Supreme Court is hearing arguments to overturn CO conversion therapy ban

Started by R. Matey
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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.
 
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.
 
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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.
 
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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.
 
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.
 
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.
 
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.
 
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.
 
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.
 
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.
 
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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?
 
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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.
 
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.
 
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?
 
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.
 
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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?
 
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
 
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.
 
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.
 
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.
 
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.
 
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Given how the argument was framed, this ruling was a foregone conclusion.

Certainly though I expected to see a little more intellectual rigor from the majority. What's interesting about the opinion, to me, at least is that our discussion upthread seems to be mirrored in the concurring opinions of Sotomayor and Kagan (i.e., your argument that laws must be applied to viewpoints equally) vs. Jackson (i.e., my argument that a psychotherapist is acting on behalf on scientific knowledge and scientific consensus has shown conversion therapy to be dangerous). So reasonable people can disagree.
 
Certainly though I expected to see a little more intellectual rigor from the majority. What's interesting about the opinion, to me, at least is that our discussion upthread seems to be mirrored in the concurring opinions of Sotomayor and Kagan (i.e., your argument that laws must be applied to viewpoints equally) vs. Jackson (i.e., my argument that a psychotherapist is acting on behalf on scientific knowledge and scientific consensus has shown conversion therapy to be dangerous). So reasonable people can disagree.

I think people, especially those in academia, overestimate how much intellectual debate goes on in court settings. This went about how I thought it would.
 
If it's still barred by the licensing board of the state, if this therapist engages in conversion therapy, wouldn't the board have reasonable cause to suspend her license to practice and perhaps require Ms. Chile to undergo remediation and training , in order to reinstate her license, on the consensus that conversion therapy is not a legitimate form of psychotherapy or treatment?
 
If it's still barred by the licensing board of the state, if this therapist engages in conversion therapy, wouldn't the board have reasonable cause to suspend her license to practice and perhaps require Ms. Chile to undergo remediation and training , in order to reinstate her license, on the consensus that conversion therapy is not a legitimate form of psychotherapy or treatment?

The board will likely amend that particular section unless they want to likely lose a fairly expensive lawsuit.
 
They're more concerned with the CO law, which they take pains to say is not the same as malpractice law. She could theoretically still be charged with malpractice, but it's likely the board will be afraid to act.

She likely hopes that she is charged with mapractice or has a board action, it will be a big payday for her.
 
If it's still barred by the licensing board of the state, if this therapist engages in conversion therapy, wouldn't the board have reasonable cause to suspend her license to practice and perhaps require Ms. Chile to undergo remediation and training , in order to reinstate her license, on the consensus that conversion therapy is not a legitimate form of psychotherapy or treatment?
1) There is a difference between Laws and Rules. That's why your state has both.
2) This ruling basically means that the board CAN'T suspend her license. SCOTUS has said the law isn't constitutional. If the state punishes her, they are infringing on her 1st Amendment right, and can be sued.
3) SCOTUS is creating a difference between physical acts and verbal acts, with the former being "treatment" and the latter being :shrug:.
4) The minority opinion said that this ruling could lead to me saying that anything I do, without touching or prescribing, is protected by the 1st Amendment.
5) SCOTUS is creating a difference between "counseling" and "medicine", even though psychiatrists offer counseling.
6) SCOTUS says that "historic" status can't be met from 1976 to present. Does that apply to psychologists? Who knows?
7) Malpractice isn't a board decision, it's a jury decision. For medmal, there has to be a NEGLIGENT departure from the standard of care, producing injury, from someone who has a duty to treat that individual. It isn't medmal if you make a reasonable and knowing departure from the standard of care so long as you document that.
 
Unfortunate.

This is why we need more malpractice lawsuits. This was, seemingly, one of the bigger reasons the satanic panic of the 80s/90s was subdued. If the laws cannot protect consumers of mental health, suing the pants of these practitioners is the next step.
 
Unfortunate.

This is why we need more malpractice lawsuits. This was, seemingly, one of the bigger reasons the satanic panic of the 80s/90s was subdued. If the laws cannot protect consumers of mental health, suing the pants of these practitioners is the next step.

As much as I love to deny @WisNeuro the pleasure of being correct, it does seem that it will be harder now to enforce malpractice laws than before.
 
As much as I love to deny @WisNeuro the pleasure of being correct, it does seem that it will be harder now to enforce malpractice laws than before.
I know courts have their own rules AND it seems that I could present enough evidence that sexual orientation and gender identity change efforts (SOGICE) lead to harm with no good evidence that they can help.
Yeah, I mean this is horrible all around but I'm really infuriated by the idea that "talk therapy" isn't medical treatment.
Another clear example of how mental health is stigmatized.
 
Yeah, I mean this is horrible all around but I'm really infuriated by the idea that "talk therapy" isn't medical treatment.
Yep, it makes it much harder to argue for legal regulation of therapists, which can put patients at risk. Also, it may open the door to the idea that physicians, etc., can tell patients to do harmful things as long as they just say it and don't do any associated procedures or issue any associated prescriptions.
 
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Yep, it makes it much harder to argue for legal regulation of therapists, which can put patients at risk. Also, it may open the door to the idea that physicians, etc., can tell patients to do harmful things as long as they just say it and don't do any associated procedures or issue any associated prescriptions.

For many of these issues, and even in the medical arena (like bogus SPECT scans and made up MH diagnoses), the horse left the barn a long time ago. These things, and clear iatrogenic harm, have already been happening for a long time. As those had about zero chance of being stopped on similar grounds, this ruling was a foregone conclusion, for several reasons. Not saying I agree with it from a scientific or ethical perspective, but it's zero percent surprising to see this come out as the majority decision that it did,
 
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.
Glad I'm not the only one that noticed that parallel, it's wild