Understanding and Implementing the APA Task Force Paper on Appropriate Therapeutic Responses to Sexual Orientation

by Dr. Ralph Blair – The American Psychiatric Association Convention, May 7, 2012

An integration model for cognitive therapy with clients experiencing dissonance between same-sex orientation and faith commitment is discussed.
For optimal psychological coping, clients need a coherent understanding of themselves. Since experienced dissonance is evidence that clients are torn between telic congruence and orgasmic congruence (in the American Psychological Association Task Force terms), it is suggested that, in many cases and more often now than ever before, rather than having to choose between contending pressures as clients understand these when presenting for therapy, a balanced integration that safeguards what clients find most relevant in each of the valuations be explored through a more nuanced inquiry toward a coherent resolution.
Without achieving such an integrated resolution, clients can be left with continuing conflict and stress over perceived sexual misbehavior that, try as they might, they find difficult to curtail, and over discarded, or at least discounted, faith they find difficult to live without.
From over forty years of practice in cognitively integrated therapy with same-sex oriented clients, two case histories are presented to illustrate this integration model: one case that worked out well and one that did not.

Malcolm Muggeridge was seen as the quintessential insider. But he saw himself as an outsider. In his Chronicles of Wasted Time, he describes, “standing in the wings of a theatre waiting for my cue to go on stage. As I stand there I can hear the play proceeding, and suddenly it dawns on me that the lines I have learnt are not in this play at all, but belong to a quite different one. Panic seizes me; I wonder frenziedly what I should do. Then I get my cue. Stumbling, falling over the unfamiliar scenery, I make my way on to the stage, and there look for guidance to the prompter, whose head I can just see rising out of the floor-boards. Alas, he only signals helplessly to me, and I realize that of course his script is different from mine. I begin to speak my lines, but they are incomprehensible to the other actors and abhorrent to the audience, who begin to hiss and shout: ‘Get off the stage!’ ‘Let the play go on!’ ‘You’re interrupting!’ I am paralyzed and can think of nothing to do but to go on standing there and speaking my lines that don’t fit. The only lines I know.”

Such is the torment of evangelicals with same-sex attraction, estranged and stigmatized among other evangelicals and other gays. It’s not easy being gay in a script that’s straight; Christian in a plot that’s not. “Coming out” as the “outsider”, whether in Evangelicaland or in the Emerald City, invites ridicule, rejection or worse. The dread of not belonging, no matter how hard you try to belong, the anxiety of being unacceptable, no matter how much you long for acceptance – this is the despair of a seemingly unalterable alienation: I can’t change and they won’t change.

Best psychological coping requires a coherent self-understanding. Best psychosocial coping requires a caring community. Best psychosexual coping requires a compatible companion. Without practicable resolution of conflict in any of these areas, the quest for flourishing will be frustrated if not futile.

According to a Duke University sociologist, among regular churchgoers, 79 percent think homosexuality is always wrong, as do 48 percent of those who don’t go to church. (Mark Chaves) Younger evangelicals are becoming more accepting, though they still must deal with families, friends and churches. And it’s likely that none easily escapes all the residue of a homophobic upbringing or the often bitterly defensive responses to it. Yet, today, instead of having to choose between sexual and spiritual needs, clients might learn to meet both, compatibly.

The APA Task Force holds that neither psychology nor theology should “arbitrate” the other, that, clinicians should be limited to “psychological implications of religious/spiritual beliefs or practices”, while nonetheless, “tak[ing] a leadership role in opposing” religiously based “discrimination”. But the emotional, spiritual and political are not so neatly packaged nor so easily disentangled, for the controversy’s crosshairs are concentrated in a single conflicted conscience, a single everyday life. The Task Force grants there’s prejudice on all sides, though I assume it’s not “imposing a specific sexual orientation identity outcome” to help clients assess their assumptions that may be setting them up for expectations of unreasonable outcome.

When it comes to clients from faith groups that label gays “sinful”, many clinicians find this whole faith population unfamiliar, even uncomfortable. As the Task Force observes, religion is “underexamined” in psychology.

So, many clinicians must stretch simply to understand who these clients of these conflicting circumstances really are and what they’re really up against. At the same time, conservative Christians need to stretch, even to seek the help of clinicians outside their faith community – the very ones who’ll likely not be pushing the “reparative” therapy recommended by their home base.

From my over forty years in practice, here are two cases of Christians from antigay backgrounds. One ended badly; the other came out well.

The first, I’ll call Andy. He was referred to me in the mid-1970s by my friend, the late Emery Hetrick, an AGLP founder. Back in high school in the 1940s, Emery was in Youth for Christ. So he knew how crucial it was to be deft, not deaf, when listening to anyone wrestling with homosexuality and Christian faith.

