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{{Short description|Pseudoscientific attempts to change sexual orientation or gender identity}}
'''Conversion therapy''', sometimes called '''reparative therapy''', is a type of [[Sexual orientation change efforts|sexual orientation change effort]] that attempts to change the [[sexual orientation]] of a person from [[homosexual]] or [[bisexual]] to [[heterosexual]].<ref>{{cite web|url=http://www.apa.org/pi/lgbt/resources/policy/ex-gay.pdf |title=Statement of the American Psychological Association |format=PDF |date= |accessdate=2011-07-18}}</ref> Conversion therapy has been a source of intense controversy in the United States and other countries.<ref name="DrescherandZucker">{{Harvnb|Drescher|2006|pp=126, 175}}</ref> The most high-profile contemporary advocates of conversion therapy tend to be [[Christian fundamentalism|conservative Christian]] groups and other religious organizations.<ref name="Yoshino">{{Harvnb|Yoshino|2002}}</ref> The main organization advocating secular forms of conversion therapy is the [[National Association for Research & Therapy of Homosexuality]] (NARTH); however, NARTH often partners with religious groups.<ref name="Yoshino" />
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{{Use dmy dates|date=October 2020}}
{{Infobox pseudoscience
| claims = One's sexual orientation, romantic orientation, gender identity, or gender expression can be changed to fit [[heterosexual]], [[heteroromantic]], and [[cisgender]] norms.
| notableprop = [[Ex-gay movement]]
}}
{{LGBT rights sidebar}}
{{Alternative medicine sidebar|fringe}}


'''Conversion therapy''' is the [[pseudoscientific]]<!-- DO NOT remove or change to "scientific" without talk page consensus --> practice of attempting to change an individual's [[sexual orientation]], [[romantic orientation]], [[gender identity]], or [[gender expression]] to align with [[heterosexual]] and [[cisgender]] norms.<ref>{{Cite journal |last1=Fenaughty |first1=John |last2=Tan |first2=Kyle |last3=Ker |first3=Alex |last4=Veale |first4=Jaimie |last5=Saxton |first5=Peter |last6=Alansari |first6=Mohamed |date=January 2023 |title=Sexual Orientation and Gender Identity Change Efforts for Young People in New Zealand: Demographics, Types of Suggesters, and Associations with Mental Health |journal=Journal of Youth and Adolescence |language=en |volume=52 |issue=1 |pages=149–164 |doi=10.1007/s10964-022-01693-3 |pmid=36301377 |pmc=9813061 |issn=0047-2891}}</ref> Methods that have been used to this end include forms of [[brain surgery]], [[castration|surgical]] or [[chemical castration|chemical (hormonal) castration]], [[aversion therapy]] treatments such as electric shocks, nausea-inducing drugs, [[hypnosis]], counseling, spiritual interventions, visualization, [[psychoanalysis]], and arousal reconditioning. There is a scientific consensus that conversion therapy is ineffective at changing a person's sexual orientation or gender identity and that it frequently causes significant long-term psychological harm.<ref name=":0" /> The position of current [[evidence-based medicine]] and clinical guidance is that [[homosexuality]], [[bisexuality]], and [[gender variance]] are natural and healthy aspects of [[human sexuality]].<ref name=":0" />{{sfn|Haldeman|2022|p=5}} An increasing number of jurisdictions around the world have passed [[laws against conversion therapy]].<ref name="Drescher" />
The [[American Psychological Association]] defines conversion therapy as therapy aimed at changing sexual orientation.<ref name="Answers">{{citation |url=http://www.apa.org/topics/sexuality/orientation.aspx |title=Answers to Your Questions: For a Better Understanding of Sexual Orientation and Homosexuality |accessdate=2008-02-14 |year=2008 |month=February |publisher=American Psychological Association |format=PDF}}</ref> The American Psychiatric Association states that conversion therapy is a type of psychiatric treatment "based upon the assumption that homosexuality per se is a mental disorder or based upon the ''[[A priori and a posteriori|a priori]]'' assumption that a patient should change his/her sexual [[Homosexuality|homosexual]] orientation."<ref name="Psych" /> The American Psychiatric Association has condemned this type of therapy and states that, "Ethical practitioners refrain from attempts to change individuals' sexual orientation."<ref>Jason Cianciotto and Sean Cahill (2006). [http://www.thetaskforce.org/downloads/reports/reports/YouthInTheCrosshairs.pdf Youth in the crosshairs: the third wave of ex-gay activism]. New York: National Gay and Lesbian Task Force Policy Institute.</ref> Psychologist Douglas Haldeman writes that conversion therapy comprises efforts by [[mental health]] professionals and [[pastoral care]] providers to convert lesbians and gay men to heterosexuality by techniques including [[Aversion therapy|aversive treatments]], such as "the application of electric shock to the hands and/or genitals," and "nausea-inducing drugs...administered simultaneously with the presentation of homoerotic stimuli," masturbatory reconditioning, visualization, social skills training, [[Psychoanalysis|psychoanalytic therapy]], and spiritual interventions, such as "prayer and group support and pressure."<ref name="haldeman">{{Harvnb|Haldeman|2002|pp=260–264}}</ref> NARTH repudiates aversive techniques and stresses therapeutic efforts toward growing more fully into what it considers one's biologically appropriate gender identity.<ref>[http://narth.com/2012/01/narth-statement-on-sexual-orientation-change NARTH Statement on Sexual Orientation Change]</ref>


Historically, conversion therapy was the treatment of choice for individuals who disclosed same-sex attractions or exhibited gender nonconformity, which were formerly assumed to be [[pathologies]] by the medical establishment.{{sfn|Haldeman|2022|p=5}} When performed today, conversion therapy may constitute [[fraud]], and when performed on minors, a form of [[child abuse]]; it has been described by experts as [[torture]]; [[cruel, inhuman, or degrading treatment]]; and contrary to [[human rights]].
Mainstream American medical and scientific organizations have expressed concern over conversion therapy and consider it potentially harmful.<ref name="Psych">{{citation |url=http://www.psych.org/Departments/EDU/Library/APAOfficialDocumentsandRelated/PositionStatements/200001a.aspx |title=Position Statement on Therapies Focused on Attempts to Change Sexual Orientation (Reparative or Conversion Therapies) |accessdate=2007-08-28 |year=2000 |month=May |publisher=[[American Psychiatric Association]] |format=PDF}} ([http://web.archive.org/web/20100929155736/http://www.psych.org/Departments/EDU/Library/APAOfficialDocumentsandRelated/PositionStatements/200001a.aspx Archived version])</ref><ref name="APA"/><ref name="NewAPA">{{citation |url=http://www.apa.org/pi/lgbt/resources/therapeutic-response.pdf |format=PDF |title=Report of the American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation |accessdate=2009-09-24 |first=JM |last=Glassgold | coauthors=et al. |publisher=[[American Psychological Association]] |date=2009-08-01 }}</ref> The advancement of conversion therapy may cause social harm by disseminating inaccurate views about sexual orientation.<ref name="APA"/>


==Terminology ==
The ethics guidelines of major mental health organizations in the United States vary from cautionary statements to recommendations that ethical practitioners refrain from practicing conversion therapy (American Psychiatric Association) or from referring patients to those who do ([[American Counseling Association]]).<ref name="Psych" /><ref name="ACA News" /> In a letter dated February 23, 2011 to the Speaker of the U.S. House of Representatives, the Attorney General of the United States stated "while sexual orientation carries no visible badge, a growing scientific consensus accepts that sexual orientation is a characteristic that is [[Immutable truth|immutable]]".<ref name="DOMA2011">[http://www.justice.gov/opa/pr/2011/February/11-ag-223.html Letter from the Attorney General of the United States to the Speaker of the U.S. House of Representatives, RE: DOMA, 23rd February 2011],"Second, while sexual orientation carries no visible badge, a growing scientific consensus accepts that sexual orientation is a characteristic that is immutable."</ref> In a position paper released May 17, 2012, the [[Pan American Health Organization]] (PAHO) stated that 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, and noted that there is a professional consensus that [[homosexuality]] is a natural variation of [[human sexuality]] and cannot be regarded as a pathological condition.<ref name=PAHO>{{cite web|title="Therapies" to change sexual orientation lack medical justification and threaten health|url=http://new.paho.org/hq/index.php?option=com_content&task=view&id=6803&Itemid=1926|publisher=Pan American Health Organization|accessdate=26 May 2012}} archived [http://www.webcitation.org/67xKQyixE here].</ref>
Medical professionals and activists consider "conversion therapy" a [[misnomer]], as it does not constitute a legitimate form of [[therapy]].{{sfn|Haldeman|2022|p=4}} Alternative terms include sexual orientation change efforts (SOCE){{sfn|Haldeman|2022|p=4}} and gender identity change efforts (GICE){{sfn|Haldeman|2022|p=4}}—together, sexual orientation and gender identity change efforts (SOGICE).<ref name="SOGICESurvivor">{{cite web | vauthors=Csabs C, Despott N, Morel B, Brodel A, Johnson R | url=http://socesurvivors.com.au/wp-content/uploads/2020/12/Survivor-Statement-A4-Doc-v1-2-Digital.pdf | title=The SOGICE Survivor Statement | archive-url=https://web.archive.org/web/20230405220718/https://socesurvivors.com.au/wp-content/uploads/2020/12/Survivor-Statement-A4-Doc-v1-2-Digital.pdf | archive-date=2023-04-05 | date=July 2020 | url-status=dead}}</ref>{{better source needed|date=February 2023}} According to researcher [[Douglas C. Haldeman]], SOCE and GICE should be considered together because both rest on the assumption "that gender-related behavior consistent with the individual's birth sex is [[normative]] and anything else is unacceptable and should be changed".{{sfn|Haldeman|2022|p=8}} "Reparative therapy" may refer to conversion therapy in general,{{sfn|Haldeman|2022|p=4}} or to [[#Reparative therapy|a subset thereof]].<ref name="Drescher1998"/>

Advocates of conversion therapy do not necessarily use the term either, instead using phrases such as "healing from sexual brokenness"<ref>{{cite journal |id={{Gale|A586241649}} |last1=Lee |first1=Jin |title=Diversity or a flavor of diversity? |journal=Gateway Journalism Review |date=1 January 2019 |volume=47 |issue=352 |pages=34–35 }}</ref><ref>{{cite thesis |last1=Stephens |first1=John Bryant |date=1997 |title=Conflicts over homosexuality in the United Methodist Church: Testing theories of conflict analysis and resolution |id={{ProQuest|304408101}} |oclc=41964052 }}</ref> and "struggling with same-sex attraction".<ref>{{cite journal |last1=Creek |first1=S. J. |last2=Dunn |first2=Jennifer L. |title='Be Ye Transformed': The Sexual Storytelling of Ex-gay Participants |journal=Sociological Focus |date=2012 |volume=45 |issue=4 |pages=306–319 |doi=10.1080/00380237.2012.712863 |jstor=41633922 |s2cid=144699323 }}</ref>


==History==
==History==
{{main|History of conversion therapy}}
===Overview===


=== Sexual orientation change efforts (SOCE) ===
Legal scholar [[Kenji Yoshino]] argues that the history of conversion therapy can be divided broadly into three phases: an early Freudian period, a period of mainstream approval of conversion therapy during a time when the mental health establishment became the "primary superintendent" of sexuality, and a post-Stonewall period wherein the mainstream medical profession disavowed conversion therapy.<ref name="Yoshino" />
The term ''[[homosexual]]'' was coined by German-speaking Hungarian writer [[Karl Maria Kertbeny]] and was in circulation by the 1880s.{{sfn|Whisnant|2016|p=20}}<ref name=Drescher>{{cite journal |last1=Drescher |first1=Jack |last2=Schwartz |first2=Alan |last3=Casoy |first3=Flávio |last4=McIntosh |first4=Christopher A. |last5=Hurley |first5=Brian |last6=Ashley |first6=Kenneth |last7=Barber |first7=Mary |last8=Goldenberg |first8=David |last9=Herbert |first9=Sarah E. |last10=Lothwell |first10=Lorraine E. |last11=Mattson |first11=Marlin R. |last12=McAfee |first12=Scot G. |last13=Pula |first13=Jack |last14=Rosario |first14=Vernon |last15=Tompkins |first15=D. Andrew |title=The Growing Regulation of Conversion Therapy |journal=Journal of Medical Regulation |date=2016 |volume=102 |issue=2 |pages=7–12 |doi=10.30770/2572-1852-102.2.7 |pmid=27754500 |pmc=5040471 }}</ref> Into the middle of the twentieth century, competing views of homosexuality were advanced by [[psychoanalysis]] versus academic [[sexology]]. [[Sigmund Freud]], the founder of psychoanalysis, viewed homosexuality as a form of [[arrested development]]. Later psychoanalysts followed [[Sandor Rado]], who argued that homosexuality was a "phobic avoidance of heterosexuality caused by inadequate early parenting".<ref name=Drescher/> This line of thinking was popular in psychiatric models of homosexuality based on the prison population or homosexuals seeking treatment. In contrast, sexology researchers such as [[Alfred Kinsey]] argued that homosexuality was a normal variation in human development. In 1970, gay activists confronted the [[American Psychiatric Association]], persuading the association to reconsider whether homosexuality should be listed as a disorder. The APA delisted homosexuality in 1973, which contributed to shifts in public opinion on homosexuality.<ref name=Drescher/>


Despite their lack of scientific backing, some [[social conservative|socially]] or [[religious conservatism|religiously conservative]] activists continued to argue that if one person's sexuality could be changed, homosexuality was not a fixed class such as [[Race (human categorization)|race]]. Borrowing from discredited psychoanalytic ideas about the cause of homosexuality, some of these individuals offered conversion therapy.<ref name=Drescher/> In 2001, conversion therapy attracted attention when [[Robert L. Spitzer]] published a non-[[peer-reviewed]] study asserting that some homosexuals could change their sexual orientation. Many researchers made [[methodological]] criticisms of the study, which Spitzer later repudiated.<ref name=Drescher/>
During the earliest parts of psychoanalytic history, analysts granted that homosexuality was non-pathological in certain cases, and the ethical question of whether it ought to be changed was discussed. By the 1920s psychoanalysts assumed that homosexuality was pathological and that attempts to treat it were appropriate, although psychoanalytic opinion about changing homosexuality was largely pessimistic. Those forms of homosexuality that were considered perversions were usually held to be uncurable. Psychoanalysts‘ tolerant statements about homosexuality arose from recognition of the difficulty of achieving change. Beginning in the 1930s and continuing for roughly twenty years, major changes occurred in how psychoanalysts viewed homosexuality, which involved a shift in the rhetoric of psychoanalysts, some of whom felt free to ridicule and abuse their gay patients.<ref name="Lewes">{{Harvnb|Lewes|1988}}</ref>


=== Gender identity change efforts (GICE) ===
===Europe===
Gender Identity Change Efforts (GICE) refer to practices of healthcare providers and religious counselors with the goal of attempting to alter a person's gender identity or expression to conform to social norms. Examples include [[aversion therapy]], [[cognitive restructuring]], and [[psychoanalytic therapy|psychoanalytic]] and talk therapies.{{sfn|Rivera|Pardo|2022|p=52}} Western medical-model narratives have historically institutionalized [[transphobia]]: systemically favoring a binary gender model and pathologizing gender diversity and non-conformity.{{sfn|Rivera|Pardo|2022|p=53}} This aided the development and proliferation of GICE.{{sfn|Rivera|Pardo|2022|p=56}}
====Sigmund Freud====
{{Main|Sigmund Freud's views on homosexuality}}
[[Image:Sigmund Freud LIFE.jpg|thumb|Freud (1856–1939) was skeptical of the possibility of therapeutic conversion.]]


Early [[social engineering (political science)|interventions]] were rooted in psychoanalytic hypotheses.{{sfn|Rivera|Pardo|2022|p=58}} [[Robert Stoller]] advanced the theory that [[gender variance|gender-nonconforming]] behavior and expression in children assigned male at birth (AMAB) was caused by being overly close to their mother. [[Richard Green (sexologist)|Richard Green]] continued his research; his methods for altering behavior included having the father spend more time with the child and mother less, expecting both to exhibit stereotypical [[gender roles]], and having them praise their child's masculine behaviors, and shame their feminine and gender-nonconforming ones. These interventions resulted in depression in the children and feelings of betrayal from parents that the treatments failed.{{sfn|Rivera|Pardo|2022|p=58}}
[[Sigmund Freud]] was a physician and the founder of psychoanalysis. Freud stated that homosexuality could sometimes be removed through hypnotic suggestion,<ref name="SigmundFreudOnSexuality">{{Harvnb|Freud|1991|p=51}}</ref> and was influenced by [[Eugen Steinach]], a [[Vienna|Viennese]] endocrinologist who transplanted [[testicle]]s from straight men into gay men in attempts to change their sexual orientation,<ref>{{Harvnb|LeVay|1996|p=74,109}}</ref> stating that his research had “thrown a strong light on the organic determinants of homo-eroticism”.<ref name="SigmundFreudOnSexualityP58">{{Harvnb|Freud|1991|p=58}}</ref> Freud cautioned that Steinach's operations would not necessarily make possible a therapy that could be generally applied, arguing that such transplant procedures would be effective in changing homosexuality in men only in cases in which it was strongly associated with physical characteristics typical of women, and that probably no similar therapy could be applied to lesbianism.<ref>{{Harvnb|Freud|1991|pp=58–59}}</ref><ref>{{Harvnb|Freud|1991|p=400}}</ref> In fact Steinach’s method was doomed to failure because the [[immune system]] rejects transplanted glands, and was eventually exposed as ineffective and often harmful.<ref>{{Harvnb|LeVay|1996|pp=32–33}}</ref>


In the 1970s, [[UCLA]] psychologist Richard Green recruited [[Ole Ivar Lovaas]] to adapt the techniques of [[Applied Behavior Analysis]] (ABA) therapy to attempt to prevent children from becoming [[transsexual]].<ref name="silberman_2016_319">{{Cite book |last1=Silberman |first1=Steve |title=Neurotribes: The Legacy of Autism and the Future of Neurodiversity |date=2016 |publisher=Avery |location=New York City, NY |pages=319–321 |isbn=978-0399185618}}</ref> Deemed the "Feminine Boy Project", the treatments used [[operant conditioning]] to reward gender-conforming behaviors, and punish gender non-conforming behaviors.<ref name="silberman_2016_319"/>
Freud‘s main discussion of female homosexuality was the 1920 paper “The Psychogenesis of a Case of Homosexuality in a Woman“, which described his analysis of a young woman who had entered therapy because her parents were concerned that she was a [[lesbian]]. Her father wanted this condition changed. In Freud‘s view, the prognosis was unfavourable because of the circumstances under which she entered therapy, and because homosexuality was not an illness or neurotic conflict. Freud wrote that changing homosexuality was difficult and possible only under unusually favourable conditions, observing that “in general to undertake to convert a fully developed homosexual into a heterosexual does not offer much more prospect of success than the reverse.”<ref name="SigmundFreudCaseHistoriesIIP376">{{Harvnb|Freud|1991|p=376}}</ref> Success meant making heterosexual feeling possible, not eliminating homosexual feelings.<ref>{{Harvnb|Freud|1991|p=375}}</ref>


{{Anchor|Living in your own skin model}}
Gay people could seldom be convinced that heterosexual sex would provide them with the same pleasure they derived from homosexual sex. Patients often wanted to become heterosexual for reasons Freud considered superficial, including fear of social disapproval, an insufficient motive for change. Some might have no real desire to become heterosexual, seeking treatment only to convince themselves that they had done everything possible to change, leaving them free to return to homosexuality after the failure they expected. Freud therefore told the parents only that he was prepared to study their daughter to determine what effects therapy might have. He eventually broke off the treatment entirely because of what he saw as her hostility to men.<ref name="OconnorandRyan">{{Harvnb|O’Connor|Ryan|1993|pp=30–47}}</ref><ref name="SigmundFreudCaseHistoriesII">{{Harvnb|Freud|1991|pp=371–400}}</ref><ref name="LewesP34">{{Harvnb|Lewes|1988|p=34}}</ref>
[[Kenneth Zucker]] at the [[Centre for Addiction and Mental Health]] adopted Richard Green's methods, but narrowed the scope to attempting to prevent the child from identifying as transgender by modifying gender behavior and presentation to conform to the expectations of the assigned gender at birth, which he dubbed the "living in your own skin" model. His model used the same interventions as Green with the addition of [[psychodynamic therapy]].{{sfn|Rivera|Pardo|2022|p=58}}<ref name="forcier_2020_177">{{Cite book |last1=Chung |first1=Kathleen |last2=Rhoads |first2=Sarah |last3=Rolin |first3=Alicia |last4=Sackett-Taylor |first4=Andrew C. |last5=Forcier |first5=Michelle |editor-last1=Forcier |editor-first1=Michelle |editor-last2=Van Schalkwyk |editor-first2=Gerrit |editor-last3=Turban |editor-first3=Jack L. |date=2020 |title=Pediatric Gender Identity: Gender-affirming Care for Transgender & Gender Diverse Youth |publisher=Springer |chapter=Treatment Paradigms for Prepubertal Children |page=177 |isbn=978-3030389086}}</ref><ref name="Hart">{{Cite book |title=Banning 'conversion therapy': legal and policy perspectives |date=2023 |publisher=Hart |year=2023 |isbn=978-1-5099-6117-7 |editor-last=Trispiotis |editor-first=Ilias |location=Oxford London New York New Delhi Sydney |pages=134 |editor-last2=Purshouse |editor-first2=Craig}}</ref><ref name="ashley_2022_4">{{Cite book |last1=Ashley |first1=Florence |title=Banning Transgender Conversion Practices: A Legal and Policy Analysis |date=2022 |publisher=University of British Columbia Press |isbn=978-0774866958 |location=Vancouver, BC |pages=4–6}}</ref>


