On March 2, Virginia became the 20th state to prohibit mental health providers from offering sexual orientation change treatments to minors (often described as “conversion therapy”).
“The presumption behind these treatments is that any sexual orientation that’s not heterosexual is inherently flawed and in need of a therapeutic fix,” says Clinton Anderson, PhD, deputy chief of the APA’s Public Interest Directorate and director of the Office on Sexual Orientation and Gender Diversity. “Our perspective is that there is nothing that needs to be fixed."
APA has expressed concern about sexual orientation change efforts since 1997, as have many other medical and mental health organizations.
Evidence shows that sexual orientation efforts can lead to negative outcomes, including treatment related anxiety, suicidal ideation, depression, impotence and relationship dysfunction. But there’s little evidence that such efforts can change sexual orientation. In a 2015 study in the Journal of Counseling Psychology, John Dehlin, PhD, at Utah State University and colleagues surveyed 1,612 people who had undergone sexual orientation change efforts as members of the Church of Jesus Christ of Latter-day Saints, and found just 3.2% indicated even slight changes in sexual orientation. The researchers found a variety of damaging outcomes from the treatments, including increased shame, depression and anxiety, decreased self-esteem, worsening of family relationships, and spiritual struggles such as feeling abandoned by God.
Another study, published in the Journal of Homosexualityopens in new window in 2020 by Caitlin Ryan, PhD, director of the Family Acceptance Project at San Francisco State University, and colleagues, found that when parents of LGBT youth tried to change their children’s sexual orientation at home and also took them to therapists or religious leaders to change their identity, the youth reported a three times greater likelihood of high levels of depression, attempted suicide, lower education and income levels, and lower life satisfaction in young adulthood.
“When caregivers take their child to a therapist or religious leader for sexual orientation change efforts, they’re breaking a bond of trust,” Ryan says.
Bans and fraud charges
In light of such evidence, some countries, states and other municipalities have passed legislation to ban sexual orientation change efforts.
Worldwide, only Ecuador, Malta and Brazil have passed national legislation to ban such efforts, and the Brazil ban was overturned and is still being considered by the courts. In the United States, California was the first state to ban sexual orientation change efforts for minors, in 2012.
Since 2015, 19 other states have followed suit (Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Nevada, New Hampshire, New Jersey, New Mexico, New York, Oregon, Rhode Island, Utah, Vermont, Virginia and Washington), along with Washington, D.C., and Puerto Rico. Various cities and counties have also enacted local bans, while Oklahoma and countries including Canada, Chile, Germany and Mexico are considering legislation.
These laws do not affect all change efforts. The bans generally focus on protecting minors, and specifically apply to services provided by licensed mental health providers, says Ron Schlittler, program coordinator in APA’s Office on Sexual Orientation and Gender Diversity. “But many of the people receiving these treatments aren’t minors, and many of the providers aren’t licensed,” since the providers are religious leaders or other non-licensed individuals, he points out.
Some advocates are working to address unlicensed providers through lawsuits that charge them with fraud. “Under consumer protection laws, if people offer a service and promote it as effective when it isn’t, consumer protection laws may provide recourse against what courts might consider to be a deceptive practice,” Anderson explains.
In addition, a federal bill introduced in Congress last summer by Rep. Ted W. Lieu (D-Calif.), the Therapeutic Fraud Prevention Act of 2019opens in new window, would prohibit “conversion therapy” on the grounds that it is a fraudulent practice, both ineffective and dangerous to mental and physical health.
Another approach to limiting sexual orientation change efforts is denying federal funding to any states that fund “conversion therapy.” That’s the tack of the Pursuing Equity in Mental Health Act of 2019, introduced by Rep. Bonnie Watson Coleman (D-N.J.) in December 2019. The bill includes a variety of activities to address mental health issues in youth, particularly youth of color, and would deny federal funding to any state that funds “conversion therapy.” Neither bill has yet come to a vote.
Avoiding a test case
While there are movements to protect people from sexual orientation change efforts, other efforts continue to undermine LGBTQ rights. Numerous state bills target LGBTQ rights in areas such as adoption, marriage equality and transgender rights, Anderson notes. Furthermore, laws to limit gender-affirming treatments for youth who identify as transgender or gender nonconforming are also emerging in a number of states, he adds. “There are troubling laws cropping up in some states that try to prohibit medical treatment for children and adolescents with gender dysphoria, despite agreement among health providers that appropriate treatments for gender dysphoria have positive outcomes for transgender and gender nonconforming young people.”
There have also been challenges to bans on sexual orientation change efforts. In 2019, APA filed amicus briefs in lawsuits challenging bans on sexual orientation change treatments for minors in Maryland and in Boca Raton, Florida. Decisions in both cases are still pending.
In another twist, New York City’s City Council announced in September 2019 that it was planning to repeal a citywide ban on sexual orientation change efforts in order to prevent a lawsuit against the legislation. City Council members and LGBTQ advocates explained that if the ban remained in place and the lawsuit went forward, the matter could reach the Supreme Court — raising the risk of a ruling that could end up protecting sexual orientation change efforts nationwide.
APA is continuing to keep tabs on these efforts and has charged a task force with compiling new research to support an updated association resolution on sexual orientation change efforts, as well as a new resolution on gender identity change efforts.
But legislation can only go so far to protect LGBTQ youth, Ryan says. Formal conversion therapy is just one of dozens of behaviors families use to reject a child’s sexual orientation and gender identity, along with verbal abuse, physical punishment, exclusion from family events, preventing children from learning about LGBTQ issues and more. Family rejecting behaviors are broadly associated with negative health outcomes, while supportive behaviors are linked to positive outcomes, as she described in her Journal of Homosexuality paper.
“The legislation has done an excellent job of increasing awareness,” Ryan says. “But if we really want to address the negative outcomes, we need to provide education and guidance to help families understand that these behaviors are actually very harmful.”
For more information on sexual orientation, download the APA report “Appropriate Therapeutic Responses to Sexual Orientation (PDF, 1.12MB)opens in new window.”
