Atlas›Domain XVI · Historical, discredited & harmful›Guide 071
Guide XVI-071

The Feminine Boy Project (UCLA)

George Rekers, Lovaas1970Los Angeles
A 30 · L 55 · M 1520 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

Version followed: the historical record as given in CNN's June 2011 Anderson Cooper 360 reporting, the Journal of Applied Behavior Analysis 2020 expression of concern about Rekers and Lovaas (1974) as reported by Retraction Watch, Johnson (2022) in Behavior Analysis in Practice, and Green (1976) for NIMH funding; current professional positions from the APA's February 2021 resolutions, the UK Memorandum of Understanding on Conversion Therapy (Version 2, Revision A, 2019) and the UN Independent Expert's 2020 report (A/HRC/44/53). This guide covers the psychotherapist's own work only. It describes the programme only in observable terms, for recognition, and is not a guide to delivering it.

1. Introduction

"The Feminine Boy Project" is the name used for 1970s research and treatment at the University of California, Los Angeles (UCLA) that tried to make young boys judged too "feminine" behave in more conventionally masculine ways. The name as a formal project title is [uncertain: not verified]. CNN's 2011 series described it as a government-funded UCLA programme. The series called George Rekers "the man behind the therapy" and said the programme used aversion therapy to remove behaviours judged effeminate [source: CNN Press Room, 7 June 2011]. The best-known published case is Rekers and Lovaas (1974), "Behavioral treatment of deviant sex-role behaviors in a male child," in the Journal of Applied Behavior Analysis (JABA). It reported treating a four-year-old boy, with his parents coached to carry out the treatment [source: Retraction Watch 2020; Johnson 2022]. Separately, Richard Green ran NIMH-funded research comparing feminine and masculine boys. His 1976 paper in Archives of Sexual Behavior acknowledges NIMH grant MH026598 [source: Green 1976, Springer]. Green's exact role in the UCLA treatment work, and Rekers's training under Lovaas at UCLA, are [uncertain: not verified].

The programme's idea of change was that "sex-role" behaviour is learned and can be reshaped by systematically rewarding some behaviours and discouraging others. One aim was to head off later homosexuality or "transsexualism" [uncertain: secondary, unverified]. Today it is classed as a conversion practice aimed at gender expression and identity in children. In 2011 CNN reported that the boy in the 1974 case, called a success at the time, had died by suicide at 38. His family described participation as deeply harmful [source: CNN 2011; Retraction Watch 2020]. In 2020 JABA issued a statement of concern but did not retract the paper. The statement said that "by today's standards" the study "would be considered unethical" [source: Retraction Watch 2020].

Professional and international bodies now state:

  • The APA found "no evidence of sexual orientation change" from these efforts. It states that transgender and nonbinary identities are "normal variations" and opposes efforts to force conformity to rigid gender identities [source: APA press release, 2 March 2021].
  • UK signatory bodies agree that conversion therapy is "unethical and potentially harmful," whether it targets sexual orientation or gender identity [source: UK MoU v2].
  • The UN Independent Expert concluded that these practices are degrading, inhuman and cruel in their essence. The report also found that subjecting children to them "constitutes ill-treatment and may constitute torture" [source: A/HRC/44/53, paras 64-65, 71]. It cites the 2020 IRCT report It's torture not therapy [source: A/HRC/44/53, para 16].

See also 072 (childhood gender-conformity programmes, a related row that is still contested).

2. Framework

Historical phases, in outline. Each step is given only as its source states it:

  • Early 1970s: NIMH-funded research on "feminine boys" [source: Green 1976].
  • The UCLA treatment programme, with parents coached to carry out treatment [source: CNN 2011; Johnson 2022].
  • Publication of single-case reports, with the 1974 JABA case presented as a success [source: CNN 2011; Retraction Watch 2020].
  • Wide citation: Web of Science counted 82 citations by 2020 [source: Retraction Watch 2020].
  • Public reckoning: CNN's 2011 series, JABA's 2020 statement of concern, and Johnson's 2022 call for retraction [source: CNN 2011; Retraction Watch 2020; Johnson 2022].

Phases of the psychotherapist's work [synthesis]. Session number and length follow the client's needs and the setting [synthesis].