==Motivations==
In 1935, Freud wrote to a mother who had asked him to treat her son a letter that later became famous:<ref>{{Harvnb|Lewes|1988|p=32}}</ref>
A frequent motivation for adults who pursue conversion therapy is their religious beliefs, especially [[evangelical Christianity]] and [[Orthodox Judaism]], that disapprove of same-sex relations. These adults prioritize maintaining a good relationship with their family and religious community.{{sfn|Haldeman|2022|p=9}} Adolescents who are pressured by their families into undergoing conversion therapy also typically come from a conservative religious background.{{sfn|Haldeman|2022|p=9}} Youth from families with low [[socioeconomic status]] are also more likely to undergo conversion therapy.{{sfn|Haldeman|2022|p=11}}


==Theories and techniques==
{{quote|I gather from your letter that your son is a homosexual...it is nothing to be ashamed of, no vice, no degradation; it cannot be classified as an illness; we consider it to be a variation of the sexual function, produced by a certain arrest of sexual development. By asking me if I can help [your son], you mean, I suppose, if I can abolish homosexuality and make normal heterosexuality take its place. The answer is, in a general way we cannot promise to achieve it. In a certain number of cases we succeed in developing the blighted germs of heterosexual tendencies, which are present in every homosexual; in the majority of cases it is no more possible. It is a question of the quality and the age of the individual. The result of treatment cannot be predicted.<ref name="ErnstLFreud">{{Harvnb|Freud|1992|pp=423–424}}</ref>}}
As [[societal attitudes toward homosexuality]] have become more tolerant over time, the most harsh conversion therapy methods such as aversion have been reduced. Secular conversion therapy is offered less often due to reduced medical pathologization of homosexuality, and religious practitioners have become more dominant.<ref>{{cite journal |last1=Andrade |first1=G. |last2=Campo Redondo |first2=M. |title=Is conversion therapy ethical? A renewed discussion in the context of legal efforts to ban it |journal=Ethics, Medicine and Public Health |date=2022 |volume=20 |pages=100732 |doi=10.1016/j.jemep.2021.100732 }}</ref>


====Isidor Sadger====
===Aversion therapy===
{{see also|Behavior modification}}
[[Isidor Isaak Sadger|Isidor Sadger]] published “Fragment der Psychoanalyse eines Homosexuellen” in the ''Jahrbuch fuer sexuellen Zwischenstufen'' in 1908. It described his analysis of a melancholy Danish count who was homosexual. The analysis lasted for only thirteen days before being terminated by the patient, whose sexual orientation was not changed. Later in 1908, Sadger published “Ist der Kontraere sexual Empfindung heilbar?”, which assessed the value of psychoanalysis as a treatment for “contrary sexual feeling“, in the ''Zeitschrift fuer Sexualwissenschaft''. He answered the question of whether it could be cured in patients who were moral and determined “''mit einem runden Ja!''“ (“''with a round Yes!''“).<ref name="LewesP51">{{Harvnb|Lewes|1988|p=51}}</ref> Sadger believed that it was not enough to establish a spurious kind of heterosexual functioning or “''masturbatio per vaginam''”, wanting instead to change a patient’s “''Sexualideal''”, the internal image of his sexual object.“<ref name="LewesP68">{{Harvnb|Lewes|1998|p=68}}</ref>


[[Aversion therapy]] used on homosexuals included electric shock and nausea-inducing drugs during presentation of same-sex erotic images. Cessation of the aversive stimuli was typically accompanied by the presentation of opposite-sex erotic images, with the objective of strengthening heterosexual feelings.<ref>{{Harvnb|Haldeman|1991|p=152}}</ref> Another method used was the covert sensitization method, which involves instructing patients to imagine vomiting or receiving electric shocks, writing that only single case studies have been conducted, and that their results cannot be generalized. Haldeman writes that behavioral conditioning studies tend to decrease homosexual feelings, but do not increase heterosexual feelings, citing Rangaswami's "Difficulties in arousing and increasing heterosexual responsiveness in a homosexual: A case report", published in 1982, as typical in this respect.<ref>{{Harvnb|Haldeman|1991|pp=152–153}}</ref>
Sadger supported his claim that homosexuality could be cured entirely by describing a four month analysis of a patient whose crucial memories “had been wholly unconscious and first had to be unearthed very laboriously through a month-long analysis.“<ref name="LewesP62">{{Harvnb|Lewes|1988|p=62}}</ref> Making striking claims about homosexuality on the basis of brief analyses appears to have been typical for psychoanalysts in the early 20th century. The material Sadger’s patients produced appears to have been influenced by his expectations. Sadger permitted his patients to engage in homosexual activity during treatment because of his belief that "behind it, a heterosexual can again be found."<ref name="LewesP51" />


Other methods of aversion therapy in addition to electric shock included ice baths, freezing, burning via metal coils, and hard labor. The intent was for the subject to associate homosexual feelings with pain and thus result in them being reduced. These methods have been concluded to be ineffective.<ref>{{Cite web |date=April 11, 2022 |title=Summary of Findings: A Review of Scientific Evidence of Conversion Therapy |url=https://www.health.state.mn.us/people/conversiontherapy.pdf |access-date=November 9, 2023 |website=Minnesota Department of Health}}</ref>
[[Magnus Hirschfeld]], a physician and the leader of the gay rights movement in Germany in the early 20th century, argued that the purpose of therapy should be to permit clients to accept their homosexuality, but accepted that gay men had the right to attempt to change their sexual orientation if they wished and therefore sometimes recommended them to Sadger. Hirschfeld believed that the failure of attempts to change homosexuality through psychoanalysis proved that it was biologically innate.<ref name="LeVay1996">{{Harvnb|LeVay|1996}}</ref>


Aversion therapy was developed in [[Czechoslovak Socialist Republic|Czechoslovakia]] between 1950 and 1962 and in the British Commonwealth from 1961 into the mid-1970s. In the context of the Cold War, Western psychologists ignored the poor results of their Czechoslovak counterparts, who had concluded that aversion therapy was not effective by 1961 and recommended [[decriminalization of homosexuality]] instead.<ref>{{cite journal |last1=Davison |first1=Kate |title=Cold War Pavlov: Homosexual aversion therapy in the 1960s |journal=History of the Human Sciences |date=2021 |volume=34 |issue=1 |pages=89–119 |doi=10.1177/0952695120911593|s2cid=218922981 }}</ref> Some men in the United Kingdom were offered the choice between prison and undergoing aversion therapy. It was also offered to a few British women, but was never the standard treatment for either homosexual men or women.<ref>{{cite journal |last1=Spandler |first1=Helen |last2=Carr |first2=Sarah |title=Lesbian and bisexual women's experiences of aversion therapy in England |journal=History of the Human Sciences |date=2022 |volume=35 |issue=3–4 |pages=218–236 |doi=10.1177/09526951211059422|pmid=36090521 |pmc=9449443 |s2cid=245753251 }}</ref>
====Felix Boehm====
German psychoanalysts who wrote about homosexuality included [[Felix Boehm]]. He accepted Freud’s earlier theory of homosexuality involving boys’ identification with their mothers and consequent narcissistic object choice. His major work was a four-part series on homosexuality published in the ''Internationale Zeitschrift fuer Psychoanalyse'' between 1920 and 1933. It attempted to present and illustrate the most up to date psychoanalytic thinking on homosexuality. In Boehm’s view, curing homosexuality meant making enjoyable heterosexual functioning possible rather than eliminating homosexual behavior. Boehm claimed to have cured gay people in the fourth part of his series on homosexuality, but presented as proof a case in which “the homosexuality never became conscious for the patient and had never expressed itself in manifest activity.” This patient does not appear to have been homosexual. Boehm claimed that manifest homosexuals regularly abandoned treatment out of hatred for their analysts just at the point when they were close to achieving heterosexual functioning. Boehm criticised Sadger’s ''Die Lehre von den Geschlechtsverwirrugen&nbsp;... auf psychoanalytischer Grundlage'' for its brief analyses, many of which lasted only weeks or months.<ref name="Lewes" />


In the 1970s, behaviorist [[Hans Eysenck]] was one of the main advocates of counterconditioning with malaise-inducing drugs and [[electric shock]] for homosexuals. He wrote that this type of therapy was successful in nearly 50% of cases. However, his studies were disputed.{{sfn|Rolls|2019|p={{page needed|date=June 2023}}}}
====Sándor Ferenczi====
Behavior therapists, including Eysenck, used [[Aversion therapy|aversive]] methods. This led to a protest against Eysenck by gay activist [[Peter Tatchell]] in a London Medical Group Symposium in 1972. Tatchell said that the therapy promoted by Eysenck was a form of [[torture]].{{sfn|Rolls|2019|p={{page needed|date=June 2023}}}}
[[Sándor Ferenczi]] was an influential psychoanalyst. Native to Hungary, he wrote many of his works in the time [[German language|German]].
Tatchell denounced Eysenck's form of behavioral therapy as inducing [[clinical depression|depression]] and [[suicide]] among gay men who were subjected to it.<ref>{{cite journal |last1=Spandler |first1=Helen |last2=Carr |first2=Sarah |title=Lesbian and bisexual women's experiences of aversion therapy in England |journal=History of the Human Sciences |date=2022 |volume=35 |issue=3–4 |pages=218–236 |doi=10.1177/09526951211059422 |pmid=36090521 |pmc=9449443 }}</ref>


===Brain surgery===
Ferenczi denied the importance of inherited factors on homosexuality, claiming that it was caused by “excessively powerful heterosexuality (intolerable to the ego)“. Ferenczi tried to distinguish between several different types of homosexuality, basing his distinctions on an unspecified number of patients whose analyses had sometimes lasted for a short period and sometimes “a whole year and even longer.” Ferenczi hoped to cure some kinds of homosexuality completely, but was content in practice with reducing what he considered gay men's hostility to women, along with the urgency of their homosexual desires, and with helping them to become attracted to and potent with women. In his view, a gay man who was confused about his sexual identity and felt himself to be “a woman with the wish to be loved by a man” was not a promising candidate for cure. Ferenczi believed that complete cures of homosexuality might become possible in the future when psychoanalytic technique had been improved. [[Sándor Radó (psychoanalyst)|Sándor Radó]] and Melanie Klein were pupils of Ferenczi.<ref name="Lewes" /><ref name="ErnestJonesVol2">{{Harvnb|Jones|1955|p=}}</ref><ref name="MartinStanton">{{Harvnb|Stanton|1991|p=}}</ref>


In the 1940s and 1950s, U.S. neurologist [[Walter Jackson Freeman II|Walter Freeman]] popularized the [[Lobotomy#Transorbital lobotomy|ice-pick lobotomy]] as a treatment for homosexuality. He personally performed as many as 3,439<ref>{{cite news |last1=Day |first1=Elizabeth |title=He was bad, so they put an ice pick in his brain... |url=https://www.theguardian.com/science/2008/jan/13/neuroscience.medicalscience |work=The Observer |date=13 January 2008 |access-date=16 November 2017 |archive-date=20 October 2013 |archive-url=https://web.archive.org/web/20131020075415/http://www.theguardian.com/science/2008/jan/13/neuroscience.medicalscience |url-status=live }}</ref> lobotomy surgeries in 23 states, of which 2,500 used his ice-pick procedure,<ref>{{cite web|title=Top 10 Fascinating And Notable Lobotomies|url=http://listverse.com/2009/06/24/top-10-fascinating-and-notable-lobotomies/|date=24 June 2009|website=listverse.com|access-date=26 December 2013|archive-date=27 December 2013|archive-url=https://web.archive.org/web/20131227024430/http://listverse.com/2009/06/24/top-10-fascinating-and-notable-lobotomies/|url-status=live}}</ref> despite the fact that he had no formal surgical training.<ref name="rowland">{{cite journal|last=Rowland|first=Lewis|date=April 2005|title=Walter Freeman's Psychosurgery and Biological Psychiatry: A Cautionary Tale|journal=Neurology Today|volume=5|issue=4|pages=70–72|doi=10.1097/00132985-200504000-00020}}</ref>
====Anna Freud====
Daughter of Sigmund Freud, Anna Freud became an influential psychoanalytic theorist in the UK after she left Austria in 1938 to escape the Nazis.<ref name="Young-Bruehl" />


In West Germany, a type of brain surgery usually involving destruction of the [[ventromedial nucleus of the hypothalamus]] was done to some homosexual men during the 1960s and 1970s. The practice was criticized by sexologist [[Volkmar Sigusch]].<ref>{{cite journal |last1=Rieber |first1=Inge |last2=Sigusch |first2=Volkmar |date=1979 |title=Psychosurgery on sex offenders and sexual "deviants" in West Germany |url=https://link.springer.com/article/10.1007/BF01541419 |journal=Archives of Sexual Behavior |language=en |volume=8 |issue=6 |pages=526 |doi=10.1007/BF01541419 |issn=1573-2800 |pmid=391177 |s2cid=41463669 |access-date=20 June 2023 |archive-date=24 September 2024 |archive-url=https://web.archive.org/web/20240924070658/https://link.springer.com/article/10.1007/BF01541419 |url-status=live }}</ref>
[[Anna Freud]] reported the successful treatment of homosexuals as neurotics in a series of unpublished lectures. In 1949 she published “Some Clinical Remarks Concerning the Treatment of Cases of Male Homosexuality” in the ''International Journal of Psychoanalysis.'' In her view, it was important to pay attention to the interaction of passive and active homosexual fantasies and strivings, the original interplay of which prevented adequate identification with the father. The patient should be told that his choice of a passive partner allows him to enjoy a passive or receptive mode, while his choice of an active partner allows him to recapture his lost masculinity. She claimed that these interpretations would reactive repressed castration anxieties, and childhood narcissistic grandiosity and its complementary fear of dissolving into nothing during heterosexual intercourse would come with the renewal of heterosexual potency.<ref name="Lewes" />


===Castration and transplantation===
Anna Freud in 1951 published “Clinical Observations on the Treatment of Male Homosexuality” in ''Psychoanalytic Quarterly'' and “Homosexuality” in the ''American Psychoanalytic Association Bulletin.'' These articles insisted on the attainment of full object-love of the opposite sex as a requirement for cure of homosexuality. In 1951 she gave a lecture about treatment of homosexuality which was criticised by Edmund Bergler, who emphasised the oral fears of patients and minimized the importance of the phallic castration fears she had discussed.<ref name="Lewes" />
{{see also|Persecution of homosexuals in Nazi Germany}}
[[File:Stolperstein von Friedrich Paul von Groszheim.jpg|thumb|[[Friedrich-Paul von Groszheim]] (1908–2006) was spared from a concentration camp after agreeing to castration under pressure in 1938.]]
In the early twentieth century Germany experiments were carried out in which homosexual men were subjected to [[unilateral orchiectomy]] and testicles of heterosexual men were transplanted. These operations were a complete failure.{{sfn|Schmidt|1985|pp=133–134}}


[[Surgical castration]] of homosexual men was widespread in Europe in the first half of the twentieth century.<ref>{{cite book |last1=Lehring |first1=Gary |title=Officially Gay: The Political Construction Of Sexuality |date=2010 |publisher=Temple University Press |isbn=978-1-4399-0399-5 |page=63 |language=en}}</ref> SS leader [[Heinrich Himmler]] ordered homosexual men to be [[persecution of homosexuals in Nazi Germany#Concentration camps|sent to concentration camps]] because he did not consider a time-limited prison sentence was sufficient to eliminate homosexuality.{{sfn|Zinn|2020b|pp=11–12}} Although theoretically voluntary, some homosexuals were subject to severe pressure and coercion to agree to castration. There was no age limit; some boys as young as 16 were castrated. Those who agreed to castration after a [[Paragraph 175]] conviction were exempted from being transferred to a concentration camp after completing their legal sentence.{{sfn|Wachsmann|2015|p=147}} Some concentration camp prisoners were also subjected to castration.{{sfn|Weindling|2015|p=30}} An estimated 400 to 800 men were castrated.{{sfn|Schwartz|2021|p=383}}
Anna Freud recommended in 1956 to a journalist who was preparing an article about psychoanalysis for the London ''Observer'' that she not quote Freud‘s letter to the American mother, on the grounds that “...nowadays we can cure many more homosexuals than was thought possible in the beginning. The other reason is that readers may take this as a confirmation that all analysis can do is to convice patients that their defects or ‘immoralities‘ do not matter and that they should be happy with them. That would be unfortunate.”<ref name="Young-Bruehl">{{Harvnb|Young-Bruehl|1988|p=327}}</ref>


Endocrinologist [[Carl Vaernet]] attempted to change homosexual concentration camp prisoners' sexual orientations by implanting a pellet that released [[testosterone]]. Most of the victims, non-consenting prisoners at [[Buchenwald concentration camp|Buchenwald]], died shortly thereafter.{{sfn|Whisnant|2016|p=223}}{{sfn|Weindling|2015|pp=183–184}}
====Melanie Klein====
The Austrian-born psychoanalyst [[Melanie Klein]] moved to London in 1926. Her seminal book ''The Psycho-Analysis of Children'', based on lectures given to the British Psychoanalytic Society in the 1920s, was published in 1932. Klein claimed that entry into the [[Oedipus Complex]] is based on mastery of primitive anxiety from the oral and anal stages. If these tasks are not performed properly, developments in the Oedipal stage will be unstable. Complete analysis of patients with such unstable developments would require uncovering these early concerns. The analysis of homosexuality required dealing with paranoid trends based on the oral stage. ''The Psycho-Analysis of Children'' ends with the analysis of Mr. B., a gay man. Klein claimed that he illustrated pathologies that enter into all forms of homosexuality: a gay man idealizes “the good penis” of his partner to ally the fear of attack he feels due to having projected his paranoid hatred onto the imagined “bad penis“ of his mother as an infant. She stated that Mr. B.’s homosexual behaviour diminished after he overcame his need to adore the “good penis” of an idealized man. This was made possible by his recovering his belief in the good mother and his ability to sexually gratify her with his good penis and plentiful [[semen]].<ref name="Lewes" />


An unknown number of men were castrated in [[West Germany]] and [[chemical castration]] was used in other Western countries, notably against [[Alan Turing]] in the United Kingdom.<ref>{{cite book |last1=Huneke |first1=Samuel Clowes |title=States of Liberation: Gay Men between Dictatorship and Democracy in Cold War Germany |date=2022 |publisher=University of Toronto Press |isbn=978-1-4875-4213-9 |pages=53–54 |language=en}}</ref>
====Edmund Bergler====
[[Edmund Bergler]]’s first contribution to the psychoanalytic theory of homosexuality was “Der Mammakomplex des Mannes“, an article co-authored with L. Eidelberg and published in the ''Internationale Zeitschrift fuer Psychoanalyse'' in 1933. It described a “breast complex“ found in both normal and pathological conditions, among which Eidelberg and Bergler included “a type of homosexuality.” The male child reacts violently to weaning, making unsuccessful attempts to inhibit his frustrated aggression that only heighten it. This causes ambivalent identifications, object choices, and narcissistic compensations. Cathexes are displaced from the breast onto the penis, and the infant substitutes urine for milk, attempting to make active what was once passive. He unsuccessfully tries to transfer hatred of the mother onto the father, but the [[Oedipus complex]] does not reach normal intensity because of the unresolved ambivalence of the oral period. The unstable organization achieved at the Oedipal period regresses to an earlier stage involving fixation on the oral mother, whose vagina is conflated with the infant‘s own cannibalistic mouth, transmuting it into the ''vagina dentata''. This oral fixation leads to character traits such as spite and libido charged with aggression.<ref name="Lewes" />


===Ex-gay/ex-trans ministries===
====J. Vinchon and Sacha Nacht====
[[File:One by One booth.jpg|thumb|right|[[OneByOne]] booth at a [[Love Won Out]] conference]]
J. Vinchon and Sacha Nacht in 1929 published "Considerations sur la cure psychoanalytique d’une nevrose homosexuelle" in ''Revue francaise de psychoanalyse''. This article divided gay people into three categories: those with glandular abnormalities, sexual perverts, and neurotics. Vinchon and Nacht believed that gay people in the second category (who were "comfortably settled in [their] vice") were incurable.<ref name="Lewes" />
{{Main|Ex-gay}}


