Beyond Critique

The Misuse of Science by UK Professional Mental Health Bodies

Dermot O’Callaghan

Dermot O’Callaghan, MA (Cantab) Studied Mechanical Sciences at Cambridge University and, after five years in industry, spent his working career as a management consultant in a variety of sectors, including mental health.  In his retirement he has taken an interest in the way that science in recent decades has sought to understand the causes and consequences of same-sex attraction.  He has followed with interest the ways in which science has been used (and sometimes misused) in society’s debates and in the shaping of social policy, including the increasingly robust actions of mental health professional bodies to prevent even a married man from being helped to reduce his unwanted same-sex attractions in order to save his marriage.

Dermot is married, with one son and two grandchildren.  He is a member of the General Synod of the Church of Ireland. He is a Council of Reference member of Core Issues Trust.

Copyright © 2013, Core Issues Trust

Published by Core Issues Trust, a company limited by guarantee (NI606015) and accepted by HMRC as a Charity (Tax Number XT29880).
Further information: www.core-issues.org
Copies available: info@core-issues.org

All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording or information storage and retrieval system, without permission in writing from the publisher.

ISBN : 978-0-9573739-3-8

Contents

Beyond Critique - Preface

Beyond Critique - 1

Beyond Critique - 2

Beyond Critique - Preface

We usually take it for granted that the historic institutions of the western world are bastions of certainty. If they make an authoritative statement the mass media assume that anyone who disagrees is somewhere on a spectrum between a villain and a fool. This is particularly the case where scientific matters are concerned.

It may come as a shock to find that such trust is not always securely grounded. In particular, a politically correct ideology is rapidly encroaching on the western world, an ideology which is subtly reshaping the values of society as regards attitudes to sexuality. The shock lies not in the fact of reshaping, for society must always adapt or die, but in the discovery that significant areas of scientific endeavour are now influenced by ideology rather than by pure research.

The book Destructive Trends in Mental Health: The well intentioned path to harm (eds Nicholas Cummings and Rogers Wright[1]) well expresses these concerns in an American context:

... gay groups within the American Psychological Association have repeatedly tried to persuade the association to adopt ethical standards that prohibit therapists from offering psychotherapeutic services designed to ameliorate “gayness,” on the basis that such efforts are unsuccessful and harmful to the consumer. Psychologists who do not agree with this premise are termed homophobic. Such efforts are especially troubling because they abrogate the patient’s right to choose the therapist and determine therapeutic goals. They also deny the reality of data demonstrating that psychotherapy can be effective in changing sexual preferences in patients who have a desire to do so. (p XXX)

On p 17 (by Cummings and O’Donohue) there is a section entitled, Is Treating Homosexuality Unethical? It says,

Although the APA is reluctant or unable to evaluate questionable practices and has thus avoided addressing the issue of best practices, this did not prevent its Council of Representatives in 2002 from stampeding into a motion to declare the treatment of homosexuality unethical. This was done with the intent of perpetuating homosexuality, even when the homosexual patient willingly and even eagerly seeks treatment. The argument was that because homosexuality is not an illness, its treatment is unnecessary and unethical. Curiously, and rightly so, there was no counterargument against psychological interventions conducted by gay therapists to help patients be gay, such as those over many decades by leading psychologist and personal friend Donald Clark (the author of the best-selling Living Gay) and many others. Vigorously pushed by the gay lobby, it was eventually seen by a sufficient number of Council members as runaway political correctness and was defeated by the narrowest of margins. In a series of courageous letters to the various components of APA, former president Robert Perloff referred to the willingness of many psychologists to trample patients’ rights to treatment in the interest of political correctness. He pointed out that making such treatment unethical would deprive a patient of a treatment of choice because the threat of sanctions would eliminate any psychologist who engaged in such treatment. Although the resolution was narrowly defeated, this has not stopped its proponents from deriding colleagues who provide such treatment to patients seeking it. (p 17,18)

Perloff commends the book saying, “Wright and Cummings persuasively and forcefully dramatize how the mental health professions will enhance patient benefits by removing from the therapeutic process such destructive barriers as political correctness and intrusive ideologies.”
Yet another past president of the APA, Jack G Wiggins, says that the authors “provide cogent examples of how in mental health circles today misguided idealism and social sophistry guarantee that good science and practice will not go unpunished.”

This withering salvo of criticism from some of the most respected people in the field should be enough to make even the most trusting person aware that all is not well in the world of psychology – at least in the USA.
Yet in America it is still permissible for therapists to assist clients to endeavour to reduce same-sex attractions if they so desire (although in California in 2012 such therapy has been banned for children under the age of consent).

But such controversial measures could not happen in the UK, could they? Events in the UK have actually overtaken the American practice, however. In a letter to The Independent on 5th February 2010, Professor Andrew Samuels, then Chair of the UK Council for Psychotherapy, wrote:

No responsible psychotherapist will attempt to “convert” a client from homosexuality to heterosexuality. It is clinically and ethically misguided. Any member of the United Kingdom Council for Psychotherapy who tried to do so would have to face the music.

A consequence of this is that therapists in the UK are now being forbidden to assist a client to reduce same-sex attractions, primarily on the grounds that such attempts are dangerous. Therapists who disagree are being threatened and disciplined.

The reader would rightly be wary of any therapist who promised an easy conversion from one end of the homosexual/ heterosexual scale to the other. On the other hand the thought of a man being given a blanket refusal to receive help to reduce his unwanted same-sex attractions even in order to hold his family together raises some important issues of human rights and freedoms which we ignore at our peril.

