Amicus Brief 7-3

Case: 19-10604 Date Filed: 07/03/2019 Page: 1 of 40
No. 19-10604
IN THE UNITED STATES COURT OF APPEALS

FOR THE ELEVENTH CIRCUIT
ROBERT W. OTTO, PH.D. LMFT, individually and on behalf of his patients, and
JULIE H. HAMILTON, PH.D. LMFT, individually and on behalf of her patients,
Plaintiffs-Appellants,
v.
CITY OF BOCA RATON, FLORIDA, and

COUNTY OF PALM BEACH, FLORIDA,
Defendants-Appellees.
On Appeal from the United States District Court for the

Southern District of Florida (Dist. Ct. Case No. 9:18-cv-80771)
BRIEF OF AMERICAN PSYCHOLOGICAL ASSOCIATION,

FLORIDA PSYCHOLOGICAL ASSOCIATION, NATIONAL ASSOCIATION
OF SOCIAL WORKERS, NATIONAL ASSOCIATION OF SOCIAL
WORKERS FLORIDA CHAPTER, AND AMERICAN ASSOCIATION
FOR MARRIAGE AND FAMILY THERAPY AS AMICI CURIAE IN
SUPPORT OF DEFENDANTS-APPELLEES AND AFFIRMANCE
Jessica Ring Amunson

Nathalie F.P. Gilfoyle Counsel of Record
Deanne M. Ottaviano Emily L. Chapuis
AMERICAN PSYCHOLOGICAL James T. Dawson
ASSOCIATION JENNER & BLOCK LLP
750 First Street NE 1099 New York Avenue NW
Washington, DC 20002 Washington, DC 20001
(202) 336-6100 (202) 639-6000
[email protected]
Counsel for American
Psychological Association Counsel for All Amici Curiae
Additional Counsel Listed on Inside Cover

Anne B. Camper
NATIONAL ASSOCIATION OF
SOCIAL WORKERS
750 First Street NE, Suite 800
Washington, DC 20001
(202) 336-8799
Counsel for National Association

of Social Workers and National
Association of Social Workers
Florida Chapter
Otto v. City of Boca Raton, Florida

Case No. 19-10604
CERTIFICATE OF INTERESTED PERSONS

AND CORPORATE DISCLOSURE STATEMENT
Pursuant to Circuit Rule 26.1-1 and Federal Rule of Appellate Procedure
29(a)(4)(A), amici curiae hereby certify that the following individuals and entities
are known to have an interest in the outcome of this case:
Abbott, Daniel L.
Alliance for Therapeutic Choice
American Association for Marriage and Family Therapy
American Psychological Association
Berger, Mary Lou
Carlton Fields Jorden Burt, P.A.
City of Boca Raton, Florida
Cole, Jamie A.
Dreier, Douglas C.
Dunlap, Aaron C.
Equality Florida Institute, Inc.,
Fahey, Rachel Marie
Flanigan, Anne R.
C-1

Case No. 19-10604
Florida Psychological Association
Gannam, Roger K.
Gibson, Dunn & Crutcher LLP
Guedes, Edward G.
Hamilton, Julie H., Ph.D. LMFT
Hoch, Rand
Hvizd, Helene C.
Kay, Eric S.
Kerner, Dave
Jenner & Block LLP
Liberty Counsel, Inc.
Mack, Bernard
Mayotte, Monica
McKinlay, Melissa
Mihet, Horatio G.
National Association of Social Workers
National Association of Social Workers Florida Chapter
O’Rourke, Andrea Levine
C-2

Case No. 19-10604
Otto, Robert W., Ph.D. LMFT
Palm Beach County, Florida
Palm Beach County Human Rights Council
Phan, Kim
Price, Max Richard
Reinhart, Hon. Bruce E.
Rodgers, Jeremy
Rosenberg, Hon. Robin L.
SDG Counseling, LLC
Singer, Scott
Staver, Mathew D.
Sutton, Stacey K.
The Trevor Project
Thompson, Andy
Valeche, Hal R.
Walbolt, Sylvia H.
Weinroth, Robert S.
Weiss, Greg K.
C-3

Case No. 19-10604
Weiss Serota Helfman Cole & Bierman, P.L.
Yasko, Jennifer A.
Pursuant to Federal Rule of Appellate Procedure 26.1 and Eleventh Circuit
Rules 26.1-1 through 26.1-3, each proposed amicus curiae hereby certifies that it
has no parent corporation and that no publicly held corporation owns 10% or more
of its stock.
/s/ Jessica Ring Amunson

JENNER & BLOCK LLP
1099 New York Ave. NW
(202) 639-6000
[email protected]
Counsel for All Amici Curiae
C-4
TABLE OF CONTENTS
CERTIFICATE OF INTERESTED PERSONS AND CORPORATE
DISCLOSURE STATEMENT ........................................................................ C-1
TABLE OF CITATIONS ......................................................................................... ii
STATEMENT OF THE ISSUE................................................................................ 1
INTERESTS OF AMICI CURIAE ............................................................................ 1

SUMMARY OF THE ARGUMENT ....................................................................... 5
ARGUMENT AND CITATIONS OF AUTHORITY ............................................. 7
I. History of “Conversion Therapy” and Amici’s Position on SOCE................ 9

II. There Is Insufficient Evidence to Support the Efficacy of SOCE................ 12
III. SOCE Poses Significant Risks to Patients and Especially to Minors. ......... 15
A. Some Individuals Report Harm from SOCE...................................... 15

B. Minors Are Particularly Vulnerable to Harm From SOCE................ 20
C. Licensed Mental Health Providers Have a Duty to Avoid Harm
to the Member of the Public Whom They are Licensed to
Serve. .................................................................................................. 21
IV. Appellants Misrepresent Various Aspects of the Task Force Report. ......... 22
CONCLUSION....................................................................................................... 27
i
TABLE OF CITATIONS *
CASES
Pickup v. Brown, 740 F.3d 1208 (9th Cir. 2014).................................................... 12
OTHER AUTHORITIES
American Association for Marriage and Family Therapy, Position on Couples
and Families (2005)............................................................................................. 4
American Association for Marriage and Family Therapy, Position on
Reparative/Conversion Therapy (2009) .............................................................. 4
American Association for Marriage and Family Therapy, Statement on
Nonpathologizing Sexual Orientation (2004)...................................................... 4
American Cancer Society, What Are the Phases of Clinical Trials? (Feb. 7,
2017), https://www.cancer.org/treatment/treatments-and-side-effects/clin
ical-trials/what-you-need-to-know/phases-of-clinical-trials.html ..................... 26
American Psychological Ass’n, Ethical Principles of Psychologists and Code
of Conduct (Jan. 1, 2017), https://www.apa.org/ethics/code............................. 21
*American Psychological Ass’n, Report of the American Psychological

Association Task Force on Appropriate Therapeutic Responses to Sexual
Orientation (2009) ...................................................................................... passim
APA Handbook of Sexuality and Psychology (Deborah L. Tolman & Lisa M.
Diamond eds., 2014).......................................................................................... 13
John Bancroft, Aversion Therapy of Homosexuality: A Pilot Study of 10
Cases, 115 Brit. J. Psychiatry 1417 (1969) ....................................................... 16
A. L Beckstead & Susan L. Morrow, Mormon Clients’ Experiences of

Conversion Therapy: The Need for a New Treatment Approach, 32
Counseling Psychologist 651 (2004) ................................................................. 17
Lee Birk et al., Avoidance Conditioning for Homosexuality, 25 Archives Gen.

