Whenever I discuss transgender medical or therapeutic treatments here at the Ex-Gay Watch, I always seem to go back to the Harry Benjamin Standards Of Care. Like or hate this document (and the GID diagnosis), what the document does is provide criteria for determining if one has a condition that falls under the document’s purview; it provides a general outline of what medical and psychological treatments are appropriate for transsexuals; and it lists timelines and benchmarks for when particular treatments are considered appropriate.
Many medical and mental health conditions have standards of care — evidence-based clinical practice guidelines. There are standards of care for everything from treating ingrown toenails to managing Alzheimer’s disease; from treating acute dental trauma to treating bipolar disorders.
The National Guideline Clearinghouse™ maintains a public resource for many of these guidelines.
Not too surprisingly, there are no entries in the National Guideline Clearinghouse™ for Same Sex Attraction Disorder (SSAD) — no evidence-based clinical practice guidelines listed there for how to conduct conversion therapies for a SSAD (or any other named disorder relating to treatment of homosexuality or unwanted homosexual propensities) diagnosis.
National Association For Research & Therapy Of Homosexuality (NARTH) indicates this about its function:
NARTH’s function is to provide psychological understanding of the cause, treatment and behavior patterns associated with homosexuality, within the boundaries of a civil public dialogue.
After reading the organization’s function one might think that the organization would maintain an evidence-based clinical practice guideline for treating unwanted homosexual propensities. Yet, if one searches the NARTH website, one finds they have no published standard of care for SSAD, or standard of care for any other titled disorder relating to treatment of homosexuality or unwanted homosexual propensities.
There are books on how to treat homosexuality with conversion therapies [i.e. Changing Homosexuality in the Male and Reparative Therapy of Male Homosexuality: A New Clinical Approach, etc.); the Catholic Medical Association has published Homosexuality and Hope; Statement of the Catholic Medical Association which has a section entitled Treatment; and ethical considerations relating to unwanted homosexual feelings have been discussed at NARTH and generated by the American Association of Christian Counselors (AACC). None of these are standards of care.
The American Psychological Association states in it’s position paper Therapies Focused on Attempts to Change Sexual Orientation (Reparative or Conversion Therapies):
The validity, efficacy and ethics of clinical attempts to change an individual’s sexual orientation have been challenged. To date, there are no scientifically rigorous outcome studies to determine either the actual efficacy or harm of “reparative” treatments. There is sparse scientific data about selection criteria, risks versus benefits of the treatment, and long-term outcomes of “reparative” therapies. The literature consists of anecdotal reports of individuals who have claim ed to change, people who claim that attempts to change were harmful to them, and others who claimed to have changed and then later recanted those claims.
Although there is little scientific data about the patients who have undergone these treatments, it is still possible to evaluate the theories, which rationalize the conduct of “reparative” and conversion therapies. Firstly, they are at odds with the scientific position of the American Psychiatric Association which has maintained, since 1973, that homosexuality per se, is not a mental disorder. The theories of “reparative” therapists define homosexuality as either a developmental arrest, a severe form of psychopathology, or some combination of both. In recent years, noted practitioners of “reparative” therapy have openly integrated older psychoanalytic theories that pathologies homosexuality with traditional religious beliefs condemning homosexuality.
The earliest scientific criticisms of the early theories and religious beliefs informing “reparative” or conversion therapies came primarily from sexology researchers. Later, criticisms emerged from psychoanalytic sources as well. There has also been an increasing body of religious thought arguing against traditional, biblical interpretations that condemn homosexuality and which underlie religious types of “reparative” therapy.
Validating the APA contention that noted practitioners of “reparative” therapy have openly integrated older psychoanalytic theories that pathologies homosexuality with traditional religious beliefs condemning homosexuality, the document Giving Pastoral Care; Addressing Gender Issues is found on the NARTH website. This document lists Understanding Root causes & issues and Biblical & Practical applications in it’s table of contents.
