3. +
History/Conversion Therapy
(The what/how)
Homosexuality was classified as a mental disorder in the DSM-
1; However it was declassified as a mental disorder for the
second DSM.
Treatment involved changing ones homosexuality to
heterosexuality OR to help someone gain control over
undesired sexual impulses
Electric shock to hand/genitals
Nausea inducing drugs
Masturbatory reconditioning
visualization
4. +
History/Conversion Therapy
cont…
The treatments were based on behavioral or in some cases
psychoanalytic theories:
Aversion and conditioning
Arrested psychosexual development
Spiritual interventions are also used:
Ministry groups use prayer, group support and pressure to change.
6. +
Intrinsic/extrinsic religiosity
Those that follow religion for intrinsic purposes, tend to report
higher internalized homonegativity and higher propensity to
seek conversion therapy
Many religions teach homosexuality as being sinful
“Many fear the possibility of discrimination and violence, rejection
from family, and social marginalization”
Less likely to seek conversion therapy for those who follow
religion for extrinsic purposes (i.e social support)
7. +“Quest”
Quest is a measure that refers to those that welcome doubt and
uncertainty in both life and religion. They are flexible and
adaptable. They question their religious beliefs and expect them
to change over time; continuously “seeking truth”.
Those that scored higher in Quest scores are less likely to seek
conversion therapy
8. +
Sexual Identity Development
Those that report being further along the continuum of sexual
identify development (acceptance) were less likely to seek
conversion therapy.
It was postulated that those further along in the development
have managed to create and maintain coping skills that allow
them to feel secure and happy with their sexual orientation
Where as those in the early stages of development
(shame/disgust) were more likely to seek conversion therapy.
9. +
Empirical Research on Conversion
Therapy
There is an absence of compelling data to support its efficacy in
either changing ones sexual orientation or helping them gain
control over sexual unwanted desires.
There are a handful of studies claiming success, however many
authors point out numerous methodological flaws
10. +
Benefits/risks
Though there is limited data to support conversion therapy
causing harm, former patients have reported worsening
depression/distress.
Many cite the failure following hope in the treatment as being a
catalyst in worsening mood and self image.
11. +
Ethical considerations (APA)
To provide conversion therapy is a breach of Competence, as
there are no empirical studies that claim its effectiveness.
Attempting to alter ones sexual orientation is disrespecting the
clients integrity and sexual orientation.
The APA states that conversion therapy reflects a deeply
homophobic and heterosexist culture; practicing conversion
therapy therefore violates peoples rights and dignity
12. +
Clinical relevance
Should inform client that conversion therapy is not supported by
research
Can offer “desired” results (acceptance by others/self) through
other means, such as countering homonegativity.
Replacing maladaptive coping with effective ways of dealing
with stress
Help to dispel myths LGB individual and community
14. +
Definition of Shame
* a painful feeling of humiliation or distress caused by
the consciousness of wrong or foolish behavior
* a loss of respect or esteem; dishonor
* used to reprove someone for something of which they
should be ashamed of
* a regrettable or unfortunate situation or action
* a person, action, or situation that brings a loss of
respect or honor (dictionary.com).
15. +
"Shame is the birth place of what feels
good and what is known to be wrong."
- Anonymous
16. +
Brief History of Shame
Inquiries into shame largely concentrate on the distinctions
between shame and guilt
Shame and guilt continue to be viewed predominantly from a
psychoanalytic perspective
Piers and Singer (1953) conceptualize shame as arising from
tension between ego and ego ideal while guilt stems from tension
between ego and superego
Shame accompanies failure and the implicit threat is abandonment
Erik Erikson (1950) places shame in the second of eight stages or
identity crises that span the life cycle (Kaufman, 2011).
17. +
History Cont.
Helen M. Lynd (1958) expands on Erikson’s work and conceives of
shame as deeply embedded in the individual’s search for identity.
Helen B. Lewis (1971) explores the relationships among guilt, shame,
identification, and the superego, again from a psychoanalytic
perspective. She views guilt and shame as different, though equally
advanced superego functions that develop along different routes of
identification
Leon Wurmser (1981), also working from a psychoanalytic perspective,
distinguishes shame anxiety, shame affect proper, and shame attitude.
Shame guards the boundary of privacy and intimacy while guilt limits
the expansion of power (Kaufman, 2011).
