Category: Professional issues

Former ex-gay leaders in Australia renounce ministries

Today’s Sydney Star-Observer reports on 5 ex-ex-gays who have denounced their former programs. I was struck by the mention of discipline in the arsenal of techniques.

Many former leaders believed that homosexuality was a choice, including Vonnie Pitts, the former leader of Living Waters, an organisation that conducts disciplinary programs for those pursuing “sexual wholeness”.

I don’t know much about Living Waters. Readers who do, what could she be referring to by the use of the term, “disciplinary programs?”

The emphasis on rigid gender roles sounds sadly familiar:

After attending Australia’s first ex-gay program in 1972, Anthony Venn-Brown spent 22 years trying to change his sexuality.

The program, he said, was about “modifying your behaviour to become more masculine”.

“You were never allowed to work in a kitchen – that was women’s work,” he said. “You were always doing maintenance work and manual labour outside … and they also removed any articles of clothing from my wardrobe that they believed were not masculine.

…and

“They believed you should have a good, strong male role model because your father was emotionally distant. Therefore they gave me a minder, who would be with me 24 hours a day and who would make sure I was behaving myself.”

Theories have consequences and thus it is important to stay true to the data and to be tentative where the data are not very clear. Dubious theories of sexual orientation development can lead to dubious practices — as is illustrated here. I may have mentioned this before on this blog, but this reminds me of an illustration Ariel Shidlo gave at the 2000 APA convention when he and Michael Schroeder presented their data on harm from reorientation. He noted a young man was asked by his reparative therapist to give up a piano scholarship because piano playing was too feminine. He gave it up but, of course did not lose his attractions to men. The client however, was angry and frustrated.

Neuroimaging study differentiates gay and straight males

It must be Bailey week here on the blog. I am reporting here on a study done in his lab led by Northwestern undergraduates Adam Safron and Ben Barch. The study titled: “Neural Correlates of Sexual Arousal in Homosexual and Heterosexual Men” was published in the April, 2007 edition of Behavioral Neuroscience.

Dr. Bailey described this study at the December conference at Catholic University. Essentially, brain scans demonstrate that activation in the brains of gay and straight men differ in response to sexual images. The abstract reads:

Men exhibit much higher levels of genital and subjective arousal to sexual stimuli containing their preferred sex than they do to stimuli containing only the nonpreferred sex. This study used event-related functional magnetic resonance imaging to investigate how this category-specific pattern would be reflected in the brains of homosexual (n = 11) and heterosexual (n = 11) men. Comparisons of activation to preferred sexual stimuli, nonpreferred sexual stimuli, and sports stimuli revealed large networks correlated with sexual arousal, spanning multiple cortical and subcortical areas. Both homosexual and heterosexual men exhibited category-specific arousal in brain activity. Within the amygdala, greater preference-related activity was observed in homosexual men, but it is unclear whether this is a cause or a consequence of their sexuality. In a subsequent analysis of regions hypothesized to support arousal, both participant groups demonstrated widespread increases in evoked activity for preferred stimuli. Aggregate data from these regions produced significant differences between stimulus types in 16 out of 22 participants. Significant activational differences matched reported sexual orientation in 15 of these 16 participants, representing an advance in psychophysiological measures of arousal.

At the Catholic University conference, Bailey showed videos of the collective response of men to preferred sexual images compared to neutral images and the results were striking. There was lots of activation with preferred sexual images (gay men to men and straight men to women) and next to nothing with non-preferred imagery. Here is his description of the scans:

And what I’m going to show you next is a movie. It’s a quick movie of somebody’s brain activity while he watches — well, it’s a contrast, actually — preferred stimuli minus neutral. So, this study has both gay men and straight men, and this is the way their brain reacts when they see their preferred sexual stimuli, which, for a straight man, would be women, for gay man would be men, against watching neutral things like — actually, our neutral stimuli here are people playing sports.

