LDS Therapists Should Abandon Harmful Ex-Gay, Conversion, Reparative and Re-Orientation Therapies

Paul’s story is not uncommon.  I have heard it dozens of times since I came out last year in support and advocacy of our LGBT sisters and brothers.  Paul did not choose to be gay.  In fact, he did everything that his church leaders counseled him to do including getting married.   He was told that getting married along with prayer and fasting, would take care of “the problem”.  Finding that marriage and “praying the gay away” did not turn him straight, Paul eventually had the heartbreaking talk that no spouse wants to hear.  His wife was understandably upset, shocked, and shaken.  She too had been conditioned to believe that these “tendencies” were a matter of will power and choice and could be simply corrected through referrals by leaders to marriage and family relations classes and “reparative therapy”.  As is most often the case, the result did not meet expectations and she blamed Paul for his inability to become heterosexual.  She began to withdraw her support, believing that he simply wasn’t motivated enough to change his sexual orientation.  They ended up divorcing and Paul began to be engulfed in feelings of self-hatred and self-loathing.  Feeling abandoned and increasingly isolated, depression escalated to the brink of Paul having suicidal thoughts and planning to take his own life.  Such is the case with many of our loved ones, friends, and neighbors who are LGBT.  Tragically many of them do end up taking their own lives.  In fact, LGBT individuals who face rejection from their families are shown to have significantly higher suicide rates.  Many LDS mental health professionals, such as myself, have come to realize that it is not the orientation of an individual that can cause depression and suicide but more often it is the rejection of family and community, as well as the homophobic rhetoric and actions of others that push many LGBT individuals to the brink.  But now new information has recently become available that has and will continue to radically change the therapeutic landscape.

A few weeks ago, Robert Spitzer, a prominent psychiatrist and researcher who authored a controversial study in 2001, apologized to the gay community.  His 2001 study on “reparative”, “conversion”, or so called “reorientation” models of therapy supported the notion of Paul, his wife, and many local church leaders, that LGBT individuals could indeed become straight through these models of therapy.  Although many researchers and therapists thought the study was already on shaky methodological ground to begin with, there were also many therapists, researchers, and authors on the subject of homosexuality and mental health who referred to this study as the definitive proof that such models were scientifically acceptable, ethical, and competent.  In many respects it was the keystone study that most non-affirming models of therapy relied on.   It turns out that Spitzer was wrong, his study was flawed, and in an unprecedented mea culpa he withdrew his support for his own study and has now apologized to the LGBT Community.  The last thread of competent scientific support for these models of therapy has been cut.

            To be fair to Spitzer, he is also notable for his bold efforts in 1973 to take homosexuality out of the Diagnostic Statistical Manual (DSM) that mental health professionals use to diagnosis mental health disorders.  Spitzer should be credited for taking this important step.  However, many therapists and counselors were still slow to embrace this change and continued to see being LGBT as a mental health disorder that could be changed through counseling or as an addiction that could be managed.  With Spitzer’s notoriety and credentials as someone who clearly was not anti-gay, his 2001 study accelerated the use of “reparative” therapies.  Books were written.  Success stories were hailed.  Money was made off of the hope for a supposed cure or control for homosexuality.  Thankfully, Spitzer in the end did not want his legacy or his name tied to this movement.  Likewise, do we who are LDS mental health professionals want to be tied to a legacy of unfounded, non-evidence based models of treatment that are ineffective at best and at worst destructive to the mental and emotional well-being of LGBT individuals and their families?

