A college psychology professor's observations about public policy, mental health, sexual identity, and religious issues
The Get Religion blog has two entries up today discussing media coverage of the APA sexual orientation and therapy report. The first one deals with the articles by the Associated Press, Washington Times, and Baptist Press.
The second one hearts the Wall Street Journal article by Stephanie Simon which discusses the sexual identity therapy framework and the APA report.
FYI
The Christian Broadcasting Network reports this morning on the APA task force findings.
UPDATE: The video now does not reflect the news report linked above.
Earlier today, the American Psychological Association governing board received the report of the Task Force on Appropriate Therapeutic Response to Sexual Orientation. The report and press release were embargoed until now. With this post, I want to comment on the paper and recommendations made by the Task Force.
Generally, I believe the paper to be a high quality report of the evidence regarding sexual orientation and therapy. The authors of the paper (see this post for the new release which contains authorship information) provide a very helpful discussion of the professional literature on sexual orientation change efforts (SOCE), potential benefits and harm and the role of religion and values in sexual orientation identity exploration. Before I get to a more detailed look at highlights, I want to note an important statement from the APA press release made by Task Force Chair, Judith Glassgold:
Practitioners can assist clients through therapies that do not attempt to change sexual orientation, but rather involve acceptance, support and identity exploration and development without imposing a specific identity outcome.
Dr. Glassgold here describes sexual identity therapy. In fact, as I will point out, the SIT framework is referred to positively throughout the paper. Whereas some evangelicals may be troubled by the negative view of sexual reorientation in this report, there is much here that clarifies important aspects of work in this field. The paper is long (130 pages) and so one post cannot capture all that is important. I want to start with what for me are the high spots, beginning with the abstract:
The American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation conducted a systematic review of the peer-reviewed journal literature on sexual orientation change efforts (SOCE) and concluded that efforts to change sexual orientation are unlikely to be successful and involve some risk of harm, contrary to the claims of SOCE practitioners and advocates. Even though the research and clinical literature demonstrate that same-sex sexual and romantic attractions, feelings, and behaviors are normal and positive variations of human sexuality, regardless of sexual orientation identity, the task force concluded that the population that undergoes SOCE tends to have strongly conservative religious views that lead them to seek to change their sexual orientation. Thus, the appropriate application of affirmative therapeutic interventions for those who seek SOCE involves therapist acceptance, support, and understanding of clients and the facilitation of clients’ active coping, social support, and identity exploration and development, without imposing a specific sexual orientation identity outcome. (p. v)
While the paper takes a dim view of change efforts, the authors indicate that attempts to change have been viewed as helpful by some and harmful by others. This is a fair reading of the research. Given these assessments of the research, the stance the APA recommends is to provide supportive psychotherapy without imposing an identity outcome on the client. To get to this view, the authors review change literature, literature on outcomes and research regarding religion and sexual orientation. I want to briefly recap each section.
Efficacy of change efforts
The Task Force reviewed 83 studies that met basic standards for inclusion. They were not impressed with the methodological rigor of the body of research. Their conclusion:
Thus, the results of scientifically valid research indicate that it is unlikely that individuals will be able to reduce same-sex attractions or increase other-sex sexual attractions through SOCE. (p. 3)
Safety of change efforts
The Task Force provided a cautious and nuanced response to the question of harm or benefit from SOCE. I believe they are on target here. Some people report harm and some report benefit but there are no studies which allow conclusions about likelihood of either outcome for any given person. About safety, the press release notes:
As to the issue of possible harm, the task force was unable to reach any conclusion regarding the efficacy or safety of any of the recent studies of SOCE: “There are no methodologically sound studies of recent SOCE that would enable the task force to make a definitive statement about whether or not recent SOCE is safe or harmful and for whom,” according to the report.
Religion and change efforts
One of the highlights of the report is the discussion of religion and sexual orientation. The authors are to be commended for their balanced and thoughtful approach. I especially like the discussion surrounding the concepts of “organismic congruence” and “telic congruence.” On page 18, the paper summarizes these concepts well:
The conflict between psychology and traditional faiths may have its roots in different philosophical viewpoints. Some religions give priority to telic congruence (i.e., living consistently within one’s valuative goals) (W. Hathaway, personal communication, June 30, 2008; cf. Richards & Bergin, 2005). Some authors propose that for adherents of these religions, religious perspectives and values should be integrated into the goals of psychotherapy (Richards & Bergin, 2005; Throckmorton & Yarhouse, 2006). Affirmative and multicultural models of LGB psychology give priority to organismic congruence (i.e., living with a sense of wholeness in one’s experiential self (W. Hathaway, personal communication, June 30, 2008; cf. Gonsiorek, 2004; Malyon, 1982). This perspective gives priority to the unfolding of developmental processes, including self-awareness and personal identity.
