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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

Off to Africa


Today is the day! We leave this evening and, Lord willing arrive in Kigali (via Belgium) tomorrow evening. I have no idea if I will have access to the Internet to update you. If I do, I’ll be sure to give you a little taste of our time. If not, I’ll post daily entries when I return.

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A Christian Psychology 2


Chapter 2 of Eric Johnson’s book, Foundations for Soul Care(IVP, 2007) traces the use of the bible as soul healing agent throughout the history of the church. Eric explores the work of early church fathers, medieval church, reformation, and Puritanism as examples of soul care writings based on the biblical text.

The chapter then moves to consider the historical movement of the relationship between Christianity and science. While early scientists saw their field of study as something revealing evidence of God’s handiwork, a “fracture” begins with Enlightenment thinking.

Ironically, while Christianity contributed to the development of the scientific revolution, that revolution came to be increasingly linked to an alternative worldview: modernism (p. 63)

 Eric does a nice job summarizing the transition. One moves from the use of metaphysics, tradition, and revelation (Eric’s words) to a focus on the specific object of study and the use of observation. Thus, human reason and empiricism rule the day.

At core what distinguishes modernism and Christianity as ways of thinking about human life are their different ultimate commitments. Christianity assumes a God-centered worldview in which the individual self (with its submissive reason) is seen as relatively important in relation to the rest of creation but relatively unimportant in comparison to the infinite God. In such a framework, science is a noble task done first for the glory of God and second for the benefit of humanity, a good means to a greater end. Modernism inherited the self of Christianity, but without its God to keep things in proper perspective, the self became the center of the universe (an anti-Copernican revolution!), eventually regarding its own experience, together with its autonomous reason, as the foundations of truth and morality…Consequently, individualism–and not relationship–was established at the base of the modern worldview. (p. 65)

Eric goes on to talk about how Christianity imbibed the modernistic assumptions (either trying to use empiricism to defend fundamentalism or accepting that psychology is the best way to understand human functioning).

Eric does a good job summarizing the modern pastoral care movement and capitulation to psychotherapy models. Further, he shows how a Barthian model of soul care was not quite liberalism nor evangelicalism. Finally, he reviews the postmodern turn and “postliberal recovery.”

Johnson’s take on modern pastoral care movement? It doesn’t offer much to the evangelical in the way of thinking biblically about souls. The postliberal engagement with the Bible does two things: re-engages the text of Scripture as a real dialogue partner while not dismissing the helps within positivist psychology.

If you are unfamiliar with the modern history of Christian counseling and pastoral care, this is a great chapter to start with. You can get  a quick overview plus a bibliography to point you to original sources. The next chapters deal with evangelical and fundamentalist counseling models and how they dealt with Scripture (i.e., biblical counseling or integrationism).

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Making sense of things and the suffering it brings


Ever had the experience of having your brain work overtime to try to make sense of some action, something done to you?

Some things make no sense and we know it–things like the premature death of a single parent, a genocide, impulsive choices that make matters much worse, etc. Yet our minds keep trying to figure it out. Why? How come? What does it mean? If only I could understand what God was up to then I could…

Sometimes, trying to understand the incomprehensible compounds and adds to our present sufferings.

We then tend to respond in one of three ways, (a) give up and stop functioning, or (b) develop antiseptic conclusions (e.g., God is going to use this to bless me later), or (c) put our heads down, ignore the pain and do the thing in front of us.

Response b may in fact be true but often it is used to help the person dissociate from the incomprehensible in a way to keep living and moving.

What do you find most helpful when dealing with an unsuccessful attempt to make sense out of suffering? How do you avoid giving in to ruminations about unanswerable angsts or hopelessness or its opposite, baseless optimism that denies the present reality?

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Yesterday’s quote on freedom


Here’s the info on yesterday’s quote about the enslaving possibilities when fighting for freedom: T.E. Lawrence.

Found on p. 29 of Seven Pillars of Wisdom: A triumph, by TE Lawrence. 1935 NY: DoubleDay.

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DIY Pictures by request


Since Amy asked, I’m posting a couple pictures of our wall DIY project

The trench
The trench
The delivery of stone
The delivery of stone
All done but the cleanup
All done but the cleanup

Now all I need are some capstones and replanting of the garden…

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What does it take to be a blessing?


On Sunday, Dr. Frans Leonard Schalkwijk gave a brief but gripping sermonette on the topic of being a blessing. Dr. Schalkwijk has served the church in Brazil as a missionary for nearly 60 years. For those of you in the Philadelphia area, he happens to be “Timmy D’s” (of WZZD DJ fame) father-in-law.

Using one of this grandsons as a visual prop he told the congregation of 4 things they needed to do to “be a blessing.” He based this on a portion of Leviticus 8 and the ordination of Aaron as priest.

