Atlas›Domain XVI · Historical, discredited & harmful›Guide 074
Guide XVI-074

Ex-gay ministries (Exodus International)

Frank Worthen1976
A 32 · L 52 · M 1619 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 psychotherapist's own work with clients affected by faith-based "ex-gay" ministries, centred on Exodus International (1976 to 2013) and its affiliates and successors as Religion News Service and Christianity Today reported them, read against the APA 2021 Resolution on Sexual Orientation Change Efforts and Resolution on Gender Identity Change Efforts, the UK Memorandum of Understanding on Conversion Therapy (Version 2, Revision A, dated 03/07/2019), UN report A/HRC/44/53 (2020) and the 2020 Statement of the Independent Forensic Expert Group on Conversion Therapy. This guide does not teach any change effort; it covers recognition, assessment, safeguarding, repair and advocacy.

1. Introduction

Ex-gay ministries are religious (mostly evangelical Christian) organisations that told gay, lesbian and bisexual people that their sexual orientation could or should be changed or suppressed through faith, and offered support groups, discipleship and, in some cases, residential and youth programmes to that end. They belong to the wider family of sexual orientation and gender identity change efforts (SOGICE), also called conversion practices. Exodus International was the best-known umbrella network: Religion News Service reported that it began in 1976, describing it as founded by Frank Worthen, and that its board voted unanimously in June 2013 to close it, while its president, Alan Chambers, apologised for promoting "sexual orientation change efforts" and for harm done by "reparative theories" that stigmatised parents [source: Religion News Service 2013]. Christianity Today reported more than 250 affiliate ministries in 2012 [source: Christianity Today 2012].

The ministries' own idea of change was religious: that same-sex attraction was a problem to be healed or overcome through faith, discipline and community [source: Christianity Today 2012; Religion News Service 2013]. Professional and international bodies state the opposite conclusion. The APA 2021 resolution states there is "no evidence of sexual orientation change" and that many former participants regard the experience as harmful [source: APA press release 2021]; the UK Memorandum of Understanding calls conversion therapy "unethical and potentially harmful" [source: MoU v2 Rev A]; the UN Independent Expert reports that these practices cause depression, anxiety, suicidality, shame and self-hatred, may be cruel, inhuman and degrading, and "may amount to torture depending on the circumstances" [source: A/HRC/44/53, paras 55-65]; and the Independent Forensic Expert Group addresses "the lack of medical and scientific validity of conversion therapy" [source: IFEG 2020].

For the psychotherapist, change happens on the other side: through an affirming, non-directive relationship in which the client can explore sexuality, faith, family and community without a preset outcome, process shame and religious trauma, assess and manage suicide risk, and rebuild identity, relationships and (if they wish) faith [source: MoU v2 Rev A, paras 6, 11; synthesis].

2. Framework

This is not a therapy with a manual. The framework below describes the phases of the psychotherapist's own work, followed by the historical phases of the ministries in outline. Session numbers are not fixed; length depends on risk, trauma load and the client's goals [synthesis].

Phases of the psychotherapist's work [synthesis, informed by MoU v2 Rev A and A/HRC/44/53]

  1. Recognition and assessment. Goal: learn whether the client was, is, or may be involved in an ex-gay ministry or other change effort, at what age, with what degree of choice, and with what effects. Move on once the history, current involvement, risk level and the client's own goals are clear enough to plan.
  2. Safety and safeguarding. Goal: assess suicide and self-harm risk, current coercion, and any minor at risk; make a safety plan and any required report. Move on once acute risk is managed and safeguarding actions are taken.
  3. Stabilisation and psychoeducation. Goal: give accurate information about what professional bodies state, normalise the client's reactions, and reduce shame. Move on when the client can hold the information without acute destabilisation.
  4. Processing and repair. Goal: work through shame, religious trauma, loss (of community, years, relationships, faith) and family injuries; integrate sexual, gender and spiritual identity on the client's terms. Move on when the client reports reduced shame and a workable self-narrative.
  5. Integration, advocacy and follow-up. Goal: consolidate identity and relationships, address legal or complaint routes if wanted, plan for triggers (family events, religious holidays, contact with former ministry members), and end or taper.

