The APA on Sexual Orientation Change

It would be remiss of me not to comment on the APA report of the Task Force on Appropriate Therapeutic Response to Sexual Orientation which has now had a good 48 hours for us to digest and ponder. There have been various responses in various places and I’ll try to reflect some of those in what I write.

Is the report good news or bad news? Well, depending on how entrenched in your views you are will affect how you see this. The danger in approaching the report is to either discard it out of hand because it comes down quite negatively on reparative therapy or equally to throw disdain upon it because it highlights and endorses the role of religious belief in the therapeutic process. There are examples of both these kind of responses on the web and I’m not going to spend time now going through those because neither extreme engages with the substance of the report.

The Report

Firstly the report itself. It is quite a long read, but well worth the effort. It first examines the literature on the subject, looking at reported effects, both negative and positive, and then moves onto recommendations for future practice. What is interesting in the report of the literature produced so far is not so much a condemnation of the research done so far, but rather a highlighting of the inadequate date assembled to date. For example, on page 52 the report says (emphasis added)

The recent literature identifies a population of predominantly White men who are strongly religious and participate in conservative faiths. This contrasts with the early research that included nonreligious individuals who chose SOCE due to the prejudice and discrimination caused by sexual stigma. Additionally, there is a lack of research on non-Christian individuals and limited information on ethnic minority populations, women, and nonreligious populations.

I think this point is important. It’s not that the APA is saying that the research indicates that SOCE doesn’t work per se, it’s that the research required to prove such a statement hasn’t been done to an adequate level. In the same way, the report doesn’t throw out all the aspects of therapy that occur with SOCE therapists, but rather gives a judgement on the benefits and negatives of such an approach (emphasis added)

The limited information provided by the literature on individuals who experience distress with their sexual attractions and seek SOCE provides some direction to LMHP in formulating affirmative interventions for this population. The following appear to be helpful to clients:

  • Finding social support and interacting with others in similar circumstances
  • Experiencing understanding and recognition of the importance of religious beliefs and concerns
  • Receiving empathy for their very difficult dilemmas and conflicts
  • Being provided with affective and cognitive tools for identity exploration and development

Reports of clients’ perceptions of harm also provide information about aspects of interventions to avoid:

  • Overly directive treatment that insists on a particular outcome
  • Inaccurate, stereotypic, or unscientific information or lack of positive information about sexual minorities and sexual orientation
  • The use of unsound or unproven interventions
  • Misinformation on treatment outcomes

This then leads the report to commend particular approaches to handling those with religious convictions who seek to reconcile their beliefs with their sexual orientation. In particular, the Sexual Identity Therapy Framework created by Throckmorton and Yarhouse is highlighted as one possible model for such therapy. The conclusion to this section (p63) makes fascinating reading because it highlights for those of us working pastorally in this field (as opposed to therapeutically) some factors which might explain what we actually have been experiencing in the lives of those we look after rather than what we believe we have been experiencing.

The appropriate application of affirmative therapeutic interventions to adults is built on three key findings in the research: (a) An enduring change to an individual’s sexual orientation as a result of SOCE was unlikely, and some participants were harmed by the interventions; (b) sexual orientation identity— not sexual orientation—appears to change via psychotherapy, support groups, and life events; and (c) clients perceive a benefit when offered interventions that emphasize acceptance, support, and recognition of important values and concerns.

On the basis of these findings and the clinical literature on this population, we suggest client-centered
approaches grounded on the following scientific facts:

  • Same-sex sexual attractions, behavior, and orientations per se are normal and positive variants of human sexuality—in other words, they are not indicators of mental or developmental disorders.
  • Same-sex sexual attractions and behavior can occur in the context of a variety of sexual orientations and sexual orientation identities.
  • Gay men, lesbians, and bisexual individuals can live satisfying lives as well as form stable, committed relationships and families that are equivalent to heterosexual relationships in essential respects.
  • No empirical studies or peer-reviewed research support theories attributing same-sex sexual orientation to family dysfunction or trauma.

