Expected and unexpected findings

8422764Last week the American Psychological Association passed a resolution that made quite a bit of news. Here’s the top of a somewhat lengthy Associated Press report explaining the basics:

The American Psychological Association declared Wednesday that mental health professionals should not tell gay clients they can become straight through therapy or other treatments.

In a resolution adopted by the APA’s governing council, and in an accompanying report, the association issued its most comprehensive repudiation of “reparative therapy” — a concept espoused by a small but persistent group of therapists, often allied with religious conservatives, who maintain gays can change.

No solid evidence exists that such change is likely, says the resolution, adopted by a 125-4 vote. The APA said some research suggests that efforts to produce change could be harmful, inducing depression and suicidal tendencies.

Instead of seeking such change, the APA urged therapists to consider multiple options — that could range from celibacy to switching churches — for helping clients live spiritually rewarding lives in instances where their sexual orientation and religious faith conflict.

The AP report wasn’t bad. It got perspective from people who changed their self-identification from homosexual to heterosexual, for instance. There are dissenting psychologists interviewed as well. The AP story was widely distributed. Most people who read about the resolution probably read the AP’s version of events. But I wanted to highlight two mainstream media stories that dug a bit deeper or looked at some angles unexplored by most of the media.

The first is by the Washington Times‘ Julia Duin. The whole thing is interesting but particularly noteworthy are the quotes she pulls from the report showing the blame the APA places on religion. There’s also this section that looks at who was on the task force. I didn’t see many other reports investigating the composition of the task force:

The report was compiled by a six-member task force that admitted to a built-in bias that “same-sex sexual attractions, behavior and orientations per se are normal and positive variants of human sexuality and are not indicators of either mental or developmental disorders.”

The National Association for Research and Therapy of Homosexuality (NARTH) said the task force was stacked with gay or gay-friendly activists who would naturally conclude that reparative therapy does not work.

“No APA member who offers reorientation therapy was allowed to join the task force,” said David Pruden, NARTH vice president. “In fact, one can make the case that every member of the task force can be classified as an activist. They selected and interpreted studies that fit within their innate and immutable view.”

Task force Chairwoman Judith Glassgold, a New Jersey psychologist, is on the board of the Journal of Gay and Lesbian Psychology, NARTH said, and was president of Division 44, APA’s gay caucus, in 2003-2004. Committee member Jack Drescher is a public gay activist. Another committee member, Roger Worthington, a chief diversity officer with the University of Missouri/Columbia, has been cited by gay groups for his advocacy on their behalf.

Clinton Anderson, an APA spokesman, did not deny NARTH’s charges.

“I think that we had a very open process where we put out a call for nominations,” he said. “We evaluated the nominees based on their qualifications. I don’t feel we have any apologies to make for how we appointed that task force.”

I don’t think anyone is surprised by the APA coming out, again, against reparative therapy and probably everyone assumes that people involved with the APA have a certain ideology — just as you might surmise that a group that thinks that religion helps individuals overcome what they consider sinful inclinations would have a different viewpoint. Still, it’s good, journalistically speaking, to go ahead and discuss that baseline ideology and how only one side was represented. There are arguments to be made in favor and against such representation but it’s good information to include in a report.

Since this is getting a bit long, I’ll hold off on discussing the second noteworthy mainstream media story until later today. But here’s an interesting take from the Baptist Press:

For those who believe homosexuality can be changed, the report concluded, “The appropriate application of affirmative therapeutic interventions for those who seek [sexual orientation change efforts] involves therapist acceptance, support, and understanding of clients … without imposing a specific sexual orientation identity outcome.” Although such a sentence may not sound significant, it actually is: It gives the patient the ability to decide his or her direction in the therapy. Conservatives feared the APA not only would call such attempts unethical but also conclude that patients who desire to change should not be assisted. In another possible nod to Christian conservatives, the report concluded, “[W]e take the perspective that religious faith and psychology do not have to be seen as being opposed to each other.”

