How to win an argument with a reparative therapy supporter

Their arguments can be quickly and summarily dismantled.

Update: James Guay interviewed me on this piece, as part of his ongoing video series. Watch the video here, and see the original article below.

The United States Supreme Court will go to conference this Thursday, where it will decide whether to hear arguments on the reparative therapy ban in California (though the case they may take is about California’s ban, it would likely impact a similarly-worded ban in New Jersey). If they take the case, the arguments there will largely come down to first amendment claims of free speech and freedom of religious expression. (Update: The Supreme Court declined to hear the case, allowing California’s ban to take effect.) In households and classrooms debating the issues, the debate is partly a legal one, and partly a moral and philosophical one. And the arguments in favor of reparative therapy should lose.

(Quick background for those unfamiliar: Reparative therapy, also called “conversion therapy” in some literature and “Sexual Orientation Change Efforts” in law, aims to change the sexual orientation of the client. Its use has been discouraged by all of the major US mental health professional associations, though none specifically prohibit the practice. The most thorough and convincing discrediting of reparative therapy came in this report from the American Psychological Association. The bans in New Jersey and California, as well as a similar ban being considered in New York, apply only to reparative therapy for minors; adults would still be able to access the treatment.)

Listed below, in no particular order, are the six arguments I most commonly hear in opposition to the California and New Jersey laws. The first two parallel the arguments made in court up to this point, and the last four are broader arguments. Each one is followed by what seems to me to be a winning response. To be clear, though, I don’t mean any ill will to those who support reparative therapy; I know they’re simply trying to live out their beliefs. I think they’re wrong, not bad, and that’s a really important difference. You’ll change more hearts and minds through a substantive conversation than you will with anger or empty rhetoric.

Argument 1: It’s a matter of free speech for the therapist.

Response: Free speech isn’t absolute — it does not give you the right to recklessly endanger another person, by, say, telling a child there is candy in a highway median if they just can dodge the traffic to get there — and speech is particularly restricted for those who have the privilege of providing psychotherapy services to the public. When you make the choice to join this profession, you are also willingly choosing to give up some freedoms in exchange for professional standing. The easiest example is that we can’t break client confidentiality. Free speech or not, I can’t go out on to a busy street corner and announce who my clients are. And I shouldn’t be able to do that — if I could, it would quickly erode public trust in the profession. Similarly, we can’t just say anything we want to our clients, particularly as it relates to what might help them. As respected professionals, we don’t have the right to endorse debunked treatments known to carry high risk of harm. Doctors are disciplined if they choose to become snake-oil salesmen, and therapists should be too. It’s an abuse of the power and respect that comes with professional licensure.

Argument 2: It’s a matter of free choice for the client.

Response: While clients generally have the autonomy to choose the treatments and treatment providers they prefer, this too is not absolute. Government routinely restricts health care providers of all sorts from providing treatments deemed likely to cause harm. Clients often can still get those treatments, by visiting unlicensed practitioners or going outside of the state or country, or in this case, by going to clergy. The practice doesn’t go away. It just isn’t available from those licensed by the state to provide a trustworthy service. This was specifically noted in the Ninth Circuit ruling allowing the California ban.

Argument 3: If it’s so dangerous, why haven’t the professional associations banned it? The lack of a specific ban must mean they don’t think it should be entirely prohibited.

Response: Two ways you can go on this. The fact is, it’s arguable that they already have banned reparative therapy, just not by name; existing standards require therapists to practice in accordance with the best current knowledge available, and the American Psychological Association has clearly made the case that the practice is too dangerous to be worth attempting. Associations don’t ban practices like this by name because then those who practice it would just call it something else, setting up a cat-and-mouse game between ethical standards and dubious practitioners trying to stay just ahead of those standards. So instead, the ethical standards lay out the principles by which we are to decide which treatments to use and which to discard. At its 2012 Annual Conference, a member of the AAMFT Ethics Committee said that the AAMFT simply hadn’t had a test case yet that it could use to make a specific ruling on the acceptability of reparative therapy within the practice of family therapy.

Of course, that may be too nuanced of an argument. A quicker and more digestible option would be essentially, “The associations have all reviewed the research and clearly discouraged this kind of treatment, especially for minors. Simply put, the associations do not think it’s a legitimate practice. There’s no doubt about that. So those who continue to practice reparative therapy have already made it clear that they don’t care what their professional associations say. All the more reason a legal ban is needed.”