Ex-gay ministries are religious groups that attempt to use religion to eliminate or change somebody's sexual orientation.<ref name="APA">{{citation |url=http://www.apa.org/pi/lgbt/resources/just-the-facts.pdf |title=Just the Facts About Sexual Orientation & Youth: A Primer for Principals, Educators and School Personnel |access-date=14 May 2010 |year=1999 |publisher=Just the Facts Coalition |archive-date=22 April 2018 |archive-url=https://web.archive.org/web/20180422101943/http://www.apa.org/pi/lgbt/resources/just-the-facts.pdf |url-status=live }}</ref><ref name="DrescherandZucker">{{Harvnb|Drescher|Zucker|2006|pp=126, 175}}</ref><ref>{{Harvnb|Haldeman|1991|pp=149,156–159}}</ref><ref name="JonesandYarhouse">{{Harvnb|Jones|Yarhouse|2007|p=374}}</ref> The ex-gay umbrella organization [[Exodus International]] in the United States ceased activities in June 2013, and the three member board issued a statement which repudiated its aims and apologized for the harm their pursuit has caused to [[LGBT]] people.<ref>{{Cite web |last=Burnett |first=John |date=20 June 2013 |title=Group That Claimed To 'Cure' Gays Disbands, Leader Apologizes |url=https://www.npr.org/2013/06/20/193965227/group-that-claimed-to-cure-gays-disbands-leader-apologizes |website=NPR |access-date=27 January 2024 |archive-date=24 September 2024 |archive-url=https://web.archive.org/web/20240924070613/https://www.npr.org/2013/06/20/193965227/group-that-claimed-to-cure-gays-disbands-leader-apologizes |url-status=live }}</ref><ref name="Change">{{citation |url=http://exodusinternational.org/2013/06/i-am-sorry |first=Alan |last=Chambers |archive-url=https://web.archive.org/web/20130623013409/http://exodusinternational.org/2013/06/i-am-sorry |archive-date=23 June 2013 |title=I Am Sorry |access-date=22 June 2013 |publisher=Exodus International}}</ref> Ex-trans organizations often overlap and portray being trans as inherently sinful or against God's design, or pathologize gender variance as due to trauma, social contagion, or "[[gender ideology]]."<ref>{{cite journal |last1=Robinson |first1=Christine M. |last2=Spivey |first2=Sue E. |title=Ungodly Genders: Deconstructing Ex-Gay Movement Discourses of 'Transgenderism' in the US |journal=Social Sciences |date=17 June 2019 |volume=8 |issue=6 |pages=191 |doi=10.3390/socsci8060191 |doi-access=free }}</ref><ref>{{cite journal |last1=Jones |first1=Tiffany |last2=Jones |first2=Timothy W. |last3=Power |first3=Jennifer |last4=Pallotta-Chiarolli |first4=Maria |last5=Despott |first5=Nathan |title=Mis-education of Australian Youth: exposure to LGBTQA+ conversion ideology and practises |journal=Sex Education |date=3 September 2022 |volume=22 |issue=5 |pages=595–610 |doi=10.1080/14681811.2021.1978964 |s2cid=241018465 |doi-access=free |hdl=10536/DRO/DU:30156953 |hdl-access=free }}</ref>
====Daniel Lagache====


=== Hypnosis ===
Daniel Lagache in 1950 published “Homosexuality and Jealousy” in the ''International Journal of Psychoanalysis''. It described the analysis of a gay man, illustrating the relation of active and passive forms of homosexuality and the defensive maneuvers that mediate between them. The patient shifted from homosexual to heterosexual interests, and experienced a stage of intense jealousy that Lagache regarded as both a sign of progress and a resistance. The heterosexual interest was a new defense against passive homosexuality, while active homosexuality had been his old defense. Passive homosexuality was intolerable to the patient because it was associated with castration, but it was deeply rooted in his psychology because “submission and obedience to the father [had] as their aim the right to take his place.”<ref name="Lewes" />
Hypnosis was used in conversion therapy since the 19th century by [[Richard von Krafft-Ebing]] and [[Albert von Schrenck-Notzing]]. In 1967, Canadian psychiatrist Peter Roper published a case study of treating 15 homosexual (some of which would probably be considered bisexual by modern standards) people with hypnosis. Allegedly, 8 showed "marked improvement" (they reportedly lost sexual attraction towards the same sex altogether), 4 mild improvements (decrease of "homosexual tendencies"), and 3 no improvement after hypnotic treatment; he concluded that "hypnosis may well produce more satisfactory results than those obtainable by other means", depending on the [[hypnotic susceptibility]] of the subjects.<ref>{{cite journal |last1=Roper |first1=P. |title=The effects of hypnotherapy on homosexuality |journal=Canadian Medical Association Journal |date=11 February 1967 |volume=96 |issue=6 |pages=319–327 |pmid=6017544 |pmc=1935956 }}</ref>{{better source needed|date=February 2023}}

===United States===
====20th century====
Psychoanalysis started to receive recognition in the United States in 1909, when Sigmund Freud delivered a series of lectures at Clark University in Massachusetts at the invitation of G. Stanley Hall.<ref name="PGay1998">{{Harvnb|Gay|2006|p=}}</ref>

[[Abraham Brill]] in 1913 wrote “The Conception of Homosexuality”, which he published in the ''Journal of the American Medical Association'' and read before the American Medical Association’s annual meeting, where it was criticised by several doctors. Brill declared that after long study he had slowly overcome his disgust for homosexuality. He denied that homosexuality was influenced by inherited factors or necessarily related to emotional disturbance. Brill observed that it was impossible to use the term ''homosexuality'' diagnostically, since it could refer to several different entities. Brill asserted that the development of sexual attraction to the same sex was always related to [[narcissism]], which he incorrectly defined as love for one‘s self. Brill criticised physical treatments for homosexuality such as [[bladder washing]], [[rectum|rectal]] massage, and castration, along with [[hypnosis]], but referred approvingly to Freud and Sadger's use of psychoanalysis, calling its results “very gratifying.“<ref name=KatzP149>{{Harvnb|Katz|1976|p=149}}</ref> Since Brill understood cure of homosexuality to mean restoring heterosexual potency, he claimed that he had cured his patients in several cases, even though many remained homosexual.<ref name="Lewes" /><ref name="Katz">{{Harvnb|Katz|1976}}</ref>

Dr. [[Wilhelm Stekel]], an Austrian, published his views on treatment of homosexuality, which he considered a disease, in the American ''Psychoanalytic Review'' in 1930. Stekel believed that “success was fairly certain“ in changing homosexuality through psychoanalysis provided that it was performed correctly and the patient wanted to be treated. In 1932, the ''Psychoanalytic Quarterly'' published a translation of Dr. [[Helene Deutsch]]'s paper “On Female Homosexuality“. Deutsch reported her analysis of a lesbian, who did not become heterosexual as a result of treatment, but who managed to achieve a "positive libidinal relationship" with another woman. Deutsch indicated that she would have considered heterosexuality a better outcome.<ref name="Katz" />

Dr. La [[Forest Potter]] of New York City published ''Strange Loves: A Study in Sexual Abnormalities'', which focused on homosexuality, in 1933, probably to exploit the interest in the subject generated by the American publication of [[Radclyffe Hall]]’s novel ''[[The Well of Loneliness]]'' and Blair Niles’s ''Strange Brother.'' He believed that homosexuality was caused by psychological and hormonal disturbances, and that it could be cured if the patient wanted to change. Potter advocated a mixture of psychoanalysis and hormone treatment. He believed that marriage might help to alter lesbianism in cases in which it was not hereditary. Potter described his treatment of two lesbians, stating that it was unsuccessful in one case but successful in the other. He stated that he had successfully cured a young man of homosexuality.<ref name="Katz" />

[[Edmund Bergler]] moved to the USA after vacating his post as psychoanalyst in Vienna in 1937.<ref name="Terry">{{Harvnb|Terry|1999|pp=308–314}}</ref> He published “Preliminary Phases of the Masculine Beating Fantasy“, a response to Freud‘s “A Child Is Being Beaten“, in ''Psychoanalytic Quarterly'' in 1938. Bergler claimed to have detected the early phase of a beating fantasy in boys. This phase began with the weaning shock, which mobilizes enormous sadistic rage against the breasts of the depriving phallic mother, which is an attempt at narcissistic restitution for the lost breasts of the mother. Due to guilt, this rage is transmuted into a masochistic fantasy of being beaten by the father, substituting the boy’s own buttocks for the mother’s breasts and idealizing the father out of hatred of the mother, thereby substituting a homosexual for a heterosexual bond. The paper shifted the important stage in the development of homosexual perversion back from the Oedipus complex to the oral stage, minimized the importance of object libido and emphasised more primitive narcissistic oral rage, and established that homosexual perversion could not be based on a primary homosexual attachment to the father, since there was always an earlier heterosexual attachment to the mother. The implication was that all outcomes of the Oedipus complex involving a passive homosexual stance toward the father are perverse.<ref name="Lewes" /><ref name="ErnestJonesVol2" />

Bergler was the most important psychoanalytic theorist of homosexuality in the 1950s.<ref name="Lewes" /> He was vociferous in his opposition to [[Alfred Kinsey]], who argued that homosexuality was normal human variation. Bergler argued that Kinsey's statistical research overestimated the incidence of homosexuality because it was conducted in cities where perversion thrived. Bergler based his theories partly on analysis of the novels of literary figures known to be gay. Kinsey's work, and its reception, led Bergler to develop his own theories for treatment, which were essentially to 'blame the victim'.<ref name="Terry"/>

Bergler claimed that if gay people wanted to change, and the right therapeutic approach was taken, then they could be cured in 90% of cases.<ref name="BerglerTime">{{Harvnb|Bergler|1956}}</ref> Bergler used confrontational therapy in which gay people were punished in order to make them aware of their masochism. Bergler openly violated professional ethics to achieve this, breaking patient confidentiality in discussing the cases of patients with other patients, bullying them, calling them liars and telling them they were worthless.<ref name="Terry"/> He insisted that gay people could be cured, and that if they believed they should be accepted, they were asking for punishment, which confirmed their pathological immaturity. Bergler initially blamed those who mistreated gay people, because it provided a rationale for the masochistic view of the world; but, from the 1950s, and following the emergence of gay rights organisations, he began to blame homosexuals for their own oppression. Bergler confronted Kinsey because Kinsey thwarted the possibility of cure by presenting homosexuality as an acceptable way of life, which was the basis of the homosexual rights activism of the time.<ref name="Terry"/> Bergler popularised his views on homosexuality and its cure in the USA in the 1950s using magazine articles and books aimed at non-specialists.<ref name="Terry" /><ref name="Bergler">{{Harvnb|Bergler|1962}}</ref>

In 1951, the mother who wrote to Freud asking him to treat her son sent Freud's response to the ''American Journal of Psychiatry'', in which it was published.<ref name="Lewes" /> The 1952 first edition of the American Psychiatric Association's [[Diagnostic and Statistical Manual of Mental Disorders]] (DSM-I) classified homosexuality as a mental disorder.<ref name="RonaldBayer" />

During the three decades between Freud's death in 1939 and the [[Stonewall riots]] in 1969, conversion therapy received approval from most of the psychiatric establishment in the United States.<ref name="Drescher">{{Harvnb|Drescher|1998|pp=19–42}}</ref> Sandor Rado in 1940 criticized Freud's theory of innate bisexuality in his article "A Critical Examination of the Concept of Bisexuality". Rado concluded that pursuing the genital organs of the opposite sex is the standard form of achieving genital stimulation and that the main cause of homosexuality is anxiety, although he granted that "constitutional factors may have an influence on morbid sex developments."<ref name="JuddMarmor1965">{{Harvnb|Marmor|1965|pp=175–189}}</ref> Rado‘s article appears to have been partly motivated by the desire to combat homosexuality.<ref name="Lewes" /><ref name="PGay1998" />

The homosexuality as sickness theory started to come under criticism in the 1950s. [[Evelyn Hooker]] in 1957 published “The Adjustment of the Male Overt Homosexual”, which found that "homosexuals were not inherently abnormal and that there was no difference between homosexual and heterosexual men in terms of pathology."<ref name="EHooker">{{Harvnb|Hooker|1957|pp=18–31}}</ref> This paper subsequently became influential.<ref name="MKirby">{{Harvnb|Kirby|1957|pp=674–677}}</ref> [[Irving Bieber]] and his colleagues in 1962 published ''Homosexuality: A Psychoanalytic Study of Male Homosexuals'', which concluded that "although this change may be more easily accomplished by some than by others, in our judgment a heterosexual shift is a possibility for all homosexuals who are strongly motivated to change."<ref>{{Harvnb|Bieber|1962|p=}}</ref> The same year, Albert Ellis published ''Reason and Emotion in Psychotherapy'', which claimed that "fixed homosexuals in our society are almost invariably neurotic or psychotic:... therefore, no so-called ''normal'' group of homosexuals is to be found anywhere."<ref name="AlbertEllis1962">{{Harvnb|Ellis|1962|p=242}}</ref> Ellis published his main work on homosexuality, ''Homosexuality: Its Causes and Cure'', in 1965.<ref name="AlbertEllis1965">{{Harvnb|Ellis|1965|p=}}</ref>

[[Image:Charles Socarides.jpg|thumb|Charles W. Socarides, M.D.]]

[[Charles Socarides]]’s first book, ''The Overt Homosexual'', was published in 1968. Socarides regarded homosexuality as an illness arising from a conflict between the [[Id, ego, and super-ego|id and the ego]] usually arising from an early age in "a female-dominated environment wherein the father was absent, weak, detached or sadistic". He credited the earlier work of Irving Bieber with clarifying progress in therapeutic knowledge and effectivenes.<ref name="Socarides">{{Harvnb|Socarides|1968|p=}}</ref>

There was a [[Stonewall riots|riot]] in 1969 at the Stonewall Bar in New York after a police raid. The Stonewall riot acquired symbolic significance for the gay rights movement and came to be seen as the opening of a new phase in the struggle for gay liberation. Following these events, conversion therapy came under increasing attack. Activism against conversion therapy increasingly focused on the DSM's designation of homosexuality as a psychopathology.<ref name="RonaldBayer" />

[[Lawrence Hatterer]] in 1970 published ''Changing Homosexuality in the Male'', which advocated a therapy based on simplified psychoanalytic ideas and behavior modification techniques.<ref name="Lewes" />

In 1973, after years of criticism from gay activists and bitter dispute among psychiatrists, the American Psychiatric Association removed homosexuality as a mental disorder from the ''Diagnostic and Statistical Manual of Mental Disorders''. Supporters of the change used evidence from researchers such as Alfred Kinsey and Evelyn Hooker. Psychiatrst Robert Spitzer, a member of the APA's Committee on Nomenclature, played an important role in the events that lead to this decision. Critics argued that it was a result of pressure from gay activists, and demanded a referendum among voting members of the Association. The referendum was held in 1974 and the APA’s decision was upheld by a 58% majority.<ref name="RonaldBayer">{{Harvnb|Bayer|1987|p=}}</ref>

Books promoting new forms of conversion therapy were published in the 1980s. Robert Kronemeyer in 1980 published ''Overcoming Homosexuality'',<ref name="Kronemeyer">{{Harvnb|Kronemeyer|1980}}</ref> while research psychologist [[Elizabeth Moberly]] in 1983 published ''Homosexuality: A New Christian Ethic''.<ref name="Moberly1983">{{Harvnb|Moberly|1983}}</ref>

The APA removed ego-dystonic homosexuality from the [[DSM-IV]] in 1987 and opposes the diagnosis of either homosexuality or ego-dystonic homosexuality as any type of disorder.<ref>{{citation |url=http://www.apa.org/pi/lgbc/policy/diagnoses.html |archiveurl=http://web.archive.org/web/20070929104523/http://www.apa.org/pi/lgbc/policy/diagnoses.html |archivedate=2007-09-29 |title=APA Policy Statement: Use of Diagnoses "Homosexuality" & "Ego-Dystonic Homosexuality" |accessdate=2007-08-28 |author=APA Council of Representatives |date=1987-08-30 |publisher=American Psychological Association}}</ref>

Joseph Nicolosi began playing an important role in the development of conversion therapy in the early 1990s, publishing his first book ''Reparative Therapy of Male Homosexuality'' in 1991.<ref name="GLAAD" /> In 1992, Joseph Nicolosi, Charles Socarides, and Benjamin Kaufman founded the [[National Association for Research & Therapy of Homosexuality]] (NARTH), a mental health organization that opposes the mainstream medical view of homosexuality and aims to "make effective psychological therapy available to all homosexual men and women who seek change."<ref name="NARTH">{{citation |url=http://narth.com/menus/goals.html |title=NARTH What We Offer |accessdate=2009-05-25 |publisher=NARTH}}</ref> Former American Psychological Association President Dr. Nicholas Cummings was the Keynote Speaker at the 2011 NARTH Conference and said that he had a "high regard" for NARTH and considered it an honor to be invited to speak at NARTH's scientific gathering.<ref>[http://www.josephnicolosi.com/former-american-psychological/ American Psychological Association Past-President To Speak at NARTH Conference Slated for November 4-6, 2011]</ref>

====21st century====

[[Surgeon General of the United States|United States Surgeon General]] [[David Satcher]] in 2001 issued a report stating that "there is no valid scientific evidence that sexual orientation can be changed".<ref name="SurgeonGeneral">{{citation |url=http://www.surgeongeneral.gov/library/sexualhealth/call.htm#III |title="The Surgeon General's call to Action to Promote Sexual Health and Responsible Sexual Behavior", A Letter from the Surgeon General U.S. Department of Health and Human Services |accessdate=2007-03-29 |publisher=U. S. Department of Health and Human Services}}</ref> The same year, a study by [[Robert Spitzer (psychiatrist)|Robert Spitzer]] concluded that some highly motivated individuals whose orientation is predominantly homosexual can become predominantly heterosexual with some form of reparative therapy.<ref>{{citation |url=http://www.springerlink.com/content/rk67865783602411/ |title=Can Some Gay Men and Lesbians Change Their Sexual Orientation? |publisher=Archive of Sexual Behavior |date = Vol. 32, No. 5, 2001|format=}}</ref> Spitzer based his findings on structured interviews with 200 self-selected individuals (143 males, 57 females). He told ''The Washington Post'' that the study "shows some people can change from gay to straight, and we ought to acknowledge that."<ref>{{citation |url=http://www.washingtonpost.com/wp-srv/aponline/20010509/aponline013921_000.htm |title=Study: Some Gays Can Go Straight |publisher=The Washington Post |date = May 9, 2001}}</ref> Spitzer's study caused controversy and attracted media attention.<ref name="DrescherandZucker" /> Spitzer recanted his study in 2012,<ref name=spitzer1 /> and apologized to the gay community for making unproven claims of the efficacy of reparative therapy,<ref name=spitzer3 /> calling it his only professional regret.<ref name=spitzer4 />

The American Psychoanalytic Association (APsaA) spoke against NARTH in 2004, stating "that organization does not adhere to our policy of nondiscrimination and ... their activities are demeaning to our members who are gay and lesbian."<ref>{{citation |last=Crow |first=C. |date=2004-11-20 |title=Irate reader's expert on gays has drawn fire from his peers |publisher=[[San Antonio Express-News]]}}</ref> NARTH believes that it is discriminatory and unethical to ignore the needs and goals of people who do not wish to be gay.<ref name=narthstatement>[http://narth.com/2012/01/narth-statement-on-sexual-orientation-change NARTH Statement on Sexual Orientation Change]</ref> In 2006, Focus on the Family and several other organizations announced that they would protest the American Psychological Association's convention in New Orleans. Mike Haley, the director of gender issues for Focus on the Family, commented that, "The APA's views on issues such as the immutability of homosexuality have caused real harm to real people and patients."<ref>{{citation |url=http://findarticles.com/p/articles/mi_hb5554/is_200608/ai_n21879692 |archiveurl=http://web.archive.org/web/20081222111709/http://findarticles.com/p/articles/mi_hb5554/is_200608/ai_n21879692 |archivedate=2008-12-22 |title=APA Convention Targeted for Protest; APA Focused More on Political Correctness Than Helping Patients, Group Says |publisher=U.S. Newswire |date = August 2006|format=}}</ref> The same year, a survey of members of the [[American Psychological Association]] rated reparative therapy as "certainly discredited", though the authors warn that the results should be interpreted carefully as an initial step, not a final word.<ref name="NorcrossKoocherandGarofalo">{{Harvnb|Norcross|Koocher|Garofalo|2006|pp=512–522}}</ref>

The [[American Psychological Association]] in 2007 convened a task force to evaluate its policies regarding reparative therapy; ex-gay organizations expressed concerns about the lack of representation of pro-reparative-therapy perspectives on the task force, while alleging that anti-reparative-therapy perspectives were amply represented.<ref>{{citation |url=http://www.washingtontimes.com/news/2007/jul/11/gay-reparative-therapy-under-scrutiny/ |title=Gay reparative therapy under scrutiny |publisher=Washington Times |location=New York |date=July 11, 2007 |accessdate=2009-02-15}}</ref>

In 2008, the organizers of an APA panel on the relationship between religion and homosexuality canceled the event after gay activists objected that "conversion therapists and their supporters on the religious right use these appearances as a public relations event to try and legitimize what they do."<ref name="Plowman">{{Harvnb|Plowman|2008}}</ref><ref name="Johnson">{{Harvnb|Johnson|2008}}</ref>

In 2009, American Psychological Association stated that it "encourages mental health professionals to avoid misrepresenting the efficacy of sexual orientation change efforts by promoting or promising change in sexual orientation when providing assistance to individuals distressed by their own or others’ sexual orientation and concludes that the benefits reported by participants in sexual orientation change efforts can be gained through approaches that do not attempt to change sexual orientation".<ref name=Apa2009>American Psychological Association: [http://www.apa.org/pi/lgbc/publications/resolution-resp.html Resolution on Appropriate Affirmative Responses to Sexual Orientation Distress and Change Efforts]{{dead link|date=July 2011}}</ref>

==Theories and techniques==
{{Wikinews|Dr. Joseph Merlino on sexuality, insanity, Freud, fetishes and apathy}}

===Behavioral modification===
{{Main|Behavior modification}}

Douglas Haldeman writes in "Sexual Orientation Conversion Therapy for Gay Men and Lesbians: A Scientific Examination" that early behavioral forms of conversion therapy mainly employed aversive conditioning techniques, involving electric shock and nausea-inducing drugs during presentation of same-sex erotic images. Cessation of the aversive stimuli was typically accompanied by the presentation of opposite-sex erotic images, with the objective of strengthening heterosexual feelings. Haldeman discusses the work of M. P. Feldman, who in "Aversion therapy for sexual deviation: a critical review", published in 1966, claimed a 58% cure rate. Haldeman is skeptical that such stressful methods permit feelings of sexual responsiveness, and notes that Feldman defined success as suppression of homosexuality and increased capacity for heterosexual behavior.<ref>{{Harvnb|Haldeman|1991|p=152}}</ref>

