Aversion therapy in conversion practices

1. Introduction

Version followed: the psychotherapist's own work with the history and legacy of aversion therapy used to try to change sexual orientation, as documented in the two 2004 BMJ oral histories of British treatment (Smith, Bartlett and King on patients; King, Smith and Bartlett on professionals), the Wellcome Collection's 2018 account of Kurt Freund's Czechoslovak work, the American Psychological Association's (APA) February 2021 resolutions, the UK Memorandum of Understanding on Conversion Therapy (version 2, October 2017, revision A, 3 July 2019) and the UN Independent Expert's 2020 report A/HRC/44/53. This guide does not teach aversion therapy and gives no procedure of it. The general history of aversion therapy in all its uses is in Domain II 051 (covert sensitisation: II 052 and XVI 064); it is not repeated here.

What it was. From the 1950s to the 1970s, clinicians in several countries used aversion therapy (pairing same-sex attraction with an unpleasant stimulus, most often electric shock or induced nausea) in an attempt to change gay men's, and some women's, sexual orientation. Wellcome Collection historians describe the aim as linking same-sex attraction with discomfort so as to change both behaviour and identity; aversion methods had been developed in America in the late 1930s for alcoholism and by the 1950s were applied in Western and Communist countries to a range of behaviours then labelled deviant [source: Williams, Marks and Pick 2018, Wellcome Collection]. In Britain, behavioural aversion therapy was the most common change treatment reported by former patients, mainly from the early 1960s to the early 1970s, given mostly in NHS hospitals [source: Smith, Bartlett and King 2004]. Hans Eysenck's advocacy of behaviour therapy in Britain is often linked to this period [uncertain: not verified].

Its proponents' idea of change, and what happened. Proponents held that conditioning could weaken same-sex attraction and strengthen heterosexual response [source: Williams, Marks and Pick 2018]. It did not work: Freund, who ran such treatments in Czechoslovakia, later wrote that they "consistently failed to eliminate gay attraction" [source: Wellcome Collection 2018]; no British former patient interviewed in 2004 reported any direct benefit, and the authors note outcome studies show no evidence that these treatments changed orientation [source: Smith, Bartlett and King 2004]. The APA's 2021 resolution states "there is no evidence of sexual orientation change" from such efforts [source: APA press release, 2 March 2021], and the UK Memorandum's signatories agree that conversion therapy is unethical and potentially harmful and that neither sexual orientation nor gender identity is itself a sign of mental disorder [source: MoU v2 rev A]. The UN Independent Expert reports that aversion methods, including electric shocks, are still reported in many countries [source: A/HRC/44/53].

The psychotherapist's work. Today this history matters mainly in work with older LGBTQ+ survivors (now usually in their seventies or older) treated in NHS, military or state settings, with veterans of military programmes such as the apartheid-era South African Defence Force aversion programme, with families and descendants, with former clinicians who administered such treatments, with clients exposed to aversive methods in present-day change efforts, and with clients who seek to change their own orientation. Change in this work comes from acknowledgement of what happened, de-shaming, an affirming relationship, safety, standard trauma and grief work, and, where the client wants it, testimony and redress [synthesis].

2. Framework

Historical phases in outline (for orientation; no methods given):

Czechoslovakia, 1950s. Psychiatrist Kurt Freund used aversion-based treatment with gay men who sought it; he also developed a physiological measure of arousal that the army used to screen conscription cases. Finding that treatment failed, he abandoned the idea that sexual preference could be altered and lobbied the Communist Party Central Committee for decriminalisation, which came in 1961, with Hungary following soon after. He emigrated to Canada in 1969; his evidence is described as one strand behind the American Psychiatric Association's 1973 removal of homosexuality from the DSM [source: Wellcome Collection 2018]. Exact dates of this work (often given as 1950–1962) [uncertain: not verified].
Britain, 1950s to 1970s. Former patients reported hormone treatment to reduce libido in the 1950s, behavioural aversion therapy mainly from the early 1960s to the early 1970s (a nausea-based form less often, in the early 1960s), and later psychoanalysis (1970s) and religious counselling (1990s); other approaches included electroconvulsive therapy, hypnosis, psychodrama and abreaction. Treatment was mostly in NHS hospitals across Britain (one case in a military hospital), with referrals from general practitioners, after teachers' referrals, and from courts after arrest as an alternative to prison [source: Smith, Bartlett and King 2004]. Professionals described clinics in several British cities, peaking in the 1960s and 1970s; the treatments never became mainstream in the UK [source: King, Smith and Bartlett 2004]. The 1967 change in the law ended government-sanctioned "treatments" within the criminal justice system [source: Wellcome Collection 2018]. Use elsewhere in the Commonwealth in this period [uncertain: not verified].
Apartheid South Africa. A secret South African Defence Force programme ran to "treat" gay men; historians link survivors' later testimony to the Truth and Reconciliation Commission's public healing process [source: Reddy, Wiebesiek and Munthree 2013].
Today. The UN Independent Expert found conversion practices in at least 68 countries, carried out by health providers, faith-based organisations, traditional healers, families and sometimes State agents; aversion methods including electric shocks are reported in many countries [source: A/HRC/44/53]. In a US study, about 7% of non-transgender LGB adults had experienced conversion efforts, 81% of them from a religious leader and 31% from a health-care provider [source: Williams Institute summary of Blosnich et al. 2020].

