Atlas›Domain XVI · Historical, discredited & harmful›Guide 065
Guide XVI-065

Psychoanalytic cure of homosexuality (Rado, Bieber)

Sandor Rado, Irving Bieber, Charles Socarides1940United States
A 30 · L 58 · M 1220 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: the psychotherapist's own work with the history and legacy of psychoanalytic attempts to "cure" homosexuality, as documented by Drescher (2015) and the American Psychological Association Task Force (2009), and set against current professional and international statements (APA 2021 resolutions; UK Memorandum of Understanding on Conversion Therapy, Version 2; UN Independent Expert report A/HRC/44/53, 2020; Independent Forensic Expert Group statement, 2020). This guide does not teach the practice and contains no steps of it.

What it was. In mid-20th-century American psychiatry and psychoanalysis, homosexuality was widely treated as a disorder that analytic treatment could and should reverse. Sandor Rado (1940) rejected both innate bisexuality and normal homosexuality, held heterosexuality to be the only biological norm, and recast homosexuality as a "phobic" avoidance of the other sex caused by inadequate parenting; his ideas strongly influenced American psychiatry and psychoanalysis [source: Drescher 2015]. Irving Bieber and nine co-authors published Homosexuality: A Psychoanalytic Study (Basic Books, 1962), proposing a family pattern of a close-binding, intimate, controlling mother and a detached, hostile, rejecting father (the "triangular system" hypothesis) [source: Drescher 2015; Siegelman 1974]. Charles Socarides (The Overt Homosexual, 1968) took a similar position. Their claims of psychoanalytic "cures" were broadly accepted by their professional community but were never verified in any meaningful or empirical way [source: Drescher 2015].

The underlying idea of change, as its proponents held it, was that same-sex attraction was a developmental failure or phobic adaptation that insight into early family relationships could undo [source: Drescher 2015]. Current professional and international bodies state the opposite: there is no sound scientific evidence that sexual orientation can be changed, the practices are medically unjustified and ethically problematic, and they are associated with serious harm, including depression, anxiety, shame, self-hatred, suicidal thoughts and suicide attempts [source: UN Independent Expert A/HRC/44/53, paras 19-21, 56; APA 2021 press release; UK MoU v2]. In June 2019 the American Psychoanalytic Association apologised for having treated homosexuality as a mental illness and for its role in discrimination and trauma [source: Reuters via KFF Health News, 24 June 2019]. For the psychotherapist the relevance today is the clients who were treated this way, their families, the theories that still circulate in covert or rebranded form, and the profession's own history.

2. Framework

This is a historical harmful practice, not a therapy to be delivered. The framework below has two parts: the historical phases of the practice in outline (for literacy), and the phases of the psychotherapist's own work.

A. Historical phases in outline [source: Drescher 2015 unless stated]

  • Pathology and immaturity models (first half of the 20th century). Most psychoanalysts of the generation after Freud came to view homosexuality as pathological, either as a disease or defect, or as a "developmental arrest". Rado's 1940 paper and later Adaptational Psychodynamics (1969) gave the phobic-avoidance account.
  • The "cure" literature (1950s-1960s). Bieber et al. (1962) and Socarides (1968) reported analytic change and family-causation patterns; the triangular system hypothesis was built on male samples, and later studies applying it to women gave inconsistent results [source: Siegelman 1974]. Evelyn Hooker's 1957 study of 30 gay men and 30 heterosexual controls, none of them patients, found no more psychological disturbance in the gay group [source: Drescher 2015].
  • Depathologisation (1973-1987). In December 1973 the American Psychiatric Association's Board of Trustees voted to remove homosexuality from the DSM. Psychoanalytic psychiatrists objected and petitioned for a referendum, in which about 58% of roughly 10,000 voting members upheld the decision. The replacement category "sexual orientation disturbance", which Drescher says legitimised conversion therapies, gave way to "ego-dystonic homosexuality" in DSM-III (1980), removed in DSM-III-R (1987). WHO removed homosexuality per se from ICD-10 in 1990.
  • Professional reckoning. Psychoanalysts followed psychiatry in dropping the illness model nearly 20 years after 1973 [source: Reuters via KFF Health News]; NBC News reported in 2019 that the American Psychoanalytic Association changed its position in 1991, under the threat of an anti-discrimination lawsuit, to allow gay and lesbian people to train as psychoanalysts; the wording of its 1991 statement is [uncertain: not verified]. The APA 2009 Task Force notes that psychoanalysis and behaviour therapy were the orientations most associated with the older change literature and that their mainstream organisations later publicly rejected these practices [source: APA Task Force 2009, p. 11]. Apology by the American Psychoanalytic Association, 21 June 2019.

