sexual identity therapy – Page 13

Sexual identity therapy: A blast from the past

In light of conversations on the Exodus-PFOX thread, I thought it might be good to review a past mainstream media article that brought SIT more into the mainstream conversation.

The LA Times article now titled “Approaching agreement in debate over homosexuality” by Stephanie Simon (now with the Wall Street Journal) was published on June 18, 2007 with the title, “New ground in debate on ‘curing’ gays.”

The article begins with some familiar ground to this blog:

Alan Chambers directs Exodus International, widely described as the nation’s largest ex-gay ministry. But when he addresses the group’s Freedom Conference at Concordia University in Irvine this month, Chambers won’t celebrate successful “ex-gays.”

Truth is, he’s not sure he’s ever met one.

With years of therapy, Chambers says, he has mostly conquered his own attraction to men; he’s a husband and a father, and he identifies as straight. But lately, he’s come to resent the term “ex-gay”: It’s too neat, implying a clean break with the past, when he still struggles at times with homosexual temptation. “By no means would we ever say change can be sudden or complete,” Chambers said.

His personal denunciation of the term “ex-gay” — his organization has yet to follow suit — is just one example of shifting ground in the polarizing debate on homosexuality.

I am not sure if I am correct, but I think Alan later nuanced the remarks about not knowing ex-gays, but I do think he has made efforts including the recent article regarding Bryce Faulkner, to paint an accurate picture of his personal situation.

This article brought to a wide audience conversations that we have been having here for quite awhile — and continue to have. The ex-gay conversation is a recurring one here. Some newer readers may want to review this post (Ex-ex-gay?) and this one ( What does change mean?) and this one (Acceptance and Commitment Therapy).

The LA Times article quoted several people who approved of the framework, including commenter Michael Bussee.

“Something’s happening. And I think it’s very positive,” agreed Michael Bussee, who founded Exodus in 1976, only to fall in love with another man — a fellow ex-gay counselor.

Now a licensed family therapist in Riverside, Bussee regularly speaks out against ex-gay therapies and is scheduled to address the Ex-Gay Survivor’s Conference at UC Irvine at the end of the month.

But Bussee put aside his protest agenda recently to endorse new guidelines to sexual identity therapy, co-written by two professors at conservative Christian colleges.

Other notable folks gave a thumbs-up to the framework as well.

He and other gay activists — along with major mental-health associations — still reject therapy aimed at “liberating” or “curing” gays. But Bussee is willing to acknowledge potential in therapy that does not promise change but instead offers patients help in managing their desires and modifying their behavior to match their religious values — even if that means a life of celibacy.

“It’s about helping clients accept that they have these same-sex attractions and then allowing them the space, free from bias, to choose how they want to act,” said Lee Beckstead, a gay psychologist in Salt Lake City who uses this approach.

The guidelines for this type of therapy — written by Warren Throckmorton of Grove City College and Mark Yarhouse of Regent University — have been endorsed by representatives on both the left and right. The list includes the provost of a conservative evangelical college and the psychiatrist whose gay-rights advocacy in the 1970s got homosexuality removed from the official medical list of mental disorders.

“What appeals to me is that it moves away from the total polarization” common in the field, said Dr. Robert Spitzer, the psychiatrist.

“For many years, mental-health professionals have taken the view that since homosexuality is not a mental disorder, any attempt to change sexual orientation is unwise,” said Spitzer, a Columbia University professor.

Some therapies are widely considered dangerous, and some rely on discredited psychological theories. “But for healthcare professionals to tell someone they don’t have the right to make an effort to bring their actions into harmony with their values is hubris,” Spitzer said.

Just over two years later, we continue to discuss very similar concerns and the tension remains.

Activists on both sides caution that the rapprochement only goes so far.

Critics of Exodus note the group still sponsors speakers who attribute homosexuality to bad parenting and assert that gays and lesbians live short, unhappy lives.

And though Chambers has disavowed the term “ex-gay,” his group’s ads give the distinct impression that it’s possible to leave homosexuality completely behind.

Haven’t we just been discussing this topic?

The article concludes with a reference to the APA Sexual Orientation Task Force.

The American Psychological Assn. set up a task force this spring to revise the group’s policy on sexual orientation therapy. The current policy is a decade old and fairly vague; it states that homosexuality is not a disorder and that therapists can’t make false claims about their treatments.

The new policy, due early next year, must help psychologists uphold two ethical principles as they work with patients unhappy about their sexuality: “Respect for the autonomy and dignity of the patient, and a duty to do no harm,” said Clinton Anderson, the association’s director for lesbian, gay and bisexual concerns. “It’s a balancing act.”

In fact, the Task Force will report soon, in August, sometime during the APA convention. Stay tuned…

Although we will soon migrate the website, more on the SIT Framework is now here.

