Blog

by Shelley Charlesworth

This post poses the question: Is Gender Identity Conversion Therapy practiced in the UK today? It looks at the background to calls for a legal ban on conversion therapy, and will argue that sexual orientation and gender identity are distinct categories which should not be grouped together. It will analyse the evidence backing up these calls to see if it is reliable and robust. It will also show how activists are attempting to redefine conversion therapy as ‘barriers to transition-related healthcare.’ Campaigners also want a spectrum of identities, such as asexual, and practices such as kink and BDSM to be protected under the ban.

Those calling for a ban not only conflate sexual orientation and gender identity but also want legislation to cover all healthcare and religious settings, both public and private, applying to children and adults. In theory, this means conversion therapy encompasses a wide range of interventions, from a teacher telling a 4-year old boy that it’s fine to wear a dress but he can never become a girl to the extremes of exorcism and corrective rape.

Stonewall defines conversion therapy as:

“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.”

They say a ban must apply

“Wherever it occurs – in public or private, through healthcare or religious and cultural interventions.” “Whoever is targeted – whether a child or an adult, whether they are coerced or have consented.”

Such wide sweeping powers could criminalise a therapist who did not affirm an adolescent who felt her distress would be solved by changing her sex, or a teenager who was unable to express same-sex feelings due to internalised homophobia. Stephanie Davies-Arai has shown that the affirmation and social transitioning approach promoted by Stonewall and its allies is in fact a form of conversion therapy in itself for gay and lesbian young people.

Stonewall should be asked what they mean by “cultural interventions.” Does it include academic debate, media investigations and websites such as Transgender Trend in which arguments are put forward that an affirmation only approach is a form of gay conversion therapy?

At present those wanting a legal ban say it is to protect sexual orientation and gender identity. But it is clear that a ban would apply to a much wider group of sexual preferences and practices. Dominic Davies of Pink Therapy, an MoU signatory, said recently that he believes paedophilia is a sexual orientation. By his definition this would be included in any ban on conversion therapy for sexual orientation. While this may be a minority view, the British Psychological Society’s definition of gender and sexual minorities, the groups that would be protected by a legal ban, include:

“lesbian, gay, bisexual and transgender (LGBT) people. However, it also includes people who: identify as asexual (do not or rarely experience sexual attraction); engage in BDSM (bondage and discipline, dominance and submission, and sadomasochism); are agender (have no gender); have a non-binary gender (have a gender other than male or female); are pansexual (have attraction irrespective of gender); and many other groups.”

Those calling for a legal ban must be asked if they support these preferences being included and how children and vulnerable people can talk about abusive experiences if these practices are normalised under the umbrella of conversion therapy. The BPS must be asked what they mean by “many other groups.”

The acronym GICT is used to refer to gender identity conversion therapy in this blog.

Background

Currently the government is under great pressure to bring in a legal ban on conversion therapy for sexual orientation and gender identity.  Calls are coming from LGBT organisations, parliamentary cross party groups, some professional therapeutic bodies and civil society groups.

Behind each of these calls is the assertion that conversion therapy is happening now in the UK, requiring a legal ban. Those campaigning for the ban conflate the distinction between sexual orientation and gender identity, offer a very broad definition of conversion therapy treatments, ranging from faith based interventions to more conventional therapeutic methods. Some of the treatments they reference such as beatings and corrective rape are already illegal.

The Memorandum of Understanding 2017

The conflation of sexual orientation and gender identity was cemented when the Memorandum of Understanding on Conversion Therapy (MoU) was revised in 2017 to include gender identity. This semi-legal document now prevents most of its therapeutic signatories from carrying out a neutral investigation into a client’s gender dysphoria, whatever their age. For young people and children with gender dysphoria this means therapists must affirm a young person’s belief that they are the opposite sex. As it has been shown conclusively, around 80% of children will outgrow a trans identity during puberty if a watchful waiting approach is taken. But even trying to discuss this possibility with a young person could lay a therapist open to charges of conversion therapy.