Argument 4: Reparative therapy may not work for everyone or even most people, but there are anecdotal accounts of it being very effective in some individual cases. Isn’t that enough that reparative therapy should be available as an option?

Response: It’s true that there are anecdotal accounts of the therapy working (often from those who now practice reparative therapy.) Still, this is perhaps my favorite argument when it comes up, because you can have such a conversation-ender at the ready that you can enjoy a little drop-the-mic moment. We get so precious few of those in life. Ready for it?

“Back when it was allowed, there were also accounts of clients who found sleeping with their therapist to be very helpful. That doesn’t make it okay for a therapist to sleep with their client, then, now, or ever.”

And there it is. Unless your counterpart also thinks that it should be legal for therapists to take advantage of their clients’ emotional vulnerability for a sexual conquest, they’ve lost that point. Even accepting that in some instances reparative therapy has been successful, that doesn’t make it worth the risk. Like sleeping with a client, frontal lobotomies, or any one of hundreds of other discarded health care practices, it’s known to cause significant long-term harm in many — certainly not all — cases. That risk is enough to justify a ban.

Argument 5: Reparative therapy may not work in most cases, and it may even harm some people, but lots of therapies may not work, and some therapy clients attempt suicide regardless of the therapeutic approach. The singling out of reparative therapy shows an animus toward religious viewpoints.

Response: Quite the opposite: By making reparative therapy the subject of license discipline, and not a criminal act, the bans exclude clergy, who would still be able to provide reparative therapy to anyone, including minors. As to the singling out of the approach, it is certainly true that lots of therapies have a small or questionable research base. But reparative therapy is unique in the frequency and severity of harm it causes, which is why state governments have taken up the issue as a way to protect children. There is a meaningful difference between being ineffective and being dangerous. If, say, Bowen therapy were suddenly shown to be driving a disproportionately large number of clients to suicidality, we would certainly and rightly be singling it out for a potential ban as well. The issue isn’t religion, it’s risk.

Argument 6: Even if I accept that reparative therapy isn’t ok, a government ban is nanny-state overreach. The professions and the free market can root out practices like this on their own, through clear ethical standards and the resulting malpractice lawsuits, until no one is willing to risk offering the treatment any more.

Response: I have some empathy for this argument. Government bans are imperfect solutions for many problems. But remember that these bans are about providing reparative therapy to minors. Government regularly steps in to protect children from danger precisely because they are more vulnerable than adults. Consider the bans on sales of alcohol and cigarettes to minors. We allow adults to take on the risks associated with drinking and smoking if they choose to, but we don’t allow children to be put in such danger. (If the person you’re arguing with thinks that cigarettes and alcohol should be sold to minors, give them points for at least being philosophically consistent. Most people would disagree with them.)

Ideally, professional self-governance would be best. One of the big concerns with SB1172 in California was that it was opening the door of government intrusion into what sorts of treatments mental health professionals provide, and we should be able to make those determinations on our own. But the fact is that state legislatures can and should get involved in various professions when professional self-governance fails to adequately protect the public. That’s clearly the case here, as the professions themselves have (at least so far) been unable to remove reparative therapists from their ranks. Government has a legitimate interest in protecting the public from professionals who would use their positions of power to recklessly endanger or exploit clients — that’s the whole reason why we have professional licenses that are government-issued.

A government ban is not a tool that should be used often. But it is appropriate in some instances, and this seems to be one of them.

I hope these are helpful to you in conversation around the water cooler, classroom, or dinner table. And if there are other arguments or good responses I’ve missed, please say so in the comments. Part of the difficulty with conversations like this is that they can get so heated on both sides, so regardless of which side you’re on, I would ask you to keep your cool, keep an open ear, and empathize as much as you can with the other person’s motives, even if you don’t agree with where those motives lead them.

I welcome your thoughts and experiences in these kinds of conversations. And please do consider that to be an open invitation to both sides of the argument; while I don’t especially want readers to re-argue the court case in the comments here, I would be curious to know what you have found most convincing as it relates to this issue, regardless of which side you’re on.

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Your comments are welcome. You can post them in the comments below, or email me at ben[at]bencaldwell[dot]com.