APA President Koocher's statement about therapy & same-sex attraction

This just in from APA’s Public Affairs office via email from Rhea Farberman:

APA Office of Public Affairs
(202) 336-5700
Public.Affairs@apa.org

August 15, 2006

Statement by Dr. Gerald P. Koocher Concerning Therapeutic Interventions To Deal With Unwanted Same-Sex Attraction

During the Town Hall Meeting that took place at APA’s 2006 convention, I was asked about the role of patient choice in therapeutic interventions to diminish same-sex attractions.

This is an extremely complex issue. And discussion of it must balance patient choice with the therapist’s ethical obligation to obtain informed consent for any therapy process.

The issue centers on patient choice and the role of the therapist in supporting that choice with fully informed consent—be it sexual orientation or any other behavior or emotion.

In a full multifaceted therapeutic relationship, the therapist has every duty to respond to patient choice and to help patients achieve their goals. I affirmed during the Town Hall discussion, and I will always affirm, the crucial importance of providing our services with careful attention to patients’ wishes.

BUT—and this is absolutely essential, especially when dealing with sexual orientation—the therapeutic responsibility, in strict accordance with APA guidelines, MUST also include the following considerations:

One: The therapist has an obligation to carefully explore how patients arrive at the choices they want to make. Therapists must determine whether patients understand that their motives may arise purely from the social pressures of a homophobic environment. No type or amount of individual therapy will modify societal prejudices.

Two, informed consent: Patients must understand the potential consequences of any treatment, including those intended to modify sexual orientation. Patients must understand that such treatments lack a validated scientific foundation and may prove psychologically harmful.

Finally, I would add that our patients ought to know from the very start that we as their therapists do not consider homosexuality a mental disorder. In fact, the data show that gay and lesbian people do not differ from heterosexuals in their psychological health. By that I mean that they have no greater instance of mental disorders than do heterosexuals.

Dr. Koocher is the President of the American Psychological Association.

###

Year in review – Top ten stories from 2006

As much for my own reference and recollection as anything else, I compiled this top ten list of stories from 2006. Since I am the only voter, the list is subjective and regular readers might arrange them differently or think I should have included another story over one of these. I am interested to hear any reactions along those lines. They are arranged in the order of the interest the story seemed to create here on the blog, not their actual importance in the real world.

I first note the topic which is a link to all relevant blog posts and then describe the story briefly. It’s been an eventful year, eh?

1. Gerald Schoenewolf’s NARTH article – This issue was reported widely on blogs as well as the mainstream press and seemed to generate the most interest of any of the issues I blogged about. The article on political correctness, Dr. Schoenewolf’s angry defense, and NARTH’s handling of it (removed it from the website but then allowed Dr. Schoenewolf to defend it) figured prominently in my decision not to attend the 2006 NARTH conference and the resignations of David Blakeslee and Ned Stringham from NARTH’s Scientific Advisory Board. A popular YouTube video also came about as a result. I wish a better and wiser 2007 to NARTH.

2. Richard Cohen’s media appearances – This series of posts garnered much interest from readers, with critics of ex-gay efforts delighting in Mr. Cohen’s decisions to take his reparative drive theories and techniques to the mainstream media. His appearances bewildered and divided people who support those who seek to live out conservative views of sexuality. I severed ties with PFOX over the matter due to Mr. Cohen’s association with them.

3. Joseph Berger’s NARTH article – This story preceded the controversy over Dr. Schoenewolf’s article. Reacting on the NARTH website to a San Francisco Chronicle article, Dr. Berger said that gender variant children might do well to face teasing in school in order to move them toward reality. With encouragement from Exodus and others, NARTH issued a retraction and removed the article. Much damage was done however, as Dr. Berger’s article was repeatedly and at times erroneously referred to by opponents of the Palm Springs Love Won Out conference.

4. Ted Haggard’s resignation – I did quite a few posts on this sad story and was quoted in a Denver Post article regarding the aftermath. Along with the revelation of fellow Colorado pastor, Paul Barnes, the disclosures of Rev. Haggard have prompted many in the evangelical world to reflect on how the church responds to homosexuality.

