Category: Professional issues

APA symposium to examine sexual identity therapy

Next week (August 17) I will participate in a symposium on sexual identity conflicts at the American Psychological Association annual conference in San Francisco, CA.

Here is the brief description from the association website (scroll down to Division 36):

Div. 36 (Psychology of Religion)

Friday, 2-2:50 p.m.• Symposium: “Sexual Identity Therapy to Address Religious and Spiritual Conflicts.” Co-chairs: Mark A. Yarhouse, PsyD, and A. Lee Beckstead, PhD.Participants: Warren Throckmorton, PhD, Mark A. Yarhouse, PsyD, and Erica S.N. Tan, PsyD.

Click the links above to read the abstracts of the sessions.

This search page supports a search of sexual identity to find further description of the symposium (or just click the link).

Session Title: Sexual Identity Therapy to Address Religious and Spiritual Conflicts

Session Type: Symposium

Division(s): 36

Building–Room: Moscone Center–Room 2016

Location: Second Floor-West Building

Day/Time: Fri/2:00PM – 2:50PM

Event Type: Division Event

US House includes counselors in Medicare legislation

This is off the usual topic of this blog, but I want to note it anyway. The following news release just came via email from Beth Powell at AMHCA:

U.S. House Passes “Children’s Health and Medicare Protection Act,” Including Provision Establishing Medicare Coverage of Mental Health Counselors

August 1, 2007, was a historic day for the mental health counseling profession, as for the first time ever, the U.S. House of Representatives passed legislation to establish coverage of state-licensed mental health counselors under Medicare. The Medicare coverage provision was included in H.R. 3162, the “Children’s Health and Medicare Protection Act,” or CHAMP Act, a bill which seeks to increase access to health insurance for uninsured children and strengthen the Medicare program.

Passage of the provision has been a long standing goal of the American Mental Health Counselors Association (AMHCA), the American Counseling Association (ACA) and the National Board for Certified Counselors (NBCC). House passage of the counselor-coverage provision brings us a step closer to achieving this objective. The bill also eliminates the discriminatory 50% co-payment requirement for outpatient mental health services.

The primary focus of the legislation is to reauthorize and strengthen the State Children’s Health Insurance Program (SCHIP), which supports health insurance coverage for more than 6 million children whose families are low income but do not qualify for coverage under Medicaid. Unless legislation is enacted by September 30th to renew SCHIP, it will expire. H.R. 3162 would expand the program to cover 5 million children who would otherwise be uninsured, and allow states to keep pace with health care cost inflation and population growth. H.R. 3162 passed the House by a largely party-line vote of 225 to 204; all but 10 Democrats voted for the bill, and all but five Republicans voted against it.

The Senate is expected to pass their version of the SCHIP reauthorization bill-which does not include Medicare-related provisions-by the end of this week. Following Senate passage, a conference committee will be appointed to reconcile differences in the House and Senate legislation. Congress will then need to negotiate the legislation with President Bush, who has threatened to veto even the Senate’s more modest bill.

Even if the Medicare-related provisions are removed from the SCHIP legislation, Congress is expected to revisit Medicare soon in order to prevent cuts in physician payment rates scheduled to take effect by the end of the year.

I cut my teeth on advocacy for Medicare recognition in the early 90s when I discovered that my clinical counselor’s license in Ohio did not allow for Medicare reimbursement. Despite a similar scope of practice to social workers and clinical psychologists, mental health counselors (and consequently clients who wanted to see counselors) were at a disadvantage without payment recognition from the Medicare program. Through the 1990s, I helped negotiate recognition from private payers (managed care and insurance companies – e.g., Magellan Healthcare) for counselors but the Federal programs have remained difficult to enter. The Senate may yet add the provision or it may be added during conference. We have been close before but I do not think we have been this close.

Is religious belief a choice?

In the ongoing discussion of sexual identity therapy, some have asserted that sexual orientation is not a choice but religion is (“The bottom line is your sexual orientation cannot change and your religion can,” [Wayne] Besen said.”). That struck me as a failure to understand the function and centrality of religious belief for those who are committed to it. On point, a reader and commenter over at ExGayWatch named “jasmine” linked to a blog post by Hugo Schwyzer who in turn linked to an article by ex-LA Times-religion-writer William Lobdell. Mr. Lobdell has experienced a crisis of faith and no longer views himself as a believer.

