Category: Applied/Clinical Integration
Academics measure time in semesters. As the summer comes to a close and we anticipate the start of the fall semester, I wanted to provide an update on two writing projects. These are “coming attractions,” if you will. A few weeks ago I hit “send” on two book-length manuscripts. One was going to Zondervan and the other to Templeton Press. (By the way, this may be the first time I worked on two larger projects at the same time. I try to do one book at a time and write-up articles or develop presentations rather than try to work on another project of that size. But poor planning on my part and an unexpected invitation led to these projects being on my plate at the same time.) Let me tell you about both.
The manuscript that went to Zondervan has the working title of Costly Obedience. It is a book-length treatment of several studies we have been conducting on the experiences of celibate gay Christians. While several studies provide valuable information throughout the book, the central study is of 300 celibate gay Christians who provided information on their psychological well-being, their experience in churches, their sexual identity development, and religiosity. If I do say so myself, it is a fascinating look at the lives and experiences of Christians who are navigating sexual identity and faith and who wish to abide by a traditional Christian sexual ethic. We include the voices of celibate gay Christians in the form of a smaller qualitative study in which we pull quotes on their experiences, and you read about them all throughout the manuscript. Also, I asked several friends and acquaintances of mine if they would share their personal experiences or recommendations for the church, and their voices are also interspersed throughout.
The other manuscript–the one that went to Templeton Press–has the working title of Sexual Identity and Faith. It is a book for clinicians about how to provide therapy to people of faith who are navigating the difficult terrain of sexual and religious identity conflicts. In other words, for some sexual minorities of faith, their same-sex sexuality and their Christian commitments collide in a way that is very difficult for them. When they enter professional therapy, they have historically been offered two broad options: one is to change their sexual orientation; the other is gay affirmative therapy. For about 20 years I and others have been providing therapy that is a “third way” model that tries to be client-centered and identity-focused. It is not a change therapy; rather, it has to do with helping clients achieve congruence so that they can live their lives and form an identity in keeping with their beliefs and values. In 2006, Warren Throckmorton and I wrote a framework for providing such therapy called the Sexual Identity Therapy Framework.
In any case, the book is fairly comprehensive, as it covers advanced informed consent, assessment, and approaches I take in therapy from a more narrative and cognitive-behavioral perspective. So it has to do with the stories that have been told about people, the stories that are currently being told, and the chapters that the person in therapy is writing and will be writing in the years to come–a story about who they are in light of their same-sex sexuality and Christian faith.
Publishing is like farming. You plant a seed (or hit “send”) and find that the harvest is months away. You can look for both of these resources in the summer of 2019.
Family Therapies 2nd Edition
Here is the cover design for the second edition of Family Therapies: A Comprehensive Christian Appraisal. This was a fun book to revisit and update.
We looked at the various schools of family therapy and updated the research that has been conducted in support of the different approaches.
Our main focus was recognizing and reflecting the changing cultural landscape regarding family. The reader will pick this up throughout the book but especially in two new chapters. The first one is on cohabitation and how trends in living together before marriage (or just living together) affect relationship and family dynamics.
The other new chapter deals with LGBT+ couples and families and really expands how we interacted with sexual and gender identity experiences in the first edition of the book.
In any case, here is an overview of the book from the revised preface:
The book is divided into four parts. In part one (chaps. 1-2), we set the stage for the discussion of the first-generation models of family therapy. Chapter one is a discussion of a distinctively Christian perspective on the family. Chapter two is a discussion of the field of family therapy, how it developed and some key terms that will help the reader better understand the field.
Part two of the book (chaps. 3-12) devotes one chapter apiece to the major models of family therapy developed in what is sometimes referred to as the first generation of family therapists (e.g., structural family therapy). If each approach to family therapy is a “map” for getting families from a place of some kind of dysfunction to a place of better functioning, each chapter in this section contains an explanation of the map, followed by a discussion of the theoretical and philosophical assumptions and practical implications. We then focus on Christian critique and engagement of the theoretical and philosophical underpinnings and the practical issues involved in using specific techniques associated with that theory. We also provide brief reflections that tie back to the three foundational themes introduced in chapter one: family identity, family functioning and family relationships. In the closing chapter of this section of the book (chap. 12) we introduce a framework for integrative Christian family therapy.
