Tag archives: counseling

State Round-Up: Protecting Access to Counseling

by Chantel Hoyt

July 8, 2021

Editor’s note: This is part of an ongoing series about key provisions that states have advanced in 2021 to defend the family and human dignity.

Most Americans would support passing laws that seek to protect minors from harm. However, the question of exactly how we should go about protecting minors and what we should be protecting them from is a bit more contentious.

This year, 21 states have introduced bills seeking to ban sexual orientation change efforts (SOCE) or what its detractors call “conversion therapy.” In actuality, what these bills ban is patient-directed counseling and talk therapy. Specifically, they prohibit licensed mental health care professionals from counseling individuals to help them cope with unwanted same-sex attraction or gender identity issues. Although eight states have introduced legislation to protect patients’ right to access the therapy of their choice, more needs to be done to stop the spread of counseling bans in the United States and protect the freedoms of counselors and their patients.

Counseling bans have almost always applied only to minors and typically define SOCE or “conversion therapy” as “any practice or treatment by a mental health professional that seeks to change an individual’s sexual orientation or gender identity…” Most often, they incur professional penalties for mental health care professionals who fail to comply. Some may contain exceptions for pastors or other religious clergy, but these exceptions do not extend to licensed professionals who are also pastors or people of faith. Some of these bills also prohibit expending public funds for “conversion therapy.”

The media’s portrayal of “conversion therapy” often evokes images of electroshock or other pain-inducing methods. However, there is no evidence that a single practitioner of SOCE is using these methods today. Counseling bans rarely, if ever, mention such methods but instead use expansive language that sweeps up mere talk therapy. (Indeed, the SOCE ban in Washington state was held up for years because Democrats there refused to agree to language outlawing these specific practices.)

Virtually every counseling ban today applies to both sexual orientation and gender identity. A counseling ban that includes gender identity is especially harmful, as it mandates that mental health care professionals use a “gender-affirming” model of care with their clients. This makes it unlawful for a therapist or psychiatrist to do anything other than affirm a minor’s gender identity, even if said identity does not align with the minor’s biological sex, and even if that’s the kind of counseling the patient wants.

These bills are harmful for three reasons:

  1. They place content and viewpoint-based restrictions on constitutionally protected speech,
  2. They undermine the autonomy of individuals and their parents to choose the therapy that is right for them, and
  3. They harm minors who are struggling with these issues by making the counseling they need unavailable.

Since 2011, 265 counseling ban bills have been introduced in 43 states. Twenty-four of these bills have been enacted in 18 states.

Currently, 20 states plus the District of Columbia have counseling bans in place. Counseling bans have been prevented from taking effect in Alabama, Georgia, and Florida due to court injunctions. Based on U.S. census data on the populations of these 20 states, it is estimated that about 41 percent of minors living in the United States today live in a state with a counseling ban in place.

From 2011 to 2019, the number of counseling bans introduced each year rose steadily, peaking in 2019 at 57. This number dropped to 28 in 2020 but has since risen again in 2021 (43 in 21 states). Fortunately, none have been enacted yet. Thirteen of the bills introduced this year applied not only to minors, but also to adults. Two bills introduced in North Carolina extended counseling bans to adults with disabilities, while Minnesota and Alaska introduced bills that applied to minors and “vulnerable adults.” Bills introduced in Kentucky and Texas apply the ban to individuals of all ages. This is somewhat of a recent development, as in years past, few of these bills applied to adults.

Six bills this year also prohibit advertising for “conversion therapy” (again, this is really talk therapy) or related goods and services. Florida’s bills even impose a criminal penalty (a felony of the third degree) for violating such prohibitions. Such dangerous penalties have become more prevalent in the past two or three years. This raises questions about what constitutes an “advertisement” and how this could affect churches and other faith-based institutions. If anything, counseling bans have gotten even more expansive this year, with more bills applying to more individuals and imposing new penalties.