In his reflections on Mr. Lobdell, Schwyzer notes that his (Schwyzer’s) response to evil in the church has not been to turn away from God. Through this awareness, he wonders if indeed there is something involuntary about belief. Some things just seem right and make sense. I have had a similar sense throughout my adult life. I know there are inconsistencies in my beliefs but I have tried on many other worldviews and have found them full of cognitive inconsistencies as well. It does not seem like my beliefs are chosen as if from a menu. To me, it seems like our brains are wired to believe but not wired well enough to find a system without holes. For folks with religiously based conflicts over sexual behavior, the conflict can be excruciating in that here are two realities, each of which seems given but at odds. The process of resolution for some folks is a dynamic, fluctuating process that may leave some aspects of both worlds intact and others modified. I suspect that the results seem less like a choice and more like a water moving to the lowest level – does water have a choice? For others, the resolution may come in a series of revelations, each with what seems like a new perspective. Sometimes, these moments are so vivid, they seem like the awareness must be the divine intruding and are certainly not experienced as a choice. In any case, I am only scratching the surface and am speaking descriptively and not prescriptively.

Suffice to say, as I experience religious belief and as it has been described to me by numerous clients, friends and colleagues, such beliefs are often not experienced as mutable or negotiable. I do not say this to say, I am comfortable with this. Some religious beliefs are not healthy in my view. However, to trifle with them as if they can be switched on and off is, in my not completely chosen opinion, to misunderstand how the religious mind works.

The Edge continues “My ex-gay life” series: Dissecting reparative therapy

The Edge’s David Foucher continues his series regarding all things ex-gay with an article today regarding reparative therapy. There are extensive and interesting quotes from Joseph Nicolosi, Clinton Anderson, Jack Drescher, Robert Jay-Green, yours truly and others.

There are a number of quotes that caught my eye. This one from Robert Jay-Green left me scratching my head:

“All these theories are all promulgated by the ex-gay people,” he points out. “They have this theory that distant fathers and overly-close mothers cause homosexuality. Well, that’s been disproved. The research shows that there is no similarities in the pattern of family development in kids who grow up to be lesbian or gay versus kids who grow up to be straight.”

I don’t think that is want he wanted to say. I think he meant no differences.

In fact, there are some differences but they are only of modest effect statistically speaking. In fact, as we have noted here, gay psychotherapist, Joe Kort thinks there are some family dynamics that can lead to homosexual behavior. He believes this homosexual behavior for these actually and essentially straight people can be changed when they get appropriate psychotherapy.

Dr. Nicolosi lays out the core of reparative therapy. As he describes, it is not compatible with the sexual identity therapy framework:

“[Success] occurs by their understanding the causes of their same-sex attraction,” Nicolosi explains. “We call it the three A’s: attention, affection, approval. These are underlying emotional needs that were not fulfilled by their same-sex parent – the father for the male homosexual and the mother for the lesbian.

“There are two jobs [for the patient],” he continues. “The first task is about the past, and the other is about the present. The past aspect is facing the reality that they did not get this love, making it very clear and conscious, and then going through a grief process. They have to grieve that their father never did and never will love them the way they need to be loved – to the extent they need it. And what that does is free them up from the illusion that they are going to get it somehow either by that father or by somebody else of the same sex.”

According to Nicolosi, the next challenge is to replace that need with an emotional connection in their present.

“[They need to] get those needs met thought a relationship with other men,” he says. “The focus is not on not having gay sex… it’s putting the emphasis on making deep emotional attachments. And we have seen that when these men make deep emotional attachments to other men, their sexual interest diminishes.”

While for people who did have problems with parents, there can be some value in acceptance and grieving. However, presenting this scenario to clients as a general explanation for all attractions to the same sex is not consistent with the sexual identity therapy framework. As I noted in this Edge article, I do not believe the research support is there. Thus, we cannot tell clients we know something we don’t know, but rather theorize.

I will be on the Michelangelo Signorile show today

Tune in Tuesday, July 24, at 4:30pm eastern time on Sirius Radio for this live interview. I suspect we will discuss many topics but focus on the sexual identity therapy framework and the work of the APA.

UPDATE – Well, hope springs eternal. I thought we might get some kind of real dialogue about the merits of sexual identity therapy as opposed to reparative therapy. However, this did not happen. He chose to focus on making me defend a client’s right to maintain a religious persuasion that Signorile obviously dislikes. It seems clear to me that he sees evangelicalism as inherently bigoted so there is no place for such beliefs in his view. So the choir was preached to but still remains ignorant of honest attempts to grapple with real human conflicts.