Conversion therapy—sometimes called reparative therapy and other names—is a widely discredited form of therapy that attempts to change people’s sexual orientation or gender identity. In recent years, a number of states have moved to ban the practice for minors, and dozens of mental health advocacy and professional organizations have produced statements against it. In spite of research showing that conversion therapy can be harmful, an Oklahoma state House committee in February 2015 approved legislation designed to protect the practice.

Concerns with Conversion Therapy

Mainstream mental health organizations and the American Psychiatric Association’s Diagnostic and Statistical Manual have long accepted that homosexuality is not a mental health diagnosis, yet conversion therapy typically focuses on changing one’s sexual orientation to heterosexual. According to the American Academy of Pediatrics, “therapy directed specifically at changing sexual orientation is contraindicated, since it can provoke guilt and anxiety while having little or no potential for achieving changes in orientation.”

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Though there are many ways to approach therapy, ethical therapy works to increase self-awareness and self-acceptance while offering judgment-free treatment in the context of a safe therapeutic relationship. Conversion therapy can include a range of approaches such as talk therapy, prayer, re-education, or aversion therapy. In some cases, techniques used in conversion therapy may be abusive and/or dangerous. For instance, a therapist might electrically shock the person every time he or she expresses interest in a person of the same sex. A group of people who experienced abusive conversion therapy recently sued their therapist, claiming he forced them to strip naked in front of him and engage in other questionable practices.

For some people, conversion therapy is an involuntary form of treatment. Parents of gay children (or children who display behavior culturally associated with the opposite sex) sometimes force their children to undergo conversion therapy, though conversion therapists may decline to work with children who do not want the treatment. Leelah Alcorn, a 17-year-old transgender girl, sparked national outrage in late 2014 when she committed suicide after being exposed to conversion therapy.

Legal Issues Regarding Conversion Therapy

California, New Jersey, and Washington, D.C. have banned conversion therapy for minors, and states such as Arizona, Colorado, Florida, Iowa, Ohio, Oregon, Washington, and West Virginia have taken preliminary legislative measures to eliminate the practice or methods associated with it. In 1997, the American Psychological Association passed a resolution disavowing conversion therapy, and since then, many leading mental health governing bodies have come out against the practice.

Nevertheless, Oklahoma legislators are diligently working to protect conversion therapy. Republican Rep. Sally Kern introduced the bill to “protect” parents’ ability to pursue such treatment for their children; the bill was later amended to prohibit “physical pain, such as electroshock or electroconvulsive therapy, touch therapy, pornography exposure, or vomit-induction therapy,” controversial tactics which not all therapists who practice conversion therapy use. Kern argues that the freedom to pursue conversion therapy for minors is a parents’ rights issue.

A host of professional organizations in the field of mental health and social work have spoken out against the bill. On March 4, 2015, GoodTherapy.org affirmed its opposition to conversion therapy, and declines to list in its therapist directory mental health professionals who advertise conversion therapy as a service they offer.

References:

1. APA resolution on “reparative therapy” (1997). Retrieved from http://psychology.ucdavis.edu/faculty_sites/rainbow/html/resolution97.html
2. Fox, F. (2015, January 8). Leelah Alcorn’s suicide: Conversion therapy is child abuse. Retrieved from http://time.com/3655718/leelah-alcorn-suicide-transgender-therapy/
3. Gay conversion therapy bill clears Oklahoma House committee. (2015, February 24). Retrieved from http://newsok.com/gay-conversion-therapy-bill-clears-oklahoma-house-committee/article/5396127
4. Homosexuality and adolescence. (1993). Retrieved from http://pediatrics.aappublications.org/content/92/4/631.full.pdf
5. Iowa senate panel approves ban on conversion therapy. (2015, February 17). Retrieved from http://stlouis.cbslocal.com/2015/02/17/iowa-senate-panel-approves-ban-on-conversion-therapy/
6. Michael Ferguson, et al. v. Jonah, et al. (n.d.). Retrieved from http://www.splcenter.org/get-informed/case-docket/michael-ferguson-et-al-v-jonah-et-al
7. Steinmetz, Katy. (2014, June 30). California Ban on Gay Conversion Therapy Stands. Time. Retrieved from http://time.com/2940790/california-ban-on-gay-conversion-therapy-stands/

It should go without saying: conversion therapy is an outdated mode of treatment for an issue that is not, and has not been, a mental health diagnosis for quite some time. GoodTherapy.org does not endorse conversion therapy —also known as reparative therapy or sexual orientation change efforts (SOCE)—for homosexuality, nor does it permit mental health professionals to advertise those services to website visitors.

