Multiple pathways to sexual orientation, Part 1

On other threads, we have discussed why reparative therapy vignettes and ex-gay testimonies are so often alike. I have suggested that there are different causal pathways which lead to different sexual orientation outcomes. Also, therapists like Joe Nicolosi and Richard Cohen have strong public positions which promote a particular causal narrative. Clients who may have histories in line with those narratives seek counseling from those therapists. The same dynamic likely occurs in Exodus ministries where unhappy people seek help based on reading or hearing public testimonies.
People seeking help for unhappiness might be more likely to have life circumstances which they view as causal. Therapists looking for such causes ask questions which validate the hunches. It seems easy enough to imagine how therapists and clients can arrive at a common narrative without even trying to do so.
Same-sex attracted people who have not been traumatized in some way often react with puzzlement and frustration when, like palm readers, therapists go through a litany of questions about non-existent past trauma, seeking some confirmation of the predicted narrative. Eventually small, forgotten hurts and deprivations are identified as evidence for the expected patterns.
While I believe this occurs often, I have no idea how often. I also am pretty sure that the histories of some people are relevant to their sexual attractions. The research on the variability of pathways to sexual orientation is sparse but there is some and it demonstrates that on average same-sex attracted people who seek help of some kind (therapy or Exodus) recall more troubling relationships with parents than same-sex attracted people who have not sought therapy or ministry help.
The primary reference in this regard is Bell, Weinberg & Hammersmith (1981) Sexual preference: Its development in men and women. Bloomington: Indiana University Press. An important section on the differences between clinical and nonclinical groups is reprinted here from pages 202-203.

Homosexuals in Therapy
More than half of the WHMs [white homosexual males] (58%) said that at one time or another they had sought help for a personal or emotional problem from a professional counselor such as a psychiatrist or a psychologist. Most previous studies of the development of male homosexuality have been based on the reports of homosexuals “in treatment,” and many scholars have tried to generalize their findings to other homosexuals as well. When our own findings failed to support so many widely held clinical views, we were curious to see whether the reports of respondents who had been in therapy would differ from those made by respondents who had never sought professional counseling or therapy.
What we found was that those respondents “ever in treatment” did indeed have the kinds of paternal variables in their model that were consistent with what clinicians have always thought to be typical of homosexual males. The path model of those “never in treatment,” on the other hand, either did not contain such variables or showed their influence to be weaker. For example, as the literature suggests, the “therapy” group tended to have Detached-Hostile Father (t.e.= .29), a variable that is tied to the son’s gender nonconformity and early homosexual experiences. This variable does not even appear in the model for the men who have never been in therapy, however. Moreover, although the “nontherapy” group had more Negative Relationships with their Fathers, this variable (t.e.= .11) did not influence their gender nonconformity at all. In addition, two other variables that were important for the therapy group — Cold father and Negative Image of Father — do not appear at all for the nontherapy males. Although the rest of the path model is much the same for both groups, clearly the model for the therapy group corresponds much more closely to the way fathers have been considered in theories about the etiology of male homosexuality.
How might this discrepancy be explained? On the one hand, it could be supposed that cold, detached fathers make for troubled sons who are likely to seek psychological treatment at some point in their lives. Likewise, it could be argued that “therapy” often involves an “education” of client by the therapist in which the client comes to believe what the therapist supposes must be true of the client’s parents. Alternatively, it could also be argued that fathers tend to withdraw (become detached) from psychologically troubled sons, who are later to seek psychological counseling.
Whatever the case may be, at least on the basis of what our respondents could remember about their parents, Cold or Detached-Hostile Fathers cannot be regarded as important in the development of male homosexuality in general, since their alleged influence does not even appear among those who neve sought therapy or counseling. Finally, it should be noted that the differences between the therapy and non-therapy groups do not stem from differences between these two groups in terms of effeminacy or bisexuality. We found no significant correlations between being exclusively homosexual and having been in therapy, the more effeminate WHMs were only somewhat more likely than the non-effeminate WHMs ever to have been in therapy (64% versus 54%).

Bell et al, also compared WHMs and WHTMs (white, heterosexual males) who had and had not been in therapy. The findings regarding these comparisons are not drawn out in the same manner as above. However, there is a footnote on page 202 briefly describing the analysis.

