Category Archives: APA

November 5, 2013 · 2:05 pm

Does the DSM 5 define pedophilia as a sexual orientation?


In recent weeks I have read a couple of postings suggesting that the new version of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) has taken Pedophilia out of the realm of (psycho)pathology and made it equivalent to sexual orientation (e.g., gay, straight, bisexual, transgendered, etc.). These postings propose that the publisher, The American Psychiatric Association, has decided to normalize pedophilia–something that some believe is mere politics and a sign of further loosening of social mores. Usually, these writers point to the fact that the APA depathologized homosexuality in previous editions and now are going steps further to normalize pedophilia.

But, is this rumor true?

The facts from DSM 5

Pedophilia, or Pedophilic Disorder still exists and is considered a disorder in the family of paraphilias (patterns of abnormal sexual desire or activity). To be diagnosed with Pedophilia, one must meet 3 criteria (summarized)

  • Have sexual fantasies, urges, or behaviors for prepubescent children
  • Either urges cause marked distress, interpersonal difficulty OR the adult has acted on the urges with children
  • Must be at least 16 and seeking those who are at least 5 years younger

So, why the rumors?

Okay, so pedophilia is still a disorder. So, where is the confusion? After listing the criterion, the DSM offers some commentary to further describe the disorder. Here’s where some confusion may enter in as they describe the person who has intense pedophilic urges but who has not acted on them:

“However, if they report an absence of feelings of guilt, shame, or anxiety about these impulses and are not functionally limited by their paraphilic impulses (according to self-report, objective assessment, or both), and their self-reported and legally recorded histories indicate that they have never acted on their impulses, then these individuals have a pedophilic sexual orientation but not pedophilic disorder.” (p. 698)

Meaning?

Unfortunately, “pedophilic sexual orientation” is not defined. By the way, neither do they define any other sexual orientation. The point being that since sexual orientation is outside the purview of  a catalog of psychopathology, it need not be discussed. So, my read of the DSM 5 intent regarding pedophilic urges is this

  • Pedophilia is NOT equated with sexual orientation when the person is acting on the urges or is troubled by them, BUT
  • Those who have these attractions, yet feel no shame about them, function in society to protect children, and have not acted to harm children are not pedophiles but can be listed in a new nonpathology category: pedophilic sexual orientation. thereby, 
  • Opening the door for some to self-identify in a nonpathological manner

Is this cause for alarm?

Short answer. No, this nor the removal of homosexuality as pathology is not evidence of APA’s moral degradation.

Longer answer. this addition/change will create confusion. It does open the door for some crazy thinking and adding the “orientation” language is wrongheaded and may harm the good research being done about sexual orientation. Further, never underestimate the power of some to use this for evil intent.

Remember, the DSM is a catalog of psychopathology, not social pathology, moral pathology or the like. So, if it is possible (and there is evidence to support this) that gay and lesbian people do not experience psychopathology solely as result of their sexual feelings, then it would be right to remove homosexuality as a psychological disorder (no matter how you classify it in terms of morality).

There is another DSM feature that may be more of issue in this debate. As of now, diagnoses are locked into using the criterion, “causes marked distress” as a way of determining the floor for a pathology. Thus, you could possibly experience recurrent and persistent obsessional thoughts and images but not have them cause “marked distress…or significantly interfere with normal routine, social activities…” and therefore NOT be diagnosed with OCD. So, if it is possible to determine that a person with sexual feelings for little children is able to be not disturbed by them AND not act on them, then you wouldn’t give the diagnosis.

See the problem?  Here’s an analogy of sorts: if all 80 year old men have cancer cells in their prostate but never have any symptoms, seek no treatment, and die of other causes, should they be diagnosed with prostate cancer? Denying the existence of the cells doesn’t seem to be the answer even if no treatment is necessary.

To the point: Is there movement in redefining pedophilia?

Not in the mainstream.