Haldeman also discusses the covert sensitization method, which involves instructing patients to imagine vomiting or receiving electric shocks, writing that only single case studies have been conducted, and that their results cannot be generalized. He writes that behavioral conditioning studies tend to decrease homosexual feelings, but do not increase heterosexual feelings, citing Rangaswami's "Difficulties in arousing and increasing heterosexual responsiveness in a homosexual: A case report", published in 1982, as typical in this respect.<ref>{{Harvnb|Haldeman|1991|pp=152–153}}</ref>

Haldeman concludes that such methods applied to anyone except gay people would be called [[torture]], writing, "Individuals undergoing such treatments do not emerge heterosexually inclined; rather they become shamed, conflicted, and fearful about their homosexual feelings."<ref>{{Harvnb|Haldeman|1991|p=153}}</ref>

Haldeman writes in "Gay Rights, Patient Rights: The Implications of Sexual Orientation Conversion Therapy" that aversive treatments sometimes involved the application of electric shock to the hands and/or genitals, or nausea-inducing drugs, administered simultaneously with the presentation of homoerotic stimuli, while less cruel methods included [[masturbation|masturbatory]] reconditioning, visualization, and social skills training. All of these methods were based on the idea that homosexuality is a learned behavior that can be reconditioned.<ref name="haldeman"/>

===Ex-gay ministry===
[[Image:One by One booth.jpg|thumb|right||[[OneByOne]] booth at a [[Love Won Out]] conference]]

{{Main|Ex-gay}}

Some sources describe ex-gay ministries as a form of conversion therapy, while others state that ex-gay organizations and conversion therapy are distinct methods of attempting to convert gay people to heterosexuality.<ref name="DrescherandZucker" /><ref name="APA">{{citation |url=http://www.apa.org/pi/lgbt/resources/just-the-facts.pdf |title=Just the Facts About Sexual Orientation & Youth: A Primer for Principals, Educators and School Personnel |accessdate=2010-05-14 |year=1999 |publisher=Just the Facts Coalition}}</ref><ref>{{Harvnb|Haldeman|1991|pp=149,156–159}}</ref><ref name="JonesandYarhouse">{{Harvnb|JonesandYarhouse|2007|p=374}}</ref> Ex-gay ministries have also been called transformational ministries.<ref name="APA"/> Some state that they do not conduct clinical treatment of any kind.<ref name=ExodusStatement /> [[Exodus International]] believe reparative therapy can be a beneficial tool.<ref name=ExodusStatement>[http://exodus.to/content/view/34/117/ Exodus International Policy Statements], [[Exodus International]]. Retrieved 04-07-2007.</ref> [[Evergreen International]] states that it is unlikely therapy can erase all homosexual feelings,<ref>{{cite web|url=http://www.evergreeninternational.org/therapy.htm |title=Evergreen Therapy |publisher=Evergreeninternational.org |date= |accessdate=2011-07-18}}</ref> and does not advocate any particular form of therapy.<ref>{{cite web|url=http://www.evergreeninternational.org/Myths.htm |title=Evergreen Myths |publisher=Evergreeninternational.org |date=1997-01-09 |accessdate=2011-07-18}}</ref>


===Psychoanalysis===
===Psychoanalysis===
{{Main|Psychoanalysis}}
{{Main|Psychoanalysis}}


Douglas Haldeman writes that psychoanalytic treatment of homosexuality is exemplified by the work of Irving Bieber and his colleagues in ''Homosexuality: A Psychoanalytic Study of Male Homosexuals''. They advocated long-term therapy aimed at resolving the unconscious childhood conflicts that they considered responsible for homosexuality. Haldeman notes that Bieber's methodology has been criticized because it relied upon a clinical sample, the description of the outcomes was based upon subjective therapist impression, and follow-up date were poorly presented. Bieber reported a 27% success rate from long-term therapy, but only 18% of the patients in whom Bieber considered the treatment successful had been exclusively homosexual to begin with, while 50% had been bisexual. In Haldeman's view, this makes even Bieber's unimpressive claims of success misleading.<ref>{{Harvnb|Haldeman|1991|pp=150–151}}</ref>
Haldeman writes that psychoanalytic treatment of homosexuality is exemplified by the work of Irving Bieber ''et al.'' in ''Homosexuality: A Psychoanalytic Study of Male Homosexuals''. They advocated long-term therapy aimed at resolving the unconscious childhood conflicts that they considered responsible for homosexuality. Haldeman notes that Bieber's methodology has been criticized because it relied upon a clinical sample, the description of the outcomes was based upon subjective therapist impression, and follow-up data were poorly presented. Bieber reported a 27% success rate from long-term therapy, but only 18% of the patients in whom Bieber considered the treatment successful had been exclusively homosexual to begin with, while 50% had been bisexual. In Haldeman's view, this makes even Bieber's unimpressive claims of success misleading.<ref>{{Harvnb|Haldeman|1991|pp=150–151}}</ref>


Haldeman discusses other psychoanalytic studies of attempts to change homosexuality. Curran and Parr's "Homosexuality: An analysis of 100 male cases", published in 1957, reported no significant increase in heterosexual behavior. Mayerson and Lief's "Psychotherapy of homosexuals: A follow-up study of nineteen cases", published in 1965, reported that half of its 19 subjects were exclusively heterosexual in behavior four and a half years after treatment, but its outcomes were based on patient self-report and had no external validation. In Haldeman's view, those participants in the study who reported change were bisexual at the outset, and its authors wrongly interpreted capacity for heterosexual sex as change of sexual orientation.<ref>{{Harvnb|Haldeman|1991|pp=151, 256}}</ref>
Haldeman discusses other psychoanalytic studies of attempts to change homosexuality. Curran and Parr's "Homosexuality: An analysis of 100 male cases", published in 1957, reported no significant increase in heterosexual behavior. Mayerson and Lief's "Psychotherapy of homosexuals: A follow-up study of nineteen cases", published in 1965, reported that half of its 19 subjects were exclusively heterosexual in behavior four and a half years after treatment, but its outcomes were based on patient self-report and had no external validation. In Haldeman's view, those participants in the study who reported change were bisexual at the outset, and its authors wrongly interpreted capacity for heterosexual sex as change of sexual orientation.<ref>{{Harvnb|Haldeman|1991|pp=151, 256}}</ref>
Line 146: Line 90:
===Reparative therapy===
===Reparative therapy===


''Reparative therapy'' has been used as a synonym for conversion therapy generally, but Jack Drescher has argued that strictly speaking it refers to a specific kind of therapy associated with [[Elizabeth Moberly]] and [[Joseph Nicolosi]].<ref name="Drescher1998" /> Joseph Nicolosi's ''Reparative Therapy of Male Homosexuality'', published in 1991, introduced ''reparative therapy'' as a term for psychotherapeutic attempts to convert gay people to heterosexuality.<ref name="GLAAD">{{citation |url=http://216.235.201.198/Page.aspx?pid=373|title=GLAAD Media Reference Guide |author=GLAAD |accessdate=September 2006|format=PDF}}</ref>
The term "reparative therapy" has been used as a synonym for conversion therapy generally, but according to [[Jack Drescher]] it properly refers to a specific kind of therapy{{clarify|date=July 2022}} associated with the psychologists [[Elizabeth Moberly]] and [[Joseph Nicolosi]].<ref name="Drescher1998">{{Harvnb|Drescher|2000|p=152}}</ref>
For example, he wrote:
:. . . the pursuit of fulfillment through same-sex eroticism is spurred by the fearful anticipation that their masculine self-assertion will inevitably fail and result in humiliation.<ref>{{cite web |last=Nicolosi |first=Joseph |title=The Traumatic Foundation of Male Homosexuality|
url=https://crisismagazine.com/opinion/traumatic-foundation-male-homosexuality}}</ref>


The term ''reparative'' refers to Nicolosi's postulate that same-sex attraction is a person's unconscious attempt to "self-repair" feelings of inferiority.<ref name="Hicks_1999">{{cite journal |last1=Hicks |first1=Karolyn A. |title='Reparative' Therapy: Whether Parental Attempts to Change a Child's Sexual Orientation Can Legally Constitute Child Abuse |journal=American University Law Review |volume=49 |issue=2 |date=December 1999 |pages=505–547 |url=https://digitalcommons.wcl.american.edu/aulr/vol49/iss2/4/ |access-date=10 June 2023 |archive-date=24 September 2024 |archive-url=https://web.archive.org/web/20240924070611/https://digitalcommons.wcl.american.edu/aulr/vol49/iss2/4/ |url-status=live }}</ref><ref name="Bright">{{Harvnb|Bright|2004|pp=471–481}}</ref>
Douglas C. Haldeman writes that Nicolosi promotes psychoanalytic theories suggesting that homosexuality is a form of arrested psychosexual development, resulting from "an incomplete bond and resultant identification with the same-sex parent, which is then symbolically repaired in psychotherapy".<ref name="haldeman" /> Nicolosi’s intervention plans involve conditioning a man to a traditional masculine gender role. He should "(1) participate in sports activities, (2) avoid activities considered of interest to homosexuals, such [as] art museums, opera, symphonies, (3) avoid women unless it is for romantic contact, (4) increase time spent with heterosexual men in order to learn to mimic heterosexual male ways of walking, talking, and interacting with other heterosexual men, (5) Attend church and join a men’s church group, (6) attend reparative therapy group to discuss progress, or slips back into homosexuality, (7) become more assertive with women through flirting and dating, (8) begin heterosexual dating, (9) engage in heterosexual intercourse, (10) enter into heterosexual marriage, and (11) father children".<ref name="Bright">{{Harvnb|Bright|2004|pp=471–481}}</ref> Nicolosi's "A Parent's Guide to Preventing Homosexuality" clarifies that Haldeman's interpretation of his work, cited above, is inaccurate; Nicolosi explains that some males are temperamentally more sensitive and esthetically oriented and can never be expected to act in a way that is stereotypically masculine. As Nicolosi says, "A gender-nonconforming boy CAN be sensitive, kind, social, artistic, gentle--and heterosexual. He can be an artist, an actor, a dancer, a cook, a musician--and a heterosexual. These innate artistic skills are 'who he is,' part of the wonderful range of human abilities. No one should try to discourage those abilities and traits." Nicolosi adds, "With appropriate masculine affirmation and support, however, they can all be developed within the context of normal heterosexual manhood.".<ref>Nicolosi, J. (2002) "A Parent's guide to PReventing Homosexuality." Downers Grove, IL, p. 48.</ref>


After California banned conversion practices, Nicolosi argued that "reparative therapy" didn't attempt to directly change sexual orientation but instead encourage exploration into its underlying causes, which he believed was often childhood trauma.<ref name="ashley_202209" />
Most mental health professionals consider reparative therapy discredited, but it is still practiced by some.<ref name="Yoshino" /> In fact, former American Psychological Association presidents Robert Perloff and Nicholas Cummings have both been Keynote Speakers at recent NARTH conferences and have strongly decried the efforts of the major professional associations, in their opinion, to marginalize reparative therapists and allegedly promote gay activism instead of scientific impartiality.<ref>[http://narth.com/2010/12/dr-robert-perloff-former-apa-president-accepts-the-narth-presidents-award/ Dr. Robert Perloff, Former APA President, Accepts the NARTH President’s Award]</ref>


===Marriage therapy===
Psychoanalysts critical of Nicolosi's theories have offered gay-affirmative approaches as an alternative to reparative therapy.<ref name="Drescher1998">{{Harvnb|Drescher|1998|p=152}}</ref><ref name="DomeniciandLesser">{{Harvnb|Domenici|1995|p=119}}</ref> [[Exodus International]] regards reparative therapy as a useful tool to eliminate "unwanted same-sex attraction."<ref>{{citation |url=http://exodus.to/content/view/34/117/ |archiveurl=http://web.archive.org/web/20070928010931/http://exodus.to/content/view/34/117/ |archivedate=2007-09-28 |title=Exodus International Policy Statements |accessdate=2007-08-28 |publisher=Exodus International}}</ref>
{{See also|Relationship counseling}}
Previous editions of the [[World Health Organization]]'s ICD included "[[sexual relationship disorder]]", in which a person's sexual orientation or gender identity makes it difficult to form or maintain a relationship with a sexual partner. The belief that their sexual orientation has caused problems in their relationship may lead some people to turn to a marriage therapist for help to change their sexual orientation.<ref name="Rosik-2003">{{cite journal |last=Rosik |first=Christopher H |title=Motivational, ethical, and epistemological foundations in the treatment of unwanted homoerotic attraction |journal=Journal of Marital and Family Therapy |volume=29 |issue=1 |pages=13–28 |date=January 2003 |pmid=12616795 |doi=10.1111/j.1752-0606.2003.tb00379.x |oclc=5154888155 }}</ref> Sexual orientation disorder was removed from the most recent ICD, [[ICD-11]], after the Working Group on Sexual Disorders and Sexual Health determined that its inclusion was unjustified.<ref>{{Cite journal |last1=Reed |first1=Geoffrey M. |last2=Drescher |first2=Jack |last3=Krueger |first3=Richard B. |last4=Atalla |first4=Elham |last5=Cochran |first5=Susan D. |last6=First |first6=Michael B. |last7=Cohen-Kettenis |first7=Peggy T. |last8=Arango-de Montis |first8=Iván |last9=Parish |first9=Sharon J. |last10=Cottler |first10=Sara |last11=Briken |first11=Peer |date=2016 |title=Disorders related to sexuality and gender identity in the ICD-11: revising the ICD-10 classification based on current scientific evidence, best clinical practices, and human rights considerations |journal=World Psychiatry |volume=15 |issue=3 |pages=205–221 |doi=10.1002/wps.20354 |pmc=5032510 |pmid=27717275 }}</ref>


===Sex therapy===
=== Gender exploratory therapy ===
Gender exploratory therapy (GET) is a form of conversion therapy<ref name="WPATH-NHS">{{Cite web |date=November 25, 2022 |title=WPATH, ASIAPATH, EPATH, PATHA, and USPATH Response to NHS England in the United Kingdom (UK) |url=https://www.wpath.org/media/cms/Documents/Public%20Policies/2022/25.11.22%20AUSPATH%20Statement%20reworked%20for%20WPATH%20Final%20ASIAPATH.EPATH.PATHA.USPATH.pdf?_t=1669428978 |website=[[WPATH]] |access-date=2 January 2024 |archive-date=30 November 2022 |archive-url=https://web.archive.org/web/20221130183416/https://www.wpath.org/media/cms/Documents/Public%20Policies/2022/25.11.22%20AUSPATH%20Statement%20reworked%20for%20WPATH%20Final%20ASIAPATH.EPATH.PATHA.USPATH.pdf?_t=1669428978 |url-status=live }}</ref><ref name="Bharat">{{Cite journal |last1=Bharat |first1=Bharat |last2=Dopp |first2=Alex |last3=Last |first3=Briana |last4=Howell |first4=Gary |last5=Nadeem |first5=Erum |last6=Johnson |first6=Clara |last7=Stirman |first7=Shannon Wiltsey |title=OSF |url=https://osf.io/gz5mk/ |journal=The Behavior Therapist |publisher=Association for Behavioral and Cognitive Therapies |publication-date=October 2023 |volume=46 |issue=7 |doi=10.31234/osf.io/gz5mk |access-date=1 January 2024 |archive-date=24 September 2024 |archive-url=https://web.archive.org/web/20240924070611/https://osf.io/gz5mk/ |url-status=live }}</ref><ref name="Lawson">{{Cite journal |last1=Lawson |first1=Zazie |last2=Davies |first2=Skye |last3=Harmon |first3=Shae |last4=Williams |first4=Matthew |last5=Billawa |first5=Shradha |last6=Holmes |first6=Ryan |last7=Huckridge |first7=Jaymie |last8=Kelly |first8=Phillip |last9=MacIntyre-Harrison |first9=Jess |last10=Neill |first10=Stewart |last11=Song-Chase |first11=Angela |last12=Ward |first12=Hannah |last13=Yates |first13=Michael |date=October 2023 |title=A human rights based approach to transgender and gender expansive health |url=https://explore.bps.org.uk/lookup/doi/10.53841/bpscpf.2023.1.369.91 |journal=Clinical Psychology Forum |language=en |volume=1 |issue=369 |pages=91–106 |doi=10.53841/bpscpf.2023.1.369.91 |issn=1747-5732 |s2cid=265086908 |access-date=1 January 2024 |archive-date=24 September 2024 |archive-url=https://web.archive.org/web/20240924070719/https://explore.bps.org.uk/content/bpscpf/1/369/91 |url-status=live }}</ref><ref name="Amery">{{Cite journal |last=Amery |first=Fran |date=2023-12-11 |title=Protecting Children in 'Gender Critical' Rhetoric and Strategy: Regulating Childhood for Cisgender Outcomes |url=https://www.digest.ugent.be/article/id/85309/ |journal=DiGeSt - Journal of Diversity and Gender Studies |volume=10 |issue=2 |doi=10.21825/digest.85309 |issn=2593-0281 |doi-access=free |access-date=1 January 2024 |archive-date=24 September 2024 |archive-url=https://web.archive.org/web/20240924070616/https://www.digest.ugent.be/article/id/85309/ |url-status=live }}</ref><ref name="Caraballo">{{Cite journal |last=Caraballo |first=Alejandra |date=December 2022 |title=The Anti-Transgender Medical Expert Industry |url=https://www.cambridge.org/core/journals/journal-of-law-medicine-and-ethics/article/antitransgender-medical-expert-industry/25EFFECB8F71CA9A37F9F089E13BC41E |journal=Journal of Law, Medicine & Ethics |language=en |volume=50 |issue=4 |pages=687–692 |doi=10.1017/jme.2023.9 |issn=1073-1105 |pmid=36883410 |access-date=1 January 2024 |archive-date=1 March 2024 |archive-url=https://web.archive.org/web/20240301135428/https://www.cambridge.org/core/journals/journal-of-law-medicine-and-ethics/article/antitransgender-medical-expert-industry/25EFFECB8F71CA9A37F9F089E13BC41E |url-status=live }}</ref> characterized by requiring mandatory extended talk therapy attempting to find pathological roots for gender dysphoria while simultaneously delaying social and medical transition and viewing it as a last resort.<ref name="WPATH-NHS" /><ref name="Lawson" /><ref name="Amery" /><ref name="ashley_202209">{{Cite journal |last=Ashley |first=Florence |date=6 September 2022 |title=Interrogating Gender-Exploratory Therapy |journal=Perspectives on Psychological Science |volume=18 |issue=2 |pages=472–481 |doi=10.1177/17456916221102325 |pmc=10018052 |pmid=36068009 |s2cid=252108965}}</ref><ref name="MacKinnon">{{Cite journal |last1=MacKinnon |first1=Kinnon R. |last2=Gould |first2=Wren Ariel |last3=Enxuga |first3=Gabriel |last4=Kia |first4=Hannah |last5=Abramovich |first5=Alex |last6=Lam |first6=June S. H. |last7=Ross |first7=Lori E. |date=2023-11-29 |title=Exploring the gender care experiences and perspectives of individuals who discontinued their transition or detransitioned in Canada |journal=PLOS ONE |language=en |volume=18 |issue=11 |pages=e0293868 |bibcode=2023PLoSO..1893868M |doi=10.1371/journal.pone.0293868 |issn=1932-6203 |pmc=10686467 |pmid=38019738 |doi-access=free}}</ref> Practitioners of GET often view medical transition as a last resort and propose their patient's dysphoria is caused by factors such as homophobia, social contagion, sexual trauma, and autism.<ref name="Lawson" /><ref name="Caraballo" /> Some practitioners of GET avoid using their patients' chosen names and pronouns while questioning their identification.<ref name="MacKinnon" /> Commenting on gender exploratory therapy in 2022, bioethicist [[Florence Ashley]] argued that its framing as an undirected exploration of underlying psychological issues bore similarities to gay conversion practices such as "[[Conversion therapy#Reparative therapy|reparative]]" therapy.<ref name="ashley_202209" /> States that have banned gender-affirming care for minors in the United States have called expert witnesses to argue that exploratory therapy should be the alternative treatment.<ref name="Pauly">{{Cite news |last=Pauly |first=Madison |last2=Carnell |first2=Henry |date=July 2024 |title=First they tried to "cure" gayness. Now they're fixated on "healing" trans people. |url=https://www.motherjones.com/politics/2024/05/conversion-therapy-lgbtq-anti-trans-gay-gender-affirming-care/ |access-date=2024-06-05 |work=Mother Jones |language=en-US}}</ref>
{{Main|Masters and Johnson}}


