Clark Carlton brings a much-needed theological sensitivity to the issues surrounding current debates about homosexuality and the ethics of sexual reorientation therapy. Yet, Carlton’s portrayal seems to mischaracterize and unnecessarily dismiss reorientation therapy on etiological and other theoretical grounds. It is suggested that for most therapists engaged in sexual reorientation therapy the role of developmental factors in homosexual attraction is neither overstated nor minimized.

This article evaluates the phenomenon of sexual reorientation therapy from the standpoint of Orthodox Christian theology. It is argued that homosexual desire is the product of the fall of mankind and cannot be considered “normal.” At the same time, however, reorientation therapies, whether secular or Christian, are inherently reductionistic and fail to address the underlying spiritual pathologies involved in homosexual desire. The purpose of therapeia in the Orthodox Church is the psycho-somatic transfiguration of the whole person into (...) the image of Christ, not merely the cessation of homosexual activity or the “reidentification” of one’s “lifestyle.”. (shrink)

In his paper “The Catholic Church, the American Military, and Homosexual Reorientation Therapy,” David W. Lutz ultimately concludes that it is “appropriate, and highly ethical” for the American military to offer reorientation therapy to help homosexuals overcome “the vice of sodomy.” The major thrust of his paper, however, is to call for abandonment of the “Don’t Ask/Don’t Tell” policy currently in place in the military. Lutz’s paper covers much ground, and this review begins by examining whether (...) such a wide view is necessary for the ultimate conclusions. It goes on to ask whether Lutz has omitted to mention important considerations bearing on this issue, and whether Lutz’s call for the introduction of reorientation therapy is a serious call or a symbolic response to homosexual activities. Lutz fails to address essential issues such as the actual experiences of other nations having homosexuals in the military, and issues regarding what constitutes “reorientation therapy,” the latter leading to questions about how such a therapy would actually be implemented. (shrink)

Homosexual activist groups have targeted the Catholic Church and the American military as institutions especially in need of transformation. Associations of healthcare professionals are also under assault from homosexual activists. It is, nevertheless, appropriate for the Church and the military to defend themselves against this assault, to affirm that homosexuality is incompatible with Christian ethics and military service, and to help homosexuals free themselves from the vice of homosexuality. Arguments that homosexual reorientation therapy is unethical are unsound. Such (...) therapy is consistent with the Christian virtue of charity. (shrink)

Knowing, either by the light of natural reason or by the light of Christian revelation, that homosexuality is a disordered condition is not sufficient for its being ethically permissible to direct self-identified homosexual persons toward just any treatment that aims to modify sexual orientation. For example, such an undertaking would be morally impermissible in cases where the available “treatments” are known to be both futile and potentially damaging to persons undertaking them. I, therefore, introduce this edition of Christian Bioethics by (...) reflecting on (a) the position of homosexuality in our current psychiatric nosology, (b) problems with drawing causal inferences from the outcomes of psychotherapy studies, and (c) the advantages and disadvantages of appealing to traditional categories of sexual orientation in this discussion, all with an eye toward more deeply elucidating core ethical concerns involving the intentional psychotherapeutic modification of sexual orientation. (shrink)

The ideal of virtue demands not only right choice and right behavior but also right desire in the emotions. Homosexual desire, then, even if it does not result in overt homosexual behavior, is contrary to virtue, and the completion of virtue demands right desire. If a homosexual has no plan to marry, then right desire implies only the removal of homosexual desire and not the revival of heterosexual desire at which reorientation therapy aims. On the other hands, if (...) a homosexual is married or plans to marry, then right desire includes heterosexual desire for one’s spouse. If homosexual desire is viewed as an emotional disorder, and not merely as a moral defect, then it may require reorientation therapy to bring about heterosexual desire. The pursuit of virtue, then, may recommend reorientation therapy, but even this recommendation is fairly limited, since reorientation therapy may be burdensome and may not be that effective. In conclusion, married homosexuals or homosexuals planning to marry may have a limited moral obligation to pursue reorientation therapy. (shrink)

