Professional issues – Page 31 – Warren Throckmorton

The Jones and Yarhouse study: What does it mean?

Let me begin by saying that I endorsed the book, Ex-Gays, A Longitudinal Study of Religiously Mediated Change in Sexual Orientation, by Stanton Jones and Mark Yarhouse which contained the first report of their longitudinal study. Since the publication of the book, Jones and Yarhouse have released results of their final follow up, first in 2009 at the annual convention of the American Psychological Association, and then most recently in the Journal of Sex and Marital Therapy. With the follow up, I believe the study remains an important investigation into the interplay of religion, sexual orientation and personal identity. I give them credit for the perseverance required to explore a topic which is highly controversial and to report their findings in detail.

Since the release of the peer-reviewed article, socially conservative groups have described the study as proof that gays can change orientation. For instance, the American Family Association’s Bryan Fischer, one of the worst offenders, claims that the study proves gays can change and that they weren’t born gay. Also, Citizenlink, an affiliate of Focus on the Family reported:

Of the 98 subjects, more than half were reported as successful; 23 percent reported a complete change in orientation after six years. Also, 20 percent reported giving up the struggle to change.

This claim is misleading. Jones and Yarhouse did not report “complete change in orientation.” Instead they cautioned against misinterpreting their findings by saying

These results do not prove that categorical change in sexual orientation is possible for everyone or anyone, but rather that meaningful shifts along a continuum that constitute real changes appear possible for some. The results do not prove that no one is harmed by the attempt to change, but rather that the attempt does not appear to be harmful on average or inherently harmful. The authors urge caution in projecting success rates from these findings, as they are likely overly optimistic estimates of anticipated success. Further, it was clear that “conversion” to heterosexual adaptation was a complex phenomenon.

Regarding the changes reported by their participants, the authors offer two related explanations. One is that some of the participants changed sexual orientation to some degree and the other is that the participants changed their sexual identity. Sexual identity involves placing more emphasis on behavioral conformity to prohibitions on homosexual behavior as a means of self definition. For the Exodus participants, less temptation to engage in homosexual behavior might be taken as a signal that orientation has changed, thus allowing a different attribution about their sexuality than once believed. The authors raise these two possibilities in the abstract for the most recent paper:

The authors conducted a quasi-experimental longitudinal study spanning 6–7 years examining attempted religiously mediated sexual orientation change from homosexual orientation to heterosexual orientation. An initial sample was formed of 72 men and 26 women who were involved in a variety of Christian ministries, with measures of sexual attraction, infatuation and fantasy, and composite measures of sexual orientation and psychological distress, administered longitudinally. Evidence from the study suggested that change of homosexual orientation appears possible for some and that psychological distress did not increase on average as a result of the involvement in the change process. The authors explore methodological limitations circumscribing generalizability of the findings and alternative explanations of the findings, such as sexual identity change or adjustment.

As I read all of the literature, including my own work, I first want to disagree with the way that Citizenlink characterized the results as “complete change.” That is not at all what Jones and Yarhouse reported. Considering the dichotomy proposed by Jones and Yarhouse — change in orientation or identity – I lean toward their alternative explanation – “sexual identity change or adjustment.” However, I believe the discussion of what their results mean needs to be broadened beyond those two possibilities. In addition to considering orientation and identity as important constructs, I believe there are other ways to account for the changes Jones and Yarhouse report which are not sufficiently addressed in their published accounts. First, I want to make some observations about the study which influence my opinions about what the results mean.

First, and most basically, the Jones and Yarhouse study did not examine in any systematic way the efficacy of reparative therapy or any other kind of psychological therapy as a means of altering sexual orientation. The participants in the study were involved in religiously based support groups which primarily had as a goal to reinforce a traditional moral view of sexuality. Clearly, the participants hoped they would change and engaged in various religious interventions to assist that end. However, the study did not assess the role of professional therapy and cannot legitimately be used to say such therapies work.

Second, there were quite a few dropouts six to seven years into the study. While true of all longitudinal studies, the final percentages being reported should also take into account the distinct possibility that many if not most of the drop outs were not successful in their efforts to change. The study began with 98 participants and ended up with 65 who were followed up for six to seven years. Some reported that they were healed of homosexuality and just didn’t want to participate, while others said they were gay and stopped trying to change. I don’t know for sure what the dropouts mean but the fact that so many failed to complete the study needs to be a part of any discussion.

