Inclusive Response to LGB and Conservative Religious Persons

An Inclusive Response to LGB and Conservative Religious Persons: The Case of Same-Sex Attraction and Behavior

Mark A. Yarhouse and Lori A. Burkett Regent University

How should psychologists demonstrate respect for religion as an aspect of diversity when that aspect of diversity seems inconsistent with another form of diversity? This is a striking challenge when considering conservative expressions of religion in relation to a person’s experience of same-sex attraction and behavior. This article (a) asserts that conservative religion is a legitimate, though often overlooked, expression of diversity; (b) identifies ways in which gay-integrative theorists and conservative religious persons fail to appreciate each other’s perspective; and (c) presents a continuum of service delivery options to expand clinical services to persons who experience same-sex attraction.

How should psychologists respond to persons who enter therapy distressed by their experiences of same-sex attraction? Does it matter if a person experiences distress about his or her same-sex attractions and behavior due to a religious valuative framework? In other words, how do psychologists balance respect for both sexual orientation and religion as legitimate aspects of diversity? Thoughtful, scientifically informed responses to these questions are often lost in the debates surrounding reorientation therapies and ex-gay1 religion-based ministries.

Respecting Religion as an Aspect of Diversity

There has been a rather dramatic interest in religion and spiri- tuality in the last few years, both in the public interest and in psychological circles. The American Psychological Association (APA) has published valuable resources on religion and spiritual- ity, including books by Shafranske (1996) and Richards and Ber- gin (1997, 2000). Other publishers have done the same (e.g., Emmons, 1999). What is implied by the availability of these resources, we believe, is that religion is an important expression of diversity. Just as race, ethnicity, socioeconomic status, age, gen- der, and sexual orientation are legitimate expressions of diversity, so too is religion.

The Ethical Principles of Psychologists and Code of Conduct of the APA (1992; henceforth referred to as the Ethics Code) clearly includes religion among many areas of diversity that psychologists are to respect. For example, General Principle D: Respect for Rights and Dignity calls for psychologists to aspire to “accord respect to the fundamental rights, dignity, and worth of all peo- ple . . . . Psychologists are aware of cultural, individual, and role differences, including those due to . . . religion . . .” (APA, 1992, p. 3). The Ethics Code also includes respect for others: “In their work-related activities, psychologists respect the rights of others to hold values, attitudes, and opinions that differ from their own” (Standard 1.09; APA, 1992, p. 5).

But what does “respecting” religion as an area of diversity entail? At a basic level, it would seem that it means not discrim- inating against clients because of their religion or religious prac- tices or the values that derive from their religion (Stan- dard 1.08, 1.10). This does not mean that psychologists agree with every belief or value associated with a religion. This is impossible because major religions disagree with one another on fundamental claims and worldview assumptions. In a similar way, when psy- chologists respect cultural differences, they do not necessarily endorse specific cultural values, but they do not discriminate against a client because of his or her cultural beliefs.

Complications arise when psychologists respect two competing expressions of diversity: sexual orientation and conservative ex- pressions of religion. The recent Resolution on Appropriate Ther- apeutic Response to Sexual Orientation (APA, 1998; http://www. apa.org/pi/sexual.html) and Guidelines for Psychotherapy with Lesbian, Gay, and Bisexual Clients (Division 44/Committee on Lesbian, Gay, and Bisexual Concerns Joint Task Force, 2000) clearly expand on what it means to demonstrate respect for sexual orientation. These documents address psychologists’ awareness of negative social messages and prejudices against lesbian, gay male, and bisexual (LGB) persons, reports of emotional distress, and

1 Throughout this article we use the terms gay, ex-gay, and ex-ex-gay; in this context, the term gay is used broadly to mean a person who has integrated his or her same-sex attraction into a lesbian, gay male, or bisexual identity.

