Supreme Court is hearing arguments to overturn CO conversion therapy ban

[R. Matey]

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US Supreme Court hears arguments on Colorado gay 'conversion therapy' ban

The argument being used by the ultra right wing groups funding the challenge is essentially something to the effect that the state does not have a right to "limit the free speech in psychotherapy."

 

[cara susanna]

With how SCOTUS has gone lately, I don't feel like this is going to go the way we want it to.

 

[WisNeuro]

Yeah, I'd just probably prepare for this to go the way of allowing conversion therapy. From a cynical point of view, we allow many other forms of iatrogenic treatments already, so is this a whole lot different?

 

[Sanman]

Yeah, I'd just probably prepare for this to go the way of allowing conversion therapy. From a cynical point of view, we allow many other forms of iatrogenic treatments already, so is this a whole lot different?

The difference is that many iatrogenic treatments are based on well meaning ignorance. The motives here are different.

 

[AcronymAllergy]

With how SCOTUS has gone lately, I don't feel like this is going to go the way we want it to.

Based on the questions that I've seen the court asking (and not just from Alito), I agree.

 

[WisNeuro]

The difference is that many iatrogenic treatments are based on well meaning ignorance. The motives here are different.

Well meaning or not, they still cause damage. Outcome is the same. I guarantee you that pediatric concussion clinics cause more harm than conversion has or will, most likely. At least from a pure numbers standpoint.

 

[Shiori]

Making this a free speech debate seems like a weird stretch. I keep looking at the rationales being presented. I think these arguments are only being entertained because people already have a desired outcome and are working backward to get to it even if it's nonsensical.

 

[R. Matey]

Making this a free speech debate seems like a weird stretch. I keep looking at the rationales being presented. I think these arguments are only being entertained because people already have a desired outcome and are working backward to get to it even if it's nonsensical.

That's kind of what it seems to me too. There are limitation to speech in psychotherapy because some speech (as studied by science) is actively harmful and is restricted by professional standards (i.e., communicating with a patient to recruit them as a sexual partner).

 

[Doctor Eliza]

US Supreme Court hears arguments on Colorado gay 'conversion therapy' ban

The argument being used by the ultra right wing groups funding the challenge is essentially something to the effect that the state does not have a right to "limit the free speech in psychotherapy."

Yes no politicians in the therapy room, but they must be allowed in the OB/GYN office!!!

 

[cara susanna]

If there's free speech in psychotherapy, doesn't that mean that VA therapists should be able to engage in political speech during session?

 

[WisNeuro]

If there's free speech in psychotherapy, doesn't that mean that VA therapists should be able to engage in political speech during session?

Well, there's that pesky Hatch Act. But if you're part of the Trump Admin it does not apply to you, apparently.

 

[PsyDr]

The PsyDr Totally Christian 😉 Conversion Center is accepting new clients in Colorado!

(Just get in here, and act like you're upset. We'll hang out, bill your loved ones crazy amounts of money, split it with you, and help you set up a new life somewhere away from those people. )

Knife cuts both ways. If I can say ANYTHING in psychotherapy, I can say ANYTHING.

 

[Sanman]

If there's free speech in psychotherapy, doesn't that mean that VA therapists should be able to engage in political speech during session?

Dear god,why?! The best part about the Hatch Act is being able to cite it and avoid more political rambling from patients.

 

[cara susanna]

Dear god,why?! The best part about the Hatch Act is being able to cite it and avoid more political rambling from patients.

The Hatch Act usually means that my patients can say stuff, and I can't. It sucks. They're always like "I know I'm not supposed to talk about politics in here, BUT..."

 

[Sanman]

The Hatch Act usually means that my patients can say stuff, and I can't. It sucks. They're always like "I know I'm not supposed to talk about politics in here, BUT..."

"Then we shouldn't as I cannot comment anyway due to the Hatch Act. How about we talk about that thing you always avoid dealing with despite complaining out it constantly"

 

[Justanothergrad]

What unethical, abusive eforts to hurt minorities and ignore science. These people make me sick trying to hurt children (honestly everyone). I have nothing to say, ever, about people who defend this crap. I wont respect it, or abide it. Its not ethical. Its abusive.

Nope. I dont nazi and I dont respect anyone who excuses or gives quarter to this crap. Im going to lecture on this in class to show how f'd it is. And im sure texas will hate it. Shrug. Thats science. Tough.

 

[The Cinnabon]

Dear god,why?! The best part about the Hatch Act is being able to cite it and avoid more political rambling from patients.

One of the perks of being more "visibly" trans. I'm usually sparred a lot of political rants.