The MoU was originally written in 2015 as a practice guide for therapists to protect gay, lesbian and bi patients from therapists who attempted to convert them to heterosexuality. It was signed by most of the therapeutic bodies, the Royal College of GPs and NHS England. But following the addition of gender identity in 2017, the MoU is now run by a small group of activist therapists and trans rights organisations. Its proceedings and membership are not published, an enormous oversight for a policy making group that influences gender related therapy and NHS policy. The NHS is now committed to contradictory guidance; on the one hand it has signed the MoU mandating an affirmation only approach to gender dysphoria and on the other it has revised its advice on treatment, stating that little is known about the long-term effects of puberty blockers or cross-sex hormones. It has also commissioned Dr Hilary Cass to conduct an independent review into gender identity services for young people.

A detailed look at how gender identity was added to the MoU 2017, and the activists behind the move, has been documented here. But whatever the government proposes in relation to a legal ban, the MoU 2017 will remain a block to an open exploratory therapeutic approach for young people who struggle with their sense of self and identity.

Key questions about the evidence for a legal ban

A ban was first promised in July 2018 by the then Minister for Women and Equalities, Penny Mordaunt, as she launched the LGBT Action Plan and National LGBT Survey.

Since then Liz Truss has taken over as Women and Equalities Minister. Liz Truss has navigated a careful path on GRA reform, acknowledging that gender self ID would impact on women’s rights to single sex spaces. She has issued carefully worded statements on a conversion therapy ban, saying “We want to make sure that transgender people are free to live their lives and don’t face the type of horrific conversion therapy that has been going on in the UK.”

On March 8^th 2020 an e-petition debate was held at Westminster following an online petition calling for a legal ban signed by over 250,000 people. Of the 18 MPs who spoke in favour of the motion and cited the government’s own National LGBT Survey as an evidence source, one, Mike Hill, quoted a Stonewall survey of LGBT health from 2018. Most of the speeches however relied on general condemnations of conversion therapy, with no reference to UK based research.

Kemi Badenoch, the Equalities Minister, responded on behalf of the government saying, “We are actively considering that issue, on which we have been consulting widely to seek a broad range of views. We will continue that engagement to ensure that any action that we take is proportionate and effective… The legal landscape is complex, and we want to ensure that we get our proposals absolutely right.”

On April 9^th, Minister for Women, Baroness Berridge, promised “The Government will ban conversion therapy. The ban will cover both sexual orientation and gender identity. How we ban these practices is a complex issue that we must get right… officials continue to assess the most up-to-date evidence…”

It is encouraging that both Kemi Badenoch and Baroness Berridge have emphasised the complexity of bringing in a legal ban and have said that they will assess the evidence before bringing forward any legislation. So, what is the evidence that the government and officials are likely to assess?

We have looked at the available open access material and asked the following questions:

[a] Is the research based on the UK LGBT population?

[b] Does it distinguish between sexual orientation and gender identity?

[c] Is it current or historical?

[d] How does it define conversion therapy?

[e] Does the research draw on a large enough sample to draw conclusions and write legislation?

Evidence from the Ban Conversion Therapy website

This website is run by a coalition of nineteen groups. Stonewall, Mermaids, Gendered Intelligence, GIRES, Humanists UK, LGBT Foundation are the better known and resourced. The email link asks you to tick a box if you are happy for Stonewall to keep in touch, indicating that Stonewall takes the leading role.

Their resources page lists six conversion therapy sources:

1 The Ozanne Foundation’s 2018 National Faith and Sexuality Survey which looked at gay conversion therapy in the UK in a faith setting.

2 A Statement from the Royal College of Paediatrics and Child Health in 2020.

3 The 2017 Memorandum of Understanding.

4 The UN’s Independent Expert on Sexual Orientation and Gender Identity 2020 report on conversion therapy. 

5 The International Rehabilitation Council for Torture Victims report on conversion therapy 2020.

6 Conversion therapies and access to transition-related healthcare in transgender people BMJ Open 2018.

1 – 3 The Ozanne Foundation survey, the RCPCH statement and the MoU

The Ozanne Foundation survey offers data about gay conversion therapy in the UK for those over 16. It asked about the impact of religious belief on sexual orientation and identity. The study looked at 4,613 respondents of whom 458 had attempted themselves or experienced attempts to change their sexual orientation, around half of them when under the age of 18.

Of the 458 the report says:

“76 LGBQ+ respondents (3.5%) had “been forced to go through attempts to change” their sexual orientation.”