MARK A. YARHOUSE received his PsyD in clinical psychology from Wheaton College in 1998. He is an assistant professor of psychology at Regent University and is in independent practice in Virginia Beach, VA. His research interests include human sexuality, ethics, and integration of psychology and theology. LORI A. BURKETT is a student in the doctoral program in clinical psychol- ogy at Regent University. PORTIONS OF THIS ARTICLE were presented as part of a symposium chaired by M. A. Yarhouse, Gays, Ex-Gays, and Ex-Ex-Gays: Examining Key Religious, Ethical, and Diversity Issues, which was conducted at the 108th Annual Convention of the American Psychological Association, August 2000, Washington, DC. CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Mark A. Yarhouse, School of Psychology and Counseling, Regent University, CRB 215, 1000 Regent University Drive, Virginia Beach, Virginia 23464. E-mail: markyar@regent.edu

Professional Psychology: Research and Practice Copyright 2002 by the American Psychological Association, Inc. 2002, Vol. 33, No. 3, 235–241 0735-7028/02/$5.00 DOI: 10.1037//0735-7028.33.3.235

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how some persons may feel pressured into treatment to change their sexual orientation.

In these resources and in the broader discussions of LGB issues, however, conservative expressions of religion often appear to be overlooked as an aspect of diversity. It appears that most psychol- ogists are comfortable with more liberal expressions of a religion (e.g., some Christian groups, such as Dignity/USA, are gay- affirmative). However, inherent in “respecting” religion as an aspect of diversity is also demonstrating respect for those who hold to the conservative, orthodox teachings of that religion. This concept becomes clearer if we return to what it means to “respect” cultural diversity. Psychologists would not, for example, demon- strate respect for cultural diversity if they worked only with members of a minority group who were sufficiently acculturated and divorced from the customs and values of their country of origin. Rather, psychologists respect cultural diversity by trying to help clients balance their traditional, cultural values and beliefs with some of their experiences in their new society. The same approach is needed regarding conservative religious beliefs.

A recent Chronicle of Higher Education article reported on data suggesting antipathy and prejudice against conservative Christians (Miller, 2000). In fact, it was reported that about 20% of Ameri- cans, and nearly 40% of highly educated Americans, are “intensely antagonistic” toward conservative Christians (p. A18). It was also reported that as many as 20% of Americans who are not Christian fundamentalists hold Christian fundamentalists in lower regard than they do illegal aliens. Are conservative religious persons at risk of becoming marginalized in society?

Psychologists can play a role in protecting those at risk of becoming marginalized by hearing the voices of those who live by traditional, conservative expressions of their religion or who are religiously orthodox. Religious orthodoxy refers to “the degree to which a person believes in and adheres to the traditional doctrines and moral teachings of his or her religion” (Richards & Bergin, 1997, p. 177). Richards and Bergin distinguished between belief orthodoxy, or “acceptance of the doctrinal beliefs of one’s reli- gion,” and behavior orthodoxy (more commonly referred to by theologians as orthopraxy), or “adherence to the moral teachings and practices of one’s religion” (p. 177).

Respecting belief orthodoxy and behavior orthodoxy is at the heart of what it means to respect religion as a legitimate expression of diversity. Respect for diversity implies that it would be intol- erant to disregard a religious person’s conservative theological view that same-sex behavior is immoral; it means understanding why a conservative religious person chooses not to engage in same-sex behavior.

When faced with a clinical situation in which a conservative religious individual is struggling with same-sex attraction or be- havior, it is critical that the psychotherapist consider what it means to an orthodox religious person to have such thoughts or to have engaged in such sexual behavior. It is important to think about what it means to conservative religious individuals to live by the normative teachings of their church and faith.

Respecting a conservative religious person’s view of same-sex behavior is not tantamount to supporting inappropriate heterosex- ism (discrimination and prejudice against LGB persons that is the equivalent of racism or sexism). There is a difference between moral evaluation of same-sex behavior as volitional conduct and prejudice against another for his or her race or sex. Some gay-

affirmative theorists acknowledge this distinction. For example, Stein (1999) acknowledged that sexual attractions and behavior are two different things and that behaviors are volitional and may be evaluated with respect to their moral status:

Even if one’s sexual orientation is primarily biological and not a choice, much of what is ethically relevant about being a lesbian or a gay man is not biologically based and is not determined, [such as] engaging in sexual acts with a person of the same sex-gender. (pp. 288–289)

Key Issues That Are Viewed Differently

Five key issues seem to be viewed differently by gay- affirmative theorists and conservative religious persons: (a) ap- praisal of same-sex behavior; (b) the existence of “ex-gays”; (c) the existence of “ex-ex-gays”; (d) the existence of reorientation therapies, alternative therapies, and religious ministries; and (e) research on change of sexual behavior and orientation.

