This past year I’ve dealt with an interesting challenge that faces Christians who produce scholarship in controversial areas. My area is sexual identity, and I’ve been researching and providing services in this area for many years now. There are not many models for how to do integration in this area, and there are few people even doing it. So the challenges are plentiful.

Specifically, the topic I’m addressing is how to provide clinical services to people who are sorting out sexual identity issues. The model I’ve been developing (and the accompanying framework I’ve been co-developing with Warren Throckmorton) is referred to as sexual identity therapy (SIT). What is SIT and how did it come about?

SIT is essentially a client-centered and identity-focused approach to navigating sexual identity questions or concerns. It has often been contrasted to reorientation therapy and gay affirmative therapy. It is based on the idea of helping people reach congruence, so that they live and identify themselves in a way that is consistent with their beliefs and values. Sexual attractions or orientation may or may not change, but the overall emphasis is on identity.

How did this approach come about? My earliest involvement with SIT traces back to a concept paper published in 2001 that suggested an alternative model of sexual identity development, which refers to how the act of labeling oneself (as gay, lesbian, bi, or choosing not to do so) is experienced developmentally over time. I was particularly interested in people I was working with in my clinical practice who did not integrate their same-sex attractions into a gay identity. This led to a series of studies comparing people who experienced same-sex attraction and identified as Christian. I compared a group that integrated their same-sex attractions into a gay identity to a group that dis-identified with a gay identity and the people and institutions that support a gay identity.

At the same time I was working with clients who were either sorting out sexual and religious identity conflicts or had tried to change their sexual orientation through involvement in professional reorientation therapy or Christian ministries. The people I saw at that time did not experience as much success in their change effort as they were led to believe was possible. They were discouraged, and some would frame their experience in an “all or nothing” way, such that they either changed their orientation or they were gay. They did not feel another option was available to them.

So my involvement with SIT was to explore a way of doing therapy that provided these people with a professional approach that would respect their beliefs and values and would allow for direction or trajectory that was meaningful even if their orientation did not change. Many people who came to see me at that time were conservative Christians, and many at the end of what was developing into SIT chose not to identity publicly or privately as gay; rather, they formed a primary identity around other aspects of who they were as a person, such as their religious beliefs and values.

In my practice today, SIT revolves around four central concepts that came from that early concept paper and subsequent research: (1) a three-tier distinction between same-sex attraction, a homosexual orientation, and a gay identity, (2) weighted aspects of identity, (3) attributional search for sexual identity, and (4) congruence. First, the three-tier distinction is between same-sex attraction, a homosexual orientation, and a gay identity. The idea is that more people report experiencing same-sex attraction or having a homosexual orientation than the number of people who identify as gay. Being gay is a unique sociocultural phenomenon, and it is a self-defining identity label that not all people who experience same-sex attraction adopt. Such a distinction creates room for using descriptive language while exploring identity considerations. Most people I work with choose to describe their attractions rather than embrace a gay identity.

Second, I discuss weighted aspects of identity, by which I mean that people consider many factors when they make decisions about public and private sexual identity labels. These ‘aspects of identity’ include biological sex, gender identity, attractions, intentions, behaviors, and beliefs/values. People often decide that one or more of these aspects of identity are really important to them, such as behavior (e.g., choosing chastity) or beliefs and values (e.g., Christian morality), and they give it greater ‘weight’.

Third, I join people on what I refer to as an ‘attributional search’ for identity. This means exploring with clients the meaning that they make out of the fact that they are attracted to the same sex. I don’t assume that their attractions are the result of childhood sexual abuse, biological predispositions, parent-child relationships, or any other particular theory; rather, I discuss with them how they make meaning out of their attractions. Many will cite these theories; some will discuss “the fall” as the cause of their attraction to the same sex.

The fourth and final key concept for me is congruence. This means helping people line up their behavior/identity and beliefs/values. I have found this to be a natural result of the first three key concepts.

What has been interesting is that this past year I have seen some people in the gay community claim that SIT is really reorientation therapy, and I have seen some people in the conservative Christian community claim that SIT is really gay affirmative therapy (at least functionally so at one stage in therapy). The first mischaracterization—that SIT is really reorientation therapy—came up this past year when a gay psychologist involved in the scientific review process attempted to portray SIT as conversion therapy to get other reviewers to reject proposals in which SIT was mentioned. This was resolved amicably when it was acknowledged that the recent APA task force report identified SIT as an identity-focused model and not as reorientation therapy.

The other mischaracterization—that SIT is really gay affirmative therapy (at least at one stage)—happened recently when someone in conservative Christian circles made the claim, and it is a statement worth responding to so that it is clear why this is a mischaracterization and not an accurate understanding of SIT.