Andy was reared in Texas among legalistic fundamentalists known as the undenominational “churches of Christ”. He’d internalized their homophobia and their wariness of Christians outside their rigidly separatist group, so even my evangelical identity didn’t fully assuage his suspicion of my faith credential. This illustrates a problem for rapport with clients whose early exposure to religion was rigidly circumscribed. His clinical picture included generalized anxiety disorder. His dependence on his parents’ financial support, mixed with their homophobia, was a complicating factor. A relaxation technique supplemented my cognitive therapy approach.

Andy neither accepted his homosexuality nor approved of his promiscuity. He’d go out and pick up the wrong guy, get beaten up and robbed. This reinforced his belief that homosexuality was a curse. And, of course, he’d take these beatings as the punishment he deserved for his homosexual sin.

Late one night, Emery phoned me at home. He’d just heard that Andy was dead. He’d jumped into the path of an onrushing subway train.

The other case is of a student at an evangelical college. I’ll call him Greg. One of his professors, a friend of mine, referred him to me. Greg’s father, a conservative minister in a mainline denomination, as well as his mother, were antigay – so much so, that on Greg’s occasional weekend visits home, and in front of Greg, his father would read an allegedly antigay Bible verse among the scriptures for that Sunday’s morning’s worship service.

In counseling, Greg wanted the truth on the Bible and homosexuality. He soon saw that the antigay interpretations dissolve under closer inspection and that God’s unlimited love in Christ could never be undone by a loving same-sex partnership. And, as Jesus had said: Loving God and loving others is the very essence of all the law and the prophets. (Matt 22:40)

So, Greg went looking for a boyfriend and found him. They’ve now been partners for 10 years and have an adopted little girl. His parents still don’t approve, but he’s okay with that. He smiles about his mother’s lament that the poor little girl will never have a mommy to buy her “pretty dresses”.

Achieving integration of faith and sexuality is not uncommon. But many never do achieve it. In their churches, their love is unrequited and they’re forced to hide or leave. Their faith was a matter of choice; their sexual orientation was not. So, when push comes to shove, what’s often left behind and lost in bitter backlash is a faith community and even their faith in God.

What I’m presenting is what I’ve found to be most helpful for Christians conflicted over same-sex attraction – whether theirs or that of a loved one.

I’ve found that a cognitive therapeutic approach that identifies a client’s assumptions and misinformation, tactfully challenges them, and facilitates an intuited revision, yields emotional and behavioral results that allow that client to live his or her life with the wholeness of coherence and integrity.

In 1962, while I was in grad school at USC – and also in the Inter-Varsity Christian Fellowship – I was urging my fellow evangelicals to affirm gay couples. That was 11 years before the APA revision on homosexuality and 7 years before Stonewall. How did an evangelical do this, 50 years ago? I did it on the basis of the Gospel, i.e., Whoever trusts God in Christ passes from death to life. (John 5:24). I took, “whoever” to mean, whoever. Period. Upon graduation, I joined the IVCF staff at the University of Pennsylvania. But, in 1964, after I’d advocated for gays in a speech at Yale, I become too big a public relations problem for IVCF headquarters, so I wasn’t reappointed for 1965. I got a job at Penn State and stayed on there to do my doctoral dissertation on homosexuality.

Since those days, however, many evangelicals have spoken out against antigay interpretations of the Bible and they’ve also been affirming gay partnership. They’re theologians, philosophers, Bible scholars – even past presidents of IVCF, the Evangelical Theological Society and the chair of Old Testament translation for evangelicals’ most popular Bible. They teach at evangelical colleges and seminaries and are authors that evangelicals’ flagship journal, Christianity Today, rated among the top 50 authors for evangelicals of the past 50 years. Yet, many folks know nothing about any of this. Evangelical media keep it quiet and “mainstream” and LGBT media tend to ignore it.

Both gay-affirming clinicians and their conflicted conservative clients – wrongly assuming the Bible to be antigay – need to know of the evangelical refutation of antigay rhetoric – else how can these clients freely choose a course of therapy. Aware of affirming views from the client’s own conservative tradition’s scholars can permit a truly informed choice.

Reparative therapist Joseph Nicolosi accuses the APA of not allowing the Bible to be the Christian’s guide. But, he fails to admit that it’s not “the Bible” that guides. It’s one’s interpretation of the Bible that guides. So, let’s all be mindful of hermeneutics. Herman who? Hermeneutics – the discipline of textual interpretation for deciphering a text’s meaning.

