Conversion therapy
Conversion therapy is the pseudoscientific practice of trying to change a person's sexual orientation or gender identity, and a 2025 American Medical Association study put a stark number on its cost. Among people subjected to these practices, 42% attempted suicide. Among those who were not, the figure was 5%.
The practice promises a cure for something evidence-based medicine does not treat as a disease. Clinical guidance holds that homosexuality, bisexuality and gender variance are natural and healthy parts of human life. Conversion therapy may amount to fraud when it is sold to adults. When it is performed on minors, it is considered a form of child abuse. Experts have described it as torture.
So why has a method with no demonstrated success survived for generations? What did its practitioners actually do to the people who came to them, or were sent to them? Why does the name keep changing? And why do courts and legislatures still disagree about whether it should be banned outright?
Medical professionals and activists reject the phrase conversion therapy as a misnomer, because nothing about the practice counts as legitimate therapy. They prefer other labels. "Sexual orientation change efforts" is shortened to SOCE, and "gender identity change efforts" to GICE. Together they form SOGICE, or in a longer version SOGIECE, which adds gender expression.
Researcher Douglas C. Haldeman argues that SOCE and GICE belong together. In his view, both rest on the assumption "that gender-related behavior consistent with the individual's birth sex is normative and anything else is unacceptable and should be changed". The American Psychological Association agreed in a 2021 resolution that parts of SOCE meet its definition of GICE. It added that an "intense focus" on gender-normative conformity is a frequent characteristic of SOCE.
The term "reparative therapy" sometimes stands for conversion therapy as a whole and sometimes for just one subset of it. Some sources favor "conversion practices", since the activities are not therapeutic. Advocates seldom use the label themselves. They speak instead of "healing from sexual brokenness" and "struggling with same-sex attraction".
Richard Fitzgibbon coined "same-sex attraction disorder" in the 1990s, offering it as a replacement for the word gay and for the ex-gay movement. Richard A. Cohen popularized the phrase in the 2000s through his book Coming Out Straight. There he invented a "diagnosis" and concluded that "Homosexuality is a Same-Sex Attachment Disorder." The ex-gay movement turned this into a script: "I used to be gay, but I don't think of myself as gay anymore. Now I just experience same-sex attraction."
A 2020 report by ILGA, which tracks bans worldwide, found that proponents adapt whenever a ban arrives. Many distance themselves from the words conversion therapy. Some claim to support homosexuality or gender variance while offering something under another name. The report called the result a "constant moving target". Its list of advertised services includes help with "unwanted same-sex attraction", promoting a "healthy sexuality", addressing "sexual brokenness", and helping clients explore "gender confusion".
In 2022, the Global Project Against Hate and Extremism began tracking this vocabulary online in a report titled Conversion Therapy Online: The Ecosystem. Its January 2024 update found that many social media platforms and search engines still serve a great deal of related material. A YouTube search for "overcoming same-sex attraction" returned videos from religious and non-religious groups aimed at gay and transgender people. One was titled "Former LGBTQers Testify: If You No Longer Want to be Gay or Transgender, You Don't Have to Be."
A second project that year, Conversion Therapy Online: The Players, mapped the organizations behind these efforts. At the center sits the London-based International Federation for Therapeutic and Counseling Choice, chaired by Mike Davidson, who founded the Core Issues Trust. Its annual conferences, held since 2015, aim to connect people "seeking help with 'same-sex attraction' and 'gender confusion'" with therapists.
The word homosexual was coined by Karl Maria Kertbeny, a German-speaking Hungarian writer, and was in circulation by the 1880s. Into the middle of the twentieth century, psychoanalysis and academic sexology offered rival accounts of it. Sigmund Freud saw homosexuality as a form of arrested development. Later analysts followed Sandor Rado, who described it as a "phobic avoidance of heterosexuality caused by inadequate early parenting".
That view shaped psychiatric models built on prison populations and on homosexual people seeking treatment. Sexologist Alfred Kinsey argued the opposite: that homosexuality was a normal variation in human development. In 1970, gay activists confronted the American Psychiatric Association and persuaded it to reconsider whether homosexuality belonged on its list of disorders. The association delisted it in 1973, which helped shift public opinion.