Third, ratings from men and women were combined. Given the low number of people involved I understand why this was done but the practice may inflate the assessments of change for the group. It has become well accepted that the sexuality of women is more fluid than for men. A few women experiencing large shifts could influence the group averages. Continue reading “The Jones and Yarhouse study: What does it mean?”

NARTH is not primarily composed of mental health professionals

Last week, the Family Research Council promoted the annual conference of the National Association for the Research and Therapy of Homosexuality, touting the group as “one of the best sources of information about homosexuality.” In the description of NARTH, the FRC claimed that NARTH is “primarily composed of psychiatrists, psychologists, and other professional therapists and counselors who offer ‘sexual reorientation therapy’ to help people overcome unwanted same-sex attractions.”
However, this is not accurate. NARTH is not composed primarily of mental health professionals. Actually, according to NARTH’s operations director, David Pruden, only about 250 of NARTH’s approximately 1000 members are mental health professionals. Furthermore, some of those 250 members who have mental health degrees are academics who write about sexuality but do not provide sexual reorientation therapy. Thus, the lion’s share of NARTH’s members consist of lay people, ministers, and activists who have an interest in the materials provided by NARTH but are not scientists or therapists.
By comparison, the American Psychological Association has 150,000 members. All mental health groups are by far much larger than NARTH. I suspect most, if not all, state chapters of these groups are larger than NARTH.
The influence of NARTH comes from the fact that religiously conservative groups like FRC recommend the organization and refer to it as a counterpart to the established organizations. However, in the mental health marketplace, NARTH is not attracting members or supporters. Given the fact that 75% of the members have no professional or scientific credentials, it seems more accurate to consider NARTH to be an advocacy group with some like-minded mental health professionals as members, rather than a scientific group.
This impression is reinforced by the fact that two prime speakers at next week’s convention in Phoenix are not scientists at all, but anti-gay activists. Sharon Slater will speak in a session about her work with United Nations’ countries, especially in Africa and the Middle East, which aims to keep laws on the books criminalizing homosexuality. Then, following Slater, will be Michael Brown who is a minister. Read this post for more about these individuals.
RELATED: What if NARTH was a scientific organization?

Marketing the Bieber Study: Cornelia Wilbur’s Other Scandal

Monday, I wrote about a new book by Debbie Nathan which examines the famous multiple personality case of Sybil, a young woman who claimed 16 personalities. For her book Nathan reviewed the notes of Flora Rheta Schreiber, the journalist who collaborated with Sybil’s psychiatrist Cornelia Wilbur in order to turn the case of Shirley Ardell Mason (Sybil’s real name) into a media sensation. Nathan’s findings debunk the claims of Wilbur and expose the distortions and fabrications which led to the famous case. In looking into Sybil’s history, Nathan also takes a long look at psychoanalyst Wilbur. It turns out that multiple personality was not the only controversial diagnosis Wilbur treated.

While Wilbur was discovering Sybil’s personalities, she also collaborated with Irving Bieber on his study of male homosexuality. Wilbur was one of nine co-authors of Homosexuality: A Psychoanalytic Study, published in 1962. Wilbur also had the distinction of being involved as co-author of the other study of homosexuality conducted by the Society of Medical Psychoanalysts published in the 1960s. Wilbur worked with psychoanalyst Harvey Kaye on a team to research female homosexuality, at the time reporting that half of subjects changed orientation.

With the publication of Sybil by author Flora Schreiber, Wilbur became famous. However, the book about Wilbur’s patient Shirley Mason was not the first collaboration between Wilbur and Schreiber. According to Sybil Exposed, Wilbur and Schreiber met when Wilbur was pitching the findings of the 1962 Bieber study. According to Nathan, Wilbur claimed that the Bieber study reported the causes of male homosexuality and boasted of the 27% cure rate as the result of work with analysts like Wilbur.

Schreiber, a free lance writer, was interested in the research and pitched the idea of a story on the subject to several magazines. Cosmopolitan accepted the pitch and assigned her to write a story about a mother with a gay son “eager to help him go straight.” Schreiber then asked Wilbur for a case which could be turned into an article.

According to Nathan, Wilbur turned over information about Case 129 from the Bieber study. You can read about this case on pages 54-58 of Bieber’s 1962 book (click the links to read it – A, B, C). The case is important for two reasons. One, Schreiber did not like it because the main character was an adult and she was assigned to write about a mother and teen son. Two, according Nathan’s research, the case may have been a thinly veiled reference to Wilbur’s work with actor Roddy McDowall.

