Outlawing goals for therapy is a Pandora's Box

New Jersey Gov. Chris Christie

I was astonished to see that New Jersey governor Chris Christie actually signed into law a bill banning therapy to change minors' orientations away from homosexuality.  If he'd done nothing, the bill would have become law anyway. But he chose to step forward and sign.

I'm just surprised he did it. Not because he risked his Republican cred by jumping headlong onto the side of gay supporters--in what some think is preparation for a presidential bid.

I'm perplexed, but not even because Christie inserted the State in parents' decisions to work with their own children on a delicate issue in their own ways. The law now makes New Jersey an adversary against traditional, religious families whose biblically-based beliefs inform their childrearing decisions.

I'm flummoxed at his signing, but not because Gov. Christie sides with the American Psychiatric Association, which condemns conversion therapy by citing frightening and extreme tactics used, we're told, "in some cases." I don't know what goes on in sessions addressing minors' sexual preferences, so I won't comment on what is also called "reparative therapy." But I do wonder if it's appropriate to peg a child's sexual orientation before that child can legally comment or consent.

No, the thing that shocks me is the audacity of New Jersey to interfere in the content of any therapy. If conversion therapy does produce in some participants negative consequences, shouldn't state licensing boards and professional groups step in? And if crimes occurred, shouldn't courts decide the evidence in individual cases?

As a therapist, I've seen plenty of discomfort on the part of clients as they confront and work through difficult issues, so I'm astounded that a state can pick one client goal and rule it forbidden for everybody at all times. It seems bizarre that a government can start rooting around the confidential relationship of therapist and client should that client desire a particular outcome that affects only himself.

I can understand that every state seeks to protect its citizens from fraud. And many gay advocates hold that changing one's sexual orientation is fraudulent--that one cannot change, even if he sincerely desires it.

Chirlane McCray de Blasio, the wife of New York mayoral frontrunner Bill de Blasio, wrote an

Chirlane McCray with husband Bill de Blasio

article in Essence Magazine in 1979 proclaiming, "I am a Lesbian." She was "out, loud and proud," according to the magazine. Now, 34 years later, she's been happily married for 19 years to the candidate, with two teenaged children, living, as she described in a May Essence update, in a "traditional marriage."

When she "came out" at age 17, she told Essence, she hadn't really dated any men, but later was attracted to them. Asked if she is bisexual, the articulate McCray responded, "I am more than just a label. Why are people so driven to labeling where we fall on the sexual spectrum? Labels put people in boxes, and those boxes are shaped like coffins."

I agree with McCray that there's a wide spectrum of sexual attraction and response, and I respect that she changed her orientation and her own label of herself from "lesbian" to "conventionally married."  But the professional psychology associations are against voluntarily changing one's orientation. I wonder what they think of Ms. McCray?

Why would Gov. Christie sign a bill that outlaws therapy to assist clients who, like Ms. McCray, choose to move to another point along the sexual spectrum?

If New Jersey can ban one type of change efforts because they're "unlikely to be successful and have some risk for harm," disgruntled clients may bring the same standard to bear on just about every form of therapy. After all, even mainstream modalities often produce negative reactions, even under the most gentle and professional of circumstances. And when the likelihood of a client achieving a goal is slim, should therapists be banned from aiding someone who still wants to pursue it?

After I authored a bestselling book describing the harms of divorce, many readers sought me out with the goal of saving their marriages. Often, their spouses were emotionally long gone, sometimes enmeshed in other relationships or new pursuits, and a remaining spouse faced devastated children, a reduced standard of living and extreme hurt.

Sometimes such couples approached me together, even though the agenda for one partner was to repair the marriage while the other was there out of guilt or to placate a pleading mate. Should I have turned away these people in their emotional pain and life transition? After all, at that point marital therapy "is unlikely to be successful and contains some risk for harm." That's the basis for outlawing conversion therapy, according to the American Psychological Association; why not apply the same standard to poor-prognosis marriage counseling?

Obese people frequently receive psychological counseling (along with diets or other program components) with the goal of reducing their weight. The recidivism rate for people who lose weight is extremely high (90-95% regain, according to a 1997 study in the New England Journal of Medicine); failure to lose or maintain lost weight can lead to anxiety, depression and even life-threatening eating disorders. Oh wait, these results would qualify weight-reduction counseling for elimination by law.

The kinds of sticky issues that arise once a state chooses one type of psychological therapy to target just keep multiplying. We're talking about clients' most personal, intimate issues, in a context protected by confidentiality and by federal laws guarding privacy. Just imagine how the client and his therapist would feel knowing they may not stray into forbidden topics like certainty about one's sexual attractions. Imagine the intrusion and taxpayer funds necessary to investigate whether someone's desired outcomes for their sessions are lawful.

States aren't protecting anyone by censoring aims of voluntary patient-doctor efforts. One could reply that the anti-conversion therapy bill that Gov. Christie signed pertains only to therapy for those under 18--but then why not censor other potentially wrenching goals of youngsters' therapy? The dangerous issue here is the state's deciding the content of therapy it will approve or disallow.

Psychology is an idiosyncratic pursuit. The fit between therapist and client may shift, or it may never work. The course of therapy may be re-adjusted as progress is made or new issues arise. Professional psychiatric organizations change their definitions, and modalities go in and out of style. The reputation right now of reparative or conversion therapy is mud. I remember when electroconvulsive therapy was vilified in the films "Snake Pit,"  "One Flew Over the Cuckoo's Nest," "Francis" and many others, yet now it's receiving new respect as a treatment for severe depression. We don't need laws prohibiting out-of-favor methods any more than we need them promoting modalities currently in vogue.

Clients dissatisfied with their therapies should have redress, and every session should contain respect and understanding for participants' backgrounds and beliefs. With that in mind, licensing boards, professional organizations and in some cases the courts are available to ameliorate specific conflicts. Legislating the types of therapy that may or may not occur is just stepping too far into the interior worlds of people already suffering and reaching out for help.