Ban on SOCE Blocked in One Ruling; Not in Another

A federal judge (Judge William B. Shubb) has blocked a ban in California that  made it illegal for licensed mental health professionals to provide sexual orientation change efforts (SOCE) to minors. Here is the link. The ruling apparently only covers the three plaintiffs and not other mental health professionals. According to the LA Times, the judge noted that the ban was “based on questionable and scientifically incomplete studies that may not have included minors.” Here is the decision itself.

That was yesterday. Today, a different judge (Judge Kimberly Mueller) handed down a decidedly different decision (not to postpone the law) on a separate case brought by different plaintiffs – that story is here.

As I mentioned in previous posts available here and here, there are several problems with the ban, including the scientific evidence on this kind of therapy on teens, as noted in the first ruling mentioned above. As important as that may be, there are issues with venue, precedent, and scope in the language of the ban itself. In any case, it is interesting that the scientific evidence was apparently not a point of focus in the other ruling, and I am sure many stakeholders will be keeping an eye on the developments in this area.

On Warranting Equal Scientific Standing

A recent commentary in USA Today discusses the frustration felt by some folks in the social and behavioral sciences that their disciplines are not treated as though they were as scientifically rigorous as the hard sciences (e.g., biology, chemistry). The author points out two issues that drive the debate: money and politics. First, the money given to one study is funding taken away from another study. So there is a vested interest in limiting who is a viable candidate for limited funds.

Second, research can be political, and academics in the softer sciences are decidedly left of center:

A recent survey by economics professor Daniel Klein revealed that Democrats outnumbered Republicans by a whopping 30-to-1 ratio in anthropology; 28-to-1 in sociology; nearly 10-to-1 in history; and nearly 7-to-1 in political science. In economics, which is widely considered “conservative” by other social fields, Republicans are merely outnumbered 3-to-1.

These ratios should get your attention.

A similar discussion takes place in several chapters in the book, Psychology’s War on Religion, edited by three folks, one of whom is Nicholas Cummings, past president of the American Psychological Association. I contributed the chapter on the battle over sexuality, which is on the front lines of the question of bias. I’ll come back to this in a moment. But first let’s discuss philosophy of science.

Several scholars have pointed out that research is value-laden – this is fairly well-established in the philosophy of science literature for the past fifty years or so. From the selection of the topic to the choice and operationalization of variables to the interpretation of data – make no mistake, science is value-laden. It is just clearer to see in the behavioral and social sciences. But that science if value-laden is true across the sciences. Perhaps the potential misuse of science is of greater concern in the behavioral and social sciences in light of the tendency to skew left of center which could keep researchers from holding one another accountable.  “Group think” about entire lines of research (let alone specific findings) can become a problem that translates into policy recommendations under the weight and auspices of “What science says…”

My experience has been that when other perspectives are brought up that go against the prevailing view (what is quickly defended as the “scientific consensus”), that other perspective (the counter-narrative, if you will) is ridiculed outright or simply left die a slow death by exclusion (from the broader “scientific” discourse).

There are plenty of examples to illustrate this point, and I offer several of them in the chapter I referenced above (in the book, Psychology’s War on Religion). One such area is the question: Can sexual orientation change? The answer “Yes” has become acceptable if it means through natural fluidity (among females) as reported by Lisa Diamond in her longitudinal work. If similar data (with more rigorous methodology) suggests “Yes” through involvement in Christian ministries, that line of research is dismissed outright as an outrageous consideration that does not even warrant discussion. It was interesting at the time of the original publication that the initial criticisms centered on who authored it, our institutional affiliations, and that it was published in book form (never mind that several studies have been published in book form and none of the early criticisms were scientific criticisms as such). Now that the study has been published in a peer-reviewed journal (in 2011, Journal of Sex & Marital Therapy), it is now facing that counter-narrative of exclusion (i.e., let’s ignore it) I mentioned earlier.

Of course, one study does not prove that change occurs, and we have offered several possible explanations for the findings in an attempt to be fair that multiple interpretations of the data are viable. But the findings themselves open a line of research that could warrant further investigation. I recognize that the question of change is not of interest to the mainstream GLB community, and that it is actually a threatening consideration, but the mainstream GLB community are not the only stakeholders in these discussions, and others are (and have been) asking what the can expect from involvement in Christian ministries. Rather than rely upon competing anecdotal accounts, empirical study can shed light on a question of personal relevance to conventionally religious people. (Now such purported “scientific consensus” is being used to advance legislation about clinical practice. The behavioral and social science community that recognizes that such a bill overreaches beyond the science stands silent or “neutral” on the matter.)

