Claims by Sen. Lieu and SB 1172 of widespread harms to minors
from SOCE represent rhetoric, not research.
"The attack on
parental rights is exactly the whole point of the bill because we don't
want to let parents harm their children," he said. "For example, the
government will not allow parents to let their kids smoke cigarettes. We
also won't have parents let their children consume alcohol at a bar or
restaurant."
-- California State Sen. Ted Lieu, as quoted by the Orange County Register, August 2, 2012
Introduction
Sponsored by state Senator Lieu (D-Torrance),
California Senate Bill 1172, which will prohibit mental health
professionals from engaging in SOCE with minors under any conditions,
appears on its way to the desk of Governor Brown and could very well
become state law. The most important revision to the bill reads as follows:
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.
As is plainly
evident, should SB 1172 become law, licensed therapists in California
who would otherwise be willing to assist minor clients in modifying
their unwanted same-sex attractions and behaviors will be seriously
jeopardizing their professional livelihoods. In defense of this bill's
clear intent to intimidate therapists and supplant the rights of
parents, Sen. Lieu has publicly compared the harms of SOCE to minors
with those of alcohol and cigarettes. This comparison certainly sounds
like a compelling analogy and clearly implies there is a conclusive body
of scientific evidence behind the legislation.
But
like so many claims of SB 1172 supporters, this analogy seems to have
been accepted at face value. Since Sen. Lieu's claim can be subjected to
empirical verification by searching relevant databases, I decided to
conduct such a search. Assuming the scientific basis for banning SOCE
with minors is similar to that of banning cigarettes and alcohol, we
should expect that the number of articles in the scientific literature
for each of these health concerns would be roughly equivalent.
Procedure and Results
To test this hypothesis, I conducted a search of the PsycARTICLES and MEDLINE databases. PsycARTICLES is a
definitive source of full text, peer-reviewed scholarly and scientific
articles in psychology, including the nearly 80 journals published by
the American Psychological Association. MEDLINE provides
authoritative medical information on medicine, nursing, and other
related fields covering more than 1,470 journals. I searched all
abstracts from these databases using combinations of key words best
suited to identify studies related to the question of interest. Below
are the totals for articles on cigarettes and alcohol (words preceding
an asterisk indicate that the search included all words with that stem,
so that a search for "minor*" would include both "minor" and "minors").
Key Words Total Articles Earliest Article
Children & Alcohol 4465 1917
Children & Cigarettes 883 1970
Adolescent* & Alcohol 6180 1917
Adolescent* & Cigarettes 1252 1971
Minor* & Alcohol 2670 1944
Minor* & Cigarettes 356 1973
These
totals make clear that the literature regarding youth as related to
alcohol and cigarettes is extensive, with studies numbering in the
thousands. With such a sizeable database, one could reasonably expect
that observations relative to the harms of cigarettes and alcohol among
youth reflect reliable scientific information that has been replicated
in numerous ways. These results, then, form the standard by which we can
evaluate the volume of scientific literature from which any claims
about SOCE and youth are based.
Since
SOCE is a relatively new term in the literature, I also conducted
searches utilizing the terms "reparative therapy," "conversion therapy,"
and "sexual reorientation therapy," which were in use long before SOCE
was coined. My extensive search of the databases to identify scientific
literature supportive of Sen. Lieu's comparison yielded the following
findings:
Key Words Total Articles Earliest Article
Children & Sexual OrientationChange Efforts (0) ---
Children & Reparative Therapy (0) ---
Children & Conversion Therapy (0) ---
Children & Sexual Reorientation Therapy (0) ---
Adolescent* & Sexual Orientation Change Efforts (0) ---
Adolescent* & Reparative Therapy (1) 2010
Adolescent* & Conversion Therapy (0) ---
Adolescent* & Sexual Reorientation Therapy (0) ---
Minor* & Sexual Orientation Change Efforts (0) ---
Minor* & Reparative Therapy (0) ---
Minor* & Conversion Therapy (0) ---
Minor* & Sexual Reorientation Therapy (0) ---
Sexual Orientation Change Efforts & Harm (0) ---
Reparative Therapy & Harm (1) 2010
Conversion Therapy & Harm (1) 2002
Sexual Reorientation Therapy & Harm (0) --
Homosexual* & Psychotherapy & Harm (1) 1977
Gay & Psychotherapy & Harm (1) 1996
Lesbian & Psychotherapy & Harm (0) ---
Bisexual & Psychotherapy & Harm (0) ---
In stark
contrast to the thousands of articles related to alcohol and cigarette
usage by youth, my search of the scientific literature for references
that would back up Sen. Lieu's claims yielded a total of four articles.
Interestingly, three of these articles were not research-oriented. Hein
and Matthews (2010) discussed the potential harms of reparative therapy
for adolescents but cited no direct research on SOCE with adolescents to
support their concerns. They relied instead primarily on adult
anecdotal accounts and did not distinguish between the provision of SOCE
by licensed clinicians and unlicensed religious practitioners. Jones
(1996) described a case of self-harm by a young gay man in response to
"profound" and "thematic" relationship difficulties. The author reported
that psychodynamic therapy was beneficial in helping the patient deal
with relational conflict without making any mention of internalized
homophobia or stigmatization.
Hochberg
(1977) discussed her treatment of a suicidal adolescent male who
finally disclosed his homosexual experience as termination neared. After
this disclosure, Hochberg reported that, "Therapy subsequently exposed
long-standing inhibitions in masculine assertiveness, longing for a love
object that would increase his masculinity, (and allay his homosexual
anxiety) and intense fear of physical harm" (p. 428). This article,
then, would in some respects appear to provide anecdotal support for
SOCE, not surprisingly coming in an era before reports of harm gained
favored status over reports of benefit within the psychological
disciplines.
