APA Task Force Report, Chapter 1 (cont’d)

I need to back up before I can go forward. I forgot that I wanted to comment on another aspect of Chapter 1 in the task force report. So that’s what this post will do, and then I will move on to Chapter 3.

In addition to the material on sexual stigma, the report covers several aspects of psychology of religion. This is a strength of the document overall. I’d like to highlight one specific distinction that is helpful to the overall discussion of the potential conflicts in this area:

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. (p. 18)

It should be noted both that the task force sought input from those with expertise in psychology of religion and that the distinction between organismic and telic congruence is quite helpful. The report goes on to discuss how it can impact clinical work, as when some may think in terms of values and trajectory and future considerations and purposes (telic) while others may think in terms of one’s sense of self unfolding developmentally such that felt impulses are believe to be natural and part of who a person really is (organismic). As I mentioned above, this may help us understand how different groups can come to appreciate completely different approaches to therapy while working toward a kind of congruence that may not be understood by those who take a different assumptive starting point.

APA Task Force Report, Chapter 2 – A Brief History

460Chapter 2 of the APA Task Force report is titled “A Brief History of Sexual Orientation Change Efforts.” The authors provide a sense of the sociocultural and  historical context in which change approaches were offered (in light of how homosexuality was viewed in the broader culture and by the mental health professions). The highlight some important studies and related efforts that eventually led to the removal of homosexuality from the official diagnostic manual of the American Psychiatric Association. They discuss the subsequent decline in research and interest in change of sexual orientation within the professions, as well as the increased scrutiny of those who continued to provide such services.

The report then notes that those who continue to seek out such change efforts are religious. They acknowledge the impact of religion-based ministries. They correctly acknowledge that the exchanges between both “sides” of this issue have often been heated and polarized. They offer that the way to move forward is with an accurate understanding of the potential benefits and harm of attempting change of orientation.

Overall, I found this chapter to be fairly accurate as a brief synopsis. I might only add that the emergence of religion-based ministries (as paraprofessional ministries) has been viewed by some as a response to what felt like a lack of resources and support within the secular mental health professions for those who wanted assistance in this area.

APA Task Force Report, Preface & Introduction (Chapter 1)

460Several people have asked if I would offer more of a review of the APA Task Force Report on Appropriate Therapeutic Responses to Sexual Orientation. Many people and organizations appear to be supportive of the document, while others have been critical. What I’d like to do is walk through the background document and discuss some of the points that stand out to me from various chapters and just offer reflections. So let’s start with Chapter 1, which is the Introduction.

The Preface opens with the charge of the task force, which included offering guidance on appropriate ways to respond to requests by adult to change their sexual orientation or behavior, how to respond to children and adolescents who have similar requests (or whose parents or guardians do), relevant issues in education and training, and other related matters. The report mentions the nomination process and selection of task force members. They note that the task force felt it best to review the relevant research on sexual orientation change efforts (SOCE). The report mentions that it was open for public comment and lists the reviewers.

The Introduction gives context to the report by discussing what is meant by “affirmative” approaches to sexual minorities. There is also a discussion of sexual stigma and relevant psychology of religion research. Both of these sections are important, but let me highlight the definition of “affirmative,” as it could be confused with “gay affirmative therapy,” which is a general approach to therapy that is often contrasted with other approaches. Anyway, here is part of what they say:

We define an affirmative approach as supportive of clients’ identity development without a priori treatment goals for how clients identify or express their sexual orientations. Thus, a multiculturally competent affirmative approach aspires to understand the diverse personal and cultural influences on clients and enables clients to determine (a) the ultimate goals for their identity process; (b) the behavioral expression of their sexual orientation; (c) their public and private social roles; (d) their gender roles, identities, and expression; (e) the sex and gender of their partner; and (f) the forms of their relationships. (p. 14)

They acknowledge in this same section that a gay affirmative approach generally emphasizes (or presumes) the adoption of a gay identity as the preferred outcome for an individual; that has been the primary reference point. However, in keeping with the concerted effort to understand the experiences of those who do not identity as gay, the report begins with a more client-centered and identity-focused approach that leaves the outcome more open-ended. Undoubtedly, some people will struggle with how best to respond to the affirmative framework. I am thinking specifically of social conservatives (religious or not) who may not agree with all of what is asserted in other sections of the Introduction. However, this idea that a model can be affirmative in a broad sense of being client-centered and identity-focused holds appeal to many clinicians and provides something of a starting point for the document.

