Julie Hamilton, Ph.D.

I was reminded again today about the incredible misinformation that abounds among professionals in our field. I received a letter regarding “ethical concerns” from a psychologist whom I’ve never met who lives in another state. He was concerned about scientifically grounded statements that I made in a video recording. While the letter had no basis whatsoever as an ethical complaint, the letter did reveal the fact that not only the general public, but also many professionals are themselves unaware of the scientific research on the topic of homosexuality. NARTH exists to correct that problem. As a scientific organization, we are familiar with the research and seek to disseminate it to the benefit of the public at large, the therapeutic community, and also for individual clients who want to better understand their homosexual attractions and options for change.

It is wonderful that fellow-professionals care about clients and want to be sure that clients are not harmed by their therapists, and even commendable that fellow-professionals are willing to confront others who they fear could potentially harm clients. Unfortunately, however, when the concerns and compassion are rooted in misinformation, greater harm is sometimes the result. Even more concerning are instances where misinformation leads to confrontation, or even, in some cases, harassment of fellow-professionals. The problem here is the misinformation. Another example would be the outrageous legislation being proposed in the state of California, again, possibly well-meaning, but based in outlandish claims, NOT rooted in scientific research. In fact, some of the claims made by the sponsors of this bill are not even based in reality – such as the ridiculous notion that shock therapy is used for treating this issue. I am reminded of the ancient proverb that addresses “zeal without knowledge.”

The letter that I received seems to reveal a lot about the mistaken assumptions of both the general public as well as even members of the professional body in the mental health field. The writer stated:

It is my obligation as an ethical psychologist to directly address other psychotherapists who are engaged in behaviors that I believe are unethical. In watching the video… I became concerned about your work as a representative of NARTH as well as within your private counseling practice.

Specifically, you state:

“While the general public seems to believe that people are born gay and can’t change, that has not been the conclusion of researchers.”

Let me not mince words here Julie, you are simply wrong. There is no credible evidence in any peer reviewed journal that provides substantive empirical evidence to suggest that so-called reparative therapy is effective or ethical.

I would like to believe that this writer does not represent the majority within our field, but I am becoming concerned that his inaccurate assumptions are widely held. Therefore, let me address the first part of my quote, that people are not simply born gay. Although in 1998 the American Psychological Association (APA) made claims of biological contributors to homosexuality, in 2008 they updated their claims. In their newer document the APA (2008) admits that researchers have not found a biological basis for homosexuality:

There is no consensus among scientists about the exact reasons that an individual develops a heterosexual, bisexual, gay, or lesbian orientation. Although much research has examined the possible genetic, hormonal, developmental, social, and cultural
influences on sexual orientation, no findings have emerged that permit scientists to conclude that sexual orientation is determined by any particular factor or factors. Many think that nature and nurture both play complex roles; most people experience little or no sense of choice about their sexual orientation. (www.apa.org/topics/sexuality/orientation.aspx; see also,
www.narth.com/docs/deemphasizes.html)

It is clear that people are not simply born homosexual. It is also important to note that most people do not choose their attractions. Instead, homosexual attractions are most likely a complex combination of factors, just as is the case with any other developmental issue.

Regarding the second part of my statement referenced in this psychologist’s letter, the myth that people cannot change is a myth for the following reasons:

1. It only takes one person having changed to nullify the myth that change is not possible.
2. There are thousands of people who claim various degrees of change in behavior, lifestyle, attractions, or all of the above.
3. Change is documented in the professional literature spanning at least the past one hundred years. A review of the
   literature demonstrating that change is possible is published in a peer-reviewed journal, Journal of Human
   Sexuality. This particular volume contains hundreds of references (NARTH, 2009).

In an attempt to evaluate the research findings, the APA put together a very biased, six member task force of individuals to look at the scientific literature regarding the issue of sexual orientation change efforts (SOCE). Each member of this task force was opposed to SOCE, and not one proponent of SOCE was included on the task force. They looked at all of the literature and dismissed any studies showing SOCE to be successful. They dismissed credible studies by applying research standards that are not applied to any other homosexuality research – not the gay parenting literature, not outcome studies on gay-affirmative therapy (which by their standards has never been found to be successful and has not been shown to be without harmful effects). In the end, they could not, as reasonable professionals, definitively claim that SOCE is ineffective or that it is harmful. At best, all they could claim was, “…there is little in the way of credible evidence that could clarify whether SOCE does or does not work in changing same-sex attractions” (APA, 2009, p. 28, emphases added).

Saying there is not enough evidence is not saying that it does not work. More research is needed, as is the case with many approaches to therapy and treatment for many therapeutic issues. There are countless methods of therapy that have never been proven through rigorous research studies to be both “effective or ethical,” as the writer of the letter is suggesting must be done before one can claim that any type of change is possible.

Furthermore, regarding misguided claims of harm, the APA task force also admitted there is not enough evidence to claim that this type of therapy is harmful, “There are no scientifically rigorous studies of recent SOCE that would enable us
to make a definitive statement about whether recent SOCE is safe or harmful and for whom” (APA, 2009, p.  83).