On March 3, 2015, The Huffington Post published an article in which Human Rights Campaign, a leading LGBT rights group, condemned Psychology Today, an online therapist directory, for allowing its therapist members to advertise conversion therapy on its profile pages. A representative of Psychology Today told The Huffington Post that the company did not intend to begin removing or refusing membership to therapists who offer conversion therapy. The backlash and criticism from health professionals, human rights advocates, and others was immediate.

Within 24 hours, Psychology Today had changed its position. In a statement issued March 4, the company asserted that it does not condone conversion therapy, and has notified therapist members that they would be de-listed if their profiles advertised this practice. Their updated stance is in line with what the majority of the mental health community has come to believe: conversion therapy has no place in mainstream mental health care.

Flaws in the Conversion Concept

Conversion therapy, also known as reparative therapy, is a controversial type of treatment aimed at changing a homosexual person’s sexual orientation on the assumption that homosexuality is an inherent flaw or disorder that must be altered. While homosexuality was once listed in the Diagnostic and Statistical Manual (DSM) as a mental health diagnosis, it was removed from the DSM by the time the third edition was published in 1980 with support from the professional mental health community.

In addition to rejecting conversion therapy as a useful treatment, GoodTherapy.org does not acknowledge homosexuality as a mental health disorder. The American Psychiatric Association (APA) agrees; a statement issued by the board of the APA in 1998 states: “The American Psychiatric Association opposes any psychiatric treatment, such as ‘reparative’ or ‘conversion’ therapy, which is based upon the assumption that homosexuality per se is a mental disorder, or based upon a prior assumption that the patient should change his/ her homosexual orientation.”

The APA isn’t the only organization to reject conversion therapy, as research over the course of years has affirmed concerns over conversion therapy as a treatment modality. The American Association for Marriage and Family Therapy, the National Association of Social Workers, the American Psychological Association, and the American Medical Association, among others, have issued statements against reparative therapy. Many cite research that suggests conversion therapy is likely to lead to harmful outcomes, such as contributing to anxiety, depression, relationship problems, self-loathing, and other issues. According to the Pan-American Health Organization (PAHO), “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.”

Several states consider conversion therapy detrimental enough that they have enforced or are considering bans on it. California, New Jersey, and Washington, D.C. have banned the use of conversion therapy on minors. Other states that have pending legislation to ban reparative therapy include New York, Massachusetts, Illinois, Iowa, Minnesota, Michigan, Ohio, Vermont, Pennsylvania, Colorado, and Hawaii.

Given a lack of research that supports the effectiveness or safety of conversion therapy, the American Psychiatric Association “recommends that ethical practitioners refrain from attempts to change individuals’ sexual orientation, keeping in mind the medical dictum to ‘First, do no harm.’ ”

GoodTherapy.org Philosophy of Membership

GoodTherapy.org is founded on a mission and vision to reduce harm in therapy by educating consumers so they can be equipped with resources and services that will help them achieve their mental and emotional health goals.

When mental health professionals sign up to be listed in the GoodTherapy.org therapist directory, applicants are required to certify that the services they provide accord in orientation and attitude to its Elements of Healthy Therapy Statement. A peer-review team verifies each clinician’s credentials and screens his or her profile content to ensure the person’s practice is in line with elements of good therapy. Profiles are reviewed for questionable content, such as homophobic, sexist, racist, or other discriminatory or harmful practices or beliefs. GoodTherapy.org does not list conversion therapy or reparative therapy as a type of therapy that members can select.