Also validating the APA contention is NARTH’s status as a signatory member of Positive Alternatives To Homosexuality (PATH). The organization describes itself as follows:
PATH is a non-profit coalition of organizations that help people with unwanted same-sex attractions (SSA) realize their personal goals for change — whether by developing their innate heterosexual potential or by embracing a lifestyle as a single, non-sexually active man or woman.
Besides NARTH, PATH’s signatory members include Courage (Catholic), Evergreen International (Latter-day Saint), Exodus International (Christian), and JONAH: Jews Offering New Alternatives to Homosexuality (Jewish).
So what treatments are PATH’s signatory organizations advocating for patients it identifies as having unwanted same sex attractions? Without standards of care for SSAD (or any other named disorder relating to treatment of homosexuality or unwanted homosexual propensities), one can draw the conclusion that its treatments (that are referred to as conversion therapies) can include just about any clinical or non-clinical practice or procedure, and can be practiced by just about anyone.
For example, a conversion therapist can be someone like Jerry Leach (of Reality Resources, another PATH signatory organization), whose qualifications are described as follows:
Jerry is an accredited member of the American Association of Christian Counselors, an ordained Christian Minister, and a participating Member Ministry of Exodus North America.
He does have a Master’s of Divinity Degree and is a duly ordained Christian minister and is registered in Kentucky as a Limited Liability Corporation (LLC).
He is not a state licensed or board certified psychologist.
And, “appropriate” therapies may be said to include the practices of unlicensed psychotherapist Richard Cohen, who engages is a “bioenergetics” (demonstrated on CNN as Cohen striking a pillow with a tennis racket in lieu of striking Cohen’s overbearing mother) and “holding therapy” (which has the therapist cradling adult patients to simulate the father’s love the patient didn’t feel he or she received as a child).
It would seem a fairly significant concern that organizations like NARTH and Exodus International have protested the 1973 removal of homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (DSM), and yet the National Association For Research & Therapy Of Homosexuality doesn’t have an evidence-based clinical practice guideline at the ready should their goal of re-disordering homosexuality actually come to pass.
If SSAD (or any other named disorder relating to treatment of homosexuality or unwanted homosexual propensities) were a real healthcare or mental health condition, would just any minister or unlicensed psychotherapist be able to practice the condition’s treatment? Would ministries unlicensed to provide mental health services be able to sign up in a coalition of organizations as competent practitioners of appropriate therapies? Would the treatments — in this condition’s case called conversion therapies — be so nebulously defined as to not even remotely resemble a set of evidence-based clinical practices?
Perhaps there are no standards of care for SSAD because SSAD is a made-up name for a made-up condition. If NARTH considers SSAD — by that name or any other name by which they want to label this “condition” — as a one that requires treatment, perhaps they should publish standards of care for it. Otherwise, it’s hard to take their stated function of providing “psychological understanding of the cause, treatment and behavior patterns associated with homosexuality” as a serious description of their function.
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Michael Airhart and David Roberts contributed to this article.
But isn’t it so Christian (when I say Christian I am referring to all the groups you mentioned above) that they don’t have evidence? When I read their material a good % of the time they have no evidence for what they say or do.
Referring back to the HBIGDA SOC and the DSM IV GID diagnostic category, there’s a couple of points that people often misunderstand – particularly about the DSM.
First, the DSM is better seen as a dictionary or lexicon for mental health (and other health practitioners) to communicate with a common language. The presence of a diagnostic category does not imply a “mental illness”, rather it is a descriptive categorization in most cases. (One of several reasons why the term ‘disorder’ is used rather than ‘disease’ through much of the DSM)
The second point that should be made is that many critics of the DSM point to the narrative associated with the GID diagnosis and complain about how it doesn’t describe them, but they have not read the “Cautionary Note” (currently on page xxxvii or xxxviii of the DSM-IV TR) which frames the manner in which those narratives should be interpreted. (They are meant as examples to help a practitioner frame their understanding, but must be filtered through clinical discipline and experience)
While it is easy to understand how a DSM IV diagnosis can be seen as “pathologizing”, it should in fact be seen as descriptive – primarily between professionals.