  1. Recognition and assessment. Identify a history of childhood treatment for gender nonconformity, whether from this programme, its descendants or religious and lay versions. Assess current risk, especially suicide risk, plus trauma symptoms, shame and family relationships. Move on once immediate risk has been assessed and a safety plan is in place where needed.
  2. Safety and stabilisation. Safety planning, crisis resources, grounding and a predictable frame. For a child in any current change effort, safeguarding comes first. Move on when the client can tolerate talking about the history without escalating risk.
  3. Processing and meaning-making. Work through the narrative, shame, betrayal by caregivers and professionals, and identity exploration from an affirming, non-directive stance [source for the stance: APA 2021; UK MoU v2]. Move on when the client can hold the history as something done to them, not a verdict on who they are.
  4. Repair, relationships and advocacy. Family work if wanted, bereavement and postvention work, records and legal routes, contact with peers and advocacy. Follow up and end with an agreed relapse and crisis plan.

Format: individual therapy is the default. Family or couple sessions only at the client's request and with their consent. Child and family work only under safeguarding frameworks [synthesis].

3. Guiding principles

  • No change goal. Never set out to change a client's sexual orientation, gender identity or gender expression. Signatory practitioners must be "free from any agenda that favours one gender identity or sexual orientation" [source: UK MoU v2].
  • Not a disorder in itself. Neither sexual orientation nor gender identity is in itself an indicator of a mental disorder [source: UK MoU v2]. Assess distress, not identity.
  • Exploration is legitimate. The MoU does not aim to "deny, discourage or exclude" people who are uncertain or distressed about their sexuality or gender from getting qualified help [source: UK MoU v2]. Uncertainty can be explored openly, with no preferred outcome.
  • Validate and normalise. The APA's practice guidelines encourage psychologists to "validate, normalize, and assist" clients in understanding how sexual orientation, gender identity and gender expression interact, "keeping cultural differences in mind" [source: APA 2021].
  • Treat suicide risk as live. Conversion efforts are linked with higher rates of suicidal thinking and attempts [source: Blosnich et al. 2020 via Williams Institute; APA 2021]. Ask directly and early, and follow safe-messaging practice.
  • Children are owed protection. The UN Independent Expert says children most often undergo these practices because parents or guardians want them to conform [source: A/HRC/44/53, para 26]. Apply child-protection duties and do not defer to a parent's wish for conformity.
  • Separate harm from blame. Parents in programmes like this were coached by professionals [source: Johnson 2022]. Hold them accountable without scapegoating them, and keep the professionals' role in view [synthesis].
  • One role at a time. The 1974 case blended treatment, research and publication. Do not combine roles that could compromise the client's interests (APA Ethics Code Standard 3.05, Multiple Relationships) [source: https://www.apa.org/ethics/code]. Do not use a client's history for research, teaching or publication without informed consent [synthesis].
  • Privacy over publicity. Survivors and families may have been written about without their say. Never name or identify them, and let the client decide what is told and to whom [synthesis].
  • Name without moralising. Describe what was done and its effects plainly. Let the client's own judgement develop [synthesis].
  • Never provide, supervise or refer. Never provide, supervise or refer to change efforts. Know your duties when a colleague or institution offers them [synthesis].

4. Intervention inventory

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

None of these interventions reproduces the 1970s programme. Where the history is discussed, describe what was done in plain observable terms, without procedures.

4.1 Building your own historical literacy

  • Purpose / when: Before working with survivors, families or trainees, and whenever a client mentions childhood treatment for being a "sissy," "too feminine" or "gender-confused."
  • Steps [synthesis]:
    1. Know the outline: the UCLA programme, the 1974 JABA case, NIMH-funded research on feminine boys, CNN's 2011 series, JABA's 2020 statement of concern and the 2022 call for retraction [source: CNN 2011; Retraction Watch 2020; Green 1976; Johnson 2022].
    2. Know the current positions: APA 2021, the UK MoU and the UN Independent Expert's 2020 report [source: as cited in section 1].
    3. Learn the lineage. Similar aims survive in religious ministries, lay coaching and some "gender-conformity" parenting advice. Under the MoU definition, conversion therapy can also be hidden within mainstream practice [source: UK MoU v2].
    4. Check your own field's history, for example if you trained in behavioural or ABA traditions, so it does not surprise you mid-session.
  • Example language (illustrative): "What you're describing sounds like treatment that some clinics offered in the 1970s to make boys more 'masculine.' It's now recognised as harmful. I'd like to hear what it was like for you."
  • Watch for: Over-teaching. The history serves the client's story and does not replace it. It's working when you can orient the client in a sentence or two and hand the conversation back.