Professor Mark A. Yarhouse proposes an ‘identity synthesis’ model of sexual modification therapy for homosexuals. This model is meant primarily to target the process by which one’s sexual identity is synthesized, rather than the changing of sexual orientation itself. I highlight some of the advantages of Yarhouse’s model along with some of its potential pitfalls. My primary point of departure with Yarhouse concerns how one ought to direct those self-identified homosexual clients who fall within our clinical sphere of influence (...) and who, in the end, contrary to our better judgment, decide that they would like to pursue a course of “homosexualization.” Based on the “autonomy”-emphasizing aspects of the identity synthesis model, it appears that Yarhouse is willing to sanction the referral of certain clients to “therapists” who are willing to facilitate these clients’ homosexualization. I do not believe that Christians involved in the care of homosexuals can licitly participate in such referrals. (shrink)

Implicit metaphysical assumptions concerning the nature of sexual orientation are reflected in the language used to frame ethical debates concerning “reorientation” therapies. An alternative metaphysical construal is presented oncerning sexual orientation and sexual identity development and synthesis. This alternative construal allows for humility concerning what we know and do not know about sexual orientation, underscores the client's self-determination and autonomy, and demonstrates regard for personal and religious valuative frameworks. Rather than focusing on therapies aimed specifically at sexual reorientation, (...) clinicians would do well to provide clients with informed consent and to facilitate identity development and synthesis in keeping with their clients' requests for professional services. (shrink)

This article addresses the treatment of individuals who experience conflict between their religious convictions and their same-sex attraction. Recently, attention has been drawn to the ethical issues involved in the practice of sexual reorientation therapy (SRT) with such conflicted individuals. This article reviews the ethical arguments for and against SRT through the lens of the general ethical principles of the American Psychological Association's (2002) ethics code. Practitioners are then challenged to think about how they might respond virtuously (Meara, (...) Schmidt, & Day, 1996) when presented with such a client. Thought questions are presented to assist therapists to develop in virtue while working with religious clients who are conflicted about same-sex desire. (shrink)

This thesis examines the practice of haemodialysis and kidney transplantation, the two medical therapies available for persons with kidney failure, from a phenomenological perspective. A basic assumption made in the thesis is that contemporary biomedicine is deeply embedded in the cultural, historical, economic, and political circumstances provided by the particular local, national, and transnational contexts in which it is practiced. The aim of the thesis is twofold. On the one hand, the aim is to examine the forms of person- and (...) patienthood enacted and negotiated in haemodialysis and kidney transplantation care and in the daily lives of persons with kidney failure. On the other hand, the aim is to investigate the ways in which the enacted and negotiated forms of person- and patienthood are culturally embedded and normatively charged. In order to examine and investigate this twofold aim, an empirical material has been gathered that comprises observations and in-depth interviews with patients and caregivers at four haemodialysis units, one in Riga, Latvia, and three in Stockholm, Sweden. The theoretical approach and methodology of the study is cultural and phenomenological in character, drawing on an ethnological and anthropological understanding of culture as processual and relational, and on a phenomenological understanding of personhood as embodied and intertwined with the surrounding world. The thesis shows that patients’ encounters and attempts to deal with the diagnoses and treatments associated with kidney failure are complex and often misalign them with the normatively charged orientations enacted and recommended by medicine. The complex situation that emerges when they undergo transplantation, for example, stands in stark contrast to the widespread official view of organ transplantation as a self-evidently health-bringing and normalising therapy. Through their repeated and extensive experiences of undergoing haemodialysis and living with the disease, patients eventually become able to create a synthesis between their lived experiences of their own body and their body as a medical object – what in the thesis is called a ‘sick body’ – a synthesis that allows them to reorient themselves in life and experience a sense of direction. This process relies, to a large extent, on the temporal structure that haemodialysis affords life; it is by repeatedly undergoing the treatment that patients become able to create a sick body. Even so, many of them find this temporal structure problematic; they experience it as disruptive of their control and future-orientedness and as causing an existentially difficult-to-handle boredom. The thesis also shows that the political developments and the norms prevalent in the two national contexts studied greatly affect the orientations of the treatment practices and the participants’ lives. In both Riga and Stockholm, ideals of freedom, activity, control, and self-actualisation influence what forms of patienthood and personhood are enacted. The study indicates that persons who fall ill with a serious and chronic disease only gradually become able to understand and actively cope with their differently embodied circumstances of life. This suggests that medical professionals should not too hastily enlist their patients as experts on their own bodies, but rather provide them with the time and support necessary for making repeated attempts at creating and maintaining a life with a sick body. (shrink)