B. Phases of the psychotherapist's work [synthesis, drawing on APA Task Force 2009, pp. 4-6; UK MoU v2]

  1. Recognition and assessment: ask about past therapy, including talk-based or analytic attempts at change; assess impact, current distress, suicide risk and trust in therapy. Move on when risk is assessed and the client has a basic sense that this therapy has no agenda about their orientation.
  2. Safety and safeguarding: crisis planning where needed; child-protection steps where a minor is involved; record and, where appropriate, report current harmful practice. Move on when immediate risk is managed.
  3. Processing and repair: internalised stigma, shame, family blame narratives, grief for lost years or relationships, religious integration, repair of trust in psychotherapy itself. Move on when the client's own goals, rather than the history, drive the work.
  4. Advocacy and follow-up: supporting complaints or testimony if the client chooses, connecting with affirming community and peer support, ending with an agreed plan for return.

Format, session number and length follow the client's needs and the setting [synthesis].

3. Guiding principles

  • No predetermined outcome for orientation or identity. Practically: you neither steer towards nor away from any orientation; the APA Task Force describes approaches without a predetermined goal for sexual orientation identity [source: APA Task Force 2009, p. 4; UK MoU v2].
  • Orientation is not a disorder. Practically: you never formulate a client's orientation as a symptom, a defence or a developmental arrest [source: UK MoU v2; Drescher 2015].
  • Unconditional acceptance and support. Practically: you name and convey acceptance of all aspects of the client, including faith and values [source: APA Task Force 2009, p. 4].
  • The harm happened inside therapy. Practically: expect the client to test whether you, too, have a hidden aim; make your stance explicit and invite challenge [synthesis].
  • Do not attempt change, but do not refuse to explore. Practically: a request to change is explored with curiosity about its sources, not met with a change attempt or a dismissal [source: UK MoU v2; APA Task Force 2009, p. 4].
  • Assess suicide risk early and repeatedly. Practically: change efforts are associated with suicidal thoughts and attempts; ask directly, without method detail [source: UN Independent Expert A/HRC/44/53, para 56; APA 2021 press release].
  • Respect religious identity alongside sexual identity. Practically: help the client explore paths to integrate both, without ranking them [source: APA Task Force 2009, p. 6].
  • Family acceptance protects. Practically: work with parents to reduce rejection and correct parent-blame myths [source: APA Task Force 2009, p. 5].
  • Minors need assent and the least restrictive setting. Practically: obtain the young person's assent and informed consent where feasible; no change efforts for minors [source: APA Task Force 2009, pp. 3, 5].
  • Covert forms exist. Practically: watch for change aims practised under other names within mainstream care, including your own theoretical habits [source: UK MoU v2].
  • Historical accuracy without moralising. Practically: describe what the profession did, attributed, and let the client draw their own conclusions [synthesis].
  • Never provide, supervise or refer to change efforts. Practically: refer only to affirming services; act on concerns about a colleague [source: UK MoU v2; synthesis].

4. Intervention inventory

The interventions below are the psychotherapist's own work; steps not drawn from a cited source are marked [synthesis].

4.1 Building historical literacy (clinician preparation)

  • Purpose: to understand what clients, especially older gay and bisexual men and their families, may have been told in analysis, so that you can recognise its traces and speak accurately. Use before working with this population and when a client mentions past analysis [synthesis].
  • Steps: (1) Learn the outline: Rado's phobic-avoidance theory (1940), Bieber et al.'s family-causation claims (1962), Socarides (1968), the December 1973 DSM decision and the membership referendum that followed, the later DSM-III and DSM-III-R steps, ICD-10 (1990) [source: Drescher 2015]. (2) Learn the evidence that undercut it: Hooker 1957; the absence of verified "cures" [source: Drescher 2015]. (3) Learn the current statements (APA 2021; UK MoU v2; UN IE 2020) and the 2019 American Psychoanalytic Association apology [sources as cited]. (4) Note what remains unverified, such as specific outcome figures reported in the 1962 book [uncertain: not verified].
  • Example language (illustrative): "Some analysts in that period taught that being gay came from family patterns and could be reversed. That view was never supported by evidence, and the main psychoanalytic association in the US has since apologised for it."
  • Watch for: overstating or simplifying (for example, implying all analysts held these views; Drescher notes dissenters such as Judd Marmor). Working: you can answer a client's questions accurately without defensiveness.