4.2 Screening for a history of childhood gender-conformity treatment

  • Purpose / when: At intake with gender-nonconforming, gay, bisexual, trans or nonbinary adults, and with any adult describing childhood treatment they did not understand.
  • Steps [synthesis]:
    1. Ask an open question about childhood treatment or counselling linked to how they played, dressed or behaved.
    2. Ask who arranged it: parents, school, clinic, religious leader. In a US sample, most people who reported conversion efforts got them from a religious leader, and about a third from a health care provider [source: Williams Institute summary of Blosnich et al. 2020].
    3. Ask about home routines that parents may have been coached to run. Do not ask for procedural detail.
    4. Note fragments: many people were very young and have little explicit memory. Records or family accounts may later fill gaps.
  • Example language (illustrative): "Some people were taken to doctors or counsellors as children because of how they played or dressed. Did anything like that happen to you?"
  • Watch for: Forcing recall of early-childhood material. A "no" may mean "I don't know." It's working when the client can return to the topic later on their own.

4.3 Suicide-risk assessment and safety planning

  • Purpose / when: With every survivor of conversion efforts and with bereaved family members. LGB adults who underwent conversion efforts were reported "nearly twice as likely" to think about and attempt suicide [source: Williams Institute summary of Blosnich et al. 2020]. The APA cites raised attempt rates among young people too [source: APA 2021].
  • Steps [synthesis, following standard risk-assessment practice]:
    1. Ask directly about suicidal thoughts, intent, plans, past attempts and protective factors.
    2. Ask about current exposure to rejection or ongoing change pressure.
    3. Build a written safety plan: warning signs, coping steps, people and places, professional contacts, crisis lines.
    4. Lethal-means counselling: agree safe storage or removal, with no discussion of methods.
    5. Crisis resources: 988 Suicide & Crisis Lifeline (US, call or text 988); Samaritans 116 123 (UK and Ireland).
    6. Review at each session during high-risk periods, such as anniversaries, family contact and media coverage.
  • Example language (illustrative): "People who went through treatment like this as children sometimes have thoughts of ending their lives. Have you had thoughts like that, recently or in the past?"
  • Watch for: Spikes in risk after news coverage of the case or of court rulings, or after talks with family. Safe messaging matters: do not discuss how anyone died or present a death as a resolution. It's working when the client can name warning signs and uses the plan.

4.4 Trauma-informed assessment of adult survivors

  • Purpose / when: After disclosure, to map effects without retraumatising the client.
  • Steps [synthesis]:
    1. Use standard trauma screening, describing any licensed instruments without reproducing their items.
    2. Map shame, self-hatred, depression, anxiety and post-traumatic stress. The UN Independent Expert lists these among lasting effects [source: A/HRC/44/53, paras 19, 56].
    3. Map relational effects: trust in caregivers and professionals, and the body and gender expression.
    4. Record identity and gender questions as the client frames them, without pathologising.
    5. Agree pacing and stop signals with the client.
  • Example language (illustrative): "We can go at whatever pace works for you. If anything we talk about feels like too much, tell me or just raise your hand, and we'll pause."
  • Watch for: Mistrust of you as a professional, which may be well founded given the history. Name it. It's working when the client can report distress in the session rather than leaving.

4.5 Psychoeducation on what is known now

  • Purpose / when: When a client blames themselves, believes the treatment "worked," or asks whether their identity was caused or fixed by it.
  • Steps:
    1. Share the professional consensus. The APA found "no evidence of sexual orientation change" and considers transgender and nonbinary identities "normal variations" [source: APA 2021]. The UK MoU calls conversion therapy unethical and potentially harmful [source: UK MoU v2]. The UN Independent Expert concluded that none of the approaches reviewed can claim conversion as an outcome [source: A/HRC/44/53, para 70].
    2. Explain that JABA has formally flagged the 1974 paper as ethically concerning [source: Retraction Watch 2020].
    3. Let the client decide how much history they want.
  • Example language (illustrative): "The professional bodies that once tolerated this now say plainly that it doesn't change who someone is, and that it can do real harm. The problem was the treatment, not you."
  • Watch for: Information used to intellectualise grief. It's working when the client's self-blaming statements soften.