Sexual abuse and the perception of children: Jerome Kagan and The Nature of the Child

In graduate school, I read and thoroughly enjoyed Jerome Kagan’s The Nature of the Child. I have excerpted the beginning of chapter 7 below as a means of continuing the conversation about the relevance of childhood events for sexuality. This chapter is titled, “The Role of the Family” and the excerpt comes from pages 240-242.

I have said little about the influence of experience on the child, especially the consequences of parental behavior. The most important reason for this omission is that the effects of most experiences are not fixed but depend upon the child’s interpretation. And the interpretation will vary with the child’s cognitive maturity, expectations, beliefs, and momentary feeling state. Seven-year-old boys who are part of a small isolated culture in the highlands of New
Guinea perform fellatio regularly on older adolescent males for about a half-dozen years; but this behavior is interpreted as part of a secret, sacred ritual that is necessary if the boy is to assume the adult male role and successfully impregnate a wife (Herdt, 1981). If an American boy performed fellatio on several older boys for a half-dozen years, he would regard himself as homosexual and possess a fragile, rather than a substantial, sense of his maleness.
Children growing up in Brahmin families in the temple town of Bhubaneswar in India hear their mothers exclaim each month, “Don’t touch me, don’t touch me, I’m polluted.” These children do not feel rejected or unloved, because they know this command is a regular event that occurs during the mother’s menstrual period (Shweder, in press). And a small proportion of American children, whose affluent parents shower them with affection and gifts out of a desire to create in them feelings of confidence and self-worth, become apathetic, depressed adolescents because they do not believe they deserve such continuous privilege.
As these examples make clear, the child’s personal interpretation of experience, not the event recorded by camera or observer, is the essential basis for the formation of and change in beliefs, wishes, and actions. However, the psychologist can only guess at these interpretations, and the preoccupations and values of the culture in which the scholar works influence these guesses in a major way. For example, Erasmus (1530), who believed the child’s appearance reflected his character, told parents to train the child to hold his body in a controlled composure – no furrowing of brows, sagging of cheek, or biting of the lip, and especially no laughter without a very good cause.
Educated citizens in early sixteenth-century London, who were disturbed by the high rate of crime, begging, and vagrancy among children of the poor, blamed the loss of a parent, living with lazy parents, being one of many children, or a mental or physical handicap. These diagnoses ignored the possible influence of genetics, parental love, or social conditions existing outside the home. Two centuries later, a comparable group of English citizens concerned with identical social problems, but still without any sound facts, emphasized the influence of the love relation between mother and child (Pinchbeck and Hewitt, 1969 and 1973).
Many contemporary essays on the influence of family experience also originate in hunches, few of which are firmly supported by evidence. This is not surprising; the first empirical study to appear in a major American journal that attempted to relate family factors to a characteristic in the child was published less than sixty years ago in The Pedagogical Seminary (Sutherland, 1930). The fact that a hunch about the role of family originates in a society’s folk premises about human nature does not mean that it is incorrect. Eighteenth-century French physicians believed that a nursing mother should bathe the baby regularly and not drink too much wine – suggestions that have been validated by modern medicine. But those same doctors also believed – mistakenly, I suppose – that cold baths will ensure a tough character in the older child. The absence of conclusive evidence means that each theorist must be continually sensitive to the danger of trusting his or her hunches too completely, for at different times during the last few centuries of European and American history, the child has been seen as inherently evil, or as a blank tablet with no special predispositions, or, currently, as a reservoir of genetically determined psychological qualities. Modern Western society follows Rousseau in assuming that the infant is prepared to attach herself to her caregiver and to prefer love to hate, mastery to cooperation, autonomy to interdependence, personal freedom to bonds of obligation, and trust to suspicion. It is assumed that if the child develops the qualities implied by the undesirable members of those pairs, the practices of the family during the early years – especially parental neglect, indifference, restriction, and absence of joyful and playful interaction – are major culprits.
I cannot escape these beliefs which are so thoroughly threaded through the culture in which I was raised and trained. But having made that declaration, I believe it is useful to rely on selected elements in popular theory, on the few trustworthy facts, and on intuition in considering the family experiences that create different types of children, even if my suggestions are more valid for American youngsters than for those growing up in other cultures.