Any translation from antiquity – from foreign frames of reference and unfamiliar assumptions – can be misunderstood with tragic results. Whether pro-gay or antigay, when we think of homosexuality – or heterosexuality – we’re not thinking the thoughts of the ancients. We can no more walk in the shoes of their assumptions and daily experience than they could have walked in ours. What we, today, understand as “gay” – e.g., homosexual orientation and same-sex peer partnership – was not a part of any ancient society. The Bible is an empty closet. Unfortunately, however, people are oblivious to this historical fact.

Throughout history, “numerous interpretations [of the Bible] have been proved wrong.” (Moises Silva) The proof-texts only seemed to support, e.g., slavery or segregation. And, of course, all these verses are still in the Bible. But they’re no longer interpreted as they once were.

With sufficient reasons, people do learn to change their minds. Cognitive dissonance and a conflicted conscience can motivate for reinterpretation. And, through a better-informed cognitive therapy, a client’s troubling notions can be identified and successfully challenged so that a realistically coherent understanding is intuited and the distress resolved in an “A-ha!” of relief.

This past winter, the Religious Right’s World magazine honored Alan Chambers of Exodus with its “Daniel of the Year” award, celebrating – incongruously – that “his homosexual desires changed, [his] same-sex attractions diminished and he stopped indulging [homosexual] temptation.” But, in his own book, Leaving Homosexuality, he’d warned that same-sex temptations remain and that his testimony is not a “guide to change from gay to straight … because [as he put it] no such plan exists.” Said Chambers: “Heterosexuality shouldn’t have been my goal – nor should it be yours.”

World’s news editor does note that Chambers says the “ex-gay” aim is “not to fix people”, but then she adds his pet equivocation: “The opposite of homosexuality isn’t heterosexuality. It’s holiness.” (Jamie Dean) She admits that, “some prominent leaders of Exodus have returned to homosexuality.” Some? Returned? No. The overwhelming majority left the movement because same-sex attractions never left them. They’ve not “returned to homosexuality”; they’ve remained in homosexuality.

She states that, “Chambers is in denial [and, she says, he] agrees.” But she and he turn his critics’ use of the term, “denial”, into “self-denial”. Cute – except that, biblically, self-denial is not enforced asceticism or mismatched marriage. And, as for “the cross” she mentions that we, as Christians, are called to bear – that cross does not call for rationalization and obfuscation.

While World magazine readers were digesting “Change We Can Believe In”, Chambers was telling Gay Christian Network’s 2011 conferees: “The majority of people that I have met, and I would say the majority meaning 99.9 percent of them, have not experienced a change in their orientation.” So, c’mon, World, where’s your exodus? You’re still down there in de’Nile!

Now, of course, nobody at World magazine, really buys their “ex-gay” change claims. Scenario: World-types send daughter to Christian college. Daughter tweets she’s dating a nice Christian guy who’s “like, ‘ex-gay’ ”. Would parents be worried? Some months later, daughter tweets she’s, “like, no longer dating ‘ex-gay’ guy – somehow it just wasn’t working out.” Now she’s dating another nice Christian guy who’s “like, just a nice guy – not ‘ex-gay’ ”. Would parents be relieved?

The board of the pretentiously billed “ex-gay” lobby’s National Association for the Research and Therapy of Homosexuality relies on this little bit of face validity in it’s own fancy footwork. It spins the failures this way: “[M]uch of the expressed pessimism regarding sexual orientation change is a consequence of individuals intentionally or inadvertently adopting a categorical conceptualization of change.” Translation: Change doesn’t mean change! NARTH calls for a refocusing from “religiously mediated outcomes” to “psychotherapeutic care”. There’s more “change” over there?

Pat Robertson still tells his TV viewers that homosexuality can be “un- acquired”. But research at Regent University, the university he founded, documents total failure in this regard. That research report, published by the Society for Christian Psychology, is that, in all of the mixed-orientation marriages studied, no shift toward a heterosexual orientation was achieved by the homosexuals – even after 16 long years of marriage. I say “long” years, because the homosexual spouses reported having done their genital duty far more often than their heterosexual spouses could recall. And the homosexuals in these mixed marriages ranked their own continuing same-sex attraction as the “most difficult factor” in these marriages. Of course, this was entirely predictable from the day they decided to wed. Who’d try to believe that a heterosexual would be happy in a same-sex marriage?

