Conversion therapy

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Conversion therapy is the pseudoscientific practice of attempting to change an individual's sexual orientation, romantic orientation, gender identity, or gender expression to align with heterosexual and cisgender norms. Conversion therapy is ineffective at changing a person's sexual orientation or gender identity and frequently causes significant long-term psychological harm. The position of evidence-based medicine and clinical guidance is that sexualities like homosexuality and bisexuality as well as gender variance are natural and healthy aspects of human sexuality and gender identity.

Terminology

Medical professionals and activists consider "conversion therapy" a misnomer, as it does not constitute a legitimate form of therapy. Alternative terms include "sexual orientation change efforts" (SOCE) and "gender identity change efforts" (GICE). Together they are referred to as "sexual orientation and gender identity change efforts" (SOGICE), or "sexual orientation and gender identity or expression change efforts" (SOGIECE).

According to researcher Douglas C. Haldeman, SOCE and GICE should be considered together because both rest on the assumption "that gender-related behavior consistent with the individual's birth sex is normative and anything else is unacceptable and should be changed". The American Psychological Association stated in a 2021 resolution that some parts of SOCE also met their definition of GICE, and "intense focus" on gender-normative "conformity is a frequent characteristic of SOCE".

"Reparative therapy" may refer to conversion therapy in general, or to a subset thereof.

Advocates of conversion therapy do not necessarily use the term either, instead using phrases such as "healing from sexual brokenness" and "struggling with same-sex attraction".

A 2020 report by ILGA tracking bans on conversion therapy worldwide explained that in many countries where "conversion therapy" has been banned, "proponents had to reshape and adapt the way in which they present and offer their 'treatment'."

In January 2024, GPAHE published an updated report for 2023, highlighting that many social media platforms and search engines are still serving a lot of content related to conversion therapy. Listing examples, using the search term "overcoming same-sex attraction" on YouTube led to results from religious and non-religious groups serving videos targeting gay and transgender people, such as videos titled "Former LGBTQers Testify: If You No Longer Want to be Gay or Transgender, You Don't Have to Be."

In 2022, GPAHE also started creating an ongoing tracking project on organizations connected to the promotion of "conversion therapy" practices online titled Conversion Therapy Online: The Players to document the actors involved in these activities and show the interconnectedness.

The report highlights some larger groups at the center of these efforts such as London-based International Federation for Therapeutic and Counseling Choice (IFTCC), chaired by Mike Davidson, founder of related Core Issues Trust (CIT) and several other organizations involved. IFTCC has been hosting annual conferences since its inception in 2015 with the purpose to connect individuals "seeking help with 'same-sex attraction' and 'gender confusion'" with therapists. Into the middle of the twentieth century, competing views of homosexuality were advanced by psychoanalysis versus academic sexology. Sigmund Freud, the founder of psychoanalysis, viewed homosexuality as a form of arrested development. Later psychoanalysts followed Sandor Rado, who argued that homosexuality was a "phobic avoidance of heterosexuality caused by inadequate early parenting". Deemed the "Feminine Boy Project", the treatments used operant conditioning to reward gender-conforming behaviors, and punish gender non-conforming behaviors.

Bans on conversion therapy

In 2020, the United Nations Independent Expert on sexual orientation and gender identity (IESOGI) published a Report on conversion therapy, which documented global practices on conversion therapy against LGBTQ individuals.

In the report, the UN IESOGI called for a global ban on "conversion therapy", as an umbrella term describing various interventions practiced to "cure" people, and to "convert" them from non-heterosexual to heterosexual, and from trans or gender diverse to cisgender. The report highlighted a 2015 US court case from New Jersey, "Ferguson v JONAH", in which a jury unanimously found the defendants guilty of fraud, claiming they were providing "services that could significantly reduce or eliminate same-sex attraction." In March of 2026, laws prohibiting conversion therapy were struck down by the US Supreme Court.

Motivations

A frequent motivation for adults who pursue conversion therapy is religious beliefs that disapprove of same-sex relations, such as evangelical Christianity, Orthodox Judaism, and conservative interpretations of Islam. These adults prioritize maintaining a good relationship with their family and religious community.

Adolescents who are pressured by their families into undergoing conversion therapy also typically come from a conservative religious background. Youth from families with low socioeconomic status are also more likely to undergo conversion therapy.