The report exposes entrenched homophobia in some faith communities:

“The influence of religious leaders is profound. They were the most likely to be identified as the person who had advised or forced attempts at sexual orientation…The primary motivations given for attempting to change were due either to their religious beliefs or internalised homophobia.” Twenty-two respondents had undergone “forced sexual activity with someone of the opposite gender.”

This Ozanne survey is a useful reminder of the serious problem of overt and internalised homophobia among some Christian faith communities. Lesbians were more likely than gay men to have experienced some form of conversion therapy. Some of the conversion practices exposed are damaging and some could be considered illegal. However, the report does not have any data about gender identity conversion therapy.

The statement by the Royal College of Paediatrics and Child Health is titled “Supporting LGBTQ+ children and young people – principle statement” and was issued by their policy team. The only research that the 2-page statement links to is the Stonewall 2018 health report. There is advice about pronouns and removing titles like Mr or Miss on call signs in health centres. It says nothing about conversion therapy. A possible reason for its inclusion by Ban Conversion Therapy is this pro-affirmation sentence: “Help parents, schools and other agencies to adopt a supportive, flexible and responsive attitude to affirm a child’s expressed sexuality and gender, whilst being sensitive to change over time.”

The MoU 2017 contains no research; it is a practice guide for therapists. As discussed above it is considered restrictive since the addition of gender identity and is now run by a wider group of activists and non-therapists led by the Coalition Against Conversion Therapy (CACT).

The remaining three sources listed by Ban Conversion Therapy do provide some evidence about GICT. Most of it, however, fails on the questions posed above, in that it isn’t UK based, it doesn’t provide a distinction between sexual orientation and gender identity, it isn’t current, it doesn’t define conversion therapy and therefore doesn’t provide a sound basis for legislation.

4 UN Independent Expert on Sexual Orientation and Gender Identity report 2020

This report calls for a global ban on conversion therapy which is defined or described as an umbrella term “to describe interventions of a wide-ranging nature…depending on the context the term is used for a multitude of practices and methods.”

The report contains much evidence of egregious, harmful practices of gay conversion therapy globally. In contrast, there is very little evidence provided about GICT.

There is no newly commissioned research in this report; it contains a largely historical literature review and a series of submissions from 33 states and 94 government bodies, civil society organisations and individuals. It does not distinguish between sexual orientation and gender identity.

The UK government did not make a submission, leaving the EHRC to submit a two-page response. The EHRC quoted and referenced the GEO’s National LGBT Survey 2018 and repeated the government’s intention to “fully consider all legislative and non-legislative options to prohibit promoting offering or conducting conversion therapy” adding that this does not prevent LGBT people from seeking legitimate medical support for their sexual orientation or gender identity.

Under the heading Public policy, the report highlights the UK’s National LGBT Survey as the only example of good data gathering.

Just two UK organisations, the Ozanne Foundation and Our Duty, made submissions. The Ozanne response was based entirely on their Faith and Sexuality Survey discussed above which made no reference to GICT. Evidence from Our Duty, a parent support and child protection group, said that affirming a child’s cross sex identity with the use of puberty blockers and hormones is itself a form of conversion therapy.

Of the submissions that attempted to provide a global overview of the evidence none provided any UK specific data, nor distinguished between sexual orientation and gender identity. To sum up, the report provides no new data that could help formulate legislation for the UK. The only material of any relevance in the report is the existing work of the National LGBT Survey.

But like all those supporting a ban the report wants to see children included in its remit. It recommends countries “take urgent measures to protect children and young people from practices of ‘conversion therapy’” and “facilitate health-care…related to the exploration and free development and/or affirmation of sexual orientation and/or gender identity.”

5 International Rehabilitation Report for Torture Victims report 2020

This report co-written with the Independent Forensic Expert Group (IFEG) concludes that “conversion therapy is practiced in more than 69 countries, is unscientific and violates the global ban on torture and ill-treatment. Based on the extreme, and often unimaginable, human suffering caused by conversion therapy, the IRCT calls for a global ban on the practice.”

