Sunday, May 20, 2012

Confessions from a Reparative Therapist

I admit it. I am a reparative therapist (also called conversation therapy)--just not the kind you think. As a psychologist I have worked with people who have sought to be relieved of unwanted same sex attractions since the dawn of my practice in 1997. Shocked? Expecting some sort of twist here? Of course there is a twist. Before we get to the twist, let's take a look at what the pseudo-scientific organisation called the National Association for Research and Therapy on Homosexuality, commonly called NARTH, has to say. This organization, by the way, has been called a hate group by the Southern Poverty Law Center.

NARTH writes:
Reorientation therapy is simply psychological care aimed at helping clients achieve their goals regarding their sexual attractions, sexual orientations and/or sexual identities. Reorientation is not decidedly different from other therapies. There are many psychological approaches to helping clients with unwanted homosexual attractions. All approaches supported by NARTH are mainstream approaches to psychotherapy. The term "Reparative Therapy" refers to one specific approach which is psychodynamic in nature, but not all who offer therapy aimed at orientation change practice Reparative Therapy.  
The Irreverent Psychologist (that's me!) wonders just what mainstream approaches to psychotherapy NARTH is speaking about. As you may have noted in another blog post of mine, not a single mainstream professional association endorses "reorientation" therapy.

Let's look at one more bit of what NARTH says before I get to my practice of reorientation therapy:
We respect the right of all individuals to choose their own destiny. NARTH is a professional, scientific organization that offers hope to those who struggle with unwanted homosexuality. As an organization, we disseminate educational information, conduct and collect scientific research, promote effective therapeutic treatment, and provide referrals to those who seek our assistance. NARTH upholds the rights of individuals with unwanted homosexual attraction to receive effective psychological care and the right of professionals to offer that care. We welcome the participation of all individuals who will join us in the pursuit of these goals.
It all sounds good, doesn't it? This business about achieving one's goals pertaining to their sexual orientation makes for a lovely thought, right? Remember the part about choosing their own destiny. This will be important.

Let's talk about the work I do, shall we?

I'd like to introduce you to four patients. They are all representative of real people. I've changed biographical details to protect their identities and privacy. I've asked for their permission to include them in this way: they have all agreed. I am thankful for the people who are behind these stories for allowing me to share a small portion of their experience. 
  • A sixteen year old male teenager coming to therapy because he's worried he might be gay.
  • A Mexican-American woman with elderly parents, struggling between staying with her same-sex partner or caring for her aging parents who believe homosexuality is a sin.
  • A businessman in his 50s who stayed closeted out of fear of his business would suffer. Facing the second half of his life, he struggles between satisfying his desire for companionship with men and maintaining strong business relationships in his conservative line of business.
  • A hipster 20 something woman, raised by a father who was a Baptist minister who sexually abused her. "I'm not even sure I'm gay, I think it might just be something that happened because of my father."
In each of these clinical situations, a person grapples with important concerns. A teen grapples with schoolyard bullies, his Catholic upbringing, parental expectations, and the confusing desires of an adolescent.  A Mexican American woman struggles with a conflict between her heart and a cultural expectation to, as the youngest daughter, stay close to home and care for her parents. A businessman struggles with strong feelings that same-sex attraction is negative, a strong attraction to men, and making a choice to risk loosing life-long friends who might reject him for his sexual orientation. A hipster struggles with separating out desire, love, and attraction from trauma and abuse.

Four very different people, with very different life situations, clinical presentations, and developmental issues. Each of them, however, questioned their same-sex attraction at one point or another in their treatment with me. Among the things they wanted to explore and work on was furthering their understanding of their same-sex attraction.

Each of these four patients, at one point or another, had the goal to remove unwanted same sex attraction. Here's where it gets complicated. Who gets too decide what the goal is? Who is deciding whom's destiny?

I have a quiz for you. Don't worry, it's painless and will be over before you know it. Who decides whom's destiny in a psychotherapist-patient relationship? Circle one: (and grammar people, is it who, whom, whose, or whom's -- I'm sure someone will tell me.)
  1. The patient
  2. The psychologist
  3. The intersubjective self
Many of you might circle number one. I like that choice. Almost without exception, I accept my patients exactly where they are at. It is not for me to decide what makes for a life worth living. Rather, it is for me to ask really good questions that help open and explore new ways of looking at their life and provide tools for my patients to be more effective agents in their life (thus making for a life that they make happen, rather than a life that happens to them). 

Choice number one, however, doesn't always make sense. Sometimes it is choice number two. For a large portion of my career, I've worked with patients who self-injure and are highly suicidal. Patients have starved themselves to near death, injected themselves with poisons, broken their own bones, and have tried to (or actually did) kill themselves. It would be disingenuous of me to say that I don't have a say in what the goals of therapy are.

There are, based on laws, ethics, and my own sense of decency, places where I need to exert power over a patient's decision making. I must intercede and protect children, senior citizens, and disabled people from abuse. I must intercede and protect my patients from killing themselves or killing another person (though from what I have gathered, if a patient kills someone and then tells me I cannot violate their confidentiality). Lastly, if I believe someone's decision making is impaired because of a mental illness I can have them involuntarily hospitalized. Those are the four ways in which the law and my ethical code dictate me to intercede and take over the life of my patient. I loathe to do this, and try to take every step I can so that my patients remain active agents in their life--not me.  

Members of SPLC Hate Groups Need Party Hats
Beyond ethics, there are myriad ways my personal beliefs directly and indirectly exert power over the the decisions I make in my consultation room. My job, as a seasoned and reflective psychologist, is to constantly work to become more and more aware of the ways in which I am using power to influence patients--and to use that power wisely, thoughtfully and transparently as possible.

