The Unscientific Nonsense of Conversion Therapy
Conversion therapy is not only ineffective at its purported goal, but also only serves to amplify psychological distress.
by Veronica Esposito
On Tuesday October 7, the Supreme Court heard oral arguments in Chiles v. Salazar, a case which seeks to upend bans on conversion therapy throughout the United States. Currently, the practice is banned or restricted in 27 U.S. states, plus Washington, D.C.
Legal commentators sound doubtful that the Court will choose to let laws against conversion therapy stand in their current form. Such a decision would make for a major setback for LGBTQ+ equality, and for ethical therapy practice.
Simply and unequivocally, conversion therapy has been determined to be extremely harmful and of no use whatsoever. One review of 28 published studies on sexual orientation and gender identity change efforts (SOGICE) found that conversion therapy increased “serious psychological distress [compared to those who received no therapy] (47% vs 34%), depression (65% vs 27%), substance abuse (67% vs 50%), and attempted suicide (58% vs 39%).” That same paper also found that affirmative therapy—where a client’s sexual orientation and/or gender identity is supported—vastly decreased these conditions: suicide attempts plummeted to 3%, depression fell to 14%, and anxiety declined to 20%.
A 2016 Cornell University literature review of 47 peer-reviewed studies on efforts to change sexuality found no evidence whatsoever that such efforts could succeed; moreover, 12 studies deemed the practice very harmful. Other reviews of the research have also found conversion therapy to be harmful, and in fact there is now burgeoning research into how to best support survivors of conversion therapy in overcoming the trauma of having experienced it.
One of the only papers in favor of conversion therapy was eventually disowned by its author. The paper in question was published in 2001 by Robert Spitzer (a colossal figure in the history of psychotherapy) in which he interviewed some 200 so-called ex-gays—indivudals who claimed to have successfully changed their sexual orientation for a period of at least five years.
Yet, upon publication that paper was met with 26 published critiques citing serious methodological flaws. Critiques centered around the fact that the study participants were self-selected, the participants generally lacked credibility, and the study never named any specific intervention that changed sexual orientation. Eleven years later, in 2012, Spitzer himself disavowed his own research and formally apologized for the study and the harm it had done to LGBTQ+ people.
In accordance with the disastrous record of conversion therapy, professional bodies have been categorical in their denouncement of the practice. In a 2018 statement on conversion therapy, The American Academy of Child and Adolescent Psychiatry declared that there is:
“[N]o evidence to support the application of any “therapeutic intervention” operating under the premise that a specific sexual orientation, gender identity, and/or gender expression is pathological. Furthermore, based on the scientific evidence, the AACAP asserts that such “conversion therapies” (or other interventions imposed with the intent of promoting a particular sexual orientation and/or gender as a preferred outcome) lack scientific credibility and clinical utility. Additionally, there is evidence that such interventions are harmful.
Widespread efforts are underway to ban the practice of conversion therapy around the world. Nation by nation, bans on conversion therapy have dramatically increased since 2020, when only 4 nations had bans in place—currently the number is 17. In addition, a 2020 United Nations report called for a worldwide end to the practice, citing a study “that found 9 in 10 conversion therapy survivors from 100 countries report suffering serious trauma.”
What is conversion therapy? Conversion therapy comprises a number of practices, united by an intent to compel LGBTQ+ individuals to desist from homosexual and transgender identities. One research paper by David J. Kinitz and colleagues offers a helpful list of some of the various techniques that might fall under the banner of such efforts.
Specific interventions included fasting, intensive prayer sessions, naked holding of other men, burning sentimental photos, practicing embodiment of stereotypical masculine qualities or engaging in masculine activities, persistent (psychological) assessment and denial of patient-determined gender identity in a medical setting, confronting parents for their role in why they (the participant) were “same-sex attracted,” re-enacting experiences of trauma and rebirth, sharing victories and failures of suppressing/avoiding nonheterosexual outcomes (e.g., “gay” porn), and psychoanalysis attempting to understand why someone was sexually diverse (i.e., where a parent was too present/absent or at what point during childhood they were molested).
Another paper by Ilias Trispiotis and Craig Purshouse added the following to the list of potential conversion therapies:
A wide range of practices have been reported, including “corrective” rape and sexual assault, imprisonment and kidnapping, physical abuse, electroconvulsive shock treatments, hormone treatments, and “aversion therapy.”
Given the devastating record of conversion therapy, proponents of conversion therapy for gender identity have recently attempted to rebrand it as “gender-exploratory therapy,” as a part of ongoing efforts to discourage trans existence. Researcher Florence Ashley has defined gender-exploratory therapy as “discourag[ing] gender affirmation in favor of exploring through talk therapy the potential pathological roots of youths’ trans identities or gender dysphoria.”
As Ashley notes, there are many reasons to view gender-exploratory therapy as simply conversation therapy by another name. First of all, the two practices share the widely discredited notion that trans identities are pathological. Gender-exploratory therapy also supports the discredited tactics of refusing to support social affirmation of a client’s gender or the need for medical interventions—both aspects of the gender-affirming approach that are supported by research. In addition, Ashley rightly states that gender-affirmative models of therapy already encourage gender exploration—including (if desired) explorations of where a client’s transness comes from—rendering the supposed purpose of gender-exploratory therapy moot.
Read Assigned Media’s interview with an activist who went undercover with an exploratory therapist.
Some commentators have attempted to argue that conversion therapy should be available to those who freely choose to pursue it, yet this argument runs up against the fact that state licensing boards regularly proscribe certain kinds of interactions between therapists and clients that they consider to be harmful and unethical. Jack Drescher and colleagues offered a vivid example of precisely why this argument fails to hold water:
Conversion therapists have at times defended their actions by claiming their clients should be able to choose to take part in these therapies. We disagree and suggest that a parallel proscribed behavior that regulatory bodies can consider while assessing how to respond to these complaints is sexual contact between therapists and patients. Sexual contact, even when consensual, has been shown to be very detrimental to the patient and has no place in the clinical setting.
Decades ago, sex between therapists and clients was considered normal and ethical. Just like with conversion therapy today, battles were fought over a period of years to outlaw sexual contact in the therapy relationship, as its immense harms were shown to be incontrovertible. All available evidence points to the need to ban conversion therapy in all forms for the same reason: These toxic practices harm patients. The Supreme Court may find a legal pretext for reversing the progress made on banning this practice, but the fight to safeguard clients will continue.
Veronica Esposito (she/her) is a writer and therapist based in the Bay Area. She writes regularly for The Guardian, Xtra Magazine, and KQED, the NPR member station for Northern California, on the arts, mental health, and LGBTQ+ issues.