Nick Cummings USA Today Article on Reorientation Therapy

A couple of readers asked me to comment on Nick Cummings USA Today column on reorientation therapy. With some caution, I think it would be good to do so.

First I want to say that I have always liked and admired Nick. His work in managed behavioral health care was pioneering. In the 1980s, Nick promoted the idea that excellent clinical services could save businesses a lot of money and actually expand access to therapy. He was correct and helped create modern managed behavioral healthcare, which is essentially the dominant system today. In addition to the new business strategies that Nick’s company (American Biodyne) innovated, Nick was/is a gifted clinician and trainer. I learned a lot from Nick about therapy as a Biodyne clinician in the mid-1980s. I will always be grateful for his influence on me at that time.

Nick is an admirable gentleman in many ways. He seems to be indestructible and maintains an ambitious and rigorous schedule into his older age. He also reads and studies Greek (another area of common interest) and has developed a cooperative program with China that is helping to shape their behavioral health system.

Having declared a sincere admiration for Nick, I have to add that we disagree about his recent push to defend reorientation therapy as a modality. Nick is an endorser of the Sexual Identity Therapy Framework and I have heard him promote the ideals we support.  Thus, I know that any person who sought change therapy from him would not get the usual reparative therapy explanations for homosexuality, nor would religion be used as a coercive tool. In other words, I don’t believe Nick wishes to defend any and all approaches to change therapy; I think he wishes to defend the right of clients to arrange their lives and seek help to do it. However, it is dismaying that his defense comes in the context of  the JONAH’s court case. Much of what is done in the name of reorientation cannot be defended.

One area Nick and I disagree about is how much to emphasize the role and importance of bisexuality. Nick once told me that clients who had no prior heterosexual experience were not successful in changing orientation and so over time, the Kaiser-Permanente therapists discouraged orientation change for those clients. To me, this suggests that many of those “changed” clients were bisexuals who found ways to live with or minimize their same-sex attractions. Furthermore, to my knowledge, no one was discussing “spousosexuals” from 1959-1979. Some men and women are generally attracted to the same sex but spontaneously fall in love with one person of the opposite sex. Some of those successes could easily have been people who had the potential for that kind of fluidity. Another problem with relying on Nick’s data is that follow up was lacking for many of the clients. Nick is aware that some of his clients remained changed, but he does not have systematic data on the population.

If all reorientation therapists were like Nick, I doubt we would have the conflict and polarization we have seen over the past decade or so. I also doubt there is anybody currently vocally defending reorientation who practices as Nick did. Current reorientation therapists blame parenting and masculinity deficits for same-sex attraction, some of them put people through emotionally taxing and empirically questionable human potential exercises, still others attempt to coerce people with religion. My impression is that Nick and his crew did none of that. Certainly, in all of my dealings with American Biodyne, no one ever suggested any of that. The emphasis was always on helping the client find strategies to enhance mental health and live in accord with their aspirations.

Nick’s closing paragraph makes me think that he believes that there are some, perhaps many, therapists who work empirically and ethically with “fully informed persons.” This is where we disagree. The way reorientation is practiced as I have seen it and heard it described at various conferences and by various therapists in my travels during the last decade or so gives me no confidence that he is right this time.

Given those concerns, I continue to support the APA’s distinction between sexual orientation and sexual orientation identity; the former being durable once established and the latter being more subject to modification. I am skeptical there are many current reorientation therapists fully inform their clients about that distinction.

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  • David Cary Hart

    I saw this last night and sent a note to Wayne Besen with the link in the hopes that he might offer an opposing Op-Ed (I would be too vitriolic).

    I assume that Cummings is in his nineties and he doesn’t seem to have an agenda.. The issue, of course, is the thoroughness, consistency and neutrality of downstream follow-up. Moreover, I would think that two years of follow is required to make these judgments.

    Since I KNOW, to a reasonable certainty, that reorientation therapy is a bust and since I must presume good faith on Cummings’ part, I have to assume that his assessment of outcomes is inaccurate.