Affirmative client-centered approaches consider sexual orientation uniquely individual and inseparable from an individual’s personality and sense of self (Glassgold, 1995, 2008). This includes (a) being aware of the client’s unique personal, social, and historical context; (b) exploring and countering the harmful impact of stigma and stereotypes on the client’s self-concept (including the prejudice related to age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, and socioeconomic status); and (c) maintaining a broad view of acceptable life choices.

I’ve added emphasis to raise a few comments on the above.

Firstly, my only gripe about the report. Where the report says “Same-sex sexual attractions, behavior, and orientations per se are normal and positive variants of human sexuality” it strays away from the remit of the taskforce on this matter and makes a moral judgement that is not covered in the literature it examines. I have no problem with the statement that homosexuality is a normal variant, but the literature examined was not intended in and of itself to explore the morality of homosexuality.

Secondly, the conclusion does not say that orientation change doesn’t happen, rather that it is unlikely. This should be read together with other statements in the report as a call for further research in this field, as the report itself admits that orientation change does occur on some occasions.

Thirdly, and of most interest to pastors, is the affirmation that it is identity not orientation which is the area within which the most positive outcomes are to be seen. In some sense this is an affirmation of what many of us have been practising for a number of years, but (as mentioned above) it does cause us to pause and reflect on what we have been doing these past few decades.

The Responses

Let me make reference to a few responses so you can get a flavour of how people are reacting to this.

Wayne Besen – “There is “no evidence that sexual orientation change efforts work.” This was the American Psychological Association’s verdict on “ex-gay” therapy after an appointed task force of experts studied the issue for two years.” Frankly, this is a naive reading of the report. As we have discussed above, the report implies that not only in some cases (mainly anecdotal) orientation change can occur, but that due to the lack of good research on the subject the APA cannot support such therapies without better evidence. The report then goes as far as it can to call for such research.

Exgay Watch has a much better (and fairer) summary of the key points that favour it’s views.

Christian Broadcasting Network has a video which articulates the Evangelical perspective on the report.

Warren Throckmorton has a great thread exploring the issues and the future possibilities for his SIF.

My Thoughts

Where does this report leave pastors like myself? Well, surprisingly in a good place. In some sense the APA report confirms that the new approach to dealing pastorally conservatively with men and women who issues with same-sex attraction is the same track that they are cautiously endorsing.

Let me explain. When a man or woman comes to me asking for my help to deal with their same-sex attraction, these are the steps that I personally take:

  1. I state categorically that I cannot guarantee any change in their sexual orientation, and indeed the purpose of these sessions is not to achieve such an outcome
  2. I lay out a program for our pastoral encounters (reminding them very firmly that I am not a therapist) which may consist of any of the following
    1. An exploration of the Biblical teaching on Sexual Practice
    2. An exploration of what holding to that Biblical teaching may mean for them as an individual
    3. An exploration of what “Identity in Christ” and a “Biblical Anthropology” might mean for their current paradigm of identity (sexual or otherwise) – see my piece on “Post-Gay” and lecture.
    4. An offer to explore biblical notions of woundedness and falleness, not that such exploration might lead to a change to in their orientation, but rather that like generations of Christians before us we might tap into the spiritual wisdom of the church about who we are in front of God and how to respond to that
  3. At any point in these encounters we may, at the client’s request or with permission, take any of the issues or ideas that emerge to God in prayer confident that he is able, if he wills, to do a supernatural work within us in healing the effects of our sin or the sin of others.

At various points in the process I might suggest a referral. Examples of such referrals are (i) attending a Living Waters / Redeemed Lives course, (ii) engaging in a mainstream Christian spiritual exercise for which I am not the best resource (e.g. Cursillo, Ignatian Reflection and Retreat etc.), (iii) seeing a qualified licensed psychiatrist or psychologist to follow up an issue that has arisen during our sessions. Where a client begins to make choices that indicate a path that would lead to decisions I could not as a pastor support, I will recommend alternative sources of pastoral support which would be more affirming of such a direction. It strikes me that looking at this approach we are performing pastorally an approach very similar to that which the SIT framework is performing therapeutically. We take seriously the spirituality of the person coming to us and, within that specific Christian framework, seek to explore how the individual might live a life that didn’t conflict with his/her moral framework.

