Advice From a Psychiatrist to Mormon Mental Health Providers When Treating LGBT Youth (Also for Parents to Consider)

There appears to be progress in the Mormon therapist community toward eliminating some of the damaging practices that they have been guilty of in the past.  In the 1970’s aversion therapy was a routine route for Mormon gays.  It was incredibly damaging, and fortunately was eventually rejected by the Mormon mental health community.  Meanwhile, Mormon therapists have often been late to reject other damaging therapies including reparative therapy.  I see that there are many therapists in the community who genuinely want to look at the evidence and give helpful treatments.  I also see that it is extremely important to take into account their Mormon history, values and mindset when working with these youth and their families. These are the points that I want to emphasize based on current understanding of treating gay teens and young adults.

 

1)  You are mental health professionals, not religious counselors.  Take sin out of the discussion, other than to explore what it means to that person.  You should take an non-judgmental and educational approach about sex.  It is possible to discourage teen sexual activity without taking a judgmental stance about sex in general, such as framing it in the following way:

 

“Sex is not a good idea for anybody until they are adult.  Sex can be very enjoyable in the right circumstances, but unfortunately it is also very dangerous.  It can have lifelong health consequences, and can cause severe emotional damage.  It requires maturity, and that is why religious leaders and mental health professionals agree that waiting until adulthood is extremely important.”

 

This message should permeate the treatment.  Withhold the judgement on gay sex.  It is not necessary for you to give them that message.  Believe me, that message comes to them loud and clear from numerous directions.  By declaring judgement, you are moving away from being an unbiased mental health professional and toward being a religious counselor.  These patients deserve unconditional and unbiased support for these issues and every issue that they face.

Meanwhile you should be aware that many teens decide to have sex in spite of the perils.  This will hopefully be addressed in the counseling and all teens will also need support and education about avoiding the dangers and bad outcomes in the event that they do decide to be sexually active.

 

2)  Please realize that most of your patients are going to leave the church and live a gay lifestyle.  Some of them won’t.  You should prepare them to face both possibilities in the most healthy, moral way.  Suicide rates are high among gay/lesbian/bisexual/transgendered youth in both groups (those that are in or out of the church).  There is excellent research that shows the impact of their home environment and their self-acceptance on their outcome.  Gays and lesbians who feel unconditional love from their family, and who have families who accept and embrace their child’s homosexuality have a much lower risk of suicide.  This includes those who leave the church and those who stay in the church.  Drug abuse and HIV infection are also much reduced in those with accepting families and self-acceptance.

 

It is fair to frame it this way with them (obviously these are educational points that aren’t meant to be given as a lecture but should be incorporated in the context of the actual therapy, which is hopefully a process of exploration for the youth):

 

“As an adult you will have to choose how to live your life.  Most gay/lesbians/bisexual/transgendered people choose to live their lives and pursue relationships in accordance with their sexual orientation.  You should not make the final decision until you are an adult, but should spend your teen years exploring non-sexual relationships, and educating yourself about your orientation. If you do choose the route of same-sex relationships, you should plan ahead to live your life in the most moral and healthy way possible.  You have to be prepared to avoid the unhealthy influence of drugs.  You have to be prepared to avoid the dangers of casual sex that are common among young people.  You should exercise your sexuality within a loving, committed relationship.  This is the healthiest and safest approach.  If for some reason you decide not to do that you should still always protect yourself and others.  It may be wrong to engage in casual sex, but it is far worse to do so in a way that can lead to pregnancy or disease.  It is far better to save your sexual behavior for a committed/loving relationship.  One that you can proudly present to the world and to your family.  One that is based on respect.  One that is based on mutual growth and mutual nourishment.  This is the most moral way to exercise your sexuality in the context of a homosexual relationship.”

