Thursday, March 24, 2016

The truth about the Mormon Mental Health Association

If you have ever contemplated looking for a Mormon therapist, or are interested in mental health as it relates to Mormonism or issues around sex addiction and pornography addiction, this post will be of interest to you. If not, this might not be your thing, and that's cool.

How do I even start this?

People often say that human beings love a scandal, and I'm not sure I disagree.

And, as it turns out, there's a bit of a scandal happening in our own backyard. If it's not a scandal, then it's at least something to be aware of if you are an LDS person who ever seeks out professional help from a therapist.

I don't report on this "scandal" to be sensational. As you'll see, I have very clear and specific reasons to be talking about this, and for attempting to set the record straight about an organization who has chosen a name that affords it credibility and status that, frankly, it doesn't deserve.

Consider this post as warning.

A couple of years ago, I was thrilled to find a new organization called the "Mormon Mental Health Association." I am Mormon, I am a psychotherapist, I love fellow Mormons, and I am deeply committed to helping people find ways to maximize their mental health. It seemed like joining this organization was a natural fit. Plus, as I looked into it, I noticed that this organization had a solid stance against reparative therapy (therapy used to try to "fix" gay people and make them straight, which, turns out, is impossible and serves to really mess people up when it's attempted for reasons you can probably imagine). As someone who was subjected to reparative therapy for many years as a youth and young adult, I was incredibly happy to see a Mormon-based organization that so clearly disavowed this highly problematic therapeutic practice, which is being outlawed in many states because of the way it harms people.

I was one of the very first people to pay money to join this group.

Since then, there have been events that have occurred--from the mildly fishy to downright manipulative and professionally negligent--such that I, for one, am no longer associated with this organization, and I regret giving them a dime.

Things got weird right out the gate.

First, the organizer of the group told me she needed to interview me before I could be "admitted" as a member of this organization. This seemed very odd to me--as a Mormon and a licensed mental health professional, was my credentialing not sufficient evidence of my qualification to be included in a group of Mormons who specialize in mental health? I was disconcerted, but I was also willing to go forward with the interview because I had nothing to hide.

Then, the interview never happened. There was some scheduling difficulty, and then . . . radio silence. I was baffled. I didn't know what to make of this, especially when a dear friend and colleague let me know that she was never asked to do an interview in the first place.

After that I didn't hear from the organization for a really, really long time. When the same colleague would mention receiving messages from MMHA (she and I had both joined right around the same time) I couldn't figure out why I wasn't hearing from them. Eventually, by accident, I discovered the problem. Somehow, instead of sending information to the the email address I had listed in my application, they had begun to send me information to another email address I had created half a decade ago when I started my private practice, and had never really used. To this day, I still don't know how they got this email address. Did they find it in an online search about me? Were they worried about me being a part of this group, and if so, why? As a gay Mormon, was I not "Mormon" enough for the Mormon Mental Health Association? I couldn't figure out what the problem was.

Soon, the real issue became clear. And it shocked me.

Several months ago the head of the organization sent out an email to its members to hold a "vote" on a position policy regarding, of all things, sex addiction.

Now, I am a Certified Sex Addiction Therapist (or CSAT). What this means is that along with helping people with many issues like depression, anxiety, marital discord, and communication, I also spend time helping people who find themselves unable to control compulsive sexual behaviors. These are often people who are deeply religious, people who you wouldn't imagine to have such struggles. They are good, good people. And they are experiencing the horror of not being able to control their behaviors, doing things ranging from hours and hours of pornography use to taking advantage of prostituted women or men on a daily or weekly basis, to exhibitionism to . . . you name it. These are things my clients--who are amazing people--experience in their lives. These behaviors are devastating to my clients. The consequences are real, and the pain these people feel--often interlaced with profound religious shame--is breathtaking. And that's not to mention the betrayal trauma inflicted on spouses when discoveries of these secret compulsive behaviors are uncovered, which is another thing I specialize in. I work hard to help spouses cope with the deep wounds they feel when they have experienced a betrayal, the pain of which I outline in this article.

Therapy with people in these challenging circumstances is incredibly intense, multifaceted and complex. I have paid thousands of dollars and have spent hundreds of hours in trainings and supervision with incredibly gifted clinicians to learn how to appropriately and effectively treat individuals and families that have encountered these problems. And the number of people who experience difficulties with these issues is staggering. This is something that affects many, many Mormons.

I was stunned when I got the email regarding a vote on this issue. Guess what the vote was? It was to exclude sexual addiction from being talked about as a problem amongst Mormons.