After summarizing Case 129 from Bieber’s book, Nathan connects the dots,

The public knew that Roddy McDowall’s father had worked on ships. They knew his mother had pushed him into voice lessons and Hollywood, and that he’d later moved to New York and found success in show business. What McDowall never talked about openly was that he was gay and that after arriving in New York he’d begun an affair with the charismatic, bisexual actor Montgomery Clift, who was eight years his senior and a raging alcoholic. When Clift called off the affair, McDowall tried to kill himself. These facts did not become widely known until after McDowall died in 1998.

Indeed, McDowall’s homosexuality was considered an open secret and one Clift biographer, Patricia Boswell, said that McDowall was suicidal after a breakup with Clift.

However, since Schreiber needed a teen-aged homosexual, the case, no matter how interesting, had to be altered. So, according to her own notes, Schreiber changed the subject of case 129 into an adolescent, Don, who tearfully confessed his homosexuality to his mother, Eve, in a fit of desperation. In the first draft of the article, according to Nathan, Schreiber used many of the details from Wilbur’s case 129 except for the age of the young man. The adolescent boy attended psychoanalysis with Wilbur, who explained the causes of homosexuality right from the Bieber study. Unfortunately for Schreiber, this clinical tale did not suit the Cosmo editor who insisted on changes just before going to press. Nathan writes:

One afternoon just before press time, Flora was summoned to Cosmopolitan’s offices on Fifty-seventh Street. When she got there she was informed that her piece was not acceptable. Eve, the homosexual boy’s mother, was overly intelligent, and her son, Don, seemed too sophisticated. The editors and printers ordered Flora to do an immediate rewrite. She sat down and worked as fast as she could.

The result was an article which was published in January, 1963 under the title, “I Was Raising a Homosexual Child” (click the link to read it on Google books). In this fabrication, Don’s homosexuality was revealed to his parents by means of a phone call from police. Don had been arrested for cuddling with another man in Central Park. However, Schreiber maintained the same causal narrative about smother-mothers and distant fathers advanced by the Bieber book. In the story, the fictional Don saw Dr. Wilbur for psychoanalysis and eventually decided that he didn’t really like guys after all. The Cosmo piece reads like a promotional piece for Bieber and Wilbur’s book, which is apparently what Wilbur hoped for. According to a letter from Wilbur, referred to by Nathan, Wilbur said Schreiber “had gotten things right” in the Cosmo article. Wilbur then thought of Schreiber when it came time to pitch the book about her multiple personality patient, Shirley.

(Note that the article says the names have been changed, implying that the case was real.)

There are many other shocking details about Wilbur’s work with Sybil detailed in the book. For instance, Wilbur supplied Shirley/Sybil with money and hired her for a variety of projects. One of the projects was typing up the manuscript for Bieber’s book on the study of male homosexuality. Although not mentioned in her book, Nathan told me in an interview that Shirley/Sybil was hired to type the book manuscript and even submitted an idea for the cover art.

So before Wilbur pitched the case of Sybil to Flora Schreiber, there was the pitch to Schreiber about the Bieber study. As it turns out, Sybil was a fictional tale only loosely tied to Shirley Mason. However, Don, the allegedly “cured” homosexual, was a complete fabrication.

The Bieber study is at the heart of the reparative narrative about the cause of homosexuality. Many articles on The National Association for the Research and Treatment of Homosexuality website refer to Bieber’s findings as authoritative. Most observers outside of NARTH dismiss the study as hopelessly subjective and flawed. However, for those inclined to give it weight, the study rises and falls on the credibility of the reports from the psychoanalysts who contributed cases since the patients were never surveyed. With the publication of Sybil Exposed, it is now reasonable to call into question the credibility of those reports.
“Sybil Exposed: The Extraordinary Story Behind the Famous Multiple Personality Case,” by Debbie Nathan, is published by the Free Press and went on sale this week.

Additional note: After Wilbur died, Richard Kluft edited a book on multiple personality disorder and included a tribute to Cornelia Wilbur. Wilbur’s work with Sybil and other patients changed the way dissociative states were treated. An interview with Wilbur is included in the opening pages of the book. Here she notes the connection of the Cosmo article on Don, the fictional cured homosexual, and her decision to use Schreiber to write Sybil.

Note Wilbur says that Schreiber got everything right.

