Additional Reflections

By now you have heard about the apology issued from Alan Chambers, president of Exodus International, as well as the reactions from ex-ex-gay individuals featured on the special, God and gays. The clips from that show are worth viewing.

There is a tension that exists that I’d like to discuss: What does it mean when the flagship evangelical ministry addressing homosexuality closes its doors? Is it a failure of nerve to stand for Christian convictions in a culture that seems increasingly hostile to Christianity? That is what some evangelical leaders claim.

Is it a compassionate response to the lived experiences of folks who have been either hurt by Exodus or at least not experienced the changes they had hoped for? That is what others in the evangelical community are saying. (You’ll notice I am citing the same web site: CT’s range of reactions; mine apparently falls in between the “dismayed” and “joyful.”)

Alan Chambers has been on a journey in which he has entered into relationships with people who have said they’ve been hurt by Exodus. That process has been ongoing for several years, I think. I suspect he initially thought Exodus could be reformed in a way that would change the focus of the ministry away from the expectation of heterosexuality. Obviously, at the end of the day, I don’t think he believed he could re-brand Exodus to do the kind of ministry that resonated with him.

At that point, it seems he felt he had two choices: leave the ministry or close the ministry. Some people believe he should have done the former; they say, “Then leave! But don’t drive Exodus into the ground!” Others applaud him for what they see as the courage to make the tough decisions from within.

I don’t know how Alan processed all of that, so I am not going to pick sides in whether he did the right thing or not. Perhaps over time we’ll have a better sense for that.

On the ISSI facebook page, a comment was made about what this means to the average person in the church who is sorting out these issues. I commented that it might not make that much of a difference in the sense that member ministries were just under the umbrella of Exodus. They may continue to minister based on their own approach; they might joint the Restored Hope Network; or they might join another group. But that answer might be too easy. Maybe it does affect the person who is in the trenches, the person who is trying to navigate sexual identity and religious identity. I’m still thinking that through…

I just got done with an interview today. It was about the Exodus situation. I don’t think I communicated my thoughts and heart about this very clearly. (I often feel that sense of “I wish I had said that differently.” Or “I wish I hadn’t framed it that way.”) So let me say this: I don’t think there is that much research support for reparative theory or therapy, and that is not an approach I take in my work. But a reparative approach is not the only means by which some people attempt to change orientation. Many have entered into Christian ministries with the hope that they would experience a meaningful change in their sexual orientation. The research on their experiences is limited. In the study I worked on (where the focus was on whether orientation could change through involvement in Exodus ministries), the findings did not please anyone on either side of the debate. Some people reported meaningful change over time, and that change appeared to be change of behavior, identity, and self-reported attractions. But most did not experience as much change as they would have liked, in my view, and even the more successful experiences were still marked by some attraction toward the same sex. I think it is wise to have an honest discussion about those kinds of findings — about what that could mean in terms of informed consent to someone who is considering likely outcomes.

So…with the closing of Exodus, the Christian community is left with a tension: What is available by way of ministry to those who wish to pursue change? What are the expectations and how will those expectations be communicated? At the same time, how will the church respond to those who don’t experience as much change as they had hoped?

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.

Defining Exodus: A Letter from Alan Chambers

Update: Here is an interview with Alan Chambers that appeared in The Atlantic.

Here is a letter from Alan Chambers, President of Exodus International. It is his attempt to define Exodus as a ministry in light of the public relations challenges they face as an organization in light of a rapidly-changing cultural context around LGB issues. Let me encourage you to read the letter in its entirety, but here are a few nuggets that stood out to me:

Exodus International is repeatedly accused of seeking to make gay people straight through conversion therapy and prayer. As the media and culture rage around us, drawing battle lines in the sand and seeking to fuel the debate about homosexuality, my team and I have been working diligently to clearly state the calling of this great ministry and focus solely on that work. We want to reiterate that our mission is, first and foremost, to serve, support and equip the Church in providing refuge to individuals or families impacted by same-sex attractions (SSA).  Quite simply, our goal is to make the Church famous for loving and serving people as Jesus would and pointing them to Him.…

People seeking this encouragement and guidance do so because they have decided to pursue an identity or life based on their relationship with Christ over their same-sex attractions. …

We believe that in Christ we have been given completely new hearts and the ability to have power over the sin that remains confined to our earthly flesh.  While believers absolutely can fall to temptation, the mark of a maturing believer is finding increased victory in areas that have, at times, overwhelmed us. …

We respect everyone’s right to pursue their own course as it relates to seeking resolution for struggles. No one is ever coerced, forced into therapy, nor do we seek to ‘pray away the gay’ as many have suggested.  In fact we are no longer an organization that associates with or promotes therapeutic practices that focus on changing one’s attraction.  I found the greatest amount of freedom when I stopped focusing on my sin and struggles and started focusing on the grace and peace found only in Christ and the man He created me to be.  This life isn’t most about sin management but about living daily as the sons and daughters of God.  In part, it is the peace and rest found in that identity alone that transforms us daily.

Exodus does not believe SSA is sinful.  However, sexual expression resulting from SSA is. Making such clear distinctions has been a failure of the Church that is slowly being realized and changed. …

We must all recognize that behavior resulting from SSA is not easily overcome. Many may struggle for the rest of their lives with some form of temptation or unwanted feelings. That is the nature of human experience on earth. However, we do believe God’s grace can give us the ability to live beyond the power of our temptations as we acknowledge and yield our weakness to Him.  Change is possible for every human being who has a destiny-altering encounter with Jesus Christ.  But, change isn’t the absence of struggle but rather the freedom in the midst of struggle to choose differently. …

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).

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.