Category Archives: sexuality

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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Filed under APA, News and politics, Psychology, Sex, sexual identity, sexuality, Uncategorized

Counselors: How do you deal with attraction to clients?


For my counseling friends, you may wish to read this piece by Ryan Neace about sexual attraction in the therapist office. Do you have someone to talk to in this kind of frank manner about the reality of attraction? How do you handle it?

Remember, sexual attraction is not limited to just wanting to have sex with someone. Ryan does a good job identifying types of sexual responses to others beyond outright lust and fantasy. Notice also his drawing attention to the myth of the sexual vortex.

“The pastor who refuses eye contact sends a clear message…‘You are seductive. You are a sexual vortex that I may get sucked in to.’ The slippery slope of my lust is your problem. And my ministry is too valuable to allow the likes of you to trip me up.”

Given that we all have examples of counselors and leaders who crossed sexual lines, the myth and fear of the vortex can keep us from addressing needs of others. And, as he notes, it sends a very loud message to some clients (mostly women) that they are a danger at the cellular level). What a burden we place on others!

Two questions for readers:

1. How do you respond to incidents of sexual attraction?

2. How would you want to respond to the question posed to Yalom copied below (about whether he would in a different situation be attracted to a female client)? Redirect? Focus on the “deeper question”? Answer it?

Yalom considers a female client who asks, “Am I appealing to men? To you? If you weren’t my therapist would you respond sexually to me?”

… [Yalom’s answer]:

If you deem it in the patient’s best interests, why not simply say… ‘If everything were different, we met in another world, I were single, I weren’t your therapist, then yes, I would find you very attractive and sure would make an effort to know you better.’ What’s the risk? In my view such candor simply increases the patient’s trust in you and in the process of therapy. Of course, this does not preclude other types of inquiry about the question—about, for example, the patient’s motivation or timing (the standard “Why now?” question) or inordinate preoccupation with physicality or seduction, which may be obscuring even more significant questions. (bold emphasis Ryan’s)

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Filed under christian counseling, christian psychology, Christianity, counseling skills, Sex, sexuality

Why “sexy wife” language hurts so many women


Maybe you’ve seen this post: http://deeperstory.com/the-sexy-wife-i-cant-be/? If not, you should read it to learn just how painful and destructive and superficial the “be a sexy wife for your husband” is, especially when combined as “biblical teaching.” Now, the feeling of being sexy isn’t the problem. What is the problem is the failure of speakers/writers to account for the large number of women (and men!) whose sexuality was stolen from them via abuse and other forms of oppression. In addition, these “be sexy” speakers/writers seem to ignore how Scriptures have been distorted to demand sex from spouses (someday I should write a post about the number of times I have been asked during public Q and As about 1 Cor 7 and the demand it makes on women to please their husbands).

Can you imagine giving a talk about the joys of giving birth to an audience where 1:3 women were infertile? Can you imagine NOT acknowledging that a large portion of the audience might struggle with the topic?

For those of you who did read the above talk, the author Mary DeMuth, posted this follow-up post regarding the weight of the stories she heard in the comments section of her first post. Note how she finds hope and comfort among darkness and heaviness. For brave ones, you might read the comments at the bottom of both posts. Note the relief expressed that someone else understands. Note the common refrain, “I didn’t breathe while reading this.” That should tell us how desperate many are for being understood and that most are expecting the other shoe (that “just do it” one) to drop. Note the links to other posts already on this topic.

We need better pictures of sexuality in marriage that recognize pleasure as something that can be had but not at the expense of reality of safety, vulnerability, and comfort. Sexual pleasure is good but it is not the highest end. And decreased quality of pleasure is not a temptation or risk for adultery…unless pleasure has become a god to us.

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Filed under Abuse, Christianity, church and culture, Sex, sexuality, trauma

Help and Hope For Porn Addiction: 2 Questions


Recently, I made a presentation to a group of men about the problem of porn use/addiction. It proved to be a lively conversation and I didn’t get an opportunity to get through all of the content. Below are 2 questions I was asked. Consider these answers:

  • What is wrong with watching porn with my wife? We both enjoy it and it spices up our sex life?

