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.

On ethics and CAMFT’s record of published statements about AAMFT

In their own words.
All bold text is my emphasis added.


“Marriage and family therapists, when acting as teachers, supervisors, and researchers, stay abreast of changes in the field, maintain relevant standards of scholarship, and present accurate information.”
CAMFT Code of Ethics, principle 3.5


On AAMFT and AAMFT-CA’s legislative interest

CAMFT statement: “The opposition [to the LPC bill] in California from AAMFT and AAMFT-CA never surfaced until 2007 and their legislative interest was limited to this single effort – this single piece of legislation.”
– CAMFT Feature Article, The Therapist magazine, March/April 2008

Fact check 1: “Assembly bill 894, introduced last year, would create a professional counselor (LPC) license in the State of California. While AAMFT-CA has no objection to the licensure of mental health professions, we had major concerns with the content of this bill, and therefore took a position of opposition. […] I spoke to the legislature’s Joint Committee on Boards, Commissions, and Consumer Protection in November [2005] to let them know our position and the reasoning behind it.”
– AAMFT-CA newsletter, Legislative and Advocacy column, Spring 2006

Fact check 2:Among our accomplishments in 2007, we have worked with the BBS to improve license portability into California. […] We also helped to defeat the bill that would have created an LPC (licensed professional counselor) license in California […] We are not opposed in principle to counselor licensure […] We also have been very vocal with the BBS in helping shape the new educational requirements for MFT graduate programs, which are likely to be put into legislation next year.”
AAMFT-CA newsletter, Legislative and Advocacy column, Fall 2007

Fact check 3:In 2007 the AAMFT experienced many successes on important advocacy initiatives. In particular, the AAMFT is pleased to announce that we were successful in obtaining participation for MFTs in the U.S. Substance Abuse and Mental Health Service Administration (SAMHSA) Minority Fellowship Program. […] Also, for the first time, the US House of Representatives passed a bill including MFTs in Medicare.”
– Membership renewal message from the AAMFT Executive Director, 2008


On working collaboratively

CAMFT statement: “CAMFT has approached the [AAMFT-CA] division about legislative issues that CAMFT is sponsoring to involve them in joining our efforts — efforts to work together to further the interests of the profession. There has been no willingness or interest in working with CAMFT on these legislative matters.
– CAMFT Feature Article, The Therapist magazine, March/April 2008

Fact check: “With the resources I have available [through] AAMFT, I think that a joint and collaborative effort would be valuable. If you let me know when and where the meeting is taking place, I would like to make arrangements to join you.”
– Email regarding counselor legislation from AAMFT-CA Executive Director Olivia Loewy to CAMFT Executive Director Mary Riemersma, March 27, 2007


On AAMFT’s interest in federal legislative matters

CAMFT statement: “Historically, AAMFT, at the federal level, had no interest in legislative matters. It was actually Richard Leslie at CAMFT who pushed AAMFT, thereby turning the tide on their involvement in federal legislative matters to attempt to advance the MFT profession.”
– CAMFT Feature Article, The Therapist magazine, March/April 2008

Fact check 1: “The association not only incorporated as a trade organization in Washington, but also began a long association when it hired Steven L. Engelberg as legal counsel for Washington (federal) affairs in 1974. […] Failing to make progress in two months of negotiations with the Department of Defense [after CHAMPUS reimbursement for MFTs had been eliminated], the AAMFT sued the DoD for reinstatement on April 26 [1975].”
– William C. Nichols, The AAMFT: Fifty Years of Marital and Family Therapy, pp. 41, 63.

Fact check 2:CAMFT contracted with Richard S. Leslie, Attorney, in 1976.”
– CAMFT Executive Director Mary Riemersma, “The building of a profession”


On correcting false information, Part I

My correction request: “At the article’s conclusion, Ms. Riemersma writes, “No one gains by steadfastness, an unwillingness to negotiate, and casting barbs at the perceived opposition.” With this, I would agree wholeheartedly. Unfortunately, much of the Feature Article appears to be an attempt to cast barbs at AAMFT – an organization that, like CAMFT, has the best interests of the profession at heart. Even when the organizations disagree, it serves us best to present information that is clear and accurate.”
– My May 7, 2008 Letter to the Editor requesting CAMFT correct the provable factual errors detailed above

CAMFT response: “Your letter will not be printed in an upcoming issue of The Therapist due to the fact that members are troubled by the debate and do not benefit from it.”
CAMFT response to my request


On CAMFT informing the legislature (and its members) about a one-license future

CAMFT magazine: “I attended the AAMFT Long Beach Conference where their president Mike Bowers made a pronouncement at a conference forum of about 500 people that Mary Riemersma of CAMFT informed the California legislature that all therapists will hold the same license in the near future! I became alarmed. […] I knew Mary. This could not have been accurate. I called Mary and she quickly informed me of this misinformation.”
– Letter to the Editor, CAMFT’s The Therapist magazine, Jan/Feb 2011, p. 5

