Transgender conversion practices occur when individuals are encouraged to repress their gender identity, present as cisgender, or are kept from transitioning. Transgender people are differently impacted and have different risk factors for exposure to conversion practices compared to their cisgender peers, and as such require specific care and support from mental healthcare providers.
Conversion practices continue to be a focal point of discussion in Australia and around the world as more jurisdictions begin to consider legislating to ban them. In 2020 and 2021 legislation prohibiting conversion practices was passed in three of eight Australian states and territories: Victoria, ACT and Queensland, as well as New Zealand. Likewise, NGOs have rallied international support for the campaign against conversion practices, for example, in 2020 Amnesty International launched a nation-wide campaign to rally for government action in Australia.
Conversion practices are any efforts to change or suppress a person’s sexuality or gender identity. These can include formal practices like one-on-one counselling as well as informal practices like prayer ministry or pastoral care. These practices are founded on a belief that cisgender heterosexuality (meaning an identification with one’s gender assigned at birth, and an attraction to the opposite sex*) is natural and that any deviation from this is a sign of brokenness or disordered identity. This underlying belief is known as ‘conversion ideology’, as coined by survivors of conversion practices in the SOGICE Survivor Statement, and drives all forms of conversion practices[i]. It is rooted in the idea that humanity can be divided into two binary genders designed to complement each other in heterosexual marriage. Conversion ideology usually professes that diverse sexuality and gender are caused by abuse, improper parenting, neglect or a lack of faith. You can read more about the specifics of conversion ideology at www.sogicesurvivors.com.au. All identities within the LGBTQA+ community can experience conversion practices**, however transgender people have different risk factors to their cisgender counterparts for a variety of reasons.
Transgender people are individuals who do not identify with the gender assigned to them at birth (by their families and doctors) and may choose to socially, medically and/or legally transition to another gender. Transgender people have vastly different experiences of conversion practices due to their lived experience of transphobia. Transphobia is the fear of or negative attitudes towards transgender people. It is usually driven by a belief that being transgender is not a real or valid identity or that being transgender is unnatural, both of which are scientifically, psychologically, socially, and historically false. Transgender conversion practices occur when individuals are encouraged or forced not to transition, to repress their gender expression/conform to their gender assigned at birth or are encouraged or forced to present as a binary gender if they are non-binary. This may include not undergoing transition, wearing clothing or adopting mannerisms that align with their gender assigned at birth, and being punished for expressing a diverse gender identity. Here are three reasons why transgender conversion practices differ from cisgender experiences of conversion:
While conversion practices are most recognisable in religious settings, transgender people also frequently experience conversion practices in secular settings such as psychological and counselling settings and clinical settings.[ii] These secular practices are equally informed by beliefs in gender essentialism (the idea that sex and gender are fixed and innate) and gender binarism (the idea that there are only two sexes and corresponding genders).
Transgender people are equally likely to experience conversion practices from secular medical professionals when seeking support for transition, or by being sent to corrective therapies. This is compounded by medical gatekeeping which requires transgender people to seek approval from medical professionals to access transition related healthcare. Conversion practices in these settings often manifest as a failure to provide information about alternative or faster pathways to transition while leading the person on an unnecessarily arduous path of assessments without seeking appropriate external advice.
While sexuality develops in teenagers at the onset of puberty, transgender people may start expressing their gender identity from a very early age. Gay, lesbian, and bisexual people often become exposed to conversion practices at the development of sexuality, however, young transgender children can be exposed to conversion practices from parents and family members, or even taken to undergo therapeutic practices to correct their gender identity. As such, transgender people are likely to be exposed to conversion practices and ideology from a much earlier age and are at higher risk of poor mental health outcomes such as suicidality.