The path analysis on which these findings were based included all the white heterosexual males, whether or not they had been “in treatment.” Separate analyses, one comparing only those WHMs and WHTMs “ever in treatment” and and one comparing those WHMs and WHTMs “never in treatment” replicated the results reported above.

For women, the picture was somewhat different. The authors noted that 2/3rds of the WHW had been in therapy and then on page 209, they wrote:

We do find some differences between the path model for the women who had been in therapy and those who had not. Notably, Childhood Gender Nonconformity appears to have been a more important factor for the respondents who had been in therapy or counseling (t.e.= .71 versus .52 for the women who had never been in therapy or counseling.)
In addition, the path model for the homosexual women who had in therapy or counseling includes two variables pertaining to a sense of estrangement or unhappiness while they were growing up: Unhappiness in Adolescence (B=.14) and Felt Different from Other Girls in High School (B=.11). The path model for the nontherapy group contains no comparable measures.
Finally the path model for the women who had been in therapy or counseling includes two variables pertaining to an unhappy recollection of the mothers: Negative Relationship with Mothers (t.e. = .24) and Unpleasant Mother (t.e. = .22). The nontherapy group on the other hand, appear to have been slightly more influenced by their fathers. Their path shows significant — but weak — paths from Weak Father (t.e. = .20), Aloof Father (t.e. = .14), Controlling Father (t.e. = -.10), and Mother Dominated Father (t.e. = .14). Otherwise, the differences between the women in therapy or counseling and those with no such experience show little pattern.

In the path analysis procedure used in Bell et al’s research, the “t.e.” you see repeated throughout this passage refers to the “total effect” of one variable on another, in this case sexual preference. Think of it as a measure of the strength of effect of each variable mentioned and sexual orientation, with the larger numbers representing a larger effect. While there are many points we could discuss here, the primary reason for this series is to examine the possibility that multiple paths exist which yield the direction of sexual attractions. A practical implication is that therapists who frequently counsel those who are seeking help probably get a skewed picture of same-sex attracted people in general. Another implication is the effects noted by the reparative drive theorists are not huge and must rely on other pre- and post-natal factors. Also, those who take a solely biological perspective should expand the complexity of their model to consider that the sexual behavior of some people are influenced by certain environment experiences.
The next posts in this series will include additional research as well as more results from Bell et al. Some research does find differences between gay and straight groups on developmental recollections. What do these differences mean? Stay tuned…

Did Masters and Johnson fake the gay change cases?

Lots of stuff today…
Here is something worth looking into; a new book by Thomas Maier questions the claims of Masters and Johnson that 70% of their homosexual clients changed orientation.
John Tierney’s blog points to an article in Scientific American by Maier which summarizes the topic.

Back in 1979, on Meet The Press and countless other TV appearances, Masters and Johnson touted their book, Homosexuality in Perspective—a 14-year study of more than 300 homosexual men and women—hoping to build on their groundbreaking sex studies of heterosexuals that had helped ignite America’s sexual revolution. The results seemed impressive: Of the 67 male and female patients with “homosexual dissatisfaction,” only 14 failed in the initial two-week “conversion” or “reversion” treatment. (The 12 cases of attempted “conversion” were for men and women who had always believed they were homosexual and were troubled by it, while the 55 “reversion” cases were in people who believed their homosexuality was more fleeting.) During five years of follow-up, their success rate for both groups was better than 70 percent.
But were Masters and Johnson’s claims of “conversion” in those 12 cases — nine men and three women — even true?

This is an important question given the reputation of Masters and Johnson. Numerous conversion therapy groups have referred to their work as evidence of change (e.g., this Narth paper).
There’s more:

Prior to the book’s publication, doubts arose about the validity of their case studies. Most staffers never met any of the conversion cases during the study period of 1968 through 1977, according to research I’ve done for my new book Masters of Sex. Clinic staffer Lynn Strenkofsky, who organized patient schedules during this period, says she never dealt with any conversion cases. Marshall and Peggy Shearer, perhaps the clinic’s most experienced therapy team in the early 1970s, says they never treated homosexuals and heard virtually nothing about conversion therapy.
When the clinic’s top associate, Robert Kolodny, asked to see the files and to hear the tape-recordings of these “storybook” cases, Masters refused to show them to him. Kolodny—who had never seen any conversion cases himself—began to suspect some, if not all, of the conversion cases were not entirely true. When he pressed Masters, it became ever clearer to him that these were at best composite case studies made into single ideal narratives, and at worst they were fabricated.
Eventually Kolodny approached Virginia Johnson privately to express his alarm. She, too, held similar suspicions about Masters’ conversion theory, though publicly she supported him. The prospect of public embarrassment, of being exposed as a fraud, greatly upset Johnson, a self-educated therapist who didn’t have a college degree and depended largely on her husband’s medical expertise.
With Johnson’s approval, Kolodny spoke to their publisher about a delay, but it came too late in the process. “That was a bad book,” Johnson recalled decades later. Johnson said she favored a rewriting and revision of the whole book “to fit within the existing [medical] literature,” and feared that Bill simply didn’t know what he was talking about. At worst, she said, “Bill was being creative in those days” in the compiling of the “gay conversion” case studies.