Theories and techniques

As societal attitudes toward homosexuality have become more accepting over time, the harshest conversion therapy methods, such as aversion therapy, have become less common. Secular conversion therapy is offered less frequently due to the demedicalization of homosexuality and bisexuality, and religious practitioners have become predominant.

Aversion therapy

Aversion therapy used on homosexuals and bisexuals included electric shock and nausea-inducing drugs during presentation of same-sex erotic images. Cessation of the aversive stimuli was typically accompanied by the presentation of opposite-sex erotic images, with the objective of strengthening heterosexual feelings. Another method used is the covert sensitization method, which involves instructing recipients to imagine vomiting or receiving electric shocks. Proponents often write that only single-case studies have been conducted to support their methods and that their results cannot be generalized. For example, Haldeman writes that behavioral conditioning studies tend to decrease homosexual feelings but do not increase heterosexual feelings, citing Rangaswami's "Difficulties in arousing and increasing heterosexual responsiveness in a homosexual: A case report", published in 1982, as typical in this respect. Other methods of aversion therapy, in addition to electric shock, included ice baths, freezing, burning via metal coils, and hard labor. The intent was for the subject to associate homosexual feelings with pain and thus result in them being reduced. These methods have been concluded to be ineffective.

Aversion therapy was developed in Czechoslovakia between 1950 and 1962 and in the British Commonwealth from 1961 into the mid-1970s. In the context of the Cold War, Western psychologists ignored the poor results of their Czechoslovak counterparts who had concluded that aversion therapy was not effective by 1961 and recommended decriminalization of homosexuality instead. Some men in the United Kingdom were offered the choice between prison and undergoing aversion therapy. It was also offered to a few British women, but was never the standard treatment for either homosexual men or women.

In the 1970s, behaviorist Hans Eysenck was one of the main advocates of counterconditioning with malaise-inducing drugs and electric shock for homosexuals. He wrote that this therapy was successful in nearly 50% of cases. However, his studies were disputed. Behavior therapists, including Eysenck, used aversive methods. This led to a protest against Eysenck by gay activist Peter Tatchell at a London Medical Group Symposium in 1972. Tatchell said that the therapy promoted by Eysenck was a form of torture. Tatchell denounced Eysenck's form of behavioral therapy as causing depression, suicidal ideation and suicide among gay men who were subjected to it. despite the fact that he had no formal surgical training. Freeman was banned from performing psychosurgery in 1967.

In West Germany, a type of brain surgery usually involving destruction of the ventromedial nucleus of the hypothalamus was done on some homosexual men during the 1960s and 1970s. The practice was criticized by sexologist Volkmar Sigusch.

Castration and transplantation

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In early twentieth-century Germany, experiments were carried out in which homosexual men were subjected to unilateral orchiectomy and testicles of heterosexual men were transplanted. These operations were a complete failure.

Surgical castration of homosexual men was widespread in Europe in the first half of the twentieth century. SS leader Heinrich Himmler ordered homosexual men to be sent to concentration camps because he did not consider a time-limited prison sentence sufficient to eliminate homosexuality. Although theoretically voluntary, some homosexuals were subject to severe pressure and coercion to agree to castration. There was no lower age limit: some boys as young as 16 were castrated. Those who agreed to castration after a Paragraph 175 conviction were exempted from being transferred to a concentration camp after completing their legal sentence. Some concentration camp prisoners were also subjected to castration. An estimated 400 to 800 men were castrated. Endocrinologist Carl Vaernet attempted to change homosexual concentration camp prisoners' sexual orientations by implanting a pellet that released testosterone. Most of the victims, non-consenting prisoners at the Buchenwald concentration camp, died shortly thereafter.

An unknown number of men were castrated in West Germany, and chemical castration was used in other Western countries, notably against Alan Turing in the United Kingdom.

Ex-gay/ex-trans ministries

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Ex-gay ministries are religious groups that attempt to use religion to eliminate or change queer individuals' sexual orientation. The ex-gay umbrella organization Exodus International in the United States ceased activities in June 2013, and the three-member board issued a statement repudiating its aims and apologizing for the harm its pursuit had caused to queer people. Ex-trans organizations often overlap with ex-gay organizations, frequently portraying trans identity as inherently sinful or against God's design and pathologizing gender variance as the result of trauma, social contagion, or "gender ideology".