Now what about therapy to rid oneself of unwanted same sex attraction? That's when we get to circle number three, the intersubjective self. What's that? That's where psychologist and patient get to have fun exploring an idea together. The patient and psychologist join together and explore many different ways of thinking. Our selves merge in a way, become one for a moment, and can see much further and deeper into any given issue. 

Choice number three isn't for the novice therapist or the weak at heart. It's painful, difficult, and challenging to be open enough to connect with another in this way. It's also dangerous if a psychologist isn't self aware enough to recognize their power and all the different ways they can use it to demand rather than guide.

What issues might one contemplate in regards to sexual orientation? Religion, morals, culture, spirituality, oppression desire, wishes, family, needs, homonegativity, heteronormativity, relevant scientific literature, scripture, and, well, it's endless really.

Do I have an opinion about people who are gay, lesbian, bisexual, queer, transgender, or questioning? Yes. I think they are people to be loved and people who are to be cared very deeply about. It's not really for me to decide whether people should or should not be LGBTQ--it is for them to decide. It's for me to help them explore, to separate fact from fiction, and to hold a picture bigger than they can hold on their own.

Some of the patients I've worked with over the years have decided (a) they are indeed an LGBTQ person. Other's have decided that (b) while they are likely an LGBTQ person, they would prefer to contain that part of their self because of a variety of reasons (family, culture, religion, etc.). Others have decided that (c) they aren't actually and LGBTQ person at all.

Options (a) and (c) are easy. I've yet to have a patient select option (b) as a way to lead their life. They have explored the notion for a long time, and in the end, opted for for either being LGBTQ and having loving fulfilling relationships with same sex partners, or choosing to LBGTQ and be celibate for religious reasons, family reasons, etc. A small handful have selected option (c)--they aren't gay, or not yet ready to decide if they are gay.

This is how therapy is done. Thoughtful. Reflective. Taking into account multiple perspectives, multiple ideas, and multiple positions. Let's return again to the so-called reorientation therapists. 

Julie Hamilton at NARTH--she had a lot to say in response to my questioning of her ethics. In reviewing her official statement on the NARTH website (this link will actually get you there, have fun with the others)

  • Dr. Hamilton demonstrates both an unsophisticated understanding of ethics in her reliance of choosing option one (remember my little quiz!) 
  • Dr. Hamilton appears to be falsely pretending that she isn't exerting any influence on her patients (a likely failure of even knowing there is a choice 3, and it's unclear if she is is able to admit to choice number two). 
  • Dr. Hamilton demonstrates an egregious misuse of science and a total failure of scientific thought. Some day I'll have to review her failings--which in her capacity of president of NARTH become NARTH's failings--in a later blog post.
NARTH states on their website they believe in open scientific dialogue. Strangely they don't invite this dialogue. Note the comments on their blog are closed. Let's be serious here: they aren't interested in dialogue. NARTH is interested in foisting their agenda of propaganda and pseudo-science on a vulnerable population.

It seems likely that Julie really isn't in the market of helping patients. It seems that she is in the market of peddling her agenda of propaganda and personal beliefs under a thinly veiled guise of pseudo-science.

Julie writes:
Ethical therapists do not solicit clients or coerce clients into seeking change. The clients served by NARTH therapists are clients requesting change.  
Ultimately it is the client who must choose with proper informed consent and without therapist-coercion, the most satisfactory life for himself or herself.
Sounds good on paper, doesn't it? It's not good. It's dangerous. Julie's unsophisticated understanding of ethics and clinical practice is dangerous. What her words reveal is a situation in which a therapist, unaware of her own agenda, dangerously foists her world view on another. Therapists who do this are, in my opinion, are engaging in the worst kind of malpractice.

So I say this: I know you are out there--survivors of damaging reparative therapy--lost, forgotten, hurting, and silenced by alienation. Come find me and let's use this place to tell your stories, to find connection, and come back into community. Come take a critical look at ex-gay propaganda with me. Come tell your story (anonymously if you're scared).


  1. It would take way too many words for me to convey all that I'd like to convey on this topic. I find it utterly tragic that people like Dr. Hamilton call themselves therapists. This woman is indeed dangerous. She is very good at twisting information to suit her own purposes. It doesn't matter how much factual information you throw at her...she will find a way to alter the facts to make them seem plausible & believable so they fit into her twisted world view that she & NARTH espouse.
    You have captured the essence of good therapy in your statement, "It's for me to help them explore, to separate fact from fiction, and to hold a picture bigger than they can hold on their own." This is what makes you such a good therapist. As a psychologist I have always felt that the single most important aspect of being a good therapist is to hold the image of your client as whole and healthy so you can reflect this back to them. The client is always more than their symptoms, their diagnosis, their pain. They are so much more than that & by helping them to see and hold a bigger picture than they can on their own, they become who they really are...& they get to decide & fully embrace who they really are. This is the essence of good therapy...this is the essence of the work you do as a therapist. This is your gift.

  2. Jason, thank you for standing up for us. I work similarly with clients and appreciate your taking the time to address the faulty thinking and promises of NARTH.

    Anonymous, I think the more than Dr. Hamilton's failure, it is a failure of the state to allow Dr. Hamilton to call herself a therapist and her claims of practicing therapy.

    I am a Professional Counselor in Colorado (after relocating from Texas). Here in Colorado, there is only title protection for mental health professionals - not practice protection. I think it does a disservice to the general public when individuals can claim to provide therapy when it is obvious they are not.