And the thing to pay attention to, these hot colors mean that preferred is activating the brain more than neutral, these cold colors mean that neutral stimuli is activating the brain more than preferred. Doesn’t really — just look at all the — you’re going to see a lot of colors like this. Okay? …did you see all those bright colors there? That is a big, big, bold brain reaction to preferred stimuli. The brain really likes seeing preferred sexual stimuli, in men.

Safron et al

Okay. So, the next one is the same sort of thing, except now what you’re going to see is nonpreferred stimuli, so this would be a straight man looking at nude men, and a gay man looking at nude women. Okay? Look how different it looks.

Were all subjects congruent with their self-reports? No, one subject, “Participant 16” demonstrated activation to same-sex imagery but his self-report was heterosexual.

Participant 16 showed unusually positive evaluations for nonpreferred stimuli. This participant, a self-reported heterosexual, had 10 instances in which he gave positive evaluations to nonpreferred stimuli, whereas other heterosexual men averaged 0.6 positive evaluations. He also tended to give less negative evaluations for nonpreferred stimuli compared with other heterosexual men (the percentages rated “strongly dislike” were 48% and 66%, respectively). Furthermore, he rated preferred stimuli less positively compared with other heterosexual men (the percentages rated “strongly like” were 46% and 82%, respectively).

Was participant 16 bisexual? In denial? Bothered by the procedure? Hard to tell. Dr. Bailey thinks his erotic preferences were really same-sex but his self-concept straight. In practice, who knows? In theory, someone like this could experience attractions to the same sex and process those attractions in a manner that would not lead to a self-attribution of being gay. To me, this highlights one interpretive issue with research like this. Clearly, brain reactions were different associated with sexual orientation differences – and before the person was very aware of the stimuli. However, humans may make a variety of meanings of the same brain activity. This research can tell us what brains are doing but not exactly what it means to any given individual.

Another issue of some import to me as Dr. Bailey and I collaborate to apply this technology with ex-gays is the difficulty some religious participants will have viewing nude pictures. We will need to discuss how what the brain might do with mixed feelings about participation and where that state might show up on the scan. And we might need to have another set of pics to view.

Investigative journal article examines Michael Bailey controversy

Michael Bailey of Northwestern University is one of the key sexuality researchers of the last 20 years. Since publication, his book The Man Who Would Be Queen has been at the center of controversy. Specific allegations of personal and research impropriety have been leveled against Dr. Bailey, all of which he has denied.

The upcoming Archives of Sexual Behavior will feature a lengthy investigative report by Alice Dreger exploring the controvery and allegations. The New York Times plans a story regarding the matter, perhaps as soon as tomorrow. I will post a link when it is published.

Here is the abstract:

In 2003, psychology professor and sex researcher J. Michael Bailey published a book entitled The Man Who Would Be Queen: The Science of Gender-Bending and Transsexualism. The book’s portrayal of male-to-female (MTF) transsexualism, based on a theory developed by sexologist Ray Blanchard, outraged some transgender activists. They believed the book to be typical of much of the biomedical literature on transsexuality—oppressive in both tone and claims, insulting to their senses of self, and damaging to their public identities. Some saw the book as especially dangerous because it claimed to be based on rigorous science, was published by an imprint of the National Academies of Science, and argued that MTF sex changes are motivated primarily by erotic interests and not by the problem of having the gender identity common to one sex in the body of the other. Dissatisfied with the option of merely criticizing the book, a small number of transwomen (particularly Lynn Conway, Andrea James, and Deirdre McCloskey) worked to try to ruin Bailey. Using published and unpublished sources as well as original interviews, this essay traces the history of the backlash against Bailey and his book. It also provides a thorough exegesis of the book’s treatment of transsexuality and includes a comprehensive investigation of the merits of the charges made against Bailey that he had behaved unethically, immorally, and illegally in the production of his book. The essay closes with an epilogue that explores what has happened since 2003 to the central ideas and major players in the controversy.

