Conversion Therapy: Understanding The Evidence-Based Dangers

Therapy can be a crucial and valuable resource for people living with mental health conditions. As society gains a better understanding of mental health, individuals may better recognize why therapy and types of therapeutic intervention can be helpful. Similarly, as society learns more about sexual orientation, gender identity, and gender expression, levels of acceptance, understanding, and inclusivity may increase.

If you are a loved one of someone who identifies as lesbian, gay, bisexual, transgender, queer/questioning, intersex, or asexual (LGBTQIA+, often referred to simply as LGBTQ), your acceptance and support may be imperative for your loved one's mental health. There are many positive, healthy ways to support the LGBTQ community, but there are also some dangerous practices.

One of these dangerous practices is called conversion therapy, which is not an officially recognized therapy or psychiatric treatment. Conversion therapies lack scientific credibility and do not work, regardless of sexual orientation identity, gender expression, gender identity, or other components of human sexuality and human development. Sexual orientation change efforts are ineffective, have no medical justification, are not recommended by health care providers, and can do more harm than good for patients who have experienced conversion therapy. 

LGBTQ youth may be encouraged to undergo conversion therapies under the misguided notion that their identities are still "in formation" and they can adjust their sexual orientation or gender identity. However, it’s important to note that young people aren't the only ones who might be targeted for experiencing conversion therapy. People of all ages may be urged to change their sexual orientation, gender identity, or pronouns.

Most American psychological associations condemn conversion practices. The American Psychiatric Association issued a formal statement that opposes conversion therapy and similar interventions, stating, "no credible evidence exists that any mental health intervention can reliably and safely change sexual orientation; nor, from a mental health perspective, does sexual orientation need to be changed." 

Conversion therapy refers to psychological interventions aimed at changing an individual's sexual orientation, gender identity, or gender expression. For example, conversion therapy may involve efforts to change a person's sexual orientation from homosexual or bisexual to heterosexual.

Conversion therapy may also focus on changing a person's gender identity from transgender or non-binary to cisgender (the gender that matches the sex a person was assigned at birth). Therapies focused on changing sexual orientation, gender identity, and gender expression lack scientific credibility and can harm LGBTQ individuals who have received conversion therapy. 

Other terms for conversion therapy

Conversion therapy may be referred to by other names, such as:

• Reorientation therapy 
• Sexual orientation change efforts (SOCE) 
• Sexual attraction fluidity exploration in therapy (SAFE-T)
• Gender identity change efforts
• Ex-gay therapy 
• Sexuality counseling
• Gender expression therapy
• Encouraging relational and sexual wholeness
• Religious purity-based therapy 

Another common term for conversion therapy is "reparative therapy," viewed as trying to "repair" gender identity, sexual orientation, or gender expression.

Sexual identity is not a trait that needs to be changed or "repaired." Sexual orientation, gender expression, and gender identity are not mental health disorders and are not included in the Diagnostic and Statistical Manual of Mental Disorders.

Sometimes religious or other groups use different terms for conversion efforts, sometimes referring to such practices as “spiritual methods.” No matter what term is used for conversion therapies, the scientific literature consistently shows that such interventions do not work for changing sexual orientation, gender identity, or gender expression.  "Reparative therapy" (and other identity change efforts) can be significantly harmful.

In addition to the ineffectiveness and possible dangers of reparative therapies, these practices are not typically guided by licensed mental health professionals and often involve the use of unmonitored methods unsupported by evidence. 

Strong opposition and rejection of conversion therapy by mental health professionals

The APA and numerous other mental health, therapy, and medical associations have stated that no gender identity, sexual expression, or sexual orientation are mental health disorders, nor do they require conversion or repair. Conversion therapies are not recognized by the American Psychiatric Association, American Psychological Association, or the American Medical Association for anyone of any sexual orientation, gender identity, or gender expression. The Human Rights Campaign and the Pan American Health Organization warn against the lies and dangers of undergoing conversion therapy with supporting research. The American School Health Association, the National Association of Secondary School Principals, the American Association for Marriage and Family Therapy, and the National Association of Social Workers vocally oppose the idea that homosexuality is a mental disorder, oppose conversion therapy, and advocate for a safe, inclusive environment for LGBTQ+ individuals.

Additionally, the US Department of Health and Human Services emphasizes that sexual orientation and gender identity are not mental illnesses and do not warrant mental health interventions or therapy. Many states and US jurisdictions have passed bills or resolutions to ban conversion therapy. Many other countries and municipalities also have laws that prohibit conversion therapy.

However, 21 states in the US do not have a ban on conversion therapy, and these practices may still take place in those locations. If you are being forced to undergo conversion therapy against your will, LGBTQ resource pages may be able to help you. 