Part three (chaps. 13-20) extends the discussion by taking topics that are commonly addressed in family therapy and inviting Christians to interact with the relevant materials. We introduce the reader to the issues (e.g., crisis and trauma, marital conflicts) and then review the literature in that area, followed by Christian engagement in light of what we see as particularly valuable from the first-generation models of family therapy and in light of what we propose for an integrative Christian family therapy. In the second edition we added a chapter on cohabitation and significantly revised the chapter on LGBT+ couples and families. We see cohabitation as an increasingly popular entryway into marriage as a a relationship status in and of itself. We want to help the reader grapple with that reality. An additional reality is the success of the marriage equality movement and the likelihood that Christian clinicians will work with LGBT+ couples and families in the years to come. We also want the reader to be familiar with those cultural shifts and to think deeply and well about some of the concerns that arise.
Part four (chap. 21) reflects our desire to cast a vision for integrative Christian family therapy/counseling/ministry. In particular, we see the need for local family therapy to be influenced by a shrinking, global world in which family therapists will need to expand their understanding of family structure and relationships. Societal and cultural changes will have an impact on our work and the ways in which we think about and engage the families in ministry and service.
Ukraine Reflections – Part 1
I just returned from a trip to Ukraine. I was part of a larger team that was there to train pastors in basic skills of counseling and more advanced skills associated with trauma care and sexual issues. The team I took taught all morning for the week we were there and then did several activities in the afternoon to get better acquainted with the city. We taught on sexual issues in counseling based on a textbook I had co-authored with Erica S. N. Tan. That book was actually sponsored by several organizations to be translated into Russian before our trip, so that students could get the most out of it. That was exciting to see.
We also participated in a conference on sexuality at one of the prestigious universities in Kiev on Saturday and Sunday. I offered a plenary address on some of the changes in approaches to sexual minorities over the years (kind of updating a 2002 publication that created a typology of sorts around this topic) and the convergence of the APA’s position on client-affirmative care and Sexual Identity Therapy. I also conducted a workshop on SIT in individual and in group therapy contexts. The co-director of the institute gave another plenary address and students led workshops on body image and female sexual addiction, as well as poster sessions on recent empirical work we have been doing. It was an extraordinary 11 days to be honest with you.
I thought I might offer a few reflections on my time there. My thoughts are a bit scattered today, however, so this may be of little use to anyone. I’ve never taught using a translator. That was an extraordinary experience. I’ve taught while someone signed my class to a deaf student, but I had not taught in another language and had to work out the pace of teaching and allowing for translation. You get roughly 1/2 of the time to move through the material. I learned quite a bit about my lack of patience.
It was also striking to me how hungry people are in Ukraine for training. You can forget that they are at war right now, and that any training that helps them, any training that is practical and skills-based can be immediately of help to them. We tried to keep things very practical. In fact, I turned more toward clinical demonstrations of skills toward the end of the week (whereas I had been more lecture-based and theory oriented toward the beginning of the week).
Students & Alumni Navigating Sexual Identity on Christian College Campuses
Several members of my research institute recently published a small, qualitative study of 18 students and alumni of Christian institutions of higher education. The students and alumni all identified as Christian; they all reported same-sex attraction or otherwise identified as lesbian, gay or bisexual (LGB).
We organized the findings around two themes: (1) experiences of attraction, orientation, identity, and associated milestone events, and (2) campus climate. I wanted to share a few impressions from the study–these are just some things that stood out to me.
We asked about specific milestone events in the formation of one’s sexual identity. Milestone events are commonly studied in research on sexual identity development. They refer to sign posts LGB adults recall as important in their own formation of an LGB identity. We ask about these even though we recognize that an LGB identity may not be an outcome for all Christians who are navigating same-sex sexuality and sexual identity considerations. In any case, first awareness of same-sex sexuality is a common milestone event. As you might anticipate, all of our participants reported first awareness of same-sex attractions–with an average age of awareness at about 11. It was interesting to me that those behaviors that are more volitional–those behaviors that a person has say about–were less commonly reported. For instance, only 50% reported a first same-sex relationship.
