BILL ANALYSIS                                                                                                                                                                                                    



                                                                      



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                                 THIRD READING


          Bill No:  SB 1172
          Author:   Lieu (D), et al.
          Amended:  5/25/12
          Vote:     21

           
           SENATE BUSINESS, PROF. & ECON. DEV. COMM.  :  5-3, 4/23/12
          AYES:  Price, Corbett, Correa, Hernandez, Vargas
          NOES:  Emmerson, Strickland, Wyland
          NO VOTE RECORDED:  Negrete McLeod

           SENATE JUDICIARY COMMITTEE  :  3-2, 5/8/12
          AYES:  Evans, Corbett, Leno
          NOES:  Harman, Blakeslee


           SUBJECT  :    Healing arts:  sexual orientation change 
          efforts

            SOURCE :     Equality California
                       Mental Health America of Northern California
                       National Center for Lesbian Rights


           DIGEST  :    This bill prohibits a mental health provider 
          from engaging in sexual orientation change efforts with a 
          patient under 18 years of age, regardless of the 
          willingness of a patient, patient's parent, guardian, 
          conservator, or other person to authorize such efforts.

           Senate Floor Amendments  of 5/25/12 removes language 
          specifying the ability for a patient to bring a cause of 
          action against a psychotherapist, removes the requirement 
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          for a psychotherapist to obtain informed consent from an 
          adult patient, specifies that the bill does not intend to 
          limit minor's access to psychotherapeutic techniques other 
          than sexual orientation change efforts, and makes other 
          technical and clarifying changes.

           ANALYSIS  :    

          Existing law:

          1. Provides for licensing and regulation of various 
             professions in the healing arts, who utilize 
             psychotherapeutic techniques, including physicians and 
             surgeons with a psychiatric specialty, licensed clinical 
             psychologists, licensed marriage and family therapists 
             (LMFTs), licensed clinical social workers (LCSWs) and 
             licensed professional clinical counselors (LPCCs).  
             (Business and Professions Code (BPC) Section 2099, 
             Section 2928, Section 2940, Section 4980.40.5, and 
             Section 4996.2)

          2. Defines psychotherapy, as practiced by licensed clinical 
             psychologists, as the use of psychological methods in a 
             professional relationship to assist a person or persons 
             to acquire greater human effectiveness or to modify 
             feelings, conditions, attitudes and behavior which are 
             emotionally, intellectually or socially ineffectual or 
             maladjustive.  (BPC Section 2903)

          3. Defines psychotherapy, as practiced by LCSWs, as the 
             psychosocial methods within a professional relationship 
             to assist the person or person to achieve a better 
             psychosocial adaptation to acquire greater human 
             realization of psychosocial potential and adaptation, to 
             modify internal and external conditions which affect 
             individuals, groups or communities in respect to 
             behavior, emotions and thinking, in respect to their 
             intrapersonal and interpersonal processes.  (BPC 4996.9)

          4. Defines counseling interventions and psychotherapeutic 
             techniques as the application of cognitive affective, 
             verbal or nonverbal, systemic or holistic counseling 
             strategies that include principles of development, 
             wellness and maladjustment that reflect a pluralistic 

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             society.  
          (BPC Section 4999.20 (b))

          5. Indicates that these interventions and techniques should 
             be specifically implemented in the context of a 
             professional clinical counseling relationship and use a 
             variety of counseling theories and approaches.  (BPC 
             Section 4999.20 (b))

          6. Permits MFTs to use applied psychotherapeutic techniques 
             to enable individuals to mature and grow within marriage 
             and the family.  (BPC Section 4980.2)

          7. Permits LPCCs to apply counseling interventions and 
             psychotherapeutic techniques to identify and remediate 
             cognitive, mental and emotional issues including 
             personal growth, adjustment to disability, crisis 
             intervention and psychosocial and environmental 
             problems.  (BPC Section 4999.20 (b))

          This bill:

          1. Defines "mental health provider" as a physician and 
             surgeon specializing in the practice of psychiatry, a 
             psychologist, a psychological assistant, a licensed 
             marriage and family therapist, a registered marriage and 
             family therapist, intern, or trainee, an educational 
             psychologist, a licensed clinical social worker, an 
             associate clinical social worker, a licensed 
             professional clinical counselor, or a registered 
             clinical counselor, intern, or trainee.

          2. Defines "sexual orientation change efforts" as practices 
             by mental health providers that seek to change 
             orientation or reduce or eliminate sexual or romantic 
             attractions, feelings, or behaviors because those 
             attractions, feelings, or behaviors are directed toward 
             persons of a particular sex or both sexes. 