Yes. You read that correctly.

They were voting to take a position that sexual addiction is not real, that any behaviors related to sexual compulsivity are the result of religious messages and other mental illness, and that treating sexual behaviors that people can't stop (after years and years of trying) as an addiction is not an acceptable way to help clients. They were making this claim even though there is no peer-reviewed science backing up their conclusions whatsoever.

They were going so far as to not letting clinician use the words "sex addiction" as they describe their specializations and even worse, not letting people like me list the fact that they are officially certified to help with sex addiction in their biographies.

I find this highly negligent.

If I am seeking help with eating disorders, I want someone with experience and training in treating eating disorders. Therapy with someone without that specialty can lead to worsening the problem, not helping it. Likewise, if someone has discovered that they or their partner has dealt with years and years of compulsive, clandestine sexual behaviors that has put their marriage (and sometimes their very lives) in jeopardy, they need to be able to find someone who is trained to help in that very complicated circumstance. CSATs have extensive training and supervision regarding how to treat trauma, how to help marriages where betrayal has happened, and how to heal relationships without worsening the trauma. Couples who see someone without that training are often told very damaging things. Wives who have been betrayed by their husbands are often told that they are the reason their husband is acting out sexually because they are repressed and prudish--when really they are neither of those things. Instead, they are traumatized by the betrayal, as well as by the ways sexual addiction has affected a husband's behavior (both sexually and non-sexually). Not surprisingly, the response to that trauma often includes not feeling comfortable or safe having sex with their husband, the very person who has hurt and betrayed them. These spouses' traumas are then discounted and explained away by theories of religious repression and lack of sex ed. Often, they have been told that told they are the problem by their sex-hungry husband for many years, and this message is then reinforced by the ignorant clinician (or religious leader). This further traumatizes the spouse, often leaving the marriage in a shambles. This is just one example of the deeply complicated, multi-layered complexity of working with people who are confronting a type of betrayal that, because of its addictive nature, happens again and again and again.

Someone without the appropriate training would not be able to make heads or tails of situations as complex as a multi-year marriage interlaced with multiple betrayals and the profound denial-based messaging this dynamic creates in a couple. It is my observation that untrained clinicians often do more damage than good when they try.

Being able to see the designation of "Certified Sex Addiction Therapist" is critical for clients in this vulnerable state.

When I got this email, which included a "survey" for the members of the organization to "vote" on the issue, I was deeply frustrated and very, very concerned. Not only was the fact that this issue was being put to a vote incredibly concerning to me, but the voting itself was profoundly biased. It did not present two sides of the issue and ask a group of professionals to use their discretion and judgment to make a collective choice. Instead, it presented one side of the information very sensationally, cited no research to back its claims (aside from quotes from a few random Master's level clinicians), and gave no primer on the actual issues being discussed. This was how they were deciding an official policy decision!

I suddenly realized that this was the modus operandi of the entire organization--even with the issues I happened to agree with. This was not a scientifically robust community searching out the answers and positions that would best help the Mormon community. It was a very small pocket--perhaps even a pocket of one--of people who wished to project the biases of their own experiences and opinions onto an entire organization, and in turn an entire culture--all while brandishing the name the "Mormon Mental Health Association." More about that later.

I reacted quickly and incisively. I found the email address of every member of the board of the organization and sent them a lengthy message with my concerns. (If you're interested, I've included the email I sent them below.) To summarize, in the letter I point out that the field of process addictions is so young that there is very little robust peer-reviewed science for or against sex addiction, and that to take such a drastic stance against sex addiction with such a paucity of data verges on unethical. (Interestingly, even in the months since sending that letter, I have encountered groundbreaking articles establishing a clear connection between pornography and addiction-based neurological reward centers, like this one or this one. If the MMHA were truly an organization interested in robust scientific inquiry as they claim, they would have already encountered this research, and would not require someone like me to point such articles out.) Additionally, in the letter I pointed out some of the logical fallacies of their conclusions, explained why a position against sex addiction would not be good for Mormons, and then said that if this action went forward, I would no longer be a member of the organization. I also informed them that if they took this step, I would feel professionally obligated to alert people to the highly problematic nature of this decision.

Though I heard through the grape-vine that my email had caused major waves, the formal response was pitiful. A tiny email from the founder of the group which said basically nothing--one or two sentences long. The response was so drastically negligent and non-conversational that I had other members of the board contact me separately apologizing for how wildly inadequate the response I got was.

