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.