The following pages will look in turn at two documents, entitled respectively:

Psychiatry and LGB People: A Submission by the Royal College of Psychiatrists to the Church of England ‘Listening Exercise’ (2007); and

The UK Council for Psychotherapy’s Ethical Principles and Codes of Professional Conduct: Guidance on the Practice of Psychological Therapies that Pathologise and/or Seek to Eliminate or Reduce Same Sex Attraction

highlighting some of their content and assessing the degree to which they are answerable to objective scientific research.

Beyond Critique - 1

The Royal College of Psychiatrists

Submission of the Royal College of Psychiatrists
LGB Special Interest Group
to the Church of England ‘Listening Exercise’ (2007)

The lesbian and gay special interest group of the Royal College of Psychiatrists made a submission to the “Church of England Listening Exercise”, dated 31st October 2007 and signed by Professor Michael King. It is to be welcomed as being a concise document which grounds its arguments in the scientific literature in a way that appears to be without parallel in the UK. In short, it is ‘best of breed’.

Two different versions of the text

The submission (hereinafter referred to as Version 1)[2] cites no fewer than nineteen scientific papers to support its arguments. These are referenced in the present discussion as (ref 1) to (ref 19). Thus, in the opening section the Royal College gives an outline of the history of LGB people in Europe over the past two centuries and references a paper by King & Bartlett 1999 (ref 1). This paper is a sobering reminder of the societal rejection and hurt experienced by LGB people so often in the past.

A link at the end of the submission (which may have been added retrospectively) links to another version of the submission (hereinafter Version 2)[3] which omits Professor King’s name and the date and adds some striking graphics (various pictures of human hands). In this version the references to the various scientific papers are embedded in the text of the submission (though ref 19 is omitted). This version appears to carry the imprimatur of the Royal College of Psychiatrists as opposed to just the special interest group. [Both the above were accessed on 21 December 2012.]

Version 2 appears to be verbally almost identical to Version 1, but it has one significant difference under heading 2 (The origins of homosexuality). Version 1 says, “It would appear that sexual orientation is biological in nature, determined by a complex interplay of genetic factors and the early uterine environment” (emphasis added). In version 2, however, the word ‘and’ is changed to ‘and/ or’. In simple language, the change is from ‘genes and hormones’ to ‘genes and/ or hormones.’

Royal College Original Submission
to Church of England (2007)

Revised version

“Genes and hormones”

“Genes and/or hormones”

The significance of this change is considered below.

Causation of Homosexuality

2.1 ‘Genes and/ or hormones’ is a self-defeating formula

Subject to clarification from the Royal College, it would appear that the ‘and/ or’ version is the preferred text; it is found in the more sophisticated version of the document (the version with graphics). The and/ or formula allows the possibilities that causation may be:
- entirely genetic
- or entirely hormonal (‘the early uterine environment’)
- or a combination of both genes and hormones.

But there is a relentless logic inherent in this formula. If the Royal College believes that the causes may turn out to be ‘entirely genetic’, then it follows that any evidence of hormonal causation that we believe we have today is merely illusory. And if the causation turns out to be ‘entirely hormonal’, then any evidence of genetic causation that we believe we have today is illusory. This means that the Royal College is prepared to accept that all supposed evidence that we have today for either genetic or hormonal causation may be illusory – in other words, it is at best very weak. But if indeed there is no compelling evidence for either genes or hormones, the College’s statement, “It would appear that sexual orientation is biological in nature”, is not based on any sound scientific evidence.

2.2 Unwarranted rejection of early childhood experiences as a causal factor

The Royal College says, “Despite almost a century of psychoanalytic and psychological speculation, there is no substantive evidence to support the suggestion that the nature of parenting or early childhood experiences play any role in the formation of a person’s fundamental heterosexual or homosexual orientation”. Yet only the previous year (2006) a major national cohort study in Denmark by Frisch et al (with a sample size of two million people) said: “Our study provides population-based, prospective evidence that childhood family experiences are important determinants of heterosexual and homosexual marriage decisions in adulthood.”[4] Also a highly regarded 1994 study by EO Laumann et al[5] based on the US National Health and Social Life Study, said (p307) that a pattern of homosexuality similar to those of biologically-based traits such as left-handedness or intelligence is “exactly what we do not find.” Further, in discussing male homosexuality, it said (p309) that the theory that “the environment in which people grow up affects their sexuality in very basic ways” is “exactly one way to read many of the patterns that we have found.”

2.3 Erroneous reference to Bell & Weinberg 1978

The Royal College supports its argument by a reference to Bell & Weinberg 1978 (ref 2). But that study does not address the question of homosexual origins. This reference therefore appears to be simply mistaken.[6]

2.4 Citation of a study by Mustanski which found nothing

The Royal College cites a study by Mustanski et al 2005 (ref 3) implying that it supports a genetic causation. But that study, which undertook a search for genetic linkages to homosexuality, found no linkage of statistical significance. A subsequent study by Rice failed to confirm even the ‘possible’ linkages suggested by Mustanski. One presumes that the Royal College have chosen their most persuasive study to support their argument in favour of genetic causation, yet Mustanski provides no evidence at all for this view.

2.5 Blanchard (2006) study – bordering on science fiction?

The Royal College also references a paper by Blanchard et al 2006 (ref 4) which investigates a possible correlation of male homosexuality with both genes and maternal hormones. This paper discusses some curious patterns in data pooled from five other studies which appear to suggest that:
- if a boy child is born left-handed (a genetically related trait) he has an elevated expectation of identifying as gay in adult life;
- similarly, if a boy is born to a mother who has already given birth to a boy child, the odds of his becoming gay-identified also appear to be elevated (this is considered to be caused by the mother’s hormones);
- yet a boy who is born both left-handed and having an older brother does not have a ‘doubly enhanced’ likelihood of being gay-identified – indeed his likelihood of being gay is not elevated at all above the average man in society.

