Docsplainin' -- it's what I do

Docsplainin'--it's what I do.
After all, I'm a doc, aren't I?

Tuesday, March 31, 2009

Anonymity and other matters

I was going to tell "Anonymous" that he can't have it both ways--either I'm an stereotypical histrionic female or I'm dogmatically scientific. (In fact, I am neither.) But then I looked at the writing style(s) a bit more closely and concluded that I may have not one but two Anonymouses (Anonymice?).

It's hard to tell without a numbering system (Anonymous 1, Anonymous 2, . . .).

Be that as it may, one or both of them wants some research citations on affirmative therapies.

Watch this space: I'll get a biblio up soon.

Saturday, March 28, 2009

Godbagism and Gays

"Anonymous," commenting on my previous post, referred Rules readers to a book on results obtained by the Exodus program in converting gays. I would like to thank "Anonymous" for that link, as I was not aware of the book. Following that link--and Googling some people and institutions referred to there--led me to a whole bunch more stuff of which I was not aware. However, I did not discuss religious conversion in that post, and I'm not going to discuss it here, because the topic, as I am sure attentive readers noticed, is the ethics (or lack thereof) of professionals attempting treatment of a core aspect of identity (not a disorder). That's number one.

Number two, I am a psychologist, not an imam, monk, priest or rabbi. As such I am neither interested in nor qualified to speak to issues of sin and redemption. And I certainly make no pretense at knowing what God does or doesn't want, or at having any authoritative knowledge of who or what "God" is. I've never even met Him/Her/It/Them. I have my spiritual beliefs, but that is all they are--beliefs. Not sure knowledge. Beliefs. That's why we call the religions of the world "faiths" and not "epistemologies".

Number three, psychology, albeit with mixed success, historically has sought to explicate the universals of human nature. We seek to help people of all faiths or none to lead happier, healthier, more productive lives, and we seek to do so on a foundation of objective science (insofar as science can be objective). And thus far, science tells us that neither gender identity nor sexual object preference, per se, have any bearing on these goals. (This data would make a whole book, never mind one post, but for starters, see the groundbreaking work of Evelyn Hooker.)

The book "Anonymous" links to was written by a Christian psychologist, a professor at a Christian university, using graduates of a Christian conversion program, published by an evangelical publishing house, and it clearly proceeds from that bias, thus violating every rule of relevance enumerated in the preceeding three paragraphs. I mention it here only because I know a certain proportion of Rules readers are going to follow that link, as I did, and will find that the book purports to be science.
"Homosexual behavior is clearly condemned in the Holy Scriptures, but God always provides a way of escape from the sin that entangles us. I am thrilled there is finally scientific research which compliments the tremendous freedom that I have experienced personally and that I have witnessed in others during my 20 years with Love In Action International. I hope this study will open the door for more unbiased research of this caliber."
Thus spaketh the Rev. John J. "Finding Freedom in Jesus Christ" Smid, President/CEO, Love in Action International, Inc. (an ex-gay group) in response to the book. In case you had any doubt, this makes clear that the book is for people whose bag is one particular version of God, not for those whose bag is objective Science, or for that matter, any other faith. It is religion, not science because it is about sin and redemption in the narrow context of one minority faith.

It is not science also because it is not the norm for scientists to first publish studies in book form, but to use peer-reviewed professional journals to disseminate new scientific knowledge to the scientific community. When one does publish one's work in a book, it is usually in the form of a roundup of not only one's own previously-published peer-reviewed articles, but those of other experts in the field as well. These studies are integrated into a well-rounded summation of the state of knowledge at the time on your topic.

So what we have here is a book on religious conversion, not on psychological or psychiatric treatment, counseling, or clinical social work. What we have here is "data" which has not been peer-reviewed and which may or may not apply to LGBT persons who are Muslim, Catholic, Jewish, or Buddhist, Jain, Baha'i, Shinto, Zoroastrian, Pagan, Sikh, Rastafarian, or Hindu. It will only appeal to people whose bag is this one particular (protestant evangelical) brand of faith.

If that suits you, if you're an evangelical Christian who believes that being gay is a sin, then by all means go buy the book and read it. Just don't be mistaking it for science.

