October 17, 2015

US Report Calls for Ban on Conversion Therapies for Gay, Lesbian and Transgender Youth

A short little update here on LGBT policies in the US, as it may help many of us gain some perspective on where the general consensus is right now as regards sexual diversity and gender variance.

The US Substance Abuse and Mental Health Services Administration (SAMSHA) has published a report on so-called "conversion therapies",  based on a thorough review of current research.

The expert panel was set up by SAMHSA and the American Psychological Association (APA) earlier this year, and included prominent American figures in LGBT human rights, policy, research, treatment, and advocacy.

"This groundbreaking report dispels widespread misconceptions about sexual and gender development and definitively concludes that treatments designed to change a child's sexual orientation or gender identity do not work, are devastatingly harmful to 'victims' of this type of therapy, and should not be considered appropriate mental health services," Dr. Celia B. Fisher, who served on the expert consensus panel says.

Conversion therapy does not work

Indeed, the main conclusions in the report are clear:
  • "Same-gender sexual orientation (including identity, behavior, and attraction) and variations in gender identity and gender expression are a part of the normal spectrum of human diversity and do not constitute a mental disorder.
  • "There is limited research on conversion therapy efforts among children and adolescents; however, none of the existing research supports the premise that mental or behavioral health interventions can alter gender identity or sexual orientation.
  • "Interventions aimed at a fixed outcome, such as gender conformity or heterosexual orientation, including those aimed at changing gender identity, gender expression, and sexual orientation are coercive, can be harmful, and should not be part of behavioral health treatment."
Gender variance is not pathological

The message from the American Psychological Association is also clear: Being a sexual or
gender minority, or identifying as LGBTQ, is not pathological.


The report discuss different life trajectories of transgender people, but do not set them up against each other, or give them different status or value. Both early onset and late onset transgender people are included, and female to male as well as male to female.

Society causes distress

The report takes, as much research on transgender today, biological factors into consideration. But the expert panel is also very much aware of the way social forces shape the lives of transgender:
"While most adolescents with gender dysphoria score within normal ranges on psychological tests (...), some gender minority children and adolescents have elevated risk of depression, anxiety, and behavioral issues. These psychosocial issues are likely related to if not caused by negative social attitudes or rejection (...).

As with sexual minority adolescents, other issues of clinical relevance for gender minority adolescents include increased risk of experiencing victimization and violence, suicidal ideation and attempts, and homelessness."
Gender identity caused by interplay of factors

Indeed, the experts stress that the development of gender identity "appears to be the result of a complex interplay between biological, environmental, and psychological factors."

Leave room for LGBT youth

The basic principle for health care for LGBT youth is simply to give them room to find out for themselves who they are. The goal of the treatment should be "the best possible level of psychological functioning, rather than any specific gender identity, gender expression or sexual orientation."

No support for transphobic science

As some of my readers will know, the extremist "autogynephilia"-tribe of sexology, Ray Blanchard and J. Michael Bailey included, continue to argue for conversion therapy for feminine boys and those Blanchard call "sissies".  But then again they consider male to female transgender people mentally ill.

It is clear that they find little support for this in the research and health communities. Autogynephilia is not mentioned. They will also find little support for the idea that they, as scientists, somehow stand outside the realm of ethics. This expert panel is acutely aware of the ethical responsibilities of scientists and health care providers.

You can download the report here. It is an interesting read, as it gives a useful summary of the current status of research on sexuality and gender identity.

10 comments:

joanna Santos said...

"As some of my readers will know, the extremist "autogynephilia"-tribe of sexology, Ray Blanchard and J. Michael Bailey included, continue to argue for conversion therapy for feminine boys and those Blanchard call "sissies". But then again they consider male to female transgender people mentally ill"

Kenneth Zucker who is also at the CAMH works hand in hand with this crowd I am afraid. Converting these kids to being "normal" essentially means curing them of their own natural inclinations hence introducing them to a potential life of depression and anxiety with the implied message that we don't accept you as you were created but want you to conform.

