You might have heard that in 2012 California enacted legislation to protect youth aged 17 and younger from methods to change their sexual minority orientation and/nonconforming gender expression. Governor Brown signed ban into law calling the practices "psychoquackery."
Originally CAMFT was opposed to the bill unless amended. CAMFT changed to neutrality on it before the legislature approved it. Meanwhile many state organizations like the California Psychological Association, National Association of Social Workers of California, the BBS and others supported it.
The new law applies to a collection of practices referred to by the acronym SOCE, which stands for sexual orientation change efforts. SOCE goes by a variety of other names: "reorientation therapy," "ex-gay therapy," "conversion therapy," or "reparative therapy." The new law applies not only to sexual orientation change efforts. It also applies to methods used to influence or coerce children to be more gender conforming. The law does not apply to providers who help youth affirm their same-sex attractions or therapists who help youth understand their true gender identity, should they be feeling that it is different than the gender identity assigned to them at birth. The new law applies to prelicensed and licensed health providers, not to unlicensed counselors or clergy.
I'm a MFT ten years post licensed and I have a private practice in San Francisco and Oakland where I work with adults and couples. I have a very deep and abiding interest in helping people realize that being LGBT is good and that reducing the myths against us is needed not only for our mental health but for our physical well-being and sometimes for protecting our very lives. That led me to volunteering to help get the new law passed. It was my first experience with seeing how a law becomes enacted. It was done with the support of untold numbers of people. I plan to keep supporting this new law through all it's legal challenges and into implementation.
The stakeholders who created the law did so to reduce the stigmatizing, dangerous outcomes from those practices, and to increase the a child's chances of getting affirming therapy. In creating the law, they drew not only from the participation of organizations such as CAMFT and the American Association of Marriage and Family Therapy in the process. They also drew from decades of solid research and clinical experiences about what is best for youth.
The new law will impact only a very small percentage of licensed therapists performing child and family therapy. It is aimed at stopping--if any law can--the practices of a small number of SOCE practitioners. The new law was to take effect Jan. 1, 2013. However, it has been delayed by legal challenges. The latest case is called Pickup v. Brown and is brought by David Pickup, MFT, among others. Mr. Pickup has been a CAMFT member and perhaps currently is still a member. The 9th Circuit Court of Appeals reports that they will act quickly on the case.
What does the law say? The first section of the law is a list of policies from major medical associations against SOCE. A typical portion of that section reads this way:
"(c) The American Psychological Association issued a resolution on Appropriate Affirmative Responses to Sexual Orientation Distress and Change Efforts in 2009, which states: "T[he American Psychological Association] advises parents, guardians, young people, and their families to avoid sexual orientation change efforts that portray homosexuality as a mental illness or developmental disorder and to seek psychotherapy, social support, and educational services that provide accurate information on sexual orientation and sexuality, increase family and school support, and reduce rejection of sexual minority youth."
(d) The American Psychiatric Association published a position statement in March of 2000 in which it stated: "Psychotherapeutic modalities to convert or 'repair' homosexuality are based on developmental theories whose scientific validity is questionable. Furthermore, anecdotal reports of 'cures' are counterbalanced by anecdotal claims of psychological harm. In the last four decades, 'reparative' therapists have not produced any rigorous scientific research to substantiate their claims of cure. Until there is such research available, the American Psychiatric Association] recommends that ethical practitioners refrain from attempts to change individuals' sexual orientation, keeping in mind the medical dictum to first, do no harm.
The potential risks of reparative therapy are great, including depression, anxiety and self-destructive behavior, since therapist alignment with societal prejudices against homosexuality may reinforce self-hatred already experienced by the patient. Many patients who have undergone reparative therapy relate that they were inaccurately told that homosexuals are lonely, unhappy individuals who never achieve acceptance or satisfaction. The possibility that the person might achieve happiness and satisfying interpersonal relationships as a gay man or lesbian is not presented, nor are alternative approaches to dealing with the effects of societal stigmatization discussed.
