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Science Consistently Shows Conversion Therapy to be Harmful and Ineffective

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Science Consistently Shows Conversion Therapy to be Harmful and Ineffective

The Iowa Psychological Association Public Education Committee has the sole purpose of bringing to the public’s awareness psychological research and science in about issues relevant to Iowans. The purpose of this committee is to inform and educate based on scientific research.  With that in mind, we share the following regarding the science on sexual orientation and the lack of science supporting sexual reorientation/conversion therapy.

In 1990, Dr. Bryant Welch, American Psychological Association Executive Director stated, “Research findings suggest that efforts to repair homosexuals (sic) are nothing more than social prejudice garbed in psychological accoutrements.” Since then, mainstream medical and psychological health associations have taken unequivocal stances against what is called conversion, reparative, or reorientations therapies due to lack of scientific evidence to support positive impact of these interventions, and the plethora of evidence documenting harm. These organizations include: American Academy of Child & Adolescent Psychiatry, American Academy of Family Physicians, American Academy of Nursing, American Academy of Pediatrics, American Association of Marriage & Family Therapy, American College of Physicians, American Counseling Association, American Medical Association, American Medical Student Association, American Psychiatric Association, American Psychoanalytic Association, American Psychological Association, American School Health Association, American School Counselor Association, American School Health Association, National Association of Social Workers, Pan American Health Organization, School Social Work Association of America, and others.

These organizations, representing the majority of U.S. medical and psychological health professionals, have taken this stance not because of political positioning, but because, as the American Psychological Association (2021) noted:

The APA affirms that scientific evidence and clinical experience indicate that sexual orientation change efforts (SOCE) put individuals at significant risk of harm;

APA encourages individuals, families, health professionals, and organizations to avoid SOCE;

APA affirms that same-gender and multiple-gender attraction, feelings, and behavior are normal variations in human sexuality, being LGBTQ+ is not a mental disorder, and APA opposes portrayals of sexual minorities as mentally ill because of their sexual orientation;

APA opposes making claims that sexual orientation can be changed through SOCE and;

APA, because of evidence of harm and lack of evidence of efficacy, supports public policies and legislation that oppose, prohibit, or aim to reduce SOCE, heterosexism, and monosexism and that increase support for sexual orientation diversity.

These organizations have taken stances validating the inherent worth, dignity, and validity of sexual/affectional orientation due to the lack of conclusive empirical evidence that supports that any one sexual/affectional orientation is less or more mentally and physically healthy.  In fact, the data is so consistent, these organizations had no other choice but to take these stances to uphold their own foundations of evidence-based decision making. Those who continue to advocate for reorientation continue to perpetuate the reductionist, bipolarity construct of sexual/affectional orientation that science left behind 50 years ago when the American Psychiatric Association declassified homosexuality as a mental health concern in the Diagnostic and Statistical Manual of Mental Disorders. A review of the history of this decision can be found here.

The faulty assumptions imbued into the claims of reorientation are numerous and include:

  1. Sexual/affectional orientation is behavior that can be changed.  This approach ignores copious evidence connoting the multimodality of sexual/affectional orientation, including identity in research across the world.
  2. Sexual/affectional orientation is limited LGBQ people.  Sexual/affectional orientation is descriptive of all people, but Straight people are not expected to engage in reorientation. Research on what science understands about the development sexual orientation and cultural expression of sexual orientation can be found in the following: Biodevelopment of Same-Sex Sexual Orientation  ,  Biological Research on Development of Sexual OrientationHuman Sexual OrientationSexual Orientation, Controversy, and ScienceStability and Change in Sexual Orientation
  3. Religion condemns LGBQ orientation. Reorientation could be sought for religious choice. However, people who identify as LGBQ do not have to abdicate their right to participate in religious practice.  Major U.S religions support LGBQ orientations include: American Baptist Church; Disciples of Christ; Episcopal Church; Metropolitan Community Church; Presbyterian Church, USA; Reform Judaism; Society of Friends; Unitarian Universalist Church; Buddhism, United Church of Christ, Congregational, and others.
  4. Research supports reorientation therapy.  Research supporting reorientation therapy has been criticized for problems with poor methodology, biased participant selection, statistical analyses, and inadequate outcome measures. Unethical behavior, sexual abuse, deception, and theological malpractice are also rife throughout this literature.  The confines here do not allow for detailing all of this research, though objective reviews can be found from infinitely wide sources including the Minnesota Department of HealthCornell University, to the Government of the United Kingdom.
  5. Straight is the standard.  There is a systematic bias toward straight orientation and a faulty mainstay assertion within reparative therapy is that people who are LGBQ are undeveloped, regressed, and fixated. Journal of Personality and Social Psychologyand Behavioral Sciences
  6. Reorientation therapies only help. An overwhelming number of studies note the harmful impact, ethical violations of, or ineffectiveness of conversion therapy. For a review see J Med Regul. 2016; 102(2): 7–12, and the Oxford Journal of Legal Studies

