What Is Conversion Therapy, Exactly?

(Image: Jennifer Fox/Yahoo Health)

A new government report released Thursday (Oct. 15) confirms that conversion therapy — a controversial practice that aims to change a person’s sexual orientation or gender identity — is not appropriate for minors.

The report, released by the Substance Abuse and Mental Health Services Administration, reviewed the scientific evidence on conversion therapy and concluded that the practice is not effective and is often harmful.

An expert panel convened by the American Psychological Association also published in the report a consensus statement warning of the dangers of conversion therapy and confirming that variations in sexual orientation are normal.

But what is conversion therapy — and how is it practiced today?

First, “conversion therapy” is a misnomer, experts say. Psychologists call the practice “sexual orientation change efforts” since they aren’t really therapy, says Douglas C. Haldeman, PhD, professor of psychology at John F. Kennedy University. Haldeman has more than 30 years of clinical experience focusing on LGBT clients. “It is not therapy; it is quackery, pure and simple, often legitimized in the name of religious freedom,” he tells Yahoo Health.

“Conversion therapy is a discredited treatment that has been rejected by all the major mental health and medical associations, including the American Psychiatric Association, the American Psychological Association, American Academy of Pediatrics, and others,” says Judith Glassgold, PsyD, Associate Executive Director and Public Interest Directorate with the American Psychological Association. 

But despite the warnings against it, conversion therapy is still practiced today. “Many people believe that now that there is greater acceptance of LGBT individuals that this doesn’t occur,” Glassgold tells Yahoo Health. Even though four states, including California, Illinois, New Jersey, and Oregon, have banned licensed therapists from performing conversion therapy, it’s still legal in many states.

It’s difficult to say exactly what goes on during sessions because “practitioners of conversion therapy are notoriously secretive about their methods,” Haldeman says. It may include a wide variety of practices, depending on the practitioner. Glassgold say that sexual change efforts may include any of the following techniques:

  • Talk therapy to try to convince someone to change. These sessions typically provide inaccurate information about sexual orientation and gender identity, Glassgold says.
  • Techniques such as snapping a rubber band when a person feels attracted to the same sex, in an effort to associate a negative stimulus with same-sex attraction. 
  • Making children play with certain toys or wear certain clothes (for example, taking away dolls from a boy and giving him trucks instead). 
  • Prayer to change one’s attractions or gender identity.

In extreme cases, conversion therapy may include nausea-inducing medications or electric shocks.

“This might involve being subjected to an electric shock while looking at photos of gay couples or same sex genitals, or brainwashing techniques designed to essentially rewire the brain so that same-sex attraction is eradicated,” says Jamie Pettus, PsyD, LPC, a clinical psychologist practicing in Portland, Oregon, who specializes in LGBT issues. “This is an extremely dangerous process, and has resulted in self-hatred, isolation, and sometimes suicide.”

Therapy may also involve homework assignments, such as encouraging someone to get into a heterosexual relationship, Haldeman says.

Aversive techniques may also include exposure to heat or cold, or even having a patient strip naked or have to listen to slurs, says Alison Gill, senior legislative counsel for the Human Rights Campaign. “These practices are based in shame and rejection, and they have been criticized by every mainstream mental health organization,” Gill tells Yahoo Health.

At its core, conversion therapy assumes incorrectly that sexual orientation and gender identity are caused by environmental factors within the family. “Conversion therapy is a pseudoscience that blames homosexuality on bad parenting. Specifically, the practice claims — without evidence — that a rift between a child and a same-sex parent can lead to a child rejecting that parent and his or her gender role. At puberty this leads to sexualizing the same sex,” says Wayne Besen, founder of Truth Wins Out, a nonprofit group that speaks out against the ex-gay movement and anti-gay messages.

“Conversion therapy seeks to reverse this alleged process through a combination of prayer, talk therapy, and creating non-sexual same-sex friendships. It also includes masculinity exercises for men, such as touch football and drinking Gatorade, and lipstick seminars for girls,” Besen tells Yahoo Health.

Experts agree that the practice is not only ineffective — it can be dangerous, especially for children and teens, who are still developing their sense of self and trying to figure out their place in the world, Pettus says.

“Young people perceive conversion therapy as a form of family rejection. Family rejection of LGBT youth has been demonstrated to greatly increase their risk for depression, HIV or other sexually transmitted infections, drug use, and suicide,” Gill says. “Family acceptance, on the other hand, is a critical protective factor that helps LGBT youth to grow and thrive.”

Conversion therapy can also have lasting negative effects into adulthood, Haldeman explains. “Adults who have been through some form of this so-called ‘treatment’ as youngsters often become depressed and suicidal due to inner conflict about sexual orientation — and guilt over the inability to change it. Such survivors of conversion efforts often become unable to form intimate relationships in adult life,” he says.

But are there any benefits to conversion therapy? In short, no. “There are no benefits to conversion therapy in children and youth,” Glassgold says. “The risks are quite high due to a child’s vulnerability and general acceptance of messages from adults that they are bad or deviant.” This can lead to depression, anxiety, substance abuse, self-harm, and risky sexual behaviors, she adds.

The American Academy of Pediatrics states that counseling “may be helpful for you if you feel confused about your sexual identity,” but advises people to avoid treatments that view homosexuality as a sickness.

“Some people, particularly parents, feel it is safe and there is no harm if their child gives it a try. In reality, such rejection of self can be psychologically devastating and leave lasting mental scars that must be undone with real therapy,” Besen says, adding: “The single worst decision a parent can make is forcing their child into conversion therapy.”

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