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HISTORY OF CONVERSION THERAPY

The History
oF Conversion therapy

Research, Examination, and Analysis of the History of the Practice

Last Updated: March 2026

Conversion Truth for Families: State Levels for Conversion
Conversion Truth for Families: Milwuakee State Courthouse
Conversion Truth for Families: Statewide conversion therapy map

TABLE OF CONTENTS

Conversion Truth for Families: Supreme Court Panorama

  • Overview

    The history of conversion therapy spans more than a century and cuts across the fields of psychiatry, psychology, medicine, religion, and law. Its trajectory reflects broader shifts in how Western medicine has understood sexual orientation and gender identity: from classification as pathology, to active efforts at clinical correction, to formal rejection by every major professional body in medicine and psychology.


    Understanding this history requires distinguishing between three overlapping but distinct streams of practice: clinical interventions administered by licensed medical or psychological practitioners; religiously framed programs operated by faith-based organizations; and informal or community-based efforts that did not operate within either a licensed clinical or formal religious structure. All three streams have operated simultaneously across different periods, and all three continue to exist in various forms today.


    This page traces the documented history of each stream, the professional and legislative responses to them, and the ongoing effort by some practitioners and organizations to rebrand change-oriented practices under new terminology.

19th Century Roots

Medicalization of Sexual Orientation

The intellectual and clinical foundations for conversion therapy predate the 20th century. The late 19th century saw the emergence of sexology as a medical discipline, and with it the formal classification of same-sex attraction as a pathological condition.


German psychiatrist Richard von Krafft-Ebing published Psychopathia Sexualis in 1886, one of the first major clinical texts to systematically categorize sexual behaviors. Krafft-Ebing classified homosexuality as a form of "contrary sexual instinct" and framed it as a degenerative condition susceptible to therapeutic intervention. His work was enormously influential in shaping how European and American medicine understood same-sex attraction through the first half of the 20th century.


Concurrent with Krafft-Ebing, the pioneering sexologist Karl Heinrich Ulrichs had argued from the 1860s onward that same-sex attraction was a natural variation rather than a disorder, placing him in early opposition to the dominant medical view. Ulrichs's position, though well documented, did not gain clinical traction for nearly a century.


Sigmund Freud's contributions to the theoretical landscape are more ambiguous than is often assumed. While Freud did theorize that homosexuality reflected arrested psychosexual development, he did not advocate for its treatment as a matter of clinical necessity.


His 1935 letter to an American mother whose son was gay stated plainly that homosexuality "is nothing to be ashamed of, no vice, no degradation" and that while he could not promise to change her son's orientation, he might be able to "bring him harmony, peace of mind, full efficiency." Later psychoanalysts, particularly in the United States, took a markedly more interventionist position than Freud himself had advocated.

Early Intervention Attempts

By the late 19th century, physicians had begun documenting attempts to change sexual orientation through physical means, including surgical procedures and hormone therapies based on theories that homosexuality reflected hormonal imbalance. These early attempts lacked clinical rigor and left no record of documented efficacy. They are important primarily as precursors to the more systematized clinical programs that emerged in the 20th century.

  • 20th Century Clinical Practices

    The Psychoanalytic Era (1900s to 1950s)

    Through the first half of the 20th century, psychoanalytic theory provided the dominant clinical framework for understanding and treating homosexuality. Influenced by the post-Freudian work of analysts including Sandor Rado, who broke with Freud in 1940 by arguing that homosexuality was a phobia-driven disruption of normal heterosexual development, American psychiatry increasingly framed same-sex attraction as a treatable disorder.


    Rado's reformulation was particularly consequential. Where Freud had considered bisexual potential to be universal, Rado argued that heterosexuality was the sole biologically appropriate sexual orientation, making homosexuality by definition an adaptive failure. This position was adopted and expanded by Irving Bieber and colleagues in their 1962 study Homosexuality: A Psychoanalytic Study, which examined 106 gay men in psychoanalysis and concluded that homosexuality resulted from pathological family dynamics.


