Spitzer Retracts his 2001 Paper – Kind Of…
As Warren Throckmorton (amongst others) reports, Dr Robert Spitzer has asked to retract a paper he authored in 2003 examining the anecdotal reporting of almost 200 people who had been through an “ex-gay” programme.
Knowing this article was coming, I talked last evening with Bob and asked him what he would like to do about his study. He confirmed to me that he has regret for what he now considers to be errant interpretations of the reports of his study participants. He told me that he had â€œsecond thoughts about his studyâ€ and he now believes â€œhis conclusions donâ€™t hold water.â€ He added that he now believes that the criticisms of the study expressed in the 2003 Archives of Sexual Behavior issue are â€œmore true to the dataâ€ than his conclusions were.
He told me that he had expressed these thoughts to Ken Zucker, editor of the Archives of Sexual Behavior several months ago. He wondered aloud to Dr. Zucker if there was some obligation to say the critics were right and that the study should be withdrawn. Although Spitzer said he did not recall Zuckerâ€™s exact reply, he did not feel encouraged to withdraw the paper.
Of course, reading the full piece that includes this interview with Spitzer we can see exactly what Spitzer said.
I asked about the criticisms leveled at him. â€œIn retrospect, I have to admit I think the critiques are largely correct,â€ he said. â€œThe findings can be considered evidence for what those who have undergone ex-gay therapy say about it, but nothing more.â€ He said he spoke with the editor of theÂ Archives of Sexual BehaviorÂ about writing a retraction, but the editor declined.
Now, read the bit in bold carefully. What Spitzer is saying is that a survey of anecdotes can provide you with anecdotes and nothing more. What Spitzer’s saying is this – his work from a decade ago isÂ useful for knowing what those who went through ex-gay programmes thought about what they had done, but it can’t be used to determine whether such self-perceived outcomes are actually true. Put in other words, Spitzer’s survey does tell us what people who went through ex-gay programmes thought about it, but it provides no qualified analysis as to whether the claims of change actually occurred.
This article in the Archives of Sexual Behaviour highlights some of the original critiques of Spitzer’s paper. These are,
- The sample was not a random sample of the actual population that had gone through such therapy. It was largely self-selecting and a group whoÂ soughtÂ change for religious reasons.
- There was ambiguity as to what form the therapy actually took. Different clients were with different therapists who had differing models they were working with.
- There was ambiguity as to what the result of such therapy actually was. Was it orientation change? Was it “happy celibacy”?
The critiques can be summarised by this quote.
As Spitzer noted, self-reports are unreliable measures.Â Freund (1960, 1977) and Conrad and Wincze (1976), forÂ example, found that clientsâ€™ self-reports of favorable reorientation outcomes tended to be imprecise, deny certainÂ facts, and were not supported by objective data. SpitzerÂ seemed to believe that he has assessed sexual attraction;Â yet, he has only measured participantsâ€™ subjective experiences of their attractions.
Now what is the point of pointing this out? Well for a while I have been emphasising that anecdotal reports are not sufficient for validating ex-gay experience. What is really needed are proper academic studies like the Jones and Yarhouse Ex-Gay Study. There is also another reason for raising these issues, namely that there doesn’t exist a single report of “harm” from ex-gay therapy that doesn’t fall foul of the same kind of critique that was (rightly) levelled against the Spitzer paper. Harm reports tend to be anecdotal, taking no account of the type of therapy involved and have very poor qualitative qualifications of harm.
But it gets better. In a landmark paper in 2009, Professor Michael King produced a paper for BACP, a Systematic Review of Counselling for LGBT clients. He reported,
We found very few papers focusing onÂ psychotherapy for transgender people that were not solelyÂ concerned with preparing them for gender reassignment orÂ assisting them afterwards to adapt to their new gender role,Â but none had data suitable for inclusion in the review. OurÂ main finding is that the standard of quantitative researchÂ into the benefits of psychotherapy for LGBT people is poor,Â and there is no published evaluation of its effectiveness inÂ either experimental (randomised trials) or quasi-experimentalÂ (cohort of clients) research. Therefore, we could not conductÂ a meta-analysis of the quantitative data. The qualitativeÂ studies provided a rich literature on LGBT clientsâ€™ perceptionsÂ of therapy, the kinds of therapists they prefer, and how theÂ attitudes, training and methods of therapists can determineÂ outcome. However, many of the findings (eg need forÂ therapist acceptance and positive regard) did not seemÂ specific to LGBT issues and might be concerns for anyoneÂ entering psychotherapy.
- ÂWhen clients report experiences of so-called Âexgay affirmativeÂ therapy, they usually describe therapy in whichÂ homosexuality and bisexuality are regarded positively,Â prejudice is avoided, the stress of externalised andÂ internalised anti-homosexual bias is recognised, and thereÂ is sensitivity to LGBT development, culture and lifestyles.Â It was a therapy that knows what it is to be LGBTÂ.