1. Purification. To be a blessing we must be purified from our uncleanness. Moses signifies this by putting blood on Aaron’s right ear, right thumb, right big toe. Dr. Schalkwijk suggests this meant to purify what we take in (hear/see), what we do, and where we go.

2. Dedication. Into Aaron’s raised, empty hands, Moses places several items to be dedicated to the Lord. We dedicate our lives by recognizing that God places a gift into our hands to be used for his glory. We ought not, he said, be focused on who gets what gift but that all gifts are for the Lord.

3. Perfumation. Moses sprinkles Aaron with a mixture of blood/oil. While not our concept of a pretty scent, it would allow others to see and smell the difference. Even though we get used to certain things that are different about us, others will still notice the differences. 

4. Meditation. The first three acts cleanses and prepares one to be a blessing to others. And yet, without meditating on God’s word, how can one have something to say to others? In order to have something to say, one has to meditate on the Word.

Dr. Schalkwijk concluded this very short study by saying something like this (my memory): “We are called to be a blessing. We won’t necessarily “see” a blessing. That is what we often want–to see a blessing. But we weren’t promised that we would see it but have the gift of being one nonetheless.

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Rwanda!


My on again off again trip is now on. I have tickets and yesterday I got my shots! Our small group of psychologists (4) will be leaving on June 22 and returning July 1. We will be going as the guests of the Right Rev. Alexis Bilindabagbo, Anglican Bishop of the Gahini diocese. You can learn a bit about him here.

We will be meeting with pastors, government officials, victims, and perpetrators of the 1994 genocide. Our goal is to immerse ourselves into the culture to learn how best to provide trauma training and counseling education at the graduate level for pastors and key leaders of the church right in Rwanda. While we know quite a bit about trauma and counseling training, we wish to avoid the mistakes of assuming we know best what this particular people need and what works within their cultural milieu.

I hope to be able to give you more details as the time approaches and to blog from Rwanda when I have Internet access.

FYI, each of us are paying our own way. Some donors at Biblical Seminary gave generously to underwrite a small portion of the trip. Further, the American Association of Christian Counselors is helping to sponsor this trip. So, if someone wants to give to the trip, I’m sure we can find a way to provide you a receipt for tax purposes :). Email me at pmonroe[at] biblical [dot]com and we’ll figure it out.

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Can your body make you sin, part 2


Yesterday I posted an introduction to this topic. Today, I want to give my answer to the first question:

Is it possible that my body (against or apart from my will) might cause me to sin?

  • What is gained and/or lost if we say yes? If we say no?

My answer: Yes.

I suppose you might like some defense of this position. Okay, here’s my best shot in five minutes:

1. Nothing is done by a person apart from their cells. We mediate all worship, desire, etc. through our cells. When we do good or evil, all of us are involved.

2. Sin is not merely an act, but a disposition. All of me is tainted and not functioning as it was originally intended, including my physical body (and don’t I feel the effects of being over 40!).  The dualist position is more in danger of treating sin as only what we consciously choose.

3. I don’t have to know that I broke the law (biblical or federal) to be guilty of violating the law. I didn’t know I was speeding but I still got a ticket. In the OT, lack of intention or knowledge violating the law did not protect against impurity or guilt (e.g., Lev. 4:22; 5:3).

4. If the body is broken and under sin’s curse it stands to reason that our bodies function in ways that are out of accord with our will. If they can move without our control (e.g., Parkinsonian tremors) can they not also move in such a way that violates God’s design for us. We have scientific evidence of this. Stimulate a certain part of the brain, and you will have rageful feelings. Stimulate another part and you may have sexual thoughts. Consider, as a commenter suggested yesterday, a person with Tourettes. There is some evidence of temporary volitional control (a surgeon is able to stop a tick during an operation) but other evidence that the ticks, and in some cases, curses burst out against the conscious effort of the person.

Saying yes to this question violates our Western sensibilities:

If we accept that our bodies can act against or without the will, what do we gain or lose? I think the primary concern by many would be that somehow we will either be held culpable for sins we didn’t want to commit or claim innocence for sins we didn’t willfully commit. And this gets to our thinking patterns here in the West. We want to be only held accountable for things we did do and not held accountable for things we either didn’t do or didn’t have any control over.

It strikes us as evil to be held accountable for that which we didn’t know was wrong. I once got a ticket for making a u-turn on a Chicago city street at 11 pm when no one (but the cop!) was around. There were no signs. I wasn’t familiar with Chicago rules, was lost in an unsavory neighborhood. And yet I still got the ticket. It didn’t seem right. But I did violate the law.

Our American judicial system isn’t the only system that holds us accountable for involuntary acts. Romans teaches us that because of Adam’s sin, all are sinners. I bear the culpability for his sin (and I make plenty of my own as well). I bear the impact of his choices in my entire being. Further we see OT prophets confessing the sins of the community as if they were their own.