Appraisal of Same-Sex Behavior

One of the primary differences between gay-affirmative theo- rists and conservative religious persons is how they view or evaluate same-sex behavior. Gay-affirmative theorists view same- sex behavior as integral to full expression of oneself as a person. Thus, gay-integrative therapy has the goal of helping people who experience same-sex attraction to integrate their experiences into a gay male or lesbian identity synthesis (Dworkin, 2000).

In contrast, conservative religious persons do not assume that same-sex identity is at the core of how a conservative religious person wants to experience himself or herself, with religious identity at the periphery. Rather, some conservative religious per- sons view sexual attraction and behavior in the context of a broader religious valuative framework (cf. Harvey, 1987; Satin- over, 1996). Conservative Christians teach that God created people as men and women and that marriage is the context for genital sexual contact (Prichard, 1991). Also, a conservative religious person would not necessarily assume that full sexual intimacy is integral to one’s core identity or self-expression.

Both views are probably not equally true—that is, same-sex behavior is not simultaneously moral and immoral. However, psychology as a science cannot determine the moral status of same-sex behavior. The behavioral sciences can only inform moral reasoning by measuring the results of specific behaviors; they cannot determine which moral system to use (e.g., egoism, the view that what is right is what produces the most happiness for a person; divine command, the claim that what is right is what God says is right; or another ethical system). Such empirical criteria may be relatively short-term (as contrasted with a conservative religious person’s concern for eternal significance), but they can inform moral reasoning and be treated as “informed consent” for the choices made by clients whom psychologists are expected to treat as autonomous, self-determining agents (APA, 1992, pp. 3–5).

Ex-Gays

How do the two groups view “ex-gays”? At one level (and a simplistic level at that), ex-gays are often viewed as those who

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succeed in changing their sexual orientation from gay to hetero- sexual. At another level, ex-gays may be understood to be those who experience same-sex attraction but choose not to integrate same-sex impulses into an LGB identity. Rather, they seek to tie their identity to other aspects of who they take themselves “to be as a person,” and they see their sexual impulses as one of many aspects of their experience that they choose not to identify with (Bergner, 1995; Comiskey, 1989). This is often the experience of many active in religion-based ministries, such as Exodus Interna- tional, Homosexuals Anonymous, and Courage.

Gay-affirmative theorists, in contrast, tend to view people who identify themselves as being ex-gay as casualties of a larger social conflict characterized by prejudice and discrimination. Change attempts are the result of repressive and condemnatory socioreli- gious prejudices. In one presentation, it was suggested that ex-gays exist because the gay community failed to support them in their efforts toward identity synthesis (Shidlo & Schroeder, 1999). In other contexts, ex-gays are sometimes characterized as really being bisexuals rather than as being true gay males or lesbians.

Is it possible that both accounts are partially true? It is important to clarify the motivations for change in relation to the existence of ex-gays. Some people pursue change because they do not feel supported in their desire to come out and identify as LGB. It is not uncommon to work with individuals who say they would like to come out but fear doing so because of the response they would receive from their family, coworkers, or others. This requires conservative religious persons to admit that not everyone who experiences same-sex attraction and seeks change does so because of a moral valuative framework; rather, some pursue change be- cause of how hard it would be to integrate their impulses into an LGB identity and live openly in society with such an identity. Of course, an alternative motivation for change is that some people pursue change because they hold convictions about the immorality of same-sex behavior that they derive from a theology of human sexuality. They are religious persons, and they want to live ac- cording to the prescriptive dimension of their religion, which, in this case, prohibits same-sex behavior. It may be that most people who pursue change do so for a combination of reasons.

Ex-Ex-Gays

A similar tension exists when we consider “ex-ex-gays.” They are individuals who once lived an LGB lifestyle, later attempted to change their behavior or attractions, and still later returned to living an LGB lifestyle. From a conservative religious perspective, ex-ex-gays may be the result of poor therapeutic technique, insuf- ficient client commitment or motivation, moral or spiritual failure, or failure of ministries to offer realistic expectations of change. This last consideration is particularly important. It might be that conservative religious persons hold out expectations for change that are too high (i.e., that a person would be free from every vestige of same-sex desire and would be happy and fulfilled in marriage). From this perspective, ex-ex-gays are discouraged, sometimes angry, about their experiences within religion-based ministries.