    Bieber reported that 27% of gay male patients in his sample "became heterosexual" through psychoanalysis, a claim that later researchers found methodologically unreliable due to selection bias, lack of control groups, and reliance on analyst-reported outcomes.


    Charles Socarides, another prominent mid-century psychoanalyst, continued to advocate for the treatability of homosexuality into the 1990s and became one of the most prominent public opponents of declassification. Socarides co-founded the National Association for Research and Therapy of Homosexuality (NARTH) in 1992 after the American Psychiatric Association's removal of homosexuality from the DSM.

    Aversive Behavioral Techniques (1950s to 1970s)

    The post-World War II era saw the expansion of behavioral psychology into the clinical management of homosexuality. Behavioral approaches operated on the premise that sexual orientation was a learned pattern of arousal and could therefore be extinguished and replaced through conditioning.

    The most widely documented techniques from this period include:


    Chemical aversion therapy: Patients were administered nausea-inducing drugs such as apomorphine or emetine and simultaneously shown homoerotic images. The intended result was an association between same-sex attraction and physical illness. This technique was documented in clinical literature throughout the 1950s and 1960s. A review of the methodology and outcomes is available in Haldeman's 1994 analysis published in the Journal of Consulting and Clinical Psychology.


    Electrical aversion therapy: Electric shocks were paired with homoerotic stimuli, with the shock either applied upon exposure to the image or upon the patient's self-reported arousal. This technique was practiced in clinical settings in the United States and United Kingdom from the 1950s through at least the 1970s. British mathematician Alan Turing was subjected to a form of hormonal aversion treatment, chemical castration via synthetic estrogen, as an alternative to imprisonment following his 1952 conviction under the United Kingdom's gross indecency statute. He died in 1954.


    Masturbatory reconditioning ("orgasmic reconditioning"): A behavioral technique in which patients were instructed to use heterosexual imagery at the point of orgasm during masturbation, with the goal of reorienting sexual arousal. This technique was described in behavioral literature from the 1970s.


    Shame aversion therapy: Exposure to homoerotic stimuli in group settings with the deliberate introduction of humiliation. This technique appears in clinical case literature from the 1960s and 1970s and was later documented in survivor accounts compiled by legal and advocacy organizations.

    A comprehensive review of these techniques and their methodological limitations is provided in the American Psychological Association's 2009 Task Force Report, which reviewed more than 80 peer-reviewed studies published between 1960 and 2007.

    The Masters and Johnson Conversion Study (1979)

    Among the most-cited studies in the conversion therapy literature is the work of William Masters and Virginia Johnson, published as Homosexuality in Perspective in 1979. Masters and Johnson reported high success rates in converting homosexual patients to heterosexual functioning. Their reported success rate of approximately 71.6% was widely cited by proponents of conversion therapy for decades.


    The study's methodology was subsequently examined critically by multiple researchers. In 2009, science writer Sanjiv Bhattacharya and, more formally, in a 2012 investigation by journalist Brandy Vines, it was reported that a co-author of the original study, Robert Kolodny, acknowledged that no contemporaneous records could be found to verify the outcomes and that patient files could not be located for independent review. The study is no longer cited as credible evidence by any major medical or psychological organization.

    Hormonal and Surgical Interventions

    Alongside behavioral and psychoanalytic approaches, some practitioners in the 20th century employed hormonal and surgical interventions in attempts to alter sexual orientation. These included testosterone administration (based on the theory that gay men were hormonally deficient), castration in institutionalized populations, and, in some cases documented in European medical literature, neurosurgical procedures including hypothalamic lesioning. These practices were confined primarily to institutional settings and were never endorsed by mainstream professional bodies even at the time of their use.

    A historical review of these practices is documented in Drescher, Zucker, and Stein's (2016) survey in the Journal of Sex and Marital Therapy.

Religious and Pastoral Frameworks

Origins of Faith-Based Conversion Programs

Organized religious efforts to change sexual orientation have operated alongside and often independently of clinical approaches throughout the 20th century. While the theological foundations for these efforts vary by tradition, the common premise across most faith-based conversion programs is that same-sex attraction is inconsistent with religious teaching and that change is achievable through spiritual disciplines, pastoral accountability, and community support.