Psychiatry 314 (1971)........................................................................................ 13
*
Authorities upon which we chiefly rely are marked with an asterisk.
ii
Kate Bradshaw et al., Sexual Orientation Change Efforts Through

Psychotherapy for LGBQ Individuals Affiliated with the Church of Jesus
Christ of Latter-day Saints, 41 J. Sex & Marital Therapy 391 (2015)........ 14, 19
Gerald C. Davison, Homosexuality: The Ethical Challenge, 44 J. Consulting

& Clinical Psych. 157 (1976) ............................................................................ 23
John P. Dehlin et al., Sexual Orientation Change Efforts Among Current or

Former LDS Church Members, J. Counseling Psych. (Online) (Mar.
2014) .................................................................................................................. 14
Basil James, Case of Homosexuality Treated by Aversion Therapy, 1 Brit.
Med. J. 768 (1962)............................................................................................. 17
Gregory M. Herek, Evaluating Interventions to Alter Sexual Orientation:

Methodological and Ethical Considerations, 32 Archives Sexual Behav.
438 (2003).......................................................................................................... 23
Steven H. Herman & Michael Prewett, An Experimental Analysis of Feedback
to Increase Sexual Arousal in a Case of Homo- and Heterosexual
Impotence: A Preliminary Report, 5 J. Behav. Therapy & Experimental
Psychiatry 271 (1974)........................................................................................ 17
Institute of Medicine, Finding What Works in Health Care: Standards for

Systematic Reviews (2011)................................................................................... 7
Stanton L. Jones & Mark A. Yarhouse, A Longitudinal Study of Attempted

Religiously Mediated Sexual Orientation Change, 37 J. Sex & Marital
Therapy 404 (2011) ..................................................................................... 14, 19
Scott O. Lillenfeld, Psychological Treatments that Cause Harm, 2 Persp. on

Psych. Sci. 53 (2007) ......................................................................................... 23
Elaine M. Maccio, Self-Reported Sexual Orientation and Identity Before and
After Sexual Reorientation Therapy, 15 J. Gay & Lesbian Mental Health
242 (2011).......................................................................................................... 14
Neil McConaghy, Is A Homosexual Orientation Irreversible?, 129 Brit. J.

Psychiatry 556 (1976)........................................................................................ 13
Neil McConaghy & R.F. Barr, Classical, Avoidance, and Backward

Conditioning Treatment of Homosexuality, 122 Brit. J. Psychiatry 151
(1973)................................................................................................................. 23
iii
National Association of Social Workers, Social Work Speaks, Adolescent and

Young Adult Health (NASW Policy Statement) (10th ed. 2015) ........................ 4
National Association of Social Workers, Social Work Speaks, Lesbian, Gay,

and Bisexual Issues (10th ed. 2015) .................................................................... 4
Joseph Nicolosi et al., Retrospective Self-Reports of Changes in Homosexual

Orientation: A Consumer Survey of Conversion Therapy Clients, 86
Psych. Rep. 1071 (2000).................................................................................... 17
John C. Norcross & Clara E. Hill, Empirically Supported Therapy

Relationships, 57 Clinical Psychologist 19 (2004)............................................ 20
Tiffany O’Shaughnessy & Zachary Speir, The State of LGBQ Affirmative

Therapy Clinical Research: A Mixed-Methods Systematic Synthesis, 5
Psych. Sexual Orientation & Gender Diversity 82 (2018) ................................ 12
J.T. Quinn et al., An Attempt to Shape Human Penile Responses, 8 Behav.
Res. & Therapy 213 (1970) ............................................................................... 17
Report of the Office of the United Nations High Commissioner for Human
Rights, Discrimination and Violence Against Individuals Based on Their
Sexual Orientation and Gender Identity (May 4, 2015),
http://www.ohchr.org/EN/HRBodies/HRC/RegularSessions/Session29/D
ocuments/A_HRC_29_23_en.doc ..................................................................... 19
Caitlin Ryan et al., Parent-Initiated Sexual Orientation Change Efforts with
LGBT Adolescents: Implications for Young Adult Mental Health and
Adjustment, J. on Homosexuality (Online) at 1 (Nov. 7, 2018) ........................ 19
Paul L. Santero et al., Effects of Therapy on Religious Men Who Have

Unwanted Same-Sex Attraction, Linacre Q., July 2018, 1 ................................ 14
Kim W. Schaeffer et al., Religiously Motivated Sexual Orientation Change,
19 J. Psych. & Christianity 61 (2000)................................................................ 17
Michael Schroder & Ariel Shidlo, Ethical Issues in Sexual Orientation

Conversion Therapies: An Empirical Study of Consumers, 131 J. Gay &
Lesbian Psychotherapy 131 (2001) ................................................................... 17
Ariel Shidlo & Michael Schroder, Changing Sexual Orientation: A

Consumer’s Report, 33 Prof. Psych.: Res. & Prac. 249 (2002) ........................ 17
iv
Ariel Shidlo & John C. Gonsiorek, Psychotherapy with Clients Who Have
Been Through Sexual Orientation Change Interventions or Request to
Change Their Sexual Orientation, in Handbook of Sexual Orientation and
Gender Diversity in Counseling and Psychotherapy 291 (Kurt A. DeBord
et al., eds., 2017) ........................................................................................... 21-22
Glenn Smith et al., Treatments of Homosexuality in Britain Since 1950—An

Oral History: The Experiences of Patients, 328 Brit. Med. J. 427 (2004)........ 17
Society for Prevention Research, Standards of Evidence: Criteria for

Efficacy, Effectiveness, and Dissemination (2005) ............................... 14, 25, 26
Substance Abuse & Mental Health Services Administration, Ending