4.2 Screening for past change efforts at intake

  • Purpose: to identify clients who experienced attempts to change or suppress orientation or gender identity, including through talk-based or analytic therapy, which the UN Independent Expert lists among psychotherapy-based forms [source: A/HRC/44/53, paras 42, 45].
  • Steps: (1) Ask every client about previous therapy, its aims and how it ended [synthesis]. (2) Ask specifically, in neutral words, whether any therapist, counsellor, faith leader or programme tried to change or suppress their orientation or gender identity [synthesis]. (3) Ask what they were told caused their orientation (for example, a parent) [synthesis]. (4) Record in the client's own words.
  • Example language (illustrative): "Some people have had therapy in the past that tried to change who they were attracted to, sometimes without calling it that. Has anything like that happened to you?"
  • Watch for: clients who do not use the term "conversion" because the work was framed as analysis or insight; shame about having sought it. Working: the client can describe the experience and its meaning without minimising.

4.3 Assessing the impact of past analytic "cure"

  • Purpose: to map how the experience affects the client now.
  • Steps: (1) Assess mood, anxiety, shame, self-worth and relationships, the harm domains reported by the UN IE and APA [source: A/HRC/44/53, paras 19, 56; APA 2021 press release]. (2) Ask about "failure" beliefs: the APA Task Force reports that people who did not change, despite expecting to, described significant emotional and spiritual distress and negative self-image [source: APA Task Force 2009, p. 3]. (3) Ask about losses: relationships ended, years spent, marriages entered under the treatment's aims [synthesis]. (4) Ask about trust in therapy and therapists [synthesis]. (5) Use standard validated measures for mood and trauma where indicated, without reproducing items [synthesis].
  • Example language (illustrative): "What did you come to believe about yourself during that treatment, and how much of that do you still carry?"
  • Watch for: trauma responses to the therapy setting itself; the client attributing all difficulties, or none, to the treatment. Working: a shared formulation that separates what the treatment taught from what the client now believes.

4.4 Suicide-risk assessment and safety planning

  • Purpose: change efforts are associated with suicidal thoughts and suicide attempts [source: A/HRC/44/53, para 56; APA 2021 press release, reporting that LGBTQ young people who experienced change efforts were significantly more likely to report a suicide attempt and repeated attempts].
  • Steps: (1) Ask directly about suicidal thoughts, past attempts and current intent, using your service's standard risk protocol [synthesis]. (2) Do not ask for or discuss method detail beyond what lethal-means counselling requires (safe storage, removal) [synthesis]. (3) Build a written safety plan with the client: warning signs, coping steps, people to contact, crisis lines [synthesis]. (4) Give crisis resources: 988 Suicide and Crisis Lifeline (US, call or text 988); Samaritans 116 123 (UK and Ireland). (5) Re-assess at anniversaries, family contact, religious events and disclosures [synthesis].
  • Example language (illustrative): "When people have been told for years that part of them is an illness, thoughts of not wanting to live can come up. Have you had thoughts like that, now or in the past?"
  • Watch for: hopelessness about ever being acceptable; renewed contact with a former treater or community; discussion that glamorises suicide (redirect calmly). Working: the client can name supports and use the plan.

4.5 Psychoeducation on depathologisation

  • Purpose: to give the client accurate history so that old diagnostic messages lose their authority [synthesis].
  • Steps: (1) Ask what the client knows and wants to know. (2) Offer, in plain terms, the timeline: removal from the DSM in 1973, the replacement categories and their removal by 1987, ICD-10 in 1990 [source: Drescher 2015]. (3) Share that current bodies state orientation is not a disorder and cannot be changed by these efforts [source: UK MoU v2; A/HRC/44/53, para 20]. (4) Mention the 2019 apology if relevant [source: Reuters via KFF Health News]. (5) Check how it lands.
  • Example language (illustrative): "The diagnosis you were given was taken out of the manual decades ago, and the people who held those theories were never able to show that their treatment worked."
  • Watch for: anger, grief or a sense of wasted life surfacing quickly; intellectual acceptance without emotional change. Working: the client begins to speak of the treatment as something done to them rather than evidence about them.

4.6 Making your stance explicit and repairing trust in therapy

  • Purpose: the injury occurred in a therapy relationship, so the frame itself must be renegotiated [synthesis].
  • Steps: (1) State early that you have no aim regarding the client's orientation or identity [source: UK MoU v2]. (2) Invite the client to tell you if anything you say echoes the old treatment [synthesis]. (3) Explain how you work, including what interpretation means here, and obtain consent to the approach [synthesis]. (4) Review the frame periodically. (5) Avoid aetiological questions about orientation unless the client raises them [synthesis].
  • Example language (illustrative): "I don't see your orientation as something to explain or fix. If anything I say ever feels like the old therapy, I want you to stop me."
  • Watch for: compliance, over-politeness or testing; strong reactions to silences, couch-like set-ups or family-of-origin questions, which may echo analytic settings [synthesis]. Working: the client challenges you and the relationship holds.

