Supreme Court is hearing arguments to overturn CO conversion therapy ban

[WisNeuro]

---

Members do not see this ad.

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.

Oh, I agree with you on the anti-science front. That does come in waves, though we're seeing some eerie parallels to Stalinist Russia, with RFK Jr. portraying a caricature of Lysenko. It will get worse before it gets better. Everyone will have to decide what their limit is, and what they will do when they reach it.

 

[R. Matey]

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.

But if we accept that psychotherapy is treatment, not speech, then treatment must be applied to a disease. In the case of conversion therapy, there is no identifiable disease.

More to the point, my rebuttal would be that how do I know that "contemporary conversion situations" wouldn't amount to child experimentation given that no studies or scientific organizations to support these methods.

 

[Sanman]

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”.

Fun fact, one of the cast members of "My Husband's Not Gay" is a therapist now:

About Us | Gender Harmony Institute

Very relevant to the conversation, I think.

 

[WisNeuro]

But if we accept that psychotherapy is treatment, not speech, then treatment must be applied to a disease. In the case of conversion therapy, there is no identifiable disease.

More to the point, my rebuttal would be that how do I know that "contemporary conversion situations" wouldn't amount to child experimentation given that no studies or scientific organizations to support these methods.

Therapy is frequently done with no identifiable condition. As to the latter, they can definitely drum up some low quality studies to support their methods.

 

[R. Matey]

Therapy is frequently done with no identifiable condition. As to the latter, they can definitely drum up some low quality studies to support their methods.

Really? I haven’t seen that. Maybe a tenable connection between the condition and mode of treatment, but someone is writing down that they are doing psychotherapy with a patient for no reason?

As someone who has heard the case for modern conversion therapy, I’d be really surprised if the alt right had any published research to support their position. I think it was Kagan that said she didn’t necessarily need a study, but in my mind, the burden of proof rests with those who claim a newer version of this treatment doesn’t produce harm given that older versions did. Even if research did exist, you would want a panel of expert reviewers to determine which research is more rigorous given the stakes in a national case. I think that panel would likely find that conversion therapy is harmful or has not sufficiently shown to be beneficial, which is the current scientific consensus.

This is why I understand them to be making a free speech argument. A standard of care argument would fail under the weight of evidence. Maybe not at the local level, but national trials are a different ballgame. Again, even the plaintiff’s attorney acknowledged that if psychotherapy is treatment than the legal analysis would change and the plaintiff still may face a malpractice suit. The argument,as I followed it, is that psychotherapy is free speech and placing state limitations on free speech is unconstitutional. It’s a bogus one because psychotherapy is treatment, not just speech. As others have said upthread, the psychotherapy-as-free-speech argument feels like a pretext to push a conservative and unscientific position in front of a sympathetic court.

 

[WisNeuro]

Really? I haven’t seen that. Maybe a tenable connection between the condition and mode of treatment, but someone is writing down that they are doing psychotherapy with a patient for no reason?

As someone who has heard the case for modern conversion therapy, I’d be really surprised if the alt right had any published research to support their position. I think it was Kagan that said she didn’t necessarily need a study, but in my mind, the burden of proof rests with those who claim a newer version of this treatment doesn’t produce harm given that older versions did. Even if research did exist, you would want a panel of expert reviewers to determine which research is more rigorous given the stakes in a national case. I think that panel would likely find that conversion therapy is harmful or has not sufficiently shown to be beneficial, which is the current scientific consensus.

This is why I understand them to be making a free speech argument. A standard of care argument would fail under the weight of evidence. Maybe not at the local level, but national trials are a different ballgame. Again, even the plaintiff’s attorney acknowledged that if psychotherapy is treatment than the legal analysis would change and the plaintiff still may face a malpractice suit. The argument,as I followed it, is that psychotherapy is free speech and placing state limitations on free speech is unconstitutional. It’s a bogus one because psychotherapy is treatment, not just speech. As others have said upthread, the psychotherapy-as-free-speech argument feels like a pretext to push a conservative and unscientific position in front of a sympathetic court.