The study most frequently cited to support claims of harm is a study conducted by Shidlo and Schroeder (2002). These researchers actually advertised for participants with the statement, “Help Us Document the Damage of Homophobic Therapists”. However, even despite their biased solicitation of clients who had been harmed by therapy, the results of their study are quite similar to outcomes for other forms of therapy (Whitehead, 2010). Across any therapeutic modality and with any
therapeutic issue, some clients report successful outcomes and other clients do not. Additionally, research studies indicate that clients sometimes become worse before they become better (Whitehead, 2010). What’s even more noteworthy is that despite Shidlo and Schroeder’s (2002) very biased solicitation of participants who had been harmed in therapy, some of their participants actually reported positive outcomes from therapy. (For an analysis of this study, see  http://narth.com/2011/08/sexual-orientation-change-efforts-do-not-lead-to-increased-suicide-attempts/).

It seems since the professional associations, having looked at the literature firsthand, are unable to claim a basis for banning SOCE or limiting it to adults only, the activists have to rely on the misinformed legislators to ban or limit it, as we’re witnessing in California.

The other point made by the psychologist who sent me the concerned letter is that the professional associations no longer consider homosexuality a mental disorder. Let me also note, NARTH does not describe homosexuality as a mental disorder. However, declassifying homosexuality as a mental disorder does not mean that homosexual clients have suddenly stopped seeking therapy for change in their lives. As they have done for hundreds of years, many homosexual clients continue to seek treatment for change. Not everyone who finds himself or herself with homosexual attractions happily embraces those attractions. There are, in fact, many dissatisfied, even suicidal homosexuals who desire change for their lives. Those clients should be accommodated in their search for a different life.

Ethical therapists do not solicit clients or coerce clients into seeking change. The clients served by NARTH therapists are clients requesting change. This includes minors brought to therapy by their parents. Ethical therapists do not help clients who are not requesting change – they help voluntary clients pursue their own goals for therapy. If parents seek change for their minor child who is perfectly content with a homosexual orientation and does not desire change, ethical therapists do not continue to work with those minor clients. An ethical therapist would never try to force or coerce someone to change. An ethical approach to this issue is made clear in NARTH’s Practice Guidelines (NARTH, 2010; also see http://narth.com/2011/12/narth-practice-guidelines).

Misinformation is very dangerous. Therapists who believe clients were born homosexual and cannot change end up passing this false information along to their clients. Although well-intended, telling clients who seek change that they have no other option for their lives can lead to hopelessness. Many individuals have shared their stories of experiencing depression, substance abuse, self-hatred, and even suicidal ideation having found no alternative to their homosexual attractions. It is so very important that therapists understand that clients have options – they were neither born homosexual, nor should they be forced to embrace something they did not choose. Ethical therapists are aware of what the research can and cannot say on this issue and provide options to their clients. Ultimately, it is the client who must choose, with proper informed consent, and without therapist-coercion, the most satisfactory life for himself or herself.

References

American Psychological Association (2009). Report of the APA task force on appropriate therapeutic response to sexual orientation. Retrieved from http://www.apa.org/pi/lgbt/resources/therapeutic-response.pdf

American Psychological Association (2008). Answers to Your Questions for a Better Understanding of Sexual Orientation and Homosexuality. Retrieved from http://www.apa.org/topics/sexuality/orientation.aspx

NARTH Scientific Advisory Committee (2009). What research shows: NARTH’s response to the American Psychological Association’s (APA) claims on homosexuality. Journal of Human Sexuality, 1, 1-128.

NARTH Task Force on Practice Guidelines for the Treatment of Unwanted Same-Sex Attractions and Behavior (2010). Practice Guidelines for the Treatment of Unwanted Same-Sex Attractions and Behavior, Journal of Human Sexuality, 2, 5-65.

Shidlo A., & Schroeder, M. (2002). Changing sexual orientation: A consumers’ report. Professional Psychology: Research and Practice, 33, 249-259.

Whitehead, N. (2010). Homosexuality and Co-Morbidities: Research and Therapeutic Implications. Journal of Human Sexuality, 2, 125-176.

Christopher H. Rosik, Ph.D.

California SB 1172 is a first-of-its-kind legislative effort to usurp the role of the professional mental-health associations and ban change-oriented psychological care to minors. This legislation assumes that sexual-orientation change efforts (SOCE) constitute a form of family rejection that will likely result in harm.

In reality, however, there is virtually no evidence to support this claim. In fact, the SOCE literature reporting harm among youth is extremely scarce and conducted only with non-representative samples.  A single study was used by the bill’s supporters to support their claim. But it is remarkable that the authors of SB 1172 could even conceive that this particular study had any relevance to their legislative aims.

Furthermore, NARTH clinicians have long been aware that parents with traditional values need not “reject” their child; they can be encouraged to love and accept their children, even when they disapprove of their child’s sexual lifestyle choices.

Secondarily, SB 1172 will also dictate the content of consent forms in SOCE therapy with adults and create the threat of legal action against therapists. Despite the existence of a substantial body of research evidence that some clients can change, and the lack of any research showing that harm is likely, clinicians will be required to tell their clients that the therapy they offer has no scientific validity and often results in harm.

While NARTH opposes this bill on many counts (see: http://narth.com/2012/04/narth-statement-on-californis-sb-1172-sexual-orientation-change-efforts/), this legislation is particularly worrisome in its use of scientific research.  The bill cites only one study to support its claims, presumably the most scientifically important research from the perspective of the sponsors of the bill (i.e., the group “California Equity”).  The citation of one single study to create new civil law can serve to clarify how activist agendas and politicians who are ignorant of research methods can work together to distort science and dictate a particular partisan outcome.

In the case of SB 1172, the specific aspect of the bill suited for this analysis is regarding the effects of SOCE on minors.