4.7 Working with internalised stigma

  • Purpose: to reduce the shame installed by being treated as ill; the APA Task Force names reducing internalised stigma within acceptance and support [source: APA Task Force 2009, p. 4].
  • Steps: (1) Identify self-statements taken from the treatment (for example, "I am arrested", "I am phobic") [synthesis]. (2) Trace their origin to the theory, not to the self [synthesis]. (3) Use active coping strategies, cognitive and emotional, for managing stigma and conflict [source: APA Task Force 2009, p. 4]. (4) Build self-compassion and positive identity experiences [synthesis].
  • Example language (illustrative): "That phrase, 'a failure to develop', came from a theory. Whose voice is it when you say it now?"
  • Watch for: shame spirals after disclosure; minimisation. Working: the client notices the old statements and responds to them differently.

4.8 Identity exploration without a predetermined outcome

  • Purpose: to support the client's own exploration of orientation and identity [source: APA Task Force 2009, p. 4].
  • Steps: (1) Ask what the client wants to understand [synthesis]. (2) Explore options for living, relationships and disclosure without ranking them [source: APA Task Force 2009, p. 4]. (3) Respect timing and context, including safety of disclosure [synthesis]. (4) Revisit as the client's understanding changes.
  • Example language (illustrative): "There isn't a right answer I'm waiting for. What do you notice when you imagine different ways your life could go?"
  • Watch for: your own preferences leaking in, in either direction. Working: the client's decisions are their own and feel coherent to them.

4.9 Responding to a client who asks to change their orientation

  • Purpose: to explore the request without attempting change, as the UK MoU and APA Task Force describe [source: UK MoU v2; APA Task Force 2009, p. 4]. The MoU states it does not aim to deny or discourage people with uncertain feelings about their sexuality from seeking appropriate help, and that clients make healthy choices when they understand themselves better [source: UK MoU v2].
  • Steps: (1) Thank the client for saying it and take the distress seriously [synthesis]. (2) Explain honestly that change efforts have not been shown to work and are associated with harm, and that you will not attempt one [source: A/HRC/44/53, paras 20-21; APA 2021 press release]. (3) Explore the sources of the wish: family, faith, community, fear, past treatment messages [synthesis]. (4) Offer what you can do: reduce distress, explore identity and values, work on conflict and acceptance [source: UK MoU v2; APA Task Force 2009, p. 4]. (5) Assess suicide risk (4.4). (6) If the client seeks change elsewhere, keep the door open and give accurate information about harms; do not refer [synthesis].
  • Example language (illustrative): "I can hear how much pain is behind that wish. I won't try to change your orientation, because that hasn't been shown to work and has hurt many people, but I will work with you on what is making this so hard."
  • Watch for: the client feeling rejected; a family or faith deadline driving the request; acute risk. Working: the focus moves from changing orientation to understanding and reducing distress.

4.10 Religious clients: integrating faith and sexual identity

  • Purpose: the APA Task Force recommends accepting clients and valuing the importance of their faith while recognising the science of sexual orientation, with aims including exploring life paths, religious coping and integrating religious and sexual identities [source: APA Task Force 2009, p. 6].
  • Steps: (1) Assess the place of faith in the client's life using a cultural formulation approach, such as the DSM-5-TR Cultural Formulation Interview and its supplementary module on spirituality, religion and moral traditions [synthesis]. (2) Where the difficulty centres on faith, the DSM-5-TR "Religious or Spiritual Problem" may be recorded (Z65.8) [source: ICD-10-CM Z65.8 (Unbound Medicine)]. (3) Explore the client's own theology and community options without ranking them [source: APA Task Force 2009, p. 6]. (4) Consider consultation with an affirming faith adviser of the client's tradition only if the client wishes [synthesis].
  • Example language (illustrative): "Your faith matters to you and so does this part of you. Let's look at how other people in your tradition have held both, and what fits for you."
  • Watch for: assuming faith must be given up; spiritual distress; community pressure towards change programmes. Working: the client can hold faith and identity with less conflict, on their own terms.