Phases of the psychotherapist's work [synthesis]; session number and length follow the client's needs and the setting:

Recognition and assessment. Goal: learn whether the client was subjected to (or is drawn to, or administered) aversion treatment, in what setting and under what coercion; assess current risk. Format: individual sessions, paced by the client. Move on when risk is assessed and a safety plan exists where needed, and the client has said what they want from therapy.
Safety, stabilisation and alliance. Goal: an affirming, non-directive relationship; managing suicidality, trauma symptoms, triggers in clinical settings and mistrust of clinicians; safeguarding any child at risk. Move on when the client can talk about the treatment without becoming overwhelmed and has ways to settle afterwards.
Processing and repair. Goal: work through shame, trauma memories, grief for lost years and relationships, sexual and relational difficulties, and spiritual or family conflict, using standard evidence-based approaches the therapist is trained in. Move on when the client's own goals are being met or the client chooses to move to testimony or closure.
Advocacy, redress and follow-up. Goal: support any wish to testify, complain, seek redress, join oral-history or survivor work, or reconnect with community; agree follow-up. End by the client's choice, with the door left open.

Phases overlap; risk reassessment continues throughout [synthesis].

3. Guiding principles

Sexual orientation and gender identity are not disorders. Never frame the client's orientation or identity as the problem; the MoU signatories agree neither is itself an indicator of mental disorder [source: MoU v2 rev A].
Change efforts do not work and are associated with harm. Say so plainly when asked; the APA (2021) and the UN Independent Expert (2020) state that change efforts lack evidence and are linked to depression, anxiety, shame, suicidality and other harm [source: APA 2021 press release; A/HRC/44/53].
No predetermined outcome. Work without an agenda that favours any orientation or identity; follow the client's own exploration [source: MoU v2 rev A].
Do not turn away the uncertain or distressed. Help clients who feel conflict or distress about their orientation or identity to reduce distress and reach self-acceptance, rather than refusing them help [source: MoU v2 rev A].
Never provide, supervise or refer to change efforts. No aversive, conditioning, "reorientation" or suppression work of any kind, and no referral to anyone offering it; NHS and other commissioners and providers are not to commission or provide conversion therapy [source: MoU v2 rev A; synthesis for referral].
Consent then was often not free. Many older survivors were referred by courts, doctors or teachers under legal and social pressure; do not assume they "chose" it, and do not blame them if they did [source: Smith, Bartlett and King 2004; King, Smith and Bartlett 2004].
Own the profession's history. The British study's authors call the medicalisation of same-sex attraction the fundamental error; acknowledging this, without defensiveness, is part of the repair [source: Smith, Bartlett and King 2004; synthesis].
Safety first. Assess suicide risk early and repeatedly; former patients reported suicide attempts after treatment, and people exposed to change efforts are nearly twice as likely to report suicidal ideation and attempts [source: Smith, Bartlett and King 2004; Blosnich et al. 2020 via Williams Institute].
Respect faith and address conflict. Religious belief is not the problem to be removed; the UN recommends services that help people explore and affirm their orientation or identity, including family, religious or social conflict [source: A/HRC/44/53].
Children are especially vulnerable. Subjecting children to these practices is contrary to international human rights law; follow child-protection procedures without delay [source: A/HRC/44/53].
Client control and pacing. The client decides what to tell, when, and whether to stop; nothing in therapy should echo the loss of control in the original treatment [synthesis].
Avoid re-enactment. Do not use physiological monitoring, conditioning, aversive imagery or any body-based procedure that could resemble the original treatment; any proposed body-based or imagery method needs explicit consent before and during, a right to stop at any moment, and is never sexual [synthesis].
Minority stress and cultural humility. Place the client's difficulties in the context of criminalisation, stigma and minority stress, and in their own culture and generation [source: A/HRC/44/53 on minority stress; synthesis].
Confidentiality and naming. Older survivors may still fear exposure; agree in advance what is recorded and shared, and never identify the client in advocacy without explicit consent [synthesis].

4. Intervention inventory

The interventions below are the psychotherapist's own work; steps not drawn from a cited source are marked [synthesis]. None is a step of aversion therapy or of any change effort.

4.1 Building your own historical literacy

Purpose / when: before working with older LGBTQ+ clients, veterans, or anyone mentioning "treatment" for homosexuality; so the client does not have to educate you [synthesis].
Steps: (1) Read the two 2004 BMJ oral histories (patients and professionals) and the Wellcome Collection account, and know the outline in section 2: settings, decades, referral routes, legal context (decriminalisation in Czechoslovakia 1961; the 1967 change in Britain; ICD-10 removal in 1992) [source: Smith, Bartlett and King 2004; Wellcome Collection 2018]. (2) Know the current professional positions (APA 2021, MoU v2, A/HRC/44/53). (3) Know your own profession's role: in Britain psychiatrists, psychologists and other clinicians delivered treatment, and GPs referred [source: Smith, Bartlett and King 2004]. (4) Reflect in supervision on your own reactions, including any defensiveness about your profession [synthesis].
Example language (illustrative): "I know something of how men were treated in British hospitals in the sixties. I'd like to hear what it was like for you, in your own words and at your own pace."
Watch for: relief when the client sees you already know the outline (working); over-explaining the history to the client, or turning their story into a history lesson (not working) [synthesis].

