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CONVERSION THERAPY EXPLAINED

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CONVERSION THERAPY EXPLAINED

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CONVERSION THERAPY EXPLAINED

Conversion therapy explained

Research, Facts, and Educational Insights

Last Updated: March 2026

TABLE OF CONTENTS

TABLE OF CONTENTS

Conversion Truth for Families: Young teenager with her mother at a therapist's office

  • Definitions and Terminology

    Conversion therapy is an umbrella term referring to any intervention (clinical, religious, or informal) that attempts to change a person's sexual orientation, gender identity, or gender expression. The goal of such interventions is to make a person identify as heterosexual, cisgender, or both.

    The practice is also referred to in the clinical and legal literature under several alternate names:

    • Sexual orientation change efforts (SOCE): the most commonly used clinical term

    • Gender identity and expression change efforts (GIECE)

    • Sexual orientation and gender identity/expression change efforts (SOGIECE): a broader term encompassing both

    • Reparative therapy: an older clinical label, largely rejected by mainstream psychology

    • Ex-gay therapy: a colloquial term used historically in religious contexts


    The American Psychological Association (APA) defines sexual orientation change efforts as "methods that aim to change sexual orientation through psychological, physical, or spiritual interventions." The Substance Abuse and Mental Health Services Administration (SAMHSA) extends this definition to include "any intervention that attempts to change a person's sexual orientation or gender identity."


    For the purposes of this page, "conversion therapy" is used as the general term covering all such efforts regardless of the setting (clinical, pastoral, or residential) in which they are administered.

What Conversion Therapy Is Not

A clinical distinction is important: conversion therapy is not the same as gender-affirming care, exploratory therapy, or any psychological support that does not have a predetermined outcome.


The APA's 2021 Resolution on Sexual Orientation and Gender Identity Change Efforts draws a clear line between interventions that seek to change identity and those that support identity exploration without a specific outcome in mind. Evidence-based psychological care for gender-diverse and LGBTQ+ individuals focuses on reducing distress, supporting identity development, and improving overall wellbeing, not on producing heterosexual or cisgender outcomes.


According to SAMHSA's 2023 report Moving Beyond Change Efforts, "gender affirmation, including social transition, and gender-affirming medical care are appropriate and beneficial for many gender minority youth." This distinction separates affirming care from change-oriented interventions.

  • Historical Context

    Origins in Psychiatric Classification:

    The historical roots of conversion therapy are tied directly to how homosexuality was classified in psychiatric medicine. From the publication of the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-I) in 1952 through the early 1970s, homosexuality was listed as a sociopathic personality disturbance. This classification gave clinical legitimacy to attempts to change sexual orientation, and a range of aversive and non-aversive techniques were developed and administered by licensed practitioners during this period.


    Techniques used historically included electroconvulsive therapy, chemical aversion therapies using nausea-inducing drugs, and behavioral conditioning methods. These approaches are now widely condemned by the medical and psychological community and are no longer practiced under the banner of mainstream mental health treatment.


    Declassification of Homosexuality as a Disorder:

    In 1973, the American Psychiatric Association (APA) voted to remove homosexuality from the DSM following extensive review of emerging research. The declassification marked a turning point: while conversion practices did not disappear, they lost their primary clinical justification. Homosexuality was replaced in the DSM by "ego-dystonic homosexuality" in the DSM-III (1980), a category describing distress about one's sexual orientation, which was itself removed in 1987 with the publication of the DSM-III-R.


    By the time the DSM-IV was published in 1994, no diagnostic category remained that framed homosexuality or same-sex attraction as a disorder requiring treatment.


    The Emergence of Religious Conversion Programs:

    As clinical justification eroded, conversion practices migrated increasingly into religious settings. Organizations such as Exodus International, which operated from 1976 to 2013 and at its peak connected hundreds of ministries across the United States, promoted the idea that sexual orientation could be changed through prayer, pastoral counseling, and group accountability programs. Exodus International officially closed in 2013, with its president publicly apologizing for the harm caused by the organization.


    Similar residential programs (sometimes called "ex-gay camps," "conversion camps," or faith-based residential programs) have continued to operate in various forms, though they face increasing legislative scrutiny.


