Mark and I will discuss the history of our work together going back to our opposition to a ban on reorientation therapy to our focus on sexual identity therapy. We also talk about Mark’s more recent work in gender identity.
I asked Mark about a relatively new group on the scene helping people navigate sexual identity concerns – Revoice. In that context, he described research into the effects of celibacy. Here is an excerpt of that conversation.
I hope you will revisit the blog on Tuesday to catch the full interview with Mark.
I assume Christopher Doyle refers to the effort around the country to prohibit sexual reorientation change efforts for minors. However, I write this post to address a couple of points.
When it comes to sexual orientation and psychotherapy, the reparative therapy narrative of defective parenting doesn’t hold water or match up with research or experience. However, there are still therapists who believe that and try to impose it on their clients and their families. Much of my work has been to develop a therapy approach (sexual identity therapy) which requires therapists to present scientific research about sexual orientation to clients and allow clients to decide what to do about it.
On the other hand, the Family Research Council speaker Christopher Doyle worked and trained with Richard Cohen who has a different approach. Here is a snapshot of a couple of Richard Cohen’s techniques.
I will leave it to readers. Is this psychotherapy?
Doyle defended these and other outrageous techniques in this legal brief designed to be used in a New Jersey trial involving JONAH, a Jewish change therapy group. JONAH lost at trial.
You can see Doyle in action in this review of a documentary called Sunday Sessions in which Doyle provides sexual orientation change counseling to a young adult man. Note that Richard Cohen is involved in the group sessions at the beginning.
In the end, the young man feels somewhat better but credits the teachings of the Catholic church for his mood improvement. There is no indication that his sexual attractions changed.
Sexual Identity Therapy
I watched the documentary (I recommend it although there is no real conclusion to the story), and I need to make another thing clear. In the film (and on this page), Doyle calls his approach to therapy “Sexual Identity Affirming Therapy.” I want to say plainly that what he does is unrelated to “Sexual Identity Therapy” as developed by Mark Yarhouse and me.
In the documentary, Doyle did not provide a range of information about the development of male homosexuality but instead authoritatively expressed the reparative narrative of weak fathers and an unmasculine upbringing. The directive style demonstrated in the movie review above is not taken out of context. None of this is consistent with sexual identity therapy. People working within the principles of SIT do not attempt to change a client’s sexual orientation. SIT is antithetical to what Doyle demonstrates in the documentary and more broadly, to what Cohen does in his various public demonstrations.
The War is Over
In my opinion, within psychotherapy, the war is actually over and change therapy has lost. No training programs teach it. I know of no Christian training programs that teach it (although I would like to be corrected if I am wrong). It is misleading to pretend there is a wronged group of psychotherapists who want to practice it and can’t. The courts have not been inclined to defend it.
While there are several reasons why mental health advocates want to ban sexual orientation change efforts, I want to focus on the recent push to legislate bans on the practice by licensed professionals.
Historically, therapists who treat gays with an aim to change them have viewed homosexuality as a developmental disorder. Some may also think same-sex sexual behavior is immoral, but principally the use of therapeutic techniques is driven by a belief that there is something psychologically wrong with someone who is attracted to the same sex. If the right techniques can be applied, eventually the GLB person will experience a shift in psychological perspective and find the opposite sex attractive. In short, homosexuality is an illness to be cured.
As most readers know, this view of same-sex orientation isn’t held by any medical or mental health professional organization today. Only a tiny group of practitioners hold to this view and they are among those who are fighting legislative efforts to ban sexual orientation change efforts. When legislators craft bills to stop treatment of same-sex orientation, they are hoping to stop efforts to cure something that isn’t a disorder.
To me, this is a sensible stance. No disorder, no need for treatment.
On the other hand, many religious traditions disagree with same-sex sexual behavior. They discourage such behavior as inconsistent with their moral teachings. Churches and religious groups have the right to teach this and advise their members in keeping with their principles. When people ask for their advice or opinion, churches can teach their views. In fact, anyone can teach and speak any view about homosexuality.
However, when a person joins a learned profession and gets a state license to practice that profession, there are certain restrictions that come along with that choice. Mental health professionals are not clergy. We have a role to enhance the mental health of our clients and curing non-existent diseases doesn’t seem to me to be a part of that mandate. If clergy need to speak against certain behaviors, that is their right and the state’s regulation of mental health professionals cannot stop them.
I do have sympathy for those clients who believe that their same-sex attractions result from some historical trauma. In fact, there is a very small subset of people for whom those factors might be relevant to an understanding of their overall personality, including their sexual interests. I also believe that those people can continue to receive therapy, under these laws, if the treatment is not framed as a direct effort to change orientation.
Ultimately, I believe this is an issue of regulation of mental health professionals and not one of religious liberty. Since there is no universe in which sexual orientation change efforts are effective, why would mental health professionals make space for them? The rare exceptions can be accommodated via other frameworks (e.g., identity exploration, trauma recovery). Religious views will continue to be shared and any challenge to them will not succeed. We can coexist.
For more information on helping non-affirming same-sex attracted people live in keeping with traditional sexual ethics without engaging in sexual orientation change efforts, see the following articles and websites:
According to the New York Times, psychiatrist and author of the third edition of the American Psychiatric Association’s diagnostic manual Robert Spitzer died on Christmas Day. Spitzer is credited with changing the way mental health professionals view diagnosis of mental disorders. By basing the assessment of mental disorder on personal distress and diminished functioning, Spitzer promoted a more rigorous approach to diagnosis.