There are plenty of people doing "depth" work with no diagnosable condition. Or never ending "adjustment disorder" that meets no current legitimate diagnosis. We've all seen this.

 

[PsyDr]

Really? I haven’t seen that. Maybe a tenable connection between the condition and mode of treatment, but someone is writing down that they are doing psychotherapy with a patient for no reason?

Example: Marriage Therapy.

It's not a treatment for a diagnosis, as far as I can determine.

 

[R. Matey]

Example: Marriage Therapy.

It's not a treatment for a diagnosis, as far as I can determine.

Fair point. The condition is the health of the relationship, but granted that it's not psychopathology.

 

[cara susanna]

But the diagnosis would be marital distress or problems in relationship with partner, would it not?

 

[R. Matey]

There are plenty of people doing "depth" work with no diagnosable condition. Or never ending "adjustment disorder" that meets no current legitimate diagnosis. We've all seen this.

Sure, but you are the one making the legal argument. My question isn't whether it exists, but can it be proven.

 

[WisNeuro]

Sure, but you are the one making the legal argument. My question isn't whether it exists, but can it be proven.

Can it be proven that people engage in, broadly speaking, therapy without a diagnosable mental health condition? Easily.

 

[PsyDr]

But the diagnosis would be marital distress or problems in relationship with partner, would it not?

Z codes? Really? If you're accepting Z codes as diagnosis, then intervention expands to poverty, being a poor student, having an "inadequate" teacher, hating your boss/work schedule, etc. I am unaware of any intervention for treating poverty, or the definition of an inadequate teacher.

 

[cara susanna]

Z codes? Really? If you're accepting Z codes as diagnosis, then intervention expands to poverty, being a poor student, having an "inadequate" teacher, hating your boss/work schedule, etc. I am unaware of any intervention for treating poverty, or the definition of an inadequate teacher.

Well, no, but if we did have treatments for them we'd do them and bill for them, wouldn't we? Diagnosis is shorthand for communicating the patient's issue and the focus of treatment. it doesn't have to be a recognized "disorder," does it? Anger isn't a diagnosis but we treat it.

 

[R. Matey]

Can it be proven that people engage in, broadly speaking, therapy without a diagnosable mental health condition? Easily.

We'll have to disagree on that one, which is fine with me. The logic of psychotherapy is such that therapy is applied to an identified mental health condition. Psychotherapy notes, no matter how badly written, tend to follow this. Even so-called "depth work" for adjustment disorder still presumes a problem that is being treated. We might be right to question whether the diagnosis justifies the intervention or whether the diagnosis or intervention are valid at all, but the logic is nevertheless inherent in the enterprise. Even in more counseling situations where the intervention is targeting a response to an external stressor (like in marriage counseling), the idea behind therapy is that it is doing something to alleviate harm.

More on topic, the plaintiff's counsel made the point the standing exists because the withholding of conversion therapy ("modern" or otherwise) is contributing to suffering of those who would want the intervention, but can't access it. To me, this implies a model of psychopathology that doesn't exist in the literature. So, the argument that withholding this "treatment" produces harm lacks any substantial evidence.

 

[WisNeuro]

We'll have to disagree on that one, which is fine with me. The logic of psychotherapy is such that therapy is applied to an identified mental health condition. Psychotherapy notes, no matter how badly written, tend to follow this. Even so-called "depth work" for adjustment disorder still presumes a problem that is being treated. We might be right to question whether the diagnosis justifies the intervention or whether the diagnosis or intervention are valid at all, but the logic is nevertheless inherent in the enterprise. Even in more counseling situations where the intervention is targeting a response to an external stressor (like in marriage counseling), the idea behind therapy is that it is doing something to alleviate harm.

More on topic, the plaintiff's counsel made the point the standing exists because the withholding of conversion therapy ("modern" or otherwise) is contributing to suffering of those who would want the intervention, but can't access it. To me, this implies a model of psychopathology that doesn't exist in the literature. So, the argument that withholding this "treatment" produces harm lacks any substantial evidence.