What we are categorically not doing is promising to heal, cure, deliver from or exorcise homosexuality and anybody who suggests that that is what we do is being disingenuous at the very least. Of course it serves the purpose of those who critique ministries like mine to caricature the work in such a way because, as the APA report suggests, such explicit aims (to “cure” gays) do not tend to do exactly that.

I want to close this post with a story that I used in my Oxford Dissertation of the experience of one man who attended a course similar to Living Waters / Redeemed Lives. I was privileged to share his journey, which at no point ever sought to directly cure the issue that he came to us with. I offer it as a point of reflection on the discussion around identity and the outworking of exploring such issues.

3.1 – Promiscuity as a consequence of subconscious denial of truth
Love is the answer, but while you are waiting for the answer, sex raises some pretty good questions.
Woody Allen

Stefan was the son of two European immigrants into this country. The youngest of three children by at least a decade, he recalled how he was always the baby of the family. His parents came from a Roman Catholic background and, though not regular weekly Mass attendees, were sufficiently ensconced in Catholic teaching that despite the fact their marriage was failing they had not considered divorce. The result was that Stefan grew up in an environment where he knew his parents weren’t on the best of terms, and being the youngest and a boy, his mother would often use him as her confidant.

Stefan came to the pastoral group after a string of promiscuous encounters with girls. Despite coming to faith in Christ in his mid teens and being a faithful member of a local evangelical church, he had found himself drawn to serial sexual encounters without almost any ability to stop. He found it impossible to maintain any relationship for more than a few days, and desperately wanted to deal with these problems in his sexual behaviour.

As we discussed his family background he revealed that his mother had told him that he was “a mistake”. The pregnancy hadn’t been planned and it was actually a shock to his parents that he was going to be born. There was never a suggestion that his parents for one moment considered abortion or adoption, but it was very clear from that moment on that at some early point Stefan had developed a deep anxiety about his very state of being. Crucially, his mother, in not wanting and planning for him and in not realising that he was coming until a few months into the pregnancy had not “brought him into being”.

There were two points of homologeo in his healing. The first was the full acceptance that his parents had sinned in the circumstances of his conception, that he was created to all intents and purposes outside of a framework that wanted to create a child and to nurture and love it. His final, tearful and painful, acceptance of this truth, the way things actually were, was the gateway for the second moment of homologeo, where he faced up to the root cause of his sexual promiscuity. By accepting the truth of the circumstances of his conception we could see that at the very point of his life when he had been created he had lacked a “sense of being”. This had driven his sexual promiscuity, an almost cannibalistic desire to acquire “being” from those he had sex with (a desire which was the physical manifestation of the spiritual truth that he needed a theotic connection with Christ to “truly be” – Stefan was substituting coming into full being with and drawing his identity from Christ with sexual activity).

We then began a session of prayer for healing of memories, and prayed specifically into the subconscious memory that Stefan had of his conception. We prayed that God would come into that moment by his Holy Spirit and reveal, both today and that moment over 20 years ago, that despite the non-desire of his parents for him he would be totally aware of the truth that God desired him and had planned for him to be. This was the second homologeo for him to make, an agreement with the truth of God’s will for him from before the foundation of the world.

Leanne Payne, Andy Comiskey and Mario Bergner were some of the first to deal with “sense of being” as being key to the wholeness of a person. Though these writers speak chiefly into areas of sexual brokenness, William T Kirwan talks of the same themes on a more generic level:

“Our views about ourselves are molded largely by the reflective appraisals we receive from people significant in our lives. Parents, siblings, friends, and peers are all mirrors by which we receive feedback about how we are acting: those individuals constantly indicate to us how they feel towards us.”

The only difference between this and the view of Payne et al is that they write (and have found, like the author, to be pastorally true) that these views we form of ourselves are generated pre-natal as well as post-natal. Kirwan makes the observation that since the Fall humans do not live in a position of full truth but rather are in an environment of “assumptive truth” which is the creation of the human ego. As Kirwan writes:

“In spite of their creation in the image of God, Adam and Eve wanted to become equal with God, and so they ate fruit from the tree of knowledge of good and evil. Suddenly and catastrophically, the image of God in humankind was shattered … Adam and Eve no longer viewed themselves and the rest of creation through the framework of the image of God, but through the framework of their own egos … They had to look to themselves for their own integration. Their own egos became the axis around which their thinking, feeling and actions revolved. Their identity, no longer God-centred, became self-centered. The human being instead of God became their standard of truth.”

