Saturday, September 12, 2009

The APA's tast force statement on orientation change efforts

I read a few posts on Warren Throckmorton's blog recently, and I really enjoyed them. The commenters there seem very reasonable, and civil by conventional internet standards. I ended up reading bits of the Report of the American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation based on Dr. Throckmorton's suggestion (although he calls himself Warren, so I'm probably going to call him by his first name).

My take?

The overall position is conservative in the sense that it avoids any definitive statement of efficacy or harm, admitting the paucity of evidence. What disturbs is the pervasive bias in the way the data is discussed, regardless of the final, almost reluctant, conclusions. This bias bleeds out as imprecision and equivocation most frequently, but occasionally as blatant inconsistency in the standards to which the evidence is being measured (or even examined at all).

I don't have the time to trot out a lot of examples (or even read every word of the document), but here are a few passages with comments.

We see this multiculturally competent and affirmative approach as grounded in an acceptance of the following scientific facts:
  • Same-sex sexual attractions, behavior, and orientations per se are normal and positive variants of human sexuality—in other words, they do not indicate either mental or developmental disorders.
What the task force here calls "scientific fact" is actually consensus opinion, and there's a big difference. Many studies have defeated the long-prevailing belief that homosexuality is or is associated with mental illness. That much I can swallow (but only on a provisional basis). But, as I've mentioned on this blog before, it's odd to me that a discussion of "human sexuality" can so thoroughly and emphatically ignore reproduction as a significant part of the equation. If one assumes, as the task force apparently does, that ejaculating and having viable sperm is all that is necessary to give the thumbs up on normal reproductive capability, then perhaps their consensus statement (which is not a fact) is defensible. However, I beg to differ.

Gay men, lesbians, and bisexual individuals form stable, committed relationships and families that are equivalent to heterosexual relationships and families in essential respects.

This is presented as another "scientific fact". What I think they meant to say was that these folks form said relationships at rates that are not statistically significantly different from heterosexual families in the essential respects that have been examined. This is not even close to the same thing. Maybe the studies satisfy non-inferiority criteria (that are subjectively assigned). Maybe there is statistical significance for the subjective answers to survey questions, but many "essential respects" are not so easily measured, and failing to show a difference is not the same as showing equivalence. They don't bother footnoting this statement, so there's probably some great quality data... but moving from great quality data to proclamations of unequivocal "fact" is a move I highly doubt I would support after reviewing the relevant literature.

...few studies on SOCE produced over the past 50 years of research rise to current scientific standards for demonstrating the efficacy of psychological interventions...

Few studies of anything produced more than a few years ago rise to current scientific standards. They still can inform, even if they can't prove. Because these studies weren't conducted as randomized controlled clinical trials, they can't show us what we'd like to know, but I don't think the task force is correct with: "there is little in the way of credible evidence that could clarify whether SOCE does or does not work in changing same-sex sexual attractions." The evidence that is presented is what it is. Just because it's not the kind of rigorous science that would demonstrate causality doesn't mean that it's not "credible"! If the researchers were found to have manipulated data there would be a credibility problem, but as the data is, it just gives us very limited evidence, albeit legitimate.

Interestingly, a footnote briefly mentions a Nicolosi study that was not included in the task force's consideration because it was published after the review period and "appeared" to be a reworking of an earlier study. I haven't read Nicolosi's 2008 study, but if it provided any new information that met "current standards" in a way that nothing else does, perhaps they could have gone ahead and extended the review period since the limited data is the whole point. And if it was a reworking of an earlier study, that's even more reason to suspect that it was specifically reworked to assuage criticisms of methodology or presentation. In other words, the task force laments having no "credible" data but can't be bothered to look at the most recent data, even when it was published a year in advance of this report.

White men continue to dominate recent study samples. Thus, the research findings from early and recent studies may have limited applicability to non-Whites, youth, or women.

This is certainly true. So is this: old people continue to dominate the cancer literature, so research findings may have limited applicability to young people. The trick is most people with cancer are old. Just like most people who seek out SOCE are white males. So it's okay to go ahead and accept that there's value in the data even if it's not completely generalizable. The population that has been studied happens to be the vast majority of those for whom this research will make any difference.