5. The return of the co-founders of Exodus – About half way through the year, I began receiving emails from Michael Bussee. Michael, one of the co-founders of Exodus International, took exception to my account of the early days of Exodus. Through some spirited and pointed exchanges, Michael and I forged a good connection via the blog and email. These exchanges eventually led to the establishment of wonderful discussions with other early movers and shakers (e.g., Robbi Kenney, Ed Hurst, Lori Rentzel) including helpful reflection on the term ex-gay.

6. Re-evaluation of the term “ex-gay” – As an aspect of the co-founders of Exodus discussion, Exodus Executive Director, Alan Chambers publicly expressed his desire to retire the term ex-gay. The discussion that ensued about the term took many tangents including the common ground discussion and built on an earlier post about what change of sexuality means. At present, it seems to me that the discussion is taking a break for the holidays. I hope to see these topics revived in the new year.

7. Swedish pheromone study and press coverage – The study was certainly news in itself as the Swedish team led by Ivanka Savic, found large differences in how the brains of lesbians and straight women were activated by what the researchers proposed were pheromone-like substances. I got involved by noting the incorrect reporting of the study from both the Associated Press and the United Press International. After I made several contacts with Dr. Savic and then the wire services, both the AP and UPI issued corrections.

8. APA President Koocher’s remarks about client self-determination – In an APA town hall meeting, guest blogger, David Blakeslee asked APA president Gerald Koocher for guidance in helping religiously conservative people who were in conflict over same-sex attraction. Dr. Koocher raised some eyebrows with his answer and subsequent clarification, published on this blog. This exchange led to an invitation from Dr. Koocher to submit my sexual identity therapy framework to the APA for a review. The entire APA convention and a NARTH inspired protest led to several posts, including the comments of APA luminary Nicholas Cummings.

9. Sexual identity therapy – I launched a blog dedicated to providing a framework for mental health interventions with people in conflict over same-sex attractions and chosen values and beliefs. The guidelines differ on several key points from gay affirmative and reparative therapy models. Related to this topic, the paper, “I am not a reparative therapist,” generated much discussion.

10. Abortion and mental health articles – In January, I wrote two articles regarding mental health consequences of abortion. These reports featured interviews with David Fergusson, David Reardon, and Nancy Russo, all prominent researchers in the field. The impetus was a report from David Fergusson’s team demonstrating some mental health risks associated with having an abortion. The interviews and attention to this topic led the APA to remove an outdated public policy information page from their website (NARTH, take note). The page is still being updated but is archived here. These reports were, as far as I can determine, the most widely distributed pieces I have written. Over 15,000 news sources worldwide ran one or both of them.

Honorable mention – The birth order effect research by Anthony Bogaert and subsequent research reports that did not find such an effect occupied my time and several posts. Research from Bearman and Bruckner and most recently the research of Frisch and Hviid found no support for the birth order effect in large and varied groups of respondents. Other issues such as the Equality Ride, Brokeback Mountain, the 60 Minutes report, Gay or Straight?, and the Foley debacle were also important. But one must stop reviewing sometime and say thanks to those who read and comment here.

Happy new year!

Australian news report on APA's presidents comments

Australian paper on the APA and the President Koocher’s comments regarding therapy for same-sex attraction conflicts.

Washington Times: APA's position unchanged

Today’s Washington Times addresses the differences in interpreting APA President Gerald Koocher’s remarks at the APA convention last month. We covered that issue here at that time noting that President Koocher clarified his remarks following the APA Town Hall meeting.

The Washington Times site has been down most of the last two days. Here is the article from the Google cache.

APA denies any retreat on gay therapy

By Joyce Howard Price
THE WASHINGTON TIMES
September 3, 2006

Some pro-family groups say recent comments by the head of the American Psychological Association suggest the organization is softening its opposition to treating homosexuals who want to change their sexual orientation.

The APA denies any changes in its stance, and the president later clarified his statements.

The Rev. Lou Sheldon, founder and chairman of the Traditional Values Coalition, a group that believes some homosexuals can become heterosexuals through “deep reparative therapy,” said he is convinced “peer pressure came down on the APA president like a mountain cougar and forced him” to back away from public comments he made less than a month ago.


“The APA has no conflict with psychologists who help those distressed by unwanted homosexual attraction,” said Gerald P. Koocher, president of the 155,000-member APA, at the group’s annual convention in New Orleans last month.

