In January 2019, the New York State Legislature voted to ban “conversion therapy,” which seeks to change one’s sexual orientation or gender identity. Governor Andrew Cuomo signed the bill, making New York the 15th state to ban the practice. Later that month, The Washington Post reported that a federal magistrate judge recommended that a ban on conversion therapy in Tampa be partially blocked, arguing it violates therapists’ First Amendment rights to free speech.
So what even is conversion therapy?
A PBS NewsHour article described it as “the widely discredited practice intended to ‘cure’ an LGBTQ individual’s sexual orientation.” The Southern Poverty Law Center points out that this has also been referred to as “reparative” or “sexual reorientation” therapy. According to the National Center for Lesbian Rights, the practices used in conversion therapy have also been called “ex-gay therapy” or “sexual orientation change efforts,” or SOCE for short.
What do these practices include?
A 2009 report from the American Psychological Association documented how the practices used have varied and changed over the years:
The pathologizing psychiatric and psychological conception of homosexuality and concomitant efforts to alter sexual orientation through psychoanalytic and behavior therapy were prevalent through the 1960s and into the early 1970s. Although behavior therapy emerged in the 1960s, adding a different set of techniques to psychotherapy, the goals of SOCE did not change. For example, Ovesey (1969) based his behavioral interventions on the belief that homosexuality developed from a phobia of taking on the normal qualities of one’s gender and that sexual intercourse with the other20 sex would cure the so-called phobia.
Behavior therapists tried a variety of aversion treatments, such as inducing nausea, vomiting, or paralysis; providing electric shocks; or having the individual snap an elastic band around the wrist when the individual became aroused to same-sex erotic images or thoughts. Other examples of aversive behavioral treatments included covert sensitization, shame aversion, systematic desensitization, orgasmic reconditioning, and satiation therapy (Beckstead & Morrow, 2004; S. James, 1978; Katz, 1995; Langevin, 1983; LeVay, 1996; Murphy, 1992, 1997). Some nonaversive treatments used an educational process of dating skills, assertiveness, and affection training with physical and social reinforcement to increase other-sex sexual behaviors (Binder, 1977; Greenspoon & Lamal, 1987; Stevenson & Wolpe, 1960). Cognitive therapists attempted to change gay men’s and lesbians’ thought patterns by reframing desires, redirecting thoughts, or using hypnosis, with the goal of changing sexual arousal, behavior, and orientation (e.g., Ellis, 1956, 1959, 1965).
According to the National Center for Lesbian Rights, current techniques include “hypnosis, behavior and cognitive therapies, sex therapies, and psychotropic medication, among others.”
So are those the only parts of conversion therapy still in practice?
No, not necessarily. Sam Brinton, head of advocacy at The Trevor Project, wrote a piece for The New York Times in 2018 explaining the conversion therapy Brinton was subjected to as a middle-schooler in the early 2000s:
For over two years, I sat on a couch and endured emotionally painful sessions with a counselor. I was told that my faith community rejected my sexuality; that I was the abomination we had heard about in Sunday school; that I was the only gay person in the world; that it was inevitable I would get H.I.V. and AIDS.
But it didn’t stop with these hurtful talk-therapy sessions. The therapist ordered me bound to a table to have ice, heat and electricity applied to my body. I was forced to watch clips on a television of gay men holding hands, hugging and having sex. I was supposed to associate those images with the pain I was feeling to once and for all turn into a straight boy. In the end it didn’t work. I would say that it did, just to make the pain go away.
Testimonies like Brinton’s are part of why people have challenged conversion therapy, because they see those practices as cruel. The Southern Poverty Law Center says that “people who have undergone conversion therapy have reported increased anxiety, depression, and in some cases, suicidal ideation. It can also strain family relationships, because practitioners frequently blame a parent for their child’s sexual orientation.”
Have any groups or organizations related to psychiatry or psychology weighed in on conversion therapy?
The American Psychiatric Association issued this statement in a 2018 report:
Since 1998, the American Psychiatric Association has opposed any psychiatric treatment, such as “reparative” or conversion therapy, which is based upon the assumption that homosexuality per se is a mental disorder or that a patient should change his/her homosexual orientation.
The Society for the Advancement of Psychotherapy has said:
…research suggests that conversion therapy is associated with many negative outcomes for LGB clients, including increased level of depressive symptoms, frequent suicidal ideation and attempts, social isolation and anger toward family members, and decreased levels of self-worth (Haldeman, 2002; Serovich et al., 2008). Although we understand that adolescence is a time of sexual fluidity and curiosity, these harmful practices are being used with adolescents who might be perceived as non-heterosexual or gender nonconforming (American Psychological Association, 2009b; SAMHSA, 2015). LGB adolescents are especially vulnerable and at risk for negative outcomes of conversion therapy such as family rejection, depression, health risks, homelessness, and death by suicide (American Psychological Association, 2009b; SAMHSA, 2015).
Similarly, The American Academy of Child and Adolescent Psychiatry states:
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.
These are just a few organizations. There’s a more full list on a website started by survivors of conversion therapy.
So are there any psychiatry or psychology professionals who support conversion therapy?
Yes. The National Task Force for Therapy Equality has billed itself as “a coalition of licensed psychotherapists, psychiatrists, physicians, public policy organizations, and psychotherapy clients/patients from across the United States of America. Their purpose is to secure therapy equality for clients that experience distress over unwanted same-sex attractions and identity conflicts.”
So what’s next for conversion therapy?
Brinton, who wrote the New York Times op-ed, works with The Trevor Project to work toward bans on conversion therapy. Similarly, the Human Rights Campaign and other groups have urged bans on the practices. As of early 2019, 15 states ban the practice. But bans on conversion therapy are being challenged. According to The Washington Post, the city of Tampa adopted an ordinance adopted in April 2017 that “barred mental health professionals from subjecting minors to conversion therapy”:
The therapists, represented by the conservative Christian legal advocacy group Liberty Counsel, argued that the ordinance was unconstitutional because it prohibited them from taking part in “speech” through their counseling, simply because city officials disagree with the content of that speech.
Amanda Arnold Sansone, a magistrate judge in Tampa, said in an opinion… that the plaintiffs — Robert Vazzo, David Pickup and New Hearts Outreach — sufficiently demonstrated a likelihood of success with their arguments that the ordinance violates their free-speech rights. The judge also said the city presented no evidence of minors being harmed by conversion therapy counseling within city limits.
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