For good or for ill, there is a lot of discussion in Christian circles about identity labels. Is it okay to identify as gay and Christian? We did not ask our participants about whether or not it was okay; rather, we asked whether they adopted a gay identity. About 44% identified themselves as gay (“took on the label of gay” was the actual wording). We also asked about disclosure, and each participant shared with someone else that they experienced same-sex attraction (“first disclosure of same-sex attraction” was the wording). But most of that disclosure was to just a few friends while they were students.
What about campus climate? It perhaps comes as no surprise that about half indicated a hesitancy on the part of their campus to discuss sexual identity. I thought it was interesting that about half indicated that their campus was open to discussion/progress in this area. Perhaps its a matter of perspective. Maybe there is greater variability among campuses. One student talked about compassion:
Our university really tries to push the issue to make it more known. Not from a specifically acceptable standpoint, but to say it’s a legitimate struggle just the same as everybody else in the sins that they have. They try to have a biblical view on it and just to encourage people to come alongside people with the struggle. I think it’s been something that’s been getting in motion. (p. 23)
I think as a research group we were also struck by what were referred to as “pockets of safety.” These are friendships or relationships that are places a person can be more honest and forthcoming. One student shared the following:
One group of friends I hung out with I chose very carefully and very intentionally because I realized that they were just a little bit more accepting in general… two of them I can think of didn’t agree that homosexuality was okay, but they still treated me like a human being, still had fun with me, still invited me to things, and my sexuality never defined me. (p. 23)
We asked what I thought was an interesting question toward the end of the study: What advice would you give to other Christian students on your campus who experience same-sex attraction? The most common response by far was to find trustworthy people. One person shared, “Find at least one person you can be open with.”
When asked what the campus could do differently in this area, answers went in a few different directions, but one thing that was shared is something I hear quite often as a guest speaker at Christian colleges and universities: Provide us with some clarification about what we as students can and cannot do to be supportive of one another without putting ourselves at risk for discipline.
There was a lot more, of course. These are just some of the findings that stood out to me. Perhaps other findings would stand out to you. You can read the entire study here.
We have a separate study along these same lines that is currently underway. It is a larger study with more quantitative measures as well as qualitative interviews. We hope to have data analyzed soon.
Forgiveness in Mixed Orientation Relationships
The following post is cross-posted at Spiritual Friendship.
The Institute for the Study of Sexual Identity has a new study available online on people in mixed orientation relationships. Recall the mixed orientation couples (MOCs) are relationships in which one partner is straight and the other partner is a sexual minority. By “sexual minority” we mean that the person experiences same-sex attraction independent of identity (that is, they may not self-identify as gay, lesbian, or bisexual). That is a definition used by other researchers in this area and it is not unique to us.
Back to the new study. We’ve been conducting a longitudinal study (a study in which data is gathered over time) of MOCs. This most recent publication examined the experience of disclosure on the part of the sexual minority and the impact of that disclosure on the straight spouse.
Spouses often progress through stages following disclosure and obviously have a lot to navigate. Amity Buxton discusses stages spouses go through following disclosure: 1) Initial shock, denial and relief, 2) Facing, acknowledging, and accepting reality; 3) Letting go, 4) Healing, and 5) Transformation. What we have seen elsewhere is that the impact of disclosure is comparable to what Gordon and Baucom have described in the affair literature. That is, disclosure of same-sex sexuality (which can include disclosure of infidelity) is often experienced as “interpersonal trauma” as it can be a significant betrayal to the offended spouse.
We were looking at the experience and impact of forgiveness on these post-disclosure experiences. Don Baucom and his colleagues say the goal of forgiveness is “to regain a more balanced and compassionate view of the offender and event, decrease negative affect towards and avoidance of the offender and giving up the right to seek revenge or lash out towards the offender.” New understanding, new meaning–these are thought to be important. Also important: forgiveness is not reconciliation. Forgiveness sets a stage upon which decisions about whether to reconcile can be made.