Apart from simply opposing counseling bans and stopping them in their tracks, some states have taken a more proactive approach by introducing legislation to protect counseling. These bills vary widely in terms of specifics, but many include two key provisions:

  1. Prohibit the state from restricting the rights of mental health professionals to counsel patients with same-sex attraction or gender identity issues, as well as the right of patients or their parents to choose such counseling.
  2. Provide that individuals may give or receive counsel in accordance with their religious beliefs or moral convictions.

In addition to these two provisions, some bills may create a civil cause of action for practitioners or patients who feel that their freedom of speech was unjustly violated.

About half of the 21 Counseling Protection Acts introduced since 2015 take the general form described above. However, the following states have taken a different approach:

  • Massachusetts introduced a bill in 2021 that would amend a section of law banning SOGI “change efforts,” adding a section specifying that SOGI change efforts do not include practices that “utilize discussion alone.”
  • Wisconsin introduced two bills in 2021 that would prohibit state regulatory boards from promulgating rules that establish that employing or promoting a treatment that attempts to change a person’s sexual orientation or gender identity is unprofessional conduct.
  • North Dakota (2021), South Dakota (2020), and Kansas (2019) each introduced bills that would preempt the state government from endorsing or enforcing certain policies, including policies banning “conversion therapy,” on the novel theory that to do so would be to establish a state religion. (None of these bills has passed, so this reinterpretation of the Establishment Clause has not been tested.)
  • Virginia introduced two bills (one in 2019, one in 2020) that would have given state regulatory boards the right to ban electroshock therapy or “similar non-speech therapy” but specifically prohibited such entities from violating an individual’s “fundamental right” to engage in the talk therapy of their choice, including counsel to assist in “reducing or eliminating unwanted attractions or concerns about gender identity.”
  • Tennessee introduced two bills in 2016, both of which would have protected licensed counselors and therapists from being required to counsel or serve a client as to goals, outcomes, or behaviors that conflict with a sincerely held religious belief, provided that the counselor or therapist coordinates a referral to another professional willing to provide such counseling.
  • Oklahoma introduced a bill in 2015 that would have prohibited the government from restricting SOCE but specified that this protection would not extend to “aversion therapy” (electroshock, electroconvulsive therapy, vomit-induction therapy, etc.).

Since 2015, at least 20 Counseling Protection Acts have been introduced in at least 12 different states. 2021 has been the biggest year for these types of bills, with a total of eight being introduced. So far, only one Counseling Protection Act has been enacted in Tennessee in 2016. This bill protected counselors and therapists from being required to counsel or serve a client as to goals, outcomes, or behaviors that conflict with a sincerely held religious belief, provided that the counselor or therapist coordinates a referral of the client to another counselor or therapist willing to provide the counseling or therapy. This bill also provided that a refusal to provide the counseling/therapy described will not be the basis for a civil cause of action, criminal prosecution, or any other action by the state to penalize or withhold benefits.

This year, some states have recognized the importance of standing against counseling bans. But more still needs to be done. Twenty states currently have counseling bans in place for minors, meaning children and teens in those states cannot legally access therapy to address unwanted same-sex attraction or gender identity issues, even if they want to. Some states are trying to take this right away from consenting adults as well. More states need to step up and protect access to such counseling.

FRC Opposes Guidance Attacking Sexual Orientation Change Efforts in Virginia

by Peter Sprigg

December 12, 2019

Editor’s Note: The following is a comment submitted on December 11, 2019 by Peter Sprigg on behalf of Family Research Council in opposition to a proposed regulation against so-called “conversion therapy” by the Virginia Board of Medicine.

I write in opposition to the proposed “Guidance Document on the Practice of Conversion Therapy,” and urge the Board not to adopt this policy.

Policy Statements Are Not Science

The guidance document is correct in stating, “Leading professional medical and mental health associations have issued position and policy statements regarding conversion therapy/sexual orientation change efforts …” However, “position and policy statements” are not the same as actual scientific findings. Unfortunately, “position and policy statements” are often the product of a highly-politicized process that is not representative of the professional population for whom they claim to speak.