4.2 Recognising a history of aversion treatment at intake

Purpose / when: many survivors never volunteer it; ask sensitively with older gay and bisexual men, trans and gender-diverse elders, veterans of conscript armies, and anyone who mentions past psychiatric admission, a court or police history linked to sexuality, or religious "help" with sexuality [synthesis].
Steps: (1) Include an open question about past attempts by anyone (doctors, therapists, clergy, family, the military, courts) to change or suppress their sexuality or gender. (2) If yes, ask only who, when and where at first; leave detail for later. (3) Note related clues: unexplained fear of hospitals or electrical equipment, avoidance of sex, a marriage entered as a "cure", or a suicide attempt after treatment, which are among outcomes former patients reported [source: Smith, Bartlett and King 2004]. (4) Record minimally and agree what is written down [synthesis].
Example language (illustrative): "Some people your age were sent for treatment to change their sexuality, by doctors, courts or churches. Did anything like that ever happen to you? You don't need to tell me details today."
Watch for: a sudden shift in tone, silence or minimising ("it was nothing"); respect it and return later. Working: the client names it and stays regulated [synthesis].

4.3 Trauma-informed history taking about the treatment

Purpose / when: once the client wishes to tell their story, to understand impact without retraumatising [synthesis].
Steps: (1) Agree a stop signal and a grounding plan beforehand. (2) Ask about context (why referred, by whom, whether under legal threat) before content. (3) Let the client choose how much of the treatment itself to describe; never ask for procedural detail. (4) Ask about effects then and now: shame, isolation, depression, sexual avoidance, relationships, any abuse by staff (some former patients alleged sexual or physical abuse by clinicians [source: Smith, Bartlett and King 2004]). (5) End each session with grounding and a check of risk [synthesis].
Example language (illustrative): "You decide how much of the treatment itself we go into. What matters most to me is what it has meant for your life since."
Watch for: flashbacks, dissociation, nausea or startle in session; slow down and ground. Working: the account becomes more coherent and less overwhelming over time [synthesis].

4.4 Suicide-risk assessment and safety planning

Purpose / when: early and repeatedly; former patients reported suicide attempts after treatment, and exposure to change efforts is associated with nearly double the rate of suicidal ideation and attempts [source: Smith, Bartlett and King 2004; Blosnich et al. 2020 via Williams Institute; APA 2021 press release].
Steps: (1) Ask directly about current and past suicidal thoughts, plans and attempts, including any after the treatment. (2) Assess current risk and protective factors with your service's standard method. (3) Build a written safety plan with the client: warning signs, coping steps, people to contact, professional contacts and crisis lines. (4) Discuss making the environment safer (safe storage or removal of means) in general terms only. (5) Reassess at anniversaries, after disclosure sessions and if contact with family or faith community changes [synthesis]. Crisis lines: 988 Suicide and Crisis Lifeline (US); Samaritans 116 123 (UK and Ireland).
Example language (illustrative): "People who went through treatments like this sometimes think about ending their lives, then or now. Have you ever had thoughts like that? Are you having any at the moment?"
Watch for: hopelessness, isolation, recent loss of a partner or friends, renewed contact with the institution or faith group involved. Talk about suicide without describing methods and without presenting suicide as a response to injustice (safe-messaging) [synthesis].

4.5 Psychoeducation: what was done and why it failed

Purpose / when: many survivors believe they failed the treatment, or that their continuing attraction proved something wrong with them; correct this when the client is ready [synthesis].
Steps: (1) Ask what the client was told then and believes now. (2) Share, briefly and accurately, that these treatments did not change orientation (Freund's own conclusion; the 2004 British study; APA 2021), that orientation is not a disorder (MoU), and that the professionals involved later expressed doubt, guilt and shame [source: Wellcome Collection 2018; Smith, Bartlett and King 2004; King, Smith and Bartlett 2004; MoU v2 rev A]. (3) Invite the client's response; do not lecture. (4) Offer reading only if the client wants it [synthesis].
Example language (illustrative): "The treatment didn't fail because of you. The doctor who ran some of the first of these programmes concluded himself that they never worked. The mistake was in treating who you are as an illness."
Watch for: relief, anger or grief (all expected). If the client reacts with anger at you as a member of the profession, see 4.12. Working: less self-blame in the client's language [synthesis].

4.6 Establishing an affirming, non-directive alliance

Purpose / when: from the first session; the MoU describes helping clients live more comfortably, reduce distress and reach greater self-acceptance, without an agenda favouring any orientation or identity [source: MoU v2 rev A].
Steps: (1) Use the client's own words for their identity and relationships. (2) Make clear you hold no preferred outcome and will not try to change orientation or identity. (3) Show interest in partners, friends and community as normal parts of life. (4) Check periodically whether the client feels judged [synthesis].
Example language (illustrative): "I'm not here to change who you are or who you love. I'm here to help with what has been hard."
Watch for: the client testing whether you are "safe" (for example, mentioning a partner obliquely); respond warmly and plainly. Working: more open talk about relationships and identity [synthesis].