Conversion Therapy: Supporting and Affirming LGBTQ Youth, (Oct.
2015), https://store.samhsa.gov/system/files/sma15-4928.pdf.................... 19, 20
Barry A. Tanner, Avoidance Training With and Without Booster Sessions to
Modify Homosexual Behavior in Males, 6 Behav. Therapy 649 (1975) ........... 13
v
STATEMENT OF THE ISSUE
The question for this Court’s consideration is whether the district court’s
Order denying a preliminary injunction to Appellants should be affirmed.
INTERESTS OF AMICI CURIAE 1
Amici submit this brief to provide the Court with context regarding the state
of scientific knowledge about the efficacy and safety of sexual orientation change
efforts (“SOCE”).
The American Psychological Association (“APA”) is a scientific and
educational organization dedicated to increasing and disseminating psychological
knowledge; it is the world’s largest professional association of psychologists, with
over 120,000 members. Among the APA’s major purposes are to increase and
disseminate knowledge regarding human behavior, and to foster the application of
psychological learning to important human concerns.
From 2007 to 2009, the APA Task Force on Appropriate Therapeutic
Responses to Sexual Orientation (the “Task Force”) conducted a systematic review
1
No party’s counsel authored this brief in whole or in part. No party or party’s
counsel contributed money that was intended to fund preparing or submitting this
brief, and no person—other than amici, their members, or their counsel—contributed
money that was intended to fund preparing or submitting this brief. See Fed. R. App.
P. 29(a)(4)(E). Although Appellees consented to the filing of this brief, Appellants’
counsel would not consent to the filing of this brief unless they were permitted to
review the brief before it was filed. This brief is therefore accompanied by a motion
for leave to file. See Fed. R. App. P. 29(a)(2)-(3); 11th Cir. R. 29-1.
1
of the peer-reviewed studies on SOCE, which culminated in a comprehensive Report
(the “Report,” 1 Appx. Tab 85-5)2 on the state of the scientific literature. As
discussed in detail below, the Report “concluded that efforts to change sexual
orientation are unlikely to be successful and involve some risk of harm, contrary to
the claims of SOCE practitioners and advocates.” Id. at v. The APA later voted to
adopt a Resolution on Appropriate Affirmative Responses to Sexual Orientation
Distress and Change Efforts (the “Resolution,” id. at 119-24), which reflects the
findings of the Report. The Resolution states that “there is insufficient evidence to
support the use of psychological interventions to change sexual orientation” and that
“elected officials” should “seek areas of collaboration that may promote the well-
being of sexual minorities.” Id. at 121-22.
The APA’s Report or Resolution were discussed in the challenged ordinances
at issue in this appeal (2 Appx. Tab 121-1 (Palm Beach); 8 Appx. Tab 126-27 (Boca
Raton)); Appellants’ Complaint (1 Appx. Tab 1 at 10-12 ¶¶ 38-54); Appellants’
motion for a preliminary injunction (1 Appx. Tab 8 at 11-12); the preliminary
injunction hearing (10 Appx. Tab 129 at 11-13, 48, 57-60, 64-71, 125-30); the Order
denying the preliminary injunction (11 Appx. Tab 141 at 21 n.8, 34-35, 37 n.12, 38,
2
“Appx.” refers to Appellants’ appendix, and the preceding numeral refers to the
applicable volume of that appendix. “AOB” refers to Appellants’ opening brief,
“PBAB” refers to Palm Beach County’s answering brief, and “BRAB” refers to the
City of Boca Raton’s answering brief.
2
41); and in the parties’ merits briefs in this Court (AOB 12-13, 15-25, 47-48, 54-55,
57; PBAB 5-6, 11-12; BRAB 5-6). In light of the attention the parties have devoted
to the Report and Resolution, and in light of Appellants’ mischaracterizations of
several of the Task Force’s key findings, the APA has a distinct interest in this case.
In addition to the APA, several other national organizations of professionals
focused on mental health or children’s health also join this brief.
The Florida Psychological Association is the sole professional association for
psychologists in the state of Florida. The mission of the association includes
promoting health and human welfare, increasing psychological knowledge, and the
application of research findings to the promotion of health and public welfare.
The National Association of Social Workers (“NASW”) is the largest
association of professional social workers in the United States, with nearly 120,000
members and 55 chapters throughout the United States and its territories (including
the Florida chapter, which has 4,300 members). As part of its mission to improve
the quality and effectiveness of social work practice, NASW promulgates
professional standards and the NASW Code of Ethics, conducts research, provides
continuing education, and advocates for sound public policies (including by filing
amicus briefs in appropriate cases, such as this). NASW and its members are
particularly committed to improving the lives of children, the most vulnerable
members of the family unit. NASW policies support adolescent health programs
3
that “respect confidentiality and self-determination needs of adolescents and are
provided in a culturally appropriate manner” and that “offer specialized training to
staff on working with vulnerable populations, including LGBT teenagers.” Nat’l
Ass’n of Social Workers, Social Work Speaks, Adolescent and Young Adult Health
3, 6 (NASW Policy Statement) (10th ed. 2015). As a matter of national policy,
NASW “encourages the development of supportive practice environments for
[lesbian, gay, and bisexual] clients” and has taken a public stance “against reparative
therapies and treatments designed to change sexual orientation” and “practitioners
or programs that claim to do so.” Nat’l Ass’n of Social Workers, Social Work
Speaks, Lesbian, Gay, and Bisexual Issues 198, 203 (10th ed. 2015).
The American Association for Marriage and Family Therapy (“AAMFT”),
founded in 1942, is a national professional association representing the field of
marriage and family therapy and the professional interests of over 62,000 marriage
and family therapists in the United States. It joins this brief for the reasons expressed
in its 2004 Statement on Nonpathologizing Sexual Orientation and related
statements.3
3
Am. Ass’n for Marriage and Family Therapy, Statement on Nonpathologizing
Sexual Orientation (2004); see also Am. Ass’n for Marriage and Family Therapy,
Position on Reparative/Conversion Therapy (2009); Am. Ass’n for Marriage and
Family Therapy, Position on Couples and Families (2005).
4
SUMMARY OF THE ARGUMENT
The APA’s findings in the Report and Resolution—and the state of the
scientific evidence regarding the efficacy and safety of SOCE more broadly—are at
the center of this case. At all stages of this dispute—from the passage of the relevant
ordinances to the preliminary injunction order now on appeal—the parties have
expressed divergent views about the effectiveness and risks of SOCE for minors.
Amici respectfully submit this brief in order to clarify and describe the scientific
evidence surrounding this type of therapeutic approach.
As discussed in detail below, SOCE developed in the middle of the nineteenth
century as a mode of ridding patients of homosexual desires, which were then
viewed as a mental illness. By the 1970s, however, the APA and other professional
organizations had reached the conclusion that homosexuality was not a pathology.
Mainstream mental health professionals began to view SOCE as unethical and
potentially harmful, and studies on SOCE became less common. By the 1980s,
however, some mental health providers within religious communities began to claim
that SOCE was safe and effective for people whose religious beliefs were perceived
as being in conflict with their sexual orientation. This development led several
mainstream mental health organizations to adopt resolutions against SOCE.
Before adopting its Resolution, the APA Task Force conducted a
comprehensive multi-year survey of the scientific literature on SOCE. The Report
5
reached two key conclusions. First, it found that SOCE is unlikely to be effective.
At the time of the Report—and continuing through the present—there is a scientific
consensus that SOCE is unlikely to reduce same-sex attractions. With respect to
minors specifically, there is no scientific evidence that any form of childhood
therapy can alter adult sexual orientation. Second, the Report concluded that SOCE
poses a risk of harm to patients. Multiple scientific studies suggest that SOCE may