4.11 Family work: undoing parent-blame and building acceptance

  • Purpose: Bieber's triangular hypothesis blamed mothers and fathers for a son's orientation [source: Siegelman 1974]; families may still carry guilt or blame. Family interventions that reduce rejection and increase acceptance are supported, and parents can receive accurate information and guidance [source: APA Task Force 2009, p. 5].
  • Steps: (1) With consent, meet parents or relatives [synthesis]. (2) Give accurate information: orientation is not caused by parenting failure as these theories claimed, and the theories were not supported [source: Drescher 2015; Siegelman 1974]. (3) Address guilt and any past decision to send the child for treatment [synthesis]. (4) Work on acceptance behaviours and repair conversations [source: APA Task Force 2009, p. 5; synthesis for the steps].
  • Example language (illustrative, to a parent): "The theory that a mother or father causes a child to be gay was popular once, but it didn't hold up. You didn't cause this, and what helps now is your acceptance."
  • Watch for: defensive denial or overwhelming guilt; a client not ready for family contact. Working: family members move from blame towards accepting behaviour.

4.12 Grief and life review for older survivors

  • Purpose: older clients may have spent years in analysis aimed at change and made life decisions under it [synthesis].
  • Steps: (1) Invite a life narrative that includes the treatment years [synthesis]. (2) Name losses (relationships, time, authenticity, health) and validate grief and anger [synthesis]. (3) Distinguish regret from self-blame [synthesis]. (4) Identify what the client still wants to live and build [synthesis].
  • Example language (illustrative): "It makes sense to grieve the years that treatment took. What would you like the years ahead to hold?"
  • Watch for: depression in later life, isolation, complicated grief for partners or spouses [synthesis]. Working: the client can tell the story with less shame and makes forward-looking choices.

4.13 Bisexual and gender-diverse clients

  • Purpose: the UK MoU covers both sexual orientation and gender identity, and the APA's 2021 Resolution on Gender Identity Change Efforts sits alongside the SOCE resolution [source: UK MoU v2; APA 2021 press release]. APA's updated guidelines give more focus to bisexuality [source: APA 2021 press release].
  • Steps: (1) Avoid assuming the client's orientation from the old treatment's labels [synthesis]. (2) Ask about any pressure on gender expression as well as orientation [synthesis]. (3) Apply the same no-agenda stance to gender identity [source: UK MoU v2].
  • Example language (illustrative): "I won't assume a label for you. How do you describe yourself, if you want to?"
  • Watch for: erasure of bisexuality; overlapping pressures about gender. Working: the client's self-description is used and respected.

4.14 Safeguarding minors

  • Purpose: no research shows that change efforts for minors affect adult orientation; services for youth should be in the least restrictive setting, with the youth's assent and informed consent where feasible [source: APA Task Force 2009, pp. 3, 5]. The UN Independent Expert notes children and young people are especially vulnerable [source: A/HRC/44/53, paras 57-58].
  • Steps: (1) If a young person reports being taken to change efforts, assess safety and risk (4.4) [synthesis]. (2) Follow your jurisdiction's child-protection and mandatory-reporting procedures where there is coercion, abuse or neglect [synthesis]. (3) Work with parents towards acceptance (4.11). (4) Document carefully [synthesis].
  • Example language (illustrative, to a young person): "Nothing about who you are is something you need to be fixed for. I want to make sure you're safe; can we talk about what's been happening?"
  • Watch for: family rejection, homelessness risk, self-harm. Working: the young person reports safety and at least one accepting adult.

4.15 A client drawn to analytic "cause and cure" ideas today

  • Purpose: some clients encounter the old family-causation and change theories through books, online material or faith-based counselling and find them persuasive [synthesis]. The UN Independent Expert describes current psychotherapy-based approaches that assume diverse orientation results from an abnormal upbringing or past experiences, such as absent paternal figures [source: A/HRC/44/53, paras 42, 45].
  • Steps: (1) Ask what the client has read or been offered and what it promises [synthesis]. (2) Explore what makes it appealing (relief from conflict, family approval, a story about pain) [synthesis]. (3) Give accurate information on origin and evidence: claims of cure were never empirically verified; current bodies find no evidence of change and evidence of harm [source: Drescher 2015; A/HRC/44/53, paras 20-21]. (4) Offer the alternative of distress-focused, no-agenda work (4.9) [source: UK MoU v2].
  • Example language (illustrative): "Those ideas come from theories of the 1940s to 1960s. The people who held them never showed their treatment worked. Can we look at what draws you to them right now?"
  • Watch for: a sense of being argued with; secret engagement with a change provider; rising risk. Working: the client can weigh the claims and keeps talking with you.