The study wrestles with this strange paradox. The researchers suggest two possible answers:
- either the two factors somehow cancel each other out (though it stretches the imagination to imagine why a genetic factor and a hormonal factor which each tend to produce the same result should cancel each other out);
- or “the combination of the older brother factor with the non-right-handedness factor is toxic enough to lower the probability that the affected fetus will survive”. This extraordinary suggestion is that an unborn boy child’s left-handedness might interact with the fact that his mother has already had a boy child, to produce a “toxic” effect that is so severe that it may kill the child before birth.

Given the sad history of flawed studies based on distorted samples, it may be pertinent to suggest that the many complexities involved in pooling data from five different studies may have introduced inaccuracies that have led to conclusions that are of questionable value.

Whichever explanation they prefer, the Royal College are advancing a problematic and unconvincing study to support their assertion that homosexuality appears to be ‘biological in nature’.

2.6 Why no discussion of twin studies?

But is there really no substantive evidence, as the Royal College says, to support the suggestion that childhood experiences play any role in the formation of one’s sexual orientation?

In addition to the studies by Frisch and Laumann mentioned above, studies of twins provide an important tool for separating biological from environmental factors; indeed they have been at the centre of the debate for more than twenty years. Very surprisingly the Royal College makes no reference at all to twin studies–yet no scientific discussion of the causation of homosexuality can be considered satisfactory without consideration of the evidence they provide.

An important study by Bailey et al (2000), found that if one identical male twin identified as gay, the second twin usually didn’t (in only one in nine cases, or 11.1%, was there concordance for homosexuality). Thus 89% of causation does not appear to be explained by biological factors (and so analogies such as race are seriously misleading). Similar figures have been found in other large studies. This strongly suggests the importance of environmental factors such as early life experiences in the formation of sexual orientation.

2.7 Causation of homosexuality – concluding summary

The Royal College appears to have incorrectly cited a study by Bell & Weinberg (1978) as having failed to find evidence of early childhood experiences (environmental effects) having any role in the formation of a person’s sexuality.

It advances only two studies in support of its contention for biological causes. One of these, (Mustanski) did not find any genetic cause; and the other (Blanchard) does not provide any serious support for the Royal College’s argument. These two studies provide no foundation at all for arguing a case for biological causation.

By contrast, Laumann, Frisch and various twin studies are quite clear: they show that it is simply not plausible that biology is the sole causal agent.

Causation of elevated levels of mental illness among LGB people

It is widely recognised that same-sex attracted people experience higher mental illness – including depression and suicide attempts – than the general population. An important question is whether this is mainly caused by society or is related to homosexuality itself. If it is caused by negative attitudes in society (‘homophobia’) then its diminution requires a cultural shift. If, on the other hand, it is related to something inherent in homosexuality itself or related to such things as gay culture or lifestyles, then cultural change in society will not resolve the problem.

The Royal College submission is quite clear in its attribution of responsibility:

“the experiences of discrimination in society and possible rejection by friends, families and others, such as employers, means that some LGB people experience a greater than expected prevalence of mental health and substance misuse problems”.

In other words, they say that the problem lies with discrimination in society, not within the condition itself or the chosen lifestyles of some LGB people.

Three scientific papers are referenced – but all of them decline to attribute causation to societal attitudes, contrary to the Royal College’s position.

Gilman et al 2001 (ref 6) says,

“the precise causal mechanism at this point remains unknown. Therefore, studies are needed that directly test meditational hypotheses to evaluate, for example, the relative salience of social stigmatization and lifestyle factors as potential contributors to psychiatric morbidity among gays and lesbians.”

Royal College (2007)
Position

Scientific Paper 1: Gilman et al 2001
(Ref 6)

Discrimination in society ... means that some LGB people experience greater than expected mental health and substance abuse problems

the precise causal mechanism at this point remains unknown. Therefore, studies are needed that directly test mediational hypotheses to evaluate, for example, the relative salience of social stigmatization and of psychosocial and lifestyle factors as potential contributors

Bailey 1999 (ref 7) says,

“.... many people will conclude that widespread prejudice against homosexual people causes them to be unhappy or worse, mentally ill. Commitment to [this position] would be premature, however, and should be discouraged. In fact, a number of potential interpretations need to be considered, and progress toward scientific understanding will be achieved only by eliminating competing explanations ...”.

In other words Bailey cautions against the very position that the Royal College chooses to adopt.

Royal College (2007)
Position

Scientific Paper 2: Bailey et al 1999
(Ref 7)

Discrimination in society ... means that some LGB people experience greater than expected mental health and substance abuse problems

“... many people will conclude that widespread prejudice against homosexual people causes them to be unhappy or worse, mentally ill. Commitment to [this position] would be premature, however, and should be discouraged . In fact, a number of potential interpretations need to be considered ...

The lead author of the third paper (ref 5) is none other than Professor Michael King himself, the signatory of the Royal College’s submission to the Church of England. His paper says,

“There are several explanations for our findings. It may be that prejudice in society against gay men and lesbians leads to greater psychological distress ... Conversely, gay men and lesbians may have lifestyles that make them vulnerable to psychological disorder.”

Royal College (2007)
Position

Scientific Paper 3: King et al 2003
(Ref 5)

Discrimination in society ... means that some LGB people experience greater than expected mental health and substance abuse problems

It may be that prejudice in society against gay men and lesbians leads to greater psychological distress ... Conversely, gay men and lesbians may have lifestyles that make them vulnerable to psychological disorder.

So all three of the referenced papers say the same thing: the evidence does not enable the researchers to determine whether the problem lies externally in society or internally with co-morbidities or lifestyle factors. It is clearly important not to jump to conclusions.

