Law to protect people from anti-gay therapy

[wigflip]

For CA residents: this goes to the floor tomorrow for a vote.

From Equality California Action Alert:

"Senate Bill 1172, sponsored by Equality California and the National Center for Lesbian Rights and authored by Senator Ted Lieu, will protect gay, lesbian, and bisexual young people from psychological abuse by banning any efforts by licensed mental health providers to change a minor patient's sexual orientation. If approved, it will be the first law of its kind in the nation.

Tomorrow, the California Senate will likely vote on this important piece of legislation.
Opponents of equality have mobilized in an effort to defeat this bill and it's critical that members of the Senate hear from Californians like you who support Senate Bill 1172 prior to the floor vote on Wednesday."

http://www.eqca.org/site/pp.asp?c=kuLRJ9MRKrH&b=8081051

---

Members don't see this ad.

 

[niknok]

For CA residents: this goes to the floor tomorrow for a vote.

From Equality California Action Alert:

"Senate Bill 1172, sponsored by Equality California and the National Center for Lesbian Rights and authored by Senator Ted Lieu, will protect gay, lesbian, and bisexual young people from psychological abuse by banning any efforts by licensed mental health providers to change a minor patient's sexual orientation. If approved, it will be the first law of its kind in the nation.

Tomorrow, the California Senate will likely vote on this important piece of legislation.
Opponents of equality have mobilized in an effort to defeat this bill and it's critical that members of the Senate hear from Californians like you who support Senate Bill 1172 prior to the floor vote on Wednesday."

http://www.eqca.org/site/pp.asp?c=kuLRJ9MRKrH&b=8081051

here's an attachment to California Psychological Association's stance on this bill

 

[JeyRo]

For CA residents: this goes to the floor tomorrow for a vote.

From Equality California Action Alert:

"Senate Bill 1172, sponsored by Equality California and the National Center for Lesbian Rights and authored by Senator Ted Lieu, will protect gay, lesbian, and bisexual young people from psychological abuse by banning any efforts by licensed mental health providers to change a minor patient's sexual orientation. If approved, it will be the first law of its kind in the nation.

Tomorrow, the California Senate will likely vote on this important piece of legislation.
Opponents of equality have mobilized in an effort to defeat this bill and it's critical that members of the Senate hear from Californians like you who support Senate Bill 1172 prior to the floor vote on Wednesday."

http://www.eqca.org/site/pp.asp?c=kuLRJ9MRKrH&b=8081051

Caveat emptor. Don't know why we have to involve the government yet again to legislate stupidity.

 

[deleted176373]

Caveat emptor. Don't know why we have to involve the government yet again to legislate stupidity.

LOL, If there is one thing the .gov may have a monopoly on, it's legislating stupidity.

I mean why not, we legislate nearly everything else, without .gov there would be chaos.

 

[JustNoticing]

Does anyone know why our professional organizations allow members who practice these "therapies" to be dues paying members who are state licensed (though they don't always practice with licenses). I'm genuinely curious about this.

 

[niknok]

Does anyone know why our professional organizations allow members who practice these "therapies" to be dues paying members who are state licensed (though they don't always practice with licenses). I'm genuinely curious about this.

Its not about allowing. Its more like if you pass licensing exams (and went through the hoops to be able to sit on the exam) then you're licensed. Unless someone complains on the ethics board, then they are investigated.

 

[crim84]

This hurts my brain. I get how a gay person feeling persecuted by religious beliefs might seek a therapist to become straight, but I don't get how those therapists go into their specialization. The existence of such "therapy" baffles me.

 

[crim84]

Btw wig flip have you seen this? It's a famous tv mishap in Japan.
http://m.funnyordie.com/videos/80ccb76082/wig-fail

 

[deleted462159]

This hurts my brain. I get how a gay person feeling persecuted by religious beliefs might seek a therapist to become straight, but I don't get how those therapists go into their specialization. The existence of such "therapy" baffles me.

Not to say that they don't believe in what they're doing, but... well, it can make money. And it's a relevant/popular/hot issue at the moment. Health professionals have their own fads. It happens in medicine; it happens in dentistry. I'm not surprised it happens in psychology/therapy.

 

[Psychadelic2012]

Did you all see the show, "What Would You Do?" on ABC last week? It was in Provo, UT, with an actor playing a son who told his father that he was gay. The onlookers were NOT supportive! One of them even suggested conversion therapy. People actually really think that this can be done and that it's good for the clients! Simply appalling.

The statement by the CPA was helpful. It helps to know the reasons why they don't support the bill, and it's not because they support conversion therapy--they are trying to make the best possible bill that they can. Very interesting.