This report also conflates sexual orientation and gender identity, contains no original research but does provide a country breakdown. Evidence relating to the UK refers to six pieces of journalism, all about gay conversion therapy, a Stonewall report from 2018 which collected some data about gay and gender identity conversion therapy, a further Stonewall report from 2015 which surveyed LGBT staff working in the NHS, a 2009 study of how therapeutic professionals treat gay clients and the National LGBT Survey.

The 2018 Stonewall report questioned 5,375 people and found that 5% LGBT and 20% [150] trans respondents were pressured to question or change their sexual orientation or gender when accessing healthcare. However, there is no more detail on this, relating to timescale, circumstance, or location. It is buried deep in a global report written by an organisation that monitors torture. Here again the Government Equalities Office’s National LGBT Survey seems to be the only reliable set of data for the UK.

6 Conversion therapies and access to transition-related healthcare in transgender people: a narrative systemic review, Wright, Candy and King

This article was published in the open access website BMJ Open in 2018. It looks at gender identity conversion therapy alone, the only one of the six cited resources to do so. Ban Conversion Therapy praises the review for including “’access barriers to transition healthcare’ as a form of conversion therapy. This is an important clarification which, if taken seriously, will fully protect Trans people’s right to transition safely.”

The authors take a dismissive view of desistance, claiming that this represents “an assumption that unknown future adult needs should supersede known childhood needs and an underestimation of harm when attempting to delay or deter transition.”

This claim hasn’t aged well; the argument that children’s needs should supersede their future adult needs was comprehensively demolished by the Keira Bell judgement which came to the opposite conclusion.

The authors claim that while much is known about conversion therapy for LGB people, “much less is known” about such therapies for trans people in the UK. This seems to be the case, for despite trawling many data bases for work since 1990 using certain key words only 117 were considered relevant. The vast majority were rejected as they contained no actual conversion aspect. This left just seven studies. Four of these were described as being psychotherapeutic conversion therapies. Of these only one, from 1997, was UK based. It was a study of just one trans person who was treated for OCD, not his transgender identification, and therefore cannot be called conversion therapy.  

The other study of note in the therapeutic category was by the renowned Canadian gender identity specialist, Ken Zucker, in which 7 children under 10 years of age were given open-ended play psychotherapy. The result was a majority desisted in their cross-sex identities. The authors claim this is an example of ‘conversion therapy.’

The remaining three studies are from the US and Canada which the authors say are examples of “access barriers to transition related healthcare.” The barriers they cite include insurance refusals and the use of incorrect pronouns. These studies have no relevance to the discussion of a legal ban on conversion therapy in the UK.

To sum up, this article found one 1997 study of one person in the UK having therapy. The authors, psychiatrists from University College London, then attempt to reframe barriers to healthcare in North America as conversion therapy. The Ban Conversion Therapy coalition present this as a useful argument for a legal ban.

This poor piece of literature research is also the only evidence cited by the Royal College of Psychiatrists for the prevalence of conversion therapy in their 2018 transgender position statement.

Other evidence: 2020 ‘Conversion Therapy and Gender Identity Survey‘

This recent report was produced by the most vocal campaign groups calling for a legal ban on conversion therapy: Stonewall, the Ozanne Foundation, Mermaids, the LGBT Foundation and GIRES. It was overseen by an ‘independent research monitor’, Richard Matousek, who works for the market research company Kantar.

The foreword contains a caveat, “The data should be approached as qualitative and demonstrative rather than statistically robust…due to a limited sample size which affects the ability to conduct statistical significance testing.” Despite these limitations the report confidently concludes that GICT takes place in the UK.

Professor Michael Biggs of Oxford University has analysed the 20-page report and found that the research is “fundamentally flawed. The respondents were not sampled from a defined population, as in a proper scientific survey. Instead they were recruited online by the same organisations that are campaigning for legislation.”

Out of 1504 respondents, 51 had experienced conversion therapy. 8 people reported being happy with the outcome, leaving 43 who were not. The majority of those conversion attempts, both forced and unforced, were carried out by family members or religious leaders.

Another major flaw concerns the age at which the respondents underwent conversion therapy. The survey found that of the 51 people who’d had some form of conversion therapy 24 were under 18. But without information on when the therapy happened it is not possible to know the prevalence of the practice today.

We have contacted Richard Matousek several times to ask if data was collected on when the conversion therapy happened but he has not responded to our request.

