Psychiatric medications, for all their problems, must be proven safe and effective through clinical trials before they win government approval. So, why aren’t talk therapies that are targeted at the same vulnerable population required to meet any minimum standards before being used?
Lack of regulation has led to the widespread misuse of harmful techniques as treatment, such as boot camps for teens with behavioral problems, drug rehabs that treat patients through confrontation and humiliation, forced psychodrama in which patients’ sexual abuse is re-enacted, and even the punitive use of electric shock therapy on children with autism.
Most recently, “gay conversion” therapy has bubbled up in the news again — a “cure” that typically uses shame, emotional attacks and invasive questioning about past abuse to try to turn gay, lesbian, bisexual or transgendered teens into heterosexuals. Similar techniques like some “pray away the gay” approaches are even more brutal, using public sexual humiliation as part of group therapy. There is no evidence that these strategies change sexual orientation — but there’s lots of data suggesting that they do significant psychological damage.
That’s why California Governor Jerry Brown signed a bill on Sept. 29 banning conversion therapy in his state, which is a big step in the right direction. Religious groups have sued California — the first state to make the therapy illegal — claiming that the law treads on their right to free speech.
But, my question is, does the right to express religious beliefs also include the right to label such beliefs as “therapy” or the right to use taxpayer money or insurance reimbursement to pay for ineffective and harmful “care”? If something is to be called “therapy,” shouldn’t it first have to be proven to be therapeutic?
Indeed, if conversion therapy — along with all the other previously mentioned dangerous psychological “cures” — were drugs, they would have long ago been pulled from the market because of the associated deaths, injuries and psychological damage. Since they are behavioral tactics, however, they go completely unregulated.
People with no credentials whatsoever are currently permitted in many states to introduce virtually any type of treatment regime they choose and sell it as “therapy” to children or adults with mental illness. None of the treatments are required to be proven effective — let alone safe. There is no Food and Drug Administration or any similar federal agency to protect these patients.
History shows that disasters have resulted. In the 1970s, brutal “encounter groups” were introduced, using confrontation, verbal abuse and humiliation to attack and “treat” patients. Almost immediately a study of the therapy in normal, healthy college students found that it could produce psychological damage lasting at least six months in nearly 1 in 10 people. Yet some drug rehabs, wilderness programs, teen boot camps and “emotional growth” boarding schools still use the technique on youth.
The ’70s also saw the launch of California’s Center for Feeling Therapy, an abusive, cult-like psychotherapy group in which therapists had sex with clients and forced them to stand naked in front of a clothed group, who savagely critiqued what they saw — as therapy. Beatings were also frequently administered, which was known as “sluggo” therapy, believe it or not.
The 1980s gave us “recovered memory” therapy, which devastated thousands of patients, who spent countless hours in sessions aimed at uncovering forgotten memories of sexual abuse. While sexual abuse for many children is an all-too-real experience, recovered memory therapies created false memories that left patients worse off after treatment than they’d been before. It often shattered families who either had to side with the “victim” and shun (or worse, prosecute) the “perpetrator,” or isolate and humiliate the accuser by refusing to believe. This treatment not only harmed innocent people, but also set back the cause of child abuse prevention by generating bizarre accounts of Satanic rituals and other implausible incidents, making it harder for true victims to be believed.
Previous decades also saw the rise of “rebirthing” therapy, which involved wrapping children in blankets and making them struggle to get free — a treatment that ended in the suffocation death of at least one child.
These bizarre therapies aren’t just a relic of the past. In 2009, I helped expose wrongdoing at an Oregon school for troubled teens, where girls who had survived rape or other sexual assaults were made to re-enact sexualized situations — including performing lap dances for male students — in an absurd attempt to force healing through recreation of trauma. Needless to say, this is not effective and can be quite harmful.
And so when psychologist Christopher Ferguson argued on TIME.com this week that banning certain therapies might do more harm than good, I was astounded. Ultimately, his reasoning was that banning dangerous therapies could simply drive them underground where they wouldn’t be subject to state regulation.
But, practically speaking, very few people would sign themselves — or their children — up for illegal, underground care. What parent would knowingly send their child to an illegal center to receive therapy that has been banned? Probably just as many as would resort to drugs that had been pulled off the market by the FDA for being dangerous. If parents engaged in such behavior, they could and should be charged with child abuse. Certainly, fear related to illegal behavior, particularly one that could result in custody loss, would deter many.
Ferguson also noted that popular anti-drug programs like DARE and teen boot camps have been shown to be ineffective (in fact, some studies show that they backfire), yet are still allowed to exist. He asks: “If we are going to start down the road of banning therapies, should we not ban these all? … Why do we ban gay conversion therapy but leave DARE programs intact?”
But DARE is a red herring. It’s a prevention program that never claimed to be therapeutic. It’s not targeted at children with addictions or other psychological problems and it consists entirely of short lectures by police officers, who do not pretend to be therapists. Yes, it should be dropped because it is a waste of time and money, and it should be replaced with evidence-based prevention programs, but it is unfair to compare “gay conversion” therapy to DARE.
Boot camps and other residential tough love programs that do target troubled teens are another story, however. These are essentially unregulated private jails for kids, whose services are sold to parents as “treatment” for mental health problems like addiction, Asperger’s syndrome and depression. Worse, because some states legally permit schools to use corporal punishment on children and some of these programs call themselves schools, children in these lockups end up with fewer rights than do convicted criminals. That is a recipe for catastrophe — and dozens of documented deaths and likely thousands of cases of post-traumatic stress disorder have resulted.
Should such programs be banned if they are proven to be both ineffective and harmful? Of course. If someone claims to be able to treat a medical condition like addiction with harmful quackery, he or she should be treated the same as any purveyor of bogus drugs. If people claim to be able to “cure” normal variants of human sexuality with tactics shown to be harmful, they should not be permitted to call themselves “therapists.”
I recognize that it’s difficult to regulate what goes on in a private residential center or to monitor what happens in every outpatient therapy session. I also acknowledge that it’s legally impossible — and rightly so — to regulate religious speech. But it’s not so hard to say simply that some tactics cannot be labeled or sold as therapy — particularly when they result in the type of lasting psychological harm caused by boot camps, punitive use of electric shock and “gay conversion” attempts.
If we require the pharmaceutical industry to prove its products safe and effective before they can be sold, why not require the same of behavioral therapies? It makes no sense that I can be legally permitted to force teens to re-enact episodes of sexual abuse and call it “therapy,” whereas if I made teens do lap dances in any other context, I’d be arrested as a pedophile.
The word therapy should not be allowed to be used as a shield for practices that would be called abuse in any other setting. If parents want to use their religion to shame and assault their gay children, they shouldn’t be permitted to do so under the auspices of the health care system — any more than they should be permitted reimbursement or medical support for using faith-healing to treat cancer.