By the Section IX Board

This is a letter to membership from the Board of Psychoanalysis for Social Responsibility (Section IX), a section of the Society for Psychoanalysis and Psychoanalytic Psychology, Division 39 of the American Psychological Association. It does not represent the position of the American Psychological Association or any of its other Divisions or subunits.

Opposition to All Forms of Conversion Therapy

This letter serves to educate and support our membership in understanding the context in which therapeutic care has been historically defined and practiced in relation to the interests of queer people, including those who identify as lesbian, gay, bisexual, transgender, intersex and asexual (LGBTQIA). This letter is also a response to a recent Supreme Court ruling, in which licensed mental health counselor Kaley Chiles argued that a Colorado state law banning conversion therapy for minors infringed on her right to freedom of speech. The ruling, which favored Chiles 8-1 and which is based on the belief that talk therapy can/should be a neutral endeavor (as opposed to inherently politically invested), will soon lead to a re-assessment of the law and a “heightened level of scrutiny” to ensure it is “viewpoint neutral.” 

Conversion therapy, also known as “reparative therapy,” “reorientation therapy,” or sexual orientation change efforts (SOCE), is a widely discredited practice that aims to change and/or suppress an individual’s sexual orientation or gender identity to align with heterosexual orientation and cisgender identity and/or presentation. This form of “treatment” is premised on the belief that diversity in sexual orientation and/or gender identity and expression is a developmental/psychological illness, biological pathology, or moral/spiritual deficit. Major medical, psychological and mental health organizations worldwide have issued statements arguing against these beliefs and have condemned this practice, which can include interventions ranging from acts of physical, psychological and sexual abuse, electrocution and forced medication, isolation and confinement, verbal abuse and humiliation. In 2020, the United Nations called for a global ban on conversion therapy, classifying it as a form of torture.

Unfortunately, both the American Psychiatric Association and the American Psychological Association have a history of classifying deviations in sexual orientation and gender identity/expression as pathological and/or regressive, leading to a culture (both clinical and in wider society) in which LGBTQIA people have until relatively recently been diagnosed and “treated” with the goal of “conversion” or “repair.” 

It was only in 1973 that the American Psychiatric Association removed homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (DSM-II). In 1990, the World Health Organization removed homosexuality from the ICD-10. In 1992, the National Association of Social Workers’ National Committee on Lesbian and Gay Issues (NCLGI) released a groundbreaking statement addressing the stigmatizing impact of “reparative therapies” and “transformational ministries.” The American Psychological Association adopted its first resolution discouraging efforts to change people’s sexual orientation in 1997. In 2000, the American Psychiatric Association adopted a position statement opposing “reparative” or conversion therapies. In 2009, a task force in the American Psychological Association found that conversion practices are ineffective and pose a risk of harm.These resolutions were updated in 2021 to include confirmation that therapeutic efforts aimed at conversion or repair lack scientific basis. The American Psychoanalytic Association issued a statement opposing conversion therapy in 2012, which it updated and reaffirmed in 2025. In 2013, “Gender Identity Disorder” was replaced by “Gender Dysphoria” in the DSM-5, with the World Professional Association for Transgender Health (WPATH) playing a significant role in the gradual depathologization and recognition of the transgender identity as inherently legitimate. 

Conversion therapy, both implicit and explicit forms of the practice, dramatically deepens the experience of alienation from self and community, as well as confounding already present depression and anxiety, shame and self-destructive behaviors, and heightened rates of suicide. LGBTQIA+ youth already experience one of the highest rates of suicidal ideation, attempts, and success primarily in response to stigma and lack of acceptance, which is the driving attitude behind the practice of conversion therapy and the communities that utilize it. Furthermore, not only is conversion therapy profoundly harmful to minors and their families, it is also ineffective in creating genuine, lasting, and healthy forms of change. 

Coding Conversion Therapy

Conversion therapy takes many forms and is often not explicitly advertised as “conversion therapy.” In fact, sometimes it is confusingly labeled as a therapy geared towards helping people explore “fluidity,” where “fluidity” refers to the development or strengthening of a person’s capacity to suppress deviation from gender and sexual orientation norms. That is, instead of creating a space in which actual fluidity is permitted and might lead to an expansion of experience and relational capacity, the therapy uses this exploration to guide a patient towards expressions of gender and sexuality that are cisheteronormative.

One example of such a therapy is called Sexual Attraction Fluidity Exploration in Therapy (SAFE-T), which advertises itself as “client centered” and “voluntary.” While practitioners claim they work in a client centered way, people (particularly minors) who present to the office of a SAFE-T practitioner often do so under coercion from parents, their community, and religious authorities, out of fear of being sinful, broken, or sick, and under threat of  alienation or expulsion. The title of their 2023 program “Recapturing and Reclaiming Our Youth” betrays the real motivations underlying the SAFE-T approach.

Conversion therapy also manifests in more subtle ways, such as treating non-normative gender or sexual orientations as resulting from trauma (if you heal the trauma, the gender and sexuality issues are fixed), due to a “broken” family structure (pathologizing the entire family system), offering “identity counseling” to help people “accept” their gender assigned at birth, sex therapy that focuses on “orgasmic reconditioning” to shift erotic attraction to partners of the “opposite” sex, subtle beliefs that gender and sexuality diversity is “unnatural,” or “sex addiction” therapy. 