If anything I've actively enjoyed working with patients that seem to be more conservative, it probably helps that I grew up in a pretty conservative area and managed to make plenty of conservative friends (despite being the pretty damn far left myself). A small part of me likes to think that having positive experiences with a trans clinician, who is not trying to "trans" their kids, may have toned down some of their more extreme anti LGBT views, but who knows.

 

[EnPsychlopedia]

Well meaning or not, they still cause damage. Outcome is the same.

I'm not so sure. If by "the same" we mean "no improvements or some worsening," sure, but a lot of other iatrogenic therapies don't communicate to people that a core part of their (non-pathological) identity is wrong and shameful. Nor are there a ton of poor kids out there being forced by their parents to go to, say, specifically an IFS therapist to specifically address part of their identity that is doing no one any harm.

 

[WisNeuro]

I'm not so sure. If by "the same" we mean "no improvements or some worsening," sure, but a lot of other iatrogenic therapies don't communicate to people that a core part of their (non-pathological) identity is wrong and shameful. Nor are there a ton of poor kids out there being forced by their parents to go to, say, specifically an IFS therapist to specifically address part of their identity that is doing no one any harm.

Outcome is the same as in harm in general. Also, in terms of the concussion clinics and associated treatments, while I would agree with the notion that the depth of the injury caused is not as great as conversion therapy, the sheer number of people harmed by those treatments is magnitudes higher.

I am obviously a staunch opponent of conversion therapy. I actively lobbied to get our own state ban when I was leader of our association. But, the argument of "the research shows it doesn't work at best, is harmful at worst" sort of fails in that we still allow many things that are the same in that capacity. Been working in the courts for a while now, judges and the system, by and large, give zero ****s about our code of ethics. It's all about the legal argument and defensibility.

 

[JeyRo]

Legal arguments aside, it's probably worth noting that a "conversion therapy" ban lumps together two different things. One is the idea of taking gay kids and trying to turn them straight, which I personally think is cruel and I have a feeling a majority agrees with me on.

The other idea is much newer, the idea that clinicians must "affirm only" when dealing with a gender dysphoric person, and that anything else is in the bucket of "conversion therapy."

I think this is a problem of policymakers own doing. I do not think that the original ban on conversion therapy is particularly controversial.

 

[Shiori]

Legal arguments aside, it's probably worth noting that a "conversion therapy" ban lumps together two different things. One is the idea of taking gay kids and trying to turn them straight, which I personally think is cruel and I have a feeling a majority agrees with me on.

The other idea is much newer, the idea that clinicians must "affirm only" when dealing with a gender dysphoric person, and that anything else is in the bucket of "conversion therapy."

I think this is a problem of policymakers own doing. I do not think that the original ban on conversion therapy is particularly controversial.

I mean, the "conversion" part is the issue. Giving a client space to explore their gender identity is fine based on all our policy standards. Efforts to push people in one direction or the other is not ethical therapy. Now, I have seen overzealous people arguing on the internet, but people will argue to the extremes on anything. Prolonged exposure therapy is practically torture to some folks.

 

[smalltownpsych]

Not a big fan of government bans on what the patient and I can talk about in therapy, but conversion therapy is such a clear cut unhealthy perspective and practice that I haven’t really had a problem with it and have told patients who presented with conversion as a goal about the laws and ethics prohibiting this and why as part of helping them to recognize it is probably not a helpful goal. Since they always seem to already know that, it’s not that hard and just helps them to get more ammunition to firm up their identity. I don’t think it will make that much difference either way how the Supreme Court rules but I do hope they rule that states can continue to regulate or prohibit sham treatments.

 

[WisNeuro]

Not a big fan of government bans on what the patient and I can talk about in therapy, but conversion therapy is such a clear cut unhealthy perspective and practice that I haven’t really had a problem with it and have told patients who presented with conversion as a goal about the laws and ethics prohibiting this and why as part of helping them to recognize it is probably not a helpful goal. Since they always seem to already know that, it’s not that hard and just helps them to get more ammunition to firm up their identity. I don’t think it will make that much difference either way how the Supreme Court rules but I do hope they rule that states can continue to regulate or prohibit sham treatments.

From a purely pragmatic perspective, states already do not do this, and/or lack the power to do so in some cases. What is the legal bar for banning something?

Again, not advocating for allowing conversion therapy, just that our scientific and ethical arguments aren't the same in the courtroom as they are in collegial debates.

 

[Shiori]

I am worried about the implications that may arise if therapy becomes more aligned with "speech" rather than "treatment."

 

[R. Matey]

What is the legal bar for banning something?