More famously, Spitzer’s modifications also paved the way for reconsidering homosexuality as a mental disorder. After meeting gay psychiatrists who did not experience distress over homosexuality, Spitzer, in the early 1970s, led the effort to remove homosexuality from psychiatry’s list of mental disorders.
I first talked to Bob Spitzer when he invited me to take part in a debate over sexual orientation change efforts at the American Psychiatric Association meeting in 2000. The debate was canceled when, near the beginning of the conference, the two psychiatrists arguing against sexual orientation change backed out. Bob later told me that the psychiatrists who declined to participate wanted out because they heard that I was a member of the National Association for the Research and Therapy of Homosexuality (NARTH). While I had been a NARTH member for one year in 1997, I had allowed my membership to lapse by 2000. An irony is that I later became one of NARTH’s biggest critics. Bob knew I tracked NARTH’s actions and about once a year asked about any news on their activities.
Although I was unable to attend, the following year Bob invited me to speak as a part of a symposium where he presented results of his research on ex-gays. Eventually, that study was published in 2003 in the Archives of Sexual Behavior and was one of the most controversial studies in modern psychiatry. At the time, due to his conversations with people who described themselves as ex-gay, Spitzer believed that some gays had been able to modify their sexuality toward the straight side of the continuum. Later, in 2012, Spitzer retracted that interpretation of his research, denounced his earlier beliefs, and apologized to gays.
In 2004, I met Bob Spitzer in person and spent a few hours at his home near New York City while filming for the videoI Do Exist, a video with the testimonies of five people who told me they changed from gay to straight. Because one of the main participants retracted his statements and two others had significant changes, I later retracted the video in January 2007. My views were also altered by the emergence of new data on sexual orientation and the failure of change therapy supporters to produce evidence in their favor.
After he published his study, Bob’s collaboration with social conservatives was something he later regretted. On one occasion in November 2008, I sent him a link to Focus on the Family’s website where they had misrepresented his study. He wrote back and said, “That is awful. Whoever wrote it must have known it to be incorrect. Can you do something about it?” Focus later modified the statements slightly but still did not fully represent Bob’s views.
In 2007, Spitzer told me in a phone call that he endorsed the sexual identity therapy framework that I developed with Mark Yarhouse. The endorsement was later published on the SIT framework site:
I have reviewed the sexual identity framework written by Warren Throckmorton and Mark Yarhouse. This framework provides a very necessary outline to help therapists address the important concerns of clients who are in conflict over their homosexual attractions. The work of Drs. Throckmorton and Yarhouse transcend polarized debates about whether gays can change their sexual orientation. Rather, this framework helps therapists work with clients to craft solutions tailored to their individual situations and personal beliefs and values. I support this framework and hope it is widely implemented. Robert L. Spitzer, M.D., Professor of Psychiatry, Columbia University, New York State Psychiatric Institute, New York City, NY. Co-editor of the Diagnostic and Statistical Manual of Mental and Emotional Disorders, 3rd Edition and 3rd Edition (Revised).
On a personal level, I liked Bob immediately. He was friendly and very approachable. While he seemed to like the controversy, in my hearing he communicated no malice toward any side of the gay change debate. He seemed to be a genuine truth seeker and wanted to follow the evidence no matter what. I will miss him.
Bob Spitzer, R.I.P.
On Sunday, I participated in a conference titled Desire, Faith and Therapy at the Kraft Jewish Student Center at Columbia University on appropriate therapeutic responses to sexual orientation. The conference was designed for therapists, rabbis and other interested members of the Orthodox Jewish community.
From the brochure:
“Desire, Faith and Psychotherapy” presents a Psychoanalytic perspective on sexual orientation and gender identity in the Orthodox Jewish community. We will explore the intersection of psychological, religious and communal issues that present with LGBT people from Orthodox & Hasidic communities. The program features experts in the field and professionals with experience working with this population. They will review the latest research and develop a conceptual framework in which therapists and Orthodox rabbis can work together to offer the best care.
I didn’t let the organizers know in time to make the brochure but I spoke as a part of a panel with Jack Drescher and Rabbi Mark Dratch. Drescher covered research and history of sexual orientation change efforts, Rabbi Dratch covered the position of the Rabbinical Council of America and I described the sexual identity therapy framework. Rabbinical Council of America Repudiates Reparative Therapy and JONAH
The framework seemed to fit the audience well in that affirming and non-affirming members of the Orthodox community were present and interested in working together for best practices. I was pleased to hear Rabbi Dratch describe the Rabbinical Council’s repudiation of JONAH, and reparative therapy in general. Dratch told the crowd that the Rabbinical Council asked JONAH numerous times to remove the 2004 letter recommending JONAH. In fact, even after the Council issued their repudiation of JONAH, the 2004 endorsement remains up on JONAH’s website. JONAH advertises falsely in more ways than one.
The lawsuit against JONAH will be a test of the consumer protection laws in New Jersey. JONAH continues to claim efficacy from the strange practices used to try to change sexual orientation. With a couple of exceptions, the crowd at the conference seemed to join the sentiment expressed by the Rabbinical Council concerning JONAH.
My powerpoint can be viewed here.