The Conversion Therapy Debate: Why It Matters
In the last week what’s known as conversion therapy has become a political flashpoint. The President now says he supports a ban on it. U.S. Rep Jackie Speier (D-CA) is calling on more states to ban it and a federal appeals court rejected a new challenge to New Jersey’s second-in-the-nation ban. Mathew Staver of Liberty Counsel represents the family behind the challenge and is appealing the case to the Supreme Court.
It’s why I asked Dr. Mark Yarhouse, professor of psychology at Regent University and founder of the Institute for the Study of Sexual Identity, to participate in a Newsroom Talk Q&A. Yarhouse regularly consults with faith organizations around difficult issues involving sexual minorities.
Heather Sells: Dr. Yarhouse, how might the President’s decision to support a ban on so-called “conversion therapy” affect the counseling world?
Dr. Mark Yarhouse: I don’t know that many psychologists or counselors practice reorientation therapy today, so it’s hard to say how much of an impact it will have. It seems to be largely symbolic and in keeping with broader cultural support for LGBT persons. It is unusual, however, to see a president weigh in on the complexities of clinical issues that may arise for a person.
HS: What is conversion therapy and how widely is it practiced?
MY: Conversion therapy is generally thought of as any approach to therapy that has as its goal to change sexual orientation from homosexual to heterosexual. I think in these legislative efforts, however, there is also a desire to ban any work with gender dysphoric children that would help that child form a gender identity in keeping with his or her biological or birth sex.
HS: Should LGBT advocates be concerned that counselors sometimes force minors to undergo therapy around sexual identity issues?
MY: I think the fear that some LGBT persons have and that I would have is if counselors or psychologists provide therapy to minors against their will. I don’t know how often that happens, at least if you look at what is reported to regulatory bodies of the mental health professions. Ethical mental health professionals would have to obtain the assent from a minor for any services provided. Assent refers to when a minor understands and agrees to participate in counseling to reach certain goals, while legal consent is obtained from a parent or guardian. If a minor does not wish to be in counseling, the ethical mental health professional would discontinue services or revisit goals so that they are in keeping with what a minor wishes to work toward.
I think the other concern that LGBT persons have and that I have as well is that if a person receives therapeutic services for sexual identity concerns, that person should have sufficient information about the potential benefits and risks of being in therapy, as well as likely outcomes. In other words, when a person gives assent (or an adult gives consent), they should have sufficient information to make an informed decision about those services. Where I don’t think there is consensus is what information constitutes informed consent when addressing sexual identity concerns. That would probably be a more helpful direction to go rather than legislative efforts to make it illegal to provide specific services.
HS: A number of states have passed or are considering legislation to ban conversion therapy for minors. You’re particularly concerned about how that would affect youth struggling with what sex they are. How might it impact them?
MY: The struggle with gender identity is very different from questions about sexual identity. The latter has to do with sexual attraction and orientation. In contrast, Gender Dysphoria refers to distress associated with incongruence between one’s biological or birth sex and one’s gender identity. For example, a biological male who states he is a woman trapped in the body of a man. When this is experienced in childhood, there are generally three approaches a family considers. The first is to help the child identify with his or her biological sex; the second is to wait to see how the child’s gender identity develops and whether the dysphoria resolves on its own (which is referred to as ‘watchful waiting’); the third is to facilitate cross-gender identification, which might including the use of hormone blockers to delay puberty until a few years later when the child who is now a teenager can make a more informed decision. This kind of legislation seems to reduce those options to only watchful waiting or facilitating cross-gender identification. That seems to be ahead of the research and may go against the wishes of some parents. Of course, these options would also have to be weighed against any risk of harm to a child.
HS: What kind of help is available for teens struggling with a conflict between same-sex attraction and a faith that considers homosexuality a sin?
MY: When a person experiences a conflict between his or her same-sex attractions and religious faith, I think most mental health professionals today would draw on what have been referred to as “third way” models of care that are neither gay affirmative nor conversion therapies. These approaches are sensitive to a person’s personal or religious convictions. The clinician would help that person make decisions about identity and behavior that are in keeping with his or her beliefs and values and focus, too, on expanding social support and health coping activities.