Warren Throckmorton

I have been meaning to blog a bit more about bioenergetics. I wanted to comment about my belief that clients who engage in this techniques do feel better and may even stay better. I was going to talk about how different theoretical perspectives all have success stories and many have limited data showing successful outcomes. Then I came across Judd Marmor's response to Alexander Lowen's speech at the Evolution of Psychotherapy convention in 1997 (published by Brunner/Mazel). In his speech, Lowen described his three years of character analysis with Wilhelm Reich and subsequent study with him. Reich was in Freud's inner circle for awhile. Lowen broke with Reich when Reich began exploring orgone energy (a kind of life energy that is in everything and emanates from living cells. Adherents claim to be able to see a blue aura around people and analyse it). Point for Lowen.

Lowen ended his speech with this summary:

My evolution has brought me to where I understand that the body will heal itself if one surrenders to it. The surrender to the body means feeling it fully from head to feet. It means sensing all the chronic muscular tensions in the body, understanding their history, and their function in the present. It means feeling one's pain and sorrow and crying. It means being able to protest the loss of one's innocence and one's joy...It means to have faith in the body, for it is the abode of God, and to trust its feelings because they express your truth. I had to learn this before I could teach it to my patients. And I have to learn it again and again, because my narcissistic ego still thinks that it knows best (p. 144-145).

Following Dr. Lowen's speech, psychiatrist Judd Marmor gave the reaction. The whole thing is worth reading (145-148). This quote is about how I feel about bioenergetics:

I have no doubt that Dr. Lowen is an excellent psychotherapist. I see him...as a warm, caring, passionate man with powerful convictions who unquestionably inspires strong feelings of positive transference in most of his patients. However, I do question his explanation of why his patients respond positively to his therapeutic method.

Dr. Marmor goes on to describe how relaxing and directly working on the body may bring some relief but does very little to address specific problems in the absence of other more accepted methods (talking, interpreting, etc.)

Marmor summarized: "...it is not what he does to or with his patients but what takes place between them in their relationship that helps them to make progress."

This summarizes my thoughts about Richard Cohen and bioenergetics. Several of his supporters have contacted me to let me know that Richard is a caring person. In my dealings with him, I have found this to be true as well. However, liking someone on a personal level does not preclude vigorous disagreement about other matters. Being of the same faith does not preclude such disagreement either.

I think the fact that a therapist is caring and charismatic can attract clients who seek personal dynamism. Motivational speakers are called this because they use the strength of their personality and communication skills to motivate. I believe many "therapies" rely on the relationship the therapist can create to motivate change a person was already capable of making.

On point, here is a segment from an interview with Lowen:

GG: How do you respond to the critics of bioenergetics who say that touching a client's body is unethical?

AL: A therapist is in some ways a substitute parent. He is not simply a guide. One doesn't get into transference relationships with a guide. Can one be a good parent if one is afraid to touch his children? But one can be a very bad parent (destructive) if touching a child is sexual. That is sexual abuse. The therapist who cannot control the way he touches a patient should never touch one.

I do not think that you can convince critics because they are projecting their anxiety about touching into the situation. Bioenergetics is a very powerful technique, and it involves doing a lot of things that other people would not do. Not all therapists are really fully qualified to be body therapists. It is unfortunate. One of the reasons is that it takes half a lifetime to be a good therapist. There are a lot of life experiences that are needed: working on yourself, working on your problems, and learning how to do bioenergetics.

If patients can trust you, then touch is not a breach of trust. If you are not trustworthy, then don't touch them! I don't always have perfect results with my patients, but they know I am sincere, straight, and doing the best that I can.