There are no known empirical studies examining psychosocial or medical outcomes following GET.<ref name="MacKinnon" /><ref name="Leising">{{Cite journal |last=Leising |first=Julie |date=September 2022 |title=Gender-affirming care for youth—separating evidence from controversy |url=https://bcmj.org/sites/default/files/BCMJ_Vol64_No7-premise-corrected%20%28ID%202375120%29.pdf |journal=Bc Medic al Journal |volume=64 |issue=7}}</ref> Concerns have been raised that by not providing an estimated length of time for the therapy, the delays in medical interventions may compound mental suffering in trans youth,<ref name="Lawson" /><ref name="MacKinnon" /> while [[gender-affirming care|gender-affirming model of care]] already promotes gender identity exploration without favoring any particular identity, and individualized care.<ref name="MacKinnon" /> GET proponents deny this.<ref name="Santoro">{{Cite news |last=Santoro |first=Helen |date=2023-05-02 |title=How Therapists Are Trying to Convince Children That They're Not Actually Trans |url=https://slate.com/technology/2023/05/gender-exploratory-therapy-trans-kids-what-is-it.html |access-date=2024-01-01 |work=Slate |language=en-US |issn=1091-2339 |archive-date=21 January 2024 |archive-url=https://web.archive.org/web/20240121062936/https://slate.com/technology/2023/05/gender-exploratory-therapy-trans-kids-what-is-it.html |url-status=live }}</ref>
Douglas Haldeman has described [[Masters and Johnson|William Masters' and Virginia Johnson]]'s work on sexual orientation change as a form of conversion therapy.<ref>{{Harvnb|Haldeman|1991|pp=149, 154}}</ref>


In 2017, [[Richard Green (sexologist)|Richard Green]] published a legal strategy which called for circumventing bans on conversion therapy by labelling the practice "gender identity exploration or development".<ref name="Eckert">{{Cite news |last=Eckert |first=A. J. |date=2022-10-22 |title=Cutting through the Lies and Misinterpretations about the Updated Standards of Care for the Health of Transgender and Gender Diverse People |url=https://sciencebasedmedicine.org/cutting-through-the-lies-and-misinterpretations-about-the-updated-standards-of-care-for-the-health-of-transgender-and-gender-diverse-people/ |access-date=2024-12-22 |language=en-US |publisher=Science-Based Medicine}}</ref><ref name="Green-2017">{{Cite journal |last=Green |first=Richard |year=2017 |title=Banning Therapy to Change Sexual Orientation or Gender Identity in Patients Under 18 |url=https://pubmed.ncbi.nlm.nih.gov/28270456 |journal=The Journal of the American Academy of Psychiatry and the Law |volume=45 |issue=1 |pages=7–11 |issn=1943-3662 |pmid=28270456}}</ref> Multiple groups now exist worldwide to promote GET and have been successful in influencing legal discussions and clinical guidance in some regions.<ref name="Amery" /> The [[Gender Exploratory Therapy Association]] (GETA) asserts that "psychological approaches should be the first-line treatment for all cases of gender dysphoria", that medical interventions for transgender youth are "experimental and should be avoided if possible", and that [[social transitioning|social transition]] is "risky".<ref name="Santoro" /> All of GETA's leaders are members of [[Genspect]], a "[[gender-critical]]" group that promotes GET and argues that gender-affirming care should not be available to those under 25.<ref name="Santoro" /> In late 2023, GETA changed their name to "Therapy First".<ref name="Pauly" />
In ''Homosexuality in Perspective'', published in 1979, Masters and Johnson viewed homosexuality as the result of blocks that prevented the learning that facilitated heterosexual responsiveness, and described a study of 54 gay men who were dissatisfied with their sexual orientation. The original study did not describe the treatment methodology used, but this was published five years later. John C. Gonsiorek criticized their study on several grounds in 1981, pointing out that while Masters and Johnson stated that their patients were screened for major psychopathology or severe neurosis, they did not explain how this screening was performed, or how the motivation of the patients to change was assessed. 19 of their subjects were described as uncooperative during therapy and refused to participate in a follow-up assessment, but all of them were assumed without justification to have successfully changed.<ref name="Gonsiorek 1991 154">{{Harvnb|Haldeman|1991|p=154}}</ref>


GETA also shares a large overlap with the [[Society for Evidence-Based Gender Medicine]] (SEGM), which promotes GET as first-line treatment for those under 25.<ref name="splc-defining-pseudoscience">{{Cite web |title=Group dynamics and division of labor within the anti-LGBTQ+ pseudoscience network |url=https://www.splcenter.org/captain/defining-pseudoscience-network |access-date=2024-01-01 |website=Southern Poverty Law Center |language=en}}</ref> GETA co-founder Lisa Marchiano stated U.S. President Joe Biden's executive order safeguarding trans youth from conversion therapy would have a "chilling effect" on GET practices.<ref name="Santoro" /><ref name="Reed">{{Cite news |last=Reed |first=Erin |date=2023-01-13 |title=Unpacking 'gender exploratory therapy,' a new form of conversion therapy |url=https://xtramagazine.com/health/gender-exploratory-therapy-243833 |access-date=2024-01-01 |work=Xtra Magazine |language=en-CA}}</ref> GETA also opposed Biden's Title IX changes protecting trans students from discrimination, stating allowing trans youth in restrooms would harm the mental health of their peers.<ref name="Reed" /> The [[American College of Pediatricians]], a small group aligned with the Christian Right,<ref group="Note">not to be confused with the [[American Academy of Pediatrics]]</ref> has cited numerous studies from SEGM to claim GET is necessary to restore transgender people's "biological integrity".<ref name="splc-defining-pseudoscience" /> In November 2023, Michelle Cretella, a board member of the pro conversion therapy group [[Alliance for Therapeutic Choice and Scientific Integrity]] (ATCSI, formerly NARTH), gave a speech at an ATCSI conference which endorsed GET and argued it "truly is very similar to how the Alliance has always approached unwanted same-sex attraction".<ref name="Pauly" />
Douglas Haldeman writes that Masters and Johnson's study was founded upon heterosexist bias, and that it would be tremendously difficult to replicate. In his view, the distinction Masters and Johnson made between "conversion" (helping gay men with no previous heterosexual experience to learn heterosexual sex) and "reversion" (directing men with some previous heterosexual experience back to heterosexuality) was not well founded. Many of the subjects Masters and Johnson labelled homosexual may not have been homosexual, since, of their participants, only 17% identified themselves as exclusively homosexual, while 83% were in the predominantly heterosexual to bisexual range. Haldeman observed that since 30% of the sample was lost to the follow-up, it is possible that the outcome sample did not include any people attracted mainly or exclusively to the same sex. Haldeman concludes that it is likely that, rather than converting or reverting gay people to heterosexuality, Masters and Johnson only strengthened heterosexual responsiveness in people who were already bisexual.<ref name="Gonsiorek 1991 154"/>


==Effects==
==Studies of conversion therapy==
{{expand section|date=June 2022}}
===''Can Some Gay Men and Lesbians Change Their Sexual Orientation?''===
There is a scientific consensus that conversion therapy is ineffective at changing a person's sexual orientation.<ref name=":0"/> Advocates of conversion therapy rely heavily on testimonials and retrospective self-reports as evidence of effectiveness. Studies purporting to validate the effectiveness of efforts to change sexual orientation or gender identity have been criticized for methodological flaws.{{sfn|Haldeman|2022|p=7}} After conversion therapy has failed to change someone's sexual orientation or gender identity, participants often feel increased shame that they already felt over their sexual orientation or gender identity.{{sfn|Haldeman|2022|p=9}}
In May 2001, [[Robert Spitzer (psychiatrist)|Robert Spitzer]] presented ''Can Some Gay Men and Lesbians Change Their Sexual Orientation?'' 200 Participants Reporting a Change from Homosexual to Heterosexual Orientation", a study of attempts to change homosexual orientation through ex-gay ministries and conversion therapy, at the American Psychiatric Association's convention in New Orleans. The study was partly a response to the APA's 2000 statement cautioning against clinical attempts at changing homosexuality, and was aimed at determining whether such attempts were ever successful rather than how likely it was that change would occur for any given individual. Spitzer wrote that some earlier studies provided evidence for the effectiveness of therapy in changing sexual orientation, but that all of them suffered from methodological problems.<ref name="DrescherandZucker" />


Conversion therapy can cause significant, long-term psychological harm.<ref name=":0">{{cite journal |last1=Higbee |first1=Madison |last2=Wright |first2=Eric R. |last3=Roemerman |first3=Ryan M. |title=Conversion Therapy in the Southern United States: Prevalence and Experiences of the Survivors |journal=Journal of Homosexuality |date=2022 |volume=69 |issue=4 |pages=612–631 |doi=10.1080/00918369.2020.1840213|pmid=33206024 |s2cid=227039714 }}</ref> This includes significantly higher rates of [[Major depressive disorder|depression]], [[substance abuse]], and other mental health issues in individuals who have undergone conversion therapy than their peers who did not,<ref>{{Cite web |last=Christensen |first=Jen |date=2022-03-08 |title=Conversion therapy is harmful to LGBTQ people and costs society as a whole, study says |url=https://www.cnn.com/2022/03/07/health/conversion-therapy-personal-and-financial-harm/index.html |access-date=2022-11-05 |website=CNN |language=en |archive-date=1 December 2022 |archive-url=https://web.archive.org/web/20221201070406/https://www.cnn.com/2022/03/07/health/conversion-therapy-personal-and-financial-harm/index.html |url-status=live }}</ref><ref name=":1" /> including a suicide attempt rate nearly twice that of those who did not.<ref>{{Cite web |last=thisisloyal.com |first=Loyal {{!}} |title=LGB people who have undergone conversion therapy almost twice as likely to attempt suicide |url=https://williamsinstitute.law.ucla.edu/press/lgb-suicide-ct-press-release/ |access-date=2022-11-05 |website=Williams Institute |language=en-US}}</ref> Modern-day practitioners of conversion therapy—primarily from a conservative religious viewpoint—disagree with current [[evidence-based medicine]] and clinical guidance that does not view [[homosexuality]] and [[gender variance]] as unnatural or unhealthy.<ref name=":0" />{{sfn|Haldeman|2022|p=5}}
He reported that after intervention, 66% of the men and 44% of the women had achieved "Good Heterosexual Functioning", which he defined as requiring five criteria (being in a loving heterosexual relationship during the last year, overall satisfaction in emotional relationship with a partner, having heterosexual sex with the partner at least a few times a month, achieving physical satisfaction through heterosexual sex, and not thinking about having homosexual sex more than 15% of the time while having heterosexual sex). He found that the most common reasons for seeking change were lack of emotional satisfaction from gay life, conflict between same-sex feelings and behavior and religious beliefs, and desire to marry or remain married.<ref name="DrescherandZucker" /><ref name="SpitzerStudy">{{Harvnb|Spitzer|2004|pp=403–417}}</ref> This paper was widely reported in the international media and taken up by politicians in the United States, Germany, and Finland, and by conversion therapists.<ref name="DrescherandZucker" />


In 2020, [[ILGA|ILGA World]] published a world survey and report ''[[ILGA#Curbing Deception|Curbing Deception]]'' listing consequences and life-threatening effects by associating specific public testimonies with different types of methods used to practice conversion therapies.<ref>{{Cite web|url=https://ilga.org/resources/conversion-therapy-global-research-ilga-world-curbing-deception-february-2020/|title=Curbing deception – A world survey of legal restrictions of so-called 'conversion therapies'|first=Lucas Ramón |last=Mendos|website=ILGA World}}</ref>
In 2003, Spitzer published the paper in the [[Archives of Sexual Behavior]]. Spitzer's study has been criticized on numerous ethical and methodological grounds, and "press releases from both [[NGLTF]] and [[HRC]] sought to undermine [[Robert Spitzer (psychiatrist)|Spitzer]]'s credibility by connecting him politically to right-wing groups that had backed the [[ex-gay movement]]." [http://books.google.com/books?id=EGMEAAAAMBAJ&pg=PA30&lpg=PA30&dq=spitzer+besen+political&source=bl&ots=LG_lH9nv20&sig=lT8CyIGi5cq2Rn4F3nHJKarnsA0&hl=en&ei=ourKTYbIEaXg0QHRjJWTCQ&sa=X&oi=book_result&ct=result&resnum=4&ved=0CDQQ6AEwAw#v=onepage&q=spitzer%20besen%20political&f=false The Advocate - Jun 19, 2001]. Gay activists argued that the study would be used by conservatives to undermine gay rights.<ref name="DrescherandZucker" /> Spitzer acknowledged that the study sample consisted of people who sought treatment primarily because of their religious beliefs (93% of the sample), served in various church-related functions, and who publicly spoke in favor of changing homosexual orientation (78%), and thus were strongly motivated to overreport success. Critics felt he dismissed this source of bias, without even attempting to measure [[deception]] or [[self-deception]] (a standard practice in self-reporting psychological tests like [[MMPI-2]]).<ref>{{Harvnb|Drescher|2006|pp=97}}</ref> That participants had to rely upon their memories of what their feelings were before treatment may have distorted the findings. It was impossible to determine whether any change that occurred was due to the treatment because it was not clear what it involved and there was no control group.<ref name="DrescherandZucker" /> Spitzer's own data showed that claims of change were reflected mostly in changes in self-labelling and behavior, less in attractions, and least in the homoerotic content during the masturbatory fantasies; this particular finding was consistent with other studies in this area.<ref>{{Harvnb|Drescher|2006|pp=98}}</ref> Participants may have been bisexual before treatment. Follow-up studies were not conducted.<ref name="DrescherandZucker" /> Spitzer stressed the limitations of his study. Spitzer said that the number of gay people who could successfully become heterosexual was likely to be "pretty low",<ref>Goode, Erica (May 9, 2001). [http://www.nytimes.com/2001/05/09/us/study-says-gays-can-shift-sexual-orientation.html?scp=2&sq=robert%2Bspitzer&st=nyt Study Says Gays Can Shift Sexual Orientation]. New York Times (retrieved 2011).</ref> and conceded that his subjects were "unusually religious."<ref name="Ucdavis">{{citation |url=http://psychology.ucdavis.edu/rainbow/html/facts_changing.html |title=Attempts To Change Sexual Orientation |accessdate=2007-08-28 |publisher=[[University of California, Davis]] Department of Psychology}}</ref>


A 2022 study estimated that conversion therapy of youth in the United States cost $650.16 million annually with an additional $9.5 billion in associated costs such as increased suicide and substance abuse.<ref name=":1">{{cite journal |last1=Forsythe |first1=Anna |last2=Pick |first2=Casey |last3=Tremblay |first3=Gabriel |last4=Malaviya |first4=Shreena |last5=Green |first5=Amy |last6=Sandman |first6=Karen |title=Humanistic and Economic Burden of Conversion Therapy Among LGBTQ Youths in the United States |journal=JAMA Pediatrics |date=2022 |volume=176 |issue=5 |pages=493–501 |doi=10.1001/jamapediatrics.2022.0042|pmid=35254391 |pmc=8902682 |s2cid=247252995 }}</ref> Youth who undergo conversion therapy from a religious provider have more negative mental health outcomes than those who had consulted a licensed healthcare provider.{{sfn|Haldeman|2022|p=9}}
Spitzer renounced his own study in 2012,<ref name=spitzer1>{{cite news| url=http://prospect.org/article/my-so-called-ex-gay-life/| work=The American Prospect | title=My So-Called Ex-Gay Life| date=April 11, 2012}}</ref> stating "I was quite wrong in the conclusions that I made from this study. The study does not provide evidence, really, that gays can change. And that’s quite an admission on my part."<ref name=spitzer2>{{cite web|last=Besen|first=Wayne|title=TWO Exclusive Video: Interview with Dr. Robert Spitzer Who Discusses Retracting His Infamous ‘Ex-Gay’ Study|url=http://www.truthwinsout.org/blog/2012/05/25725/?utm_source=Exclusive+TWO+Video%3A+Dr.+Spitzer+Retracts+Ex-Gay+Study+and+Slams+Anti-Gay+Groups&utm_campaign=Cleveland+Radio+Host|publisher=[[Truth Wins Out]]. ''truthwinsout.org''|accessdate=30 May 2012}}</ref> He also apologized to the gay community for making unproven claims of the efficacy of reparative therapy,<ref name=spitzer3>{{cite web|last=Becker|first=John M.|title=EXCLUSIVE: Dr. Robert Spitzer Apologizes to Gay Community for Infamous ‘Ex-Gay’ Study|url=http://www.truthwinsout.org/news/2012/04/24542/|publisher=truthwinsout.org|accessdate=May 26, 2012}}</ref> calling it his only professional regret.<ref name=spitzer4>{{cite news|last=Carey|first=Benedict|title=Psychiatry Giant Sorry for Backing Gay ‘Cure’|url=http://www.nytimes.com/2012/05/19/health/dr-robert-l-spitzer-noted-psychiatrist-apologizes-for-study-on-gay-cure.html?pagewanted=3&_r=1|accessdate=May 26, 2012|newspaper=nytimes.com|date=May 18, 2012}} archived [http://www.webcitation.org/67xWBOdwX here].</ref> Spitzer has requested that all "ex-gay" therapy organizations such as [[National Association for Research & Therapy of Homosexuality|NARTH]], [[Parents and Friends of Ex-Gays and Gays|PFOX]], [[American College of Pediatricians]], and [[Focus on the Family]] stop citing his study as evidence for conversion therapy.<ref name=spitzer2 />


==Public opinion==
===''Changing Sexual Orientation: A Consumer's Report''===
A 2020 survey carried out on US adults found majority support for banning conversion therapy for minors.<ref>{{cite journal |last1=Flores |first1=Andrew R. |last2=Mallory |first2=Christy |last3=Conron |first3=Kerith J. |title=Public attitudes about emergent issues in LGBTQ rights: Conversion therapy and religious refusals |journal=Research & Politics |date=2020 |volume=7 |issue=4 |pages=205316802096687 |doi=10.1177/2053168020966874|s2cid=229001894 |doi-access=free }}</ref>


A 2022 [[YouGov]] poll found majority support in England, Scotland, and Wales for a conversion therapy ban for both sexual orientation and gender identity, with opposition ranging from 13 to 15 percent.<ref>{{cite web |last=Kirk |first=Isabelle |date=3 May 2022 |title=The majority of Welsh people support a ban on trans conversion therapy in Wales |url=https://yougov.co.uk/topics/politics/articles-reports/2022/05/03/majority-welsh-people-support-ban-trans-conversion |access-date=30 June 2022 |website=[[YouGov]] |language=en-gb |archive-date=30 June 2022 |archive-url=https://web.archive.org/web/20220630035322/https://yougov.co.uk/topics/politics/articles-reports/2022/05/03/majority-welsh-people-support-ban-trans-conversion |url-status=live }}</ref>
Ariel Shidlo and Michael Schroeder found in "Changing Sexual Orientation: A Consumer's Report", a peer-reviewed study of 150 respondents<ref>{{cite book | last1 = Shidlo | first1 = Ariel | last2 = Schroeder | first2 = Michael | title = Sexual conversion therapy: ethical, clinical, and research perspectives | date = May | year = 2002 | page = 137 | url = http://books.google.com/books?id=1jYuientrGoC&pg=PA137&lpg=PA137&dq=Shidlo+and+Schroeder+gay+sample&source=bl&ots=eItHDTKVEw&sig=U1S7jLKQL-WxXLW2w6gZlwsJb5g&hl=en&ei=L-nSTeuSAsbz0gGJldWBDA&sa=X&oi=book_result&ct=result&resnum=1&ved=0CBkQ6AEwAA#v=onepage&q=Shidlo%20and%20Schroeder%20gay%20sample&f=false | accessdate = 2011-05-17 | isbn = 978-0-7890-1911-0}}</ref> published in 2002, that 88% of participants failed to achieve a sustained change in their sexual behavior and 3% reported changing their orientation to heterosexual. The remainder reported either losing all sexual drive or attempting to remain celibate, with no change in attraction. Some of the participants who failed felt a sense of shame and had gone through conversion therapy programs for many years. Others who failed believed that therapy was worthwhile and valuable. Shidlo and Schroeder also reported that many respondents were harmed by the attempt to change. Of the 8 respondents (out of a sample of 202) who reported a change in sexual orientation, 7 worked as ex-gay counselors or group leaders.<ref name="ShidloandSchroeder">{{Harvnb|Shidlo|Schroeder|2002|pp=249–259}}</ref> NARTH states that the Shidlo study has often been used by gay activists as "proof" that conversion therapy is on average harmful, but they advertised for study participants with an ad that said, "Help Us Document the Harm".<ref name=narthstatement /> The Shidlo-Schroeder recruitment poster is available at NARTH online,<ref name=narthstatement2>[http://narth.com/2011/07/activist-researchers-misuse-studies-finding-harm Activist Researchers Misuse Studies Finding “Harm”]</ref> stating that the study's authors did not seek to measure the average outcome of conversion therapy, although their study has often been used by activists as if it had, in fact, sought a representative sample; the lack of a representative sample therefore makes the 80% failure rate, cited above in this same paragraph, a meaningless number.


