# Professionalism/Sexual Orientation Conversion Therapy
## Sexual Orientation Conversion Therapy Overview
### Definition

Sexual Orientation Conversion therapy is a pseudoscience that aims to change a person’s sexual orientation, gender identity, or gender expression. It is important to note that "pseudoscience" means a practice that is not compatible with the scientific method. .

### Overview

Sexual orientation therapy dates back to the early 1900s, when homosexuality was deemed to be a mental illness in the 1920s. As a result psychoanalysts began extensive research into various methods of conversion therapy.The American Psychiatric Association (APA) believes that conversion therapy is both unethical and ineffective, and that homosexuality is not a mental disorder. The APA is only one example of organizations worldwide disregarding the validity of conversion therapy. American associations from different disciplines such as child adolescent psychiatry, pediatrics, marriage and family therapy, physicians, and psychoanalytic associations share similar sentiments and beliefs towards conversion therapy. sexual orientation therapy dates back to the early 1900s, when homosexuality was deemed to be a mental illness in the 1920s. As a result psychoanalysts began extensive research into various methods of conversion therapy. This led into a time period where LGBTQ individuals faced discrimination, emotional and physical abuse. Despite how far the United States has come in terms of the acceptance of LGBTQ individuals, there are still many licensed therapists and "professionals" that continue to administer conversion therapy today. This issue is an ongoing debate in terms of government regulation and the ethical implications of this practice.

### Organized Groups Promoting Sexual Orientation Conversion Therapy

One of the biggest advocacy organizations that supports conversion therapy is the National Association for Research and Therapy of Homosexuality (NARTH). It was founded in 1992 under the name NARTH, but was renamed in 2014 to the Alliance for Therapeutic Choice and Scientific Integrity (ATCSI). This organization believes that it is important that individuals have the option to enroll themselves in conversion therapy. They claim to offer licensed, trained, and ethical therapists to people in need. They claim that the majority of research published on conversion therapy is biased and incorrect. ATCSI claims that people "can and do experience some degree of modification in their sexual behavior, identity, and attractions" and that conversion therapy does not harm individuals in any way.
Another advocacy organization is Evergreen International, a 501(c)(3) non-profit based in Salt Lake City, Utah. It is a Mormon church-based group that promotes conversion therapy, citing religious views as their motivation. Evergreen International claims to "help people who want to diminish their attractions and overcome homosexual behavior". A big focus of Evergreen International is to offer individuals resources and references to support groups and therapists in their area of residence.

### Campaign to End Conversion Therapy

The Human Rights Campaign (HRC) advocacy group is also a non-profit 501(c)(3) organization. This Washington D.C. based group has over 3 million members, and it is one of the biggest gay rights advocacy groups in the nation. Conversion therapy, especially when minors are subjected to it, is a big issue HRC is fighting to end. HRC believes that conversion therapy is ineffective and cites many instances of published research that supports this belief. They believe conversion therapy is dangerous and that it can lead to problems such as depression, suicidal thoughts, substance abuse, and family rejection. HRC actively pursues government legislation in Congress and on the state and local levels through the HRC Political Action Committee.

## Therapy Types
### Aversive Conditioning

In the 1960s and early 1970s, therapists employed aversive conditioning techniques. Patients were administered a nausea-inducing drug (apomorphine) or an electric shock while viewing same-sex erotic images, or they were instructed to snap an elastic band around the wrist when they were aroused to same-sex erotic images or thoughts.

### Psychoanalytic Therapy

The psychoanalytic theory begins with the founder of psychoanalysis himself, Sigmund Freud. His theory was that humans are initially bisexual, and heterosexuality and homosexuality would develop from this bisexuality. Homosexuality, which he more frequently called inversion, was formed because of unconscious childhood conflicts. Cases considered to cause homosexuality included a lack of a strong father figure and a close-binding mother. However, Freud soon found out that he could convert one to heterosexuality. In his 1920 paper concerning his failed attempt The Psychogenesis of a Case of Homosexuality in a Woman, he states that the best anyone could do for a homosexual is restore their bisexuality. In a now-famous letter to a woman asking Freud to convert her son, Freud writes:
   "Homosexuality is assuredly no advantage, but 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, 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 this. 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."
Despite Freud concluding that therapists cannot abolish someone's homosexuality, people continue to investigate the theory and practice psychoanalysis.