The modern faith-based conversion movement in the United States took organized form primarily in evangelical Protestant Christianity, beginning in the early 1970s.

Exodus International (1976 to 2013)

Exodus International was the largest and longest-running umbrella organization for faith-based conversion programs in the United States. Founded in 1976, it grew to affiliate with more than 400 ministries across the country and claimed international reach into Canada, Europe, and Latin America at its peak.


Exodus operated primarily through local ministries offering counseling, support groups, and residential programs under the theological framework that while same-sex attraction might persist, sexual behavior could be governed through spiritual discipline and that some members might experience a shift in attraction over time. The organization used the language of "freedom from homosexuality" rather than making direct clinical claims about orientation change.


The organization formally closed in June 2013. Its president, Alan Chambers, issued a public apology at the organization's final conference, stating that he was "deeply sorry" for the "pain and hurt" that Exodus had caused. Chambers acknowledged that he did not believe that conversion therapy, including Exodus's own programs, had changed the sexual orientation of more than 99.9% of participants.
NARTH (1992 to present, restructured)

The National Association for Research and Therapy of Homosexuality (NARTH) was founded in 1992 by psychoanalysts Charles Socarides and Joseph Nicolosi, along with sociologist Benjamin Kaufman, following the American Psychiatric Association's reaffirmation of its declassification of homosexuality and the growing professional consensus against SOCE. NARTH positioned itself as providing a clinical and scientific counterpoint to that consensus.


NARTH published its own journal, provided referrals to therapists offering SOCE, and submitted amicus briefs and legislative testimony opposing conversion therapy bans. The organization restructured in 2016 and the clinical arm was reorganized under the name Alliance for Therapeutic Choice and Scientific Integrity (see Rebranding and Renaming Efforts below).

Catholic and Other Denominational Programs

Faith-based conversion efforts have not been confined to evangelical Protestantism. Catholic programs, operating variously under the names Courage International and Encourage, have offered pastoral support frameworks premised on the theology that same-sex attracted Catholics are called to celibacy. Courage International, founded in 1980 by Father John Harvey, does not make claims of orientation change and focuses instead on what it describes as chaste living, distinguishing it from programs that explicitly promise reorientation.


Mormon-affiliated support programs, operating for decades within The Church of Jesus Christ of Latter-day Saints' institutional structure, also offered change-oriented programs and group support systems. The church's posture on these programs has shifted over time. A 2012 resource published on the church's website acknowledged that "the origins of same-sex attraction are not fully understood" and did not endorse orientation change efforts, though the church continues to teach that same-sex sexual activity is contrary to its doctrine.

Residential "Ex-Gay" Programs

Throughout the 1980s and 1990s, a network of residential programs operated in the United States offering intensive live-in environments aimed at producing or supporting change in sexual orientation and gender identity. These programs typically combined elements of pastoral counseling, behavioral accountability, group confession or testimony, and structured community living.


Programs such as Love in Action (founded 1973, Memphis) became subjects of public scrutiny and, ultimately, legal investigation. Love in Action operated a residential program called Refuge specifically for minors, which came to significant public attention in 2005 following a teenager's public disclosure of his enrollment and subsequent activism. The state of Tennessee investigated the program in 2005 but found that it did not meet the statutory definition of a mental health facility and thus fell outside the regulatory scope of existing licensure requirements, a gap in oversight that advocates subsequently used to argue for broader legislative action.


The historical and operational details of these residential programs are documented in Shidlo and Schroeder's (2002) study published in Professional Psychology: Research and Practice, which gathered accounts from 202 individuals who had undergone SOCE and provided one of the first systematic retrospective analyses of the participant experience.

  • Clinical Evolution and Professional Reversal

    The Shift in Research Methodology

    Through the 1970s and 1980s, a growing body of researchers applied increasingly rigorous methodological standards to the question of whether SOCE produced lasting change. The conclusions of this research consistently undermined the claims of earlier, less rigorous studies.