 

[JeyRo]

I'm more supportive of laws that prohibit fraud when one is advertising services; a therapist always has the ethical duty to inform their consumers about what services they are being delivered, costs and benefits, whether it's the generally accepted standard of care or not.

As far as "gay conversion therapy" goes (and I'm no expert on this obviously fringe area) I would think an ethical practicioner of such a dubious technique would probably need to basically inform their consumer, "well, I can work with you and use all these (presumably behavioral?) approaches to change your behavior from gay to straight, and I may have X chance of success in doing so if you stick to the treatment, but one major downside is that your same-sex attraction may, in fact, be somewhat innate and all this therapy will do is make you feel more miserable over the long term. Some say the better alternative is to adapt to the fact that you have same-sex attraction. On the other hand, some think that this therapy will make you lose your same-sex attraction, however, this view is not in the mainstream of clinical thinking."

If you decide to contract with a provider who makes a fully informed consent pitch like that, I'd say I have no problem with it. I wouldn't do it, and I'd advise anyone else against doing it. And if you advertised your services fraudulently, I wouldn't oppose some sort of prosecution. However, I think banning it is dumb.

 

[futureapppsy2]

It was in Provo, UT,

Well, that explains a lot...

 

[FadedC]

Well I think that it's important to note that it's only being banned from beng practiced on minors, who realisticially do not have that much of a say in whether they are forced into this type of therapy. It's one thing if an adult wants to engage in dangerous and harmful activities for themselves, but it's another thing if they hurt their children with their stupidity.

I'm more supportive of laws that prohibit fraud when one is advertising services; a therapist always has the ethical duty to inform their consumers about what services they are being delivered, costs and benefits, whether it's the generally accepted standard of care or not.

As far as "gay conversion therapy" goes (and I'm no expert on this obviously fringe area) I would think an ethical practicioner of such a dubious technique would probably need to basically inform their consumer, "well, I can work with you and use all these (presumably behavioral?) approaches to change your behavior from gay to straight, and I may have X chance of success in doing so if you stick to the treatment, but one major downside is that your same-sex attraction may, in fact, be somewhat innate and all this therapy will do is make you feel more miserable over the long term. Some say the better alternative is to adapt to the fact that you have same-sex attraction. On the other hand, some think that this therapy will make you lose your same-sex attraction, however, this view is not in the mainstream of clinical thinking."

If you decide to contract with a provider who makes a fully informed consent pitch like that, I'd say I have no problem with it. I wouldn't do it, and I'd advise anyone else against doing it. And if you advertised your services fraudulently, I wouldn't oppose some sort of prosecution. However, I think banning it is dumb.

 

[wigflip]

Well I think that it's important to note that it's being only being banned from beng practiced on minors, who realisticially do not have that much of a say in whether they are forced into this type of therapy. It's one thing if an adult wants to engage in dangerous and harmful activities from them themselves, but it's another thing if they hurt their children with their stupidity.

Faded C, you beat me to it. Couldn't have said it better myself.

 

[MCParent]

The complications are that

a. this "therapy" is often performed by para-professionals (religious leaders who have no or little training in therapy, etc)

b. the "informed consent" argument is illogical--if an anorexic girl came to you asking you to help her get down to 70 lbs, would you give a little informed consent speech and do it? Of course not--you'd recognize that social influences are negatively impacting her personal goals, and work to fix the goals not help her meet them

c. the therapies are demonstrated to not only do nothing, but to harm. Sue Morrow's longitudinal work on the topic has lost participants who kill themselves during the "therapy," including those who never attempted suicide prior to the therapy.

 

[wigflip]

Btw wig flip have you seen this? It's a famous tv mishap in Japan.
http://m.funnyordie.com/videos/80ccb76082/wig-fail

Oh THANK YOU!! That really made my day!!!

 

[JeyRo]

The complications are that

a. this "therapy" is often performed by para-professionals (religious leaders who have no or little training in therapy, etc)

b. the "informed consent" argument is illogical--if an anorexic girl came to you asking you to help her get down to 70 lbs, would you give a little informed consent speech and do it? Of course not--you'd recognize that social influences are negatively impacting her personal goals, and work to fix the goals not help her meet them

c. the therapies are demonstrated to not only do nothing, but to harm. Sue Morrow's longitudinal work on the topic has lost participants who kill themselves during the "therapy," including those who never attempted suicide prior to the therapy.