This difference in worldviews can impact psychotherapy. For instance, individuals who have strong religious beliefs can experience tensions and conflicts between their ideal self and beliefs and their sexual and affectional needs and desires (Beckstead & Morrow, 2004; D. F. Morrow, 2003). The different worldviews would approach psychotherapy for these individuals from dissimilar perspectives: The telic strategy would prioritize values (Rosik, 2003; Yarhouse & Burkett, 2002), whereas the organismic approach would give priority to the development of self-awareness and identity (Beckstead & Israel, 2007; Gonsiorek, 2004; Haldeman, 2004). It is important to note that the organismic worldview can be congruent with and respectful of religion (Beckstead & Israel, 2007; Glassgold, 2008; Gonsiorek, 2004; Haldeman, 2004; Mark, 2008), and the telic worldview can be aware of sexual stigma and respectful of sexual orientation (Throckmorton & Yarhouse, 2006; Tan, 2008; Yarhouse, 2008). Understanding this philosophical difference may improve the dialogue between these two perspectives represented in the literature, as it refocuses the debate not on one group’s perceived rejection of homosexuals or the other group’s perceived minimization of religious viewpoints but on philosophical differences that extend beyond this particular subject matter. However, some of the differences between these philosophical assumptions may be difficult to bridge.
On this blog, we have frequently grappled with these differences. Many such discussions have sides talking past each other because different views of congruence are assumed to be determinative. In this CNN clip about the Task Force, Psychiatrist McCommon and I came to about the same conclusion regarding congruence.
There are different assumptions about what best constitutes the answer to the question: ‘who am I?’ This paper nicely addresses these assumptions and acknowledges that people who are deeply committed to a non-gay-affirming religious position may stay same-sex attracted but not identify as gay. As the paper notes, this is an acceptable alternative.
Clinical approaches
The authors consider the role of therapy and ministries groups as aspects of SOCE. What they say about support groups is interesting.
These effects are similar to those provided by mutual support groups for a range of problems, and the positive benefits reported by participants in SOCE, such as reduction of isolation, alterations in how problems are viewed, and stress reduction, are consistent with the findings of the general mutual support group literature. The research literature indicates that the benefits of SOCE mutual support groups are not unique and can be provided within an affirmative and multiculturally competent framework, which can mitigate the harmful aspects of SOCE by addressing sexual stigma while understanding the importance of religion and social needs. (p. 3)
In a nutshell, support groups can have benefit when the singular focus is not change of orientation. Our conversations here regarding the change versus congruence model is relevant. I think the kind of changes that are most common are ideological and behavioral. And when I say behavioral, I mean both cessation of unwanted behavior and also less preoccupation with seeking harmful sexual behavior. I think some people feel they have moved on the Kinsey scale because they have better self-control regarding same-sex behavior. These are good and important telic changes but they don’t represent the kinds of changes which reflect dramatic organismic shifts. Orthodox Christianity does not require organismic changes in order to pursue spiritual development.
Moving from ministry to clinical worlds, the application seems obvious to me. And perhaps it seems obvious since I have been advocating for this stance for several years now. The client sets the value direction and the outcome is not imposed.
In our review of the research and clinical literature, we found that the appropriate application of affirmative therapeutic interventions for adults presenting with a desire to change their sexual orientation has been grounded in a client-centered approach (e.g., Astramovich, 2003; Bartoli & Gillem, 2008; Beckstead & Israel, 2007, Buchanan et al., 2001; Drescher, 1998a; Glassgold; 2008; Gonsiorek; 2004; Haldeman, 2004, Lasser & Gottlieb, 2004; Mark, 2008; Ritter & O’Neill, 1989, 1995; Tan, 2008; Throckmorton & Yarhouse, 2006; Yarhouse & Tan, 2005a; and Yarhouse, 2008). (P.55)
It is heartening to see the SIT framework referenced here (and elsewhere in the APA paper) as one “appropriate application of affirmative therapeutic interventions.” In general, I think the APA strategies and the SIT framework are quite compatible.
Bottom line: The APA report will likely be quite influential for years to come. They call for more research on SOCE and a cautious, and I think accurate, interpretation of the research on reorientation. I believe the therapeutic strategies called for are akin to the SIT framework and clarifies nicely the appropriate stance of therapists. The report also respects the place of religion in identity development and exploration. These issues were not clear prior to this report.
In additional posts, I will deal with various aspects of the paper as well as media coverage. The press release is here and here on the APA website.
The APA released the report from the Task Force on Appropriate Therapeutic Responses to Sexual Orientation today. This post is the APA press release, I also have an analysis of the report and another post coming with press reports.
