Regent PsyD Colloquium – Reflections

Erica Tan and I spoke today at the Regent University PsyD Colloquia Series. We discussed the clinical applications of the longitudinal study of attempted change in sexual orientation through religious ministries. I was struck by several things:

  • There are people on both “sides” of these discussions who genuinely care about the people who are sorting out sexual and religious identity conflicts;
  • When research is conducted on people’s experience in various religious ministries, it can feel threatening to some members of the gay community, who want to make sure that the people they care about are protected;
  • It is good to hear directly from those people;
  • It is encouraging when one person does not dismiss another person but instead listens and then shares their own experiences.

Several audience members came up afterward to express their gratitude for the way in which the material was conveyed. Many people thought it was going to be a combative meeting, with people glaring at one another from both sides. One person said he thought from what he had heard that I had three heads and was some kind of monster. One person shared that if he had met more people like some of the students in the audience, he might still be a Christian. Many people just had tears in their eyes.

What happened? A lot of different things happened. But we acknowledged the different stakeholders in these kinds of discussions, and we reviewed the data, recognizing the limitations and various interpretations. We also shared some information on the approach we take to working with sexual minorities who are navigating their sexual identity in light of their religious identity. This included sharing some of the real-life challenges past clients have shared with us. There was at least 30 minutes for questions and answers, and that gave many audience members the chance to ask questions, share their experiences, and clarify potential misunderstandings.

There is much to be gained from listening to one another and being respectful to one another. This doesn’t mean we will agree on everything, but it does keep us from talking past one another or from pushing an agenda that overlooks the people (from various communities) who have a stake in the discussion. I hope that this is the beginning of an ongoing discussion.

Psychology Colloquia Series

The 2009-2010 Regent University Doctoral Program in Clinical Psychology Colloquia Series begins this Friday. I was asked if I would give a talk that goes over the findings from the Ex-Gays? study (or Exodus study, the 6-year longitudinal study of attempted change in sexual orientation through involvement in Exodus ministries). The talk is really on the clinical implications of the study. I am going to present with Dr. Erica S. N. Tan. Dr. Tan is a former student and now colleague who works with sexual identity issues, too, and she and I follow a similar approach. In any case, we will go over the major findings from the Ex-Gays? study and then discuss what we know and don’t know based on this research (and other studies), as well as what we recommend for clinical practice. This point about recommendations will include a discussion of the recent APA task force background document that informed recent policy on appropriate therapeutic responses to sexual orientation.

Christian Counseling Conference in Nashville

opryland hotelThe American Association of Christian Counselors (AACC) world conference is this week in Nashville. It is held at the Opryland Hotel and Conference Center. I just arrived last night and am getting ready to co-lead a pre-conference workshop today with Jim Sells. The session is titled “Christian Family Therapy.” We are presenting on an integrative approach to family therapy, drawing on our recent book Family Therapies.

On Friday I’ll be co-presenting a workshop on “Working with Mixed Sexual Orientation Couples.” I’ll be presenting with Jill Kays, a doctoral student in clinical psychology at Regent, and we will be discussing some of the characteristics of mixed orientation relationships, as well as present a framework for counseling that address some of the unique considerations that come up when working with these couples.

SIT Framework Site and Listserv

Dr. Warren Throckmorton and I recently launched the new Sexual Identity Therapy Framework website for those interested in learning more about the framework and for those who are looking for resources.

Also, we launched the SIT Framework listserv and invite people to join in on discussion and announcements related to the framework.

The listserv portal is here:

Click to join sexualidentitytherapy

The listserv discussions will focus largely on professional and related ministry issues.

APA Task Force Report – Chapter 4 (Outcomes)

460The next chapter (Chapter 4) dealt with the outcomes from the studies that met the criteria for review set forth by the Task Force. They believed that the change efforts had several goals, and this chapter is organized around a discussion of the findings in each of the following areas:

  • Decreased interest in, sexual attraction to, and sexual behavior with same-sex sexual partners
  • Increased interest in, sexual attraction to, and sexual behavior with other-sex sexual partners
  • Increased healthy relationships and marriages with other-sex partners
  • Improved quality of life and mental health (p. 35)

The Task Force addressed much of the existing data on SOCE and organized the review in a way that I think is accessible to the reader. I thought that the critique of the Exodus study (or Ex-Gays? study by myself and Stan Jones) in a later footnote was particularly unusual, reflecting disproportionate methodological criticisms that may reflect to the reader a bias. The approach to this study was apparently due to a number of considerations, e.g., that the report did not appear in a peer-reviewed journal. However, the task force cited other studies that were presented in book format throughout their report (e.g., Kinsey studies, Laumann et al. study, which had spin off reports while the core of the material was presented in book format) and did not exclude them from consideration as valuable for informing the report. Also, the way the footnote was written appeared to throw the book at the study without really explaining the criticisms (as I mentioned in my previous post – without acknowledging ways in which it was an improvement in design to previous studies). This was particularly surprising given the attempt throughout much of the rest of the report to be evenhanded in responding to the literature in this controversial area.