The delisting did not end the practice. Some socially or religiously conservative activists kept arguing that if one person's sexuality could change, then it was not a fixed class like race. Borrowing from the discredited psychoanalytic theories, some of them offered conversion therapy. In 2001, Robert L. Spitzer published a study asserting that some homosexual people could change their orientation. It had not been peer reviewed. Many researchers criticized its methods, and Spitzer later repudiated it.
For adults who seek out the practice, the usual motive is religion. Evangelical Christianity, Orthodox Judaism and conservative interpretations of Islam all disapprove of same-sex relations. These adults often want to keep a good relationship with their family and religious community.
Adolescents are a different case, because families push them into it. They too typically come from conservative religious backgrounds, and youth from families with low socioeconomic status are more likely to undergo it. As attitudes toward homosexuality became more accepting, the harshest methods grew rarer. Secular practice declined with the demedicalization of homosexuality and bisexuality, and religious practitioners now predominate. The harshest methods, though, left the longest paper trail.
Electric shock and nausea-inducing drugs were the core of aversion therapy. Gay and bisexual patients received them while being shown same-sex erotic images. When the aversive stimulus stopped, opposite-sex images appeared, with the aim of strengthening heterosexual feeling. A variant called covert sensitization asked recipients to imagine vomiting or receiving electric shocks. Other methods included ice baths, freezing, burning with metal coils, and hard labor. The intent was for the subject to link homosexual feelings with pain. These methods have been concluded to be ineffective.
Haldeman notes that proponents themselves often admit only single-case studies support their methods. He cites Rangaswami's 1982 case report on the difficulties of arousing heterosexual responsiveness in a homosexual man as typical. Behavioral conditioning tended to reduce homosexual feelings without increasing heterosexual ones.
Aversion therapy was developed in Czechoslovakia between 1950 and 1962, and in the British Commonwealth from 1961 into the mid-1970s. The Czechoslovak practitioners concluded by 1961 that it did not work, and recommended decriminalizing homosexuality instead. In the context of the Cold War, Western psychologists ignored those poor results. Some men in the United Kingdom were offered a choice between prison and aversion therapy. A few British women received it too, though it was never the standard treatment for either men or women.
In the 1970s, behaviorist Hans Eysenck was among the main advocates of counterconditioning with malaise-inducing drugs and electric shock. He wrote that the therapy succeeded in nearly 50% of cases, but his studies were disputed. In 1972, gay activist Peter Tatchell protested against Eysenck at a London Medical Group Symposium. Tatchell called the therapy a form of torture and said it caused depression, suicidal ideation and suicide among gay men.
American neurologist Walter Jackson Freeman II popularized the ice-pick lobotomy as a treatment for homosexuality in the 1940s and 1950s. He personally performed more than 3,000 lobotomies across 23 US states, and 2,500 of them used his transorbital method. He had no formal surgical training. Freeman was banned from performing psychosurgery in 1967. In West Germany in the 1960s and 1970s, some homosexual men underwent brain surgery that usually destroyed the ventromedial nucleus of the hypothalamus. Sexologist Volkmar Sigusch criticized the practice.
In early twentieth-century Germany, experimenters removed one testicle from homosexual men and transplanted testicles from heterosexual men. The operations were a complete failure. Surgical castration of homosexual men was widespread in Europe in the first half of the century. SS leader Heinrich Himmler ordered homosexual men sent to concentration camps, because he thought a time-limited prison sentence could not eliminate homosexuality.
Castration was theoretically voluntary, but some men faced severe pressure to agree. Boys as young as 16 were castrated. Men convicted under Paragraph 175 who agreed were exempted from transfer to a concentration camp after their sentence. An estimated 400 to 800 men were castrated, and some camp prisoners were castrated as well. Endocrinologist Carl Vaernet implanted a testosterone-releasing pellet in homosexual prisoners at the Buchenwald concentration camp. They had not consented, and most died shortly afterward.
An unknown number of men were castrated in West Germany. Other Western countries used chemical castration, notably against Alan Turing in the United Kingdom.