Point 'a' is not suprising. Regarding point 'b,' no, I wouldn't offer a service to an anorexic girl to help them get down to 70 pounds, or offer gay conversion therapy either. But is that really the question? If I did offer such a dubious service, to at least offer it honestly (e.g., to be honest that it's fringe, probably won't work, and may actually harm) isn't "illogical" - it's the least you can do if you're offering a product or service that might be dangerous.

Also, I have my doubts that there's a growing market for "gay conversion therapy" - given the growing rates of acceptance for gay people and gay marriage in this country I have a feeling that the market for "gay conversion therapy" will dry up on it's own without government getting involved.

Regarding point 'c' - those sound like pretty compelling reasons not to get "gay conversion therapy," with one of the risks of getting such a service is that you'd end up unhappier at the end (and possibly suicidal). However, without knowing much about it I'd guess that these therapies don't actually "do nothing," and I could imagine a behavioral conditioning regimen for some hypothetical person who wants to "stop being gay" that might at least make some inroads towards extinguishing external homosexual behaviors.

The most serious issue to me is what to do about minor children, which someone else brought up. When it comes to consenting adults, I tend to take the position that an adult should be allowed to contract for whatever product or service they wish, regardless of how harmful it might be for them, whether it's dangerous drugs, or assisted suicide, or gay conversion therapy, or "ana" support, or whatever.

Kids are a little different. I'm not necessarily against people forcibly intervening when people do something harmful to a person who can't consent to it or is otherwise vulnerable (e.g., like when parents physically abuse or neglect their kids). On the other hand, giving the state carte blanche to set standards for what is acceptable parenting isn't without pitfalls either.

 

[JeyRo]

That's great, except that the ethical standards of most mental health professionals require that the professional do no harm (even if the patient requests it and is willing to pay for it). We are meant to look out for our patients' best interests (even when they may not do so themselves). So in light of evidence that conversion therapy is potentially harmful, no ethical mental health professional should deliver it, period. Given that psychology does not have an FDA-equivalent to regulate potentially harmful psychological treatments, I think legislation is the next best thing. I can't see a scenario in which less quackery in our field is anything but a good thing.

I'm not going to be going to bat for people who want to practice gay conversion therapy and would never offer it and never recommend people purchase such a service. I wouldn't offer it or recommend it because of my own ethical standards, not because of what some government told me to do.

The issue isn't whether gay conversion therapy is ethical to offer (I'd say there's a good argument that it absolutely isn't), or whether it benefits the field to not have practicioners out there offering it (I'd say it benefits most everybody), or whether it's potentially harmful or not (without even seeing the research I'm sure it is). The question is why the government needs to get involved in all of these things. Ethical standards shouldn't be dictated by legal sanction.

Would you want an FDA for psychologists, BTW? Would you think that was a good idea? Just curious.

 

[Ollie123]

I agree, and would love to see something "loosely" like the FDA for psychologists. Closest we have is APA's modest support for a list of empirically supported treatments, complete with vague statements that boil down to "Research is nice, but do whatever you want as long as you keep paying membership fees!".

I'd, of course, like it to be a far better and more effective organization than the FDA seems to be, and there are a great many complications that arise with behavioral research, but after seeing what goes on in community settings, its incredibly clear to me that ethical standards are not nearly enough. Of course, whether this is best handled at the federal level, the state level (i.e. through licensure boards), etc. is an open question and I don't have a good answer for that. I'm not tied to the idea that legislation is best, but I am tied to the idea that an unregulated system is far, far worse than legislation.

I do question whether it is wise for it to refer to specific therapies (pretty much guarantees the legal system will never be able to keep up and there will always be loopholes), and I'd be okay with stricter laws regarding false advertising, better application of those laws, etc. There is definitely still a culture of paternalism throughout all healthcare fields. I know very few psychologists who truly explain their approach and a thorough list of alternatives to clients (heck, I'm guilty of it myself at times), and the pros and cons of each. How we continue to get away with it baffles me, but someone needs to step in.

All that said, I definitely support this bill - even if I don't think it should be necessary or is the optimal solution, it might be somewhat effective as a temporary solution while we come up with a better long-term one.

 

[crim84]

I can't see a scenario in which less quackery in our field is anything but a good thing.

lol

 

[JeyRo]

I'd, of course, like it to be a far better and more effective organization than the FDA seems to be

"I would like to have a cat provided it barked." - Milton Friedman

 

[ClinPsychEnthus]

I agree, and would love to see something "loosely" like the FDA for psychologists. Closest we have is APA's modest support for a list of empirically supported treatments, complete with vague statements that boil down to "Research is nice, but do whatever you want as long as you keep paying membership fees!".

