Saving Psychotherapy from Conversion Therapy Bans

The term conversion therapy strikes a note of fear in many people’s hearts, calling to mind barbaric practices such as electric shock therapy, forced watching of porn, and even “corrective rape.” All decent people denounce these awful, outdated practices, and there is consensus among reputable therapeutic and medical bodies that such abhorrent interventions should never take place.

Given this consensus view and the absence of evidence that conversion therapy is being practised, why are conversion therapy bans suddenly being tabled in so many legislatures and governing bodies worldwide? A scoping paper prepared by the Irish Department of Children, Equality, Disability, Integration and Youth analysed research from Ireland, Europe and the USA and found no evidence of conversion therapy being practised by medical or mental health professionals in those areas. The scoping document did include some evidence of religious practises aimed at changing a person’s sexual orientation from homosexual to heterosexual, but none at all among medical and mental health practitioners. So why the “urgent” call for new conversion therapy bans?

Passing a conversion therapy ban provides politicians with a powerful messaging tool. We’re the good guys because we passed this bill outlawing some truly heinous practices! Never mind that no one actually engages in those practices – it still looks good. To illustrate the point, the scoping paper mentioned above, which found no evidence of conversion therapy practices, was never published; apparently, the politician who instigated the study, Roderic O’Gorman, cared less about discovering whether there was an actual problem than bringing forward an unnecessary bill that would make him appear “progressive.” For voters, too, supporting such a bill or candidate is an easy way to signal virtue. Unnecessary conversion therapy bans that cost nothing feel like a win for everyone.

Of greater concern are bans that expand the meaning of conversion therapy to cover much more than barbaric and obsolete practices aimed at changing sexual orientation. Increasingly, these legal bans will define conversion therapy in broad terms, such as: “any practice or treatment that seeks to change the sexual orientation or gender identity of a patient or client, including mental health therapy that seeks to change, eliminate, or reduce behaviours, expressions, attractions, or feelings related to a patient or client’s sexual orientation or gender identity.”[1] Such language is so broad as to exclude even basic insight-oriented interventions that promote growth and development, if result is confused with intent.

The shift from narrow conversion therapy bans to ones with more encompassing language is a product of trans rights activists (TRAs) working to exploit sympathy for gays, lesbians, and bisexuals and their long struggles for acceptance. Liberal-minded people don’t want to be on the “wrong side” of history this time around, and so when TRAs say “, we deserve the same protections as the LGB community,” everyone enthusiastically agrees. Thus the bans now make it illegal to try changing a client’s sexual orientation OR gender identity. TRAs have appropriated sympathy for the LGB community and made it their own.

They enlarge upon their claim for sympathy by painting trans people as the most marginalised and persecuted minority in the world as if they currently hold no legal rights even in modern democracies. In truth, trans people have the same human rights and legal protections as everyone else in the West. But TRAs loudly proclaim that they are persecuted, and the media dutifully support their demands for further legal protections and more robust conversion therapy bans. Leary of public disapproval and being labelled a bigot, politicians have complied with those demands and passed ill-considered, overly broad legislation to ban all forms of “conversion therapy.”

Appropriating sympathy for the LGB cause depends on the false assumption that protecting gender identity and preventing coercive efforts to change one’s sexual orientation are no different, and legislators should therefore cover them in a single bill. This forced alignment of gender identity with sexual orientation obscures the fundamental differences between them and the very different goals of their advocates. The campaign for gay rights argued that those who are same-sex attracted should be accorded the same rights as those granted by society to heterosexuals; it asked for freedom from persecution and the right to live one’s life married to the person of one’s choosing. Gays and lesbians never challenged the reality of biological sex, binary in nature, or the long-accepted belief that one’s sex is immutable.

By contrast, TRAs have a long list of demands, all of them implicit in the expansive language of these new conversion therapy bans. First of all, in addition to the protections they already possess under existing anti-discrimination laws, TRAs require everyone else to adopt a new belief system that has no scientific support – that each human being possesses a unique gender identity knowable only to that person, independent of and overriding her or his biological sex. They demand that we suppress the verdict of our own senses and align our internal responses to conform with their expectations. They insist that we forget their former names and consistently use their new ones, along with their “preferred pronouns.” Anything less than full compliance is transphobic.

In short, the expansive new bans which seek, on their surface, to shield minority groups from persecution actually enforce a dramatic revision of biological reality and force every last one of us to alter our own perceptions and beliefs. It has been a highly effective sleight of hand, sneaking enforcement of a new ideology into law by inserting only two words: gender identity. The audacity is breathtaking.

Because TRAs insist that validating a person’s self-identification as trans is “life-saving,” they advocate for “affirmative care” – an approach compelling therapists to agree with and affirm a client’s self-perceptions. Affirmative care has been in existence for little more than a decade, with no long-term studies conducted to demonstrate its efficacy, but TRAs have nonetheless convinced many governmental bodies to ban anything outside their preferred approach. If you examine the legislative code section quoted above, you will see this pernicious intent at work. The language is so comprehensive as to define virtually everything other than affirmative care as “conversion therapy.”

Abiding by these new guidelines, how would a therapist work with LGB clients, afflicted by internalised homophobia, who identify as “trans” in a bid to escape from it? A 14-year-old girl might initially come out as a lesbian and become increasingly uncomfortable with the way she is perceived; then, some months later, she might abruptly identify as a heterosexual boy. In such a case, a therapist might fear charges of practising “conversion therapy” if they were to explore homophobia in that child’s environment and its relation to her internalised homophobia. The therapist will feel conflicted about how to proceed and may ultimately feel unable to carry on effective therapy. It might seem easier simply to avoid working with this cohort.

The fear that one accusation could ruin their reputation has already had a chilling effect on therapists, with many now refusing to work with LGBTQ+ clients altogether. “The stakes are too high,” as one colleague recently put it; as a result, there’s a terrible shortage of mental health professionals willing to undertake this much-needed work. At the same time, the rising number of young people with gender dysphoria means that waiting lists are growing exponentially longer while qualified therapists stay away.

As practised for decades, conventional psychotherapy includes probing, thoughtful questions that seek to bring about a deeper awareness of the self. One regular feature is a technique called “Socratic questioning,” a disciplined and thoughtful dialogue between therapist and client that gradually reveals and unravels the deeply held values and beliefs of the individual. This can be a powerful intervention that helps the person understand themselves more deeply, uncover unrecognised motivations, and discover new possibilities for self-expression. Successful psychotherapy helps clients to make fully informed decisions for themselves, which might mean continuing on to medical/surgical interventions, desisting from trans-identification, or finding their way to a unique form of self-expression.

Genspect believes that governments should reject these new expansive conversion therapy bans that make the practice of conventional therapy a crime or leave so much doubt that therapists will avoid working with an underserved population for fear of putting themselves and their professional license at risk.

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[1] Utah Occupational and Professional Licensing Code, R 156-60-102.