==Legal status==
===''Ethical Issues in Attempts to Ban Reorientation Therapies''===
{{main|Legality of conversion therapy}}
[[File:Countries banning conversion therapy.svg|thumb|upright=1.3|Map of jurisdictions that have bans on sexual orientation and gender identity change efforts with minors.
{{legend|Navy|Criminal prohibition against conversion therapy on the basis of sexual orientation and gender identity}}
{{legend|#0000ff|Only medical professionals are banned from performing conversion therapy}}
{{legend|LightGrey|No ban on conversion therapy}}]]
Some jurisdictions have criminal bans on the practice of conversion therapy, including Canada, Ecuador, France,<ref>{{Cite web |date=3 February 2022 |title=France Passed Law To Protect LGBTQ People From 'Conversion Therapy' |url=https://lqioo.com/europe-news/france-passed-law-to-protect-lgbtq-people-from-conversion-therapy |access-date=2023-02-24 |website=LQIOO |language=en-US}}</ref> Germany, Malta, Mexico and Spain.<ref>{{Cite web |last=Legislative Services Branch |date=2022-01-10 |title=Consolidated federal laws of canada, An Act to amend the Criminal Code (conversion therapy) |url=https://laws.justice.gc.ca/eng/annualstatutes/2021_24/page-1.html |access-date=2022-07-06 |website=laws.justice.gc.ca |archive-date=11 February 2023 |archive-url=https://web.archive.org/web/20230211034855/https://laws.justice.gc.ca/eng/annualstatutes/2021_24/page-1.html |url-status=live }}</ref> In other countries, including Albania, Brazil, Chile, Vietnam and Taiwan, medical professionals are barred from practicing conversion therapy.<ref name=Trispiotis/>


In some states, lawsuits against conversion therapy providers for [[fraud]] have succeeded, but in other jurisdictions those claiming fraud must prove that the perpetrator was intentionally dishonest. Thus, a provider who genuinely believes conversion therapy is effective could not be convicted.<ref>{{cite journal |last1=Purshouse |first1=Craig |last2=Trispiotis |first2=Ilias |title=Is 'conversion therapy' tortious? |journal=Legal Studies |date=2022 |volume=42 |issue=1 |pages=23–41 |doi=10.1017/lst.2021.28 |s2cid=236227920 |doi-access=free }}</ref>
Mark Yarhouse and [[Warren Throckmorton]], of the private Christian school [[Grove City College]], in 2002 published "Ethical Issues in Attempts to Ban Reorientation Therapies", which argues that conversion therapy should be available out of respect for a patient’s values system and because there is evidence that it can be effective. They state that studies from the 1950s–1980s generally reported rates of positive outcomes at about 30%, with more recent survey research generally consistent with the extant data. Their paper was partly a response to Jack Drescher's 2001 paper, "Ethical issues surrounding attempts to change sexual orientation", which used the principle of "Do no harm" to argue against conversion therapy.<ref name="EthicalIssues">{{Harvnb|Yarhouse|Throckmorton|2002|pp=66–75}}</ref>


Conversion therapy on minors may amount to [[child abuse]].<ref name=irct/><ref>{{cite journal |last1=Canady |first1=Valerie |title=New report calls for an end to 'conversion therapy' for youth |journal=The Brown University Child and Adolescent Behavior Letter |date=2015 |volume=31 |issue=12 |pages=3–4 |doi=10.1002/cbl.30088}}</ref><ref>{{cite journal |last1=Lee |first1=Cory |title=A Failed Experiment: Conversion Therapy as Child Abuse |journal=Roger Williams University Law Review |date=2022 |volume=27 |issue=1 |url=https://docs.rwu.edu/rwu_LR/vol27/iss1/3/ |access-date=4 July 2022 |archive-date=24 September 2024 |archive-url=https://web.archive.org/web/20240924072750/https://docs.rwu.edu/rwu_LR/vol27/iss1/3/ |url-status=live }}</ref>
==Medical, scientific and legal views==
{{Further2|[[Biology and sexual orientation]], [[Environment and sexual orientation]], [[Timeline of sexual orientation and medicine|sexual orientation and medicine]] and [[homosexuality and psychology]]}}


===United States===
===Human rights===
In 2020, the [[International Rehabilitation Council for Torture Victims]] released an official statement that conversion therapy is torture.<ref name=irct>{{cite web |title=Conversion Therapy is Torture |url=https://irct.org/media-and-resources/latest-news/article/1027 |website=International Rehabilitation Council for Torture Victims |access-date=31 May 2021 |language=en |archive-date=7 January 2021 |archive-url=https://web.archive.org/web/20210107053543/https://irct.org/media-and-resources/latest-news/article/1027 |url-status=dead }}</ref> The same year, UN Independent Expert on sexual orientation and gender identity, [[Victor Madrigal-Borloz]], said that conversion therapy practices are "inherently discriminatory, that they are [[cruel, inhuman and degrading treatment]], and that depending on the severity or physical or mental pain and suffering inflicted to the victim, they may amount to torture". He recommended that it should be banned across the world.<ref>{{cite web |url=https://www.ohchr.org/EN/NewsEvents/Pages/ConversionTherapy_and_HR.aspx |title='Conversion therapy' Can Amount to Torture and Should be Banned says UN Expert |date=July 13, 2020 |website=United Nations Human Rights: Office of the High Commissioner |access-date=July 20, 2021}}</ref> In 2021, Ilias Trispiotis and Craig Purshouse argue that conversion therapy violates the prohibition against degrading treatment under [[Article 3 of the European Convention on Human Rights]], leading to a state obligation to prohibit it.<ref name=Trispiotis>{{cite journal |last1=Trispiotis |first1=Ilias |last2=Purshouse |first2=Craig |title='Conversion Therapy' As Degrading Treatment |journal=Oxford Journal of Legal Studies |date=2021 |volume=42 |issue=1 |pages=104–132 |doi=10.1093/ojls/gqab024|pmid=35264896 |pmc=8902017 |doi-access=free }}</ref><ref>{{cite journal |last1=Nugraha |first1=Ignatius Yordan |title=The compatibility of sexual orientation change efforts with international human rights law |journal=Netherlands Quarterly of Human Rights |date=2017 |volume=35 |issue=3 |pages=176–192 |doi=10.1177/0924051917724654|s2cid=220052834 |doi-access=free }}</ref> In February 2023 [[Commissioner for Human Rights]], [[Dunja Mijatović]], qualified those practices as “irreconcilable with several guarantees under the European Convention on Human Rights" and having no place in a human rights-based society urging the Member States of the Council of Europe to ban them for both adults and minors,<ref>{{Cite web |title=Nothing to cure: putting an end to so-called "conversion therapies" for LGBTI people - Commissioner for Human Rights - www.coe.int |url=https://www.coe.int/en/web/commissioner/-/nothing-to-cure-putting-an-end-to-so-called-conversion-therapies-for-lgbti-people |access-date=2023-07-22 |website=Commissioner for Human Rights |language=en-GB}}</ref> later in July 2023 she advocated for clear actions during a public hearing at the [[European Parliament]] studying different approaches to legally ban "conversion therapies" in the [[European Union]].<ref>{{Cite web |date=2023-07-17 |title='Conversion therapies' in the EU: MEPs discuss potential ban with experts {{!}} News {{!}} European Parliament |url=https://www.europarl.europa.eu/news/en/press-room/20230717IPR03013/conversion-therapies-in-the-eu-meps-discuss-potential-ban-with-experts |access-date=2023-07-22 |website=www.europarl.europa.eu |language=en |archive-date=22 July 2023 |archive-url=https://web.archive.org/web/20230722140351/https://www.europarl.europa.eu/news/en/press-room/20230717IPR03013/conversion-therapies-in-the-eu-meps-discuss-potential-ban-with-experts |url-status=live }}</ref> In September 2024 it was reported that the European Union is considering banning "conversion therapies" across its Member States,<ref>{{Cite web |last=Ramsay |first=Max |date=2024-09-17 |title=EU to Pursue Ban on Conversion Therapy in New LGBTQ Strategy |url=https://www.bnnbloomberg.ca/business/politics/2024/09/17/eu-to-pursue-ban-on-conversion-therapy-in-new-lgbtq-strategy/?utm_source=substack&utm_medium=email |access-date=2024-10-05 |website=BNN Bloomberg |language=en}}</ref> while a [[European Citizens' Initiative]] that started collecting signatures in May 2024 is also calling on the [[European Commission]] to outlaw such practices.<ref>{{Cite web |title=Initiative detail {{!}} European Citizens' Initiative |url=https://citizens-initiative.europa.eu/initiatives/details/2024/000001_en |access-date=2024-10-05 |website=citizens-initiative.europa.eu}}</ref>
Mainstream health organizations in the United States find that conversion therapy is harmful, and that there has been no scientifically adequate demonstration of its efficacy in the last forty years.<ref name="Answers"/><ref name="APA"/><ref name =APA_Position/><ref name="PsychNews">{{citation |last=H. |first=K |title=APA Maintains Reparative Therapy Not Effective |url=http://www.psychiatricnews.org/pnews/99-01-15/therapy.html |publisher=Psychiatric News (news division of the American Psychiatric Association) |date=1999-01-15 |accessdate=2007-08-28}}</ref> Anecdotal claims of cures are counterbalanced by assertions of harm, and the American Psychological Association, for example, cautions ethical practitioners under the [[Hippocratic oath]] to do no harm to refrain from attempts at conversion therapy.<ref name =APA_Position>{{cite web|url=http://www.psych.org/Departments/EDU/Library/APAOfficialDocumentsandRelated/PositionStatements/200001a.aspx |title=Therapies Focused on Attempts to Change Sexual Orientation |publisher=Psych.org |date= |accessdate=2011-07-18}}</ref> Mainstream medical bodies state that conversion therapy can be harmful because it may exploit guilt and anxiety, thereby damaging self-esteem and leading to depression and even suicide.<ref name="nytconversion">{{citation |last=Luo |first=Michael |title=Some Tormented by Homosexuality Look to a Controversial Therapy |url=http://www.nytimes.com/2007/02/12/nyregion/12group.html?_r=2&oref=slogin&oref=slogin |publisher=''The New York Times'' |page=1 |date=2007-02-12 |accessdate=2007-08-28}}</ref> There is also concern in the mental health community that the advancement of conversion therapy can cause social harm by disseminating inaccurate views about sexual orientation and the ability of gay and bisexual people to lead happy, healthy lives.<ref name="APA"/>


==In media==
Mainstream health organizations critical of conversion therapy include the [[American Medical Association]],<ref name="AmericanMedicalAssociation">{{citation |url=http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/glbt-advisory-committee/ama-policy-regarding-sexual-orientation.shtml |title=American Medical Association policy regarding sexual orientation |accessdate=2007-07-30 |date=2007-07-11 |publisher=American Medical Association}}</ref> [[American Psychiatric Association]], the [[American Psychological Association]], the [[American Association for Marriage and Family Therapy]], the [[American Counseling Association]], the [[National Association of Social Workers]], the [[American Academy of Pediatrics]], the [[National Association of School Psychologists]], and the American Academy of Physician Assistants.<ref name="APA"/><ref name="Aap">{{citation |first=Committee on Adolescence |title=Homosexuality and Adolesence |year=1993 |journal=Pediatrics, Official Journal of the American Academy of Pediatrics |volume=92 |pages=631–634 |url=http://pediatrics.aappublications.org/cgi/reprint/92/4/631.pdf |accessdate=2007-08-28 |format=PDF |issue=4}}</ref><ref>{{citation |url=http://www.spiritindia.com/health-care-news-articles-10085.html |title=Physician Assistants vote on retail clinics, reparative therapy |accessdate=2007-08-28 |publisher=SpiritIndia.com}}</ref>


Efforts to change sexual orientation have been depicted and discussed in popular culture and various media. More recent examples include: ''[[Boy Erased]]'', ''[[The Miseducation of Cameron Post (film)|The Miseducation of Cameron Post]]'', [[The Book of Mormon (musical)|''Book of Mormon'' musical]], ''[[Ratched (TV series)|Ratched]]'', and documentary features ''[[Pray Away]], Homotherapy: A Religious Sickness.''<ref>{{Cite web |title=MEDIAWAN - HOMOTHERAPY, A RELIGIOUS SICKNESS (2019) |url=https://rights.mediawan.com/world-catalogue/documentary/program/4397 |access-date=2023-07-22 |website=rights.mediawan.com |archive-date=22 July 2023 |archive-url=https://web.archive.org/web/20230722140353/https://rights.mediawan.com/world-catalogue/documentary/program/4397 |url-status=live }}</ref><ref>{{Cite news |date=2019-11-26 |title=" Homothérapies " sur Arte : le scandale des " conversions " sexuelles forcées |language=fr |work=Le Monde.fr |url=https://www.lemonde.fr/culture/article/2019/11/26/homotherapies-sur-arte-le-scandale-des-conversions-sexuelles-forcees_6020634_3246.html |access-date=2023-07-22 |archive-date=22 July 2023 |archive-url=https://web.archive.org/web/20230722140350/https://www.lemonde.fr/culture/article/2019/11/26/homotherapies-sur-arte-le-scandale-des-conversions-sexuelles-forcees_6020634_3246.html |url-status=live }}</ref>
The American Psychological Association undertook a study of the peer-reviewed literature in the area of [[sexual orientation change efforts]] (SOCE) and found a myriad of issues with the procedures used in conducting the research. The taskforce did find that that some participants experienced a lessening of same sex attraction and arousal, but that these instances were "rare" and "uncommon." The taskforce concluded that, "given the limited amount of methodically sound research, claims that recent SOCE is effective are not supported.<ref>[http://www.apa.org/pi/lgbt/resources/therapeutic-response.pdf Appropriate Therapeutic Responses to Sexual Orientation] Page 2</ref> An issue with SOCE claims is that conversion therapists falsely assume that homosexuality is a mental disorder, and that their research focuses almost exclusively on gay men and rarely includes lesbians.<ref name="Haldeman">{{Harvnb|Haldeman|2002}}</ref><ref name="APA"/><ref name="Bright" /><ref name="Ucdavis" /><ref>{{citation |last=Haldeman |first=Douglas |title=The Pseudo-science of Sexual Orientation Conversion Therapy |year=1999 |month=December |journal=The Policy Journal of the Institute for Gay and Lesbian Strategic Studies |volume=4 |issue=1 |pages=1–4 |url=http://www.iglss.org/media/files/Angles_41.pdf |accessdate=2007-08-28 |format=PDF |archiveurl = http://web.archive.org/web/20080302192810/http://www.iglss.org/media/files/Angles_41.pdf |archivedate = 2008-03-02}}</ref>


==Medical views==
===Self-determination===
{{main|Medical views of conversion therapy}}


National health organizations around the world have uniformly denounced and criticized sexual orientation and gender identity change efforts.<ref name="Lambda">{{cite news|title=Health and Medical Organization Statements on Sexual Orientation, Gender Identity/Expression and 'Reparative Therapy'|url=https://www.lambdalegal.org/publications/health-and-med-orgs-stmts-on-sex-orientation-and-gender-identity|newspaper=Lambda Legal|access-date=16 December 2017|archive-date=15 June 2017|archive-url=https://web.archive.org/web/20170615154255/https://www.lambdalegal.org/publications/health-and-med-orgs-stmts-on-sex-orientation-and-gender-identity|url-status=live}}</ref><ref name="HRC">{{cite web|title=Policy and Position Statements on Conversion Therapy|url=http://www.hrc.org/resources/policy-and-position-statements-on-conversion-therapy|website=Human Rights Campaign|access-date=12 April 2017|archive-date=27 April 2017|archive-url=https://web.archive.org/web/20170427021742/http://www.hrc.org/resources/policy-and-position-statements-on-conversion-therapy|url-status=dead}}</ref><ref>{{Cite web |date=December 2021 |title=Memorandum of Understanding on Conversion Therapy in the UK |url=https://www.psychotherapy.org.uk/media/cptnc5qm/mou2.pdf |publisher=[[United Kingdom Council for Psychotherapy]] |access-date=31 May 2023 |archive-date=24 September 2024 |archive-url=https://web.archive.org/web/20240924072651/https://www.psychotherapy.org.uk/media/cptnc5qm/mou2.pdf |url-status=live }}</ref> They state that there has been no scientific demonstration of "conversion therapy's" efficacy.<ref name="APA"/><ref name="APA-Answers">{{cite web | url=http://www.apa.org/topics/lgbt/orientation.aspx | title=Answers to Your Questions: For a Better Understanding of Sexual Orientation and Homosexuality | publisher=American Psychological Association | date=2008 | access-date=31 January 2015 | archive-date=20 January 2019 | archive-url=https://web.archive.org/web/20190120024548/https://www.apa.org/topics/lgbt/orientation.aspx | url-status=live }}</ref><ref name =APA_Position/><ref name="PsychNews">{{citation |title=APA Maintains Reparative Therapy Not Effective |url=http://www.psychiatricnews.org/pnews/99-01-15/therapy.html |publisher=Psychiatric News (news division of the American Psychiatric Association) |date=15 January 1999 |access-date=28 August 2007 |archive-date=20 August 2008 |archive-url=https://web.archive.org/web/20080820042149/http://www.psychiatricnews.org/pnews/99-01-15/therapy.html |url-status=dead }}</ref> They find that conversion therapy is ineffective, risky and can be harmful. Anecdotal claims of cures are counterbalanced by assertions of harm, and the American Psychiatric Association, for example, cautions ethical practitioners under the [[Hippocratic oath]] to do no harm and to refrain from attempts at conversion therapy.<ref name=APA_Position>{{cite web|url=http://www.psych.org/Departments/EDU/Library/APAOfficialDocumentsandRelated/PositionStatements/200001a.aspx |title=Therapies Focused on Attempts to Change Sexual Orientation |publisher=Psych.org |access-date=18 July 2011 |url-status=dead |archive-url=https://web.archive.org/web/20080910045820/http://www.psych.org/Departments/EDU/Library/APAOfficialDocumentsandRelated/PositionStatements/200001a.aspx |archive-date=10 September 2008 }}</ref> Furthermore, they state that conversion therapy is harmful and that it often exploits individual's guilt and anxiety, thereby damaging self-esteem and leading to depression and even suicide.<ref name="nytconversion">{{citation |last=Luo |first=Michael |title=Some Tormented by Homosexuality Look to a Controversial Therapy |url=https://www.nytimes.com/2007/02/12/nyregion/12group.html |work=The New York Times |page=1 |date=12 February 2007 |access-date=28 August 2007 |archive-date=20 April 2019 |archive-url=https://web.archive.org/web/20190420120908/https://www.nytimes.com/2007/02/12/nyregion/12group.html |url-status=live }}</ref> There is also concern in the mental health community that the advancement of conversion therapy can cause social harm by disseminating inaccurate views about gender identity, sexual orientation, and the ability of LGBT people to lead happy, healthy lives.<ref name="HRC" /> Various medical bodies prohibit their members from practicing conversion therapy.<ref>{{cite news |title=Albania becomes third European country to ban gay 'conversion therapy' |url=https://www.france24.com/en/20200516-albania-becomes-third-european-country-to-ban-gay-conversion-therapy |access-date=30 June 2022 |work=France 24 |date=16 May 2020 |language=en |archive-date=24 May 2020 |archive-url=https://web.archive.org/web/20200524174458/https://www.france24.com/en/20200516-albania-becomes-third-european-country-to-ban-gay-conversion-therapy |url-status=live }}</ref>
The [[American Psychological Association]]'s code of conduct states: "Psychologists respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self-determination," but also: "Psychologists are aware that special safeguards may be necessary to protect the rights and welfare of persons or communities whose vulnerabilities impair autonomous decision making."<ref name="apacode">{{cite web
|url = http://www.apa.org/ethics/code2002.html#principle_e
|archiveurl = http://web.archive.org/web/20070809034136/http://www.apa.org/ethics/code2002.html#history#principle_e
|archivedate = 2007-08-09
|title = Ethical Principles of Psychologists and Code of Conduct
|accessdate = 2007-08-28
|date = 2003-06-01
|publisher = American Psychological Association
}}</ref> The [[American Counseling Association]] says that "it is of primary importance to respect a client's autonomy to request a referral for a service not offered by a counselor."<ref name="ACA News">{{citation |url=http://www.counseling.org/PressRoom/NewsReleases.aspx?AGuid=b68aba97-2f08-40c2-a400-0630765f72f4
|last1=Whitman |first1=Joy S. |last2=Glosoff |first2=Harriet L. |last3=Kocet |first3=Michael M. |last4=Tarvydas |first4=Vilia |title=Ethical issues related to conversion or reparative therapy |accessdate=2007-08-28 |date=2006-05-22 |publisher=American Counseling Association}}</ref> No one should be forced to attempt to change their sexual orientation against their will, including children being forced by their parents.<ref name=apa1997>{{Citation |url=http://www.apa.org/pi/sexual.html |archiveurl=http://web.archive.org/web/20090324034818/http://www.apa.org/pi/sexual.html |archivedate=2009-03-24 |title=Resolution on Appropriate Therapeutic Responses to Sexual Orientation |accessdate=2007-08-28 |date=1997-08-14 |publisher=American Psychological Association}}</ref>


== See also ==
Supporters of SOCE focus on patient self-determination when discussing whether therapy should be available. Mark Yarhouse, of [[Pat Robertson]]'s [[Regent University]], wrote that "psychologists have an ethical responsibility to allow individuals to pursue treatment aimed at curbing experiences of same-sex attraction or modifying same-sex behaviors, not only because it affirms the client's rights to dignity, autonomy, and agency, as persons presumed capable of freely choosing among treatment modalities and behavior, but also because it demonstrates regard for diversity."<ref name=Right2Choose>{{Citation
| doi = 10.1037/h0087753
| last = Yarhouse
| first = Mark
| year = 1998
| month = Summer
| title = When Clients Seek Treatment for Same-Sex Attractions: Ethical Issues in the "Right to Choose" Debate
| journal = Psychotherapy: Theory, Research, Practice, Training
| volume = 35
| issue = 2
| pages = 248–259
| accessdate = 2007-08-28
| postscript = .
}}</ref> Yarhouse and Throckmorton, of the private Christian school [[Grove City College]], argue that the procedure should be available out of respect for a patient’s values system and because they find evidence that it can be effective.<ref name="EthicalIssues" /> Douglas Haldeman similarly argues for a client's right to access to therapy if requested from a [[Informed consent|fully informed]] position: "For some, religious identity is so important that it is more realistic to consider changing sexual orientation than abandoning one's religion of origin... and if there are those who seek to resolve the conflict between sexual orientation and spirituality with conversion therapy, they must not be discouraged."<ref name="haldeman">
{{Citation
|last= Haldeman
|first= Douglas C.
|year= 2002
|month= June
|title= Gay Rights, Patient Rights: The Implications of Sexual Orientation Conversion Therapy
|journal= Professional Psychology: Research and Practice
|volume= 33
|issue= 3
|pages= 260–264
|doi= 10.1037//0735-7028.33.3.260
|accessdate= 2007-08-28
|postscript= .
}}</ref>