Hypnosis entered conversion therapy in the nineteenth century, first employed by Richard von Krafft-Ebing and Albert von Schrenck-Notzing. In 1967, Canadian psychiatrist Peter Roper published a case study of 15 homosexual individuals, some of whom would probably count as bisexual today. He reported that eight showed "marked improvement", meaning they reportedly lost all attraction to the same sex. Four improved mildly, and three did not improve. Roper concluded that hypnosis might produce more satisfactory results than other means, depending on how susceptible the subject was.
Irving Bieber and colleagues, in Homosexuality: A Psychoanalytic Study of Male Homosexuals, advocated long-term therapy to resolve the unconscious childhood conflicts they blamed for homosexuality. Haldeman presents the book as typical of psychoanalytic treatment. He notes that its methods drew criticism because it relied on a clinical sample, judged outcomes by subjective therapist impression, and presented follow-up data poorly. Bieber reported a 27% success frequency. Yet only 18% of those deemed successful had been exclusively homosexual at the start, while 50% had been bisexual.
Haldeman discusses further psychoanalytic studies. Curran and Parr's 1957 analysis of 100 male cases reported no significant increase in heterosexual behavior. Mayerson and Lief's 1965 follow-up of nineteen cases reported that half were exclusively heterosexual in behavior four and a half years later. That result rested on patient self-report without outside validation. In Haldeman's view, those who reported change had been bisexual from the outset, and the authors mistook the capacity for heterosexual sex for a change of orientation.
According to Jack Drescher, the term "reparative therapy" more correctly names a specific school tied to the psychologists Elizabeth Moberly and Joseph Nicolosi. Nicolosi held that same-sex attraction is an unconscious attempt to "self-repair" feelings of inferiority. After California banned conversion practices, he argued that reparative therapy did not directly try to change orientation. Instead, he said, it explored underlying causes, which he believed were often childhood trauma.
Robert Spitzer's phone study reported that "about 66 percent of the men respondents and 44 percent of the women were able to function as heterosexuals after the therapy". Spitzer conceded that his subjects were not representative of the gay and lesbian population in the United States.
Earlier editions of the World Health Organization's ICD listed a "sexual relationship disorder", in which a person's orientation or gender identity makes it hard to form or keep a partnership. Someone who blamed their orientation for relationship trouble might therefore turn to a marriage therapist for change. The Working Group on Sexual Disorders and Sexual Health found the diagnosis unjustified, and it was removed from ICD-11.
Exodus International, the ex-gay umbrella organization in the United States, ceased activities in June 2013. Ex-gay ministries use religion to try to eliminate or change queer people's sexual orientation, and prayer and exorcism number among their practices. Exodus's three-member board issued a statement repudiating its aims and apologizing for the harm its pursuit had caused. Ex-trans organizations often overlap with ex-gay ones. They frequently portray trans identity as sinful or against God's design, and pathologize gender variance as the result of trauma, social contagion or "gender ideology".
Gender identity change efforts draw on the practices of healthcare providers and religious counselors who try to alter gender identity or expression to fit social norms. Examples include aversion therapy, cognitive restructuring, and psychoanalytic and talk therapies. Western medical-model narratives historically favored a binary gender model and pathologized gender diversity, which helped these efforts develop and spread.
Robert Stoller advanced the theory that gender-nonconforming behavior in children assigned male at birth came from being overly close to their mothers. Richard Green continued the research. His methods had the father spend more time with the child and the mother less, expected both to show stereotypical gender roles, and had them praise masculine behavior while shaming feminine and gender-nonconforming behavior. The interventions produced depression in the children. They also produced feelings of betrayal toward parents when the treatments failed.
In the 1970s, UCLA psychologist Richard Green recruited Ole Ivar Lovaas to adapt applied behavior analysis to prevent children from becoming transsexual. The program was dubbed the "Feminine Boy Project". It used operant conditioning to reward gender-conforming behavior and punish gender nonconformity.
