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The Lies and Dangers of Efforts to Change Sexual Orientation or Gender Identity

So-called “conversion therapy” is a range of dangerous and discredited practices that falsely claim to change a person’s sexual orientation or gender identity or expression. Such practices have been rejected by every mainstream medical and mental health organization of decades, but due to continuing discrimination and societal bias against LGBT people, some practitioners continue to conduct conversion therapy. Minors are especially vulnerable, and conversion therapy can lead to depression, anxiety, drug use, homelessness, and suicide.

California, New Jersey, and the District of Columbia have passed laws to prevent licensed providers from offering conversion therapy to minors, and at least 18 states have introduced similar legislation this year (AZ, CO, CT, FL, IL, IA, MA, MN, NV, NY, OH, OR, PA, RI, TX, VT, VA, WA). One state (OK) introduced legislation which would have specifically legitimized conversion therapy and immunized it from state oversight, but that bill failed to pass. 

In August of 2013, the 9th U.S. Circuit Court of Appeals upheld California’s law which was signed by Democratic Governor Jerry Brown in 2012. In September of 2014, the 3rd U.S. Circuit Court of Appeals upheld New Jersey’s law which was signed by Republican Governor Chris Christie in August of 2013. In February of 2015, a NJ Superior Court judge ruled that misrepresenting homosexuality as a disorder violates the state’s consumer protection laws.

Many right-wing religious groups promote the concept that an individual can change his or her sexual orientation, either through prayer or other religious efforts, or through so-called "reparative" or "conversion" therapy. The limited research on such efforts has disproven their efficacy, and also has indicated that they can be affirmatively harmful. Beyond studies focused solely on reparative therapy, broader research clearly demonstrates the significant harm that societal prejudice and family rejection has on lesbian, gay, bisexual and transgender (LGBT) people, particularly youth. Furthermore, there is significant anecdotal evidence of harm to LGBT people resulting from attempts to change their sexual orientation. Based on this body of evidence, every major medical and mental health organization in the United States has issued a statement condemning the use of reparative therapy.

Psychiatrist Dr. L. Spitzer, who once offered a study on reparative therapy, has since denounced the practice and has apologized for endorsing the practice. Read more here.


Research on the Impacts of Reparative Therapy, Harms Caused by Societal Prejudice

In 2007, a task force of the American Psychological Association undertook a thorough review of the existing research on the efficacy of reparative therapy. Their report noted that there was very little methodologically sound research on sexual orientation change efforts (SOCEs) and that the "results of scientifically valid research indicate that it is unlikely that individuals will be able to reduce same-sex attractions or increase other-sex sexual attractions through SOCE." In addition, the task force found that "there are no methodologically sound studies of recent SOCE that would enable the task force to make a definitive statement about whether or not recent SOCE is safe or harmful and for whom." Read the full report.

In short, there is clear evidence that reparative therapy does not work, and some significant evidence that it is also harmful to LGBT people.

In contrast, there is ample evidence that societal prejudice causes significant medical, psychological and other harms to LGBT people. For example, research on the issue of family acceptance of LGBT youth conducted at San Francisco State University found that "compared with LGBT young people who were not rejected or were only a little rejected by their parents and caregivers because of their gay or transgender identity, highly rejected LGBT young people were:

More than 8 times as likely to have attempted suicide. Nearly 6 times as likely to report high levels of depression. More than 3 times as likely to use illegal drugs. More than 3 times as likely to be at high risk for HIV and STDs.
 

Organizational Positions on Reparative Therapy

American Academy of Child Adolescent Psychiatry

"Clinicians should be aware that there is no evidence that sexual orientation can be altered through therapy, and that attempts to do so may be harmful. There is no empirical evidence adult homosexuality can be prevented if gender nonconforming children are influenced to be more gender conforming. Indeed, there is no medically valid basis for attempting to prevent homosexuality, which is not an illness. On the contrary, such efforts may encourage family rejection and undermine self-esteem, connectedness and caring, important protective factors against suicidal ideation and attempts. Given that there is no evidence that efforts to alter sexual orientation are effective, beneficial or necessary, and the possibility that they carry the risk of significant harm, such interventions are contraindicated."
Practice Parameter on Gay, Lesbian, or Bisexual Orientation, Gender Nonconformity, and Gender Discordance in Children and Adolescents.