### Ex-Gays

Ex-Gays are religion-based interventions.

## Therapy Effectiveness

There are not many studies that hold to a high scientific standard, but those that do claim that homosexual tendencies are suppressed. However, some of these cases rid the patients of all sexual arousal completely, and some had their homosexuality "resurface" in the long term. Many participants reported having depression, anxiety, suicidal ideation, self-blame, negative self-image, loss, guilt, and a strain on their relationship with others.

## Legal Issues
### Legal Status

In the U.S., sexual orientation conversion therapy on minors is banned in 20 states, 2 territories, and local counties/municipalities. The earliest bans were in California and New Jersey in 2013.

### Legal Challenges
#### First Amendment Infringement

In Doe v. Christie, United States District Court Judge Freda L. Wolfson rejected the claim of New Jersey parents that it violated their rights by keeping them from treating their child for same-sex attraction. Unnamed parents filed a lawsuit against the government of New Jersey challenging the constitutionality of the sexual orientation conversion therapy ban. They claimed it was a violation of their First Amendment rights of freedom of speech and religious expression to deny them of practicing sexual orientation conversion therapy on their child. The ruling was given that First Amendment rights were not infringed upon and that the Plaintiffs’ claim was without merit.
On August 29, 2013 in the case of Pickup v. Brown and Welch v. Brown, the United States Court of Appeals for the Ninth Circuit again upheld California’s sexual orientation conversion ban. The panel held that the state has authority to prohibit licensed mental health providers from administering therapies that the legislature has deemed harmful, and the fact that speech may be used to carry out those therapies does not turn the prohibitions of conduct into prohibitions of speech. They went further to say that the First Amendment doesn’t prevent a state from regulating treatment even when that treatment is performed through speech alone.
In January 2019, an Orthodox Jewish psychotherapist filed a federal lawsuit against the city of New York for violating his freedom of speech and infringing on his and his patients religious faith. He said that the government has no right to dictate the personal goals an adult pursues with their therapist. Many of his patients want help in overcoming same sex attraction due to religious beliefs.
This lawsuit was in response to a 2018 law making it illegal for any person to provide services for a fee that seek to change a person’s sexual orientation. In the case, the Alliance Defending Freedom, a conservative Christian organization aimed at repealing anti-conversion therapy laws, said that regulating the private sessions between an adult and their counselor is a direct violation of freedom of speech. They also said that the government trying to control conversations between therapists and patients is interference on confidential counselor patient relationships.
In response to this, New York city proposed repealing the ban to prevent a potential Supreme Court battle that would set precedent and complicate efforts to outlaw the practice. Since the Supreme Court is majority conservative, a case about conversion therapy could have nationwide effects for the LGBTQ community.

#### Consumer Fraud

On February 10, 2015, a New Jersey Superior Court Judge ruled that offering conversion services on the basis of a description of homosexuality as abnormal or a mental illness is a violation of the New Jersey Consumer Fraud Act. In Ferguson v. JONAH, prosecutors argued that Jews Offering New Alternatives to Homosexuality (JONAH) violated the New Jersey Consumer Fraud Act while the defense argued that the First Amendment and religious freedom allowed them to sell conversion therapy services to people who wanted them.
A jury determined that conversion therapy constituted consumer fraud since multiple experts and research has shown that conversion therapy isn’t effective. The lawsuit accused (JONAH) of consumer fraud for selling services that they claimed could change a person from gay to straight. This violated the New Jersey Consumer Fraud Act and JONAH was found guilty. This case was the first to use consumer protection laws to legally challenge the practice of conversion therapy.
Another important effect of this case was a pretrial ruling which declared for the first time in American history that homosexuality was not a mental disease or disorder. The judge cited that homosexuality was removed from the DSM and that classifying it as a mental disorder, as JONAH experts did, is therefore inadmissible: “because the generally accepted scientific theory is that homosexuality is not a mental disorder and not abnormal, these opinions are inadmissible." The judge compared the theory that homosexuality is a disorder to the notion that the earth is flat and the sun revolves around it, both are outdated and refuted.