There are many organizations that espouse, practice and teach forms of therapy that arise from the same basic premise as conversion therapy, which is that there is something fundamentally awry or unnatural in those whose identity and experience are non-normative in terms of gender and sexuality. Signifiers that point to this include: claims of neutrality (sexuality and gender are inherently political), claims that their interventions are effective and client-centered (attempts to “fix” the “problem” of sexuality or gender are ineffective and harmful), pseudo-education about what forms of sexuality and gender are “un/natural,” invocation of “family values,” and parental love and community acceptance that is conditional on cisheteronormativity. 

For Therapists

When families of LGBTQIA youth bring their children to therapy hoping that the therapy will change their child’s sexual orientation or gender identity, we should understand the conflict these families face. If the family is embedded in community that is trans- or homophobic (due to political or religious reasons), parents might be trying to protect their child from stigma, exclusion and expulsion. Without proper supports and education, however, they might not realize that their attempts at protection worsen the situation. They might also, in addition to their child, be intensely shamed by the beliefs held in these communities, oftentimes going so far as to believe that they are to “blame” for their child’s identity/orientation. This can leave parents desperate for a solution to the “problem,” which is identified in the child rather than in the larger system.

It is our responsibility to provide education and support to these families when they bring their children to our offices. First, we need to be educated about the ways that our beliefs impact how we understand our clients’ experience of gender and sexuality. If we believe that there is something inherently problematic about non-normative forms of sexuality and gender, we are not prepared to provide truly affirmative care. When we understand the oppressiveness of these norms and have learned how to provide care that is genuinely affirmative, we will be better positioned to help these youth and their families. 

Ways to Help

First:

• Familiarize yourself with resources and supports for affirmative medical, community, mental health care.
• Engage in educational programming led by LGBTQIA-centered and affirmative clinicians and organizations.
• Develop partnerships, collaborations, networks, consultation and supervision groups that center the interests and rights of LGBTQIA people

Then:

• Facilitate access to educational/training programs that bridge gaps in understanding between LGBTQIA+ youth and their families.
• Remind families and colleagues that virtually every major medical and mental health organization—including the American Psychological Association (APA) and the American Academy of Child & Adolescent Psychiatry (AACAP)—has condemned conversion therapy.
• Reframe the goal of therapy around health, safety, growth, trust and family connection. Therapists can be supported through resources like those from the Family Acceptance Project, which provide data showing that family acceptance actively protects youth against suicide and depression. 
• Validate parental fears: Parents often request these therapies because they fear for their child’s safety and security. Acknowledge these emotions and provide psychoeducation about why interventions aimed towards “conversion” are harmful and ineffective. Either offer affirming care, or refer to someone who can provide affirming care.
• Reframe the narrative: Help parents understand that true “counseling” should facilitate open exploration of a child’s identity without a predetermined outcome, allowing the child to develop naturally, with the goal being self-trust and inclusion in community, rather than forcing change by creating conditional acceptance and internalized self-hatred. 

When families remain stuck in their demand for change efforts, therapists need actionable, external resources to offer them:

• The Trevor Project: Offers extensive guides, such as their resource on So-Called Conversion Therapy and LGBTQ+ Youth Mental Health, which therapists can share with parents to explain the harms of the practice in accessible terms.
• Crisis intervention: The TrevorLifeline is available 24/7 at 1-866-488-7386 for immediate youth support.
• Parents, Friends and Families of Lesbians and Gays (PFLAG): Connecting parents with local PFLAG chapters allows them to speak with other parents of LGBTQ+ children, which often helps shift their perspective toward acceptance and understanding.
• Trans Lifeline: A trans-led organization offering direct emotional and financial support to the trans community. Call their hotline at 1-877-565-8860.
• Trans Youth Emergency Project (TYEP): Operated by the Campaign for Southern Equality, this program offers one-on-one patient navigation and travel grants to families of transgender youth needing to access out-of-state gender-affirming care due to state bans.
• TransFamily Support Services: Provides free family coaching, legal and insurance navigation, and local parent support circles.
• The Trans Youth Equality Foundation (TYEF) provides education, advocacy and support for transgender, nonbinary and gender non-conforming children and youth and their families.
• Gender and Family Project: Empowering youth, families and communities with gender affirming services, training and research.

Queer people possess a profound and radiant brilliance that continuously reshapes culture and social systems, in addition to catalyzing major shifts in how family and community are fluid and entangled. Queer power resides in a resilient joy and the extraordinary courage required to live authentically in a world that so often demands conformity to norms that oppress everyone. The antidote to the erroneous beliefs and fears underlying interventions that seek to suppress queerness is mental health and medical education and treatment that is queer affirming, education about the natural diversity of sexual and gender experience, queer affirmative/centered community-building and access to community engagement, and participation in the creation of systems that protect and affirm gender and sexuality deviations from cishetero norms. 

In solidarity,

The Board of Section IX