I think that worldview commitments and assumptions impact how all of us reach and frame conclusions on this literature. The report used words like “limits claims for the efficacy and safety” (p. 42), which I think is accurate; but it also uses words like “very small minority” regarding “enduring change” and “rare” to describe “decreased same-sex sexual behavior and increased attraction to and engagement in sexual behavior with the other sex…” (p. 43). Again, regarding the older studies, they were conducted in ways that are comparable to how other studies were conducted at that time, and so we would not expect them to meet present-day standards for evaluation. The lack of methodological rigor does not disprove success but would rather suggest the need for better studies for those who are interested in continuing to offer such interventions.

The report concludes that “non-aversive and recent approaches to SOCE have not been rigorously evaluated” (p. 43). Again, I agree with this, but I think some studies (e.g., Jones & Yarhouse, 2007) have challenged the claim sexual orientation is immutable as modest gains through involvement in religious ministries (clinical meaningful and statistically significant changes to attractions, behavior, and identity over time, as noted above) were documented over time.

Discover Article on Change of Orientation

Let me take a break from my review of the APA task force report on appropriate therapeutic responses to sexual orientation to point out the new on-line Discover article on efforts to change sexual orientation.

There is an interesting quote from the chair of the task force on the Exodus study:

“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.”

This critique of our study (as it is reported in this article) is overstated and simply fails to acknowledge ways in which the study was an improvement in design to previous studies (e.g., longitudinal, prospective [Phase 1 participants], use of multiple measures of sexual orientation and sexual identity, symptom distress, etc.). The study also had a good retention rate (~75% over a three year span). The comment on preferred statistical analyses is incorrect. More sophisticated analyses would have been important had we been comparing different groups of participants to see if they responded to the ministry differently over time. That was not the point of the study; rather, we were interested in falsifying a theory that there would be a uniformly negative effect, which would have shown up with the statistical analyses we used.

While this kind of dismissal of the study is unwarranted, I think the potential misuse of our study comes from those who want to see in it categorical change (completely gay to completely straight). We reported meaningful shifts (for some) along a continuum, and this should be nuanced in light of the retrospective and prospective aspects of the study. It would make sense to me to have ministries begin there (the possibility of meaningful shifts along a continuum for some) and keep expectations realistic.

APA Task Force Report – Chapter 3 (Methodological Issues)

460The task force indicated that they felt the best way to answer the charge to them was to provide a review of the literature on attempted change of sexual orientation. So the next chapter of the report reviews the methodological issues present in the existing research. The authors also set up the criteria upon which they based their review (such as inclusion/exclusion criteria).

Many people, myself included, have been quite clear that there are definitely methodological limitations in this older research. After all, much of the research was conducted in the 1950s-1970s. The studies were conducted in keeping with the standards of the day, so we want to be careful to keep that in mind when critiquing them from that standpoint. It has also been said that poor methodology does not disprove success.

It is interesting to note, too, that many current textbooks still cite older studies with similar methodologies as evidence for the effectiveness of other approaches to therapy. I remember looking into this several years ago, and one leading family therapy textbook cited studies from the 1970s and 1980s that had similar methodological concerns as evidence for the effectiveness of widely practiced models of family therapy. I think people who feel that the task force unfairly applied rigorous standards to this literature may feel that a similar standard would sink many other therapy models for a wide range of practices. On the other hand, I think those who provide such scrutiny point out the potential for misleading and harmful outcomes are greater given the topic.

On the question of standards being applied consistently, one other observation that has been made about the report is that the task force used different standards when reviewing the evidence about change of orientation than when they looked at the question of harm or how normal homosexuality is or other issues. On these other matters, they cited studies that had significant methodological limitations.

I do agree that it is important that better studies are developed and conducted, particularly if clinicians provide change of orientation therapy. As with so much of counseling and psychotherapy, there is a need to conduct more and better studies on various treatment models.