A college psychology professor's observations about public policy, mental health, sexual identity, and religious issues
This two part series first focuses on Christianity and science and then apparently includes some discussion of sexuality and Christianity, probably on Thursday night.
Here is the description of tonight’s segment:
Big questions about how the universe came to be and how we got here. Science says one thing, the Bible says another. Can the two co-exist? “What is a Christian?” tonight, 10 ET
Reading this article in the New York Times made me think of some of the cases I have worked with involving teens and family disclosures of sexual attractions to others of the same sex.
Most stories of teens, sexual identity and religion of late involve references to live-in programs or parent-child discord. With permission from those involved, I want to briefly describe a situation that challenges several stereotypes. I am masking this to avoid identification but the basic points are right on. Scott (not his real name, of course) felt intense attractions to boys since he was in mid-elementary school. He was a well rounded boy who did well at any sport he tried, although he preferred individual sports. He also enjoyed singing, playing in the band, and acting in community plays. The younger of two boys, he loved his brother and they had a harmonious relationship. He recalls no sexual molestation.
In his early teens, he confided in his father (with whom he felt most comfortable) that he wasn’t getting “those feelings” for girls but that he was getting them toward certain boys. His dad was a sensitive and involved father who assured Scott of his love. Scott and his dad then told Scott’s mom who was upset but also reassured Scott that he was loved. In their discussions, they talked over what Scott thought about being attracted to the same sex. In addition to his other gifts, Scott demonstrated a devotion to his faith. He told his parents that he wanted to talk to a Christian counselor to ask some questions. They agreed and called me.
In the mean time, Scott parents contacted the local PFLAG chapter and attended a meeting. They wanted to talk to other parents who had conservative views about sexuality but had found ways to support and love their children. At least at this chapter, they did not find this. Instead, the participants said they would need to change their religious views because of their gay son. Otherwise, they were told, they would harm their son unless they began attending an affirming church. They did not go back.
For his part, Scott had some questions for me which surprised me. Was I one of those therapists who would tell him to just accept being gay? If I was, he said, he wanted to leave now. I assured him that I would take his values and beliefs seriously. Here is a long story, shortened: Scott was quite set against “being gay” but understood that, for him, being same-sex attracted was nothing anyone caused. He also did not have hopes that he could just change. Once he was assured I would not try to push him to come out, he asked questions about sexuality, maturation, and disclosure. In our visits, we discussed the social and identity issues probably most kids with attractions to the same sex experience – whether gay-identified or not. Scott believed he had lots of time to figure things out.
That was several years ago, and I am now aware that Scott’s beliefs about sexuality are essentially the same and have been integrated within a consistent worldview. Although he is not fond of labels, if pressed, he describes himself as bisexual and dates girls selectively. His parents have struggled with the typical theories of homosexuality and at times, been quite resentful of the church in their odyssey. They have been to an Exodus conference (which they loved) but cannot find a parent’s group they like.
Of course, this is a story in progress. I am not offering it as typical. In fact, when it comes to the relatively calm manner these folks handled the disclosure, sadly, it isn’t typical. However, in many respects, this seems to be a different path to a healthy sexual identity.
In light of the Exodus statement regarding the techniques displayed by Richard Cohen in the media, I thought it good to point out that the sexual identity therapy framework specifically identifies “holding therapy” as being inappropriate. From the framework:
Therapists should maintain professional boundaries in the therapeutic relationship. Therapists should follow ethical guidelines of their profession in conducting sexual identity therapy. Some approaches to sexual reorientation may blend appropriate therapeutic boundaries and are discouraged (e.g., Cohen, 2000). For instance, therapists should not engage in dual relationships with clients or provide physical touch or nurturance to clients. Therapists may supervise or oversee the client’s involvement in physical contact with others of the client’s choosing (friend, family member) during sessions only if the client has given consent. Clients should not be expected to become physically close to other clients in a group therapy situation. Therapists should not refer clients to retreats, support groups or interventions requiring boundary violations as a condition of participation.
Clearly, at times, family sessions involve hugging and the like, but the therapist should not participate. Especially troubling is the paternalism of this arrangement. Clients seeing the therapist as a parent figure should worked through, not encouraged. While we do not specifically discourage emotive techniques (beating pillows and screaming), we might consider whether we should add something to this effect – if for no other reason, to manage liability risk exposure. I have mentioned Genesis & Associates before as a negative example of how good intentions can go very wrong. Indeed, people who feel positive about an alternative technique at the time can later feel quite damaged by it. Specifically, a former Genesis & Associates client reported to CBS News in 2004 that she was damaged by therapists she formerly lauded on the 1995 documentary Divided Memories. In that CBS News report, the techniques were described that led to Ms. Diament’s dissatisfaction with her Genesis experience:
Carol says Mansmann prescribed two controversial treatments. One was “rage therapy” which included beating pillows while screaming. The other, “detachment therapy.” Mansmann urged Carol to move out of her home, away from her family. (italics mine)
To be fair, I suspect the detachment caused as much or more harm than the rage therapy. However, the rage therapy set up her willingness to believe that she was mistreated as a child and then to detach from her family. In hindsight, the “therapy” led to harmful results she was not able to anticipate.
In our guidelines, we do discourage therapists who have apriori determined the “root reasons” for same-sex attraction. Such emotive techniques as a given cannot be consistent with our guidelines since they are predicated on the notion that all same-sex attraction is a response to historical trauma or relational wounding.
UPDATE: 4/4/07 – I received an email from Richard Cohen this evening taking exception to my characterization of his work. Here is the email, which I indicated that I would include here to allow him to describe his work.