 

These are a few of the many faulty and specious assumptions that undergird this movement.  The leading national organizations who represent the majority of U.S. licensed medical and psychological providers, clearly state that as there is no illness, there is no cure.  Legal prohibitions against such practices, which cannot sufficiently document positive outcomes over risk for harm, exist in 27 states+ D.C. and this number grows annually. It is time, as it is with all medical and mental health matters, to listen to the evidence and move on from practices whose predominant basis is bias, poor science, historical limitations, and societal prejudice.

Submitted by:

The Iowa Psychological Association Public Education Committee, ipa@iowapsychology.org

The Iowa Psychological Association Public Education Committee has the sole purpose of bringing to the public’s awareness psychological research and science in about issues relevant to Iowans. The purpose of this committee is to inform and educate based on scientific research.

Reparative Therapy: What the Facts Really Are

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Reparative Therapy: What the Facts Really Are

As far back as 1990, Dr. Bryant Welch, Executive Director of the American Psychological Association stated, “Research findings suggest that efforts to repair homosexuals (sic) are nothing more than social prejudice garbed in psychological accoutrements.” Since then, mainstream medical and psychological health associations have taken unequivocal stances against what is called conversion, reparative, and reorientations therapies due to lack of evidence to support positive impact and the plethora of evidence documenting harm.  These organizations include: American Academy of Child & Adolescent Psychiatry, American Academy of Family Physicians, American Academy of Nursing, American Academy of Pediatrics, American Association of Marriage & Family Therapy, American College of Physicians, American Counseling Association, American Medical Association, American Medical Student Association, American Psychiatric Association, American Psychoanalytic Association, American Psychological Association, American School Counselor Association, American School health Association, National Association of Social Workers, the Pan American Health Organization, and others.

These organizations, who represent the majority of U.S. medical and psychological health professionals have taken this stance not because of political positioning, but because, as the American Psychological Association (2007) noted:

APA affirms that same-sex sexual and romantic attractions, feelings, and behaviors are normal and positive variations of human sexuality regardless of sexual orientation identity;

APA reaffirms its position that homosexuality per se is not a mental disorder and opposes portrayals of sexual minority youths and adults as mentally ill due to their sexual orientation;

APA concludes there is insufficient evidence to support the use of psychological interventions to change sexual orientation;

APA encourages mental health professionals to avoid misrepresenting the efficacy of sexual orientation change efforts by promoting or promising change when providing assistance to individuals distressed by their own or others’ sexual orientation;

APA concludes that the benefits reported by participants in sexual orientation change efforts can be gained through approaches that do not attempt to change sexual orientation.

These organizations have taken stances validating the inherent worth, dignity, and validity of sexual/affectional orientation due to the lack of conclusive empirical evidence that supports that one sexual/affectional orientation is less or more mentally and physically healthy. In fact, the data is so consistent, these organizations had no other choice but to take these stances to uphold their own foundations of evidence-based decision making. Those that continue to advocate for reorientation continue to perpetuate the reductionist, bipolarity construct of sexual/affectional orientation that current science and service left behind 50 years ago when the APA declassified homosexuality as a mental health concern.

