Not every man or woman who finds himself or herself sexually attracted to someone of the same sex is happy with that attraction. Parents of adolescents who show such tendencies may consider it best for the happiness of their child to seek counseling or other professional help for them. And such help is available.
However, the assumption that homosexual attraction, and, in some cases at least, more established orientation, can change, runs into a wall of opposition from gay rights campaigners and professional bodies. These assert that it is harmful to try and change something they believe is not even a problem, but a naturally occurring phenomenon.
In April this year the White House threw its weight behind this anti-therapy campaign, which had already seen three US states ban sexual orientation change therapy for minors (New Jersey, California and Washington, D.C.). In May the openly lesbian Governor of Oregon, Kate Brown, signed another such law. At the same time Representative Ted W. Lieu introduced a bill into the US Congress that would ban so-called “conversion therapy” throughout the United States.
MercatorNet believes this is a very one-sided culture war. Where is there space given to professional therapists who work in this area to explain what they do and to defend it? Well, right here. We emailed some questions to Dr Christopher Rosik, a practising psychologist and director of research at Link Care Center in Fresno, California, as well as a clinical faculty member of Fresno Pacific University. Here, in the first of three articles, we begin his responses.
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Earlier this year President Obama endorsed a ban on “gay conversion therapy” for minors. What would this mean for the kinds of young people you see in your practice?
In my opinion, this topic is above our President’s pay grade. What the ban in California has meant for me is that I immediately added language to my advanced consent forms, which parents and adolescents read at the outset of therapy, indicating that the law is in effect and therefore I can no longer engage in any intervention that could be construed as promoting change in unwanted same-sex attractions and behaviors.
The California law is very nebulous, as I am still allowed to share information, talk about change, or provide support to a minor, but not say anything that could be viewed as promoting change. Given that costly ethics complaints are made by patients, whose perceptions may vary wildly, such distinctions are of little practical value, and I suspect these laws will hinder the provision of any type of professional psychological care to these minors that is not overtly gay-affirmative in nature.
The White House defined “conversion therapy” as “any practices by mental health providers that seek to change an individual’s sexual orientation or gender identity.” – Does this term and its definition describe what you do?
The progressive left has done a superb job of demonizing terms such as “conversion therapy” or “reparative therapy” beyond recognition. These terms have been repeatedly and widely associated with abusive aversive techniques that have not been used within the psychological professions for over three decades, and this includes licensed therapists who do such work.
We are further characterized as coercing minors into treatment and telling such patients they must have been sexually abused.
However, my colleagues and I always follow the lead of the client in goal setting because we understand that there is no genuine therapeutic process without client self-determination. Nor do we assume every client has a history of childhood sexual abuse, although there is reason from the literature to believe such abuse can be an important influence on the development of sexual orientation for some people (Beard et al. 2013; Bickham et al. 2007; O’Keefe et al. 2014; Roberts, Glymour, & Koenen, 2013; Wells, McGee, & Beautrais, 2011; Wilson & Widom, 2009).
Such poor practices, were they actually being used by licensed therapists, would surely risk ethical censure or even loss of licensure without the aid of such bans. Yet I am not aware of a single therapist who has had to deal with an ethics complaint on such a basis. Indeed the lack of any ethics complaints against such therapists at the state level suggests that their professional conduct is not the problem but rather their willingness to entertain the possibility of change for some patients.
Recent legislation in Washington State further disclosed ban supporters motives as seeking to suppress the free speech rights of therapists. A bill with bipartisan support to prohibit harmful aversive techniques with minors (e.g., electrical shocks, chemically induced nausea, ice baths) eventually died after ban advocates protested that the bill still allowed for therapist speech in the potential facilitation of change.
In point of fact, there is no one special kind of therapy for such patients. I am not a reparative therapist, but I do see insights from this paradigm as being applicable to some patients. Therapists like me who work in this area typically utilize a number of mainstream interventions that address relevant emotional and cognitive processes as well as certain relational dynamics. While many of these therapists operate from a psychodynamic and developmental perspective, they often incorporate insights from the cognitive, interpersonal, narrative, and psychodrama traditions as well, to name just a few (Hamilton & Henry, 2009).
Often these therapists are not focusing on same-sex attractions at all, but rather on the broader issues of identity and specifically gender identity in an attempt to resolve various factors that may contribute to the patient’s difficulties.
For those patients who prioritize their traditional religious and/or cultural values above acting upon their same-sex attractions, chastity/celibacy, behavioral management, and the modification of same-sex attractions and behaviors are all valid options that should be embraced by their faith communities.
Having said all this, it has to be acknowledged that conservative hyperbole on these issues (e.g., Ben Carson’s recent statements on people choosing to be gay; mean-spirited and scientifically uninformed comments by some leaders of the religious right) also does damage to how this work is seen by the public and makes a reasoned discussion around these issues more difficult.
Are there any questionable practices in this field, in your opinion?
Among licensed therapists working in this area I believe questionable practices are kept to a minimum by accountability to a professional code of ethical conduct, including full informed consent and careful assessment of client motivation. I spearheaded a related effort to provide practice guidelines for clinicians who affirm the right of patients to pursue change of unwanted same-sex attractions and behavior. Therapists doing work in this area should be familiar with this document.
There is much greater variability regarding questionable practices among unregulated and unaccountable religiously oriented counselors and life coaches. It is a great irony that legal bans that prevent licensed therapists from assisting a patient’s free choice to pursue change actually increase the risk of harm by causing some of these individuals to seek out such non-licensed counselors.
Any sort of “therapeutic” nudity, which has apparently been offered by some ministries, is an invitation to (so to speak) get one’s pants sued off.
Less egregious but very important concerns arise when the counselor wanders too far from what current science says (or does not say) about sexual orientation.
Examples of this include the counselor overselling the likelihood and degree of change, not sufficiently exploring the role of outside pressure on the client’s motivation to pursue change, offering reductionistic explanations for homosexuality, overstating the co-occurrence of psychopathology in homosexuality, and ignoring or minimizing the potential impact of stigmatization and discrimination, both as a cause for the symptomology of a client or possibly resulting out of their pursuit of change.
Do many of these patients drop out of therapy or decide to embrace a gay identity after all?
Psychotherapy patients in general do drop out of therapy with some regularity. In itself, this is not a clear indicator of harm. Some may drop out because of dissatisfaction, but others may drop out because they are doing better and no longer feel a need to continue in therapy. Some patients do decide to adopt a gay identity, and that is their right. As a psychologist, I am obligated to honor that decision as well.
Next: In Part 2 of this interview Dr Rosik discusses his work with minors and the position of the leading US professional groups on sexual orientation therapy. The entire interview can be read here.
Christopher Rosik is a Phi Beta Kappa graduate of the University of Oregon and earned his doctorate in clinical psychology from Fuller Graduate School of Psychology. He is currently a psychologist and director of research at Link Care Center in Fresno, California, as well as a clinical faculty member of Fresno Pacific University. He has published more than 45 articles in peer reviewed journals and has served as President of the Western Region of the Christian Association for Psychological Studies. He is currently Past-President of the Alliance for Therapeutic Choice and Scientific Integrity.