Historical phases of Exodus International in outline

  • 1976: founding of an umbrella network of ex-gay ministries [source: Religion News Service 2013].
  • Growth period: by 2012 Exodus had more than 250 affiliate ministries [source: Christianity Today 2012].
  • 2012: disavowal and split. Chambers disavowed reparative therapy at the Gay Christian Network conference in January 2012; Exodus moved from a therapy-centred to a discipleship model; dozens of affiliates left, including Desert Stream Ministries, and the Restored Hope Network formed, led by Andrew Comiskey and Frank Worthen among others, holding its first conference in September 2012 [source: Christianity Today 2012; Religion News Service 2013].
  • 2013: closure and apology. The board voted to close Exodus; Chambers said his core beliefs about sexuality had not changed; local affiliates were to continue autonomously, not under the Exodus name. A former Exodus chairman, John Paulk, also apologised for promoting reparative therapy [source: Religion News Service 2013].
  • After 2013: successor networks and formerly affiliated local ministries continued [source: Christianity Today 2012; Religion News Service 2013]; their present scale is [uncertain: not verified].

3. Guiding principles

  • No change effort, ever. The psychotherapist never attempts, supervises or refers for change or suppression of sexual orientation or gender identity. Practical meaning: decline such goals openly and offer exploration instead [source: MoU v2 Rev A; APA 2021].
  • No identity is preferable. Work "free from any agenda" favouring one sexual orientation or gender identity over another. Practical meaning: check your own wording and silences for hidden preferences [source: MoU v2 Rev A].
  • Orientation and gender identity are not disorders. Practical meaning: do not formulate the orientation itself as the problem; formulate the distress and its causes [source: MoU v2 Rev A, para 4].
  • Exploration is allowed and protected. People uncertain about their sexuality or gender identity must not be excluded from help. Practical meaning: open-ended exploration with no predetermined outcome is the offer [source: MoU v2 Rev A, para 6].
  • Faith is not the enemy. The UN Independent Expert notes there is no direct link between religion and the exclusion of sexual or gender diversity and that many religious communities reject these practices. Practical meaning: never require a client to give up faith; help them find their own position [source: A/HRC/44/53, paras 30, 50, 68].
  • Safety first. Change efforts are associated with suicidal ideation and attempts [source: Williams Institute summary of Blosnich et al. 2020; Trevor Project]. Practical meaning: ask about suicide directly and early, follow safe-messaging principles, give crisis resources [synthesis].
  • Children are especially vulnerable. Subjecting children to these practices is ill-treatment that may amount to torture, according to the UN Independent Expert. Practical meaning: any minor currently subjected or about to be sent triggers a safeguarding assessment [source: A/HRC/44/53, paras 71-74].
  • Self-determination with informed choice. Practical meaning: the client decides on faith, relationships and disclosure; the therapist ensures the decision is informed by accurate information and free of coercion [synthesis].
  • Trauma-informed pacing. Practical meaning: let the client control the pace of recounting ministry experiences; no pressure to disclose detail [synthesis].
  • Cultural humility. Practical meaning: learn the client's tradition and vocabulary (for example "same-sex attraction", "freedom", "brokenness") from the client rather than assuming [synthesis].
  • Competence and training. Practical meaning: keep up to date on gender and sexual diversity and seek supervision or consultation where your knowledge is thin [source: MoU v2 Rev A, paras 11, 13-16].
  • Boundaries with religious communities. Practical meaning: if you share or hold a role in the client's congregation or a ministry, address the multiple relationship under APA Ethics Code Standard 3.05 before proceeding [source: APA Ethics Code].
  • Non-moralising language. Practical meaning: describe what happened and its effects; let the client name it [synthesis].
  • Accurate law, dated. Practical meaning: give legal information only with a date and an official or major-news source, and refer to a lawyer for advice [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 Historical literacy about ex-gay ministries