Bieber Study Co-Author, Cornelia Wilbur, Accused of Fabricating Case of Sybil

Sunday, Salon briefly reviewed a book by Debbie Nathan which claims to debunk the case of Sybil. Sybil, actually a young Minnesota girl named Shirley Mason, was one of the first cases of multiple personality disorder to catch the public attention. The book about the case sold 6 million copies and inspired a movie starring Sally Field.
The Salon article by Laura Miller gives enough detail to hook my inner skeptic. According to Nathan, most of the details reported in the book were fabricated, based on grueling sessions where Shirley/Sybil was under the influence of Sodium Pentothal, administered by her psychoanalyst, Cornelia Wilbur. At one point, Shirley Mason wrote Wilbur confessing that the information about lost time, and other personalities was made up to keep her therapist’s attention. Miller writes:

Nevertheless, Mason did at one point attempt to jump off Wilbur’s train, writing her doctor a long letter confessing that all the multiple-personality stuff — the lost time, the named “alters” and the grotesque tortures supposedly inflicted on Mason as a child by her supposedly psychotic mother — had all been made up. Wilbur briskly dismissed this as a “major defensive maneuver” designed to derail the “hard work” of therapy lying ahead. The pitiably vulnerable Mason soon caved.

The Salon article and the book it features would be interesting enough for a post. However, it gets more interesting. While she was involved in the invention of multiple personalities, Cornelia Wilbur was a member of the Society of Medical Psychoanalysts, along with Irving Bieber. In fact, she was a co-author of the famous “Bieber study” from which current reparative therapists derive much of their claims about the causes of male homosexuality. The Bieber authors surveyed psychoanalysts about their patients (presumably Wilbur was one of the participants as well) and reported their results in the 1962 book Homosexuality: A Psychoanalytic Study.
The Bieber study has been widely criticized, and for good reason. First, the homosexual participants were psychoanalytic patients in analysis with doctors who already believed that homosexuality was a pathological condition. Also, the patients themselves were never interviewed. Rather, the authors surveyed the analysts to assess the histories and attitudes of their patients. The analysts had already formed the opinion that homosexuality was shaped in childhood and that is exactly what they reported as results.
So it is intriguing to read about Cornelia Wilbur’s conduct in relationship to her most celebrated case. Is it possible that her biases about homosexuality operated first in the Bieber study? While one cannot say based on the case of Sybil, I think is natural to question her part in the Bieber study as a result. This seems especially true given how open the Bieber methodology was to confirmation bias.
The Bieber study is central to reparative therapy. Whenever I have asked reparative therapists for the three best studies which they believe support reparative therapy, they always mention Bieber.
A number of studies mentioned over the years as supports for sexual reorientation change efforts have later come into disrepute. Rekers work with Kyle Murphy, and the Masters and Johnson studies are just two other prominent investigations which later have been questioned.
Additional information: The New York Time Magazine has a lengthy piece on Wilbur and the Sybil case here. This article makes it clear that the sessions with Mason took place while Wilbur was involved with the Bieber study.

The American College of Pediatricians versus the American Academy of Pediatrics: Who leads and who follows?

Just for fun, let’s compare the American College of Pediatricians with the American Academy of Pediatrics.
In August, David Barton and Rick Green at Wallbuilders said the ACP is the leading association of pediatricians in the nation. Even after their error was pointed out by the AAP and a reader of this blog, Rick Green said yesterday on air that the AAP “has more members and has been around a little longer” but both Barton and Green stuck by the story that the ACP was the leading group. However, ACP’s own comparison demonstrates significant differences between the two organizations. The following chart comes from the ACP website:

Note that the ACP does not provide Continuing Medical Education or a professional journal. Access to other professional programs (Red Book, Prep program) is offered via higher fees, but the AAP or affiliated groups actually provide the services. In other words, if there was no AAP, there would be no continuing education or professional publications.
A hallmark of a profession is the provision of training, certification, and continuing education. The ACP does not none of this independently. The ACP has been around since 2002 and the AAP since 1937. Annually, the AAP spends millions on professional publications and continuing education; the ACP receipts in 2008 were less than $60,000. The AAP has over 60,000 members, the ACP about 200.
Specialty groups have a long history in the professions and they can have a place, but it is not in the lead. If the ACP disappeared, members of the group would probably miss it, but nothing would change about pediatrics as a medical specialty. The ACP relies on the AAP for the CMEs and research information required to stay in practice.
Who is leading and who is following?
Additional information about gender identity issues and ACPed:
ACPed leaves out crucial information on gender dysphoria
Interview with Kenneth Zucker on gender identity issues
Common sense on gender identity dysphoria
Interview with mother of child with gender dysphoria
ACPed removes member who called for gender disorder treatment