lead to depression, suicidal ideation, anxiety, substance abuse, impotence and sexual
dysfunction, nightmares, gastric distress, dehydration, social isolation, deterioration
of relationships with friends and family, and an increase in high-risk sexual
behaviors, as well as a number of indirect harms such as loss of time and money. In
the absence of data showing that SOCE is safe for children and adolescents, the
potential for psychological risks of SOCE for minors are especially concerning.
In their challenge to the Appellees’ bans on SOCE for minors, Appellants
repeatedly misstate or mischaracterize the Report’s key findings. For example,
Appellants attempt to discredit the Report by (1) noting the lack of published
research on SOCE; (2) suggesting that the Report does not indicate evidence of
harm; and (3) claiming that the Report improperly dismisses evidence of SOCE’s
purported benefits. Each of these claims is inconsistent with the Report itself, and
with the available scientific evidence regarding SOCE.
6
Contrary to Appellants’ suggestion (and consistent with the best available
evidence), the APA recommends “provid[ing] multiculturally competent and client-
centered therapies to children, adolescents, and their families rather than SOCE.”
1 Appx. Tab 85-5 at 80 (emphasis added). Amici urge this Court to reject Appellants’
mischaracterizations of the scientific evidence and to affirm the decision below.
ARGUMENT AND CITATIONS OF AUTHORITY
This brief primarily reports the conclusions of a systematic review 4 of peer-
reviewed empirical research on the efficacy of SOCE completed and published by
the APA in 2009. The systematic review was conducted by the APA Task Force,
which was established by the APA in 2007 to address several concerns that had been
raised in the professional literature and by advocacy organizations about the use of
SOCE on children and adolescents. Although the APA did not explicitly charge the
Task Force to review the efficacy literature on SOCE, the Task Force decided that
such a review was necessary in order to provide a context for the larger Report and
its conclusions.
The APA’s systematic review attempted to answer three questions: (1)
whether SOCE can alter sexual orientation; (2) whether SOCE is harmful; and (3)
4
The Institute of Medicine has defined a systematic review as “a scientific
investigation that focuses on a specific question and uses explicit, prespecified
scientific methods to identify, select, assess, and summarize the findings of similar
but separate studies.” Institute of Medicine, Finding What Works in Health Care:
Standards for Systematic Reviews 1 (2011).
7
whether SOCE may result in any outcomes other than changing sexual orientation.
The review considered only peer-reviewed empirical research on treatment
outcomes published from 1960 to the time of the Report. See 1 Appx. Tab 85-5 at
93-117 (references).
The 2009 Report presented an accurate summary of the state of scientific
knowledge on the efficacy of SOCE up to that time. For this brief, amici have made
a good faith effort to review and report the findings of all valid, empirical studies
published on the efficacy of SOCE since the completion of the Report.
The Report also conducted narrative reviews of the larger body of studies on
SOCE that did not meet the scientific standards necessary to be a valid study of
efficacy. These studies are useful in understanding the motivations and experiences
of those who have participated in SOCE (including whether they look back on those
experiences as harmful or helpful), but they are not valid bases for conclusions
regarding efficacy. The Task Force’s conclusions regarding those studies (and the
results of similar studies that have been published since the Report was completed)
will be reported in this brief when they are pertinent to important questions other
than the question of efficacy.
It is important to note that the lack of recent scientifically valid efficacy
studies of the broad range of SOCE that have been used in recent decades is due in
part to the ethical barriers to such research. To conduct a random controlled trial of
8
a treatment that has not been determined to be safe is not ethically permissible and
to do such research with vulnerable minors who cannot themselves provide legal
consent would be out of the question for institutional review boards to approve.
Before citing a study, amici have critically evaluated the study’s
methodology, including the reliability and validity of the measures and tests the
study employed and the quality of the study’s data-collection procedures and
statistical analyses. Scientific research is a cumulative process, and no empirical
study is perfect in its design and execution. Accordingly, amici base their
conclusions as much as possible on findings that have been replicated across studies
rather than on the findings of any single study. Even well-executed studies may be
limited in their implications and generalizability. Many studies discuss their own
limitations and provide suggestions for further research. This is consistent with the
scientific method and does not impeach these studies’ overall conclusions.
I. History of “Conversion Therapy” and Amici’s Positions on SOCE.
SOCE developed in the mid-nineteenth century to “cure” homosexual desires,
which were then viewed as a mental illness. See 1 Appx. Tab 85-5 at 21. Because
homosexuality was seen as a consequence of either “psychological immaturity” or
pathologies such as genetic defects and hormonal exposure, early SOCE “treatments
9
attempted to correct or repair the damage done by pathogenic factors or to facilitate
maturity.” Id.
These erroneous perspectives on homosexuality persisted through much of the
twentieth century. Id. Indeed, “efforts to alter sexual orientation through psycho-
analytic and behavior therapy were prevalent” by the mid-twentieth century. Id. at
22. These techniques included inducing nausea and paralysis; providing electric
shock therapy; providing shame-aversion therapy; and attempting “systematic
desensitization.” Id. Some therapists also used non-aversive treatments such as
assertiveness and dating trainings, so-called “satiation therapy,” or hypnosis. Id.
At the same time, “countervailing evidence was accumulating” against the
proposition that homosexuality was a pathology. Id. In the 1940s and 1950s, Alfred
Kinsey showed that homosexuality was more prevalent than previously assumed,
and Evelyn Hooker cast doubt on the notion that homosexuality was a mental
disorder. Id. at 22-23. By 1973, the American Psychiatric Association had removed
homosexuality from the Diagnostic and Statistical Manual of Mental Disorders
(“DSM”). Id. at 23. In 1975, the APA adopted a policy reflecting the same
conclusion. Id. at 24. Over the course of the next several decades, professional
health and mental health organizations increasingly adopted the view that
homosexuality is “a normal variant of human sexuality.” Id. at 12.
10
After homosexuality was removed from the DSM, experiments and studies
concerning SOCE decreased dramatically. See id. at 23-24; see also id. at 2 (noting
that most studies on SOCE were conducted before 1981). Behavioral therapists
“became increasingly concerned that aversive therapies designed as SOCE for
homosexuality were inappropriate, unethical, and inhumane.” Id. at 24-25. By the
1980s, mainstream mental health professionals had rejected SOCE because they saw
same-sex sexual orientation as a normal part of the continuum of sexual orientation.
However, in the 1990s, a counter-movement led primarily by mental health
providers practicing within religious communities began to assert that SOCE was
safe and effective for people whose religious beliefs were in conflict with their
sexual orientation.
This led mental health organizations—including the American Counseling
Association, the American Psychiatric Association, and the American
Psychoanalytic Association—to adopt resolutions opposed to SOCE on the ground
that “such efforts were ineffective and potentially harmful.” Id. at 12.
In order to assess the safety and effectiveness of SOCE, the Task Force
conducted an extensive review of the literature and published a 124-page Report in
2009. The Report concluded that “the peer-refereed empirical research on the
outcomes of efforts to alter sexual orientation provides little evidence of efficacy
and some evidence of harm.” Id. at 35.
11
Several states and localities—including Appellees Boca Raton and Palm
Beach—have relied upon the APA’s findings when passing bans on SOCE for
minors. See 2 Appx. Tab 121-1 (Palm Beach); 8 Appx. Tab 126-27 (Boca Raton);