Much the same could be said for coaches. Therapists that create paternalistic transference reactions can expect strong positive and sometime negative reactions. The strong reactions may lead to transference cures or actual breakthroughs as a client begins to make the learning his own. However, the risk for negative reactions seems greater than those therapy styles that are more collaborative and egalitarian. If you can get the therapeutic benefit generated by a warm, trusting, and yes, emotive, therapy relationship without the baggage of the parental role and invasive touch, then why not do it? I believe Marmor is correct. If research on this point is accurate, most change in therapy occurs due to the therapeutic relationship and the application of common factors (learning, change, emotion) that most therapies share. Figure out how to apply them properly and you've got something.

LA Times article regarding ex-gays and schools.

Comments anyone?

In this section of the LA Times article, the "ex-gay pamplet" refers to my brochure Respect and the Facts:

In Boulder, Colo., educators are considering including an ex-gay pamphlet in a resource guide to help teachers handle questions about sexuality. The pamphlet states that sexual identity is fluid and that conversion therapy can help some gays and lesbians overcome depression. The district — in one of the most liberal cities in the country — does not endorse that philosophy, but "we're a big believer in providing all viewpoints," spokeswoman Maela Moore said. "It would be negligent to omit."

One thing I will say about the CNN segment about touch therapy and sexual reorientation, it has generated a lot of strong feelings. I guess that is what Who Therapy is supposed to do.

There have been some interesting comments on my post regarding Richard Cohen's techniques as depicted on CNN. You should read through them if interested. In particular, one eye witness account about Elizabeth Kubler-Ross deserves consideration.

One poster I don't know, we'll call him George, since that is what he calls himself, said and asked the following:

I believe that the role of the therapist and the validity of the techniques are two separate issues. I am not contesting the importance of client/therapist boundaries. My interest in this continued dialogue is to further explore the validity of the techniques. If they (touch, holding, bio-energetics, etc . . .) are valid approaches then the delivery method (therapist, group, retreats, peers) can be worked out to fit within healthy and ethical guidelines. As Jim requested the other day, I would be very interested in your insights on the techniques as they relate to emotional healing, SSA and otherwise.

These are good questions. People who have felt benefit from experiential techniques have been giving me a hard time since I posted about the CNN segment. My experience with these techniques is limited to graduate school, discussions with other therapists, some clients who have had bad experiences with them, dealing with body psychotherapists as president of American Mental Health Counselors Association and what I read. Demonstrations in graduate school were not convincing. One of my good friends in graduate school had been trained in some kind of massage psychotherapy. He said more often than not, the "therapy" ended up with the client in love with him (male or female). He said some people were helped but he came to believe that traditional psychotherapy would have helped just as much. These body psychotherapy approaches were quite popular when I went to school in the 70s and 80s. But I never heard knew anyone personally who benefitted and knew some friends and clients who came to believe using such techniques was a part of a therapist's need to be a guru. When I was president of AMHCA, we determined that body psychotherapy was not compatible with mental health counseling as a profession. More about that in another post.

I would not ask anyone to doubt his/her own experience due to my experience. However, since I have been asked, I thought my background with this issue would be relevant.

I looked for research to support these therapies and I found only one research study. This was a small group of adolescents using touch techniques in 1982. Some benefits were reported in lowered aggression. Other than that all I find when I look up bioenergetics and catharsis and body work, etc. are theoretical pieces and anecdotes. We have more research on change therapies in general than we do on the outcomes of bioenergetics and touch therapies specifically. I looked for a society regarding bioenergetics and found the International Institute for Bioenergetic Analysis. On that website, only two research reports are summarized showing some positive benefits.

There are reports critical of some of the techniques. There is significant debate in play therapy for instance about the advisability of allowing children to vent and beat up toys. Some research shows aggression increases in such cases, and some mostly anecdotal reports cite exceptions. Bandura's Bobo doll experiments initiated a line of research that has led to great concerns over television and video game violence. In other words, aggression can lead to more aggression and not to ventilation and relief. I suppose people who have found the opposite will contest that but one cannot say that venting by beating things has a uniform outcome. There is potential for harm and worse outcomes. The lawsuits lost by Genesis and Associates testify to that very real possibility.