This raises the question of why the Royal College places the blame squarely on society, distorting the judgement of the scientific research – even the research of Professor King himself. The contrast between his careful statement to the scientific community and his submission to the Church of England is significant:

It is clear that when addressing the scientific community Professor King leaves open the matter of causation – as do all the other scientific papers. His message to the Church of England, however, places the blame squarely on discrimination.

It is also ironically true that the Bell & Weinberg (1978) study, which seems to have been mistakenly referenced by the Royal College above, identifies relationship breakup as a major factor in suicide (and since gay people have more relationships and thus more breakups they are for that reason more vulnerable to depression and suicide).

The Royal College should revise its submission to the Church of England to acknowledge that the scientific research does not attribute to societal attitudes the problem of elevated mental illness among LGB people, but rather insists that the question of causation has not been resolved.

Causation of short duration of sexual relationships

Citing the work of Mays & Cochran (ref 8) and McWhirter & Mattison (ref 9), the Royal College says that there is “considerable variability in the quality and durability of same-sex, cohabiting relationships” and that a “considerable amount of the instability in gay and lesbian partnerships arises from lack of support within society, the church or the family for such relationships.”

Once again, in other words, it’s largely society’s fault. But in fact the Mays & Cochran study does not refer at all to the quality or durability of same-sex relationships, but rather confirms the consensus of the scientific papers in the foregoing section, to the effect that “it is unclear whether the greater risk for discriminatory experiences, if it does exist, can account for the observed excess of psychiatric morbidity seen among lesbians and gay men”. Its own methodology “precludes drawing causal inferences.”

Royal College (2007)
Position

Scientific Paper 1: Mays et al 2001
(Ref 8)

A considerable amount of the instability in gay and lesbian partnerships arises from lack of support within society, the church or the family for such relationships

“it is unclear whether the greater risk for discriminatory experiences, if it does exist, can account for the observed excess of psychiatric morbidity seen among lesbians and gay men”

The Royal College says that there is already “good evidence that marriage confers health benefits on heterosexual men and women”. Indeed this is true, but without reference to any scientific study the College extrapolates this argument to say that “similar benefits could accrue from same-sex civil unions” (legislation for which had been introduced three years previously, in 2004). Similar logic today (2013) would argue that same-sex marriage would deliver these benefits (which civil partnerships failed to deliver).

Yet the Royal College fails to acknowledge a crucial finding of McWhirter and Mattison, that a ‘common problem’ for male couples is “between their value systems ... for example, holding different values about sexual exclusivity and emotional fidelity can be very problematic and induce jealousy.” This issue is discussed at greater length in McWhirter and Mattison’s major work The Male Couple (1984) on which their paper (ref 9) is based – that gay men seek ‘fidelity’ (that is, they want to live together as a couple) yet without ‘sexual exclusivity’. This can be achieved only by changing the meaning of the word fidelity. McWhirter and Mattison found that “all couples with a relationship lasting more than five years have incorporated some provision for outside sexual activity in their relationships.” They comment that “To arrive at the acceptance of being gay and of extrarelational sex, each of these men has had to alter his own value systems” (The Male Couple, p.252 - 3).

Royal College (2007)
Position

Scientific Paper 2: McWhirter & Mattison 1996
(Ref 9)

A considerable amount of the instability in gay and lesbian partnerships arises from lack of support within society, the church or the family for such relationships

One of the more common problems ... is differences between their value systems. Religious differences and a tendency to make heterosexual assumptions about their relationship are often responsible. For example, holding different values about sexual exclusivity and emotional fidelity can be very problematic and induce jealousy.

It seems highly probable that rather than civil partnerships (or now ‘gay marriage’) bringing stability to gay relationships, the tensions inherent in such relationships will lead to rejection of the ‘heterosexual assumption’ of the requirement of sexual exclusivity in the relationship as noted by McWhirter and Mattison. But we are constantly told that there can only be one type of marriage, so those heterosexual assumptions will de facto be removed from marriage itself. If it is acceptable for gay married couples to have outside sexual liaisons, why not for heterosexuals? Rather than help the stability of the relationships of those few gay and lesbian people who will choose to marry, it seems probable that marriage for the heterosexual community will be undermined by a new ‘equality’ in which marriage is redefined according to value systems of gay culture noted by McWhirter and Mattison. Children will be taught in school that the value system of ‘gay marriage’ does not require monogamy. The principle of equality will then demand the same for heterosexual marriage – and children will draw that conclusion automatically anyway. Whatever small benefit may accrue to the very few LGB people who will marry, is likely to be overwhelmed by the negative impact on heterosexual marriage, which has until now been the chosen relationship for the majority of the population. And what about the bisexuals, who will want three in a marriage?

Citing Kiecolt-Glaser & Newton 2001 (ref 10) and Johnson et al 2000 (ref 11), the Royal College argues that since there is good evidence that marriage confers benefits on husband and wife, similar benefits could accrue to same- sex couples in civil partnerships. But Kiecolt-Glaser and Newton argue that there are differential costs and benefits in a marriage, which are gender-specific. The costs and benefits that accrue to the wife are different from those that accrue to the husband. It does not therefore follow that if the gender of the spouse changes (eg a man marries a man rather than a woman) that the usual benefits of marriage are to be expected. Indeed any assumption of such read-across is nothing more than speculation. The Johnson et al study did not include any same-sex partners at all.

Royal College (2007)
Position

Scientific Paper 3: Kiecolt-Glaser 2001 (Ref 10)
Scientific Paper 4: Johnson et al (ref 11)

“There is already good evidence that marriage confers health benefits on heterosexual men and women and similar benefits could accrue from same-sex civil unions.”