It appears that there is an effort to better understand those who are being charged and convicted of child sex offenses. I see a growing research beginning to differentiate between three types of people who commit sex crimes: contact sex offenders (those who directly abuse actual children), internet offenders (those who use or send child pornography), and solicitation offenders (those who use technology to communicate with minors for sexual purposes).  The idea is that there may be differences between these three types and thus arguments for different punishments and treatments. It seems, thus far, that contact sex offenders have far more distortions in empathy for victims, cognitive distortions about self and children while the other two categories seem to have some features that might protect them from becoming contact offenders. NOTE: the data is small at this point and we can’t predict who will and who will not become contact offenders.

Go ahead and worry some

If one could really argue that child porn viewers are not statistically more likely to become offenders against actual children, you can easily imagine someone arguing that virtual child porn (i.e., digital created images of children having sex) harm no one and ought to be legal for the pedophilic orientation individuals. On recent report stated that at any given moment in time there are 750,000 individuals accessing and viewing child porn. And that is with it being a crime. Do we really want to open this door to normalization? No. We want to understand, empathize, restrict, and intervene.

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March 25, 2010 · 5:02 am

Considering a doctoral program?


In recent weeks I have had several students ask me about the pros/cons of doctoral programs in psychology. I would point those who know they want to attend a traditional clinical psych program to this book by the APA. It offers lots of helpful data on programs and what they require.

For those not sure what they want to do or if they should pursue doctoral studies, consider the following. If readers have additional questions we should consider, post them in a response and we’ll expand on these. This is my first pass:

What career doors do I want to open that are not available to me now? Do I want to teach? Do I see myself in private practice? In a research job? in the business world?

The PhD in Clinical Psych from an APA accredited program (and with an APA approved predoctoral internship) probably opens the most doors of all. This degree allows you to teach in both undergrad and grad depts., work in research settings, government settings, private practice, etc. There are specific kinds of jobs that it might not help: such as an area focusing entirely on social psychology or developmental psychology.

One caveat. If you want to teach in a MA Counseling program that is either seeking or already obtained CACREP accreditation (counseling accreditation sponsored by the ACA), you will need a PhD in Counselor Education (which entitles you to work towards an LPC credential). This is a recent and troubling change (turf warfare with psychology).

Part of your work dream should answer whether or not you are looking to work in either a secular or faith environment. Now, you can change your mind but there will be some doors that are easier to open with secular degree and other doors that a Wheaton/Fuller/Regent degree will open more easily.

What areas of counseling/psychology most excite you?

Try to be creative here. Think more than just private practice, 50 minute hour. Who do you know who is doing what you would like to do? Find out where they got their education? Be bold, ask them (even if you do so by email) what they would recommend as an educational route to do the kind of work they do now.

Programs tend to have both a model of psychology (some are CBT others are more analytic) and a focus (specialties). Further programs tend to either be scientist focused or practitioner focused.

Many programs are generalist, but it is helpful to have a specialty. Child? Forensic? Neuropsych? Geropsych? Marriage & Family?

Look at what the professors are publishing at the schools you are thinking about attending. Anything there excite you? FYI, professors love those who are excited to help them with their research

PhD or PsyD?

There are some differences. Typically, the PhD student completes a very rigorous dissertation (has more coursework in research and stats) but has fewer practice hours (maybe 800 total) leading up to their yearlong pre-doctoral internship year.

PsyD students tend to have a less rigorous dissertation (though my PsyD program acted more like a PhD) but have far more practice hours under their belts (maybe 2000!).

PsyDs do get teaching jobs but less likely in undergrad programs because of old assumptions (i.e., PsyDs are practitioners and PhDs are scientists).

Secular vs. Christian programs?

The first question: what is your current theological/biblical literacy level? How well do you understand the depths and complexities of your faith? How well versed are you in the controversies surrounding Christianity, Psychology, biblical counseling, integration, etc.? Your answer will dictate how ready you are to jump into a PhD or PsyD in clinical psychology. If your faith is weak, then you may want to strengthen it in an MA program at a Seminary. Or do some reading on your own. Psychology is not just an art and science, but a philosophy. You want to know what philosophy, even religion, you are imbibing. Sometimes the glittering images of psychology cause students to neglect the source of the power of change.

Practical matter: Christian doctoral programs in Psychology tend to be a year longer (because of extra bible/theology courses). Being a graduate of these programs will not harm you in secular settings (usually) if the program is accredited by the APA.

