Warren Throckmorton has just published a preliminary document developed by himself and Mark Yarhouse. Titled Sexual identity therapy: Practice guidelines for managing sexual identity conflicts (100K pdf) Its intended audience is mental health professionals, and at this point the authors are going public with it in order to invite review from their peers.
Before going any further, let’s acknowledge the context in which this document is being presented. Much of the ex-gay movement has shied away from establishing standards of care, resisted external oversight, made vague and/or unverifiable claims, insisting that their role was limited to ministry or peer-to-peer support. Those that have made a case for ethical care have tended to be those who also cited Paul Cameron extensively. This document, at first glance, seems to move beyond those constraints.
And I need to make my personal limitations clear. I’m not a therapist of any flavor, and I won’t be trying to digest all of the references in the Guidelines and their historical and academic context. I’m going to post about my personal (very positive) experience with therapy and how it relates at A Tenable Belief, hopefully this weekend.
But, my initial impression is that the Guidelines offer some promise and some concerns.
The promise lies in Dr. Throckmorton’s and Dr. Yarhouse’s effort to get this far, first, and second, doing so with the intention of inviting input from their peers in order to work towards professional consensus.
Simply, it is essential that people — adolescents, young adults, all adults — working through issues related to sexuality, identity, culture, and religion should be able find professional care that neither demeans nor promotes the therapist’s or the individual’s religious perspectives. That’s a tricky thing to achieve. While many professional do, there are conservative Christians who discover disconnects with therapists’ perspectives about their faith, and clients who have found themselves at odds with their therapists’ faith-based practices.
So, what about the Throckmorton/Yarhouse Principles? What follows amounts to anecdotal observations by and questions from an amateur.
Under the heading, Working with Adolescents:
Adolescents should be dealt with conservatively because sexual identity confusion and change can be more prevalent during the teen years than during adulthood, when individuals begin to synthesize their identity (Savin-Williams, 2005). Adolescents should be followed, provided psychotherapeutic support, educated about identity options, and encouraged to attend to other aspects of their social, intellectual, vocational, and interpersonal development. Because an adolescent shift in self-reported sexual and religious identities can occur primarily to please family, peers, or other adult role models, changes may not persist or reflect a permanent in sexual identity. Clinical follow-up is encouraged.
Parents may bring in teens who are unable to provide legal consent. The role of the therapist here is to take a consultative role. Therapists can point parents and younger teens to research showing that confusion concerning sexual identity is common and that there should be no rush to declare a sexual identity at a young age (Remafedi, 1992; McConaghy, 1993; Savin-Williams, 2005). Clinicians should communicate that an appropriate parental stance is to provide consultation and support for their child and to refrain from shaming children for openly expressing their distress to parents and the therapist.
But, adolescence is also a period in which people wrestle with questions about “Who am I in relation to who my parents, family, and culture? In what ways do I find myself to be different, or do I want to assert myself as distinct?”
Key to that process is negotiating how one fits within, adapts to, accommodates, or rejects the faith and values of the parents, extended family, and/or culture. My experience in adolescence was that the orientation and the family/cultural issues could not be divorced from each other.
Under Phase one: Assessment, we read:
Sexual feelings that are in conflict with religious ideals can produce a sense of difference and distress. An assessment of the consequences of same-sex attractions and a potential gay identity to aspects of ethnic, cultural, and occupational identity as well as to familial attachments is vital. Therapists should be open to the possibility that embracing same-sex attractions may place other vital aspects of identity at risk. It is also important for therapists to take a neutral stance toward the client’s worldview.
A question: Therapists should attribute the distress of “sexual feelings that are in conflict with religious ideals” solely to the sexual feelings? Isn’t that at odds with taking a neutral stance towards the worldview?
Under Phase two: Advanced Informed Consent:
In all cases, therapists must provide clients with accurate information to support a client’s consent for further intervention.
Advanced informed consent is foundational to all subsequent interventions and should cover the following:
- Hypotheses as to what is causing their distress (including etiology of same-sex attraction, rationale for identity conflict and the subjective experience of distress);
- Professional interventions available, including success rates and definitions and methodologies used to report and define “success”;
- Alternatives to therapy, including reported success rates and the relative lack of empirical support for claims of success;
- Possible benefits and risks of pursuing treatment at this time;
- Possible outcomes with or without treatment (and alternative explanations for possible outcomes). (Yarhouse, 1998, p. 252).
It is beyond the scope of this article to fully delineate all information that might be needed during this phase.
Providing informed consent seems to be a major challenge of ex-gay groups, ministries, and therapists. Call me an amateur, but I don’t understand why it might be unreasonable to expect this document to develop these points in greater detail. What are the hypotheses? What general classes of hypotheses, given that this field of study is rife with misrepresentation, exaggeration, and hyperbole, might safely be labeled untenable?
And, what about success rates? Or, perhaps more importantly, what about the dearth of credible results garnered from peer-reviewed studies?
From the same section:
What is most important during informed consent is to help each client make a truly informed decision about the kinds of goals they might have for treatment and the kinds of services that are available. This can be an involved process when clients frequently ask about change of same-sex attraction and behavior. Clinicians may find that this takes more than one or even two sessions to process with some clients. Informed consent is also an ongoing process depending on how a person is progressing in treatment. If in therapy a client is not making much headway, it is important (just as in any other treatment program) to revisit treatment goals as to whether they are the best fit for their present needs.
Truly. Informed. Consent. Absolutely! Maybe it’s just that I’m an ordinary gay guy, and the authors are as invested in their psycho-babble as I am in techno-babble with my colleagues, so the language keeps me from getting my arms around this paragraph.
It just makes sense that more than one or two 45-minute sessions are necessary to come to terms with the coming-out process. Full disclosure at this point, in my mind, would include that very few folks experience black-to-white shifts in their baseline attractions to men or women.
Advertising by Jenny Craig and Weight Watchers includes disclaimers specifying that long-term, stable, 80+ pound weight loss happens but is outside the norm. Full disclosure by Throckmorton and Yarhouse, it seems to me, should include that the experiences of Stephen Bennett and D.L. Foster (going from 100% gay to 100% straight) represent a tiny minority; the experience of Randy Thomas (going from actively gay to finding purpose, value, and spiritual fulfillment in being single and celibate) is another option, and it is possible that being married in sync with life-long struggling/questioning is another common outcome.
There is much more to explore in the Principles document. So, let’s explore. Thoughtfully. Openly. Appreciatively toward professionals opening up their work to review by their peers.