Gay-affirmative theorists tend to see ex-ex-gays as casualties of professional interventions and religious ministries (Haldeman, 1994). Gay-affirmative theorists propose that ex-ex-gays are the result of the predictable failure of sexual reorientation therapy and

religion-based ministries to accomplish what they purport to ac- complish. According to Haldeman, some question whether these proponents of reorientation and reparative therapies are not dis- turbed themselves, preying on vulnerable persons who are hoping against hope to experience change.

Again, is there merit to both accounts? Is it possible that some people are misled about what reorientation and reparative therapy can offer? It is possible that some people do hold expectations for change that are too high. Whether the individual is freely seeking changes for personally felt reasons or is being taken to a program for change by a third party is also a factor in relation to this topic. All of this depends on several factors, including what sexual orientation is, whether it is immutable, and what evidence exists for the effectiveness of reorientation and reparative therapies. It is important for professionals and ministry leaders to recognize, too, that there have been attempts to cover up sexual indiscretions by past ministry leaders (Blair, 1982). Presumably, a small percentage of ministry personnel are involved in ministry for the wrong reasons or are at least vulnerable to acting-out behavior and do not have a sufficient support system and accountability structure to facilitate their ministry.

Reorientation/Alternative Therapies and Religious Ministries

Gay-affirmative and conservative religious persons also dis- agree about the existence of reorientation therapy, alternative therapies (e.g., sexual identity management, behavior manage- ment), and religious ministries. Some gay-affirmative theorists believe that the very existence of religious ministries and reorien- tation therapies suggests that LGB persons are “sick” (and should be “cured”). They fear other negative repercussions for the LGB community overall. For example, Stein (1999) argued that

the availability of conversion programs, hormonal therapy, dietary supplements, or other techniques for changing sexual orientations would encourage the view that lesbians, gay men, and bisexuals are diseased; increase pressure to keep one’s homosexuality secret; en- gender and perpetuate attitudes that lesbians and gay men are worth- less; encourage policies that discriminate against lesbians and gay men; and increase violence towards them. (p. 323)

Some may say that the existence of the alternative therapies is detrimental to the LGB community if the therapies do not work. Others, including Stein (1999), have argued that these therapies are detrimental even if the therapies are found to be successful: “The availability of psychological conversion programs have [serious negative] effects whether or not they are ‘successful’” (p. 325).

Haldeman (1994) pointed out that some reorientation ap- proaches and religious ministries promote the view that homosex- uality is a pathology. Some organizations may also share misin- formation about sexual orientation, a concern raised by the APA’s Resolution on Appropriate Therapeutic Responses to Sexual Ori- entation (APA, 1998; http://www.apa.org/pi/sexual.html). The public is often unaware that although some religious ministries and alternative therapies promote accurate information, others do not.

The concern for the conservative religious person is the impli- cation for what it means to “respect” the autonomy and self- determination of persons who have different beliefs and values about same-sex behavior. From a conservative religious perspec-

237SPECIAL SECTION: RELIGION AS AN ASPECT OF DIVERSITY

tive, reorientation therapies, alternative therapies, and religious ministries exist as a response to a person’s decision that acting on same-sex attraction is wrong. Change may mean attempting to change sexual orientation, although it may also mean attempting to decrease same-sex fantasies and behavior, increase heterosexual fantasies and behavior, or achieve celibacy.

The middle ground here may be to recognize that in a diverse and pluralistic society, gay-affirmative therapy, reorientation ther- apy, and alternative approaches may be viable options, and psy- chologists should be mindful of ways in which harm can result from misinformation. The challenge may lie in whether the poten- tial impact of the existence of such programs outweighs the po- tential impact of not providing such services to those who request them. In the meantime, the key concern is whether such programs are effective.

Research on Change of Sexual Behavior and Orientation

Perhaps the greatest point of disagreement is whether change in sexual orientation is possible. Many gay-affirmative theorists ar- gue that therapy cannot change sexual orientation or that, at least, there is no evidence to date that therapy can change sexual orien- tation. In his review of the change literature, Haldeman (1994), for example, discussed several individual and group treatments from the 1960s and 1970s, as well as more recent efforts by Nicolosi (1991). Haldeman was particularly concerned that researchers and clinicians may sometimes mislabel gay men and lesbians as bi- sexual. He also criticized the research as too often emphasizing changed behavior rather than a more fundamental change of orientation.

