Category: NARTH

The value of self-determination in counseling

In response to the recent attacks on the sexual identity therapy framework, a supportive reader contacted me with a story of one of her experiences in counseling. I do know the person and can confirm the accuracy of the situation. Why should therapists avoid imposing their beliefs on clients? Read and see what you think.

As someone who has been in counseling, I enormously appreciate your emphasis on self-determination.  As you wrote the other day, any therapist can force any views at any patient. When I was in grad school, I had just started with a female therapist.  She was given plenty of information about my Christian beliefs and how it was important to operate within that for me to succeed.  And then within 5 weeks (before I quit), she sent me to the library to read a book that was essentially how to be a lesbian. And then she basically told me that if I’d just go and have sex with someone that I wouldn’t have problems with it anymore.  And then I quit.  Why is respecting beliefs a better way? I really had a hard time with that, because she tried to force me out of my beliefs.  And it was awful.  I had a hard time trusting any therapist after that.

That therapist should have made a referral. Apparently, the value conflict was so great that the therapist apparently was not able to get past it. Therapists are not machines and have strong beliefs about many things so when the conflict is great, referral is indicated. The sexual identity therapy framework allows for such referrals while at the same time requiring respect for clients and their values.

Is NARTH the next target?

As I noted yesterday, Peter LaBarbera of American for Truth About Homosexuality doesn’t like the sexual identity therapy framework, saying

As you can see above, Throckmorton’s and Regent University’s Mark Yarhouse’s “Sexual Identity Therapy” model grants the possibility that some clients may come to embrace a positive “gay identity” that “modifies” their religious beliefs in such a way as to “allow integration of same-sex eroticism within their valued identity.”

If he is consistent, he will need to expand his crusade to include an organization and therapist he often cites approvingly. On the AFTAH website, the National Association for Research and Therapy of Homosexuality is referenced at least 46 times (e.g., here). However, on the NARTH website, co-founder of NARTH, Joe Nicolosi says that gay affirming counseling should be available.

The developmental model we suggest must deeply resonate with the men we work with, or they will (rightfully) leave our office and pursue a different therapeutic approach. We explain that our position differs from the American Psychological Association, which sees homosexuality and heterosexuality as equivalent, and along the way, we encourage them to clarify and re-clarify the direction of their identity commitment. Gay-affirmative therapy should, of course, be available for any such client.

A few gay-identified clients do decide to stay with us. Out of respect for diversity and autonomy, I affirm them in their right to define themselves as they wish, and I accept them in their gay self-label.

Nicolosi affirms these clients in “their right to define themselves as they wish,” and he accepts “them in their gay self-label.” Of course, here Nicolosi is speaking as a professional therapist and as such acknowledges that such affirmations come from a respect for autonomy. There is little difference between these options and the options LaBarbera criticizes in his article on the SITF.

There are many problems with LaBarbera’s recent crusade. One, highlighted by this post, is that his critiques of the SITF are devoid of any proper context. The SITF is intended for mental health professionals and professional relationships with clients of all ideologies. Pastors and ministry workers follow a more directive line in keeping with the teachings of their faith. Will NARTH now become a target since they support acceptance of some clients “in their gay self-label” and affirmation of “them in their right to define themselves as they wish?”

On the application of the sexual identity therapy framework: An answer to critics

Recently a brief portion of the sexual identity therapy framework was attacked by Peter LaBarbera. More broadly, his criticism challenges Christians in counseling: Should a counselor who is Christian insist that clients conform to the counselor’s beliefs?

LaBarbera argues that Christians in counseling should suspend neutrality and require their clients to conform to what the counselor believes. In my view, this confuses the roles of professional counselor versus pastor, respectively.  

He faults the SITF because he says counselors who practice in line with it must affirm behaviors with which they disagree. However, he misreads the intent of the SITF, and in violation of professional ethics, urges professional counselors to act as pastors. If professional counselors acted in this manner then there would be no restraints on ideological coercion from counselors. Here I respond to his contentions and point out the proper application of the SITF. 