Before I do that, let me offer one observation on this idea that I am defending SIT against assertions that it is either reorientation therapy or gay affirmative therapy. What’s interesting is that these are the two polarized positions in the models of therapy offered to sexual minorities today. The whole purpose of developing SIT was to offer an alternative to these two polarized positions. It is interesting to me that those most invested in this debate will not allow a third option to develop; rather, they appear to need to frame the debate in the two models they know.

The focus in SIT is sexual identity not sexual orientation. Again, much of my work is with people who have tried to change and had modest success with it, and so they are looking for other meaningful ways to grow and develop, and sexual identity is one way to do that, particularly for those who focus on other aspects of who they are as a person.

As to the charge that SIT is gay affirmative therapy. Gay affirmative therapy tends to assume that a person is gay, that they are discovering this about themselves. The therapist simply creates a safe place to discuss “coming out” and is mindful of issues such as bullying and family dynamics, etc., that make “being gay” difficult. It tends to rest on the metaphor of discovery. That is, a person discovers that they are gay—they have been all along. There is much more to gay affirmative therapy, but this gets at one way to understand it at least at a general level.

The way I practice SIT is based not on the discovery metaphor but on the metaphor of integration. People have choices to make about whether they integrate their same-sex attractions into a gay identity or not. If they choose not to, they often form a positive identity around other aspects of who they are as a person. One of the most salient aspects of identity for Christians is an identity that is “in Christ.” But in creating space in therapy for a person to make a genuine choice about identity, there is by necessity the option of making other choices (otherwise the choice was not a genuine one to begin with). So a person might choose to integrate same-sex attractions into a gay identity. That is a possible outcome when a person is given an opportunity to genuinely choose to dis-identify with a gay identity.

A related question is this: Is creating a space for people to make choices so unusual in therapy? I would answer no. People make choices all of the time in therapy, and some of those choices are not ones I would choose for them. For example, I provide a lot of marital therapy. I want the couples I work with to stay married. However, some decide to divorce. For them to genuinely choose to stay in their marriage means that they could also choose to dissolve the marriage. It is a choice, and it is not a choice that I make for them. This principle of client autonomy and self-determination is a central principle in how therapy is practiced today, and it is based on many things, including case law that established a patient’s right to informed consent to treatment in medical ethics.

The concern that has been raised about whether SIT is gay affirmative therapy raises a broader and more fundamental question about the place for Christians in the mental health fields. This is not limited to the topic of homosexuality. The question is: How ought Christians to position themselves in the field? Do they provide therapy in a direction toward a certain outcome? Do they provide information and opportunities for clients to make their own choices? If so, at what point might those choices run contrary to the values of the Christian mental health professional? This happens in many controversial areas, as well as areas that are not that controversial. It is more of a fundamental question about the role of the mental health professional, and there are legitimate disagreements among Christians in this area.

Some people will assume that Christians in the mental health field should function like they are a particular kind of pastoral care provider. Although there are many ways in which pastoral care providers practice, I see pastoral care providers as representing their faith tradition in a very intentional way. They hold up a standard and provide pastoral care to help people move toward that standard of orthodoxy (right belief) and orthopraxy (right practice). Orthodoxy and orthopraxy is not determined by the counselee but by the pastoral care provider in the sense that he or she represents the faith tradition and its doctrines out of which the care is being provided. Some people view licensed mental health professionals in the same way; that is, they should counsel in a specific direction because they represent Christian commitments in a particular way. This is a point for discussion among Christians in the field.

Others would view licensed mental health professionals as different than pastoral care providers in some important ways. They would see a licensed Christian psychologist, for example, as entering enter into a fiduciary relationship with the public, a relationship built upon trust, and part of that trust is built upon the assumption that the services provided are in keeping with the standards in the field as it is currently governed by the state in which the psychologist practices. So a group of one’s peers (psychologists, in this case, not Christian psychologists necessarily) would reflect on what is standard practice for addressing the topic of homosexuality in clinical practice. In this context, one might look at SIT as helping to provide a kind of therapy that the broader field can support, even as it stands in contrast to gay affirmative therapy (and reorientation therapy). This is important in part because gay affirmative therapy would be an unrealistic option for some religious clients.

Indeed, SIT provides an alternative that safeguards client autonomy and self-determination in making decisions about identity and behavior. With respect for client autonomy and self-determination comes the possibility that a client may make choices about identity that go against the values of the Christian mental health professional. But we can respect the client’s right to make that choice.

Note: this is cross posted here. Warren Throckmorton has offered his perspective on the SIT Framework here.

Here is the link to the interview of Dr. Mark Yarhouse who was a guest this past Monday on the Dennis Prager Show with guest host Dinesh D’Souza. The interview deals with the Ex-Gays? longitudinal study of attempted change of sexual orientation through involvement in religious ministries. D’Souza was interested in claims about immutability and the possible relevance of the study to that discussion.