Research has also demonstrated that beating things while focusing on an image of a person or in an environment where one might be expected to remember abuse can actually generate inaccurate recollections. Telling clients that "memories" (imagery) experienced while in emotionally heightened conditions are invariably real has been the basis for lawsuits (Ramona case - not sure where that one is now). I believe such practices to be poor therapy and a disservice to clients and families. This "rage work" was a part of the basis for the successful malpractice suits lost by Genesis and Associates. (Any purported therapeutic technique ending in "work" is generally a red flag to me - rage work, grief work, body work, memory work, voice work.)

So we have what may seem like contradictory findings: some people seem to be relieved by beating and screaming and some people are deceived and harmed. While research is limited, it suggests that the disclosure of feelings can be helpful for clients who have known unfinished business with someone from a past relationship. For instance, Gestalt therapy uses the empty chair technique to drum up affect and restucture introjections. Paivio & Greenberg researched the impact of using the empty chair technique versus a class on resolving past hurts. The study
(Resolving "unfinished business": Efficacy of experiential therapy using empty-chair dialogue. By Paivio, Sandra C.; Greenberg, Leslie S.Journal of Consulting and Clinical Psychology. 63(3), Jun 1995, 419-425) found that releasing feelings toward a not-present person while in therapy was helpful, moreso than the educational group. Here is the point: the expression and awareness of feelings may be the therapeutic aspect of expressive therapies. The aggression and beating of things may not add anything to the benefit received from expression but may for many clients lead to the generation of inaccurate and disturbing imagery that would not be beneficial.

I don't have time now to comment further on holding and touch but I hope to. Before I draw this post to a close, let me add one thing. Whatever the benefit of these techniques might be for general mental health or relief of mental distress, they have not been evaluated or researched. No claims can be made for this use of them. Bioenergetics have barely been researched for any purpose with negative results in some highly public cases; they have not been researched at all for use in changing sexual orientation.

George asked about delivery methods. I am right now only commenting on what is done by therapists.

I think I will stop here for awhile.

I received word today that APA past president Dr. Nicholas Cummings supports the sexual identity therapy guidelines. This is an important beginning.

In the left hand column there is a little mp3 player providing some instrumental music when you load this page. Some people seem to like it and some don't. So I am taking a vote. Should the music stay or go? Leave me your vote in the comments section.

CNN, the Paula Zahn Now show (transcript), about a 6 minute clip, I was speechless for a few minutes afterwards. My wife and the rest of the sane people in the house were watching Idol. At last count, my daughter voted for Taylor 62 times.

Anyway, when my wife watched the clip (I taped it), she said she couldn't get past the "ick factor" to even evaluate what was said. We discussed which was the ickiest, the tennis racket slamming the pillow while screaming at mom; or the client-cuddle technique where Richard holds his client like a baby in a kind of nursing position. We couldn't decide.

I am reminded of a 1995 PBS Frontline documentary called Divided Memories. Part 1 of the documentary examines past-life therapy and Part 2 examines repressed memory therapy. The documentary crew was allowed to film "therapists" from the now defunct counseling group, Genesis & Associates. Genesis & Associates used something called Rage Work, that required clients to beat on pillows with bats while envisioning maltreatment from family members. Sound familiar? The two therapists who ran G&A lost their licenses and a significant malpractice action. I show Divided Memories to every intro to counseling class I teach. It is a powerful teaching tool about the proper role of therapy and the boundaries that are absolutely critical. Then we discuss why some people who were seeing the Genesis counselors described improvement. It is an amazing thing indeed how people can allow themselves to do something like Rage Work and still come away saying it was helpful. Well, at least at the time. One of the (at the time) satisfied customers on the video, later sued and as recently as 2004 described scars from her experience at Genesis.

I digress. The CNN segment focused mostly on Cohen and a current client. There were interviews with Jack Drescher and an ex-ex-gay. Drescher fudged a bit on the research but he didn't get much face time in the segment. I thought the ex-ex-gay was articulate. I think Deborah Feyerick did a good job of keeping her journalistic game face on during the pillow assault and client hugging.