4.16 Duties when a colleague or institution practises change efforts

  • Purpose: the UK MoU signatories, including the British Psychoanalytic Council, BACP and the British Psychological Society, agree conversion therapy is unethical and potentially harmful, and that it may be practised covertly within mainstream care [source: UK MoU v2]. UKCP signed the Memorandum (UKCP statement, May 2021) and withdrew from it on 5 April 2024, citing "concerns relating to children and young people", while stating that it is "wholly against conversion therapy for any age" [source: UKCP 2021; UKCP 2024].
  • Steps: (1) Document what you have learned, from whom, with the client's consent where the information is theirs [synthesis]. (2) Seek supervision or ethics consultation [synthesis]. (3) Where appropriate and safe, raise concerns with the colleague directly; otherwise use your employer's procedures and the colleague's registering or licensing body's complaints procedure [synthesis]. (4) Where a minor or adult at risk is involved, follow safeguarding procedures (4.14) [synthesis]. (5) Where you share roles with the colleague or client in another setting, such as a training institute or faith community, consider multiple-relationship risks (APA Ethics Code, Standard 3.05) [source: APA Ethics Code]. (6) Never supervise, co-work or refer to such work [synthesis].
  • Example language (illustrative, to a colleague): "I'm concerned that the treatment aim here is to change this client's orientation. Our professional statements describe that as unethical and harmful, and I need to raise it."
  • Watch for: institutional pressure, client fear of exposure, your own conflicts of interest. Working: the concern is recorded and routed to the body able to act.

4.17 Supporting complaints, testimony and legal routes

  • Purpose: the UN Independent Expert calls for specific allegations to be promptly investigated and, where relevant, prosecuted, and for states to ban these practices [source: A/HRC/44/53, paras 65, 87]. Legal status varies and changes (see Harm account).
  • Steps: (1) If the client wishes, explain the options in general terms: a complaint to the treater's professional body, legal advice, participation in inquiries or historical projects [synthesis]. (2) Do not pressure either way; the decision is the client's [synthesis]. (3) Help prepare emotionally for the process and its outcome [synthesis]. (4) Keep your own notes factual [synthesis].
  • Example language (illustrative): "Some people want to make a complaint or tell their story publicly, and some don't. Either is valid. Would it help to think through what each would involve?"
  • Watch for: retraumatisation during the process; disappointment where historical complaints cannot proceed. Working: the client makes an informed choice and feels supported in it.

4.18 Referral and community connection

  • Purpose: social support is a named component of affirmative responses [source: APA Task Force 2009, p. 4].
  • Steps: (1) Map the client's current support [synthesis]. (2) Offer referral only to affirming services: LGBTQ+-affirming therapists, community centres, affirming faith groups, peer groups for survivors of change efforts, as the client prefers [synthesis]. (3) Check any service's stance before referring [synthesis]. (4) Follow up on whether the connection helped.
  • Example language (illustrative): "Would it help to meet other people who went through something similar? I can look into groups whose approach I'm confident about."
  • Watch for: isolation, unsafe disclosures in hostile settings. Working: the client has at least one accepting connection outside therapy.

4.19 Working with the profession's own history (trainees, analysts and psychodynamic clinicians)

  • Purpose: psychoanalysis was among the orientations most associated with the older change literature, and its mainstream organisations later rejected these practices; in 2019 the American Psychoanalytic Association apologised for its role in discrimination and trauma [source: APA Task Force 2009, p. 11; Reuters via KFF Health News]. Clinicians trained in psychodynamic traditions, and clients who are themselves clinicians, may need to work through this history [synthesis].
  • Steps: (1) In supervision or training, read the history, including dissenters [source: Drescher 2015]. (2) Review case formulations for residual aetiological framing of orientation [synthesis]. (3) Distinguish contemporary psychodynamic practice from the historical illness model [synthesis]. (4) Where a client was harmed by an analyst, acknowledge the profession's responsibility without defensiveness [synthesis].
  • Example language (illustrative): "Psychoanalysis got this badly wrong, and the field has said so publicly. I want to be clear about where I stand."
  • Watch for: defensiveness, or over-identification that leaves no space for the client's anger. Working: the client experiences acknowledgement rather than justification.