- There was little consistent use of standardised measuresÂ of outcome. However, therapists were mostly highly ratedÂ in terms of general satisfaction and perceived helpfulnessÂ of the therapy.
- Most quantitative studies involved convenience samplesÂ of LGBT people, which means that selection bias is likely,Â and the generalisability of existing results to all LGBTÂ people undergoing therapy is questionable.
What can we conclude from this? Quite simply, that anecdotal data isn’t normally valid for making useful qualitative assessments of therapy, but that goes across the board. Those who criticise “positive” research into ex-gay therapy tend to employ double-standards, for the same plumb-lines they measure such research by can be equally used to critique not only “research” into the “harm” of ex-gay therapy, but also gay-affirming therapies in general. As King’s 2009 paper rightly points out, there are real issues around self-selecting sample bias in most research in this field, and there are also concerns about how self-reporting anecdotal data is not reliable.
Critics of ex-gay therapy need to accept this inconsistency as much as proponents of such therapy need to rely only upon proper research methodology. For both camps, what’s sauce for the goose needs to be sauce for the gander.
Not being a psychologist, and not always having had the best experiences with them, I wonder if the harm often reported is inherent in the power imbalance of therapist / client.
I wonder whether often the “harm” is simply anger that the promise, or perceived promise, of change has not been delivered.
But then, I can’t qualify that as the research hasn’t been done to prove it either way.
Just wanted to say, Peter, that your informed analyses into research and statisticalÂ method are insightful and fascainating – we don’t hear enough of this sort of thing, on any topic. You ought to be on Radio 4’s ‘More or Less’!
Hush. It’ll go to my head…
Just waiting for Jill to come in on cue here – “he was bullied into into retracting it by those awful Pink News people…..” Â Sorry, Jill, couldn’t resist it:-)
But seriously it isn’t just about the riskiness of putting too much weight (or any weight at all?) on anecdotal data; assessors also have to consider what is being told them – is it likely, less likely or unlikely to be objectively true (even though the subject may devoutly wish it or believe it)? Extraordinary claims require extraordinary evidence, and all that, so I’d have thought comparing the results for ex-gay therapy with other (more natural?) kinds of therapy such asÂ gay-affirming therapiesÂ is comparing apples and oranges. For the latter, accepting the hand that life has dealt you applies to an awful lot of what psychiatry and therapy must deal with; the outcomes may not always be as positive as one would wish but if psychotherapy has any point at all it must be the more likely outcome that you can persuade people to accept their condition positively and make the best of it rather than to make the radical (ontological?) changes claimed by the ex-gay movement. The best they can do for most cases, it seems, is to change behaviour. But then there are exceptions……Some people (perhaps a very few) may not be “set” in their sexuality; I think of this in a similar way that other peopleÂ (not many in the population at large perhaps)Â keep their childhood’s power easily to absorb languages, which for most of us seems to dry up once we start using our mother tongue fluently.
I thought the main concerns were around the methodology of the sample.
He has agreed now that those concerns were valid.
In this field and on that sort of ground – that’s pretty final. he is saying that the document is anecdotal – telephone gossip, no more.
Or have I missed something again????
Yes, you’re pretty much on the mark.
His wording is interesting. He has no issue with the idea that the people he spoke to believed that they had seen a change in their sexual orientation. However, there was no way of proving that such change had actually occured.
The same goes with most research in this area. I don’t know of a single piece of “research” on the harm of sexual orientation change therapies that isn’t just anecdotal (like this). Similarly, there is no non-anecdotal research that shows these therapies *don’t* work.
Basically, we don’t know if they do or don’t work. The closest we’ve come to the kind of research needed to prove this is the Jones and Yarhouse study.
Which would have been a better reason for Boris to pull the adverts – say, on the grounds that they were “promoting an unproven therapy about which we don’t know whether it causes harm – so best avoided”?
But then on that basis you’d ban most psychotherapy adverts…
Â Ah. Bliss!!
Not aware there are any on buses.
I’m taking in general. Most psychotherapy has little strong evidential basis.
What struck me was how much resemblance Robert Spitzer, in the little portrait above, bears Â to Raymond Burr as Perry Mason. I doubt that that’s significant ;)Â
in friendship, BlairÂ
That’s probably HUGELY significant, but I can’t for the life of me work out how.
He looks more like Bin Laden to me ;)
@Peter:”He has no issue with the idea that the people he spoke to believed that they had seen a change in their sexual orientation”
I have met many people who claimed to be ex-gay, got married, and then about ten years later became gay again and left their spouse, and often children, leaving a broken family.
Bin Laden?! *makes appointment at Specsavers for Origen*