Dr. Mark Yarhouse, Director of the Institute for the Study of Sexual Identity, was recently interviewed by guest host Dinesh D’Souza on the Dennis Prager Show. The main focus of the interview was the Ex-Gays? longitudinal study of attempted change in sexual orientation. Dr. Yarhouse was asked about the results from the study, namely, whether sexual orientation can change and whether it is harmful to attempt such change.

Dr. Yarhouse spoke about the percentages of reported change, particularly at Time 3, which was 3-4 years into the study. He also discussed the risk of harm and the claim that change attempts are intrinsically harmful. Dr. Yarhouse acknowledged that change is complicated and multifaceted, that there is a question about whether such change is of attraction and orientation or identity or both. He also acknowledged that even those who reported significant and meaningful change often also reported some experiences of same-sex attraction at times.

Dinesh D’Souza was interested in the political implications of such findings, particularly in response to the claim that sexual orientation is an immutable characteristic. Dr. Yarhouse noted that the study was about attempted change rather than the etiology (or cause) of sexual orientation, but that the question of change is an important consideration in these discussions, although he himself is not actively involved in public policy discussions.

Dr. Mark Yarhouse, director of the Institute for the Study of Sexual Identity, is travelling to Asbury College in Wilmore, Kentucky for three days, followed by a presentation at the Council of Christian Colleges and Universities (CCCU) Critical Breakthroughs conference in Atlanta.

The schedule at Asbury College includes two chapel addresses on Monday and Wednesday, February 22 and 24. Dr. Yarhouse will also participate in a panel discussion Monday night which has a “What does the Scripture say about…” theme. On Tuesday morning, Dr. Yarhouse will meet with Student Development staff. That evening, Dr. Yarhouse will speak at Asbury Theological Seminary on pastoral care and sexual identity, followed by an informal Coffee House Q&A with students back at the college later that night.

The CCCU is holding its International Forum on Christian Higher Education in Atlanta. It has as its theme Critical Breakthroughs. Dr. Yarhouse will be giving a presentation titled, “Navigating Sexual Identity Issues on Christian College Campuses.” He will draw on a recent study conducted with colleagues from Asbury College and Seminary (Stephen Stratton and Janet Dean) that dealt with the experiences of Christian sexual minorities on Christian college campuses.

The recent article on two providers of ex-gay therapy by Patrick Strudwick has been getting some attention. The story is based upon his experiences pretending to be a client interested in changing his sexual orientation. Strudwick goes on to share some of his experiences in a few sessions with two providers of such services. His article raises again the question of whether such change attempts are intrinsically harmful for those who might pursue change of sexual orientation.

There is a lot in the article for discussion. Professional ethical issues, in particular, are important considerations, such as what constitutes informed consent for therapy, providing religiously-congruent interventions, competence to provide services, and how such practices are conveyed to third-party payors.

At ISSI, we have written about the need for informed consent. Although we do not provide reorientation therapy, we have about the need for informed consent for those who are consumers of such therapy. We recommend that clinicians provide advanced informed consent, by which we mean that they should provide more detail than they normally would given the controversies surrounding this practice. We have recommended discussing the causes of same-sex attraction and personal distress, professional therapy options, paraprofessional or ministry alternatives, potential benefits and risks of therapy, and potential outcomes if a person does not pursue therapy. This would seem to be important if a professional offers reorientation therapy; but advanced informed consent or something like this should also be provided if a professional offers Sexual Identity Therapy, which we discuss here at ISSI, or gay-affirmative or gay-integrative therapy. Consumers needs to be in a position to make an informed decision about their treatment.

In addition to these ethical concerns, the article also raises the issue of potential for harm. This is where such a story can really be misleading. The conclusions rest with the reporter doing the investigation, and it appears he goes into the project expecting it to be harmful, at least if you look (as observed by Peter Ould) at the people he interviews regarding harm toward the end of the piece.

But what about the possibility of harm? There have been some studies that have suggested a risk of harm. The most frequently cited study is by Shidlo and Schroeder - a study of 202 consumers of conversion therapy. This was not a representative sample; in fact, it was a study initially designed to find people who had been harmed in such therapy, so it is no wonder that they reported what they were looking for. What therapy model would stand up to a request for participants who had failed in that therapy approach? What was more remarkable was that the researchers found people who reported benefits from such therapy. (The researchers did change the title of the study part-way through to reflect that they were finding people who benefited from the change attempt.)

There is a need, though, to look to research to answer the question about risk of harm. One possible source of information is the Ex-Gays? study by Jones and Yarhouse published in 2007 (after 3-4 years in the change attempt) and the update to that study presented at the American Psychological Association in 2009 (after 6-7 years). Participants in Exodus-affiliated ministries did not report the kind of harm suggested by the article by Strudwick, at least not on average. If anything, participants reported an average slight improvement over time. Of course, averages suggest that some people reported more of a reduction in symptoms and distress, while other likely reported some increase. But what that means is that the change attempt itself is unlikely to be intrinsically harmful. (It should be noted that the story by Strudwick is about reorientation therapy, while the Ex-Gays? study was about involvement in Exodus-affiliated ministries; professional therapy and Christian ministry are not identical.)