    Haldeman's 1994 review in the Journal of Consulting and Clinical Psychology examined studies from the prior three decades and found that no study meeting basic methodological standards had demonstrated that sexual orientation change was achievable or durable. Haldeman identified a consistent pattern: studies reporting positive outcomes relied on small, self-selected samples; used outcome measures that conflated behavior change with attraction change; lacked follow-up data; and in many cases were conducted by researchers with an explicit prior commitment to the treatability of homosexuality.


    Spitzer (2003) published a study in the Archives of Sexual Behavior reporting that some highly motivated individuals could achieve sustained change in sexual orientation following SOCE. The study was widely cited by conversion therapy proponents and represented one of the few post-1990 attempts by a credentialed researcher to argue for the possibility of change. In 2012, Spitzer formally retracted the study's conclusions, stating that his study had been fatally flawed because it relied on self-report from individuals recruited through pro-SOCE organizations and that he could not verify whether genuine change in underlying attraction had occurred. He published a formal apology to gay men and lesbians who had "wasted years in useless attempts to change."

    The APA Task Force (2009)

    The most systematic review of the clinical literature to date was produced by the American Psychological Association's Task Force on Appropriate Therapeutic Responses to Sexual Orientation, which reviewed 83 peer-reviewed studies published between 1960 and 2007. The Task Force concluded that the evidence did not support the efficacy of SOCE and that evidence existed of associated harm, including depression, anxiety, and suicidal ideation.


    The Task Force report also addressed the question of what constitutes appropriate care for clients experiencing distress related to sexual orientation, recommending "affirmative multiculturally competent" approaches that support clients' wellbeing without a predetermined outcome goal.

    Gender Identity and the Expansion of Clinical Concern

    While the early history of conversion therapy focused almost entirely on sexual orientation, clinical attention to gender identity change efforts expanded significantly beginning in the 1990s and 2000s. The work of Kenneth Zucker at the Centre for Addiction and Mental Health (CAMH) in Toronto became a focal point of this debate.


    Zucker's approach to childhood gender nonconformity, which involved encouraging children to develop comfort with their birth-assigned sex rather than supporting gender-nonconforming expression, was classified by critics as a form of gender identity change effort. CAMH conducted an external review of the Gender Identity Service that Zucker led, and in 2015 closed the clinic, citing findings that included approaches that were "not in step with the current clinical and research evidence." The case became central to debates about the boundary between gender-exploratory therapy and gender identity change efforts.


    The APA's 2021 resolution on Sexual Orientation and Gender Identity Change Efforts formally extended the professional consensus against SOCE to include gender identity change efforts, applying the same framework of documented harm and lack of efficacy to both.

The Declassification of Homosexuality


The 1973 APA Vote

The formal pivot in American psychiatry's treatment of homosexuality occurred on December 15, 1973, when the Board of Trustees of the American Psychiatric Association voted to remove homosexuality from the Diagnostic and Statistical Manual of Mental Disorders. The vote was subsequently ratified by the full membership in 1974.


The decision followed several years of organized advocacy, public protests at APA conventions beginning in 1970, and a sustained internal review process. Key figures in the declassification effort included Frank Kameny, an astronomer and activist who had been dismissed from a federal job in 1957 because of his sexual orientation and who became one of the most persistent advocates for declassification, and Dr. Evelyn Hooker, whose landmark 1957 study demonstrated that independent clinicians could not distinguish between the psychological profiles of gay and heterosexual men on standard projective tests, directly undermining the clinical premise that homosexuality was a pathological condition.


Hooker's 1957 study, published in the Journal of Projective Techniques, is widely cited as a foundational empirical contribution to the declassification movement. It is discussed in detail in the APA's own retrospective accounts of the declassification process.


The history of the declassification process is comprehensively documented in Ronald Bayer's (1981) book Homosexuality and American Psychiatry: The Politics of Diagnosis, which remains the standard historical reference on the subject.