Obviously, programs and schools have identity. You graduate from Harvard, you get an identity. You graduate from Fuller, you get an identity—fair or not.

In my experience, secular programs tend to have less issues about a student’s Christian faith than do quasi-Christian programs or those housed in catholic institutions. These programs have had more fundamentalist-liberal wars and so you find faculty more sensitive.

If a student has a strong theological base, I would probably go for a secular institution unless you want the Wheaton/Fuller credential to open Christian doors.

Counseling Psychology vs. Clinical Psychology programs?

Not much of a distinction here anymore. I think the clinical one is more valuable (my bias) but once you have the degree, no one explores your transcript.

Would you rank the Christian doctoral program?

No. Each one has their own strengths and liabilities. I would look at the professors at each and what they are writing/doing. Try to go learn from some professors you’ve come to respect. For example (and this is a limited sample. Some schools I haven’t really known much about)

Regent University (VA Beach): Mark Yarhouse, Jen Ripley and Bill Hathaway are topnotch Christian psychologists. With Mark you get the sexual ethics research as well as someone well-versed in Puritan writings. With Jen, you might get access to her and Ev Worthington’s work (forgiveness, couples, etc.). Of course Ev is at VA Commonwealth and so you might want to go right for him.

Wheaton: There are a number of great faculty there. But let me mention just three. Sally Schwer Canning is doing child and urban stuff. Bob Gregory is doing neuropsych stuff and William Struthers just published on porn and the male brain.

George Fox: At Wheaton I came to really respect Mark McMinn. He is now at George Fox (Oregon). He’s great to study under for psych testing and his integrative model. Plus, if you get in on his research team, he’ll teach you how to be a survey king or queen. He is a publishing machine!

Biola: Todd Hall and Jon Coe just published a key work called Psychology in the Spirit. It is going to be a significant work.

On-line vs. residential programs

Online programs only if they are APA accredited (psychology programs that is). You have to be a self-starter. These still get negative reactions from some of those in the position to hire you. In the PhD in counselor ed, both Regent and Liberty have programs with good quality eworlds.

Residential provides lots of time to interact with profs on a daily basis. There isn’t a way to really do this in the on-line programs (which tend to have lots of students in them!). You can get good peer relationships in on-line programs, sometimes even better than in person.

I’m sure I’ve left something out. What else should we consider? Of course, you should get your MA from Biblical Seminary. That way, you will be prepared to think Christianly, biblically, and yet able to think psychologically about the world. 😉

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February 5, 2010 · 1:28 pm

Mental Retardation passe?


Did you see the news stories about Rahm Emanuel’s use of the word, “retarded” as a slur against his political opponents? It has spawned a number of conversations about the term mental retardation. Some are arguing for the removal of this term in legal and medical arenas. It is too closely connected to the abusive use of the word. Others, probably a small minority, even suggest not using the word retarded in other contexts unrelated to intellectual capacity (e.g., retarded growth, retarding energy consumption).

I’m not much of a fan of this latter idea. I remember when a DC official was castigated for using the term “niggardly” (having absolutely nothing to do with race) just because it sounded like the other “n” word. However, maybe we do need another term. Some are suggesting, “intellectual disabilities” “neurodevelopmental disorder” as options.

I’m for terms that are very descriptive and less pejorative. However, I will also say that stigma and the use of terms to harm will not change as the human heart that does such activity has not changed.

What do you think?

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August 17, 2009 · 11:59 am

The APA on identity therapy and conversion therapy


[Let me wade into something that tends to fire up lots of feelings and lead to controversy. And let me ask all to be civil. Civility seems to be the first thing that disappears when we discuss matters near and dear to our hearts. But let us be different and listen to each other rather than talk at or past each other. As James tells us, let us be quick to listen and slow to speak.]

In recent days media outlets have picked up the story of the American Psychological Association’s release of a report and declaration of their official stance on reparative or conversion therapies for individuals seeking to change their sexual orientation. You can read their press release and find their 100 page research review here. Being a member of the organization, knowing a few of the players in the research side of things, and knowing how easy it is to get caught up in debate and miss some of the finer points, I thought I might make a few comments that may not make it to the public eye.

