Peter Jenkins is a counsellor, supervisor, trainer and researcher. He has been a member of both the BACP Professional Conduct Committee and the UKCP Ethics Committee. He has published a number of books on legal aspects of therapy, including Professional Practice in Counselling and Psychotherapy: Ethics and the Law (Sage, 2017). https://us.sagepub.com/en-us/nam/author/peter-jenkins. Peter Jenkins is also a member of Thoughtful Therapists whose scoping survey for the government consultation on conversion therapy can be found here: https://thoughtfultherapists.org/scoping-survey-pdf/
Unpacking research into the prevalence of conversion therapy by therapists in the UK
by Peter Jenkins
Pressure on the UK government to bring in a legal ban on all forms of conversion therapy is clearly ramping up, with the publication of the government’s Consultation document (HMG, 2021). Conversion therapy, or enforced change of sexual orientation or gender identity, is to be outlawed. As one MP described it, “the only people who are speaking in defence of conversion therapy are quacks, bigots and bullies. They need to be called out for what they are, and their dreadful activities and consequences criminalised” (HoC, 2021).
The evidence for the incidence of conversion therapy is apparently contained in the Government Equalities Office own LGBT survey of 2018 (GEO, 2018). According to another MP speaking in the same debate, this survey provides “a clear picture of the geographic spread and the demography of conversion therapies across the UK” (HoC, 2021). The Government’s own research, commissioned from Coventry University, into the effects, rather than the prevalence of conversion therapy, has already been comprehensively critiqued elsewhere (Sex Matters, 2021).
Comparisons are drawn with similar legal bans on conversion therapy either recently introduced, or in progress, in other countries, such as Malta, Germany, Canada, and Ireland. However, recent research suggesting that the much vaunted criminal ban on conversion therapy in Victoria, Australia rests on a slim evidence base of just 15 survey respondents should perhaps give us pause for just a moment’s thought (Jenkins, 2021).
Conversion therapy is, in practice, hard to define, without unintentionally including (and hence criminalising) mainstream exploratory therapy. It will be even harder to translate into hard-edged and unforgiving legislative prose. Conversion therapy essentially refers to an intentional attempt by a professional therapist to use therapy to change specific client behaviour. (This article does not discuss conversion therapy applied in non-therapy settings, such as faith or religious contexts.) Some forms of behaviour change may be positive in social terms, e.g. to reduce sexual offending. Other forms of behaviour change e.g. to change a client’s homosexual orientation, contravene well-established ethical principles of autonomy and avoidance of harm. Some forms of intended behaviour change via therapy may therefore be justifiable, or alternatively may be completely contra-indicated by agreed ethical principles.
Banning all forms of conversion therapy (or intended behaviour change, if defined in this way) is therefore likely to have serious and possibly unintended consequences for broad swathes of legitimate and mainstream therapeutic practice. These problematic areas could include issues relating to safeguarding young people and also therapeutic work with detransitioners, amongst others.
Defining conversion therapy:
We argue as Thoughtful Therapists, in our recent Scoping Survey, that there is no agreed operational definition of conversion therapy (Jenkins and Esses, 2021). The term conversion therapy is in many ways a contradiction in terms. The term conversion derives from a religious vocabulary, i.e. to convert a person from one religion to another. Therapy requires a voluntary, contractual relationship between client and therapist; involuntary or coercive therapy is therefore both unethical and ineffectual. The term conversion therapy is an ideological construct, which only carries meaning in the context of a very specific political narrative. Interestingly, the Ozanne Foundation now prefers the term ‘conversion practices’, an implicit acknowledgement of this fact (Ozanne Foundation, 2021).
In the recent past, classic conversion therapy was understood to apply to psychological and medical interventions intentionally designed to change a client’s sexual orientation from gay, lesbian or bisexual to heterosexual. It has now been extended to cover attempts to change the client’s gender identity from trans to gender congruent identity. The extended use of this term has the clear advantage of culling additional support for this new aim from those opposed to classic conversion therapy, which was previously aimed at gay, lesbian and bisexual clients.
Gay conversion therapy:
A Memorandum of Understanding on Conversion Therapy (MoU) was agreed between all major counselling bodies in 2015. This defined conversion therapy in the following terms:
“‘Conversion therapy’ is the umbrella term for a type of talking therapy or activity which attempts to change sexual orientation or reduce attraction to others of the same sex. It is also sometimes called ‘reparative’ or ‘gay cure’ therapy” (NHS England et al, 2015, p. 2).
