The 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.
The 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.
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.
Several 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.