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Friday, May 12, 2006

 

Sexual Identity Therapy Guidelines

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.

Comments:
Glad to see it out at last.

We'll give it a good look over, as it deserves, but on the face of it you seem to be at odds with the Exodus attitudes and practices.

Time to resign as an official speaker? :)

(And I'm not even touching, snigger, Richard Cohen's "hug me straight, my therapist, my only true friend" approach).
 
I'll look at it too. At first glance (I'm only through the first 8 pages), I think it sounds balanced. One grammatical comment--your first sentence should read "...experience little, if any conflict..." or "...experience few, if any conflicts..." :)

I can look for dangling participles as well... I got larned at a good English program:)

Have a good weekend.
 
Here are my comments on the guidelines:
Page 8.
"Psychology cannot provide empirical support for choosing one set of religious beliefs over another." Can they provide empirical support for the harm/benefits involved for those who decide to live as celibate Christians (or other religions), who choose to live as gay Christians, or reject their religious identity because of the benefit of other kinds of identity integration?

Page 13 ...the focus is on sexual identity as a construct... how is this different from adopting a social constructionist approach?

Page 14 Adolescents should be dealt with conservatively... What does "conservatively" mean? Isn't adolescence also one of the most dangerous times for people in sexual identity crisis? Wouldn't that require a more than conservative approach?

...appropriate parental stance is to...refrain from shaming children
What would this mean about groups such as Love in Action, or others who use shame as an impetus to change?

Page 17
Advanced informed consent...should cover....(2)...success rates"
What if there are no success rates, as in the case of groups such as Exodus? Is it the clinician's responsibility to discourage using them? Would this be true of groups who refuse to allow tracking of their success rates, because they are not "psychological", but rather "religious"?

Page 21
Some approaches to sexual identity therapy may seem to blend appropriate therapuetic boundaires and are discouraged. Can you cite some examples?

Therapists should not refer clients to retreats, support groups or interventions requiring boundary violations as a condition of participation. Again, back to LIA and other kinds of groups--how to define 'boundary violation'? Should this be explicit in the guidelines?

Page 23--Conclusion. No mention of suicidal thoughts (only depression). Back to the 'conservative' approach for adolescents--it seems that there are motivations for a more urgent treatment.
 
Thanks CK for the comments. Here are my selective replies:

Psychology cannot provide empirical support for choosing one set of religious beliefs over another." Can they provide empirical support for the harm/benefits involved for those who decide to live as celibate Christians (or other religions), who choose to live as gay Christians, or reject their religious identity because of the benefit of other kinds of identity integration?

No, I don't think so. I hope that we can move some research along those lines. I may not be reading the spirit of your question properly though...

Page 13 ...the focus is on sexual identity as a construct... how is this different from adopting a social constructionist approach?

It is constructionist. We believe people construct a valued sexual identity.

Page 14 Adolescents should be dealt with conservatively... What does "conservatively" mean? Isn't adolescence also one of the most dangerous times for people in sexual identity crisis? Wouldn't that require a more than conservative approach?

We also state that the therapist should assess for pathology (suicidal thinking, intent, etc) and take appropriate clinical steps. Not all identity distress has this clinical picture.


...appropriate parental stance is to...refrain from shaming children
What would this mean about groups such as Love in Action, or others who use shame as an impetus to change?


Inasmuch as any group or approach uses it, we would disagree with their stance.

Page 17
Advanced informed consent...should cover....(2)...success rates"
What if there are no success rates, as in the case of groups such as Exodus? Is it the clinician's responsibility to discourage using them? Would this be true of groups who refuse to allow tracking of their success rates, because they are not "psychological", but rather "religious"?


This is always a problem with community based support groups for any clinical issue. I think each group needs to be assessed as to its fit and benefit for the client. Exodus may have some outcome data soon but not now.

Page 21
Some approaches to sexual identity therapy may seem to blend appropriate therapuetic boundaires and are discouraged. Can you cite some examples?
Theophostic, Bioenergetics, Holding therapies, etc.