In the 2018 UK National LGBT Survey, 13% of transgender people had undergone or been offered conversion practices compared to 7% of cisgender people.[iii] Similarly, in a survey of 27,715 US transgender people, it was found that 14% experienced efforts to change or suppress their gender identity[iv]. Significantly, 19.6% of transgender people who had discussed their gender identity with a medical professional had been exposed to conversion practices.[v] These statistics suggest that transgender people are at higher risk of exposure to conversion practices, likely because they are more likely to access clinical and psychological services for support with transition.[vi] It is also worth noting that transphobia is more socially permissible than homophobia and has increased in the last 5 years with conservative backlashes to gains in LGBTQIA+ civil rights.
Conversion practices are extremely harmful for transgender people and result in damaging mental health outcomes. Studies have shown that exposure to conversion practices leads to severe psychological distress, self-harm, suicidal ideation, and suicide attempts.[vii] There is also significant evidence that survivors of conversion practices experience symptoms of PTSD and that experiences of conversion are a significant trauma.[viii] Findings from a recent survey revealed that Australian survivors of conversion practices reported increased symptomology of anxiety and psychological distress than their counterparts who had not been exposed to conversion practices.
Transgender survivors experience specific harms that cisgender queer people are less likely to experience from conversion practices, and because of this, transgender people have specific needs and requirements from affirming healthcare and psychology in both their recovery from conversion practices and when seeking transition related services. Mental healthcare providers would do well to understand the conversion ideology that transgender individuals are exposed to in both religious and secular settings in order to properly care for and aid the transition journeys of transgender clients.
*Cisgender refers to a person who identifies with their gender as it was assigned at birth (by parents and doctors), as opposed to transgender or gender diverse which refers to a person who identifies with a gender other than their assigned gender at birth. Heterosexuality refers to attraction to the opposite gender, as opposed to homosexuality: attraction the same gender, bisexuality: attraction to two or more genders, or asexuality: attraction to no gender.
**Advocates have chosen not to include intersex people in campaigns against conversion practices because intersex communities experience specific forms of discrimination and medical malpractice that require a separate movement and strategies (See Csabs et al. 2020)
Percy is a survivor of conversion ideology and practices and has been a steering committee member of Brave Network for four years. They were involved in advocating for a conversion practices ban in Victoria. They are passionate about the intersection of queerness and religion in research and the everyday world.
[i]Csabs, C, Despott, N, Morel, B, Brodel, A & Johnson, R 2020, SOGICE Survivor Statment, SOGICE Survivors, <http://socesurvivors.com.au/wp-content/uploads/2020/12/Survivor-Statement-A4-Doc-v1-2-Digital.pdf>.
[ii] Turban, JL, Beckwith, N, Reisner, SL & Keuroghlian, AS 2019, 'Association between recalled exposure to Gender Identity Conversion Efforts and psychological distress and suicide attempts among Transgender adults', JAMA Psychiatry, vol. 77, no. 1, pp. 68-76.
[iii] Government Equalities Office UK 2018, National LGBT Survey: Research Report., Research Report, Government Equalities Office, <https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/721704/LGBT-survey-research-report.pdf>.
[iv] Turban et al. 2019
[v] Ibid.
[vi] Ibid.
[vii] Fish, JN & Russell, ST 2020, 'Sexual orientation and gender identity change efforts are unethical and harmful', American Journal of Public Health, vol. 110, no. 8, pp. 1113–1114.
[viii] Jones, TW, Jones, TM, Power, J, Despott, N & Pallotta-Chiarolli, M 2021, Healing spiritual harms: supporting recovery from LGBTQA+ Change and Suppression Practices, ARCSHS Monograph series, Australian Research Centre in Sex Health and Society, <https://www.latrobe.edu.au/__data/assets/pdf_file/0007/1201588/Healing-spiritual-harms-Supporting-recovery-from-LGBTQA-change-and-suppression-practices.pdf>.
9 Jones, TM, Power, J, Hill, AO, Despott, N, Carman, M, Jones, TW, Anderson, J, Bourne, A 2021, ‘Religious conversion practices and LGBTQA+ youth’, Sexuality Research and Social Policy, pp. 1-11. https://doi.org/10.1007/s13178-021-00615-5