  • David Cary Hart

    I saw this last night and sent a note to Wayne Besen with the link in the hopes that he might offer an opposing Op-Ed (I would be too vitriolic).

    I assume that Cummings is in his nineties and he doesn’t seem to have an agenda.. The issue, of course, is the thoroughness, consistency and neutrality of downstream follow-up. Moreover, I would think that two years of follow is required to make these judgments.

    Since I KNOW, to a reasonable certainty, that reorientation therapy is a bust and since I must presume good faith on Cummings’ part, I have to assume that his assessment of outcomes is inaccurate.

  • Teresa

    Thank you, Warren, for picking up on this Op-Ed piece by Nick Cummings in the July 30, 2013, USA Today.

    What I find troubling from whence all this stuff of Reparative Therapy, SOCE, Exodus, NARTH, Courage grew is the inability to differentiate professionals from the self-help groups (mainly 12-Step) as well as lumping everyone into binary categories (str8/gay) and complete ignorance of the radical difference of male/female same sex attractions. Sexual orientation is complex, little understood, and is not addiction.

    Many of the folks leading the myriad of ‘ministries’, as I understand the history, had little to no training or expertise in this highly complex area. As well intentioned as most of these ‘trainers’ were, and I suspect the vast majority were, they were ignorant as to what the subject matter was. Ignorance may diminish culpability in acting; but, it is nowise trumps nature’s results.

    But, now, we’re faced with a true professional who states categorically, at least in the 2005 NARTH Conference Q&A, that he had, was aware of in his clinics, of 2,400 ‘changed’ persons out of 18,000 clients. OK, I’m going to believe this. What bothers me, though, is Mr. Cummings defense of JONAH, perhaps the worst case scenario of ‘change’ therapy.

    Is Mr. Cummings simply supporting freedom of choice, no matter what, in the area of therapy? I can get onboard with the freedom thingy; but, what about “first do no harm”? Is he thinking, if JONAH goes, then everything is up-for-grabs?

    BTW, after much reflection, I’m of the belief (my opinion, only) that sexual orientation identity (particularly gay) is harmful, overall, to one’s personhood.

    • ken

      “that he had, was aware of in his clinics, of 2,400 ‘changed’ persons out of 18,000 clients. ”

      You misunderstood what he was saying (although the NARTH article is very unclear). He is saying his clinics treated 18,000 homosexuals, not that they all tried to change their orientation. His 2,400 number is confusing as to what it actually means. Note, he said only about 10% ( less than 2000) were interested in changing orientation, so claiming 2,400 changed seems a bit confusing to me (it suggests a > 100% success rate at changing orientation).

      In the USA article he never specified the number of patients who successfully changed orientation only that there were “hundreds.” Personally, I’d say his “successes” are a bit high and I suspect the numbers are a bit biased.

      “that sexual orientation identity (particularly gay) is harmful, overall, to one’s personhood.”

      Harmful how?

  • ken

    One other thing about Cummings’ article is he says:

    “I sponsored the resolution by which the APA stated that homosexuality is not a mental disorder”

    yet ignores the fact that most of the therapists that associate with orgs like JONAH and NARTH do claim that homosexuality is a mental disorder.

    Further, he paints the SPLC lawsuit as a general attack on all conversion therapy without actually addressing the issues the lawsuit brought up about the specifics of the therapy the plaintiffs underwent. ex: (from SPLC):

    “These techniques encourage clients to blame their parents for being gay. Clients even participate in violent role play exercises where they beat effigies of their mothers.”

    Does Cummings’ really want to defend the above as a valid form of therapy?

  • Tom Van Dyke

    Nick once told me that clients who had no prior heterosexual experience were not successful in changing orientation and so over time, the Kaiser-Permanente therapists discouraged orientation change for those clients.

    This opens the door to the more pressing societal question, whether sexual response can be habituated.