Bob Stith, the Southern Baptist national strategist for gender issues and the representative of the denomination’s Task Force on Ministry to Homosexuals, said “the report was much better than I had expected” and that it had “enough to give anyone who read it some support.” But he, like other conservatives, was frustrated with much of the report.

I just found it interesting that while much of the mainstream media portrayed this report as a huge blow to religious conservatives, many religious conservatives didn’t react with abject horror to the report. I suspect that the difference may be that religious conservatives don’t actually view homosexuality and attendant therapy in precisely the same way that the media think they do.

Since same-sex attraction issues seem to generate quite a bit of off-topic commentary here, so let me take the opportunity to remind readers that this is not the place to discuss anything except for how the mainstream media handled the religious angles of the report. Your comments must be heavily focused on journalism — and not your feelings about how awesome or awful reparative therapy or same-sex attraction are. Otherwise they will be deleted.

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  • Shaun G

    In accordance with Mollie’s guess, the only version I read was the AP’s … but after reading the Washington Times snippet posted above, I think the AP definitely should have quoted the same line about the panel’s self-acknowledged bias that “same-sex sexual attractions, behavior and orientations per se are normal and positive variants of human sexuality and are not indicators of either mental or developmental disorders.” That line’s directly from the report, right?

    For a reader who’s totally unaware of the APA’s record on this and similar issues, that line could put the entire report in a different perspective.

  • http://lowly.blogspot.com Undergroundpewster

    In the AP report we read,

    Instead of seeking such change, the APA urged therapists to consider multiple options — that could range from celibacy to switching churches — for helping clients live spiritually rewarding lives in instances where their sexual orientation and religious faith conflict.

    The APA left out the option of changing the church, a method that has been used with some “success” in the Episcopal church.

  • Matt

    This may or may not be the second report Mollie has in mind, but the only story I read on this topic was the Wall Street Journal‘s, written by former GetReligion pin-up Stephanie Simon (where’s she been?). I really liked the way she led off the article with a conservative Christian counselor who feels his methods are vindicated by the APA’s report.

  • http://www.getreligion.org Mollie

    Yep — the post on Simon’s piece is going up any minute!

  • Jerry

    First, the complaints are political not scientific. The assumption is that those on the panel were more politically motivated than scientifically motivated. Such charges need proof. We want to be included because we want our point of view represented is not ipso facto justifiable.

    APA urged therapists to consider multiple options — that could range from celibacy…

    I think that will or should surprise many.

    The issue with stories like this is that they gloss over the science involved. Here’s an example of the science should work: I’m having trouble with my knees and went online to look to see what my treatment options are. I found a web site http://www.guideline.gov/ with a list of treatments and “levels of evidence” and “grade of recommendation” scores.

    Levels of evidence range from the best 1++ “high quality of meta-analysis, systemic reviews of randomized controlled trials with very low risk of bias” to the lowest “expert opinion”. So first I want to know what the “evidence level” is behind the statement.

    Next, grades of recommendation are based on the evidence. The best, grade A is based on 1++ evidence or at worst 1+ under certain conditions. The lowest, good practice points, basically is an educated guess.

    So my unanswered question is how good is the evidence and the recommendation based on it from a scientific perspective? The story speaks of the evidence in general terms but without the specificity for which I was looking.

  • dalea

    Left out of the coverage is the fairly large and very vocal group of those who find themselves harmed by reparative therapy. The APA does not stand alone; they have many complaints about the process. Why there is only one brief reference to Wayne Besen, when it is people like him who drive the process, I don’t know. One source of information on the subject is:

    http://www.exgaywatch.com/wp/

    Why the press gives voice to clients who had good experiences but not to those with bad is an interesting question.