          3. Specifies "sexual orientation change efforts" does not 
             include psychotherapies that aim to provide acceptance, 
             support, and understanding of clients or the 
             facilitation of clients' coping, social support, and 
             identity exploration and development, without seeking to 

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             change orientation or reduce or eliminate sexual or 
             romantic attractions, feelings, or behaviors because 
             those attractions, feelings, or behaviors are directed 
             toward persons of a particular sex or both sexes.

          4. Specifies that under no circumstances shall a mental 
             health provider engaged in sexual orientation change 
             efforts with a patient under 18 years of age, regardless 
             of the willingness of a patient, patient's parent, 
             guardian, conservator, or other person to authorize such 
             efforts.

          5. Provides findings and declarations of the Legislature 
             including that being lesbian, gay or bisexual is not a 
             disease, and that sexual orientation change efforts can 
             pose critical health risks, as described. 

          6. Provides statements of psychological, psychiatric, 
             medical, and other associations' regarding their 
             disproval of therapy aimed at changing sexual 
             orientation or therapy based on the assumption that 
             homosexuality is a mental disorder. 

          7. States that California has a compelling interest in 
             protecting the lives and health of lesbian, gay, and 
             bisexual people.

           Comments  

          According to the author's office, the intent of this bill 
          is to limit deceptive therapies that are harmful to minors 
          by mental health providers.  This bill seeks to provide 
          awareness of the alternatives to and the potential harmful 
          effects of sexual orientation change therapies while also 
          protecting children from these treatments.  The author 
          states "?this so-called reparative therapy, conversion 
          therapy or reorientation therapy is scientifically 
          ineffective and has resulted in much harm."  This bill 
          seeks to provide protections for lesbian, gay, bisexual, 
          and transgender youth by preventing these types of 
          therapies that are potentially dangerous as well as making 
          adults aware of the potential harms associated with sexual 
          orientation change therapies. 


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           Background  

           History of Homosexuality and the American Psychiatric 
          Association (APA)  .   A number of research studies on 
          homosexuality conducted in the 1940s and 1950s, combined 
          with protests during the civil rights movement of the 1960s 
          and 1970s led to the reformation of how homosexuality was 
          classified by mental health and medical associations such 
          as the APA and the APA removed homosexuality from its 
          official Diagnostic and Statistical Manual of Mental 
          Disorders (DSM) in 1973.  

          Prior to the civil rights movement, the medical view of 
          homosexuality was that it was a mental disorder and 
          disease.  There were a series of resulting encounters 
          between activists and psychiatrists at the annual meetings 
          of the APA between 1970 and 1972 where gay activists 
          challenged the APA.  As a result, the diagnosis of 
          homosexuality was deleted from the DSM-II.  

          The APA did not initially embrace this change.  In 
          recognition of those who opposed deleting the 
          classification, the APA made a compromise.  The DSM-II 
          diagnosis of Sexual Orientation Disturbance replaced 
          homosexuality.  Accordingly, individuals comfortable with 
          their homosexuality were no longer classified as having a 
          mental disorder.  Instead, only those who were "in conflict 
          with" their sexual orientation were classified as having a 
          mental disorder.  However, this change engendered continued 
          controversy.  Those opposing the diagnosis argued that 
          there were no reported cases of unhappy heterosexual 
          individuals seeking treatment to become homosexual.  This 
          problem was addressed in the 1980s DSM-III where Sexual 
          Orientation Disturbance was replaced by ego-dystonic 
          homosexuality (EDH).

          In the mid-1980s during the revision of the DSM-III, the 
          diagnosis of EDH also engendered controversy.  Those on the 
          APA Advisory Committee working on the revision who desired 
          to retain the EDH diagnosis argued that they believed the 
          diagnosis was clinically useful and that is was necessary 
          for research and statistical purposes.  The opponents noted 
          that making a patient's subjective experience of their own 
          homosexuality the determining factor of their illness was 

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          not consistent with the new evidence-based approach that 
          psychiatry had embraced.  They argued that empirical data 
          did not support the diagnosis and that it was inappropriate 
          to label culturally induced homophobia as a mental 
          disorder.  The APA Committee agreed with the opponents and 
          the diagnosis of EDH was removed from DSM-III-R in 1987. 
          
           History of Homosexuality and the World Health Organization 
          (WHO)  .  In 1992, WHO removed the diagnosis of homosexuality 
          as a mental disorder from the International Classification 
          of Disorders-10 (ICD-10).  Similar to the DSM, the ICD-10 
          is a classification system for medical and mental disorders 
          used internationally.  WHO replaced homosexuality with the 
          diagnosis of ego-dystonic sexual orientation which falls 
          under the category of "Psychological and behavioural 
          disorders associated with sexual development and 
          orientation".  The ICD-10 ego-dystonic sexual orientation 
          diagnosis is defined as "The gender identity or sexual 
          preference (heterosexual, homosexual, bisexual, or 
          pre-pubertal) is not in doubt, but the individual wishes it 
          were different because of associated psychological and 
          behavioural disorders, and may seek treatment in order to 
          change it."   