After sending the email and getting no response, I felt powerless and very concerned. It seemed apparent to me that the action of taking this official position was going to go forward--how could it not, when the system was rigged to get the outcome that fit the leaders' bias?--and I didn't know what to do about it. Part of me wanted to fight. Part of me wanted to rally all the professionals I know who are passionate about helping the issue of sex addiction and push against this. But then, as I thought about it, I wondered if my time would be better spent building something different and more helpful rather than trying to tear something down I disagreed with. I contemplated the idea of doing nothing directly about MMHA and their policy (kind of a "not my circus, not my monkeys..." stance) and instead focus on building resources that would help the vulnerable population I was concerned about. I have many plans in play to accomplish this end. As months passed, I forgot about the situation and was leaning towards not acting.

UNTIL last week when one a dear friend of mine contacted me in a panic. This person texted me asking what my thoughts were about the position she had just read by the Mormon Mental Health Association regarding sex addiction.

Do you see the problem here? Do you see how that question sounds? Do you see how what she saw must have struck her? How it must have felt to read that position coming from a group with that name?

This is a personal friend, whose story I happen to know. I happen to know of her devastation when confronting issues of sexual addiction in her marriage. I happen to have seen her shed tears, and wonder if she should leave her husband (an incredibly good man) because of his dishonesty and his compulsive sexual behaviors. When I received this text from her, wondering how a Mormon Mental Health Association could so blatantly disregard her real-life experience--both the pain she went through for years, as well as the recovery and healing she experienced when she and her husband received treatment from Certified Sex Addiction Therapists--I knew immediately I needed to write this post.

There is a reason my friend texted me within days of this organization posting their official statement. It is because she felt harmed by this position, most especially in the context of the word "Mormon" brandished in this organization's name.

There is a reason the church does not generally allow organizations not affiliated with it to use the word "Mormon" in their title. It is because that term has cultural significance. It is a term that adds credibility when being assessed by populations who have no way of knowing that credibility was earned by nothing more than typing the word "Mormon" into the name itself.

When people hear that "the Mormon Mental Health Association" thinks this or that other thing, they are often, just as my friend did, going to assume that the Mormon church, or an organization endorsed by the Mormon church, thinks that thing.  That is not okay.

And I have to take ownership of my own problematic behavior here: back when it was associated with a cause I believed in (the disavowal of reparative therapy), this incongruous messaging didn't seem so bad. I regret not thinking more deeply about this then. Now that it is affecting me professionally, and affecting people I love, the highly deceptive nature of the branding, the poor messaging, and the biases of this organization sing out loud and clear.

The truth about the Mormon Mental Health Association is that it is neither Mormon, nor particularly concerned with the pursuit of scientifically-based mental health. More so, the organization is a reflection of the cultural biases of its creator and some of its leaders, who appear to hope to make an impact on the trends of Mormon culture by using the word "Mormon" as part of its branding, even when it is highly deceptive, and perhaps even illegal, to do so. This is ironic when their own code of ethics reads: (2.4) MMHA members seek to be aware of personal bias, such as religious or ideological views, which could interfere in allowing clients to explore freely within a therapeutic process.

Obviously, it would behoove them to follow their own stated guideline.

And here's the real kicker: being Mormon is not even one of the requirements of becoming listed in the directory of the Mormon Mental Health Association, nor is there any requirement to clarify one's connection to the LDS church at all. You can be Mormon, former-Mormon, never-been-Mormon, or even excommunicated-Mormon--and there is no requirement to outline your link to the church. The only thing ostensibly connecting any of these therapists to the Mormon Church is the very title of the organization itself--a very flimsy umbrella of association for a public who will be hungry to find therapist who who share their beliefs. To be clear, I have great confidence in well-trained clinicians of any religion or creed to treat LDS folks--indeed I often refer my surplus of LDS clientele to professionals who are not LDS (and always inform said clients of the religious difference so that the client can make an informed choice). What I am saying here is that I believe that to become a member of an organization called the "Mormon Mental Health Association" as a non-Mormon, and then to not clarify your status with the religion, is tantamount to false advertising. Yet the organization makes no provision that a practitioner make explicit these differences in believe.

Apparently, they're so busy making sure professionals aren't allowed to mention their documented certification as a sex addiction therapist that they can't be bothered with minor details like making sure an LDS client seeking out a Mormon therapist from the Mormon Mental Health Association is informed whether or not the therapist listed is, in fact, an actual member of the Mormon church.