Besides the clear command to avoid all sexual immorality and to not lust after another? Supposing you want more than that here are some additional thoughts. God has given us imagination as a tool to be used for our good and our pleasure. Therefore, it stands to reason that imagination is highly important in the bedroom. However, it should be used as a tool to honor each other and to promote oneness. As soon as our eyes our off our spouse (whether in a literal sense or a figurative sense), we are seeking to use another for our sexual pleasure. Porn necessarily brings images of others into your bedroom thus moving away from reality and oneness. The images porn uses are not accurate or real and only encourages disappointment in the real thing.

And may I note that I have only heard this question from men. Given my experience of hearing so many wives who have been hurt by their husband’s interest in bringing porn into their own lovemaking, I am suspicious that the wife enjoys it as much as might be thought. At the end of your lovemaking and/or porn use, does she feel special? Does she feel honored? Does she feel she cannot measure up to what is not the screen?

Despite the injunction against porn use by Christians, do not take this to mean that the sex life of Christians must be boring. Seeking to satisfy the pleasures of your spouse gives ample room for creative fun in the bedroom.

  •  How long can I enjoy looking at [name of well-known female star]  and not begin to lust? Is it always wrong to enjoy female beauty?

Of course there is no specific answer that can be given as to how many nano-seconds are pure and at what point the look ogle turns lustful.  Is it possible to enjoy beauty in a person not your spouse? Yes. I would suggest that it is impossible not to notice beauty when you see it. However, I would quickly add that some forms of beauty are more likely to turn lustful in a split second. Noticing Beyoncé’s lovely singing voice probably won’t turn to lust. Noticing her Super Bowl attire…that is another matter.

Here’s what I would like you to consider. The question you are asking, “how long can I look before sinning” may reveal a dangerous motive. It seems that you might be asking, how close can I get to the cliff without falling over? Is it okay to have one foot on solid ground but lean over the edge? Can you see the danger in this thinking? Instead, we ought to humbly recognize that it is easy for us to move from momentary admiration to fantasy. It is good to accept that we will notice beauty and that we must guard our very next thought.

One more thought for you. While noticing beauty is part of who God has made you, is it possible that you have well-trained yourself to search for beauty? Is your head on a swivel? Have you long practiced taking the second and third look? If so, then you are likely not merely noticing beauty but actively looking for images you can use for your own fantasy.  

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Filed under addiction, pornography, self-deception, Sex, sexuality, Uncategorized

Book idea: Sexual Crises in the Church


Pastors and church leaders have to navigate a variety of sexual crises that may arise in their congregations. These crises may or may not be crises for some churches even while they devastate another community. And surely these are not the only crises a church may face. But matters of sexuality often unnerve the leadership.

What crises am I referring to? Sexual abuse allegations, date-rape, infidelity among attendees and, pastoral (or leader) sexual abuse, couples living together, sex offenders returning to church, sexual addictions, individuals struggling with sexual or gender identity issues, etc.

Where would they turn to get helps in thinking about the various issues, practical pastoral responses (to the individuals involved as well as the entire congregation)? I’m thinking about a one source document that might survey biblical foundations, explore possible responses as well as prevention plans where appropriate. Why wait til the Crisis to consider how one might want to think about it?

Anyone seen such a resource? I’ve got some other writing assignments but I could imagine an edited volume on the topic. Maybe I’ll skip grading today and see if I can start a proposal.

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Filed under Abuse, christian counseling, christian psychology, Christianity, pornography, Sex, sexual addiction, sexual identity, sexuality

When Sex in Marriage Doesn’t Work


Today is the first full day of the CCEF annual conference in Valley Forge, PA. The conference is entitled, “Sex Matters” and so all plenary and breakouts are on said theme. It is not too late to drop by if live in the area and want to register. I believe they will still take walk-ups.