4.7 Responding to a client who asks to change their orientation or gender identity

Purpose / when: a client, perhaps influenced by family, faith or internalised stigma, asks you to help them become heterosexual or to stop being trans, or asks about aversive methods they have read about [synthesis].
Steps: (1) Thank them for saying it; do not refuse help. The MoU says practitioners should not deny or discourage help to people distressed about their orientation or identity [source: MoU v2 rev A]. (2) Say honestly that you will not attempt change, that change efforts do not work and are associated with harm [source: APA 2021 press release; A/HRC/44/53]. (3) Explore the distress itself: what makes change feel necessary, what they fear, whose voice says it, what life they hope for. (4) Work on the conflicts (faith, family, culture, shame) and on self-acceptance, with no predetermined outcome [source: MoU v2 rev A]. (5) Assess suicide risk (4.4) [synthesis].
Example language (illustrative): "I won't try to change your orientation, because that has never been shown to work and it often harms people. But I can help with the distress you're feeling, and we can look together at what's making change feel so urgent."
Watch for: a plan to seek aversive or other change methods elsewhere; give accurate information about harm and keep the door open. Working: the focus shifts from "fixing" to understanding the conflict [synthesis].

4.8 Working with shame and internalised stigma

Purpose / when: shame and isolation were reinforced by treatment, according to former patients [source: Smith, Bartlett and King 2004]; core work in phase 3 [synthesis].
Steps: (1) Help the client trace where each shame belief came from (law, family, faith, the clinic). (2) Distinguish the messages they received from their own values. (3) Use whatever shame-focused or compassion-focused methods you are trained in, adapted to avoid any aversive or imagery-based element the client finds evocative of treatment. (4) Link with affirming community where the client wishes [synthesis].
Example language (illustrative): "Whose voice is that, when you say you're disgusting? Where did you first hear it?"
Watch for: shame spikes after disclosure sessions (check in by the next session); working: the client separates the old messages from themselves [synthesis].

4.9 Trauma-focused work for lasting traumatic stress

Purpose / when: for clients with traumatic stress symptoms linked to the treatment or to abuse during it; many former patients described lasting emotional distress [source: Smith, Bartlett and King 2004]. Harms reported by the UN include depression, anxiety, suicidal thoughts and permanent physical harm [source: A/HRC/44/53].
Steps: (1) Assess traumatic stress with a standard measure your service uses. (2) Offer, or refer to a trained colleague for, a recognised trauma-focused therapy in line with your national guideline [synthesis]. (3) Agree with the client which elements might echo the treatment (for example, exposure to physical sensations or to memories of the clinic) and plan consent before and during, with a right to stop. (4) Keep stabilisation going alongside [synthesis].
Example language (illustrative): "Some trauma therapies ask you to go back over memories. We'd plan that together, and you can stop at any moment. Nothing we do here will involve anything done to your body."
Watch for: retraumatisation, dropout after early sessions; slow down, return to stabilisation. Working: fewer intrusions and less avoidance [synthesis].

4.10 Grief for lost years, relationships and selves

Purpose / when: former patients described avoiding sex, marriages entered as a "cure" that ended in divorce, and lasting distress [source: Smith, Bartlett and King 2004]; older survivors may also grieve partners lost to stigma or illness and the life they could not live [synthesis].
Steps: (1) Name the losses with the client. (2) Allow grief, anger and regret without hurrying to meaning. (3) Where wanted, help the client mark losses (letters, rituals of the client's choosing, visiting places). (4) Explore what remains possible now: relationships, community, creativity [synthesis].
Example language (illustrative): "It sounds like the treatment took more than those months. It took years of a life you might have had. Can we make room for that?"
Watch for: depression deepening into hopelessness (reassess risk, 4.4); working: grief becomes bearable and the client re-engages with present life [synthesis].

4.11 Sexual and relationship difficulties after treatment

Purpose / when: some former patients avoided sex afterwards; some marriages entered as part of a "cure" ended [source: Smith, Bartlett and King 2004].
Steps: (1) Ask permission before raising sexuality; let the client set the language. (2) Explore how the treatment linked desire with fear, disgust or pain in the client's experience, without asking for details of the treatment. (3) Work on safety, pleasure and intimacy at the client's pace; refer, with consent, to an affirming sex and relationship therapist where specialist work is needed (the College of Sexual and Relationship Therapists is a signatory of the MoU [source: MoU v2 rev A]). (4) Include partners only at the client's request [synthesis].
Example language (illustrative): "Sometimes treatments like that leave people feeling that desire itself is dangerous. Is that something you recognise? We can go as slowly as you like."
Watch for: any suggestion that the work aims at a particular sexual outcome (avoid it); working: less fear and avoidance, more choice [synthesis].