Conservative religious persons who have looked at the change research have argued that sexual orientation does not appear to be immutable (Satinover, 1996). Recent survey research by MacIn- tosh (1994; see also National Association for Research and Treat- ment of Homosexuality, 1997; Nicolosi, Byrd, & Potts, 2000) has challenged the claim of the absolute immutability of sexual orien- tation; 274 psychoanalysts reported working with 1,215 gay male and lesbian patients, with reported change of sexual orientation for 22.7% of patients (23.9% of men; 20.2% of women). Studies of therapist recall are susceptible to overreporting of treatment suc- cess and underreporting of treatment failure; however, from the conservative religious person’s perspective, the MacIntosh study and those like it cannot be dismissed as irrelevant to the debate about whether such therapy can be beneficial.

More recent research, also of a convenience sample, suggests that religious motivation is an important factor for some people who report behavioral change and change of “feeling-based sexual orientation” (Schaeffer, Hyde, Kroencke, McCormick, & Notte- baum, 2000, p. 64). Moreover, at the one-year follow-up, those who were highly successful in attempting change of behavior and maintaining celibacy reported positive mental health on a variety of measures of happiness, loneliness, self-acceptance, and depres- sion (Schaeffer, Nottebaum, Smith, Dech, & Krawczyk, 1999).

These studies are mentioned simply because some conservative religious persons dispute the claim that sexual orientation is im- mutable. It should be noted, however, that these studies are with convenience samples and are not meant to be representative of all LGB persons.

What complicates this area of research is that gay-affirmative theorists disagree on what sexual orientation actually is. Essential- ists argue that sexual orientation is a universal reality, a stable aspect of who an individual is as a person. Social constructionists, in contrast, view sexual orientation as a linguistic category con- structed by society to explain a person’s sexual preference. This is not a debate between conservative religious and gay-affirmative persons; rather, this is a discussion among theorists on both “sides,” and the research does not yet clearly support one perspec- tive over the other. But if theorists are uncertain as to what sexual orientation is, then it is understandable that there is disagreement on whether it can be changed.

Respect for Diversity: Clinical Applications

What are the practical applications for psychologists who wish to demonstrate respect for religion and sexual orientation when they work with clients who enter therapy distressed by their experiences of same-sex attraction? Psychologists can expand what they see as viable resources for clients by thinking of a continuum of professional and paraprofessional services for a variety of presenting concerns. On either end of the continuum are gay-integrative approaches and reorientation therapies, and in be- tween are programs to help people achieve celibacy/chastity or work toward sexual identity management (see Table 1).

Gay-Integrative Therapy

The goal of gay-integrative therapy is to integrate same-sex impulses into an LGB identity. The assumption often expressed is that sexual orientation cannot (or, in some cases, should not) be changed, and those who experience same-sex attraction are better off, all things considered, integrating their impulses into an LGB identity.

Dworkin (2000) is a professional exemplar of this approach. She has discussed several themes in therapy with LGB clients, includ- ing sexual identity and self-identification, coming out, internalized homophobia, and victimization. She has viewed the coming-out process as particularly important to LGB identity development and synthesis.

Dignity/USA is a paraprofessional exemplar of the gay-integra- tive approach. Dignity/USA is an organization of LGB and trans- gender religious persons. Although not an official group sanc- tioned by the Roman Catholic Church, Dignity is made up of Catholics who seek to integrate their experiences of same-sex attraction into an LGB identity. Dignity has five primary areas of concern and commitment: spiritual development, education, social justice, equality, and social support (http://www.dignityusa.org).

Sometimes clients request a gay-integrative approach following unsuccessful attempts to change their sexual orientation or behav- ior. With an increasingly visible LGB community, more clients will presumably request this approach without having seriously considered change. Psychologists who consider a referral to a gay-integrative therapist should consider whether their client (a) states this as a goal for treatment; (b) is in his or her normal state of mental health (e.g., has worked through feelings of anger, frustration, or depression following unsuccessful approaches to change orientation or behavior); (c) has had same-sex experiences (as opposed to fantasy); (d) is motivated by internal factors (e.g.,

238 YARHOUSE AND BURKETT

personal values or sense of congruence) or external factors (e.g., peer or subculture pressure); (e) has considered whether he or she has adequate social support and access to friends, family, places of worship, and community services that support such a decision; and (f) is aware of some of the possible benefits of and risks in pursuing gay-integrative therapy at this time. Psychologists should remember that gay-integrative therapy can result in strained friend- ships and family relationships, as well as threats to employment and housing. Benefits of gay-integrative therapy can include pos- itive self-esteem and a sense of congruence.