4.20 Clinician self-audit and supervision

  • Purpose: the MoU expects training and guidelines to ensure ethical practice with sexually and gender diverse clients, and continuing professional development in cultural competence [source: UK MoU v2].
  • Steps: (1) Review your own assumptions about the causes of orientation [synthesis]. (2) Take supervision on cases involving change requests or survivors [synthesis]. (3) Keep up to date with professional statements and legal changes [synthesis]. (4) Seek CPD on working with sexually and gender diverse clients [source: UK MoU v2].
  • Example language (illustrative, in supervision): "I noticed I asked about this client's father in a way that might have echoed what the old treatment did. Can we look at that?"
  • Watch for: curiosity about causes that steers sessions; discomfort that leads to avoidance. Working: your formulations focus on the client's goals and distress, not on explaining orientation.

5. Handling problems

  • Client distrusts all therapy because of past analysis. Response: name it openly, offer more transparency than usual (explain why you ask what you ask), let the client set pace and topics, and review the frame regularly (4.6) [synthesis].
  • Client insists you help them change. Response: hold the boundary kindly and repeatedly; explain why; keep working on distress and values (4.9); assess risk; if they leave to seek change elsewhere, end with accurate information and an open door, never a referral [source: UK MoU v2; synthesis for the steps].
  • Overwhelm when recalling treatment or diagnoses. Response: slow down, use grounding and stabilisation before narrative work, and return to safety planning if risk rises (4.4) [synthesis].
  • Rupture triggered by an interpretation or family-of-origin question. Response: acknowledge the echo of the old treatment, apologise for the impact, ask what it brought up, and agree how to approach such topics in future [synthesis].
  • Stuck in anger at the profession. Response: validate the anger as proportionate to documented harm; avoid defending the field; explore what acknowledgement or action would mean to them, including complaint or testimony (4.17) [synthesis].
  • Stuck in self-blame for having sought "cure". Response: place the choice in its historical context, when psychiatry and psychoanalysis presented homosexuality as an illness and the treatment as legitimate [source: Drescher 2015]; work on self-compassion (4.7) [synthesis].
  • Family refuses to engage or still holds causation beliefs. Response: offer accurate written information through the client if they wish; focus on the client's boundaries and other sources of support (4.11, 4.18) [synthesis].
  • Religious conflict intensifies. Response: return to integration work without ranking faith or identity; consider an affirming adviser from the client's tradition if they ask (4.10) [source: APA Task Force 2009, p. 6; synthesis].
  • Non-attendance or dropout. Response: reach out once with a low-pressure message and crisis resources; dropout after change efforts may signal shame or risk [synthesis].
  • Suicidal crisis. Response: follow your service's crisis protocol; give 988 (US) and Samaritans 116 123 (UK and Ireland); arrange urgent care where needed; no method discussion [synthesis].
  • A minor disclosing current change efforts. Response: follow child-protection and mandatory-reporting procedures; assess safety and home stability (4.14) [synthesis].
  • Discovering a colleague's covert change aims. Response: supervision, documentation, and reporting through the colleague's professional body (4.16) [source: UK MoU v2; synthesis for the steps].
  • Client cites legal changes as proof change efforts are endorsed. Response: distinguish legal rulings from clinical evidence: a court ruling on speech regulation is not a finding that change efforts work [synthesis]; the clinical position of the professional bodies is unchanged [source: APA 2021 press release; UK MoU v2].
  • Your own reaction (guilt about the profession, irritation with a change request). Response: take it to supervision before it shapes the session (4.20) [synthesis].

Harm account

What was actually done

From roughly the 1940s to the 1970s, chiefly in the United States, many psychiatrists and psychoanalysts treated homosexuality as a mental disorder and offered long-term psychoanalytic treatment with the aim of changing patients' orientation to heterosexuality [source: Drescher 2015]. The theoretical basis included Rado's 1940 account of homosexuality as a phobic avoidance of the other sex caused by inadequate parenting, Bieber et al.'s 1962 study proposing a close-binding, controlling mother and a detached, hostile father as the cause in men, and Socarides's 1968 book [source: Drescher 2015; Siegelman 1974]. Proponents reported "cures"; these were accepted by their professional community but never verified in any meaningful or empirical way [source: Drescher 2015]. When the American Psychiatric Association removed homosexuality from the DSM in December 1973, psychoanalytic psychiatrists opposed the decision and petitioned for a referendum; the successor diagnoses "sexual orientation disturbance" and "ego-dystonic homosexuality" kept a basis for treatment until 1987 [source: Drescher 2015]. Psychoanalysts dropped the illness model nearly 20 years after psychiatry, and in June 2019 the American Psychoanalytic Association apologised; its president said it was "long past time to recognize and apologize" for the profession's role in discrimination and trauma [source: Reuters via KFF Health News, 24 June 2019]. The UN Independent Expert notes that most schools of psychology and psychiatry acted as providers of conversion practices during the period when sexual diversity was classed as illness [source: A/HRC/44/53, para 22].