see also BRAB at 30. Numerous courts, including the district court below, have
cited and discussed the Report or Resolution in concluding that bans on SOCE for
minors are justified. See 11 Appx. Tab 141 at 34-38, 41 (district court Order);
Pickup v. Brown, 740 F.3d 1208, 1224, 1232 (9th Cir. 2014) (discussing and citing
Report while upholding California’s ban on SOCE for minors).
Rather than endorsing SOCE, “mainstream mental health professional
associations [currently] support affirmative approaches that focus on helping sexual
minorities cope with the impact of minority stress and stigma.” 1 Appx. Tab 85-5
at 24.5
II. There Is Insufficient Evidence to Support the Efficacy of SOCE.
Based on a systematic review of the literature on the efficacy of SOCE, the
Task Force concluded that there is no scientific evidence that SOCE is likely to
5
Affirmative therapy in this context refers to “therapy that is culturally relevant and
responsive to LGBQ clients and their multiple social identities and communities;
addresses the influence of social inequities on the lives of LGBQ clients; fosters
autonomy; enhances resilience, coping, and community building; advocates to
reduce systemic barriers to mental, physical, relational, and sexual flourishing; and
leverages LGBQ client strengths.” Tiffany O’Shaughnessy & Zachary Speir, The
State of LGBQ Affirmative Therapy Clinical Research: A Mixed-Methods Systematic
Synthesis, 5 Psych. Sexual Orientation & Gender Diversity 82, 83 (2018).
12
reduce same-sex attractions. 6 As the Report observes, a systematic review of the
small number of rigorous peer-reviewed empirical studies found little evidence that
SOCE decreased same-sex attraction or increased other-sex attraction or behaviors.
Moreover, the studies showed little evidence of any enduring changes or changes
that generalized from the treatment context into the real world.7 Some studies that
claimed to find sexual orientation change were not rigorous enough to permit the
Task Force to draw any conclusions from those studies about the efficacy of SOCE. 8
Studies post-dating the Report do not alter the conclusions contained in the
Report. The APA has identified only one post-Report study that purports to show
6
Mental health and medical organizations now see homosexuality as a normal
variant of sexual orientation and not something that needs change, alteration, or cure.
Moreover, the current scientific consensus is that theorizing about the nature of
human sexuality and sexual orientation should take into account both biological and
cultural perspectives. See generally APA Handbook of Sexuality and Psychology
(Deborah L. Tolman & Lisa M. Diamond eds., 2014).
7
The Task Force Report noted that “enduring change to an individual’s sexual
orientation is uncommon and that a very small minority of people in the[ early
SOCE] studies showed any credible evidence of reduced same-sex sexual attraction,
though some showed lessened physiological arousal to all sexual stimuli. . . . Few
studies provided strong evidence that any changes produced in laboratory conditions
translated to daily life.” 1 Appx. Tab 85-5 at 43; see id. at 11; see also Lee Birk et
al., Avoidance Conditioning for Homosexuality, 25 Archives Gen. Psychiatry 314
(1971); Neil McConaghy, Is A Homosexual Orientation Irreversible?, 129 Brit. J.
Psychiatry 556 (1976); Barry A. Tanner, Avoidance Training With and Without
Booster Sessions to Modify Homosexual Behavior in Males, 6 Behav. Therapy 649
(1975).
8
See 1 Appx. Tab 85-5 at 37-38.
13
that SOCE is effective and that meets the minimum standards of an efficacy study,9
though even that study suffers from methodological flaws. 10 See Stanton L. Jones
& Mark A. Yarhouse, A Longitudinal Study of Attempted Religiously Mediated
Sexual Orientation Change, 37 J. Sex & Marital Therapy 404 (2011); see also supra
9
Peer-reviewed empirical research on SOCE that does not meet the minimum
standards for efficacy studies has been published since the Report was released. See,
e.g., Kate Bradshaw et al., Sexual Orientation Change Efforts Through
Psychotherapy for LGBQ Individuals Affiliated with the Church of Jesus Christ of
Latter-day Saints, 41 J. Sex & Marital Therapy 391, 391 (2015) (finding that SOCE
efforts for Mormons suggest a “very low likelihood of a modification of sexual
orientation”); John P. Dehlin et al., Sexual Orientation Change Efforts Among
Current or Former LDS Church Members, J. Counseling Psych. (Online) at 1 (Mar.
2014) (“[O]verall results support the conclusion that sexual orientation is highly
resistant to explicit attempts at change and that SOCE are overwhelmingly reported
to be either ineffective or damaging by participants.”); Elaine M. Maccio, Self-
Reported Sexual Orientation and Identity Before and After Sexual Reorientation
Therapy, 15 J. Gay & Lesbian Mental Health 242, 242 (2011) (reporting “no
statistically significant differences in sexual orientation . . . from before SRT [sexual
reorientation therapy] participation to the time of participation in this study”).
10
The Jones & Yarhouse study resulted in a high attrition rate, which the researchers
do not explain or address; lacks a baseline measure that represents a state of being
untreated; did not maintain constancy regarding assessment intervals; had significant
variations among participants in terms of the length of exposure to treatment, the
nature of treatment, and the amount of time between a person’s initial and
subsequent assessments; and fails to explain significant gaps in data regarding
participants. For these reasons, among others, the Jones and Yarhouse study does
not demonstrate the efficacy of SOCE by any scientifically valid standard. See
generally Society for Prevention Research, Standards of Evidence: Criteria for
Efficacy, Effectiveness, and Dissemination (2005) (“2005 SPR Standards”).
Another paper released after the Report was published purports to show that
SOCE led to shifts in sexual orientation for most participants in the study with no
harmful side effects. See Paul L. Santero et al., Effects of Therapy on Religious Men
Who Have Unwanted Same-Sex Attraction, Linacre Q., July 2018, at 1. But that
study was recently retracted by the publishing journal due to statistical flaws.
14
at 11 (noting that SOCE-related studies have become less prevalent in recent years).
The Jones and Yarhouse study found little evidence of decreased same-sex sexual
orientation; it could not distinguish to what extent reported changes involved
attraction, rather than identity; and it provided no evidence of increase in other-sex
sexual orientation. Accordingly, the conclusions of this study are substantially the
same as the conclusions of the Task Force. And because the Jones and Yarhouse
study related to SOCE conducted by religious ministries—not psychotherapy
provided by licensed psychotherapists—it is also irrelevant to the ordinances at issue
in this dispute.
III. SOCE Poses Significant Risks to Patients and Especially to Minors.
A. Some Individuals Report Harm from SOCE.
As the Report explained, there is “evidence to indicate that individuals
experienced harm from SOCE.” 1 Appx. Tab 85-5 at 3; see id. at 6 (noting that
SOCE “has the potential to be harmful”); id. at 43. With respect to aversive SOCE
therapies, studies show that “negative side effects includ[e] loss of sexual feeling,
depression, suicidality, and anxiety.” Id. at 43. Even with respect to so-called
“nonaversive” SOCE, research reports that had been published at the time of the
Report “indicate[d] that there are individuals who perceive that they have been
harmed.” Id. at 3.
15
Based on its exhaustive review of the SOCE literature, the Task Force
ultimately concluded that, while there was a “dearth of scientifically sound research
on the safety of SOCE,” the best available evidence suggested that “attempts to
change sexual orientation may cause or exacerbate distress and poor mental health
in some individuals, including depression and suicidal thoughts.” Id. at 42. The
Task Force also described in detail a number of “studies that report perceptions of
harm” and noted that those studies “represent[] a serious concern.” Id.
As to older, non-experimental studies, the Task Force observed that “negative
[side] effects of treatment are reported to have occurred for some people during and
immediately following treatment.” Id. For example, in John Bancroft’s 1969 study,
SOCE interventions “had harmful effects on 50% of the 16 research subjects who
were exposed to it,” including a 20% rate of anxiety, a 10% rate of suicidal ideation,
a 40% rate of depression, a 10% rate of impotence, and a 10% rate of relationship