American Academy of Pediatrics

"Confusion about sexual orientation is not unusual during adolescence. Counseling may be helpful for young people who are uncertain about their sexual orientation or for those who are uncertain about how to express their sexuality and might profit from an attempt at clarification through a counseling or psychotherapeutic initiative. Therapy directed specifically at changing sexual orientation is contraindicated, since it can provoke guilt and anxiety while having little or no potential for achieving changes in orientation."
Homosexuality and Adolescence, Pediatrics.

American Association for Marriage and Family Therapy

"[T]he association does not consider homosexuality a disorder that requires treatment, and as such, we see no basis for [reparative therapy]. AAMFT expects its members to practice based on the best research and clinical evidence available."
AAMFT Position on Couples and Families.

American College of Physicians

"The College opposes the use of “conversion,” “reorientation,” or “reparative” therapy for the treatment of LGBT persons."

Lesbian, Gay, Bisexual, and Transgender Health Disparities: Executive Summary of a Policy Position Paper From the American College of Physicians 

American Counseling Association

“The belief that same-sex attraction and behavior is abnormal and in need of treatment is in opposition to the position taken by national mental health organizations, including ACA. The ACA Governing Council passed a resolution in 1998 with respect to sexual orientation and mental health. This resolution specifically notes that ACA opposes portrayals of lesbian, gay and bisexual individuals as mentally ill due to their sexual orientation. . . . In 1999, the Governing Council adopted a statement ‘opposing the promotion of reparative therapy as a cure for individuals who are homosexual.’ . . .

[T]he ACA Ethics Committee strongly suggests that ethical professional counselors do not refer clients to someone who engages in conversion therapy or, if they do so, to proceed cautiously only when they are certain that the referral counselor fully informs clients of the unproven nature of the treatment and the potential risks and takes steps to minimize harm to clients. . . . This information also must be included in written informed consent material by those counselors who offer conversion therapy despite ACA’s position and the Ethics Committee’s statement in opposition to the treatment. To do otherwise violates the spirit and specifics of the ACA Code of Ethics.”
Ethical Issues Related to Conversion or Reparative Therapy.

American Medical Association

"Our AMA… opposes, the use of 'reparative' or 'conversion' therapy that is based upon the assumption that homosexuality per se is a mental disorder or based upon the a priori assumption that the patient should change his/her homosexual orientation."
H-160.991, Health Care Needs of the Homosexual Population.

American Psychiatric Association

"Psychotherapeutic modalities to convert or 'repair' homosexuality are based on developmental theories whose scientific validity is questionable. Furthermore, anecdotal reports of "cures" are counterbalanced by anecdotal claims of psychological harm. In the last four decades, "reparative" therapists have not produced any rigorous scientific research to substantiate their claims of cure. Until there is such research available, [the American Psychiatric Association] recommends that ethical practitioners refrain from attempts to change individuals' sexual orientation, keeping in mind the medical dictum to first, do no harm.

The potential risks of reparative therapy are great, including depression, anxiety and self-destructive behavior, since therapist alignment with societal prejudices against homosexuality may reinforce self-hatred already experienced by the patient. Many patients who have undergone reparative therapy relate that they were inaccurately told that homosexuals are lonely, unhappy individuals who never achieve acceptance or satisfaction. The possibility that the person might achieve happiness and satisfying interpersonal relationships as a gay man or lesbian is not presented, nor are alternative approaches to dealing with the effects of societal stigmatization discussed.

Therefore, the American Psychiatric Association opposes any psychiatric treatment, such as reparative or conversion therapy which is based upon the assumption that homosexuality per se is a mental disorder or based upon the a priori assumption that the patient should change his/her sexual homosexual orientation."
Position Statement on Therapies Focused on Attempts to Change Sexual Orientation (Reparative or Conversion Therapies).

American Psychoanalytic Association

“As with any societal prejudice, bias against individuals based on actual or perceived sexual orientation, gender identity or gender expression negatively affects mental health, contributing to an enduring sense of stigma and pervasive self-criticism through the internalization of such prejudice.

Psychoanalytic technique does not encompass purposeful attempts to ‘convert,’ “repair,” change or shift an individual’s sexual orientation, gender identity or gender expression. Such directed efforts are against fundamental principles of psychoanalytic treatment and often result in substantial psychological pain by reinforcing damaging internalized attitudes.”
Position Statement on Attempts to Change Sexual Orientation, Gender Identity, or Gender Expression.

