sexual identity therapy – Page 10

Spontaneous change compared to therapeutically mediated change

Something has been bothering me, running around in my head since I did the brief series of posts on Dean Byrd’s review of LDS book, In Quiet Desperation (here, here and here).

In their review of Ty Mansfield’s book, Byrd et al make this statement:

The book inadvertently limits the power of the Atonement in the lives of people who struggle with homosexual attraction. As professionals with many combined years of practice in treating those with unwanted homosexual attraction, we have witnessed changes in the lives of many of these individuals, and the epiphanies have been many.

Like all emotional challenges, the outcome data has ranges of success. What is clear is that when the same standard applied to treatment outcomes of similarly situated difficulties is applied to the treatment outcomes of those with unwanted homosexuality, the results are remarkably similar. There is much in the professional treatment protocols that are compatible with the restored gospel. Appropriate professional help along with the healing powers of the gospel have repeatedly convinced us that there is no struggle for which the Atonement is not sufficient.

There are several things that bother me about these two paragraphs, but for now I want to focus on this sentence:

What is clear is that when the same standard applied to treatment outcomes of similarly situated difficulties is applied to the treatment outcomes of those with unwanted homosexuality, the results are remarkably similar.

Despite a claim of clarity, nothing is particularly clear to me about treatment outcomes for “unwanted homosexuality.” It is not clear to me what other conditions are “similarly situated” in comparison to same-sex attraction. This was not explained.

However, my thoughts about outcomes ran to the studies reported in the NARTH literature review of sexual reorientation, the Jones and Yarhouse study and the usual reparative therapy contention that change results were along a continuum – one-third dramatically changed, one-third somewhat changed and one-third not changed. However, whatever numbers one likes, one cannot put it in context without a control or comparison situation. Another term for this in this context is spontaneous remission. Don’t some people change in various ways for reasons unrelated to therapy?

Certainly that is the case for other situations which are the proper focus of therapy. Note this abstract for a study of improvement rated by patients at a community mental health center in Utah.

It was hypothesized that outpatient psychotherapy in a mental health center would result in an improvement rate of 65% or more, a spontaneous remission rate of 36% or less, and a difference of at least 29% from gain in improvement due to therapy. The analysis of 201 follow-up questionnaires supported all three hypothesis. A five-year follow-up questionnaire provided evidence for external validity in the form of a correlation between original improvement rate and subsequent need for outpatient treatment and inpatient treatment. The results were interpreted as being significant evidence for the efficacy of psychotherapy and for the validity of self-report method of measuring improvement and spontaneous remission.

Note that the rate of improvement was significantly higher than expected based on a spontaneous improvement rate of 36% or less. The authors had reasons to predict this rate and took it into account when assessing the meaning of a 65% improvement rate overall.

My point is not to compare sexual reorientation to mental health improvement near Salt Lake City, Utah. However, I want to raise the issue that considering spontaneous improvement is important when one is communicating the meaning of changes reported without a control group. There are a couple of studies which have looked at spontaneous change, although none would be directly comparable to any current studies of sexual reorientation. Diamond found spontaneous change in her study of 100 women. In 2005, Kinnish, Strassburg and Turner reported varying levels of sexual orientation flexibility in the Archives of Sexual Behavior. Their report found that 19% of men and 17% of women in their sample moved in a heterosexual direction (from gay to bisexual, or bisexual to straight — none went from exclusively gay to exclusively straight). In 2003, Dickson, Paul and Herbison reported spontaneous change in a New Zealand cohort. The chart of movement can be viewed here. Note that 5 of 15 went from some same-sex attraction to only heterosexual attraction and none from “major attraction to the same sex” to straight.

While these studies are suggestive, they cannot be directly compared to existing studies of sexual reorientation. However, the fact that some men with some same-sex attraction and many women might shift spontaneously should be taken into account when thinking about the role of therapy in mediating sexual orientation change.