Therefore, the American Psychiatric Association opposes any psychiatric treatment such as reparative or conversion therapy which is based upon the assumption that homosexuality per se is a mental disorder or based upon the a priori assumption that a patient should change his/her sexual homosexual orientation."
What is does the law define as illegal? The section defining what is illegal reads:
"Article 15. Sexual Orientation Change Efforts
865. For the purposes of this [law], the following terms shall have the following meanings:
(a) "Mental health provider" means a physician and surgeon specializing in the practice of psychiatry, a psychologist, a psychological assistant, intern, or trainee, a licensed marriage and family therapist, a registered marriage and family therapist, intern, or trainee, a licensed educational psychologist, a credentialed school psychologist, a licensed clinical social worker, an associate clinical social worker, a licensed professional clinical counselor, a registered clinical counselor, intern, or trainee, or any other person designated as a mental health professional under California law or regulation.
(b) (1) "Sexual orientation change efforts" means any practices by mental health providers that seek to change an individual's sexual orientation. This includes efforts to change behaviors or gender expressions, or to eliminate or reduce sexual or romantic attractions or feelings toward individuals of the same sex.
(2) "Sexual orientation change efforts" does not include psychotherapies that: (A) provide acceptance, support, and understanding of clients or the facilitation of clients' coping, social support, and identity exploration and development, including sexual orientation-neutral interventions to prevent or address unlawful conduct or unsafe sexual practices; and (B) do not seek to change sexual orientation.
865.1. Under no circumstances shall a mental health provider engage in sexual orientation change efforts with a patient under 18 years of age.
865.2. Any sexual orientation change efforts attempted on a patient under 18 years of age by a mental health provider shall be
considered unprofessional conduct and shall subject a mental health provider to discipline by the licensing entity for that mental health provider."
That is the full description of what the law entails. What does the law mean for CAMFT members? CAMFT members who continue to use standard affirmative practices for healthy same-sex attractions in youth and to use standard treatment approaches for youth working through gender identity changes will not be in violation of the new law. Therapists who support the child's development through connectedness and caring as the child affirms for himself or herself his or her true sexual orientation and gender identity are in compliance with the law.
The new law complements a policy about SOCE issued by CAMFT last year. That policy states that CAMFT "is concerned about children and youth, who are especially vulnerable to harm and who lack adequate legal protection from involuntary or coercive treatment and whose parents and guardians may not have accurate information to make informed decisions regarding the child’s development and well-being." CAMFT's policy was developed to specifically support children--as this new law does--from attempts to change their attraction to their own sex. You can read CAMFT's position at their web site.
Clinical research and experience has shown that when stigma and discrimination are proactively managed there are healthier outcomes than when the person is left with the option of trying to conform to societal norms to relieve distress. One body of research that substantiates this comes from Dr. Caitlin Ryan. Dr. Ryan heads the Family Acceptance Project at San Francisco State University. During the past decade Dr. Ryan has trained more than 30,000 health and mental health providers on the mental health care of LGBT adolescents. Dr. Ryan has earned awards such as the National Social Worker of the Year and many others. Dr. Ryan actively supports California's new law banning SOCE.
Dr. Ryan and her collaborators have used a new evidence-based family intervention model based on their extensive peer-reviewed research over decades. That research has identified 106 specific accepting and rejecting behaviors that parents engage in to respond to their LGBT children. Dr. Ryan reports "these accepting behaviors include advocating for their children when others mistreat or discriminate against them because of their LGBT identity or connecting them with positive adult LGBT role models."
Their research has found there are "significant major health risks when parents insist on rejecting behaviors such as sending them to a therapist or clergy to change their sexual orientation, preventing them from learning about their LGBT identity, or making them pray and attend religious services to change their sexual orientation." She reports that they "found that these specific parental and caregiver rejecting behaviors were related to health risks for the LGBT youth in young adulthood, including attempted suicide, suicidal ideation, depression, illegal drug use and risk for HIV infection." (Ryan, Huebner, Diaz, & Sanchez, 2009). Their research also found that family accepting behaviors help protect LGBT youth against these major risks and promote well-being including higher levels of self-esteem and social support in young adulthood. (Ryan, Russell, Huebner, Diaz, & Sanchez, 2010).