What had happened in the case of Stefan was that his ego had constructed a truth that he was unloved and unwanted. Until he entered into homologeo with the real truth, that his creator had designed and purposed him, he was destined to attempt to resolve the disconnection between his ego’s construction of truth and the actual state of affairs by “ingesting” his being from others through sexual encounters.

The effect of the prayer for a sense of being at conception was remarkable. The next week he entered the group with a completely different demeanour – confident and assured in his being as a man created and intended by God. A few months later he departed for another European country to spend 6 months as an  intern at a Christian community and after this half year was invited to become a full staff member,  organising weekend holidays / spiritual retreats and longer periods for church groups all over that country and the wider continent. He hadn’t even considered himself capable of this ministry twelve months previously, but God had so remoulded his sense of self within God’s truth that he had made  enormous strides in his relationship with Christ over the previous year.

Comments are welcome, but please address the content of the APA report.

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16 Comments on “The APA on Sexual Orientation Change

  1. I have not read all of this yet, but I have just read an item by Julia Duin of the Washington Times, which points out:

    The report was compiled by a six-member task force that admitted to a built-in bias that “same-sex sexual attractions, behavior and orientations per se are normal and positive variants of human sexuality and are not indicators of either mental or developmental disorders.”

    The National Association for Research and Therapy of Homosexuality (NARTH) said the task force was stacked with gay or gay-friendly activists who would naturally conclude that reparative therapy does not work.

    “No APA member who offers reorientation therapy was allowed to join the task force,” said David Pruden, NARTH vice president. “In fact, one can make the case that every member of the task force can be classified as an activist. They selected and interpreted studies that fit within their innate and immutable view.”

    Task force Chairwoman Judith Glassgold, a New Jersey psychologist, is on the board of the Journal of Gay and Lesbian Psychology, NARTH said, and was president of Division 44, APA’s gay caucus, in 2003-2004. Committee member Jack Drescher is a public gay activist. Another committee member, Roger Worthington, a chief diversity officer with the University of Missouri/Columbia, has been cited by gay groups for his advocacy on their behalf.

    Clinton Anderson, an APA spokesman, did not deny NARTH’s charges.

    http://www.washingtontimes.com/news/2009/aug/07/report-criticizes-cure-for-gays/?feat=home_headlines

    NARTH has issued a press release which gives an account of the lack of diversity in the task force, and how any study which does not fit in with the pre-formed worldview of the homosexualists is immediately squashed.

    http://www.narth.com/docs/apaleaders.html

    I know this to be true, as Dr Joseph Nicolosi played a recording of the Town Hall meeting referred to at the recent Sex & The City conference in London.

    It is my belief that until the APA membership stands up to these activists and puts clinical excellence ahead of political expedience, with some genuine diversity in the task force, the truth will not come out, reparative therapy will be actively discouraged, (therapists are already being threatened) and those persons with unwanted same-sex attraction will be left to flounder.

    • Is there any actual psychiatrist who offers reparative therapy that has the credentials to sit on a task force of this kind, though? I think Nicolosi has made a fool of himself time and time again. Even as a Christian who thinks homosexual behavior is wrong (and is thus celibate), I wouldn’t want him or those aligned with him sitting on a task force of this type, because he has made some awful statements in the past. Not to mention the fact that it’s not like NARTH is a non-political organization. They have a very constant record of being involved in conservative political activism.

  2. “Same-sex sexual attractions, behavior, and orientations per se are normal and positive variants of human sexuality”

    You correctly point out that science cannot address morality. I would also object to the term “normal.” What is a normal variant? The usual criteria for “normal” would be in terms of bell curves and lying with in 2 standard deviations of the median or about the middle 96% excluding the 4% consisting of the 2% tails on each side. Now, homosexuality is not a numerical quantity like blood pressure. (In fact, the “homosexuality” is not defined in many of these discussions. Is it having had a homosexual encounter in college 20 years ago? Is it having exclusively same sex attractions?) What encompasses a normal variant? It is left undefined. Cross-dressing, foot fetishism, etc.? Are these normal variants, too? (One can also ask if these positive as well?)