Now, a detour through “ex-gay” ministry can be useful. When a same-sex romance goes awry, a “been-there-done-that” history inside an “ex-gay” group can forearm against “if only” rumination on roads never taken to reorientation. And here’s a young man who went through an “ex-gay” group and now posts on the LGBT website of Bob Jones University alumni. Though now “wholeheartedly disagree[ing]” with the “ex-gay” effort, he says he’s “forever grateful” for his time there. He says: they “took in a scared young evangelical and held him as he cried [in that] safe space, unload[ing] years and years of secrets and shame and fear.” (Carl Allison)

So, with all this doublespeak and failures, how are “ex-gay” promises not more readily seen as disingenuous? The misinformed are desperate, fearing that gays go to hell. The willfully ignorant – such as preachers and heads of conservative denominations and lobbies, etc. – can’t afford the political and economic costs of changing their tune. But the “ex-gay” claim is, indeed, becoming harder to sell. Exodus has recently announced the cancellation of its next “Love Won Out” conference “due to low numbers of registrants”.

Yet, preachers keep on projecting our era’s gays into the Bible and people in the pews aren’t prepared to counter it. Neither are most clinicians. But, as clinicians, we can point to alternative readings by scholars in a client’s own community of faith. Bibliotherapy is a longstanding supplement to psychotherapy, and now, besides a book or journal article, websites can be noted for clients, like ECinc.org and GayChristian.net.

Also, clinicians can point to biblical data even if we don’t push them. For example, the phrase, “practicing homosexuals of whichever sort”, has been put into a new version of the Bible and it’s stated that such persons will be excluded from God’s kingdom. (I Cor 6:9) This overreaching insinuation has no basis in the two Greek words paraphrased. Besides violating the text, it can strike terror into the tender consciences of uninformed readers.

One of these terms is malakoi, “soft” – perhaps, morally soft. The other, arsenokoitai, is unknown before Paul’s use of it here – in a list. Even if it was not in a list – which always confounds analysis of a singularly occurring word – an evangelical textual scholar cautions: With “such a rare word, you can count on no end to the speculation, [even if it’s] based on thin air.” (Daniel Wallace)

Arsenokoitai links terms for “male” and “bed”. But, does a lexical hook-up indicate a sexual hook-up? Meaning is determined by common usage, not by components. Should folks 2,000 years from now think that our “wise-guys” were distinguished men of eminent wisdom and our “lady killers” murdered women? The King James Bible uses “effeminate” here, but in the 1600s, what they called the “effeminate”, we call “lady killers”. And, here at APA, we’re having a symposium. But, where’s the booze? A symposium in the ancient world was a drinking party – sym (together), pinein (to drink).

Clement of Alexandria, a near contemporary of Paul, knew of Paul’s use of arsenokoitai. Yet Clement never used this term in his own discussion of same-sex acts. He used many other terms for such. And another 2nd century writer put the arsenokoitai among economic sinners, not sexual sinners.

In a debate back in the 1970s, I was arguing that the arsenokoitai were not gays. My opponent interrupted: “What’s that word?” “Arsenokoitai”, said I. He shot back: “Of course it’s about the homosexuals – arse, arse, they put the penis in the arse!” He was conflating ancient Greek with a British vulgarism. I told him he was etymologically incorrect. And besides, I said, they don’t all “put the penis in the arse” – especially, the lesbians!

The New Testament’s only other allegedly “antigay” text is Paul’s polemic against Gentile idolatry, Romans 1:26f, of which an evangelical exegete states, “There can be little doubt but that Paul is referring to the practice of ritual prostitution [noting that Paul] “was writing from Corinth where more than a thousand [such] sacred prostitutes were [attached to] one large temple.” (Leon Morris) This is also the only so-called lesbian text in the Bible, though in the first 400 years CE it was interpreted by church fathers as referring to anal penetration of Gentile women to avoid procreation.

As I’ve said, early Christians did not confront gay issues as we know them today. But, as Jews and former pagans, they did face other big challenges going back for centuries – Sabbath laws, circumcision requirements, purity codes, meat that had been offered to idols – and coping with this strange new experience of Jewish-Gentile fellowship.

How did they accommodate each other’s conflicted conscience? They prioritized what was most important to them all and minimized the more minor matters.

Paul identified with the more liberated, but insisted that those who did not feel free to engage in what they believed to be wrong, be supported in their abstaining. He knew, as we do, that, to violate conscience is not a good idea. So, for the good of all, he wrote: “Let each be fully convinced in his or her own mind.” (Romans 14) He urged the more mature to be patient with the less mature, while strengthening the less mature toward a fuller, more flourishing, faith.

Perhaps here, Paul and the APA are sufficiently in sync to suggest a client-centered approach with clients conflicted over same-sex attraction, so that they might learn, at their own pace, emotionally and spiritually, to see their way clear toward a more integrated life – one that’s all of a piece and not all in pieces.


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