NARTH). But the Grove City College psychology professor has come to believe that changing a person’s sexual orientation is at best difficult.

Rather than focusing on reparative therapy, he has embraced “sexual identity therapy,” which focuses on helping a person live in a way that is consistent with his or her beliefs.

My issues with reparative therapy involve the lack of research support for the basic perspectives on the formation of same-sex attraction as well as the paucity of robust demonstrated outcomes.

“The reparative side sees the objective as healing the trauma [of family dysfunction] and thus curing the homosexuality,” said Throckmorton, former president of the American Mental Health Counselors Association. “The sexual identity side doesn’t see the efficacy of that approach and doesn’t think change is necessary in order to help people live in congruence with their faith.”

Ross then addresses the Jones and Yarhouse study and notes Mark Yarhouse’s views on change and therapy paradigms.

Yarhouse says more Christian psychologists are providing sexual identity therapy rather than reparative therapy. He recommends “a range of options” to help believers make sense of their sexual and religious identities.

“I don’t want to discourage people from making that attempt [to change orientation],” he said. “But for most of those people, success will not be a categorical shift from gay to straight. The gains will likely be modest, more along a continuum.”

As co-author of the Sexual Identity Therapy Framework, Mark offers a balanced view of the landscape. Most of the people who consider Exodus a success have a story of congruence with their faith than tell a story of some degree of change in their sexual arousal patterns.

Alan Chambers weighs in with more of the reparative therapy side of the divide.

Alan Chambers, president of Exodus International, said it is wrong to assert that sexual orientation cannot change as a result of therapy.

“That flies in the face of the testimonies of tens of thousands of people just like me,” said Chambers, a married father of two who credits God and counseling for helping him leave a homosexual lifestyle. “That’s not to say that you can flip a switch and go from gay to straight.”

Finally, NARTH’s David Pruden worries that the APA report will keep people from trying to change.

David Pruden, vice president of operations for NARTH, said the APA’s resolution likely will not affect how Christian psychologists counsel. He voiced concern, though, about its impact on potential clients.

“[This] could discourage individuals from even seeking assistance or entertaining the thought that growth or change is possible,” he said.

Well, if the proper information is disclosed to people, I doubt they will not seek assistance. However, if therapists practice in accord with the SIT Framework and recent APA guidance, they will not experience over promising or be directed to developmental theories which may not fit their lives.

New SIT Framework website and list

Late Friday afternoon might not be the best time to post this but…

I want to announce the new Sexual Identity Therapy Framework website and invite people to join the SIT Framework list serv.

Here is the listserv portal:

Click to join sexualidentitytherapy

The discussions will be geared primarily to mental health professionals but interested ministry leaders and others may find them to be of value. There may be some overlap with the blog but there will be unique material as well.

Your brain on sex

Well, maybe not your brain but this article is an intriguing review of some research relating to brain scans of sexual arousal. I have not examined the original sources yet (plan to) but wanted to put this up for some TGIF reading.

Perhaps the author was unaware of the Safron et al study but I am going to see if there are points of connection.

Thanks, Lynn David for the tip.

York, PA paper examines faith, sexuality and APA report

The York Daily Record ran a story in the September 6 print edition and then online on the 8th which examined the American Psychological Association report as well as the Jones and Yarhouse study. The article by Melissa Nann Burke included interviews from local Exodus ministries as well. Some good things here…

The men and women who come to Dan Keefer with moral distress about being gay or bisexual often seek to change because their sexual attractions conflict with their religious beliefs.

Keefer, who works at the Christian counseling center Day Seven Ministries in Lancaster, tells the men he can’t “turn them straight,” but he can help them work toward a way of living that’s congruent with their faith, he said.

“We approach it from the angle that ‘there’s hope for you,'” Keefer said.

Efforts might include choosing celibacy, learning to resist sexual urges or viewing the struggle as a way to draw closer to God. Some even go on to marry, Keefer said.

Note that hope and belief congruence are not mutually exclusive. One does not need to promote change as a means to instill hope for a value congruent life.