In an e-mail message early last week, Sharon Slater, president of United Families International, a nonprofit that works to protect the family as the fundamental unit of society, called Mr. Koocher’s comments “an amazing turnabout,” given that for more than 30 years, the “APA has aggressively opposed treatment of unwanted same-sex attraction.”

Leaders of groups engaged in treating homosexuals who want to become heterosexuals, such as the National Association for Research and Treatment of Homosexuals and Exodus International, also described Mr. Koocher’s remarks as a positive development. They indicate the APA is “recognizing a person’s autonomy and right to self-determination,” Alan Chambers, president of Exodus International, told the Baptist Press. Mr. Chambers and other therapists who offer such treatment picketed outside the APA convention and believed their presence was a contributing factor in Mr. Koocher’s comments.

But the APA executive clarified his comments shortly after the convention. “In a full, multifaceted therapeutic relationship, the therapist has every duty to respond to patient choice and to help patients achieve their goals,” Mr. Koocher said. “I will always affirm the crucial importance of providing our services with careful attention to patients’ wishes.”

But Mr. Koocher said discussion of interventions in the “extremely complex issue” of sexual orientation “must balance patient choice with the therapist’s ethical obligation to obtain informed consent for any therapy process.” “When dealing with sexual orientation,” he said, a therapist “must” be sure that a person wishing to change is not “motivated purely from the social pressures of a homophobic environment” because therapy “will not modify societal prejudices.” Mr. Koocher further stressed that “patients must understand” that treatments intended to modify sexual orientation “lack a validated scientific foundation and may prove psychologically harmful.”

There is not much new here but the Times is the only paper that I know of that has covered the post-convention spin.

APA president speaks about a client's right to self-determination

In a Q&A today at the American Psychological Association convention in New Orleans, APA president Gerald Koocher was asked about a client’s right to seek therapy to modify same-sex attraction. He reportedly said (and I am seeking confirmation from the APA) that clients may seek psychotherapy to affirm their religious values even if that meant that the therapy involved objectives to modify same-sex attractions. He reportedly said that it would not be outside the APA’s ethical guidelines to work with such a client toward the client’s chosen course, even if that course meant seeking to reduce or eliminate same-sex attractions.

Update: I spoke with David Blakeslee who was in the Q&A and asked Dr. Koocher a question about APA guidance regarding clients who have religious conflicts surrounding sexuality. Dave’s question went something like this: “Dr. Koocher, I appreciate you participation in constructing and presenting guidelines for ethical behavior and attended your conference in Portland 18 months ago which I found very helpful. As a social and religious conservative I have found myself in a difficult situation about which I think the APA has not provided sufficient ethical guidance. I have been sought out by clients with deeply held religious beliefs who also have unwanted same-sex attractions. For these persons their religious beliefs are even more important to their identity than their same-sex attractions. Because of APA’s lack of guidance in this matter, I am forced to seek advice outside APA. What is APA doing to give explicit guidance to psychologists like myself and thereby ensure that treatment of my clients honors their deeply held religious beliefs as they struggle with their same-sex attractions and is consistent with APA values of self-determination and client autonomy?”

In addition to what I reported above, Dr. Koocher reportedly emphasized that the therapeutic relationship is constructed by both the client and the therapist along the goals of the client and that the whole person must be taken into account when considering an intervention.

Dave tells me that Dr. Nicolosi followed up with a comment that his response seemed in conflict with official policy of the APA on homosexuality and that clients sometimes come to therapy wishing to explore their potential for heterosexual attraction; to which Dr. Koocher reemphasized his position of client self-determination and then cautioned about coercion.

I have heard back from Rhea Farberman, of the APA Publication Office this morning that she will soon give a complete response to my request for confirmation. She did add this:

In brief, this is a complex issue and one about which we seek to balance patient choice with the therapist’s obligation to gain informed consent. There are also questions about the efficacy of therapies intended to change sexual orientation and potential harm of such techniques. APA’s position is based on the standing Council of Representatives resolution on the topic.

Hit the link for the APA’s official statement. Anything that is said here or is said anywhere must be interpreted in light of that resolution.

My take on this is that the APA has stopped short of banning change therapies but guides psychologists to inform clients of the APA position on homosexuality, to forbid coercion, to oppose therapy that has as its premise homosexuality per se is a mental disorder and to avoid making public statements that cannot be supported.

Now where have I read guidance consistent with that…

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