Dear Warren,
If you’re going to reference my work, here is the correct statement and my position:
Holding is not done by the therapist or by ministry leaders. It is to be done by OSA (Opposite-Sex Attracted) mentors, ideally the individual’s parent.
For clarification, this is stated clearly in Coming Out Straight on page 203, and in Chapters Ten and Twelve. I highly suggest you read the book and those chapters to better understand this issue.
Richard
Richard Cohen, M.A.
Director
International Healing Foundation
I recall asking Richard in an email about two weeks before his CNN appearance if he held his clients and he said he did not. Then he shows up on CNN holding one of his clients. Where was the mentor? Past clients have said he does indeed hold them so I think it is up in the air. I am also referring in this post to the whole approach which is promise change based on a faulty view of homosexuality in general. It is not hard to see how boundaries bent can become boundaries broken.
During the Montel Williams Show called Homosexuality…Can it be cured?, Dr. Alicia Salzer said in response to Alan Chambers:
…science has shown us that 96% of people cannot change and along the way, absorb an enormous amount of self-loathing, a lot of confusion, a lot of family conflict, so I know the harm.
Surprised that she would make this dogmatic statement, I contacted the show to ask how she arrived at the 96% figure. The producer Melissa Borusso called to say Dr. Salzer relied on the 2002 study by Ariel Shidlo and Michael Schroeder, titled “Changing Sexual Orientation: A Consumer’s Report” published in the APA journal Professional Psychology: Research and Practice. I am quite familiar with this research. I presented along side Drs. Shidlo and Schroeder at the 2000 APA convention in Washington DC, where they 
made their results public in a symposium titled “Gays, ex-gays, and ex-ex-gays: Examining key religious, ethical and diversity issues.” The symposium was organized by Mark Yarhouse and also included a presentation by Doug Haldeman. The Shidlo and Schroeder study is valuable in that it provides documentation that some efforts to reorient sexuality may have harmful outcomes for some people.
However, the Shidlo and Schroeder study cannot provide a basis for Dr. Salzer’s claim made before a national audience. In fact, Drs. Shidlo and Schroeder were very clear about this in their research report, saying:
The data presented in this article do not provide information on the incidence and the prevalence of failure, success, harm, help, or ethical violations in conversion therapy. (italics in the original, p. 250).
Exactly. Probability of change cannot be gleaned from this study. The cautious rendering of the research would be that some people report being harmed and some people report benefit from efforts to modify aspects of their sexuality. At present, we do not know with precision how likely either outcome is to occur for anyone.
After hearing from the Montel folks that Dr. Salzer relied on Shidlo and Schroeder for this authoritative sounding figure of 96%, I remembered seeing how she arrived at this figure in her video, Abomination: Homosexuality and the Ex-Gay Movement. First, the stage is set with on-screen appearances from Dr. David Scasta and Dr. Robert Spitzer. Dr. Scasta describes how the scientific community reviews data to come to a consensus about an issue and then says, “what’s been coming out of the consensus is that much of the data coming out of the Christian right groups is really not scientific.” Now I do not completely disagree with this statement because the 30% figure that is often used is an educated guess based on clinical experience of certain reparative therapists as well as research on methods that are not used frequently (e.g., aversive conditioning) or widely (traditional psychoanalysis) in the present. Also, it is not clear that all studies or therapists use the same definition of change or success. However, lack of knowledge does not mean that number is incorrect, it means we don’t know.
Following Dr. Scasta is Dr. Spitzer who says, “The people who do this therapy claim that about a third make a substantial change in behavior and feelings, I very much doubt that that happens.” Bob has been on the record with this point before.
If the film had stopped there or simply said, we do not know how frequently change occurs, I would not be writing this post. However, following the introduction of doubt about the numbers offered by “the Christian right,” Dr. Salzer’s video segues to Dr. Ariel Shidlo and a description of his 2002 report.
We decided to do research on the effects of conversion therapy, because at the time there wasn’t a lot of scientific data about it. We interviewed 202 people who had undergone conversion therapy. Only 13% of those had felt the therapy had been a success. When we took a closer look at that 13% we found some very interesting things.
With this prelude, Ariel Shidlo describes his study with Michael Schroeder. Recall that Shidlo and Schroeder said their report does not provide data that could address prevalence of harm or benefit, and yet the video spent much time reviewing prevalence of different outcomes. While the film does not say what Dr. Salzer said on Montel, it does provide numbers that appear to be authoritative, especially in the context of disparaging estimates attributed to the “Christian right.”
First, Dr. Shidlo notes that 13% of the participants said they benefitted from their therapy experiences. From there, Dr. Shidlo partitions the 13% into those who were still struggling, single and celebate and finally, the 4% of their group who viewed themselves as heterosexual. The video depicts an 87% failure rate. On the Montel show, Dr. Salzer moves the failure rate to 96%.
In my opinion, the Montel Show should retract Dr. Salzer’s statement and I have asked them to do so. While I recognize there are problems with how research is used by the ex-gay movement, the Montel quote is also a significant misuse of research by a psychiatrist and in then to a lesser degree by an association of psychiatrists via the Abomination video as well.
Note: All graphics are from the video Abomination: Homosexuality and the Ex-gay Movement
UPDATE: An op-ed on this subject is posted on DrThrockmorton.com.
This statement was posted this afternoon on the Exodus International website:
Statement on Richard Cohen
Exodus International does not endorse the work of Richard Cohen or the methods utilized in his practice. Some of the techniques Mr. Cohen employs could be detrimental to an individual’s understanding of healthy relational boundaries and disruptive to the psychological and emotional development of men and women seeking clinical counsel and aid.
UPDATE: Alan Chambers has resigned from the PFOX (Parents & Friends of Ex-gays and Gays) board.