    If our kids are encouraged to full sexual experimentation ["Try it, you may like it"]—and they are these days, on the premise that all sexualities are created equal—can we say for certain that we might not be opening the door to “imprinting” impressionable adolescents with certain sexual responses, irreversible sexual responses that were not psycho-physiologically inevitable?

    Indeed, that these imprintings/habituations may not respond to therapy makes the question even more pressing: It may be that for some people, sexual “experimentation” can be a one-way ticket. I don’t know if this comes up in these discussions and scientific studies, but it seems it should. We may be encouraging our kids to play with fire.

    • William

      Absolutely fascinating, evidence-free conjectures, Tom Van Dyke. Here is another one. Homosexual experimentation, for a number of different reasons, is by no means uncommon among adolescents, but most of those who engage in it eventually emerge as decidedly and permanently heterosexual. There are also those who never engage in homosexual experimentation during their adolescent years, and even those who not only resist any same-sex attractions but desperately try to conform to the heterosexual “norm”, but nonetheless eventually emerge as decidedly and permanently homosexual.

      Can we say for certain that experimentation of this kind might not in effect be inoculating impressionable adolescents against certain sexual responses, and thus opening the door to irreversible heterosexual responses that were not psycho-physiologically inevitable? Can we say for certain that, by discouraging kids from such experimentation – on the premiss that a gay sexuality is not equal to a straight one – we are not actually blocking the psycho-sexual development of at least some of them, preventing them from moving through a necessary transition phase on the route to heterosexuality?

      I don’t know if this comes up in these discussions and scientific studies, but maybe it should.

      • Tom Van Dyke

        They are indeed conjectures, William, but they are not unreasonable. Can sexual response be habituated, or is it ultimately inevitable despite our experiences/experimentations?

        There are those who don’t want that question asked, let alone answered. The “wrong” answer would be quite a threat.

        • William

          Can sexual response be habituated?

          It depends on what kind of sexual response you mean. If we are talking about sexual response to blondes, brunettes, slim people, chubby people, dark-eyed people, and that kind of thing, then yes, very possibly. I think that people’s sexual tastes in this respect do often change. The kind of person you fancy when you’re 15 may very well not be at all the kind of person you fancy when you’re 35.

          But if we are talking about sexual response to people of the other sex, of the same sex, or of both – which is what you obviously mean here – the facts of everyday experience clearly indicate that, even if for a small minority of people sexual response in this respect may be malleable, for the vast majority of people it is not. As I have already pointed out, while homosexual experimentation is not at all uncommon in adolescence, most of those who engage in it end up with a permanent heterosexual orientation. People, whether heterosexual or homosexual, who abstain altogether from sexual activity for years do not normally lose their sexual response. That’s why you have Catholic priests who have been celibate for decades suddenly jacking the whole thing in and shacking up with a woman, or with another guy, as the case may be. Warren has previously noted that research into mixed orientation marriages indicates that on the whole, homosexual men, after years in these marriages with women, are just as homosexual in their attractions and fantasies as they ever were, if not more so. What price habituated sexual response?

          I don’t personally know of anyone who doesn’t want the question asked. It does sound to me, however, as though there is at least one person who doesn’t want it answered with any other answer than “yes”, irrespective of the evidence, and who finds the “wrong” answer (i.e. “no”) quite a threat – to something or other.

          • Tom Van Dyke

            even if for a small minority of people sexual response in this respect may be malleable, for the vast majority of people it is not.

            “Therapy” seems ineffective, true, after they’re grown up, “habituated.” That was acknowledged in the first sentence, indeed it was the jumpoff point.

            As I have already pointed out, while homosexual experimentation is not at all uncommon in adolescence, most of those who engage in it end up with a permanent heterosexual orientation.

            As high as 99%, by some estimates*. But that doesn’t answer the question “Does encouraging youngsters to experiment sexually leave some of them with sexual responses/attractions that they consider unwanted/harmful when they reach adulthood?”

            [And of course we haven't touched on unwanted sexual contact, even male-female--iincest, sexual molestation by elders, etc.--but the psychosexual response mechanism might be the same, that is, "habituation."]