I'd, of course, like it to be a far better and more effective organization than the FDA seems to be, and there are a great many complications that arise with behavioral research, but after seeing what goes on in community settings, its incredibly clear to me that ethical standards are not nearly enough. Of course, whether this is best handled at the federal level, the state level (i.e. through licensure boards), etc. is an open question and I don't have a good answer for that. I'm not tied to the idea that legislation is best, but I am tied to the idea that an unregulated system is far, far worse than legislation.

I do question whether it is wise for it to refer to specific therapies (pretty much guarantees the legal system will never be able to keep up and there will always be loopholes), and I'd be okay with stricter laws regarding false advertising, better application of those laws, etc. There is definitely still a culture of paternalism throughout all healthcare fields. I know very few psychologists who truly explain their approach and a thorough list of alternatives to clients (heck, I'm guilty of it myself at times), and the pros and cons of each. How we continue to get away with it baffles me, but someone needs to step in.

All that said, I definitely support this bill - even if I don't think it should be necessary or is the optimal solution, it might be somewhat effective as a temporary solution while we come up with a better long-term one.

I think there are a ton of problems with governments regulating what treatments can be done.

1. This leaves room for lobbyists and politics to interfere in a field that is attempting to base its recommended treatments on an ever evolving field of research. That could get really sticky, really fast.

2. What about the people who do not prefer or do not respond to the ESTs (there's a reason why none can ever claim 100% effectiveness...) who may decide to attempt a less mainstream therapy? Is it within their rights to choose to do so (assuming that they are provided informed consent about empirically supported and recommended versus non-traditional/not supported treatments)?

3. There is a cultural competence piece here that makes me uncomfortable, that would mandate my referring certain clients, but is worth bringing up. What if a person's culture or religion (many monotheistic religions have opinions on homosexuality, whether we agree with them or not) factors into their decision to attempt conversion rather than acceptance of their sexual orientation? There are reasons why many of us would never be the practitioner of these types of interventions, but that doesn't mean that we should mandate they not exist. For people whose religious beliefs are the most important priority, these types of treatment interventions may be 'worth the risks'

4. Opinions don't always agree on ESTs, to a certain extent. Debates continue on everything from the research methodology in some RCT studies of various interventions, the lack of funding for studies of a variety of interventions, and even the generalizability when utilizing ESTs in various settings or with any degree of flexibility...

Point is, advocating that informed consent be done to the appropriate degree and have ramifications for licensure is a logical safeguard, but mandating that any specific treatment (even ones I dislike and would never practice) be banned doesn't seem to be a good move, on principle...

 

[roubs]

Are we really challenging the idea that the FDA performs an essential function cause it's "big gov'mint" ? Most of my reading/knowledge on the agency has been focused in the oncology area where you do see a lot of debate and strong feelings but they are usually surrounding the particular intersection of science and ethics that the experts that make the recommendations are grappling with. There are legitimate concerns about how slow and tedious the approval process is, but when you work in new drug approval and see how many drugs and treatments flame out after being promising you begin to see why a rigorous process is needed. And even then you do get drugs that gain approval on a basis of extending life for an average of 4 months.

In behavioral health people can ignore or push the limits of the ethics code until they maybe get brought to the licensing board with something egregious that the Nth aggrieved client finally spoke out on. A framework for promoting ESTs and discouraging sand trays would obviously look really different, but the "anything goes" system we have now obviously has drawbacks too.

 

[Ollie123]

I think there are a ton of problems with governments regulating what treatments can be done.

1. This leaves room for lobbyists and politics to interfere in a field that is attempting to base its recommended treatments on an ever evolving field of research. That could get really sticky, really fast.

2. What about the people who do not prefer or do not respond to the ESTs (there's a reason why none can ever claim 100% effectiveness...) who may decide to attempt a less mainstream therapy? Is it within their rights to choose to do so (assuming that they are provided informed consent about empirically supported and recommended versus non-traditional/not supported treatments)?

3. There is a cultural competence piece here that makes me uncomfortable, that would mandate my referring certain clients, but is worth bringing up. What if a person's culture or religion (many monotheistic religions have opinions on homosexuality, whether we agree with them or not) factors into their decision to attempt conversion rather than acceptance of their sexual orientation? There are reasons why many of us would never be the practitioner of these types of interventions, but that doesn't mean that we should mandate they not exist. For people whose religious beliefs are the most important priority, these types of treatment interventions may be 'worth the risks'

4. Opinions don't always agree on ESTs, to a certain extent. Debates continue on everything from the research methodology in some RCT studies of various interventions, the lack of funding for studies of a variety of interventions, and even the generalizability when utilizing ESTs in various settings or with any degree of flexibility...

