Category: reparative therapy

NARTH likes half of the NYT Magazine's coverage of sexual identity issues

NARTH is recommending the Glatze article but not the article by Mimi Swartz which addresses the APA position on sexual orientation change.
At least they tell readers

While the story is his own and does not necessarily represent a typical NARTH client his observations and thoughts are very interesting. They represent a perspective usually missing in the popular press on the subject of homosexuality.

Missing from the NARTH post is the perspective of the longer article of the two. Gotta go to the popular press for that.

Roots of reparative therapy – Momism and psychiatry in the 1940s

For our amusement and for a book I am completing this summer, I am looking into multiple roots of reparative therapy. As I noted recently, reparative therapy finds parents to be the root of homosexuality in children. Mother blaming has a long history in psychoanalysis. Reparative therapy doesn’t spare the mother but adds father for his special share of responsibility.

One of the most famous cases of mother blaming is Bruno Bettelheim’s reference to “refrigerator mothers” as culprits for autism. Bettelheim’s diagnosis was not based on empirical research but his own experiences in Nazi concentration camps, or at least that is what Bettelheim claimed. In any case, a couple of generations of professionals were trained to believe that autism was mom’s fault.

On the other side of the spectrum from the refrigerator mother was “Mom.” Philip Wylie coined the word “momism” to refer to overprotective mothers in a chapter of his 1943 best seller, Generation of Vipers. I will have more from that book later this week.

Wylie was a journalist who didn’t like soft moms, or soft men. Psychiatry was quite supportive of Wylie at the time, at least in the person of Edward A. Strecker. Strecker was a consultant to the Army and Navy through World War II and blamed mothers for men dismissed from the services for psychiatric reasons. Not only was mom the blame for individual pathology, but her failures threatened democracy and nation security. Here is the description of Strecker’s 1946 book, Their Mothers’ Sons

Their Mother’s Sons (From the book jacket)

This is a book about Mother, the great American “Mom,” and what she is doing to the young men of America. In its pages a world-famous psychiatrist describes in unforgettable terms a new American tragedy – the millions of young men in this country today who live in confusion and emotional chaos, condemned by millions of well-meaning and unthinking “Moms” who will not cut the apron strings between them and their sons.

During the past war, Dr. Strecker served as special consultant to the Secretary of War, and to the Surgeon Generals of the Army and Navy. In casualty hospitals, both overseas and at home, he viewed the incredible neuroses of vast numbers of American young men. At the induction centers and in the screening areas, he learned the case histories many thousands of so-called psychoneurotics. Now, in this book, he crystallizes his thinking into a timely warning concerning a system which condemns enormous numbers of men to a miserable, maladjusted life – simply because “Mom” has never weaned her son emotionally.

During the past war, 1,825,000 men were rejected for military service because of psychiatric disorders. Another 600,000 were discharged for neuropsychiatric reasons. And at least 500,000 attempted to evade the draft and all war responsibility. The handwriting of “Moms” looms large and plain.

Influenced by Sandor Rado, Irving Bieber and Elizabeth Moberly, Nicolosi extends the blame to the father with his version of reparative therapy. The overbearing, overprotective mother looms large in reparative therapy and appears to be an idea with a long history of tapping into collective fears and insecurities.

Is coming out always best?

I am going to look for this article later today. Looks interesting and potentially relevant to the sexual identity therapy discussions generated by the New York Times Magazine last week.

Released: 6/15/2011 12:25 PM EDT
Embargo expired: 6/20/2011 1:00 AM EDT
Source: University of Rochester

Disclosing Sexual Orientation Makes People Even Happier Than Thought, But Mainly in Supportive Settings
Newswise — Coming out as lesbian, gay, or bisexual increases emotional well-being even more than earlier research has indicated. But the psychological benefits of revealing one’s sexual identity — less anger, less depression, and higher self-esteem – are limited to supportive settings, shows a study published June 20 in Social Psychology and Personality Science.

Sexual identity: Thoughts on the status of the reorientation wars

(First posted on August 12, 2009)
So now that the dust has started to settle from the APA convention in Toronto, let’s review the status of the Reorientation Wars.
Does therapy change orientation?
In anticipation of the APA’s report, NARTH fired an opening salvo with their paper (What Research Shows…). Perhaps sensing, incorrectly as it turns out, that the APA would advocate a ban on reorientation therapy, NARTH tossed every positive reference to change they could find into the paper. They noted problems in defining sexual orientation but did little to distinguish the various definitions and their meaning in the many studies they cited. They concluded, of course, that therapy can change orientation.
The APA on the other hand, differentiated sexual orientation and sexual orientation identity. Sexual orientation for them is the biological responsiveness to one gender or both. According to their literature review, the evidence that therapy can change orientation is not sufficient to permit therapists to inform clients that therapy can change their orientation. However, sexual orientation identity (i.e., self-labeling) may shift and be responsive to a variety of factors, including religious mediation.
It seems to me that what NARTH is calling sexual orientation includes the APA’s sexual orientation identity. While this statement risks taking us into the “all or nothing” dead end discussion about change, I do not mean that one must change completely for change to be important and psychologically relevant. I suggest instead that what many studies measure is how people see themselves, even if their sexual responsiveness (orientation) has only shifted by a degree (e.g., an average of less than a point on the Kinsey scale in the Jones and Yarhouse study). Jones and Yarhouse suggest as much in their recent paper when they write:

There is also the question of sexual identity change versus sexual orientation change (see Worthington & Reynolds, 2009). Recent theoretical (e.g., Yarhouse, 2001) and empirical (e.g., Beckstead & Morrow, 2004; Yarhouse & Tan, 2004; Yarhouse, Tan & Pawlowski, 2005; Wolkomir, 2006) work on sexual identity among religious sexual minorities suggests that attributions and meaning are critical in the decision to integrate same-sex attractions into a gay identity or the decision to dis-identify with a gay identity and the persons and institutions that support a gay identity. In light of the role of attributions and meaning in sexual identity labeling, is it possible that some of what is reported in this study as change of orientation is more accurately understood as change in sexual identity?

I believe the answer to their question is that it is not only possible but probable that change in sexual identity is what is being reported. The distinction between orientation and identity (or attraction and identity as we often describe it here) is key, in my view, in order for us to understand the experience of those who say they have changed while at the same time experiencing same-sex attraction. I also believe that men and women are different and their change may be different. Women seem to describe less exclusivity than men. Fluidity may be more likely with complete shifts described. I think we need to accommodate atypical experiences such as men and women who completely shift for a time and then shift back. Whatever the pattern, I hope we can agree that sexual attraction patterns may be one thing while meaning making aspects may lead two people with the same attraction pattern to identity in disparate ways.
Is sexual reorientation harmful or beneficial?
NARTH says reorientation might harm some people but that for the most part it is not harmful. The APA says existing studies are not good enough to allow conclusions. Point for the APA here. All we can say is that some people report harm and some people report benefit. The APA notes that the benefits can occur in programs which promote congruence with religious faith. This is clear and the Jones and Yarhouse study demonstrate that health status improves modestly for those who remained in the study. However, I would say we do not yet know much about what the potent or beneficial elements of those programs are. The APA report identified some of those elements.
Homosexuality and pathology
NARTH says homosexuals have more pathology than any other group of similar size. The APA says homosexuality is normal. By this they mean that homosexuality is not a developmental disorder or indicator of a mental disorder. The two recent reports go off in different directions but some observations can be made.
The NARTH report spends lots of time reporting on greater levels of mental health and health problems among homosexuals as compared to heterosexuals. The APA report does not do this. However, I believe the point regarding different levels of symptoms would be stipulated by the APA. However, the APA raises the minority stress model as responsible for many difficulties faced by non-heterosexual people. The NARTH report discounts the role of stigma.
I doubt the APA would dispute the health status data for another reason: greater group pathology does not mean inherent disorder. The APA’s position is not that gays have equal health outcomes but rather that the unequal health outcomes do not imply inherent pathology – that SSA is not inherently the result of pathological development. This is of course in great contrast to the reparative therapists. Joseph Nicolosi says that the only way you get SSA is to traumatize a child.
The reparative impulse to find trauma behind every gay person is misguided I believe, conceptually and for sure empirically. Women have greater levels of mental health problems than men but we would not consider women inherently disordered. NARTH has chosen some good studies to cite in the section of their paper which relates to health status (as well as some really bad and irrelevant ones). However, I don’t think it really gets them where they want to go.
And where do they want to go? This is clear from their press release complaining about the APA task force report. They state:

Further, if some clients are dissatisfied with the therapeutic outcome [of reorientation therapy], as in therapy for other issues, the possibility for dissatisfaction appears to be outweighed by the potential gains. The possibility of dissatisfaction also seems insignificant when compared to the substantial medical, emotional, and physical risks associated with homosexual behavior.
NARTH would suggest that these medical and emotional risks, along with the incongruity of homosexual behavior with the personal and religious values of many people will continue to be the motivation for some individuals to seek assistance for their unwanted homosexual attraction.