So, to return to the question of whether the behavioral and social sciences warrant equal scientific standing: I am unlikely to shed a tear for my colleagues who lament that the behavioral and social sciences are not seen as equal to the hard sciences. As a psychologist, part of me would like to see behavioral science findings valued, and in many (if not most) cases, this would not be an issue. But I see first-hand how the field functions within political space that warrants the criticisms we have received.

When we get our house in order, we will be able to have a legitimate complaint. Until then, the devaluing of the behavioral and social sciences can function as a corrective if we are open to constructive criticism.

An Interesting Development at Exodus and a Tension for Christian Ministries

On their blog, Exodus International is offering their official position on reparative therapy. This is getting a lot of attention (see here and here). The impetus appears to be the California Bill that was recently passed by the CA senate that would make it illegal to provide reorientation therapy to minors (I commented on that here).

This is what Exodus International is saying about reparative and/or conversion therapy:

Exodus International supports an individual’s right to self-determine as they address their personal struggles related to faith, sexuality and sexual expression.  As an organization, we do not subscribe to therapies that make changing sexual orientation a main focus or goal. Our ministry’s objective is to equip the Church to become the primary place where people of faith seek support, refuge and discipleship as they make the decision to live according to Christian principles.

We believe in a “gospel-centric” view, meaning that all people, regardless of individual life struggles, can experience freedom over the power of sin through a daily relationship with Jesus Christ, a commitment to scripture, and by being a part of a vibrant, transparent and relational community of believers found in the local church.  Exodus is partnered with more than 260 churches and support-based ministries who serve individuals and families experiencing a conflict between their faith and sexuality.

There is a tension here between being a Christian ministry that is “gospel-centric” and the questions that naturally arise when ministering in the area of same-sex sexuality about whether sexual orientation can change (or whether a Christian can receive healing).

I was recently contacted by a parent of a young adult how had adopted a lesbian identity. He asked me about his perception that I did not think people could change sexual orientation – and how that fit with Paul’s letter to the church in Corinth (1 Cor. 6:9-11) in which he indicates “such were some of you” – with reference to homosexual behavior (among other behaviors).

Here is part of what I shared:

When Paul writes “such were some of you,” I don’t read Paul as saying that orientation necessarily changed. Paul may be suggesting something like that, but I don’t think we have enough evidence to say that we know he is saying that. Rather, I think we can assume he is at least suggesting a pattern of behavior that used to characterize the person. … He can say “such were some of you” because — and now I think he is referring to a meaningful change due to their relationship with Christ — they have now ceased that pattern of behavior. I would note that the list also includes the adulterer. An adulterer ceases to be an adulterer when they cease a pattern of behavior (infidelity) that characterized them as a person. They may still find themselves attracted to people outside of their marriage, but they do not lust after or engage in behavior with them in a way that would characterize them as a person. I think we are on better footing to say that this is the kind of change Paul is referring to.

I went on to share a little about my views of sexual orientation change:

As for my view of whether orientation can change, I actually think it can, but my view is not one that is popular with the mainstream gay community or with conservatives in the church. Let me explain: To say that orientation can change, I mean that there may be meaningful shifts (along a continuum) away from same-sex attraction (and in some cases meaningful shifts toward attraction to the opposite sex). Some of this appears to be the result of natural fluidity, which is more so the case among females. But I don’t think that everyone can change or that anyone can change, as though it were just a matter of enough effort or of enough faith. Also, the data we have sees from our own research suggests that categorical change – 180 degrees – from gay to straight is less likely than what I refer to as meaningful shifts along a continuum (from same-sex to opposite-sex attraction).

New Spitzer Interview

The sponsoring organization that made this video is trying to ge more mileage out of Robert Spitzer’s change of heart regarding his 2001 study (later published in Archives of Sexual Behavior in 2003). In this interview, Spitzer shares several thoughts that range from how he responded to his own doubts about the study to whether others should show a video of Spitzer talking about his study initially.

It is difficult to know what to say about this interview, but let me offer a few thoughts:

Citing the study. On the question of whether others should cite the study, I can appreciate Spitzer’s desire that others not cite the study, but that is beyond any researcher. The findings are what they are, limitations and all. And many people have pointed out the limitations of the study (see the original publication in ASB and the 20+ commentators). As the editor of ASB noted, retractions and regrets are two different things.

“Seeding” the study. A comment is made by the narrator on how a reparative therapist “seeded” the study with his clients. That sounds more like a design issue for Spitzer. If the researcher solicited participants from reparative therapists, then I don’t see the issue with a reparative therapist informing his patients of the study. If the therapist had been conducting the study, then we would be having a different discussion about how best to obtain a sample.

Past interviews. I don’t think I’ve seen these other videos of Spitzer talking about his study previously (with the exception of the I Do Exist DVD from Throckmorton). Is it wrong or unethical to show those videos? I think it wise that if the videos are shown to acknowledge that the researcher has had a change of heart toward his initial interpretation of the findings.

