Most Americans have probably at least heard of conversion therapy, a broad term encompassing various dangerous practices aimed at changing the gender identity or sexual orientation of an individual. These practices have historically included everything from hypnosis to electroconvulsive shock therapy to behavioral correction, many of which are still used today. Conversion therapy has been a widely discussed topic in recent years, whether that’s because Vice President Mike Pence has debatably come out in support of it or because numerous survivors have come forward to speak out about the abuse they suffered because of it. Research has shown that not only is conversion therapy almost always unsuccessful, but it also causes immeasurable harms to those who are forced to undergo it. Today, national health associations agree that conversion therapy is “at best ineffective and at worst harmful to those who experience it.” Because of that, many states have banned conversion therapy from being performed on children under 18 years old.
But what most people probably don’t know is that conversion therapy is still alive and well in the United States, masquerading under a different name: “reparative therapy.”
“Reparative therapy” is a form of conversion therapy provided to adults who voluntarily seek to change their sexual orientation or gender identity, usually out of a desire to live their lives in accordance with their religious or political beliefs. Proponents of “reparative therapy” attempt to distance it from conversion therapy by arguing that the practice is not harmful because it does not involve client-shaming or shock treatments, but rather consists of client discussions and behavioral modification. “Reparative therapists” market their practice as a voluntary experience where the client who does not “identify with their homosexual urges” comes to them wishing to no longer be LGBTQ+, at which time the practitioner and client set goals to get the client on a path to heterosexuality or cisgender identity.
This is false advertising. In 2007, the American Psychological Association (“APA”) conducted a comprehensive study of various methods that are used to “change” sexual orientation and gender identity. “Reparative therapy” was among the practices investigated. The APA ultimately concluded that “reparative therapy,” like other forms of conversion therapy, does not work. People who undergo “reparative therapy” are taught to behave in accordance with a “straight” identity, a practice that may sometimes change behaviors but doesn’t actually change a person’s sexual orientation or gender identity. Moreover, when individuals who seek out “reparative therapy” realize that it is not effective, they tend to experience depression, isolation, self-destructive behavior, and self-hatred. They often suffer guilt and shame, or may be blamed by people in their lives who feel as though they didn’t try hard enough to be straight. Often, people who undergo “reparative therapy” ultimately require actual therapy to undo the damage.
The harms of “reparative therapy” extend well beyond those committed against patients who are deceived into thinking the practice is successful. “Reparative therapy” has many negative implications for the LGBTQ+ community and for society as a whole. For one thing, “reparative therapy” is based in large part on toxic masculinity: male clients with “homosexual urges” are told they need to “reconnect with their masculinity” or learn how to become manly again, rhetoric that defines the worth of men based on traditionally masculine traits. The same is true for queer women and people who are questioning their gender identity as well; they are taught to behave in accordance with traits that are stereotypically associated with femininity, or with whatever gender the person was assigned at birth. “Reparative therapy” thus reinforces stereotypical gender norms which, in turn, contributes to negative views and treatment of LGBTQ+ people who do not conform to these stereotypes.
More fundamentally, the very existence of “reparative therapy” implies that being a member of the LGBTQ+ community means a person is broken and needs fixing. It implies that LGBTQ+ people have a mental disorder that needs to be cured. By teaching people that gender identity and sexual orientation is a choice or something that can be changed, proponents of “reparative therapy” put LGBTQ+ people at risk for more societal prejudice, which has been proven to lead to harms against LGBTQ+ people, particularly youth. “Reparative therapy” promotes stereotypes and stigmas that in turn lead to hate crimes against LGBTQ+ adults and bullying against LGBTQ+ youth, both of which place LGBTQ+ people at an increased risk of suicide and mental health problems compared to heterosexual and cisgender individuals. Permitting “reparative therapy” thus places LGBTQ+ people in danger just for existing, and hinders the progress that the LGBTQ+ community is making toward being accepted in society.
Many leading professional organizations for mental health practitioners have condemned “reparative therapy.” The APA, for example, has ethically condemned the practice because being LGBTQ+ is not a mental disorder, and “reparative therapy” is not an effective or psychologically sound treatment, but a harmful one. Similarly, the American Counseling Association states that “reparative therapy” violates their Code of Ethics because it “does not work, can cause harm, and . . . is an attempt to treat something that is not a mental illness.” Many mental health professionals have condemned “reparative therapy” on an individual basis as well.
The United States should follow the lead of these professional mental health organizations and prohibit “reparative therapy” from being practiced, even on adults who seek it out voluntarily.
People who practice “reparative therapy” argue that they are simply promoting what is morally accepted within their religion, and that they are not forcing change upon anyone who does not already want to change. They argue that “reparative therapy” is different from conversion therapy and should not be banned. Those who seek out “reparative therapy” for themselves claim that such a prohibition would unreasonably restrict their free will and their right to make voluntary choices about how to live their lives.
However, federal and state governments do have the authority to prohibit people from seeking out medical treatments that the government has reasonably deemed harmful or deceitful. For this reason, some states have prohibited all efforts to change the gender identity or sexual orientation of a person under 18, including “reparative therapy” sought voluntarily. In 2017 the Supreme Court of the United States refused to hear a challenge against one such ban in California, thereby upholding the complete ban on all Sexual Orientation Change Efforts (“SOCEs”) including “reparative therapy” voluntarily sought by minors under 18 years of age.
There’s no doubt that “reparative therapy” is harmful to those who endure it, regardless of age. Yet unlike other forms of medical treatment that are harmful, it’s still legal for an adult to seek out “reparative therapy” on a voluntary basis from providers who are typically religiously-based and do not adhere to prohibitions by mainstream mental health professional organizations. This system fails some of the adults who need its support and care the most. The United States shouldn’t only focus on protecting children from conversion therapy; we should also try to protect adults who, driven by shame or self-hatred, seek out ineffective psychological practices that cause more harm than good.
If “reparative therapy” were banned, there would still be plenty of options for adults who struggle with their sexual orientation or gender identity, most notably traditional therapy. Traditional therapy does not have a preconceived end goal in mind, but instead adapts to the needs of the client, thus creating a healthier environment and mindset. Unlike “reparative therapy,” traditional therapy has also been proven to be successful at helping individuals learn to accept sexual orientations or gender identities that were previously sources of struggle in their lives. There are also numerous support groups for people who struggle with their LGBTQ+ identity.
Prohibiting “reparative therapy” would do more than protect people who fall victim to its false promises; it would protect LGBTQ+ people across the country by reducing stigmas and increasing acceptance, thus making the United States a safer place to be LGBTQ+.