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Momentum against reparative therapy

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Spitzer-BP.jpgIn recent months public momentum has been building against reparative therapy for individuals who are gay, lesbian, and bisexual. For more two decades organizations and associations that work with mental health professionals have been advising that sexual orientation change efforts are not likely to work and that these efforts may be harmful to patients.

Recently several incidents have brought this issue into the headlines. First, two leaders of organizations that have promoted reparative therapy have publically stated that sexual orientation change does not work, and they have apologized for the harm that their work may have caused to individuals: John Smid, former director of Love in Action,* October 2011 on Hardball with Chris Matthews and Alan Chambers, director of Exodus International, January 2012 at the Gay Christian Network conference. Since then Exodus International has shifted its stance on reparative therapy. In a blog post dated June 19, 2012, Chambers states that Exodus International is "no longer an organization that associates with or promotes therapeutic practices that focus on changing one's attraction." The organization states that they will now focus on helping individuals to reconcile their faith and same-sex attractions by not acting on those attractions.

In May 2012, the Archives of Sexual Behavior published a letter to the editor from Robert Spitzer, MD, retracting his study about the effectiveness of reparative therapy published by the journal in 2003.** In his letter Spitzer concluded, "I believe I owe the gay community an apology for my study making unproven claims of the efficacy of reparative therapy. I also apologize to any gay person who wasted time and energy undergoing some form of reparative therapy because they believed that I had proven that reparative therapy works with some 'highly motivated' individuals." Since 2003 Spitzer's study has been held up by organizations and even international governments as scientific proof that sexual orientation change is possible. Ironically, in 1973 Spitzer lead the efforts to remove homosexuality from the Diagnostic and Statistical Manual of Mental Disorders. Gabriel Arana, a writer for The American Prospect broke this story in April 2012 in his article "My So-Called Ex-Gay Life."

Currently the California Legislature is considering a bill that would make reparative therapy for individuals under the age of 18 illegal and require adults seeking conversion therapy to sign informed consent forms indicating that they understand the potential dangers, including depression and suicide, and that reparative therapy has no medical basis. The bill SB 1172 passed the House on May 30, 2012, and is now under active consideration in the Assembly. The bill states that

• Under no circumstances shall a mental health provider engage in sexual orientation change efforts with a patient under 18 years of age.

• Any sexual orientation change efforts attempted on a patient under 18 years of age by a mental health provider shall be considered unprofessional conduct and shall subject a mental health provider to discipline by the licensing entity for that mental health provider.

The bill's author Senator Ted Lieu said, "Under the guise of a California license, some therapists are taking advantage of vulnerable people by pushing dangerous sexual orientation-change efforts. These bogus efforts have led in some cases to patients later committing suicide, as well as severe mental and physical anguish. This is junk science and it must stop." Lieu went on to say, "Being lesbian or gay is not a disease or mental disorder for the same reason that being a heterosexual is not a disease or a mental disorder. The medical community is unanimous in stating that homosexuality is not a medical condition."

On May 17, 2012, the International Day Against Homophobia and Transphobia, the Pan American Health Organization released a statement outlining the dangers or reparative therapy, psychopathologization, and homophobia. The statement concludes, "A therapist who classifies non-heterosexual patients as 'deviant' not only offends them but also contributes to the aggravation of their problems. 'Reparative' or 'conversion therapies' have no medical indication and represent a severe threat to the health and human rights of the affected persons. They constitute unjustifiable practices that should be denounced and subject to adequate sanctions and penalties." The document makes recommendations of how homophobia and ill-treatment can be overcome through the efforts of governments, academic institutions, professional associations, media, and civil society organizations.

In 2009 the American Psychological Association issued a report based on two years of work that stated that sexual orientation change efforts can pose critical health risks to gay, lesbian, and bi-sexual patients and advised patients to avoid such treatments (see PHS Newsletter articles "APA warns against telling clients their sexual orientation can be changed," and Eli Coleman's "Letter from the Chair in Sexual Health September 2009").

*As of March 15, 2012, the organization Love in Action changed its name to Restoration Path.