Kagan refers to Gilbert Herdt’s book, Guardians of the Flutes, published in 1981 which describes the masculinity rituals of the Sambian tribe (not the actual tribal name) in Papua New Guinea. Essentially the tribe “believes” boys become men by ingesting the semen (“male milk”) of older boys. And of course, by the teen years, it “works” and the boys attain manhood. At that point, the vast majority of males choose a female partner.
Kagan’s reference to this practice reminds us that these experiences are embedded in a culture. In our own, such experiences would not be normalized and contextualized as a contributing to masculinity but rather detracting from it.
I cannot improve on Kagan’s description of his thesis. He is a gifted writer. However, I will elaborate for sake of discussion. He proposes that perception drives the psychological impact of a given experience. How differing perceptions effect the development of sexuality seems to me to be highly individualistic. Thus, for some, sexual maltreatment might push an essentially heterosexual person toward same-sex preoccupations. For others, abuse might strengthen the budding heterosexual impulses toward heterosexual preoccupations. For others, the abusive events may have no effect on attractions but rather influence attachment security. My point here is not to describe all possible trajectories, but rather to illustrate the potential of many variations.
A related point made by Kagan is that our culture looks at parenting as causative of adult personality. I believe many people do not question this assumption. In the last several years, I have looked for data to support or contradict it. I find little support that individual personality traits or conditions are strongly related to particular family dynamics. However, some broad trends can be observed. Fatherlessness is associated with a variety of problems in children and society. However, not having a father around may be interpreted in different ways by different children. For some, having the wrong kind of father around might lead to anti-social behavior. Thus, simply isolating childhood variables and relating them to adult outcomes is insufficient. These points are often lost on reparative therapists and other advocates who want to reduce homosexuality to a set of family dynamics or childhood experiences. On the other hand, biological determinists err on the side of discounting these social experiences as potentially influential for some people.
A satisfying position to me is to consider homosexual behavior to be determined by different factors in different ways for different people. For some, there is a very early awareness of romantic and sexual attraction for the same-sex independent of any trauma or parenting actions. For others, trauma and poor parenting occur but the same-sex attractions appeared prior to these unhappy events. For yet others people, the unhappy experiences may serve to create a disconnect between impulse to same-sex behavior and internal desire and attraction which may be toward the opposite sex. While these complexities create PR problems for culture warriors on both sides, I believe we must recognize the existence of multiple pathways to adult sexuality if we are to be true to the data and experience.

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…

Blog in the news: Sacramento Bee article on ex-gay programs

Yours truly is quoted in this article by Ed Fletcher on a Sacramento area Exodus ministry. Alan Chambers is also quoted as is Greg Herek. Chambers reflects on his experience:

Chambers said he grew up in the church, but as an adolescent discovered he was attracted to men. As a young adult he had relations with men. He said he found a church that would accept him and led him to the Exodus ministry.
He said for him temptation still exists, but he no longer wants to act on those feelings, has been happily and faithfully married for 11 years, and has two children.
“That is success for me. Not heterosexuality, so to speak,” Chambers said, “but a life that is congruent with my faith.”

Of course, the last sentence is music to my sexual-identity-therapy ears – at least coming from one (Mr. Chambers) who embraces Evangelical Christianity. I should take care to say that sexual identity therapy recognizes that the value direction of sexual identity work comes from the client. For Alan, given his core commitment to Christianity, this was the option that fit him best.
Others of course, do not find the same outcome.

Jacques Whitfield, a Sacramento attorney, said he tried for years to squelch his homosexual feelings and attended meetings with the group at Sunrise Community Church in Fair Oaks. Finally, he decided he couldn’t change.
“I was in the program because I wanted to do what is right. I wanted to preserve my family,” said Whitfield, who is the new board chairman of the Sacramento Gay and Lesbian Center. “And if this was a choice, I could choose not to be gay.”
Whitfield was married for 11 years and spent much of that time trying, with the help of the church, to resist his attraction to men.
“The people who run the program are well-meaning,” he said. “They love God and they want to do the right thing.”
“I don’t believe that sexual orientation is a choice,” Whitfield said. “I think you can abstain, but that doesn’t make you straight.”

The Mr. Fletcher brings in the professors.

Psychologists disagree that you can change sexual orientation.
“It’s maybe among the most controversial subjects you could bring up,” said Dr. Warren Throckmorton, an associate professor of psychology at Grove City College in Pennsylvania.
While some studies suggest people have happily changed, others chronicle harmful psychological effects of trying to change sexual orientation.
Throckmorton, who blogs about sexual identity at wthrockmorton. com, said he allows clients to set their own course. Throckmorton said research that relies on self-reported data isn’t conclusive.
Some people will report changing their sexual orientation through some form of counseling or therapy, but that doesn’t mean it actually worked or that trying it is worth the effort, said Gregory Herek, a professor of psychology at the University of California, Davis.
“Being gay is a perfectly normal sexual orientation,” Herek said.

Reading the comments section of this article, I am re-instructed in the role of observer bias. Several commenters take Mr. Fletcher to task for being too hard on religion, and then in the same thread, several others say he is too easy on archaic religious views.

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…