Researchers found that lesbian, gay or bisexual young adults who reported high levels of family rejection during adolescence were 8.4 times more likely to report having attempted suicide, 5.9 times more likely to report high levels of depression (at the cut off point for medication), 3.4 times more likely to use illegal drugs, and 3.4 times more likely to report having engaged in unprotected sexual intercourse – compared with peers from families that reported no or low levels of these family rejecting behaviors (Ryan, Huebner, Diaz, & Sanchez, 2009).
"Specifically," Dr. Ryan explains, "young adults whose parents sent them to a therapist or religious leader to attempt to cure, treat or change their sexual orientation during adolescence were far more likely to consider suicide and to attempt suicide than peers who were not sent to undergo SOCE. They also were far more likely to report clinical depression and to report levels of depressive symptoms that reached or exceeded the threshold for medication." (Russell, Ryan, Toomey, Sanchez, & Diaz, in preparation).
Sexual and gender minority youth who are not affirmed for their attractions may miss out on important developmental milestones. At a time when heterosexual adolescents are learning to socialize about romantic and sexual attractions, sexual and gender minority youth who undergo SOCE may be disadvantaged. They will be conflicted about dating those of their own gender when dating them will subject them to stigma, and they will be conflicted about dating those they do not romantically or erotically prefer (Hetrick & Martin, 1987; Lasser & Gottlieb, 2004; Ream & Savin-Williams, 2005). The American Psychological Association's Practice Guidelines for Lesbian, Gay and Bisexual clients (2012) indicate that these attempts to mask or deny sexual identity put sexual and gender minority youth at risk for unwanted pregnancy, unsafe sex, interpersonal violence, substance abuse, and suicide attempts.
Minors are in the initial stages of exploring and acquiring information to enhance their understanding and skills associated with their sexuality and choices. The problem with offering SOCE to minors is that youth may not realize their long-term needs and may overestimate their ability to cope in the long-term with denying their deeper same-sex attractions. If youth are overfocused on meeting the religious needs of their parents and the heterosexual norms of society, youth may not realize that not acting on their authentic same-sex romantic and sexual desires will create deep conflicts and emotional pain for them later in life, if not sooner.
The Mormon church has long disallowed same-sex attractions and relationships. In a recent major shift, church elders abandoned their former practice of encouraging members with same-sex attractions to marry members of the opposite sex. Too much emotional pain came out of that practice when spouses discovered they could not remain married without distress and pain coming from forcing themselves to deny or hide their attractions to their sex in order to be married to a person of the other sex. In 2012 the church leaders reversed their position after coping with decades of broken marriages and family pain resulting from encouraging young people to marry despite their same-sex romantic or sexual orientation. See http://gayandlesbianmormons.org
Healthy sexuality depends on developing an integrated awareness and acceptance of one’s needs and values, which can provide meaning, authenticity, wholeness, and satisfaction as it orients the individual toward intimacy, love, and companionship. Sexual development therefore requires periods of exploration without bias. It requires learning how to live positively with one’s attractions, regardless of one’s sexual identity and life choices. Although some SOCE youth clients may feel supported by their SOCE provider, at its core, SOCE reinforces a message that their sexual/romantic desires are wrong. They are something to extinguish. The new law reinforces that adolescent development is supported by therapeutic interventions that affirm living positively with one's same-sex attractions.
For extensive, expert information about how to affirm LGBT and questioning youth, reliable information is available online at the following sites: http://leadwithlovefilm.com, http://www.genderspectrum.org,http://familyproject.sfsu.edu
For more updates about the new law, watch the news this spring.
Jim Walker, MFT
510-684-4508 cell
Offices in Oakland and San Francisco
http://mindbodytherapyservices.com
http://lgbtcounseling.com