Consider the first organization cited in the guidance document, the American Medical Association (AMA). According to a 2012 media report, there are 1.2 million physicians and medical students in the United States. Only 17 percent (217,490) are members of the AMA. (The AMA claims “approximately 250 thousand members” as of December 31, 2018.) Furthermore, AMA “position and policy statements” are not voted on by their entire membership, but rather adopted by a “House of Delegates” which consists of only 640 members as of June 2019. That means only one-quarter of one percent of all AMA members—and only a little more than one in every two thousand U.S. doctors—approve AMA position and policy statements.

The AMA press release announcing the new House of Delegates policy stated, “The AMA heard testimony, including first-hand accounts, regarding the significant harms triggered by conversion therapy …” Unfortunately, it has been documented that such “first-hand accounts” by LGBT activists are often implausible and sometimes demonstrably fabricated. What was not included in the AMA press release was any indication that the organization had undertaken a systematic review of the scientific evidence regarding either the effectiveness of sexual orientation change efforts (SOCE) or their alleged harms.

Concessions by the American Psychological Association

By contrast, the American Psychological Association (APA) did undertake a systematic review ten years ago. Although the resulting task force report was critical of SOCE, it did not call for legislative or regulatory restrictions on the practice. In fact, the APA made concessions that undermine the case for government intervention. For example:

1) Opposition to SOCE is based on the belief that people are born gay as a result of a “gay gene” or some other biological factor present at birth.

However, the APA admits that “there is no consensus among scientists” about what causes homosexuality, and that “nurture” may play a role.

2) Opposition to SOCE is based on the belief that sexual orientation is fixed and unchangeable.

However, the APA has acknowledged that “for some, sexual orientation identity … is fluid or has an indefinite outcome” (see page 2).

3) Opposition to SOCE, especially for children and adolescents, is based on the belief that individuals, especially children or adolescents, are often coerced into undergoing therapy (e.g., by parents).

However, the APA acknowledges that some people, including children and adolescents, may experience “distress” about having same-sex attractions and consider such feelings to be unwanted (see page 9).

The APA has also acknowledged that concerns about potential coercion could be mitigated by implementing a system of “developmentally appropriate informed consent to treatment” (see pages 74, 79, and 87).

4) Most of the therapy bans that have been enacted or proposed are specifically targeted at minor clients.

However, the APA acknowledges that there has been virtually no actual research done on SOCE with children or adolescents (see pages 33, 72-73, and 76).

5) Opposition to SOCE is premised on the belief that it has no benefits for the clients who undertake it.

However, the APA acknowledged, “Some individuals perceived that they had benefited from SOCE …” (see page 3).

6) Opposition to SOCE is based on the claim that it is always (or at least usually) harmful to clients.

However, the APA admits that there is no “valid causal evidence” that SOCE is harmful (see page 42).

7) The APA acknowledges that licensed mental health providers (LMHP) should “respect a person’s (client’s) right to self-determination,” allow the client to choose her or his own goals, and “be sensitive to the client’s … religion.”

However, legislative or regulatory restrictions on SOCE directly violate this core ethical principle of client self-determination.

A Literature Review of Studies Alleged to Show Harm from SOCE

When a recently-published book included an appendix titled, “Peer-Reviewed Journal Articles and Academic Books on ‘Conversion Therapy’ Outcomes that Include Measures of Harm,”[i] I set out to do a literature review (soon to be published) of this list of 79 sources. I discovered that a number of them make no reference to SOCE being harmful at all—it is inexplicable how they ended up on such a list. Of the remainder, approximately half are literature reviews or opinion pieces—not studies of actual SOCE participants.

All the entries that did study SOCE participants had significant methodological weaknesses, such as a lack of random sampling. Almost all of these studies represent anecdotal evidence only (via retrospective self-reports). Only one of the 79 sources used the gold-standard social science technique of a prospective and longitudinal design (that is, enrolling subjects at the beginning of or early in their therapy experience and interviewing the same individuals at different points in time to identify changes). That study found,

The attempt to change sexual orientation did not appear to be harmful on average for these participants. The only statistically significant trends that emerged … indicated improving psychological symptoms …” (emphasis added)

The most frequently cited article purporting to find harm from SOCE is a 2002 article by Shidlo and Schroeder. They asked respondents if they felt that “this counseling harmed you or had a negative effect,” and then followed up with a checklist of symptom areas. Oddly, the authors said in their article, “We do not report here on the frequency of responses to these items.” Because of this “qualitative” approach, the authors explicitly acknowledge,

The data presented in this article do not provide information on the incidence and the prevalence of failure, success, harm, help, or ethical violations in conversion therapy.”

