The APA report and the sexual identity therapy framework

The recent American Psychological Association task force report on sexual orientation and psychotherapy included several positive references to the SITF. I have archived those on the SITF website and am providing two here with brief commentary.

The abstract of the sexual identity therapy framework (SITF) says

Sexual identity conflicts are among the most difficult faced by individuals in our society and raise important clinical, ethical and conceptual problems for mental health professionals. We present a framework and recommendations for practice with clients who experience these conflicts and desire therapeutic support for resolution. These recommendations provide conceptual and empirical support for clinical interventions leading to sexual identity outcomes that respect client personal values, religious beliefs and sexual attractions. Four stages of sexual identity therapy are presented incorporating assessment, advanced informed consent, psychotherapy and sexual identity synthesis. The guidelines presented support the resolution of identity conflicts in ways that preserve client autonomy and professional commitments to diversity.

 

I think the APA report and the SITF are compatible in many important ways.  They both recognize the difference between attractions, behavior and identity. They both recognize that informed consent is critical and that client may seek congruence with other aspects of personality, other than sexual desire, a distinction made in this segment from page 18 of the APA report:

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). (p. 18)

I like the distinction between telic and organismic congruence. I think this distinction expresses the tension many clients experience. For them, SSA seems like who they are on an experienced level, but at the level of how they construe meaning in the world, SSA does not seem like it reflects how they ought to live. I think the new APA report and the SITF gives voice to that dissonance and helps provide therapists with guidance to work through it with clients.

In several passages in the APA report, the SITF is mentioned as conforming to the approach outlined in the new guidance. For example,

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). The client-centered approach (Rogers, 1957; cf. Brown, 2006) stresses (a) the LMHP’s unconditional positive regard for and congruence and empathy with the client, (b) openness to the client’s perspective as a means to understanding their concerns, and (c) encouragement of the client’s positive self-concept. This approach incorporates aspects of the therapeutic relationships that have been shown to have a positive benefit in research literature, such as empathy, positive regard, and honesty (APA, 2005a, 2005b; Lambert & Barley, 2001; Norcross, 2002; Norcross & Hill, 2004). (p. 55)

The APA model, like the SITF stresses assessment, support, identity exploration and supportive psychotherapy.

A Framework for the Appropriate Application of Affirmative Therapeutic Interventions 

On the basis of the three findings summarized previously and our comprehensive review of the research and clinical literature, we developed a framework for the appropriate application of affirmative therapeutic interventions for adults that has the following central elements: (a) acceptance and support, (b) assessment, (c) active coping, (d) social support, and (e) identity exploration and development. (p. 55)

Go here for all of the portions of the APA report with the framework is mentioned.