Coming Attractions

IMG_6212Academics measure time in semesters. As the summer comes to a close and we anticipate the start of the fall semester, I wanted to provide an update on two writing projects. These are “coming attractions,” if you will. A few weeks ago I hit “send” on two book-length manuscripts. One was going to Zondervan and the other to Templeton Press. (By the way, this may be the first time I worked on two larger projects at the same time. I try to do one book at a time and write-up articles or develop presentations rather than try to work on another project of that size. But poor planning on my part and an unexpected invitation led to these projects being on my plate at the same time.) Let me tell you about both.

The manuscript that went to Zondervan has the working title of Costly Obedience. It is a book-length treatment of several studies we have been conducting on the experiences of celibate gay Christians. While several studies provide valuable information throughout the book, the central study is of 300 celibate gay Christians who provided information on their psychological well-being, their experience in churches, their sexual identity development, and religiosity. If I do say so myself, it is a fascinating look at the lives and experiences of Christians who are navigating sexual identity and faith and who wish to abide by a traditional Christian sexual ethic. We include the voices of celibate gay Christians in the form of a smaller qualitative study in which we pull quotes on their experiences, and you read about them all throughout the manuscript. Also, I asked several friends and acquaintances of mine if they would share their personal experiences or recommendations for the church, and their voices are also interspersed throughout.

The other manuscript–the one that went to Templeton Press–has the working title of Sexual Identity and Faith. It is a book for clinicians about how to provide therapy to people of faith who are navigating the difficult terrain of sexual and religious identity conflicts. In other words, for some sexual minorities of faith, their same-sex sexuality and their Christian commitments collide in a way that is very difficult for them. When they enter professional therapy, they have historically been offered two broad options: one is to change their sexual orientation; the other is gay affirmative therapy. For about 20 years I and others have been providing therapy that is a “third way” model that tries to be client-centered and identity-focused. It is not a change therapy; rather, it has to do with helping clients achieve congruence so that they can live their lives and form an identity in keeping with their beliefs and values. In 2006, Warren Throckmorton and I wrote a framework for providing such therapy called the Sexual Identity Therapy Framework.

In any case, the book is fairly comprehensive, as it covers advanced informed consent, assessment, and approaches I take in therapy from a more narrative and cognitive-behavioral perspective. So it has to do with the stories that have been told about people, the stories that are currently being told, and the chapters that the person in therapy is writing and will be writing in the years to come–a story about who they are in light of their same-sex sexuality and Christian faith.

Publishing is like farming. You plant a seed (or hit “send”) and find that the harvest is months away. You can look for both of these resources in the summer of 2019.

The Appeal and Motivation of Types of Congruence

I was providing a training for counselors recently, and at one point we were discussing the concept of congruence, which I was describing as an end goal in a counseling process I had helped co-develop with Warren Throckmorton (referred to as Sexual Identity Therapy). The thinking is that when you counsel someone who experiences a conflict between their sexual identity and their religious identity, you want to help them resolve that conflict; that resolution can be thought of as congruence.  The experience of congruence may look different for different people.

cropped-identity2.jpgWhen I think of congruence, I am thinking of helping a person live his/her life and form an identity in keeping with his/her beliefs and values. I came across the idea of congruence among gay Christians when I conducted a series of studies of sexual minority Christians. (“Sexual minority” in the mainstream LGBT literature refers to people who experience same-sex attraction whether or not they identify as LGBT or report same-sex behavior.) In any case, I was comparing those who integrated their attractions with a gay Christian identity and those Christians who dis-identified with a gay identity. If I were to translate this to the SF crowd, I would say that the gay Christian identity was closest to what we might describe as a Side A gay Christian. The group that dis-identified with a gay identity were either closer to what readers here would think of as Side B gay Christians (in terms of not viewing same-sex relationships as morally permissible) but without the “gay” identification, if that makes sense.

Our research group concluded that both groups achieved personal congruence. The one group achieved congruence as (“Side A”) gay and Christian by adjusting their beliefs and values so that they aligned with their behavior and identity as gay persons. They were part of a fellowship that affirmed them as gay Christians and celebrated gay as an expression of God’s creativity. (I saw these findings as comparable in some ways to the results Michele Wolkomir reported in her book, Be Not Deceived, where she reported that the shift for gay Christians was toward the valuing of tolerance in supporting a gay Christian identity.)