What we found was that forgiveness was shown to play a role in how spouses progress through the post-disclosure stages–particularly moving toward the stages of Letting Go, Healing and Transformation. We also saw movement in both forgiveness and post-disclosure stages over the course of a year. Spouses tended to report less cognitive, emotional, and behavioral disruption over time in response to the offense.
What are the practical implications for people who are providing services or ministry to MOCs? MOCs may process disclosure in ways that are similar to how heterosexual couples process affairs. It may be helpful to create space to talk through how disclosure took place, and how each partner processed disclosure, including relational conflicts, rejection, and emotional distancing before and after disclosure.
Processing disclosure and other experiences allows everyone an opportunity to consider if forgiveness is a potential option, as forgiveness provides a healthy way to address the consequences of offenses by allowing for closure to what has been painful; forgiveness, which is itself a process, can also help prepare the couple for reconciliation. If the MOC has chosen to divorce, then forgiveness would not have marital reconciliation as its goal.
If you are interested in past posts on mixed orientation relationships, see Part 1, Part 2, Part 3, Part 4, and a post with Additional Thoughts on MOCs.
Here is an excerpt from my new book (co-authored with Dr. Erica S. N. Tan) titled Sexuality & Sex Therapy: A Comprehensive Christian Appraisal.In the chapter on Sexual Interest and Arousal Disorders, we have a closing reflection on integration. It’s here that we introduce the concept of “creative fidelity” by Lewis Smedes. It’s a concept I have long appreciated and just wanted to highlight:
For those who marry, we appreciate the concept of “creative fidelity” introduced by Lewis Smedes (1994, p. 145). Smedes points out that a married person’s obligation to be faithful should not be reduced to avoiding sexual behavior that detracts from the marriage; rather, there is a positive expression of fidelity that warrants our attention. Smedes develops this idea of creative fidelity as faithfulness to calling (the state of marriage), service, one’s partner (and their well-being), our own personal growth, and so on. On the matter of desire,
“A man or woman can be just too busy, too tired, too timid, too prudent, or too hemmed in with fear to be seriously tempted by an adulterous affair. But this same person can be a bore home, callous to the delicate needs of his partner. He or she may be too prudish to be an adventuresome lover, but too cowardly to be in hones communication and too busy to put himself out for anything more than a routine ritual of personal commitment. He/she may be able to claim that he/she never cheated; but he/she may not be able to claim that he/she was ever really honest. He/she may never have slipped outside the marriage; but he/she may never have tried to grow along with his/her partner into a deep, personal relationship of respect and regard within marriage. His/her brand of negative fidelity may be an excuse of letting the marriage fall by neglect into dreary conformity to habit and, with that, into a dull routine of depersonalized sex…. anyone who thinks that morality in marriage is fulfilled by avoiding an affair with a third party has short-circuited the personal dynamics of fidelity.” (pp. 146-147)
So discussions of sexual desire/interest/arousal should not be limited to a negative discussion about what is absent; it should also reference a positive discussion about what is possible. It should include a proactive posture toward one’s partner (for those who are married) in terms of “creative fidelity” toward the whole person and redemptive structure of marriage itself.
Developmental Trajectories among Gender Dysphoric Children
InterVarsity Press Academic and the Christian Association for Psychological Studies are set to publish a new book I wrote with Erica S. N. Tan titled, Sexuality & Sex Therapy: A Comprehensive Christian Appraisal. I am hearing it will be out in April.
After four foundational chapters offering theological, sociocultural, biological, and clinical perspectives on sexuality, we discuss several sexual dysfunctions, the paraphilias, sexual addiction, and other clinical presentations. Here is an excerpt from the chapter on Gender Dysphoria.
What we are discussing is onset and course. Specifically, we are discussing a study of children who persist and desist in their experience of Gender Dysphoria:
Although there is relatively little research on gender dysphoria as compared to many other sexual concerns, there has been some preliminary research (Steensmaet et al., 2010) on possible developmental trajectories among those who persist (in their experience of gender dysphoria) and those who desist (or who do not continue to experience gender incongruence).