Fact check: “CAMFT states, “At some time in the future, we project that there will only be one masters level profession in California, with individuals specializing within that license. Thus, those who wish to specialize in systems work will do so; those who wish to specialize in art therapy will do so, etc. The current system with a variety of acronyms is confusing for consumers who just want to be helped and do not perceive greater value from one professional compared to the next.””
California Senate Committee Analysis of AB1486, July 2007
– Same text appears in a CAMFT email to members, May 24, 2007


On correcting false information, Part II

My request for correction: “Michael Bowers [is] AAMFT’s Executive Director, not its president […] It is true that Riemersma’s letter refers to “some time in the future,” and not the “near future” as the letter writer wrote – but this minor difference is an error on the part of the letter writer, not Bowers. Bowers quoted, in his speech and in his presentation slides, the exact text the legislative report quoted.”
– My Letter to the Editor again requesting CAMFT correct provable errors of fact

CAMFT response: “Your request to print the proposed correction was denied.”
– CAMFT response email


Marriage and family therapists treat and communicate with and about colleagues in a respectful manner and with courtesy, fairness, and good faith, and cooperate with colleagues in order to promote the welfare and best interests of patients.”
CAMFT Code of Ethics, principle 5

Call for Change group offers non-rebuttal rebuttal

MFT Call for Change group responds to my previous post, where I highlighted several of their erroneous statements about California.                                                                                                                                                                                     

The group calling themselves “MFTs Call for Change” (CFC) has posted a lengthy rebuttal to my earlier post criticizing CFC misstatements about California, specifically in areas related to the LPCC license and its development here.

Notably, they rarely, if ever, challenge my statements of fact. They claim that my post included “misinformation,” but their arguments are more often of the moving-the-target (“yes, but”) variety than they are factual disagreement. And they add at least one to the list of factual errors of their own.

  • CFC criticizes my statement that “When CAMFT was negotiating changes to various versions of the LPCC bill, they sought to make MFTs and LPCCs as indistinguishable as possible.” They would prefer I label this as my own belief, or an opinion of AAMFT-CA. But there’s no need. I saw, firsthand, CAMFT’s opposition to language supporting distinctiveness of professions during the negotiation process. Remember, CAMFT wanted grandparenting to be automatic for licensed MFTs based just on coursework (this version of the bill allowed exactly that), and indeed, CAMFT has continued to argue there are no meaningful differences in practice between the MFT and LPCC professions (as CAMFT themselves said, they believe “LMFTs and LCSWs may do in practice everything LPCCs may do“) — which would make the licenses effectively indistinguishable. That’s not my belief, that’s an argument CAMFT itself is continuing to make and act upon.
  • Along similar lines, CFC calls my discussion of CAMFT’s lawsuit against the BBS “patently irresponsible” because… well, I can’t tell why, exactly. I’m not even sure which part they’re taking issue with. CAMFT sued the BBS to try to make the “gap exam” for MFT grandparenting go away, based on their belief that the practices of the professions are indistinguishable. They have very clearly said so. That the lawsuit attempted to use technical means (like the BBS’s failure to consult with a state agency on exams, the one point of three in the lawsuit on which CAMFT won) to reach their desired ends (no gap exam) does not change those desired ends or the publicly-stated rationale behind them.
  • AAMFT-CA and AAMFT have not been “against the LPCC bill since its inception,” as CFC newly and falsely claims. Primary sources here tell the tale. California counselor legislation was first introduced in February 2005. In November 2005, nine months later, I first spoke to a legislative committee about AAMFT-CA’s concerns with bill language. Even then, AAMFT-CA took no formal position, as we understood the bill would be further amended. AAMFT-CA only formally opposed LPCC legislation in 2007 (this legislative committee analysis is the first mention of AAMFT-CA opposition), after it became clear that the legislation was moving in a direction that would hurt the MFT profession. Furthermore, in 2009, once we worked out the compromise language that became the LPCC law, AAMFT-CA’s opposition was removed [page 2], helping the bill pass. The larger AAMFT never took any formal position at all on the bill.
  • In discussing Kim Madsen, the BBS Executive Director, the CFC rebuttal suggests that in my post, “The reader has been lead [sic] to believe Ms. Madsen would be less than forthcoming” when discussing licensure issues. Nonsense. Ms. Madsen has been, in my experience, extremely professional, highly ethical, and very forthcoming, even when we have disagreed on policy. In my earlier post, what I suggested was that CFC, not Ms. Madsen, was being less than forthcoming by leaving out important details. This should have been evident in my preface “I suspect what Ms. Madsen said was…” Given my experiences with each of them, I trust her to be complete and forthcoming much more than I presently trust CFC to do so.

As I said previously, the CFC group seems to be well-meaning. I just don’t understand their dogged pursuit of this line of criticism. It is not supported by facts, and makes CFC look more interested in finding fault with AAMFT than actually supporting or developing the profession.

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If I did make any errors of fact — there or here — I would like to correct them. Email me at ben[at], post a comment, or call for a change to my Twitter feed.

Call for Change group erroneously calls California licensure threat “unsubstantiated rumor”

A group of well-meaning MFTs has been trying to make AAMFT more transparent and accountable. But their latest report about the LPCC license in California, which claims to have found deception by AAMFT, gets the important facts wrong.

Nuvola apps error* See updates below.