4.12 Working with mistrust of clinicians and triggers in health settings

Purpose / when: the treatment was given in hospitals by psychiatrists, psychologists and other clinicians, and some former patients alleged abuse by staff [source: Smith, Bartlett and King 2004]; survivors may fear hospitals, avoid health care or distrust you [synthesis].
Steps: (1) Name the power difference and invite the client to tell you if anything you do feels like the past. (2) Offer choices about room, seating and session structure. (3) Explain any assessment form before using it. (4) Help the client plan for medical appointments (what to say, bringing a companion), and, with consent, liaise with the GP or care home about trauma-aware care [synthesis].
Example language (illustrative): "I'm part of the same profession that did this to you. It would make sense if part of you doesn't trust me. Please tell me if anything I do feels like back then."
Watch for: compliance that hides fear (an echo of court-referred patients saying what was expected [source: King, Smith and Bartlett 2004]); working: the client disagrees with you safely [synthesis].

4.13 Working with religious clients and spiritual conflict

Purpose / when: much present-day conversion work comes from religious leaders [source: Blosnich et al. 2020 via Williams Institute]; the UN recommends services that address family, religious and social conflict around orientation and identity [source: A/HRC/44/53]. Older British former patients also reported religious counselling in the 1990s [source: Smith, Bartlett and King 2004].
Steps: (1) Use the DSM-5-TR Cultural Formulation Interview with its supplementary module on spirituality, religion and moral traditions to understand the client's faith. (2) Where faith conflict is central, the DSM-5-TR "Religious or Spiritual Problem" may be recorded as Z65.8 [source: ICD-10-CM Z65.8 (Unbound Medicine)]; DSM-5-TR wording [uncertain: not verified]. (3) Hold the client's faith with respect; explore the range of positions within their tradition and affirming communities of their faith, without steering. (4) With consent, involve a faith leader the client trusts who does not seek change [synthesis]. Draw on spiritual and religious competencies (Vieten et al. 2013) [synthesis].
Example language (illustrative): "Your faith matters to you, and so does who you are. I won't ask you to give up either. Shall we look at what your tradition actually offers on this, including the voices that don't often get heard?"
Watch for: the therapist's own views about religion leaking in; spiritual distress deepening into risk (4.4). Working: the client experiences faith and identity as less at war [synthesis].

4.14 Work with families and descendants

Purpose / when: the 2004 study included relatives of former patients, one of whom described a brother's death in hospital from treatment side effects [source: Smith, Bartlett and King 2004]; families may carry grief, guilt for having agreed to treatment, or a family story never told [synthesis].
Steps: (1) Hear the family member's account and feelings (grief, guilt, anger). (2) Offer accurate context on the era's law, medicine and pressure, without excusing harm. (3) Support conversations within the family, including with an affected relative if alive and willing. (4) Where a parent today is considering change efforts for a child, give clear information that such efforts do not work and are associated with harm, and that the UN calls for parents and families to be informed of this [source: A/HRC/44/53; APA 2021 press release]; offer family support aimed at acceptance [synthesis].
Example language (illustrative): "You agreed to it because doctors told you it would help. The doctors were wrong. What you feel now makes sense."
Watch for: blame turning into rupture within the family; safeguarding concerns about a child (4.15). Working: the family can speak about it [synthesis].

4.15 Safeguarding children and young people

Purpose / when: whenever a child or young person is being, or is about to be, subjected to change efforts (aversive or otherwise), at home, in a faith setting, abroad, or by any provider. The UN states this is contrary to international human rights law and calls for urgent protection [source: A/HRC/44/53].
Steps: (1) Listen and record the child's own words; do not investigate yourself. (2) Follow your service's child-protection procedure and your jurisdiction's mandatory-reporting duties without delay; consult your safeguarding lead. (3) Where there is immediate danger, contact police or emergency child-protection services. (4) Seek the young person's assent and explain what will happen next, within the limits of confidentiality. (5) Continue affirming support [synthesis].
Example language (illustrative): "Thank you for telling me. Nobody should be trying to change who you are, and it isn't your fault. I need to make sure you're safe, so I'm going to talk to someone whose job is to protect young people, and I'll tell you what happens."
Watch for: risk of the young person being sent abroad or to a residential setting; suicide risk (4.4). Working: the young person stays in contact and safety measures are in place [synthesis].

4.16 When a colleague or institution uses aversive or change practices

Purpose / when: you learn that a colleague, service, faith group or organisation offers or refers to conversion practices, including aversive methods [synthesis].
Steps: (1) Do not take part, supervise or refer [synthesis]. (2) Record what you know factually. (3) Raise it with your line manager or clinical lead and, as appropriate, with the practitioner's professional body or regulator; MoU signatories have committed that NHS and other commissioners and providers will not commission or provide conversion therapy [source: MoU v2 rev A]. (4) If a child is involved, follow 4.15. (5) If you are a psychologist bound by the APA Ethics Code (https://www.apa.org/ethics/code), check whether any dual role (for example, in a faith community that runs such a programme) raises a multiple relationship under Standard 3.05; other ethics duties to report or protect: [synthesis]. (6) Where a practice involves force or lack of consent, the Independent Forensic Expert Group's view, quoted by the UN, is that it constitutes cruel, inhuman or degrading treatment and may amount to torture [source: A/HRC/44/53]; seek legal advice on referral to police.
Example language (illustrative), to a manager: "I'm concerned that this service is referring clients for therapy that aims to change sexual orientation. Our professional bodies say this is unethical and harmful. I'd like us to stop and to review the cases involved."
Watch for: pressure to stay quiet, junior status limiting action (as British professionals described in the 1960s and 1970s [source: King, Smith and Bartlett 2004]); seek support from your professional body. Working: the practice stops and affected clients are offered support [synthesis].