So, in short, I think we can answer yes to the question about whether our bodies can make us sin. They can because we (body and soul) are tainted by the Fall. It doesn’t make us more or less out of sorts with God whether our sin is chosen or involuntary. Happily, God doesn’t just forgive willful sin, he forgives sin period and makes it possible to not sin by imputing his righteousness to us.

For those still thinking about culpability, I’ll give a little vignette tomorrow to chew on.

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Filed under Biblical Reflection, christian counseling, Christianity, Doctrine/Theology, sin, Uncategorized

Psychiatric vs. Psychological evaluations: What is the difference?


In place of my usual physiology Phriday post, I give you this…

“I think I need a psychiatric evaluation? Can you test me?” These are some of the questions I get from time to time. And they reveal an ongoing confusion about testings, assessment, evaluations, the world of psychiatry, psychology, and neurology. Interestingly, if you type in “psychiatric evaluation” into wikipedia, you actually get redirected to an entry on psychological evaluations and testing. So, let me try to differentiate a bit here:

What is a psychiatric evaluation? It is done by a psychiatrist who is a physician with special psychiatry training (courses and residencies). This evaluation is comprehensive but medical in nature. Expect the person to ask for your physical, behavioral, and cognitive histories, order blood tests or other medical exams, evaluate (by observation and interview) your mood, your reality testing, and mental status etc. Ultimately, after an extensive (and usually expensive) interview, the doctor will arrive at a psychiatric diagnosis (if appropriate) and may also recommend medicines to help with the problem–which they can prescribe. A few also provide ongoing talk therapy but most do not. Rather, they recommend you find a therapist for that part. They will follow up with med checks as needed to titrate or refine your medicines. When a person has a very difficult, complex, or lengthy history of mental health, or, when the person is needing a diagnosis for legal reasons, a psychiatrist is a good choice. They are usually gifted at extracting subtle physical and behavioral matters that may help correctly pinpoint the problem. While a person might well get anti-depressants from their regular doctor, a good psychiatrist is better able to deal with complex matters and follow you more closely to get the right compound and dosage.

Neurological Evaluation. Stating the obvious, a physician with neurological specialties and qualifications does a neurological evaluation. Neurologists specialize in…wait for it…the nervous system (brain, spinal cord, and 12 cranial nerves). A neurological evaluation includes many of the things evaluated by psychiatrists but with special attention to your motor and sensory systems, your reflexes, and similar kinds of things. You might more likely see a neurologist when you obviously have a neurological issue. Neurologists are more likely to specialize in ADHD, brain injuries, and psychiatric problems that result from dementias or other known physical problems. They are often better able to give and interpret MRIs and other imaging that might be appropriate. They will also prescribe and follow medications.

Psychological Evaluation, AKA testing, psych assessment. These are offered, mostly, by doctoral level psychologists. These evaluations will cover much of the same history, mental status, and provide diagnoses when appropriate. Interviews, just like the previous two options, are essential. However, what sets psychological evaluation apart is its use of standardized tests. These may be paper and pencil or electronic. They may be filled out by the client or by family members. The results provide a snapshot of behavior, or cognitive functioning, or mood by contrasting the individual results against a peer group. For example, a child may complete a computerized test to assess attention span. The results are compared to thousands of children taking this test who either are “non ADHD” and or ADHD. A good psychologist collects data from multiple data points (test data, interviews by client and maybe family, observations, etc.) and uses that data to make interpretations and recommendations for ongoing care. Usually, the best psychological evaluations begin with a very objective, specific question. Just throwing a bunch of tests at a person to “see what comes up” isn’t all that helpful. Just because something pops up doesn’t mean it is meaningful.

It is true that masters level therapists (licensed or not) give and interpret some tests. But most of the best tests can only be given and interpreted by doctoral level, licensed psychologists.

There are other types of evaluations. Neuropsychologists are doctoral psychologists with specialized training and help pinpoint brain injury, unravel more complex learning disabilities, etc. Neuropsychiatric evaluations are done by another similar but slightly different professional. You can check out their interesting history on this wikipedia page.

So, how do you choose what is best for you? Answer a few questions.

1. What do I really want to know when it is all said and done? What might help me decide how to proceed? The more specific you are, the more likely you can get the answer you want.

2. Do I think I need to focus more on physical options or behavioral options?

3. Do I think I’m likely to need medications? The physician types are better. Psychologists cannot prescribe meds (unless you live in Hawaii or are in the military).

4. If I am given a diagnosis, what do I need it for? Both doctoral level psychologists and psychiatrists are capable of giving you diagnoses. However, some people or systems value one opinion over another. Figure out if it matters for your purposes.

5. Am I looking for specific behavioral/relational suggestions? Then psychological evaluations are more appropriate.

6. Am I looking to form an ongoing therapeutic talk based relationship? See the psychologist.

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