  • Pingback: Get Religion discusses media coverate of the APA report — Warren Throckmorton

  • Chris

    It’s always dangerous when assessing the efficacy of a therapy to use “testimonials”, either positive or negative. Pro and con interviews with individuals who administer or receive a given therapy can be very biased, and amount to case reports. Scientifically, it is almost impossible to arrive at a truthful assessment using such evidence. Committees that issue practice guidelines–this seems to be one–try to assess efficacy based on clinical trials, the strongest of which is a randomized, prospective and blinded, as Jerry discusses. As far as I can tell by reading the press release from the APA, only very small, case series reports exist, and they do not support efficacy because of study design. The actual report can be requested at the APA website.

    I think these articles point out a larger problem with the reporting of medical therapy efficacy in the press. Scientifically, what an individual thinks about a therapy he received means next to nothing. Some patients will have side effects or poor effects from an effective therapy, and some patients will perceive efficacy where none exists (the placebo effect). Interviewing patients at the extremes (even on both sides) doesn’t help in assessing the therapy. Opinions are subjective.

  • danr

    From the AP report: “An evangelical psychologist, Mark Yarhouse of Regent University… and a colleague, Professor Stanton Jones of Wheaton College, will be releasing findings at the APA meeting Friday from their six-year study of people who went through Exodus programs. More than half of 61 subjects either converted to heterosexuality or “disidentified” with homosexuality while embracing chastity, their study said.”

    I was actually pleased not to see scare quotes around “converted” re: homo-to-heterosexuality. It allowed the contrarian study to speak for itself.

  • Deacon John M. Bresnahan

    Putting ALL the media reports (and comments here) about psychology conclusions supposedly arrived at makes it seem like there is a lot of politics involved in the give and take on this issue. Maybe people should be reminded that psychology is NOT an objective science in the same manner that other fields of medicine are (such as using a thermometer to see if one has a fever, or an angiogram to look at the cholesterol build-up-if any- in one’s arteries.) Yet the media does seem to treat psychology research as if many of its conclusions have objective qualities they really don’t have. In fact, according to some news reports, many psychology conclusions seem based on what looks like log-rolling at a political convention of psychologists.

  • http://www.chaosprg.com/blog irv

    I suspect that the difference may be that religious conservatives don’t actually view homosexuality and attendant therapy in precisely the same way that the media think they do.

    Could you expand on this line? It sounds to me like it comes very close to the title of this blog. The media have a blind spot, an assumption so deeply ingrained they don’t even know they should ask anyone if it’s true in this particular case.

    Is there anyone who thought to follow up rather than accept the assumption? Is homosexuality or related therapy a topic where this blind spot is particularly strong? Just how different do you believe the reality is from the perception?

    There’s a lot of room for exploration here.

  • Dave

    Opinions are subjective.

    Opinions are also factual, in that it is a fact that a certain number of people hold one opinion and another number hold the opposite opinion. When the people involved have been through a therapy and all the citations are from those with one opinion, that’s not balanced reporting. It’s also not getting religion if the topic is sufficiently religiously infused (that’s more an opinion of the principals of GR than my own).

  • Chris

    I think the reporting would be more balanced if the reporter had asked questions that have more to do with the science of the studies considered, rather than opinions (pro or con) about the therapy from individuals who have had it. Questions like: how was it determined that a change in sexual orientation had occurred?; how durable was the change (6 days, 6 weeks, 6 months, 6 years?); what were the demographics of the participants?; how large was the study?, etc.
    As the Deacon pointed out, psychologic studies may have “soft” endpoints/outcomes (although, alas, many other medical studies suffer from the same problem). One really good question is what was the outcome that was measured, and how was it measured?
    A lot of journalists don’t get the science of medical therapeutics either–they need to get beyond patient and practitioner testimonials.

  • Julia

    This thread is worth reading if only for the link that Jerry provided. It went into my bookmarks and I sent it around to family and friends.

    The government website has the “best practices”, evidence-based guidelines for medical treatments that the proposed health care reform would promote. This is the future of medicine, and is being used by some hospitals and doctors already.

    Here it is again. Reporters could/should use it as a resource, along with interviews.

    http://www.guideline.gov/

    Thanks, Jerry.


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