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Friday, May 26, 2006

 

More on the Who Therapy (See me, feel me, touch me, heal me)

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.

Comments:
Hmmm, also have that feeling you want to stop there for awhile. Oh, look, a large can of worms :)

(Who on earth has ever canned worms? And why? But I digress.)

Without wishing to get into the story of any individual -- anecdotes have a place (to find outliers that often raise further questions) -- but it does strike me that the dynamics of the situations have some strong parallels to exgay therapy.

> not been evaluated or researched
> driven by anecdotal (and/or solicited) testimony
> reports critical of techniques used
> promotion of the immediate but no long-term follow-up
> re-labelling of (obvious) “failures”
> ditto, (not-obvious) “successes”
> triggering or tapping into other issues, possibly deliberately
> issues with boundaries
> generating inaccurate recollections
> issues of client choice and a (professional) therapist's decision to participate
> fringe and non-professional "experts", many of whom aren't even qualified to drive a bus let alone mess around with such strong emotions from distraught people.

"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."

This sounded like an echo. It was: the APA/APsA/ACA et al statements on exgay therapy. Beating a phone book with a hose. A cushion with a tennis racket. Or beating up on ones own self.

Since we're in the middle of doing it, we might just use your recent exgay guidelines as a template and see where that takes us.

"I looked for research to support these therapies".

Yes, well, let's not even go there... :)
 
I understand that there are some similarities but there is more research about change and reactions to change than exists regarding bioenergetics. So why hasn't the APA issued an advisory about bioenergetics?

In contrast to your list, not all approaches to exgay therapy match up with the concerns you listed. This was one of the real problems from my vantage point with the CNN report. Richard Cohen is a convenient target for critics but he is not representative of all reorientation counselors, probably even all reparative therapists.
 
Well, they say the same thing about "touchy-feely" therapists too. QED...

But we said we're seeing parallels, not an identical match up in all cases etc.

And, please, don't get me started on the way psych. professional bodies have long dealt with, ummm, "newly emerging therapies". Thank heavens you lot don't build bridges or aircraft :)
 
I'm just a woman with a computer and husband who's been through some of this *crap* (and some of it actually helped)....so...I know not alot that has ANY weight whatsoever. But....it does seem to me that this particular issue so overlaps between the mind, the body, and the soul of people...until it's just almost darn impossible to figure out some sort of set "formula" for those who seek to change unwanted sexual attractions.
It's sad...really....that we don't have more folks trying some of these techiniques (just in case they work) to rid themselves of opposite sexual attractions. Sexual struggle is no respector of persons, ya know? But...that's not "our" issue...I get that. :)
grace
 
Grace - I am not sure I am following you here. You want more people to beat up inanimate objects?

Seriously, I am not even against controlled trials of most approaches. However, one problem is that none of these things have been examined well. When it comes to SSA, psychoanalytic therapy, some behavioral therapies, cognitive behavior therapy and group therapy has been used and modestly evaluated.

Mark and I try to avoid some of the problems in that by suggesting we focus on the total client rather than the SSA and help a person construct a valued identity. This is pretty standard therapy.
 
nope Warren....not saying that at all...
i didn't even watch the peice so I probably should not have commented...
i am just saying that sometimes, unconventional methods do have some positive affect....and yeah...i guess i'm saying that it might make anyone feel better for at least a little bit if they got their anger/agression out....maybe on a pillow...but probably at a gym...i should have watched the thing before i attempted to comment. sorry! i guess i just don't see how hitting a pillow is all that helpful specifically to lessening same sex attraction. But, again, I didn't watch the piece.
 
Dear Dr. Throckmorton,
thank you for your thorough and thoughtful response. I look forward to hearing more about your insights on touch and SSA as well.

I must agree with you that much more research and documentation is needed in order to determine the validity of these techniques, above the anecdotal level, in helping men overcome unwanted same sex attraction.
 
How do you suggest clients deal with pent up anger or frustration from the past due to neglect or abuse?

I would assume there has to be a way to release that energy or resolve those feelings.

Thanks!
 
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