In addition to Spitzer’s historic and monumental announcement, another study by Renee Galliher, Ph. D., John Dehlin, M.S., and Bill Bradshaw, Ph.D. has also come out showing empirical support that LGBT Mormons typically do not benefit from reparative therapy and many of them have in fact been harmed by those models.  The research is well worth reading and may be one of the first of its kind to assess the efficacy of different treatment modalities with the LGBT Mormon population.   Preliminary results of that study can be found here:   http://ldshomosexuality.com/wp-content/uploads/USU-LDS-SSA-Newsletter-v1.pdf

The Church Handbook of Instructions wisely advises ecclesiastical leaders to encourage members not to “use medical or health practices that are ethically or legally questionable” and instead encourage members “to consult with competent professional practitioners who are licensed  . . .” (CHI 2010, 17.2.6, pg. 162).  I can’t think of more ethically questionable models of therapy than ones that attempt to change orientation and are sometimes developed and run by unlicensed individuals.  I believe it is up to us as LDS mental health professionals to help educate the LDS Community to know what is helpful, ethical, competent, safe, and evidence based practice in mental health treatment for our friends and family members.  Promoting orientation as an “addiction” or telling individuals and families that non-credible treatment models are effective should not continue.

I believe we need to turn our backs on these models, as well as the equally ineffective or destructive view that somehow orientation itself is an addiction.  It is not unusual for LGBT Mormons to be referred to church sponsored addiction recovery groups and programs due to their orientation.  Like many other Mormon therapists have come to realize, I have found that there are more affirming models that will promote the mental and emotional well being of LGBT Mormons that are scientifically sound and also consistent with Christ-Centered principles.   I believe that 20-30 years from now the practice of reparative therapy for LGBT individuals will be viewed with ethical abhorrence in a similar way as we now look back at the eugenics movements of the early and mid twentieth century.

Thankfully, more affirming and evidence-based models of care for LGBT individuals and their families are being developed.  One of the most promising is the Family Acceptance Project developed by Dr. Caitlin Ryan and her colleagues.  Their family support work is based on rigorous research with LGBT youth, young adults and families. Their studies are published in peer reviewed journals starting with the first study on family rejection -- published in the distinguished journal Pediatrics in 2009 -- that showed a clear link between parental and caregiver rejection of lesbian, gay and bisexual youth with negative health outcomes such as drug use, depression, and suicide and HIV risk in young adulthood.  Thus, to a greater extent than was previously understood, the critical work that must be done is with the family and the community to help educate them on interactions that will be supportive and affirming.  For more information on The Family Acceptance Project and Dr. Caitlin Ryan’s research, please visit:  http://familyproject.sfsu.edu/.

Recognizing that spirituality can be one of many important protective factors against suicidal ideation, Dr. Ryan has attuned her work and research into being culturally sensitive to the religious and spiritual milieu of LGBT individuals and their families.  Her work will soon generate the first evidence - based education materials for LDS families with LGBT children followed by an education program specifically targeted and customized to the needs of LGBT Mormons and their families.   It is expected that her materials for Mormon families of LGBT individuals will start to be released in July 2012.

Educating families and other crucial members of an LGBT individuals’ support system may be one of our most important challenges and opportunities as LDS mental health professionals.  Families, school officials, community and church leaders need to know what interactions are potentially harmful and what interactions are helpful with our loved ones, students, and neighbors.  Knowing this could be a matter of life and death.  Many LDS therapists have already changed course and become more affirming of orientation in their practice.  These pioneering Mormon therapists search for safe pathways through a homophobic wilderness and a polarizing political, cultural, and religious climate.  LGBT Mormons are particularly vulnerable.  On one hand they hear loud angry voices telling them to leave their “hate filled” religion, and on the other hand religious, cultural, and political extremists in the church continue to use the church to promote fear, long dispelled myths about being gay, and even hateful words and actions towards LGBT Mormons.  Dr. Ryan’s evidence – based, competent research and compassionate family intervention approach will only bolster those therapist’s conceptual models and effectiveness in helping their LGBT clients navigate these challenges as well as the essential component of educating family members how to become a safe and protective shield for their loved ones against these angry voices.

Now more than ever before, competent, fair-minded, LDS mental health professionals need to protect the emotional and mental health of our LGBT clients and educate families, community, and church officials in the LDS Community.  I am confident that as LDS therapists take these steps, not only will we be more competent and effective in helping individuals such as Paul and his family members, but we will also help save lives.