The Dickson study is intriguing in that the results can be interpreted as supporting the existence of different types of homosexual orientation. About their results, the authors note in the abstract:

These findings show that much same-sex attraction is not exclusive and is unstable in early adulthood, especially among women. The proportion of women reporting some same-sex attraction in New Zealand is high compared both to men, and to women in the UK and US. These observations, along with the variation with education, are consistent with a large role for the social environment in the acknowledgement of same-sex attraction. The smaller group with major same-sex attraction, which changed less over time, and did not differ by education, is consistent with a basic biological dimension to sexual attraction. Overall these findings argue against any single explanation for homosexual attraction.

To me, this is a reasonable hypothesis. I believe there are multiple pathways to adult sexual orientation and for some, apparently the social context means more than for others. Also, for some the trait may continue to shift around through life with changing circumstances, yet for others, not at all.

UPDATE: In an odd attack piece, the gay website Queerty reads this post (actually the Crosswalk version) as a kind of strange defense of change therapies or change of orientation in general. A commenter named Timothy (is it our Timothy?) gets the point, but whoever writes for them and the commenters thus far over there are clueless.

Christianity Today on evangelical divide over reparative therapy

Christianity Today has an article out online today which covers familiar ground to readers here.

Written by Bobby Ross, the article notes the divisions over reparative therapy which have been accentuated by the recent APA report on sexual orientation and therapy.

No surprise here: Evangelical leaders who advocate gay reparative therapy took umbrage at a highly publicized American Psychological Association (APA) resolution that criticized such efforts.

By a 125-4 vote, the 150,000-member association’s governing council adopted a task force report in August claiming a lack of evidence that efforts to change one’s sexual orientation work.

One aspect of the 138-page resolution, however, drew praise from some Christian psychologists—and exposed a divide in the evangelical therapy community.

As we discuss here often, modest change in orientation has been reported but, in my opinion, the change paradigm for therapy and ministry is old school.

Warren Throckmorton, a counselor who believes that the Bible prohibits homosexuality, commended the task force for “clarifying the value of helping clients sort out their beliefs and work out an identity and life that fit within the clients’ beliefs.”

A one-time proponent of sexual reorientation efforts, Throckmorton said he spoke up until 2004 at conventions of the National Association for Research and Therapy of Homosexuality (NARTH). But the Grove City College psychology professor has come to believe that changing a person’s sexual orientation is at best difficult.

Rather than focusing on reparative therapy, he has embraced “sexual identity therapy,” which focuses on helping a person live in a way that is consistent with his or her beliefs.

My issues with reparative therapy involve the lack of research support for the basic perspectives on the formation of same-sex attraction as well as the paucity of robust demonstrated outcomes.

“The reparative side sees the objective as healing the trauma [of family dysfunction] and thus curing the homosexuality,” said Throckmorton, former president of the American Mental Health Counselors Association. “The sexual identity side doesn’t see the efficacy of that approach and doesn’t think change is necessary in order to help people live in congruence with their faith.”

Ross then addresses the Jones and Yarhouse study and notes Mark Yarhouse’s views on change and therapy paradigms.

Yarhouse says more Christian psychologists are providing sexual identity therapy rather than reparative therapy. He recommends “a range of options” to help believers make sense of their sexual and religious identities.

“I don’t want to discourage people from making that attempt [to change orientation],” he said. “But for most of those people, success will not be a categorical shift from gay to straight. The gains will likely be modest, more along a continuum.”

As co-author of the Sexual Identity Therapy Framework, Mark offers a balanced view of the landscape. Most of the people who consider Exodus a success have a story of congruence with their faith than tell a story of some degree of change in their sexual arousal patterns.

Alan Chambers weighs in with more of the reparative therapy side of the divide.

Alan Chambers, president of Exodus International, said it is wrong to assert that sexual orientation cannot change as a result of therapy.

“That flies in the face of the testimonies of tens of thousands of people just like me,” said Chambers, a married father of two who credits God and counseling for helping him leave a homosexual lifestyle. “That’s not to say that you can flip a switch and go from gay to straight.”

Finally, NARTH’s David Pruden worries that the APA report will keep people from trying to change.

