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from NARTH - APA Highlights
Thoughts on the 2009 "Report of the American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation"
By Philip M. Sutton, Ph.D.
1. The Report is an arbitrary dismissal of the importance of evidence about sexual-orientation change efforts (SOCE) provided prior to the past 50 years.
In drafting its list of criteria for acceptable research designs for evaluating the effectiveness of sexual-orientation change efforts (SOCE), the American Psychological Association Task Force (subsequently referred to as APA unless otherwise noted) applies post hoc criteria to discount the credibility of older studies and clinical reports of SOCE. These older studies were case and qualitative studies, many with multiple subjects/clients/patients, which were reported in the professional and scientific literature.
APA begins its evaluation of the most recent fifty years (i.e., the latter half of the 20th century) of scientific efforts to document SOCE's effectiveness, while ignoring the prior 75 years of reports (admittedly sparse in the latter 19th and earlier 20th century).
2. Misrepresentation of the basis for originally removing homosexuality from the DSM II (cf no. 3 below).
Prior to the 1973 and 1974 actions by the APA's, treatment of same-sex attraction (SSA) was considered normative, effective for some, and -- like all psychotherapeutic approaches-- not generally harmful. No research showed it to be otherwise. What has changed is the perceived and ascribed acceptability of diagnosing and treating homosexuality.
The 1973 and 1974 decisions to normalize homosexuality were based on politics- not science, and certainly not on any new science which had refuted these old studies, or which had refuted existing psychotherapeutic practice. Those who have written about this history, including pro-gay activists, admit that no new research showing that homosexuality was healthier than previously thought, or actually could not be changed, was used to justify the decision. Yet, these decisions by both APA are cited now as if they were proof for what they asserted.
3. The Report makes undocumented and I think erroneous (even fraudulent) claims to a scientific basis for the normality of homosexuality.
- On page 2, the Task Force Report's Executive Summary asserts that the following are "scientific facts" (I do not quote all):
* "Same-sex attractions, behavior, and orientations per se se are normal and positive variants of human sexuality-- in other words, they do not indicate either mental or developmental disorders" (p. 2, cf. pg. 54).
*** The first Resolution reads similarly that the APA "affirms that same-sex sexual and romantic attractions, feelings, and behaviors are normal and positive variations of human sexuality regardless of sexual orientation identity"; while the second Resolution adds that APA "reaffirms its position that homosexuality per se is not a mental disorder and opposes portrayals of sexual minority youths and adults as mentally ill due to their sexual orientation" (p. 121).
* Gay men, lesbians, and bisexual individuals form stable, committed relationships and families that are equivalent to heterosexual relationships and families in essential respects (p. 2).
* "Affirmative approaches [to treating]...the distress surrounding sexual orientation...are based on the evidence that homosexuality is not a mental illness or disorder, which has significant empirical foundation (APA, 2000: Gonsiorek, 1991).
* "There are no empirical studies or peer-reviewed research that support theories attributing same-sex sexual orientation to family dysfunction or trauma [long list of authors cited as evidence]" (pg. 54-55). In fact, such evidence does exist in significant amount of clinical reports and case studies.
The Introduction to the main document of the Task Force Report opens with reference to "the basis of emerging scientific evidence" and "on the growing scientific evidence" (citing Gonsiorek, 1991) as rationales for removal of homosexuality from the DSM-II, "that homosexuality per se is not a mental disorder" and that diagnosing and treating it as such has perpetuated a "stigma of mental illness that the medical and mental-health professions had previously placed on sexual minorities" This "emerging [and]...growing scientific evidence" also led to the acceptance by "licensed mental health providers of all professions ...that homosexuality per se is a normal variant of human sexuality and that lesbian, gay, and bisexual (LGB) people deserve to be affirmed and supported in their sexual orientation" (pg. 11).
***There is no "empirical foundation," or "emerging or growing scientific evidence" for these assertions of which I am aware, other than the fact that gay-activist mental-health professionals and researchers have asserted that they are true. The 1973 & 1974 decisions (i.e., political votes) by the APAs seem to provide self-serving proof, i.e. a circular argument: the APAs would not have said so if they were not true, and they are true because the APAs have said so.
4. The criteria for empirical acceptability are inconsistently applied. None of the studies cited in support of the Task Forces "scientific facts" (pg. 2) meet their own stringent criteria (summarized on pg. 6; cf. pg. 21-22; 26-34; 42-43; 90-91) for scientific research. Also, as they apply and require them, the criteria regarding sampling and control groups should not and could not ever be met in a clinically responsible way.