If you’re a member of AAMFT or have been connected in any way with the “Call for Change,” you may have received an email with an unsettling headline:

Unsubstantiated Rumor Influences AAMFT’s Strategic Plan

The email goes on to say that this “unsubstantiated rumor” was the notion that there was a threat to MFT licensure in California connected to the development of the state’s Professional Clinical Counselor (LPCC) license. You can read the CFC’s complete report online: CA LPC Deception Revealed.

Because the threat posed by LPCC licensure was all “unsubstantiated rumor,” the CFC logic goes, perhaps someone at AAMFT knowingly ginned it up for political reasons:

What could be the motives behind generating such rumors, fear, and speculation within our membership in relation to a document and process as significant as a long range Strategic Plan? Since the truth of this matter was already known by AAMFT leadership, could the reason be political?

For anyone unfamiliar, the CFC group is made up largely of well-meaning MFTs who want a more open, accountable professional association. That’s a laudable goal, and they have pushed AAMFT into making some much-needed changes, especially around organizational transparency. There is surely more work to be done on that front, and for that reason, a subgroup like CFC can sometimes ultimately be a positive thing for the larger association they criticize.

In this case, though, CFC gets the important facts wrong, and loses a great deal of its own credibility in the process. It starts by reporting that Kim Madsen, the California Board of Behavioral Sciences Executive Director, told them “there had been no current or past discussions regarding replacing the LMFT license in California with the LPC license” (I’m quoting the CFC’s paraphrase of Ms. Madsen). I of course was not in on this phone call, but I suspect what Ms. Madsen said was that no such discussion took place at the BBS. And, with that kind-of-important detail, that’s true — the BBS never had a public meeting or vote where replacing the MFT license was discussed or voted on.

For the CFC to extrapolate that to the notion that no one in California ever discussed eliminating the MFT license, however, is a rather significant error. CAMFT (which is not affiliated with AAMFT or its California Division) specifically discussed replacing the MFT license. You can see it in page 14 of this California legislative committee report, and the same text was in an email to members that CAMFT sent in May 2007 (emphasis mine):

CAMFT states, “At some time in the future, we project that there will only be one masters level profession in California, with individuals specializing within that license. Thus, those who wish to specialize in systems work will do so; those who wish to specialize in art therapy will do so, etc. The current system with a variety of acronyms is confusing for consumers who just want to be helped and do not perceive greater value from one professional compared to the next.”

When CAMFT was negotiating changes to various versions of the LPCC bill, they sought to make MFTs and LPCCs as indistinguishable as possible. And without distinctiveness between professions, it becomes much harder to argue that distinct licensure should be maintained. Sure enough, the following language was inserted into a version of the 2008 LPCC bill (which ultimately failed; again, emphasis mine):

The Department of Consumer Affairs and the Board of Behavioral Sciences shall collaboratively evaluate the licensing requirements and scope of practice for licensed professional
counselors, licensed clinical social workers, licensed educational psychologists, and marriage and family therapists. The evaluation shall include a recommendation on whether or not these licensed professions should become a general license category, and if such a recommendation is made, how it is proposed to occur.

CAMFT projected a one-license future, and that proposal found its way into proposed legislation. These are facts on the public record. They are indisputable. That legislation may have become law had AAMFT-CA and the California Psychological Association not worked diligently in opposition. For CFC to dismiss the threat to California MFT licensure as “unsubstantiated rumor” is clearly and demonstrably incorrect.

CFC goes on to question how CAMFT could possibly have any influence over license transitions, since it is the BBS and not any professional association that enforces licensure standards. This is shockingly naive. CAMFT does a tremendous amount of work (often very good and beneficial) on state legislation, and the licensure standards the BBS exists to enforce are written in state law; the BBS has no right or authority to refuse to enforce a law once it takes effect. Almost every major piece of state legislation that has impacted California MFTs in a generation has had CAMFT’s fingerprints on it. If CAMFT wanted MFTs to become LPCs, they wouldn’t politely ask the BBS to make it happen. They would seek to change the law, and they have the resources to do so. As you can see above, a change in the law is precisely what could have happened.

Even after the final version of the LPCC law passed in California, CAMFT has continued to work hard at making MFTs and LPCCs seem indistinguishable. When even the relatively minor barrier of a “gap exam” for MFTs seeking grandparenting into LPCC licensure arose, CAMFT not only fought it, they sued the BBS — a suit that could have, among other things, led to a court ruling that the professions are not distinct.

Thankfully, CAMFT largely lost that suit. There will be a gap exam, and the BBS is supporting distinctiveness between MFTs and LPCCs in other ways. But for CFC to suggest that there never was a threat to the MFT license in California — or indeed, to even suggest that threat has fully abated now — is simply out of line with reality.


Full disclosure: I have served as a consultant to AAMFT in the past (not currently), and still volunteer regularly for the California Division, though I hold no official role there. I was part of the AAMFT-CA negotiating team on California LPCC legislation. I’m a former CAMFT member; their lawsuit against the BBS led me out the door.


Updated 3-16-2011: The Call for Change folks have posted a rebuttal to my post here. See: CFC rebuttal // My response

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