The faculty assumptions imbued into the claims of reorientation are numerous and include:

  1. Sexual/affectional orientation is behavior that can be changed.  This approach ignores copious evidence which connotes the multimodality of sexual/affectional orientation. Additionally, current conceptualizations include sexual/affectional orientation as having the components of identity connected to it.
  2. Sexual/affectional orientation is only something LGBQ people have.  Sexual/affectional orientation is something heterosexual people have as well, but ironically is not seen as something open to reorientation.
  3. Religion condemns LGBQ orientation. Religion is a choice and perhaps reorientation could be for religious choice, re-orienting to the major U.S religions that support LGBQ orientations: American Baptist Church; Disciples of Christ; Episcopal Church; Metropolitan Community Church; Presbyterian Church, USA; Reform Judaism; Society of Friends; Unitarian Universalist Church; Buddhism, United Church of Christ, Congregational, and many others. People who are LGBQ have not abdicated religion to those who would seek to change them and many organized religions agree.
  4. Research supports reorientation therapy.  There is bottomless research denoting the bad science of these “studies” and their sufficiency of methodological, participant selection, statistical analyses, and outcome measure problems. Also, unethical behavior, sexual abuse, deception, and theological malpractice are rife throughout this literature. The confines of here do not allow for detailing all of this research, though objective reviews can be found from infinitely wide sources including everything from the Minnesota Department of Health to the Government of the United Kingdom.
  5. Heterosexuality is the Standard.  A mainstay assertion is that people who are LGBQ are undeveloped, regressed, and fixated and thus need changing due to an inability to have mature relationships. It is a specious argument that when people who are LGBQ have problems with relationships, it is due to their sexual/affectional orientation and when people who are Straight have relationships, it is not.
  6. Reorientation Therapies Only Help.  Reorientationists consistently produce data that only indicates that their actions help. The very idea that treatment cannot cause harm is a dangerous and unethical position for any psychologist. Once again, there is a bottomless set of studies demonstrating first-person accounts of the harmful impact of these therapies. These range between them being destructive to them being, at the very best, unable to produce what they proport.

These are a few of the many faculty assumptions that undergird this movement. The leading national organizations who represent the majority of U.S. licensed medical and psychological providers, clearly state that as there is no illness, there is no cure. Prohibitions against such practices, which cannot sufficiently document positive outcomes over risk for harm, exist in 27 states+ D.C. and this number grows annually. It is time, as it is with all medical and mental health matters, to listen to the evidence and move on from practices which rest on bias, poor science, historical limitations, and societal prejudice.

This article was written by Barry Schreier, Ph.D., in collaboration with the Public Education Committee of the Iowa Psychological Association. 

Taking Action to Sustain Care in Challenging Times: Supporting our TGNB Clients and Communities

headshot of Dr. Barry Schreier

Taking Action to Sustain Care in Challenging Times: Supporting our TGNB Clients and Communities

headshot of Dr. Barry SchreierWe are in a time of significant legislative challenge focused on Iowa citizens who are transgender/non-binary (TGNB). Recent changes to Iowa law include, amongst several actions, prohibiting youth who are TGNB from accessing gender affirming medical care. This creates challenges for psychologists who work with youth who are TGNB and their family and friends.

As a gay, cis-gender psychologist with a long history of working with people who are TGNB and their communities, I have had the privilege to deepen my understanding about the challenges people who are TGNB must manage and emotionally attend to, while also just moving forward with daily life. State laws that then negatively impact youth who are TGNB make this “lifting” of daily life infinitely more challenging. People of color who are TGNB may experience even heavier burden and may more strongly feel the impact of these laws.

What can psychologists do then to be helpful with TGNB identified youth clients when they are disvalued by their state, do not have access to gender affirming medical care amongst other things, and must also function in daily life? Here are some ideas to consider in our ongoing work to be advocates with and care for those with whom we work.