Kevin Kloosterman, LMFT is a mental health professional in Illinois who works in an outpatient mental health hospital setting and in private practice.  He has been a licensed marriage and family therapist for 12 years and is an advocate and ally for LGBT individuals in and out of the church.

Forgiveness

Written by St. Jude

A few weeks ago I decided to run away from home for a few days. I received some really bad news. So bad that when I heard it, I began to shake and then just kind of went numb. I ran away to my sister’s house and announced to her that I didn’t want to talk about it.  She was amazing and let me stay as long as I needed to. I wanted to stay forever, but eventually you have to grow up and go home and face life. Somewhere out along the I-10 it seemed like the closer I got to home the more the numbness began to wear off. The shaking returned along with uncontrolled tears and anger. I didn’t deserve this, and I knew I didn’t. I wanted to pull my car off on to a dirt road out the middle of the desert and get out and scream at anything that would listen, a lizard, a snake, a scorpion it didn’t matter. A thousand and one thoughts raced through my head. I glanced up at a sky that looked completely void of life or anyone or anything who cared and with every cell in my body I yelled “F____! I proceeded to “F this, and F that.” In the back of my head I realized I looked like a crazy women; 50 years old, driving through the dessert yelling profanities at a universe that probably wasn’t listening. And it didn’t matter. It didn’t matter that no one saw my dance of insanity out in the desert, or that no one showed up with any answers to my problems. It was like the freedom you feel when you are alone; dancing to the radio, completely lost in the melody. Having no partner to dance with is hardly the issue.  But, the thing of it is, I felt better. Well, most of me felt better, my throat hurt for 3 days.

This one event made me feel so much better that I started wondering what else I could do that might make me feel better about life. To answer this I had to ask myself what doesn’t make me feel good about my life.

What I ended up with was a list of everything I have never forgiven myself for. It amazed me the things I was still carrying around. I had managed to still be feeling guilty about things I had done at age 9. And as ridiculous as it was, the feelings of guilt were no less real. I totaled up 28 things I had not forgiven myself for. Looking at the list was depressing. It really doesn’t do a lot for your self-esteem to put all that down on paper. “Well that’s great.” I thought “Now what? All I have to show for this list is a clearer perspective on how much I suck.” On my list I saw people who I wished I could apologize to. Some I had apologized to but I still carried it around. A few I had even asked for God to forgive me for, and yet they still stuck with me. After all this time, I couldn’t help but wonder if forgiveness is even possible or is it just a nice thought that makes our own regrets seem more palatable. Looking at this list made me realize that if there is a God, he may or may not forgive me, and there really isn’t much I can do about that other than lay it at his/her feet and say “Thy will be done.” When it comes to asking for others to forgive us some will, and some won’t. There are no guarantees there either. The only thing we have control over is the ability to forgive ourselves.

I decided to dance with my list. To really look at each issue and confront it for what it really was no matter how uncomfortable it made me. I promised myself I wouldn’t make excuses or place blame on anyone else. I would own all 28 of them.

What started as a really uncomfortable honest look at my life, turned into something I would never have imagined. I came away feeling as though I was perfectly flawed, as if my life was not being lived if it was mistake free. In any given moment I am making choices based on the tools I have in that moment. What will turn out to be an obvious stupid choice to me 10 years from now probably isn’t so obvious to me now or I would be making a better choice. These are my mistakes and my lessons and I felt happy to have lived them, and to have learned from them. These mistakes are what make me who I am and you who you are. The good choices we make are part of who we are, just as the bad choices we make are part of who we are, but the bad choices can only go from being a burden to a gift if we face them, live the lesson learned and let it go.

When I finally finished dancing with my list I ran to the store and bought 4 helium filled balloons. On each I wrote the things I had forgiven myself for. Where I wrote someone’s name underneath it I wrote “thank you” because I realized that I had learned a valuable life lesson from how I dealt with that person, even if the lesson was I will never treat someone like that again. Or maybe it’s because the people I meet in my future will benefit from the mistakes I made while I knew you. And that’s a gift I wanted to thank them for giving me. On the top of each balloon I wrote “let it go”.