Ego-Dystonic Homosexuality and the DSM-III

Declassification did not immediately end the clinical framework for treating homosexuality. The DSM-III, published in 1980, introduced the category of "ego-dystonic homosexuality," defined as homosexuality accompanied by persistent distress about one's sexual orientation and a desire to change it. This category effectively preserved a clinical pathway for conversion-oriented treatment for patients who expressed a desire to change.

The category was removed in the DSM-III-R in 1987.


The rationale for removal, as documented in the revision process, was that the category was redundant, since any sustained and unwanted aspect of one's psychological life could generate clinically significant distress, and that its continued presence in the manual implied a unique pathological status for homosexuality that was not applied to other aspects of identity.

Subsequent DSM Revisions

The DSM-IV (1994) and DSM-5 (2013) retained no diagnostic category premised on homosexuality or same-sex attraction as pathological. The DSM-5 replaced the category of Gender Identity Disorder with Gender Dysphoria, a revision that shifted the diagnostic focus from identity to distress, with the explicit intent of facilitating access to care rather than pathologizing gender diversity. The DSM-5-TR (2022) retained Gender Dysphoria with clarifying language.

  • Post-Declassification Persistence

    The Continued Practice After 1973

    The removal of homosexuality from the DSM did not end the practice of conversion therapy. Practitioners affiliated with psychoanalytic traditions, particularly those organized around NARTH following its 1992 founding, continued to offer SOCE. Religious programs continued and, in some periods, expanded. Surveys of practicing therapists conducted by researchers including Shidlo and Schroeder (2002) documented ongoing referral networks and active practices into the 2000s.


    The Williams Institute at UCLA estimated in 2019 that approximately 698,000 LGBTQ+ adults in the United States had been subjected to conversion therapy at some point in their lives, with approximately 350,000 having been subjected to it as minors. These figures indicate that the practice did not diminish significantly following declassification without legal intervention.

    The Emergence of "Voluntary" Framing

    In the decades following declassification, proponents of SOCE increasingly emphasized the voluntary nature of treatment and the importance of client self-determination as a defense against professional and legislative challenges. This framing argued that adults who sought to change their sexual orientation for religious or personal reasons had a right to access such services.


    The APA's 2009 Task Force addressed this framing directly, noting that the voluntariness of treatment does not insulate it from ethical scrutiny if the treatment lacks a credible evidence base and carries documented risks. The Task Force also noted the structural complications of consent in cases involving minors, where the decision to undergo SOCE is typically made by parents rather than the young person.

Modern Bans and Legislative History

The First State Ban: California (2012)

California became the first state in the United States to enact a law banning licensed mental health practitioners from administering conversion therapy to minors when Governor Jerry Brown signed Senate Bill 1172 into law on September 30, 2012. The law prohibited mental health providers from engaging in SOCE with patients under 18 and took effect on January 1, 2013.


The law was immediately challenged on First Amendment grounds. The Ninth Circuit Court of Appeals upheld the law in 2013 in Pickup v. Brown, ruling that it regulated professional conduct, not speech, and that such regulation fell within the state's established authority over licensed professionals.

Federal Court Divergence and Resolution

As more states enacted bans, federal circuit courts diverged on the constitutional question. The Third Circuit upheld New Jersey's ban in King v. Governor of New Jersey (2014), applying the same conduct-regulation framework as the Ninth Circuit. However, the Eleventh Circuit in Otto v. City of Boca Raton (2020) struck down local bans in Florida, applying a higher level of First Amendment scrutiny and ruling that therapy consisted substantially of speech.


This circuit split has elevated the constitutional question toward potential Supreme Court resolution. The case Chiles v. Salazar, involving Colorado's ban, has been identified by legal scholars as the most likely vehicle for a definitive ruling.

State-by-State Legislative Expansion

Following California's 2012 law, additional states moved to enact similar legislation, with the pace accelerating through the late 2010s and early 2020s. According to tracking by the Movement Advancement Project, more than 23 states and the District of Columbia had enacted laws banning conversion therapy for minors by licensed practitioners as of early 2026.


