Sexual Identity Therapy to Address Religious

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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

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Sexual Identity Therapy Framework Practice
Framework for Navigating Religious Conflicts

• Warren Throckmorton, Ph.D.
• Grove City College

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Sexual Identity Therapy Framework
Practice Framework for Managing Religious and
Sexual Identity Conflicts

• By Warren Throckmorton and Mark Yarhouse
• http//www.sexualidentity.blogspot.com/

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• 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

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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.).

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Clinical Picture

• Clinical concern and intervention is warranted
  when stress or issues concerning sexual
  orientation become a central conflict in a
  persons 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.

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Orientation vs. Identity

• Orientation describes the pattern of sexual and
  emotional attractions experienced by a person
  the givens of a persons sexuality.
• Sexual identity refers to a personal
  identification with sociocultural categories of
  gay, straight, bi, and so on.

In Sexual Identity Therapy, the focus is on
sexual identity as a construct that incorporates
the persons assessment sexual orientation,
emotional preferences and inclinations to engage
in sexual activities.
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Phases of Sexual Identity Therapy

• Assessment
• Advanced Informed Consent
• Psychotherapy
• Social integration of a valued identity

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Assessment

• 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

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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

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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

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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.

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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 ones beliefs and values and
  ones behavior and identity.

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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

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Social Integration of Valued Sexual Identity

• Explore the practical elements of a synthesized
  sexual identity
• Develop social support
• Ongoing assessment of client desire and
  direction, as well as clients emotional status

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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