In general, the results from studies indicate that while some people who undergo SOCE do engage in other-sex sexual behavior afterward, the balance of the evidence suggests that SOCE is unlikely to increase other-sex sexual behavior.

Again, this is true. So is this: chemotherapy for breast cancer patients will not give any benefit to a majority of patients but will give toxicity to all of them. The trick is, I don't care what happens to the "majority," I want to know quantitatively whether there was a difference in the rate of other-sex behavior from the therapy (if not causally demonstrated, at least temporally). And it sounds like there was a quantitative difference, even a significant one. But I wouldn't know from this report as they just go ahead and stick with vague dismissals like the quote above.

Two participants reported experiencing severe depression, and 4 others experienced milder depression during treatment. No other experimental studies reported on iatrogenic effects.

Woah. Suddenly the fact that participants are experiencing things in association with treatment can be automatically causally linked. Well, hey, we moved on to harms, so the rules of scientific rigor have all changed. These cases of depression are "iatrogenic". Umm... how do you know? Although the task force does go on to admit that there is no causal attribution for harms or benefits, they go ahead and refer to "some evidence" of harm repeatedly through the report while adamantly holding that there is "no credible evidence" of benefit.

We recommend that APA take a leadership role in opposing the distortion and selective use of scientific data about homosexuality by individuals and organizations and in supporting the dissemination of accurate scientific and professional information about sexual orientation in order to counteract bias.

Ah. Here's something I totally agree with. I just wish they'd followed their own advice. I couldn't find it just now rescanning through, but there's a great gem in there where the task force refers to itself as an example of authoritative and reliable source of scientific information. Ha. Or... maybe individuals can actually go ahead and critically examine things for themselves since science isn't a religion and appeals to authority are both unnecessary and fallacious. A scientist ought to know that.


Samantha said...

You're alive? Well, that's good news. I was sure you were dead.

Bravone said...

So good to hear from you again!

Kengo Biddles said...

I've said it in many locations, but I'll say it again: I think human sexuality is a LOT more fluid than the current political viewpoints on the issue would like us to believe.

I would hope that the APA does what is suggested in your last quote.

And welcome back L, all taunting aside.

Ron Schow said...

I am interested that you respond favorably to Throckmorton, because I do also. His position on reparative therapy appeals to me because he basically says that those with SGA can conform their behavior to their goals and they don't need to pin their hopes on SOCE. At least that is the impression I have of what he is saying. I also like what he says about the recent Jones & Yarhouse study---namely, he says

"I think if anything the Jones and Yarhouse study is not very positive for sexual reorientation. Flaws aside, it does not help those who want to promote change as the proper focus of therapy or ministry."

He seems to feel there are some good things about the APA statement...

" ...the important news from the APA report, i.e., (is) the respectful and appropriate treatment of religion as a diversity variable and the interface with client self-determination."

All of this meshes for me with the important work by Caitlin Ryan and her group published in the Jan 2009issue of Pediatrics. Her work, I feel, supports the approach of Throckmorton much more than those promoting reparative therapy.

I wish Evergreen would move in the direction of Throckmorton because according to Ryan, et al, there is significant risk of suicide, depression, and other negatives when families and caregivers push for change and are rejecting of those who acknowledge their SGA feelings. Acceptance of the feelings is possible in the approach by Throckmorton it seems to me, and much more healthy according to Ryan's work.

-L- said...

Yes, I don't think people should pin their hopes on SOCE, even if they undergo them. For me, at least, SOCE was beneficial for many reasons other than actual orientation change, and the fact that I went in with low expectations for change seemed to minimize the ostensible harms.

My critique here is of science and the fallacious appeal to authority (their own, in this case) that permeates this discussion. The presentation in the APA report may take a more reasonable approach to religion and may not overstate the risks as has been done in the past, but it's still biased non-scientific hooey. If you accept the anecdotal "self-reported" harms of certain therapies, accept the causal link of therapy and mental illness (as they did when they labeled it iatrogenic), then you are not being scientific. They could pass it off as ignorance of rigorous scientific requirements except that they rail on the reports of benefit (limited albeit legitimate) for the exact same reasons.