I waited until it got dark before I released my balloon. I didn’t want to watch them slowly fade in the distance, to me that was like trying to hold on to something I no longer needed. In the dark I could let them go and they would be gone. As I walked into the field I told all the people on my balloons that I could no longer carry the blame or the guilt on their behalf. I had done it for too long and they could forgive me or not, but it was time I forgave myself.

We dance with complete abandon when no one is watching. We can scream at the universe when no one is listening, and we can free ourselves when we seek forgiveness from the only one who can truly give it.

Suspension of Disbelief and Compartmentalism

Written by Bill Law

How the ideas of “Suspension of Disbelief” and “Compartmentalism” relate to each other and how this dynamic affects an individuals relationship to their religious organizations.

As a person who struggles with their relationship to the LDS church I do a fair bit of thinking about why that is.  A lot of people who struggle with the church say that they had no idea the church had these troublesome things in its past and when confronted with reality can know longer be in the church and still maintain their integrity.  That is not my story.  Others say they knew some things about church history, but put them on a shelf.  Eventually the shelf got so heavy it crashed and left them without a testimony.  That is closer to my story, but I still don’t think it is a good explanation.

For myself, I don’t think it really matters how much stuff is on the shelf.  Something else external to the shelf has caused me to look at the history of the church and look at it more objectively.  This is one of my attempts at trying on an explanation and seeing if it makes sense of my relationship with the church and how it came to its current state of being.

We learn how to behave and interact in the world largely by trial and error.  We learn what is socially acceptable by doing things that aren’t socially acceptable or watching other people do things that aren’t socially acceptable and seeing the reaction of society.  I suppose this is a bit negative.  We also do things that are socially desirable and see the results of those actions, which reinforce the behaviors that are acceptable.

These lessons are highly situational.  What is acceptable or desirable in one environment may be very unacceptable in another.  We compartmentalize our behavior.  We behave very differently at home, at school, at work, at church, and when alone with our friends.  It gets even more complex than this as your position within the environment also affects what is appropriate or desirable behavior. 

There was a study that argued that work environments where cussing occurred had a stronger sense of community. Why would that be?  Does the sense of community allow people to be more relaxed and allow them to feel free to cuss, or does the cussing increase the bond within the members of community?  I believe that both occur simultaneously. 

Relationships of any sort are really just about trust.  A relationship between a supervisor and employee is really about a manager trusting the employee to act in a way that will reflect well on the supervisor and the company and that the supervisor will act in a way that meets the needs of the employee to feel valued for their efforts.  This trust builds in a transactional sort of way. 

To illustrate, imagine yourself on a work team that has to fix a problem because another group failed to foresee how a change they made would affect your team.  The manager says with a smile something like “those bastards over in IT did it to us again.”  One reason the statement builds community is because it creates a common enemy for the team, but another reason is because of the word “bastards.”  By using that word the manager is being “open” and in a sense is sharing vulnerability. 

Your team knows that your manager won’t use that word in other environments, therefore her willingness to use it with you, is a demonstration that there is a closer bond or rapport that isn’t shared with those other groups.  This invites members of the team to be more relaxed.  Maybe the team isn’t relaxed enough to also use the word “bastard”, but surely feels more freedom to express frustration at the IT department.  In a small way both the manager and the team allowed themselves be a little more vulnerable.  After the exchange, both the manager and the team feel a great sense of community.  Both parties trust that the others won’t use the increase openness and vulnerability to hurt the other.

Another example is friends who rib each other about their recent performances during some sport.  One friend says something derogatory about the other and the other returns the favor by flipping him off.  Neither is mad. These are displays of friendship.  This behavior would never be used while at work or while serving in their religious positions.

Everyone must learn to compartmentalize behavior in order to interact positively in society.  Religions attempt and in some respects are successful at moderating behavior in all “compartments” of individuals’ lives.  Now we will look at the concept of “suspension of disbelief” and then attempt to show how that concept is related to compartmentalism and then tie that into the religious sphere.