Key legislative milestones include:

  • New Jersey (2013): Second state to enact a ban, signed by Governor Chris Christie.

  • Illinois (2015): Enacted a ban covering licensed mental health professionals.

  • Oregon (2015): Enacted a ban.

  • Vermont (2016): Enacted a ban.

  • New Mexico (2017): Enacted a ban.

  • Connecticut (2017): Enacted a ban.

  • Nevada (2017): Enacted a ban.

  • Rhode Island (2017): Enacted a ban.

  • Washington (2018): Enacted a ban.

  • Hawaii (2018): Enacted a ban.

  • Maryland (2018): Enacted a ban.

  • New Hampshire (2018): Enacted a ban.

  • Delaware (2018): Enacted a ban.

  • New York (2019): Enacted a ban.

  • Massachusetts (2020): Enacted a ban.

  • Colorado (2019): Enacted a ban, subsequently the subject of Chiles v. Salazar.

  • Virginia (2020): Enacted a ban.

  • Utah (2020): Enacted a ban, notable given the state's predominant religious composition.

Consumer Protection Approaches

Beyond licensing regulation, some states and localities pursued conversion therapy under consumer fraud and deceptive trade practice statutes. The 2015 verdict in Ferguson v. JONAH in New Jersey established that the fraudulent marketing of conversion therapy constituted actionable consumer fraud under the state's Consumer Fraud Act. This approach addressed a gap in purely licensing-based regulation by targeting the commercial representation of conversion therapy services regardless of the provider's licensure status.

Federal Legislative Efforts

Multiple federal bills have been introduced in Congress to restrict or ban conversion therapy nationwide. The Therapeutic Fraud Prevention Act was introduced in multiple sessions, framing conversion therapy as a deceptive commercial practice subject to Federal Trade Commission oversight. As of early 2026, no federal ban has been enacted.

International Bans

Several countries have enacted national prohibitions on conversion therapy at the criminal law level:

  • Canada (2021): Bill C-4 amended the Criminal Code to criminalize causing a person to undergo conversion therapy, performing conversion therapy, advertising it, and receiving financial benefit from it. The law passed with unanimous support in both the House of Commons and the Senate.

  • France (2022): Enacted a national criminal ban.

  • Germany (2020): Enacted a ban covering minors and adults who are not capable of freely consenting.

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

  • Malta (2016): Among the earliest national bans, enacted as part of a broader civil rights framework.

  • Albania (2021): Enacted a ban on conversion practices by licensed professionals.


The World Health Organization's 2023 report characterizes conversion therapy as a practice lacking medical justification that poses documented risks to mental health and calls for its end globally.

  • Rebranding and Renaming Efforts

    The Pattern of Terminological Shift

    One of the more documented phenomena in the recent history of conversion therapy is the systematic effort by some practitioners and organizations to rebrand change-oriented practices under new terminology following legislative and professional bans. Researchers and policy analysts have identified a recurring pattern: as specific terms become legally restricted or professionally stigmatized, practitioners and organizations introduce new language to describe substantially similar practices.


    SAMHSA's 2023 report addresses this pattern explicitly, noting that "efforts to change SOGI have been rebranded using terms such as 'sexual attraction fluidity exploration in therapy' (SAFE-T), 'sexual orientation change efforts,' 'reintegrative therapy,' 'gender-exploratory therapy,' and others."


    NARTH's Restructuring

    Following increasing professional isolation and the wave of state legislative bans beginning in 2012, NARTH restructured in 2016, with its clinical arm reorganizing under the name Alliance for Therapeutic Choice and Scientific Integrity (ATCSI). The organization's stated focus shifted from promoting orientation change to advocating for the right of clients to access therapy that aligns with their religious values, including treatment that does not presuppose a fixed sexual orientation.


    The rebranding adopted language centered on "therapeutic choice," "client self-determination," and "sexual fluidity" rather than the explicit language of reorientation.


