Where’s the harm? Assisting change in adolescent sexual orientation

It happens naturally, so why not in the therapist’s office?
Christopher Rosik | Jul 16 2015 | comment  



 

The campaign for banning professional therapy open to change in same-sex attraction and behavior invokes “harm” to young people from such therapy. Yet the American Psychological Association has admitted that there is virtually no scientific evidence to support this claim.

In the second instalment of a three-part interview psychologist Dr Christopher Rosik answers MercatorNet’s questions about minors with same-sex issues, and why the main professional associations are so opposed to therapy open to change.

* * * * *

Do you see many minors? Under what conditions would they come to you – on their parents’ initiative? Their own initiative? The advice of a pastor? … Is it easier to resolve sexual orientation issues when a person is young than when they older?

I see minors with some regularity, although they are by no means the bulk of my caseload. Typically, they are accompanied by distressed parents. A professionally conducted therapy in such situations must first involve a careful assessment of the adolescent’s motivation and suitability for therapy.

It may interest your readers that, contrary to how ban advocates would portray me, the majority of adolescent patients I have evaluated were not deemed candidates to pursue change. In these instances, my main focus becomes working with the parents and encouraging them to love their child and keep the lines of communication open, even where they are having to manage value and/or theological differences.

Another rather heinous aspect of these bans is that research seems to indicate that change of same-sex attractions and behaviors is especially common in adolescence and young adulthood. While research directly addressing therapeutically assisted change in same-sex attractions and behaviors is limited, there is a growing research literature on sexual orientation fluidity that must inform this discussion (Diamond, 2008; Dickson, Paul, & Herbison, 2003; Dickson, van Roode, Cameron, Paul, 2013; Far, Diamond, & Boker, 2014; Moch & Eiback, 2010; Savin-Williams & Ream, 2007).

Large numbers of young non-heterosexual women and (to a slightly lesser extent) non-heterosexual men report fluidity in their sexual attractions and identities (Katz-Wise, 2014; Katz-Wise & Hyde, 2014), which typically first begin before the age of 18. I find it especially of interest that men who had experienced fluidity believed sexuality was changeable much more than men who did not experience fluidity, who tended to believe that sexuality was something a person is born with.

This raises the possibility many non-heterosexual male activists who fight against a client’s right to pursue professional care for unwanted same-sex attractions are men who have not experienced change and who assume that this is the case for all non-heterosexuals. Therefore they may erroneously assume that all claims of change must either be lies or self-deception.

Although this research is addressing spontaneous changes in same-sex attractions and behaviors rather than change facilitated by professional therapy, the discovery of sexual orientation fluidity to such an extent certainly makes more plausible claims that professional psychological care has contributed to such change for some people. To quote one research group, “People with changing sexual attractions may be reassured to know that these are common rather than atypical” (Dickson et al., 2013, p. 762).

With such changes in same-sex attractions and behaviors occurring all around us, is it reasonable to maintain that the only place where such change can never happen is in the therapist’s office?

The professional bodies: "It doesn't fit into our world view"

What is the position of the American Psychiatric Association, the American Counseling Association and other professional groups on this issue? What are their grounds?

The major professional associations are generally in lock step agreement on the subject. Their formal pronouncements typically claim that there is no good evidence that such therapies are effective and that they have the potential to be harmful. This unanimity of perspective does look like a kind of trump card, which is why opponents typically pile on the references to statements by professional associations against such therapies in their arguments. But by looking a little deeper, it’s evident things are not that simple.

The fact of the matter is that there is little to no ideological diversity in the leadership of these organizations, leading to a left-of-center groupthink process when addressing contentious social issues, including those involving sexual orientation (Duarte et al., in press; Redding, 2001; 2012; 2013; Wright & Cummings, 2005). This has an inhibitory influence on the production of diverse scholarship in areas such as same-sex attraction change that might run counter to preferred worldviews and advocacy interests.

Keep in mind that the case against change oriented therapy with minors is typically based on four sets of data: anecdotal accounts of harm (mostly from adults), a very few quantitative studies (compilations of anecdotal accounts from adults with severe methodological limitations), inferences from other research domains of questionable relatedness to this therapy (e.g., harms from family rejection of gay youth), and citations of the pronouncements on these therapies from professional mental health and medical associations. These various sources tend to cite one another in an almost symbiotic manner that provides little if any new information relevant to answering important questions about therapies that may facilitate change in unwanted same-sex attractions and behavior. 

There is no need to manufacture some sort of conspiracy here. This is just what naturally occurs when the leaders of mental health associations all share the same basic values and worldview. Just a few of a multitude of examples should be sufficient to underscore my contention.

Although many qualified conservative psychologists were nominated to serve on the highly influential American Psychological Association’s (APA) Task Force (2009) concerning “Appropriate Therapeutic Responses to Sexual Orientation,” all of them were rejected. This fact was noted in a book co-edited by a past-president of the APA (Yarhouse, 2009). The director of the APA’s Lesbian, Gay and Bisexual Concerns Office, Clinton Anderson, offered the following defense: “We cannot take into account what are fundamentally negative religious perceptions of homosexuality—they don’t fit into our world view” (Carey, 2007).