    Reclassification and the Current DSM:

    The current edition of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) does not classify homosexuality, bisexuality, or transgender identity as mental disorders. Gender dysphoria, defined as clinically significant distress associated with the incongruence between a person's experienced gender and their assigned sex, is included as a diagnosis, but its inclusion is intended to facilitate access to care, not to pathologize gender diversity itself.


    Types and Methods:

    Contemporary conversion therapy takes multiple forms. The 2015 SAMHSA report on ending conversion therapy and the APA's 2009 Task Force Report identify the following general categories:


    Talk-based or psychological approaches: Individual therapy, group sessions, or family-based counseling aimed at modifying sexual orientation or gender identity through cognitive or psychodynamic techniques. These may include efforts to identify and address presumed "root causes" of LGBTQ+ identity, such as childhood trauma, parental relationships, or peer experiences.


    Spiritual or religiously framed interventions: Prayer, scripture study, pastoral counseling, accountability partnerships, and exorcism-based practices framed within a religious context. These may occur in churches, residential programs, or informal community settings.


    Residential programs: Structured, often live-in programs that combine behavioral, psychological, and religious components. These programs vary widely in structure, duration, and intensity.


    Aversive techniques: Historically, this category included electroconvulsive therapy, pharmacological aversion (nausea-inducing drugs paired with same-sex images), and shame-based conditioning. These techniques are now widely prohibited and condemned.


    The APA Task Force (2009) noted that the majority of contemporary SOCE relies on non-aversive methods, primarily talk therapy and religiously based counseling, and that the shift away from aversive techniques does not change the fundamental concern about efficacy or harm.

Current Positions of Major Research Bodies

Every major medical, psychological, and mental health organization in the United States has taken a formal position opposing conversion therapy. The following represents the documented positions of key professional bodies as of the most recent available publications.


American Psychological Association (APA)

The APA's 2009 Task Force Report on Appropriate Therapeutic Responses to Sexual Orientation conducted a systematic review of peer-reviewed research from 1960 to 2007 and concluded that there is insufficient evidence that SOCE is effective, and that evidence exists of potential harm. The report recommended that psychologists not practice SOCE and called for a moratorium on such efforts with minors.


The APA further strengthened its position with its 2021 Resolution on Sexual Orientation and Gender Identity Change Efforts, which states that conversion practices are "ineffective, harmful, and not appropriate therapeutic practice."


American Psychiatric Association

The American Psychiatric Association's position statement on conversion therapy states: "The American Psychiatric Association does not believe that same-sex orientation should or needs to be changed, and efforts to do so represent a significant risk of harm by subjecting individuals to forms of treatment which have not been scientifically validated and by undermining self-esteem of gay men and lesbians."


American Academy of Pediatrics (AAP)

The AAP's 2018 Policy Statement, published in Pediatrics, states that "attempts to change a child's sexual orientation or gender identity are not effective and can be harmful." The statement supports gender-affirming care and affirming therapeutic relationships as protective factors for LGBTQ+ youth.


Substance Abuse and Mental Health Services Administration (SAMHSA)

SAMHSA's 2015 publication Ending Conversion Therapy: Supporting and Affirming LGBTQ Youth states that conversion therapy "can cause significant harm" and that "the appropriate response to LGBTQ youth is support and affirmation." Its 2023 update reinforces that "SOGI change efforts in children and adolescents are harmful and should never be provided."


American Medical Association (AMA)

The AMA has adopted policies opposing the practice of conversion therapy and supporting legislative efforts to ban such practices, particularly for minors.


American Association for Marriage and Family Therapy (AAMFT)

The AAMFT's position states that the organization "does not consider homosexuality a disorder that requires treatment" and discourages therapists from practicing therapies aimed at changing sexual orientation or gender identity.


Association for Behavioral and Cognitive Therapies (ABCT)

The ABCT Task Force (2022) concluded that "sexual orientation and gender identity/expression change efforts (SOGIECEs) have been discredited by decades of scientific research as ineffective and harmful" and that "a growing body of research documents that individuals who undergo SOGIECEs experience significant increases in depression, anxiety, suicidal ideation, and suicide attempts."


World Health Organization (WHO)

The WHO has called for an end to conversion therapy globally, characterizing it as a practice that "constitutes a serious threat to the health and human rights" of those subjected to it.