During the segment, Richard was described as one of the leaders in the reparative therapy "movement." Did I mention that I am not a reparative therapist?

You can view the segment on the CNN website.

According to Richard Cohen, the CNN segment scheduled to air tonight will not air as planned. No word on a reschedule date.

FOLLOW UP: The Paula Zahn Now segment is now slated for tonight - 5/23/06

To give the guidelines their own identity (they were whining about being here), I created a blog for them. Moderated by Dr. Yarhouse and me, we will keep the focus on comments and endorsements regarding the guidelines.

CNN is set to air a segment regarding reparative therapy on Monday night, May 22, some time between 8-9pm. It will be during the Paula Zahn Show. The segment includes interviews with Richard Cohen, one of Cohen's clients, Robert Spitzer and Jack Drescher.

As if to say, "me too!" The UPI is taking its turn at incorrectly reporting the Savic study. Here is what the UPI report said:

Lesbians like men - with major difference

WASHINGTON, May 16 (UPI) -- Lesbians react to body odors like heterosexual men but with an important difference -- they are not sexually aroused, Swedish researchers say.
In a study of lesbians who smelled a derivative of progesterone found in male sweat and an estrogen-like steroid found in female urine, the female compound activated the hypothalamus among the 12 lesbians, researchers at Stockholm's Karolinska Institute reported.
While the reaction was like that of heterosexual males, the lesbians' response was different in that they were not sexually aroused, said the study published in The Proceedings of the National Academy of Sciences.

That differs from earlier studies by the Swedish team, which found gay men and heterosexual women react to male sweat in the same way.

"This observation could favor the view that male and female homosexuality are different," lead researcher Ivanka Savic told The New York Times.

One problem: the Savic study states specifically that the participants did not report sexual arousal. None of them, not just the lesbians.

ADDENDUM: I requested a review and correction and I just heard from the UPI that they did so.

I am saddened today by the recent loss of two friends: Karen Danielson and Mike Price. Karen died suddenly (May 10) as did Mike (May 11), within a day of each other.

Karen was Health Services Director for the college. As such, I worked along side Karen every school day for 11 years while I was Director of Counseling. She was still vital and full of energy until a stroke took her. She and I worked on diverse creative projects simultaneously: she wrote and published a cookbook and I produced my music CD, and the video, I Do Exist. Although we were an odd pair I think, we supported each other through the details of creating something from nothing.

My former secretary Polly Witherup, said about Karen "she could make a dead dog taste good." And Polly was right. Karen was always whipping up something really tasty in the Zerbe Health Center's kitchen. When I could get a minute free at lunch, I often shamelessly begged for food at the kitchen door. I never went away hungry. I will miss Karen.

Mike was a professor of English here. We were not close friends but I liked him immensely. He proofed several things for me, including most recently, a chapter of a book I am working on. He was amazing at his craft.

He also was a rocker and tomorrow in honor of Mike, and at the request of his wife, I will be wearing my black tee shirt sporting appliques of about 20 electric guitars to the funeral. Several of us who play will be wearing this gear.

Rock on, Mike.

On Friday afternoon, May 12, the AP issued a "clarification" of their report covering the study of the brains of lesbians. Here is the statement:

Clarification: Lesbian Brains Story
Fri May 12, 2:36 PM ET

WASHINGTON - In a story May 8, The Associated Press reported on the perceptions of lesbian women and heterosexual men and women when sniffing chemicals derived from human hormones. That report was based on a chart in a research study which indicated different perceptions of the chemicals, such as pleasantness, familiarity and irritability.

While there were differences in how the brains of homosexual and heterosexual participants reacted to the chemicals, the story should also have included the conclusion that indicated differences in individual perceptions were not statistically significant.

