Sunday, April 24, 2005

Heterosexual-Affirming Therapy Endorsed by Insurance Behemoth

Heterosexual-Affirming Therapy Endorsed by Insurance Behemoth...despite lack of empirical support.

I started to write about the lawsuit threatened by the Thomas More Law Center against the Gull Lake school district, near Kalamazoo, Michigan.  The TMLC decided to come to the aid of two teachers who had been barred from teaching Intelligent Design (1  2  3). I'm sure, though, that others will write about this, and I probably don't have much to add. 

The TMLC site included a separate news release that I noticed, which deserves a little more attention:
Health Board Reinstates Controversial Therapist
Fri, Apr 22, 2005

(CNSNews.com) - After booting a controversial Christian therapist from its advisory council in February, the nation's largest behavioral health services company this week confirmed it had invited him to participate once again.

A press release from Magellan Health Services on Wednesday announced that Dr. Warren Throckmorton, a psychologist and counselor who advocates what he calls "heterosexual-affirming therapy," will serve on the company's advisory council.

Throckmorton advocates a type of counseling intended to change the orientation of homosexuals who feel uneasy about their sexual preference. [...]
Magellan is an insurance company that contracts with other insurance companies to manage (i.e. restrict) mental health benefits.  It is a large and influential organization, which, by the way, got "relief" from six hundred million dollars of debt by filing bankruptcy in 2003. 

I guess that's one way to lower the cost of health care.  Just don't pay your bills.

In any case, Magellan hired this guy in 1999, but on February 14, 2005, dismissed him.  Then, in April 2005, they appointed him to their new National Professional Advisory Council. 
 "As the largest behavioral health disease management company in the nation, Magellan has the opportunity to positively influence health care outcomes for millions of individuals every day," said Alex Rodriguez, M.D., chief medical officer for Magellan. "Establishing the National Professional Advisory Council allows us to tap into the extensive clinical knowledge, intellectual rigor and creativity of leaders in the health care delivery system for the benefit of our members, customers and the practitioners without whom we could not fulfill our mission."
Why do we care?  In 1998 he published an article1, arguing that there is a valid clinical role for therapists to assist clients who are bothered by their sexual orientation and who want to convert from homosexuality to heterosexuality.  A fiskophile could spend weeks on the article.  Most of what he says, though, only supports his statement that "it has not been shown that such counseling is intrinsically harmful."  He does cite some findings that appear to show that some persons maintain different sexual orientation following therapy, but there is a conspicuous lack of evidence that anything clinically significant was changed, or even measured.  He seems to accept the presence of behavioral change as evidence of efficacy.  That is meaningful only if one assumes a priori  that such behavioral change is beneficial to the patient, an assumption that has no empirical support.

Throckmorton.jpgThrockmorton has a list of references on his website, but there are only three items there.  His therapeutic approach is referred to as "heterosexual-affirming therapy," or "reparative therapy."  A Medline search for the former string yields exactly one hit.  The latter yields 1,756 hits, but most of them have nothing to do with psychotherapy.  The first hit, for example, is a Czech article about ligneous conjunctivitis.  Increasing the specificity by searching for "reparative therapy homosexual" yields eight hits.  In contrast, "interpersonal psychotherapy" yields 5,882 hits, and "cognitive-behavioral therapy" yields 2,539.  This tells us that the scientific basis for his treatment method has about as much scientific support as Intelligent Design. 

Not only does Throckmorton have remarkably little support for his method, but several major organizations have adopted policy statements opposing it.  In December 1998, a few months after his publication on the subject, the American Psychiatric Association formally opposed such treatment:
APA Position Statement on Psychiatric Treatment and Sexual Orientation December 11, 1998

The Board of Trustees of the American Psychiatric Association removed homosexuality from the DSM in 1973 after reviewing the evidence that it was not a mental disorder. In 1987, ego-dystonic homosexuality was not included in the DSM-III-R after a similar review.

The American Psychiatric Association does not currently have a formal position statement on treatments that attempt to change a persons sexual orientation, also known as reparative or conversion therapy. There is an APA 1997 Fact Sheet on Homosexual and Bisexual Issues which states that there is no published scientific evidence supporting the efficacy of reparative therapy as a treatment to change ones sexual orientation.