Thursday, March 26, 2009

Homosexuality was removed from the Diagnostic and Statistical Manual list of psychiatric disorders in 1973. On August 14, 1997, the American Psychological Association (APA) Council of Representatives passed, by a vote of 10 to one, a resolution against so-called "reparative therapy" for gays. The first "whereas" makes crystal clear our view, as a profession, of this type of "treatment":
Whereas societal ignorance and prejudice about same-gender sexual orientation put some gay, lesbian, bisexual, and questioning individuals at risk for presenting for "conversion" treatment due to family or social coercion and/or lack of information . . .
And yet.

And yet, more than ten years later, there are still folks out there who think they can and should "cure" people of being gay. Or bi. Or transgendered. Twisty Faster, over at I Blame the Patriarchy, or IBTP for short, has brought to the attention of Blamers worldwide this BBC report on a study just out about some retro Neanderthal types in Great Britain. The journal, BMC Psychiatry, is open access and you can read the entire study here. The study reportedly found that, if asked by the client to do so, 17% of the mental health professionals surveyed would attempt to help a client change her or his sexual orientation*. The authors' conclusion?
Given lack of evidence for the efficacy of such treatments, this is likely to be unwise or even harmful.
"Likely" to be unwise? "Or even" harmful? You think? This lukewarm disapproval is bitterly disappointing, to say the least. Such practices are deemed unethical if not downright abusive (I believe the American Psychiatric Association uses that word) by every major professional group in the United States, Canada, and Great Britain that I know of, and I assume in most other progressive societies. I wish that the authors had unequivocally condemned such behavior, called for more education of the holdouts, and stern discipline of those therapists offering such "treatments".

The authors note that this is a "significant minority" but again, I think they are under-reacting. That one in six British therapists may have attempted to "cure" somebody's sexual orientation is scary. As the writer of a student dissertation on a related topic pointed out, this reveals a really serious problem with these people's training and ethics. It points up serious failings in training programs and in our ethical oversight of our peers. In other words, this is a problem for the profession as a whole, and it is a big one. The estimates of the proportion of therapists who violate sexual boundaries is, by comparison, much smaller, but our profession has generated reams of ink on why they do it, how to stop it, the effects on the victims, and so forth. If this kind of abuse is so much more frequent, how come it's not getting the same attention?

And according to the BBC, another group of researchers is trying to collect "stories" of successful changes via a website. I couldn't track them down, so I can't tell you anything else about it. But lord, lord. Does it never end? How can any ethical psychologist contemplate conducting research into unethical treatments? How can the rest of us, as ethical psychologists, countenance others doing it? And who the hell is funding this garbage?

They just don't get it. Except for one pretty seriously flawed study, there's no evidence that this even works, never mind that it is the right thing to do. Unfortunately, some groups advocating reparative "therapy" have seized on that one. It was published in 2003, by Robert Spitzer, in the Archives of Sexual Behavior. Spitzer asked, "Can some gay men and lesbians change their sexual orientation?" His answer was a qualified "yes," and it sparked a storm of criticism (26 letters to the journal, which is almost unheard of) and outrage.

Spitzer interviewed 200 self-selected reparative "therapy" patients and reported that the majority reported achieving re-orientation to at least "predominant" heterosexuality that lasted more than five years. At what cost to their general mental health? He didn't ask. Besides that little omission, his study was criticized for its sampling method (subjects were self-selected) and for its reliance on self-report.

It has been long established scientifically that there can be extensive differences between potential subjects who do not participate in a study and those who self-select in. It is also long-established fact that people in similar situations are motivated to perceive change in the desired direction. These clients after all have spent money and time in therapy to change, and their views of what they got from these efforts are going to be biased accordingly. Spitzer's data would have been a lot more credible had he studied all the clients of a given treatment program or programs and had he obtained objective before-and-after assessments. In short, it's lame even as pilot studies go.

He's not a bad guy. But I think he exhibited terrible judgment in conducting this study. If we are going to study treatments that have already been declared unethical, of "problems" that have already been ruled not problems, then we need to be focusing our money and our time, effort, and talents on exploring the damage done by those treatments and how, if it's possible, to undo the damage to their victims. But nobody asked me.