Although I am not advocating that every child that demonstrates gender variance be put on puberty blockers without doing your homework first, we need to allow room for the reality that not every person is not to fit into a predetermined society-created model.

Its about time we abandon the psycho-sexual model of the "Blanchardians" and adopt the biological medical model and treat these kids with dignity and respect.

Anonymous said...

Do you have any evidence that they in fact argue for conversion therapy?

joanna Santos said...

http://www.genderpsychology.org/psychology/dsm_v_workgroup.html

Anonymous said...

This is written by someone else about what Dr. Blanchard allegedly said and believes. That's not really proof.

joanna Santos said...

you will have to do your own reading Anonymous as finding a more direct correlation that you seek will require this. Drs Blanchard and Zucker worked at the same institution (CAMH). One tries to repair kids before they need to get to see Blanchard and Zucker supports Blanchard in his work. I don't know what more proof you need.

Essentially both take the position that this is an abnormality. By the time it takes to Blanchard its become a psycho-sexual paraphilia. Presumably Zucker is trying to head them off at the pass.

Jack Molay said...

Blanchard actually wrote a comment in the Toronto Star about this. For me it is amazing to see how he opposes conversion therapy for gay and lesbians, while he supports it for transgender children and teenagers.

Blanchard and his supporters use the favorite straw man argument of undermining transgender care for children and youth: That many gender non-conformative young people are simply expressing gender variance; they are not truly transsexual. The fear is apparently that the health system will cause non-transgender kids to transition.

It is also fascinating to see how Blanchard now argues that the children we are talking about here are homosexual children. He is using the exact same arguments used against homosexual children previously, but now against transgender children. It used to be "heterosexual is good, gay is bad"; now it is: "homosexual is good, trans is bad."

I should add that many of the gender non-confirming children do not grow up to become "homosexual", but will -- like non-transgender people develop different sexual orientations.

It would be tempting to bring up the maxim: "Those who do not know their history, are bound to repeat it." Blanchard knows this history, however. He is only transphobic.

In the real world, the dichotomy "only gender variant vs. transsexual" is rarely a problem, as children and youth will have to present persistent gender dysphoria over a longer period of time to be considered legible for hormone blockers. If the health personell follow the procedures recommended by WPATH, there will be no irreversible medical procedures before the child has reached adulthood and can make a well informed decision for him- or herself.

Dee Sparling wrote a good response to Blanchard in the same newspaper, which you will find here.

Sparling writes:

"It is true that people’s understanding of their gender identities can evolve over time. But, contrary to what Dr. Blanchard says, the role of the professional is not to force people toward gender conformity, but to follow and support them as they discover themselves, whatever path that may take."

Exactly!

Lisa Mullin said...

Apart from his book Bailey is a bit player in trans children reparative therapy, as is Blanchard.

Zucker has long been the doyan of all this, with over 120 papers produced and 600 (from memory) gender variant children going though hs regime at CAMH.

He dominated every discussion about them. Here is the US APA in 2008 (with no less than 46 references to his work). Note that the APA has completely changed now and totally condemns reparative therapy, but back then it supported it as the standard 'treatment'.

Snippets
"Treatment modalities used with children have focused on modifying children’s cross-gender behavior or on assisting children to feel more satisfied or less distressed with their natal sex and associated gender roles. These modalities include behavior modification, psychotherapy, and cognitive-behavioral approaches."

"The research on gender identity issues for children and adolescents is largely clinical in nature, and focuses on treatment and intervention of gender identity disorder (GID) as described in the DSM. There is very little research and commentary on psychosocial issues for children and adolescents with gender identity issues, although that is slowly changing."

"Treatment has generally focused on modifying the child’s cross-gender behavior or assisting the child to feel more satisfied or less distressed with his or her natal sex and associated gender role. In general, there seem to be five rationales for intervention with children with GID. The first two are (a) reduction in social ostracism, and (b) treatment of the underlying distress, which speak for themselves. The third rationale is the prevention of transsexualism in adulthood, which is predicated on the assumption that this, too, will prevent social ostracism and distress, as well as the social and physical complexities of transitioning. The fourth is the treatment of any underlying psychopathology, and the last and least credible is the prevention of same-sexattraction in adulthood"

"Accordingly, these behavioral interventions for GID systematically arrange to have rewards follow gender-typical behaviors and to have no rewards (or perhaps punishments) follow crossgender behaviors."

