The Lies and Dangers of Efforts to Change Sexual Orientation or Gender Identity
So-called “conversion therapy,” sometimes known as “reparative 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 for 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, Illinois, New Jersey, Oregon and the District of Columbia have passed laws to prevent licensed mental health providers from offering conversion therapy to minors, and more than 20 states have introduced similar legislation. In addition, New York State agencies have taken administrative action to protect LGBT youth by barring insurance coverage for the harmful practice and making it unlawful for state-licensed mental health providers to provide conversion therapy to minors. Oklahoma has introduced legislation which would specifically legitimize conversion therapy and immunize it from state oversight.
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 May of 2015 and again in February of 2016, the United States Supreme Court let stand decisions of the 3rd U.S. Circuit Court of Appeals upholding 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. Additionally, in June of 2015, the jury in that case found a conversion therapy provider liable for consumer fraud and ordered the provider to pay the plaintiffs for refunds and damages.
In February 2016, the Human Rights Campaign, National Center for Lesbian Rights, and Southern Poverty Law Center filed a consumer fraud complaint with the Federal Trade Commission (FTC) against People Can Change, a major provider of conversion therapy. The complaint alleges that People Can Change’s advertisements and business practices which claim they can change a person’s sexual orientation or gender identity constitute deceptive, false, and misleading practices and can cause serious harm to consumers, all in direct violation of Section 5 of the Federal Trade Commission Act. The complaint urges the FTC to take enforcement action to stop these deceptive practices and investigate all practitioners making similar claims.
Some right-wing religious groups promote the concept that an individual can change their sexual orientation or gender identity, either through prayer or other religious efforts, or through so-called "reparative" or "conversion" therapy. The 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 and gender identity. 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 conversion 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 conversion 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 conversion 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:
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.
World Psychiatric Association
“There is no sound scientific evidence that innate sexual orientation can be changed. Furthermore, so-called treatments of homosexuality can create a setting in which prejudice and discrimination flourish, and they can be potentially harmful (Rao and Jacob 2012). The provision of any intervention purporting to “treat” something that is not a disorder is wholly unethical.
WPA considers same-sex attraction, orientation, and behaviour as normal variants of human sexuality. It recognises the multi-factorial causation of human sexuality, orientation, behaviour, and lifestyle. It acknowledges the lack of scientific efficacy of treatments that attempt to change sexual orientation and highlights the harm and adverse effects of such “therapies”.”
WPA Position Statement on Gender Identity and Same-Sex Orientation, Attraction, and Behaviours
Government Positions on Conversion Therapy
Substance Abuse and Mental Health Services Administration
“Specifically, conversion therapy—efforts to change an individual’s sexual orientation, gender identity, or gender expression —is a practice that is not supported by credible evidence and has been disavowed by behavioral health experts and associations. Conversion therapy perpetuates outdated views of gender roles and identities as well as the negative stereotype that being a sexual or gender minority or identifying as LGBTQ is an abnormal aspect of human development. Most importantly, it may put young people at risk of serious harm”
Ending Conversion Therapy: Supporting and Affirming LGBTQ Youth
Valerie Jarrett, Senior Advisor to the President of the United States
“The overwhelming scientific evidence demonstrates that conversion therapy, especially when it is practiced on young people, is neither medically nor ethically appropriate and can cause substantial harm.
As part of our dedication to protecting America’s youth, this Administration supports efforts to ban the use of conversion therapy for minors….This Administration believes that young people should be valued for who they are, no matter what they look like, where they’re from, the gender with which they identify, or who they love.”
Response to Your Petition on Conversion Therapy
Andrew Cuomo, Governor of New York
“Conversion therapy is a hateful and fundamentally flawed practice that is counter to everything this state stands for. New York has been at the forefront of acceptance and equality for the LGBT community for decades – and today we are continuing that legacy and leading by example. We will not allow the misguided and the intolerant to punish LGBT young people for simply being who they are.”
Governor Cuomo Announces Executive Actions Banning Coverage of Conversion Therapy
Chris Christie, Governor of New Jersey
“…on issues of medical treatment for children we must look to experts in the field to determine the relative risks and rewards. The American Psychological Association has found that efforts to change sexual orientation can pose critical health risks including, but not limited to, depression, substance abuse, social withdrawal, decreased self-esteem and suicidal thoughts. I believe that exposing children to these health risks without clear evidence of benefits that outweigh these serious risks is not appropriate.”
Gov. Christie Signs Bill Banning Gay Conversion Therapy On Minors
Kate Brown, Governor of Oregon
"There are many things that young people need, but breaking them down based on their sexual or gender identity is not one of them — and in fact, it's inexcusable. Our young people deserve acceptance, support, and love. To the young people who question their identities, suffer from bullying, or struggle with what it means to come out, today is your day. Your voices have been heard."
Oregon Gov. Emotionally Signs Conversion Therapy Ban Into Law
Jerry Brown, Governor of California
"These practices have no basis in science or medicine and they will now be relegated to the dustbin of quackery."
Gov. Jerry Brown bans gay-to-straight therapy for minors