 

“Unfortunately, if you choose this path, it is very hard to remain part of the LDS church.  You might find yourself facing church discipline.  If you choose this path, you will have to face some of life’s challenges without the church.  You will manage this better if you have a strong spiritual and moral foundation.  If you are going to choose this path it is all the more reason to continue your personal spiritual development.”  (*note that this is distinct from religious advice, because it is well known by mental health professionals that personal spirituality and religion are beneficial to mental health)

 

“If you choose to stay in the church you will have a different set of challenges.  You will have to navigate your path to growth in ways that are different than most around you.  You have to embrace this if you are going to choose this path.  You will absolutely fail if you choose this path out of guilt or self-hatred.  You have learn to understand that you are not inferior to others even if you are gay/lesbian/bisexual/transgendered, and whether or not you are in the church.  Your religion and all religions teach that God loves all of his children equally.  If you believe that, you need to learn to apply that to yourself in the context of what you are, whether you are gay/lesbian, bisexual, straight, transexual or asexual, and whether you are in the church or out.  If you realize these things, you have a chance of growing there.  But it only works if you are honest and accepting about who you are.  It is a hard environment, because currently in the church there is a huge amount of homophobia and judgment.  You will have to show people Christlike forgiveness on a regular basis in order to keep growing.  You will have to teach them the truth that about homosexuality.”

 

“You will also have to choose to be alone.  This is a hard choice.  Some people who choose to pursue a homosexual relationship will also find themselves alone.  We need to prepare for this possibility by surrounding ourselves with affirming friends and loved ones.  Cultivate friends.  Cultivate close relationships with your parents and siblings.  That will enrich your future no matter what path you choose.”

 

“The church leaders counsel you to choose the church and not to choose homosexual relationships.  You have to make your own decision.  I have my beliefs, but it is not for me to decide, nor your parents.  You have to use your own investigation, moral compass and spiritual practice (ie prayer) to determine which path you want and what you believe god wants.  You may get an answer that your family doesn’t agree with.  As your mental health counselor I will support whatever path you choose and do my part to help you manage it in a healthy and happy way”

 

“If you choose a homosexual relationship, it will not be easy to have children.  Many do however find a way to have children either through adoption or other means.  The church leaders do not encourage this.  Once again you have to make your decision based on your own spiritual practice (ie prayer) and your own relationship to your religion/god.  As your mental health counselor I will support whatever path you choose and do my part to help you manage it in a healthy and happy way.”

 

“Some gay/lesbian/bisexual/transgender youth might consider a mixed-orientation marriage.  Even though the success stories get a lot of publicity, there is a very high rate of failure.  This leads to broken families and pain to all people involved.  You should be very very reluctant to pursue this course.  If you do, you should wait until you have substantial maturity.  You should give yourself many years as an adult to really understand yourself, and what you need in life.  Many people enter these marriages with love and commitment, but after many years they find the cost too high.  As hard as they try, they are unable to maintain happiness in these marriages.  It is devastating to them.  It is devastating to their spouse.  It is devastating to their children.  You should never enter this kind of relationship without full disclosure to your spouse that there will never be the same kind of sexual desire toward them.  They are making a huge sacrifice to be with you, so you should be very reluctant to submit them to that sacrifice, not to mention the high risk that it can not be maintained.”

 

“As your therapist, I am not a religious counselor or pastor.  Meanwhile, your religion is extremely relevant to your mental health.  My job is to help you explore and evaluate what your religion means to you in an unbiased way.  Every human and every mormon has their unique understanding and relationship with important concepts such as sin, salvation and obedience.  I may have my own religious beliefs, and I can use my belief system as a tool for having empathy for you and your path.  Meanwhile it is not my place to let my religious beliefs influence yours.  My place is to accept your position whatever it may be and accept that your position may or may not evolve/change during the course of the treatment.”

 

“At the same time it will be very useful for you to evaluate your relationship with your sexual orientation and how it will impact your life decisions.  Once I again, I have my personal beliefs and I can use my experiences as a tool for having empathy with your path.  Meanwhile it it not my place to let my beliefs influence yours.  My place is to accept your position whatever it may be and to accept that your position may or may not evolve/change during the course of the treatment.”