That same year, another group published a study of a more general nature, also using survey data. This one, "Predictors of psychotherapeutic benefit of lesbian, gay, and bisexual clients: The effects of sexual orientation matching and other factors," was published in 2003 in Psychotherapy: Theory, Research, Practice, Training. Note that the authors were not specifically investigating reparative therapies, but therapy for LGB clients in general. These authors found that
Negative predictors include having a therapist who is an analyst, who uses reparative therapy, or who violates sexual boundaries (p. 289).
A quick check of PsychLit tonight produced no additional published research, only a how-to book containing "personal testimonies" and one single-case study (by an analyst). In short, no one advocating this practice is producing any real data to say that it works. (Spitzer, it must be noted, is not an advocate. He just thinks we need more data, which is hard to disagree with, except I just have to ask, "Man, if it's not a disorder, why do we give a rat's ass whether you can cure it?") Plus, those advocating this practice are proceeding on the clearly-stated assumption that being gay is dysfunctional, which assumption no professional group of which I am aware accepts.

If being gay, bi-sexual, or lesbian is normal, which the helping professions all now agree that it is, then buying into the client's desire to change it is buying into their internalized homophobia. (I'm not even going into forced treatment of children and adolescents: That's a whole 'nother rant.) It is agreeing with them that a core facet of their very identity is something to be disgusted by and ashamed of. Therapists like the 17% in the Great Britain survey may claim the best of intentions, but in fact are using their power as credentialed healers to do severe damage to suffering individuals who instead need to be relieved of their shame, not their orientations.

One of my absolute favorite clients made her first call to the office to ask The Question: "My son needs a therapist. But he is gay and before I make an appointment with you, I want to know how you feel about that." Usually, that question is code for, "Our kid just came out to us and we're in total panic and want you to fix him/her now, if not sooner." It's a hard question to answer, not because I don't know how I feel--I do--but because I want that teen in therapy with me. The last thing I want for him or her is for ignorant, homophobic parents to keep calling around until they find a therapist who will agree it's just a phase, a fad, or something to be cured. So I took a deep breath, and answered, as I usually do, "That's like asking me how I feel about gravity, or the weather. It just is what it is. May I ask why you want to know?" When the parent(s) tell me that they want treatment for the gay-ness or the trans-ness I do my best to educate them and get them to schedule an intake. Sometimes it works, sometimes it doesn't.

This mom, God bless her, laughed out loud, and said "Good! Because being gay is not his problem and I didn't want a therapist who would assume that it was." And we scheduled an appointment.

We did talk about being gay in that young man's therapy, because his father wasn't quite 100% on board with it, and because his school allowed bullying to continue unabated--even blaming my client for coming out at school (he didn't, he was outed). He was already well wired-in to the gay community, so he didn't need any pointers there. What he was here for was his obsessive-compulsive anxiety disorder, and that is what we focused on.

And that is as it should be. Any therapist who attempts to make a lesbian's or gay man's orientation an issue any more than a straight patient's would be ought to be taken to the ethics woodshed. Same goes for any therapist who would make an issue out of a transgendered person's identity: It should be no more of a factor in the therapist's mind than a straight client's gender identity would be, except for the obvious--that LGBT clients are a harassed, discriminated-against, abused, and not-infrequently-murdered-for-it minority who also suffer internalized homophobia. And those problems certainly should be at the top of a therapist's list of issues to deal with.

*A student at Kennesaw State is conducting a similar study, but asking whether therapists think a long list of practices associated with reparative therapy are ethical. To me, it's not up for discussion (this is Ethics Codes for Dummies) and I'm more than a little uncomfortable with the study for that reason; nevertheless, it will be interesting to see whether his results tally with the 17% of the other study. I'll keep you posted.

Wednesday, March 25, 2009

Sometimes you feel like a nut!

Dear Readers:

It's a cool spring day, but these leaves are warm here in the sun, AND I've got a bone! Life is perfect.


Editors Note: Dogs know how to live in the moment. And if we will let them, they can teach us. -vsw

Friday, March 20, 2009

Two Things I'm Unhappy About Today:

1. That the press thinks it's necessary to identify a murderer as a "transgendered wife", and
2. That Mr. Obama thinks it's funny to joke about Special Olympics.