I made a request to the AP Thursday afternoon for the original AP story to be reviewed by the Science editor. Then, at the request of the AP, I supplied all of the correspondence between Dr. Ivanka Savic, Randolph Schmid and me. I have heard nothing directly from the AP as yet.

This is an important correction because many were misinterpreting the study thinking that lesbians responded differently in their feelings to the different smells. No such differences were reported, nor did any of the gay or straight participants experience sexual arousal in response to the substances inhaled. The study authors, lead by Ivanka Savic, have been clear all along that they do not know what the brain differences mean. No one knows how these differences would directly relate, if at all, to chosen sexual behavior.

So the correction did not go far enough. About the Savic study, the original story said: "It's a finding that adds weight to the idea that homosexuality has a physical underpinning and is not learned behavior." As Dr. Savic stated, "This is incorrect and not stated in the paper." Since the study did not explore learning factors, one cannot state that the study adds weight to any ideas about learning and sexual feelings or behavior.

The website GayNZ came closer to an accurate correction, reporting:

AP says lesbian brains story was wrong

The Associated Press has clarified a story they released which inferred that lesbian brains are significantly different to those of heterosexuals.

The story was released on May 8 and carried by GayNZ.com on May 9 (“Lesbian brains react differently”). The story cited Swedish research that showed lesbians are more likely to find male pheromones, essentially the scent of men, more irritating, and furthermore that lesbians processed both male and female hormones in the ‘scent area’ of the brain, whereas heterosexuals processed the pheromone of the opposite sex in the hypothalamus, or ‘sexual stimulation’ area of the brain.

The report prompted a number of sexuality-researchers to claim that this revealed that sexuality is biologically formed, rather than solely through life experiences.

The Associated Press now claims this conclusion to be unsupported by the research, as no statistically significant differences were found. Most researchers continue to maintain that the formation of sexuality is a complex issue, stemming from both biological and cultural factors – or, simply put, both nature and nurture.

The state of the art is much closer to this statement from GayNZ than the article from the AP.

(Thanks to Colleen Keating for the tip.)

I am posting a link to a document called "Sexual Identity Therapy Guidelines." These are in a form now where Mark and I feel comfortable with them being publicly reviewed. Please feel free to post comments here. Eventually, we hope to post them on a site devoted to the topic.

Much correspondence has gone on regarding this study and the way it has been reported by the Associated Press. I can say this: the Associated Press writer, Randolph Schmid, has been made aware that the new study says nothing about whether sexual behavior is learned. Here is a quote from a recent email from Dr. Savic: "The easiest way to clarify the situation is to go to the original data. I do therefore refer to the manuscript in PNAS. The study does not give answer to the cause-effect issue. Sincerely, Ivanka Savic"

She also pointed out other flaws in the AP report. For instance, this section is misleading:

"Heterosexual women found the male and female pheromones about equally pleasant, while straight men and lesbians liked the female pheromone more than the male one. Men and lesbians also found the male hormone more irritating than the female one, while straight women were more likely to be irritated by the female hormone than the male one.All three groups rated the male hormone more familiar than the female one. Straight women found both hormones about equal in intensity, while lesbians and straight men found the male hormone more intense than the female one."

To this, Dr. Savic said: "...the perception of these compounds was similar in ALL the subjects and all statements [in the AP article] about the pleasantness, irritability etc. are erroneous."

In fairness to Mr. Schmid, the graph in the article gives the impression of differences but in statistical terms, the differences were small enough that they cannot be considered signficant. The AP report gives the impression that there were more sexual preference related differences than were actually found.

So we have this situation: the AP writer knows the study author has found significant errors in the story. She even asked if they could be corrected and to date there has been no correction. Perhaps one is in the works. Corrections are issued all the time, I wonder why this story is different.

I do not take interest in this just to be difficult. I think the media have a great responsibility in this climate to report accurately. And saying that "the findings add weight to the idea that homosexuality...is not learned behavior" is not accurate reporting. The other factual errors just add weight to the idea that a correction is in order.