**Spitzer, R. (2012). Spitzer Reassesses His 2003 Study of Reparative Therapy of Homosexuality. Archives of Sexual Behavior, 41 (4), 757. doi: 10.1007/s10508-012-9966-y

PHOTO:  Robert Spitzer, MD, Courtesy of Truth Wins Out, from Spitzer's video apology

 

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med-class-crop-2.jpgA study conducted at the Stanford School of Medicine confirms that a majority of American medical schools are lacking LGBT-related health curriculum in the classroom and in clinical training. The study findings were published on September 7, 2011, in the Journal of the American Medical Association.

The Stanford research team surveyed deans of medical schools in Canada and the United States.  Of the complete responses the group received (132 = 75%) they found that of the entire medical school curricula the median reported time dedicated to LGBT-related content was 5 hours.  Some schools reported dedicating no time to LGBT-related content in the classroom or the clinic.

At this time, most schools (128) teach student that when taking a patient's sexual history students should ask the question, "Do you have sex with men, women, or both?"  However, on a list of 16 LGBT-specific topics,* only 11 schools reported covering all 16 topics in their curricula.  The topics covered most frequently by schools are sexual orientation, HIV, and gender identity, and the topics covered least often by schools are genital reconstruction surgery, body image, and transitioning.

*LGBT specific curricula topics:  barriers to Care, body image, chronic disease risk, coming out, DSD/intersex, gender identity, HIV, LGBT, adolescents, mental health issues, safer sex, sexual orientation, SRS, STI, substance use, transitioning, unhealthy, and relationships/IPV

Obedin-Maliver, J., Goldsmith, E. S., Stewart, L., White, W., Tran, E., Brenman, S., . . . Lunn, M. R. (2011). Lesbian, Gay, Bisexual, and Transgender-Related Content in Undergraduate Medical Education. JAMA, 306(9), 971-977. doi: 10.1001/jama.2011.1255

Photo: PHS faculty teaching the human sexuality course at University of Minnesota Medical School

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LGBT-report-BP.jpgResearchers need to proactively engage lesbian, gay, bisexual, and transgender people in health studies and collect data on these populations to identify and better understand health conditions that affect them, says a new report from the Institute of Medicine (IOM).

The scarcity of research yields an incomplete picture of LGBT health status and needs, which is further fragmented by the tendency to treat sexual and gender minorities as a single homogeneous group, said the committee that wrote the report.

The historic report, The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding, provides a thorough compilation of what is known about the health of each of these groups at different stages of life and outlines an agenda for the research and data collection necessary to form a fuller understanding.

"Based on a thorough review of the science, this report recommends a research agenda to better understand the characteristics of the LGBT population, assess their unique health needs, and to identify the factors that either compromise or promote their health and well-being," said Walter Bockting, PhD, IOM committee member and professor at the Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School. "The report recognizes that the LGBT population is diverse in terms of gender, age, race, and ethnicity, and calls for intervention research that addresses the needs of those with documented health inequities."

LGBT individuals make up a minority of the population, therefore researchers face challenges in recruiting sufficient numbers of these individuals in general population surveys to yield meaningful data. Stigma experienced by gender and sexual minorities can make them reluctant to disclose their orientation, worsening the problem. Moreover, it is difficult to synthesize data about these groups when studies and surveys use a variety of ways to define them.

Demographic data provides the foundation for understanding any population's status and needs, federally funded surveys should proactively collect data on sexual orientation and gender identity, just as they routinely gather information on race and ethnicity, the new report says. Information on patients' sexual orientation and gender identity also should be collected in electronic health records, provided that privacy concerns can be satisfactorily addressed, the committee said.

The National Institutes of Health should support the development of standardized measures of sexual orientation and gender identity for use in federal surveys and other means of data collection.

In addition, the National Institutes of Health should provide training opportunities in conducting research with LGBT populations. Training should engage researchers who are not specifically studying LGBT health issues as well as those who are. The agency also should use its policy on the inclusion of women and racial and ethnic minorities in clinical research as a model to encourage grant applicants to address how their proposed studies will include or exclude sexual and gender minorities.

Throughout his tenure at the University of Minnesota, Bockting has conducted research on the health disparities found among transgender people.

Bockting said, "This Report recognizes that we have much to learn about the health of this subgroup of the LGBT population, and calls for research to improve access to quality, evidence-based transgender care. The acknowledgment of this still largely invisible population and the attention the Report draws to their specific health needs is enormously validating and holds the promise of new initiatives to promote transgender health."