In answer to our questions [a] – [e] above, this survey fails to provide robust evidence; the sample isn’t big enough and it is not clear how many of the accounts refer to historical conversion therapies.

The National LGBT Survey 2018

In terms of evidence of conversion therapy, the Government Equalities Office’s  much cited report published in 2018 remains the best source, despite not defining what it was attempting to measure:

“We did not provide a definition of conversion therapy in the survey, but it can range from pseudo-psychological treatments to, in extreme cases, surgical interventions and ‘corrective’ rape.” (Summary report p14.)

108,100 people took part in the survey. 14,320 identified as trans and within this figure around 50% described themselves as non-binary.

The survey found that 2%, 2,640, of the LGBT respondents had had conversion therapy, 613 of whom were transgender.  

51% of conversion therapy experiences took place in faith settings, 25% in the family or community. Healthcare professionals were responsible for 19%.

The findings show that the frequency of conversion therapy drops sharply across the age range indicating that such practises may be largely historical. Respondents were asked “whether” they had had conversion therapy not when. It could be that the 19% who experienced conversion therapy by healthcare professionals are referring to something that is no longer practiced in the NHS.

This survey does distinguish between sexual orientation and gender identity, it is based on the UK population, it is a large sample. But as noted above the experience of conversion therapy may be historical. It also indicates that most conversion therapy takes place in faith communities and that proportionally BAME respondents are more likely to have undergone conversion therapy.

How robust is the evidence?

It’s important to remember that like the Stonewall reports, the 2020 Conversion Therapy and Gender Identity Survey, and the Ozanne Foundation surveys, the National LGBT Survey data is self-selected. It was “…promoted widely by GEO, by stakeholders, at national LGBT pride events, via national media coverage and on social media…and videos during the 2017 LGBT pride celebrations.”

There is no evidence produced in any of the above reports of documented conversion therapy taking place in professional healthcare settings in the UK. There is evidence that gay conversion therapy, but not GICT, is happening in faith settings. Undercover journalists have exposed some practices by therapists who were also motivated by religious conviction. 

The GEO has funded further research from Coventry University, investigating experiences of both sexual orientation and gender identity conversion therapy. The lead researcher Adam Jowett says there’s a “wealth of evidence” about it but says at the same time “there is still a lot we don’t know…” The research was completed some time ago but has not been released by the GEO.

This refrain that conversion therapy happens but we don’t have a lot of evidence is repeated constantly. It is echoed by the 2020 Conversion Therapy and Gender Identity Survey which calls for more research to understand its current “…prevalence, forms and locations…”

None of the evidence cited above fulfils all the criteria set out in our questions [a] – [e] and should not be used as a basis for legislation. Importantly, there is no reliable evidence that GICT is occurring in healthcare settings.

We shouldn’t be surprised that there is no robust evidence for GICT. Ruth Pearce, of the Trans Learning Partnership admitted as much in 2018:

“I was not very much involved in the drafting of the Memorandum of Understanding, but did attend one of the early meetings that discussed how it might be extended to ensure asexual and trans inclusion. At this meeting we struggled with the lack of formal evidence that trans people in particular were undergoing conversion therapy, although I supported others in arguing that the prevalence of deeply concerning anecdotal accounts alone necessitated action.”

Individual and anecdotal evidence of conversion therapy

The Conservative MP for Carshalton and Wallington, Elliot Colburn, proposed the motion “Make LGBT conversion therapy illegal in the UK” for the e-petition debate in the House of Commons on March 8^th. He began with stories of conversion therapy, one about a young gay Jewish man, the second a journalist’s undercover account of church based therapy and thirdly the story of Carolyn, a transwoman.

“At 17, Carolyn confided in her local vicar her feelings of self-hatred and depression, and her suicidal thoughts, because she did not feel like a boy. Her vicar took her to a doctor and a psychiatric hospital, where Carolyn was strapped to a wooden chair in a dark room. As images of women’s clothing were projected on to the wall in front of her, doctors would deliver painful electric shocks, hoping to associate the feelings of being a woman with memories of intense pain.” 

Carolyn’s experience is distressing to read. But what Elliot Colburn omitted to mention was that it took place in 1964. Over the last few years, Carolyn’s story has appeared in national and local newspapers, news websites, the BBC, and Channel 5.