Point is, advocating that informed consent be done to the appropriate degree and have ramifications for licensure is a logical safeguard, but mandating that any specific treatment (even ones I dislike and would never practice) be banned doesn't seem to be a good move, on principle...

Don't want to derail this too far since we could easily have a new thread on this topic, but a couple additional points. I agree with a lot of what has been said.

In reply to JeyRo - I definitely agree that it would be challenging to develop a better system. I'm not convinced its impossible, nor (as I said) am I convinced that "nothing" is better than "something less than ideal".

Briefly, I agree that many of the issues you raised are concerns - to me its just a question of the degree of harm that would be done by those problems, versus the current system.

Lobbyists and politics can and will interfere (and already do, though perhaps not as much). This is without a doubt true of the FDA as well, yet I think it would be INCREDIBLY difficult to argue that the FDA (in some form - not necessarily its current one) is unnecessary. For all their flaws, I don't even want to think about what the healthcare system would be like without them - for all the reasons Roubs said, and more. The day we eliminate them and rely on drug companies to set their own ethical code is the day I flee this country and start relying on 3rd world countries for all my medical needs. This also relates to point #4 - data will always conflict and this absolutely happens with drug research as well. It isn't a reason not to have some standards that ensure professionals provide treatments with established safety records.

Regarding those who do not respond to ESTs...there are always be individuals who do not respond to standard treatments. This is why things that have been demonstrated to at least be "safe" are often used off-label. I do think the nature of behavioral interventions necessitates a bit more flexibility (just as an example...its far more difficult to test for "purity"!), but that still doesn't justify the current system. There is certainly some middle-ground between "If you have OCD, the only therapy you can ever be given is EXRP" and "Anything goes and professionals have little/no accountability for their actions".

The culture piece is, I agree, a tricky one to handle. I'm comfortable with where I stand on this issue, but there is a lot of grey involved and where exactly we draw the line on these things is tough to say. That said, I again don't feel "Its tricky" is an adequate justification for "So let's not do anything about it". I think we need to do our best to draw that line, and if we find out we screwed up, we can move it later.

Again - I'm by no stretch of the imagination arguing that the "best" solution is for congress to pass a new law for each and every therapy that we should or should not do. That's wildly impractical, if nothing else. I am arguing that better regulation is sorely needed. I look to the community and I see tons of vulnerable individuals being essentially bilked out of money by completely unregulated practitioners. The number of clients I've seen who have been in therapy for years and who seemingly have never gotten much beyond "supportive" therapy is astounding. I'm far from enthralled by the idea of the government getting involved, but its clear to me the current system isn't working - if the solution isn't some sort of regulation, I don't know what else could be done.

 

[roubs]

Agree w/the above, but let's not get hasty, if you have a Ph.D. I bet you could find some way to rely on Canada for your health care needs.

 

[Qwerk]

Point is, advocating that informed consent be done to the appropriate degree and have ramifications for licensure is a logical safeguard, but mandating that any specific treatment (even ones I dislike and would never practice) be banned doesn't seem to be a good move, on principle...

The new rule only affects minors, so I'm curious how a child could give informed consent to conversion therapy designed to change his/her sexual orientation. I would argue that this is impossible -- so "informed consent" for minors would mean that it essentially would be banned.

I agree with you as far as adult treatment goes -- I'm absolutely in favor of competent adults deciding their own courses of treatment, no matter whether I disagree with it -- but I'm reluctant to say that there should be no top-down standards for the treatment of minors. On the extreme end, unorthodox mental health treatments like restraint-based attachment therapy have been known to cause harm and even death.

 

[niknok]

The new rule only affects minors, so I'm curious how a child could give informed consent to conversion therapy designed to change his/her sexual orientation. I would argue that this is impossible -- so "informed consent" for minors would mean that it essentially would be banned.

I agree with you as far as adult treatment goes -- I'm absolutely in favor of competent adults deciding their own courses of treatment, no matter whether I disagree with it -- but I'm reluctant to say that there should be no top-down standards for the treatment of minors. On the extreme end, unorthodox mental health treatments like restraint-based attachment therapy have been known to cause harm and even death.

In California, minors, ages 14 and above are allowed to consent for treatment without parent's consent and has right to privacy. At least this is done in the substance abuse side of things so i would think it applies to mental health in general as well. (i hope you guys can access the link)

http://www.teenhealthlaw.org/filead...ights/ahwg/ahwg_minor_consent_wallet_card.pdf

I think like what others have mentioned I'm most concerned about slippery slope with this kind of bill. CPA is not saying to never support this bill, instead to ammend it so slippery slope situations could be prevented and practitioners who do address sexuality issues whether its conversion therapy or not, will not be liable. This country is so litigious I cant imagine how expensive your insurance will be.

