Conversion Therapy - a medical understanding

What is conversion therapy?

Conversion therapy is a type of talking therapy which attempts to change sexual orientation or reduce same sex attraction in lesbian, gay and bisexual (LGB) people. Sometimes it is used to make transgender people suppress their gender identity and accept their sex assigned at birth. Conversion therapy is sometimes called ‘reparative’ or ‘gay cure’ therapy, or ‘sexual orientation change efforts’. Conversion treatments may have a spiritual element to them when LGB people in various religious settings are urged to change their feelings and behaviour using prayer and self-control. There is no evidence that these attempts to change a person’s sexual orientation are effective and considerable evidence that such practices are harmful to people’s mental health, wellbeing and sense of self.

All leading psychotherapy organisations and other health bodies in the UK oppose this type of intervention and consider it unethical. The Synod of the Church of England is also opposed to all such conversion treatments.

Conversion therapy in context

Attitudes towards sexuality have changed profoundly in recent decades. There has been a long history of psychological professions regarding homosexuality as a form of disordered sexual development. Up until 1974 the American Psychiatric Association classified homosexuality as a mental illness. It was not until 1992 that the World Health Organisation declassified homosexuality as a mental disorder. Though homosexuality is no longer considered a mental illness among the healthcare professions, as the Royal College of Nursing states: “There is a long legacy of an association between the two which continues to have an impact.". Furthermore, this view of sexual orientation has had a long impact on other sectors of society such as the Christian churches or other religions. Many religions have held views that homosexuality is undesirable and any same sex behaviour a sin. In this context, some people still feel impelled to seek and offer cures and treatments for homosexuality as if it were an illness or a condition that falls short of God’s will for us.

What does research tell us about conversion therapy?

Psychological treatments must be known to be effective before being recommended by professional bodies or adopted by services such as the NHS. As already noted, same-sex attraction and sexual behaviour are not disorders. Nevertheless, there are claims that conversion therapy should be available to people distressed by their same sex attraction. So is there any evidence that such therapy can change sexual orientation?

Randomised controlled trials are the scientific gold standard for assessing the effectiveness of treatments. There are no randomised trials of conversion therapies. There are a number of follow-up studies of volunteers, often long after they underwent therapy but all have been poorly conducted. However, people may be damaged by such therapies and there are many anecdotal accounts of harm. Oral history studies of people who underwent treatments (such as aversion therapy) for homosexuality in the 1970s and 1980s also show there is a potential for harm. Other more recent studies in the USA also show a considerable potential for harm, especially when conducted in a religious context.

It is not surprising that people may be harmed by treatments that have no evidence for their effectiveness and are given simply because they are distressed by hostile reactions to their sexuality. Offering to change a person’s sexual orientation or control his or her same sex attraction reinforces the notion that same sex attraction is wrong or abnormal.

Why conversion therapy is unethical

The professional bodies which regulate psychotherapists in the UK – the UK Council for Psychotherapy, the British Association for Counselling and Psychotherapy and others – provide a regulatory and ethical framework to ensure therapists work responsibly and safely. All such professional bodies in the UK have united in condemning conversion therapy as unethical. This is because it is based on the assumption that homosexuality is a mental disorder and that therefore LGB people should change their sexuality.

The UK Council for Psychotherapy states that:

“It is exploitative for a psychotherapist to offer treatment that might ‘cure’ or ‘reduce’ same sex attraction as to do so would be offering a treatment for which there is no illness.”

The British Association for Counselling and Psychotherapy says:

“There is no scientific, rational or ethical reason to treat people who identify within a range of human sexualities any differently from those who identify solely as heterosexual.”

The British Psychological Society has published guidance which says:

“As same-sex sexual orientations… are not diagnosable illnesses, they do not require any therapeutic interventions to change them.”

It is common for people to see a therapist to talk about their feelings, including troubling feelings of sexual attraction (of any orientation). But, for a therapist to attempt to try and change someone’s sexual orientation risks reinforcing pressure on individuals to conform to a set of cultural or religious attitudes which sees homosexuality as wrong.

Michael King is professor of psychiatry at University college London. He specialises in the mental health of LGBT people and advises national bodies such as the church of england.

Further Reading

Dehlin, J. P., Galliher, R. V., Bradshaw, W. S., Hyde, D. C., & Crowell, K. A. (2014). Sexual Orientation Change Efforts Among Current or Former LDS Church Members. Journal of Counseling Psychology

Drescher, J., Schwartz, A., Casoy, F., McIntosh, C. A., Hurley, B., Ashley, K., . . . Tompkins, D. A. (2016). The Growing Regulation of Conversion Therapy. Journal of Medical Regulation, 102(2), 7-12.

General Synod Private Member’s Motion Coversion Therapy. GS207/0A

Memorandum of Understanding on Conversion Therapy in the UK. Version 2. Oct 2017.

Royal College of Psychiatrists’ Position Statement: Supporting transgender and gender-diverse people. PS01/18