Validate the Real. It is possible to read the next four suggestions and perceive the guidance to be: Look for rainbows and just be happy. Hope can be elusive especially when threats are real and suicide risk among TGNB youth is high, with potentially higher risk stemming from the current legislative climate. Validation of what is real is so critical to authenticate and make space for what feels wrong, threatening, and which our evidence-based work tells us is fundamentally counter to the wellbeing of TGNB people.

Resilience is Not a Bottomless Resource. As emphasized above, it is important to lean in with our TGNB clients to hold and sustain wide open space for anger, frustration, sadness, bewilderment, angst, and everything that comes with feeling targeted and alienated. It is equally important to encourage our clients to continue to also lean into those things that also bring feelings of care, connection, belonging, future orientation, and so on. It takes even more resilience than ever to manage and we must remind and assist our clients so they replenish their wells of resilience.

Coins Are Always Two Sided. As psychologists, we know the “both/and” becomes universally critical in these times. It is reasonable to be in a doom and despair rabbit hole. In what feels so invalidating and prevents needed medical access, there remains a friend, a family member, a teacher, an online connection, an organization, or someone who cares and who can help struggling clients find or hold onto grounding. Remind your clients they can be angry, despondent, and scared, AND at the same time, feel loved, creative, and motivated. Emotion is both/and, and in challenging times it can be harder to hold and keep this lens in focus.

The Arc of Justice. In the current zeitgeist it is easy to feel fear and the deepest of apprehensions about the future. How far will this legal parlay go? Is this just the beginning? Is this a testing of the waters for even more legislative actions? Crisis can create a mindset of categorical thinking, loss of perspective, and diminished emotional bandwidth. In this framing, it is useful to remind young TGNB clients of the trajectory that has happened for the TGNB communities in a few decades. When I was a youth, there was no TNGB, there was such shame, hidden community, and no useful language to even understand self. The arc of justice is clear in the greater direction we are heading, even with such setbacks and devastating humps as these. Help clients keep a broad a perspective as possible by seeing the larger arc we are in and not remain stuck exclusively in the current moment.

Power in Numbers. There are many great state organizations that are a source of support and advocacy, such as OneIowa, United Youth For Action, and others. It is critical in such challenge to have a feeling of being part of something bigger than oneself. The strength we have is in our numbers. It is useful to help our youth connect or stay part of communities larger than their individual selves.
Support the Supporters. Family and friends need our help, too. We often focus only on the target of such legislative actions and forget the caregivers. Meeting with support systems to shore them up often helps our clients, too.

Agents of Change. Lastly, for we psychologists, there is the call from the American Psychological Association to be “agents of change.” It is infinitely helpful to assist our clients and, at the same time, we also have the privilege that comes with our education, standing, and expertise to use our abilities at the public health level. Join an organization, write an op-ed, speak out at events, publish, contact legislators, and anything else you can do to make your expertise heard at the larger communal level.

Activist Angela Davis stated, “I am no longer accepting the things I cannot change. I am changing the things I cannot accept.” Let’s do the same!

Please check out this related podcast from IPA: https://spotifyanchor-web.app.link/e/VcroAW5PJyb.

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Staying Mentally Healthy in the Holiday Season

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Staying Mentally Healthy in the Holiday Season

This blog first appeared on the PSYowa blog, a public education blog that can be shared on social media or emailed to friends and family. The link for the public post is found here.

headshot of Amanda Johnson

Holidays are often sources of joy, connection, and celebration for people all over the world. However, we sometimes forget that they can also be reminders of painful losses and loneliness. Even before the pandemic the holidays were often sources of stress for many of us. With the pandemic impacting all of our lives in many ways, holidays haven’t looked like they used to. We have had to connect with loved ones through nursing homes and hospital windows, we’ve had to Facetime friends and family when we normally would’ve joined in person, and many of us have lost friends and family members who have been an important part of our holidays. For some, the holidays will continue to be very different this year. Dealing with this ongoing disruption in the traditions we hold dear can lead to struggles with our well-being and our mental health. 