#### Supreme Court of the United States

Despite growing attention and pressure, the U.S. Supreme Court has repeatedly rejected challenges against conversion therapy bans.

## Ethics
### Conversion Therapy Movement Changes

Former leaders of the conversion therapy movement are now speaking out against the practice and some are even coming out as gay. David Matheson who was the leader of the organization Journey into Manhood blamed the shame-based, homophobic-based system of the Mormon Church in which he was raised for his methods and views regarding sexual orientation.
The founder of faith-based conversion therapy center Hope for Wholeness Network came out as gay and recognized the harm he had caused; “it’s all in my past but many, way too many continue believing that there is something wrong with themselves and wrong with people that choose to live their lives honestly and open as gay, lesbian, trans, etc. … the very harmful cycle of self shame and condemnation has to stop."
Many of these leaders had personal shame associated with being a closeted homosexual and this caused them to project that onto others. It remains an ethical question whether or not it is deemed acceptable for these individuals to use others’ suffering for their eventual realization of their true identity. Many of these people are now content with their sexual identity, by way of years worth of shaming and trying to convert those who were struggling with the same inner dilemma.

### Ethical Questions for Consideration

If you were to ask professionals in the 60s if it was right to conduct conversion therapy, even though it would cause serious pain and distress to the patients, you would likely get a similar response to MacCulloch and Feldman's:
   "Which seems more unethical: to treat someone in distress, or to suggest to him that he waits until his practice is as socially acceptable as heterosexuality? The vast majority of our patients have been sad an unhappy individuals seeking help for a problem they see as central in their lives, and pleased with the results when these have been successful."
However, times have changed significantly since then. Homosexuality is a more acceptable practice than it was in the 60s, but some 'therapists' still conduct conversion therapy even when there is no concrete evidence on its effectiveness, and in most cases it does more harm than good.
Consider the following ethical questions:
* Therapists bringing significant harm to their patients, such as depression, anxiety, suicidal ideation, self-blame, negative self-image, loss, guilt, and a strain on their relationships with others
* Therapists breaking standards of patient autonomy as therapists forgo their neutral stance by influencing their patients to change their sexuality
* Modern 'therapists' lying to consumers and giving them a false hope
* Holding high scientific standards to avoid the promotion and use of pseudoscience