I think we all have the best intentions for the minors at heart but jumping into the first bill that comes along without investigating and considering all the points will also be harmful for them. There is no harm in ammending the bill to make it robust and to get it right the first time

 

[JeyRo]

In California, minors, ages 14 and above are allowed to consent for treatment without parent's consent and has right to privacy. At least this is done in the substance abuse side of things so i would think it applies to mental health in general as well. (i hope you guys can access the link)

http://www.teenhealthlaw.org/filead...ights/ahwg/ahwg_minor_consent_wallet_card.pdf

I think like what others have mentioned I'm most concerned about slippery slope with this kind of bill. CPA is not saying to never support this bill, instead to ammend it so slippery slope situations could be prevented and practitioners who do address sexuality issues whether its conversion therapy or not, will not be liable. This country is so litigious I cant imagine how expensive your insurance will be.

I think we all have the best intentions for the minors at heart but jumping into the first bill that comes along without investigating and considering all the points will also be harmful for them. There is no harm in ammending the bill to make it robust and to get it right the first time

Definitely slippery slope is an issue. Regardless of how you feel about "reparative therapy" (apparently that's what it's called), which I think is basically kind of vile to offer, when the government gets involved like this it reduces the autonomy of parents and professionals.

 

[Qwerk]

In California, minors, ages 14 and above are allowed to consent for treatment without parent's consent and has right to privacy. At least this is done in the substance abuse side of things so i would think it applies to mental health in general as well. (i hope you guys can access the link)

Sure, but there's a difference between a fourteen-year-old getting treatment without parental knowledge and a fourteen-year-old being forced into unnecessary treatment by his/her parents. I would argue that a child going into treatment on his/her own has more of a capacity to consent than a child whose parents initiated the treatment. It's rare for a minor to voluntarily seek conversion therapy.

I do agree that the law seems unnecessarily broad. I wouldn't want to be sued because I helped a minor client explore conflicting feelings about his/her sexuality, for example.

 

[niknok]

Sure, but there's a difference between a fourteen-year-old getting treatment without parental knowledge and a fourteen-year-old being forced into unnecessary treatment by his/her parents. I would argue that a child going into treatment on his/her own has more of a capacity to consent than a child whose parents initiated the treatment. It's rare for a minor to voluntarily seek conversion therapy.

I do agree that the law seems unnecessarily broad. I wouldn't want to be sued because I helped a minor client explore conflicting feelings about his/her sexuality, for example.

I agree. I'm not sure about minors but there are some adults who sought reparative therapy on their own because of religious or cultural belief. Not advocating for that therapy though.

 

[JeyRo]

I think there's a line at which mental health professionals should not cater to cultural or religious belief. Just because a client wants it, doesn't mean we should offer it. Doing harm trumps not going along with someone's cultural or religious belief.

Is "harm" something that can be objectively determined in every case or is "harm" something that has to be largely (or perhaps wholly) made in reference to a consenting adult client's self-defined best interest? I would personally say the latter.

Either way, it doesn't matter to me what a client's self-defined best interests were in this particular case - I wouldn't provide so-called "reparative" therapy regardless of the circumstances. However, again, I for the most part don't support the force of law being used against people who do provide such a service (although I would certainly understand and support each and every professional organization condemning such a practice). At the same time, I wouldn't necessarily object if a provider was legally sanctioned for providing such "therapy" to a minor children, particularly those well below the age of consent.

 

[ClinPsychEnthus]

I think there's a line at which mental health professionals should not cater to cultural or religious belief. Just because a client wants it, doesn't mean we should offer it. Doing harm trumps not going along with someone's cultural or religious belief.

JeyRo and psycscientist-

the excellent point you make is along the lines of my own on this topic-

I would never, could never do reparative therapy. If a client came in asking for that, I would't know where to refer them, but I'd also have to tell them that I couldn't do it. I'd certainly not place judgments on their desired goal, just state to them that I'm not the one to work on that goal with them. I'm comfortable being able to not practice on goals I'd find potentially harmful, knowing that I wouldn't be providing a harmful service.

To me, this is similar in some ways to psychologists who work with substance abuse issues- some are comfortable with abstinence only policies, while others are comfortable with Harm Reduction, Moderation management, and other perspectives that allow the clients to continue using or don't require abstinence. Abstinence only practitioners, I've heard it said, struggle with the potential "harm" done in implying that use is ok when its harming the client. "Do no harm" sometimes ends up meaning different things to different people even within ethical practice.

