Tag Archives: APA

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?


Filed under APA, News and politics, Psychology

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?


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

APA’s resolution on religious, religion-based, and/or religion-derived prejudice

Just got my 2007 annual report from the American Psychological Association. I rarely read this thick document except for the ethics violation reports. But I saw that the board and council passed the above-named resolution. Some key passages to consider in the long document:

Prejudice based on or derived from religion and antireligious prejudice has been, and continues to be, a cause of significant suffering in the human condition. …

Prejudices are unfavorable affective reactions to or evaluations of groups and their members…

…it is a paradoxical feature of these kind of prejudices that religion can be both target and victim of prejudice, as well as construed as justification and imperative for prejudice. The right of persons to practice their religion or faith does not and cannot entail a right to harm others or to undermine the public good.  …

While many individuals and groups have been victims of antireligious discrimination, religion itself has also been the source of a wide range of beliefs about and attitudes and behaviors toward other individuals…

Allport and his colleagues observed that the relationship between religion and prejudice is curvilinear rather than linear, with highly religious individuals having lower levels of prejudice than marginally religious adherents.

It is important for psychology as a behavioral science, and various faith traditions as theological systems, to acknowledge and respect their profoundly different methodological, epistemological, historical, theoretical, and philosophical bases. Psychology has no legitimate function in arbitrating matters of faith and theology, and faith traditions have no legitimate place arbitrating behavioral and other sciences.

The document goes on to list multiple “whereas” and “therefore be it resolved” statements. The gist of which is to say, don’t discriminate; respect religion and spirituality; avoid prejudice; give no preference (as an Association to either belief or unbelief; recognize that psychology and religion cannot adjudicate either party’s tenets (but psychology can comment on the psychological impact of spiritual beliefs and religion can comment on theological implications of psychology); and try to collaborate if you can.

Problems galore despite their effort not to just paint religion as the bad guy. I’ll post just two. First, what is prejudice? They mention it as an “unfavorable affective reaction.” Okay. So, if I gently and cognitively say that my faith disapproves of certain behaviors or beliefs and based on those differences I decide not to hire you in my private, faith-based school, is that prejudice? I think some would say so. Currently, the debate over the appropriateness of having someone seek counseling to change sexual orientation has plenty of folk arguing that the problem is not affective but cognitive. If you believe you can or should change your orientation then you are accepting dominant prejudices.

Second, the whole document stinks of the separation of science and faith–as if science is all empirical and faith is all unsubstantiated belief. Also, what do those psychologists do who find themselves well trained in both worlds. It would seem from this document that the psychologist training trumps theological training. Again this is thought to be best for “the public good” and yet they do not recognize this as value, non-emprically based statement.

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Filed under church and culture, philosophy of science, Psychology

How long should you keep clinical records?

The APA has updated and republished their “Record Keeping Guidelines” (2007 American Psychologist, 62:9, 993-1004). In this they discuss 13 separate guides (e.g., content of records, responsibility for records, confidentiality of records, retention of records, disposition of records, etc.).

How long should psychologists keep their records? This guideline suggests the full record is kept for a minimum of 7 years after the last service contact (for adult clients). Why should a psychologist destroy records? Some records might contain out-of-date assessment data that is either no longer valid or superseded by better tools. Some records might include information that was based on a very limited context and could be used against the client (e.g., 15 year old is seen for criminal activity but this information comes out at the age of 50…).

But consider the other side of destroying records. I once saw a client at a counseling center who was returning after 12 years for more counseling. This person had been in counseling for 3 years with a previous counselor who was no longer with the agency. Rules had allowed the disposal of his record. When I told him I could not review his prior record (he had asked that I do so) he was surprised and hurt that we did not keep his record. He felt that we had violated his trust in some way and that the good work that he had done was minimized. He felt the agency didn’t care about him and should have handled his history with more kindness.

So, how would you feel to go to your old therapist and find that your records no longer exist? 


Filed under counseling and the law, Psychology