It is important  not to minimize the possibility of harm, but it should also be pointed out that harm may come from many sources, such as unrealistic expectations, therapy or ministry techniques, external circumstances, such as pressure from family, or other sources. It is equally important not to declare harm based upon anecdotal accounts. After all, that is precisely why research is conducted: it helps us come to a better understanding of what can be expected by the average person attempting a specific course of therapy or ministry. With that understanding - communicated through advanced informed consent - comes the opportunity for mental health organizations to respect the autonomy and self-determination of the client, even if that decision runs contrary to the specific professional’s (or reporter’s) personal values.

The Institute for the Study of Sexual Identity (ISSI) core team members have been reading Love is an Orientation by Andrew Marin for the monthly trainings this year. Today was the last training on the book, and Andrew Marin was available by speaker phone to field questions and interact with the team. The team was discussing the final two chapters (Chapter 9: Building a Bridge and Chapter 10: Crossing a Bridge). Andrew shared some of the challenges he has faced living out many of the principles in the book, and the team looked at ways to make personal applications in relationships and professional applications to the work being conducted through ISSI.

Dr. Yarhouse, director of ISSI, shared his thoughts on the training:

“Andrew Marin has a heart for the gay community and for the church. He cares deeply about people, but more than that, he cares radically about people, and he has been willing to change how he lives to show that love in practical ways. But love like that can come at a cost. He’s a game-changer, and there is a lot that the church can learn from him.”

Those interested in Marin’s unique approach to building bridges between evangelical Christians and the gay community can learn more about The Marin Foundation by going to the foundation’s web site and following Marin on his blog.

Dr. Mark Yarhouse is speaking today to students from Lutheran Brethren Seminary in Fergus Falls, MN. He was asked to speak during a course offered in their J-term on “Ministry in a Romans 1 World.” The two talks Dr. Yarhouse is giving are on the etiology of homosexuality and the question of whether sexual orientation can change.

On the subject of etiology, Dr. Yarhouse will review highly publicized studies implicating Nature, as well as explore some of the questions that have arisen in whether or to what extent Nurture plays a role. In keeping with his previous writing on this topic, he will discuss a ‘weighted interactionist hypothesis’ for the etiology of homosexuality (or multiple ‘homosexualities’ to be more precise).

On the topic of change, Dr. Yarhouse will review some of the older studies and methodological limitations found therein, as well as more recent research on change attempts, including his own study (with Stanton Jones) of people attempting religiously mediated change through involvement in Exodus ministries. He will also offer suggestions for pastoral care.

Dr. Mark Yarhouse and Veronica Johnson will be offering a therapy group for Christians who experience same-sex attractions. The group is a 10-week, time-limited group that begins February 8 and runs through April 12. The emphasis in this group is reducing shame. Here are some goals for participants:

• You’ll learn to identify shame as soon as it’s happening.
• You’ll learn skills that help reduce the horrible feeling that comes with shame.
• You’ll learn how your relationship with God can reduce feelings of shame.
• You’ll be with others who experience very similar feelings.

You can go here for more information about the group.

Dr. Mark Yarhouse and core team members of ISSI - Katie Maslowe, Rob Kay, and Heidi Jo Erickson- will present at the Cultural Diversity Lunch Series at Regent University on being intentional about climate considerations for Christian sexual minorities. They will be drawing on several lines of research underway through ISSI, including a recently-conducted study of campus climate at Christian colleges and universities. The title of their workshop is: “Creating Climates of Care for Christian Sexual Minorities.” The workshop is scheduled for January 26th from noon to 1pm in Classroom Building 107.

Dr. Mark Yarhouse and ISSI team members from the doctoral program in clinical psychology at Regent University are giving a talk on multicultural competence for working with sexual minority clients at the Christian Association for Psychological Studies (CAPS) East Region Conference in Chambersburg, Pennsylvania. The talk itself will examine the two often-polarized options of gay affirmative therapy and reorientation therapy for religious sexual minorities who experience conflict due to their experiences of same-sex attraction. Both gay affirmative therapy and reorientation therapy have inherent limitations with this population, and the presentation will focus on an alternative model, that is, Sexual Identity Therapy (SIT). The presentation will then explore the multicultural movement and its approach to sexual minorities, as well as the place of SIT as a client-centered, identity-focused approach that is consistent with what is best about the multicultural movement as applied to multiple aspects of diversity, as is often found when working with religious sexual minorities. The presentation is scheduled for Saturday, November 8th.