Recently Carolyn took part in a webinar on conversion therapy introducing her story of GICT in a 3-minute video. Carolyn’s story also features as one of the nine first person accounts on the Ban Conversion Therapy website. (Only one other account relates to gender identity. It recounts the experience of a young lesbian who told her pastor that “I’d been secretly binding my chest for years and desperately wanted surgery to remove them. She told me not to have surgery and to leave my body alone.”)

Evidence from professional psychotherapeutic bodies

The webinar which featured Carolyn’s story was supported by the main big psychotherapeutic bodies, BACP, UKCP, BPC, BPS, the Royal College of Psychiatrists and the MoU coalition. All those participating were in favour of a legal ban. Alicia Kearns MP, who has said this ban is her main parliamentary aim, told the audience that all the letters she received about a ban said it was happening in faith settings. Despite the presence of so many psychotherapists the event was evidence-lite in terms of GICT.

Dr Igi Moon, for the BPS, chair of the Campaign against Conversion Therapy and Independent Chair of the MoU Coalition, stated “…we know from all of the studies that have been done that there is a gender lockdown for 16-24-year olds and what we do know about is that those 16-24-year olds from the LGBT community are going to be offered or given but likely to be offered conversion therapy.”

This is a bold statement. It would be interesting to read those studies, if they exist, and see what evidence there is for this cohort being offered or given conversion therapy. Perhaps Dr Moon will use the “barriers to healthcare is conversion therapy” argument. Ban Conversion Therapy is already doing this.  

A legal ban on conversion therapy will have repercussions for therapists, compounding the already restrictive effect of the MoU. But there has been little open debate about this among them.

We asked five professional bodies with an approximate combined membership of 140,000 for their views. Despite repeated requests only the British Psychoanalytic Council and the Royal College of Psychiatrists gave us some limited information on our 3 questions.

[1] Have you undertaken any research on sexual orientation and/or gender identity conversion therapy?

[2] If not, what research informs your understanding of this issue?

[3] Do you support a legal ban on conversion therapy?

The BPC said it had not conducted any research of its own, omitted to say if it relied on any other research, but confirmed it had signed the MoU and believed a legal ban was one means to bring an end to conversion therapy.

The Royal College of Psychiatrists sent a 2018 position statement in answer to our first two questions.

“The extent of use of conversion therapies with transgender people is unclear. A review of academic publications has recently been completed and submitted for publication (Wright et al., 2018). The findings suggest that specific treatments to persuade transgender and gender-diverse people to accept their gender as assigned at birth are rare, but there is evidence of barriers to transgender people receiving appropriate help to enable medical and social transition. Denying access to gender affirming treatment is likely to have a detrimental effect on the wellbeing of transgender and gender-diverse people.”

The review they cite by Wright et al is the one recommended by Ban Conversion Therapy discussed above and found to have no robust evidence of conversion therapy.

They confirmed that, despite the evidence being “unclear” for GICT, they are in the process of signing the 2017 MoU and support a legal ban.

All these bodies are letting down their patients by not engaging in debate within their own membership and the wider public. A former Tavistock GIDS clinician told us “it’s hard to explain the clamour to ban something that fell out of fashion in the 70s, there is no evidence that conversion therapy is happening in healthcare settings. Despite being asked the Royal College of Psychiatrists has refused to survey its membership on their position statement.”

While gender self ID via the Gender Recognition Act has been rejected by the government, LGBT activists continue to push for gender self ID in other forms, in our schools and healthcare systems. Affirmation and social transitioning are experimental treatments. They lock children and young people with gender dysphoria into a one-way system as lifelong medical patients. If a legal ban on conversion therapy for gender identity, applying to all ages, becomes law, all those who offer a cautious, exploratory approach could be criminalised.

Our analysis shows that any anecdotal evidence of gender identity conversion therapy is likely to be historical and dependent on the definition of ‘conversion therapy.’ In answer to the question we posed at the start of this post: we have found no evidence that gender identity conversion therapy exists today in the UK, or has ever existed in healthcare settings. Our conclusion? Any draft legislation must exclude healthcare and allow for open, neutral therapeutic exploration of gender identity, in line with normal professional practice and duty of care.