How can they possibly claim with a straight face that their report here is authoritative, unbiased, etc., implying that it is the definitive statement on the subject when it's just biased boloney couched in scientific sounding language.

I'm not criticizing the ultimate conclusions, although they are inconsistent within the report. My critique is not of the merits of SOCE but the merits of this report. And I point out the perils of accepting such reports because they sound like they can be trusted.

Ron Schow said...

Like you, I have not read the entire 129 page report. However, I have read significant portions of it and I know that some statements in the early part are amplified with more references and explanation in the later sections. This is an important summary with over 60 references and it has tabular data and a review on 83 studies in terms of samples size, type, research design, etc. I don't think anyone should dismiss their review of the subject without very careful and thorough study. Lee Beckstead, an RM, and Ph.D. from the UofU who was on the committee was probably responsible for including findings from his study of Evergreen participants and also refers to other NARTH affiliated work so there is an effort to consider the full range of views on this issue. I don't see blatant bias, but I wonder if you have looked at the Ryan, et al study in the recent Pediatrics article. I'd be interested in your take on that because the issue of harm there is very much a concern in our LDS community when we consider the teens and young adults who are coming out to their parents in ever greater numbers, I think.

Like you and Throckmorton I think the conclusions from the task force have moved the APA in a good direction.

Anonymous said...

Thank you. I believe the team is biased (granted, it's impossible to not be when it comes to homesexuality) and don't hold themselves to their own standards. It was nice to read your dissection of it.

Draek said...

I get very confused by gays who are out as gay, but yet still either think being gay is a mental disease, or still listen to these people try and make sense of it with science...

Look in your heart and you will find the answers...

The fact that you can "swallow" the pill that being gay is a mental illness, saddens me.. not sure I'll keep reading this blog if this is your viewpoint...

-L- said...

Hello, Draek. I specifically say in the post that homosexuality is not a mental illness, so hopefully that clarifies that. And that homosexuality makes having babies tricky is a fact, not an opinion, and not something that makes me see my self-worth any differently. I'm just fine recognizing reality for what it is, and my heart really doesn't have much to say about it that's relevant. My heart frequently speaks up anyway. :-)

If you read much of my blog you'll find that I'm not a self-loathing gay, and the fact that I don't tow the gay party line doesn't mean that I have anything against gays either. Happily, I can just sit back and enjoy my happy life knowing that it's a very rare thing in my demographic.

Draek said...

Thanks for clarifying that.

And I'm not a pride parade gay either. I dont think we need Pride in the sense that we have it today. I used to walk in protest against discrimination of gays, but I don't take "pride" in being gay. I don't think that parades are really necessary anymore. What we need now, is we need gay people to live honest, wholesome, constructive lives.

And yes, having kids is tricky, but thats just a reality like you said. Personally, I believe that the command to "Multiply and Replenish the Earth" is applicable to gays as well as straight people. It doesn't mean that EVERYONE has to procreate, some people can't. But those people who cannot, are still able to replenish the earth by raising kids who have been given up or abused by their heterosexual parents. We can still help raise an enlightened generation.

I agree with the position that the "gay lifestyle" as mormons see it, the bars, the drinking and the sex, is a bad way to live, and is sinful and hurtful to the individuals involved. But that in itself has nothing to do with homosexuality, thats just the mainstream society. And honestly, branding that a "gay lifestyle" is actually completely inaccurate. Its no different than the "straight lifestyle" that many "bar stars" live in both worlds, gay or straight.

If anyone thinks that gays who party and go to bars are MORE PRONE to sexual promiscuity than straight people who live the same type of life, that person is COMPLETELY ignorant.

Anonymous said...

Draek, I think we can check "multiply and replenish the earth" off the list. At least the multiply part.

Draek said...

I disagree. The call to multiply and replenish is not a individuals mission. It would be absurd to ask your creations, some of which may not be able to reproduce for various reasons, something they cannot do. It is more just and logical to ask everyone to contribute according to their skills and talent toward this goal.

I believe God is just.