 

[crim84]

Sign this to stop crazy "therapists" from performing anti-gay therapy. The law may pass in California with enough support. I believe this law only applies to clinical practitioners. The movement is aimed at protecting gay adolescents from being subjected to anti-gay therapy by their parents. This would make it so that a therapist who performed such illegal therapy could have his/her license revoked. I signed it.

http://www.allout.org/en/actions/go...english&utm_medium=email&utm_source=actionkit

 

[psych51489]

I totally agree that reparative therapy is harmful, however, we need to be careful as a field in restricting practice....this toes the line.

 

[Azure1]

I totally agree that reparative therapy is harmful, however, we need to be careful as a field in restricting practice....this toes the line.

I disagree.. In my opinion, Clinical Psychologists should not be offering a "treatment" that is not founded on a scientific basis.

I believe you are implying that by restricting the practice of this particular treatment, one may see a greater restriction in general to all types of treatments currently offered by Psychologists, but this is a slippery slope argument.

 

[crim84]

Yeah I don't think this toes the line, because such therapy is harmful and has no empirical supportive evidence. Maybe the line you are thinking of is in considering people who voluntarily choose to seek anti-gay therapy. Those people can still seek such therapy. This law is aimed at protecting children from being involuntarily subjected to anti-gay therapy. I don't mean to offend.

 

[JustNoticing]

I hear the slippery slope argument, but there is a difference between demonstrably harmful therapies, and therapies that might not have full empirical backing.

 

[Azure1]

I hear the slippery slope argument, but there is a difference between demonstrably harmful therapies, and therapies that might not have full empirical backing.

Well, I don't believe there will ever be one therapy with full empirical backing. If that were the case, there would just be one type of therapy, which would act as the gold standard. However, you are correct to make the delineation.

 

[futureapppsy2]

Merged with the previous thread on this bill.

 

[Pragma]

Merged with the previous thread on this bill.

I wondered how over 35 responses occured in such a fast amount of time!

 

[Iwillheal]

I have mixed feelings about this. I don't want to decide what's best for the patient. If someone is having conflicted feelings about his or her sexuality, I want to help them figure out who they are, but from a neutral position. Teens should not be forced into some kind of dogmatic anti-gay therapy against their will. That goes, by the way, for any other kind of therapy as well. Once someone reaches adulthood, however, I'm fine with someone who wants to be gay, not gay, whatever. And therapists and patients should have the freedom to explore feelings and let the patient decide what kind of life he or she wants to live.

 

[crim84]

I hear the slippery slope argument, but there is a difference between demonstrably harmful therapies, and therapies that might not have full empirical backing.

Anti-gay therapy is demonstrably harmful and has zero empirical backing. Take for example a gay teen who wants to be straight for religious reasons or because his/her friends family want them to be straight. He/she gets treatment to become straight. Obviously it fails. He/she is still gay. The "patient" is in a worse position than before therapy started because he or she believed such therapy would change his/her sexuality but failed. It would be much more helpful to encourage gay teens to work out their feelings with a therapist about being gay than to try and completely change them. I can't imagine changing my feelings of attraction to a different sex. That would be awkward and traumatizing.

 

[wigflip]

I have mixed feelings about this. I don't want to decide what's best for the patient.

Isn't that what psychologists are trained to do? Familiarize themselves with the empirical literature and implement EBTs? And avoid doing harm?

 

[Doctor Eliza]

Isn't that what psychologists are trained to do? Familiarize themselves with the empirical literature and implement EBTs? And avoid doing harm?

Agreed.

Psychologists need to take a stand on things that are harmful. Period.

We cannot avoid taking a stand because others think it is wrong or “politically incorrect” when we have data and theory and common sense suggesting otherwise. When people say that it may be a cultural issue for some, I think that is a weak excuse. Are we going to allow genital mutilation aka female circumcision because it is okay in some cultures? Beating your children? Beating your wife?

Psychologists shouldn’t condone harmful "cultural" practices. If an individual potential client disagrees with that approach, then they are free to seek counsel from a cultural or spiritual leader. Not a psychologist who is obligated to do no harm.

Dr. E

 

[Pragma]

Agreed.

Psychologists need to take a stand on things that are harmful. Period.

I agree if something is absolutely harmful. I am not opposed to this law as I don't think that minors can be consenting to this type of therapy.

However, what if something is differentially harmful? What if it is subjective? What may be harmful for one person is not seen as harmful to another?

I don't think psychologists should be involved in those kinds of decision-making when there isn't a very clear answer, or if it is more of a philosophical choice.