This essay recounts the author’s journey with her father during his prolonged decline due to dementia. The experience pushed her to break out of the confines of conventional scholarly research in her academic field of architectural history to a multi-disciplinary consideration of nineteenth-century environmental, sensory and horticultural therapies for the mentally ill. During her father’s illness, she discovered the tangible therapeutic benefits of momentary engagements with his environment through his five senses and through the emotional filter of poetry. This (...) class='Hi'>reorientation to sensory and poetic experience had a beneficial impact on the caretaker as well. (shrink)

While Garfinkel’s early work, captured in Studies in Ethnomethodology, has received a lot of attention and discussion, this has not been the case for his later work since the 1970s. In this paper, we critically examine the aims of Garfinkel’s later ethnomethodological studies of work programme and evaluate key ideas such as the ‘missing what’ in the sociology of work, ‘the unique adequacy requirements of methods’, and the notion of ‘hybrid studies’. We do so through a detailed engagement with a (...) study that has frequently been singled out as exemplary by Garfinkel for his studies of work programme, namely Livingston’s The Ethnomethodological Foundations of Mathematics. We show how Livingston uses the proof of Gödel’s Incompleteness Theorem as a way to exhibit the work involved in understanding mathematical proofs. We then discuss how Livingston uses this example to introduce a distinction between the written ‘proof account’ and the associated ‘lived work’ of working through that proof, which we argue allows Livingston to provide a powerful critique of a formalist understanding of the objectivity of mathematics. We then discuss three aspects that we find problematic in Livingston’s and Garfinkel’s claims about Livingston’s study. Firstly, we question whether written proofs are best conceived of as descriptions or accounts. Secondly, we interrogate whether an ethnomethodological study could teach mathematicians how to make discoveries. Thirdly, we throw doubt on Garfinkel’s claim that Livingston’s results are results in mathematics. We conclude this paper with a discussion of how Livingston’s study Gödel’s proof highlights key tensions in Garfinkel’s later work. Firstly, we argue that there exists an ambiguity in Garfinkel’s treatment of texts as ‘incompetent’. Secondly, we show that Garfinkel’s attempt to extend his idea of classical studies from sociology to other professions and disciplines is problematic. Finally, we question Garfinkel’s proposals to reorient ethnomethodological studies away from sociological audiences and ask whether ethnomethodological studies promise the delivery of a ‘large prize’ or, rather, provide something like ‘helpful therapy’. (shrink)

The later Wittgenstein advanced a revolutionary but puzzling conception of how philosophy ought to be practised: Philosophical problems are not to be coped with by establishing substantive claims or devising explanations or theories. Instead, philosophical questions ought to be treated ‘like an illness’. Even though this ‘non-cognitivism’ about philosophy has become a focus of debate, the specifically ‘therapeutic’ aims and ‘non-theoretical’ methods constitutive of it remain ill understood. They are motivated by Wittgenstein’s view that the problems he addresses result from (...) misinterpretation, driven by ‘urges to misunderstand’. The present paper clarifies this neglected concept and analyses how such ‘urges’ give rise to pseudo-problems of one particular, hitherto little understood, kind. This will reveal ‘therapeutic’ aims reasonable and ‘non-theoretical’ methods necessary, in one clearly delineated and important part of philosophy. I.e.: By developing a novel account of nature and genesis of one important class of philosophical problems, the paper explains and vindicates a revolutionary reorientation of philosophical work, at the level of both aims and methods. (shrink)

Obstacles to Divine Revelation examines the notion that there are obstacles to God giving revelation, if God exists. Rolfe King argues that exploring these significantly refines ideas of evidence for God, including the claim that God must operate within a logically necessary structure of revelation. Examining obstacles to divine revelation clarifies this structure and paves the way to evaluating its significance.

The goal of an "integral psychology" is to honor and embrace every legitimate aspect of human consciousness under one roof. This book presents one of the first truly integrative models of consciousness, psychology, and therapy.