The portion in question is here (The entire framework can be read here):

The guidelines do not stigmatize same-sex eroticism or traditional values and attitudes. The emergence of a gay identity for persons struggling with value conflicts is a possibility envisioned by the recommendations. In addition, the recommendations recognize, as do many gay and lesbian commentators, that some people who have erotic attraction to the same-sex experience excruciating conflict that cannot be resolved through the development of a GLB identity (Haldeman, 2002). Thus, for instance, some religious individuals will determine that their religious identity is the preferred organizing principle for them, even if it means choosing to live with sexual feelings they do not value. Conversely, some religious individuals will determine that their religious beliefs may become modified to allow integration of same-sex eroticism within their valued identity. We seek to provide therapy recommendations that respect these options.

First, it is important to understand that the SITF applies to professional counseling and psychotherapy and not to ministry or pastoral counseling. Often when people seek a professionally trained counselor with a graduate degree, they seek an unbiased relationship to discuss their conflicting values and feelings. This neutral stance is provided out of respect for clients’ status as a free moral agent. This, I believe, is a God-given freedom and must be respected, even when the outcome is a choice which is contrary to the beliefs of the counselor. Recently, Saddleback Church pastor, Rick Warren, said it this way: 

The freedom to make moral choices is endowed by God. Since God gives us that freedom, we must protect it for all, even when we disagree with their choices. 

Consistent with this Christian view of persons, all health care codes of ethics require basic respect for the moral autonomy of clients/patients. For instance, the ethics principles of the American Medical Association as applied to psychiatrists state:

The psychiatrist should diligently guard against exploiting information furnished by the patient and should not use the unique position of power afforded him/her by the psychotherapeutic situation to influence the patient in any way not directly relevant to the treatment goals.

Health care providers can exert significant influence over patients and due to the power differential must take special care not to act coercively. This duty falls to all health care providers, Christian and non-Christian alike.

In addition, the American Counseling Association code of ethics reads:

Counselors are aware of their own values, attitudes, beliefs, and behaviors and avoid imposing values that are inconsistent with counseling goals. Counselors respect the diversity of clients, trainees, and research participants.

These ethics codes apply to health and mental health care providers who enter into professional contracts with clients, may be receiving reimbursement for services from third party or government payers, and are often regulated by state certifying agencies. In other words, these relationships are regulated by several state and federal laws which require sensitivity to activities which could be coercive and damaging to clients of all belief systems. Christians who are professionally trained and credentialed are not exempt from these considerations because they of their religious beliefs and loyalties. The sexual identity therapy framework was written with this professional audience in mind.

In the ethics codes and the SITF, there is provision for counselors who cannot take a neutral stance. As noted in the SITF, sensitive referral is an option:

The need for referral can arise for reasons involving therapeutic capability and value conflicts. Therapists who rarely conduct sexual identity therapy may find their knowledge and skill base challenged by the needs of some clients.

Therapists who find themselves disappointed by a client’s choices or who even attempt to dissuade a client from pursuing a particular integrative course should secure consultation and consider referral. Moreover, if a therapist’s value position or professional identity (e.g., gay affirming, conservative Christian) is in conflict with the client’s preferred direction, the referral to a more suitable mental professional may be indicated (Haldeman, 2004). Therapists considering referral must take care to consider the therapeutic alliance and any institutional difficulties which might occur due to the referral. Referral may generate charges of discrimination and trigger legal or clinical liability exposure in certain cases (Hermann & Herlihy, 2006). When referral seems clinically appropriate, legal counsel and consultation with one’s liability insurer should be considered.

Akin to the conscience clauses for medical and pharmacy professionals, the referral option acknowledges that counselors may not be able to work against their deeply held beliefs and commitments in their professional work.

Those who believe Christian counselors should be free to take a more pastoral role and direct clients should consider an implication of that perspective. Consider the case of a Christian client who seeks counseling with a moral conflict from a non-Christian counselor. Under the current codes of ethics, the counselor must be sensitive to the client’s faith. However, if coercion and imposition were permitted, then the counselor would be on safe ground to recruit the client away from Christianity and to another faith or no faith.

Much of my work in recent years has been to persuade the professions that respect for religious liberty requires that the professions respect the choices of religious clients. In the area of sexual identity, this means that clients who do not affirm same-sex behavior can be supported to live in accord with their conscience. In August 2009, the American Psychological Association released a task force report which supported such religious clients.