Hypnosis

Hypnosis has been used in conversion therapy since the 19th century, first employed by Richard von Krafft-Ebing and Albert von Schrenck-Notzing. In 1967, Canadian psychiatrist Peter Roper published a case study of treating 15 homosexual individuals—some of whom would probably be considered bisexual by modern standards—with hypnosis. Allegedly, eight showed "marked improvement" (they reportedly lost sexual attraction towards the same sex altogether), four showed mild improvements (decrease of "homosexual tendencies"), and three exhibited no improvement after hypnotic treatment. He concluded that "hypnosis may well produce more satisfactory results than those obtainable by other means", depending on the hypnotic susceptibility of the subjects.

Psychoanalysis

Haldeman writes that psychoanalytic treatment of homosexuality is exemplified by the work of Irving Bieber and colleagues in Homosexuality: A Psychoanalytic Study of Male Homosexuals. They advocated long-term therapy aimed at resolving the unconscious childhood conflicts that they considered responsible for homosexuality. Haldeman notes that Bieber's methodology has been criticized because it relied upon a clinical sample, the description of the outcomes was based upon subjective therapist impression, and follow-up data were poorly presented. Bieber reported a 27% success frequency from long-term therapy, but only 18% of those deemed successful were exclusively homosexual initially, while 50% had been bisexual. In Haldeman's view, this makes even Bieber's unimpressive claims of success misleading.

Haldeman discusses other psychoanalytic studies of attempts to change homosexuality. Curran and Parr's "Homosexuality: An analysis of 100 male cases", published in 1957, reported no significant increase in heterosexual behavior. Mayerson and Lief's "Psychotherapy of homosexuals: A follow-up study of nineteen cases", published in 1965, reported that half of the 19 subjects included were exclusively heterosexual in behavior four and a half years after treatment; its outcomes were based on patient self-report and had no external validation. In Haldeman's view, those participants in the study who reported change were bisexual at the outset, and its authors wrongly interpreted the capacity for heterosexual sex as a change of sexual orientation.

Reparative therapy

The term "reparative therapy" has been used as a synonym for conversion therapy generally, but according to Jack Drescher, it more correctly refers to a specific kind of therapy associated with the psychologists Elizabeth Moberly and Joseph Nicolosi.

For example, he wrote:

The term reparative refers to Nicolosi's postulate that same-sex attraction is a person's unconscious attempt to "self-repair" feelings of inferiority. After California banned conversion practices, Nicolosi argued that "reparative therapy" did not attempt to change sexual orientation directly but instead encouraged exploration into its underlying causes, which he believed was often childhood trauma.

A phone study by Robert Spitzer reported that "about 66 percent of the men respondents and 44 percent of the women were able to function as heterosexuals after the therapy," while conceding that "his subjects did not constitute a study population representative of the gay and lesbian population in the U.S."

Marriage therapy

Previous editions of the World Health Organization's ICD included sexual relationship disorder, in which a person's sexual orientation or gender identity makes it difficult to form or maintain a relationship with a sexual partner. The belief that their sexual orientation causes problems in their relationship may lead some to turn to a marriage therapist for help to change their sexual orientation. Sexual relationship disorder was removed from ICD-11 after the Working Group on Sexual Disorders and Sexual Health determined that its inclusion was unjustified.

Gender exploratory therapy

Gender exploratory therapy (GET) is a form of conversion therapy characterized by requiring mandatory extended talk therapy attempting to find pathological roots for gender dysphoria while simultaneously delaying social and medical transition and viewing it as a last resort. Practitioners propose that their patients' dysphoria is caused by factors such as homophobia, social contagion, sexual trauma, and autism.

, there are no known empirical studies examining psychosocial or medical outcomes following gender exploratory therapy. Concerns have been raised that by not providing an estimated length of time for the therapy, the delays in medical interventions may compound mental suffering in transgender youth,

In 2017, Richard Green published a legal strategy that called for circumventing bans on conversion therapy by labelling the practice "gender identity exploration or development". Multiple groups now exist worldwide to promote gender exploratory therapy and have been successful in influencing legal discussions and clinical guidance in some regions. GETA co-founder Lisa Marchiano stated US President Joe Biden's executive order safeguarding trans youth from conversion therapy would have a "chilling effect" on GET practices. GETA also opposed Biden's Title IX changes protecting trans students from discrimination, stating allowing trans youth in restrooms would harm the mental health of their peers. a small group aligned with the Christian Right, has cited numerous studies from SEGM to support the claim that 'gender exploratory therapy' is necessary to restore transgender people's "biological integrity". This includes significantly higher rates of depression, substance abuse, and other mental health issues in individuals who have undergone conversion therapy than their peers who did not,

After conversion therapy has failed to change someone's sexual orientation or gender identity, participants often feel increased shame that they already felt over their sexual orientation or gender identity.