Research shows that the risk of developing adverse mental health outcomes, including depression, increased substance use, suicide attempts, and other serious concerns, is significantly higher for those who have undergone conversion therapy (if you or a loved one is experiencing thoughts of suicide, you can reach out to the National Suicide Prevention Lifeline by calling 988). 

Additionally, people whose families or religious groups support conversion therapy may feel rejected or hurt. When a person's community believes in conversion therapy, the belief may send a message that any gender identity, sexual orientation, or gender expression that is different from what the community views as "mainstream" is a mental health disorder in need of treatment. 

Same-sex attraction, bisexual sexual orientation, gay or transgender identity, or being LGBTQ does not lead to mental health problems. However, experiencing homophobia, transphobia, and other messages that invalidate one’s identity may lead to depression or other adverse mental health outcomes. The World Health Organization notes that people who identify as LGBTQ are also at higher risk for experiencing sexual assault and sexual abuse, which can lead to trauma-related mental health symptoms. 

A person who is LGBTQ may feel shame about their identity when their community sends them a message that they need to change or "be repaired." They may also experience fractured relationships or broken religious connections resulting from the non-acceptance of their identity and the pressure placed on them to undergo conversion therapy.

Conversion therapy still happens around the world. There is no clear justification for conversion therapy. Still, research shows that approximately 700,000 lesbian, gay, bisexual, and transgender adults underwent conversion therapy at some point in their lives. There may be several reasons why this practice is still used worldwide. 

Conversion therapy may occur because people are uncomfortable with gender identities, gender expressions, and others’ sexual orientations that do not match their own. They may not understand why someone else would desire something they do not want, such as a same-sex relationship or a gender-affirming surgery. 

Some parents may believe that the best way to help their children thrive and survive is to help them to “fit in” with peers. Fearing societal stigmatization discussed earlier, parents may believe they are genuinely helping their children through conversion therapy by trying to make their child become more “normal”. 

Religion may be one of the top motivations behind conversion therapy. Studies show that religion-based trauma is common when someone experiences conversion therapy. Religions may state that a person’s sexuality or gender identity is a "sin" or runs counter to religious texts or practices. However, there are also religious organizations and resources that support the LGBTQ community. 

Understanding gender identity and gender expression

Some people or groups may believe conversion therapy can change those whose gender identity doesn't align with their birth gender. However, this practice will not change anyone’s gender identity or gender expression and can cause harm.

If you want to support a loved one who is gender non-conforming, it may help to gain a greater understanding of gender identity. Gender and human sexuality are multi-dimensional and exist on a broad spectrum. 

Gender identity is not the same as sexual orientation or gender expression. Gender identity is considered a social construct—an idea that gender comes with expectations. For instance, male gender identity may be associated with certain societal expectations of dressing, talking, feeling, and interacting like a stereotypical man.

Society has defined gender roles related to gender identity—what it means to be female or male, a girl or boy, a man or woman. However, there are many ways that people may express gender identity and genders outside of the constructs of man and woman. Gender identity is a personal sense of what your gender is.

According to the American Psychiatric Association, gender expression is the expression of one's gender identity through appearance and behaviors. Gender expression is different from sexual orientation and gender identity. Gender expression is often defined by society as feminine or masculine.

Someone who is transgender or non-binary may decide to undergo gender-affirming surgery or take hormone medication to change their body, which may be part of their gender expression. They may also use androgynous, feminine, or masculine styles. 

The American Psychiatric Association describes gender dysphoria as psychological distress resulting from one's gender identity not matching the sex assigned at birth. If a person is experiencing gender dysphoria, they may benefit from the support of a licensed mental health professional.

Someone experiencing gender dysphoria may have the following symptoms:  

• Discomfort looking at their body
• A feeling of not having the "right" genitals 
• A feeling that their body is "bad" or "wrong" 
• A feeling that they want to remove or hide a part of their body to feel more comfortable 
• A desire to look like someone else of a different gender 
• Feeling that their body or assigned gender does not match their true gender 

Conversion therapy attempts are often not helpful for gender dysphoria, but helping patients explore their feelings and experiences of gender identity and gender expression through talk therapy may be. 

How to support gender diversity

What can you do to be supportive of gender identity diversity? You may choose to show respect for others. For example, if someone has told you what pronouns they use, try to make every effort to use those pronouns. It may feel confusing at first, but learning a new word or way of speaking can be possible, and studies show that using someone's pronouns correctly can improve their mental well-being. Positive and accepting interpersonal relationships can also benefit LGBTQ individuals.

You might also try paying attention, without judgment, to how a person refers to themselves regarding their specific sexual orientation and gender identity. For instance, do they call themselves a boy or a girl? Do they refer to themselves as trans, non-binary, or another label? 
Make genuine efforts to avoid misgendering people. Misgendering can include using incorrect pronouns or forms of address for a person. If you mistakenly misgender someone, sincerely apologize and try to be more mindful of respecting the person's gender identity in the future. Purposefully misgendering a person can be hurtful.