4.17 Supporting testimony, complaints and redress

Purpose / when: some survivors want acknowledgement, to tell their story or to seek redress. The UN recommends complaint mechanisms and access to reparation, including rehabilitation and legal assistance [source: A/HRC/44/53]; in South Africa, survivors' accounts entered the Truth and Reconciliation Commission's public process [source: Reddy, Wiebesiek and Munthree 2013].
Steps: (1) Explore what the client wants (acknowledgement, apology, record, compensation, nothing). (2) Weigh costs: re-exposure, publicity, delays, disappointment. (3) Help them find independent legal or advocacy advice; you do not give legal advice. (4) If they take part in oral history or research, help them plan consent, anonymity and aftercare. (5) Provide reports only within your competence and with consent [synthesis]. Official apologies or redress schemes specific to aversion treatment [uncertain: not verified].
Example language (illustrative): "Some people want an apology, some want it on the record, some want to put it down. What would feel right for you?"
Watch for: your own wish for justice overriding the client's choice; distress spikes around hearings or publication. Working: the client feels heard on their own terms [synthesis].

4.18 Working with veterans of military and state programmes

Purpose / when: for clients treated in military settings (one British former patient was treated in a military hospital [source: Smith, Bartlett and King 2004]; the apartheid-era South African Defence Force ran a secret aversion programme [source: Reddy, Wiebesiek and Munthree 2013]) or screened at conscription [source: Wellcome Collection 2018].
Steps: (1) Recognise the added layers: coercion by the State, loss of career, secrecy, moral injury, and possibly other military trauma. (2) Use the client's terms for the institution and the era. (3) Explore available veterans' services and their affirming record before referral. (4) Support any wish to give testimony (4.17) [synthesis].
Example language (illustrative): "You were young, under orders, and the army decided what was wrong with you. That's a particular kind of betrayal."
Watch for: distrust of any official body; working: the client separates their worth from the institution's verdict [synthesis].

4.19 Working with a client who administered such treatments

Purpose / when: British professionals who gave these treatments later described unease, guilt and shame and felt unable to discuss their involvement; many had become involved by accident and had little autonomy as juniors [source: King, Smith and Bartlett 2004].
Steps: (1) Offer a non-judgemental space to tell the story. (2) Help the client hold responsibility and context together, without either excusing or self-condemnation. (3) Explore repair the client might choose (acknowledgement, contributing to oral history, supporting LGBTQ+ health work). (4) Keep boundaries if the client seeks absolution from you [synthesis].
Example language (illustrative): "You've carried this a long time. Can we look at what you did, what you believed then, and what you'd want to do with it now?"
Watch for: depression and risk in late life (4.4); defensive justification of the treatment (explore it, do not endorse it). Working: the client can speak of it with less shame and more responsibility [synthesis].

4.20 Working with a client drawn to aversive self-conditioning

Purpose / when: a client wants to use aversive methods on themselves (from online advice, a faith group or a device or app) to suppress attraction or gender feelings. Change efforts do not work and are associated with harm [source: APA 2021 press release; A/HRC/44/53]; the UN notes aversion methods are still reported [source: A/HRC/44/53].
Steps: (1) Ask, without alarm, what the client is planning or doing; do not ask for or discuss method detail. (2) Assess risk of self-injury and suicide (4.4); route any physical injury to medical care. (3) Give accurate information on lack of effect and on harm. (4) Explore the distress driving it, as in 4.7. (5) If the client is a minor, or another person is administering it, follow 4.15 or 4.16 [synthesis].
Example language (illustrative): "I can hear how badly you want these feelings to stop. Punishing yourself for them won't change them, and it's likely to hurt you. Can we talk about what's making them feel so unbearable?"
Watch for: secrecy, injuries, escalating self-punishment; working: the client stops and engages with the underlying conflict [synthesis].

5. Handling problems

The problems below are the psychotherapist's own synthesis [synthesis] unless tagged.