Modern-day practitioners of conversion therapy—primarily from a conservative religious viewpoint—disagree with evidence-based medicine and clinical guidance that does not view homosexuality and gender variance as unnatural or unhealthy. According to Bailey, although individuals may choose not to act upon their sexual attractions, "there is no good evidence, however, that sexual orientation can be changed with therapy". Youth who undergo conversion therapy from a religious provider have more negative mental health outcomes than those who had consulted a licensed healthcare provider.

A 2022 research by Outright International found out that half the respondents surveyed from Kenya, Nigeria and South Africa had undergone some form of conversion practice. Some of the forms including force and coercion, which inflict severe physical and mental pain and suffering.

Legal status

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Some jurisdictions have criminal bans on the practice of conversion therapy, including Canada, Ecuador, France, Germany, Malta, Mexico and Spain. In other countries, including Albania, Brazil, Chile, Vietnam and Taiwan, medical professionals are barred from practicing conversion therapy.

Conversion therapy on minors may amount to child abuse.

Human rights

In 2020, the International Rehabilitation Council for Torture Victims released an official statement that conversion therapy is torture. The same year, UN Independent Expert on sexual orientation and gender identity, Victor Madrigal-Borloz, said that conversion therapy practices are "inherently discriminatory, that they are cruel, inhuman and degrading treatment, and that depending on the severity or physical or mental pain and suffering inflicted to the victim, they may amount to torture". He recommended that it should be banned across the world. In 2021, Ilias Trispiotis and Craig Purshouse argue that conversion therapy violates the prohibition against degrading treatment under Article 3 of the European Convention on Human Rights, leading to a state obligation to prohibit it. In February 2023 Commissioner for Human Rights, Dunja Mijatović, qualified those practices as "irreconcilable with several guarantees under the European Convention on Human Rights" and having no place in a human rights-based society urging the Member States of the Council of Europe to ban them for both adults and minors, later in July 2023 she advocated for clear actions during a public hearing at the European Parliament studying different approaches to legally ban "conversion therapies" in the European Union. In September 2024 it was reported that the European Union is considering banning "conversion therapies" across its Member States, while a European Citizens' Initiative that started collecting signatures in May 2024 is also calling on the European Commission to outlaw such practices.

In media

Efforts to change sexual orientation have been depicted and discussed in popular culture and various media. Some examples include: Boy Erased, But I'm a Cheerleader, The Miseducation of Cameron Post, Book of Mormon musical, Ratched, and the documentary features Pray Away and Homotherapy: A Religious Sickness.

Medical views

National health organizations around the world have uniformly denounced and criticized sexual orientation and gender identity change efforts. They state that there has been no scientific demonstration of "conversion therapy's" efficacy. They find that conversion therapy is ineffective, risky and can be harmful. Anecdotal claims of cures are counterbalanced by assertions of harm, and the American Psychiatric Association, for example, cautions ethical practitioners under the Hippocratic oath to do no harm and to refrain from attempts at conversion therapy. Furthermore, they state that conversion therapy is harmful and that it often exploits individuals' guilt and anxiety, thereby damaging self-esteem and leading to depression and even suicide. A 2025 study completed by the American Medical Association found that 42% of those subjected to conversion therapy attempted suicide, compared to 5% of those not subjected to these practices. For transgender individuals in particular, exposure to conversion therapy before age 10 is associated with a fourfold increase in the risk of lifetime suicide attempts compared to peers who received other forms of therapy.

There is also concern in the mental health community that the advancement of conversion therapy can cause social harm by disseminating inaccurate views about gender identity, sexual orientation, and the ability of LGBT people to lead happy, healthy lives.

Public opinion

Opinion polls have found that conversion therapy bans enjoy popular support among the U.S. population. Surveys in three states (Florida, New Mexico and Virginia) show support varying between 60% and 75%. According to a 2014 national poll, only 8% of the U.S. population believed conversion therapies to be successful.

A 2020 survey carried out on US adults found majority support for banning conversion therapy for minors. 18% of respondents said it should be legal for minors, 56% said it should be illegal for minors, and 26% said they did not know. The survey also found that LGB contact was positively associated with opposition to conversion therapy.