APA PRESS RELEASE
August 5, 2009
Contact: Kim Mills
(202) 336-6048 until Aug. 5
(416) 585-3800 – Aug. 5-9
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INSUFFICIENT EVIDENCE THAT SEXUAL ORIENTATION CHANGE EFFORTS WORK, SAYS APA
Practitioners Should Avoid Telling Clients They Can Change from Gay to Straight
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TORONTO—The American Psychological Association adopted a resolution Wednesday stating that mental health professionals should avoid telling clients that they can change their sexual orientation through therapy or other treatments.
The “Resolution on Appropriate Affirmative Responses to Sexual Orientation Distress and Change Efforts” also advises that parents, guardians, young people and their families avoid sexual orientation treatments that portray homosexuality as a mental illness or developmental disorder and instead seek psychotherapy, social support and educational services “that provide accurate information on sexual orientation and sexuality, increase family and school support and reduce rejection of sexual minority youth.”
The approval, by APA’s governing Council of Representatives, came at APA’s annual convention, during which a task force presented a report that in part examined the efficacy of so-called “reparative therapy,” or sexual orientation change efforts (SOCE).
“Contrary to claims of sexual orientation change advocates and practitioners, there is insufficient evidence to support the use of psychological interventions to change sexual orientation,” said Judith M. Glassgold, PsyD, chair of the task force. “Scientifically rigorous older studies in this area found that sexual orientation was unlikely to change due to efforts designed for this purpose. Contrary to the claims of SOCE practitioners and advocates, recent research studies do not provide evidence of sexual orientation change as the research methods are inadequate to determine the effectiveness of these interventions.” Glassgold added: “At most, certain studies suggested that some individuals learned how to ignore or not act on their homosexual attractions. Yet, these studies did not indicate for whom this was possible, how long it lasted or its long-term mental health effects. Also, this result was much less likely to be true for people who started out only attracted to people of the same sex.”
Based on this review, the task force recommended that mental health professionals avoid misrepresenting the efficacy of sexual orientation change efforts when providing assistance to people distressed about their own or others’ sexual orientation.
APA appointed the six-member Task Force on Appropriate Therapeutic Responses to Sexual Orientation in 2007 to review and update APA’s 1997 resolution, “Appropriate Therapeutic Responses to Sexual Orientation,” and to generate a report. APA was concerned about ongoing efforts to promote the notion that sexual orientation can be changed through psychotherapy or approaches that mischaracterize homosexuality as a mental disorder.
The task force examined the peer-reviewed journal articles in English from 1960 to 2007, which included 83 studies. Most of the studies were conducted before 1978, and only a few had been conducted in the last 10 years. The group also reviewed the recent literature on the psychology of sexual orientation.
“Unfortunately, much of the research in the area of sexual orientation change contains serious design flaws,” Glassgold said. “Few studies could be considered methodologically sound and none systematically evaluated potential harms.”
As to the issue of possible harm, the task force was unable to reach any conclusion regarding the efficacy or safety of any of the recent studies of SOCE: “There are no methodologically sound studies of recent SOCE that would enable the task force to make a definitive statement about whether or not recent SOCE is safe or harmful and for whom,” according to the report.
“Without such information, psychologists cannot predict the impact of these treatments and need to be very cautious, given that some qualitative research suggests the potential for harm,” Glassgold said. “Practitioners can assist clients through therapies that do not attempt to change sexual orientation, but rather involve acceptance, support and identity exploration and development without imposing a specific identity outcome.”
As part of its report, the task force identified that some clients seeking to change their sexual orientation may be in distress because of a conflict between their sexual orientation and religious beliefs. The task force recommended that licensed mental health care providers treating such clients help them “explore possible life paths that address the reality of their sexual orientation, reduce the stigma associated with homosexuality, respect the client’s religious beliefs, and consider possibilities for a religiously and spiritually meaningful and rewarding life.”
“In other words,” Glassgold said, “we recommend that psychologists be completely honest about the likelihood of sexual orientation change, and that they help clients explore their assumptions and goals with respect to both religion and sexuality.”
A copy of the task force report may be obtained from APA’s Public Affairs Office or at http://www.apa.org/pi/lgbc/publications/therapeutic-response.pdf.
Members of the APA Task Force on Appropriate Therapeutic Responses to Sexual Orientation:
Judith M. Glassgold, PsyD, Rutgers University – Chair
Lee Beckstead, PhD
Jack Drescher, MD
Beverly Greene, PhD, St. John’s University
Robin Lin Miller, PhD, Michigan State University
Roger L. Worthington, PhD, University of Missouri
The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States and is the world’s largest association of psychologists. APA’s membership includes more than 150,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare.