American Psychological Association

"THEREFORE, BE IT RESOLVED, That the American Psychological Association affirms that same-sex sexual and romantic attractions, feelings, and behaviors are normal and positive variations of human sexuality regardless of sexual orientation identity;

BE IT FURTHER RESOLVED, That the American Psychological Association reaffirms its position that homosexuality per se is not a mental disorder and opposes portrayals of sexual minority youths and adults as mentally ill due to their sexual orientation;

BE IT FURTHER RESOLVED, That the American Psychological Association concludes that there is insufficient evidence to support the use of psychological interventions to change sexual orientation;

BE IT FURTHER RESOLVED, That the American Psychological Association encourages mental health professionals to avoid misrepresenting the efficacy of sexual orientation change efforts by promoting or promising change in sexual orientation when providing assistance to individuals distressed by their own or others' sexual orientation…"
Resolution on Appropriate Affirmative Responses to Sexual Orientation Distress and Change Efforts.

American School Counselor Association

"Lesbian, gay, bisexual, transgendered and questioning (LGBTQ) youth often begin to experience self-identification during their pre-adolescent or adolescent years, as do heterosexual youth. These developmental processes are essential cognitive, emotional and social activities, and although they may have an impact on student development and achievement, they are not a sign of illness, mental disorder or emotional problems nor do they necessarily signify sexual activity.

The professional school counselor works with all students through the stages of identity development and understands this development may be more difficult for LGBTQ youth. It is not the role of the professional school counselor to attempt to change a student's sexual orientation/gender identity but instead to provide support to LGBTQ students to promote student achievement and personal well-being."
The Professional School Counselor and LGBTQ Youth.

American School Health Association

“[T]he American School Health Association . . . expects that comprehensive sexuality education in schools will be scientifically accurate and based on current medical, psychological, pedagogical, educational and social research . . . [and recommends] that teachers be well-trained and competent to teach sexuality education as defined by . . . insight into and acceptance of their own personal feelings and attitudes concerning sexuality topics so personal life experiences do not intrude inappropriately into the educational experience.”
Quality Comprehensive Sexuality Education.

National Association of Social Workers

"People seek mental health services for many reasons. Accordingly, it is fair to assert that lesbians and gay men seek therapy for the same reasons that heterosexual people do. However, the increase in media campaigns, often coupled with coercive messages from family and community members, has created an environment in which lesbians and gay men often are pressured to seek reparative or conversion therapies, which cannot and will not change sexual orientation. Aligned with the American Psychological Association's (1997) position, NCLGB [NASW's National Committee on Lesbian and Gay Issues] believes that such treatment potentially can lead to severe emotional damage. Specifically, transformational ministries are fueled by stigmatization of lesbians and gay men, which in turn produces the social climate that pressures some people to seek change in sexual orientation. No data demonstrate that reparative or conversion therapies are effective, and in fact they may be harmful."
Position Statement, "Reparative" and "Conversion" Therapies.

Pan American Health Organization (PAHO): Regional Office of the World Health Organization

Services that purport to "cure" people with non-heterosexual sexual orientation lack medical justification and represent a serious threat to the health and well-being of affected people, the Pan American Health Organization (PAHO) said in a position statement launched on 17 May, 2012, the International Day against Homophobia. The statement calls on governments, academic institutions, professional associations and the media to expose these practices and to promote respect for diversity.
Statement, "Therapies" to change sexual orientation lack medical justification and threaten health.

Just the Facts Coalition  (American Academy of Pediatrics, American Association of School Administrators, American Counseling Association, American Federation of Teachers, American Psychological Association, American School Counselor Association, American School Health Association, Interfaith Alliance Foundation, National Association of School Psychologists, National Association of Secondary School Principals, National Association of Social Workers, national Education Association, School Social Work Association of America)

“The most important fact about 'reparative therapy,' also sometimes known as 'conversion' therapy, is that it is based on an understanding of homosexuality that has been rejected by all the major health and mental health professions. The American Academy of Pediatrics, the American Counseling Association, the American Psychiatric Association, the American Psychological Association, the National Association of School Psychologists, and the National Association of Social Workers, together representing more than 477,000 health and mental health professionals, have all taken the position that homosexuality is not a mental disorder and thus there is no need for a 'cure.'”
Just the Facts About Sexual Orientation and Youth: A Primer for Principals, Educators, and School Personnel.