Besides the faculty-led plenary sessions, Lauren Winner (Girl Meets God; Mudhouse Sabbath, & Real Sex) will speak on Saturday. For those of you who can’t come, CCEF sells mp3 downloads on their website.

I will be providing an hour long seminar entitled, “When Sex in Marriage Doesn’t Work” at 4 pm today. We will focus on desire, arousal, technique, and relationship problems (whether perceived, physical or emotional) couples sometimes encounter. Slides and an additional home-grown sex therapy questionnaire is available here (#16 on the list, scroll to the bottom).

The best part is that after I’m done, Biblical Seminary is hosting a pizza party for current students and alums (5:30p) at our information table.

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Filed under "phil monroe", biblical counseling, Biblical Seminary, CCEF, christian counseling, christian psychology, counseling skills, Sex, sexuality

Theological thoughts on intersex and gender


For those in the Philly area, you are invited to come to Biblical to hear a guest lecturer speak on the subject of intersex. Megan De Franza will be guest lecturing in an MDiv theology class, Tuesday, November 3rd, starting at 6 pm. She is a doctoral student at Marquette University and writing her dissertation on the topic of gender and how Christian theology might address “intersex” (formerly known as hermaphrodism). As many as 1:2200 births result in a form of intersex (anywhere from ambiguous external genitalia to more hidden gender anomalies).

Is there room for a third gender? Megan will explore Jesus’ teaching in Matthew 19 about marriage and eunuchs and consider if this relates to the subject.

No charge (but I’m sure someone would take a check if you felt so inclined).

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Filed under Christianity, Doctrine/Theology, sexuality

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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Filed under APA, Christianity, counseling science, ethics, homosexuality, Psychology, sexual identity, sexuality, Uncategorized

Most common sexual dysfunction?


I’m doing some prep for a November talk at CCEF‘s annual conference which I am entitling, “When sex in marriage doesn’t work.” I’ll be giving a brief overview of how counselors can be a help to couples facing sexual dysfunction (whether biological, psychological, or relational). But in my prep today I ran across this little telephone survey result from 2002 where callers asked married men and women between the ages of 40 and 80 about their most frequently experienced sexual problem.

Any guesses yet?

For men, 26.2% reported problems with “early” ejaculation. [No definition given for “early.” Usually early or premature means earlier than he wanted.] Another 22% said the problem was ED. It is interesting that we are bombarded with ED commercials but I can’t say that I’ve ever seen PE treatments advertised in mainstream media. This is probably due to the number of baby boomers with cash seeking to turn back the hands of time.

For women? No surprises. 33% report problems with interest/desire and nearly 22% report problems with lubrication.

Did the respondents seek help? 75% had not.  Another study of men after prostate surgery reveals that those who do seek help quit soon after. Seems that while there are a number of medical and psychological interventions that can help to a degree, nothing turns back the clock to one’s twenties.

A caveat. The researchers only got a 9% response rate for their random calls. Why didn’t more participate? Did those who participated have more or less problems than those who refused?

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Filed under christian counseling, counseling, counseling skills, marriage, Psychology, Sex, sexuality

Hooking up less difficult than admitting love?


Listened this am to NPR’s Morning edition and a story on “hooking up.” Definitely worth your listening for the 8 minute story. Here’s a couple of amazing thoughts (not quotes) from female interviewees:

1. The hook-up is all about the tension, build-up, and the sex.

2. Dating actually costs too much money; hook-ups are much cheaper

3. Talking about being in love is more embarrassing than talking about one’s sex life (hooking up) on the radio.

4. Dating a guy means bringing him into your circle of close friends and the preference is to have the hook-up but do nothing that could harm real friendships

5. It is vulnerable to be needy of love. Not so of sex.

Scary stuff here. Think about it. Taking your clothes off and sharing genital sexual activity with an acquaintance puts you in a less vulnerable position than asking someone out for a formal date?  Can someone explain that one to me?

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Filed under Cultural Anthropology, news, Psychology, Relationships, Sex, sexuality