[fat_widget_left]Because the review process for inclusion in GoodTherapy.org’s therapist directory is done on a case-by-case basis by human beings, and because members are able to update their listings at any time, it is possible that an inappropriate listing could appear for a period of time in its directory. However, GoodTherapy.org addresses any such listing as soon as it becomes aware of it and takes action to remove the individual from its directory. Since GoodTherapy.org was founded in 2007, situations like this have been extremely rare.

It is important to note that there are people who seek therapy as part of an effort to change their sexual orientation. GoodTherapy.org’s position is in no way an invalidation of these individuals’ desires to work toward their chosen goals in therapy. GoodTherapy.org respects individuals’ rights to identify their treatment goals and choose treatment modalities that appeal to them for any reason.

It is perfectly acceptable for individuals to discuss, explore, and evaluate their sexual orientation in the context of a therapeutic relationship. Trained therapists should be equipped to support people in these efforts without prejudice or discrimination. GoodTherapy.org works to ensure that it offers people seeking treatment quality choices so they can find a therapist who meets their unique needs.

GoodTherapy.org was founded in 2007 with the mission of:

• Reducing harm in therapy
• Advocating healthy and ethical psychotherapy practices
• Encouraging therapists to work collaboratively and nonpathologically
• Depathologizing diagnostic-based language and therapy practices
• Educating consumers about the differences between healthy and unhealthy therapy practices

Toward this end, GoodTherapy.org makes every effort to avoid and remove from its site any content—including blog material and therapist listings—that contains a homophobic, sexist, racist, ableist, or otherwise discriminatory message. Dan Fajans, director of member services at GoodTherapy.org, explains, “Everything we do, from our therapist directory, to our Continuing Education Program, to The Good Therapy Blog, to our GoodCause program and beyond, is first and foremost an effort to put this mission into action. Providing an advertising platform for conversion therapy would be directly at odds with our mission.” GoodTherapy.org takes this stand based on mounting evidence that conversion therapy causes harm; leading mental health organizations do not view it as ethical; and it requires the therapist to operate from a fundamentally pathology-based understanding of the person who is seeking therapy.

Noah Rubinstein, GoodTherapy.org’s founder and CEO, stands behind GoodTherapy.org’s position on conversion therapy both professionally and personally. As a licensed marriage and family therapist who has worked in the mental health field for over 25 years, Rubinstein elaborates:

“In general, any psychotherapy that focuses on trying to depreciate, banish, or exile a psychological aspect of a person at the expense of curiosity, appreciation, and compassion is not in the best interest of the individual. Even with issues such as depression, anxiety, addiction, anger, self-criticism, and nearly every other symptom which motivates a person to seek help, the only agenda ever set by the therapist, in my opinion, should be to help the individual understand the purpose, function, and existence of such an aspect. The decision to help a person change some aspect of themselves should be made by the person in therapy only when he or she is in a psychological state of calm and self-compassion.

“I can only imagine how difficult it is in this culture for some individuals to recognize, accept, and explore their sexuality when it differs from the majority. I assume that those who want to change their sexual orientation are under enormous pressure internally and/or externally to assimilate and that any desire to alter their sexuality does not originate from self-compassion, unless their sexual practices are harmful to self and others—which homosexuality in and of itself is not. The only way to tell, I imagine, would be to first work with an individual to access the internal resources to transcend any internal or external pressures. At that point, one could reach a place of understanding, acceptance, and self-compassion for his or her own sexuality.”

As an organization, GoodTherapy.org reiterates its support for individuals experiencing any type of mental health challenge, in any stage of their mental health journeys. No person should be made to feel inadequate or broken because of a psychological concern, and all people are worthy of healing and love—especially self-love. If you feel discouraged or troubled, or if you feel you have been treated unfairly in therapy, there is hope and help available.

We invite you to share your thoughts or comments in the “Leave a Reply” section below.

