Sexual Identity Therapy to Address Religious & Spiritual Conflicts

1. Sexual Identity Therapy to Address Religious & Spiritual Conflicts Co-Chairs: Mark A. Yarhouse, PsyD & Lee Beckstead, PhD Participants: Warren Throckmorton, PhD Erica S. N. Tan, PsyD Lee Beckstead, PhD Mark A. Yarhouse, PsyD APA August 17, 2007

2. Sexual Identity Therapy Framework: Practice Framework for Navigating Religious Conflicts Warren Throckmorton, Ph.D. Grove City College

3. Sexual Identity Therapy Framework By Warren Throckmorton and Mark Yarhouse http://www.sexualidentity.blogspot.com/ Practice Framework for Managing Religious and Sexual Identity Conflicts

4. “Drs. Throckmorton and Yarhouse have brilliantly resolved contention in psychotherapy by providing the field with unbiased guidelines that are responsive to scientific evidence, are sensitive to professional practice, and which restore patient determination in choosing his/her goals in psychotherapy.” - Dr. Nicholas Cummings, Past President, American Psychological Association

7. Treatment Objective • The purpose of these recommendations is to develop professional consensus around appropriate mental health responses to those individuals seeking assistance due to distress surrounding sexual identity. • The general objective of interventions in this area should be the synthesis of a sexual identity that promotes personal well-being and integration with other aspects of personal identity (cultural, ethnic, relational, spiritual, worldview, etc.).

8. Clinical Picture • Clinical concern and intervention is warranted when stress or issues concerning sexual orientation become a central conflict in a person’s daily experience or interferes with personal identity formation or other functioning. • Varying degrees of depression and anxiety may be present • The DSM-IV describes something like this in Sexual Disorder NOS: “Persistent and marked distress about sexual orientation”, as well as V62.89, which addresses identity and religious conflicts. • Distress may stem from confusion about sexual attractions in relationship to emotional attachments, conflicts with personal values and desires, or conflict with religious beliefs.

9. Orientation describes the pattern of sexual and emotional attractions experienced by a person – the “givens” of a person’s sexuality. Sexual identity refers to a personal identification with sociocultural categories of gay, straight, bi, and so on. Orientation vs. Identity In Sexual Identity Therapy, “the focus is on sexual identity as a construct that incorporates the person’s assessment sexual orientation, emotional preferences and inclinations to engage in sexual activities.”

10. Assessment Advanced Informed Consent Psychotherapy Social integration of a valued identity Phases of Sexual Identity Therapy

11. What? Milestone events in the history of distress Systems assessment (religion, sexual identity, etc.) Why now? Mental health status How? Semi-structured interview Quality of Life measures Family history Mental health measures as needed Assessment

12. Factors associated with distress • Personal beliefs or values about homosexuality  • Fear of HIV/AIDS or other STDs • Religious teaching regarding the moral status of same-sex behavior • Desire to be married • Interest in having children with the opposite sex • Friends or family member pressure • Their spouse may have given them an ultimatum • Feeling unhappy with sexual behavior • Please parents • Lack of social support as a homosexual person • Confusion regarding their sexual identity • Sorting out whether to identify as “gay” in a mostly heterosexual society • Concerns about discrimination against homosexuals • Internal, irrational fear of same-sex attraction

13. Advanced Informed Consent • Homosexuality per se is not considered a mental illness by any professional association and sexual orientation is considered a core diversity variable. • Questions regarding etiology of sexual orientation. • No well-designed, controlled outcome studies of reorientation therapies, gay affirmative therapies or sexual identity therapy. • Some research on attempts to change erotic orientation documents participant self-report of modest mental health benefits (e.g., Spitzer, 2003, Throckmorton & Welton, 2005), while other research documents participant self-report of harm (e.g., Shidlo & Schroeder, 2002; Liddle, 1996). Some research finds both outcomes (e.g., Beckstead & Morrow, 2004). Research on sexual orientation change per se is hampered by many methodological problems. • Statements regarding change would require measurement consensus

14. Advanced Informed Consent • For some clients, alternatives to therapy may be suggested, including religious-based groups. Clients need to be made aware that there are few studies on ministry-based approaches. (See Erzen, 2006; Wolkomir, 2006). • Research showing harm and benefit has tended to collapse all interventions, professional and ministry-based, into one category, thus obscuring what might be helpful and what might be harmful about each approach (Miville & Ferguson, 2004). • Bottom line – We have little consensus regarding etiology and the probability and therapeutic factors associated with either harm or benefit.

15. Psychotherapy “In the authors’ experience, some clients are satisfied with therapy once they work through their questions and concerns via the informed consent phase. Clients may begin to identify ways to live that are consistent with their beliefs and values.” Psychotherapy, then, is a process for seeking congruence with one’s beliefs and values and one’s behavior and identity.

16. Psychotherapy • Objectives of SIT are improved mental health and reduction of distress/dissonance • Change in sexual orientation is not the aim • Many modalities of psychotherapy are compatible • Reparative therapy per se is incompatible with SIT

17. Explore the practical elements of a synthesized sexual identity Develop social support Ongoing assessment of client desire and direction, as well as client’s emotional status Social Integration of Valued Sexual Identity

18. References Beckstead, A.L., & Morrow, S.L. (2004). Mormon clients’ experiences of conversion therapy: The need for a new treatment approach. The Counseling Psychologist, 32, 651-690. Erzen, T. (2006). Straight to Jesus: Sexual and Christian conversion in the ex-gay movement. Berkeley: University of California Press Liddle, B.J. (1996). Therapist sexual orientation, gender, and counseling practices as they relate to ratings of helpfulness by gay and lesbian clients. Journal of Counseling Psychology, 43, 394-401 Miville, M.L., & Ferguson, A.D. (2004). Impossible “choices”: Identity and values at a crossroads. The Counseling Psychologist, 32, 760-770. Shidlo, A., & Schroeder, M. (2002). Changing sexual orientation: A consumers’ report. Professional Psychology: Research and Practice, 33, 249-259. Spitzer, R.L. (2003). Can some gay men and lesbians change their sexual orientation? 200 participants reporting a change from homosexual to heterosexual orientation. Archives of Sexual Behavior, 32, 403-417. Throckmorton, W. & Welton, G. (2005). Counseling practices as they relate to ratings of helpfulness by consumers of sexual reorientation therapy. Journal of Psychology and Christianity. Wolkomir, M. (2006). Be not deceived: The sacred and sexual struggles of gay and ex-gay Christian men. New Brunswick, NJ: Rutgers University Press