Busting myths about Gender Identity “Conversion Therapy”

Efforts to suppress trans and variant gender expressions are only recently being taken seriously leading to a lot of myths remaining.

Content note: In this article I’m going to talk about a range of sensitive topics. All of these involve forms of harm to trans people, but these include non-graphic discussion of sexual, physical, or psychiatric violence.

This article is largely inspired by the public campaigning of people like Stella O’Malley, James Esses and the organisation Thoughtful Therapists who are sowing a great deal of misinformation about conversion therapy in the British and Irish press recently.

Before I start, James Esses was thrown off of his course as a student therapist for reasons which are not yet clear in public, but may relate to his attempts to campaign against regulation of conversion therapy, or potentially his decision to use his role as a ChildLine volunteer to attempt unsupervised experimental therapy techniques to challenge children reporting trans gender identities calling the service.

Stella O’Malley is a psychotherapist in Ireland who’s accreditation body has made absolutely no commitments to regulate against conversion therapy. On August 9th 2021, O’Malley with her collaborators Jacky Grainger and Madeleine Ní Dhailigh wrote an article for the Irish Times arguing against the prospect of a conversion therapy ban. The wording of the opening claims this article is based on differ only barely from the Thoughtful Therapists F.A.Q, and this misinformation if allowed to go unchallenged is likely to lead to wrong conclusions about what conversion therapy is and how it should be dealt with.

What Actually Is Conversion Therapy?

First of all, let’s start off on the right footing by dealing with common misunderstandings around the term. Thanks to activists in the 1990s, almost noone in the present day admits to doing conversion therapy, and the term Conversion Therapy itself is a misnomer in some ways. Conversion Therapy is defined in the most recent report on conversion therapy by the UN Independent Expert as an umbrella term which includes a very wide range of practices which are linked only in that they are consistently aimed at effecting a change in a patient’s identity or behaviour towards heterosexuality or from trans or gender diverse towards cisgender norms.

To assure readers that this is not a cherry picked the International Review of Conversion Therapy says:

IFEG — a global body of medico-legal jurisprudence experts defined conversion therapy this way in a report to the United Nations:

In the UK the MoU2 — a joint agreement by a consortium of psychological/psychiatric bodies in the UK to stop conversion therapy — says:

In most recent academic and technical contexts, the correct term used is Sexual Orientation and Gender Identity/Expression Change Efforts (usually written as SOGIECE or SOGICE) in order to address the lack of clarity in what people mean when they say Conversion Therapy. Gender Identity Change Efforts or Gender Identity Conversion Therapy is generally used to describe, specifically those efforts which are targeted at normalising trans victims.

But talking therapies aren’t abusive like aversion therapy and corrective rape?

There is an increasing tendency of advocates for conversion therapy to try to isolate specific violent forms in order to distract people from how these normalisation and diversity eradicating practices have actually played out historically. This is generally suggested to be archaic, a thing of the past, and brutal and contrasted with more modern talking therapy approaches which are presented as being more gentle and effective.

It is absolutely true that behavioural approaches, aversion therapies and corrective rape have historically played a role in conversion therapy approaches (and continue to play such a role in many parts of the world). But talking therapies were being used in an attempt to “cure” homosexuality and gender diversity as far back as the 1950s and earlier, during the early rise of the psychotherapeutic movement itself. Even then, there are countless references in psychoanalytic literature to the fact that attempts at psychotherapy did not work to stop people being gay or trans. It may even have been that the fact that these therapies failed was a motivation for advancing other approaches. One paper in the 1970s psychiatric literature claims that a transsexual was cured through exorcism despite acknowledging that existing “efforts at treatment [of gender dysphoria] through psychotherapy had been ineffective”.

Suffice to say that this article was a one-off, and there has been no subsequent replication of the efficacy of exorcism as a way of “curing” transsexuality. It is completely false however to suggest that psychotherapy was not tried and disproven in the past to change people’s gender identities and expressions, or to try and create a false distinction between the brutal past and the more virtuous present.

The International Lesbian, Gay, Bisexual and Trans Association (ILGA) are more pointed when discussing the history of medical experimentation on gay and gender diverse people in North America and Europe:

In fact the International Review of Conversion Therapy found that psychotherapy was the most common form of attempted conversion therapy undertaken in the present day:

Clearly the idea that there is some way of distancing past more archaic techniques from more modern therapies is flatly wrong. The claims made by Thoughtful Therapists in the media and elsewhere are flagrant misinformation completely disconnected from the established literature on the topic.

Isn’t conversion therapy only something applied to homosexuality?

I already demonstrated above with the example of the exorcism on a transsexual it very much is not restricted to attempts at curing homosexuality. This myth is sadly widespread, in part because a great deal of activism and resources have been put into revealing the harms done by conversion therapists to homosexuals, and comparatively little effort has been put into analysing the experiences of transgender people suffering under the psychiatric system.

One of the key reasons for this is that understanding and historicising conversion therapy has happened in the context of the wider historic exclusion of trans voices from forming an understanding of it in the first place. It is only relatively recently that LGBT organisations have committed serious resources to taking on board information from trans populations, despite the often shared oppression and co-involvement of transvestite, transsexual and transgender people in the gay liberation movement for much of its history in multiple locales.