Seems strange that the CO law would have a lower standard than our professional ethics, if the ruling goes the way I think it will go. If a treatment is shown to be harmful by professional standards, it seems like banning it is reasonable. Hell, bottle rockets are banned in my state for far dumber reasons.

I am worried about the implications that may arise if therapy becomes more aligned with "speech" rather than "treatment."

I was disappointed that this wasn't brought up in oral arguments (or I missed it if it was) because this is a key distinction between psychotherapy and talking to your lawyer (i.e., "professional speech"). In psychotherapy, the words are the treatment and the plaintiff in this case is advocating for the right to conduct a treatment, shown to be harmful scientifically (even under the Cass report!) under the guise of "free speech." I'm all for free speech, but when speech is shown to be harmful to others (e.g., inciting a riot, communicating with a minor for immoral purposes), it seems like community standards of beneficence come into play.

 

[WisNeuro]

Seems strange that the CO law would have a lower standard than our professional ethics, if the ruling goes the way I think it will go. If a treatment is shown to be harmful by professional standards, it seems like banning it is reasonable. Hell, bottle rockets are banned in my state for far dumber reasons.

I guarantee you I can find multiple providers who will testify with "empirical evidence" for either side of any MH debate. Showing something is harmful from a legal standpoint, especially in MH, is much harder than most think.

 

[Fan_of_Meehl]

Legal arguments aside, it's probably worth noting that a "conversion therapy" ban lumps together two different things. One is the idea of taking gay kids and trying to turn them straight, which I personally think is cruel and I have a feeling a majority agrees with me on.

The other idea is much newer, the idea that clinicians must "affirm only" when dealing with a gender dysphoric person, and that anything else is in the bucket of "conversion therapy."

I think this is a problem of policymakers own doing. I do not think that the original ban on conversion therapy is particularly controversial.

I'm still confused about 'conversion therapy'-- admittedly, I should make more of an effort to educate myself.

However, isn't it axiomatic that the *patient* decides on what their goals are in therapy (with respect to clarifying/exploring sexual orientation, gender expression, resolving dysphoria, etc.)?

 

[R. Matey]

I guarantee you I can find multiple providers who will testify with "empirical evidence" for either side of any MH debate. Showing something is harmful from a legal standpoint, especially in MH, is much harder than most think.

Apparently. Most professional organizations in MH seem to be against conversion therapy. This one seems like a softball.

 

[WisNeuro]

Seems strange that the CO law would have a lower standard than our professional ethics, if the ruling goes the way I think it will go. If a treatment is shown to be harmful by professional standards, it seems like banning it is reasonable. Hell, bottle rockets are banned in my state for far dumber reasons

Also, from a legal standpoint, from what I've heard of the arguments, they are coming at this from a much more nuanced perspective as opposed to just conversion therapy being harmful or not. Whether I agree with it or not, my money is not on COs side.

 

[WisNeuro]

Apparently. Most professional organizations in MH seem to be against conversion therapy. This one seems like a softball.

Professional orgs being for or against something is far from enough to secure any sort of judgment in a legal case. Seen plenty of judges give zero ****s about position statements.

 

[Justanothergrad]

Professional orgs being for or against something is far from enough to secure any sort of judgment in a legal case. Seen plenty of judges give zero ****s about position statements.

I suspect this is reflective of the larger problems in this country with science being ignored

Which is the real issue at hand, semantics aside.

 

[WisNeuro]

I suspect this is reflective of the larger problems in this country with science being ignored

Which is the real issue at hand, semantics aside.

Eh, at least legally, we've been here for a while. You can always find junk science for any position. At that point it's up to how well it's argued, and/or the bias of the court. To be honest, the tact that the plaintiffs counsel in this case are taking is pretty smart, regardless, the most right leaning court in history will make sure it goes a certain way, regardless of the arguments. But, to be honest, I think they'd have a decent chance even with a more balanced court.

 

[The Cinnabon]

Eh, at least legally, we've been here for a while. You can always find junk science for any position. At that point it's up to how well it's argued, and/or the bias of the court. To be honest, the tact that the plaintiffs counsel in this case are taking is pretty smart, regardless, the most right leaning court in history will make sure it goes a certain way, regardless of the arguments. But, to be honest, I think they'd have a decent chance even with a more balanced court.

I must admit the conservative takeover of the bench, particularly through FedSoC, has been masterful.

I just wish the dems played the game as well as the GOP. Really reminds me of this quote.

 

[R. Matey]

Also, from a legal standpoint, from what I've heard of the arguments, they are coming at this from a much more nuanced perspective as opposed to just conversion therapy being harmful or not. Whether I agree with it or not, my money is not on COs side.