dysfunction. Id. at 41-42; see John Bancroft, Aversion Therapy of Homosexuality:
A Pilot Study of 10 Cases, 115 Brit. J. Psychiatry 1417 (1969). Other early studies
of SOCE reported “cases of debilitating depression, gastric distress, nightmares, and
anxiety,” as well as “severe dehydration,” and at least one case where a research
16
participant “began to engage in abusive use of alcohol” that required hospitalization.
1 Appx. Tab 85-5 at 42.11
The Task Force noted that more recent studies “document that there are people
who perceive that they have been harmed through SOCE.” Id. Among those studies,
“the reported negative social and emotional consequences include self-reports of
anger, anxiety, confusion, depression, grief, guilt, hopelessness, deteriorated
relationships with family, loss of social support, loss of faith, poor self-image, social
isolation, intimacy difficulties, intrusive imagery, suicidal ideation, self-hatred, and
sexual dysfunction.” Id. 12; see id. at 50. Participants in these studies also described
“decreased self-esteem and authenticity to others”; “increased self-hatred and
11
See J.T. Quinn et al., An Attempt to Shape Human Penile Responses, 8 Behav.
Res. & Therapy 213 (1970); Steven H. Herman & Michael Prewett, An Experimental
Analysis of Feedback to Increase Sexual Arousal in a Case of Homo- and
Heterosexual Impotence: A Preliminary Report, 5 J. Behav. Therapy &
Experimental Psychiatry 271 (1974); Basil James, Case of Homosexuality Treated
by Aversion Therapy, 1 Brit. Med. J. 768 (1962).
12
See A. Lee Beckstead & Susan L. Morrow, Mormon Clients’ Experiences of
Conversion Therapy: The Need for a New Treatment Approach, 32 Counseling
Psychologist 651 (2004); Glenn Smith et al., Treatments of Homosexuality in Britain
Since 1950—An Oral History: The Experiences of Patients, 328 Brit. Med. J. 427
(2004); Ariel Shidlo & Michael Schroder, Changing Sexual Orientation: A
Consumer’s Report, 33 Prof. Psych.: Res. & Prac. 249 (2002); Michael Schroder &
Ariel Shidlo, Ethical Issues in Sexual Orientation Conversion Therapies: An
Empirical Study of Consumers, 131 Journal of Gay & Lesbian Psychotherapy 131
(2001); Joseph Nicolosi et al., Retrospective Self-Reports of Changes in Homosexual
Orientation: A Consumer Survey of Conversion Therapy Clients, 86 Psych. Rep.
1071 (2000); Kim W. Schaeffer et al., Religiously-Motivated Sexual Orientation
Change, 19 J. Psych. & Christianity 61 (2000).
17
negative perceptions of homosexuality”; “an increase in substance abuse and high-
risk sexual behaviors”; and a variety of harms to their relationships, including
hostility towards their parents and the loss of lesbian, gay, and bisexual friends and
potential romantic partners. Id. at 50-51.
In addition to the direct harms posed by SOCE (which may present as mental
health issues, physical ailments, sexual dysfunction, or substance abuse), SOCE also
has the potential to cause indirect harms such as the loss of time, energy, and money.
See id. at 50. Moreover, some SOCE patients may suffer an indirect harm in the
form of disappointment or psychological damage resulting from the fact that a
therapy they thought would be effective turned out not to work. Indeed, the Report
found that “[i]ndividuals who failed to change sexual orientation, while believing
they should have changed with such efforts, described their experiences as a
significant cause of emotional and spiritual distress and negative self-image.” Id. at;
3; see id. at 50 (noting that some participants in SOCE studies reported “anger at and
a sense of betrayal by SOCE providers” or that they “blamed themselves for the
failure” of SOCE to work as expected); id. at 51 (noting that some SOCE recipients
reported “stress due to the negative emotions of spouses and family members
because of expectations that SOCE would work”). Given that SOCE is unlikely to
be effective, there is a risk that SOCE poses psychological harms by promising a
result that is unlikely to occur.
18
The one scientifically valid efficacy study published since the Report found
significant reduction in psychological distress among the participants in the study
over the six to seven years that the participants were followed. See Jones &
Yarhouse, supra. 13 Because the SOCE studied in this research was a group ministry,
this result is consistent with earlier studies that found some participants reported
benefits from the social support of others who shared their concerns about their
sexual orientation. See 1 Appx. Tab 85-5 at 41. As the Task Force suggests in the
13
There have been other studies of SOCE published since the Report that do not
meet APA’s standards for efficacy studies. As discussed above, these studies may
nonetheless be useful in understanding the motivations and experiences of those who
have participated in SOCE. See supra at 8-9. Some participants in more recent
studies have reported harmful effects of SOCE. For example, one 2015 study on
SOCE efforts for individuals affiliated with the Church of Jesus Christ of Latter-day
Saints reported that 37% of study participants found their therapy to be moderately
to severely harmful and that there was “clear evidence” that “dutiful long-term
psychotherapeutic efforts to change [sexual orientation] are not successful and carry
significant risk of harm.” Bradshaw et al., supra, at 391, 409-10. In another 2018
study that focused specifically on young adults aged 21-25, researchers found that
“[a]ttempts by parents/caregivers and being sent to therapists and religious leaders
for conversion interventions were associated with depression, suicidal thoughts,
suicidal attempts, less educational attainment, and less weekly income.” Caitlin
Ryan et al., Parent-Initiated Sexual Orientation Change Efforts with LGBT
Adolescents: Implications for Young Adult Mental Health and Adjustment, J.
Homosexuality (Online) at 1 (Nov. 7, 2018); see id. at 10.
Moreover, both the federal government and the United Nations have recently
raised concerns about SOCE. See Substance Abuse & Mental Health Servs. Admin.,
Ending Conversion Therapy: Supporting and Affirming LGBTQ Youth (Oct. 2015)
(“SAMHSA Report”), https://store.samhsa.gov/system/files/sma15-4928.pdf;
Report of the Office of the United Nations High Commissioner for Human Rights,
Discrimination and Violence Against Individuals Based on Their Sexual Orientation
and Gender Identity at 11, 14-15, 20 (May 4, 2015), http://www.ohchr.org/EN/
HRBodies/HRC/RegularSessions/Session29/Documents/A_HRC_29_23_en.doc.
19
alternative therapeutic model it presented, this benefit is not specific to SOCE.
Indeed, many of the purported benefits of SOCE (such as stress reduction and
experiencing empathy) “are not unique” and may be achieved by talk therapy and/or
treatment approaches that do not attempt to change sexual orientation. Id. at 68; see
id. at 3; John C. Norcross & Clara E. Hill, Empirically Supported Therapy
Relationships, 57 Clinical Psychologist 19 (2004).
B. Minors Are Particularly Vulnerable to Harm From SOCE.
Importantly, the Report also discusses the considerable ethical issues with
providing SOCE to minors. See 1 Appx. Tab 85-5 at 71-80 (Report Chapter 8). In
the absence of scientifically valid studies of efficacy showing safety of SOCE and
in the presence of retrospective reports of harm, the potential for SOCE to harm
minors is of great concern to licensed mental health professionals (“LMHPs”),
amici, and the public.
Generally speaking, youth may be particularly vulnerable to the potential
harms of SOCE because they have been exposed to negative messages about sexual
minorities but have not yet developed the resources to reject these messages. See,
e.g., SAMHSA Report at 12-13, 20. The Report therefore advised LMHPs to “take
steps to ensure that minor clients have a developmentally appropriate understanding
of treatment” and noted that the APA recommends that LMHPs “support
adolescents’ exploration of identity.” 1 Appx. Tab 85-5 at 76. Given that “[t]here
20
is no research demonstrating that providing SOCE to children or adolescents has an
impact on adult sexual orientation” (id. at 4; see id. at 73), the Report also
recommended that LMHPs “provide multiculturally competent and client-centered
therapies” to children and adolescents “rather than SOCE” (id. at 80). Ultimately,
the Task Force concluded in the Report that it had “concerns that [SOCE-type]
interventions may increase self-stigma and minority stress and ultimately increase
the distress of children and adolescents.” Id. at 4.
C. Licensed Mental Health Providers Have a Duty to Avoid Harm to

