Wednesday, June 22, 2005

Good Debate on Reparative Therapy

Recently, a Presbyterian therapist, C. Richard Carlson, published a short article on the Covenant Network entitled Sexual Reparative (Conversion) Therapy Revisited, in which he reviewed a paper that had been published in 2001 by Robert Spitzer, and the news splash that succeeded it. As Carlson notes, even Spitzer himself expressed surprise at the interpretations that were made of his work, saying:
Of course no one chooses to be homosexual and no one chooses to be heterosexual.

Carlson reviewed some of the ethics statements of professional organizations, discussed NARTH -- an organization that seeks to convert homosexuals to heterosexuals -- and listed some reasons that reparative therapy, discredited by medical and counseling professionals, has survived.

Morton Throckmorton, who has written on the MCPS curriculum (he's against it) and supports the CRC, wrote an article of response to Carlson's: Sexual reorientation therapy reconsidered. In this article, Throckmorton defended reparative therapy. His main argument was that it was the client's choice what he (almost always a he) considered to be a psychological problem. If a gay person wants to change, what could be wrong with helping them?

Carlson responded with a third article in the series: A Reply to Professor Warren Throckmorton concerning Reorientation Therapy. If you're busy and don't have time to wade through all of these, flip immediately to this one. He takes Throckmorton's points apart very carefully. He names two distortions in Throckmorton's arguments.
The first distortion has to do with the need for selection criteria for the treatment. This is something that reparative therapists never even mention. In their view, everyone is a candidate who is willing to try. This hardly constitutes a scientific or ethically sound basis for treatment.

To understand the second distortion, consider what happens when reparative therapy doesn't work - which according to Dr. Spitzer himself - would be most of the time, since the "vast majority of gay persons would be unable to change." Persons, frequently full of self-loathing, find a therapist who agrees with them that there is indeed something wrong with them, that their sexual orientation is a sickness at best and a terrible sin at worst. They have come because newspaper ads and "ex-gay" ministries and many churches have proclaimed that they can change. The therapist tells them that change is possible if only they try hard enough, pray fervently enough and keep coming long enough. God, after all, wants them to change, and "with God all things are possible."

But change doesn't happen. What happens to their self-worth when the cash runs out and there is no reorientation? What happens when these "children of God are unable to integrate their sexual identity with their faith and beliefs?"

We know what happens: at best, their self-loathing worsens; at worst, drug and alcohol addiction, hospitalization for mental illness and suicide happens. The harm goes tragically beyond "distress."

Next, Carlson challenges Throckmorton's claims on scientific groups.
Second, where is the evidence for sustained change? In the past four decades, reparative therapists have not produced any rigorous scientific research to substantiate their claims of cure. I asked Jack Drescher, MD, Author, Training and Supervising Analyst at the William A. White Institute in NYC and a past president of the American Psychiatric Association to comment on Dr. Throckmorton's clinical arguments:

"Dr. Throckmorton neglects to mention that despite the claims of people like himself of innumerable people being helped by sexual conversion therapists, that it was quite difficult for Dr. Spitzer to even find 200 subjects. First, Dr. Spitzer's study lacks any claim of scientific objectivity. Given that all of Spitzer's data stemmed from a 45-minute telephone interview, that there were no measures of pre- and post-treatment, that there was no follow-up interview to see if people's stories remain unchanged, all one really sees are 200 subjects primarily recruited by NARTH, who claimed that everything got better. One's interpretation of the data depends upon one's willingness to believe the subjects who were recruited. By analogy, if an organization that opposed the strict new antismoking regulations in New York City wanted to do a "study" debunking the harmful effects of tobacco, they could situate themselves outside a Manhattan cigar bar. Then one of the researchers could go in and tell everyone inside about the study they were doing and why they were doing it. They could then interview the first 200 people who walked out, asking them if cigarette smoking had any harmful effects on them. I can only imagine the objectivity of the data such a study would provide."

Third, he confronts Throckmorton on the spurious comment that the APA and other groups were pressured by gay activist groups into issuing statements sayiing that reparative therapy is unethical:
Third, Dr. Throckmorton quotes Dr. Spitzer as saying essentially that a gay activist group, very strong and vocal, has taken over the American Psychiatric Association and there is nobody to give the other side. I asked Dr. Dresher about this:

"Dr. Spitzer, whom I consider a friend, currently occupies no official position within the APA. Dr. Spitzer has no current knowledge of how APA position statements are initiated or the lengthy vetting process they must undergo before official APA adoption. The 2000 position statement, for example, came out of the Commission on Psychotherapy by Psychiatrists (COPP) which at the time was chaired by Dr. Glenn Gabbard, MD. One would be hard pressed to make the case that a psychiatrist of Dr. Gabbard's stature is under the sway of "a gay activist group" as Dr. Throckmorton claims. In fact, this commission studied the issue, modified and edited it, then sent it on to the APA Board of Trustees for approval. After BOT approval, it then went to the APA Assembly where psychiatric representatives from around the country, the vast majority not gay, approved it.

Fourth, he takes on Throckmorton's" comment that clients have the right to determine what kind of therapy they will receive:
Fourth, I asked Dr. Drescher to comment on Ray Fowler's statement, quoted by Dr. Throckmorton, that a client has the "right to self-determination." (Dr. Fowler is the Director of the American Psychological Association).

"Throckmorton neglects to point out that historically, sexual conversion therapists have tried to convince patients struggling with their sexual orientation that they should change. Anyone who has read the literature in this area will see the strong antigay bias in it. According to Shidlo and Schroeder, clients who saw sexual conversion therapists and who did not change were rarely referred to gay affirmative therapists. Dr. Throckmorton's argument that undergoing conversion therapy "is the decision of the client" overlooks the obvious fact that professional organizations have an ethical obligation to protect clients from "clinicians" who engage in practices that fall outside the mental health mainstream. By analogy, a patient has the right to choose laetrile to treat his cancer. However, a physician who prescribes laetrile as the treatment of choice is in violation of professional standards and ethics."

And finally, Throckmorton's assertion that the APA and other organizations' ethical principles were politically influenced by gay activists:
Fifth, Dr. Throckmorton's claim that "mental health associations have politicized the issue of reparative therapy" is ingenuous at best. In fact, those on the political and religious right are heavily invested in publicizing sexual conversion therapies as effective, primarily as it dovetails with their political position that homosexuality is not innate, that it should not be normalized and that gay people are not entitled to civil rights protection (that would represent "special rights"). As a matter of fact, Dr. Throckmorton's research seems to have a bit of politicizing to it as he suggests that it is not sexual reorientation therapies which are harmful, but gay-affirmative ones.

He closes this article with a statement that reflects, to me, what Christianity can be about -- of course, I was raised Presbyterian, maybe this is just my own prejudice here:
Perhaps the true reorientation therapy which is needed is one that helps the Church and society understand that "homosexuality per se implies no impairment in judgment, stability, reliability, or general social or vocational capabilities" and that homosexuality is a normal variant of human sexuality and not something bad needing to be fixed.

That true reorientation therapy is simply the Good News of God's wildly inclusive love in Jesus Christ.

Good discussion, this is a hard topic, and one that goes to the core of the MCPS sex-ed controversy. There are people in our county who want you to believe that reparative therapy, also called conversion therapy and reorientation therapy, is an acceptable and successful technique for making gay people straight.

It isn't.


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