Banning Sexual Orientation and Gender Identity Change Efforts

Suggested Discussion Points With Resources to Oppose Transgender Exclusion Bills
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Background

“Reparative therapy” or “conversion therapy” are commonly used terms that include efforts to discourage or change behaviors related to LGBTQ+ identities and expressions (American Psychological Association, 2009a; Ashley, 2021). These efforts assume that being LGBTQ+ is an illness that must be cured, and any behaviors that indicate or reflect LGBTQ+ identities must be avoided. There are several other names for these practices. The American Psychological Association refers to them instead as “sexual orientation change efforts” or “gender identity change efforts” to differentiate from recognized evidence-based forms of therapy.

Sexual orientation and gender identity (SOGI) change efforts commonly use an array of psychosocially harmful techniques, including public shaming or inducing adverse physiological reactions. As of November 2023, the Movement Advancement Project reportedopens in new window 22 states and the District of Columbia had enacted legislation banning these practices with minors by licensed mental health care providers. Additionally, five states and one territory held partial bans for SOGI change efforts, and some cities and counties located in states without a statewide ban—such as Miami— enacted limited local bans. These laws resulted in several legal challenges with mixed results. So far, none have gone on to the U.S. Supreme Court. Additionally, Representative Lieu (D-CA) has introduced The Therapeutic Fraud Prevention Act in the U.S. Congress for several years, which would amend the Federal Trade Commission Act to clarify that providing conversion therapy to any person in exchange for monetary compensation or advertising such services is an unfair or deceptive act or practice.

Suggested discussion points

  • Ever since the American Psychiatric Association removed homosexuality from its diagnostic manual in 1973, it has been widely known that someone’s minority sexual orientation is not mental disorder to be “cured” or “treated.” Rather, it encompasses an individual’s sense of personal and social identity based on their attraction to men, women, or more than one gender (Institute of Medicine, 2011). In 2013 the American Psychiatric Association removed “gender identity disorder” from the diagnostic manual (American Psychiatric Association, 2013). Gender identity “refers to a person’s basic sense of being male, female, or of indeterminate sex,” and every person has a gender identity (APA, 2009b).
  • Efforts to change an individual’s sexual orientation or gender identity may encourage people to hide these aspects of their identity, which can lead to mental health problems such as depression, sexual problems, low self-esteem, and suicide (Beckstead and Morrow, 2004; Blosnich, et al., 2020; Dehlin, et al., 2015; Green, et al., 2020; Ryan et al., 2018).
  • Experts at the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) have concluded that sexual orientation or gender identity change efforts are “coercive, can be harmful, and should not be part of behavioral health treatment” (SAMHSA, 2015).
  • Many who offer change efforts are not licensed mental health practitioners, so it is unclear what, if any, training or education they may have received to represent themselves as qualified. As of January 2018, an estimated 698,000 LGBTQ+ adults have undergone these efforts, 350,000 as adolescents (Mallory, et al., 2019).
  • For these reasons and many others, we are asking you to support or cosponsor [bill number and name]. Please contact us if you have any questions, and we look forward to working with your office on this.

Examples of advocacy

Testimony regarding conversion therapy (PDF, 164KB)opens in new window
Andy Johnson, PhD, to the St. Paul City Council, June 16, 2020

Nebraska Psychological Association letter about prohibiting conversion therapy to individuals under the age of majority (PDF, 188KB)opens in new window
Rosemary Esseks, PhD, February 6, 2019

Washington State Psychological Association's testimony supporting banning “conversion therapy”
Lucy Homans, PhD, testifying before State House of Representatives Committee in support of a law to ban efforts to change sexual orientation, gender identity or gender expression. February 7, 2018

Are you a psychologist or a representative of a state, provincial or territorial psychology association who has written a letter to your state legislative representative or representatives, provided testimony at a committee hearing, or participated in direct advocacy individually or with organized community advocacy efforts? If so, would you be willing to share either copies of letters or testimony, or videos of testimony, for consideration to be added here as examples to inform and inspire others to take similar action? If so, please send via email.

References

American Psychological Association. (2009a). Report of the American Psychological Association Task Force on Appropriate Affirmative Responses to Sexual Orientation. Retrieved from: https://www.apa.org/pi/lgbt/resources/therapeutic-response.pdfopens in new window

American Psychological Association. (2009b). Report of the task force on gender identity and gender variance. https://www.apa.org/pi/lgbt/resources/policy/gender-identity-report.pdfopens in new window

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596opens in new window

Ashley, F. (2021). The clinical irrelevance of “desistance” research for transgender and gender creative youth. Psychology of Sexual Orientation and Gender Diversity. Advance online publication. https://doi.org/10.1037/sgd0000504opens in new window

Beckstead, A.L., & Morrow, S.L. (2004). Mormon clients’ experiences of conversion therapy: The need for a new treatment approach. The Counseling Psychologist, 32(5), 651-690. https://doi.org/10.1177/0011000004267555

Blosnich, J. R., Henderson, E. R., Coulter, R. W. S., Goldbach, J. T., & Meyer, I. H. (2020). Sexual Orientation Change Efforts, Adverse Childhood Experiences, and Suicide Ideation and Attempt Among Sexual Minority Adults, United States, 2016–2018. American Journal of Public Health, 110, 1024-1030 . https://doi.org/10.2105/AJPH.2020.305637

Dehlin, J. P., Galliher, R. V., Bradshaw, W. S., Hyde, D. C., & Crowell, K. A. (2015). Sexual orientation change efforts among current or former LDS church members. Journal of Counseling Psychology, 62, 95–105. https://doi.org/10.1037/cou0000011opens in new window

Green., A. E., Price-Feeney, M., Dorison, S. H., & Pick, C. J. (2020). Self-Reported Conversion Efforts and Suicidality Among US LGBTQ Youths and Young Adults, 2018. American Journal of Public Health, 110 (8), 1221-1227. doi: https://doi.org/10.2105/AJPH.2020.305701

Haldeman, D.C. (2002). Therapeutic antidotes: Helping gay and bisexual men recover from conversion therapy. Journal of Gay and Lesbian Psychotherapy, 5(3/4), 117-130. https://doi.org/10.1300/J236v05n03_08

Institute of Medicine. (2011).  The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. https://doi.org/10.17226/13128opens in new window

Mallory, C., Taylor, N.T., & Conron, K.J. (2019, update). Conversion Therapy and LGBT Youth. The Williams Institute, UCLA School of Law. https://williamsinstitute.law.ucla.edu/demographics/conversion-therapy-and-lgbt-youth/opens in new window

Ryan, C., Toomey, R.B., Diaz, R.M., & Russell, S.T. (2018). Parent-initiated sexual orientation change efforts with LGBT Adolescents: Implications for young adult mental health and adjustment. Journal of Homosexuality, 67(2), 1-15. https://doi.org/10.1080/00918369.2018.1538407

Substance Abuse and Mental Health Services Administration (SAMHSA). (2015). Ending Conversion Therapy: Supporting and Affirming LGBTQ Youth. HHS Publication No. (SMA) 15-4928. https://store.samhsa.gov/sites/default/files/d7/priv/sma15-4928.pdfopens in new window

Special thanks

APA thanks and acknowledges Andrew Arriaga, MA, Melissa Grey PhD, and Kim Skerven PhD, for their contributions to this content.

APA Resources

See Also