Covert sensitisation in conversion practices

Domain XVI · Historical, discredited & harmful · Joseph Cautela · 1965

What it is

Covert sensitisation is a behaviour-therapy technique described in the mid-1960s by the psychologist Joseph Cautela: an aversion procedure in which an unwanted behaviour is linked, in imagination rather than physically, with an unpleasant consequence. It was developed and studied for alcohol and…

Format

• Session number and length follow the client's needs and the setting; the phases below are a practice structure built on the affirmative framework the APA 2009 Task Force describes: acceptance and support, comprehensive assessment, active coping, social support, and identity exploration and…
• Phase C, stabilisation and psychoeducation. Goal: accurate information on orientation, gender identity and change efforts; grounding skills for intrusive, conditioned distress. Move on when the client can talk about the history without being overwhelmed.

Who practises it, and how they are trained or regulated

• Phase E, integration, advocacy and follow-up. Goal: community connection, optional complaint or legal routes, relapse-prevention for shame spirals, follow-up. Ending is guided by the client's goals.

Evidence status, as the guide reports it

• The claimed mechanism of change was conditioning: repeated imagined pairing was meant to make same-sex attraction itself aversive. Professional and international bodies state that this does not change sexual orientation. The APA's 2021 resolution states there is "no evidence of sexual orientation…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• tokenism. Working when policy and practice change.
• dissociation or panic; slow down. Working when the client recovers faster after triggers.
• partners' confusion or blame; offer couple sessions if wanted. Working when intimacy feels safer.
• retraumatisation through the process; pace it. Working when the client feels the choice is theirs.
• groups that mix support with renewed pressure to change. Working when the client reports belonging.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.