- Ironically, the 2007 study by Jones and Yarhouse, which clearly is the most rigorous study of SOCE to date, is not mentioned in Chapter 4 of the Task Force Report, which purports to be "A Systematic Review of Research on the Efficacy of SOCE: Outcomes." In footnotes, this study is described with others as being unable to "access whether actual sexual-orientation change occurred...due to their methodological issues" (pg. 44). A lengthier footnote (pg. 90) criticizes in detail the "study's methodological problems," yet a fair reading of the 2007 study and the three-year additional follow-up reported at the 2009 APA convention in Toronto clearly shows that the four of five key scientific criteria emphasized in this Task Force Report (pg. 6) were, in fact met, and that the criteria concerning sampling and control groups could not and should not have been met.
- If a demonstrably empirically sound study like Jones and Yarhouse's yields results that are "unpersuasive" (pg. 90), then no further study could be persuasive. The Task Force has set the bar so artificially high that no study done in a clinically, as well as scientifically, responsible manner ever would be good enough.
- Ironically, the criteria insisted on by the Task Force could not be met by themselves. The way that the Task Force insists research be done would preclude either its ever being done- or ever being good enough.
5. Two resolutions appear to accuse the likes of NARTH and religiously-mediated ministries for the very practices which the Task Force and others of their ilk themselves practice.
- The APA "opposes the distortion and selective use of scientific data about homosexuality by individuals and organizations seeking to influence public policy and public opinion" (pg. 122)
- The APA "supports the dissemination of accurate scientific and professional information about sexual orientation in order to counteract bias that is based in lack of knowledge about sexual orientation" (pg. 122).
6. Spurious, novel, and non-empirically-supported distinctions obscure rather than clarify the lived realities of clients with homosexual attractions and behaviors.
- Sexual orientation vs. sexual orientation identity: The Task Force Report attempts to identify an objective phenomenon (orientation) vs. a subjective phnemonenon (identity). "Orientation" is defined as an unchangeable characteristic, while "identity" is changeable. Yet, the Report also admits as a "psychological fact" that for some people, sexual orientation identity - but not orientation itself - is "fluid." This is pseudo-science (at best, conjecture, with no objective way of clarifying someone's orientation -- i.e., real self) from their self-reported identity (i.e., "individual or group membership or affiliation, self labeling," pg. 2).
Clients do report satisfaction with efforts to change their "sexual orientation." How one defines "sexual orientation" affects how one measures and attempts to change this phenomenon, and whether or not one has, in fact, been helped.
Finally, the Report defines "sexual orientation" as "an individual's patterns of sexual, romantic, and affectional arousal and desire for other persons based on those persons' gender and sex characteristics" and states that "orientation is tied to physiological drives and biological systems that are beyond conscious choice and involve profound emotional feelings" (pg. 30; cf. its definition of "sexual orientation identity"). While it can be acknowledged that persons typically don't choose to develop such physiological drives, arousals, desires, etc., the latest neuro-bio-psycho-social research reveals the "plasticity" and "learnability" of "physiological drives, arousals, desires, etc.," and behavioral habits as well as ways of gratifying or expressing them. It is difficult to believe how na•ve the writers of this section could be.
- The report compares "telic congruence" ("commitments and decisions about how to live according to specific ethics and ideals") with organismic congruence ("i.e., living with a sense of wholeness in one's experiential self," which the Report says "would give priority to the development of self-awareness and identity." While the Report acknowledges "that the organismic worldview can be congruent with and respectful of religion," its discussion seems to imply that it is "OK" to seek telic congruence, but organismic congruence is of greater importance. While the Report does explicitly voice for the importance of respecting religious values, it strikes me as offering mere "lip service" to these values.
7. The discussion fails to acknowledge the current research documenting the greater prevalence of medical, psychological and relational disorders among practicing homosexuals. Its simplistic "stigma model" (pg. 15-17) fails to account for these findings (cf. Section 3, Volume 1 (2009), Journal of Human Sexuality).
8. The Report engages in misdirection and inconsistent criticism. It emphasizes the importance for current outcome research to meet modern criteria for evidenced-based psychotherapy and declares that attempts to document SOCE do not meet these criteria. But it does not acknowledge that its own preferred model (gay-affirmative therapy) is also in need of empirical validation.
9. APA is unjustifiably mischaracterizing a process with which many client-consumers are satisfied and for which they are grateful, and thereby stigmatizes the practice of therapists who provide such care. APA claimed in its press release: "INSUFFICIENT EVIDENCE THAT SEXUAL-ORIENTATION CHANGE EFFORTS WORK, SAYS APA" and says that "Practitioners Should Avoid Telling Clients They Can Change from Gay to Straight" (APA, 2009, http://www.apa.org/releases/therapeutic.html).
Updated: 19 April 2010
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