1. Researchers are beginning to distinguish between sexual identity and orientation. This is a good thing. I dare say that the public lags far behind on this matter. Separating these two different aspects of sexuality allows for individuals to consider and interpret their sexual feelings in accord with their beliefs and NOT as how either the minority or majority of the world tells them to define themselves. This is akin to biracial people determining how they want to self-identify rather than be forced to say they are black or white.  Consider the following quote by one of the players (whom  I don’t know),

The distinction between orientation and identity (or attraction and identity as we often describe it here) is key, in my view, in order for us to understand the experience of those who say they have changed while at the same time experiencing same-sex attraction….I hope we can agree that sexual attraction patterns may be one thing while meaning making aspects may lead two people with the same attraction pattern to identity in disparate ways. (emphasis mine; from http://www.crosswalk.com/blogs/EWThrockmorton/11607271/)

If I understand the relationship between identity and orientation, it would seem that one forms identity from a variety of “data” which leads to an orientation. This is true outside of sexual identity. A number of factors come together for a person to see themself in a particular way (this may include biology, family, life experiences, key “flashbulb” moments, etc) and in cementing that particular identity they develop an orientation towards the world. SO, this may explain why trying to change orientation has little positive effect. Until the person reviews, explores, and reconsiders their identity (something that happens in nearly every counselee I’ve ever worked with) and begins to practice another way of seeing self, not much is going to change in attraction and orientation. Further, what may change is one’s sense of importance (and therefore meaning) of various parts of themself. When my clients explore their identity, it is rare they come to understand that they were completely mis-perceiving their feelings or experiences. Rather, they begin to see those experiences and feelings from a different vantage point.  

2. Change. What constitutes change is still up in the air. Ask a depressed person if they have changed even if they are only 50% less depressed and they will say likely say yes. Ask someone else and they may say “no,  I’m still depressed.” In the realm of sexual orientation, however, many see orientation as all/nothing. All same sex or all opposite sex orientation. Many will tell you this is just not their particular experience. So, IF someone wanted to change their direction of sexual attraction, what standard would they use to determine if change had taken place? Would 50% change be good? Who would decide this?

There is another analogous scenario in psychology. Should psychologists provide weight loss treatment? Given that an extremely large portion of those who lose weight gain it back and more, many have felt it unethical for a psychologist to offer weight loss therapies when they know that success is extremely low. So, how long do you need to keep the weight off to make a treatment worthwhile? How much do you need to lose? Who decides?

My gut feel is that the APA is not accurate in saying that there isn’t evidence that individuals can change. There is some evidence. Not complete change, but let us not deny what is there. Neither are they accurate about their reporting of harm. Harm reports are difficult to objectify. The best research will show you that some are harmed and some are not. Instead of assuming harm, let us evaluate more closely how some are harmed and how some are helped. Just as one might do with the weight loss scenario.  

3.  APA makes an attempt to make room for the work of helping one to find congruence between faith commitments and sexual feelings. This is also a good thing. Now, just how a psychologist does this matters greatly. Does he or she evangelize here? By that I mean (a) encourage a client to choose a different faith or change it to fit one’s sexual feelings, or (b) encourage a client to deny feelings and deny the suffering one might have by choosing not to act on a desire? My personal opininon is that option c (stay neutral) does not exist and is not possible. So, where does that leave us? Informing clients of our personal positions and yet not attempting to force individuals into our view of the situation. In other words, truthful but humble without being demanding.   

This is a divisive topic. Do individuals seeking to change their sexual orientation have the right to try to do so with the help of psychologists? Is change possible? Desirable? Damaging? And of course in trying to answer these questions you have a number of players on each side–each reading the “evidence” the way they would like to see it. You have those who have personal experiences in one direction or another. You have those with political or philosophical agendas. And, on top of that, you have media players interested in creating controversy where they can. I observed this last one myself where a local talk show host did his level best to create differences between two parties that weren’t disagreeing with each other as much he wanted them to.

So, what do you make of the difference between identity and orientation? Is it meaningful? How do we speak of change? Can we admit that it happens for some and not for others no matter our personal opinion whether change is good or not? And finally, can we avoid the “what if…” tendency in our conversations so that we deal with what is happening and not what we fear might happen?

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