According to NARTH, gays ought to seek reorientation therapy because being gay is a risky life, full of health and mental health disadvantages. Their hypothesis is implied but hard to miss: reduce the SSA and reduce the health risks. The assumption appears to be that ex-gays will have better health outcomes than gays. One problem with this line of thinking is that there is no empirical evidence for it and some evidence against it.*
One researcher quoted in the NARTH paper regarding health risks was New Zealand’s David Fergusson. Dr. Fergusson has done significant work in this field. I asked him to look at the section of the NARTH paper in which his work was quoted. Here is a statement he provided about it:

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 one would need to develop studies to demonstrate that any changes in orientation associate with improvements in health status. The Jones and Yarhouse study provide some very general assessment but many potential confounds are uncontrolled. For instance, it is not possible to say that the modest shifts on the Kinsey scale were responsible for the shifts in health status. These folks were quite religious and religion is associated with enhanced health status. I suspect religious gays have a better health status than non-religious gays, on average. The point is we do not have evidence that sexual orientation status per se is what leads to the differences in health status.
While I am on the subject of health status, I need to mention that there are other factors which NARTH ignored. One, gender non-conformity is strongly correlated with adult homosexuality and is also associated with poorer mental health. Two, homosexuals report higher levels of sexual victimization which is also associated with higher levels of mental health problems. And, three, no one can discount the possibility that biological factors which associate with the development of homosexuality may also influence the development of emotional problems (i.e., in the same way women are more likely to report depression than men).
So where are we? I hope we have a larger middle and smaller numbers of people at the opinion extremes. People on both sides can agree that erotic responsiveness is extremely durable for men and perhaps less so for women, but behavior and self-identity reflection is alterable. People on both sides agree that conclusions about benefit and harm are not possible in any general sense. Also, I hope we can agree that full informed consent should be conducted prior to engaging in counseling. Regarding health status, both sides can agree that homosexuals have higher levels of problems but there is little agreement about what the differences mean.
Those on the far sides of the continuum will continue to argue that change is possible or change is impossible, and/or that reorientation is always harmful or never harmful and/or that health status difference mean something vital or irrelevant about inherent pathology.
The wars will continue but perhaps fewer people will be engaged in them; now is the time rather to reason together.
*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) – In this study, the authors found that mental health was better among the gay sample than the Exodus sample.
(Note: Social psychologist David Myers referred to this post in an op-ed on the APA task force printed in the Wall Street Journal.)

Sexual identity: Wall Street Journal reports on APA report and sexual identity therapy

(First posted on August 6, 2009)
The Wall Street Journal’s Stephanie Simon has captured well the application of the APA task force sexual orientation report in an article out this morning. Of course I would say that…

The men who seek help from evangelical counselor Warren Throckmorton often are deeply distressed. They have prayed, read Scripture, even married, but they haven’t been able to shake sexual attractions to other men — impulses they believe to be immoral.
Dr. Throckmorton is a psychology professor at a Christian college in Pennsylvania and past president of the American Mental Health Counselors Association. He specializes in working with clients conflicted about their sexual identity.
The first thing he tells them is this: Your attractions aren’t a sign of mental illness or a punishment for insufficient faith. He tells them that he cannot turn them straight.
But he also tells them they don’t have to be gay.
For many years, Dr. Throckmorton felt he was breaking a professional taboo by telling his clients they could construct satisfying lives by, in effect, shunting their sexuality to the side, even if that meant living celibately. That ran against the trend in counseling toward “gay affirming” therapy — encouraging clients to embrace their sexuality.
But in a striking departure, the American Psychological Association said Wednesday that it is ethical — and can be beneficial — for counselors to help some clients reject gay or lesbian attractions.
The APA is the largest association of psychologists world-wide, with 150,000 members. The association plans to promote the new approach to sexuality with YouTube videos, speeches to schools and churches, and presentations to Christian counselors.
According to new APA guidelines, the therapist must make clear that homosexuality doesn’t signal a mental or emotional disorder. The counselor must advise clients that gay men and women can lead happy and healthy lives, and emphasize that there is no evidence therapy can change sexual orientation.
But if the client still believes that affirming his same-sex attractions would be sinful or destructive to his faith, psychologists can help him construct an identity that rejects the power of those attractions, the APA says. That might require living celibately, learning to deflect sexual impulses or framing a life of struggle as an opportunity to grow closer to God.

While the report doesn’t use my exact words (e.g., I don’t say ‘you don’t have to be gay’), she does catch important aspects of the APA report and the stance I use within the sexual identity therapy framework. Furthermore, I don’t show the video at the same time in the same order of things to clients and then they make a decision about their direction. I do however, do extensive informed consent and answer lots of questions which involves videos and slides to answer. Thanks to Michael Bailey for those vids.
This report captures the essence of the novel findings in the APA report in contrast to the AP report which continues to present a polarized picture. For sure, as long as the dialogue around change is important to people, we keep talking past each other. However, when you look at what both sides actually claim, they are not that far apart. According to the AP report, Jones and Yarhouse are going to report over half of 61 subjects either changed or are celibate. Whatever the percentage, it is clear that change cannot be promised to clients as a predictable function of therapy or ministry. We should be able to agree about that and then place emphasis on belief and value congruence. From there, see what happens.