Since, as a transitioning TS I am in fact asking for medical intervention to achieve congruity, I don’t see it as “pathologizing” for my therapist and doctor to have a lexicon of commonly understood terminology. (most homosexuals are not asking for medical intervention)
Sorry to be slightly off-topic, but I’ve become quite aware of how badly people can misinterpret the DSM and its intent in recent months – and it is quite disturbing.
I think you’ve really gotten to the heart of the issue. True professionals are held accountable to standards. Conversion therapists — whatever their methods — are not. That’s why it is absolutely impossible for any consumer of conversion therapies to know who’s the charlatan and who’s not. The only word they have to take is possibly another charlatan. There’s no professionalism in that.
The second point that should be made is that many critics of the DSM point to the narrative associated with the GID diagnosis and complain about how it doesn’t describe them, but they have not read the “Cautionary Note” (currently on page xxxvii or xxxviii of the DSM-IV TR) which frames the manner in which those narratives should be interpreted. (They are meant as examples to help a practitioner frame their understanding, but must be filtered through clinical discipline and experience)
This isn’t just a problem for the clients tho. There are many clinicians who insist on seeing these “narratives” as absolute diagnostic categories, to the extent of witholding treatment and accusing the client of lying if their life does not conform to the narrative. In fact, the man most responsible for writing the diagnosis, Ray Blanchard, is one of the most notorious offenders in this area, and most definitely does see it as a way to pathologize his clients as mentally ill. Whatever the intent may have been, there can be no doubt it’s been severaly abused.
Sorry for continuing to wander off topic. On topic, Warren Throckmorton has been putting together a set of guidelines he’s trying to get everyone in the bidness to adopt:
https://www.sexualidentity.blogspot.com/
I asked this question of Nicolosi directly, and those of Exodus.
When you’re talking about CLINICAL issues. Documented human behaviors, compared to what norms are. Or whether they are acute, or chronic. Evidenced by brain chemical imbalances or changes.
The fact still remains, NARTH and EXODUS would be at odds.
What standards of care manuals say that religious belief and religious commitment is a clinical intervention tool to cure it?
And if it’s a disorder, what person has control and choice over having it?
And of all disorders and standards of care still listed in the DSM or other current guides…
What other disorders are called upon to politically and socially exclude the sufferer from the professions they qualify for and marriage and child care?
I’ve asked that question over and over again.
And every time, there is no answer. Because I and I’m sure the rest of you…already know the answer.
NO ONE with ANY disorders is excluded from marriage, bearing children….or continuing in the job they continue to be talented and competent in.
Or any other profoundly important institution that would further their happiness and security.
Except gay folks.
They want to make the RELIGIOUS institution the most imposing and influential part of gay lives, almost to the exclusion of all else.
And a citizen of this country usually has FREEDOM from this. Our entire legal and social network was built against religious imposition.
So gay people again are the exception to this.
So the question now is….WHY?
Why so much overwhelming attention do homosexuality?
Especially when no other disorders, incompetences and behaviors disruptive to the function of the individual and society clearly aren’t excluded this way.
My experience with the therapists I was sent to by my Mormon bishops was that they had a clearly defined idea of what caused my homosexual feelings upon first meeting me and spent the time looking for what they wanted to find. As a psychology major, I had severe issues with the methods used as they seemed to me clearly biased in favor of the diagnosis and at one point I actually had to laugh and leave the office of a hypno-therapist who spent all her time looking for the childhood abuse she was certain I had repressed.
Luckily, I survived the treatment and eventually came out and found the peace I had been looking for.
There are many clinicians who insist on seeing these “narratives” as absolute diagnostic categories
Ummm…if that’s the case, then those clinicians are misunderstanding things quite badly. Given that gender and sexual identity are somewhat unique specialty areas in the mental health world, it may be a failure to recognize when someone should engage a specialist in the domain.
(My therapist is a specialist – but it took me a long time to find him)
Blanchard, along with a few others, seem to come out of an “old school” view that advocates for highly structured “gender clinic” programs (a la the Clarke in Toronto). They seem to be somewhat out of step with the overall direction in the field.