The concept of “suspension of disbelief” is often used in terms of movie watching.  We see good guys get shot at by guys with automatic weapons and manage to escape unharmed, yet the good guy is able to take a 9mm,pop out from behind a barrier, and pick a bad guy off the top of a building with a single shot.  Another example was a man in a convertible who drove up a ramp sitting on the side of a freeway causing his car to do a 365 degree spin.  While upside down he connected a hook (which is attached to some immovable object) to the bad guy’s car.  He lands the car, does a bit of fishtailing, but otherwise escapes into the sunset unharmed. Meanwhile the bad guy’s car has a spectacular wreck and explosion.

Why do we participate in and enjoy something so spectacularly impossible?  Well to be honest, sometimes the implausibility becomes too much and pulls us out of the movie and our suspension of disbelief fails and we don’t enjoy the movie.  But we are willing to suspend a whole lot of belief and still find movies worthwhile and entertaining.

The concept of suspension of disbelief is largely an argument that the audience has a role in their movie going experience.  In any work of fiction there are going to be things that don’t completely make sense.  The audience acts with faith that there is some human interest and semblance of truth to make the movie worthwhile.  Some of the burden of whether a movie is successful falls on the shoulders of the moviegoer.  The moviegoer can choose to suspend disbelief or can be distracted by the inconsistencies to the point where the experience fails.

This doesn’t mean that the creators of the movie are free to do whatever and blame the moviegoer for being nitpicky if a movie isn’t well received.  If movie creators want a movie to be well received (and they do) then they need to create a film that doesn’t overly challenge the viewer's sensibility.

So far we have only talked about suspension of belief in terms of "over the top" action sequences.  There are much more subtle ways that a movie can make itself too implausible to be believed.  Sometimes movies are criticized as being too derivative.  Another way to voice this complaint is to say that the movie was so formulaic and the plot had been seen so many times before that it was overly difficult to suspend disbelief due to its predictability.

If you have watched very many scary movies, and you see a character go up to a monster to confirm that the monster is dead, you may find yourself laughing in anticipation of that character being eaten.  If you see a minor Star Trek character in a red shirt leading the way into a dark tunnel, you can bet something bad is going to happen to that character.  If there’s another hour left in the romantic comedy and one of the lead characters is about to divulge their undying love to the other main character, you can bet that other character is going to start dating someone else before they get the chance to express their feelings.  You can also bet that right before the end they will have "the talk" and be together.

When you know what is going to happen in a movie before it happens it pulls you out of the movie.  The movie is no longer authentic.  It just becomes actors on a screen performing a role.   Instead of being inside the movie you take a step outside the movie.  Sure you always knew the two dimensional characters on the screen weren’t real, but on some level you could relate to them.

This brings us back to compartmentalization.  We compartmentalize our knowledge that the movie isn’t real, with our belief in the characters as people we know and like.  In a 100% rational world, we would never find any movies enjoyable.  We couldn’t never resolve the cognitive dissonance between knowing that Leonardo Di’Caprio was paid to pretend he was sacrificing his life for Kate Winslett, and the emotional belief that Jack truly cared for Rose.  Instead we compartmentalize.  The story and actors may be completely fake, but we believe in and have faith in the meaning or emotions expressed by the made up story.

My struggles with the church doesn’t stem from the fact that the first vision story is implausible.  My problem is that I know longer relate to that foundational story, because the characterization of Joseph Smith has become so contrived and simplistic that I no longer relate to the correlated church version of the story.  I have been pulled out of the story by the lack of authenticity.  Correlation has made the teaching of church doctrine so derivative and simplistic, that I can know longer suspend disbelief as my more complex views aren’t accepted in the narrow and shallow universe that correlation has created.  Interactions within the religious setting have become role playing exercises where we say all the appropriate things.  The plot is so predictable, that it is no longer meaningful or helpful.  Interactions now lack any conviction or believability.