Claims of SB 1172

In section 1 of the bill, following a laundry list of quotes from professional organizations hand-picked to directly or indirectly suggest the discouragement of SOCE, the bill states in item (i):

Minors who experience family rejection based on their sexual orientation face especially serious health risks.  In one study, lesbian, gay, and 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, 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 family rejection.  This is documented by Caitlin Ryan, et al., in their article entitled Family Rejection as a Predictor of Negative Health Outcomes in White and Latino Lesbian, Gay, and Bisexual Young Adults (2009), 123, Pediatrics, 346.

This is followed by item (j):

California has a compelling interest in protecting the lives and health of lesbian, gay, and bisexual people.

Now clearly, NARTH is on record in our Practice Guidelines (http://narth.com/2011/12/narth-practice-guidelines/) as being very concerned that minors who engage in SOCE and the parents who bring them to treatment are provided with a high level of professional care. Such care extensively evaluates the clinical and motivational context of all parties to minimize any risk of harm.

In my own clinical work, I have told several parents upon initial evaluation that their teenage child is not invested in change at this time, and therefore their best path forward is to love their child and keep the lines of communication as open as possible. Yet SB-1172 appears to be engaging in a guilt-by-association argument, whereby SOCE with minors is by definition a marker of family rejection which endangers the lives and well-being of these youth.

The rhetoric coming from the office of the Senator who introduced this bill (Senator Lieu) certainly seems to confirm this assertion (see http://sd28.senate.ca.gov/news/2012-04-23-senate-panel-cracks-down-deceptive-sexual-orientation-conversion-%E2%80%98therapies). It asserts, among other things, that:

“[SOCE]….has resulted in much harm, including a number of lesbian, gay, bisexual and transgender youth committing suicide.”

“Some individuals perceived that they had benefited from sexual orientation change therapy, but the vast majority of participants perceived that they had been harmed.”

“Sexual orientation change therapies….are the types of sham therapies that California law does not protect against for minors.”

“These bogus [SOCE] efforts have led in some cases to patients later committing suicide, as well as severe mental and physical anguish.  This is junk science and it must stop.”

These quotes, not to mention the content of the bill, make painfully obvious that for the sponsors of this legislation, licensed clinicians who engage in SOCE are placing significant numbers of their minor clients in serious physical and psychological danger.

To bolster their case with research, the sponsors cite a study by Ryan, Huebner, Diaz, and Sanchez (2009) in the respected journal Pediatrics that provides the genuinely sobering statistics noted above.  But does this study really support the bill’s implication that SOCE constitutes a form of family rejection that results in such increased risk of negative health outcomes for minors?  To answer this question, we must take a closer look at the actual research.

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Methodological Analysis of Ryan, et al. (2009)

In order to provide a certain degree of objectivity to this analysis, I will refer to the standards for conducting research outlined in the Report of the on American Psychological Association Task Force Appropriate therapeutic responses to sexual orientation (2009). Keep in mind that these are the standards that the APA used in their report to justify the nearly complete dismissal of the vast body of research literature supporting the effectiveness of SOCE.  Thus, it is appropriate and highly relevant to examine the Ryan, et al. (2009) study through the APA’s own analytical lens, since in this instance research is being cited not to support, but rather to ban, SOCE.

Sampling issues. The Ryan, et al. (2009) study described its sample procedure as one of “participatory research” whereby the researchers “…advised at all stages…the population of interest (LGB adolescents, young adults, and family members), as well as health care providers, teachers, and advocates” (p. 347).  However, as the APA’s Task Force (2009) noted, “Knowing that one is being studied and what the experimenter hopes to find can heighten people’s tendencies to self-report in socially desirable ways and in ways that please the experimenter” (p. 32).

This very same standard of avoiding potential demand characteristics was clearly violated in the Ryan, et al., study where, “Providers, youth, and family members met regularly with the research team to provide guidance on all aspects of the research, including methods, recruitment, instrumentation, analysis, coding, materials development, and dissemination and application of findings” (p.347).

Recruitment issues. Ryan, et al. (2009) described their procedure for recruitment of participants as follows:

Participants were recruited conveniently from 249 LGB venues within 100 miles from our office.  Half of the sites were community and social organizations that serve LGB young adults, and half were from clubs and bars serving this group. Bilingual recruiters conducted venue-based recruitment from bars and clubs and contacted each agency to access all young adults who use their services. (p. 347)

A main methodological critique of the SOCE literature offered by the APA Task Force (2009) had to do with the limitations of convenience sampling.  The Task Force warned that, “Additionally, study respondents are often invited to participate in these studies by [therapists] who are proponents of SOCE, introducing unknown selection biases into the recruitment process”  (p.34). Futhermore, the APA observed that since “…study recruiters were openproponents of the techniques under scrutiny; it cannot be assumed that the recruiters sought to encourage the participation of those individuals whose experiences ran counter to their own view of the value of these approaches” (p. 34).

Although the Ryan, et al. (2009) study had an admittedly different focus than the APA Task Force (family rejection of LGB young adults versus outcomes of SOCE), the APA’s warnings are relevant here, in that selection bias in recruitment is certainly a plausible risk.  While it no doubt appears probable that LGB youth face higher risks of family rejection which can contribute to negative health consequences, Ryan, et. al.’s recruitment methods make their findings unreliable for generalization to LGB
youth as a whole, and provide no scientifically relevant information for assessing perceptions of family rejection among SOCE minor clients.  In fact, SOCE-related family rejection experiences were not even assessed in Ryan, et al.’s study.