A "problem" or an "issue" does not always equal meeting the clinical definition of a diagnosis. As @PsyDr alluded to above, there is plenty of treatment happening in mental health for Z codes. It would be exceedingly easy to get multiple affadavits into the court asserting the fact that this is commonplace.

As to your latter part, the presumed person's distress and desire to talk about it is in line with treating a host of z-codes, and if they were experiencing anxiety or depressive symptoms as a result of said distress, many providers would say it qualifies as an adjustment disorder, so they'd have those grounds as well. Honestly, in the framework of MH treatment as it currently exists, this argument seems disingenuous and merely picking winners and losers based on what we do and do not like.

 

[R. Matey]

A "problem" or an "issue" does not always equal meeting the clinical definition of a diagnosis. As @PsyDr alluded to above, there is plenty of treatment happening in mental health for Z codes. It would be exceedingly easy to get multiple affadavits into the court asserting the fact that this is commonplace.

As to your latter part, the presumed person's distress and desire to talk about it is in line with treating a host of z-codes, and if they were experiencing anxiety or depressive symptoms as a result of said distress, many providers would say it qualifies as an adjustment disorder, so they'd have those grounds as well. Honestly, in the framework of MH treatment as it currently exists, this argument seems disingenuous and merely picking winners and losers based on what we do and do not like.

1. Maybe it's easy. Maybe it's not easy. Neither of us can produce evidence of how easy it is so I think we've reached aporia here.

2. It's a bit of strawperson though given that z-codes usually don't require clinically significant distress to be assigned. Cara's point about problematic anger is a good one. It's transdiagnostic, inherent in many areas of psychopathology (including less obvious ones, like ADHD), and there are protocols for intervention. Even if I accept this straw, there isn't a z-code for this intervention therefore the analogy is meaningless.

In terms of picking winners or losers, I assume you mean I'm placing bounds of what qualifies as a psychosocial stressor, which I suppose could be true. Nevertheless, you're still stuck with an intervention that is historically harmful and presently untested and not recommended by the current scientific community. Why choose this one when other interventions for adjustment disorder currently exist and have been shown not produce the same harm? Why would you rather experiment on children than use an evidence-based practice?

 

[WisNeuro]

1. Maybe it's easy. Maybe it's not easy. Neither of us can produce evidence of how easy it is so I think we've reached aporia here.

2. It's a bit of strawperson though given that z-codes usually don't require clinically significant distress to be assigned. Cara's point about problematic anger is a good one. It's transdiagnostic, inherent in many areas of psychopathology (including less obvious ones, like ADHD), and there are protocols for intervention. Even if I accept this straw, there isn't a z-code for this intervention therefore the analogy is meaningless.

In terms of picking winners or losers, I assume you mean I'm placing bounds of what qualifies as a psychosocial stressor, which I suppose could be true. Nevertheless, you're still stuck with an intervention that is historically harmful and presently untested and not recommended by the current scientific community. Why choose this one when other interventions for adjustment disorder currently exist and have been shown not produce the same harm? Why would you rather experiment on children than use an evidence-based practice?

1. Ask anyone here who works in the court and I'm pretty sure they'll agree that convincing the court if this will be one of the easier things that they've done. Convincing them against TPO issues much harder, and we do that all the time.

2. But, in this case, you're still treating a symptom, not a disorder, which was the point.

As for the winners and losers, my point was that we as a profession at times, gleefully, champion "treatments" that do more harm than good, with as much evidence to that fact that is equal to, if not more convincing than the conversion literature. So, in this case, it has the appearance, to some, that we do not like it simply because of it's political nature as opposed to the merit of the literature.

 

[R. Matey]

1. Ask anyone here who works in the court and I'm pretty sure they'll agree that convincing the court if this will be one of the easier things that they've done. Convincing them against TPO issues much harder, and we do that all the time.

2. But, in this case, you're still treating a symptom, not a disorder, which was the point.

As for the winners and losers, my point was that we as a profession at times, gleefully, champion "treatments" that do more harm than good, with as much evidence to that fact that is equal to, if not more convincing than the conversion literature. So, in this case, it has the appearance, to some, that we do not like it simply because of it's political nature as opposed to the merit of the literature.