Kenneth Zucker, at the Centre for Addiction and Mental Health, adopted Green's methods but narrowed the aim. He sought to prevent a child from identifying as transgender by changing gender behavior and presentation to match the sex assigned at birth. He called this the "living in your own skin" model, and added psychodynamic therapy to Green's interventions.
Gender exploratory therapy, or GET, is described as a form of conversion therapy. It requires extended talk therapy to find pathological roots for gender dysphoria, while delaying social and medical transition and treating it as a last resort. Practitioners propose causes such as homophobia, social contagion, sexual trauma and autism. Some avoid using patients' chosen names and pronouns. In 2022, bioethicist Florence Ashley argued that its framing as undirected exploration resembles conversion practices such as reparative therapy.
The source reports that no empirical studies are known to have examined psychosocial or medical outcomes after GET. Critics worry that therapy with no stated length could delay medical care and compound the suffering of transgender youth. GET proponents deny this. US states that have banned gender-affirming care for minors have called expert witnesses to argue that exploratory therapy should be the alternative.
In 2017, Richard Green published a legal strategy for getting around conversion therapy bans by labeling the practice "gender identity exploration or development". Multiple groups now promote GET worldwide, and they have influenced legal discussions and clinical guidance in some regions. The Gender Exploratory Therapy Association asserts that psychological approaches should be first-line treatment for all gender dysphoria. It calls medical interventions for transgender youth experimental and social transition risky. In late 2023, it renamed itself Therapy First.
All of its leaders belong to Genspect, a gender-critical group that argues gender-affirming care should not be available to anyone under 25. The association also overlaps heavily with the Society for Evidence-Based Gender Medicine, which promotes GET as first-line treatment for those under 25. GETA co-founder Lisa Marchiano said President Joe Biden's executive order safeguarding trans youth from conversion therapy would have a "chilling effect" on GET. The American College of Pediatricians, a small group aligned with the Christian Right, cites studies from the society to argue that GET is necessary to restore transgender people's "biological integrity".
Scientific consensus holds that conversion therapy cannot change a person's sexual orientation. Studies of people who went through it find significantly higher rates of depression, substance abuse and other mental health problems than among peers who did not. When the attempt fails, participants often feel more of the shame they already carried about their orientation or gender identity. For transgender people, exposure before age 10 is associated with a fourfold increase in the risk of lifetime suicide attempts, compared with peers who received other forms of therapy.
Modern practitioners, mostly from a conservative religious viewpoint, reject the clinical view that homosexuality and gender variance are neither unnatural nor unhealthy. They rely heavily on testimonials and retrospective self-reports. Studies purporting to validate change have been criticized for methodological flaws.
Bailey and colleagues argue that self-reports of success are unreliable, since participants may be especially susceptible to believing and reporting that therapy worked. They suggest that measures of men's genital arousal could supply better evidence, but existing studies have not supported effectiveness. Kurt Freund used penile phallometric testing and found that clients' reported changes in orientation were not borne out. Research by Conrad and Wincze in 1976 reached the same result. Bailey adds that individuals may choose not to act on their attractions, but there is no good evidence that orientation can be changed with therapy.
A 2022 study estimated that conversion therapy of youth in the United States costs $650.16 million a year. Associated costs, such as increased suicide and substance abuse, add another $9.5 billion. Youth who underwent it with a religious provider had worse mental health outcomes than those who consulted a licensed healthcare provider.
In 2022, Outright International surveyed respondents in Kenya, Nigeria and South Africa and found that half had undergone some form of conversion practice. Some involved force and coercion that inflicted severe physical and mental pain and suffering. ILGA World's 2020 report Curbing Deception matched specific public testimonies to the different methods and their life-threatening effects.
National health organizations around the world have uniformly denounced these practices. They find them ineffective, risky and potentially harmful, noting that they often exploit guilt and anxiety, damage self-esteem, and can lead to depression and even suicide. The American Psychiatric Association cautions that ethical practitioners, under the Hippocratic oath, should do no harm and refrain from conversion attempts. Mental health professionals also worry about social harm from spreading inaccurate views about the ability of LGBT people to lead happy, healthy lives. Various medical bodies prohibit their members from practicing it.