Generalization difficulties are also created by the sample composition of Ryan, et al. (2009).  The sample is limited to young adult non-Latino and Latino LGB persons. The APA Task Force (2009) noted that research on SOCE has “…limited applicability to non-Whites, youth, or women” (p. 33) and, “No investigations are of children and adolescents exclusively, although adolescents are included in a very few samples” (p. 33). This means that even had Ryan and colleagues assessed for SOCE backgrounds among participants, it would be inappropriate to generalize their findings in a manner that would cast aspersions on all SOCE experiences of minors, which again is precisely what AB 1172 is determined to do.

The SOCE literature pertaining to harm among youth is extremely scarce and conducted only with non-representative samples, and I am unaware of any studies assessing specifically for family rejection among SOCE with minors.  This may be why the authors of SB 1172 had to set aside all pretensions of scientific restraint in their citation of Ryan, et al.

Measurement issues. Finally, the inapplicability of Ryan, et al. (2009) as demonstrable support for SB 1172 can be questioned on measurement grounds as well. unds, observing that, “…overreliance on self-report measures and/or measures of unknown validity and reliability is common” (p. 31).  Even more to the point, “People find it difficult to recall and report accurately on feelings, behaviors, and occurrences from long ago, and with the passage of time, will often distort the frequency, intensity, and salience of things they are asked to recall” (p. 29).

It appears that these cautions could equally apply to the Ryan, et al. (2009) study, in that participants averaged just under 23 years of age, meaning that they were recalling experiences that occurred on average 3 to 10 years ago.  Furthermore, psychometric information on reliability and validity was not provided by Ryan, et al., for some of the measures they developed (i.e., substance use and abuse, sexual risk behavior).

In addition, Ryan, et al. (2009) acknowledge that “…given the cross-sectional nature of this study, we caution against making cause-effect interpretations from these findings” (p. 351).  Presumably, this caution alone should have been enough to prevent the authors of SB 1172 from employing the Ryan study.  Even had the study findings been generalizable, they would have not been able to indicate whether SOCE caused the negative health outcomes or if youth with negative health markers disproportionately sought SOCE.

Other problematic aspects of Ryan, et al.’s construct development include the dangers of losing important interpretive information by dichotomizing continuous variables, the limitations of using perceptions of family rejection (e.g., being blamed by a parent) versus objectively verifiable variables (e.g., registration at a homeless shelter), and the lack of a measure of impression management.

The question is not why the designers of SB 1172 failed to report such limitations of the Ryan study; rather, it is how the authors could even conceive that this research had relevance to their legislative aims.

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SB 1172: A Legislative Solution in Search of a Clinical Problem

This analysis of the science behind SB 1172’s intention to ban SOCE to minors should in no way be construed to imply that psychological injury does not occur from family rejection for some GLB youth.  NARTH clinicians share a concern for the welfare of GLB youth and therefore take great care to determine if coercive influences are implicated when minors present for SOCE.  While some opponents no doubt view SOCE with minors by definition as reflecting family rejection, there is no data to back up this claim, and the experience of NARTH professionals is that parents can be assisted to love and accept their child without having to sacrifice their traditional values regarding sexual expression.

My intent in this brief investigation of the Ryan, et al. (2009) study through the lens of the APA Task Force’s (2009)methodological standards is simply to demonstrate how science appears to have been hijacked in the service of concocting an authoritative-sounding link between SOCE, family rejection, and negative health outcomes.

Based on this analysis, there appears to be no scientific grounds for referencing the Ryan study as justification for a ban on SOCE to minors.  The study’s findings, while likely reflecting some underlying connection between family rejection and mental health outcomes, are not reliable and have no scientific justification for being generalized to minors who engage in SOCE with licensed therapists. It is troubling that SB 1172 would utilize Ryan, et al.’s work when the internal and external validity limitations of the study make such claims profoundly misguided, as underscored by the APA Task Force.

SB 1172 therefore supports its attempt to ban SOCE for minors with a study that cannot be generalized, and it cherry-picked citations from several mental health associations, none of which have banned SOCE with minors.

By way of conclusion, it needs to be pointed out that an unmistakable implication of SB 1172 is that the California licensing agencies and mental health associations are so derelict in their protection of GLB youth that politicians must step in and do their work for them.  How else should we understand the complete absence of licensure revocations or membership suspensions among California therapists who provide SOCE when suicides and severe mental and physical anguish are so presumably widespread among GLB youth and attributable to this form of psychological care?

Either these agencies and professional associations are incredibly negligent and inept, or SB 1172 is an ideological agenda masquerading as a legislative solution to a clinical problem that simply does not exist. Citing research that cannot be generalized and professional pronouncements in the absence of censorious actions against SOCE professionals cannot, by any reasonable measure, provide sufficient justification for the ban on SOCE with minors that SB 1172 sponsors seek.

References

American Psychological Association (2009). Report of the APA task force on appropriate therapeutic response to sexual orientation.  Retrieved from http://www.apa.org/pi/lgbt/resources/therapeutic-response.pdf

Ryan, C., Huebner, D., Diaz, R. M., & Sanchez, J. (2009). Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics, 123, 346-352.

On Tuesday afternoon the members of the State Senate Judiciary Committee voted by 3 – 2 to recommend to the full Senate SB 1172.  This dangerous legislative initiative will now move forward in the Senate and, if passed there, on to the state Assembly for committee review.