The study was sponsored by the National Institutes of Health. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.

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Robert Garofalo MD, MPH, to speak at UMN

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Robert-Garofalo-MD-200x275.jpg"Advancing the Health of Lesbian, Gay, Bisexual, and Transgender Youth"

Robert Garofalo MD, MPH

Thursday, May 12, 2011, 4:30 PM

University of Minnesota

Mayo Memorial Auditorium

425 Delaware Street SE, Minneapolis, MN 55455

Free and open to the public. Allow for extra travel time to campus due to Central Corridor Light Rail construction.

On May 12, 2011, Robert Garofalo, MD, MPH, will discuss the process and findings of the recent Institutes of Medicine (IOM) Committee Report, The Health of Lesbian, Gay, Bisexual, and Transgender People. He will summarize and contextualize the state of the science as it exists for LGBT youth and, as suggested by the IOM, offer a paradigm for the next generation of academic work for this vulnerable population.

Dr. Garofalo is an associate professor of Pediatrics and Preventative Medicine at Northwestern University Fienberg School of Medicine. He is also an attending physician at Children's Memorial Hospital where he directs the Adolescent/Young Adult HIV Program. Dr. Garofalo is a national authority on LGBT health issues, adolescent sexuality, and HIV clinical care and prevention. He has been the principal investigator on five National Institute of Medicine (NIH) and two Centers for Disease Control and Prevention (CDC) funded research grants and serves as a co-investigator on three additional NIH-funded projects. He is the former past-President of the Gay and Lesbian Medical Association. In 2010, Dr. Garofalo served as a committee member for the National Academy of Sciences/Institute of Medicine Committee on Lesbian, Gay, Bisexual and Transgender Health Issues and Research Gaps and Opportunities.

Joycelyn-Elders-MD-BW200x226.jpgFormer US Surgeon General, Joycelyn Elders, MD, will attend the lecture as a discussant.

Please join us for the John Money Lecture in Pediatric Sexology hosted by the Program in Human SexualityDepartment of Family Medicine and Community Health, and the University of Minnesota Medical School.

Event co-sponsors

Boynton Health Service

Division of Pediatric Endocrinology, Department of Pediatrics

GLBTA Programs Office

Healthy Youth Development Prevention Research Center, Division of Adolescent Health and Medicine

Planned Parenthood Minnesota, North Dakota, South Dakota

School of Public Health

SHADE (Sexual Health Awareness and Disease Education)

Teenwise Minnesota

Transgender Commission

Youth and AIDS Projects, Division of Adolescent Health and Medicine


 

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Hate crime protections have been expanded

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Shepard-Byrd-Act-BP.jpgOn October 28, 2009, President Obama signed the Matthew Shepard and James Byrd, Jr. Hate Crimes Prevention Act into law.  This act expands federal hate crime protection to include gender, sexual orientation, gender identity, and disability.

FBI data suggests that since 1991 there have been more than 118,000 hate crimes reported.  In 2007 more than 7,600 were reported, and in the last ten years there have been more than 12,000 reported hate crimes that were based on sexual orientation.

Obama affirmed the importance of this legislation in his remarks at a reception to celebrate the new act, "You understood that we must stand against crimes that are meant not only to break bones, but to break spirits -- not only to inflict harm, but to instill fear.  You understand that the rights afforded every citizen under our Constitution mean nothing if we do not protect those rights -- both from unjust laws and violent acts."  

View a video of the president's remarks

Read the full text of president's remarks.

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India decriminalizes homosexuality

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India-BP.jpgOn July 2, 2009, India's High Court decriminalized homosexuality by removing Section 377 of the Indian Penal Code.  The historic judgment reverses a nearly 150-year old law which brought about sentences ranging from fines to a 10-year term in jail.  In his conclusion, Chief Justice Dr. S Muralidhar wrote, "Where society can display inclusiveness and understanding, such persons can be assured of a life of dignity and nondiscrimination. . . . It cannot be forgotten that discrimination is antithesis of equality and that it is the recognition of equality which will foster the dignity of every individual."  August marked gay pride celebrations in India, and this year they celebrated legally.

