Law and ethics

California may become first state to limit “reparative therapy”

Senate Bill 1172 would stop licensed therapists from providing reparative therapy to minors. It awaits Governor Brown’s signature or veto.

California Capitol-fromSWUpdated 9/30/12 – Governor Brown signed the bill into law. It takes effect January 1, 2013.

Senate Bill 1172, a proposed California law that would prevent licensed therapists from offering so-called “reparative therapy” to minors, has passed the state Assembly and Senate and is currently on Governor Jerry Brown’s desk. The Governor has until the end of this month — less than a week away — to sign or veto the bill.

If he signs it, California would be the first state in the US to take such action. Other states are eyeing the California bill closely, with some planning to propose similar bills. Gay rights organizations are also paying close attention to the bill, and have been pushing the Governor to sign it.

“Reparative therapy,” also sometimes known as “conversion therapy” and referred to in the bill as “sexual orientation change efforts,” is a form of therapy that aims to help people distressed by same-sex attraction change those attractions and ultimately become more heterosexual. The therapy was pioneered by Dr. Joseph Nicolosi, who suggests in his original book on the topic that same-sex attractions are unhealthy.

All the major professional associations in mental health have issued statements discouraging their members from using reparative therapy, though none has gone so far as to declare the practice inherently unethical. (See statements from the AAMFT, ACA, APA, CAMFT, and NASW; there’s a nice history of associations’ stances on the topic here.) These statements typically cite the lack of research support for any therapy succeeding in altering sexual orientation, and the serious risk of harm that comes to gay and lesbian clients when a therapist tells them that their sexuality is wrong or unhealthy.

However, the therapy remains practiced by a number of mental health professionals, who offer anecdotal reports of clients who say they were helped by the approach.

While professional associations are usually loath to accept government intrusion into clinical practice, it is noteworthy that all of the major professional associations in mental health in California are now either neutral on the bill or actively supporting it. All were initially opposed, but as the language of the bill has been amended, all have dropped their opposition. Here is where the major mental health professional associations currently stand:

AAMFT-CA: Support

The American Association for Marriage and Family Therapy, California Division was (with NASW-CA) one of the first associations to move from opposition to support. (Full disclosure: I’m the current Legislative and Advocacy Committee Chair for AAMFT-CA, and I’ve worked a great deal on this bill.)

NASW-CA: Support

The National Association of Social Workers, California Division was (with AAMFT-CA) one of the first associations to move from opposition to support.

CPA (Psychologists): Support

The The California Psychological Association had initially joined three other organizations (Psychiatrists, CAMFT, and CALPCC) in jointly oposing the bill. While all four organizations have since dropped their opposition, CPA appears to be the only one of the four to move to a position of support.

CALPCC: Neutral

The California Association of Licensed Professional Clinical Counselors has dropped its opposition, though the bill is not currently mentioned anywhere on the group’s web site.

CAMFT: Neutral

The California Association of Marriage and Family Therapists has dropped its opposition to the bill. The CAMFT web site includes a relatively soft caution to its members about the use of reparative therapy (referred to here as “sexual orientation change efforts”) but otherwise does not address the bill.

CPA (Psychiatrists): Neutral

The California Psychiatric Association has officially withdrawn its opposition to the bill, citing a 1998 statement of the American Psychiatric Association which reads in part, “The American Psychiatric Association opposes any psychiatric treatment, such as ‘reparative’ or ‘conversion’ therapy, which is based upon the assumption that homosexuality per se is a mental disorder.”

Whatever your stance on the bill, both sides are suggesting you contact Governor Brown’s office directly to let him know. The Governor’s office can be reached by phone at 916-445-2841, by email here, or on Twitter at @JerryBrownGov.

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Your comments are welcome. You may post them in the comments section below, via email to ben [at] bencaldwell [dot] com, or to my Twitter feed.

Therapists targeted by spam, scams

Therapists and counselors around the country have been targeted by scams via phone, email, and postal mail. Here are warnings on three of the most common recent ones.