The NARTH delegation had the opportunity to address our concerns about the bill in the testimony gathering portion of the committee hearing. The Pacific Justice Institute spoke against the legislation pointing several unconstitutional provisions that would open the bill up to legal challenges if it were to be passed by the full California legislature and signed into law by Governor Jerry Brown.

While the results were discouraging, the bill has a long way to go before it becomes California state law. NARTH efforts now move toward informing the full 40 member Senate of our concerns about the loss of freedom for California families and the restrictions it places on mental health professionals. Stopping the bill in the Judicary committee was our first line of defense, but considering the make-up of the committee members it was always a difficult challenge. Senator Mark Leno, a well known gay activist is a member of the committee and advocated for SB 1172 in the hearings.

Importand information and background articles:

A bill has been introduced in the California legislature that would threaten the right of individuals with unwanted homosexual attractions to receive therapy.

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April 23, 2012

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April 23, 2012

The National Association for Research and Therapy of Homosexuality NARTH wishes to be on record as objecting to SB 1172 and strongly recommending that this bill not be passed out of committee.  NARTH is a professional, scientific organization whose members include fully qualified academics and therapists who are fully licensed professionals and who abide by high standards of ethical care.  NARTH supports the freedom of individuals to claim a gay identity or to explore their unwanted attractions and make changes in their lives.  NARTH objects to this bill for the following reasons:

1. SB 1172 inaccurately represents the science on SOCE.

SB 1172 makes serious errors in its representation of both the issue of change in sexual orientation and in the likelihood of harm.  SB 1172 references the report by the American Psychological Association’s (2009) Task Force on Appropriate Therapeutic Responses to Sexual Orientation.  We would first point out to this committee that when the Task Force committee was being formed, NARTH and others submitted the names of highly esteemed professionals who either practice or were sympathetic to the informed and professional provision of SOCE.  However, none of these individuals were appointed to this committee, which ended up being comprised of professionals who essentially were in ideological lock step with one another in their preconceived notions regarding SOCE.  In NARTH’s view, this limits the scientific authority of this document.  However, even with this highly restricted range of viewpoints, the Task Force’s statements related to change of sexual orientation and harm seem to be ignored by the crafters of SB 1172.

First, SB 1172 presents the issues of change and harm in a partisan manner. The bill in Section 1 (c) (and again in Section 865.1 (b)) states that “…there is no evidence that any type of psychotherapy can change a person’s sexual orientation…”  The Task Force report, however, actually “concluded that there is little in the way of credible evidence that could clarify whether SOCE does or does not work in changing same-sex attractions” (p. 28, emphases added).   We would like to point out that absence of
conclusive evidence of effectiveness is not logically equivalent to positive evidence of ineffectiveness.  A more accurate statement regarding SOCE’s effectiveness based on the Task Force report would include a statement that there is also not sufficient scientific evidence to conclude that SOCE is not effective and in the end the current research only allows the conclusion that, “We simply do not know.”  We would submit that this omission seriously misrepresents the science on SOCE as presented in SB 1172.

Second, regarding the issue of harm, SB 1172 states that SOCE “..may cause serious and lasting harms.”  While we have no doubt that harm can occur in SOCE, as can occur in any form of psychotherapy, we would point out that the Task Force report’s statements about harm rely heavily on a study by Shidlo and Schroeder (2002). The authors of this study make clear what the Tasks Force report failed to mention and SB 1172 therefore neglected: “The data presented in this study do not provide information on the incidence and prevalence of failure, success, harm, help, or ethical violations in conversion therapy” (p. 250, emphases in the original).  Again, what we can say with confidence is that some SOCE clients report harm and others report benefit and we do not know from the scientific literature how often either outcome occurs.  Again, to present the issue of harm in the manner put forth in SB 1172 constitutes a clear failure to provide necessary context and therefore creates an unfair characterization SOCE.

NARTH believes that the Task Force employed unrealistically stringent methodological standards in dismissing the research on SOCE in order to make the blanket conclusion that it is not effective. By these standards, it is quite conceivable that other approaches to psychotherapy currently in practice could be considered ineffective and potentially harmful.  Does the committee
really wish to become an arbitrator of psychotherapeutic approaches?  We would further note that, to their credit, the Task Force also acknowledged that the gay affirmative therapeutic approach “..has not been evaluated for safety and efficacy” (p. 91) and that research meeting their methodological standards is still needed to establish this.  Based on such considerations, we believe it is inappropriate for SB 1172 to single out only SOCE for questioning on the grounds of efficacy.

2. SB 1172 would restrict the rights of parents to determine the appropriate psychological care for their minor child and hinder adult clients’ ability to make informed choices regarding their preferred therapeutic approach.

SB 1172 frequently mentions the necessity for informed consent in clients’ pursuit of SOCE.  NARTH fully affirms the need for
informed consent that provides accurate scientific information leading to autonomous choices by clients regarding the nature of their psychological care. Unfortunately, the informed consent mandated by SB 1172 in Section 865.1 (b) of the bill repeats the inaccuracies we noted above concerning what science can currently tell us about SOCE.  This incomplete and therefore inaccurate portrayal of the science seems likely to bias consumers against SOCE in a manner not warranted by the relevant literature and may therefore hinder the exercise of free trade within the profession.