The plaintiff's counsel essentially admitted that treatment is not the same as speech and even admitted that this person may have to whether a malpractice suit, but argued (successfully, I guess) that because the counselor is not a psychiatrist or doing aversion therapy, she is not doing treatment, but speaking. As a psychologist, I take issue with that position. Psychotherapy is treatment, not just professional speech and certain types of treatments are harmful. Every state has a licensing board that takes away licenses of people who do harm to patients by talking to them.

They also oversold this issue as a scientific debate, rather than a general consensus among mental health professionals. From there they claimed that harm is being done to children and families because this counselor cannot practice. That line didn't really strike me as "clever argumentation" but rather misrepresentation of the current clinical guidance and state of the science.

ETA: transcript here. I had a cancellation so a bit of time to look into this.

 

[WisNeuro]

The plaintiff's counsel essentially admitted that treatment is not the same as speech and even admitted that this person may have to whether a malpractice suit, but argued (successfully, I guess) that because the counselor is not a psychiatrist or doing aversion therapy, she is not doing treatment, but speaking. As a psychologist, I take issue with that position. Psychotherapy is treatment, not just professional speech and certain types of treatments are harmful. Every state has a licensing board that takes away licenses of people who do harm to patients by talking to them.

They also oversold this issue as a scientific debate, rather than a general consensus among mental health professionals. From there they claimed that harm is being done to children and families because this counselor cannot practice. That line didn't really strike me as "clever argumentation" but rather misrepresentation of the current clinical guidance and state of the science.

ETA: transcript here. I had a cancellation so a bit of time to look into this.

Yes, the focus on free speech and patient choice is key here, and maintaining that what they are asking for is not as Sotomayor tried to define it, "aversion therapy."

 

[aim-agm]

However, isn't it axiomatic that the *patient* decides on what their goals are in therapy (with respect to clarifying/exploring sexual orientation, gender expression, resolving dysphoria, etc.)?

I think a big part of the problem with conversion therapy is that minors are being subjected to it, so even if the patient doesn't want it as a goal the parents are deciding for them or the therapist may unduly pressure/influence the patient into making it a goal.

 

[WisNeuro]

I think a big part of the problem with conversion therapy is that minors are being subjected to it, so even if the patient doesn't want it as a goal the parents are deciding for them or the therapist may unduly pressure/influence the patient into making it a goal.

I'll return to the concussion clinic example, with well-known iatrogenesis literature, parents can pressure their kids into these clinics after an uncomplicated concussion, likely worsening their outcomes. And, in the case of those with somatic tendencies, likely long-lasting damage. We allow, if not encourage that, in healthcare today. Why is one legal in all instances and the other illegal in some?

Devil's advocate question, but very germane to the issue here, as you can find junk science to support conversion therapy whatever they're trying to pass off here, just like you can for the "uncomplicated concussions cause catastrophic damages!" camp.

 

[R. Matey]

Devil's advocate question, but very germane to the issue here, as you can find junk science to support conversion therapy whatever they're trying to pass off here, just like you can for the "uncomplicated concussions cause catastrophic damages!" camp.

The argument builds on itself. If you accept that psychotherapy is just speech, then it can't be held to a community standard of care. The first premise is faulty. If psychotherapy is just professional speech, then why do people need licenses to speak?

 

[WisNeuro]

The argument builds on itself. If you accept that psychotherapy is just speech, then it can't be held to a community standard of care. The first premise is faulty. If psychotherapy is just professional speech, then why do people need licenses to speak?

That can definitely be argued, but you're assuming that "community standard of care" sets a bar that has legal merit in many cases.

 

[R. Matey]

That can definitely be argued, but you're assuming that "community standard of care" sets a bar that has legal merit in many cases.

I'm adopting the malpractice standard (i.e., a deviation from a community standard of care), which has enough legal weight to take people's licenses away and compel them to pay civil damages. Even the plaintiff's attorney admitted the plaintiff may have to face a malpractice suit.

 

[WisNeuro]

I'm adopting the malpractice standard (i.e., a deviation from a community standard of care), which has enough legal weight to take people's licenses away and compel them to pay civil damages. Even the plaintiff's attorney admitted the plaintiff may have to face a malpractice suit.

Due to the current laws. Additionally, deviation from community standard of care really doesn't have the weight you may think it does. On many issues, we can easily find credentialed experts who will testify the "community standard of care" is the exact opposite. They'll argue that the "community standard of care" in this instance only exists due to ideologically based statutes that violate freedoms.

I do agree that it is harmful in many circumstances, but as I said, many "treatments" are more harmful than helpful, so it's a standard I don't really buy as an argument as you can point to many treatments that have negative side effects in some people.

