By David S. Prescott, LICSW, Kasia Uzieblo, Ph.D., & Kieran McCartan, Ph.D.
According to Forbes and other media outlets, a federal appeals court in
the US recently struck down local ordinances prohibiting conversion
therapy. This has happened at a time when conversion therapy has been condemned
in many locations around the world, including Germany this past spring and then Israel in the summer. As many readers will know, the term “conversion
therapy” (also known as reparative therapy) is used to describe “any attempt to
change a person’s sexual orientation, gender identity, or gender expression”.
(This is taken from the GLAAD website’s description, which is worth reviewing, as
is this document from a United Nations Independent Expert.) We freely
acknowledge that we are not lawyers; we are interested in this case as
professionals in the area of preventing sexual offending.
A quick Google
search on the term “conversion therapy” identifies many ways that it harms
people, despite a robust literature showing that it is ineffective. The
American Psychological Association and the American Psychiatric Association
have issued statements condemning it, as have numerous other professional
organizations. In the US, 14 states and the District of Columbia have put laws
into place protecting LGBTQ+ youth. There is a considerable historical context that is beyond the scope of this blog, involving the
medically and psychologically false idea that LGBTQ (and for that matter,
gender-diverse individuals) are sick or pathological, just as there is a long
history of severe pain and suffering resulting in long-lasting psychological and
physical damage. Conversion therapy continues to take place in a multitude of
countries, in all regions of the world.
This last point,
regarding conversion therapy with youth, could be worthy of an entire
conference, given the numerous questions of what would actually constitute
informed consent. For example, young people who may be unable to judge the
risks and benefits for themselves and the question of parental consent for various forms of treatment, may signal pressure
on the youth, whose identify and wellbeing may hang in the balance.
In the main,
however, it’s important to clarify that the federal appeals court in this case
has struck down laws, but made no changes to the ethics codes of the numerous
professional organizations that render the practice of conversion therapy
unethical. Practicing conversion therapy and holding a license to practice
psychotherapy no longer mix, and rightfully so. We are not advocates of conversion
therapy as it has been practiced (which has often involved undue coercion
either by the therapist, family members, or both). In fact, earlier this year, the
Independent Forensic Expert Group (IFEG) of health specialists, declared that
conversion therapy is a form of deception, false advertising, and fraud.
There are
implications, however, of these and related legal proceedings for people
working with those who have abused and have sexual disorders. The rationale of
the federal appeals court centered on free speech. Number one on the list of
freedoms in the US Constitution’s Bill of Rights, free speech is near and dear
to the vast majority of people in the world, and not given to many. People have
fought and died for it and other freedoms. The court used as one example, that
other free-speech cases have involved a Florida law that prevents doctors from
talking with their patients about gun ownership (for example, a doctor would
not be allowed to talk about the potential health hazards of weapons access
where children are present despite the empirical research regarding weapons
access and ownership; does free speech end at the door to the doctor’s office?).
What are some
potential implications of the federal appeals ruling for professionals who work
with those who have offended? At the front lines, a number of possible questions
emerge. We know that sexual orientation as a broad term is different from
sexual interest, sexual arousal, and sexual behavior, but at the front lines of
practice, the situation can be more obscure. For example:
Between the
ethical codes of my profession and the laws protecting free speech, in what
ways might I be at risk for treating people who have sexually abused others? There
would seem to be a difference between conversion therapy and helping people who
have a sexual interest in children, but do I possess the requisite scholarly
papers to make a case should I be accused of practicing a variation of conversion
therapy? Conversion therapy has traditionally been about changing someone’s
same-sex interests; where is the line with changing someone’s age-related
interests? I understand that changing someone’s sexual orientation is
unethical, but what about changing someone’s sexual interests? How possible is
that really? Am I in a safer position trying to help people manage those sexual
interests without directly influencing them? Or do I need to think about all
this differently?
Further, there has
been debate about whether pedophilia is a sexual orientation; am I at risk for
ethics complaints or prosecution under the wrong conditions? Can I work to
change someone’s sexual arousal patterns? Is there a clear line between these
and orientation? How would I communicate that to a licensing board? Is it really
different when the sexuality I am attempting to influence has to do with harming
others (as opposed to traditional conversion therapy focusing on gender-related
orientation? Where is the line between influencing someone’s sexuality and
helping them to manage urges, thoughts, and fantasies? What are the
implications when working with a client who is not their own guardian?
We wish to
emphasize that we have neither all the questions nor all the answers. To our
minds, this is a discussion that has not yet occurred in any meaningful
fashion. Questions about pathologizing sexuality will likely exist well into
the future, including to what degree various elements of sexuality are innate
and biologically based versus learned. Our point in bringing this discussion to
the fore is to encourage all professionals to think about the broad dimensions and
diversity of the questions that emerge in the assessment, treatment, and
prevention of sexual offending.
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