Conversion Therapy: An evidence assessment and qualitative study

The UK Government has committed to exploring legislative and non-legislative options for ending so called ‘conversion therapy’. In this report the term ‘conversion therapy’ is used to refer to any efforts to change, modify or suppress a person’s sexual orientation or gender identity irrespective of whether it takes place in healthcare, religious or other settings.
The aim of this research was to improve understanding of the practice and to address the
following four research questions:
1. What forms does conversion therapy take?
2. Who experiences conversion therapy and why?
3. What are the outcomes of conversion therapy?
4. What measures have been taken to end conversion therapy around the world?
In order to answer Questions 1-3, a rapid evidence assessment was conducted examining research published from January 2000 to June 2020. Forty-six published studies were identified. Most of the evidence identified was specifically focused on conversion therapy aimed at changing sexual orientation, with only five articles that specifically addressed conversion therapy to change
gender identity. A qualitative study was also conducted to gather evidence on the experiences of people in the UK who had undergone conversion therapy. Thirty individuals were interviewed (16 men, 12 women, 2 non-binary persons) who had experienced sexual orientation change efforts (24), gender identity change efforts (3) or both (3). To answer Question 4, an additional search of the grey literature was conducted to identify measures taken around the world to end conversion therapy.
Key Findings
1. What forms does conversion therapy take?
• Evidence suggests that modern forms of conversion therapy are commonly based on a belief that same-sex sexual orientations and transgender identities are developmental disorders, addictions and/or a spiritual problem.
• The most common methods identified involved a combination of spiritual (e.g. prayer ‘healing’/exorcisms, pastoral counselling) and psychological methods (e.g. talking therapies). The boundaries between religious and psychological approaches are often
unclear with many combining the two in a way that could be described as pseudo-scientific.
• Conversion therapy appears to most commonly be delivered in religious settings by religious individuals or organisations but may also be delivered by mental health professionals or family members. In some cases, secular mental health professionals may treat minority gender identities (e.g. non-binary) or minority sexual orientations (e.g. asexual) as symptoms of existing mental health conditions; it is unclear how often this is a deliberate attempt at conversion therapy.
• There is less evidence relating to gender identity change efforts but what evidence there is suggests that conversion therapy with transgender people can take a very similar form to that aimed at changing sexual orientation.
2. Who experiences conversion therapy and why?
• There is no representative data on the number of lesbian, gay, bisexual and transgender (LGBT) people who have undergone conversion therapy in the UK, however some evidence appears to suggest that transgender people may be more likely to be offered or receive conversion therapy than cisgender lesbian, gay or bisexual people.
• There is consistent evidence that exposure to conversion therapy is associated with having certain conservative religious beliefs.
• Common reasons given for seeking out conversion therapy are:
- a perceived irreconcilability between one’s religious values and one’s sexual orientation or gender identity
- a desire to belong and feel ‘normal’ within a community
- external pressure or coercion by family members or people from one’s faith community
- Some people report that while they underwent conversion therapy voluntarily, they feel these ‘choices’ were shaped by powerful influences in their social environment and under guidance from authority figures.
3. What are the outcomes of conversion therapy?
• There is no robust evidence to support claims that conversion therapy is effective at changing sexual orientation or gender identity. Some of the largest studies report little to no reported change in sexual orientation and reports of success are unpersuasive due to serious methodological limitations and sometimes major flaws in study designs. No studies examining the effectiveness of conversion therapy aimed at changing gender identity were identified within the search period (2000 – 2020).
• Evidence of harm associated with conversion therapy outweighs reports of some benefits such as social support and a sense of belonging. Furthermore, the reported benefits are common to most forms of talking therapy or support groups and could be provided by other, more affirmative, approaches that mitigate risks of harm.
• There is a growing body of quantitative evidence that exposure to conversion therapy is statistically associated with poor mental health outcomes including suicidal thoughts and suicide attempts. This body of evidence is larger for sexual orientation change efforts; however, one recent study has also found that gender identity change efforts are associated with similar negative health outcomes. Although care needs to be taken when making causal inferences, qualitative studies have found that those who have undergone conversion therapy attribute such feelings to the conversion therapy. The majority of those interviewed in this study described experiencing conversion therapy as harmful, including reports of self-harm and suicidal thoughts. Plausible explanations for such harms include that conversion therapy exacerbates internal conflicts rather than resolves them and reinforces stigma associated with minority sexual orientations or gender identities.
4. What measures have been taken to end conversion therapy around the world?
• Most interventions employed by states to combat conversion therapy appear to apply to both sexual orientation and gender identity change efforts. Some apply to sexual orientation change efforts only.
• A range of legal and regulatory interventions have been introduced internationally to restrict conversion therapy. These vary in scope and have targeted a variety of sectors either individually or in combination (e.g. healthcare contexts, religious contexts, advertising).
• There have been several legal challenges to bans in the USA; however, no judicial decision to date has overturned a ban on conversion therapy.
• A conversion therapy ban has been successfully applied to sanction a life coach offering conversion therapy in Madrid, which has one of the world’s most comprehensive laws on conversion therapy.
Conclusions
Modern forms of conversion therapy appear to largely take the form of talking therapies and spiritual interventions. There is evidence that these forms of conversion therapy can be harmful but there is no robust evidence that identifies whether certain techniques or practices used by conversion therapists are more or less harmful than others. The evidence base is larger for sexual
orientation change efforts than for gender identity change efforts. A growing number of legal jurisdictions are legislating to restrict conversion therapy. The scope of such laws varies and due to many legislative measures being relatively recent there is little
evidence on what are the most effective policies for ending conversion therapy.