About the congruence model, Burke continues

For years, such an approach departed from the trend in counseling that encouraged clients to affirm their gay identities and embrace their sexuality.

That was troubling for counselors such as Dr. Warren Throckmorton, a psychology professor at a Christian college in Mercer County.

He encouraged the 150,000-member American Psychological Association to acknowledge that, for some people, religious identity is such an important part of their lives, it transcends sexual orientation.

“A number of us said many evangelicals are never going to affirm this. Is there any guidance for those of us dealing with them?” said Throckmorton, who teaches at Grove City College.

In a significant departure, the APA last month said it’s ethical for mental health professionals to help some people reject their same-sex urges. Indeed, it can be beneficial.

The association said counselors should explain that homosexuality isn’t a mental or developmental disorder and that there’s insufficient evidence that therapy can change sexual orientation.

I agree with the APA that some harm can come from reparative therapy.

Concerns about so-called “reparative therapy” prompted the two-year study by a task force of academics and counselors, who noted that efforts to produce change could be harmful and induce depression or suicidal tendencies.

Throckmorton said he’s worked with clients who did find harm in “change” therapies — most notably broken familial relationships.

“My particular concern is psychologists who tell people they have homosexual tendencies because of bad parenting,” he said. “I’ve worked with families who’ve been ripped apart over this.”

Here is a rather candid statement by an Exodus affiliated person:

One group that promotes the possibility of change is Exodus International, a network of ministries whose message is “freedom from homosexuality through the power of Jesus Christ.”

In the midstate, visitors to Exodus’ Web site might be referred to Tim Winters of Elizabethtown, a lay member at Hope Community Church near Mount Joy.

“The official stance of the people at these Web sites is that they’ve changed forever. Officially, they’ll say that you turn and stay turned, and you’ve gone on to another plane. But in reality, that’s not a lot of people that happens to,” Winters said.

“You can’t say a magic prayer and make it go away. I’ve known many gay people who have walked away from the lifestyle. But it’s behavioral modification. It’s choosing to do one thing over another.”

While I wouldn’t use the term “lifestyle” to refer to gay identification, I do believe I get what this man is saying. He is describing what the APA described as “sexual orientation identity” which does change and reflects what the APA called “telic congruence.”

The quote from the psychologist indicates where the ongoing work is needed now that the work of the APA task force is complete.

Dr. Elizabeth Revell, a psychologist in Hellam Township, said she probably wouldn’t work with a client who asked her to help him shunt his sexuality to the side.

“Mine is a more gay-affirming approach. If the person says I don’t want to be gay or lesbian, I don’t do those therapies,” she said.

“The concern I have with the ‘re-orientation therapies’ is they start out by promising something (change), instead of listening to what the person’s saying they need.”

Why wouldn’t she work with the client? Because she is gay-affirming. This woman should refer to another counselor in those situations. She seems to conflate “re-orientation therapies” with what the APA recommends. I wonder if she has read the report?

The article concludes with more from Jones and Yarhouse.

Jones said the task force overlooked noteworthy research suggesting otherwise. He and a colleague last month presented a study that followed people trying to change their sexual orientation through Exodus International programs.

Jones and Mark A. Yarhouse, a psychologist at Regent University, concluded that sexual orientation may be “changable for some;” however, those in the study who reported a change to heterosexuality stipulated they weren’t without homosexual arousal.

The study also concluded that concerns over the likely harm caused by re-orientation therapy to be overstated.

“We don’t know what causes (same-sex attractions). We don’t know what the probabilities are of change. It’s a very complex situation,” Jones said.

“We ought to be a lot more hesitant about making assertions about scientific conclusions.”

With all due respect to Stanton, I think the APA report was cautious. The task force concluded that the evidence was insufficient to recommend that therapists tell clients will change with therapy. Actually, given their study, I think the APA pessimism is warranted. Where are the controlled studies showing levels of change (not satisfaction) is likely? Their study did not provide a control group which would allow an examination of the role of spontaneous change.

(PS – to readers, it seems that the end of this post was truncated by the blog software. I am looking in to where it went.)