The potential risks of reparative therapy are great, including depression, anxiety and self-destructive behavior, since therapist alignment with societal prejudices against homosexuality may reinforce self-hatred already experienced by the patient. [...]
In 2000, they adopted a revised Statement that is even more strongly-worded than the first one.  They point out that most other pertinent organizations have similar positions:
In doing so, the APA joined many other professional organizations that either oppose or are critical of "reparative" therapies, including the American Academy of Pediatrics, the American Medical Association, the American Psychological Association, The American Counseling Association, and the National Association of Social Workers (1).
This being the case, it is perplexing that Magellan would have appointed him in the first place, let alone reappoint him.  I tried to figure out exactly what they did, and why.  Their website is not very informative. It does not have a global search function, but it is possible to search their press releases.  Such a search on the string "Throckmorton" only turns up one hit, which is the one announcing his appointment to their NPAC.

Curiously, some of the news articles on the subject, such as this one from the Philadelphia Enquirer, state that Throckmorton had been dismissed from the NPAC in February, while the Magellan press release from April is an announcement that the NPAC was just created.  This would imply that he was dismissed from the NPAC before it was created, which I should think would be impossible.  In fact, searching their press releases, I did find a prior reference to a "national professional advisory board," which is not capitalized in the press releases, while the NPAC is written out as "National Professional Advisory Council".  This suggests that they disbanded the original organization, then reconstituted it with a slightly different name, possibly with different membership.  I think that has been a source of confusion for the mainstream media.

When Throckmorton was appointed to the NPAC, Magellan was fully aware of his views.  In the Washington Times article, linked to previously, stated on 3/17/2005:
Magellan Health Services Inc. expelled Warren Throckmorton, psychology professor and counseling director at Grove City College in northwestern Pennsylvania, as "a business decision."

The company said Mr. Throckmorton's positions on homosexuality were "potentially controversial" and not "in the best interests" of the company's corporate clients and employees, company spokesman Erin S. Somers told The Washington Times.

"We made the decision ... out of concern that certain of his publicly expressed views could be potentially controversial to Magellan's stakeholders," she said.
Interestingly, that same article contains a statement by a psychiatrist at he University of Utah, who is critical of the expulsion:
Dean Byrd, clinical professor of psychiatry at the University of Utah, said Magellan's expulsion of Mr. Throckmorton "is merely a cloak for intolerance and a blatant disregard for differing worldviews, the essence of true diversity."

"I would hope that there would be an investigation of Magellan's business practices by both the government as well as their subscribers," he said.
Regarding his first statement, I would encourage Dr. Byrd to acquaint himself with the position statements of the American Medical Association and the American Psychiatric Association.  Magellan dismissed someone who practices a form of therapy that major professional organizations have denounced.  That is hardly a "disregard for differing worldviews."  Rather, it is a recognition of generally accepted standards of practice. 

Regarding his second statement, I must say I agree with him.  I do hope there is an investigation.  Recall that the Magellan press release states:
"As the largest behavioral health disease management company in the nation, Magellan has the opportunity to positively influence health care outcomes for millions of individuals every day," said Alex Rodriguez, M.D., chief medical officer for Magellan.
Indeed, they are highly influential; therefore, they can be dangerous, especially if they deviate from accepted practice.  Magellan claims that the creation of their NPAC is supposed to be a positive influence.  It light of the fact that they have just appointed a therapist who advocates a denounced form of therapy, a treatment that has nanoscale empirical support, I would say that an investigation is needed. 

Magellan is a corporation, one that does not have a reputation of acting in accord with humanistic values.  If it is true that the dismissal of Throckmorton was due to concern about offending the gay/lesbian population, then the reinstatement probably resulted from a recognition of the fact that a large corporation is better off offending that population, than offending Christian fundamentalists.  While that may be good for their bottom line, it serves to reinforce a malignant social prejudice.
1 Throckmorton, W. (1998). Efforts to modify sexual orientation: A review of the outcome literature and ethical issues. Journal of Mental Health Counseling, 20, 283-304. (The author kindly provides a copy on his own website.)

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