Conversion therapy (sexual orientation and gender identity change efforts)
Any effort to change a person’s sexual orientation toward heterosexual, or a gender identity toward the sex assigned at birth, whether through talk therapy, religious counseling, prayer groups, aversion methods or family pressure. Some people seek it themselves, often from religious conviction. Others are sent by parents or leaders.
What drives it
Change efforts start from the premise that same-sex attraction or a trans identity is a problem to fix. When the attraction stays, which the APA task force found to be the likely result, the person may read the failure as their own and add shame to the original conflict. For identification it helps a person place lasting distress that dates from a program, a counselor or a family campaign.
How it shows
Work
Years later, steering clear of any job linked to the church or school where it happened. Tensing at a training session when a speaker talks about ‘struggling with same-sex attraction’.
Relationships
Parents who arranged the sessions and now never mention them. A marriage entered after a program declared someone ‘healed’. Trouble trusting any counselor afterward.
Self
Notice whether phrases from the program still run in your head, and what you feel about yourself when your attractions show up.
What tells it apart
Conflict between faith and sexual orientation or gender identity: Faith conflict is the tension itself, and change efforts are one response to it. Religious people also take other paths, such as celibacy, a different congregation or holding both identities, and the APA task force asked therapists to respect religious beliefs while supporting exploration without a set outcome.
Trauma (big T and small t): Some people describe a change program as traumatic, especially where aversion methods, isolation or coercion were used. Others describe it as unhelpful or confusing. Trauma may be the better lens when intrusive memories, avoidance and fear are tied to it.
Internalized homophobia (internalized stigma): Internalized homophobia can lead someone to seek change, and the program’s messages may deepen it afterward. The two often occur together, and the self-criticism may date from before or after the program.
A test
Ask the person what they were told would happen, what happened to their attractions, and how they explained the gap to themselves. Lasting self-blame for an outcome the research suggests is the common one may point to harm from the effort itself.
Questions to carry
- What was I told would happen to my attractions, and what happened?
- Whose words from that time do I still hear when I think about myself?
How strong the research is
moderate. An American Psychological Association task force reviewed 83 peer-reviewed studies from 1960 to 2007 (2009). It found insufficient evidence that efforts to change sexual orientation work, few methodologically sound studies and none that systematically measured harm, though some qualitative research suggested the potential for harm. Robert Spitzer, whose 2003 study of 200 people reported change, wrote in 2012 that there had been no way to judge whether their accounts were valid, and apologized to the gay community. In 1,612 current or former Latter-day Saints (Bradshaw and colleagues, 2015), fewer than 4% reported any change in core same-sex attraction, and 37% rated their change-oriented therapy moderately to severely harmful. In a US national sample of 1,518 sexual minority adults (Blosnich and colleagues, American Journal of Public Health, 2020), the 7% who had been through change efforts, most from a religious leader, had nearly twice the odds of lifetime suicidal thoughts after allowing for childhood adversity. Donald Sullins (2022) reanalyzed those data counting only suicidality that came after the change effort, found no raised risk, and argued the efforts may reduce later attempts. Judith Glassgold, who chaired the 2009 task force, and Douglas Haldeman disputed his reading (2023). In 27,715 transgender adults (Turban and colleagues, JAMA Psychiatry, 2020), recalled gender identity conversion efforts went with about twice the odds of lifetime suicide attempts. All of these studies are cross-sectional and rely on recall. A study that followed 98 people in Christian ministries for 6 to 7 years (Jones and Yarhouse, 2011) reported change for some and no average rise in distress, and its authors named sexual identity change or adjustment as other explanations.
Where it comes from
American Psychological Association, Report of the Task Force on Appropriate Therapeutic Responses to Sexual Orientation, 2009, chaired by Judith Glassgold. Robert Spitzer, ‘Spitzer reassesses his 2003 study of reparative therapy of homosexuality’, Archives of Sexual Behavior, 2012