homosexuality – Page 9 – Warren Throckmorton

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.

Shame and attachment loss: Reparative therapy and father-son estrangement

Picking up the narrative on the new book from Joseph Nicolosi, Shame and attachment loss: The practical work of reparative therapy, I want to focus on the family dynamics Nicolosi proposes to be at the source of male homosexuality. There are two basic types of family soil which Nicolosi believes grows some same-sex love: the “classic-triadic family” and the “narcissistic family.” If you are looking for the “relatively-normal-often-happy family” in this book, you won’t find it. According to Nicolosi, they don’t produce same-sex attracted men.

In the classic triadic family, the boy “experiences the father as an unsafe/unworthy object of identification,” mothers are “over-involved, intrusive, possessive and controlling,” and the sons are “temperamentally sensitive, timid, passive, introverted, artistic (!), and imaginative.” The result is that the mother and father do not have a good relationship, the father is distant and/or hostile with the son, the son avoids masculine play, the father fails to bring out the son’s masculinity, the mother smothers the boy and robs him of his assertion.

The narcissistic family is worse, it seems to me. The parents are more into themselves than the children. The family is invested in looking good to the world but has many family secrets which must be protected at all costs. I could say more about this family but I will save that for another post. What I want to get to is Nicolosi’s concept of “shared delight.” He says same-sex attracted males didn’t have any of that with their fathers. In a section with the heading, “The ‘Delight-Deprived’ Boy,” Nicolosi expounds on the experiences he says same-sex attracted males missed.

In my search for the particular quality of father-son bonding that is fundamental to the development of the boy’s masculine identity, I have been led to what I call a “shared delight.” I am convinced that the healthy development of masculine identification depends on this phenomenon. This special emotional exchange should be between the boy and his father, although a father figure or grandfather may serve the purpose where no father is available. It is not a single event or one-time occurrence, but should characterize the relationship.

This particular style of emotional attunement is especially important during the critical time of gender identification. Homosexual men rarely if ever recall father-son interaction that includes activities that they both enjoy together. In this vital experience father and son share in the enjoyment (“delight”) in the boy’s success. (p.52).

Nicolosi then declares that homosexual men have great difficulty recalling childhood father-son times which were fun and exciting and which included success for the son. He stacks the deck a bit in favor of his thesis here by saying that gay men infrequently remember being coached by their fathers in an activity that “involves bodily activity or strength.” I say he stacks the deck because he is no doubt aware of research which finds a strong correlation between childhood gender nonconformity and adult homosexuality. While not true of all gay males, many do not remember such activities because neither father nor son liked those activities. And where dad did like them and son did not, it is often a sign of sensitivity that the dad did not force the son to pursue a sport for which the son has no interest or aptitude. An aspect of what Nicolosi defines as “shared delight” sounds like having fun playing sports or active games together.

He then gives an excerpt of Malcolm Muggeridge’s autobiography where he describes going to his father’s office.

When he saw me, his face always lit up, as it had a way of doing, quite suddenly, thereby completely altering his appearance; transforming him from a rather cavernous, shrunken man into someone boyish and ardent. He would leap agilely off his stool, wave gaily to his colleague…and we would make off together. There was always about these excursions an element of being on an illicit spree, which greatly added to their pleasure. They were the most enjoyable episodes in all my childhood. (Wolfe, 2003, p.26).

He then contrasts this depiction of father-son bliss with clinical tales of clients who were not delighted with their fathers.

When I read this section, I was reminded of stories my clients have told me about their fathers over the years. Most of those clients were straight, and many of those stories were sad and empty. People do benefit when they feel approved by their fathers and indeed people with clinical concerns often relate pain from their upbringing. Here again, Nicolosi seems to be oblivious to the fact that his clients are unhappy and experiencing various problems which bring them to counseling. That these men fail to remember happy office visits may not say anything generalizable to all gay men.

Then I also thought of an email exchange I had with a gay man who wanted to understand my positions on various issues related to sexual orientation. The man is well educated and was raised in the Catholic church. He also sought reparative therapy for several years in an effort to reverse his homosexuality. He eventually determined the effort was futile and accepted that he was attracted to the same sex and worked toward a resolution within his faith. I asked him what he remembered about his father and he wrote:

My father was probably one of the most honest men I ever knew. Being Italian, FAMILY was important and he showed his love by making sure that we did things as a family. We ate dinner together always and took many educational vacations. Dad was very handy with his hands and could fix almost anything around the house that “broke.” I often helped him when he needed a “third” hand. He was intelligent and hardworking. When I was young, he tried very hard to get me interested in sports and other traditionally “masculine” activities, etc., but I just wasn’t interested. So…what I was able to give him — something that he also valued — was being good in my studies, ultimately obtaining my Ph.D. He was very proud of me. When my mother was so rigid in her religious beliefs that she was not able to accept me as a “gay son,” it was my dear father who told me he loved me and who kept the family together.