References:

1. APA Board of Trustees. Position Statement on Issues Related to Homosexuality. March 2000. Retrieved from http://www.aglp.org/pages/LGBTPositionStatements.php#Anchor-55000
2. Herek, Gregory M. Facts about Homosexuality and Mental Health. Retrieved from http://psychology.ucdavis.edu/faculty_sites/rainbow/html/facts_mental_health.html
3. Millar, Katharine S. The Myth Buster. February 2011. Retrieved from http://www.apa.org/monitor/2011/02/myth-buster.aspx

While the terms “pedophile” and “child molester” are often used interchangeably, they do not mean the same thing. A pedophile is a person who is attracted to children, but not all people with pedophilia molest children. Many individuals who are attracted to children never act on their attraction, and some seek help in order to keep from harming children.

Pedophilia is considered by some to be one of the most difficult social problems to understand. The 5th edition of the Diagnostic and Statistical Manual classifies pedophilia as a paraphilia, distinguishing it from pedophilic disorder: It is diagnosable as a mental health condition when it causes distress to the affected individual or to someone who is unwilling or unable to consent. Thus, according to this classification, having an attraction to children and not acting on it does not indicate a mental condition.

New research shows that pedophilic disorder may be neurological in nature, lending further support to the position that an attraction to children is not a choice. Some may find this difficult to accept, as those who do act on their desires and molest children have the potential to cause serious and lasting harm to many children. They may repeat their crime over and over until stopped by the criminal justice system. Many people may believe that, once caught, people who molest children deserve to spend the rest of their lives in prison, but the reality is that many of these individuals will eventually be released.

Upon release from prison, offenders are often required to enter rehabilitation programs, which are meant to redirect pedophilic urges and help a person refrain from harming children. These programs are often viewed with skepticism, as many believe that a person who molests children cannot be rehabilitated and that pedophilic urges will always lead to the sexual abuse of a child. However, there are several perspectives on the issue.

The Difference Between Pedophilia and Child Molestation

Psychological perspectives on child molestation vary greatly, but experts agree that most people who molest children fall into one of four categories:

1. Children or teenagers under the age of 16 who are sexually curious and may experiment with younger children.
2. Adults who have a brain condition, intellectual disability, or other mental health issue.
3. Individuals who have an antisocial personality and may use children sexually but have no particular sexual desire for children.
4. Individuals who are older than 16 and experience ongoing sexual desire for children. Sexual desire for children, or pedophilia, can be identified and treated or controlled with therapy and medication.

Ninety-five percent of all known instances of child molestation are committed by people with pedophilia. Other individuals may molest children for the above reasons, out of sexual frustration, or in order to maintain power or exert control.

Though nearly all those who molest children have pedophilia, many people with pedophilia will never molest a child, and some work to eliminate their attraction to children through various forms of treatment and therapy.

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Non-Offenders

Dan Savage, who frequently writes on the topic of human sexuality, has published several accounts of people who, despite their attraction to young children, avoid being alone around children and are able refrain from committing acts of molestation. It is generally acknowledged that it may take a significant amount of self-control to avoid offending and that pedophiliac inclinations typically mean a person with pedophilia will find it difficult to have a healthy sexual relationship.

In several European countries, Savage points out, people experiencing a sexual attraction to children are often able to seek treatment confidentially. In the United States, however, an individual who discloses pedophilic tendencies may be arrested, as therapists and physicians are required by law to report anyone who poses a threat to children. This law, in addition to the stigma surrounding pedophilia and the limited number of resources available to those seeking help in the U.S., is likely to discourage non-offenders from seeking professional help, help that may enable them to continue to keep from offending.

Free and confidential prevention and treatment programs–such as Germany’s Prevention Project Dunkelfeld–may help those who are attracted to children refrain from acting on their desires. Some European countries do have lower child molestation rates than the United States, and this fact may be connected to the availability of treatment.

Many people who are attracted to children are horrified and frightened by their preferences and attempt to do everything they can to keep from harming a child. They may wish to attend therapy, explore ways to curb their desires, or take medication. Making treatment available and accessible to individuals before they offend may reduce instances of child molestation.