  • Research on Efficacy

    The clinical question of whether conversion therapy is effective, that is, whether it produces lasting changes in sexual orientation or gender identity, has been the subject of multiple systematic reviews and task force investigations. The weight of the available evidence indicates that it does not.

    The APA 2009 Systematic Review

    The most comprehensive review of SOCE research to date was conducted by the APA Task Force between 2007 and 2009. The Task Force reviewed 83 peer-reviewed studies published between 1960 and 2007 and found that:

    • The methodological quality of most pro-SOCE studies was poor, relying on self-report, lacking control groups, and using non-representative samples.

    • No high-quality study demonstrated that SOCE produces lasting changes in sexual orientation.

    • Some individuals reported shifts in behavior or identity labeling, but these were not demonstrated to reflect changes in underlying sexual attraction.


    The Task Force concluded that "enduring change to an individual's sexual orientation is uncommon" and that practitioners should "inform clients of the available evidence, including that the benefits reported by participants in SOCE can be counteracted by its potential risks."

    The Ferguson v. JONAH Legal Record

    In 2015, a New Jersey jury found that Jews Offering New Alternatives for Healing (JONAH), a conversion therapy provider, had engaged in consumer fraud by falsely representing that their services could change sexual orientation. The defense presented seven witnesses described as "success stories" of conversion therapy. As the legal record reflects, not one of those witnesses testified to experiencing regular opposite-sex attraction following treatment. The presiding judge ruled that "the theory that homosexuality is a disorder is not novel but, like the notion that the earth is flat and the sun revolves around it, instead is outdated and refuted."

    SAMHSA's 2023 Evidence Assessment

    SAMHSA's 2023 comprehensive report found that "no available research supports the claim that SOGI change efforts are beneficial to children, adolescents, or families" and that "no available research indicates that change efforts are effective in altering gender identity." The report addressed concerns about the absence of randomized controlled trials (RCTs) by noting that "there are valid ways to assess harm from SOGI change efforts without conducting an RCT," including retrospective studies, case studies, patient registries, and self-report surveys.

Documented Harms


Across multiple independent research bodies, consistent evidence documents psychological, relational, and social harms associated with exposure to conversion therapy, particularly among minors.

Mental Health Outcomes

The Williams Institute at UCLA School of Law estimates that approximately 698,000 LGBTQ+ adults in the United States have undergone conversion therapy, with approximately 350,000 having done so as adolescents.

A 2018 analysis of 25,791 LGBTQ+ youth conducted by The Trevor Project found that respondents who had undergone conversion therapy were more than twice as likely to have attempted suicide compared to those who had not.


The Family Acceptance Project (FAP), led by Dr. Caitlin Ryan at San Francisco State University, conducted longitudinal research documenting specific family behaviors, including involvement in or support for conversion attempts, that predict negative health outcomes. Key findings from FAP-affiliated research include:


  • Youth who experienced both parental SOCE involvement and conversion interventions administered by therapists or religious leaders had attempted suicide at nearly three times the rate of peers who experienced no conversion attempts (63% vs. 22%).

  • Depression rates more than doubled (33% vs. 16%) among youth subjected to parental SOCE involvement.

  • Exposure to conversion efforts was associated with lower life satisfaction, reduced social support in adulthood, lower educational attainment, and lower weekly income.


The ABCT Task Force (2022) found that "a meta-analysis found that exposure to SOGIECEs was associated with a more than twofold increase in the odds of suicide attempts."

Relational and Family Harm

The research record includes documentation of harm to family relationships as a consequence of exposure to conversion therapy. Specific relational harms include:


  • Erosion of trust between children and parents, particularly when parents initiated or supported conversion interventions.

  • Long-term damage to the parent-child relationship, sometimes persisting for years or decades.

  • In some documented cases, permanent family estrangement.


The FAP research found that many of these relational harms are addressable and, in some cases, reversible when families shift from rejecting to accepting behaviors. The research showed that family-accepting behaviors, including use of a young person's preferred name and pronouns, advocating for the young person in school or community settings, and maintaining relationship connection, are associated with measurably better health outcomes.

Harm Documented in the Legal Record

The Ferguson v. JONAH verdict documents firsthand accounts of participants who described personal harm from conversion therapy participation, including emotional distress, family estrangement, and, in at least one participant's account, years-long psychological consequences. The Southern Poverty Law Center, which brought the suit, described testimony revealing group exercises involving humiliation, boundary violations, and tactics that externalized blame onto participants' family members.