Thursday, March 12, 2009

My First Therapist

My first therapist was a leftist Black social worker with a 'fro out to here. She looked like Angela Davis: Initially I suspected she might even be Angela inexplicably gone to ground in the South. I mention all that not because race per se is the important thing here but to demonstrate the power of social expectations of women to seize hold even of someone like her.

I knew a little about her: The VietNam war was raging at the time, and when her boyfriend's II-S wasn't enough to keep him out of the war any more, she married him to give him a higher deferment. When they started drafting married men, she got pregnant to get him his III-A. I knew that she was not happy being married, and she was not happy being a mother, either: She did it because she didn't want another Black man to die in some godforsaken jungle on the other side of the planet. That's a hell of a personal sacrifice to make for a man, and I have often wondered what she would have done to keep him out of that war if they'd started drafting married men with babies. What else of herself could she give up?

She did me a lot of good. Looking back, I know it must have been hard for her to listen to my middle-class white-chick whine for 45 minutes every week, but listen she did. Unfortunately, she laughed when I told her I intended to keep my own name when I married. She worried that I was emasculating my husband when I dreamed of living in a home that belonged to my family and having a house full of foster kids instead of going to live with him in his house and having his babies. In short, she'd swallowed the gender paradigm hook, line, and sinker--she would wrench her entire life off course to save a man the inconvenience of serving a little jail time or going to Canada. And she would worry more in my sessions about a boyfriend/fiancé/husband I didn't even have yet than about the real (female) me sitting right in front of her.

I don't know why exactly I have been thinking about her today, but I have. And I'm not sure exactly what I'm trying to say here, either. But there it is.

Thursday, March 5, 2009

Web CT hates me

Neek, originally uploaded by wherepineswhisper.

According to the Urban Dictionary Online, a "neek" is a cross between a nerd and a geek. I needed one today.

I was happily reviewing and returning proposed bibliographies to my Personality class, when I logged out for something or other. When I tried to log back in, it wouldn't let me! I could get into WebCT, and from there to my Ethics class, but clicking on Personality just got me a blank screen. Not even an error message.

So. I'm proctoring the Ethics exam and so can hardly get on the phone. I go to the Support page and start a Chat. The first fellow tells me my problem is because I am using Mozilla Firefox (not). So, knowing it will do me no good (I mean, it's never been a problem before, and I can get into one class, so how could it be Firefox??), I log off, close Firefox, and open Microsoft Internet Explorer. Of course, it does not work.

So I log back into Chat and get another fellow, who asks me to wait one while he reads the report I just filed. Which identifies me, by the way, as the Instructor for this course. So I wait. And wait. And wait.

And then I get a message from him asking, "We haven't heard from you in a while. Do you still want to talk about this problem?" I answer politely that he told me to wait. I think, what, you want me to whistle or something while I wait?

So I wait some more. Then he asks me if can see the "My Computer" icon. I'm a bit of an impatient person, so I fire back, "What does the 'my computer' icon have to do with anything?" A reasonable question, in my opinion. We exchange a few more lines, and then he asks if I'm sure the Instructor has given me the necessary permissions to access this class! He tells me that it is up to the Instructor to do that.

I'm betting if I had logged on with a man's name he would not have said that.

Again, more polite than I'm feeling, I respond nicely: "I AM the Instructor!" OK. Sort of nicely. I only yelled one word. And I didn't call him names.

We finally got on the same page, as it were, and he had me do something esoteric in Java, and it works fine now. But good Lord!


Do you read your student evaluations?

Do you even open the envelope?

Tuesday, March 3, 2009

My first job: food service

My very first job ever was at a cafeteria-type restaurant. I don't even remember the name of it. It was a summer job, and I lasted approximately the summer. I don't remember the name of it, or how much I made, but I do remember that when I got home every night my feet hurt so bad I'd tiptoe into the house so as not to wake anyone up, fill the kitchen sink with water as hot as I could stand it, climb up on the counter and stick my feet in. Then I'd fall asleep leaning against the cabinets. I had fun because my best friend worked there too, but I hated the job qua job.