NARTH finds particularly egregious the complete ban SB 1172 would place on the availability of SOCE to minors and the accompanying restrictions on parental rights.  We affirm that no minor should be subject to a form of psychological care they or their legal guardians do not wish to pursue and that great care must be undertaken by mental health professionals providing SOCE to assure that client freedom and autonomy is respected with minors.  However, it needs to be observed that the great majority of coercive experiences of minors purported to have occurred in SOCE, which are almost exclusively anecdotal in nature, took place in religiously based programs with pastoral providers who do not fall under the jurisdiction of this bill.  In addition, mechanisms already exist within licensing boards and professional mental health organizations to address unethical behavior or malpractice by licensed clinicians.  It is curious to us that the impediments and prohibitions SB 1172 places on consumers of SOCE far exceed the cautions already put into place by the relevant professional associations, which again brings into question the objectivity of those who are lobbying for this bill.

3. SB 1172 represents a usurping of the role of mental health organizations and licensing boards to provide oversight in psychological care.

As alluded to above, NARTH is concerned that SB 1172 transfers the oversight of proper psychological care from mental health professionals and licensing boards into the hands of politicians.  In so doing, this bill would unfairly and unethically subvert the purposes of mental health associations and licensing boards and place in the hands of politicians the regulation of professional
mental health practices.  We believe that such oversight should be the sole purview of professional mental health associations and licensing boards.  Such regulation should not be given to legislators who cannot be familiar with the breadth of the science on SOCE and, therefore, are at risk of making laws based on inaccurate or incomplete representations of the science provided by highly partisan activist groups.

The fact that this legislation is solely directed at SOCE should be a red flag suggesting that ideological and political motivations may motivate backers of this legislation as much as any concern for consumers derived from the relevant science.  It appears that those opposed to the ethical and professional provision of SOCE, having been unable to impose their will on professional organizations and licensing boards, are now attempting an end around power grab through the legislative process.  NARTH believes this effort, if successful, would set a dangerous precedence for the mental health professions, unjustly restrict client rights, and almost certainly invite legal action.

In summary, NARTH respects each client’s dignity, autonomy, and free agency in choosing their preferred form of psychological care to address same-sex attractions.  We believe that SB 1172 would make for bad law based on its misrepresentation of the science pertaining to SOCE, its potential to unnecessarily restrict client and parental choices, and its assumption of the regulatory functions of mental health associations and licensing boards.  We would urge committee members who are open to broadening their information base regarding SOCE to visit our web site at www.narth.org and review our recent statement about SOCE as well as our Practice Guidelines for the Treatment of Unwanted Same-Sex Behavior and Attractions.

We deeply appreciate your willingness to consider our concerns.

Sincerely on behalf of the NARTH Board of Directors,

Christopher H. Rosik, Ph.D. – NARTH President

References-

American Psychological Association (2009). Report of the APA task force on appropriate therapeutic response to sexual orientation.  Retrieved from http://www.apa.org/pi/lgbt/resources/therapeutic-response.pdf

Shidlo, A., & Schroeder, M. (2002). Changing sexual orientation: A consumer’s report. Professional Psychology: Research and
Practice, 33(3), 249-259.

Donate today to NARTH!

NARTH has already sent a delegation to Sacramento to speak at a legislative hearing, to petition Senator Lieu directly, and begin the process of lobbying key Judicial Committee members. Fighting this damaging legislation will be expensive and we need your help. Please consider making a donation to help us in this vital effort.

However, research has little to do with politics, or feelings, or regrets. It is really about science. May we recommend Dr. Mark Yarhouse’s bolg comment for your consideration. He sums up the issue nicely.

http://psychologyandchristianity.wordpress.com/

A viewing will be held this Friday evening April 13th from 6:00 to 8:00 MST at the Larkin Mortuary in Sandy, Utah. The funeral will take place Saturday April 14th at noon (MST) in a chapel near his home in Highland, Utah.

Dean was a true clinical pioneer paving the way for many others in the treatment of unwanted homosexual attractions. He had been a member of the NARTH Board of Directors for more than a decade and made a tremendous contribution to the early work in establishing NARTH as a reliable scientific and research organization. He is the author of many books, was a noted educator and speaker, and served on the Board of the Utah Psychological Association.

The members of NARTH and the Board of Directors find it difficult to adequately describe what a great loss this is to the organization and to express just how much he will be missed.

A. Dean Byrd, PhD, MBA, MPH (brief biography)
served as president of Thrasher Research Fund, which funds research for children’s health around the world. He is also a clinical professor with the University of Utah School of Medicine, with appointments in the Department of Family and Preventive Medicine and the Department of Psychiatry. He is a past president of the National Association for Research and Therapy of Homosexuality (NARTH), a board member of the Association of Mormon Counselors and Psychotherapists (AMCAP), and a director of the Foundation for Attraction Research. Employed more than twenty-five years with LDS Family Services as a clinical psychologist, Dr. Byrd is a prodigious writer, with numerous published books, book chapters, and peer-reviewed scholarly journal articles to his credit. He is also one of the editors of Understanding Same-Sex Attraction. Dr. Byrd is an internationally recognized expert in the field of research and treatment of unwanted homosexual attractions.

Former American Psychological Association President Dr. Nicholas Cummings interviewed at NARTH convention.

Please Click to watch the video!

Several clinical members of the California Association of Marriage and Family Therapists (CAMFT), some of whom are also members of NARTH, have filed a formal ethical complaint against the Board of Directors of the San Francisco chapter of CAMFT.

The therapists have complained about the dissemination of biased and inaccurate statements about SOCE (Sexual Orientation Change Efforts) since the American Psychological Association’s publication of Appropriate Therapeutic Responses to Sexual Orientation (APA, 2009).