Closing declarations. This was probably the most interesting part of the interview for me. I’m not sure what to make of Spitzer’s claims toward the end of the interview. These include that those who advance ex-gay therapy are “full of hatred of homosexuality”; that any attempt to change is “misguided”; that orientation “cannot be changed”; and that efforts to change will be “disappointing” and “can be harmful.” Where to begin?

There are no doubt people who hold a great deal of hatred toward homosexuals, but is it true that those who provide such therapy are full of this hatred? I know that that is the developing narrative, but is it true? Is the offering of such therapy (or assistance in the form of ministry) an act of hatred toward homosexuals? Although I do not provide reparative therapy, I know some people who do, and I am quite familiar with the various Christian ministries that exist, and I find this kind of declaration fails to grasp the motivations some people have who pursue such therapy (as well as the motivations of those who provide such therapy). Without some evidence to support the charge, it comes off as rather unscientific as stated.

The claim toward the end of the interview that sexual orientation “cannot be changed” is particularly interesting given Spitzer’s change of heart regarding the methods of his own study. It is one thing to admit growing doubts about whether the design was adequate to support the initial conclusion that in some cases sexual orientation can change, but it is quite another thing to declare that orientation cannot change. Presumably this is coming from the same study that was not of adequate design to support the claim of change. If a researcher concludes that the design is poor, and it cannot prove success, then that study cannot disprove success or prove failure.

On Legislating around the Complexities of Clinical Practice

There has been a lot in the news recently about whether California will ban the practice of reorientation therapy with teens and have specific wording as part of informed consent for adults who seek such services. The California senate committee has passed Bill 1172 to the full senate for a vote. I was interviewed about this today for a story that may run over the weekend, and let me share a few thoughts.

In terms of practicing cognitive complexity, let’s take a look at this from the perspective of those who are advancing Bill 1172. It appears to be out of a genuine regard to protect young people who are believed to be at risk for a type of therapy that proponents of the Bill believe is ineffective and inherently harmful.

On the other side are those who disagree with the Bill for several reasons. The main concerns that come to my mind are these:

1. Venue. I tend to agree with the various CA mental health organizations that have either opposed the Bill or expressed concern that legislating around the complexities of clinical practice in this area is not a good idea. Although it isn’t the first case of making a technique or practice illegal, it is not a common practice at all. Opponents also point out that mental health professionals have regulating bodies that oversee clinical practice, license practitioners, and follow up on ethical complaints. Further, several mental health professions also convene working groups and task forces to review the extant literature and provide updates on research in this area, trying to make that information available to practitioners and the public alike.

2. Science around SOCE for teens. There is not much by way of well-designed research on adolescents who pursue sexual orientation change efforts (SOCE). I don’t think the 2009 APA task force report on appropriate therapeutic responses to sexual orientation was able to identify one such study (if memory serves); instead, the task force cited published articles with case examples of clinicians who worked with adolescents navigating sexual and religious identity conflicts. The science that seems to be cited is that of adults who participated in SOCE and then extrapolated to the adolescent.

3. Science around SOCE for adults. This brings up the research on SOCE for adults that has been reviewed by a number of professionals and organizations. The Bill references a number of mental health organizations. One concern is that the Bill uses stronger language than the organizations, in at least a few cases. For example, the Bill indicates that SOCE are ineffectual, while the APA task force tends to talk about not have sufficient evidence to support claims of change, that change is “uncommon”, and that newer studies are not sufficient in quality to answer whether or not SOCE does or does not change orientation. I would note that there are those who disagree with these conclusions, but even if you agreed with these conclusions, this language and these nuances are simply not seen in the Bill.

4. Beyond attractions/desires. The other issue that has been brought up by some of the CA mental health organizations that oppose the Bill in its present form has to do with how broad it is. I believe their concern had to do with a possible unintended consequence if clinicians were not to work with teens to explore a range of sexual and gender identity issues for fear of legal ramifications associated with Bill 1172. I would also note that the Bill covers therapies to change attractions, desires, and behavior. That is rather remarkable and extends far beyond therapies that purport to change orientation. Is anyone really wanting to get behind a legal measure that restricts a clinician from helping someone change their behavior?

5. Issues with informed consent. I wrote an article published in 1998 that argued that those who provide reorientation therapy should obtain advanced informed consent for their services. Informed consent refers to the kind of information the average person would need in order to make a meaningful, informed decision about services. Advanced or expanded informed consent provides even more details about services, potential benefits, risk of harm, and so on. What I did not like about the Bill is that the language overreaches in it’s claim of SOCE being ineffective and the extent of potential harms associated with it. These seem to me to be important considerations that need to be tied to well-designed research studies. The existing research (with the use of convenience samples and seeking out those who were not pleased with services) is fraught with too many methodological problems to be the last word on risks associated with this type of therapy. I am not saying that there are not risks. But I am saying that important questions about the interventions, expectations, and competence of the clinician should also be better understood.