David Pruden, vice president of operations for NARTH, said the APA’s resolution likely will not affect how Christian psychologists counsel. He voiced concern, though, about its impact on potential clients.

“[This] could discourage individuals from even seeking assistance or entertaining the thought that growth or change is possible,” he said.

Well, if the proper information is disclosed to people, I doubt they will not seek assistance. However, if therapists practice in accord with the SIT Framework and recent APA guidance, they will not experience over promising or be directed to developmental theories which may not fit their lives.

New SIT Framework website and list

Late Friday afternoon might not be the best time to post this but…

I want to announce the new Sexual Identity Therapy Framework website and invite people to join the SIT Framework list serv.

Here is the listserv portal:

Click to join sexualidentitytherapy

The discussions will be geared primarily to mental health professionals but interested ministry leaders and others may find them to be of value. There may be some overlap with the blog but there will be unique material as well.

Social psychologist David Myers opines on APA report in Wall Street Journal

The Wall Street Journal invited Hope College social psychologist David Myers to write a column regarding the APA task force report on appropriate therapeutic responses to sexual orientation. Dr. Myers is the author of several books, including the text I use in teaching the social psychology class at GCC. I highly recommend the text, as well as his book on Happiness.

Here is a taste of the article:

Applause for the APA’s sensitivity to religious diversity has come from previously opposing sides within evangelicalism. Psychotherapist Ralph Blair, the founder of Evangelicals Concerned, the gay-supporting “national network of gay and lesbian evangelical Christians and friends,” welcomes APA’s “clear rejection of ‘reparative therapy.’?” But he also welcomes its openness to supporting homosexual people “who nonetheless think that it’s wrong for them to act on their same-sex desires.” Grove City College psychologist-blogger Warren Throckmorton, who supports those who want to control same-sex attractions and reject a gay identity, sees hope for “a larger middle and smaller numbers of people at the opinion extremes. People on both sides, he says, “can agree that erotic responsiveness is extremely durable.”

That last line you read here first.

Dr. Myers takes a pro-gay marriage position in this piece which will not set well with social conservatives, but I do think he is correct about the increasing number of issues where some common ground can be found.

I think Myers makes a good observation picking up on Focus on the Family’s language, “the aim is ‘to steward their impulses in a way that aligns with their faith convictions.’” This is the kind of language which reflects the congruence model and which I see more and more from Focus and Exodus.

Blog post at US News & World Report: Does the APA advise a church switch?

Here’s the blog post over at Dan Gilgoff’s US News and World Report blog, God and Country.

The backdrop: The initial article about the APA sexual orientation and therapy report to hit the wire was by David Crary at the AP. However, some (many?) papers truncated the article in such a way that it seemed as though the APA was recommending either celibacy or a church switch as a way to resolve sexual orientation conflict.

Not long afterwards, OneNewsNow picked up that point and ran with it. From the US News blog post:

A news report from OneNewsNow, the information arm of the American Family Association, said the APA report “suggests that if a person with same-gender attractions has problems because of their religious beliefs, they should just change churches.” About the APA report, spokesperson for the National Association for the Research and Therapy of Homosexuality (NARTH) and executive director of Evergreen International, a ministry to homosexuals of the LDS Church, David Pruden, told OneNewsNow:

“The suggestion was as a Christian, when your conscience comes in conflict with what’s going on in your life — temptations, attractions, concerns, whatever they happen to be — that what you simply do is jettison your standards so that it becomes easier to live with your temptations.”

Both OneNewsNow and Mr. Pruden stand by their statements. But is it accurate to say that the APA report advises that conflicted people switch churches or “jettison” beliefs?

Of course it is not accurate. In the US News & World Report post, I quote Rhea Farberman who directly denies the claim. I then quote from the APA report which finds benefit in social support groups even if not gay affirming.

This is not to say that the APA discourages someone from changing churches if the client feels it is best. I suspect this goes in any direction. For instance, a client might decide to leave a gay affirming church if this seemed more in keeping with identity development. According to this report, psychologists would not try to prevent such a move, but neither would they encourage it.

I approached both NARTH and OneNewsNow with no change.