PHOTO credit:  158 at NowPublic.com

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Glassgold-BP.jpgThe American Psychological Association (APA) adopted a resolution on August 5, 2009, which states that practitioners should avoid telling clients that they can change from gay to straight through therapy.  "Resolution on Appropriate Affirmative Responses to Sexual Orientation Distress and Change Efforts" is the work of an APA task force which was convened to examine their standing recommendations.  

The task force conducted a systematic review of peer-reviewed journals and concluded that there is insufficient evidence to support claims that sexual orientation change efforts (SOCE) -- often referred to as "conversion therapy" or "reparative therapy" -- actually works.  According to a statement released by the APA the resolution "advises that parents, guardians, young people and their families avoid sexual orientation treatments that portray homosexuality as a mental illness or developmental disorder and instead seek psychotherapy, social support and educational services 'that provide accurate information on sexual orientation and sexuality, increase family and school support and reduce rejection of sexual minority youth.' "

Task force chair, Judith M. Glassgold, PsyD, stated,
Contrary to claims of sexual orientation change advocates and practitioners, there is insufficient evidence to support the use of psychological interventions to change sexual orientation.  Scientifically rigorous older studies in this area found that sexual orientation was unlikely to change due to efforts designed for this purpose. Contrary to the claims of SOCE practitioners and advocates, recent research studies do not provide evidence of sexual orientation change as the research methods are inadequate to determine the effectiveness of these interventions.  At most, certain studies suggested that some individuals learned how to ignore or not act on their homosexual attractions. Yet, these studies did not indicate for whom this was possible, how long it lasted or its long-term mental health effects. Also, this result was much less likely to be true for people who started out only attracted to people of the same sex.

The task force recognized that some individuals who see SOCE treatment do so because of the distress that they feel from a conflict between their sexual desires and religious or cultural beliefs.  The resolution advises therapists "be completely honest about the likelihood of sexual orientation change, and that they help clients explore their assumptions and goals with respect to both religion and sexuality," said Glassgold.

Read the full resolution:
"Resolution on Appropriate Affirmative Responses to Sexual Orientation Distress and Change Efforts"

PHOTO: Judith M. Glassgold, PsyD; credit Grant Martin

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Letter from the Chair in Sexual Health

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Chair-BP.jpgThe global problem of psychotherapists' complicity in societal discrimination and stigma against gay, lesbian, and bisexual individuals is reprehensible and must stop immediately.  Recently the American Psychological Association (APA) adopted a resolution which states that practitioners should avoid telling clients that they can change from gay to straight through therapy (see report in this issue of the newsletter).  I find it incredible that such a resolution is still needed in 2009.  But, unfortunately, the practice of "conversion therapy" or "reparative therapy" is still alive and well despite significant evidence that it does not work and it is highly unethical.

Thirty years ago, I published a review of treatment approaches to homosexuality that debunked the notion that homosexuality is a mental disorder and that it can be "cured."  I also presented evidence that these approaches were highly unethical, ineffective, and harmful.  That review along with a plethora of scientific research led to the 1973 decision of the APA to depathologize homosexuality as a mental disorder.  

I am very pleased to see this recent APA resolution which reiterates what we have known for a long time.  I hope that the message will be heard loudly around the world.

As I put forth thirty years ago, through therapy we need to assist gay, lesbian, bisexual, and "questioning" individuals to clarify their sexual orientation.  We need to help them to develop a positive self image, help them cultivate intimate relationships, and help them integrate their sexual orientation into a society that remains predominately heterosexist.  Our preoccupation with the etiology of homosexuality is misplaced, and we must shift our energies and focus to the study of the tremendous impact of stigma and discrimination and the develop methodologies to combat it.

I look forward to the day when our society is no longer heterosexist -- a day when all individuals can grow up and realize their true identity in terms of gender and sexual orientation.  And, I look forward to the day when the wide spectrum of gender identities and sexual orientations is fully integrated into our society.

We have a long way to go to achieve this goal, and one essential step is to put outdated notions about homosexuality behind us to move toward a new, sexually healthy society.

Eli Coleman, PhD
Professor and Director
Academic Chair in Sexual Health

Coleman, E. (1978). Toward a new model of treatment of homosexuality: A review. Journal of Homosexuality, 3, 345-359.

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