the Members of the Public Whom They are Licensed to Serve.
The charge to “do no harm” has long been a foundational component of
practice for healthcare professionals. This means that certain aspirational principles
(such as the patient’s self-determination) must be balanced against other principles,
such as beneficence and non-malfeasance. See Am. Psychological Ass’n, Ethical
Principles of Psychologists and Code of Conduct, at Principles A, E (Jan. 1, 2017),
https://www.apa.org/ethics/code. For this reason, there are a number of patient
requests that an ethical psychologist would be required to resist on the grounds that
they would harm the patient’s health or that there is no evidentiary basis for the
requested treatment; for example, a psychologist would decline a request for a
weight loss program from a patient with anorexia nervosa. Self-determination, while
important, is not the only ethical principal—or even the most important ethical
principle—in clinical decision-making. See Ariel Shidlo & John C. Gonsiorek,
21
Psychotherapy with Clients Who Have Been Through Sexual Orientation Change
Interventions or Request to Change Their Sexual Orientation, in Handbook of Sexual
Orientation and Gender Diversity in Counseling and Psychotherapy 291 (Kurt A.
DeBord et al., eds., 2017). Phrased simply, self-determination does not justify
dispensing with other ethical obligations regarding patient care.
IV. Appellants Misrepresent Various Aspects of the Task Force Report.
Both in this Court and below, Appellants have mischaracterized key aspects
of the APA’s Report and Resolution. Appellants’ misleading claims concern the
nature of the scientific research on SOCE, the possibility that SOCE may result in
harm, and the methodological approaches that the Task Force used when evaluating
reports of SOCE benefits.
First, Appellants make much of the fact that the Report acknowledges the lack
of recent research on the harms of SOCE. See AOB 13-14, 57; 1 Appx. Tab 1 at 10
¶¶ 40-43. Although the Report acknowledges that scientifically valid efficacy
research on SOCE is limited (see 1 Appx. Tab 85-5 at 6-7, 42), Appellants ignore
the body of research that is not efficacy studies, but which finds that some
participants in SOCE do retrospectively report harms.
Numerous researchers and LMHPs have concluded that SOCE should be
neither studied nor provided precisely because it may cause harm to patients. See
1 Appx. Tab 85-5 at 91 (“Some authors have stated that SOCE should not be
22
investigated or practiced until safety issues have been resolved.”); 14 id. at 24 (noting
that, “[f]ollowing the removal of homosexuality from the DSM [in 1973], the
publication of studies of SOCE decreased dramatically”).
Modern LMHPs’ concerns about SOCE find significant support in early
studies on SOCE. The Report recognizes that “[h]igh dropout rates characterize
early [SOCE] studies and may be an indicator that research participants experience
these treatments as harmful.” See id. at 42; see Scott O. Lillenfeld, Psychological
Treatments that Cause Harm, 2 Persp. on Psych. Sci. 53 (2007). To name just one
example, a 1973 study on SOCE included one respondent who “dropped out” after
“lo[sing] all sexual feeling” and six others who reported some form of depression.
1 Appx. Tab 85-5 at 41; see Neil McConaghy & R.F. Barr, Classical, Avoidance,
and Backward Conditioning Treatment of Homosexuality, 122 Brit. J. Psychiatry
151 (1973).
Thus, the relative lack of empirical studies on SOCE is not evidence of lack
of harm, as Appellants appear to suggest. If anything, the lack of studies on SOCE
may be indicative of the risk of harm. The district court correctly recognized this
14
See, e.g., Gregory M. Herek, Evaluating Interventions to Alter Sexual Orientation:
Methodological and Ethical Considerations, 32 Archives Sexual Behav. 438 (2003);
Gerald C. Davison, Homosexuality: The Ethical Challenge, 44 J. Consulting &
Clinical Psych. 157 (1976).
23
fact in its Order. See 11 Appx. Tab 141 at 37 n.12 (“Notably, the APA Task Force
Report suggests that the lack of rigorous studies is because SOCE is harmful.”).
Second, Appellants claim that the Report does not indicate clear evidence of
harm. See AOB 13-14, 47-48, 57; 1 Appx. Tab 1 at 10 ¶ 42); 1 Appx. Tab 8 at 11-
12. This is simply mistaken. As explained in detail above, the Report does show
evidence of harm. See supra § III.A. Moreover, Appellants’ suggestion that the
Report is deficient because it does not focus on patients who are alleged to have
sought SOCE voluntarily misses the mark. Even putting aside Appellants’
mischaracterization about the risk of harm, SOCE cannot be justified by invoking
client autonomy or self-determination. See supra § III.C. As the Task Force
recognized in the Report, “simply providing SOCE to clients who request it does not
necessarily increase self-determination but rather abdicates the responsibility of
[LMHPs] to provide competent assessment and interventions that have the potential
for benefit with a limited risk of harm.” 1 Appx. Tab 85-5 at 69. Moreover, the
concept of self-autonomy with respect to minors who “opt into” SOCE is a canard
because minors are typically emotionally and financially dependent on adults. See
id. at 77, 121.
Third, Appellants claim that the Report improperly ignores evidence on the
benefits of SOCE, and that the benefits from SOCE that are “at least equivalent to
anecdotal evidence of harm.” See AOB 15-16 (capitalization omitted). Again,
24
Appellants are incorrect. The Task Force did review evidence related to the
purported benefits of SOCE. See 1 Appx. Tab 85-5 at 36-41.15 Carefully balancing
this scattered evidence against the evidence of harm, the Task Force ultimately
concluded that there is evidence of harm from SOCE. See supra § III.A. That
conclusion comes as no surprise, especially given that there is no documented
evidence of benefits of SOCE that are distinct from other forms of talk therapy.
As a related matter, Appellants appear to suggest that the Task Force used
different standards when examining research concerning the harms of SOCE than it
did when examining research concerning the purported benefits of SOCE. This
suggestion is also incorrect. In conducting their review, Task Force members relied
on multiple, well-accepted sets of efficacy criteria, including the standards of
evidence for efficacy promulgated by the Society for Prevention Research (SPR).
See 2005 ASR Standards; see also 1 Appx. Tab 85-5 at 28, 114. Furthermore, in
reporting on the studies of SOCE that were not valid efficacy studies, the Report did
report benefits, as well as harms. See id. at 49-50.
In any event, it is erroneous to assume that the same standards—or even the
same research methods—should be used when interrogating the harms of a proposed
15
But see 1 Appx. Tab 85-5 at 35 (“[N]onexperimental studies often find positive
effects that do not hold up under the rigor of experimentation.”). The Task Force
pointed to studies showing that some participants in SOCE “described experiencing
first the positive effects and then experiencing or acknowledging the negative effects
later.” Id. at 42.
25
therapy and that therapy’s purported benefits. Indeed, various mainstream medical
groups—including the American Cancer Society—have recognized that different
standards do and should apply when examining harm vs. benefit (or effectiveness).
See Am. Cancer Society, What Are the Phases of Clinical Trials? (Feb. 7, 2017),
https://www.cancer.org/treatment/treatments-and-side-effects/clinical-trials/what-
you-need-to-know/phases-of-clinical-trials.html.
Relatedly, it is incumbent on proponents of a particular type of therapy to
show that it is both effective and safe (not on opponents of that method to show that
it causes harm). As the SPR standards emphasize, where a study claims to show the
efficacy of a therapeutic method, “there must be no serious negative (iatrogenic)
effects on important outcomes.” See 2005 ASR Standards at 5. Here, the available
scientific evidence provides no reason to believe that SOCE is effective or safe.
26
CONCLUSION
For the foregoing reasons, the district court’s Order should be affirmed.
June 17, 2019 Respectfully submitted,