The other group achieved congruence by dis-identifying with a gay identity and the gay community, which was in keeping with their sexual ethic; instead, they aligned their behavior and identity with their conservative Christian beliefs and values. (This result, too, was in some ways comparable to but different from Wolkomir’s findings about ex-gays, as she found that they valued personal righteousness in a way that reflected their primary motivation for moving away from a gay identity.)

Completely independent of that research, I saw the concept of congruence discussed in the 2009 American Psychological Association task force report on Appropriate Therapeutic Responses to Sexual Orientation. In my own work, I had not been explicitly naming different kinds of congruence. What I was doing was simply describing different maneuvers (that is, shifting beliefs/values or shifting behavior/identity; Wolkomir’s emphasis on tolerance or righteousness). But I had not thought that much about the motivation to do so or given a name to the various motivations that could be present.

460In any case, in the 2009 task force report, the task force recognized that when people who adhere to traditional faith commitments experience a tension with their sexual identity, they may prefer one type of congruence over another. Much of psychology is steeped in what they referred to as organismic congruence, which they defined as “living with a sense of wholeness in one’s experiential self” (APA, 2009, p 18).  I think of this as essentially recognizing one’s impulses as important data, in some cases as a reliable moral guide for making decisions about one’s life. Congruence is then achieved by making changes in beliefs and values that will align well with the impulses one experiences in one’s sensate self.

In contrast, the task force reported that telic congruence refers to “living consistently within one’s valuative goals” (APA, 2009, p. 18).  I think of this as essentially connecting life here to transcendent reality and purposes, and making decisions based on one’s ideals.

Many gay Christians who experience a tension between their same-sex sexuality and their Christian faith experience their sexual drives and desires as instructive for how they should best meet their needs for intimacy.  Other gay Christians who feel that same tension turn to sources of authority outside of their sensate self and choose to live in a way that corresponds with that ethic.

Where do Side B gay Christians fit into this discussion of congruence? I’ll invite them to chime in for themselves, but I would wonder if they wouldn’t find the telic congruence as more of a reflection of how they align their behavior to correspond with their beliefs and values as traditionally believing Christians. They don’t appear to me to be making a shift that is obviously a reflection of organismic congruence. Where does identity fit in? I imagine there is great variability among Side B gay Christians, but the identity piece is not found in denying a gay identity in the same way people did in the research I noted above; rather, identity seems more nuanced and multifaceted, framed in many ways in positive terms (by use of the word “gay” at least as an adjective).

Let me take this one step further. In the context of this training, we were discussing the appeal of both types of congruence. As we discussed organismic congruence, the draw that most everyone recognized is the role of impulses in decision-making. We reference our sensate self as we decide about when and how much to eat, about the importance of regular exercise, ample sleep, and so on. It’s not as though we want to distrust these impulses, although we might feel impulses that we need to curb in one way or another.

When we turn to sexual ethics, however, can we as readily turn to our impulses as reliable moral guides? As we extend the discussion to sexual impulses, how does the discussion change? Should it? You could imagine scenarios in which impulses may not provide particularly helpful guidance that should in all cases by followed.  In The Abolition of Man, C. S. Lewis challenges the appeal to instincts: “Telling us to obey instinct is like telling us to obey ‘people.’ People say different things: so do instincts. Our instincts are at war.” I think of Christians I’ve met in counseling who will talk about God releasing them from their commitment to their spouse in order to pursue another person who they have fallen in love with. I think of men who have justified affairs because their wife was not as responsive to sexual intimacy as they wanted.

Other gay Christians who experience a tension between their same-sex sexuality and their Christian faith look to ideals they wish to live by. They see these as transcendent purposes that they trust will provide a way of living and an identity.

What is the appeal of telic congruence? Telic congruence can give a person a sense of peace or security or worth if they believe they are doing something or making choices that are tied to transcendent purposes and structures of meaning. While this may be part of the appeal, there may be potential dangers as well. We discussed whether a person could connect striving toward telic congruence as a reflection of their worth or believe failure to make sufficient strides as placing them at risk of salvation or something along those lines.