Being creative? One member of the M&J team had no first hand knowledge of the results and wanted to back away from the claims. I would say this is a significant problem.
Maier continues:

Until he died in 2001 Masters felt confident their book would be embraced eventually by the medical community, not just by purveyors of religious or political agendas. He believed the prospect of “conversion” therapy offered more hope, more freedom to patients than psychoanalysis ever could. “The criticisms are based on old concepts,” Masters replied dismissively to the press. “We’re reporting on 10 years of work with five years of follow-up—and it works.”
But despite his claims, the success of Masters’s “gay conversion” therapy have never been proved.

It will be interesting to see if any of the patients involved step forward…

Treatmentshomosexuality website open to positive experiences

Michael King, British psychiatrist and researcher, is behind a research wesbite called Treatmentshomosexuality.org.uk. The website’s purpose is stated up front:

The website is new and under development. It is about use of so-called “treatments” that aim to make homosexual people heterosexual. It arose from research funded by the Wellcome Trust from 2001 to 2004 into the oral history of such treatments in Britain since 1950.
Treatments to change a person’s sexuality are unethical and may be damaging. This is because homosexuality is NOT a disorder. Nor is there any evidence that any such “treatments” are effective. That is the reason why we collected a number of oral histories from lesbian, gay and bisexual (LGB) people who had undergone therapy. We also collected oral histories from professionals who had developed and conducted the treatments. We wanted to know how patients had coped with the potentially damaging effects of “treatment” and whether the professionals had eventually realised the harm they were doing.
On this website you will find some of the oral histories that arose from that research. We have not put all the narratives here; rather we have included only those that show particular issues and that are the most revealing of how treatments were conducted. To read them click on the Narratives button and then on Patient Story or Professional Story. You can also read about and listen to views about such treatments on the Interviews page.
We are eager to make contact with other people around the world who may have undergone these “treatments”. Unfortunately, we are aware that many lesbian, gay and bisexual people have undergone psychotherapy, aversion behaviour therapy, or various forms of spiritual or reparative therapy, to try to become heterosexual. This may have happened to you or be happening to you now. You may even be a friend or relative of someone who has received or is receiving treatment. If so, we would like you to send us your story.
We are also eager to hear from professionals, be they doctors, psychotherapists, counsellors or psychologists, who may have undertaken these treatments at any time in their career. Please send us your accounts of giving these therapies and what you think about them now.
You can do this by contacting us with a written account, or an audio or video digital recording of your account. If it is suitable we shall edit it to ensure it is anonymous and will not cause offence to third parties. We shall then add it to the stories already on this website.
In particular, we want to hear from people living in places such as India, South America and China where much less research into these matters has been conducted.

With this tone and content on the front page, one might be surprised to learn that the research team is also interested in positive experiences in change therapy. Yesterday, Dr. King disclosed this apparent shift in response to a question from commenter Peter Ould. Ould asked, “Would you be amenable to using your website here to also post anecdotal stories of those who have had positive experiences of reparative therapy or other faith-based pastoral approaches?”
To which, Dr. King replied:

And yes, we will place positive accounts of treatments on the website. When we conducted our original oral history research, we couldn’t find any. However, we did find professionals who continued to advocate treatments and their comments were published in our papers in the British Medical Journal and on our website.