Remember that gender and human sexuality cannot always be readily perceived. Someone's gender identity may be fluid, or they may not want to specify a gender identity. Some individuals may be intersex or transgender, and you may not know how they identify. Gender identity can be personal.

Your local mental health services administration or a local LGBTQ task force may have helpful resources for best practices to support people in the LGBTQ community. You might also try to spread understanding and best practices by joining a task force or group to promote LGBTQ inclusivity. Your school, workplace, or community may have a group, or you could spearhead forming one. A safety-related task force can also help promote a safe environment. The Human Rights Campaign offers resources and information regarding supporting LGBTQ individuals, their loved ones, and their greater community.

Understanding sexual orientation

According to the American Psychological Association, sexual orientation is an "enduring pattern of emotional, romantic, or sexual attraction to men, women, or both sexes." Sexual orientation may also refer to a person's sense of identity based on those patterns. 

Sexual orientation is often spoken of in labels. Some common sexual orientation labels include:

• Heterosexuality: Romantic or sexual interest in genders other than your own 
• Bisexuality: Romantic or sexual interest in the same gender as your own and genders other than your own  
• Homosexuality: Same sex sexual orientation. Romantic or sexual interest in the same gender as your own 
• Asexuality: Not experiencing sexual attraction (may experience sexual desire or romantic attraction)
• Queer: Some individuals choose to identify with the umbrella label of "queer" to mean someone who identifies as a member of the LGBTQ community 

It’s important to note that many individuals may identify with a label that is not on this list.

According to experts, sexual orientation cannot be voluntarily changed. Some individuals might try to hide their sexual orientation. Homosexual and bisexual issues can sometimes include feelings of shame, especially if the person was exposed to homophobia as a child. Conversion therapy may reinforce this shame and harm their mental health.

The adolescent stage of human development is often when people begin to discover and question their sexual orientation or gender identity. They may become begin sexual attraction fluidity exploration or want to learn more about LGBTQ issues, topics, identities, and personal feelings.       

Families or religious groups may feel they can "form" or influence a young person's particular sexual orientation or sway one's gender identity. They may attempt to use the practice of conversion therapy to try to intervene as LGBTQ youth explore or express their identity. 

LGBTQ youth-related problems often involve rejection, discrimination, and bullying. Acceptance and support at school may benefit LGBTQ+ youth who are facing these issues. Inclusive school and after-school programs may open the doors to more children. Many schools have established a task force to develop inclusive, welcoming, and safe measures for sexual minority youths. Some schools have a GSA (gay-straight alliance) club where individuals of all sexual and gender identities can support each other in a safe environment. School psychologists may also be valuable allies for LGBTQ+ students. According to the National Association of School Psychologists, school psychologists are ethically required to promote “a school climate that is safe, accepting, and respectful of all persons and free from discrimination, harassment, violence, and abuse”.

There are many ways to support the mental and physical health of those who identify as LGBTQ, without conversion therapy, sexual orientation change efforts, reparative therapy, or similarly harmful interventions. Satisfying interpersonal relationships, for example, may support emotional health and well-being.

Additionally, therapy methods that are research-based and offered by a licensed mental health professional may be beneficial for LGBTQ people who may be experiencing negative mental health symptoms. It’s important to note that mental health services are not necessary for someone based solely on their sexual orientation, gender identity, or gender expression. However, if someone is experiencing a mental health condition, therapy can be helpful.
An individual's LGBTQ identity does not mean they have or will have a mental disorder. However, some LGBTQ people may face increased challenges that can harm their mental health. For example, they may experience the following:

• Rejection 
• Discrimination
• Trauma
• Harassment 
• Labeling
• Stereotyping
• Bullying
• Assault
• Abuse (verbal, emotional, physical, or sexual)
• Hate crimes 
• Fear of hate crimes or being harmed based on their identity 

Conversion therapy, reparative therapy, and attempts to change sexual orientation offer little or no potential defense against these dangers, and in fact can reinforce them. However, there are legitimate, positive ways to support the safety of LGBTQ people.

To support the mental health of LGBTQ people, the National Alliance on Mental Illness has several helpful suggestions. Satisfying interpersonal relationships with loved ones, families, friends, and allies in the community can play a critical, positive role in supporting the mental wellness of LGBTQ people, according to research conducted by San Francisco State University.

First, respecting and affirming sexual orientation, gender identity, and gender expression can foster a sense of acceptance. Being publicly supportive can also be helpful, as can using respectful language and terminology regarding sexual orientation and gender identity. 

Rejecting harmful practices, such as conversion therapies and other efforts to change an individual's sexual orientation and gender identity, can show LGBTQ individuals that you care about their safety, well-being, and human rights.