Authored by NARTH member Robert Vazzo, MFT, the complaint delineates how the SF CAMFT Board of Directors has seriously misrepresented the APA’s findings on its website (www.sfcamft.org).

NARTH members are very concerned about the publication of accurate information about SOCE, Vazzo says, as misrepresentation of the facts has resulted in professional marginalization of therapists who do such work, as well as continuing attempts by CAMFT to makeSOCE unethical.  “What is amazing,” Vazzo notes, “is that the Board of Directors of SF-CAMFT has already decided that the best therapy for clients presenting with same-sex attraction is gay-affirmative therapy without any regard for the clients’ needsand wishes, cultural or religious values, or therapeutic goals. At a minimum,this constitutes professional irresponsibility because like many forms of SOCE, gay-affirmative therapy has not been subject to rigorous evaluation for safety or effectiveness.”

More than 60 NARTH members signed the complaint, and Vazzo reports that he received many more signatures after the complaint had already been submitted.

NARTH has now learned that certain factions of CAMFT want the Board of Directors of their parent organization to publish a negative statement about SOCE.  NARTH members are encouraged to contact the executive director, Jill Epstein, of CAMFT at jepstein@camft.org to voice their opposition to such a statement.

NARTH remains committed to protecting the rights of clients with unwanted same-sex attractions to pursue change, as well as the rights of clinicians to provide such psychological care.

The full text of the letter to CAMFT along with supportive documentation is presented below:

February 13, 2012

Jill Epstein, J.D., CAMFT Executive Director

CAMFT Ethics Committee Members

CAMFT President James Sanders and CAMFT Board of Directors

California Association of Marriage & Family Therapists

7901 Raytheon Road

San Diego, CA  92111-1606

Dear Ms. Epstein, CAMFT Ethics Committee Members, Mr. Sanders and CAMFT Board Members:

We, the undersigned, are writing to file a formal ethical complaint against each of the board members of the San Francisco chapter of CAMFT (SF CAMFT). The names and titles of these individuals are indicated below:

1. Jane Reingold, President
2. Rose Marie Dito, Vice-President
3. Gregory Rowe, Secretary
4. Bruce Weitzman, Treasurer
5. Rick Appleby, Board Member at Large

More specifically, we are complaining about public statements that SF CAMFT has made regarding the ethicality of SOCE (Sexual Orientation Change Efforts) on its Website (www.sfcamft.org) and about current research regarding SOCE.

The issue of SOCE has already been brought to the attention of CAMFT itself and has been addressed by the Ethics Committee. Nevertheless, on its Website, SF CAMFT has implicitly taken upon itself the task of deciding what is and is not ethical. We find SF CAMFT’s statements regarding SOCE to be misleading, inaccurate, potentially harmful, and most importantly, unethical.

Please allow us to delineate the misunderstanding of the research that SF CAMFT has demonstrated.  (Please also find a copy of the SF CAMFT home page attached for your convenience.)

First, SF CAMFT has posted the following heading on the front page of its Website:

San Francisco Chapter of CAMFT Statement on the Ethical Treatment of Sexual Orientation and Gender

Given the wording of the heading, we believe that SF CAMFT has implicitly commented on the ethicality of therapy and treatment, a right reserved uniquely for the Ethics Committee of CAMFT. In bullet points below this heading, the organization “denounces psychotherapeutic treatments that seek to alter a person’s sexual orientation or mode of gender expression.”

Furthermore, the explanation continues, “This position is consistent with the ample empirical research accepted by our profession, which holds that sexual orientation change efforts (SOCE) do not lead to effective, enduring or beneficial change.”  This statement is inaccurate and misleading.  Evidence of beneficial and lasting change for some clients can be found in peer reviewed studies including the Spitzer study (2003) published in the Archives of Sexual Behavior, and more recently, in Jones and Yarhouse’s study (2011) published in the Journal of Sex & Marital Therapy. However, because of the dearth of high quality studies on SOCE, the APA, in Appropriate Therapeutic Responses to Sexual Orientation, has stated the following, ” “…we cannot draw a conclusion regarding whether recent forms of SOCE are or are not effective” (p. 43).

SF CAMFT states (in the second bullet point) that “therapeutic treatments should beaimed at helping clients come to terms with their sexual orientation and to discover authentic modes of gender expression.”

SF CAMFT has already decided the client’s therapeutic goals in violation of ethical principle 1.4 (discussed in the attached appendix).

Likewise, SF CAMFT fails to inform the public that affirmative approaches have “not been evaluated for safety and efficacy” (APA, 2009, p. 91).

One of the most misleading statements that SF CAMFT has made concerns the American Psychological Association’s report Appropriate Therapeutic Responses to Sexual Orientation (2009). SF CAMFT declares that” much of the literature emphasizes the harm to clients that can result from such efforts.” What SF CAMFT doesn’t tell the public is that the APA
itself declared in that same publication that “Research on harm from SOCE is limited, and some of the research that exists suffers from methodological limitations that make broad and definitive conclusions difficult” (p.67).

SF CAMFT has seriously misrepresented the APA’s findings resulting in numerous ethical violations.

Please find attached an Appendix, which lists the CAMFT ethical codes and how SF CAMFT has violated the codes.

To remedy these ethical violations, we are asking the Ethics Committee to take the following measures:

(1)    To send letters of caution to the officers of SF CAMFT regarding the multiple ethical violations.

(2)    To instruct the directors of SF CAMFT to “cease and desist” and remove the nonfactual and misleading information immediately.