18. +
Shame in Correlation to Relationship Status
Findings suggest a strong relationship between shame, internalized
homophobia, and anxious and avoidant attachment style
A significant proportion of gay men reported that they were not easily accepted
when they first came out
There was a significant relationship between coming out and internalized
homophobia but not with shame and attachment style
Furthermore, men who had never come out to family and friends reported higher
levels of internalized homophobia but not higher levels of shame and attachment
style
Of particular significance was the connection between previous marriage and
higher levels of shame and internalized homophobia.
Finally, gay men who were not currently in a relationship reported higher levels
of shame anxious and avoidant attachment style (Jac Brown & Robert
Trevethan, 2010).
19. +
Cont.
It was thought that shame might play a major role in gay men
coming out to a range of family members and friends
Kaufman hypothesized a link between shame and the formation
of identity
He extended these ideas to gay men and lesbians, suggesting
that judgmental parents, friends, and the broader society
provide repeated experiences of shame that become
internalized (Jac Brown & Robert Trevethan, 2010).
20. +
Relationship Status Cont.
Gay men who had previously been married tended to report
greater amounts of shame than did gay men who had not
previously married
Gay men who were not in a relationship reported more shame
than did those who were currently in a relationship
It may be that shame relates to sense of self and as such
inhibits developing relationships
Perhaps having a relationship provides a buffer for managing
shame (Jac Brown & Robert Trevethan, 2010).
21. +
How to Recognize Client Shame
Symptoms such as:
Decreased eye contact
Slumped or rigid posture
Avoidance of the here and now
Freezing
Stammering
Tightened voice
Self-deprecating comments
Anger, rage, envy, contempt
Expressions of grandiosity
(Dearing, 2011)
22. +
Potential Treatment Interventions
Two-Chair Dialogue
Greenbern and Iwakabe Identified two-chair dialogue as the intervention of choice
for clients mired in self-criticism. By encouraging clients to take on the dual roles of
condemner and condemned, therapists can help them in capturing.
Interpersonal Coping
Epstein and Falconier focused most explicit on the process of recovering from and
experience of shame in the moment. They emphasized the importance of sufficient
self-awareness so clients can identify their own shame experience.
Group Therapy
When facilitated by a clinician who is sensitive to shame issues, group therapy can
be a powerful context for resolving shame based concerns.
(Dearing, 2011).
23. +
LOSS OF RELIGION AND/OR
SPIRITUALITY
Detachment and/or diminished conviction
and participation in religious and/or spiritual
beliefs and activities; complete loss or
change of beliefs
‘As a result of religious/spiritual (R/S) abuse
and struggles, individuals lose R/S identity’
Westernized countries are displaying more
liberal views, however religion worldwide
maintains ‘varying degrees of
homonegativity’
Jäckle, S., & Wenzelburger, G. (2015). Religion, religiosity, and the attitudes toward
homosexuality—A multilevel analysis of 79 countries. Journal of
homosexuality, 62(2), 207-241.
Wood, A. W., & Conley, A. H. (2014). Loss of religious or spiritual identities among
the LGBT population. Counseling and Values, 59(1), 95-111.
This Photo by Unknown Author is licensed under CC BY
24. +
LOSS OF RELIGION/SPIRITUALITY:
IMPACT
Loss of peers/social opportunities
Loss of direction/purpose
Loss of identity
Feelings of betrayal/abandonment
Reduced/No participation in faith based
routines and rituals
Can be traumatic and create complex
experience of discrimination
…Less expansive life
https://youtu.be/RC-Xkbbks-A
25. +
LOSS OF RELIGION/SPIRITUALITY:
CLINICAL IMPLICATIONS
Comprehensive evaluation and
clinical interview should be
performed; cover potential latent
vulnerability in history
Vulnerability for depression and
anxiety in a variety of presentations
including:
Depression NOS
Generalized Anxiety Disorder
Adjustment Disorder (include
specifiers)
**Presentations of depression
should be assessed for suicidality
This Photo by Unknown Author is licensed under CC BY-SA
26. +
LOSS OF RELIGION/SPIRITUALITY:
ACCEPTANCE OR AMBIVALENCE
Loss of spirituality may present the
conflict of acceptance of or
ambivalence for an individual
A religious or spiritual community
may be ambivalent toward the
LGBTQQI community and ongoing
efforts for rights and protection
contributing to loss of religion
How do you address
personal ambivalence (if
any) around LGBTQQI
concerns? And other
social justice concerns?