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Today, Crosswalk.com published my article, “Fathers, sons and homosexuality.” It is also up at the Christian Post blog and soon a few other places. In this piece, I examine Joseph Nicolosi’s reparative drive theory via a very specific claim made recently in London while speaking to the Anglican Mainstream conference, Sex in the City. In an interview with David Virtue, Nicolosi said:
In other words, that fact remains that if you traumatize a child in a particular way you will create a homosexual condition. If you do not traumatize a child, he will be heterosexual. If you do not traumatize a child in a particular way, he will be heterosexual. The nature of that trauma is an early attachment break during the bonding phase with the father.
Many straight New Warrior brothers will tell you that they had attachment breaks with their fathers during this period. In fact, many straight men go to men’s groups to address those matters. On the flip side, this article focuses on a father’s perspective on his relationship with his same-sex attracted son.
Fathers, sons and homosexuality
The causes of homosexuality continue to both fascinate and divide people. Recently, in London, a conservative group of Anglicans, called the Anglican Mainstream hosted a conference to discuss the causes of homosexuality and promote change from gay to straight. Featured at the conference was American psychologist, Joseph Nicolosi. Dr. Nicolosi stirred much controversy when he said, without research support, that most of his clients show some degree of change in their sexual orientation.
Nicolosi’s views regarding causes of homosexuality are also controversial. In response to a question about the existence of a gay gene, Nicolosi said:In other words, that fact remains that if you traumatize a child in a particular way you will create a homosexual condition. If you do not traumatize a child, he will be heterosexual. If you do not traumatize a child in a particular way, he will be heterosexual. The nature of that trauma is an early attachment break during the bonding phase with the father.
In a popular book written with his wife, A Parent’s Guide to Preventing Homosexuality, Nicolosi pegs the “crucial period” for bonding between father and son at “between one and a half to three years.” Elsewhere, Nicolosi argues that fathers of homosexual sons are unavailable, detached and/or hostile. To fathers in London, he advised, “If you don’t hug your sons, some other man will,” suggesting that male homosexual attraction is a search for a father’s love.
The father-deficit theory is considered outdated by mainstream sexuality researchers, but is popular among conservative Christians. This evangelical acceptance has always puzzled me because Nicolosi’s statements regarding the origins of homosexuality can be discounted not only by research but by common experience. His theory is contradicted in at least two ways. The first way should be quite obvious to Nicolosi’s audiences: there are many men who experienced poor fathering not only during the first six years of life but throughout childhood and are nonetheless, exclusively heterosexual.
Since many in Nicolosi’s audiences are either unhappy with their homosexual attractions or do not know many secure gay people, the second problem might not be so clear. In contrast to Nicolosi’s depictions of the typical family of gay males, many such men experienced loving, close relationships with their fathers throughout childhood with no break in attachment. Listen to one such father who spoke to me recently about his gay son.When my son was 18 months to 3 years old (and on into childhood), we enjoyed a wonderfully close relationship. We explored the world behind the YMCA and called it travelling, looking for creatures in nooks and crannies. When it would snow, we bundled up and follow the same path. We hunted for snakes together in the creek, built a swamp world for various amphibians and generally loved each others’ company. Wherever I was, there was my son; as my wife would say, we were like “Peel and Stick.”
As he got older our relationship changed, but in a way that it should change. It matured into a friendship as father and son. After our son came out to us, our relationship did not change.Does this sound like an uninvolved, detached father? This man’s son concurs with his dad’s assessment of the relationship. They were and are close, with no breaks during the period Nicolosi theorizes should cause homosexuality.
Devout Christians, the family attended conferences put on by conservative Christians who believed parental deficits were responsible for homosexuality. The answers they heard were very much like what Dr. Nicolosi promotes. These parents also took their son to a reparative therapist (i.e., counselor who holds to Nicolosi’s theory) who evaluated the potential for sexual orientation change. The father reported that it wasn’t helpful.Not understanding the nature of his condition, we did take our son to a counselor. After several weeks of “therapy,” our counselor told our son that he didn’t know what to do. None of the stereotypes fit. Our son told his counselor that he had a wonderful and close relationship with his father and mom.
Although the parents hold the traditional Christian, non-affirming view of homosexual behavior, parents and son have maintained their relationship. What they all do much less often now is become preoccupied over causes and self-blame. The father sees a bigger picture.
Dr. Nicolosi gets it wrong to reduce the thorns in our sides/lives to a human event where we have but one chance to get it right. Does that sound like the relationship we have with our heavenly Father? God has allowed all of us to experience thorns, some painfully obvious, others less so. No doubt the thorns God allows are refining our character and leading us back to Him.
In fact, sexual orientation is quite complex. Most likely, multiple pre-and post-natal factors are involved in different ways for different people. One size does not fit all. What this means for Christian groups, however, is the stuff of controversy. For some, it means that homosexuality should be affirmed and Scripture reframed. For others, it does not lead to a change of orthodoxy, but rather to greater humility regarding the need for spiritual support to live a different and often difficult calling. What is not needed is adoption of simple, but misleading, answers.