There was limited (and now somewhat outdated) research evidence that conversion therapy for homosexuality was being practised on any significant scale. The first MoU referenced a survey of therapists (n: 1328) carried out during 2002-3, to explore attitudes towards providing therapy for clients wanting to change their sexual orientation (Bartlett et al, 2009). This found that a subset of respondents (n: 222, or 17% of the sample) had helped at least one client to reduce their homosexual or lesbian feelings. This subset of therapists was more likely to be male and older than other respondents. The findings thus relate to historic practice reported by a minority of therapists in the sample for the pre-2003 period. This survey may therefore have little relevance to establishing the likely incidence of conversion therapy aimed at gay, lesbian and bisexual people in the current period.
Current definitions of conversion therapy:
There are a number of definitions of conversion therapy in current use:
- Memorandum of Understanding
- Government Equalities Office
- Matousek report
Memorandum of Understanding:
“’(C)onversion therapy’ is an umbrella term for a therapeutic approach, or any model or individual viewpoint that demonstrates an assumption that any sexual orientation or gender identity is inherently preferable to any other, and which attempts to bring about a change of sexual orientation or gender identity, or seeks to suppress an individual’s expression of sexual orientation or gender identity on that basis” (BPS et al, 2019, p.2).
This definition is over-inclusive, as it includes both intentional attempts to change sexual orientation or gender identity and perceived attempts to suppress the latter. Subjective perceptions could include experiencing inadvertent therapist responses, such as deadnaming, misgendering, incorrect use of pronouns, or non-affirmative therapy, etc. as suppression. It is impossible to translate the concept of ‘suppression’ into an accurate legislative format, except at the cost of criminalising both minor therapeutic errors, and legitimate therapeutic approaches. This definition is therefore not fit for purpose.
Government Equalities Office:
“So-called conversion therapies, sometimes also referred to as cure, aversion or reparative therapies, are techniques intended to change someone’s sexual orientation or gender identity. These techniques can take many forms and commonly range from pseudo-psychological treatments to spiritual counselling. In extreme cases, they may also include surgical and hormonal interventions, or so-called ‘corrective’ rape“(GEO, 2020, p.83).
This GEO definition is restricted to the aim of changing sexual orientation and gender identity. It is intended to apply to classic gay conversion therapy and trans conversion therapy. It does not address areas of therapist concern identified above, i.e. the distinct and overlooked needs of detransitioners, and issues relating to safeguarding young people. It is not a workable definition of conversion therapy.
The Matousek report has provided the most overtly partisan definition of conversion therapy.
“Our recommended legal definition combines elements of the legislation in place in both Madrid, Spain and Queensland, Australia, which are the two best examples of international legislation. This is because the Madrid definition is the most inclusive of various forms of conversion practices and the Queensland definition ensures that gender-affirming treatments are not included in a ban:
- Encompass all medical, psychiatric, psychological, religious, cultural or any other interventions that seek to erase, repress or change the sexual orientation and/or gender identity of a person, including aversive therapies or any other procedure that involves an attempt to convert, cancel or suppress sexual orientation, gender identity and/or gender expression.
ii) Do not include any practice that— (a) assists a person who is undergoing a gender transition; or (b) assists a person who is considering undergoing a gender transition; or (c) assists a person to express their gender identity; or (d) provides acceptance, support and understanding of a person; or (e) facilitates a person’s coping skills, social support and identity exploration and development” (Matouzek, 2020, p.4).
This definition is overtly partisan, in seeking to prohibit attempts to erase, repress, change, convert, cancel or repress sexual orientation and gender identity. It is, in addition, explicitly framed to exclude gender identity affirmative therapy from risk of legal sanction. It does not address areas of therapist concern identified above, i.e. the distinct and overlooked needs of detransitioners, and issues relating to safeguarding young people. It is also not a workable definition of conversion therapy.
Research evidence on the prevalence of conversion therapy:
There is no credible research evidence that classic conversion therapy (i.e. against gays, lesbians and bisexuals) is currently practised by therapists on any significant scale, as distinct from its use in the period from roughly 1950 to around 1975. There is even less evidence of trans conversion therapy being practised currently by therapists on trans clients, in the sense of intentional therapeutic practices designed to actively change incongruent gender identity.
Government Equalities Office 2018 LGBT survey:
The most frequently cited source is the Government Equalities Office (GEO) 2018 LGBT survey. This is a non-random, online self-report survey, which cannot be generalised to the wider LGBT population. Its methodology is seriously flawed – its starting definition of conversion therapy is to ‘change’, while the question actually posed in the questionnaire refers to ‘cure’, which implies a quasi-medical procedure. Its data on conversion therapy is based on only four questions in a much longer survey of LGBT experiences. No time frame is requested in the questionnaire, or provided in the data analysis, so some of the positive responses may be historic rather than current. The survey produces very generic findings. Fuller details of the survey data obtained (Annex 5) are missing from the final published report and are not available for independent scrutiny.
