A systematic review of the efficacy, harmful effects, and ethical issues related to sexual orientation change efforts.

Abstract

Sexual orientation change efforts (SOCE) are practices intended to eliminate same-sex attraction. We systematically review the literature on the efficacy of SOCE and discuss ways in which SOCE violate ethical guidelines for working with LGBQ clients. Existing literature indicates that SOCE are not efficacious in altering sexual orientation. Studies concluding otherwise often contain methodological limitations, such as biased recruitment or a retrospective design, that weaken the validity or prevent the generalizability of results. Many studies report negative outcomes associated with SOCE, such as depression, relationship dysfunction, and increased homonegativity. SOCE-oriented therapies also violate the American Psychological Association's (APA) ethical guidelines for working with LGBQ populations. In contrast, affirming therapies are efficacious, consistent with APA guidelines, and are associated with positive outcomes for LGBQ clients. Public Health Significance StatementTherapies promoting attempts to alter sexual orientation are unlikely to be successful and, in many cases, may cause significant harm to participants. Such therapies also violate the American Psychological Association's (APA) ethical guidelines for working with LGBQ clients. Individuals who experience conflict between their sexual orientation and other identities should instead seek affirming therapy to learn how to integrate these identities.

LGBTQ+ conversion therapy and applied behavior analysis: A call to action

“…First, a much larger body of research on conversion therapy exists beyond Rekers and Lovaas (1974), much of which is published in behavior‐analytic journals or makes use of fundamental behavior‐analytic principles and procedures. Rekers and Lovaas is just one example of this body of research, which was especially prevalent throughout the 1960s and 1970s across a range of behavioral and psychological journals (for more complete historical accounts see: Davison, 2016; Przeworski et al, 2020; Serovich et al, 2008).…”

“…Many syntheses of these procedures have also been attempted, such as providing release from electric shock when heterosexual or gender‐conforming stimuli were presented (e.g., Solyom & Miller, 1965; Thorpe et al, 1964). It should also be noted that, although these examples clearly illustrate the involvement of behavior‐analytic principles in the design of conversion therapy practices, other disciplines and fields have been involved as well (e.g., medical, mental health, and religious practices; Flentje et al, 2013; Przeworski et al, 2020).…”

“…Moreover, these three papers in JABA comprise only a relatively small portion of the broader research literature on conversion therapy that was published in other behavioral and psychological journals around the same time period. Other journals containing studies on conversion therapy practices include Behaviour Research and Therapy (e.g., Barlow et al, 1975; McConaghy, 1975), Behavior Therapy (e.g., Tanner, 1974), Journal of Consulting and Clinical Psychology (e.g., Brownell et al, 1977), British Journal of Psychiatry (e.g., Fookes, 1969), and others (for more complete reviews, see Przeworski et al, 2020 and Serovich et al, 2008). This broader group of studies may also merit consideration for the same review processes according to the COPE (2019) standards by the leadership of their respective journals.…”

“…However, it is likely that not all behavior analysts are in contact with the relevant literature, history, and terminology regarding conversion therapy that we used to arrive at the above conclusions. For example, many behavior analysts may be unaware of the history and discriminatory nature of conversion therapy practices, or of all the various forms that such practices may take (Flentje et al, 2013; Johnson, 2020; Przeworski et al, 2020). The code items referenced above are also not a comprehensive review.…”

“…Presently, a clear scientific consensus exists regarding conversion therapy: There is no sound scientific evidence to support its purported effects (Adelson & AACAP, 2012; American Psychiatric Association, 2018; Przeworski et al, 2020; Serovich et al, 2008), and there is abundant evidence that conversion therapy causes substantial harm to those subjected to it, such as increased risks for depression, anxiety, and suicide (Drescher et al, 2016; James et al, 2016; The Trevor Project, 2020). Accordingly, conversion therapy is today considered a fundamentally unscientific and unethical practice by a wide range of professional organizations and public institutions (e.g., Human Rights Campaign, 2020; Pan American Health Organization, 2012; United Nations General Assembly, 2020).…”