‘They were told there was something wrong with them that could be healed’

How did you come to carry out the research on conversion therapy?

Much of my research and teaching has focused on gender and sexuality and I'm currently Chair of the Sexualities Section, which provides a forum for psychologists whose work is relevant to lesbian, gay, bisexual and trans (LGBT+) issues. I had already started to take a scholarly interest in the topic of conversion therapy in the UK and had presented at a conference some preliminary work looking at UK-based 'ex-gay' literature. In 2018, I heard that the Government was inviting expressions of interest to tender for a research project to conduct a rapid evidence assessment and a qualitative study into people's experiences of conversion therapy in the UK. Together with a group of colleagues (including Dr Simon Goodman – now Chair of the BPS Qualitative Methods in Psychology Section) we submitted a bid and won the contract. 

What types of 'therapy' does the term 'conversion therapy' encompass?

'Conversion therapy' is a colloquial term to describe any efforts to change, modify or suppress a person's sexual orientation or gender identity, irrespective of whether it takes place in healthcare, religious or other settings. The term 'therapy' may not accurately reflect the nature of all these practices. For this reason, the term 'sexual orientation change efforts' and 'gender identity change efforts' is often preferred in the scientific literature. 

When people hear the term conversion therapy, electric shock, and other aversive behavioural treatments conducted in the mid-20th century, is probably what springs to mind. But the most commonly documented forms of conversion therapy today take the form of spiritual and talking therapy approaches. It's typically premised on the idea that being LGBT+ is some form of mental illness, addiction or a spiritual problem to be healed. So the methods often include things like 'prayer healing' or exorcisms, forms of psychotherapy that loosely draw on out-dated psychological approaches that pathologise gender and sexual minorities. Some providers of conversion therapy will often draw on a combination of spiritual and pseudoscientific ideas. Those who undergo conversion therapy are also often provided with materials such as books, videos or attend talks by conversion therapists that reinforce negative social stereotypes about LGBT+ people and characterise LGBT+ identities as disordered or a problem to be overcome.   

Who are the 'therapists' in conversion therapy?

The Government's national LGBT survey found over half of people who had undergone conversion therapy had it via a faith group organisation, although 19 per cent said it had been provided by a health professional and some experienced it from family members or people in their community. Most of the people we spoke to had experienced it within religious contexts. Some people described some quite traumatic experiences of exorcisms or humiliating experiences of being made to confess their sexual thoughts and behaviours publicly. But conversion efforts conducted by faith groups weren't restricted to prayer. For example, many attended religious organisations offering pastoral ministry for people with same-sex attraction or gender incongruence. These organisations essentially provided non-professional forms of counselling, drawing on out-dated or pseudoscientific psychological ideas. Some also attended retreats or courses by organisations that presented themselves as secular, but often had links to religious groups. 

Others did describe being offered conversion therapy by a professional therapist, but these were sometimes also described as being religious and would bring 'healing' prayer into the therapy session. In some cases, mental health professionals appeared to have assumed that the individual's sexuality or gender identity was a symptom of a co-existing mental health condition (e.g. schizophrenia) and/or had heteronormative and cisnormative expectations for what returning to 'normal' should look like for these patients' mental health recovery. This might suggest that mental health professionals really need more training on gender, sexuality and relationship diversity.   

Are certain groups more likely to undergo conversion therapy?

As you might expect from what I've just said, LGBT+ people of faith appear to be more likely to be offered or undergo conversion therapy. There is also some indicative evidence from the national LGBT survey and similar evidence from a Canadian study that transgender people and people of colour may be more likely to be offered or undergo conversion therapy. 

Do people choose to undergo conversion therapy?

Not always. Some people are coerced into it. For example, one young lesbian told us she was locked in a room for days by her parents until she agreed to undergo conversion efforts, and her father threatened to kill himself if she didn't comply. Most, however, told us they had undergone conversion therapy 'voluntarily' but in the face of powerful social pressures. Many believed that being LGBT+ was incompatible with their faith and religious identity: they had internalised stigma regarding their sexual orientation or gender identity or feared being rejected by their families or whole communities. They were also often following the guidance of people in positions of authority who told them that there was something wrong with them that could be healed, and that undergoing conversion therapy was the right thing to do. 