  • Economic Burden

    Research published in JAMA Pediatrics (2022) conducted the first systematic economic modeling of the costs associated with conversion therapy in the United States. Key findings include:


    • The estimated total annual cost of SOGIECE among LGBTQ+ youth in the U.S. is approximately $650 million.

    • When associated harms, including increased rates of substance abuse, depression, and suicide attempts requiring medical attention, are factored in, the total estimated annual economic burden reaches approximately $9.23 billion.

    • On a per-individual lifetime basis, SOGIECE is estimated to be associated with approximately $97,985 in additional costs and 1.61 quality-adjusted life years (QALYs) lost.

    • By contrast, affirmative therapy yielded estimated cost savings of $40,329 with 0.93 QALYs gained compared to no intervention.


    The study modeled outcomes across a broad national population of LGBTQ+ youth and used a standard public health cost-effectiveness framework to reach these estimates.

Legal Landscape in the US

Federal Level

As of 2026, there is no federal law banning conversion therapy. However, federal agencies including SAMHSA and the Department of Health and Human Services (HHS) have issued guidance and policy statements opposing the practice.

State Bans

According to tracking by the Movement Advancement Project (MAP), as of early 2026:

  • 23 states and the District of Columbia have enacted laws banning conversion therapy for minors by licensed mental health professionals.

  • 5 states have enacted partial bans.

  • 5 states have enacted laws prohibiting local governments from enacting their own bans.

  • 18 states have no statewide law addressing the practice.

State bans generally apply to licensed mental health practitioners and do not, in most cases, regulate religious or pastoral counseling.

Key Litigation: Chiles v. Salazar

A significant legal challenge to state-level bans is currently working its way through the U.S. court system. In Chiles v. Salazar, the Alliance Defending Freedom has challenged Colorado's ban on conversion therapy for minors, arguing that it violates First Amendment free speech protections for licensed therapists. Legal scholars, including Harvard Law professor Noah Feldman, have noted that if the Court treats talk therapy as protected speech, it could have significant downstream implications for other forms of professional speech regulation.


Legal experts, including Claudia Haupt, Professor of Law and Political Science at Northeastern University, have noted that the Supreme Court's resolution of this case will determine whether therapists' conversations with patients are regarded as medical treatment or as a form of protected speech. The American Psychological Association, as amicus, has argued that professional therapy is regulated conduct, not speech, and falls within states' established authority to regulate professional practice.

Consumer Fraud Applications

Beyond professional licensing regulation, some states and localities have pursued conversion therapy under consumer protection and fraud statutes. The Ferguson v. JONAH case in New Jersey established a legal precedent for treating the sale of conversion therapy services, specifically the false representation that they can change sexual orientation, as consumer fraud actionable under state consumer protection law.

  • International Legal Context

    Several countries have enacted national bans or restrictions on conversion therapy:


    • Canada: The Conversion Therapy Criminal Code Amendment Act (Bill C-4), passed in 2021, criminalizes the practice of conversion therapy, including causing a minor to undergo it, and prohibits advertising or profiting from it.

    • France: Enacted a national ban in 2022.

    • Germany: Banned conversion therapy for minors in 2020.

    • New Zealand: Enacted the Conversion Practices Prohibition Legislation Act in 2022.

    • United Kingdom: Legislative efforts to enact a national ban have been ongoing, with England and Wales under continued review.

    • Malta: Banned the practice in 2016, among the first countries to do so nationally.


    The WHO's call to end conversion therapy characterizes it as a practice that lacks medical justification, is not grounded in evidence, and poses measurable risks to mental health.

Clinical Alternatives Recognized by Professional Bodies

The research literature and professional body guidance consistently identify several evidence-based therapeutic approaches as appropriate for gender-diverse and LGBTQ+ youth seeking clinical support. These approaches do not have a predetermined outcome and are not designed to change identity.


Affirmative therapy: A clinical framework described in the SAMHSA 2023 report and endorsed by the APA that "provides culturally responsive and client-centered treatment" including acceptance and support, identity exploration and development, and help managing minority stress.