In conclusion, I want to say that I really don't relish in posting this. There are people I know and very much respect who are part of the MMHA, and I don't want them to be maligned in any way because of this association. I dislike the idea of trying to tear something down instead of spending my energy elsewhere--building something I believe in. After this post, I plan to do exactly that, and let the cards (if any) fall as they may. That being said, I would feel deeply negligent if I didn't publish a post outlining what I know about this situation so that people like my friend (when searching for Mormon therapists or even Googling "Mormon Mental Health Association") can find helpful information regarding some of the more troubling details of this group instead of just assuming--as the advertising implies--that this is a legitimate group affiliated with the Mormon church.

All right. Enough serious talk for me for one day. Time to go play with my kids.

Below is the letter I sent to the board:

Dear MMHA board,

I recently got your email with the proposed changes and direction regarding sex addiction within the MMHA community. I am sending you this email because I have some significant concerns about it that I thought you might want to be aware of. I have written the following in response to the emailed proposal, but wanted to email it to the board specifically (instead of submitting it in the form) so that it can be a dialogue as opposed to a random, anonymous response.  Consider the following as if it were written in the “comment box” on the survey you sent MMHA members:
The opinion that sex addiction does not exist is not based in science. It is based on the personal biases and conclusions of individuals like the clinicians quoted in your proposal. To wit: instead of peer reviewed science backing the claims contained in your proposed statement/position, you have included nothing more than quotes from practitioners who hold the opinion that sex addiction does not exist, or could be explained through differential diagnosis. However quotes from probably-very-good clinicians do not a peer reviewed, robust scientific analysis make. For the MMHA to take such a definitive stance on this issue without proper scientific backing is very concerning and, in my opinion, verges on being unethical.

While general addiction science and treatment is well established and recognized in the psychological community, the science behind process addictions (like hyper sexuality, gambling addiction, food addiction (binge eating disorder), and internet gaming addiction) is still very nascent, as evidenced by some of the research proposed within and about the DSM-V itself. While at least one field study has already indicated that proposed criteria for hypersexuality are valid and reliable, it will be many years before our field has definitive answers regarding the diagnosis and classification of any of these disorders. And that's okay. That's how science works. Sometimes it takes time.

In one of the quotes from your proposed statement, a clinician admits that the "struggle" of hypersexuality (or at least its symptoms) "is real." That means that these symptoms are showing up in practitioners’ offices, and must be responded to. At this point, the science is so fledgling that no specific modality, treatment model or even diagnostic criteria for said "struggle" has been decided on by the broader scientific community. As such, taking a stand that bars a completely valid treatment model (addiction therapy) when there is not sufficient scientific research to justify its exclusion is jumping the gun in a big way, and in this case seems to reflect deep bias and a profound misunderstanding by MMHA of the sex positive, non-religious-based stance taken by Certified Sex Addiction Therapists, of which I am one. 

Weak, mostly anecdotal articles exist that will buttress the biases of either side of this dialogue, but there is currently a paucity of robust, peer reviewed literature on this topic in either direction.  It is important to note that a lack of robust scientific studies is not proof that sex addiction (hypersexuality) isn't real in the same way that a lack of people testifying that the sky is blue does not prove that it is purple. This is a logical fallacy called argumentum ex silentio (argument of silence) and it is a grossly negligent basis for a policy decision like the one(s) proposed by MMHA.

Inchoate science and a lack of definitive research does not preclude clinicians from treating presenting symptoms of this "real struggle" using best practice, research based modalities like cognitive behavioral therapy, motivational interviewing, and group therapy, etc, which are the bedrock of the addiction model. To claim otherwise before there is robust scientific data sufficient to back that claim is a severe overreach.

If this is the policy that MMHA adopts around this issue, not only will I no longer endorse, support, or participate in this organization, but I will feel a professional obligation to publicly discredit the non-scientific, non-research based nature of this decision. Obviously, I am only one voice, but I feel strongly that publicizing accurate information about this decision would be especially critical for the LDS community, given that the sex negative messages propagated by the LDS church arguably create a larger population than average of people who--because of negative messaging around normal developmental behaviors like masturbation, arousal, developmentally appropriate experimentation, etc.--have especially maladaptive sexual dysfunctions that call for appropriate, best-practices-based interventions (like addiction therapy, among others) to resolve.