Nathalie F.P. Gilfoyle Counsel of Record
Deanne M. Ottaviano Emily L. Chapuis
AMERICAN PSYCHOLOGICAL James T. Dawson
ASSOCIATION JENNER & BLOCK LLP
750 First Street NE 1099 New York Avenue NW
Washington, DC 20002 Washington, DC 20001
(202) 336-6100 (202) 639-6000
[email protected]
Counsel for American
Psychological Association Counsel for All Amici Curiae
Anne B. Camper
NATIONAL ASSOCIATION OF
SOCIAL WORKERS
750 First Street NE, Suite 800
(202) 336-8799
Counsel for National Association

of Social Workers and National
Association of Social Workers
Florida Chapter
27
CERTIFICATE OF COMPLIANCE
1. This brief complies with the type-volume limitation of Federal Rules of
Appellate Procedure 29(a)(5) because it contains 6,472 words, excluding the parts
of the brief exempted by Federal Rule of Appellate Procedure 32(a)(7)(B)(iii).
2. This brief complies with the typeface requirements of Fed. R. App. P.
32(a)(5) and the type style requirements of Fed. R. App. P. 32(a)(6) because it has
been prepared in a proportionally spaced typeface using Microsoft Word 2010 in 14-
point Times New Roman type style.

June 17, 2019

CERTIFICATE OF SERVICE
I hereby certify that on this 17th day of June, 2019, I electronically filed the
foregoing document with the Clerk of the Court using CM/ECF, which will send
notice to all counsel of record in this matter.

June 17, 2019

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Case: 19-10604 Date Filed: 07/03/2019 Page: 1 of 40

IN THE UNITED STATES COURT OF APPEALS

CITY OF BOCA RATON, FLORIDA, and

On Appeal from the United States District Court for the

BRIEF OF AMERICAN PSYCHOLOGICAL ASSOCIATION,

Jessica Ring Amunson

Additional Counsel Listed on Inside Cover

Counsel for National Association

Otto v. City of Boca Raton, Florida

CERTIFICATE OF INTERESTED PERSONS

Pursuant to Circuit Rule 26.1-1 and Federal Rule of Appellate Procedure

are known to have an interest in the outcome of this case:

Alliance for Therapeutic Choice

American Association for Marriage and Family Therapy

American Psychological Association

Berger, Mary Lou

Carlton Fields Jorden Burt, P.A.

City of Boca Raton, Florida

Equality Florida Institute, Inc.,

Fahey, Rachel Marie

Otto v. City of Boca Raton, Florida

Florida Psychological Association

Gibson, Dunn & Crutcher LLP

Hamilton, Julie H., Ph.D. LMFT

Jenner & Block LLP

Liberty Counsel, Inc.

National Association of Social Workers

National Association of Social Workers Florida Chapter

O’Rourke, Andrea Levine

Otto v. City of Boca Raton, Florida

Otto, Robert W., Ph.D. LMFT

Palm Beach County, Florida

Palm Beach County Human Rights Council

Price, Max Richard

Reinhart, Hon. Bruce E.

Rosenberg, Hon. Robin L.

SDG Counseling, LLC

The Trevor Project

Otto v. City of Boca Raton, Florida

Weiss Serota Helfman Cole & Bierman, P.L.

Pursuant to Federal Rule of Appellate Procedure 26.1 and Eleventh Circuit

/s/ Jessica Ring Amunson

Jessica Ring Amunson

Counsel for All Amici Curiae

STATEMENT OF THE ISSUE................................................................................ 1

INTERESTS OF AMICI CURIAE ............................................................................ 1

ARGUMENT AND CITATIONS OF AUTHORITY ............................................. 7

I. History of “Conversion Therapy” and Amici’s Position on SOCE................ 9

A. Some Individuals Report Harm from SOCE...................................... 15

*American Psychological Ass’n, Report of the American Psychological

A. L Beckstead & Susan L. Morrow, Mormon Clients’ Experiences of

Lee Birk et al., Avoidance Conditioning for Homosexuality, 25 Archives Gen.

Kate Bradshaw et al., Sexual Orientation Change Efforts Through

Gerald C. Davison, Homosexuality: The Ethical Challenge, 44 J. Consulting

John P. Dehlin et al., Sexual Orientation Change Efforts Among Current or

Gregory M. Herek, Evaluating Interventions to Alter Sexual Orientation:

Institute of Medicine, Finding What Works in Health Care: Standards for

Stanton L. Jones & Mark A. Yarhouse, A Longitudinal Study of Attempted

Scott O. Lillenfeld, Psychological Treatments that Cause Harm, 2 Persp. on