The Dutch Protocol (watchful waiting approach): An approach developed at the VU University Medical Center in Amsterdam, described in the clinical literature as prioritizing comprehensive psychological assessment and careful, individualized monitoring of gender-related distress before any medical intervention. The protocol is associated with the original research cohort on which current understanding of gender dysphoria in adolescents is substantially based. See de Vries & Cohen-Kettenis (2012) for the foundational clinical description.


Family-based support models: The Family Acceptance Project has developed and published evidence-based family education materials showing that increased parental acceptance is measurably associated with improved mental health outcomes. This model supports families in adjusting their responses to LGBTQ+ young people without requiring ideological shifts as a precondition.


Supportive individual and group therapy: General therapeutic support focused on managing distress, building resilience, and improving functioning, without a predetermined identity outcome, is recognized by major professional bodies as appropriate and potentially beneficial.

  • Frequently Asked Questions

    What is the difference between conversion therapy and gender-affirming care?

    Conversion therapy attempts to change a person's sexual orientation or gender identity to conform to a predetermined standard (typically heterosexual and cisgender). Gender-affirming care supports a person in aligning their life (socially, medically, or legally) with their experienced gender identity. The two are clinically and ethically distinct: one aims to change identity; the other supports identity as expressed by the individual. The APA and SAMHSA have each addressed this distinction explicitly in their published guidance.


    Is conversion therapy legal in the United States?

    It depends on the state and the setting. More than 23 states and the District of Columbia have enacted laws prohibiting licensed mental health practitioners from practicing conversion therapy on minors. In states without such laws, licensed practitioners may still face professional discipline through licensing board action. Religious or pastoral counseling is generally not regulated by these statutes. See the Movement Advancement Project's tracking map for current state-by-state status.


    Do any major medical organizations support conversion therapy?

    No. Every major medical and mental health professional organization in the United States, including the APA, American Psychiatric Association, American Academy of Pediatrics, American Medical Association, and SAMHSA, has issued formal statements opposing conversion therapy. No peer-reviewed clinical evidence supports its efficacy, and multiple systematic reviews document associated harms.


    Does conversion therapy work?

    The available research does not support the conclusion that conversion therapy reliably or durably changes sexual orientation or gender identity. The APA's 2009 systematic review of more than 80 studies found no high-quality evidence of lasting change in sexual attraction, and SAMHSA's 2023 report states that "no available research supports the claim that SOGI change efforts are beneficial."


    What does the research say about conversion therapy and suicide risk?

    Multiple independent studies have found elevated rates of suicidal ideation and suicide attempts among individuals who have undergone conversion therapy, particularly when exposure occurred in adolescence. The Trevor Project's analysis found that LGBTQ+ youth who underwent conversion therapy were more than twice as likely to have attempted suicide. The Family Acceptance Project's research found attempted suicide rates reaching 63% among youth subjected to combined parental and clinical conversion efforts, compared to 22% among peers with no such exposure.


    What is the DSM's current classification of homosexuality and transgender identity?

    Neither homosexuality nor transgender identity is classified as a mental disorder in the current DSM-5-TR. Homosexuality was removed from the DSM in 1973. Gender dysphoria, defined as clinically significant distress related to gender incongruence, remains a DSM diagnosis, with the explicit note in professional guidance that its inclusion is intended to ensure access to care, not to pathologize gender diversity.


    Are residential conversion camps legal?

    Residential programs are regulated inconsistently across states. While some state bans explicitly include residential settings, others apply only to licensed practitioners, leaving religiously affiliated residential programs in a legal gray area. Legislation targeting residential conversion programs specifically has been introduced in multiple states. Advocates have also pursued these programs through child welfare statutes, consumer protection laws, and professional licensing boards.


    Is there a difference between conversion therapy and exploratory therapy?

    Yes. Exploratory or gender-exploratory therapy is a clinical approach in which a therapist supports a young person in examining their gender identity without a predetermined outcome. It is not designed to produce a cisgender or heterosexual result. The key clinical distinction, as articulated by the APA, is whether the intervention has a fixed outcome goal or whether it supports open-ended identity exploration.

Primary Sources and Further Reading

The following peer-reviewed, governmental, and professional sources were consulted in the preparation of this page. All links are to original or primary sources.


Systematic Reviews and Task Force Reports

Peer-Reviewed Research

Professional Position Statements

Legal and Policy Sources