When these two groups are compared, it is interesting to note that there are apparent differences in underlying motives in cross-identification, as well as differences in responses to changes at puberty. In considering motives for cross-identification, one persister shared the following: “In childhood (and still), I had the feeling that I was born as a boy. I did not ‘want’ to be a girl. To myself I ‘was’ a boy, I felt insulted if people treated me as a girl. Of course I ‘knew’ I was a girl, but still, in my view I was not” (Steensmaet et al., 2010, p. 6). In contrast to this, a desister shared this: “I knew very well that I was a girl, but one who wished to be a boy. In childhood I liked the boys better, the girls were always niggling [petty, nagging]. I was tough and wanted to be as tough as the boys” (p. 6).
When the researchers looked at the different responses to puberty, they noted the strong reaction against these changes among those who persisted with their gender incongruence. One persister shared the following: “It was terrible, I constantly wanted to know whether I was already in puberty or not. … I really did not want to have breasts, I felt like, if they would grow, I would remove them myself. I absolutely did not want them!” (Steensmaet et al., 2010, p. 8).
Again, in contrast, a desister shared this: “Before puberty, I disliked the thought of getting breasts. I did not want them to grow. But when they actually started to grow, I was glad they did. I really loved looking like a girl, so I was glad my body became more feminine” (Steensmaet et al., 2010, p. 12).
Keep in mind that both groups engaged in some cross-identification at a young age, about 6 or 7 years old. However, Steensma et al (2010) reported that for those who desisted—whose gender dysphoria abated over time—that change occurred at between 10-13 years of age, whereas the gender dysphoria seemed to increase for those who were called persisters.
The persisiters would go on to disclose and make a plan for some kind of transition between the ages of 10-13 years old, while those who desisted tended to identify with their birth sex at age 13 and older.
Although I have provided clinical services and consultations in the area of gender dysphoria and have conducted research involving transgender Christians, I have not written that much about it. I enjoyed the opportunity to work on this chapter with Erica and to reflect further on gender identity and gender dysphoria from a Christian worldview.
The year before last I was driving home from a psychology conference with two of my colleagues, and we were discussing ways in which technology could be a resource in facing any number of issues people deal with in our culture. We began sharing back and forth about some of those challenges, and one that we spent more time on what that of pornography. It’s been estimated that as much as 40% of web traffic is porn related, and numerous articles have recently pointed out ways in which it can have an effect on a person or couple.
So we began to explore how technology could be leveraged to help people who struggle with porn and who want to decrease their porn use. We discussed what people often do in counseling to make changes in this area and how to translate that into an app. That conversation led to a process I never thought I’d be a part of: app development.
Let me say with confidence that app development takes time and you make a lot of mistakes along the way. But that is just part of the story. The other part of the story is that I am excited to say we have finished it up and it has been released.
The name of the resource is “Private Integrity,” and we have officially launched it as both a website and an app–the app is available in English and Spanish through the iTunes Store. It already has one nice review from a user.
The website is www.privateintegrity.org. We are actually signing people up for free through the month of January, so if you know someone who might benefit from this resource, please point them in that direction.
Here is a little bit about the resource (from our web site):
Pornography is an easy behavior to use to help yourself feel better momentarily. Many individuals end up feeling guilty and then once again loop back into the process of looking at pornography again. It becomes a downward spiral. Private Integrity reverses this process and helps you create an upward spiral. Instead of a downward spiral that results in more pornography viewing, you are going to learn how to use exercises to increase positive behaviors and decrease porn viewing. – See more at: http://www.privateintegrity.org/
“My Gay Breaking Point”
I was reading over a dissertation completed by one of my former students–I know, I know, I need to find a decent hobby–but I was struck by her work. She had conducted in-depth interviews with 12 Christian parents whose son or daughter had come out. It was a study that that captured many of the challenges and nuances families face at and following disclosure.
What caught my attention when she proposed her research idea was the focus on Christian parents. Much of the research and discussion to date is on the experience of the gay child (the adolescent or young adult), which is obviously important. As a field, we have learned a lot about the experiences of those who disclose their same-sex sexuality, and yet we have so much more to learn. At the same time, I see fewer studies of parental reactions, and fewer studies still of Christian parents. Since I work with a lot of Christian parents, the idea of interviewing them and hearing their stories was compelling.