Does this sound like a distant father and son? It is clear that this man loves his dad, knows his dad loved him and was proud of him and viewed him as a salient father. If we are to believe adult recollections as Nicolosi does when they come from unhappy men, then what keeps us from believing this man? If the reparative therapist complains that this man is in denial, I will respond that reparative therapist’s clients have been indoctrinated. Or perhaps a more neutral response would be to say that the therapist’s clients are correct and so is my email friend. In which case, perhaps “shared delight” is a feature of the child development of many fortunate boys, gay and straight, but has little, if anything, to do with eventual sexual attractions.

I emphasize attractions here because I do think a poor relationship with father could affect self-control and thus influence a person to gravitate to a more behaviorally promiscuous life, whether gay or straight. I also wonder if some men are so damaged by their fathers that they respond to any kindness and their sexual responses are guided and shaped by their emotional hunger. Although it is possible that father-deprived males compose some important share of the caseload at Nicolosi’s Thomas Aquinas Psychological Services, I do not believe the lion’s share of gay males who are not in therapy would describe their lives this way.

In fact, father-son estrangement is as universal as fathers and sons. Books and movies (note this website with this theme in 25 movies) use this theme constantly as it tugs at the experience of so many men, gay or straight. For a description of this estrangement from a straight male, see this book (I Thought We’d Never Speak Again) and especially the story of Paul Howerton (“There was nothing about his father that Paul wanted to emulate…”).

The next post will address more of the father-son issues raised by Nicolosi’s book and discuss the concerns I have about Christian groups ratifying them uncritically.

Shame and Attachment Loss: Going from bad to worse

Also read Fathers, Sons and Homosexuality for a father’s view of the reparative thesis.

Brain plasticity and sexual orientation: Wrapping up with a couple of experts

Earlier this month, I posted three times regarding an article by Neil and Briar Whitehead with the title, “Brain Plasticity Backs Up Orientation Change.” This is a wrap up for those posts to indicate that very little backs up the Whiteheads’ article.

I asked Adam Safron and Norman Doidge to comment about the Whitehead article. Dr. Doidge is the author of the book (The Brain that Changes Itself) misrepresented by the Whiteheads. As I noted in a previous post, the Whiteheads failed to cite Doidge completely and provided quotes which gave the incorrect impression of Dr. Doidge’s views. About sexual reorientation, Dr. Doidge pointed me to the correct passages in his book and wrote in an email:

Readers of all my actual quotes will see that I have made no comments on therapeutic techniques for changing sexual preference and plasticity in my book.

And of course, that is the problem with how the Whiteheads treated Doidge’s book. As I pointed out here, they provided only part of his quotes and failed to include what he actually said about sexual preferences, which was very little.

Adam Safron is a researcher at Northwestern University and the lead author of the article I often cite here titled, “Neural Correlates of Sexual Arousal in Homosexual and Heterosexual Men.” He read the Whitehead article and had several reactions, two of which I will share here. First, the Whiteheads say that changing sexual orientation and learning a musical instrument would be about the same.

Because of brain plasticity it’s quite possible that homosexuals can become more heterosexual and heterosexuals could become homosexual, though persistent work could be needed, about equivalent to learning a new musical instrument.

Safron’s reaction to this was to say, “There is absolutely no evidence for this statement.” However, in spite of no evidence, the Whiteheads press their case regarding musical lessons and sexual preference. They write:

Even if part of the brain is strongly associated with a particular sexuality it should be possible to change it. Stopping a sexual activity and avoiding stimulation of that brain region, and plunging into some other intense brain activity for months would lead to a diminishing of the intensity of that sexual response. Months is about the timescale of first significant change. That can be true for learning a musical instrument too!

To this proposition, Safron responded,

But the devil is in the details here. How large is the change? How permanent? People can frequently modify their behavior on short time-scales but find themselves going back to their old ways on longer time scales. These arm-chair speculations are no substitution for real studies actually looking at the efficacy of therapy designed to change orientation.

No substitute indeed. Safron makes a good observation. What does plasticity mean in terms of durability? And then how would be able to know unless research can find some verification. Unless the Whiteheads are keeping secrets, we can only go on what research we have. Apparently, learning a new orientation is not as easy as learning a new musical instrument, given the modest changes reported in existing studies.

Parents and Friends of Ex-gays now has this article up as well.

NARTH authors again mislead readers: More on brain plasticity and sexual orientation

My Genes Made Me Do It and brain plascticity

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.

Discover article on sexual orientation change and the APA report

Discover magazine has an online article out today which covers the APA report, NARTH and the Jones and Yarhouse study.

Here are some excerpts:

Joseph Nicolosi, a psychologist in Encino, Calif., says he can rid adults, teens, and even children of homosexuality. For nearly 30 years, he has offered a “psychodynamic” form of reparative therapy for people—mostly men—seeking to change their sexual orientation.