This research effort seems to be going down a similar road as did Ariel Shidlo and Michael Schroeder. When Shidlo and Schroeder began recruiting subjects for their study of harm from reorientation, they began with the project titled: “Homophobic therapies: Documenting the damage.” They changed their focus somewhat after some people presented with stories of benefit. A similar course may be in store for this newer effort.
To be clear, I am not posting this because I favor change therapies. I think there are some people who have experienced change to varying degrees, but I also think that if you are going to research a topic, you should minimize confirmation bias to the greatest degree possible. If it was my project, I would make the website more neutral and also hold out an invitation to clients and therapists who are/were involved in sexual identity therapy.
It will be interesting to follow this project…

Reorientation therapies in the UK: Survey results

A new survey from BMC Psychiatry found that 4-17% of therapists surveyed offer some form of therapy designed to reduce homosexual attractions.
From the article in the BBC News:

A significant minority of mental health professionals had agreed to help at least one patient “reduce” their gay or lesbian feelings when asked to do so.
The survey, published in the journal BMC Psychiatry and conducted by London researchers, involved 1,400 therapists.
Many were acting with the “best of intentions”, said the lead author.
Only 4% said they would attempt to change a client’s sexual orientation, but when asked if they would help curb homosexual feelings some 17% – or one in six – said they had done so.
The incidence appeared to be as prevalent in recent years as decades earlier.

Here is the abstract from the journal article:

Background
We know very little about mental health practitioners’ views on treatments to change sexual orientation. Our aim was to survey a representative sample of professional members of the main United Kingdom psychotherapy and psychiatric organisations about their views and practices concerning such treatments.
Methods
We sent postal questions to mental health professionals who were members of British Psychological Society, the British Association for Counselling and Psychotherapy, the United Kingdom Council for Psychotherapy and the Royal College of Psychiatrists. Participants were asked to give their views about treatments to change homosexual desires and describe up to six patients each, whom they have treated in this way.
Results
Of 1848 practitioners contacted, 1406 questionnaires were returned and 1328 could be analysed. Although only 55 (4%) of therapists reported that they would attempt to change a client’s sexual orientation if one consulted asking for such therapy, 222 (17%) reported having assisted at least one client/patient to reduce or change his or her homosexual or lesbian feelings. 413 patients were described by these 222 therapists: 213 (52%) were seen in private practice and 117 (28%) were not followed up beyond the period of treatment. Counselling was the commonest (66%) treatment offered and there was no sign of a decline in treatments in recent years. 159 (72%) of the 222 therapists who had provided such treatment considered that a service should be available for people who want to change their sexual orientation. Client/patient distress and client/patient autonomy were seen as reasons for intervention; therapists paid attention to religious, cultural and moral values causing internal conflict.
Conclusions
A significant minority of mental health professionals are attempting to help lesbian, gay and bisexual clients to become heterosexual. Given lack of evidence for the efficacy of such treatments, this is likely to be unwise or even harmful.

Going a little deeper into the study, it appears that some of the efforts designated as change might not be direct efforts to change after all. Consider some reasons given for what is labeled by the authors as support for change efforts:

“…where someone had a strong faith, then working to help the person accept their feelings but manage them appropriately may be the best approach if (the) person felt they would lose God and therefore their life was not worth living.”
“Some bisexual individuals may wish to choose an orientation that is
comfortable for them and their lifestyle choices for example. This is a
therapeutic issue to explore and support if that is their wish. It is different from behavioural attempts to reshape desire.”
“Yes, possibly those within marriages that wish to continue with that
relationship rather than break up”

Rather, these therapists give what sound like client-centered responses based on the individual circumstances of the clients. I wonder if the authors of this article may have pushed these responses into either change or gay affirming camps without considering a third more neutral position – what Mark Yarhouse and I call sexual identity therapy.
Most of the other comments relied on a belief that therapists should follow the wishes of the client. This seems reasonable if the client is informed that change is infrequent at best and we do not know going in who might shift and by how much. Also, it is necessary to provide prospective clients with accurate information regarding homosexuality without regard to the ideological loyaties of the therapist. Also, it seems clear that non-homosexually identified people experience same-sex attraction. Helping them sort out their particular situation and arrive and a value-congruent position is not the same thing as reparative or reorientation therapy.
The authors paint a picture of 1 in 6 therapists engaging in change therapy and I think that is misleading. The 4% figure seems like the right number of therapists who deliberately promote change among their same-sex attracted clients.

PANDAS article in the Christian Post

The Christian Post has published my feature on PANDAS – Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococci.
There are some great quotes from Susan Swedo, MD, who is often credited with discovering the relationship between psychiatric symptoms and strep throat. I don’t say much about it but I also report some new research regarding the mechanism of action for the strep antibodies in the brain. Crosswalk.com will put it up next week.