A Nice Offering from JPT

jptThe Journal of Psychology and Theology web site has a nice feature. They offer selected articles for download at no charge. Check out the current titles here. The current offerings are really good articles on integration. Here are the article titles and authors. Gary Moon, Ev Worthington, Dallas Willard, and Eric Johnson are four terrific contributors on Christian integration. In fact, the article by Eric Johnson had been selected as one of the most influential integration articles and published in the edited book Psychology and Christianity Integration.

  • Spiritual Direction: Meaning, Purpose, and Implications for Mental Health Professionals
    by G.W. Moon
  • Forgiving Usually Takes Time: A Lesson Learned by Studying Interventions to Promote Forgiveness
    by E.L. Worthington, Jr. et al
  • Spiritual Disciplines, Spiritual Formation, and the Restoration of the Soul
    by Dallas Willard
  • Christ, the Lord of Psychology
    by E.L. Johnson

The Exodus Study & The APA Report


Those who are following issues related to religion and sexual orientation and identity are aware that the APA Task Force Report on Appropriate Therapeutic Responses to Sexual Orientation and the update on the Exodus study were reported at the same APA conference. Both are receiving some attention, and it may be difficult to understand how they relate (or if they do). In terms of whether or not sexual orientation can ever change, they are likely to be contrasted, and some may contrast them quite sharply. At the same time, there are some points of intersection that should not be overlooked, and I’ve been thinking a lot about this, especially in light of my own clinical practice in which I focus on sexual identity and congruence rather than change of orientation.

Although we have not yet analyzed all of the questions at Time 6 that we analyzed at Time 3, I was struck in the Time 3 report by what participants found helpful in their local ministry. They appreciated the support they received – they knew that they were not alone. They appreciated the opportunity to grow in their identity in Christ – to be strengthened in their faith. It is not really my place to speak to how ministries provide services, but I imagine these are the strengths of ministries affiliated with Exodus. They may be at their best when they focus on fostering a religious identity that is in keeping with the ministry statements of faith. In the context of this support, might some people experience a reduction in same-sex attraction? Apparently some do. Might some even experience an increase in attraction to the opposite sex? Apparently some do, although this seems less likely and less salient (again, on average, for those who reported it).

The evidence from the Exodus study does not appear to reflect categorical change (from completely gay to completely straight). Rather, these are meaningful shifts for some participants, and some individuals experienced more of a shift. That was enough for us to conclude that change is possible for some, but it is unclear exactly what percentage. That we are talking more about shifts in degree (rather than categorical shifts) will be important to a ministry and to participants.

I mentioned above that for some people the Exodus study will not be a sharp contrast to some of what is recommended toward the end of the APA Task Force report. I read the Task Force report as recommending a client-centered, identity-focused approach that emphasizes support and coping skills, as well as sensitivity and respect for religious beliefs and values. I think that is a lot of what is helpful in religious ministries.

It may be true that ministries are not client-centered in the same way that the Task Force may mean it, but ministries do provide support and coping resources that are religiously-congruent, if you will (by which I mean, these resources are offered in the context of the religious beliefs and identity of the ministry and would correspond with the beliefs and identity of those who self-select to participate in the ministry).

As for the identity focus, this seems to be a good fit with religious ministries that emphasize an identity ‘in Christ’ or similar understandings. Whether sexual attractions change or shift for an individual will be an important question for him or her, but it may be less critical if the primary emphasis of the ministry is on identity, support, and coping, much as what was recommended in the report.

Reflections on the APA Session

The APA presentation on the Exodus study went well. The session itself was respectful and professional. I would say about 40-45 people were there, which was in some ways remarkable given the early hour (8am start time [!] on the last day of the conference). It was a 2 hour symposium. There were a number of folks from both “sides” of the issue (although it may not be helpful to frame the topic in terms of “sides” – I would like to think that what we all hold in common is a desire to provide the best options for those requesting help – too often, however, we seem to be talking past one another).