The pre-payment scam. In a therapy-specific variation on an old scam, a therapist receives a call from someone looking to set up therapy for themselves or a family member, telling the therapist that the client is not yet in their city but will soon be arriving (usually for work or school). The caller asks to prepay for several sessions in advance, and mails a check. Within a few days, they call back to say the “client” has had an emergency change of plans, and the money needs to be refunded immediately. Only after the therapist has issued a refund do they discover the original check has bounced.

What to do: This scam could be stopped at several points in the process. 1) Don’t accept payment for services from someone you’ve never met in person. 2) If you do accept pre-payment, do not accept pre-payment for more than one session at a time (this at least limits your potential losses). 3) You may choose to not accept check payments at all; many therapists now accept fees via credit cards, which offer much better fraud protection. 4) If you do accept checks, your bank may allow for instant electronic check processing, so you’ll know right away if a check will not be covered by the issuing bank. 5) If you accept prepayment by mailed check — and again, it’s far better not to — have a clearly written refund policy that establishes your process and timeline for issuing refunds on services paid but not received. This may be part of your cancellation policy, which is related. 6) Never issue a refund before you have actually received the funds in your account.

The counselor scam. A privately-owned company called the American Psychotherapy Association (I will not link to their site because they don’t deserve the traffic, but you can Google it if you’re really interested) has been blanketing California with brochures promising MFTs that they can become “grandparented” into being a “Board Certified Professional Counselor.” The brochure appears to be carefully crafted to mislead MFTs into thinking that the certification might equate to LPC licensure (it does not and will not), without actually saying anything that is factually untrue. The organization does offer a Counselor Certification, and California MFTs can be “grandparented” into it. At least in the sense that the requirements for that designation will change if California eventually licenses professional clinical counselors, as it may soon do.

What to do: Look, I don’t know anything about the American Psychotherapy Association (not to be confused with the far better-known APA); they do have a few folks I highly respect on their board, they put on an annual conference, and they may well be a worthwhile organization. But this is a callous marketing effort designed more to take advantage of California MFTs’ lack of knowledge about how LPC licensure might work than anything else, and it greatly tarnishes their reputation in my eyes. If you receive their mailer, throw it away.

The “men’s movement” spam. On the CAMFT listserv, there have been several posts from therapists who received an email threatening to take action against them based on their name and contact information being listed on AllAboutCounseling.com, one of many sites that host therapy-related articles, blogs, and a therapist directory. (I’m naming them because they’re a victim here, though I would caution that this site was unknown to me before researching this post.) In the email that’s been going around, the attacker — who doesn’t deserve to be named or linked to — suggests that there are dangerous and false articles on the site, and that therapists should be fearful of associating themselves with it. Having reviewed what’s actually on the site, I can’t say it’s all that good, but it’s certainly no worse than what’s on a hundred other therapy- and counseling-oriented sites. What seems to have gotten this attacker’s anger up are the articles about women and women’s issues. He claims to be part of a “men’s movement,” but a men’s movement that uses threats to get its way does a massive disservice to the term “men’s movement” and to men in general.

What to do: This is a tough one. If you’re listed on the web site (and not that many are), you can ask to have your listing removed… but should you? That would seem to be giving in to the threat. On the other hand, if you leave your listing up, this guy could make good on his threat, spewing bile onto the internet and attempting to associate you with his attacks. Yes, his actions are wrong, threatening, juvenile bullying. But some therapists understandably want to be nowhere near anything that looks like controversy. Is it a battle you want to fight? That’s a judgment call.

Generally speaking, therapists can avoid scams like these by using common sense; if a prospective client sounds too good to be true, asks you to violate your own policies or standards, or raises other red flags for you, consult with colleagues, supervisors, and your professional associations. And if you’ve been the victim of any of these scams (or any others), the worst thing to do is stay silent out of embarrassment; that only allows these scams to continue. You serve the profession and the public well by alerting others to such risks.