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.
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.