            *http://www.dailymail.co.uk/news/article-1314720/Only-1-100-Britons-gay-despite-myth-71-say-Christian.html

            The first ever official count of the gay population has found that only one in 100 adults is homosexual.

            The figure explodes the assumption – long promoted by social experts and lobbyists – that the number is up to ten times higher than this at one in ten.

            The Office for National Statistics said 1.3 per cent of men are gay and 0.6 per cent of women are lesbian.

            Tying the knot: Chris Bryant MP, right, and Jared Cranney are among the 1.3% of men who are gay. ONS figures explode the myth that one in ten are homosexual

            Another 0.5 per cent consider themselves bisexual, according to the figures gathered from questions put to nearly 250,000 – the biggest survey possible outside a full national census.

            This means that, in total, around 1.5 per cent of the population is either homosexual or bisexual.

            As we see by the large disparity of estimates about how widespread homosexuality even is, there is still so much we don’t know.

  • Ann

    BTW, after much reflection, I’m of the belief (my opinion, only) that sexual orientation identity (particularly gay) is harmful, overall, to one’s personhood.

    Teresa,

    I agree – sexual orientation identity speaks so little to who we are as individuals.

  • Boo

    Ann- being right handed speaks so little to who I am as an individual. So obviously it is harmful to me to acknowledge I am right handed. Oops.

  • David

    “Another problem with relying on Nick’s data is that follow up was lacking for many of the clients.”

    Dr. Throckmorton, what data? As far as I can determine, there are no data. There are no published articles in scientific journals. No peer review. No documentation of his work. No outside access to or review of case files. If Cummings simply asserts “Gay people turned straight at Kaiser Permanente 50 years ago.” does that count as “data”? Or am I wrong and there are in fact published articles documenting and supporting his claims?

    Leaving this aside, there is the issue of follow up. I do not understand why no one in the SOCE community is capable or willing to do follow up. It is especially puzzling since sexual orentation change therapy is under such scrutiny and there has been such a tremendous debate for so many years as to whether it works. In this context, what possible reason could there be for this consistent and uniform failure to conduct long-term follow up? Nicolosi’s clinic has been operating since the mid-1980s and he doesn’t do it. Cummings has had decades to circle back and revisit his success stories. Why hasn’t he? He has time to study Greek and involve himself in Chinese health care, but no time to confirm with his former patients whether the claims he makes in USAToday are actually true. You might conclude that they don’t want to do that follow up because they know they won’t like what they find.

    Last thought: Cummings’ work at KP was from 1959-75. For most of that time, homosexuality was illegal throughout the US and homosexuals were routinely arrested and then sent to treatment as part of a sentence or plea bargain. I’d be interested to know how many of the change success stories were patients responding to the demands of the criminal justice system. There is literature on that type of patient, and for obvious reasons they tended to be very eager to proclaim themselves fully changed.

    • Zoe Brain

      As far as I can determine, there are no data. There are no published articles in scientific journals. No peer review. No documentation of his work. No outside access to or review of case files.

      That’s the crux of the issue.

      Many claims have been made, by NARTH etc, but when you ask for the data that’s been objectively reviewed by neutral parties, there’s bupkiss.

    • http://www.patheos.com/blogs/warrenthrockmorton Warren

      David – When I referred to data, I was imprecise. I should have differentiated between Cummings recollection of his data and having them at hand. Part of the reason I went into my history with Cummings to explain why I give his recollections of the outcomes research done by Kaiser more weight than I would give others in the same situation. However, it is true that his recollections cannot be used in a scientific sense. All of the elements of research and peer review are missing and thus can’t really be used in any scientific manner.

      I asked Nick for the KP documents some years ago and he said they had been lost or destroyed. I can understand why some (probably most) people would be skeptical but I believe him. In any case, without those documents and the actual observations, his recollections are interesting but not evidence in the scientific sense.