Reorientation/Reparative Therapy

On the other end of the continuum are reorientation/reparative approaches, the goal of which is to assist individuals in changing their sexual orientation. A reparative approach is probably best suited to those who come to view their inclinations as reflective of normal developmental needs that were unmet. These clients may feel more compelled to find some kind of resolution, and they may feel that integrating their experience into an LGB sexual identity is irreconcilable with their beliefs and values.

The professional exemplar of the reparative approach is the work of Nicolosi (1991, 1993), who responded to these clients by exploring their gender identity development. According to Nico- losi, this involves exploring how some people can become at- tracted to the attributes of their gender and later eroticize same-sex attraction through genital sexual activity and self-identification.

The paraprofessional exemplars of this approach are many religion-based ministries, such as some Exodus International af- filiates and Homosexuals Anonymous. Exodus is an umbrella organization of many religion-based ministries, and some (though not all) of the specific affiliates place emphasis on change of sexual orientation (http://www.exodusnorthamerica.org). Homo- sexuals Anonymous also holds to a view that is consistent with conservative religious clients who would view same-sex be- havior as inconsistent with their religious values about human sexuality and sexual behavior (http://members.aol.com/Hawebpage/ AboutHA/AboutHA.html).

When considering a referral to a reorientation therapist, the psychologist should ask or assess if the client (a) states this as a goal for treatment, (b) is not also suffering from a mental illness that is having an impact on decision making (e.g., the client has

worked through feelings of depression following unsuccessful attempts to integrate his or her impulses into an LGB identity), (c) is motivated internally (e.g., personal values) versus externally (e.g., societal disapproval), (d) has had experience with same-sex or opposite-sex behavior, (e) has adequate social support, (f) has sufficient emotional and financial resources to pursue an extended course of therapy, (g) has not already found reorientation therapy to be unsuccessful, and (h) is aware of the possible benefits and risks of pursuing reorientation at this time. Psychologists may also discuss success rates and definitions of success in professional therapy and paraprofessional ministries. Alternative approaches, such as sexual identity management or celibacy/chastity ap- proaches, may be appropriate for those who do not see a reorien- tation therapist but whose values do not support gay-integrative therapy.

Sexual Identity Management

The primary goal of sexual identity management is to make deliberate choices about sexual behavior and how one identifies oneself to others. From this perspective, individuals may experi- ence same-sex attraction, but some choose not to act upon that attraction or to identify with it.

The professional exemplar is McConaghy (1993), who has viewed same- and opposite-sex attractions as a ratio rather than as fixed categories of homosexual, heterosexual, and bisexual. In this approach, sexual preference is related to choice, regardless of sexual orientation identification. On the basis of his review of the literature, McConaghy believes that, for a variety of reasons, some people who have and continue to experience same-sex attraction sometimes choose to engage in heterosexual behaviors and iden- tify themselves socially as heterosexual. To the best of our knowl- edge, there is no paraprofessional exemplar of a sexual-identity management approach to working with people who experience same-sex attraction.

Sexual identity management may be an appropriate goal for those clients who (a) state it as a goal for therapy, (b) are in their normal state of mental health, (c) do not want to identify publicly as having same-sex attractions (e.g., the conservative Christian who does not wish to identify himself as “gay” but who also does not want to admit to others that he struggles with same-sex attractions), and (d) do not want an integrated LGB identity.

Table 1 Continuum of Services for Clients Who Experience Same-Sex Attraction

Variable Gay-integrative

therapy Sexual identity

management Chastity/celibacy Reorientation/reparative

therapy

Goal Integrate same-sex impulses into a gay, lesbian, or bisexual identity

Make deliberate choices about sexual behavior and how one identifies to others

Change sexual behavior and aspire to chastity

Change sexual orientation

Assumption Immutability of sexual orientation; best to integrate impulses into an LGB identity

Although sexual orientation cannot be changed, people can choose how to identify themselves and what behaviors they engage in

Sexual orientation may or may not change, but people can refrain from same- sex behavior

