Medical and Mental Health Experts Reject Conversion Efforts
Due to the aggressive promotion of efforts to change sexual orientation through therapy, a number of medical, health and mental health professional organizations have issued public statements about the dangers of so-called conversion therapy. Together, representing more than 480,000 mental health professionals, they have taken the position that homosexuality is not a mental disorder and thus is not something that needs to or can be “cured.”
Conversion or reparative therapy is the discredited practice of using “therapy” to attempt to change someone’s sexual orientation. The American Counseling Association opposes conversion therapy because it does not work, can cause harm, and violates our Code of Ethics. It is an attempt to treat something that is not a mental illness.
The American Psychiatric Association made clear with its 1998 position statement that “APA opposes any psychiatric treatment, such as ‘reparative’ or ‘conversion’ therapy, that is based on the assumption that homosexuality per se is a mental disorder or is based on the a priori assumption that the patient should change his or her homosexual orientation.” APA expanded on that position with a statement in 2013: “The American Psychiatric Association does not believe that same-sex orientation should or needs to be changed, and efforts to do so represent a significant risk of harm by subjecting individuals to forms of treatment which have not been scientifically validated and by undermining self-esteem when sexual orientation fails to change. No credible evidence exists that any mental health intervention can reliably and safely change sexual orientation; nor, from a mental health perspective does sexual orientation need to be changed.
“We know from well-documented research and clinical experience that “reparative therapy” may cause significant psychological trauma and contribute to increased risk of depression, anxiety, PTSD, drug and alcohol misuse or abuse, as well as suicidal thoughts and behavior. In our 2012 position statement we affirm the right of all people to their sexual orientation, gender identity, and gender expression without interference or coercive interventions.”
The American Psychological Association reaffirms its position that homosexuality per se is not a mental disorder and opposes portrayals of sexual minority youths and adults as mentally ill due to their sexual orientation…The American Psychological Association concludes that there is insufficient evidence to support the use of psychological interventions to change sexual orientation…The American Psychological Association advises parents, guardians, young people, and their families to avoid sexual orientation change efforts that portray homosexuality as a mental illness or developmental disorder and to seek psychotherapy, social support and educational services that provide accurate information on sexual orientation and sexuality, increase family and school support, and reduce rejection of sexual minority youth…Sexual minority youth and adults who have undergone SOCE are significantly more likely to experience suicidality and depression than those who have not undergone SOCE (Dehlin, et al., 2015; Ryan et al., 2018); and this elevated risk of suicidality, including multiple suicide attempts, persists when adjusting for other risk factors…Research studies using a wide range of designs have found harms associated with SOCE.
The AMA opposes, the use of “reparative” or “conversion” therapy for sexual orientation or gender identity…The AMA will develop model state legislation and advocate for federal legislation to ban so-called reparative or conversion therapy for sexual orientation or gender identity. The support for legislative bans strengthens AMA’s long-standing opposition to this unscientific practice. The AMA heard testimony, including first-hand accounts, regarding the significant harms triggered by conversion therapy, including depression, post-traumatic stress disorder, and suicidal thoughts and attempts. “It is clear to the AMA that the conversion therapy needs to end in the United States given the risk of deliberate harm to LGBTQ people,” said AMA Board Member William E. Kobler, M.D. “Conversion therapy has no foundation as scientifically valid medical care and lacks credible evidence to support its efficacy or safety.
“Therapy directed at specifically changing sexual orientation is contraindicated, since it can provoke guilt and anxiety while having little or no potential for achieving changes in orientation.”
“The National Association of Social Workers condemns the use of SOCE or so-called Reparative Therapies by any person identifying as a social worker or any agency that identifies as providing social work services…Social workers recognize the long-term detrimental consequences of conversion therapy, such as increased risk of depression, suicidal ideation, substance use, social withdrawal and self-loathing.”
“Reparative therapies, sometimes called conversion therapies or sexual orientation change interventions, have been widely discredited by most major health care professional organizations for their lack of scientific justification, failure to achieve intended results, questionable clinical practices, disregard and lack of respect for normal human differences, and inherently harmful effects on mental and physical health of individuals being pressured to change.”
Services that purport to “cure” people with non-heterosexual sexual orientation lack medical justification and represent a serious threat to the health and well-being of affected people…No rigorous scientific studies demonstrate any efficacy of efforts to change sexual orientation. However, there are many testimonies about the severe harm to mental and physical health that such “services” can cause. Repression of sexual orientation has been associated with feelings of guilt and shame, depression, anxiety, and even suicide.
“Since homosexuality is not a disorder or a disease, it does not require a cure. There is no medical indication for changing sexual orientation,” said PAHO Director Dr. Mirta Roses Periago. Practices known as “reparative therapy” or “conversion therapy” represent “a serious threat to the health and well-being—even the lives—of affected people.”
As an aggravating factor, there have been a growing number of reports about degrading treatments, and physical and sexual harassment under the guise of such “therapies,” which are often provided illicitly. In some cases, adolescents have been subjected to such interventions involuntarily and even deprived of their liberty, sometimes kept in isolation for several months.
“These practices are unjustifiable and should be denounced and subject to sanctions and penalties under national legislation,” said Dr. Roses. “These supposed conversion therapies constitute a violation of the ethical principles of health care and violate human rights that are protected by international and regional agreements.”
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. As a result, “conversion therapies” should not be part of any behavioral health treatment of children and adolescents.
“Health Professionals Advancing LGBTQ Equality condemns the behavioral and psychological interventions known as “reparative” or “conversion” therapies that attempt to change sexual orientation and gender identity.”
“[T]he association does not consider homosexuality a disorder that requires treatment, and as such, we see no basis for [reparative therapy]. AAMFT expects its members to practice based on the best research and clinical evidence available.”