4.6 Affirming, non-directive identity exploration

  • Purpose / when: When the client wants to understand their sexual orientation, gender identity or gender expression after a childhood in which these were "corrected."
  • Steps:
    1. State that there is no preferred outcome, in line with the MoU requirement to be free of any agenda favouring one gender identity or orientation [source: UK MoU v2].
    2. Explore what the client feels, wants and has suppressed, paying attention to how sexual orientation, gender identity and expression interact and to cultural context [source: APA 2021].
    3. Separate what was trained into them from what they now choose. Both are theirs to keep or drop [synthesis].
    4. Refer to gender services only if the client wants assessment, and only through mainstream clinical routes [source: UK MoU v2 on clinical assessment; synthesis].
  • Example language (illustrative): "I don't have an outcome in mind. I'm interested in what fits for you now that it's your choice."
  • Watch for: Subtle steering in either direction. It's working when the client's choices are clearly their own and they report less fear.

4.7 When a client asks you to change their orientation or gender identity

  • Purpose / when: A survivor or anyone else asks for help becoming straight, or becoming comfortable in their birth-assigned gender role because they believe they must.
  • Steps:
    1. Do not attempt change. Explore the distress behind the request. The MoU explicitly protects help for people in distress about their sexuality or gender and for those wanting to reduce distress or reach self-acceptance [source: UK MoU v2].
    2. Explore the sources of pressure: family, faith, community, safety, internalised messages from childhood treatment [synthesis].
    3. Be transparent: say you will not try to change their orientation or identity, and explain why [synthesis].
    4. Offer goals that can be reached: less distress, values-based choices, safety, relationships [synthesis].
  • Example language (illustrative): "I won't try to change who you're attracted to or who you are. There's no good evidence that can be done, and attempts can hurt people. I'd like to understand what makes this feel so necessary, and help with that."
  • Watch for: The client seeking a change provider elsewhere. Assess suicide risk (4.3). It's working when the client stays engaged and the distress becomes the focus.

4.8 Working with shame and internalised stigma

  • Purpose / when: When the client describes self-hatred or disgust about their own gentleness, voice, interests or body. These are among the lasting effects the UN Independent Expert describes [source: A/HRC/44/53, para 56].
  • Steps [synthesis]:
    1. Name shame as an expected response to having been taught that you were wrong.
    2. Trace specific shame triggers to childhood messages without making the client re-live them.
    3. Use self-compassion and compassion-focused approaches as they are taught in mainstream training.
    4. Gradually reconnect with valued activities and expression the client chooses.
  • Example language (illustrative): "That flinch when you noticed you'd crossed your legs a certain way: where do you think you learned it?"
  • Watch for: Pushing reclamation faster than the client wants. It's working when the client can do valued things with less self-attack.

4.9 Processing caregiver involvement and betrayal

  • Purpose / when: When parents took part in the treatment, as the 1974 case describes [source: Johnson 2022], and the client feels love and anger toward them at once.
  • Steps [synthesis]:
    1. Make room for mixed feelings. Professionals advised the parents, and the parents still acted.
    2. Distinguish responsibility, blame and forgiveness. None is required.
    3. Explore what the client wants now: distance, honest talk, apology, nothing.
    4. Prepare any conversation with the family in session first.
  • Example language (illustrative): "It can be true that your parents were told this was best for you, and also true that it hurt you badly. You don't have to settle which one counts more."
  • Watch for: Forced forgiveness, and the client protecting parents at their own expense. It's working when the client can state their own position.

4.10 Work with parents and families who took part

  • Purpose / when: A parent, now older, asks for help with guilt about having enrolled a child in such a programme, or the family wants repair.
  • Steps [synthesis]:
    1. Assess the parent's own risk and grief.
    2. Give accurate history. Parents acted on professional advice that bodies now reject [source: APA 2021; UK MoU v2].
    3. Support accountability without collapse: acknowledgement and apology only if the adult child wants contact.
    4. Offer facilitated family sessions only with the adult child's consent, set at their pace.
  • Example language (illustrative): "You trusted the experts, and the experts were wrong. What would taking responsibility look like for you now, in a way that puts your son's needs first?"
  • Watch for: The parent seeking absolution from the child through you. It's working when the parent can listen without defending.

