Why 'conversion therapy' is not coercive

So-called “conversion therapy” is a boogeyman that antagonists of the Christian faith paint as a widespread, aggressive, predatory practice, as if we’re snatching hapless victims off the street and forcing them into our offices for us to torture and exploit. 

If you’ve read my firsttwo parts in this series on “conversion therapy” myths, there’s an irony present in the coercion myth — the assertion that counseling (or ministry) for unwanted same-sex attraction is always coercive and discriminatory. In reality, the direct effect of the global efforts to outlaw any counseling to help troubled people explore this area of their lives is that people are forced to receive only LGBT-affirming therapy. The discrimination is actually against the people seeking help.

What’s the truth? Some clients, especially minors, might be coerced into therapy or ministry for sexuality. But let’s use some perspective. In general, adolescents in counseling are there most often at the behest of their parents. This is true of counseling for any issue — not just for same-sex attraction or gender confusion. The therapists are not the ones doing the coercing. 

Nevertheless, using the possibility of coercion as an argument for banning a specific type of therapeutic goal has some problems. Because of the common practice of parents requiring therapy against a child’s preferences, it calls into question the rights of parents to have their children attend counseling for any issue. Then, it essentially amounts to the state overruling the parents’ own authority in raising their children according to their worldview and values and declaring that the state ought to be the parent. Next, it causes a chilling effect for counselors who start off using a neutral, exploratory approach to sexuality, or who were not even aware of it as a clinical concern until later in treatment. But as it becomes more relevant to the client’s case, the therapists avoid discussing it at all for fear of being falsely accused of coercing the client into “conversion therapy.” Finally, it neglects or dismisses the less common — but very real — possibility of minors who sincerely desire help dealing with these unwanted sexual inclinations.  

Yes, there are therapists who have practiced unethically. They may have played into or reinforced the coercion of the client’s family members. They may themselves demand a client to understand sexuality according to their own worldview. They might oversimplify the causes of same-sex sexuality or oversell the likelihood of change in attractions, arousal, desires, behaviors, and self-concepts.

Yes, all of that may be true. And yet, these therapeutic approaches should not be banned in general. For the basic ethical principle of respecting client autonomy, a principle that all of the major mental health organizations claim to uphold. Good therapy promotes freedom.

If the previously mentioned unethical practices do occur, the proper response is to enforce the ethics that have guided our profession for decades already — not to outlaw clients’ right to obtain counseling in line with their values. Make the therapy better — safer and more effective; don’t just get rid of it. But with all of that said, the fact is that the problematic “conversion therapist” is not representative of my colleagues doing SAFE-T (sexual attraction fluidity exploration in therapy).

The Alliance for Therapeutic Choice and Scientific Integrity (formerly the National Association for the Research and Therapy of Homosexuality), the premier professional organization for SAFE-T, provides this answer to the question “Does the Alliance respect client rights and diversity?”:

The Alliance respects each client's dignity, autonomy, and free agency. We believe that clients have the right to claim a gay identity, or to diminish their homosexuality and to develop their heterosexual potential. The right to seek therapy to support a gay identity as well as to change one's sexual adaptation should be considered self-evident and inalienable. We call on our fellow mental health associations to stop falsely claiming to have "scientific knowledge" that settles the issue of homosexuality. Instead, our mental health associations must leave room for diverse understandings of the family, of core human identity, and the meaning and purpose of human sexuality. "Tolerance and diversity" means nothing if it is extended to activists and not traditionalists on the homosexual issue. Tolerance must also be extended to those people who take the principled, scientifically supportable view that homosexuality works against our human nature.

In 2010, NARTH published their “Practice Guidelines for the Treatment of Unwanted Same-Sex Attractions and Behavior.” Guidelines include statements such as “Clinicians are encouraged to recognize the complexity and limitations in understanding the etiology of same-sex attractions,” “Clinicians are encouraged to respect the value of clients’ religious faith and refrain from making disparaging assumptions about their motivations for pursuing change-oriented interventions,” and “Clinicians strive to respect the dignity and self-determination of all their clients, including those who seek to change unwanted same-sex attractions and behavior.” 

In practical terms, what does an ethical therapist do in this field? For one, the client sets the goals — not the therapist. I use this illustration with my clients: “Consider me the cab driver and you’re the passenger. Tell me where you want to go and I’ll figure out the best route to get us there.” I adequately inform clients of the modality I use, explaining the interventions and their evidence-based outcomes. 

I’m also testing my clients’ resolve and the rationale for their goals. In general, when people set out to make a life change, they have internal ambivalence about making the change. Therefore, I don’t assume by virtue of the client being in my office that the person is all in. Even if the client is coming enthusiastically, I will slow them down to check their motivations. Are they intrinsically motivated or trying to please people in their lives? Are they prepared for the possibility of not reaching the degree of change they’d like? Are they motivated by shame or to grow and heal?

I disagree with the idea from my graduate school training that therapists can be value-neutral.  Whether we want to admit it or not, our worldview impacts how we counsel — from the questions we ask to the treatments we plan. Take a non-sexuality situation as an example: suicidality. Our imperative to prevent clients from killing themselves is a value judgment.

The ethical therapist minimally discloses his or her values and worldview as it pertains to the client’s case; they don’t impose those values. This empowers the client to make an informed decision about consenting to counseling and it avoids covertly influencing the client toward the therapist’s worldview. Of course, if the client is highly ambivalent about sexuality, it’s best to take an exploratory approach and share only very judiciously. But once the client settles on a goal, therapy is most effective when the therapist genuinely supports the client’s goals.

In contrast, gay-affirmative therapy does not merely disclose values, but it decidedly imposes the therapist’s values upon the client. Gay-affirmative therapist Kathleen Mooney says “In normal therapy, we take a neutral stance and therapist’s values and standards should not affect how we treat clients. But with sexual orientation, we must make an exception and affirm the same-sex attraction in order to combat the bigotry in the world, even if the client does not yet embrace a gay identity” (Scott, 2005). This is typical protocol for gay-affirmative therapy. I’ve had numerous clients recount to me how previous therapists started off attempting to be neutral and exploratory as the client wrestled with his attractions, only to eventually confront the client with what the therapist presumed was a reality check: “You need to accept that you’re gay!” If any form of therapy deserves to be called innately coercive, it’s this!

So, how do gay-affirmative therapy activists justify violating ethical principles? Because of the harm myth, which we’ll discuss next time.

Reference

Scott, Ronald (Dir.).  (2005).  Psychotherapy with Gay, Lesbian, and Bisexual Clients: Program 1 – Historical Perspectives.