Conversion Therapy – Part 2: Where It Stands Today

News Flash – It’s Still Being Practiced. Why?

Conversion therapy persists to this day, despite the fact that the APA declassified homosexuality as a mental illness, removing it from the DSM in 1973. The practice continues despite the 2003 Lawrence v. Texas decision making homosexual activity legal in every U.S. state and territory. California, Connecticut, Delaware, Hawaii, Illinois, Maryland, Massachusetts, New Jersey, New Hampshire, New Mexico, New York, Nevada, Oregon, Rhode Island, Vermont, Washington, the District of Columbia, and Puerto Rico all have laws or regulations that protect minors from attending sessions. Enacting these policies makes good sense given the fact that conversion therapy has led to depression, anxiety, drug use, homelessness, and suicide among our youth. Still, these laws do not restrict the practice among religious providers. Adults who have undergone conversion therapy experience long-term effects such as depression, suicidal ideation, anxiety, relationship dysfunction, sexual dysfunction, and de-masculinization.

[ READ: Conversion Therapy Part 1: Where It Comes From ]

So why does this fringe therapeutic practice persist? Because the belief that homosexual behavior is “wrong” still persists; And, this belief is most certainly not considered “fringe”. Imagine for a moment, that you *truly believe* that someone will go to hell, and *you* have the ability to save them. Vividly imagine this. Why wouldn’t you try everything you possible could to save them? Regardless of the liberalization of western society that continues to shift around you, you are focused on the salvation of one or more souls from eternal damnation. Who cares what the courts say right now? If you can empathize and perspective take, then it should be no surprise at all that conversion therapy is still being practiced, albeit out of the mainstream.

What Happens in Conversion Therapy Today?

About 700,000 LGBTQ+ adults in the U.S. have received conversion therapy at some point in their lives. The entire premise of the practice stems from the “axiomatic” claim that homosexual behavior is wrong. In reparative therapy, homosexuality is seen as an adaptation to trauma. However, the mainstream psychotherapeutic community take the position that conversion therapy is ineffective, unethical and often harmful. It has the potential to exacerbate anxiety and self-hatred among those treated.

Gone are the days of estrogen treatments, chemical castrations, and electroconvulsive therapy. These have been replaced by talk therapy that emphasizes pseudoscientific theories like, “Your overbearing mother and/or distant father made you gay as a child.” Treatment methods include prayer, secluding individuals from the larger community, fostering nonsexual male bonding, and masturbatory reconditioning – in a 2012 New York Times piece, one consumer of conversion therapy reported that his therapist asked him to strip down and touch himself to “reconnect with his masculinity.”

Because conversion therapy has become largely discredited by mainstream culture, churches have adapted and taken the practice to covert facilities, known as camps, to administer treatment to members of their community. Conversion camps are primarily located in rural areas and conservative states. If you haven’t seen it, I strongly recommend watching Vice’s piece on the subject.

 

Organizations Across Disciplines Oppose Conversion Therapy

The following organizations oppose conversion/reparative therapy:

• American Academy of Child Adolescent Psychiatry – “The American Academy of Child and Adolescent Psychiatry finds no 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. As a result, “conversion therapies” should not be part of any behavioral health treatment of 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.”

 

• 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.”

• American College of Physicians – “The College opposes the use of “conversion,” “reorientation,” or “reparative” therapy for the treatment of LGBTQ persons.”

• 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.”

• 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.”

 

• American Psychiatric Association – … In 1997, APA produced a fact sheet on homosexual and bisexual issues, which states that “there is no published scientific evidence supporting the efficacy of “reparative therapy” as a treatment to change one’s sexual orientation.” The potential risks of “reparative therapy” are great and include 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 are not presented, nor are alternative approaches to dealing with the effects of societal stigmatization discussed… Therefore, APA opposes any psychiatric treatment, such as “reparative” or “conversion” therapy, that is based on the assumption that homosexuality per se is a mental disorder or is based on the a priori assumption that the patient should change his or her homosexual orientation.

 

• 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.”

 

• 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…”

 

• 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.”

 

• 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.”

 

• 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.”

 

• 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.

 

• 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”.”

All major medical associations agree that LGBTQ+ identities are a normal variant of human nature. On the other side of the argument? Supporters of conversion therapy cherry-pick the research that has been conducted, and often point to a single study to support the practice. In 2003, Robert Spitzer, the psychiatrist who spearheaded the removal of homosexuality from the DSM, reported in the journal Archives of Sexual Behavior, that interviews with conversion therapy patients suggested that some people could change their sexual orientation. He has since apologized for his reparative therapy study.

I have waited far too long to write about this subject. This Pride Month, I reflect on the progress made, and the progress needed. According to the FBI, in their 2017 Hate Crime Statistics report, attacks against members of the LGBTQ+ community are up 5% over previous years. I will continue to stand with those on the right side of history as a straight ally. And, I will also try to open up conversations that need to be had by people who deeply disagree with one another. It’s one of my skills as a therapist. Finally, there are a lot of folks out there who need help. If you, or someone you know needs immediate help, CALL, CHAT, or TEXT The Trevor Project.

In solidarity – #Pride2019

Robin S. Smith, MS, LCMFT is a Licensed Marriage and Family Therapist in clinical practice in Bethesda MD, and specializes in relationship issues for couples, families, and individuals, for improved quality of life. His clinical specialties include: transition to parenthood for new and expecting parents, infidelity, sex and intimacy issues, premarital counseling, and trauma. Robin has given talks to various groups including hospital administrators, graduate students, therapists, and child birth educators. He is the primary contributor to The Couple and Family Clinic Blog.