4.11 Bereavement and postvention after a suicide

  • Purpose / when: Siblings, parents, partners or friends of someone treated in childhood who later died by suicide. CNN reported such a death in 2011 [source: CNN 2011].
  • Steps [synthesis]:
    1. Assess the bereaved person's own suicide risk (4.3). Suicide bereavement raises risk.
    2. Support grief that may be complicated by guilt, anger at institutions, and public attention.
    3. Follow safe messaging: talk about the person's life and the harms done to them, not about how they died.
    4. Offer suicide-bereavement peer support where it is available locally.
  • Example language (illustrative): "Many people who lose someone this way carry questions with no answers. We can make space for the questions and for him, not only for how it ended."
  • Watch for: Anniversaries, renewed press interest and court rulings as triggers. It's working when grief can be spoken about without collapse.

4.12 Intergenerational and sibling effects

  • Purpose / when: When a sibling saw the treatment, or the client fears repeating the pattern with their own children.
  • Steps [synthesis]:
    1. Ask what the sibling saw or was told.
    2. Explore survivor guilt and loyalty binds.
    3. With client-parents, explore their fears about a child's gender expression and give the current professional position [source: APA 2021; A/HRC/44/53, para 71].
  • Example language (illustrative): "Watching it happen to your brother taught you something too. What did you learn about what was safe to be?"
  • Watch for: A parent-client pressuring their own gender-nonconforming child. Move to safeguarding (4.15) if that is present. It's working when the client separates their own parenting from the old messages.

4.13 Records, publications and the client's own story

  • Purpose / when: A survivor or family member wants to find clinical records or learns that they were a published case.
  • Steps [synthesis]:
    1. Explore what they hope to find and what they fear finding.
    2. Signpost legal routes to records, such as data-subject or patient-records requests through the institution, with legal advice. Do not make requests on their behalf without written consent.
    3. Plan support around reading records, and pace the reading.
    4. If they want to contact a journal, note that JABA has issued a statement of concern about the 1974 paper and that others have called for retraction [source: Retraction Watch 2020; Johnson 2022].
  • Example language (illustrative): "Before you open the file, let's plan what you'll do afterwards and who you'll have around."
  • Watch for: Re-traumatisation from clinical language describing the client as a child. It's working when the client feels the material belongs to them rather than to the researchers.

4.14 Media, publicity and privacy

  • Purpose / when: When a case connected to the client is in the news, or the client is thinking about speaking publicly.
  • Steps [synthesis]:
    1. Weigh benefits (validation, advocacy) against risks (exposure, family conflict, online abuse).
    2. Agree boundaries, and offer contact with journalists only through a trusted advocate.
    3. Prepare for responses from people connected to the programme. In 2011 CNN gave Rekers a right of reply [source: CNN 2011].
  • Example language (illustrative): "You get to decide whether your story is told, how much, and when. What would you need in place before saying yes?"
  • Watch for: Pressure from advocacy groups or family. It's working when decisions are paced and owned by the client.

4.15 Safeguarding children today

  • Purpose / when: A parent asks you, or another provider, to make a young child's play or behaviour "more masculine" or "more feminine," or you learn that a child is in such a programme.
  • Steps:
    1. Decline to attempt change. The UN Independent Expert concluded that subjecting children to these practices "constitutes ill-treatment and may constitute torture" [source: A/HRC/44/53, para 71].
    2. Assess the child's safety: physical punishment, deprivation, isolation, distress. Follow your jurisdiction's mandatory reporting and child-protection procedures where abuse is suspected [synthesis].
    3. Work with the parents' fears: social stigma, religion, safety. Offer accurate information [source: APA 2021] and parenting support for an accepting home [synthesis].
    4. Seek the child's assent and the parents' consent for any work, and attend to the child's voice in an age-appropriate way [synthesis].
    5. For gender-identity questions, refer only to mainstream, evidence-based paediatric or child mental-health services. See 072 for the contested evidence on childhood gender-conformity programmes [synthesis].
  • Example language (illustrative): "I can hear how worried you are about how others will treat him. I won't try to change how he plays. I can help you support him, and help you with your own worries."
  • Watch for: The family moving to an unregulated provider. Note the US legal picture after Chiles v. Salazar (section 5). It's working when the parents' focus shifts from changing the child to the child's wellbeing.