As the task force report observed, telic congruence may prioritize values, but it “can be aware of sexual stigma and respectful of sexual orientation.” Likewise, organismic congruence, while it prioritizes “self-awareness and identity,” it can “be congruent with and respectful of religion” (p. 18).

It was a thought-provoking discussion that introduces not just the value of personal congruence but the motivations and appeal of different types of congruence. Perhaps there are yet more ways to conceptualize congruence that can add to our discussion as well.

Counseling Sexual Minorities

In a previous post, I mentioned that a second edition of the book, Christian Counseling Ethics, has just been published. This is a book edited by Randolph Sanders, former executive director of the Christian Association for Psychological Studies (CAPS). I wanted to share a little from that book and the chapter I contributed on counseling sexual minorities. Before I do that, let me acknowledge how much I enjoyed writing this chapter, as I had a chance to work with one of my mentors, Stan Jones, and one of the grad students I had a chance to mentor, Jill Kays. Let me recommend collaboration whenever possible! It increases the chances someone will catch your blind spots, and there are always ways in which you can grow.

ChristiancounselingethicsWe first address the topic of competence by reviewing current research findings in four relevant areas. There are (1) prevalence estimates; (2) theories of etiology (causation); (3) mental health correlates (e.g., greater risk of substance use disorders); and (4) research on attempts to change orientation. We then discuss controversies and issues in treatment, including professional controversies surrounding efforts to change orientation.

The next major topic is understanding sexual minorities in the context of the multicultural movement. We discuss here recent attempts at developing counseling competency scales, as well as what we know in terms of milestone events in sexual identity development.

Next we discuss integrity and client well-being. There are a number of issues that can be discussed here, and we spend some time on the ongoing cultural and professional discussions about reorientation efforts in terms of how those efforts are seen by different stakeholders. This is also where we introduce the reader to the Sexual Identity Therapy Framework and to different ways in which Sexual Identity Therapy can be conducted to facilitate client well-being, recognizing significant differences in how people might prefer to achieve congruence between their identity/behavior and their beliefs/values.

We then turn our attention to client autonomy and self-determination. We suggest language that can be used in obtaining advanced informed consent to therapy that address sexual identity. The language provides examples for how a Christian counselor might discuss causes of sexual orientation, professional and paraprofessional options, and so on.

The last section of the chapter address value conflicts and referrals. This has become a major point of professional discussion and debate with the Julea Ward v. EMU case being recently settled out of court, as well as other major cases that have led to discussions of practice location, training, and so on. One regret is that I wish statement from The Board of Educational Affairs of the American Psychological Association (APA) had been available at the time we wrote the chapter. I had a post about that recently, and I think it would have enhanced the chapter even further.

So check out the chapter and the rest of the book. There are a number of great contributions from leading Christian psychologists and counselors on a number of important and interesting topics.

Mixed Orientation Marriages – Part 4

couples-counselingIn Part 4 of our series on mixed orientation marriages, we turn our attention to how counselors might work with these unique couples. In an article I coauthored a couple of years ago, we introduced the PARE Model for working with mixed orientation couples. PARE stands for (1) Provide Sexual Identity Therapy, (2) Address ‘interpersonal trauma’; (3) foster Resilience through marriage counseling; and (4) Enhance sexual intimacy. Let’s take a look at each of these.

The first step is to provide Sexual Identity Therapy (SIT). SIT refers to an approach to addressing sexual identity concerns in clinical practice. SIT client-centered and identity-focused. The SIT Framework can be downloaded and read here.  In my own work providing SIT, I see it as drawing on the results from a series of studies I’ve been doing on sexual identity development. In terms of the core elements of how I provide SIT, I tend to focus on the following: (1) a 3-tier distinction between same-sex attractions, homosexual orientation, and gay identity; (2) weighted aspects of identity; (3) attributional search for sexual identity; and (4) personal congruence.

So in this first step I would provide SIT to the sexual minority spouse. Some of the psychoeducational concepts would also be helpful for the straight spouse to hear. In particular, I have found it helpful to explain the 3-tier distinction and weighted aspects of identity. Both of these discussions provide options for both the sexual minority spouse and the straight spouse in terms of moving away from a pre-determined script for making sense out of same-sex sexuality. It provides them with what someone explained to me felt like “intellectual space” to make decisions about identity and behavior while not denying or minimizing same-sex attractions.