## References

* 1 2 Human Rights Campaign. (n.d.). The Lies and Dangers of "Conversion Therapy". Retrieved from https://www.hrc.org/resources/the-lies-and-dangers-of-reparative-therapy
* ↑ Blakemore, E. (2018, June 22). Gay Conversion Therapy's Disturbing 19th-Century Origins. Retrieved from https://www.history.com/news/gay-conversion-therapy-origins-19th-century
* ↑ ATCSI. (n.d.). Frequently Asked Questions: therapeutic-choice. Retrieved from https://www.therapeuticchoice.com/frequently-asked-questions
* ↑ Evergreen International. (2005, February 12). Evergreen International is the most complete resource for Latter-day Saints on same-sex attraction. Retrieved from https://web.archive.org/web/20050310190034/http://www.evergreeninternational.org/index.html
* ↑ Human Rights Campaign. (n.d.). The Lies and Dangers of "Conversion Therapy". Retrieved from https://www.hrc.org/resources/the-lies-and-dangers-of-reparative-therapy#stq=&stp=1
* ↑ Human Rights Campaign. (1969, December 11). HRC Local. Retrieved from https://www.hrc.org/local-issues
* ↑ McConaghy, N. (1969). Subjective and Penile Plethysmograph Responses Following Aversion-Relief and Apomorphine Aversion Therapy for Homosexual Impulses. British Journal of Psychiatry, 115(523), 723-730. doi:10.1192/bjp.115.523.723
* 1 2 3 American Psychological Association (2009). Report of the American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation. https://www.apa.org/pi/lgbt/resources/therapeutic-response.pdf
* ↑ Freud, S. (1918). Three Contributions to the Theory of Sex. United States: Nervous and Mental Disease Publishing Company.
* ↑ Fuss, D. (1993, Jan 1). Freud's Fallen Women: Identification, Desire, and "A Case of Homosexuality in a Woman". The Yale Journal of Criticism, 6(1).
* ↑ https://en.wikisource.org/wiki/A_Letter_from_Freud_(to_a_mother_of_a_homosexual)
* ↑ Bieber, I., Dain, H. J., Dince, P. R., Drellich, M. G., Grand, H. G., Gundlach, R. H., Kremer, M. W., Rifkin, A. H., Wilbur, C. B., & Bieber, T. B. (1962). Conclusions. In Homosexuality: A psychoanalytic study. (pp. 303–319). Basic Books. https://doi.org/10.1037/11179-012
* ↑ LGBTMap. Conversion "Therapy" Laws. https://www.lgbtmap.org/equality-maps/conversion_therapy
* ↑ Wolfson, F.L. (2014, Jul). Doe v. Christie. Casetext. https://casetext.com/case/doe-v-christie
* ↑ Graber, S.P. (2013, Aug). Pickup v. Brown Opinion. https://cdn.ca9.uscourts.gov/datastore/opinions/2013/08/29/12-17681.pdf
* 1 2 Alliance Defending Freedom. (2019, Jan). Psychotherapist Challenges NYC's Censorship of Private Conversations with Adult Patients. http://www.adfmedia.org/News/PRDetail/10695
* 1 2 3 Iati, M. (2019, Sep). Why the N.Y. City Council Made the 'Painful' Decision to Repeal its Ban on Conversion Therapy. The Washington Post. https://www.washingtonpost.com/religion/2019/09/13/why-nycs-council-made-painful-decision-repeal-its-ban-conversion-therapy/5
* 1 2 Gallagher, M.P. (2015, Feb). Gay 'Conversion Therapy' Consumer Fraud Ruling First in U.S. New Jersey Law Journal. https://www.law.com/njlawjournal/almID/1202717571907/gay-conversion-therapy-consumer-fraud-ruling-first-in-us/
* ↑ Grant, j. (2015, Feb). Selling Cure for Being Gay Found Illegal in New Jersey. New York Times. https://www.nytimes.com/2015/02/14/nyregion/selling-cure-for-being-gay-found-illegal-in-new-jersey.html
* ↑ Superior Court of New Jersey. (2015, Feb). https://www.splcenter.org/sites/default/files/d6_legacy_files/downloads/case/jonahopinion.pdf
* ↑ Stohr, G. (2017, May). Gay-Conversion Therapy Ban Survives as Supreme Court Rejects Appeal. Bloomberg. https://www.bloomberg.com/news/articles/2017-05-01/gay-conversion-therapy-ban-survives-as-high-court-rejects-appeal
* ↑ Hatewatch Staff. (2019, Jan). Well-Known Ex-Gay Therapist Comes Out as Gay, Seeks to Date Men. Southern Poverty Law Center. https://www.splcenter.org/hatewatch/2019/01/22/well-known-ex-gay-therapist-comes-out-gay-seeks-date-men
* ↑ MacCulloch, M., & Feldman, M. (1967). Aversion Therapy In Management Of Homosexuals. The British Medical Journal, 4(5570), 51-52. www.jstor.org/stable/20389817