4.16 Religious clients and families

  • Purpose / when: When faith shaped the original treatment or still shapes the client's or family's distress. US survey data show that conversion efforts are most often delivered by religious leaders [source: Williams Institute summary of Blosnich et al. 2020].
  • Steps:
    1. Use the DSM-5-TR Cultural Formulation Interview with its supplementary module on spirituality, religion and moral traditions [uncertain: DSM-5-TR wording not verified].
    2. Where the difficulty centres on faith, the DSM-5-TR Religious or Spiritual Problem may be recorded as Z65.8 [source: ICD-10-CM Z65.8].
    3. Approach with cultural humility and spiritual competencies (Vieten et al. 2013) [uncertain: not verified]. Never treat faith as the problem to be removed.
    4. Help the client find their own path: reconciling faith and identity, changing communities, or stepping back, with no preferred outcome [synthesis].
  • Example language (illustrative): "Your faith matters to you, and so does being honest about who you are. I'm not here to make you give up either. Let's look at what each part of you needs."
  • Watch for: Your own assumptions about religion. It's working when the client can hold both identities with less conflict.

4.17 When a colleague or institution uses change efforts

  • Purpose / when: You learn that a colleague, supervisee, clinic or training programme is offering or teaching orientation or gender-identity change efforts, including disguised versions.
  • Steps:
    1. Do not provide, supervise or refer to it. Under the UK MoU, signatory organisations commit not to commission or provide conversion therapy [source: UK MoU v2].
    2. Raise the concern directly where it is safe to, then use your professional body's complaints route or your licensing board. The MoU signatories (e.g. BACP, BPS, BPC) publish guidance for registrants; the signatory list changes over time, so check the current version [source: UK MoU v2; synthesis].
    3. Where a child is involved, follow child-protection procedures (4.15).
    4. Document what you observed and when [synthesis].
  • Example language (illustrative, to a colleague): "I'm concerned that what you're offering this client aims to change their orientation. Our professional bodies say that's unethical and harmful, and I'd like us to talk about it before I take it further."
  • Watch for: The approach being relabelled, for example as "exploration" that in fact has a fixed endpoint. The MoU covers practice hidden within mainstream work [source: UK MoU v2].

4.18 Research-ethics literacy and dual roles

  • Purpose / when: In supervision, teaching, or your own research with clients.
  • Steps:
    1. Use the 1974 case and JABA's 2020 decision as a teaching case. Discuss the journal's statement that the study would be considered unethical "by today's standards," and the counter-argument that it was unethical then too [source: Retraction Watch 2020; Johnson 2022].
    2. Check that you do not combine therapist, researcher and author roles in ways that compromise the client (APA Ethics Code Standard 3.05) [source: https://www.apa.org/ethics/code].
    3. Do not publish case material without informed consent and real de-identification [synthesis].
  • Example language (illustrative, supervision): "If you were the child's therapist and also writing him up as a success, whose interests would you be serving?"
  • Watch for: Treating the history as a closed chapter. It's working when trainees can spot similar risks in current practice.

4.19 Legal and advocacy routes

  • Purpose / when: A survivor wants accountability or redress.
  • Steps:
    1. Refer to legal advice. Do not give legal opinions yourself [synthesis].
    2. Explain that, according to the Trevor Project, after Chiles v. Salazar people subjected to conversion therapy still have other legal options such as consumer fraud and malpractice claims [source: Trevor Project 2026]. As an often-cited precedent, the Associated Press reported that a New Jersey jury found JONAH liable for consumer fraud in June 2015 (see 076).
    3. The UN Independent Expert recommends that States ban these practices and that claims be investigated and, where relevant, prosecuted [source: A/HRC/44/53, paras 65, 87].
    4. Support the client through legal processes, which can be retraumatising [synthesis].
  • Example language (illustrative): "A lawyer can tell you what's possible where you live. I can help you decide whether you want to pursue it, and support you if you do."
  • Watch for: Legal timelines driving the pace of therapy. It's working when the client's choice is informed and paced.