 Others may be dealing with a different sort of difficulty. For many, it will be the first time they are rejoining their families for a more traditional holiday celebration. With that comes great joy but also challenges that come with adjusting to spending time with people who you haven’t seen in quite a while. Additionally, families are often made up of individuals with different beliefs, political parties, and viewpoints on world events. This can create potential for conflict and uncomfortable situations often made more severe by holiday stress and large family gatherings. 

Holidays and Mental Health 

Whether you are continuing to deal with a holiday season that looks very different from the one you hoped for or you are dealing with anxieties related to spending time with your family for the first time in a long time, you may be experiencing new or increasing mental health symptoms. Many people have always struggled with “holiday blues” but now more than ever it is something to be aware of for yourself and for those you love. Some things to watch out for include: 

  • Changes in appetite or weight 
  • Changes in sleep patterns 
  • Depressed or irritable mood
  •  Difficulty concentrating 
  • Feelings of worthlessness or guilt 
  • Feeling more tired than usual 
  • Feeling tense, worried, or anxious 
  • Loss of pleasure in doing things you used to enjoy 

Get Help 

If you or someone you care about is experiencing these or any other difficulties with mental health there is help available. Some good resources include: 

  • Call your therapist, psychiatric provider, or primary care doctor 
  • Iowa Psychological Association Psychologist Finder
  •  Iowa Warm Line (844) 775-WARM (9276)
  • Your Life Iowa Crisis Line (855) 581-8111 
  • United Way’s Help Line: Dial 211 
  • National Suicide Prevention Hotline 1-800-273-TALK (8255) 
  • SAMHSA’s National Helpline: 1-800-662-HELP (4357) 

Coping Strategies 

In addition to reaching out for help when you need it, there are some things you can do to make the holidays less difficult and help yourself to stay healthy. 

Don’t Isolate: One of the most difficult parts of the holidays can be loneliness. We can often make it worse because one of the ways that anxiety and depression can impact us is by making us feel like we don’t want to be around others. To top it all off, because of the pandemic many people have to be physically isolated because they are ill or to protect others. Get creative about connecting with others through the phone, video chat and messengers, email, a holiday card, or even an old fashioned letter! 

Everything in Moderation: Over-eating, holiday spending, and drinking are some of the biggest sources of stress during the holidays. One strategy to avoid issues related to alcohol is to try a holiday season without drinking, since alcohol can often increase symptoms of depression. There are plenty of tasty nogs sans alcohol. But if you do drink, make a plan to limit it. Same goes with holiday eating and spending, plan your holiday budget and eating ahead of time to avoid stress later. 

Get a Move On: One way to offset all of the tasty holiday treats and to improve our mood is to exercise. It can be hard with a holiday schedule to fit it in but it can make a big difference. You can integrate it into your day like parking further away at the store, going sledding and enjoying the snow, or offering to carry your nanna’s packages out to her car! 

Setting Boundaries: During the holiday season there are all manner of demands on our time. There can be family dinners, work functions, volunteer responsibilities, shopping, and all of this on top of our regular schedule. It is okay to say no and prioritize your time. Setting boundaries can help you protect time and your health so that you can enjoy the things that are important. This goes for family functions as well. Sometimes it is healthier to avoid a toxic family gathering than to participate. 

Create Something New: Many people struggle because Christmas doesn’t look the way it did before. One way to overcome this is to create new experiences and traditions that will be memorable for years to come. They often say that the one certainty in life is change. No matter what we do things always change, and while that is hard we can make positive changes and be grateful for the good things in our lives. 

Practice Gratitude: It can often seem like everything is wrong, especially when we are struggling with depression. Depression can impact the way we think. It can help to take time each day to focus on the things in our lives that we are thankful for. It can be something as grand as our family or something as wonderful and simple as peppermint cheesecake. It can help our minds begin to see the good in each day. 

Hopefully this holiday season finds you and yours well, but if not, know that there are people out there who care and can help you get through this holiday season. Have a happy holiday and a wonderful new year from the Iowa Psychological Association.

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