27. + LOSS OF RELIGION/SPIRITUALITY:
ACCEPTANCE OR AMBIVALENCE-CHANGING
LANDSCAPE
Have your views changed
over time? How so?
28. +
LOSS OF
RELIGION/SPIRITUALITY:
CLINICAL APPROACH
• Fowler’s (1981) model can help both clinician and patient identify level of faith to explain and predict clinical concerns
• The model can also help identify access points for a corrective experience
https://faithonthefringe.com/2016/06/29/understanding-christians-in-fowlers-stages-of-faith/
29. +
LOSS OF
RELIGION/SPIRITUAL
ITY: CLINICAL
APPROACH
• Cass’ (1979) model of identity
formation and other resources
can aid both clinician and
patient with case
conceptualization and
treatment planning
Take a moment to
assess where you land
on these models.
30. +
LOSS OF RELIGION/SPIRTUALITY:
CLINICAL APPROACH
• Utilize Fowler and Cass’ model to
inform case conceptualizations and
interventions; integration of
techniques can be applied and
should be reviewed regularly
• Inquire, shape and reframe
expectations of therapy specifically
those around sexual identity and
desires
31. +
LOSS OF RELIGION/SPIRITUALITY:
YOU AS THE CLINICIAN
After this course, will you
consider marketing
yourself as a gay
affirmative clinician? Why
or why not?
32. +
LOSS OF RELIGION/SPIRITUALITY:
YOU AS THE CLINICIAN
How would you
interact with a
family that was
considering
conversion therapy
for their minor?
33. +
Discussion Questions
How would you work with a client who is interested in conversion
therapy?
As future psychologists, how might we better spread the word
about it’s potential harmfulness?
How would you treat a client who did not want to talk about their
shame?
Do you believe that shame has some part in everyone’s life?
Would it be of benefit for a therapist to disclose current or past
feelings of ambivalence with a patient struggling with
homosexual identity formation? Why?
34. +
References
Brown, J., & Trevethan, R. (2010). Shame, Internalized Homophobia, Identity Formation, Attachment Style, and the
Connection to Relationship Status in Gay Men. Retrieved from
http://www.bing.com/cr?IG=A5D0C3F576D0430D9E9116D0BC07B0F0&CID=3A7C5B8D0DBC6F84388651570C
BA6EC6&rd=1&h=ggM-imf-
Jtixj9q8N2POE2R1AFKrT2wSD3Xujyli11M&v=1&r=http%3a%2f%2fciteseerx.ist.psu.edu%2fviewdoc%2fdownloa
d%3fdoi%3d10.1.1.876.8426%26rep%3drep1%26type%3dpdf&p=DevEx,5060.1Tozer, E. E., & Hayes, J. A. (2004).
Why Do individuals seek conversion therapy?: The role of religiosity, internalized homonegativity, and identity
development. The Counseling Psychologist, 32(5), 716-740. doi:10.1177/0011000004267563
Dearing, R. L., & Tangney, J. P. (2011). Summary and Integration. In Shame in the therapy hour (pp. 375-404).
Washington, D.C: American Psychological Association.
Dictionary.com. (n.d.). Retrieved from http://www.dictionary.com/
Kaufman, G. (2011). The psychology of shame theory and treatment of shame-based syndromes. New York:
Springer.
Tozer, E. E., & McClanahan, M. K. (1999). Treating the purple menace: Ethical considerations of conversion therapy
and affirmative alternatives. The Counseling Psychologist, 27(5), 722-742. doi:10.1177/0011000099275006
Beckstead, A. L., & Morrow, S. L. (2004). Mormon clients' experiences of conversion therapy: The need for a new
treatment approach. The Counseling Psychologist, 32(5), 651-690. doi:10.1177/001100000426755
American Psychological Association (2017). Resolution on Appropriate Affirmative Responses to Sexual Orientation
Distress and Change Efforts. http://www.apa.org/about/policy/sexual-orientation.aspx
Hinweis der Redaktion
Religious doctrine plays a major role in creating internalized homonegativity and thus creates a pressure to change.
“Quest” was used in a research paper to measure one mental flexibility in regards to religion.