4.20 Peer connection and community repair

  • Purpose / when: Isolation, or the belief that nobody else went through this.
  • Steps [synthesis]:
    1. Explore what kinds of contact the client wants with other survivors and LGBTQ+ communities.
    2. Signpost local LGBTQ+ centres and survivor peer groups as they describe themselves, and check them for any change agenda.
    3. Use the connections in therapy to counter shame.
  • Example language (illustrative): "Some people find it helps to meet others who went through similar things. Would that interest you, or not yet?"
  • Watch for: Groups with a hidden change agenda, such as some "support" ministries. It's working when the client reports belonging.

5. Handling problems

  • The client says the treatment "worked" or "was for my own good." Do not argue. Explore what "worked" means to them: safety at home, parental approval, avoiding bullying. Then offer the professional consensus gently [source: APA 2021; A/HRC/44/53, para 70]. Remember that the 1974 case itself was presented as a success at the time [source: CNN 2011] [synthesis].
  • Little or no memory. The treatment may have taken place in early childhood. Do not try to recover memories or suggest events. Work with present effects and the family narrative, and use records only if the client chooses (4.13) [synthesis].
  • Mistrust of therapists, or ruptures. Your profession did this. Acknowledge that openly, invite feedback, and repair ruptures by naming what happened between you without getting defensive [synthesis].
  • Overwhelm and dissociation in session. Slow down, ground, shift to the present, and shorten exposure to the history. Do not use exposure-based trauma work until stabilisation has been reached and the client consents to it [synthesis].
  • Rising suicide risk. Return to 4.3: update the safety plan, involve supports with consent, and use crisis services: 988 (US), Samaritans 116 123 (UK and Ireland). Watch for triggers such as news coverage, legal rulings and family contact. Safe messaging: never discuss methods, and never frame a death as meaningful or inevitable [synthesis].
  • Stuck in rage at parents or professionals. Validate the anger as proportionate. Explore what it protects, and what the client wants from it: justice, acknowledgement, distance. Do not push forgiveness [synthesis].
  • Non-adherence and missed sessions. These may be avoidance of shame, or a reaction to the structure of the original treatment, where compliance was rewarded. Avoid contingency-style "homework" frames. Give the client control over pacing and tasks [synthesis].
  • The client asks for change again later. Repeat 4.7, explore what has changed, and assess risk [source: UK MoU v2; synthesis].
  • A parent wants a gender-conformity programme for a child. Follow 4.15, apply safeguarding duties, and be aware of the US legal picture. 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]. At that date, OSV News reported 23 states and DC prohibiting licensed providers from conversion therapy, with four more states and Puerto Rico restricting it [source: America/OSV News]. State laws may have changed since [uncertain]. Legal status in other countries changes often; check official government sources [uncertain]. Whatever the law, professional-body positions are unchanged [source: Trevor Project 2026; APA 2021].
  • Pressure from faith communities or family during therapy. Hold an affirming stance without attacking the faith. Use 4.16 and plan for safety around family events [synthesis].
  • Therapist countertransference. Feelings of rage, rescue fantasies, or guilt by professional association (especially in behavioural or ABA-trained clinicians) belong in supervision [synthesis].
  • Contested territory. Clients may bring current debates about childhood gender care. Keep to the evidence statements of professional bodies, avoid political positioning, and see 072 for the contested programmes [synthesis].

Harm account

What was actually done

In the 1970s, researchers at UCLA, working in a government-funded programme, treated young boys considered too feminine, with the aim of making them more conventionally masculine. CNN named George Rekers as the person behind the therapy [source: CNN 2011]. The published case by Rekers and O. Ivar Lovaas (JABA, 1974) concerned a four-year-old boy. Treatment was carried out partly by his parents, under professional direction, using reinforcement and punishment of behaviours labelled feminine. Johnson (2022) describes the paper as coaching the parents "to ignore and physically abuse" their son for such behaviours [source: Johnson 2022; Retraction Watch 2020]. CNN described the boy's effeminate behaviours as having been beaten out of him, physically and psychologically [source: CNN 2011]. Related research on feminine and masculine boys led by Richard Green was funded by NIMH [source: Green 1976]. The programme presented the 1974 case as a success, and it became widely cited [source: CNN 2011; Retraction Watch 2020]. The exact start and end dates, the number of children treated, and any formal project title are [uncertain: not verified]. Rekers later sat on the board of NARTH. He resigned from that board in 2010 after press reports about his private life, and denied being gay [source: Christianity Today 2010].

