Practices that intend to change or suppress an individual’s sexual orientation or gender identity are harmful and have complex impacts on survivors. Understanding the nature of contemporary conversion practices can assist healthcare providers to support survivors in their recovery.
The Change or Suppression (Conversion) Practices Prohibition Act 2021 came into effect in Victoria on 17 February 2022, which means that practices seeking to change or suppress an individual’s sexual orientation or gender identity are now against the law[i]. Similar legislation that prohibits these ‘conversion practices’ have also been passed in Queensland, the ACT, and New Zealand, with moves towards the same in the remaining states and territories.
There are implications for these new laws around how mental health practitioners should respond to LGBTQA+ individuals presenting for treatment. A nuanced understanding of both the nature of conversion practices and the range of impacts can help practitioners formulate best-practice responses to working with conversion practice survivors.
Conversion practices include a range of efforts that lead LGBTQA+ people to try to change their sexual or gender minority identity, with the goal of becoming a cisgender and heterosexual individual. Underlying these practices are conversion ideologies or beliefs about the origins of sexual orientation and gender diversity. These typically involve beliefs that gender diversity and deviation from heterosexuality results from a sexual ‘brokenness’, and thus that there is the option to be ‘fixed’ or ‘cured’[ii]. As such, the goal of conversion practices is often identity and behaviour change, which can involve continued engagement with these practices until ‘healed’ or ‘fixed’, avoiding same-sex behaviours or sexual thoughts, or striving for abstinence or celibacy. However, the goal can also be identity suppression, which can involve an individual denying or refusing to accept their diverse sexuality or gender identity.
It is commonly believed that conversion practices involve formal conversion programs, run by faith-based dedicated organisations. These can include versions of group or one-to-one ‘therapy’ or counselling, conversion camps, or conversion support groups. These formal practices are often represented in media discussions around conversion practices, and are based in the legacy of medical beliefs around sexual minority identities and same-sex behaviours being an issue of pathology[iii]. These formal practices are becoming less common –in line with decreasing social acceptability of such practices, and also with increasing legal and ethical regulations around offering such practices.
More common are the conversion practices that occur in informal settings within religious environments, which include various pastoral care and support groups, and interactions with religious leaders or friends/family. These practices exist across most religious and faith groups, however they can also can be initiated within secular cultural contexts.
The practices can also be performed in a range of settings beyond places where religion is practiced. These settings can including faith-based organisations such as schools and hospitals, but also in secular environments, such as in the practices of counsellors, psychologists, and psychiatrists.
There are also conversion practices that are not based in religion or faith, but instead in secular cultural beliefs, or a combination of the two. It is also worth noting that in some instances there is substantial overlap between religion and culture, and the two should be considered in unison.
Estimates of the experiences of prevalence of conversion practices vary, but estimates for Adults are typically reported at around 10%[iv]. There have not yet been studies of prevalence in Australia for the broader LGBTQA+ community, however a research large scale survey in 2019 revealed that nearly 1 in 20 LGBTQA + Australian youth (aged 14-21) had attended counselling, group work, programs or interventions aiming to change their sexuality or gender identity[v]. This is likely to be an underestimate, given that it did not ask about informal conversion practices.
Particular groups of LGBTQA+ individuals are more likely to be exposed to conversion practices than others, including transgender individuals or bisexual, and individuals from an ethnic or cultural minority. Data from the United Kingdom suggest that individuals from these groups are more than 6 times as likely to experience conversion practices[vi].
There is a growing body of evidence showing the wide range and severity of harmful impacts experienced by survivors of conversion practices. The most commonly researched impacts are associated with impacted mental health – including disproportionately high levels of depression, anxiety, stress, suicidality, and trauma, as well as increased risk for homelessness, unemployment, problematic drug and alcohol use[vii].
In additional to mental health impacts, experiences of conversion practices have been linked to poor family relationships, impacted identity formation, reduced participation in the workplace and places of higher education, and exposure to violence and harassment[viii].
There is a limited amount of data available from Australia. However, the recent survey of Australian youth shows that those who have survived conversion practices are over three times more likely than their peers to self-harm, attempt suicide, and to have a PTSD diagnosis than their peers. They also reported higher levels of psychological distress and anxiety, lower levels of self-reported wellbeingiv.