Sexual orientation can be changed

Professional exemplar Dworkin (2000) McConaghy (1993) Lundy & Rekers (1995) Nicolosi (1991) Paraprofessional exemplar Dignity None Courage; Exodus

International Homosexuals Anonymous;

Exodus International

239SPECIAL SECTION: RELIGION AS AN ASPECT OF DIVERSITY

Psychologists should also remember that clients may not have as much social support because, by definition, they are attempting to manage their sexual identity in circles where acknowledgment of such impulses would lead to negative repercussions. Also, it may be helpful to discuss what keeps the person from integrating his or her experiences into an LGB identity or pursuing chastity or reorientation. Clients may choose to maintain these goals for treatment, or they may choose in time to work toward chastity/ celibacy, reorientation, or LGB integration.

Chastity/Celibacy Approaches

The goals of the chastity/celibacy approaches are to change sexual behavior and to aspire to chastity. Therapeutic interventions and/or ministry approaches focus not on the reorientation of one’s sexuality but rather on refraining from same-sex behavior. Propo- nents of this perspective view chastity as a virtue and assume that although sexual orientation may or may not change, people make choices about behavior.

Lundy and Rekers (1995) offer a professional exemplar empha- sizing self-control and abstinence when working with adolescents. They view “age-inappropriate” sexual behaviors as “simply pre- mature . . . whether homosexual or heterosexual” (p. 344). Delay- ing both homosexual and heterosexual behaviors diminishes the high-risk factors and consequences associated with sexual activity during adolescence. This delay of sexual behavior is not change of orientation; the focus instead is onset and engagement of sexual activity.

The Catholic support group Courage is a paraprofessional ex- emplar of the chastity/celibacy approach. This is a support group for people who experience same-sex attraction. The mission of Courage is “to provide spiritual support for men and women striving to live chaste lives in accordance with the Catholic Church’s pastoral teaching on homosexuality” (http://world.std. com/�courage/back2b.htm). Harvey (1996) suggested that some within Courage are giving more consideration to change of sexual orientation, although change is not viewed as a necessary part of Courage’s program. From Courage’s perspective, success is de- fined as chastity, which is achieved through a commitment to Christ as expressed through the spiritual disciplines of service, prayer, reading of Scripture, spiritual direction, corporate worship, Penance, and the Eucharist.

Psychologists who consider a referral to support chastity/celi- bacy should consider whether the client has (a) stated this as his or her goal for treatment, (b) worked through any depression or other mental illness that might have had an impact on decision making, (c) had extensive same-sex experiences that may make celibacy more difficult to achieve at the outset, (d) had unsuccessful at- tempts at changing sexual orientation, and (e) values or beliefs that are incongruent with gay-integrative approaches. This approach may also be appropriate for adolescents who are at a developmental stage when sexual behavior may simply compound their difficulties.

Referrals to any one of these models would typically come from psychologists helping a client sort through sexual identity confu- sion. As the APA’s (1998) Resolution on Appropriate Therapeutic Responses to Sexual Orientation suggests, clients experiencing sexual identity confusion are vulnerable, and psychologists will need to clarify additional ethical issues. These issues are beyond the scope of this article and are beginning to be addressed else-

where, and they include definitions of competence to work with gay, ex-gay, and ex-ex-gay clients, therapist values, respect for diversity, use of informed consent, and knowledge of referral options (e.g., Yarhouse, 1998). Also, research that further clarifies what clients can expect from each approach would enhance psy- chologists’ understanding of the continuum. This could be chal- lenging and would require conservative religious persons to further scrutinize specific models of therapy and ministry while allowing for some models that are in conflict with their beliefs and values; it would also require gay-integrative professionals to support al- ternative responses to experiences of same-sex attraction and be- havior—again, models of therapy that are in conflict with gay- integrative beliefs and values.

In an effort to demonstrate respect for the interests of clients who experience same-sex attraction and pursue change and to respect those who wish to integrate those experiences into an LGB identity, psychologists must expand their understanding of profes- sional and paraprofessional responses to same-sex attraction and behavior. Such a continuum is one way in which psychologists can show respect for multiple expressions of diversity in a pluralistic society.

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Received October 2, 2000 Revision received March 26, 2001

Accepted August 8, 2001 �

241SPECIAL SECTION: RELIGION AS AN ASPECT OF DIVERSITY