* [[Christianity and homosexuality]]
In response to Yarhouse's paper, Jack Drescher argued that "any putative ethical obligation to refer a patient for reparative therapy is outweighed by a stronger ethical obligation to keep patients away from mental health practitioners who engage in questionable clinical practices."<ref>{{Citation
* [[Corrective rape]]
| last = Drescher
* [[Recovering from Religion]]
| first = Jack
* [[Sexual orientation change efforts and the LDS Church]]
| year = 2001
| title = Ethical Concerns Raised When Patients Seek to Change Same-Sex Attractions
| journal = Journal of Gay & Lesbian Psychotherapy
| volume = 5
| issue = 3/4
| page = 183
| publisher = Haworth Press
| accessdate = 2007-10-14
| postscript = .
}}</ref> Chuck Bright wrote that refusing to endorse a procedure that "has been deemed unethical and potentially harmful by most medical and nearly every professional psychotherapy regulating body cannot be justifiably identified as prohibiting client self-determination."<ref name="Bright">{{Citation
|last= Bright
|first= Chuck
|year= 2004
|month= December
|title= Deconstructing Reparative Therapy: An Examination of the Processes Involved When Attempting to Change Sexual Orientation
|journal= Clinical Social Work Journal
|volume= 32
|issue= 4
|pages= 471–481
|doi= 10.1007/s10615-004-0543-2
|accessdate= 2007-08-28
|postscript= .
}}</ref> Some commentators, recommending a hard stand against the practice, have found therapy inconsistent with a psychologist's ethical duties because "it is more ethical to let a client continue to struggle honestly with her or his identity than to collude, even peripherally, with a practice that is discriminatory, oppressive, and ultimately ineffective in its own stated ends."<ref name=PurpleMenace>{{Citation
| last = Tozer
| first = Erinn E.
| coauthors = McClanahan, Mary K.
| year = 1999
| title = Treating the Purple Menace: Ethical Considerations of Conversion Therapy and Affirmative Alternatives
| journal = The Counseling Psychologist
| volume = 27
| issue = 5
| pages = 722–742
| doi = 10.1177/0011000099275006
| accessdate = 2007-08-28
| postscript = .
}}</ref> They argue that clients who request it do so out of social pressure and internalized homophobia, pointing to evidence that rates of depression, anxiety, alcohol and drug abuse and suicidal feelings are roughly doubled in those who undergo therapy.<ref name="shildo">{{Citation
| last = Shidlo
| coauthors = Schroeder, Michael
| year = 2002
| title = Changing Sexual Orientation: A Consumers’ Report
| journal = Professional Psychology: Research and Practice
| volume = 33
| issue = 3
| pages = 249–259
| doi = 10.1037//0735-7028.33.3.249
| accessdate = 2007-08-28
| first1 = Ariel
| postscript = .
}}</ref>


== Notes ==
[[Douglas Haldeman]] wrote:
{{Reflist|group=Note}}
{{quote|However this distinction between religious identity and sexual orientation may be viewed, psychology does not have the right to interfere with individuals’ rights to seek the treatments they choose. This is why the mental health organizations have adopted advisory policies about conversion therapy that affirm the right of LGB clients to unbiased treatment in psychotherapy and that reject treatments based upon the premise that homosexuality is a treatable mental disorder. They do not, however, ban the practice of conversion therapy outright out of concern for the individual whose personal spiritual or religious concerns may assume priority over his sexual orientation.<ref name="haldeman" /> }}


==References==
===Ethics guidelines===
{{Reflist}}
In 1998, the [[American Psychiatric Association]] issued a statement opposing any treatment which is based upon the assumption that homosexuality is a mental disorder or that a person should change their orientation, but did not have a formal position on other treatments that attempt to change a person's sexual orientation. In 2000, they augmented that statement by saying that as a general principle, a therapist should not determine the goal of treatment, but recommends that ethical practitioners refrain from attempts to change clients' sexual orientation until more research is available.<ref name="Psych" />


==Bibliography==
The [[American Counseling Association]] has stated that they do not condone any training to educate and prepare a counselor to practice conversion therapy. Counselors who do offer training in conversion therapy must inform students that the techniques are unproven. They suggest counselors do not refer clients to a conversion therapist or to proceed cautiously once they know the counselor fully informs clients of the unproven nature of the treatment and the potential risks. However, "it is of primary importance to respect a client's autonomy to request a referral for a service not offered by a counselor." A counselor performing conversion therapy must provide complete information about the treatment, offer referrals to gay-affirmative counselors, discuss the right of clients, understand the client's request within a cultural context, and only practice within their level of expertise.<ref name="ACA News"/>
{{refbegin|indent=yes}}
*{{citation |last=Bright |first=Chuck |title=Deconstructing Reparative Therapy: An Examination of the Processes Involved When Attempting to Change Sexual Orientation |date=December 2004 |journal=Clinical Social Work Journal |volume=32 |issue=4 |doi=10.1007/s10615-004-0543-2 |pages=471–481|s2cid=189871877 }}
* {{cite book |last1=Cohen |first1=Richard A. |title=Coming Out Straight: Understanding and Healing Homosexuality |date=2000 |publisher=Oakhill Press |isbn=978-1-886939-41-7 |url=https://archive.org/details/isbn_9781886939417 |url-access=registration }}{{unreliable source?|date=February 2023}}
* {{cite journal |last1=Cruz |first1=David B. |title=Controlling desires: sexual orientation conversion and the limits of knowledge and law |journal=Southern California Law Review |date=July 1999 |volume=72 |issue=5 |pages=1297–1400 |pmid=12731502 |hdl=10822/925326 }}
*{{citation |last=Drescher |first=Jack |title=I'm Your Handyman: A History of Reparative Therapies |date=June 1998a |journal=Journal of Homosexuality |pmid=9670099 |volume=36 |issue=1 |pages=19–42 |doi=10.1300/J082v36n01_02}}
*{{Citation |last=Drescher |first=Jack |year=2001 |title=Ethical Concerns Raised When Patients Seek to Change Same-Sex Attractions |journal=Journal of Gay & Lesbian Psychotherapy |volume=5 |issue=3/4 |page=183 |doi=10.1300/j236v05n03_11|s2cid=146736819 }}
*{{citation |editor-last=Drescher |editor-first=Jack |editor2-last=Zucker |editor2-first=Kenneth |title=Ex-Gay Research: Analyzing the Spitzer Study and Its Relation to Science, Religion, Politics, and Culture |year=2006 |publisher=Harrington Park Press |location=New York |isbn=978-1-56023-557-6}}
* {{cite journal |last1=Drescher |first1=Jack |title=Psychoanalytic Therapy and the Gay Man |journal=The American Journal of Psychoanalysis |date=2000 |volume=60 |issue=2 |pages=191–196 |doi=10.1023/a:1001968909523 |pmid=10874429 }}
* {{cite book |doi=10.4135/9781483325422.n10 |chapter=Sexual Orientation Conversion Therapy for Gay Men and Lesbians: A Scientific Examination |title=Homosexuality: Research Implications for Public Policy |year=1991 |last1=Haldeman |first1=Douglas |pages=149–160 |isbn=978-0-8039-3764-2 }}
* {{cite book |doi=10.1037/0000266-001 |chapter=Introduction: A history of conversion therapy, from accepted practice to condemnation |title=The case against conversion 'therapy': Evidence, ethics, and alternatives |year=2022 |last1=Haldeman |first1=Douglas C. |pages=3–16 |isbn=978-1-4338-3711-1 |s2cid=243777493 }}
* {{cite book |last1=Jones |first1=Stanton L. |last2=Yarhouse |first2=Mark A. |title=Ex-Gays?: A Longitudinal Study of Religiously Mediated Change in Sexual Orientation |date=2007 |publisher=InterVarsity Press |isbn=978-0-8308-2846-3 }}{{unreliable source?|date=February 2023}}
*{{Cite book |last1=Rivera |first1=David P. |title=The Case Against Conversion Therapy: Evidence, Ethics, and Alternatives |last2=Pardo |first2=Seth T. |publisher=American Psychological Association |year=2022 |isbn=978-1-4338-3711-1 |editor-last=Haldeman |editor-first=Douglas C. |pages=51–68 |language=en |chapter=Gender identity change efforts: A summary |doi=10.1037/0000266-003 |s2cid=243776563 }}
* {{cite book |doi=10.4324/9780429294754 |title=Classic Case Studies in Psychology |year=2019 |last1=Rolls |first1=Geoff |isbn=978-0-429-29475-4 |editor-first1=Geoff |editor-last1=Rolls }}
*{{cite journal |last1=Schmidt |first1=Gunter |title=Allies and Persecutors |journal=Journal of Homosexuality |date=1985 |volume=10 |issue=3–4 |pages=127–140 |doi=10.1300/J082v10n03_16}}
* {{cite journal |last1=Schwartz |first1=Michael |title=Homosexuelle im modernen Deutschland: Eine Langzeitperspektive auf historische Transformationen |trans-title=Homosexuals in Modern Germany: A Long-Term Perspective on Historical Transformations |language=de |journal=Vierteljahrshefte für Zeitgeschichte |date=25 June 2021 |volume=69 |issue=3 |pages=377–414 |doi=10.1515/vfzg-2021-0028 |s2cid=235689714 }}
*{{citation |last=Waidzunas |first=Tom |title=The Straight Line: How the Fringe Science of Ex-Gay Therapy Reoriented Sexuality |year=2016 |publisher=University of Minnesota Press |location=Minneapolis |isbn=978-0-8166-9615-4 }}
* {{cite book |last1=Wachsmann |first1=Nikolaus |author1-link=Nikolaus Wachsmann |title=[[Hitler's Prisons|Hitler's Prisons: Legal Terror in Nazi Germany]] |date=2015 |publisher=[[Yale University Press]] |isbn=978-0-300-22829-8 |language=en|orig-year=2004}}
*{{cite book |last1=Weindling |first1=Paul|author-link=Paul Weindling |title=Victims and Survivors of Nazi Human Experiments: Science and Suffering in the Holocaust |date=2015 |publisher=[[Bloomsbury Academic]] |isbn=978-1-4411-7990-6 |language=en}}
*{{cite book |last1=Whisnant |first1=Clayton J.|author-link=Clayton J. Whisnant |title=Queer Identities and Politics in Germany: A History, 1880–1945 |date=2016 |publisher=[[Columbia University Press]] |isbn=978-1-939594-10-5 |language=en}}
*{{citation |last=Yoshino |first=Kenji |title=Covering |year=2002 |journal=Yale Law Journal |volume=111 |issue=4 |pages=769–939 |url=http://www.yalelawjournal.org/article/covering |doi=10.2307/797566 |jstor=797566 |hdl=20.500.13051/9392 |access-date=7 May 2015 |archive-date=25 October 2015 |archive-url=https://web.archive.org/web/20151025034757/http://www.yalelawjournal.org/article/covering |url-status=live }}
* {{cite journal|last1=Zinn|first1=Alexander|title='Das sind Staatsfeinde' Die NS-Homosexuellenverfolgung 1933–1945|trans-title="They are enemies of the state": The Nazi persecution of homosexuals 1933–1945|journal=Bulletin des Fritz Bauer Instituts|pages=6–13|date=2020b|url=https://www.fritz-bauer-institut.de/fileadmin/editorial/publikationen/einsicht/Einsicht-2020_Einzelseiten.pdf|archive-url=https://ghostarchive.org/archive/20221009/https://www.fritz-bauer-institut.de/fileadmin/editorial/publikationen/einsicht/Einsicht-2020_Einzelseiten.pdf|archive-date=2022-10-09|url-status=live|issn=1868-4211|language=de}}
{{refend}}


==Further reading==
NARTH states that refusing to offer therapy aimed at change to a client who requests it, and telling him that his only option is to claim a gay identity, could also be considered ethically unacceptable.<ref>[http://narth.com/2012/01/narth-statement-on-sexual-orientation-change]</ref>
*{{cite book |last1=Haldeman |first1=Douglas C. |title=Sexual Orientation and Gender Identity Change Efforts: Evidence, Effects, and Ethics |date=2021 |publisher=Columbia University Press |isbn=978-1-939594-36-5 |language=en}}


===International medical views===
{{See also|LGBT rights in the United Kingdom}}
The [[World Health Organization]]'s [[ICD-10]], which along with the [[DSM-IV]] is widely used internationally, states that "sexual orientation by itself is not to be regarded as a disorder". It lists [[ego-dystonic sexual orientation]] as a disorder instead, which it defines as occurring where "the gender identity or sexual preference (heterosexual, homosexual, bisexual, or prepubertal) is not in doubt, but the individual wishes it were different because of associated psychological and behavioural disorders, and may seek treatment in order to change it."<ref name="icd">{{citation |url=http://www.who.int/classifications/apps/icd/icd10online/?gf60.htm+f661 |title=ICD-10, Chapter V: Mental and behavioural disorders: Disorders of adult personality and behaviour |year=2007 |accessdate=2007-08-28 |publisher=World Health Organization}}</ref>

The development of theoretical models of sexual orientation in countries outside the United States that have established mental health professions often follows the history within the U.S. (although often at a slower pace), shifting from pathological to non-pathological conceptions of homosexuality.<ref>{{citation |title=Special Issue on the Mental Health Professions and Homosexuality |year=2003 |journal=Journal of Gay & Lesbian Psychotherapy |volume=7 |issue=1/2 |publisher= Haworth Medical Press}}</ref>{{Request quotation|date=November 2010}}

===Legal issues===
In a 1997 U.S. case, the [[Ninth Circuit]] addressed conversion therapy in the context of an asylum application. A Russian citizen "had been apprehended by the Russian militia, registered at a clinic as a 'suspected lesbian,' and forced to undergo treatment for lesbianism, such as 'sedative drugs' and hypnosis.... The Ninth Circuit held that the conversion treatments to which Pitcherskaia had been subjected constituted mental and physical torture. The court rejected the argument that the treatments to which Pitcherskaia had been subjected did not constitute persecution because they had been intended to help her, not harm her, and stated "human rights laws cannot be sidestepped by simply couching actions that torture mentally or physically in benevolent terms such as 'curing' or 'treating' the victims."<ref name="Gans">{{citation |last=Gans |first=Laura A. |title=Inverts, Perverts, and Converts: Sexual Orientation Conversion Therapy and Liability |year=1999 |month=Winter |journal=The Boston University Public Interest Law Journal |volume=8}}</ref>

==Notes==
{{reflist|2}}

==Bibliography==
*{{citation |last=Bright |first=Chuck |title=Deconstructing Reparative Therapy: An Examination of the Processes Involved When Attempting to Change Sexual Orientation |year=2004 |month=December |journal=Clinical Social Work Journal |volume=32 |issue=4 |doi=10.1007/s10615-004-0543-2 |page=471}}
*{{citation |last1=Domenici |first1=Thomas |last2=Lesser |first2=Ronnie C. |title=Disorienting Sexuality: Psychoanalytic Reappraisals of Sexual Identities |year=1995 |publisher=Routledge |location=New York |isbn=0-415-91198-2}}
*{{citation |last=Drescher |first=Jack |title=I'm Your Handyman: A History of Reparative Therapies |year=1998 |month=June |journal=Journal of Homosexuality |pmid=9670099 |volume=36 |issue=1 |doi=10.1300/J082v36n01_02 |page=19}}
*{{citation |editor-last=Drescher |editor-first=Jack |editor2-last=Zucker |editor2-first=Kenneth |title=Ex-Gay Research: Analyzing the Spitzer Study and Its Relation to Science, Religion, Politics, and Culture |year=2006 |publisher=Harrington Park Press |location=New York |isbn=1-56023-557-8}}
*{{citation |last=Drescher |first=Jack |title=Psychoanalytic Therapy and the Gay Man |year=1998 |publisher=The Analytic Press |location=Hillsdale, New Jersey |isbn=0-88163-208-2}}
*{{citation |last=Freud |first=Sigmund |title=On Sexuality: Volume 7 |year=1991 |publisher=Penguin Books |location=London |isbn=0-14-013797-1}}
*{{citation |last=Haldeman |first=Douglas C. |contribution=Sexual orientation conversion therapy for gay men and lesbians: A scientific examination |editor1-last=Gonsiorek |editor1-first=John |editor2-last=Weinrich |editor2-first=James |title=Homosexuality: Research Implications for Public Policy |year=1991 |publisher=Sage Publications, Inc |location=Newbury Park, California |isbn=0-8039-3764-4 |contribution-url=http://www.drdoughaldeman.com/doc/ScientificExamination.pdf}}
*{{citation |last=Haldeman |first=Douglas C. |title=Gay Rights, Patient Rights: The Implications of Sexual Orientation Conversion Therapy |year=2002 |month=June |journal=Professional Psychology: Research and Practice |volume=33 |issue=3 |page= 260|doi=10.1037//0735-7028.33.3.260 |url=http://www.drdoughaldeman.com/doc/GayRightsPatientRights.pdf}}
*{{citation |last=Johnson |first=Chris |title=Robinson backs out of symposium on "ex-gays" |publisher=Washington Blade |url=http://www.washblade.com/thelatest/thelatest.cfm?blog_id=18015 |archiveurl=http://web.archive.org/web/20080502044844/http://washblade.com/thelatest/thelatest.cfm?blog_id=18015 |archivedate=2008-05-02 |date=2008-05-12 |format=}}
*{{citation |last1=LeVay |first1=Simon |title=Queer Science: The Use and Abuse of Research into Homosexuality|year=1996 |publisher=MIT Press |location=Cambridge |isbn=0-262-12199-9}}
*{{citation |last1=Lewes |first1=Kenneth |title=The Psychoanalytic Theory of Male Homosexuality|year=1988 |publisher=Simon & Schuster |location=New York |isbn=0-671-62391-5}}
*{{citation |last1=O'Connor |first1=Noreen |last2=Ryan |first2=Joanna |title=Wild Desires and Mistaken Identities: Lesbianism and Psychoanalysis |year=1993 |publisher=Virago |location=London |isbn=1-85381-303-6}}
*{{citation |last=Plowman |first=William |title=Homosexuality Panel Squelched by Gay Activists |date=2008-05-12 |url=http://www.npr.org/templates/story/story.php?storyId=90365869 |publisher=NPR}}
*{{citation |last1=Shidlo |first1=Ariel |last2=Schroeder |first2=Michael |title=Changing Sexual Orientation: A Consumers’ Report |year=2002 |journal=Professional Psychology: Research and Practice |volume=33 |issue=3 |doi=10.1037//0735-7028.33.3.249 |page=249}}
*{{citation |last=Spitzer |first=Robert L. |title=Can Some Gay Men and Lesbians Change Their Sexual Orientation? 200 Participants Reporting a Change from Homosexual to Heterosexual Orientation |year=2003 |month=October |journal=Archives of Sexual Behavior |volume=32 |issue=5 |pmid=14567650 |doi=10.1023/A:1025647527010 |pages=403–17; discussion 419–72}}
*{{citation |last1=Yarhouse |first1=Mark A. |last2=Throckmorton |first2=Warren |title=Ethical Issues in Attempts to Ban Reorientation Therapies |year=2002 |journal=Psychotherapy: Theory/Research/Practice/Training |volume=39 |issue=1 |doi=10.1037//0033-3204.39.1.66 |page=66}}
*{{citation |last=Yoshino |first=Kenji |title=Covering |year=2002 |journal=Yale Law Journal |volume=111 |issue=4}}

==External links==
* [http://www.independent.co.uk/news/uk/this-britain/the-exgay-files-the-bizarre-world-of-gaytostraight-conversion-1884947.html Investigation into Conversion Therapy] ''[[The Independent]]'' ([http://www.webcitation.org/683h7AYsv Archive])
* [http://www.nytimes.com/2012/05/19/health/dr-robert-l-spitzer-noted-psychiatrist-apologizes-for-study-on-gay-cure.html?pagewanted=all Psychiatry Giant Sorry for Backing Gay 'Cure'] ''[[The New York Times]]''
* {{YouTube|id=gIifMxPcRnI |title= Interview with Dr. Robert Spitzer, M.D. (retracting his study on conversion therapy)}}
{{LGBT |orientation=yes}}
{{LGBT |orientation=yes}}
{{Pseudoscience|orientation=yes}}


{{DEFAULTSORT:Conversion Therapy}}
{{DEFAULTSORT:Conversion Therapy}}
[[Category:Alternative medicine]]
[[Category:Conversion therapy| ]]
[[Category:Conversion therapy| ]]
[[Category:Controversies]]
[[Category:Gender identity]]
[[Category:Obsolete medical theories]]
[[Category:Human rights abuses]]
[[Category:Medical controversies]]

[[Category:Religion and mental health]]
[[bg:Репаративна терапия]]
[[Category:Religion and science]]
[[de:Konversionstherapie]]
[[Category:Sexual orientation and medicine]]
[[es:Terapia de reorientación sexual]]
[[Category:Violence against LGBTQ people]]
[[it:Terapia di conversione]]
[[Category:Anti-LGBTQ sentiment]]
[[he:טיפול המרה]]
[[Category:Homophobia]]
[[pl:Terapia konwersyjna]]
[[Category:Transphobia]]
[[ru:Репаративная терапия]]
[[Category:Biphobia]]
[[fi:Eheytymiskurssi]]
[[Category:Abuse]]
[[vi:Liệu pháp chuyển đổi]]
[[Category:Torture]]
[[Category:Romantic orientation]]

Latest revision as of 02:06, 11 January 2025

Conversion therapy
ClaimsOne's sexual orientation, romantic orientation, gender identity, or gender expression can be changed to fit heterosexual, heteroromantic, and cisgender norms.
Notable proponentsEx-gay movement
(Overview of pseudoscientific concepts)

Conversion therapy is the pseudoscientific practice of attempting to change an individual's sexual orientation, romantic orientation, gender identity, or gender expression to align with heterosexual and cisgender norms.[1] Methods that have been used to this end include forms of brain surgery, surgical or chemical (hormonal) castration, aversion therapy treatments such as electric shocks, nausea-inducing drugs, hypnosis, counseling, spiritual interventions, visualization, psychoanalysis, and arousal reconditioning. There is a scientific consensus that conversion therapy is ineffective at changing a person's sexual orientation or gender identity and that it frequently causes significant long-term psychological harm.[2] The position of current evidence-based medicine and clinical guidance is that homosexuality, bisexuality, and gender variance are natural and healthy aspects of human sexuality.[2][3] An increasing number of jurisdictions around the world have passed laws against conversion therapy.[4]

Historically, conversion therapy was the treatment of choice for individuals who disclosed same-sex attractions or exhibited gender nonconformity, which were formerly assumed to be pathologies by the medical establishment.[3] When performed today, conversion therapy may constitute fraud, and when performed on minors, a form of child abuse; it has been described by experts as torture; cruel, inhuman, or degrading treatment; and contrary to human rights.

