FAQ

What is “conversion therapy”?

“Conversion therapy” is a term broadly applied to any sort of effort to explore change in same-sex attractions, desires, behavior, and identification, as well as efforts to align one’s gender identity and/or gender expression with biological reality and social norms. It is a misleading and inaccurate term for several reasons.

· It carries connotations of abusive and unethical practices, such as “electroshock” therapy, using shame and other forms of aversive techniques, and coercion as if it is a practice being imposed (or “perpetrated”) on unwitting clients who are being forced or manipulated into receiving treatment.

· The label of “conversion therapy” is used so broadly that it is applied to any form of change-exploring efforts, ranging from professional psychotherapy to religious interventions (such as pastoral care or group ministry) and self-help (such as reading books or personal prayer). Most of these efforts are not psychotherapy at all, thus making the term “conversion therapy” a misnomer.

· The term relies on the idea that social constructs like “sexual orientation” and “gender identity” are biologically innate and immutable (unchangeable), or at the very least, essential to one’s identity. Therefore, any efforts to explore the potential for change in one’s sexual feelings and gender self-concept are deemed attempts to change someone categorically from one type of “orientation” or “gender identity” to another, and are considered successful only if categorical levels of change are achieved.

· Furthermore, the use of the word “conversion,” so often used in the context of religious conversion, seems to be exploited by anti-therapy activists to misrepresent change-exploring psychotherapy as a religious practice, and thus not professional psychotherapy (bolstered by the use of phrases like “pray the gay away”). This enables activists to easily conjure up images in the public’s mind of bizarre (and sometimes harmful) religious practices or approaches, influencing people to view psychotherapy for sexuality and gender as pseudoscience and quackery.

· The term “conversion therapy” does not actually describe any particular approach or psychotherapeutic practice (for example, behaviorist approaches that use aversion and counter-conditioning). So, efforts to ban or outlaw “conversion therapy” are essentially banning a client’s goal in therapy, rather than specific harmful or ineffective approaches that may have been used in the past or could be used by certain providers. Critics of change-exploring therapies are not interested in determining best practices for therapeutic approaches in exploring changes in sexuality and gender identification; they are opposed to the goals themselves, no matter the approaches used.

Which terms are more accurate?

Mental health professionals who provide therapy to explore changes in unwanted same-sex attraction, behavior, and identification, or to explore resolution of gender identity discordance, do not refer to themselves as “conversion therapists” (neither do those who use religious ministry, pastoral care, group work, coaching, or self-help approaches). These mental health providers may prefer a range of alternate terms, such as change-allowing therapy, change-oriented therapy, or most commonly, change-exploring therapy. In 2016, the Alliance for Therapeutic Choice and Scientific Integrity adopted the designation SAFE-T (sexual attraction fluidity exploration in therapy), a term exclusive to psychotherapeutic approaches (as opposed to pastoral or self-help approaches) but inclusive of any application of mainstream psychotherapy to explore change in sexual attractions.

Reparative Therapy is often unfairly used synonymously with “conversion therapy.” However, Reparative Therapy was a specific therapeutic approach developed by the late Joseph Nicolosi, who named it based on the reparative drive theory to explain male homosexual inclinations. It is more accurate to understand Reparative Therapy as a subtype of SAFE-T or change-exploring therapy, rather than as representative of all forms of such therapies.

Please note: the American Psychological Association has used the term SOCE (sexual orientation change efforts), which has been adopted into certain laws. Opponents have broadened SOCE to include efforts to explore change in “gender identity” and “gender expression” by using SOGICE or SOGIECE. Like “conversion therapy,” SOCE, SOGICE, and SOGIECE are labels imposed upon practitioners. Therefore, most therapists do not prefer these labels, though some may use them as a readily recognizable shorthand when publishing research or other articles.

What actually happens in change-exploring therapy?

Change-exploring therapists generally do not hold to the dogma that “sexual orientation” is divided into distinct, biologically determined categories, nor would they hold that a mental conception of one’s “gender identity” is intrinsic to one’s identity. Therefore, it would be inaccurate to assert that these professionals are attempting to “convert” clients from one particular “sexual orientation” to another, nor from one “gender identity” to another. Rather, change-exploring therapists see change in terms of degrees of shifts along a continuum for each domain of client concerns: the sexual (or gender-related) thoughts, feelings (arousal, desire), behavior and relationships, and identification labels.

Change-exploring therapies are not uniform. Therapists willing to help clients with sexuality and gender identity differences bring their existing therapeutic approaches into these cases, using the same techniques they would for issues like anxiety or addiction. Each therapy model has its own focus, understanding of human nature and psychological problems, and interventions. For example:

· Psychodynamic and other depth psychology therapists would be interested in exploring the client’s upbringing, family of origin, and early life experiences to gain insight into current emotions, attractions, and ways of relating between self and others. They tend to use the dynamic in the therapeutic relationship to resolve unconscious conflicts and motivations.