Ironically, the one number that was reported—suicide attempts—showed that 25 participants had attempted suicide before “conversion therapy,” but only 11 had done so after such therapy. This would seem to suggest that SOCE is effective at reducing the risk of suicide, rather than increasing it as is sometimes alleged.

Conclusion

The evidence compiled so far regarding SOCE is either scientifically inconclusive or suggests that SOCE benefits those who seek treatment. It indicates a need for better and more extensive research on SOCE outcomes and techniques. The current state of research provides no valid scientific support for a draconian legislative or regulatory policy that would infringe upon the freedom of both clients and therapists to pursue the voluntary goal of sexual orientation change.

Unelected government officials should not insert themselves into the doctor/patient relationship, especially when relying on the politicized “policy statements” issued by a tiny minority of health professionals—statements that are unsupported by research and that are heavily qualified or even contradicted by the APA. I urge you not to adopt the proposed “Guidance Document on the Practice of Conversion Therapy.”



[i] “Appendix C: Measures of Harm: Peer-Reviewed Journal Articles and Academic Books on ‘Conversion Therapy’ Outcomes that Include Measures of Harm;” in Christopher Doyle, The War on Psychotherapy: When Sexual Politics, Gender Ideology, and Mental Health Collide (Manassas, VA: Institute for Healthy Families, 2019), pp. 365-74. The book’s author says that he received this list from A. Lee Beckstead (p. 107); but it is unclear whether Beckstead himself compiled the list.

Cohabitation: Everyones doing it?!

by Family Research Council

August 30, 2012

But, mom, everybodys doing it?!

It might have been your favorite childhood expression as you lobbied for that new toy or extra handful of cotton candy.

But for todays millennials its an underlyingif unstatedreason why so many decide to pack up their belongings and move in with their significant other.

According to the CDCs March 22, 2012 National Health Statistics Report, cohabitation (before first marriage) has risen significantly over the past 25 years and contributed to a delay in first marriage for both women and men.

Bloomberg.com reviewed at the data through a personal finance lens in their article, Living Together Trumps Matrimony for Recession-Wary Americans. Quoting theUniversity ofVirginias Brad Wilcox, the article noted that In todays economic climate, many young adults are reluctant to pull the trigger…. They may be unemployed or underemployed or not know what the future looks like. Theyre hedging their bets.

But the cohabitation-trend isnt limited to the younger generation. According to a new study, more and more Americans over age 50 are choosing to live with their partner instead of getting married.

If everyone is doing it, why discuss the trend; or to put it bluntly, who exactly cares?

Since the creation of marriage itself, the Christian tradition has clearly taught that sexual intimacy outside of marriage (and cohabitation, by definition), is a step away from the holiness and commitment that God intends for his people.

Modern Christian leaders, therefore, wrestle through their role in how to council church members or other believers who are cohabiting, but desire to marry. Last September, Christianity Today invited various Evangelical leaders to weigh in on the question: Should Pastors Perform Marriages for Cohabitating Couples?

But the questions surrounding cohabitation continue, even in the public space outside of our churches. In an April NY Times Opinion piece, clinical psychologist Meg Jay warned that far from safeguarding against divorce and unhappiness, moving in with someone can increase your chances of making a mistake or of spending too much time on a mistake.

Earlier this month, Huffington Posts Women Blog highlighted offered the following: Cohabitation? 5 Questions To Ask Before Moving In Together. The author offered no moral qualms about cohabitation but, throughout her piece. noted the inherent obstacles to a successful move, considering how many couples do not survive that first year of living with one another.

Does cohabitation matter? On Thursday, August 30 marriage expert Mike McManus revealed the myths and risks of cohabitation and offered solutions for your church and your community.

Everybodys doing it, never saved you from the childhood bellyache. It may also fall short when it comes to more adult decisions.

Click here to view the video recording.

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