“If [a patient] can accept his bodily homoerotic experience while staying connected to the therapist,” he wrote in “The Paradox of Self-Acceptance,” “the sexual feeling soon transforms into something else: the recognition of deeper, pain-generated emotional needs which have nothing to do with sexuality.”

He cites the following case: A 43-year-old married accountant was recalling another man that he had seen at the airport while on a business trip. “This had awakened his sexual fantasies and dreams. I asked him to hold onto that image and observe his bodily sensations while staying connected to me. As he did, he felt an intense sexual longing. But as he followed that fantasy through an imaginary sexual scenario, quite unexpectedly, he then experienced an embodied shift to sadness, longing, and emptiness. In tears, he spoke of his sense of deep unworthiness. ‘I would just love him to be my friend! He’s the kind of guy that I always wanted to be close to. How much I just want to be friends with a guy like him.'”

This describes an aspect of the approach advocated in Nicolosi’s new book, Shame and Attachment Loss. People I have seen who have been through this approach describe it as being a chase for making sense of what they eventually come to see as an automatic reaction in search of a justification. Having said that, perhaps this gives some men a greater sense of control over their automatic impulses.

The center of this so-called “reparative therapy” is the National Association for Research and Therapy of Homosexuality (NARTH). Its membership—around 1,100 people, according to current NARTH president Julie Harren Hamilton—is dwarfed by the APA’s 150,000 members.

Treatments follow from the assertion that homosexuality is not an innate trait, but rather a result of childhood trauma and lack of attachment to members of the same sex.

“The treatment is different for men and women,” Nicolosi, one of NARTH’s former presidents, told DISCOVER. “The principles are the same—we find that for the lesbian, there is a traumatic attachment loss with the mother, and for the males it’s a traumatic attachment loss with the fathers. We believe the male homosexual should work with a male therapist, and the lesbian should work with a woman.”

It is always difficult to know who Nicolosi is referring to when he says, “we.” Is he referring to NARTH or those who are reparative therapists, or the royal we, referring to himself? However, Hamilton seems to distance NARTH from the singular approach used by Nicolosi when she says:

These treatments take on several approaches. “Psychological care for individuals with unwanted homosexual attractions includes a variety of approaches. There are many paths that lead into and out of homosexuality,” NARTH president Julie Harren Hamilton wrote DISCOVER in an email. “Therapists who assist clients with unwanted homosexual attractions vary in their…methods, [which include] object relations, interpersonal therapy, cognitive-behavioral therapy, family therapy, and many others.”

This would be a welcome departure for NARTH and Hamilton. On her video Homosexuality 101, she lays out the typical reparative drive explanation as the most common pathway. If NARTH truly wants to move away from the singular cause, it should make it clear what other pathways they view as possible.

Then the article turns to the Jones and Yarhouse study.

SOCE advocates have done studies in recent years to try and show that their efforts are working. One of the more influential among sexuality-change advocates was a study by two professors at Christian colleges: Mark Yarhouse, a psychology professor at Regent University, and Stanton Jones, provost and professor of psychology at Wheaton College.

The six-year study started with 98 subjects, most of whom were white, male, and religious—92 percent identified themselves as “born again.” All of the treatments were provided by Exodus International. Of the 61 who provided data in all six years, 14 of them—23 percent—reported that they had successfully converted to heterosexuality “in some form or another,” according to Jones. Meanwhile, 18 subjects—30 percent—reported that they had dis-identified as homosexuals and were now “chaste,” meaning no overt sexual activity at all. The results were based entirely on self-reported surveys.

I think Judith Glassgold’s assessment of the study was too harsh when she said:

The study was dismissed by the APA task force on multiple grounds, and held as an example of the systematic scientific problems of SOCE today. “Everything was wrong with that study,” Glassgold says. “[Yarhouse and Stanton] chose the wrong statistics to evaluate, they violated statistical laws, and they didn’t have a control group—just a small sample of people recruited from religious groups. They followed the individuals over a couple of years, but didn’t specify that the subjects should only try one intervention at a time, so they tried many at the same time. So we aren’t sure which, if any, intervention was causal.”

The reporter is a little sloppy here referring to Yarhouse and Stanton (Jones, I assume; a little later someone named Miller is named without a first name or introduction) and does not interview another person to provide another perspective. I think if anything the Jones and Yarhouse study is not very positive for sexual reorientation. Flaws aside, it does not help those who want to promote change as the proper focus of therapy or ministry.

There is a historical review of some of the behavioral sexual reorientation methods that might be new to some readers. The article notes that the polarization continues between NARTH and the APA. However, the article failed to really grasp the important news from the APA report, i.e., the respectful and appropriate treatment of religion as a diversity variable and the interface with client self-determination.