BackgroundWhereas many adolescents and young people with HIV require the transfer of care from paediatric/adolescent clinics to adult ART clinics, this transition is beset with a multitude of factors that have the potential to hinder or facilitate the process, thereby raising ethical challenges of the transition process. Decisions made regarding therapy, such as when and how to transition to adult HIV care, should consider ethical benefits and risks. Understanding and addressing ethical challenges in the healthcare transition could ensure a (...) smooth and successful transition. The purpose of this study was to analyze the ethical challenges of transitioning HIV care for adolescents into adult HIV clinics.MethodsData presented were derived from 191 adolescents attending nine different health facilities in Uganda, who constituted 18 focus group discussions. In the discussions, facilitators and barriers regarding adolescents transitioning to adult HIV clinics were explored. Guided by the Silences Framework for data interpretation, thematic data analysis was used to analyze the data. The principles of bioethics and the four-boxes ethics framework for clinical care (patient autonomy, medical indications, the context of care, and quality of life) were used to analyze the ethical issues surrounding the transition from adolescent to adult HIV care.ResultsThe key emerging ethical issues were: reduced patient autonomy; increased risk of harm from stigma and loss of privacy and confidentiality; unfriendly adult clinics induce disengagement and disruption of the care continuum; patient preference to transition as a cohort, and contextual factors are critical to a successful transition.ConclusionThe priority outcomes of the healthcare transition for adolescents should address ethical challenges of the healthcare transition such as loss of autonomy, stigma, loss of privacy, and discontinuity of care to ensure retention in HIV care, facilitate long-term self-care, offer ongoing all-inclusive healthcare, promote adolescent health and wellbeing and foster trust in the healthcare system. Identifying and addressing the ethical issues related to what hinders or facilitates successful transitions with targeted interventions for the transition process may ensure adolescents and young people with HIV infection remain healthy across the healthcare transition. (shrink)

Cognitive Behavioral Therapy has become the dominant form of psychotherapy in North America. The CBT model is theoretically based on the idea that all external and internal stimuli are filtered through meaning-making, consciously accessible cognitive schemas. The goal of CBT is to identify dysfunctional or maladaptive thoughts and beliefs, and replace them with more adaptive cognitive interpretations. While CBT is clearly effective as a treatment, there is good reason to be skeptical that its efficacy is due to the causal (...) mechanisms posited by the CBT model. This paper will argue that the specific cognitive schemas posited by the CBT model likely do not play a direct role in the development or treatment of psychological illness. Cognitive schemas, as identified in CBT interventions, are likely to be the result of patient confabulation and epistemically under-supported practitioner-based identification. CBT interventions appear to impose coherence on patients’ psychological states, rather than identifying and modifying preexistent causally efficacious core beliefs. (shrink)

Silence has gained a prominent role in the field of psychotherapy because of its potential to facilitate a plethora of therapeutically beneficial processes within patients’ inner dynamics. This study examined the phenomenon from a conversation analytical perspective in order to investigate how silence emerges as an interactional accomplishment and how it attains interactional meaning by the speakers’ adjacent turns. We restricted our attention to one particular sequential context in which a patient’s turn comes to a point of possible completion and (...) receives a continuer by the therapist upon which a substantial silence follows. The data collection consisted of 74 instances of such post-continuer silences. The analysis revealed that silence can retroactively become part of a topic closure sequence, can become shaped as an intra-topic silence, and can be explicitly characterized as an activity in itself that is relevant for the therapy in process. Only in this last case, the absence of talk is actually treated as disruptive to the ongoing talk. Although silence is often seen as a therapeutic instrument that can be implemented intentionally and purposefully, our analysis demonstrated how it is co-constructed by speakers and indexically obtains meaning by adjacent turns of talk. In the ensuing turns, silence indeed shows to facilitate access to the patient’s subjective experience at unconscious levels. (shrink)

When bringing philosophical attention to bear on social movement slogans in general, philosophers have often focused on their communicative nature—particularly the hermeneutical failures that arise in discourse. Some of the most popular of these failures are illustrated in ‘all lives matter’ retorts to ‘black lives matter’ pronouncements. Although highlighting and criticizing these failures provides much needed insight into social movement slogans as a communicative practice, I claim that in doing so, philosophers and slogans’ users risk placing too much importance on (...) outgroup understandings. This emphasis is misguided because gaining such uptake is not required of particular slogans to perform their functions; indeed it is an inherent risk of them. I show how such an emphasis can also be distracting to users. Since social movement slogans that express values are first and foremost for users, I argue for a shift in focus in what these slogans (such as ‘Black Is Beautiful’ and the more recent ‘Black Lives Matter’) do for users, as well as what they demand from users and enable them to express. When slogans have done these things, regardless of uptake, we can say they have performed one of their key functions. (shrink)

Undeniably, a strikingly higher number of people die with direct health care provider involvement in Canada’s euthanasia regime, euphemistically termed “Medical Assistance in Dying” [MAiD], than un...