  • Ann

    being right handed speaks so little to who I am as an individual. So obviously it is harmful to me to acknowledge I am right handed. Oops.

    Boo,

    I respect however you want to identify as an individual and to what degree that identify is beneficial or harmful to you. My comment was limited to how little a sexual orientation identity, to me, means in comparison to the totality of an individual and how they live their lives.

  • Graham

    Am very interested to learn more about the distinction between sexual orientation and sexual orientation identity and how this operates. I wonder if this links to the differences between same-sex desire and the notion of a ‘gay’ identity with the concept of it being ‘who I am’ and an accompanying subculture?

  • Zoe Brain

    Some men and women are generally attracted to the same sex but spontaneously fall in love with one person of the opposite sex.

    And some men and women are generally attracted to the opposite sex but spontaneously fall in love with one person of the same sex?

    Does this love require sexual attraction too?

    As you know, I’m in an unusual situation. Diagnosed as an Intersex male in 1985 (I looked male mostly then), and as an Intersex female in 2005 (I looked mostly female by then).

    Despite always having had a female gender identity, I fell head-over-heels in love with another girl in 1981. I just never really understood the concept of sexual attraction until the pubescent changes of 2005, with associated hormonally-induced neural re-wiring – which left me decidedly straight. I acquired a sexual orientation that would have been highly inconvenient, except my partner, my companion and BFF who I want to spend the rest of my life with is straight too, so not physically attracted to me either. Unrequited passion would have sucked badly. Both of us being Lesbian or Bi would have been ideal, but both being straight is next best I think.

    With such a biologically unusual situation as my own, there might be no lessons to be learnt. Too much of an outlier. Or, as with some Intersex situations, it could be regarded as a “natural experiment””, albeit with only one data point, that might teach us something.

    I wish I could be objective here, but obviously any claim to objectivity on my part is questionable, I have to rely on third parties for assessment.

    Any ideas?

  • David

    I respectfully repeat my question to Dr. Throckmorton: Has Cummings produced data relating to his work with homosexual patients and, if so, where can it be found?

    • ken

      You seem to be mis-interpreting Warren’s use of the word data. Data simply means items of information. It doesn’t mean “published, peer-reviewed information.” According to Cummings, he has treated about 2000 homosexuals and has had access to the records of another 16000 homosexuals who were treated. Just because the information hasn’t been made publically available doesn’t mean it isn’t data, just that it may not be that reliable, which Warren was pointing out in the quote from him that you cited earlier.

      • David

        “Just because the information hasn’t been made publically available doesn’t mean it isn’t data . . .”

        Cummings unsubstantiated description of his success in converting homosexuals is a claim. The data, if it exists, must be produced to support the claim. If he doesn’t produce the data, the claim fails. That is how science works. You don’t get to make a claim and then assert that supporting data exists but you won’t show it to anyone. That data may not say what Cummings says that it says or it may be unreliable for some other reason or it may not exist at all.

        Also, if I have misinterpreted anything Dr. Throckmorton has written, he might take a moment to clarify. He might take a second moment to respond to my query about the data.

  • ken

    David says:

    August 4, 2013 at 9:46 pm

    “If he doesn’t produce the data, the claim fails. ”

    No it doesn’t. It simply means the claim is unsubstantiated, it does not mean it is disproven or “fails.”

    • David

      If it is unsubstantiated, it fails. The burden is not on me or anyone else to “disprove” Cummings’ claims. Absent actual data, his claim is in the same category of every other claim proffered without evidence. It has the same value and is accepted to the same extent as a claim that there is a colony of pink unicorns living underground on Venus. That claim has not been disproven; it is simply unsubstantiated. Neither Cummings claim nor my Venusian unicorn colony claim are the basis for forming public policy, as Cummings urges in his USA Today piece.

      • ken

        “Neither Cummings claim nor my Venusian unicorn colony claim are the basis for forming public policy, as Cummings urges in his USA Today piece.”

        I agree. I doubt anyone on this thread would disagree.


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