Therapists should not refer clients to retreats, support groups or interventions requiring boundary violations as a condition of participation. Again, back to LIA and other kinds of groups--how to define 'boundary violation'? Should this be explicit in the guidelines?

We may be more explicit in guidance that we will include on a separate website later. For now, I question men's weekends where people have to hug each other to "repair male bonds" and disclose personal stuff to strangers, therapy where the therapist holds the clients, or other stuff like that.

Page 23--Conclusion. No mention of suicidal thoughts (only depression). Back to the 'conservative' approach for adolescents--it seems that there are motivations for a more urgent treatment.

Again, therapists must assess severity and stop working on sexual identity concerns if the well being of the client is compromised. Maybe I am optimistic but I believe many of the reparative therapy horror stories could be addressed by these guidelines, if implemented.
 
Just getting back to some replies.
Me: What would this mean about groups such as Love in Action, or others who use shame as an impetus to change?

You: Inasmuch as any group or approach uses it, we would disagree with their stance.


Yes, but do you think, since shame is also a religiously loaded term, that there needs to be some discussion of how to recognize inappropriate shaming, as opposed to, say, a viewpoint which identifies homosexual activity as sinful?

Page 17
Advanced informed consent...should cover....(2)...success rates"
Me: What if there are no success rates, as in the case of groups such as Exodus? Is it the clinician's responsibility to discourage using them? Would this be true of groups who refuse to allow tracking of their success rates, because they are not "psychological", but rather "religious"?

You: This is always a problem with community based support groups for any clinical issue. I think each group needs to be assessed as to its fit and benefit for the client. Exodus may have some outcome data soon but not now.


Do you think that refusing to allow oversight should be a warning sign? Would it be fair to say that exclusively 'community based' support is not the best path to go down?


Page 21
Some approaches to sexual identity therapy may seem to blend appropriate therapuetic boundaires and are discouraged.
Me: Can you cite some examples?
You: Theophostic, Bioenergetics, Holding therapies, etc.


Do you have examples of groups which use them?

Page 23--Conclusion.
Me: No mention of suicidal thoughts (only depression). Back to the 'conservative' approach for adolescents--it seems that there are motivations for a more urgent treatment.

You: Again, therapists must assess severity and stop working on sexual identity concerns if the well being of the client is compromised. Maybe I am optimistic but I believe many of the reparative therapy horror stories could be addressed by these guidelines, if implemented.


Maybe you could explain how these guidelines would alleviate the horror stories. And I'm confused--when you say 'stop working' if the well-being is compromised, do you mean if someone is suicidal/depressed because of cognitive dissonance, the therapist should stop trying to assist with that dissonance? Or focus on prevention of acting on those thoughts? I may be missing something.
 
CK - RE: Shame - I do not think we can expand this point in the guidelines. However the plan to write a book around these guidelines and spell out some of them. I think many of the questions will be addressed in that way. I think the distinction between feelings and doing is a way to address that. It may sound strange and could be imprecise but I work with people now to examine what many people call internalized homophobia. I think of it a little differently. I think of it as examining why the client thinks having same sex attractions is any worse than any other impulse you believe is sinful.

Support groups might be just fine if they focus on valued behavior and bringing order out of chaos. For someone who is not sexually compulsive but is troubled by feelings unwanted, then support groups would not be a great referral.

Bioenergetics, etc. - My understanding is that Richard Cohen and the Journey into Manhood groups promote active techniques that involve touching, etc. These groups do boast of successes but I think the potential for problems is greater in those environments.

About dissonance: We are simply saying if the client has a mental disorder, treat that first. If the client develops one, then treat that first. If the distress over sexual identity is tied directly to the depression, etc, then redevise your counseling plan to address both. We have heard that some reparative therapists are not sensitive to the worsening mental condition of clients and continue a focus on homosexual feelings as the cause of all distress. We think this is naive and could lead to poor mental health outcomes.
 
PS - CK - we would accept any grammar help you can lend :)
 
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