Studies have underscored the complexity of the encounter between ultra-Orthodox society and psychotherapy, as well as the challenges involved in developing a therapeutic relationship in cross-cultural therapy. However, there is scant research on therapy for ultra-Orthodox children, especially when it comes to arts therapies that take place in a cross-cultural setting. The current study examined the perceptions of 17 arts therapists who are not ultra-Orthodox, and who currently work or have previously worked with ultra-Orthodox children. Semi-structured interviews were (...) conducted with the therapists and analyzed using the principles of Consensual Qualitative Research. The study covered four domains: perceptions of the significance and objectives of arts therapy with ultra-Orthodox children; the influence of the cultural difference between therapist and client on the emotional experience and the therapeutic relationship; the use of arts in therapy; systemic aspects. The findings indicate significant perceptual and value-based disparities between therapists and clients, which pose difficulties and challenges to all participating parties and require therapists to be highly sensitive. Aside from the difficulties, the findings suggest that this cultural difference may also have certain advantages for clients as well as therapists. The findings likewise attest to the multifaceted process of change that is taking place within Haredi society in its attitude toward psychotherapy in general and arts therapy in particular. (shrink)

The history of maternal-fetal therapy is a complex and compelling one. It can be argued that the science and ethics underpinning this field evolved together, with emerging technology spurring on th...

Limited research has been done among pregnant people participating in investigational drug trials. To enhance the ethical understanding of pregnant people’s perspectives on research participation, we sought to describe motives and risk perceptions of participants in a phase 1 trial of ledipasvir/sofosbuvir treatment for chronic Hepatitis C virus during pregnancy. Pregnant people with chronic HCV infection enrolled in an open-label, phase 1 study of LDV/SOF participated in semi-structured, in-depth interviews to explore their reasons for participation and experiences within the study. (...) Pregnant people took 12 weeks of LDV/SOF and were interviewed at enrollment and at the end of study. We recorded the interviews, transcribed them verbatim, coded them using NVivo software, and performed inductive thematic analysis. Nine women completed the study yielding 18 interview transcripts. We identified two themes regarding motives and one regarding risk perception. Motives— Women conceptualized study participation as part of the caregiving role they associate with motherhood; participating was viewed as an act of caregiving for their infants, their families, themselves, and other pregnant women with chronic HCV. Women also noted that they faced multiple barriers to treatment prior to pregnancy that created a desire to receive therapy through trial participation. Risk perception— Women acknowledged personal and fetal risk associated with participation. Acceptance of risk was influenced by women’s concepts of motherhood, preexisting knowledge of HCV and medical research, family members, intimate partners, or by the study design. Women enrolled in a phase 1 trial for chronic HCV therapy during pregnancy acknowledged risks of participation and were motivated by hopes for fetal and personal benefit and by lack of prenatal access to treatment. Ethical inclusion of pregnant people in research should acknowledge structural factors that contribute to vulnerability and data deficiencies for treatment in pregnancy. (shrink)

Is nonhuman animal-assisted therapy a form of exploitation? After exploring possible moral vindications of AAT and after establishing a distinction between "use" and "exploitation," the essay distinguishes between forms of animal-assisted therapy that are morally unobjectionable and those modes of it that ought to be abolished.

The article addresses critical discourses pertaining to triangulation methodology as a step forward in dealing with policy formulation, particularly at the Bank of Sierra Leone. Alternative prescriptive measure like critical discourse analysis have been proposed as a means to the cutting head development in bridging the gap between orthodox and heterodox views of economic sciences investigations.