Consistent with respect to conscience and professional ethics, Wheaton College Provost, Stanton Jones, endorsed the SITF, saying:

Throckmorton and Yarhouse have advanced a masterful synthesis of best practice in the confusing and troubled area of sexual orientation, sexual identity, and personal values.  No one should be forced toward a resolution of personal identity that violates their personal conscience; our commitment to being guided by the findings of scientific inquiry and respect for client autonomy and religious freedom should lead us toward empowering individuals to make informed choices about their lives. These guidelines are consistent with the ethical principles of the major mental health professional organizations and are superior to any other existing guidelines for practice in this area. 

In contrast, ministers are able and expected to operate with a more directive stance. Religious leaders are expected to lead and guide according to their understanding of their faith system. When people seek help from them, they expect such guidance. Often people seek the services of both counselors and clergy and each has a role to play in working toward resolution.

To sum up, the SITF is written as a guide to professionals who operate in a legal environment which is open to people of all faiths and no faith. Mr. LaBarbera’s stance confuses roles and if applied to professional Christian therapists across the board would expose them to significant liability.

UPDATE: My friend and co-author, Mark Yarhouse, weighs in on this discussion on his blog. His treatment of this issue is more detailed than mine and well worth the read.

NARTH: Does the research speak for itself?

Writing in defense of unnamed NARTH leaders, Julie Hamilton recently said on the NARTH (National Association for Research and Therapy of Homosexuality) website:

NARTH will continue its mission as a scientific organization despite the propaganda, and the research will continue to speak for itself.

However, then just across the page, one encounters a “NARTH Research Report” titled, Health Risks: Fisting and other Homosexual Practices. NARTH authors Michelle Cretella and Philip Sutton suggest that gay advocacy group GLSEN is currently teaching high school kids that fisting is safe practice. However, the authors fail to say that the incidents provoking their article happened 9 and 10 years ago. The NARTH article begins by framing the concern over those incidents as being in “recent weeks” but the incidents are old news. I am no fan of GLSEN’s conferences or reading list, but why use old news as a hook?

Furthermore, the article is a clear effort to associate risky practices with gays in a way similar to that being used now by Martin Ssempa in Uganda. However, the title and tone of the article overlooks an important fact – some heterosexuals also engage in those practices. In fact, if you go on Amazon.com and look up the practices referenced in this article, you will find how-to books written for straights (actually just take my word for it). Would a scientific organization claiming to provide science on sexuality overlook such things?

Now after a brief selective review of opinion and some studies, the authors determine that all things gay are harmful and lead to dysfunction. The studies don’t actually say that but most studies do find that homosexuals as a group report more psychiatric problems than straights and that there are risks associated with some sexual practices. However, the scientific train goes off the track with the conclusion.

Conclusion: An adolescent’s desire to prevent or cease experiencing serious medical, psychological, and relational health risks is sufficient reason for him or her to seek and receive competent psychological care to minimize or resolve the desires, behaviors and lifestyles associated with such increased risks.

Translation: If you experience same-sex attraction, better get some reparative therapy quick so you can avoid all the nastiness.

A scientific organization would then offer research the benefit of reparative therapy for mental health outcomes. The claim in the conclusion above is that changing orientation will allow you to avoid the problems NARTH finds with being gay. However, the problem with the claim is that those studies have not been done. To evaluate Cretella and Sutton’s conclusion, one would want to assess the mental health of ex-gays and gays and see who has the best outcomes.* Or one would expect to see large gains in mental health outcomes as the result of the therapy NARTH proposes. Where are the studies?

An author Cretella and Sutton quote is David Fergusson. Last year, Fergusson had this to say about a similar NARTH review of homosexuality and health risks:

While the NARTH statement provides a comprehensive and accurate analysis of the linkages between sexual orientation and mental health, the paper falls far short of demonstrating that homosexuality should be classified as a psychiatric disorder that may be resolved by appropriate therapy. To demonstrate this thesis requires an in depth understanding of the biological and social pathways that explain the linkages between homosexual orientation and mental health. At present we lack that understanding. Furthermore it is potentially misleading to treat what may be a correlate of mental disorder as though it were a disorder in its own right.

