The American Psychological Association has found that efforts to change a child's sexual orientation can cause "critical health risks" like depression, substance abuse and suicidal thoughts. Kevork Djansezian/Getty Images

A federal appeals court on Thursday ruled to uphold the state of California's ban on gay “conversion therapy” among underage children, a practice in which therapists try to change the sexual orientation of gay youths. The law, which was signed by California Gov. Jerry Brown in September 2012, was the first legislation to prevent state-licensed therapists from counseling children to “cure” their homosexuality. New Jersey Gov. Chris Christie followed California's lead in August by signing a law banning gay “conversion therapy” for minors in his state, expressing reluctance to step in to limit parents' choice in treating their own children but ultimately deciding to focus on the American Psychological Association's finding that efforts to change a child's sexual orientation can cause "critical health risks" like depression, substance abuse and suicidal thoughts. California's law was stalled from taking effect because of injunctions filed by practitioners of sexual-orientation change therapy and groups that support it, such as the Utah-based National Association for Research and Therapy of Homosexuality (NARTH) and the Virginia-based American Association of Christian Counselors. They, along with two families who said their children had benefited from the therapy, argued that the constitutional right of free speech as well as "parents' fundamental rights" were violated by the ban. But the U.S. Court of Appeals for the Ninth Circuit in San Francisco struck down the injunctions on Thursday, ruling that "talk therapy does not receive special First Amendment protection merely because it is administered through speech," and that "the overwhelming consensus" was that sexual-orientation change efforts were "harmful and ineffective."

‘Cure, treat or change’

While no one knows how many people have gone through gay “conversion therapy,” studies from San Francisco State University's Family Acceptance Project found that more than half of LGBT people ages 21 to 24 report having been pressured by their parents to change their sexual orientation when they were teenagers. A little more than one-third said they were sent outside the home to a therapist or religious leader to "cure, treat or change" their orientation. Sexual-orientation change efforts have been panned as detrimental by medical and mental health associations like the American Psychiatric Association, the American Academy of Pediatrics and the American Psychological Association, which instead "call on their members to respect a person’s right to self-determination." According to documents in the California appeals court ruling, gay “conversion therapy” arose in the decades before the removal of homosexuality from the Diagnostic and Statistical Manual of Mental Disorders in 1973. The opinion noted that "aversive treatments” included "inducing nausea, vomiting or paralysis; providing electric shocks; or having an individual snap an elastic band around the wrist when aroused by same-sex erotic images or thoughts." Documents filed in the California injunctions include testimony from additional people who received gay “conversion therapy” (PDF). Kirk Andrew Murphy was enrolled by his parents in a federally funded experimental program at the University of California, Los Angeles, in 1970, when he was 5 years old. His parents rewarded him for playing with stereotypical "boy" toys and punished him for playing with stereotypical "girl" toys by shunning him or whipping him with a belt, according to court documents. Murphy's sister testified that he first attempted suicide at the age of 17, because he believed "no one could ever love him as he was." When he was 38, he took his own life. Modern-day treatments rooted in talk therapy aim to cement heterosexual gender roles, based on the theory that children's imbalanced relationships with opposite-sex parents have led to homosexual impulses. The treatments often draw on religious teachings.

‘Distress and shame’

What the California and New Jersey laws don't do is prevent religious leaders or groups from practicing “conversion therapy” on children, because the legislation applies only to licensed mental health practitioners. That means groups like the Jersey City organization Jews Offering New Alternatives to Homosexuality, or JONAH, which says it provides therapist referrals and support for people struggling with gay urges, can still legally work with minors to change their sexual orientation. Last year, JONAH was sued for fraud (PDF) by four gay men who alleged it "repeatedly presented to plaintiffs that their services were effective in changing a person’s sexual orientation from gay to straight," according to court documents filed by the Southern Poverty Law Center. The lawsuit alleges that JONAH's program, as mandated by co-founders Arthur Goldberg and Alan Downing, neither of whom is a licensed therapist, included making the plaintiffs strip naked and attack effigies of their mothers with baseball bats and that the plaintiffs suffered depression and emotional harm when they couldn't change their sexual orientation, according to the court documents.