          WHO also notes:  "Sexual orientation by itself is not to be 
          regarded as a disorder? it is often a result of unfavorable 
          and intolerant attitudes of the society or a conflict 
          between sexual urges and religious belief systems."
            
           Sexual Orientation Change Therapy  .  Sexual Orientation 
          Change Therapy, sometimes called reparative therapy, 
          conversion therapy, or reorientation therapy, is an attempt 
          to change the sexual orientation of a person from 
          homosexual or bisexual to heterosexual.  According to the 
          APA conversion therapy is a type of psychiatric treatment 
          "based upon the assumption that homosexuality is a mental 
          disorder or based upon the a priori assumption that a 
          patient should change his/her homosexual orientation."  

          Joseph Nicolosi, one of the founders of modern reparative 
          therapy, promotes psychoanalytic theories suggesting that 
          homosexuality is a form of arrested psychosexual 
          development, resulting from "an incomplete bond and 
          resultant identification with the same-sex parent, which is 

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          then symbolically repaired in psychotherapy."  Nicolosi's 
          intervention plans involve conditioning a man to a 
          traditional masculine gender role via participation in 
          sports activities, avoidance of the other sex unless for 
          romantic contact, avoiding contact with homosexuals, 
          increasing time spent with heterosexuals, engaging in group 
          therapy, marrying a person of the opposite sex and 
          fathering children.

          Others, particularly conservative Christian 
          transformational ministries, use the term conversion 
          therapy to refer to the utilization of prayer, religious 
          conversion, individual and group counseling to change a 
          person's sexual orientation.

          The federal Ninth Circuit Court of Appeals addressed the 
          issue of sexual orientation therapy in the context of an 
          asylum application.  The court held that a Russian citizen 
          who was subjected to sexual orientation change treatments 
          that included sedative drugs and hypnosis "constituted 
          mental and physical torture."  (Pitcherskaia v. INS 118 
          F.3d 641 (9th Cir. 1997))

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  No   
          Local:  No

           SUPPORT  :   (Verified  5/29/12)

          Equality California (co-source)
          Mental Health America of Northern California (co-source)
          National Center for Lesbian Rights (co-source)
          American Association for Marriage and Family Therapy, 
          California Division
          California Communities United Institute
          COIL Foundation
          Lesbian and Gay Psychotherapy Association of Southern 
          California
          National Association of Social Workers, California Chapter

           OPPOSITION  :    (Verified  5/29/12)

          Board of Behavioral Sciences
          California Association for Licensed Professional Clinical 
          Counselors 

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          California Association of Marriage and Family Therapists 
          California Catholic Conference, Inc.
          California Psychiatric Association 
          California Psychological Association 
          Liberty Counsel Action
          NARTH (National Association for Research & Therapy of 
          Homosexuality)
          Pacific Justice Institute

           ARGUMENTS IN SUPPORT  :    In support of this bill, Equality 
          California writes, "Sexual orientation change efforts pose 
          critical health risks to lesbian, gay, and bisexual people, 
          including depression, shame, decreased self-esteem, social 
          withdrawal, substance abuse, risky behavior and 
          suicidality.  Recognizing that there is no evidence that 
          any type of psychotherapy can change a person's sexual 
          orientation, and that sexual orientation change efforts may 
          cause serious and lasting harms, the American Psychiatric 
          Association, the American Psychological Association, the 
          American Counseling Association, the National Association 
          of Social Workers, and the American Academy of Pediatrics 
          uniformly oppose efforts to change the sexual orientation 
          of any individual."

           ARGUMENTS IN OPPOSITION  :    The California Psychological 
          Association (CPA), in their opposition to this bill, states 
          that the professional guilds have researched the efficacy 
          and purpose of sexual orientation change therapy and have 
          passed resolutions based on that data and research.  They 
          go on to state, "Each profession has a national 
          organization with a prescribed Code of Ethics, as well as 
          state organizations and licensing boards to which they 
          report and weigh in on professional and ethical conduct.  
          The statutory ban on types of therapy is not the right 
          venue and there is very little precedent in state law to 
          make an outright ban on a specific type of therapy."  
          The CPA believes that this bill micromanages the work of 
          individual therapists.   
           

          JJA:mw  5/29/12   Senate Floor Analyses 

                         SUPPORT/OPPOSITION:  SEE ABOVE


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