In addition, survivors will often experience moral injury, spiritual harm, and religious trauma as a result of the abusive and coercive elements of religion-based conversion practices[ix]. For instance, LGBTQA+ religious individuals are often told that their sexuality or gender identity is caused by something that they have done, and as such they will be unable to continue participating in their religion, may be cut off from their family and community, and will be condemned until they are ‘healed’. This can result in damage to the spiritual aspects of oneself, a damaged concept of their future and purpose in life, and broken relationships with their religion or faith, religious community, and with their family and friends.
In many parts of Australia and New Zealand, conversion practices and ideologies are now illegal, meaning that such practices cannot be engaged in, even at the request of the client[x].
Beyond the legal concerns, these practices have been opposed by all major professional bodies in Australian (including the Australian Psychological Society, the Australian Medical Association, and the Australian Counselling Association). In addition, it is widely considered to be violation to human rights[xi].
Finally, there is no credible evidence for successful long-term change[xii]. Conversely, the evidence shows the opposite – that these practices are both ineffective at achieving their goals of change or suppression, and instead are more likely to cause harm to the individuals being ‘converted’.
When working with survivors, it is vital for practitioners to recognise the harm of living with conflicted religious and sexual or gender diverse identities, and to provide client-directed goals about resolving this conflict. More information about the experiences of conversion practices from the perspectives of survivors can be found at www.sogicesurvivors.com.au.
Finally, there is a need for the profession to continue to develop an evidence-based approach for dealing with religious and cultural-based trauma for LGBTQA+ individuals.
His current postdoctoral fellowship is working as part of a national research project into the history, nature, and impacts of conversion practices in Australia. Twitter: @JoelMelb
[i] https://www.legislation.vic.gov.au/bills/change-or-suppression-conversion-practices-prohibition-bill-2020
[ii] Csabs, C, Despott, N, Morel, B, Brodel, A & Johnson, R 2020, SOGICE Survivor Statement, SOGICE Survivors, <http://socesurvivors.com.au/wp-content/uploads/2020/12/Survivor-Statement-A4-Doc-v1-2-Digital.pdf>.
[iii]Anderson, J. R., & Holland, E. (2015). The legacy of medicalising ‘homosexuality’: A discussion on the historical effects of non-heterosexual diagnostic classifications. Sensoria, 11(1), 4-15. doi: 10.7790/sa.v11i1.405
[iv] The Trevor Project, 2020. National Survey on LGBTQ Youth Mental Health https://www.thetrevorproject.org/wp-content/uploads/2020/07/The-Trevor-Project-National-Survey-Results-2020.pdf.
[v] Jones, T., Power, J., Hill, A. O., Despott, N., Carman, M., Jones, T. W., ... & Bourne, A. (2021). Religious conversion practices and LGBTQA+ youth. Sexuality Research and Social Policy, 1-10.
[vi] UK Government Equalities Office, 2018. National LGBT Survey: Research Report, Manchester
[vii] Green, A.E., Price-Feeney, M., Dorison, S.H., Pick, C.J.,2020. Self-Reported Conversion Efforts and Suicidality Among US LGBTQ Youths and Young Adults, 2018. American Journal of Public Health, 110(8),1221-1227, https://doi.org/10.2105/AJPH.2020.305701.
[viii] Blosnich, J.R., Henderson, E.R., Coulter, R.W.S., Goldbach, J.T., & Meyer, I.H., 2020. ‘Sexual Orientation Change Efforts, Adverse Childhood Experiences, and Suicide Ideation and Attempt Among Sexual Minority Adults, United States, 2016-2018’. American Journal of Public Health 110(7), E1-1030
[ix] Jones, T., Jones, T., Power, J., Despott, N., & Pallotta-Chiarolli, M. (2021). Healing spiritual harms: supporting recovery from LGBTQA+ change and suppression practices.
[x] Power, J., Jones, T. W., Jones, T., Despott, N., Pallotta‐Chiarolli, M., & Anderson, J. (2022). Better understanding of the scope and nature of LGBTQA+ religious conversion practices will support recovery. Medical Journal of Australia.
[xi] Fitzsimmons, T. (2020, June). U.N. calls for global end to conversion therapy, says it 'may amount to torture'. https://www.nbcnews.com/feature/nbc-out/u-n-calls-global-end-conversion-therapy-says-it-may-n1230851
[xii] Przeworski, A., Peterson, E., & Piedra, A. (2021). A systematic review of the efficacy, harmful effects, and ethical issues related to sexual orientation change efforts. Clinical Psychology: Science and Practice, 28(1), 81.