The chair of the symposium, Dr. Dean Byrd, opened the session with an overview statement and then introduced each of the presenters and the discussant. My co-author (Dr. Stanton Jones) and I presented our paper, which was 6 to 7 year follow-up data on attempted change of sexual orientation through involvement in Exodus affiliated ministries. Then Dr. Nicholas Cummings, past president of APA, presented his paper. (He was actually ill and asked a colleague to give his paper for him.) The Cummings paper covered a lot of ground, including concerns about APA governance, political correctness, and other topics, some of which are covered in his edited book Psychology’s War on Religion. So those were the two actual papers in the symposium. The discussant was Dr. Frank Farley, who is also a past president of APA. He reiterated some of the concerns raised by Dr. Cummings, although he was more restrained. Dr. Farley also raised concerns he had about the misuse of the ethics code within the APA, which was interesting. He also offered his thoughts on our study. He seemed to appreciate the challenges in conducting such a study (politically or ideologically), but he offered some suggestions that might be quite difficult to do in a similar project. Dr. Byrd then distributed packets with the two papers included.

We then took questions from the audience. Dr. Jones was able to respond to one question on how the recent APA Task Force report dealt with our previous report on attempted change. I thought he offered important counterpoints to that specific review. Other questions dealt with a range of topics, such as methodological considerations (e.g., what about the use of a control group), but each of these exchanges was appropriate and professional. It was a good session from that standpoint.

I think everyone will need time to digest both the APA Task Force report and findings from this study, as well as other relevant resources. It is important to think about what is appropriate to make available to those interested in either professional or paraprofessional or ministry services, as well as how to communicate what can be expected from what is available. It is also important to reflect on how all of what is offered is understood within a broader framework of professional care based on an ever-changing understanding of what we know (and what we do not know) from the current research.

Extended Ex-Gays Study Presented at APA

The American Psychological Association conference just wrapped up. This morning I presented (with my co-author, Stan Jones) findings from the 6 to 7 year follow-up of the Exodus study. The study is a longitudinal and prospective look at efforts to change sexual orientation through involvement in ministries affiliated with Exodus International. The book covered the first 3 years of attempted change; the paper is the 6 to 7 year follow-up. Here is the pdf of the paper session (thanks, WT, for creating the pdf).

Here are a few highlights:

  • The current presentation provided an update on 63 subjects (a 6-7 year retention rate of 64%);
  • Data is provided on Phase 1 subpopulation (<1 year involvement in current ministry at Time 1); Truly Gay subpopulation (above the scale midpoint at Time 1 for measures of homosexual attraction, and past homosexual behavior, and previous gay identity); the whole population;
  • On multiple measures (Kinsey and Shively & DeCecco scales), subjects experienced statistically significant change way from a homosexual orientation. The change toward heterosexuality was not a strong as the change away from homosexuality for those who reported such change. Results for the Phase 1 subpopulation were not statistically significant;
  • Subjects did not report an increase in distress on average for making the change attempt. When changes were present, it was in the direction of improved psychological status (for the Whole population and the Truly Gay subpopulation);
  • Subjects indicated which category described their experience (the categories were created by the researchers at Time 3). Here’s the breakdown at  Time 6 by self-categorization:
    • Success: Conversion (23%) – substantial reduction in homosexual attraction and substantial conversion to heterosexual attraction and functioning;
    • Success: Chastity (30%) – reduced homosexual attraction allowing for chastity without distress;
    • Continuing (16%) – modest decrease in homosexual attraction but not enough to say successful; still attempting change;
    • Non-response (7%) – no change so far – unsure which direction to go;
    • Failure: Confusion (5%) – no change; no longer attempting change; not yet embraced gay identity; and
    • Failure: Gay Identity (20%) – no change; no longer attempting change; identify as gay (NOTE: not intended as “failure” in the true sense of the word; rather, with reference to stated goals of ministry);

Toward the end of the paper we discuss how to understand chastity from a Christian worldview, a more pessimistic view of the data (focusing only/principally on Phase 1 participants), and understanding the data with reference to sexual identity. The paper closes with noting the importance of putting information in the hands of the consumer and making a number of options available.