“Contemporary models of gender ... furnish alternative perspectives on the differential costs and benefits of marriage for men’s and women’s health.”
[ie The benefits of marriage are very gender-specific]

Johnson et al had no same-sex partners in study

The Royal College continues to hope that civil unions will bring benefits. It says, “Legal and social recognition of same-sex relationships is likely to reduce discrimination, increase the stability of same sex relationships and lead to better physical and mental health for gay and lesbian people.” But in the cited paper King & Bartlett 2005 (ref 12) Professor King admits that “we do not know” whether the short duration of male relationships is due to intrinsic or extrinsic factors.

Royal College (2007)
Position

Scientific Paper 5: King, Bartlett 2006
(Ref 12)

Legal recognition of civil partnerships seems likely to stabilise same-sex relationships

“We do not know whether gay male, same sex relationships are less enduring because of something intrinsic to being male or a gay male, the gay male subculture that encourages multiple partners, or a failure of social recognition of their relationships. The ‘social experiment’ that civil unions provide will enable us to disentangle the health and social effects of this complex question”

He looks to the ‘social experiment’ of civil unions to provide some answers. For many people, of course, this is a social experiment too far and the risks inherent in what Professor King describes as ‘this complex question’ are too great and have not been thought through.
After all the discussion of possible reasons for the short duration of same-sex relationships, a fair summary of the science would seem to be ‘we don’t know’.

Psychotherapy and Reparative Therapy for LGB People

The Royal College urges therapists to take care in the initial diagnosis of clients who present with issues that they may think are caused by homosexual attractions, referencing King et al 2007. Therapists may wrongly regard homosexuality as the root cause of any depression, anxiety etc. This is good advice and should be followed by all therapists.

Royal College (2007)
Aspiration

Scientific Answer: King et al 2007
(Ref 13)

LGB people “may be misunderstood by therapists who regard their homosexuality as the root cause of any presenting problem such as depression or anxiety”

“... no randomised trials of effectiveness of ... (gay affirmative) treatments”.

“Both therapist and client need to be aware of the dominant discourses and stereotypes in the LGBT world, because, if they fail to do so, the possibility of collusion and shared assumptions may limit the depth and utility of the therapy.”

The paper also discusses its assessment of gay-affirmative therapy saying, “We identified no randomised trials of effectiveness of general or specialised mental health treatments for LGBT people. Nor did we identify any ‘before and after’ or cohort studies assessing outcomes of therapy and counselling for LGBT people. There was no consistency in the instruments used to assess past or current therapy, satisfaction with care or other outcomes. None of the studies reviewed measured mental health outcomes using validated psychometric measures.”

The Royal College next addresses the important question of whether change in sexual orientation is ever possible, and whether it is dangerous to attempt such change. Citing Bartlett et al 2001 (ref 14) it says, “A small minority of therapists will even go so far as to attempt to change their client’s sexual orientation. This can be deeply damaging. Although there is now a number of therapists and organisations in the USA and in the UK that claim that therapy can help homosexuals to become heterosexual, there is no evidence that such change is possible. The best evidence for efficacy of any treatment comes from randomised clinical trials and no such trial has been carried out in this field.” It is important to acknowledge, however, that as noted in the previous paragraph, the very same considerations apply to gay-affirmative therapy.

The twin claims that there is no evidence that change is possible and that attempts to change are deeply damaging need to be considered most carefully. Insofar as the issue is framed in polarised terms (that ‘change’ means complete change from homosexual to heterosexual), the large amount of evidence that fluidity of orientation (moving up or down the homosexual/ heterosexual continuum) is a common phenomenon, not least among women, is neglected. For example, a respected 10-year longitudinal study of non-heterosexual women by Diamond[7] found that “all women reported declines in their ratio of same-sex to opposite-sex behaviour over time.”

Royal College (2007)
Version

Bartlett, King & Phillips 2001 (Ref 14)

“A small minority of therapists will even go so far as to attempt to change their client’s sexual orientation. This can be deeply damaging…
there is no evidence that such change is possible … no randomised clinical trial has been carried out.”

This does reflect what the paper says.
But the study used
-no measures of harm, and
- no measures of change. It merely reflects the opinions of certain therapists.

BUT: Jones & Yarhouse in 2007 published the results of the best study to date. Their findings “contradict the commonly expressed view ... that change of sexual orientation is impossible and that the attempt to change is highly likely to produce harm ...”. [Jones & Yarhouse used a validated measure of psychological distress to assess harm, but found benefit rather than harm.] Their study was updated in 2011 with similar results.

A paper by Jones and Yarhouse, the best study to date, seems to have been published a few months before the Royal College’s submission but is not discussed. The study improved on earlier ones in that it followed a cohort of people prospectively through therapeutic programmes (not knowing what the outcome would be) and used well-tried psychological measures of sexual orientation and psychological distress (to identify indications of harm). They said that their findings “contradict the commonly expressed view ... that change of sexual orientation is impossible and the the attempt to change is highly likely to produce harm ...”.

We turn now to the papers discussed by the Royal College. The submission refers to two well-known studies. The first, by Dr Robert Spitzer, who was the leading scientist in the de-listing of homosexuality from the Diagnostic Manual of Mental Disorders in the USA in 1973. He subsequently encountered a number of people who claimed to have moved away from homosexuality, and he decided to undertake a study of this phenomenon. The Royal College describes the results of the study thus:

“The first study claimed that change was possible for a small minority (13%) of LGB people, most of who (sic) could be regarded as bisexual at the outset of therapy”.

In fact, the actual claims of Spitzer’s study could hardly be more different:

“The majority of participants gave reports of change from a predominantly or exclusively homosexual orientation before therapy to a predominantly or exclusively heterosexual orientation in the past year”.