I haven’t had much time to review Throckmorton’s work personally. He seems a little less loopy than the traditional “ex-gay” crowd, but I’m not exactly comfortable with the perspective I’ve seen him present in the past.
I have another form of SSAD, Same Sex Attraction Difference. I would rather call that SGAD – Same Gender Attraction Difference. Or maybe that should be SGLAD – Same Gender Love Attraction Difference. I’S GLAD to be whom I am.
Years ago, I told my younger brother, Sam, homosexuality is not a defect, it is a difference.
“Gender Identity Disorder” (GID) has to do with transsexuals, aka transgenders, where one’s body’s outside physical gender is not the same as one’s spiritual gender or the gender of one’s actual DNA.
I don’t have any disorder related to my sexual orientation and my physical gender. I am definitely male in my physical makeup and my physiological sexual attractions are exclusively homosexual in nature.
I seem to go off on a tangent here; but, I have no problems with transgendered/transsexual persons as long as they are assured within their spirit that they are normal, just different from myself.
I had a friend whom some thought was a transsexual; but, she told me that she had a male chromosome in addition to her female chromosomes and that is why she looked like a man. I haven’t seen Tony in years but, she was special to me.
Ah, Todd and Joe Allen, herein is exactly where those with moral clarity, would understand what qualifies difference, and issue that doesn’t characterize a person as bad or evil or inherently incapable of doing good, well or with considerable above average intelligence.
There are disorders that the person with it cannot help in themselves, but at the same time cannot be something that denotes danger or caution for other people.
And of course, plenty that must.
Qualified doctors are doing their required duty when they relieve a person of suffering, as a paranoid schizophrenic would, or be able to warn others of sociopathy.
Both of these make the person with these issues a danger.
However, Exodus and all the other ex gay groups keep investing in menace, (fear of God), risk (homosexuality is an automatic death sentence from AIDS and homosexuality makes you inherently promiscuous), and inferiority (your sex life is barren of procreation therefore you’re unworthy of not only having sex, but marrying another gay person.)
These beliefs are passed off as a basis in fact, and statistics are presented as confirmed and the sources reliable.
Todd, in your case…they are a cause looking for a reason. Rooting out what isn’t there and exaggerating the negative, and denying any positives to life as a gay person.
When they aren’t engaged in one extreme to the other , the rest is determined vagueness.
I’m already straight, so I’m not subjected to such treatment.
However, if I give off a whiff of support for gay people as WHOLE people, not deconstructed to a bunch of component parts with no resemblence to straight people, this is where I’m accused of being not too bright, or treated as if I’m too stupid to understand what they REALLY mean.
It’s the worst kind of condescension.
Especially since I’m not interested in quoting Scripture to validate MY prejudice, as they do.
I find ex gays to be very strange inauthentic people. They validate the prejudices of the straight folks, by ‘staying in their place’, so to speak.
And I can’t respect them for wanting to have so many other gay people share that same place.
It’s disturbing to me on so many levels. Just another level of denial in my observation.
Regan,
I have no problem with “ex-gays” per se. If that’s the identity that they wish to frame their lives within, that’s fine with me. Where I have a problem with them – and ex-gay orgs in general – is the notion that they seem to present that somehow they have a “magic path” that’s right for everybody that they see as “similar” to them.
This crystallized for me recently when a girl appeared on a TS mailing list I belong to, and she was in ‘crisis’ – desperate to transition, but at the same time not sure at all where to start.
Over the coming months she got into therapy and started to sort out her feelings – and eventually concluded that she didn’t need to transition to be happy with who she was.
Meanwhile, on my side of those conversations, I am in the midst of transition – quite aware of my own needs. We formed a great relationship which continues, even though our paths only intersected ever so briefly on our personal journeys through the forests of gender identity.
The point? Even though much of what this girl expressed were things I could have written, the path that was needed for her was not even similar to the path I needed to follow.
Recognizing the reality of our paths all being different and somewhat unique is important, and possibly the single biggest issue that the “ex-gay” and GLBT communities have to recognize about each other.