To no one’s surprise, only psychologists unsympathetic to sexual orientation change efforts (SOCE) were appointed—and at least 5 of the 6 Task Force members were LGB identified. It appears that the APA operated with a litmus test when considering Task Force membership—the only views of homosexuality that were tolerated were those the APA deemed acceptable. Of course the APA has every right to stack the deck however they wish on such matters, but they should at least publicly acknowledge that they represent a firmly and consistently left-of-center take on the science and politics of sexual orientation.

This was made even clearer in 2011 when the APA’s leadership body—the Council of Representatives—voted 157-0 to support same-sex marriage (Jayson, 2011). Likewise, the leadership of the National Association of Social Workers endorsed a total of 169 federal candidates in the 2014 elections—all of whom were affiliated with the Democratic Party (Pace, 2014)—and thus functioned like an arm of the Democratic National Committee. These figures undoubtedly represent a “statistically impossible lack of diversity” (Tierney, 2011). Even the esteemed American Medical Association has been hemorrhaging membership due to supporting left-of-center programs like Obamacare and now represents less than 20% of physicians in America (Pipes, 2011). With statistics such as these, sensible people will take the pronouncements of these associations regarding therapy assisted change in same-sex attractions with a huge grain of salt.

No research means there is no scientific evidence of harm

Opponents of therapy cite “harm” done by trying to change the sexual orientation or preferred identity of young people – the suicide of the “transgender” teenager known as Leelah Alcorn last December sparked the campaign to extend legal bans. What’s the hard evidence of harm – for any age group?

While every suicide of a young person is a real tragedy, these cases have been utilized with a complete loss of objectivity and instead are framed for maximum partisan political leverage.

Firstly, there is virtually no research on harm to minors from professional therapy that accepts the possibility of change in same-sex attractions and behaviors. The APA (2009) has acknowledged this in its Task Force Report. Second, the vast majority of anecdotal accounts of harm involve unlicensed religious counselors or ministries that are not even under the jurisdiction of these bans. Third, without good quality outcome research, of which none exists, we have no way of disentangling preexisting suicidality and distress from that which is allegedly caused by the therapy. Fourth, there is plenty of evidence of the “potential for harm” for psychotherapy in general, with 5-10% of adults and 15-24% of minors getting worse from their treatments (Lambert, 2013; Lambert & Ogles, 2004).

So claims of potential harm simply cannot be offered as an indictment of such therapies unless opponents can marshal evidence that the prevalence of harm specific to professionally assisted change efforts is greater than it is for all forms of psychotherapy, and no such data currently exist.

I think the most striking display the lack of science behind these bans occurred a few months after then California State Senator Ted Lieu (D) introduced the law to ban therapies allowing for change. Just before he seemed to stop making public comments on the bill while it was being debated, he made the following comparison: "The attack on parental rights is exactly the whole point of the bill because we don't want to let parents harm their children," he said. "For example, the government will not allow parents to let their kids smoke cigarettes. We also won't have parents let their children consume alcohol at a bar or restaurant."(quoted by the Orange County Register, August 2, 2012).

This prompted me to put Sen. Lieu’s harm equivalency statement to the test. I conducted a search of the PsycARTICLES and MEDLINE databases. PsycARTICLES is a definitive source of full text, peer-reviewed scholarly and scientific articles in psychology, including the nearly 80 journals published by the American Psychological Association. MEDLINE provides authoritative medical information on medicine, nursing, and other related fields covering more than 1,470 journals. I searched all abstracts from these databases using combinations of key words best suited to identify studies related to the question of harm to youth from alcohol, cigarettes, and change oriented therapy. You can check the specifics of the results here: http://www.therapeuticchoice.com/#!analysis-of-anti-soce-legislation/cwgr.

What I discovered was that, in stark contrast to the thousands of articles related to alcohol and cigarette usage by youth, my search of the scientific literature for references that would back up Sen. Lieu's claims yielded a total of four articles. Interestingly, three of these articles were not research-oriented (one of them actually appeared supportive of change efforts) and the only empirical article identified had well known methodological flaws. Consequently, I had to conclude from this investigation that Sen. Lieu's comparison lacked merit scientifically and therefore attempts to legally prohibit therapies facilitating change on the basis of harms to minors lacks a clear scientific justification. This is a conclusion I hold just as firmly today as I did in 2012.

Next: Ex-ex-gays, obstacles to research, and how to continue working in a “banned” enterprise. The entire interview can be read here.

Christopher Rosik is a Phi Beta Kappa graduate of the University of Oregon and earned his doctorate in clinical psychology from Fuller Graduate School of Psychology.  He is currently a psychologist and director of research at Link Care Center in Fresno, California, as well as a clinical faculty member of Fresno Pacific University. He has published more than 45 articles in peer reviewed journals and has served as President of the Western Region of the Christian Association for Psychological Studies.  He is currently Past-President of the Alliance for Therapeutic Choice and Scientific Integrity.



This article is published by Christopher Rosik and MercatorNet.com under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines. If you teach at a university we ask that your department make a donation. Commercial media must contact us for permission and fees. Some articles on this site are published under different terms.

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