The second step in the PARE model is to address “interpersonal trauma,” which refers to the serious injury that may arise from discovery or disclosure of same-sex sexuality. Then language actually comes from the literature on affairs. It has been suggested that the disclosure or discovery of same-sex attraction in one partner is experienced by some straight partners as an interpersonal injury or a betrayal of trust, especially if there has been same-sex behavior.

In this stage it is important to work through various steps for responding to broken trust, and I have found Gordon and Baucom’s stages of exploring (1) impact (understanding the impact of the disclosure/discovery on the marriage and on each spouse); (2) a search for meaning (placing the disclosure/discovery in a broader context/explanatory framework); and (3) recovery (moving past the pain and hurt and anger, reevaluating the relationship, and making more informed, intentional decisions about one’s future), to be helpful here. I have found that depending on the severity of broken trust, it may take upwards of one year to really navigate the interpersonal injury. Even then, there may be ongoing issues associated with rebuilding trust if the couple decides to work on restoring their marriage. This work is ideally occurring parallel to (at the same time as) the SIT services provided to the sexual minority spouse.

Third, the PARE models turns to fostering resilience through marriage counseling. At the end of SIT for the sexual minority spouse and exploring interpersonal trauma for the straight spouse, both the sexual minority spouse and the straight spouse are usually in a better position to make informed decisions about the future of their marriage. If they decide to work on their marriage, we would look at marriage counseling together. What we see in the literature and in our own research is that it can be helpful to foster frequent and honest communication, strengthen the emotional bond in the marriage (the sense of “us”), and explore and demonstrate more flexibility in their existing roles (exploring ways for both partners to meet emotional and physical interests and needs), learn personal and relational coping strategies, and develop social support.

The final part of the PARE Model–E–is for enhancing sexual intimacy. I usually discuss the following principles:

  • They are developing something unique together–their sexual intimacy (not bringing in comparisons);
  • There are different experiences of desire that may be helpful to discuss (for example, a kind of initiating desire that seeks sexual intimacy, which can be contrasted with a more responsive or receptive desire that is present when a person experiences proper (to them) emotional and/or physical stimulation;
  • Explore lifestyle and daily/weekly routine in terms of giving sexual intimacy the time and attention it may need;
  • Learn enhancement exercises, communication in general (and about sexual intimacy in particular), and mindfulness.

These are just a few basic principles that have at times guided my discussions with couples. None of this is direct advice for how any particular couple should move forward. These principles would need to be applied to the unique experiences of any specific couple that is navigating this terrain.

On Sexual Identity Therapy

Warren Throckmorton has a post up clarifying the differences between reparative therapy and Sexual Identity Therapy. He notes a difference recently in how some reparative therapists are presenting themselves in various venues. Those presentations are coming across differently than how the theory itself is discussed in professional meetings and in published writings.

My own experience with Sexual Identity Therapy (SIT) grew out of working with clients who had been through reparative therapy or a ministry with a focus on healing. What I was seeing was that the folks had not experienced as much change or healing as they would have liked. The question was: What else do mental health professionals have to offer them?

SIT is not for everyone. I’ve known of folks who have sought services elsewhere because SIT was not focused on change of orientation, and that is precisely what they wanted. Similarly, I suppose a person could want explicitly gay affirmative therapy, and SIT might be too exploratory to make much sense to them.

But for those who are exploring their sexual identity, or for those who experience a conflict between their personal beliefs and values and their experience of same-sex sexuality, SIT might be an attractive alternative, as it provides a place for the person to “navigate difficult terrain”, as I often put it. It is client-centered and identity-focused, lending itself more to a discussion of multicultural competence for working with these concerns, as emphasis is placed on healthy coping activities and broadening social support.

On “Crossing the Divide”

I had the opportunity to collaborate on two peer-reviewed journal articles both of which were published in this fall. One is on whether people can change their sexual orientation. It has received a lot of attention. It was published in Journal of Sex & Marital Therapy. Information about that study can be found on the web site: www.exgaystudy.org.