 

[jdawg2017]

We live in a time where Tylenol causes autism and windmills cause cancer. Do I think that SCOTUS will understand the overwhelming evidence that conversion therapy is absolute garbage and actively harmful…? No.

I do hope that they rule in favor of states having ability to regulate professional standards, otherwise WTF are we doing in healthcare? The same exact argument is what essential now allows states to restrict abortions. Do I think that is right? No. But do I think that states should have regulatory control of healthcare providers? You betcha.

It’ll be interesting to see how this all pans out.

 

[R. Matey]

I do agree that it is harmful in many circumstances, but as I said, many "treatments" are more harmful than helpful, so it's a standard I don't really buy as an argument as you can point to many treatments that have negative side effects in some people.

In the case of conversion therapy, you can make the argument that it is more harmful than other unhelpful treatments. While some treatments are unhelpful (like supportive therapy for generalized anxiety disorder), they do not produce harm in the same manner.

 

[WisNeuro]

In the case of conversion therapy, you can make the argument that it is more harmful than other unhelpful treatments. While some treatments are unhelpful (like supportive therapy for generalized anxiety disorder), they do not produce harm in the same manner.

One can definitely make that argument for conversion therapy, as well as many other therapies/treatments that are currently practiced and not banned in certain jurisdictions. One can also poke multiple holes or come at that argument in different ways to support a variety of views.

Again, I am not on the pro-SOCE side, merely pointing out that how arguing two sides of a MH/healthcare issue in court is vastly different than arguing about it amongst colleagues.

 

[PsyDr]

If an adult wants to engage in a scientifically disproven treatment for a non-diagnosis, I guess that’s conceptually similar to plastic surgery.

* kids are different

**I really don't like that I'm saying that.

 

[MCParent]

If an adult wants to engage in a scientifically disproven treatment for a non-diagnosis, I guess that’s conceptually similar to plastic surgery.

* kids are different

**I really don't like that I'm saying that.

Well, but a bit more like plastic surgery that actively causes harm.

And there is no surgery.

And the person walks around going “look at my new nose everyone loves it” but there’s no new nose.

And their faith community pretends there’s a new nose.

And they write a book about their new nose that doesn’t exist.

And then it comes out that their nose is on Grindr and has been hooking up with dudes.

….I think I lost the ball on that analogy but you get the idea.

 

[PsyDr]

Well, but a bit more like plastic surgery that actively causes harm.

And there is no surgery.

And the person walks around going “look at my new nose everyone loves it” but there’s no new nose.

And their faith community pretends there’s a new nose.

And they write a book about their new nose that doesn’t exist.

And then it comes out that their nose is on Grindr and has been hooking up with dudes.

….I think I lost the ball on that analogy but you get the idea.

I think we all love “My Husband’s Not Gay”.

 

[R. Matey]

Again, I am not on the pro-SOCE side, merely pointing out that how arguing two sides of a MH/healthcare issue in court is vastly different than arguing about it amongst colleagues.

I know you're not and I appreciate the dialogue. I'm just taking the position that, in this case, it seems more clear cut than, say, whether Jungian psychoanalysis is the standard of care for social anxiety disorder. Here, we have metrics of harm to patients that, in my opinion at least, justify state intervention.

 

[WisNeuro]

I know you're not and I appreciate the dialogue. I'm just taking the position that, in this case, it seems more clear cut than, say, whether Jungian psychoanalysis is the standard of care for social anxiety disorder. Here, we have metrics of harm to patients that, in my opinion at least, justify state intervention.

Indeed, but I can easily spin a case that much of that research relies on older methods (aversion therapies, actual abuse, etc) that are not practiced today in "contemporary conversion" situations. That the argument is akin to comparing modern mental health care to lobotomies and forced cold water immersions.

 

[Justanothergrad]

Eh, at least legally, we've been here for a while. You can always find junk science for any position. At that point it's up to how well it's argued, and/or the bias of the court. To be honest, the tact that the plaintiffs counsel in this case are taking is pretty smart, regardless, the most right leaning court in history will make sure it goes a certain way, regardless of the arguments. But, to be honest, I think they'd have a decent chance even with a more balanced court.

Eh, at least legally is just not an argument to me. It misses the forest for the trees in implication. I dont disagree with you or anything you said about process or outcome related to legal systems, just more envy your perspect taking ability lol I imagine its less stressful.

The attack on science, new or old, is still the problem. We just have a group of idiots paving the way for the worst case of intentional censorship in education (like is happening now) to the ignoring of science. Like, with circumcision. I just cant stand it.