On the Expectation of Change

A recent World magazine article centers on the hiring of Julie Rodgers at Wheaton College. Julie is a self-described celibate gay Christian who works as an associated in the chaplain’s office at the college. I consider Julie a friend, and I am an alumni of Wheaton (’98) and I have served as an adjunct professor there for the past decade. I also blog occasionally at Spiritual Friendship which is mentioned in the article.

I was surprised to see my research cited in the article about the hiring of Julie. The way the argument was set up was to express concern for Wheaton as the flagship evangelical college hiring a staff member who is known to be gay and who actually uses the word “gay” as an adjective to describe herself to others. Julie had spent about 10 years in Exodus International attempting to change her sexual orientation, and I have spoken with Julie on several occasions about this. She is gracious and positive about her own personal experience with the Exodus member ministries she participated in. However, speaking graciously about involvement in a ministry and declaring that it made her straight are two different things. She, like many other people who have attempted to change, did not experience a dramatic shift in her attractions as a result of ministry.

In my view, the article would serve the Body of Christ better if it were about this reality.

I am co-author of the study cited in the World magazine article about Julie and Wheaton. That study was published in book form in 2007 and then again as a peer-reviewed journal article in 2011, after six years of attempted change. If I were to summarize my view of the findings, I would put it this way: While on average people reported a modest shift along a continuum of attraction, most people did not experience as much of a shift as they would have liked, particularly as people entering ministry envision change as a 180-degree shift from gay to straight.

The author of the World magazine piece frames the study as being about “showing that changing sexual orientation is possible.” A more accurate way to think about the study is this: “Is it ever possible that sexual orientation can change?” This is important because it leaves open the question of what causes the change. The original study was launched at a time when the broader cultural consensus seemed to be that sexual orientation is an immutable characteristic. That is, that sexual orientation is unchanging. Period. We asked whether it is ever possible to witness change in sexual orientation over time and whether such experiences were intrinsically harmful. We documented average changes along a continuum. Averages that suggested that for some those shifts were more significant; for others, not significant (or no change).

The study was an outcome study. That is, we were studying whether changes in orientation occurred; we were not studying the process of change. We do not even know if it was involvement in the Christian ministry that contributed to the changes that were documented. It is possible that the changes that were documented were the result of natural fluidity or some other variable that we did not account for. There was certainly (for some) changes in identity and behavior, as we discussed in the journal article about the study.

Why is this important? It is important because the evangelical Christian community has an opportunity to think carefully about pastoral care which is intimately connected to the message it sends to people who are navigating sexual identity concerns in their lives. We can affirm a God who can bring about the miraculous while also being gracious to those who do not experience the miraculous. We do this all the time when we pray for people for any number of concerns that are brought to us. But in this one area–homosexuality–there seems to be an added expectation that the person receive experience significant shifts in the direction of their sexual attraction or assume a posture of ongoing attempts to alter patterns of attraction even when such efforts have not produced the shift the person has sought.

I once wrote about a man in his forties who came to see me in therapy. He had been to a Christian ministry for the past three years to try to change his attractions. After the first year going through a popular 30-week curriculum, he shared with the ministry leader that he still experienced same-sex attraction. The leader encouraged him to go back through the curriculum for a second year. He did. At the end of that year, he approached the ministry leader with the concern that while he had grown in his relationship with Christ and sincerely appreciated the fellowship with others, he was still experiencing same-sex attractions as strong as ever; what should he do? He was advised to go back through the curriculum for a third time. It was only after the end of the third year that he came to see me to discuss other options. We discussed how he thought about his same-sex sexuality and various postures he could take in light of his personal moral convictions. We discussed an ongoing posture of attempting to change; we discussed living with an enduring condition; we discussed a “thorn in the flesh” that he has asked to be removed many more times that Paul could have imagined. These different conceptualizations were difficult for this particular man. He had been led to believe that it was a personal, spiritual failure to come to terms with his same-sex attractions as something that would not go away–as something he would not experience a shift around. Such a belief drove him to depression and shame.

Yet he is not alone. Many people do not experience a dramatic shift in their experiences of same-sex attraction despite years of ministry involvement. This man spoke to me about three years. Julie in her speaking references 10 years. The question for the church is: What kind of pastoral care will the church provide in cases in which there is an enduring experience of same-sex attraction? A related question for pastoral care is to reflect on what is the nature of sexual attraction? Is it just a desire for genital sexual intimacy or is it broader than that? How we reflect on these questions will inform our care for one another. Although space will not permit an adequate exploration of that question, we need to at least ask: Is it a moral failure of the person to come to terms with an enduring condition? Although the issues are not the same, it was not in the case with Paul; I don’t believe it was a failure in the case of the man I discussed. I also don’t believe it is a failure on the part of Julie. In fact, I believe these are more likely outcomes than the testimonies of dramatic change. I don’t want to discourage a person from attempting such change, but I also want to be careful not to convey to that person that there worth before God is wrapped up in their capacity to experience sexual attraction to the opposite sex. I know countless men and women who are no more Christlike by virtue of their attraction to the opposite sex.

Also, how ought a person describe him or herself? Same-sex attracted? Gay? Struggler? Sexual minority? Overcomer? There are about as many names as there are opinions on the matter. I find there is a point of diminishing returns for me as someone who is not navigating this terrain to act as though I have the final word on how another brother or sister in Christ ought to use language. This is an internal discussion among followers of Christ who are talking to one another about the benefits and drawbacks of various words or phrases. One observation: younger people–Christians and nonChristians alike–are using gay as simply an adjective to describe their sexual orientation.

The church may benefit from finding  a way to hold onto different ministry approaches. Some will place greater emphasis on a more complete and dramatic shift in patterns of attraction. Most people will not experience this. Others will turn to changes in identity and behavior and language will be important here, as certain words may be experienced as indicative of identity. Still others will pursue celibacy as a way to live faithfully before God; different language may match up with their ways of naming their experience. We have to find a way to extend one another grace. To suggest that all people who experience same-sex attraction have to achieve dramatic shifts as a testimony to the power of God will be unnecessarily divisive, a poor model of pastoral care, and a sure way of driving people out of the church altogether.

Note: This is cross-posted with SF.

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.

APA Task Force Report – Chapter 4 (Outcomes)

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.

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)

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.

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, Preface & Introduction (Chapter 1)

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.

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.