Fergusson also told me that studies designed to demonstrate positive changes in mental health via reparative therapy have not been done. In other words, there are no guarantees that changing orientation, if it could be accomplished in the manner suggested by Cretella and Sutton, would alter the mental health differences currently observed between gay and straight groups.

Julie Harren-Hamilton says the scientific research will speak for itself. However, just across the page, we have two authors providing a conclusion without adequate research. Apparently, on the NARTH website, the research needs a little help to speak in advance.

*There was a study which found better mental health outcomes among a sample of gays than an Exodus sample but this has not been replicated to my knowledge. Nottebaum, L. J., Schaeffer, K. W., Rood, J., & Leffler, D. (2000). Sexual orientation—A comparison study. Manuscript submitted for publication. (Available from Kim Schaeffer, Department of Psychology, Point Loma Nazarene University, 3900 Lomaland Drive, San Diego, CA 92106).

Another study of some relevance is the study of Exodus participants from Jones and Yarhouse. They found that their entire group of participants experienced enhanced mental health over the study period. Inconvenient for the NARTH claim is that the entire sample, whether gay or ex-gay, experienced improved health from Time 1 to Time 6.

NARTH: Forced therapy unethical and ineffective

In the recent letter from the Ugandan National Pastors Task Force Against Homosexuality to Rick Warren, the Task Force disclosed that the Uganda Joint Christian Council agreed to support the Anti-Homosexuality Bill with the following amendments:

a. We suggested reduction of the sentence to 20 years instead of the death penalty for the offense of aggravated homosexuality.

b. We suggested the inclusion of regulations in the law to govern provision of counseling and rehabilitation to persons experiencing homosexual temptations. The churches are willing to provide the necessary help for those seeking counseling and rehabilitation.

c. Even with the provision for counseling and rehabilitation in the law, homosexuality should remain a punishable offense to control its spread.

These amendments sound very much like the suggestions of Scott Lively who spoke to the Ugandan Parliament in March of this year. According to a post on his website, Lively suggested these points at that time.

My trip was quite successful, encompassing multiple seminars, sermons, media appearances and private meetings with key leaders, all packed into a single week. My hosts were very pleased. But the high point of the week was my address to members of the Ugandan Parliament in their National Assembly Hall. In it I urged the government to shift the emphasis of its criminal law against homosexuality from punishment to rehabilitation by providing the option of therapy, similar to the option I once chose after being arrested for drunken driving many years ago (in my wild pre-Christian days). Such a change would represent a considerable liberalization of its policies (currently a holdover from Colonial British common law, similar to US policy until the 1950s), while preserving sufficient legal deterrent to prevent the international “gay” juggernaut from homosexualizing the society as it has done in Europe and other countries. I thought it was an inspired compromise.

Lively’s “inspired compromise” seems to have inspired the Ugandan pastors’ coalition. Lively elaborated a bit in a recent posting:

In my view, homosexuality (indeed all sex outside of marriage) should be actively discouraged by society — but only as aggressively as necessary to prevent the mainstreaming of alternative sexual lifestyles, and with concern for the preservation of the liberties of those who desire to keep their personal lifestyles private.

The suggested changes in the Anti-Homosexuality Bill could follow Lively’s suggestions although it is not clear how the regulations would be written. Would counseling be available for those who present themselves as having temptation as framed by the pastors’ coalition or would counseling be available to those who offend the law in some way as an option to jail? Or will Bahati re-write the bill to include both options?

Ethics and Integrity Minister Nsaba Buturo may have signaled the direction he favors with recent comments to Ugandan television, saying:  

“…we are saying, that look… instead of killing somebody, provide mechanisms for counseling, and other supports, so that the person may actually be rehabilitated. And I see logic in that one, because already we have some former homosexuals who are being rehabilitated.”

Given how closely the pastors and the legislators seem to be there, the changes may appear in the second draft of the bill. The “kill the gays” bill may turn into the “cure the gays” bill by February, 2010.