· Trauma-informed therapists may have similar theories as the depth psychologists, but they will be further trained in memory reprocessing interventions to heal the emotional roots of the client’s concerns. They may also employ forms of mindfulness, body work, and cognitive-behavioral skills to train the client in self-regulation of emotional states.

· Psychodrama and other experiential therapists will employ controlled dramatizations of internalized interpersonal dynamics, usually in a group setting, in order to gain insight and heal emotional memories.

· Group therapists, in general, focus on meeting unmet developmental and social needs through deeply engaging relationships (either with individuals who share the same sexuality conflicts or those with other life issues but who demonstrate acceptance in the larger world of the person’s gender).

· Cognitive-behavioral therapists will tend to focus on changing conscious thoughts and behaviors, using counter-conditioning strategies to fortify the client’s resolve to adhere to personal convictions despite any persistent unwanted arousal and attractions.

· Person-centered and narrative therapy strategies honor the client’s agency in choosing the scripts and social constructs that reflect personal values and sense of self.

Change-exploring therapy for sexuality or gender is not intrinsically religious. However, it is more common to find such therapy among religious clinicians. Change-exploring therapists may integrate mainstream therapy with their personal religion, or they may practice psychotherapy without reference to their own or the client’s religious faith and practice.

One commonality all ethical change-exploring therapists share is respect for the client’s right to choose his/her therapeutic goals. This principle (expressed as client autonomy or self-determination) is one supposedly upheld by the ethics codes of all the helping professions. Even in cases in which the client is a minor, ethical change-exploring therapists respect the client’s right to choose his/her own therapy goals and would not impose goals or values upon the client or serve as a proxy for the parents. Or the therapist would consider the family unit itself the client and focus efforts on increasing healthy communication, respect for individual boundaries and parental authority, and emotional need-fulfilment within the family system. (Note: The concerted efforts to ban therapeutic choice are violations of client rights and parental rights. Anti-therapy activists justify the injustice of their bans by claiming that all forms of change-exploring therapies are innately harmful and ineffective.)

But is it coercive or harmful?

No, in ethical change-exploring therapy, the client identifies his/her own areas of concern and goals. The client and therapist collaborate in developing the treatment plan, and the client gives informed consent. The therapist makes no guarantees about the outcome of therapy, explaining the risks and responsibilities of both therapist and client.

Furthermore, testimonies of harm by so-called “conversion therapy survivors” often have reasons for scrutiny. Though the practice in question is generally professional psychotherapy, the stories of harm often occur more in the individual’s non-affirming home or place of worship. Ethical change-exploring therapists are often punished for deeds they did not commit. Certain activists have testified in court or before the legislature with stories that were later proven to be fabricated or at least lacking evidence.[1]

What about “scientific consensus”?

Claims of harm by activists and legislators are not based on methodologically definitive evidence. There is no evidence-based consensus against change-exploring therapies. Most cited studies utilize biased samples, are cross-sectional and thus cannot determine causality (meaning the studies involved all forms of change efforts, so we cannot determine if the reports of harm are associated with psychotherapeutic efforts), are conducted by researchers and organizations ideologically committed to therapy bans, and are conceptually underspecified such that the reliability and generalizability of findings are suspect. Recruitment for studies claiming harm or inefficacy overwhelmingly occurs in spaces specifically for those who identify as LGBTQ+. Such studies typically ignore individuals who are most likely to report positive experiences of change exploration, i.e., those who have experienced same-sex attraction or gender confusion and have never or do not now identify as LGBT+. This is analogous to assessing the benefits and harms of marital therapy by researching only individuals recruited through divorce support groups.

It is important to be aware that, though some studies report evidence of harm or lack of benefit from forms of change-exploring therapy, there are just as many that report the opposite, despite efforts in the journal publishing world to thwart studies that provide evidence of the helpfulness of change-exploring therapies. We encourage readers to peruse this website to better inform themselves of the science.

How does this relate to free speech?

Talk therapy is pure speech protected by the First Amendment, not regulable conduct, per precedents like NIFLA v. Becerra. Banning one viewpoint (exploratory talk therapy) while allowing LGBTQ+ affirmative talk therapy created a federal appeals court split needing U.S. Supreme Court resolution, noted in the Chiles v. Salazar decision, declaring bans on speech-based therapy unconstitutional.

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[1] See: https://www.wnd.com/2013/03/transgendered-woman-lies-about-therapy-torture/, The War on Psychotherapy: When Sexual Politics, Gender Ideology, and Mental Health Collide, May 28, 2019, by Christopher Doyle MA/LPC/LCPC, https://ruthinstitute.org/dr-j-show/susan-constantines-evaluation-of-sam-brinton/, and https://nypost.com/2023/02/19/family-claims-sam-brinton-lied-about-abuse-conversion-therapy/

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