The second journal article has not received nearly the same attention, and it probably won’t, which in my view is unfortunate. It was an experiment in “crossing the divide” between the evangelical Christian communityand the gay community. It was a collaborative effort with Lee Beckstead, a gay psychologist whose clinical practice is in Utah. The title of the article we coauthored is: “Using group therapy to navigate and resolve sexual orientation and religious conflicts.” It was published in Counseling and Values.

Here is the abstract:

This article considers the use of group therapy to explore sexual identity questions in light of religious beliefs and values. The authors describe the basis of their group therapy approaches for sexual, religious, and social conf…licts that differ from approaches that provide group members only the option of sexual reorientation to an ex-gay identity or adoption of a lesbian, gay, or bisexual identity. The authors come from different backgrounds and discuss how their perspectives and biases can potentially affect group process and outcome. They present guidelines, structure, content, and strategies for their group therapy approaches.

We begin the article by pointing out that the two polarized approaches to sexual orientation and religious conflicts are insufficient to meet the needs of all people seeking services in this area. The two approaches are, of course, reorientation therapy and gay affirmative (or gay integrative) therapy. We discuss emerging “third way” models, including the Sexual Identity Therapy Framework. We then discuss the overall benefits of group therapy in general and in the area of sexual identity issues. Then Lee Beckstead shares his experience running groups. He discusses his model, guidelines, and theoretical framework. Then I discuss my guidelines and theoretical framework. We then write about our combined understanding in terms of similarities in how we approach group therapy and strategies for resolving sexual identity conflicts. The basic idea here was to explore the question: “What can we agree on?”

We then close the article with a brief discussion of the lessons we learned from our dialogue:

“Crossing the divide” between supposedly opposing viewpoints by extending questions and honest feeback between us proved beneficial on many levels. Central to these dialogues involved offering respect for each other and being more curious rather than combative with each other’s views. This step toward healing the divide between our views seemed congruent with our desire to help clients change the way in which they relate to divides within themselves and their communities. (p. 113)

It was a rewarding experience for me. I know both Lee and I will be criticized for the collaboration. The criticisms will likely come from those who are invested in the polarization. Those who benefit from the “culture war” frame of reference and resulting polarization often react the strongest against those they feel are letting down their side.

But for me there are some potential benefits that come from trying to identity areas of agreement between people who otherwise may disagree. I know that I benefit from working with and having my work critiqued by people who do not have the same blind spots. I see things I did not see before. I also have a chance to review my beliefs and make a more explicit case for them – either in writing or in my own thinking. You can sharpen your thinking and argument by exposing it to those who represent different interest groups. Finally, I learn to identify superordinate goals that can be more readily met in collaboration. This has been helpful for me in many areas of my life, both professionally and personally.

I should also add this: One key to collaboration is identfying moderate voices on the “other side” and being a moderate voice on “your side.” That is harder than it sounds. The pressure to be on the extremes can be great. In this context and for those who are concerned, moderate does not mean a failure of nerve or conviction. Indeed, I appreciate Richard Mouw’s phrase, “Convicted civility”, a posture in which one is clear about one’s beliefs/values/convictions but articulates them with great civility or respect for the other person and his or her views/beliefs/convictions.

I am sure there are people who would not view either Lee or me as “moderate”; so I understand that concern. But compared to some of the voices out there, we would be viewed as moderate to many people. Perhaps it depends in part on your comparison group!

I hope that others will consider whether their work can benefit from similar collaborations.

Understanding Sexual Identity Therapy

This past year I’ve dealt with an interesting challenge that faces Christians who produce scholarship in controversial areas. My area is sexual identity, and I’ve been researching and providing services in this area for many years now. There are not many models for how to do integration in this area, and there are few people even doing it. So the challenges are plentiful.

Specifically, the topic I’m addressing is how to provide clinical services to people who are sorting out sexual identity issues. The model I’ve been developing (and the accompanying framework I’ve been co-developing with Warren Throckmorton) is referred to as sexual identity therapy (SIT). What is SIT and how did it come about?

SIT is essentially a client-centered and identity-focused approach to navigating sexual identity questions or concerns. It has often been contrasted to reorientation therapy and gay affirmative therapy. It is based on the idea of helping people reach congruence, so that they live and identify themselves in a way that is consistent with their beliefs and values. Sexual attractions or orientation may or may not change, but the overall emphasis is on identity.