Two more excerpts of interest to readers here:

Notably, because it is often scientifically and politically atypical in its claims, Bailey’s work seems particularly inclined to create critics and allies on all sides; so, for example, we’ve seen how he was criticized and praised in both the left-wing and rightwing media. And we find the anti-gay National Association for Research & Therapy of Homosexuality (NARTH) trying, largely through highly selective quotation, to use Bailey’s words on homosexuality to defend their homophobic policies (see, e.g., Byrd, 2006) even while Bailey has been reasonably positioned to debate against NARTH representatives on a Catholic radio program and in academic conferences on homosexuality. (pg. 51)

One of those conferences, I attended and reported on here. And I can relate to this passage:

And Bailey? Undaunted, he plugs ahead, working on more sexual-orientation studies—studies likely to keep angering people on both the right and the left who wish his work fell simply into one of the politicized scientific boxes on which they insist.

The article quite long (62 pages with references) but if you have followed this saga at all or are interested in the human side of research, this is a worthwhile read. Consider this post a kind of open forum, but any allegations or other claims about the players or situation must be backed up with references.

UPDATE: 8/21/07 – Here is Benedict Carey’s New York Times article regarding the controversy.

Sexual identity therapy and neutrality, Part two

In this second post about therapeutic neutrality, I want to discuss what it does and doesn’t mean in sexual identity therapy. Again, I want to react to some of the thoughts from Dr. Nicolosi in his article, Why I Am Not a Neutral Therapist.

Dr. Nicolosi writes:

What will happen when the uncommitted (“neutral”) therapist hears his client revealing self-destructive behaviors that are statistically proven to be associated with SSA? How will he interpret these behaviors? Staying out of philosophical territory with the client would require a sort of “Rogerian neutrality” that even Carl Rogers himself couldn’t live up to. I can’t imagine any psychologist who actually does this therapy on a regular basis believing that such an approach would be successful.

This needs to be unpacked a bit. First of all, when clients, either gay or straight or in between, describe self-destructive behavior, I believe therapists should confront the consequences to the client and others of this behavior. Asking clients about the consequences and pointing out denial is a standard therapeutic stance. SIT can be used by directive and non-directive therapists. There is nothing in the SIT framework that prevents the confrontation of self-harm.

What Dr. Nicolosi seems to be implying about the behavior of homosexuals in this paragraph, he make more explicit in the next:

Along the way, clients always report a host of maladaptive, self-defeating behaviors that restrict their maturation. The successful clinician must have an understanding of the meaning of these common factors. He will also observe fundamental distortions of self-identity. Once seen, how can these factors — including their meaning and likely origins — be ignored?

Apparently, he sees self-destructive behaviors in all of his clients. I do not, and in my research investigations, I have not found this to be invariably true. Statistical association is not cause nor does statistical significance implicate an entire group of people. I have addressed elsewhere on this blog, to wit:

Thus, it would be inconsistent with the research on psychiatric risk to deny members of at-risk groups “even the possibility” of a “fulfilling life,” whether partnered or not. Higher risk, yes; inevitable mental health maladjustment for all members of a group of people? No.

To further address Dr. Nicolosi’s question: when maladaptive, self-defeating behaviors are evident, therapeutic respect for the client’s value position does not mean that these behaviors are ignored. They are not. However, not all clients who are attracted to the same sex have the same issues. The SI therapist does not assume that all same-sex attracted clients have the same concerns, problems, issues, behaviors or backgrounds. This is more like theoretical neutrality; the SI therapist interprets the literature to depict a varied clinical landscape, not one of uniform histories and dynamics. We also do not tell clients that being attracted to the same sex assigns them to a life of despair and promiscuity. Nor do we tell them that their attractions to the same sex mean one thing. In the advanced informed consent phase, we discuss the research on the health and mental health correlates of behavior. Thus, if we have a client who is engaged in risky behavior, we inform them of the risks. If we learn that a client’s draw to the same sex has some historical referent, we certainly help that client process the issue. However, we do not assume that all attractions to the same sex mean the same thing, or that such attractions are of necessity tied to some historical set of deficits.