    The statement is non-scientific “talking point” thrown in for political purposes.

    (Also, I was reading that any practitioners of reparative therapy were refused participation in the investigative board.)

    • While I think there might be some grounds for critiquing the use of “normal” on statistical ground, I think that in the context of the report it is less a mathematical statement and more one of moral judgement. So yes, your point still stands.

      I’m not sure I’d want to push the point on the membership of the survey group too much (though I do recognise where your criticism is coming from). Analysts like Throckmorton and Yarhouse have worked hard to get the good response that they have in this paper and perhaps next time round they will be included in work of this kind.

  3. When the APA (psychiatric and psychological) groups succumbed to political pressure they lost credibility and can no longer be considered a reliable and ethical source of science information. The statue of Justice blindfolded is not a desirable image for Science, but it is applicable to these organizations who have blindfolded themselves to real and credible evidence, thus causing many people to live in pain, distress, disease and early death.

    Sufficient credible evidence is readily available in the form of research studies, anecdotal evidence, case studies, clinical medicine, mental health agencies, Center for Disease Control statistics, vital statistics and police statistics, but the APA politicalized organizations are not willing to accept it because they are biased and complicit with the agenda.

    Here is a hard fact:
    All good physical, mental and spiritual care is reparative.

    And another hard fact:
    Therapy isn’t painless, fun or easy.

    Change of mind and heart is like a series of corrective surgeries; it is usually both a relief to have hope and someone on your side, but is also a very painful and slow process. And things get worse before they get better. So if someone bails out in the early stages, he or she would be tempted to say, ‘reparative therapy hurt me’ or ‘reparative therapy doesn’t work, it makes things worse.’ The success of therapy is dependent on the skill, honesty, training, patience and good will of the therapist and the honesty, courage and perseverance of the client.

    For those who who want truth and reality enough to be courageous and persevere, the freedom and peace gained is worth the cost. In mental health as in physical health, the rule is ‘no pain, no gain.’ Facing and embracing the truth is not easy or painless, but as Scripture says, ‘it yeildeth the peaceable fruit of righteousness’.

    Here is another hard fact:
    Honest science will never refute Scripture.

    The activists may take over and mute science, dominate and change governments, laws, judges and some of the Church.
    They may change the meanings of words and invent new words and foist their paradigm into the public consciousness over decades.
    They may succeed in making approval or even participation in homosex behavior mandatory.

    However…
    They cannot change facts and reality.
    They cannot change or stop the negative physical, emotional, relational, social and spiritual effects of sin are unstoppable.
    They cannot stop the shifting of spiritual entities and strongholds that sin activates.
    They cannot make sin healthy, harmless or holy.

    The laws governing all creation rest upon the unchanging character of the Creator.
    God’s laws cannot be repealed or changed or even ignored. The effects of violating them cannot be stopped or changed.

    We cannot break God’s laws, we only break ourselves in the attempt.

  4. Sibyl is quite right. Dr Nicolosi has referred to the homosexualist ‘gatekeepers’ in the APA, and the virtual impossibility of getting past them with clinical studies which do not tally with their worldview. Any study which does not include these lacks credibility.

    I linked to NARTH’s response above. Here is a clip from it:

    In fact, one can make the case that every member of the task force can be classified as an activist. They selected and interpreted studies that fit within their innate and immutable view. For example, they omitted the Jones and Yarhouse study, the Karten study, and only gave cursory attention to the Spitzer study. Had the task force been more neutral in their approach, they could have arrived at only one conclusion: homosexuality is not invariable fixed in all people, and some people can and do change, not just in terms of behavior and identity but in core features of sexual orientation such as fantasy and attractions.

