Box Turtle Bulletin

Informed Consent

As reported more than two weeks ago, the APA released this statement directed at NARTH and Focus on the Family:

“For over three decades the consensus of the mental health community has been that homosexuality is not an illness and therefore not in need of a cure. The APA’s concern about the positions espoused by NARTH and so-called conversation therapy is that they are not supported by the science. There is simply no sufficiently scientifically sound evidence that sexual orientation can be changed. Our further concern is that the positions espoused by NARTH and Focus on the Family create an environment in which prejudice and discrimination can flourish.”

This apparently sparked some controversy at the APA meeting in New Orleans. On first glance, many took it to be a repudiation of conversion therapy — which would mean a change in the APA’s official policy statement. But a closer reading gives what I believe to be a more accurate understanding, that the APA is concerned about how NARTH and Focus on the Family (which sponsors Exodus) uses conversion therapy — and misrepresented science — to nonscientific (political) ends. At least that’s how I read it. Yes, it calls into question conversion therapy’s efficacy, but the APA does not prohibit it. In my opinion at least, it’s the only way to read this statement without throwing away the APA’s official policy on conversion therapy altogether, which a statement like this does not have the capacity to do.

Neither NARTH nor Focus on the Family responded to the APA statement directly. Instead, they claimed a sort of victory by reporting on a Town Hall Meeting between the APA leaders and members. According to NARTH’s rendition of events, APA President Gerald Koocher said this about conversion therapy:

Highlighting the importance of client autonomy and self-determination, Dr. Koocher stated, “APA has no conflict with psychologists who help those distressed by unwanted homosexual attraction.”

He emphasized that —

1. The choice to enter therapy to diminish homosexual attractions and to strengthen heterosexual potential must be respected.

2. The choice to enter therapy must be voluntary and not coerced in any way.

3. Treatment options must be discussed by the therapist.

4. Treatment goals must be mutually agreed upon.

5. The “iterative process” must be a part of therapy. That is, client choice regarding treatment goals must be reiterated throughout the treatment process.

Focus on the Family issued a statement claiming credit for Dr. Koochers’s “endorsement” of conversion therapy, calling it a “policy change”:

Koocher’s response was simple: “APA has no conflict with psychologists who help those distressed by unwanted homosexual attraction.”

Alan Chambers, president of Exodus International, a network of ministries for those struggling with unwanted same-sex attraction, said it was an unexpected turn of events.

“Given the APA’s track record of the last two years,” Chambers told CitizenLink, “it is very unusual that the president would come out and state our case for us, that people have a right to self-determination — to determine their own path for their mental-health status.”

Chambers said he believes a protest organized by ex-gays and their therapists outside the convention hall had an impact.

Let’s stop here a moment and review what happened. First, Exodus organized a protest by “ex-gays” at the APA convention in New Orleans. The APA responded by issuing a statement denouncing the particular practices of NARTH and Exodus (via Focus on the Family). NARTH and Focus in the Family respond by describing a meeting where Dr. Koocher appears to “endorse” conversion therapy, and Focus goes so far as to claim this “policy change” as a victory brought on by their protest.

First, let’s be clear of one thing. There was no policy change. The APA does not prohibit conversion therapy. Go ahead and read the APA’s policy statement.

But read the whole thing. I’ll wait.

Notice that the APA insists that homosexuality is not a disease, and that all members must refrain from disseminating false information about homosexuality, about gays and lesbians themselves, and about treatment options and success rates. Therapists are required to ensure that the client understands the likelihood of change, what change may mean or may not mean, and the possible negative consequences of pursuing therapy to try to change sexual orientation. This is essential if “informed consent” is to be achieved according to the APA’s policy statement:

THEREFORE BE IT RESOLVED that “psychologists do not make false or deceptive statements concerning … the scientific or clinical basis for … their services,” (American Psychological Association, 1992); and

THEREFORE BE IT RESOLVED that “psychologists attempt to identify situations in which particular interventions … may not be applicable … because of factors such as … sexual orientation” (American Psychological Association, 1992); and

THEREFORE BE IT RESOLVED that “psychologists obtain appropriate informed consent to therapy or related procedures” [which] “generally implies that the [client or patient] (1) has the capacity to consent, (2) has been informed of significant information concerning the procedure, (3) has freely and without undue influence expressed consent, and (4) consent has been appropriately documented”

Maybe due to the free-wheeling nature of the discussion, the issues surrounding informed consent didn’t come up at the town hall meeting. Or maybe they did and NARTH and Exodus neglected to mention them. But Warren Throckmorton posted this follow-up statement from the APA’s Public Affairs office to clarify the importance of informed consent:

One: The therapist has an obligation to carefully explore how patients arrive at the choices they want to make. Therapists must determine whether patients understand that their motives may arise purely from the social pressures of a homophobic environment. No type or amount of individual therapy will modify societal prejudices.

Two, informed consent: Patients must understand the potential consequences of any treatment, including those intended to modify sexual orientation. Patients must understand that such treatments lack a validated scientific foundation and may prove psychologically harmful.

Finally, I would add that our patients ought to know from the very start that we as their therapists do not consider homosexuality a mental disorder. In fact, the data show that gay and lesbian people do not differ from heterosexuals in their psychological health. By that I mean that they have no greater instance of mental disorders than do heterosexuals.

This is critical, because NARTH and Exodus both are flagrant violators of many components of the APA’s policy on sexual orientation conversion therapy, especially in those areas concerned with ensuring that informed consent is truly “informed.” And for that, they deserve to be singled out for criticism.