Dr. Nicolosi then contrasts himself further:

As Charles Socarides once said, the therapist must be neutral in judging the client, his behavior, and his choices; but he cannot be neutral about the condition of homosexuality.

Indeed the SI therapist is open to the distinct possibility that sexual preferences derive from multiple pathways and follow multiple trajectories. The SI therapist agrees with APA past president Nicholas Cummings who said: “There are as many kinds of homosexuals as heterosexuals. Homosexuality is not a unitary experience.”

So to summarize, SI therapists are not neutral when confrontation of self-destructive behavior is warranted, but we do not presume a uniform set of antecedents and outcomes of homosexual attractions. I guess you might say, we have an “Ask, Don’t Tell” policy.

Sexual identity therapy and neutrality, Part one

Continuing the discussion about sexual identity therapy, I want to contrast our framework with both gay affirming and reparative therapies on the dimension of value neutrality in two posts. As a springboard for my thoughts, I want to quote from an article by Joseph Nicolosi on the NARTH website called, “Why I Am Not A Neutral Therapist.” He led with this explanation:

A Christian psychologist contacted me to discuss reorientation therapy for SSA men. Hoping to find a politically “safe” compromise with the APA, he was anxious to avoid value judgments and remain noncommittal about homosexuality. The solution, he thought, would be a simple behavior modification program. Speaking from my 25 years of experience in this field, I told him I found his approach naïve and ultimately unworkable.

Then he adds:

“Furthermore, why should I refuse to discuss philosophical issues with clients,” I told him, “when gay-affirmative therapists are working very hard as boosters of their philosophy? They tell clients that same-sex feelings are ‘sacred.’ They push them to revolutionize society’s and the church’s attitudes. Any client’s conviction that heterosexuality is the norm will be redefined by the therapist as a ‘psychological illness — homophobia.'”

“The fact is, neutrality fails for clinicians on both sides of this issue,” I told the psychologist. “Clinicians like you and me, who believe that humanity was designed for heterosexuality, must speak up about our philosophy. These men with unwanted SSA want boosters, allies, advocates, as they claim their masculine identity — someone who believes in them and stands strongly at their side.”

Dr. Nicolosi parallels his disclosure of reparative drive theory as an ideology to what he believes gay affirming therapists do with clients but from an opposing perspective. After all, if it is ethical for gay affirming therapists to promote homosexuality as a moral good, then why shouldn’t reparative therapists promote heterosexuality as God’s design?

Before I discuss this further, one might question whether gay affirming therapists or therapists in general really have a worldview on the matter. I cannot go into this exhaustively but a statement from the APA’s Clinton Anderson from a recent AP article by David Crary suggests there are favored and disfavored religious views on matters gay. Speaking about religious views which are at odds with homosexual behavior, Dr. Anderson said:

“We cannot take into account what are fundamentally negative religious perceptions of homosexuality — they don’t fit into our worldview,” Anderson said.

So can therapists be neutral?

In my view, not all therapists can practice in a neutral manner. In our sexual identity therapy framework, we have clear guidance which allows for referrals when value conflicts impair what therapy has to offer a client. In other situations, the role of the therapist is to assist clients clarify their own perspectives and work toward congruence. For clients who do not know what they believe, it can be very valuable for the therapist to refrain from imposing a religious worldview or stigmatizing conservative religious views.

Some people want a non-neutral therapist on either side of the worldview spectrum. Perhaps they would not be happy with sexual identity therapy. My investigations into this arena suggest that retrospective assessments of therapist helpfulness are associated with therapists not attempting to impose a contrary value position on to the client. And so, I continue to believe that SIT occupies a niche that offers something not available in ideologically-driven approaches. For those who are still figuring things out or have not felt successful with other approaches, our framework could provide something different.

Part two will explore where the sexual identity therapist isn’t neutral.