Spitzer’s finding of change for ‘the majority’ is transformed by the Royal College into ‘a small minority’. And his claim that most of his participants had been ‘predominantly or exclusively’ homosexual at the outset is trivialised to say that they were mostly bisexual rather than homosexual.

Royal College (2007)
Version

Spitzer (Ref 15)

The study “claimed that change was possible for

a small minority (13%) of LGB people,
most of whom were bisexual at outset.”

The study actually said,
- majority of participants gave reports of change
- from a predominantly or exclusively homosexual orientation before therapy

It is most disturbing that the Royal College of Psychiatrists should so misrepresent the findings of a respected scientist.

Such radical misrepresentation of the work of a fellow-scientist is beyond words. It inevitably casts a shadow over the Royal College of Psychiatrists as a venerable and trusted institution. It gives clear evidence that in the field of sexual ethics the Royal College is being driven by a special interest group whose fundamental motivation is not scientific discovery but ideological dogma.[8]

The second study referenced is Shidlo and Schroeder 2002, which is described as finding ”little effect as well as considerable harm.” There are several aspects of this study that must be taken into account:

It set out to recruit participants who were dissatisfied with their experience of therapy (see in sidebar copy of initial advertisement, which was later changed) just as the Spitzer study set out to find participants who were satisfied with their therapy

It found that a majority (61%) of people found some help from the therapy

A bigger majority (85%) found some harm

But since no measure of harm was used, it is wrong for the Royal College to imply that the therapies caused ‘considerable harm’.

The reality is that the above-mentioned Jones & Yarhouse study is the best scientific evidence that we have, and it did not find that people were harmed on average. Yet the Royal College refers to the danger of ‘harm’ and ‘damage’ in such a way as to imply that attempts to reduce same-sex attraction are in themselves harmful.

The Royal College now puts forward two studies (refs 17 & 18) co-authored by Professor King, which are described as ‘oral histories’ – respectively the views of professionals and of patients – both dated 2004. Both studies collected historical recollections from the 1960’s and 1970’s, when draconian treatments using electric shocks and drugs to try to ‘cure’ homosexuality were widespread. These are not used today, and it is important that the general public should realise that today’s ‘talking therapies’ are totally different.

It is interesting to note in passing that Professor King reported in 2004 that only “a small minority [of professionals] believed that current practice denied people distressed by their homosexuality an effective means to change their sexual orientation.” This is the very position that he opposes today in his submission to the Church of England.

Royal College (2007)

Oral History (Professionals’ views) King et al 2004 (Ref 17)

Treatments in 1960s and 1970s were very damaging and affected no change in orientation

The practices of this period are no longer relevant to the present debate.

“Only a small minority believed that current practice denied people distressed by their homosexuality an effective means to change their sexual orientation”.
How different today!

The second study documents some reflections of patients of their recollections of experiences of therapy decades ago. Once again, it is of historical interest only, and hardly appropriate.

Royal College (2007)

Oral History (Patients’ views) King et al 2004 (Ref 18)

Treatments in 1960s and 1970s were very damaging and affected no change in orientation

As before, the practices of this period are no longer relevant to the present debate.

A poignant comment from the study:
“Many participants felt they lacked parental affection during childhood and adolescence”

These two historical studies allow the Royal College to say, “we know from historical evidence that treatments to change sexual orientation that were common in the 1960s and 1970s were very damaging to those patients who underwent them and affected no change in their sexual orientation.” This information is superfluous to the present situation and may be misleading to the incautious reader. One poignant comment from the latter study, however, is that, “Many participants felt they lacked parental affection during childhood and adolescence”

The final study, ref 19, is by Dougas Haldeman, a respected gay-affirming scholar.

Royal College (2007)

Haldeman, Gay Rights, Patient Rights 2002
(Ref 19)

People are happiest and are likely to reach their potential when they are able to integrate the various aspects of the self as fully as possible

... gay-affirmative therapists need to take seriously the experiences of their religious clients, refraining from encouraging an abandonment of their spiritual traditions in favour of a more gay-affirming doctrine or discouraging their exploration of conversion treatments.

Haldeman’s conclusion:
...we must respect the choices of all who seek to live life in accordance with their own identities; and if there are those who seek to resolve the conflict between sexual orientation and spirituality with conversion therapy, they must not be discouraged. It is their choice ...

He is cited in version 1 of the Royal College’s submission, in support of the contention that people “are happiest and are likely to reach their potential when they are able to integrate the various aspects of the self as fully as possible.” The implication is that people who feel same-sex attraction will be happiest when they are encouraged to shape their lives around that inclination, regardless of other factors. Haldeman is much more balanced, however. He says that “... gay-affirmative therapists need to take seriously the experiences of their religious clients, refraining from encouraging an abandonment of their spiritual traditions in favour of a more gay-affirming doctrine or discouraging their exploration of conversion treatments.”

Haldeman continues, “... we must respect the choices of all who seek to live life in accordance with their own identities; and if there are those who seek to resolve the conflict between sexual orientation and spirituality with conversion therapy, they must not be discouraged. It is their choice ...”.

Indeed so. Yet there is no reason why only those clients who are religious should have freedom of choice: any man or woman who wishes to live a heterosexual life should be assisted to do so.

This is not the message that the Royal College of Psychiatrists wishes to give to the Church of England, however. The ‘revised version’ of the text deletes the reference to Haldeman.

The insistence on client autonomy and choice, which formerly was a cornerstone in psychiatry and psychology, has been set aside. Hopefully the Church of England will demand its reinstatement, in the interests not only of those who are religious, but of all who value the freedom to determine their own life goals.