This is not to say that addiction therapy is the only solution. Naturally, any good practitioner will rule out differential diagnoses, as the quotes in your proposed action suggest. But when those rule-outs come up empty, addictions treatment is a perfectly legitimate, scientifically sound therapeutic modality choice for the treatment of the aforementioned “struggles” of those who present with symptoms of hypersexuality while we wait for the science to further elucidate this issue. Furthermore, to conflate religiosity with professional sex addiction treatment is a blatant mischaracterization of a professional modality that is not connected to faith traditions of any kind, has a fundamental aim to reduce shame around sexual behavior, and that arguably helps thousands of people effectively respond to the deep wounds and poor sexual health caused by negative religious messaging—i.e. the kinds of wounds and poor sexual health we so often see in the Mormon community.

In reality, I feel that all practitioners within MMHA have similar goals in helping LDS people who have been hurt by the religious pathologizing that happens around sexuality in our congregations: we want our clients to rid themselves of shame, and we want them to be able to live sex positive, healthy intimate lives with their partners. Cognitive behavioral therapy, motivational interviewing, and group therapy, etc. (the essence of addictions treatment), and the sex addiction treatment model as a whole, are perfectly reasonable modalities to employ in order to achieve that aim.

I realize this is a new organization, and growing pains are inevitable. However issues like the one I address here have me questioning whether this organization, which I was thrilled by initially, can adequately represent Mormon mental health practitioners like me who are tired of the church-tethered, insular practices of former decades and wish for an organization based on sound scientific research instead of fear-based, reactive biases. (Biases, misunderstandings, and fear-based exclusions of healthy clinical models are something that the church has been plagued by for many years, so it is frustrating to see that happening here as well, in the other direction.) It makes me question this organization's perception of science, its assessment of what constitutes best practices, and its ability to participate responsibly in cutting edge social activism that would promote the mental health of Mormons. In other words, I contend, and plan to publicly point out, that if the MMHA takes this stance on sex addiction, it will fail to meet its own objective "to be up-to-date on credible, peer-reviewed, best-practice approaches to all issues surrounding mental health and serve as educators of such information.”

At the same time, I appreciate the methodical nature of your decision making process, and the opportunity you have given your members to contribute to the dialogue around this issue. I would be happy to engage in a conversation around these ideas if that were of interest to you. Thank you so much for your time.


Josh Weed, LMFT, CSAT

Thursday, March 10, 2016

Lamb of God

I'm doing something very new to me.

This Sunday, and the Sunday after, I'm singing a solo in an oratorio called "Lamb of God." I'm playing the character of Thomas.

I've never, until three weeks or so ago, had a voice lesson. No training. Just a lot of singing loudly in church choirs and being told to "blend, Josh. Blend!" This is a total departure from what I know of myself as a musician--usually I'm in the orchestra. Not on stage, singing.

If I think about it too much, my hands go numb and my gut clenches and I want to crawl into my bed and not come out for a week and a half. But then, I also feel a surge of excitement, and a feeling that I know I'm supposed to be doing this. Remember when I mentioned in my New Year's post that I would be fearless this year? That I would throw my hat in the ring and do things, even when they feel terrifying? Well, this is one of those moments.

There's a whole, long story about how all of this came about that I might get into later. But for now I want you to know this one key thing: I have struggled so much to know how to articulate my thoughts around the policy that happened in November. My thoughts and feelings are incredibly complex, and my pain around it is deep and difficult to put in words. I have been unable to write about it, but please know that--hokey as this might sound--my singing of this song is part of my response to the policy. Words have largely failed me. But this music has encapsulated my emotions and hopes and feelings in a way I've never experienced before, and I mean that sincerely. I've never connected to music on this level, and the circumstances of me doing this were very providential.

So, if you live nearby and if you want to truly understand my feelings--not just about the policy, but about a great number of things--I would be honored if you came and saw my performance. This is an instance where, perhaps for the first time in my life, what I feel in my heart is better expressed not in written word, but in song. (I'm trying hard not to feel cheesy about how that sounds! Because I mean it.)

Please come. If your heart is hurting, come. If you feel confusion of any kind in your life, come to this performance. Not just to see me, but to experience this powerful piece of music, which has made me cry pretty much every day for the last three weeks. The entire oratorio is a treatise on Christ, on His atonement and sacrifice, and on why we are permitted to have hope in the face of cruelty, death and profound difficulty. (Here I go again, trying to describe something in words that can be better described in music.)

If you have a heavy heart for any reason, or just need a spiritual pick-me-up; if you feel disenfranchised and frustrated; if your faith has taken a hit, and you need to feel God's love, this performance will be a safe place for you.

Come. Enjoy this music. Celebrate the ministry of Christ.

Watch me do something utterly terrifying.

And please, whether you come or not, say huge prayers for me that I'll be able to do this scary thing with courage and a solid sense of self, in a way that's pleasing to God.