The
only article my database search identified that could be considered
quantitative research was Shidlo and Schroeder's (2002) well-known study
on reported harms from SOCE. The Shidlo and Schroeder study suffered
from many methodological limitations, including recruiting specifically
for participants who had felt harmed by their SOCE, obtaining
recollections of harm that occurred decades prior to the study, and not
distinguishing between SOCE provided by licensed mental health
professionals and unlicensed religious counselors. As the authors
correctly acknowledged, the findings of this study can not be
generalized beyond their specific sample of consumers. This research can
therefore tell us nothing about the prevalence of harm from SOCE
provided by licensed therapists.
Discussion
In
an effort to corroborate the scientific accuracy of Sen. Lieu's
comparison between the harms to minors of cigarettes, alcohol, and SOCE,
I conducted a search of one major medical database and one main mental
health database associated with the American Psychological Association.
Results from this analysis revealed that the literature related to youth
and cigarettes or youth and alcohol numbered in the thousands while
studies relating directly to SOCE with minors appeared to be
non-existent. While the utilization of different sets of related key
words might yield slightly different totals with additional database
searches, it seems highly unlikely the results would differ in any
substantive fashion. Consequently, I have to conclude from this
investigation that Sen. Lieu's comparison lacks merit scientifically and
therefore SB 1172's prohibition of SOCE on the basis of harms to minors
lacks a clear scientific justification.
Some
additional observations from this investigation seem worth noting.
First, the case against SOCE with minors is typically based on four sets
of data: anecdotal accounts of harm (mostly from adults), a very few
quantitative studies (compilations of anecdotal accounts from adults
with severe methodological limitations), inferences from other research
domains of questionable relatedness to SOCE (e.g., harms from family
rejection of gay youth), and citations of the pronouncements on SOCE
from professional mental health and medical associations. These various
sources tend to cite one another in an almost symbiotic manner that
provides little if any new information relevant to answering important
questions about SOCE.
It
seems the science as pertains to SOCE is stuck in neutral and the
professional associations and critics of SOCE do not appear interested
in doing any cooperative research with proponents of SOCE that might
actually move our understanding forward. With SOCE on the defensive,
those within government and public university settings in a position to
make large scale scientific contributions to this literature appear
content to speak out of both sides of their mouths. On the one hand,
they demand rigorous empirical support for SOCE but on the other hand
they display no interest in facilitating bipartisan research that could
potentially address their demands. One could make the case that this is
hardly a shining moment in the history of social scientific integrity.
Secondly,
the lack of a clear and direct grounding in the scientific literature
for the claims of harm to youth from SOCE lend credence to the suspicion
that political rather than scientific motivations are the driving force
behind SB 1172. Reasonable clinicians and mental health association
representatives should agree that anecdotal accounts of harm constitute
no basis upon which to prohibit a form of psychological care. If this
were not the case, the practice of any form of psychotherapy could place
the practitioner at risk of regulatory discipline, as research
indicates 5-10% of all psychotherapy clients report deterioration while
up to 50% experience no reliable change during treatment (Hansen,
Lambert, & Forman, 2002; Lambert & Ogles, 2004). What may be at
play among supporters of SB 1172 is a dislike for how many SOCE
therapists view same-sex attractions, i.e., as a developmental
adaptation. It would certainly be a new and sobering development if
approaches to psychological care can now be prohibited on the basis of
disputed aspects of its theory rather than on a scientifically
established prevalence of harm that significantly exceeds those of other
therapeutic approaches.
Without
a basis in the scientific literature, the claims by Sen. Lieu and SB
1172 of widespread harms to minors from SOCE represent rhetoric, not
research. My database search suggests this is a superfluous piece of
legislation from the perspective of harm. Any harm that might occur from
the unprofessional practice of SOCE by licensed therapists can and
should be handled within the existing regulatory structures on a
case-by-case basis. But rather than take such a rational approach, SB
1172 supporters have politicized the issues in the form of this
legislative overreach (Los Angles Times, May 11, 2012), declaring SOCE
with minor ipso facto unprofessional conduct. They have thrown their
anti-SOCE wish list against the proverbial wall in order to see what
politicians and mental health associations would let stick. Sadly, the
blanket prohibition of SOCE with minors appears to be sticking and may
become law in California. If this occurs, the present analysis indicates
it will be in the absence of scientific literature and not because of
it.
References
Hansen, N. B.,
Lambert, M. J., & Forman (2002). The psychotherapy dose-response
effect and its implications for treatment delivery services. Clinical
Psychology: Science and Practice, 9, 329-343. doi:
10.1093/clipsy.9.3.329
Hein, L. C., &
Matthews, A. K. (2010). Reparative therapy: The adolescent, the psych
nurse, and the issues. Journal of Child and Adolescent Psychiatric
Nursing, 23(1), 29-35. doi: 10.1111/j.1744-6171.2009.00214.x
Hochberg, R.
(1977). Psychotherapy of a suicidal boy: Dynamics and interventions.
Psychotherapy: Theory, Research, and Practice, 14(4), 428-433.
Jones, A. (1996).
An equal struggle (psychodynamic assessment following repeated episodes
of deliberate self-harm). Journal of Psychiatric and Mental Health
Nursing, 3(3), 173-180.
Lambert, M. J., & Ogles, B. M. (2004). The efficacy and effectiveness of psychotherapy. New York, NY: Wiley.
Los Angles Times (May 11, 2012). Bill overkill in Sacramento. Retrieved from http://articles.latimes.com/2012/may/11/opinion/la-ed-0511-therapy-20120511
Shidlo, A., &
Schroeder, M. (2002). Changing sexual orientation: A consumers' report.
Professional Psychology: Research and Practice, 33(3), 249-259.