Chemical Castration

Chemical castration is one method that may keep child molesters from reoffending. Many states in the U.S. offer voluntary chemical castration in exchange for earlier release. Some states, such as California, mandate castration for offenders with multiple convictions as a condition of release. The treatment has been shown to greatly reduce sexual desire in men who are attracted to children and to lower rates of recidivism.

Those who have not yet harmed a child and who are committed to avoiding doing so may find relief from their desires through chemical castration. In some cases, an antidepressant, which may have the effect of further limiting one’s sex drive, is also prescribed.

Sexual desire cannot be completely eliminated by castration, a fact that leads many individuals to question the efficacy of the treatment and the risk of releasing offenders who may still experience some sexual desire for children. Another objection stems from the fact that the person undergoing treatment must be relied on to take their medication regularly. However, chemical castration has been shown to be effective for many individuals and thus is likely to protect many children who would potentially be victims of sexual abuse.

Group Therapy

Many therapists use group therapy as a type of treatment for people with pedophilic tendencies. Groups can provide a safe environment to discuss inappropriate and harmful urges, and the support of a group of individuals facing similar challenges may give some people the strength to avoid offending or reoffending.

However, when someone is involuntarily enrolled into group therapy and has no particular desire to stop offending, a support group can become a different environment. Other members may, knowingly or unknowingly, support a high-risk offender’s further attempts at molestation. But because mandated group therapy may be of benefit to some convicted offenders or those who are at risk for offending, group leaders may not wish to withhold a potentially helpful treatment from anyone. They may, however, choose to carefully screen participants prior to program entry and during treatment.

Aversion Therapy

Aversion therapy pairs an unpleasant stimulus such as an electric shock, pinch, or flick along with a pleasant stimulus. Sex offenders may use aversion therapy to attempt to eliminate their attractions to children. While this therapy can be effective, it often poses ethical problems, as therapists cannot shock their patients. It can also be difficult to maintain consistency with this type of treatment. Further, when aversion therapy does work, it is unlikely to do more than eliminate the attraction to children. It likely will not help people develop an attraction to age-appropriate adults if they do not already experience such an attraction.

Fake Porn

Psychologists have still not reached an agreement about whether pedophilia is a sexual orientation or a mental illness. Those who believe it is a sexual orientation may advocate the use of fake porn, depicting animated or CGI children, as a way for those with pedophilic tendencies to achieve sexual release. Some therapists have reported that this method has been successfully used to reduce an individual’s desire to molest a child.

However, other therapists point to studies demonstrating the effect pornography can have on sexual desire and express concern that such pornography may actually create or increase a desire to sexually abuse children. Many also question the ethics of making such pornography, even when it does not involve actual children.

References:

1. Early Diagnosis and Effective Treatment. (n.d.). Retrieved from http://www.childmolestationprevention.org/pages/focus_on_the_cause.html
2. Goode, S. D. (2010). Understanding and addressing adult sexual attraction to children: A study
   of paedophiles in contemporary society. New York, NY: Routledge.
3. Jenkins, P. (2004). Moral panic changing concepts of the child molester in modern
   America. New Haven, CT: Yale Univ Press.
4. Kaplan, M. (2014, October 5). Pedophilia: A Disorder, Not a Crime. Retrieved from http://www.nytimes.com/2014/10/06/opinion/pedophilia-a-disorder-not-a-crime.html?_r=0
5. Kincaid, J. R. (1998). Erotic innocence: The culture of child molesting. Durham, NC: Duke
   University Press.
6. Nanos, J. (2014, March 1). Can Chemical Castration Help Pedophiles Tame the Beast Within? Retrieved from http://www.bostonmagazine.com/news/article/2014/02/25/chemical-castration
7. Schwartz, C. (2011, December 7). What Science Reveals about Pedophilia. Retrieved from http://www.thedailybeast.com/articles/2011/12/06/what-science-reveals-about-pedophilia.html
8. Seto, M. C. (2008). Pedophilia and sexual offending against children: Theory, assessment, and
   intervention. Washington, DC: American Psychological Association.