"This has led behavioral therapists to seek more effective strategies of promoting generalization, including self-regulation or self-monitoring, in which children reinforce themselves when engaging in a sex-typical behavior"

"A cognitive approach to treatment might help children with GID to develop more flexible and realistic notions about gender-related traits (e.g., “boys can wear pretty cool clothes too” or “there are lots of boys who don’t like to be rough”), which may result in more positive gender feelings about being a boy or being a girl."


And the conclusion by the APA back then?
"Because comparative treatment approaches have not been conducted, it is not possible to say whether or not this supportive or “cross-gender affirming” approach will result in more beneficial short-term and long-term outcomes in comparison to more traditional (reparative) approaches to treatment."

"REPORT OF THE TASK FORCE ON GENDER IDENTITY AND GENDER VARIANCE"
American Psychological Association

MEMBERS
Margaret Schneider, PhD, Chair University of Toronto
Walter O. Bockting, PhD University of Minnesota Medical School Minneapolis, MN Randall D. Ehrbar, PsyD New Leaf Services Our Community San Francisco, CA
Anne A. Lawrence, MD, PhD Seattle, WA
Katherine Rachlin, PhD New York, NY
Kenneth J. Zucker, PhD Centre for Addiction and Mental Health Toronto, Ontario, Canada

Jack Molay said...

Thank you, Lisa, this is very helpful.

It was after having read Bailey's paper on the hypothetical benefits of aborting gay fetuses, I realized how bad this tribe can get.

They are so hell bent on discipling young boys into adhering to the gender stereotypes, that Bailey is even willing to contemplate killing feminine, gay, boys before they are born in order to achieve the overreaching objective of happy parents.

As you can see from the comment from "anonymous" above, people find it hard to believe me when I tell them the truth about the Zucker/Blanchard tribe. Which is, of course, why we must continue to expose them.

Lisa Mullin said...

Jack do you (or someone you know) have access to these?


Article: A Developmental, Biopsychosocial Model for the Treatment of Children with Gender Identity Disorder
Kenneth J Zucker · Hayley Wood · Devita Singh · Susan J Bradley
[Show abstract]
Journal of Homosexuality 03/2012; 59(3):369-97. DOI:10.1080/00918369.2012.653309 ·



Article: Assessment of Gender Variance in Children
Kenneth J Zucker · Hayley Wood
[Show abstract]
Child and adolescent psychiatric clinics of North America 10/2011; 20(4):665-80. DOI:10.1016/j.chc.2011.07.006 ·



Article: Commentary on “An Affirmative Intervention for Families with Gender Variant Children: Parental Ratings of Child Mental Health and Gender” by Hill, Menvielle, Sica, and Johnson (2010). Journal of Sex and Marital Therapy, 37, 151-157
Devita Singh · Susan J Bradley · Kenneth J Zucker
Journal of Sex and Marital Therapy 03/2011; 37(2):151-7; discussion 158-60. DOI:10.1080/0092623X.2011.547362

Expressed Emotion in Mothers of Boys with Gender Identity Disorder
Allison F H Owen-Anderson · Susan J Bradley · Kenneth J Zucker
[Show abstract]
Journal of Sex and Marital Therapy 06/2010; 36(4):327-45. DOI:10.1080/0092623X.2010.488115


Article: Children with Gender Identity Disorder: Is There a Best Practice?
K. J. Zucker
[Show abstract]
Neuropsychiatrie de l Enfance et de l Adolescence 09/2008; 56(6):358-364. DOI:10.1016/j.neurenf.2008.

Jack Molay said...

@Lisa,

I know that two of these articles are available for research purposes over at the Crossdream Life library. http://www.crossdreamlife.com/viewtopic.php?f=13&t=160

I am afraid I do not have the others.

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