    With regard to possible negative effects of therapy, as in all provisions of psychological care, the possibility exists that the client may not be happy with the outcome. We believe the report indirectly supports the findings published in the current Journal of Human Sexuality that reveal no significant ill-effects of therapy. Further, if some clients are dissatisfied with the therapeutic outcome, as in therapy for other issues, the possibility for dissatisfaction appears to be outweighed by the potential gains. The possibility of dissatisfaction also seems insignificant when compared to the substantial medical, emotional, and physical risks associated with homosexual behavior.

    http://www.narth.com/docs/presstask.html

    • Is it really appropriate that, as Christians, we should want people to change more than their identity and behavior? I mean, I don’t think it’s a positive outcome if a man who once lusted after men is now having sexual fantasies about women. Both are sinful. Christ cares about what we do, not necessarily what we feel. A man can have a very functional and loving relationship with his wife, but he may still be attracted to men outside of his marriage. That only makes sense, though. After all, because of sin, all men are attracted to people outside of their marriage. Faithfulness rests on what they actually do.

      And I don’t think there is any logical reason that a person would want to change their sexual orientation. Christ is the only reason that someone would want to change their behaviors, and many of us are perfectly content just being celibate. I have better things to do than try to become heterosexual.

      • I made an error in my original comment here. I meant I don’t think there is any logical reason that a person would want to change their sexual orientation outside of religion. Even due to faith, however, some of us are fine with celibacy.

        • What about those who are not fine with celibacy, Jay? Some people long for an intimate, loving relationship ( not necessarily just or even largely for the sexual side.)

          I have straight friend who is single by choice, she is perfectly happy on her own. It is nothing to do with religion, it is just her personality. There are other people, myself included, who do better in a relationship.

          • I think it’s important that any Christian learn to be content with any possibility of a life path that God may offer, and let Him work out the details. If an SSA friend wants to date a person of the opposite sex, I’m all for it. I just caution them to realize that their relationships may look very different from the heterosexual norm.

            From my own experience, most of the time, successful mixed-orientation marriages are more like convenient and practical agreements between the couple, and often happen later in life. This isn’t to say that the couple isn’t sexually active, or isn’t happy and fulfilled. But I do think that an SSA individual who desires the same kind of mushy, normal romantic relationships as heterosexuals might have to recognize that such things are not likely for them, and I also encourage celibacy as a possible option.

            Obviously, I didn’t desire celibacy when I was 17, when I first came to Christ, but I made the decision and I stuck to it, and God has worked on my heart to mold it to a place where I am happy with it. I’m in no place to tell God what His laws are, nor am I in a place to ask “why?” If I made decisions based on my feelings, I wouldn’t be a Christian at all. Sin is easy, and obedience is hard and undesirable when one first starts out.

            Also, celibacy does not exclude me from loving, stable relationships. It simply excludes me from the exclusive, covenanted, and sexual relationship of marriage.

            • I agree that Christians should be content with- or even seek- a life path that God may offer. To some people that God-given path involves a relationship with someone of the same sex.

              What is “mushy” about a love, whether heterosexual or homosexual?

  5. Is there a psychologist or psychiatrist who has the credentials to sit on the board? Not if you think like the members of the board and an open mind to even the possibility is a disqualification.

    • Exactly how do you know how these board members think? If you’re right, and they would have disqualified anyone who had an “open mind to even the possibility” of change, then don’t you think their denouncement of reparative therapy and celibacy would have been a good deal stronger than it ended up being?

  6. RE: the Task Force. No one who practices reorientation was on the task force but Lee Beckstead, who I have presented at APA with was on the TF. Three evangelicals (there may have been more but I only know three) were reviewers (Yarhouse, Hathaway and me). I can tell you that the Task Force read everything sent to them by NARTH and everyone else.

    NARTH’s press release says the report omitted Jones and Yarhouse and Karten. Not true. Read the report. Those two studies were not given as much weight as NARTH hoped but they are in there.

    I urge people to read the report.

  7. I know several prior homosexuals who are now married (Christianly) to those of the opposite sex (and are happy!).

    Change is not easy. One needs to want to change, one needs to confront deep emotional problems and scars (often involving parents), one needs to realize the homosexuality is disordered and wrong, one needs to have faith, and one needs to reject modern day Gaydeology (all of which is built on deep and evil lies).

    There will always be some homosexual temptations, since parts of the brain have been rewired (just as with bulimics, for example) – but over time they diminish and have less of a hold on those who truly seek change.

    The first step is to have faith, and to commit to living chastely and with a pure heart (rather than see those of the same sex as objects of lust).

    The author of this blog is proof that such is possible.

    Brand

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