What it looked like to the child and family. CNN reported that the parents brought their son to the programme because they feared he was too effeminate, and that behaviours judged feminine were then suppressed, physically and emotionally [source: CNN Press Room 2011]. Retraction Watch's account of the 1974 paper and of the journal's 2020 expression of concern describes treatment given partly in a clinic and partly at home: in the clinic the mother was trained to give her son social reward for behaviour labelled masculine and to withhold her attention from behaviour labelled feminine; at home a token system tracked "feminine" behaviour, and the boy could be spanked by his father for it [source: Retraction Watch 2020]. For the child this meant being watched for how he played, moved and spoke, losing his mother's warmth when he behaved "like a girl", and being physically punished at home for the same things [synthesis, from the sources above]. The journal's editor wrote in 2020 that the treatment did not work as its proponents suggested, and the family described taking part as very harmful [source: Retraction Watch 2020]. The UN Independent Expert lists training to make behaviour more stereotypically masculine or feminine among conversion practices still reported (para. 44) [source: A/HRC/44/53].

How it caused harm

CNN reported in 2011 that the boy in the 1974 case was severely depressed as an adult and died by suicide at 38. His family regarded participation as harmful [source: CNN 2011; Retraction Watch 2020]. JABA's editor wrote that the suicide could not be causally linked to the study [source: Retraction Watch 2020]. Johnson (2022) argues that the evidence strongly suggests the study was unethical even by the standards of its time [source: Johnson 2022]. More broadly, LGB adults in a US sample who underwent conversion efforts were nearly twice as likely to report suicidal ideation and attempts [source: Williams Institute summary of Blosnich et al. 2020]. The causal reading of such data has been disputed in published exchanges [uncertain: not verified]. The UN Independent Expert describes lasting effects including shame, self-hatred, depression, anxiety, post-traumatic stress and suicide attempts. The report also notes that children usually undergo these practices at parents' or guardians' wish [source: A/HRC/44/53, paras 19, 26, 56]. The APA reports emotional distress, loss of relationships and low self-worth among people subjected to gender identity change efforts [source: APA 2021].

Recognising it today

  • An adult who describes childhood treatment, often at a university clinic or by a psychologist, for "sissy" or "girlish" behaviour, sometimes with parents carrying out the rewards and punishments at home [synthesis].
  • Present-day offers to make a child's play, clothes, voice or mannerisms more gender-typical as treatment, in clinics, coaching, ministries or parenting programmes. The MoU notes that conversion therapy can be hidden within mainstream practice [source: UK MoU v2].
  • Practice framed as "exploration" that in fact has a fixed endpoint favouring one gender identity or orientation [source: UK MoU v2].
  • Literature still citing the 1974 paper as a model, without the 2020 statement of concern [source: Retraction Watch 2020].

What to do instead and how to help those harmed

  • Alternative care. Affirming, non-directive support that validates and normalises sexual orientation, gender identity and gender expression [source: APA 2021]. It is free of any agenda favouring one outcome, while still helping clients explore uncertainty and reduce distress [source: UK MoU v2]. For children, mainstream evidence-based child mental-health or paediatric services, and family support toward acceptance [synthesis; see 072].
  • Survivors. Trauma-informed assessment, suicide-risk assessment and safety planning, and work on shame, identity and family (4.2-4.9, 4.20). Crisis lines: 988 (US); Samaritans 116 123 (UK and Ireland).
  • Families. Work with parents' guilt and accountability, sibling effects, and postvention after a suicide (4.10-4.12).
  • Reporting duties. Child-protection reporting where a child is subjected to such practices now. The UN Independent Expert regards these practices with children as ill-treatment that may amount to torture [source: A/HRC/44/53, para 71]. Complaints to professional bodies and licensing boards about practitioners who offer change efforts (4.17).
  • Legal routes. Legal advice on consumer-fraud and malpractice claims [source: Trevor Project 2026]. The UN Independent Expert calls for bans and for investigation and prosecution of specific claims [source: A/HRC/44/53, paras 65, 87].
  • Survivor organisations. Signpost LGBTQ+ community centres and survivor peer networks as they describe themselves, after checking that they have no change agenda [synthesis].

Sources

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