For example, Home teaching is now viewed as duty of assigned friendship and not about friendships based on trust where vulnerability and honesty are shared for the benefit of both.  When the home teacher asks “is there anything we can do for you.” This isn’t an honest interaction.  Sure, the person asking may be willing to do the service, but that service would be rendered out of a sense of duty.  We don’t care about the characters in the interaction.  The foundational interactions that gain trust and allow people to be vulnerable haven’t occurred.  The people in that interaction don’t trust each other as evidenced by the fact that they don’t know what the other person needs.  Home teaching is too simplistic and doesn’t provide the means for authentic relationship building where people trust each other enough into their real authentic lives.  Instead we frantically clean our homes to present an image of what we think the culture wants us to be, even though that’s not who we really are.

My problem is that the church has become fake.  A parody of what it should be.  I have been pulled out of the religious experience and am no longer able to compartmentalize my knowledge of certain aspects of history with the truths I have found within religion in the past.  Some of the blame may fall on me as an overly picky movie goer unwilling to suspend disbelief.  A large portion of the blame goes to some suits who have insisted on editing the cultural experience into an overly simplistic derivative plot.  I now stand as an analytical outsider of the culture, no longer able to relate or interpret my own experiences through the broader religious culture.  I am no longer able to compartmentalize my knowledge of history and science with my knowledge of what is true spiritually within the church.

Mother's Day

I have to admit it.  Mother’s Day has been my least favorite holiday for a very long time.  If there was a national holiday celebrating root canals or bunions, I would probably prefer those days to Mother’s Day.

I don’t hate being a mother.  My ambivalence for the day has nothing to do with my own children.  I have grown up with my children, in a very real way.  I have good children.  I can see them turning into happy and productive members of society.  This makes me very happy.

But for many years, Mother’s Day meant two things for me. One was the reminder of the strained relationship I have had most of my life with my own mother, and the other was the permanent reminder that I was never quite the mother I thought I should be.

Two or three different times I was asked to speak in Sacrament Meeting on Mother’s Day.  I would have never said no, but I wanted to shout it back at the bishopric member who asked me.  The last thing I wanted to do on Mother’s Day was stand and speak before two hundred people about all of the blessings of motherhood when I felt so woefully inadequate myself. My heart broke a little each time I had to speak of motherhood after the years I had struggled to make some sort of relationship with my own mom.

Then the worst part of the day would always come when each woman in the ward was presented some small trinket or gift.  Once it was a chocolate chip cookie on a stick.  This was almost never a good idea; give the mother of small children a cookie for herself after her children have endured long hours of sitting still and listening in church clothes.  I had three small children who, after several hours of church, wanted that cookie worse than they wanted oxygen.  Of course I would not have denied them a bite.  Who wants to spend Mother's Day selfishly chomping on a cookie in front of a three-year-old?

Most popular were the flower plants.  Neither of my two thumbs is green.  Receiving a plant reminded me of just another aspect of Mormon womanhood that I hated.  Every attempt I made to grow a garden, vegetable or otherwise, usually ended with me sunburned, exhausted, and in a heap of tears.  But the prophet said to plant one, so that’s what I did.  Worse was the inevitable church leader who was always ready with the razor sharp wit: “We’ll see how many of you mothers still have the plants alive next year.”  Great, thanks.  More guilt.  More work.

Some years the gifts were handed out to the mothers according to the number of children she had.  For someone having just two children for many years, this always left me feeling embarrassed for not having more children.  I hated feeling as if my worth depended upon the number of children I had.  I know only the best intentions were ever part of the efforts to recognize mothers, but the messages were still there.

Motherhood means something more to me now.  After so many wasted  years I am beginning to let go of unrealistic expectations and guilt and focus on the joys.  I don’t feel guilty for a quickly prepared dinner or balancing my career and my home.  I find joy in the milestones my kids reach, and in watching them grow into people of integrity and principle.  And for my little girl, hearing the future she plans is the icing on the cake.  She has the idea that she can be anything she wants to be, including a mom and about fifty million other things.  I just want her to feel like whatever she is, well, that’s good enough.  And worth celebrating.