Criminal bans on conversion therapy exist in Canada, Ecuador, France, Germany, Malta, Mexico and Spain. In Albania, Brazil, Chile, Vietnam and Taiwan, medical professionals are barred from practicing it. Fraud lawsuits have succeeded in some states. In other jurisdictions, plaintiffs must prove the perpetrator was intentionally dishonest, so a provider who sincerely believes it works could not be convicted.
The 2015 New Jersey case Ferguson v JONAH shows the fraud route working. A jury unanimously found the defendants guilty of fraud for claiming to offer "services that could significantly reduce or eliminate same-sex attraction". The United Nations Independent Expert on sexual orientation and gender identity highlighted the case in a 2020 report that called for a global ban. In March of 2026, the US Supreme Court struck down laws prohibiting conversion therapy.
Opinion polls in the United States show popular support for bans. Surveys in Florida, New Mexico and Virginia found support between 60% and 75%. A 2014 national poll found that only 8% of Americans believed conversion therapies were successful. In a 2020 survey of US adults, 18% said it should be legal for minors, 56% said illegal, and 26% did not know. Contact with LGB people was associated with opposition. A 2022 YouGov poll found majority support in England, Scotland and Wales for a ban covering both orientation and gender identity, with opposition between 13 and 15 percent.
Popular culture has taken up the subject in Boy Erased, But I'm a Cheerleader, The Miseducation of Cameron Post, the Book of Mormon musical and Ratched. Documentaries include Pray Away and Homotherapy: A Religious Sickness.
In 2020, the International Rehabilitation Council for Torture Victims issued a statement that conversion therapy is torture. The same year, UN Independent Expert Victor Madrigal-Borloz called the practices inherently discriminatory and cruel, inhuman and degrading. Depending on the severity of the pain and suffering, he said, they may amount to torture. In 2021, Ilias Trispiotis and Craig Purshouse argued that conversion therapy violates the prohibition on degrading treatment in Article 3 of the European Convention on Human Rights.
In February 2023, Council of Europe Commissioner for Human Rights Dunja Mijatović called the practices irreconcilable with several guarantees under that convention. She urged member states to ban them for adults and minors alike, and in July 2023 she pressed for clear action at a public hearing at the European Parliament. In September 2024 it was reported that the European Union was considering a ban across its member states. A European Citizens' Initiative, which began collecting signatures in May 2024, is calling on the European Commission to outlaw the practices.
Updated
Common questions
What is conversion therapy?
Conversion therapy is the pseudoscientific practice of trying to change a person's sexual orientation, romantic orientation, gender identity or gender expression to match heterosexual and cisgender norms. It is ineffective and frequently causes significant long-term psychological harm.
Does conversion therapy work?
No. There is a scientific consensus that conversion therapy is ineffective at changing sexual orientation. Claims of success rest on testimonials and self-reports, and studies that tested them objectively did not support the claims.
What methods has conversion therapy used?
Methods have included aversion therapy with electric shock or nausea-inducing drugs, ice-pick lobotomy, castration, hypnosis, psychoanalysis, talk therapy, and religious practices such as prayer and exorcism.
Is conversion therapy harmful?
Yes. People who underwent conversion therapy show significantly higher rates of depression, substance abuse and other mental health problems than peers who did not. A 2025 American Medical Association study found that 42% of those subjected to it attempted suicide, compared with 5% of those who were not.
Where is conversion therapy banned?
Canada, Ecuador, France, Germany, Malta, Mexico and Spain have criminal bans. Albania, Brazil, Chile, Vietnam and Taiwan bar medical professionals from practicing it.
What is sexual orientation and gender identity change efforts (SOGICE)?
SOGICE combines sexual orientation change efforts (SOCE) and gender identity change efforts (GICE). Critics prefer these terms to conversion therapy because the practices are not legitimate therapy.
Has conversion therapy been called torture?
Yes. In 2020 the International Rehabilitation Council for Torture Victims stated that conversion therapy is torture. The UN Independent Expert Victor Madrigal-Borloz said it may amount to torture depending on the pain and suffering inflicted.
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