Correcting these erasures (and the erasures of trans perspectives in much of the medical literature of the time), I’ll share this exerpt from the conference proceedings document from the National Transsexual/Transvestite conference in Leeds, UK, 1974. During the conference, the working group on medical/psychiatric treatment recorded the following short but damning judgements:

The Maudsley Hospital [a psychiatric institution in the UK]

One member of the group had recently undergone an unsuccessful course of aversion therapy there. She felt with the rest of us who had not had that privilege (?), that there was no place for such therapy in the resolution of our problem. Dr. Goldberg who had been in charge of this therapy has moved his shocking habits down to Oxford, leaving the field open for Dr. Isaac Marks.

Psychiatrists:

Limited in their individual experience. An adjustment rather than a curative approach must be concentrated on. The Maudsley type of experience in using aversion therapy was only valid if, by using it in a strictly controlled way, they could authoritatively discredit it for ever.

Isaac Marks’ aversion clinic at the Maudsley was documented in a paper entitled Sexual Deviants Two Years after Electric Aversion (1970), where he scored patients on their “improvements in heterosexuality”, making claims to a degree of efficacy in reducing homosexuality among some “deviants”, but not transsexual subjects. He also cites other researchers working in the field of aversion targeted at homosexual victims.

Not only were the horrors of conversion therapy very much targeted at both trans and homosexual patients, but these dubious “therapies” were used on both populations with findings from each used to inspire the other. They are inseparable. Conversion therapy was never something simply targeted at homosexuality alone, and it is an unquestionably good thing that trans and gender diverse people are now being listened to regarding the harms they have been subjected to.

“There is no evidence that anyone has used conversion therapy to attempt to ‘cure’ a person of their gender identity”

Even charitably interpreting “therapy” here to only mean talking therapies, this too is a lie. In an independently reviewed study published in 2020 organised by 5 different LGBT charities to investigate the nature of Gender Identity Conversion Therapy in the UK, found that

• Gender identity conversion therapy takes place in the UK
• Gender identity conversion therapy is harmful and has negative impacts on public health
• A gender identity conversion therapy ban is popular among those who’ve undergone the practice.

In this study, religious and psychological based formed of conversion therapy accounted for the vast majority of gender identity conversion therapy people had experienced.

Disturbingly the study also found that in some cases survivors of conversion therapy had experienced it from services provided through the NHS.

Claims that the MOU forces therapists to abandon exploratory approaches

Thoughtful Therapists claim that because of the MOU2, a ban on conversion would mean that “psychotherapists would feel unable to practice exploratively for fear of complaints or prosecution. Without exploratory psychotherapy, people with gender dysphoria would be more likely to seek and receive ‘gender affirming’ medical treatment.”.

This is another obfuscation. The MoU is a loose commitment by psychological bodies against conversion therapy rather than a prescriptive discussion of everything which is ruled out. However, even ignoring that, the MOU clearly states:

This document supports therapists to provide appropriately informed and ethical practice when working with a client who wishes to explore, experiences conflict with or is in distress regarding, their sexual orientation or gender identity.

Nor is it intended to stop psychological and medical professionals who work with trans and gender questioning clients from performing a clinical assessment of suitability prior to medical intervention. Nor is it intended to stop medical professionals from prescribing hormone treatments and other medications to trans patients and people experiencing gender dysphoria.

For people who are unhappy about their sexual orientation or their gender identity, there may be grounds for exploring therapeutic options to help them live more comfortably with it, reduce their distress and reach a greater degree of self-acceptance. Some people may benefit from the support of psychotherapy and counselling to help them manage unhappiness and to clarify their sense of themselves. Clients make healthy choices when they understand themselves better

There is no question whatsoever that exploratory work with patients unsure of their gender identity or sexual orientation is acceptable. What is not acceptable under the Memorandum is:

…a therapeutic approach, or any model or individual viewpoint that demonstrates an assumption that any sexual orientation or gender identity is inherently preferable to any other, and which attempts to bring about a change of sexual orientation or gender identity, or seeks to suppress an individual’s expression of sexual orientation or gender identity on that basis.

That is to say, it’s fine to provide therapy and counselling, but the therapist must behave ethically and not advance an agenda in terms of trying to normalise the client towards a preferred identity. That’s all.

Conclusion

There’s a great deal of misinformation being supported in the press right now about conversion therapy, including well respected publications completely irresponsibly publishing as expert opinion therapists who are not regulated with respect to conversion therapy and have a deep commitment to bias around the topic of conversion therapy.

However, a growing mass of expertise by numerous internationally respected bodies (including the United Nations expert on Sexual Orientation and Gender Identity) shows that:

• Gender conversion therapy is not a thing of the past
• Talking therapies are routinely part of it
• There are multiple crossovers and a shared history between Gender and Sexuality related conversion therapies
• The MOU is open to exploratory and supportive therapy and does not prevent these. It only rules out agenda driven attempts at conversion.