Although I am unable to go into all the details here (dissertations are LONG), I will note that she offered in the discussion section of her dissertation a tentative model of post-disclosure that emerged from the interviews she conducted with these parents: (1) Initial awareness and worldview response; (2) Navigation period–help-seeking; (3) Navigation period–maintaining relationship with child; and (4) Acceptance of reality.
Initial awareness and worldview response. The first issue deals with first becoming aware and responding to the disclosure of same-sex sexuality. Responses to disclosure or discovery of a gay identity were frequently tied to conventionally religious morals, values, and beliefs that were seen as incompatible with a gay identity. Parents here reported ambiguous loss, negative emotions (e.g., shock, anger, concern, fear, shame), and strained relationships with their child.
One parent shared her initial response. I won’t offer an extended quote here, but suffice it to say she spoke of her daughter making this choice (“that kind of choice”–“why would she want to be like that?”), which suggests the view that this pattern of attraction is volitional. This automatically sets the parent and child against one another, because the child knows he or she did not choose to experience same-sex attractions. The assumption that this is just a poor choice has them speaking past one another. I wish that were a rare report, but it isn’t in my experience.
Navigation period–help-seeking. The next response entails gaining information from multiple sources. In this study it was often from counselors, the church, pastors, ministries, and so on. In terms of meaning-making, parents reported turning to and trusting God, finding support from family/community, and spending time in prayer and in Scripture. Marital conflict was not uncommon, and many parents reported a kind of shame as they tried to relate to and share with people in their local faith community.
One parent shared how hard it was to find information, resources, and support. “We couldn’t find anyone” is a typical response, as is the decision not to take this disclosure to the local church. The common assumption and experience is that the local church is not “safe” in terms of gossip, making it all the more difficult, as parents often sort through painful and confusing emotions in isolation.
Navigation period–maintaining relationship with child. At the same time as parents are seeking help, they are also trying to maintain a relationship with their son or daughter. There were strained relationships, to be sure, but also a commitment to maintaining some contact, arranging ways to see their son or daughter, and so on. This commitment was typically a reflection of love.
One mother who eventually moved toward what she saw as a good, healthy relationship with her son, recounted her “gay breaking point” at an earlier stage: it was when her son wanted to get a pedicure with her. It sent her spinning. My initial response to that language was that it was kind of off-putting or even offensive, but as I thought about it, I got what she was saying, at least I think I got it. I actually see her gay breaking point as tied in important ways to acceptance of reality, to coming to terms with the reality of having a son or daughter who is gay. Sometimes parents move from a fantasy that this whole thing will work itself out or dissipate or resolve or whatever… perhaps the breaking point tells them there is something real here, something that they have to deal with seriously and in a meaningful way.
Acceptance of reality. This involves really coming to terms with a gay son or daughter in the sense of how the relationship with that child has changed. It could still involve negotiating boundaries, but it also often entails changing expectations. What is often reflected here is a greater respect for one another and one’s decisions.
I would have to say that this study reflects the experiences of a small number of Christian parents, it does reflect pretty closely much of what I have seen in my work with parents over the years. There is definitely a time of first awareness and associated feelings, such as confusion, anger, disappointment, and anticipatory grief. Also, since I frequently work with Christian parents, I have seen the clash of worldviews and the difficulty finding a way forward. Parents then do navigate getting help while simultaneously trying to make a way to stay in relationship with their son or daughter. Often attempts to stay in touch are in the hopes that this will go away or be easily resolved or be a phase their son or daughter is going through. That’s what makes the other stage meaningful–coming to terms with the reality of what has been shared and finding a way forward based on this new reality.
One thing about models is that they do not capture the complexities faced by each and every parent. If you are reading this and say, “That doesn’t quite fit my experience,” that’s understandable. There is no one experience everyone shares. At the same time, these observations provides a framework for understanding some of the experiences reported by some Christian parents. It also gives those in the church who wish to provide support an idea of what parents may be navigating in the months and years following disclosure.