Just an example (and not trying to incite a big debate here): I knew a woman who had an abortion when she was in her late teens. Her psychological reaction to having the abortion was negative - lots of grieving, guilt, PTSD symptoms that persisted for years. She shared this with me as a friend and had a lot of regrets about going through the procedure, despite the fact that it wasn't a good time for her to have a child.

Would it be a psychologists role to advise their clients against abortions because some may suffer psychological harm afterwards? Of course not. A lot of women cope perfectly well. We can't blur the line between what is the client's choice and what is the psychologist's personal opinion on the matter. The psychologist is there to help the client understand the risks and benefits, not decide for them.

In the case of actually providing the controversial service, I personally think it is hogwash (psychologists providing conversion therapy). But I'm sure there is a small market out there. I am sure some new approaches could be developed and researched, and consenting adults could partake in these treatments if they chose to. A law such as this one is a step in the right direction, because as things stand now, I don't think there is enough education about risks being provided by the unlicensed/unprofessional practitioners using these methods. At least this would keep children out of potential harm's way.

 

[cara susanna]

A lot of therapies are still legal even though they are harmful. I do agree with banning conversion therapy for minors, of course.

 

[wigflip]

But I'm sure there is a small market out there. I am sure some new approaches could be developed and researched, and consenting adults could partake in these treatments if they chose to.

Why should new approaches be developed? If there was a small market for trephination to let the spooky ghosts out, would that be a good rationale for "developing new approaches"?

From APA Task Force on Appropriate Therapeutic Responses to Sexual Orientation:

"The task force conducted a systematic review of the peer-reviewed journal literature on sexual orientation change efforts (SOCE) and concluded that efforts to change sexual orientation are unlikely to be successful and involve some risk of harm, contrary to the claims of SOCE practitioners and advocates."

http://www.apa.org/pi/lgbt/resources/sexual-orientation.aspx

 

[Pragma]

Why should new approaches be developed? If there was a small market for trephination to let the spooky ghosts out, would that be a good rationale for "developing new approaches"?

From APA Task Force on Appropriate Therapeutic Responses to Sexual Orientation:

"The task force conducted a systematic review of the peer-reviewed journal literature on sexual orientation change efforts (SOCE) and concluded that efforts to change sexual orientation are unlikely to be successful and involve some risk of harm, contrary to the claims of SOCE practitioners and advocates."

http://www.apa.org/pi/lgbt/resources/sexual-orientation.aspx

I said "could" not "should" - big difference. If someone is passionate about this topic and wants to develop a protocol, and get it past appropriate regulations (e.g., IRB) to conduct a study, I don't see why they couldn't. the APA's statements about this and other topics don't really carry any weight, practically speaking. Plus they are wishy washy.

All of that said, as a scientist I think we should (see that?) always be conservative when we don't conclusively understand the etiology for what we are trying to change. Even if we have a good idea about the relative genetic vs. environmental contributions towards what determines sexual identity (which we can't even agree on a definition of in many cases), attempts to make dramatic changes in a construct not well understand compounds the potential risk for harm, IMO.

That's part of why I can't wait to get on my institution's IRB - I love shooting things down in the name of human subjects

 

[Psychadelic2012]

I believe you are implying that by restricting the practice of this particular treatment, one may see a greater restriction in general to all types of treatments currently offered by Psychologists, but this is a slippery slope argument.

However, what if something is differentially harmful? What if it is subjective? What may be harmful for one person is not seen as harmful to another?

These two things. This is a political issue, IMO, in terms of professional regulation. By that I mean that there is absolutely no argument from me that conversion therapy is sick, with no empirical basis, is harmful, and all of that other stuff that makes me want to banish it forever. However, if the law starts restricting practice, the law will have a precedent for restricting practice. That includes practice that is "potentially harmful" or without full empirical backing. I agree with the slippery slope here, although I'm not sure if that is exactly what Azure meant.

It's really too bad, because it means allowing freedom to practice ridiculously offensive techniques in the name of protecting our practice in a wider sense. At best, this means stalling on the bill so that it's the very best it can be.

 

[wigflip]

I said "could" not "should" - big difference...All of that said, as a scientist I think we should (see that?) always be conservative when we don't conclusively understand the etiology

Oh my. I didn't say that you said "should." I meant, "Why might pursuing sexual orientation change efforts be desirable? Given the available evidence regarding lack of efficacy and for harm (not to mention how offensive--yes, I said it--the goal of turning gay folks into straight folks is), why should anyone develop new methods for doing so?"

And I didn't edit your words, or I would have inserted ellipses, as I have above. You linked the ideas of market and new research together through their immediate proximity.