I think the study of attraction is just full of fun. What pheromones?

Yours truly was quoted in a HealthDay article by Kathleen Doheny. This piece sticks much closer to the actual report than the AP article does.

Here is an email I sent to Dr. Ivanka Savic today about the study of lesbians' response to putative pheromones. My note is in italics and Dr. Savic's reply is in bold letters.

Dr. Savic:
The Associated Press story came out today about your study and I think they have reported it incorrectly.

First I am wondering if you can help me understand things more clearly. I am enclosing a link to the AP report: http://www.forbes.com/entrepreneurs/feeds/ap/2006/05/08/ap2729698.html

First, in the report the reporter writes: "It's a finding that adds weight to the idea that homosexuality has a physical underpinning and is not learned behavior."

THIS IS INCORRECT AND NOT STATED IN THE PAPER

As I understand your article in PNAS, you specifically offer learning as a hypothesis for your findings. Isn't this true? I believe the reporter is misleading on that point.

THIS IS VERY UNFORTUNATE; AND YOU ARE ABSOLUTELY RIGHT

Second, the AP report says: "In lesbians, both male and female hormones were processed the same, in the basic odor processing circuits, Savic and her team reported." I understand that the study did show that AND (male condition) was processed akin to other odors by lesbians. But wasn't there also some hypothalamic processing of EST (female condition) by lesbians?

YES! AND ALSO CONJUNCTIONAL ANALYSIS SHOWED A COMMON HYPOTHALAMIC CLUSTER IN THE HYPOTHALAMUS:

It was weaker and apparently not in the anterior hypothalamus but didn't you also find dorsomedial and paraventricular hypothalamic activation? So it would be inaccurate, would it not, to say "both male and female hormones were processed the same?"

YOU ARE FULLY CORRECT

THANK YOU VERY MUCH. HOW DO I ACCESS THE AP REPORT??

Ivanka Savic

ADDENDUM: Someone posted and asked why I changed the AP wording when I wrote to Dr. Savic. I did not change it but it appears the AP did from saying homosexuality had a "physical underpinning" to a "physical basis."

News is starting to leak out about an article embargoed until 5PM today. The article reports a study by the same Swedish team that did the gay male and pheromone study about a year ago. This study shows that sexual orientation at the extreme (5-6 Kinsey scale) differentiates how the brain responds to a putative pheromone. The response from lesbians is not as clear cut as gay males. Lesbians process estrogen derived pheromones both in the normal olfactory fashion and via the hypothalamus (a link in the sexual response). The participants did not experience any sexual response so it is interesting that these lesbians' brains registered the pheromones in a different way than did straight women. Lesbians were somewhat like straight men but not exactly like them. The reference is: Berglund, H., Lindstro"m, P., & Savic, I. (2006). Brain response to putative pheromones in lesbian women. Proceedings of the Natural Academy of Science, Early Edition (www.pnas.org).

As usual, Gay 365 has it wrong. Their article says: "It's a finding that adds weight to the idea that homosexuality has a physical underpinning and is not learned behavior." The study doesn't say anything about how the brain responses occurred. In fact, the study suggests that the differing responses may indeed be learned.

I proposed to Dr. Savic that the team consider an additional study of bisexuals and ex-gays. Dr. Savic replied favorably that the team would consider it.

Addendum: My apologies to Gay 365, they took their info from the AP story. Here is what Dr. Savic said about learning in a New Scientist article on the subject: "But our study can't answer questions of cause and effect," cautions lead researcher Ivanka Savic at the Karolinska Institute in Stockholm, Sweden. "We can't say whether the differences are because of pre-existing differences in their brains, or if past sexual experiences have conditioned their brains to respond differently."

Since moving from full-time counselor to full-time prof, I have come to understand what full-time profs do with all of their full time. Papers being the number one filler of the time. I have discovered that I do not like paper work anymore as a professor than I did when I disliked it as a counselor. That's all.