Beyond Critique - 2

The UK Council for Psychotherapy

UKCP’s Ethical Principles and
Codes of Professional Conduct:
Guidance on the Practice of Psychological Therapies that Pathologise and/or Seek to Eliminate or Reduce Same Sex Attraction

The UK Council for Psychotherapy has written a document called Ethical Principles and Code of Professional Conduct (dated 26th September 2009) which therapists who belong to the Council or its affiliated organisations must uphold at all times.[9] This document sets out in general terms an admirable set of standards for its practitioners.

A subsidiary document, UKCP’s Ethical Principles and Codes of Professional Conduct: Guidance on the Practice of Psychological Therapies that Pathologise and/or Seek to Eliminate or Reduce Same Sex Attraction, applies the overall principles of the primary document to the specific context of homosexuality

This present critique comments on the second document.
In considering the UKCP Ethical Principles two hypothetical cases will serve as examples

A young man has a lady friend whom he would like to marry. He is concerned, however, that he experiences same-sex attractions which he fears might derail the relationship a few years down the line. For as long as these feelings continue, he is unwilling to take the risk of marrying, not least for the sake of the woman he loves, and would like help in reducing his same-sex attractions.

A woman in her thirties is married with two children. She falls in love with another woman and is torn between leaving her family or staying. She would like help to reduce her same-sex attraction to enable her to keep her family intact.

1. Blanket Ruling: Not in the client’s best interests

Each of the above people seeks the advice of an appropriately qualified therapist and is told that science has shown that “agreeing to the client’s request for therapy for the reduction of same sex attraction is not in a client’s best interests” (2.1 - 1.1(a)).[10] They are both distressed by the news, and by the therapist’s advice that they should try to conform their lives to their sexuality.

Such client dilemmas are not uncommon and organisations such as the UKCP have a clear duty of care to avoid harm in their ethical guidance to psychotherapists. A high burden of proof is needed to show that public safety is enhanced by following the UKCP ethical guidance to decline a reasonable client request.

One must question whether research has in fact shown that therapy for the reduction of same-sex attraction is always “not in a client’s best interests.” The ethics document cites Drescher, Shidlo and Schroeder 2002 – the only scientific paper cited in the entire document, and certainly not an adequate basis for refusing all such client requests (where the client has not even been seen, let alone assessed as regards symptoms).

2. Argument 1: Overwhelming evidence of psychological cost

In section 2.1 – 1.1(b) it is stated that “There is overwhelming evidence that undergoing such therapy is at considerable emotional and psychological cost.”

Where is this “overwhelming evidence” of harm? Dr Stanton Jones in a current commentary on this debate[11] says that his research (with Dr Mark Yarhouse) into the question of harm “[did] not prove that no one is harmed by the attempt to change, but rather that the attempt to change does not appear to be harmful on average or inherently harmful. These findings challenge the commonly expressed views of the mental health establishment that change of sexual orientation is impossible or very uncommon, and that the attempt to change is highly likely to produce harm for those who make such an effort.” Any argument against the findings of Jones and Yarhouse would need to be based on a study that has followed clients prospectively, administered generally accepted psychological tests to measure distress, and proved that, on average, harm is caused by sexual orientation change efforts. But no such study (other than theirs) has been carried out.

3. Argument 2: A treatment for which there is no illness

Section 1.3 – (e) says that for a psychotherapist to offer treatment that might ‘reduce’ same sex attraction would be “exploitative” as “to do so would be offering a treatment for which there is no illness.”

This logic simply falls apart when applied to the two cases outlined above. In neither case is the person described as “ill”. But the Guidance implies that if a therapist were to offer treatment to help persons such as these to achieve their life goals, the therapist would thereby be ‘exploiting’ the client. The error here is to imagine that ‘treatments’ can be offered only in the case of ‘illness’. But one can have ‘treatment’ for everything from nervousness in public speaking, to weight loss without being declared ill. These people are being denied a human right to treatment intended to help them shape their lives as they wish.

4. Argument 3: Client autonomy denied because client is ‘oppressed’

Section 1.3 – (g) denies client ‘autonomy’ as sufficient justification for a therapist attempting to reduce same sex attractions, by wrongly suggesting that all such clients are experiencing “externalised and internalised oppression.” In our case examples, it is clearly wrong to imply that the desire to reduce same sex attractions in order to protect one’s family is a sign of “oppression” – either external or internal.

5. A Question: Where is the real oppression?

Section 3.1 (ii) concludes that “Based on the above considerations” offering ‘Sexual Orientation Change Efforts’ is “incompatible with UKCP’s Ethical Principles and Code of Professional Conduct.” But does it not seem rather that the blanket refusal of such therapies is a form of oppression?

6. Some key questions to be addressed by the UKCP

In order to set out clearly the issues at stake, there are eight questions to which the UKCP needs to provide answers:

Is it fair to say that requests for client autonomy such as in the two examples above are entirely reasonable and based on legitimate life goals?

What is the evidence that “agreeing to the client’s request for therapy for the reduction of same sex attraction is not in a client’s best interests” – that is to say, that there are no cases in which such a client request should be honoured and that in no case would the maxim ‘first do no harm’ be violated by refusing the client’s request.

Does the UKCP consider that their reference to Drescher, Shidlo & Schroeder has “shown that offering ... therapy for the reduction of same sex attraction is not in the client’s best interests?

Can the UKCP provide specific references to high quality scientific research which shows what they describe as “overwhelming evidence that undergoing such therapy is at considerable emotional and psychological cost.” Such evidence would need to be better than that of Jones & Yarhouse who found to the contrary. That is to say, one or more studies would need to have followed clients prospectively, administered generally accepted psychological tests to measure distress, and proved that, on average, harm is caused by sexual orientation change efforts.

In the context of the two cases outlined above, can the UKCP explain how it would be “exploitative” for a therapist to offer treatment that might ‘reduce’ same sex attraction“?