How did this approach come about? My earliest involvement with SIT traces back to a concept paper published in 2001 that suggested an alternative model of sexual identity development, which refers to how the act of labeling oneself (as gay, lesbian, bi, or choosing not to do so) is experienced developmentally over time. I was particularly interested in people I was working with in my clinical practice who did not integrate their same-sex attractions into a gay identity. This led to a series of studies comparing people who experienced same-sex attraction and identified as Christian. I compared a group that integrated their same-sex attractions into a gay identity to a group that dis-identified with a gay identity and the people and institutions that support a gay identity.

At the same time I was working with clients who were either sorting out sexual and religious identity conflicts or had tried to change their sexual orientation through involvement in professional reorientation therapy or Christian ministries. The people I saw at that time did not experience as much success in their change effort as they were led to believe was possible. They were discouraged, and some would frame their experience in an “all or nothing” way, such that they either changed their orientation or they were gay. They did not feel another option was available to them.

So my involvement with SIT was to explore a way of doing therapy that provided these people with a professional approach that would respect their beliefs and values and would allow for direction or trajectory that was meaningful even if their orientation did not change. Many people who came to see me at that time were conservative Christians, and many at the end of what was developing into SIT chose not to identity publicly or privately as gay; rather, they formed a primary identity around other aspects of who they were as a person, such as their religious beliefs and values.

In my practice today, SIT revolves around four central concepts that came from that early concept paper and subsequent research: (1) a three-tier distinction between same-sex attraction, a homosexual orientation, and a gay identity, (2) weighted aspects of identity, (3) attributional search for sexual identity, and (4) congruence. First, the three-tier distinction is between same-sex attraction, a homosexual orientation, and a gay identity. The idea is that more people report experiencing same-sex attraction or having a homosexual orientation than the number of people who identify as gay. Being gay is a unique sociocultural phenomenon, and it is a self-defining identity label that not all people who experience same-sex attraction adopt. Such a distinction creates room for using descriptive language while exploring identity considerations. Most people I work with choose to describe their attractions rather than embrace a gay identity.

Second, I discuss weighted aspects of identity, by which I mean that people consider many factors when they make decisions about public and private sexual identity labels. These ‘aspects of identity’ include biological sex, gender identity, attractions, intentions, behaviors, and beliefs/values. People often decide that one or more of these aspects of identity are really important to them, such as behavior (e.g., choosing chastity) or beliefs and values (e.g., Christian morality), and they give it greater ‘weight’.

Third, I join people on what I refer to as an ‘attributional search’ for identity. This means exploring with clients the meaning that they make out of the fact that they are attracted to the same sex. I don’t assume that their attractions are the result of childhood sexual abuse, biological predispositions, parent-child relationships, or any other particular theory; rather, I discuss with them how they make meaning out of their attractions. Many will cite these theories; some will discuss “the fall” as the cause of their attraction to the same sex.

The fourth and final key concept for me is congruence. This means helping people line up their behavior/identity and beliefs/values. I have found this to be a natural result of the first three key concepts.

What has been interesting is that this past year I have seen some people in the gay community claim that SIT is really reorientation therapy, and I have seen some people in the conservative Christian community claim that SIT is really gay affirmative therapy (at least functionally so at one stage in therapy). The first mischaracterization—that SIT is really reorientation therapy—came up this past year when a gay psychologist involved in the scientific review process attempted to portray SIT as conversion therapy to get other reviewers to reject proposals in which SIT was mentioned. This was resolved amicably when it was acknowledged that the recent APA task force report identified SIT as an identity-focused model and not as reorientation therapy.

The other mischaracterization—that SIT is really gay affirmative therapy (at least at one stage)—happened recently when someone in conservative Christian circles made the claim, and it is a statement worth responding to so that it is clear why this is a mischaracterization and not an accurate understanding of SIT.

Before I do that, let me offer one observation on this idea that I am defending SIT against assertions that it is either reorientation therapy or gay affirmative therapy. What’s interesting is that these are the two polarized positions in the models of therapy offered to sexual minorities today. The whole purpose of developing SIT was to offer an alternative to these two polarized positions. It is interesting to me that those most invested in this debate will not allow a third option to develop; rather, they appear to need to frame the debate in the two models they know.