  • Purpose and when to use: before and during work with any client who mentions a ministry, a support group for "same-sex attraction", or a church programme about sexuality. Knowing the landscape lets the therapist ask informed questions and avoid both minimising and sensationalising [synthesis].
  • Steps: (1) Know the outline: Exodus International (1976 to 2013), its many local affiliates, its 2012 disavowal of reparative therapy and shift to discipleship, the departure of affiliates and the formation of the Restored Hope Network, and the 2013 closure and apology [source: Christianity Today 2012; Religion News Service 2013]. (2) Know that local ministries continued after 2013 without the Exodus name [source: Religion News Service 2013]. (3) Know that the UN Independent Expert identifies faith-based organisations as among the main providers of conversion practices, and that many religious communities reject them [source: A/HRC/44/53, paras 30, 50, 68]. (4) Ask the client which group, years and setting; do not assume their experience matches the general history [synthesis].
  • Example language (illustrative): "Some people I work with were part of ministries linked to Exodus, or groups that carried on after it closed. Can you tell me about the group you were part of, in your own words?"
  • Watch for: the client correcting your picture (their group may have been gentler or harsher than the general account); your own reactions to the history. Working signs: the client feels understood rather than labelled [synthesis].

4.2 Establishing an affirming, non-directive frame

  • Purpose and when to use: at contracting with every client whose concerns touch sexuality, gender identity or faith [source: MoU v2 Rev A].
  • Steps: (1) State that you do not try to change or suppress anyone's sexual orientation or gender identity, and that you will help the client explore whatever they bring without a preset outcome [source: MoU v2 Rev A, paras 3, 6]. (2) Say that their faith, doubts and values are welcome topics [synthesis]. (3) Invite the client to tell you if anything you say feels like pressure in any direction [synthesis]. (4) Record the agreed goals in the client's words [synthesis].
  • Example language (illustrative): "I won't try to make you straight, and I won't push you to leave your faith. My job is to help you work out what's true for you and what you want your life to look like."
  • Watch for: relief, or suspicion (some clients were told secular therapists will "push an agenda"). Working signs: the client raises faith and sexuality topics without hedging [synthesis].

4.3 Screening and history-taking for past change efforts

  • Purpose and when to use: at intake with LGBTQ+ clients and with clients from religious backgrounds where these ministries were common. Change-effort exposure is not rare: a national summary of Blosnich et al. reported about 7% of non-transgender LGB adults in the US had experienced conversion therapy, 81% of them from a religious leader [source: Williams Institute summary of Blosnich et al. 2020].
  • Steps: (1) Ask a neutral, open question about any attempt by anyone to change or suppress their orientation or gender identity [synthesis]. (2) If yes: who (ministry, pastor, counsellor, family), at what age, for how long in general terms, voluntary or pressured, residential or not, and what it was like [synthesis]. (3) Ask about current contact with the group or its members [synthesis]. (4) Ask about present effects: shame, mood, sleep, relationships, faith, sexual and relational wellbeing [synthesis]. (5) Ask about adverse childhood experiences, since the same study linked them with greater likelihood of change-effort exposure [source: Williams Institute summary of Blosnich et al. 2020]. (6) Do not ask for detail of techniques or rituals; let the client choose what to share [synthesis].
  • Example language (illustrative): "Has anyone, a church, a counsellor, family, ever tried to change who you're attracted to or how you see your gender? You can tell me as much or as little as feels right."
  • Watch for: minimising ("it was just a support group"), dissociation or flat affect when recounting, sudden shame. Working signs: a coherent history emerges at a tolerable pace [synthesis].