Because the changes may appear soon, I want to engage the discussion on the topic of reorientation therapy in an environment where the other option is jail or worse. Almost immediately after there were rumblings of the bill being changed to included coerced therapy, Alan Chambers, President of Exodus International came out in opposition to the proposal. On the Facebook group dedicated to opposing the bill, Chambers said:

I am NOT for forced therapy for gay and lesbian people. While no one chooses their attractions I do believe that it is everyone’s God given right to choose what you do with those attractions (consenting adults). I believe that those who are conflicted by their faith and feelings have the right to choose therapy and those who aren’t conflicted shouldn’t be forced into anything.

I also asked the National Association for the Research and Therapy of Homosexuality to give their opinion of the proposed therapy option. Past-president A. Dean Byrd responded in an email:

Dear Dr. Throckmorton, 

As you are aware, NARTH’s Governing Board has accepted the Leona Tyler Principle which states that NARTH, as a scientific organization, takes no position on any scientific issue without the requisite science or professional experience.  NARTH members, as individuals, are free to speak on any issue.

NARTH values the inherent worth of all individuals and respects individual right of autonomy and self determination.

NARTH’s position on homosexuality was clearly articulated by Dr. Julie Harren Hamiliton in a recent edition of the APA Monitor: homosexuality is not invariably fixed in all people – some people can and do change.  And psychological care should be available to those who seek such care.

NARTH encourages its members to abide the Code of Ethics of their respective organizations and such codes proscribe the coercive efforts. It goes without saying that NARTH would support the humane treatment of ALL individuals.

We are aware of the situation in Uganda but thank you for bringing this to our attention. I am sure that you are aware that as a scientific organization, NARTH does not take political positions; however, we are happy to provide a summary of what science can and cannot say about homosexuality for those who do.

Dr. Throckmorton, if history is a good indicator, you will likely not be happy with this response. However, I hope such responses will help you understand NARTH’s mission as a scientific organization. 

With warm regards,

A. Dean Byrd, PhD, MBA, MPH

Leaving aside the comments about NARTH not taking political positions, I want to point out the money quote:

NARTH encourages its members to abide the Code of Ethics of their respective organizations and such codes proscribe the coercive efforts.

Byrd’s answer did oppose coercion (although undefined), but did not comment on the efficacy of such measures. Given that Byrd’s answer was not clear, I wrote back to ask for clarification. David Pruden, NARTH administrative director answered saying:

Research tells us that forced therapy is almost always a failure. It is unethical and unworkable.

Normally, I do not look to Exodus or NARTH for research state-of-the-art on sexual orientation, but there are two important reasons to ask their position on this question. One, since the proposal may call for some kind of treatment or ministry, it seems reasonable to poll the views of the two most prominent groups who currently provide those efforts. The second reason is because the guy who recommended the option in the first place, Scott Lively, highly recommends Exodus and NARTH.

Here is a 2007 video of Scott Lively in Latvia recommending Exodus and NARTH. Note how crucial it is to Lively to convince the nation of a gay cure.

And then in Uganda, he continued his praise of NARTH by saying their website was an important source of information, second only to his.

Here is what Scott Lively could not have told his Ugandan audience but can now be told. One, both Exodus and NARTH have removed any reference to Scott Lively’s work from their websites (click the links to read about these actions). Two, NARTH and Exodus (at least informally through Alan Chambers) consider coercive therapy to be unethical and ineffective.

Let me speak directly to the Ugandan supporters of the bill. The man, Scott Lively, you brought to speak in Parliament to recommend a rehabilitation option has been removed from the websites of the organizations he recommended to you. Furthermore, the organizations which Scott Lively encouraged you to trust says coercive therapy is not ethical or effective. I know he has said that such measures were once used effectively but this is not the case.

I need to add that I do not agree with NARTH about very much and certainly think that they are wrong in the way they discuss sexual orientation as a fluid trait. However, even this group, who exists to promote the idea that some people can change, rejects the idea that a coercive environment is appropriate. While they dramatically underestimate the role of social stigma as an aspect of why people seek their services here in the US, at least they see clearly that forced therapy of the kind contemplated by Lively and UJCC are in David Pruden’s words, “unethical and unworkable.”