142. “Have you ever had so-called “conversion” or “reparative” therapy in an attempt to “cure” you of being LGBT? “
The GEO Survey (n: 108,100) divides respondents into Cis and Trans respondents. According to Table 5.6 (p.88), 2% of Cis respondents have had CT, while 92% have neither been offered CT, or had it. Whereas for Trans respondents, 4.3% had had CT, and 84.3 had neither been offered it or had it (p.89). The majority of conversion therapy (81%) is allegedly provided by non-professional sources, which would reduce the estimated total numbers having experienced conversion therapy by professionals to 450. A further 20% of those reporting experience of conversion therapy were aged 55 years or older, so these respondents may be reporting historic experiences pre-1975, further reducing the total by an unknown but possibly significant amount. Any data regarding conversion therapy is clearly concerning, but the GEO findings do not confirm that conversion therapy by professionals is in any way a serious, widespread, or current problem.
The Matousek report (2020) has carried out further research specifically into Gender Identity Conversion Therapy (GICT), as distinct from classic conversion therapy intended to change gay, lesbian and bisexual sexual orientation. This was also a non-random, online self-report survey which cannot be generalised to the wider Trans population. Gender identity can be defined as an internal subjective state of feeling, rather than as denoting specific sexual behaviours. The Matousek research relies on a very broad definition of conversion therapy, as discussed above, i.e. ‘erase, repress and change’, and ‘convert, cancel or repress’. These processes depend largely on the subjective perceptions of an individual, and are hard to evidence in any systematic or reliable manner. An individual may perceive unintended therapist interactions such as misgendering, deadnaming, incorrect use of pronouns, or an absence of overtly affirmative therapy, as attempts to apply conversion therapy. This would therefore provide an overly sensitive measure for identifying instances of gender identity conversion therapy. Its use would be very likely to produce a high number of false positives as a result, and would provide unreliable evidence of the extent of conversion therapy.
“Have you ever gone through (all or part way) gender identity ‘conversion therapy’?”
According to the GICT survey (n: 450) 51 people (11%) had experienced CT, of which 39 (9%) were Gender Diverse, 7 (2%) were Cis and 5 (1%) preferred not to say (p.10). The total numbers are very small, and again are subject to the kind of factors discussed in relation to the GEO survey. For example, 56% of GICT was reported to be provided by non-professionals (p.12), which would reduce the notional figure of those undergoing GICT provided by professionals and health workers to around 22 in total. No time frame was requested via the questionnaire or presented in the data analysis, so a proportion of the positive responses may well be historic rather than current. The format used for reporting of the survey data obtained does not permit further detailed analysis.
The findings of the GEO and Matousek surveys are summarised below (see Table 1: Summary of survey data on Conversion Therapy reportedly carried out by professionals).
The main surveys into conversion therapy are by the GEO (2018) and the Matousek report (2020). These are non-random surveys, which cannot be generalised to the wider LGBT and Trans populations respectively. These surveys do not therefore provide an accurate estimate of the extent of conversion therapy in the UK. The GEO provides generic data on LGBT respondents, and the Matousek survey provides similar data on GICT. No time frame is provided for the data obtained, and the original data is not available for further independent scrutiny. If final data is adjusted to exclude conversion therapy provided by non-professionals, the resultant figures are significantly reduced in size. The data therefore does not provide compelling evidence of the widespread practice of conversion therapy by professional therapists against either homosexual, lesbian and bisexual clients, or against trans clients in the UK.
Bartlett, A., Smith, G. and King, M. (2009) “The response of mental health professionals to clients seeking help to change or redirect same-sex sexual orientation.” BioMed Central Psychiatry, 9, 11
British Psychological Society et al (2017) Memorandum of Understanding on Conversion Therapy in the UK. Version 2. (Updated 2019).
Government Equalities Office (2018) National LGBT Survey: Research Report. Department for Education: Manchester. www.gov.uk/government/consultations/national-lgbt-survey
HMG (2021) Banning Conversion Therapy Government Consultation. Command Paper 535.
HMSO: London. https://www.gov.uk/government/consultations/banning-conversiontherapy
House of Commons, (2021) LGBT Conversion Therapy, Volume 690: debated on Monday 8 March.
Jenkins, P. (2021) ”LGBT research and the push for a legal ban on conversion therapy in the UK”, Critical Therapy Antidote.
Matousek, R. (2020) ‘Conversion therapy’ and gender identity survey.
NHS England et al (2015) Memorandum of Understanding on Conversion Therapy. Www.psychotherapy.org.uk/media/npbjy1cw/memorandum-of-understanding-on-conversion-therapy.pdf (link broken)
Ozanne Foundation (2021) The Cooper Report: Recommendations on Legislating Effectively
For a Ban on Conversion Practices.
Sex Matters (2021) Rapid review of Coventry University research on conversion therapy. https://sex-matters.org/posts/publications/rapid-review-of-coventry-university-research-on-conversion-therapy/