 

“As a therapist I will always advise you to seriously consider both sides of any issue and to look for resources that honestly present different viewpoints.  This will be in an effort to help you make your decisions based on as much information as possible.  However, it will be up to you to drive this process and decide which type of materials you want to explore.  I promise to inform my work with you with the latest scientific research, and the standards of the mental health community and professional bodies.”

 

“The one exception to my freedom from bias is this: I reject that you are an inferior person.  I want you to develop and grow and learn how to love and accept yourself. I affirm that your life is worth living. I reject suicide as an option. I will reject any path that you are following if you are finding that it is leading toward suicide. I will expect you to be open with me on this issue and work with me to live.  Any path you choose can be altered except for suicide.  I won’t reject you for feeling suicidal. But we must discuss it, with an alliance between us to avoid it.”

 

3) In dealing with families, they should be encouraged to adopt the same unconditional accepting attitudes.   They also have to realize that in the end the child has to make his/her own choice about whether to pursue a homosexual relationship or follow the teachings of the church.  The parents will need support from mental health professionals in accepting that they might not agree with the child’s choice, but that the child needs their love and support even more when this happens. Please review the Family Acceptance Project  pamphlet (I include here a couple of important elements from this pamphlet):

Supportive Families, Healthy Children

Helping Latter-day Saint Families with Lesbian, Gay, Bisexual & Transgender Children

This booklet contains the results of scientific research into the family factors that lead to better or worse outcomes with regard to the health and well-being of LGBT teens and young adults–and an evidence-based approach to help families support their LGBT children.   It is currently the best possible tool for informing families about harmful attitudes and behaviors toward their children, as well as helpful attitudes.  It is also the only “Best Practice” resource for suicide prevention for LGBT young people in the national Best Practices Registry for Suicide Prevention.

Please download and study the complete brochure from http://familyproject.sfsu.edu/publications#faith_based

 

(important excerpts)
Highly rejected LGBT young people are:*

n More than 8 times as likely to attempt suicide

n Nearly 6 times as likely to report high levels of depression

n More than 3 times as likely to use illegal drugs, and

n More than 3 times as likely to be at high risk for HIV and sexually transmitted diseases

—compared with LGBT youth who are not at all or only slightly rejected by their parents and caregivers because of their identity.

*(from one of Dr. Ryan’s studies published in Pediatrics – the journal of the American Academy of Pediatrics.)

 

Behaviors to Avoid:**

n Hitting, slapping or physically hurting your child because of your child’s LGBT identity

n Verbal harassment or name-calling because of your child’s LGBT identity

n Excluding LGBT youth from family and family activities

n Blocking access to LGBT friends, events and resources

n Blaming your child when she is discriminated against or has negative experiences because of her LGBT identity

n Pressuring your child to be more (or less) masculine or feminine

n Telling your child that God will punish him because he is gay or bisexual

n Telling your child that you are ashamed of her or that how she looks or acts will shame the family

n Preventing or not allowing your child to talk about his LGBT identity

**SOURCE: Supportive Families, Healthy Children: Helping Latter-day Saint Families with Lesbian, Gay, Bisexual & Transgender Children by Caitlin Ryan and Robert A. Rees, Family Acceptance Project, San Francisco State University, 2012. Copyright © 2009, Caitlin Ryan, PhD. 

 

4) Offer your patients a variety of information and resources.  Don’t just offer LDS literature.  LDS is a religion and their leaders are experts in religious advice, but church leaders have wisely acknowledged that understanding roots of homosexuality is best left to the scientific community, and don’t claim to be mental health counselors.  Have available a variety of literature that is respected by the mental health community.  Don’t offer them books that offer discredited information about changing sexual orientation.  Offer them affirming literature that will help that person where there are at and the path they are pursuing.  Accept that most will not choose the church.  Give them accurate information about what they really face.  Give them literature based on up-to-date scientific research that will help them understand the sexuality and exercise it in a healthy productive way.  Let them find religious the literature on their own, but be available to discuss it in an informed way and also be ready to educate them about mis-information that appears in a substantial portion of religious literature about homosexuality.