Sexual Identity & Family Therapy

This past week I spoke at the Chicago Area Christian Training Consortium on the topic of sexual identity and family therapy. We opened the discussion with foundational considerations, so that we were essentially on the same page. To get at the foundational issues, we discussed questions family members often ask, such as What causes same-sex attraction? (Parents are often wondering if it is something they did.) and Can sexual orientation change? (A question more frequently asked by parents than by adolescents – but teens sometimes ask this, too.)

We then looked specifically at two major family therapy issues. The first issue: working with families in which an adolescent experiences same-sex attraction or identifies as gay, lesbian, or bisexual. This involved recognizing the difference between disclosure and discovery (of a gay identity), and how parents and teens frequently become polarized at this point. We also discuseed the polarization that occurs between parents as they try to find a way to work together and respond to their teen. In this context we also discussed issues with social support, use of descriptive language, and milestone events in sexual identity development that often leads to labeling.

The second major content area had to do with mixed orientation marriages. We discussed some of the challenges these marriages face – also often related to disclosure versus discovery. Some couples go into a relationship aware of same-sex attraction (or past same-sex attraction) having even discussed this, while most do not. It has been reported that most mixed orientation relationships end in separation or divorce; however, some couples stay together and work out a way to sustain the relationship. I drew on some of the past research we’ve conducted at the Institute for the Study of Sexual Identity on mixed orientation marriages in which both partners report satisfaction in their relationship.

Sexual Identity

homosexualityWe discussed sexual identity in Human Sexuality today. We reviewed and updated research in key content areas covered in the book Homosexuality: The Use of Scientific Research in the Church’s Moral Debate. This meant updating research on the prevalence of sexual minorities, causes of same-sex attraction and homosexual orientation, mental health correlates, and whether sexual orientation can change. On this last point, change, we discussed the Ex-Gays? longitudinal study among others. 

In addition to this background information, we discussed sexual identity as another way to approach the topic of homosexuality. This included a review of research and theories related to sexual identity development and synthesis, as well as milestone events in identity formation. 

What is particularly interesting is the study of Christians who experience same-sex attraction and are sorting out identity issues in light of their faith. We discussed the decision to integration same-sex attractions into a gay identity as well as the decision to dis-identify with a gay identity and the persons and organizations that support that identity. 

In this context we discussed Sexual Identity Therapy among other approaches to providing clinical services to sexual minorities. We discussed common clinical concerns, including public and private identity labeling, conflicts between religious and sexual identities, issues related to stigma and bullying, and so on.

Gender Identity

                                     principles                           This last class focused on gender identity issues. We discussed causes of gender identity concerns, the clinical presentation, and treatment options. Concerning treatment options, although the procedure has been practiced for about 10 years in the Netherlands (and about 4 years in the U.S.), we discussed the practice of “blocking puberty” at about age 10-12 so that a several years later (around age 16) a young person can decide whether to transition to their preferred gender identity. According to the NPR report on this topic, young people who have done this appear to be satisfied with the transition (100% in a study of young people in the Netherlands). This is not the only option, of course. Others accept their biological sex and gender identity. In the study (from the Portland Clinic) mentioned in the NPR report, most young people (80%) who had been part of programs to assist them in living in conformity to their biological sex were apparently satisfied with that decision as adults.

In any case, it is a very challenging issue for everyone involved. Parents of children or teens struggle with what to do. The child or teen is often confused by how others react (not to mention the experience of dysphoria itself). Clinicians, too, may struggle with the various options that are available. Treatment options raise a number of questions about theological anthropology and ethics, among other concerns. 

We watched a couple of video clips from the Barbara Walters special on gender identity in childhood and adolescence, as well as a brief clip from Sy Rogers’ testimony (as someone who was scheduled for sex reassignment surgery before the procedure was abandoned at Johns Hopkins). As you might imagine, it was a good discussion of the challenges Christians may face in understanding the experience of transgender persons and providing services to gender dysphoric youth.

The Sexual Dysfunctions

principlesIn our last class we finished our discussion of recent research on assessment and treatment of common sexual dysfunctions, including desire disorders, arousal disorders, orgasmic disorders, dyspareunia, vaginismus, premature ejaculation, and erectile dysfunction. Although much emphasis is placed on biological insights and the ‘medicalization’ of many sexual concerns, we framed the issues in the context of a broader biopsychosocial model. This model helps students see the role of a competent mental health professional in working with sexual concerns in a multidisciplinary treatment team. 

Next class we shift our focus toward the atypical sexual behaviors – the paraphilias and sexual addiction. Although the sexual dysfunctions are quite common, most students tend to be particularly interested in understanding how clinicians conceptualize and intervene to address atypical sexual concerns, so it should be an interesting discussion.

We will also finish our discussion of one of our primary integration resources. As I mentioned in a previous post, we have been discussing Lisa McMinn’s book, Sexuality & Holy Longing.  We are on the last chapter that addresses sexuality and culture. I think the students have genuinely appreciated Lisa’s writing on sexuality from a Christian perspective.