Research Ethics, Volume 18, Issue 2, Page 132-150, April 2022. Limited research has been done among pregnant people participating in investigational drug trials. To enhance the ethical understanding of pregnant people’s perspectives on research participation, we sought to describe motives and risk perceptions of participants in a phase 1 trial of ledipasvir/sofosbuvir treatment for chronic Hepatitis C virus during pregnancy. Pregnant people with chronic HCV infection enrolled in an open-label, phase 1 study of LDV/SOF participated in semi-structured, in-depth interviews to (...) explore their reasons for participation and experiences within the study. Pregnant people took 12 weeks of LDV/SOF and were interviewed at enrollment and at the end of study. We recorded the interviews, transcribed them verbatim, coded them using NVivo software, and performed inductive thematic analysis. Nine women completed the study yielding 18 interview transcripts. We identified two themes regarding motives and one regarding risk perception. Motives— Women conceptualized study participation as part of the caregiving role they associate with motherhood; participating was viewed as an act of caregiving for their infants, their families, themselves, and other pregnant women with chronic HCV. Women also noted that they faced multiple barriers to treatment prior to pregnancy that created a desire to receive therapy through trial participation. Risk perception— Women acknowledged personal and fetal risk associated with participation. Acceptance of risk was influenced by women’s concepts of motherhood, preexisting knowledge of HCV and medical research, family members, intimate partners, or by the study design. Women enrolled in a phase 1 trial for chronic HCV therapy during pregnancy acknowledged risks of participation and were motivated by hopes for fetal and personal benefit and by lack of prenatal access to treatment. Ethical inclusion of pregnant people in research should acknowledge structural factors that contribute to vulnerability and data deficiencies for treatment in pregnancy. (shrink)

ObjectiveTo explore how clients in clinical settings experience the process of opening up and sharing their inner experiences in the initial phase of therapy.MethodsTwo psychotherapy sessions of clients were videotaped and followed by interviews. Interpersonal process recall was used to obtain in-depth descriptions of clients’ immediate experiences in session. A follow-up interview was conducted 3 months later. The interviews were analyzed using thematic analysis.ResultsThe data revealed how and why clients distanced themselves from inner experiences in the initial phase of (...) therapy. The overarching theme was “Holding back and struggling to open up,” which included four subthemes: fearing the intensity and consequences of negative emotions; experiences of being incapable and bodily stuck; being insecure about one’s worthiness and right to share inner experiences with the therapist; and struggling with feeling disloyal to loved ones.ConclusionThe participants held back because they feared different consequences of opening up. A range of concerns led participants to distance themselves from their inner experiences and/or to refrain from openly talking about them to the therapist. Concerns related to appropriate interpersonal conduct as client were especially important. This knowledge is highly relevant to clinicians when building safety for psychotherapeutic work. (shrink)

Recombinant DNA technology will soon allow physicians an opportunity to carry out both somatic cell- and Germ-Line gene therapy. While somatic cell gene therapy raises no new ethical problems, gene therapy of gametes, fertilized eggs or early embryos does raise several novel concerns. The first issue discussed here relates to making a distinction between negative and positive eugenics; the second issue deals with the evolutionary consequences of lost genetic diversity. In distinguishing between positive and negative eugenics, the (...) concept of malady is applied as a definitional criterion for identifying genetic disorders that could qualify for Germ-Line therapy. Because gene replacement techniques are currently unavailable for humans, and because even if they were possible the number of people involved would be quite small, the loss of diversity concern seems moot. Finally, we dissuss the issue of iatrogenic disorders associated with gene therapy and discuss several ‘real world considerations.’. (shrink)

Immersive virtual environments can produce a state of behaviour referred to as ‘presence’, during which the individual responds to the virtual environment as if it were real. Presence can be arranged to scientifically evaluate and affect our consciousness within a controlled virtual environment. This phenomenon makes the use of virtual environments amenable to existing and in-development forms of therapy for various conditions. Delirium in the intensive care unit (ICU) is one such condition for which virtual reality (VR) technology has (...) not been evaluated to date. We are currently assessing the feasibility and utility of a delirium prevention and treatment system, which implements VR to improve quality of sleep, reduce pain, lower usage of sedatives, and stimulate cognition. The proposed system will consist of 3-axis wearable accelerometers, 6-DOF position trackers, a VR system and apps designed to promote sleep quality and mindfulness. Our a priori hypothesis is that our VR therapy system would lower the occurrence of delirium in patients admitted to ICUs. (shrink)

The development of photodynamic therapy and anti-vascular endothelial growth factor agents have revolutionized the treatment of retinal diseases, transforming the retina subspecialty by ushering in an age of pharmacological treatments for a wide range of diseases, including age-related macular degeneration.