Terminology

Medical professionals and activists consider "conversion therapy" a misnomer, as it does not constitute a legitimate form of therapy.[5] Alternative terms include sexual orientation change efforts (SOCE)[5] and gender identity change efforts (GICE)[5]—together, sexual orientation and gender identity change efforts (SOGICE).[6][better source needed] According to researcher Douglas C. Haldeman, SOCE and GICE should be considered together because both rest on the assumption "that gender-related behavior consistent with the individual's birth sex is normative and anything else is unacceptable and should be changed".[7] "Reparative therapy" may refer to conversion therapy in general,[5] or to a subset thereof.[8]

Advocates of conversion therapy do not necessarily use the term either, instead using phrases such as "healing from sexual brokenness"[9][10] and "struggling with same-sex attraction".[11]

History

Sexual orientation change efforts (SOCE)

The term homosexual was coined by German-speaking Hungarian writer Karl Maria Kertbeny and was in circulation by the 1880s.[12][4] Into the middle of the twentieth century, competing views of homosexuality were advanced by psychoanalysis versus academic sexology. Sigmund Freud, the founder of psychoanalysis, viewed homosexuality as a form of arrested development. Later psychoanalysts followed Sandor Rado, who argued that homosexuality was a "phobic avoidance of heterosexuality caused by inadequate early parenting".[4] This line of thinking was popular in psychiatric models of homosexuality based on the prison population or homosexuals seeking treatment. In contrast, sexology researchers such as Alfred Kinsey argued that homosexuality was a normal variation in human development. In 1970, gay activists confronted the American Psychiatric Association, persuading the association to reconsider whether homosexuality should be listed as a disorder. The APA delisted homosexuality in 1973, which contributed to shifts in public opinion on homosexuality.[4]

Despite their lack of scientific backing, some socially or religiously conservative activists continued to argue that if one person's sexuality could be changed, homosexuality was not a fixed class such as race. Borrowing from discredited psychoanalytic ideas about the cause of homosexuality, some of these individuals offered conversion therapy.[4] In 2001, conversion therapy attracted attention when Robert L. Spitzer published a non-peer-reviewed study asserting that some homosexuals could change their sexual orientation. Many researchers made methodological criticisms of the study, which Spitzer later repudiated.[4]

Gender identity change efforts (GICE)

Gender Identity Change Efforts (GICE) refer to practices of healthcare providers and religious counselors with the goal of attempting to alter a person's gender identity or expression to conform to social norms. Examples include aversion therapy, cognitive restructuring, and psychoanalytic and talk therapies.[13] Western medical-model narratives have historically institutionalized transphobia: systemically favoring a binary gender model and pathologizing gender diversity and non-conformity.[14] This aided the development and proliferation of GICE.[15]

Early interventions were rooted in psychoanalytic hypotheses.[16] Robert Stoller advanced the theory that gender-nonconforming behavior and expression in children assigned male at birth (AMAB) was caused by being overly close to their mother. Richard Green continued his research; his methods for altering behavior included having the father spend more time with the child and mother less, expecting both to exhibit stereotypical gender roles, and having them praise their child's masculine behaviors, and shame their feminine and gender-nonconforming ones. These interventions resulted in depression in the children and feelings of betrayal from parents that the treatments failed.[16]

In the 1970s, UCLA psychologist Richard Green recruited Ole Ivar Lovaas to adapt the techniques of Applied Behavior Analysis (ABA) therapy to attempt to prevent children from becoming transsexual.[17] Deemed the "Feminine Boy Project", the treatments used operant conditioning to reward gender-conforming behaviors, and punish gender non-conforming behaviors.[17]

Kenneth Zucker at the Centre for Addiction and Mental Health adopted Richard Green's methods, but narrowed the scope to attempting to prevent the child from identifying as transgender by modifying gender behavior and presentation to conform to the expectations of the assigned gender at birth, which he dubbed the "living in your own skin" model. His model used the same interventions as Green with the addition of psychodynamic therapy.[16][18][19][20]

Motivations

A frequent motivation for adults who pursue conversion therapy is their religious beliefs, especially evangelical Christianity and Orthodox Judaism, that disapprove of same-sex relations. These adults prioritize maintaining a good relationship with their family and religious community.[21] Adolescents who are pressured by their families into undergoing conversion therapy also typically come from a conservative religious background.[21] Youth from families with low socioeconomic status are also more likely to undergo conversion therapy.[22]

Theories and techniques

As societal attitudes toward homosexuality have become more tolerant over time, the most harsh conversion therapy methods such as aversion have been reduced. Secular conversion therapy is offered less often due to reduced medical pathologization of homosexuality, and religious practitioners have become more dominant.[23]

Aversion therapy

Aversion therapy used on homosexuals included electric shock and nausea-inducing drugs during presentation of same-sex erotic images. Cessation of the aversive stimuli was typically accompanied by the presentation of opposite-sex erotic images, with the objective of strengthening heterosexual feelings.[24] Another method used was the covert sensitization method, which involves instructing patients to imagine vomiting or receiving electric shocks, writing that only single case studies have been conducted, and that their results cannot be generalized. Haldeman writes that behavioral conditioning studies tend to decrease homosexual feelings, but do not increase heterosexual feelings, citing Rangaswami's "Difficulties in arousing and increasing heterosexual responsiveness in a homosexual: A case report", published in 1982, as typical in this respect.[25]

Other methods of aversion therapy in addition to electric shock included ice baths, freezing, burning via metal coils, and hard labor. The intent was for the subject to associate homosexual feelings with pain and thus result in them being reduced. These methods have been concluded to be ineffective.[26]

Aversion therapy was developed in Czechoslovakia between 1950 and 1962 and in the British Commonwealth from 1961 into the mid-1970s. In the context of the Cold War, Western psychologists ignored the poor results of their Czechoslovak counterparts, who had concluded that aversion therapy was not effective by 1961 and recommended decriminalization of homosexuality instead.[27] Some men in the United Kingdom were offered the choice between prison and undergoing aversion therapy. It was also offered to a few British women, but was never the standard treatment for either homosexual men or women.[28]

In the 1970s, behaviorist Hans Eysenck was one of the main advocates of counterconditioning with malaise-inducing drugs and electric shock for homosexuals. He wrote that this type of therapy was successful in nearly 50% of cases. However, his studies were disputed.[29] Behavior therapists, including Eysenck, used aversive methods. This led to a protest against Eysenck by gay activist Peter Tatchell in a London Medical Group Symposium in 1972. Tatchell said that the therapy promoted by Eysenck was a form of torture.[29] Tatchell denounced Eysenck's form of behavioral therapy as inducing depression and suicide among gay men who were subjected to it.[30]

Brain surgery

In the 1940s and 1950s, U.S. neurologist Walter Freeman popularized the ice-pick lobotomy as a treatment for homosexuality. He personally performed as many as 3,439[31] lobotomy surgeries in 23 states, of which 2,500 used his ice-pick procedure,[32] despite the fact that he had no formal surgical training.[33]

In West Germany, a type of brain surgery usually involving destruction of the ventromedial nucleus of the hypothalamus was done to some homosexual men during the 1960s and 1970s. The practice was criticized by sexologist Volkmar Sigusch.[34]

Castration and transplantation

Friedrich-Paul von Groszheim (1908–2006) was spared from a concentration camp after agreeing to castration under pressure in 1938.

In the early twentieth century Germany experiments were carried out in which homosexual men were subjected to unilateral orchiectomy and testicles of heterosexual men were transplanted. These operations were a complete failure.[35]

Surgical castration of homosexual men was widespread in Europe in the first half of the twentieth century.[36] SS leader Heinrich Himmler ordered homosexual men to be sent to concentration camps because he did not consider a time-limited prison sentence was sufficient to eliminate homosexuality.[37] Although theoretically voluntary, some homosexuals were subject to severe pressure and coercion to agree to castration. There was no age limit; some boys as young as 16 were castrated. Those who agreed to castration after a Paragraph 175 conviction were exempted from being transferred to a concentration camp after completing their legal sentence.[38] Some concentration camp prisoners were also subjected to castration.[39] An estimated 400 to 800 men were castrated.[40]

Endocrinologist Carl Vaernet attempted to change homosexual concentration camp prisoners' sexual orientations by implanting a pellet that released testosterone. Most of the victims, non-consenting prisoners at Buchenwald, died shortly thereafter.[41][42]

An unknown number of men were castrated in West Germany and chemical castration was used in other Western countries, notably against Alan Turing in the United Kingdom.[43]

Ex-gay/ex-trans ministries

OneByOne booth at a Love Won Out conference

Ex-gay ministries are religious groups that attempt to use religion to eliminate or change somebody's sexual orientation.[44][45][46][47] The ex-gay umbrella organization Exodus International in the United States ceased activities in June 2013, and the three member board issued a statement which repudiated its aims and apologized for the harm their pursuit has caused to LGBT people.[48][49] Ex-trans organizations often overlap and portray being trans as inherently sinful or against God's design, or pathologize gender variance as due to trauma, social contagion, or "gender ideology."[50][51]

Hypnosis

Hypnosis was used in conversion therapy since the 19th century by Richard von Krafft-Ebing and Albert von Schrenck-Notzing. In 1967, Canadian psychiatrist Peter Roper published a case study of treating 15 homosexual (some of which would probably be considered bisexual by modern standards) people with hypnosis. Allegedly, 8 showed "marked improvement" (they reportedly lost sexual attraction towards the same sex altogether), 4 mild improvements (decrease of "homosexual tendencies"), and 3 no improvement after hypnotic treatment; he concluded that "hypnosis may well produce more satisfactory results than those obtainable by other means", depending on the hypnotic susceptibility of the subjects.[52][better source needed]

Psychoanalysis

Haldeman writes that psychoanalytic treatment of homosexuality is exemplified by the work of Irving Bieber et al. in Homosexuality: A Psychoanalytic Study of Male Homosexuals. They advocated long-term therapy aimed at resolving the unconscious childhood conflicts that they considered responsible for homosexuality. Haldeman notes that Bieber's methodology has been criticized because it relied upon a clinical sample, the description of the outcomes was based upon subjective therapist impression, and follow-up data were poorly presented. Bieber reported a 27% success rate from long-term therapy, but only 18% of the patients in whom Bieber considered the treatment successful had been exclusively homosexual to begin with, while 50% had been bisexual. In Haldeman's view, this makes even Bieber's unimpressive claims of success misleading.[53]

Haldeman discusses other psychoanalytic studies of attempts to change homosexuality. Curran and Parr's "Homosexuality: An analysis of 100 male cases", published in 1957, reported no significant increase in heterosexual behavior. Mayerson and Lief's "Psychotherapy of homosexuals: A follow-up study of nineteen cases", published in 1965, reported that half of its 19 subjects were exclusively heterosexual in behavior four and a half years after treatment, but its outcomes were based on patient self-report and had no external validation. In Haldeman's view, those participants in the study who reported change were bisexual at the outset, and its authors wrongly interpreted capacity for heterosexual sex as change of sexual orientation.[54]

Reparative therapy

The term "reparative therapy" has been used as a synonym for conversion therapy generally, but according to Jack Drescher it properly refers to a specific kind of therapy[clarification needed] associated with the psychologists Elizabeth Moberly and Joseph Nicolosi.[8] For example, he wrote:

. . . the pursuit of fulfillment through same-sex eroticism is spurred by the fearful anticipation that their masculine self-assertion will inevitably fail and result in humiliation.[55]

The term reparative refers to Nicolosi's postulate that same-sex attraction is a person's unconscious attempt to "self-repair" feelings of inferiority.[56][57]

After California banned conversion practices, Nicolosi argued that "reparative therapy" didn't attempt to directly change sexual orientation but instead encourage exploration into its underlying causes, which he believed was often childhood trauma.[58]

Marriage therapy

Previous editions of the World Health Organization's ICD included "sexual relationship disorder", in which a person's sexual orientation or gender identity makes it difficult to form or maintain a relationship with a sexual partner. The belief that their sexual orientation has caused problems in their relationship may lead some people to turn to a marriage therapist for help to change their sexual orientation.[59] Sexual orientation disorder was removed from the most recent ICD, ICD-11, after the Working Group on Sexual Disorders and Sexual Health determined that its inclusion was unjustified.[60]

Gender exploratory therapy

Gender exploratory therapy (GET) is a form of conversion therapy[61][62][63][64][65] characterized by requiring mandatory extended talk therapy attempting to find pathological roots for gender dysphoria while simultaneously delaying social and medical transition and viewing it as a last resort.[61][63][64][58][66] Practitioners of GET often view medical transition as a last resort and propose their patient's dysphoria is caused by factors such as homophobia, social contagion, sexual trauma, and autism.[63][65] Some practitioners of GET avoid using their patients' chosen names and pronouns while questioning their identification.[66] Commenting on gender exploratory therapy in 2022, bioethicist Florence Ashley argued that its framing as an undirected exploration of underlying psychological issues bore similarities to gay conversion practices such as "reparative" therapy.[58] States that have banned gender-affirming care for minors in the United States have called expert witnesses to argue that exploratory therapy should be the alternative treatment.[67]

There are no known empirical studies examining psychosocial or medical outcomes following GET.[66][68] Concerns have been raised that by not providing an estimated length of time for the therapy, the delays in medical interventions may compound mental suffering in trans youth,[63][66] while gender-affirming model of care already promotes gender identity exploration without favoring any particular identity, and individualized care.[66] GET proponents deny this.[69]

In 2017, Richard Green published a legal strategy which called for circumventing bans on conversion therapy by labelling the practice "gender identity exploration or development".[70][71] Multiple groups now exist worldwide to promote GET and have been successful in influencing legal discussions and clinical guidance in some regions.[64] The Gender Exploratory Therapy Association (GETA) asserts that "psychological approaches should be the first-line treatment for all cases of gender dysphoria", that medical interventions for transgender youth are "experimental and should be avoided if possible", and that social transition is "risky".[69] All of GETA's leaders are members of Genspect, a "gender-critical" group that promotes GET and argues that gender-affirming care should not be available to those under 25.[69] In late 2023, GETA changed their name to "Therapy First".[67]

GETA also shares a large overlap with the Society for Evidence-Based Gender Medicine (SEGM), which promotes GET as first-line treatment for those under 25.[72] GETA co-founder Lisa Marchiano stated U.S. President Joe Biden's executive order safeguarding trans youth from conversion therapy would have a "chilling effect" on GET practices.[69][73] GETA also opposed Biden's Title IX changes protecting trans students from discrimination, stating allowing trans youth in restrooms would harm the mental health of their peers.[73] The American College of Pediatricians, a small group aligned with the Christian Right,[Note 1] has cited numerous studies from SEGM to claim GET is necessary to restore transgender people's "biological integrity".[72] In November 2023, Michelle Cretella, a board member of the pro conversion therapy group Alliance for Therapeutic Choice and Scientific Integrity (ATCSI, formerly NARTH), gave a speech at an ATCSI conference which endorsed GET and argued it "truly is very similar to how the Alliance has always approached unwanted same-sex attraction".[67]

Effects

There is a scientific consensus that conversion therapy is ineffective at changing a person's sexual orientation.[2] Advocates of conversion therapy rely heavily on testimonials and retrospective self-reports as evidence of effectiveness. Studies purporting to validate the effectiveness of efforts to change sexual orientation or gender identity have been criticized for methodological flaws.[74] After conversion therapy has failed to change someone's sexual orientation or gender identity, participants often feel increased shame that they already felt over their sexual orientation or gender identity.[21]

Conversion therapy can cause significant, long-term psychological harm.[2] This includes significantly higher rates of depression, substance abuse, and other mental health issues in individuals who have undergone conversion therapy than their peers who did not,[75][76] including a suicide attempt rate nearly twice that of those who did not.[77] Modern-day practitioners of conversion therapy—primarily from a conservative religious viewpoint—disagree with current evidence-based medicine and clinical guidance that does not view homosexuality and gender variance as unnatural or unhealthy.[2][3]

In 2020, ILGA World published a world survey and report Curbing Deception listing consequences and life-threatening effects by associating specific public testimonies with different types of methods used to practice conversion therapies.[78]

A 2022 study estimated that conversion therapy of youth in the United States cost $650.16 million annually with an additional $9.5 billion in associated costs such as increased suicide and substance abuse.[76] Youth who undergo conversion therapy from a religious provider have more negative mental health outcomes than those who had consulted a licensed healthcare provider.[21]

Public opinion

A 2020 survey carried out on US adults found majority support for banning conversion therapy for minors.[79]

A 2022 YouGov poll found majority support in England, Scotland, and Wales for a conversion therapy ban for both sexual orientation and gender identity, with opposition ranging from 13 to 15 percent.[80]

Map of jurisdictions that have bans on sexual orientation and gender identity change efforts with minors.
  Criminal prohibition against conversion therapy on the basis of sexual orientation and gender identity
  Only medical professionals are banned from performing conversion therapy
  No ban on conversion therapy

Some jurisdictions have criminal bans on the practice of conversion therapy, including Canada, Ecuador, France,[81] Germany, Malta, Mexico and Spain.[82] In other countries, including Albania, Brazil, Chile, Vietnam and Taiwan, medical professionals are barred from practicing conversion therapy.[83]

In some states, lawsuits against conversion therapy providers for fraud have succeeded, but in other jurisdictions those claiming fraud must prove that the perpetrator was intentionally dishonest. Thus, a provider who genuinely believes conversion therapy is effective could not be convicted.[84]

Conversion therapy on minors may amount to child abuse.[85][86][87]

Human rights

In 2020, the International Rehabilitation Council for Torture Victims released an official statement that conversion therapy is torture.[85] The same year, UN Independent Expert on sexual orientation and gender identity, Victor Madrigal-Borloz, said that conversion therapy practices are "inherently discriminatory, that they are cruel, inhuman and degrading treatment, and that depending on the severity or physical or mental pain and suffering inflicted to the victim, they may amount to torture". He recommended that it should be banned across the world.[88] In 2021, Ilias Trispiotis and Craig Purshouse argue that conversion therapy violates the prohibition against degrading treatment under Article 3 of the European Convention on Human Rights, leading to a state obligation to prohibit it.[83][89] In February 2023 Commissioner for Human Rights, Dunja Mijatović, qualified those practices as “irreconcilable with several guarantees under the European Convention on Human Rights" and having no place in a human rights-based society urging the Member States of the Council of Europe to ban them for both adults and minors,[90] later in July 2023 she advocated for clear actions during a public hearing at the European Parliament studying different approaches to legally ban "conversion therapies" in the European Union.[91] In September 2024 it was reported that the European Union is considering banning "conversion therapies" across its Member States,[92] while a European Citizens' Initiative that started collecting signatures in May 2024 is also calling on the European Commission to outlaw such practices.[93]

In media

Efforts to change sexual orientation have been depicted and discussed in popular culture and various media. More recent examples include: Boy Erased, The Miseducation of Cameron Post, Book of Mormon musical, Ratched, and documentary features Pray Away, Homotherapy: A Religious Sickness.[94][95]

Medical views

National health organizations around the world have uniformly denounced and criticized sexual orientation and gender identity change efforts.[96][97][98] They state that there has been no scientific demonstration of "conversion therapy's" efficacy.[44][99][100][101] They find that conversion therapy is ineffective, risky and can be harmful. Anecdotal claims of cures are counterbalanced by assertions of harm, and the American Psychiatric Association, for example, cautions ethical practitioners under the Hippocratic oath to do no harm and to refrain from attempts at conversion therapy.[100] Furthermore, they state that conversion therapy is harmful and that it often exploits individual's guilt and anxiety, thereby damaging self-esteem and leading to depression and even suicide.[102] There is also concern in the mental health community that the advancement of conversion therapy can cause social harm by disseminating inaccurate views about gender identity, sexual orientation, and the ability of LGBT people to lead happy, healthy lives.[97] Various medical bodies prohibit their members from practicing conversion therapy.[103]

See also

Notes

  1. ^ not to be confused with the American Academy of Pediatrics

References

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Bibliography

Further reading

  • Haldeman, Douglas C. (2021). Sexual Orientation and Gender Identity Change Efforts: Evidence, Effects, and Ethics. Columbia University Press. ISBN 978-1-939594-36-5.