The client minimises ("it was a long time ago", "it didn't affect me"). Respect it; do not push. Note gently any links the client makes to present difficulties, and return to the topic only if they open it [synthesis].
Overwhelm during disclosure. Stop the account, ground, and shift to the present. Re-plan with smaller steps and agree what not to go into. Check risk before the session ends (4.4) [synthesis].
Rupture: anger at the therapist as a representative of the profession. Accept it as legitimate; acknowledge the profession's role (the 2004 study names medicalisation as the fundamental error [source: Smith, Bartlett and King 2004]); do not defend, explain or take it personally; ask what would help trust now [synthesis].
The client asks the therapist to attempt change. Do not attempt change; explore the distress (4.7). If the client leaves to seek change elsewhere, give accurate information about harm, keep the door open, and assess risk [source: MoU v2 rev A; APA 2021 press release; synthesis].
Family or faith pressure to resume change efforts. Explore the pressure and the client's own wishes; plan how to respond to relatives or leaders; involve trusted affirming supporters if the client wants. If a minor, follow 4.15 [synthesis].
Stuck in self-blame. Return to the history (4.5) and the coercive context (court, GP and teacher referrals [source: Smith, Bartlett and King 2004]); use the client's own compassion for others as a bridge [synthesis].
Non-attendance or dropout. Older survivors may fear records, institutions or being seen entering a clinic. Offer flexibility of place or format where your service allows, minimal records agreed with the client, and a simple way back [synthesis].
Trauma triggers from ordinary care (hospital admission, care home, electrical equipment, nausea from illness or treatment). Plan ahead with the client; with consent, brief medical or care staff in general terms; never advise on any medicine [synthesis].
Late-life issues: isolation, cognitive decline, entering care. Liaise, with consent, with care providers about affirming care; consider LGBTQ+ older people's services where available; in cognitive decline, protect the client's dignity and confidentiality [synthesis].
Suicidal crisis. Follow your service's crisis procedure and the safety plan; crisis lines 988 (US) and Samaritans 116 123 (UK and Ireland); arrange urgent medical or crisis-team assessment where risk is high. Talk about suicide without method detail or glamorising [synthesis].
Therapist's own reactions (outrage, guilt, rescuing, or discomfort with sexuality). Take them to supervision; check that your stance remains non-directive [source: MoU v2 rev A on practising without an agenda; synthesis].
Conflicting evidence raised by the client. Some clients cite reanalyses disputing the link between change efforts and suicide (for example, a 2022 reanalysis of the 2020 US data [uncertain: not verified]). Acknowledge that studies are debated; state accurately what the APA (2021) and the UN Independent Expert (2020) conclude; return to the client's own experience [source: APA 2021 press release; A/HRC/44/53; synthesis].
Legal uncertainty (for example, in the United States after Chiles v. Salazar). Do not give legal advice; refer to a lawyer or advocacy body; stay with your own professional code, which still sets your own practice [synthesis].

Harm account

What was actually done

Czechoslovakia, 1950s. Psychiatrist Kurt Freund used aversion-based behavioural treatment with gay men who sought treatment, aiming to link same-sex attraction with discomfort; the army used his physiological arousal measure to screen conscripts. He concluded that the treatments consistently failed and campaigned for the decriminalisation that followed in 1961 [source: Wellcome Collection 2018].
Britain, 1950s to 1970s. In NHS hospitals across Britain, and in one reported case a military hospital, psychiatrists, psychologists and other clinicians gave treatments intended to change homosexuality. Former patients reported hormone treatment to reduce libido (1950s), behavioural aversion therapy (mainly early 1960s to early 1970s), a nausea-based aversive approach (early 1960s), and also electroconvulsive therapy, hypnosis, psychodrama and abreaction. Referrals came from GPs, after teachers' referrals, and from courts after arrest as an alternative to prison. Most were not followed up beyond a few months [source: Smith, Bartlett and King 2004]. Clinics existed in several British cities; professionals were often junior, technically focused and gave little attention to ethics or efficacy [source: King, Smith and Bartlett 2004].
Apartheid South Africa. The South African Defence Force ran a secret aversion programme to "treat" gay men, which historians describe as part of the militarised apartheid State's treatment of homosexuals as deviant political subjects [source: Reddy, Wiebesiek and Munthree 2013]. Further detail (dates, sites, reports of other abuses) [uncertain: not verified].
Present day. The UN Independent Expert reports aversion methods, including electric shocks, among conversion practices in many countries, alongside psychotherapy, medical interventions and faith-based practices, carried out by health providers, faith-based organisations, traditional healers, families and sometimes State agents [source: A/HRC/44/53].

What it looked like to patients. British former patients described being shown photographs of undressed men and women while being given electric shocks, so that their attention would shift to the opposite sex; this was usually given as outpatient sessions over weeks, for some for up to about two years, and some were given equipment to use at home [source: Smith, Bartlett and King 2004]. In the less common nausea-based approach, a drug was used to make patients sick; several were admitted to hospital with severe sickness and dehydration, and a relative reported that one participant's brother died in hospital from the drug's effects [source: Smith, Bartlett and King 2004]. Women were treated too, in NHS psychiatric hospitals and as outpatients, usually by psychologists or psychiatric nurses with a consultant psychiatrist's endorsement: sexual images of women were paired with shocks or with nausea-inducing drugs, and in a variant called anticipatory avoidance a woman waited in fear of a shock that she could avoid only by choosing an image of a man [source: Spandler and Carr 2022]. Patients found the sessions dull and unerotic; afterwards they reported nausea at the sight of same-sex partners, fear, months of feeling terrible, and deepened shame and isolation, and one man attempted suicide soon after leaving treatment; none reported direct benefit [source: Smith, Bartlett and King 2004; Spandler and Carr 2022]. Some sought treatment themselves; others were sent by GPs, by teachers or by courts as an alternative to prison, and many women were treated after pressure from parents or clinicians [source: Smith, Bartlett and King 2004; Spandler and Carr 2022]. Warning signs today: any programme that pairs a person's attractions with pain, nausea or fear, or offers treatment for orientation as an alternative to punishment [synthesis].

