Reparative therapy banned in California

California became the first state to ban licensed mental health professionals from engaging in sexual orientation change efforts (often called reparative or conversion therapy) on patients under age 18.

The legislation, signed by the governor in Sept., takes effect Jan. 1. At press time, New Jersey legislators were preparing to introduce similar legislation.

In California, Joseph J. Nicolosi, Ph.D., one of the founders of The National Association for Research & Therapy of Homosexuality (NARTH), says the Liberty Counsel will represent NARTH and others (including several teenagers and their parents) as plaintiffs in a legal challenge to the legislation.

Nicolosi has practiced reparative therapy for many years at his California clinic, which treats unwanted same-sex attractions and has about 135 ongoing cases, many of them minors, he says.

“These are all people who want to change and we work with assisting them in fulfilling their desire,” he says. “We believe in the client’s right to choose and this piece of legislation is a direct violation against that. And there’s no justification for it.”

Nicolosi says claims that reparative therapy is harmful are unsubstantiated.

In 2009, the American Psychological Association (APA) commissioned a task force on sexual orientation change efforts, which concluded that efforts to change sexual orientation are unlikely to be successful and involve some risk of harm. The APA adopted a policy statement on the issue.

The APA has not taken a position on the legislation itself. “What we have said in our policy statement is that we strongly caution parents and young people against therapies that are trying to change sexual orientation because we don’t believe the evidence supports their effectiveness and we don’t believe the evidence supports their safety,” says Clinton Anderson, Ph.D., director of APA’s LGBT Concerns Office and associate executive director for APA’s Public Interest Directorate.

“I think, for young people in particular, to put them in the position of being treated for something that is not a disorder, that is probably a very intrinsic and emergent aspect of their personality, to make them feel that that is something that they should change, or ought to change, or can change, when that may not be possible for them, is really to put them in a position of feeling very bad about themselves, because they don’t succeed at something that certain other important people in their lives are telling them they should be succeeding at,” Anderson says.

Cory Nohl, M.D., medical director of the LGBT Inpatient Program at the Brattleboro Retreat in Vermont, says the program opposes any form of reparative therapy. “To suggest that sexual orientation is subject to therapeutic intervention perpetuates the erroneous and long debunked theory of homosexuality as an illness,” Nohl says.

“In my view, proponents of reparative therapy are misguided and are much more likely to do harm than good,” Nohl says. “There is ample evidence to show that therapy directed at changing sexual orientation is ineffective and is likely to exacerbate symptoms of anxiety and depression.”

Margaret R. Rogers, Ph.D., a University of Rhode Island Department of Psychology professor, says minors are still trying to get a sense of who they are and who they are attracted to.

“We’ve known for a very long time that homosexuality is a normal variation among humans,” Rogers says. “It is a really troubling set of approaches to trying to change a person, particularly among youth, who may be afraid to be honest about their feelings or may conform to parents’ wishes or fear being ostracized.”

Nohl says that while he fully agrees with efforts to protect minors from potentially harmful treatment, he struggles with the idea of governmental legislation of psychotherapy. “I would prefer to see ethical, LGBT-affirming therapies promoted by responsible training programs and for practitioners to be overseen by mental health licensing boards and ethics committees that would obviate the need for such legislation.”

The California Psychological Association (CPA), which supported the bill, had similar concerns initially.

Jo Linder-Crow, Ph.D., CPA executive director, says when Sen. Ted Lieu first introduced the bill, there were a number of elements that were not acceptable to the CPA.

The CPA originally held an Oppose Unless Amended position, based on concerns about the intrusion of the legislature into clinical practice, as well as a concern that an overly broad definition of Sexual Orientation Change Efforts may discourage legitimate therapeutic interventions with minors seeking to explore their sexual orientation and identity. But the CPA and other mental health organizations worked with Sen. Lieu’s office to revise the language and the CPA eventually gave its support.

“Normally, we would prefer that the legislature has a very light hand stepping into the clinical arena,” she says. “So it required a lot of thought and a lot of conversation.

“The bill was changed quite a bit from the way it was when it was initially introduced.”

Ultimately, CPA leaders determined that such practices were not legitimate therapy. “It doesn’t really belong on the continuum of clinical practice approaches,” Linder-Crow says. “And so we began to look at it not as therapy, but as a discriminatory practice. Once we began to think about it that way, it became clear for us. In this case, we believe this would be banning a discriminatory practice, one that is harmful and can be particular harmful for young people.”

Linder-Crow says much discussion was centered on defining such therapy within the law. “That is important, because we wanted to be as sure as we could that the definition was narrow enough so that a person doing legitimate therapy with a minor to explore their sexual orientation would not be caught up on this definition,” she says.

Lieu introduced a “Letter to the Journal,” which Linder-Crow says further preserves the intent of the bill’s author, to avoid future ambiguity.

Nicolosi says activists have misrepresented reparative therapy. “Reparative therapy is as subtle in its approach as any other kind of therapy,” he says. “(Activists) portray reparative therapy as intimidating, coercing, pressuring a teenager to give up his feelings,” and such claims are inaccurate, he says. “We do what we do with any other therapy – we ask why. The power of a psychotherapist is to ask why.

“Reparative therapy is simply asking why – why do you have this feeling, what is going on, where does this come from?” Nicolosi adds, noting that the legislation will have an intimidating effect within the profession, about asking such questions. “They now have legal clout in saying, ‘Don’t even think about it.’ This is the message to psychologists.’”