1. You're falsely assuming I have no knowledge of the workings of the legal system and how it intersects with mental health. Second, anecdotal evidence is not evidence so personal testimonies with state and local proceedings are irrelevant. My point is the burden of proof relies on expert testimony in national cases and any expert testimony would likely reflect the current state of the literature.

2. If you mean distress broadly defined, maybe. But you haven't addressed why conversion therapy would be the treatment of choice over, say, teaching a person to accept their sexuality. Discussed dispassionately, one carries fewer inherent risks than the other.

3. So, as an example, I've been equally critical of relational-cultural or feminist psychotherapy for similar concerns of scientific weakness. I don't claim to speak for the whole field, but these seem to fall into the category of politically-laden, probably unhelpful psychotherapies in my view. Even so, I'd argue they don't carry the same risks to patients as conversion therapy.

 

[WisNeuro]

1. You're falsely assuming I have no knowledge of the workings of the legal system and how it intersects with mental health. Second, anecdotal evidence is not evidence so personal testimonies with state and local proceedings are irrelevant. My point is the burden of proof relies on expert testimony in national cases and any expert testimony would likely reflect the current state of the literature.

2. If you mean distress broadly defined, maybe. But you haven't addressed why conversion therapy would be the treatment of choice over, say, teaching a person to accept their sexuality. Discussed dispassionately, one carries fewer inherent risks than the other.

3. So, as an example, I've been equally critical of relational-cultural or feminist psychotherapy for similar concerns of scientific weakness. I don't claim to speak for the whole field, but these seem to fall into the category of politically-laden, probably unhelpful psychotherapies in my view. Even so, I'd argue they don't carry the same risks to patients as conversion therapy.

1. Ah, if only that were true in many cases 🙂

2. At least in this theoretical, you are imposing your own belief system on the patient. What if the patient expressed a consistent and earnest desire for conversion, and is not interested in an acceptance framework?

3. I'd generally degree, the argument can still be made. And, at that point, where are you placing the bar for risk and what is unacceptable?

 

[Justanothergrad]

Fair point. The condition is the health of the relationship, but granted that it's not psychopathology.

Is treatnent of psychopathology the only function of therapy? I cant see a reason.

 

[R. Matey]

2. At least in this theoretical, you are imposing your own belief system on the patient. What if the patient expressed a consistent and earnest desire for conversion, and is not interested in an acceptance framework?

3. I'd generally degree, the argument can still be made. And, at that point, where are you placing the bar for risk and what is unacceptable?

Let me ask you this: someone presents to you seeking a neuropsychological evaluation for a mTBI without any external history of impairment but they are insistent that they have mTBI and want you to find evidence of it. Do you take their case?

The review linked upthread documents the iatrogenic consequents of conversion therapy that include depressive disorders, anxiety disorders, and even suicidal ideation/behavior. Seems like a pretty good place to draw the line. If we're going with the new and improved therapy doesn't cause the same harm argument, the burden of proof rests with you to show (1) it's different than the old versions and (2) it doesn't produce harm in the same manner. In you can't do that, then you're an advocate of child experimentation.

 

[R. Matey]

Is treatnent of psychopathology the only function of therapy? I cant see a reason.

You're raising a good point that I don't have time in this moment to fully respond to. Alleviating health conditions or marital problems are other reasons why people seek out therapy.

 

[WisNeuro]

Let me ask you this: someone presents to you seeking a neuropsychological evaluation for a mTBI without any external history of impairment but they are insistent that they have mTBI and want you to find evidence of it. Do you take their case?

The review linked upthread documents the iatrogenic consequents of conversion therapy that include depressive disorders, anxiety disorders, and even suicidal ideation/behavior. Seems like a pretty good place to draw the line. If we're going with the new and improved therapy doesn't cause the same harm argument, the burden of proof rests with you to show (1) it's different than the old versions and (2) it doesn't produce harm in the same manner. In you can't do that, then you're an advocate of child experimentation.