    "Reintegrative Therapy"

    Reintegrative therapy is a model developed by British psychotherapist Joseph Nicolosi Jr. following the death of his father, Joseph Nicolosi Sr., who had been a co-founder of NARTH and one of the most prominent practitioners of SOCE. Reintegrative therapy presents itself as addressing trauma-based "unwanted same-sex attraction" rather than directly changing sexual orientation.


    Researchers and professional bodies have characterized this framing as a substantive rebrand of reparative therapy. A 2021 peer commentary in the Journal of Sexual Medicine observed that reintegrative therapy shares the foundational premise of earlier SOCE models, specifically that same-sex attraction is a symptom of unresolved trauma or attachment deficit, and that addressing the underlying issue may allow heterosexual attraction to emerge. Critics argue that this constitutes a functional orientation change effort regardless of the terminology used.


    "Gender-Exploratory Therapy"

    The term "gender-exploratory therapy" has been used in two substantially different ways in the clinical literature and this distinction is important to document accurately.


    In the mainstream clinical context, gender-exploratory therapy refers to an approach endorsed by several professional bodies, including aspects of the approach described in the Royal College of Psychiatrists' guidance, in which a therapist works with a young person to explore their gender identity without a predetermined outcome, neither toward transition nor away from it. This approach is not considered conversion therapy by the clinical mainstream.


    However, the same term has been adopted by a separate group of practitioners whose stated clinical goal is to resolve or reduce gender dysphoria without transition. SAMHSA's 2023 report and the APA's 2021 resolution both address this terminological ambiguity, noting that the label "gender-exploratory" does not itself determine whether an intervention constitutes a gender identity change effort. The determining factor, per professional guidance, is whether the intervention has a predetermined outcome goal of reducing or eliminating the patient's gender incongruence.

    "Sexual Attraction Fluidity Exploration in Therapy" (SAFE-T)

    SAFE-T is a term developed and promoted by Christopher Doyle, a certified professional counselor and conversion therapy advocate. The SAFE-T framing draws on research into sexual fluidity (primarily the longitudinal work of researcher Lisa Diamond at the University of Utah) to argue that some individuals' sexual orientation is genuinely fluid and that therapy can support clients in exploring that fluidity in accordance with their values.


    Lisa Diamond has publicly stated that her research on sexual fluidity has been misappropriated by conversion therapy proponents and does not support the use of therapeutic techniques to direct or encourage the change process. Diamond's research documents naturally occurring variability in sexual attraction over time, not the efficacy of therapeutic intervention.


    SAMHSA's 2023 report lists SAFE-T among the rebranded forms of SOCE that the report's guidance is intended to address.

    "Unwanted Same-Sex Attraction" Framing

    A common thread across several rebranding efforts is the use of the phrase "unwanted same-sex attraction" to reframe the therapeutic goal. By centering the client's stated desire to reduce same-sex attraction rather than the practitioner's treatment goal, this framing attempts to position SOCE as a form of client-centered therapy responsive to the patient's own stated values and preferences.


    Professional bodies have addressed this framing by distinguishing between a therapist's obligation to respond to client distress (which is well established) and a therapist's obligation to pursue a specific clinical goal on the basis of a client's expressed preference (which is subject to the same standards of evidence and harm assessment as any other clinical intervention). The APA's ethical guidelines state that psychologists do not engage in unfair discrimination and that therapeutic practice must be grounded in scientific and professional knowledge.

    Legislative Responses to Rebranding

    Some states have begun to address rebranding by drafting legislation with broader functional definitions of conversion therapy rather than definitions tied to specific named techniques or terminology. For example, Colorado's ban (subsequently challenged in Chiles v. Salazar) defines conversion therapy by its goal (changing sexual orientation or gender identity) rather than by any specific method, a drafting approach intended to capture rebranded practices under the same prohibition.


    SAMHSA's 2023 report recommends that policymakers and licensing boards adopt functional definitions for similar reasons.

Primary Sources and Further Reading

Historical and Foundational Studies

Systematic Reviews and Task Force Reports

Historical and Clinical Surveys

Legal and Policy Sources

Peer-Reviewed Research on Harms and Rebranding