I would also like to see an advanced inform consent form co-authored by people who represent the different stakeholders in these discussions. Is the research far enough along that we could see an informed consent form where people who might otherwise disagree on a number of issues can at least agree on what the public needs to know to make truly informed decisions about services?

6. Trends in providing services to minors. One last thought is that Bill 1172 appears to run contrary to current trends in terms of access to services by minors. I do not want to make too much of this because there are legitimate concerns here about potential harm to minors through misinformation about unrealistic expectations, stigma, and so on. But the trend is toward putting mental health and related health care decisions into the hands of adolescents rather than restricting access (think reproductive health, parental notification laws, issues with consent, etc.). This discussion moves in the other direction – toward restricting access even if an adolescent where to assent to treatment.

I want to reiterate that I recognize the concern that minors may be at greater risk in some ways. Of course a competent clinician knows that he or she has to obtain assent from any minor who seeks any kind of mental health services, even in cases where the parent have provided consent. If the minor does not assent to services, the services should not be provided. I also recognize that some minors may give assent because of pressure they feel from their parents – and this is a genuine concern.

Although I do not provide reorientation therapy, I would say that in my experience not that many teens request reorientation therapy. The interest in it tends to come more from the parents, so the idea that there could be  pressure from parents is definitely something that should be addressed with all involved.  I think the best way to handle the potential for undue pressure is to do a good and thorough assessment of goals, expectations, motivations, and so on. I am really open to ideas on this one, but it is worth more reflection.

I am sure that there are other arguments both for and against the Bill. These are just a few thoughts. And I don’t intend to come across as a defender of reorientation therapy for minors. I have mixed feelings about reorientation therapy. It is not something I provide. My preference is to explore sexual identity questions and to navigate conflicts between religious and sexual identity concerns (following the SIT Framework). But I have defended the rights of clients to pursue such therapy if they are given sufficient advanced informed consent. I hadn’t thought about it that much for teens in part because I have not seen that many teens asking for it.

In any case, I hope these reflections show that this is at least a  complicated issue. My main concern is that legal answers such as the one proposed rarely reflect the complexity inherent in providing clinical services.

UPDATE: CBN News ran a story on the CA Bill.

UPDATE: The CA Senate approved Bill 1172. (5.30.12)

Interview on CBN News

The questions raised by the clinical practices at Bachman & Associates in Minnesota have led to some interesting questions about whether sexual orientation can change. I was interviewed today on CBN news on that topic, which you can see here. Before that interview, they show a segment on my prior research, published originally in book form, which started with 98 participants attempting to change their sexual orientation through involvement in Exodus International, a Christian ministry. What we reported at Time 3 is probably the more helpful information in the sense that we had a larger number of peope still in the study. We reported that 15% indicated in their transcipts change of orientation (though some still reported some same-sex attraction), while 23% reported a sufficient reduction in same-sex attraction such that chastity was more achievable. Another 29% were continuing in the process but were not reporting sufficient reductions in same-sex attraction to classify as successful in their change attempt thus far. Fifteen percent reported non-response, while 4% ‘failed’ and were confused but had discontinued change attempts, and 8% ‘failed’ and adopted a gay identity. (We used ‘failed’ from the perspective of the original goal to change sexual orientation.) The percentages around ‘success’ and ‘failure’ increased at Time 6, which is what is reported on in the CBN news piece, but the numbers were also smaller at Time 6, so I just offer this as clarification. 

You will note from the CBN news interview that the question is raised whether reorientation therapy is mainstream. I indicated that it is not but that there is some question as to how many people provide such therapy, and there is little research being conducted today by those who provide reorientation therapy. I thought later that what people want are fewer soundbites and hyperbole and more by way of realistic expectations for their experience in therapy (or in a Christian ministry). These are real people who often experience great conflict between their religious and sexual identities. 

I also discussed what reparative therapy is. It is essentially a subtype of reorientation therapy that is based on the premise that faulty parent-child relationships cause homosexuality by creating an emotional need that later becomes sexualized. If you are familiar with my work, you know that I do not practice reorientation therapy; rather, I focus on sexual identity and how it develops and synthesizes over time. This is actually the primary area of research I am involved in through the Institute for the Study of Sexual Identity. I think a focus on sexual identity is ultimately more client-centered and holistic. So toward the end of the interview I shared that sexual identity can be explored and discussed in therapy without practicing reorientation therapy. One expression of this type of therapy is Sexual Identity Therapy(SIT), which has as its focus helping a person achieve congruence so that the person’s behavior and identity is congruent with his or her beliefs and values. SIT is cited favorably in the 2009 APA task force report on appropriate therapeutic responses to sexual orientation.