Can the UKCP confirm that there are no circumstances in which it permits therapists to offer treatments “for which there is no illness”?

Can the UKCP explain how the desire to reduce same sex attractions in order to protect one’s family is a sign of “oppression” – either external or internal?

Does the UKCP affirm that the denial of a client’s request to receive help to achieve the type of life goals outlined above is based on scientific evidence that is of such a high standard as to warrant denial of this basic human right in the interest of public safety?

The writer has set out these questions in writing several times to the UKCP in the hope that they would acknowledge their reasonableness and address their content, but without result.

Postscript: The Royal College of Psychiatrists and the UK Council for Psychotherapy

Overall, the conclusions of this review document are:

The Royal College of Psychiatrists appears to be the only body in the UK that has taken the trouble to set out a written argument with references to appropriate scientific studies to support the narrative that those who experience same-sex attraction are born that way, that they cannot change and that any attempt to do so is liable to cause great damage to them. Other professional organisations fall in line on a “me too” basis, so that the general public assume that ‘it must be so’ since so many independent organisations say that it is so.

Yet the Royal College’s argument is not only unconvincing, but has to twist the evidence in order to make it fit the narrative. This even involves Professor Michael King ‘spinning’ his own scientific findings and misrepresenting the work of Dr Robert Spitzer.

The UKCP takes the narrative to its next logical stage: therapy seeking to reduce same-sex attractions is automatically deemed to be harmful and therefore must be forbidden. And therapists who support such client requests must be disciplined. The UKCP does not feel the need to establish a scientific underpinning for its position because it considers that other authorities such as the Royal College have already done so. Moreover, the principle of client autonomy, so important in the provision of mental health services, is overridden by stereotyping and stigmatizing any client who voluntarily wants to reduce same-sex attraction as ‘suffering from internal or external oppression’.

The result of the positions taken by the professional bodies is that vulnerable individuals seeking to reduce unwanted same-sex attractions are now denied professional help to pursue their legitimate therapeutic goals. A logical consequence of this is that these organisations are making it more likely that amateur therapists and informal church-based ministries will be the only way open to people who want to reduce same-sex attractions, even if they are simply seeking to protect their marriage and family. Such therapeutic approaches will not be supported by professional competencies, protection, regulation, supervision or professional indemnity insurance. This is analogous to promoting the practice of back street abortion, which society has striven so hard to eliminate.

It is time to call the mental health professional bodies to account. They must acknowledge that sexuality is not as fixed as they have suggested. Change is possible, at least for some, change attempts are more likely to lead to wellbeing than to harm, and clients should be free to have their therapy of choice, within a context of informed consent.

The present writer became aware of the position taken by the UKCP on these matters as a result of action being taken against a therapist who has been suspended by his professional body for the past year without any charge against him, because of his work in assisting people such as the young man in the example above. There has been no client complaint against him; indeed his clients are most grateful for his help to them in working towards achievement of their life goals. He has done nothing wrong, but his livelihood has been affected to the point where he is now trying to sell his house to raise much-needed money.

It is against the UKCP ethical principles critiqued above that such people are judged, but in my view it is these principles themselves that must be brought into the spotlight.

Over a period of months during 2012, I corresponded with various representatives of the UKCP with a view to generating a responsible discussion around the ethical guidelines regarding same-sex attraction. Eventually I made a formal complaint against the UKCP, asking that the matter be taken through their own internal complaints procedures.

Their response was that I did not have grounds for a complaint, I merely had a ‘difference of opinion’ with them. The injustice of this is that if I were a therapist who had the same ‘difference of opinion’ I could be struck off their register and have my entire career destroyed.

This does not affect me directly, but it has a devastating impact on those who are forbidden their therapy of choice and on those who are brave enough to try to help them.

Notes

1 Cummings is a past president of the American Psychological Association; Wright is a past president of two of the Association’s divisions.

2 www.rcpsych.ac.uk/pdf/Submission%20to%20the%20Church%20of%20England.pdf

3 www.rcpsych.ac.uk/workinpsychiatry/specialinterestgroups/gaylesbian/
submissiontothecofe.aspx

4 M Frisch et al (2006). Childhood Family Correlates of Heterosexual and Homosexual Marriages: A National Cohort Study of Two Million Danes.

Archives of Sexual Behavior 35, 533-47

5 The Social Organization of Sexuality, E O Laumann et al, University of Chicago Press 1994

6 It seems likely that the intended reference is to Bell, Weinberg & Hammersmith (1981). But even after making this presumed correction there is a problem. An authoritative critic has written, “There is a persistently repeated statement in the literature that there is no social connection with the development of same-sex attraction, but the only authority cited is Bell, Weinberg and Hammersmith (1981). There appears to be no subsequent critical statistical evaluation of this work and the attached paper shows that from internal data, there is substantial correlation with social factors.” The ‘attached paper’ is found at http://www.mygenes.co.nz/Bell_WeinbergJHS.pdf It shows that there is an urgent need to revisit Bell, Weinberg and Hammersmith (1981) to re-evaluate the implications of the data collected in that study

7 Developmental Psychology Copyright 2008 by the American Psychological Association 2008,

Vol. 44, No. 1, 5–14

8 Spitzer has been viciously attacked by gay activists for more than a decade because of his study findings. Already in 2005 he referred to ‘battle fatigue’ in repelling attacks. Wikipedia reports that eventually in 2012 “he spoke with the editor of the Archives of Sexual Behavior about writing a retraction, but the editor declined.” Retraction is normally based on gross errors or deception and these do not apply here.

9 http://www.psychotherapy.org.uk/download725.html

10 Quotations followed by numbered references are taken from the ethical principles document on same sex attraction that is being critiqued here.

11 http://www.wheaton.edu/CACE/Hot-Topics