How it caused harm

No benefit. No former patient in the British study reported direct benefit; outcome studies show no change in orientation; Freund reached the same conclusion [source: Smith, Bartlett and King 2004; Wellcome Collection 2018]. The APA (2021) states there is no evidence of sexual orientation change [source: APA 2021 press release].
Psychological harm. Treatment reinforced shame and isolation; many former patients had lasting emotional distress; some attempted suicide after treatment ended; some avoided sex; several marriages entered as a "cure" ended in divorce [source: Smith, Bartlett and King 2004]. In the UN survey, 98% of 940 respondents who had undergone conversion practices reported damage, including depression, anxiety, shame, self-hatred, suicidal thoughts and attempts, and permanent physical harm [source: A/HRC/44/53]. LGB adults exposed to change efforts were nearly twice as likely to report suicidal ideation and attempts [source: Blosnich et al. 2020 via Williams Institute].
Physical harm and death. A relative in the British study described a brother's death in hospital from treatment side effects [source: Smith, Bartlett and King 2004].
Abuse. Some former patients alleged sexual or physical abuse by clinicians during treatment (allegations the authors did not verify) [source: Smith, Bartlett and King 2004].
Coercion and rights. Treatment was often given under legal or social pressure, including court referral [source: King, Smith and Bartlett 2004]. The Independent Forensic Expert Group (2020), quoted by the UN, holds that conversion therapy constitutes cruel, inhuman or degrading treatment when forced or non-consensual and may amount to torture; the Independent Expert considers the practices degrading and inherently discriminatory [source: A/HRC/44/53]. The IRCT link to this group [uncertain: not verified].
Harm to professionals and the field. Clinicians later described guilt and shame; the authors conclude that social and political assumptions sometimes lie at the heart of what is called pathology [source: King, Smith and Bartlett 2004].

Recognising it today

In clients' histories: older LGBTQ+ people (especially men) treated in NHS, military or court-linked settings in the 1950s to 1970s; veterans of conscript armies; clues include fear of hospitals or equipment, sexual avoidance, a "cure" marriage, a suicide attempt after treatment, or long silence about a period of "treatment" [source: Smith, Bartlett and King 2004; synthesis].
In present-day offers: any service, faith ministry, coach, app or device promising to reduce, suppress or change same-sex attraction or gender identity, including through discomfort or punishment. The MoU notes conversion therapy may be practised covertly under mainstream labels and is also called "reparative therapy" or "gay cure therapy" [source: MoU v2 rev A]. Present-day efforts most often come from religious leaders, and also from health-care providers [source: Blosnich et al. 2020 via Williams Institute].
Legal status (dated; may have changed: check official sources). As of May 2020 the UN reported national bans in a few countries (for example Ecuador and Malta), local or regional bans elsewhere, and court cases holding providers accountable (for example in New Jersey and China) [source: A/HRC/44/53]. Later national bans reported elsewhere [uncertain: not verified]. On 31 March 2026 the US Supreme Court ruled 8–1 in Chiles v. Salazar that Colorado's conversion-therapy law, as applied to a counsellor's talk therapy, regulates speech based on viewpoint; it reversed the lower courts, which had not applied sufficiently rigorous First Amendment scrutiny, and sent the case back (SCOTUSblog; NPR). Its effect on other states' laws is [uncertain]. In the wider history, the Associated Press reported that a New Jersey jury found JONAH liable for consumer fraud in June 2015 (see 076), and Religion News Service reported Exodus International's June 2013 closure and its president's apology (see 074).

What to do instead and how to help those harmed

Supported care. Affirming, non-directive therapy that helps people explore their orientation or identity, reduce distress and reach self-acceptance, with no predetermined outcome [source: MoU v2 rev A]; services addressing family, religious and social conflict and minority stress [source: A/HRC/44/53]; the APA's 2021 Guidelines for Psychological Practice with Sexual Minority Persons encourage psychologists to validate and normalise these identities [source: APA 2021 press release]. Standard evidence-based treatment for depression, trauma and suicidality as the client needs [synthesis].
Survivor support. Acknowledgement, de-shaming, trauma and grief work, sexual and relationship support, and help with testimony, complaints and redress (sections 4.3 to 4.17). The UN calls for complaint mechanisms and reparation including rehabilitation and legal assistance [source: A/HRC/44/53]. Survivor organisations: refer only to those you have checked locally [synthesis].
Family support. Accurate information that change efforts are invalid, ineffective and harmful, as the UN recommends for parents and families [source: A/HRC/44/53]; family work toward acceptance (4.14) [synthesis].
Reporting and legal routes. Child-protection and mandatory-reporting routes for any minor (4.15); concerns about practitioners to managers, professional bodies or regulators (4.16); forced or non-consensual practices to police, with legal advice [source: A/HRC/44/53; synthesis].
Crisis resources. 988 Suicide and Crisis Lifeline (US); Samaritans 116 123 (UK and Ireland).

Sources

← Previous · XVI-062Ariosophy (List, Wiligut)Next · XVI-064 →Covert sensitisation in conversion practices