The focus in SIT is sexual identity not sexual orientation. Again, much of my work is with people who have tried to change and had modest success with it, and so they are looking for other meaningful ways to grow and develop, and sexual identity is one way to do that, particularly for those who focus on other aspects of who they are as a person.

As to the charge that SIT is gay affirmative therapy. Gay affirmative therapy tends to assume that a person is gay, that they are discovering this about themselves. The therapist simply creates a safe place to discuss “coming out” and is mindful of issues such as bullying and family dynamics, etc., that make “being gay” difficult. It tends to rest on the metaphor of discovery. That is, a person discovers that they are gay—they have been all along. There is much more to gay affirmative therapy, but this gets at one way to understand it at least at a general level.

The way I practice SIT is based not on the discovery metaphor but on the metaphor of integration. People have choices to make about whether they integrate their same-sex attractions into a gay identity or not. If they choose not to, they often form a positive identity around other aspects of who they are as a person. One of the most salient aspects of identity for Christians is an identity that is “in Christ.” But in creating space in therapy for a person to make a genuine choice about identity, there is by necessity the option of making other choices (otherwise the choice was not a genuine one to begin with). So a person might choose to integrate same-sex attractions into a gay identity. That is a possible outcome when a person is given an opportunity to genuinely choose to dis-identify with a gay identity.

A related question is this: Is creating a space for people to make choices so unusual in therapy? I would answer no. People make choices all of the time in therapy, and some of those choices are not ones I would choose for them. For example, I provide a lot of marital therapy. I want the couples I work with to stay married. However, some decide to divorce. For them to genuinely choose to stay in their marriage means that they could also choose to dissolve the marriage. It is a choice, and it is not a choice that I make for them. This principle of client autonomy and self-determination is a central principle in how therapy is practiced today, and it is based on many things, including case law that established a patient’s right to informed consent to treatment in medical ethics.

The concern that has been raised about whether SIT is gay affirmative therapy raises a broader and more fundamental question about the place for Christians in the mental health fields. This is not limited to the topic of homosexuality. The question is: How ought Christians to position themselves in the field? Do they provide therapy in a direction toward a certain outcome? Do they provide information and opportunities for clients to make their own choices? If so, at what point might those choices run contrary to the values of the Christian mental health professional? This happens in many controversial areas, as well as areas that are not that controversial. It is more of a fundamental question about the role of the mental health professional, and there are legitimate disagreements among Christians in this area.

Some people will assume that Christians in the mental health field should function like they are a particular kind of pastoral care provider. Although there are many ways in which pastoral care providers practice, I see pastoral care providers as representing their faith tradition in a very intentional way. They hold up a standard and provide pastoral care to help people move toward that standard of orthodoxy (right belief) and orthopraxy (right practice). Orthodoxy and orthopraxy is not determined by the counselee but by the pastoral care provider in the sense that he or she represents the faith tradition and its doctrines out of which the care is being provided. Some people view licensed mental health professionals in the same way; that is, they should counsel in a specific direction because they represent Christian commitments in a particular way. This is a point for discussion among Christians in the field.

Others would view licensed mental health professionals as different than pastoral care providers in some important ways. They would see a licensed Christian psychologist, for example, as entering enter into a fiduciary relationship with the public, a relationship built upon trust, and part of that trust is built upon the assumption that the services provided are in keeping with the standards in the field as it is currently governed by the state in which the psychologist practices. So a group of one’s peers (psychologists, in this case, not Christian psychologists necessarily) would reflect on what is standard practice for addressing the topic of homosexuality in clinical practice. In this context, one might look at SIT as helping to provide a kind of therapy that the broader field can support, even as it stands in contrast to gay affirmative therapy (and reorientation therapy). This is important in part because gay affirmative therapy would be an unrealistic option for some religious clients.

Indeed, SIT provides an alternative that safeguards client autonomy and self-determination in making decisions about identity and behavior. With respect for client autonomy and self-determination comes the possibility that a client may make choices about identity that go against the values of the Christian mental health professional. But we can respect the client’s right to make that choice.

Note: This is cross posted on the ISSI web site here. Warren Throckmorton has offered his own perspective on the SIT Framework here.