Yes, I take those cases. For a variety of reasons. They may have a pre-existing issue that explains the symptoms, or undiagnosed issues. Or, and sometimes related to that, there is something in their history that helps explain their atypical response. The feedback in this case can be quite illuminating and help to limit potential damage from other "treatments" or iatrogenic effects from misinformation.

As to my earlier argument, we still allow many treatments for which we have good evidence of iatrogenesis, including depression, anxiety, and other issues. Why don't we draw the line at those?

 

[Justanothergrad]

You're raising a good point that I don't have time in this moment to fully respond to. Alleviating health conditions or marital problems are other reasons why people seek out therapy.

Oh yeh I figured. I dont know that i have the mental space to discuss at any depth either. I would suggest broader growth, unbiased support and perspective, and other reasons beyond just deficits are important life outcomes to measure beyond function (aka work adjustment). Anyway. Cheers

 

[WisNeuro]

Let me ask you this: someone presents to you seeking a neuropsychological evaluation for a mTBI without any external history of impairment but they are insistent that they have mTBI and want you to find evidence of it. Do you take their case?

The review linked upthread documents the iatrogenic consequents of conversion therapy that include depressive disorders, anxiety disorders, and even suicidal ideation/behavior. Seems like a pretty good place to draw the line. If we're going with the new and improved therapy doesn't cause the same harm argument, the burden of proof rests with you to show (1) it's different than the old versions and (2) it doesn't produce harm in the same manner. In you can't do that, then you're an advocate of child experimentation.

Just a quick aside, relevant to this in a general sense. We experiment on children all the time. Entire research lines are built on it. Even in the examples mentioned in this thread, expectations and outcomes in concussion, including purely experimental studies, is built on peds concussion samples.

 

[R. Matey]

As to my earlier argument, we still allow many treatments for which we have good evidence of iatrogenesis, including depression, anxiety, and other issues. Why don't we draw the line at those?

Can you provide examples that these other, unnamed, treatments produce the same amount of harm as conversion therapy? I have my doubts.

ust a quick aside, relevant to this in a general sense. We experiment on children all the time. Entire research lines are built on it. Even in the examples mentioned in this thread, expectations and outcomes in concussion, including purely experimental studies, is built on peds concussion samples.

Certainly, but this is done under IRB protections. You are advocating for an experimental treatment done, in this case, by a master's level clinician without any scientific training. I appreciate you being willing to take the devil's (irony!) advocate position in this debate. It's the harder one to defend.

 

[WisNeuro]

Can you provide examples that these other, unnamed, treatments produce the same amount of harm as conversion therapy? I have my doubts.



Certainly, but this is done under IRB protections. You are advocating for an experimental treatment done, in this case, by a master's level clinician without any scientific training. I appreciate you being willing to take the devil's (irony!) advocate position in this debate. It's the harder one to defend.

I named one of the most salient, concussion treatments, especially in the acute state. CISD, which is still somehow happening. DID oriented therapies. Grief counseling in the acute stage. Myriad of others in smaller numbers.

 

[R. Matey]

Oh yeh I figured. I dont know that i have the mental space to discuss at any depth either. I would suggest broader growth, unbiased support and perspective, and other reasons beyond just deficits are important life outcomes to measure beyond function (aka work adjustment). Anyway. Cheers

Yeah, I got busy midweek, had to put the internet message board on the backburner, sadly. There's probably an entire thread just on this post alone. Something I was thinking about when we were discussing psychotherapy in the counseling psych thread. There is a ton of variability in reasons why people seek out treatment, what their presenting symptoms are (and whether those meet criteria for DSM versions of mental illness), and the heterogenity of many mental health conditions in general. All of these impact treatment decisions.

 

[R. Matey]

I named one of the most salient, concussion treatments, especially in the acute state. CISD, which is still somehow happening. DID oriented therapies. Grief counseling in the acute stage. Myriad of others in smaller numbers.

Ok, would you have a problem with states outlawing these treatments based on their harm to patients?

 

[WisNeuro]

Ok, would you have a problem with states outlawing these treatments based on their harm to patients?

Not at all.