(3)    To instruct the directors of SF CAMFT to arrange a meeting with the author of this letter and another therapist of his choosing to draft a new statement, which is accurate and factual.

(4)    To send letters of caution to other chapters of CAMFT, advising them against publishing any material that violates legal or ethical codes of the profession.

(5) To recommend to the CAMFT Board of Directors that any statements regarding SOCE emanating from CAMFT itself include the consultationand collaboration of CAMFT members who practice or have practiced current therapies designed to assist a client in changing his/her sexual orientation. The author of this letter will gladly provide those names upon request.

SF CAMFT’s statements regarding SOCE hurt clients and potential clients (who choose these therapies voluntarily), and they
marginalize therapists who assist these clients.

CAMFT would never tolerate false or misleading statements about gays, lesbians, or gay affirmative therapy.  We are asking that you protect the welfare of the public by ensuring that chapters of CAMFT maintain the highest ethical standards for research and scholarship when communicating about SOCE on their Websites.

We look forward to hearing from you soon. You may contact us by contacting the author of this letter.

Sincerely,

Robert L. Vazzo, M.M.F.T.

Licensed Marriage & Family Therapist (Author)

121 W. Lexington Drive, Suite 342

Glendale, CA 91203

cc: Kevin T. Snider, Chief Counsel, Pacific Justice Institute

Appendix: SF CAMFT Ethical Violations

1.1 NON-DISCRIMINATION:
Marriage and family therapists do not condone or engage in discrimination, or refuse professional service to anyone on the basis of race, gender, gender identity, gender expression, religion, national origin, age, sexual orientation, disability, socioeconomic, or marital status. Marriage and family therapists make reasonable efforts to accommodate patients who have physical disabilities.

We argue that SF CAMFT’s position on SOCE is so radical that it results in discrimination against clients desiring therapy to bring same-sex attractions and sexual behaviors under control. Furthermore, therapists agreeing with SF CAMFT may be prone to decline to treat those seeking sexual orientation change because of these clients values or their religious beliefs. SF CAMFT is
advocating orthodoxy on the treatment of same-sex attraction. We judge this as prejudicial and leading to discrimination.

1.13 TREATMENT ALTERNATIVES: Marriage and family therapists discuss appropriate treatment alternatives with patients. Marriage and family therapists do not limit their discussions of treatment alternatives to what is covered by third-party
payers.

Given SF CAMFT’s position on SOCE, we can be sure that none of the Board members would ever discuss the possibility of SOCE with clients.

1.4 PATIENT AUTONOMY: Marriage and family therapists respect the right of patients to make decisions and help them to understand the consequences of their decisions. When clinically appropriate, marriage and family therapists advise their patients that decisions on the status of their personal relationships, including dissolution, are the responsibilities of the patient(s).

SF CAMFT is making recommendations that, if followed, will unduly limit the choices that potential clients have. These proclamations work to unilaterally prescribe what is best for the client rather than to work collaboratively with the client to
choose the best course of treatment. These declarations (on the Website) also limit client goals to “com[ing} to terms with their sexual orientation and to discover[ing] authentic modes of gender expression” when it is not a therapist’s role to predetermine what the aim of therapy should be, but, rather, to work in partnership with the client to determine goals. Some clients may not know what their sexual orientation is. How then would such a client be ready to come to terms with it? Furthermore, clients often have a self-identified sexual orientation that they would like to modify in some way, whether in terms of desires, thoughts, and/or behaviors.

1.5.1 DISCLOSURE: Where a marriage and family therapist’s personal values, attitudes, and/or beliefs are a determinative factor in diagnosing or limiting treatment provided to a client, the marriage and family therapist shall disclose such information
to the patient.

By denouncing an entire class of psychotherapeutic treatments, SF CAMFT is seeking to limit client treatment options on a massive scale. Furthermore, it is doing so within a context of strongly and deeply held moral, religious, and political views.

SF CAMFT Chapter has demonstrated itself to have strong values concerning homosexuality, same-sex marriage, and the ethicality of SOCE. Several of its members have been involved in California Therapists for Marriage Equality, which is seeking to change public policy in favor of same-sex marriage. Several of its members also lobbied the CAMFT Board to declare SOCE unethical. Any statement given to the consumer should be provided along with information about these advocacy activities, as these activities severely call into questions this chapter’s impartiality when it comes to clinical recommendations.

3.5 STAYING CURRENT: Marriage and family therapists remain abreast of developments in their field through educational activities or clinical experiences. Marriage and family therapists, when acting as teachers, supervisors, and researchers, stay abreast of changes in the field, maintain relevant standards of scholarship, and present accurate information.

SF CAMFT Board members have an ethical responsibility to present accurate information, based on current research about SOCE.

3.7 THERAPIST VALUES: Marriage and family therapists make continuous efforts to be aware of how their cultural/racial/ethnic identities, values, and beliefs affect the process of therapy. Marriage and family therapists do not exert undue influence on the choice of treatment or outcomes based on such identities, values and beliefs.

As written, the Website is biased against SOCE and against any client considering SOCE.

The violation of ethical standard 3.13 is particularly egregious:

3.13 PUBLIC STATEMENTS: Marriage and family therapists, because of their ability to influence and alter the lives of others, exercise care when making public their professional recommendations and opinions through testimony or other public statements.

Marriage & Family Therapists must take a conservative approach when voicing their opinions, lest they mislead and harm
the public. SF CAMFT’s statements are careless in this regard.