What it looked like to the person in treatment. Outwardly it was ordinary psychoanalysis or psychoanalytic psychotherapy, usually long-term, conducted by a psychiatrist or psychoanalyst in a private office or hospital clinic, with change to heterosexuality as the stated aim [source: Drescher 2015]. Analysts in this tradition went back over the patient's childhood relationships with mother and father and interpreted same-sex desire as a phobic flight from the other sex or as development arrested by poor parenting [source: Drescher 2015]; the UN Independent Expert still describes present-day psychotherapeutic conversion practices in the same terms, as treating sexual diversity as the product of an abnormal upbringing and having clients revisit their childhood relationships with their parents (para. 42) [source: A/HRC/44/53]. Not everyone came voluntarily: the APA Task Force notes that many participants in early change-effort research were adult White men, often mandated to treatment by courts [source: APA Task Force 2009, p. 3]. The profession applied the same view to itself: NBC News reported in 2019 that the American Psychoanalytic Association allowed gay and lesbian people to train as psychoanalysts only from 1991, when it changed its position under the threat of an anti-discrimination lawsuit [source: NBC News, June 2019]. For the patient, this could mean years in a relationship with a trusted authority who treated their desire as a symptom, their parents as its cause, and the absence of change as their own resistance [synthesis].

How it caused harm

  • No change, but lasting damage: there is no sound scientific evidence that sexual orientation can be changed, and offering such practices may amount to deception or fraud [source: A/HRC/44/53, paras 20-21].
  • Psychological harm: reported effects include depression, anxiety, shame, self-hatred, suicidal thoughts and suicide attempts; in one survey of 940 people who underwent such practices, 98% reported damage [source: A/HRC/44/53, paras 19, 56].
  • Distress from "failure": people who did not change, despite expecting to, described significant emotional and spiritual distress and negative self-image [source: APA Task Force 2009, p. 3].
  • Suicide risk: LGBTQ young people who experienced change efforts were significantly more likely to report attempting suicide, including more than once [source: APA 2021 press release]. A US population study (Blosnich et al. 2020) reported higher suicidality among sexual minorities who underwent change efforts; a later reanalysis disputed the association [uncertain: not verified].
  • Family harm: family-causation theories placed blame on parents, especially mothers [source: Siegelman 1974 for the hypothesis; synthesis for the effect].
  • Ill-treatment: the UN Independent Expert concludes conversion practices are degrading and inhuman in their very essence and create a significant risk of torture; the Independent Forensic Expert Group addresses whether such practices amount to cruel, inhuman or degrading treatment or torture [source: A/HRC/44/53, paras 62-65, 83; IFEG 2020].

Recognising it today

  • In clients: a history of analysis or talk therapy whose aim was to change orientation; beliefs that their orientation is a "developmental arrest", a phobia or the result of a parent's failings; shame about not having "changed" [synthesis drawing on Drescher 2015 and APA Task Force 2009].
  • In current practice: psychotherapy-based approaches that assume diverse orientation results from abnormal upbringing or experiences such as absent fathers [source: A/HRC/44/53, paras 42, 45]; change or suppression aims practised under other names or covertly within mainstream care [source: UK MoU v2]; any approach that treats one orientation or gender identity as inherently preferable [source: UK MoU v2 definition].
  • Legal status (dated): 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]. Legal status in other countries varies and changes; check current official or major-news sources before advising [uncertain].

What to do instead and how to help those harmed

  • Supported care: affirmative, client-centred approaches with acceptance and support, comprehensive assessment, active coping, social support, and identity exploration and development without a predetermined outcome [source: APA Task Force 2009, p. 4]; work on conflict, distress and self-acceptance without an agenda [source: UK MoU v2]; affirming guidelines for practice with sexual minority persons [source: APA 2021 press release].
  • Survivors: assessment, suicide-risk management, repair of trust, work on internalised stigma and grief (4.2-4.8, 4.12); peer and community connection (4.18).
  • Families: accurate information and work to reduce rejection and increase acceptance [source: APA Task Force 2009, p. 5].
  • Reporting and legal routes: safeguarding and mandatory reporting for minors; complaints to professional or licensing bodies about current practitioners; prompt investigation of specific allegations, as the UN Independent Expert recommends [source: A/HRC/44/53, para 65; synthesis for routes].
  • Crisis resources: 988 Suicide and Crisis Lifeline (US); Samaritans 116 123 (UK and Ireland).

Sources

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