What kinds of outcomes of conversion therapy did you find in this research?

We found no robust evidence that conversion therapy can change a person's sexual orientation or gender identity, but there is a growing body of evidence that undergoing it is associated with poor mental health such as depression and suicidal thoughts. Most of the people we spoke to had found it a harmful experience. It had generally made them feel worse about themselves, resulting in feelings of shame, low self-esteem and hopelessness when they experienced no change. The messages they were being given also appeared to exacerbate the internal conflicts they were experiencing, rather than helping to resolve them.

Some people do report some secondary benefits of conversion therapy, such as having the opportunity to talk about feelings they had previously kept secret and an opportunity to meet people in a similar situation to themselves who they could identify with. But such benefits aren't unique to conversion therapy: they could be gained from approaches that provide support without the premise that being LGBT+ is a defect or deficiency. Ethical forms of support for LGBT+ people engage in open and explorative discussions in a non-directive way and provide non-judgemental support.  

Did anything surprise you during the course of your research?

I perhaps expected that more of the people we spoke to would have lost their faith as a result of what they'd been through. Most had left their previous faith community at great personal cost and some had lost their faith entirely. But many had gone on to achieve self-acceptance, reconciled their faith with being LGBT+ and found a faith community accepting of their LGBT+ identity. Debates over conversion therapy are often framed as a clash of LGBT rights and the rights of religious freedom, but the victims are often both LGBT and people of faith. Those we spoke to often framed this issue in terms of safeguarding LGBT+ people within faith communities and preventing what they saw as forms of spiritual and psychological abuse by people in positions of trust and authority. 

What about the public reaction to your report?

The report has been well received by most, particularly from conversion therapy survivors and other psychologists. I was, of course, expecting some criticism, particularly from those involved in the 'ex-gay' movement. What I perhaps hadn't anticipated at the outset was that the most vocal critics would be people who describe themselves as having 'gender critical' views. I've been at the sharp end of some abuse on Twitter due to the ferocity of debate when it comes to anything related to gender identity. Criticism from both ex-gay and gender critical movements have been broadly the same and largely focused on me. They've claimed that I'm biased because I'm Chair of the Sexualities Section (for psychologists whose work focuses on LGBT+ issues) and because I've consistently opposed homophobia and transphobia. I'd encourage people to judge the report on its own merits.

There's been quite a lot of misinformation circulated about the Memorandum of Understanding on conversion therapy, signed by over 20 professional bodies including the BPS, and scaremongering that a ban on conversion therapy might prevent therapists from engaging in exploratory discussions with clients about gender identity. I can understand why some people might be concerned when they read such suggestions. But this isn't what the government are proposing, it isn't what the MoU calls for and there is nothing in our report suggesting this.  

How did the government respond to your report?

Our job was to conduct independent research to help inform the government's policy. But as we've seen throughout the pandemic, things are rarely as simple as ministers 'following the science'; a range of political, legal and other considerations influence government policy. As part of our report, we identified a range of measures different jurisdictions have used to address conversion therapy which vary widely in scope. The UK government is not proposing to go as far as some other countries and its plan to not ban conversion therapy for consenting adults is proving to be controversial among LGBT+ campaigners. The government has published our report alongside their proposals so people can read the proposals in light of the evidence, form their view and respond to the public consultation accordingly.

What happens next? 

Part of the reason the government has published our report alongside the public consultation is for people to form their own view of their proposals. So we're trying to ensure that people are aware of what our findings were and what the government's proposals are. The government have said they will bring forward legislation by spring 2022, when it will then be debated in parliament. We're engaging with the Parliamentary Office of Science and Technology to ensure that MPs are aware of the report's findings. The issue of conversion therapy is also a devolved matter in Scotland and Northern Ireland, and we're already starting to engage with the devolved administrations. Of course, the law is a blunt instrument and I think real change will come from winning hearts and minds, so I'm also keen to share our findings and engage with practitioners and faith leaders around how they might better support the wellbeing of LGBT+ people.  

You can read the full report here. The public consultation on banning conversion therapy closes at 11.45pm on Friday 10 December. 

The society will continue to engage with its coalition partners on the Memorandum of Understanding on Conversion Therapy, as well as the BPS Sexualities Section, Practice Board and Diversity Taskforce to produce a response to the public consultation.