4.4 Suicide and self-harm risk assessment with safe messaging

  • Purpose and when to use: with every client who has experienced change efforts, early and whenever distress rises. Blosnich et al. found LGB people who underwent conversion therapy were "nearly twice as likely to think about and attempt suicide" [source: Williams Institute summary of Blosnich et al. 2020]; the Trevor Project reports LGBTQ+ youth exposed are "more than twice as likely to attempt suicide" [source: Trevor Project]; the UN Independent Expert lists suicidal thoughts and attempts among reported harms [source: A/HRC/44/53, paras 55-58].
  • Steps: (1) Ask directly about suicidal thoughts, past attempts, intent and plans, using your service's standard risk-assessment approach [synthesis]. (2) Explore specific drivers: shame, fear of rejection by family or congregation, loss of faith, being outed, or pressure to return to a programme [synthesis]. (3) Make a collaborative safety plan: warning signs, coping steps, people and places, professional contacts, and lethal-means counselling about safe storage and removal (no method discussion) [synthesis]. (4) Give crisis resources: 988 Suicide and Crisis Lifeline (US); Samaritans 116 123 (UK and Ireland) [synthesis]. (5) Follow safe-messaging principles: no method details, no glamorising, emphasise that help works and recovery is common [synthesis]. (6) Escalate per local protocols where risk is high [synthesis].
  • Example language (illustrative): "A lot of people who went through programmes like this have had thoughts of ending their life. Have you had thoughts like that, now or in the past?"
  • Watch for: spikes around coming out, family confrontations, religious holidays, anniversaries, or contact with former leaders. Working signs: the client can name warning signs and uses the plan [synthesis].

4.5 Responding to a client who asks to change orientation or gender identity

  • Purpose and when to use: when a client (often from a religious community, sometimes a former ministry participant) asks the therapist to help them become straight, stop same-sex attraction, or change gender identity.
  • Steps: (1) Thank the client for being open and take the distress seriously [synthesis]. (2) State clearly that you will not attempt change, that professional bodies find no evidence such change works and associate it with harm [source: APA 2021; MoU v2 Rev A]. (3) Offer what you can do: explore the distress, its sources (family, faith, community, fear, shame) and the client's values, with no preset outcome [source: MoU v2 Rev A, para 6]. (4) Explore what the client hopes change would bring (belonging, acceptance, peace with God, keeping a marriage) and whether there are other routes to those goods [synthesis]. (5) Keep open all outcomes the client may reach, including celibacy, staying in their tradition, moving to an affirming one, or leaving religion; do not steer [synthesis]. (6) If the client wants to seek a change effort elsewhere, do not refer; share the professional statements and keep the door open [synthesis]. (7) Assess suicide risk (4.4).
  • Example language (illustrative): "I can hear how much pain this is causing. I won't try to change your orientation, because the evidence is that it doesn't work and often harms people. What I can do is help you work out what's underneath this and what you most want for your life and faith."
  • Watch for: the client feeling rejected and leaving; intense shame; family or pastoral pressure behind the request. Working signs: the focus shifts from "fix me" to exploring needs and values [synthesis].

4.6 Psychoeducation on the evidence and professional statements

  • Purpose and when to use: once the client is stable enough, especially if they still believe their failure to change is a personal or spiritual failure.
  • Steps: (1) Ask what they were told about change and why it did not happen [synthesis]. (2) Share, briefly and accurately, what bodies state: APA 2021 (no evidence of change; many former participants regard it as harmful) [source: APA press release 2021]; the UK MoU (unethical and potentially harmful; orientation and gender identity not disorders) [source: MoU v2 Rev A]; the WPA, as quoted by the UN Independent Expert, "no sound scientific evidence" that innate orientation can change [source: A/HRC/44/53, para 20]. (3) Note that Exodus's own president publicly disavowed reparative therapy in 2012 and apologised in 2013 [source: Religion News Service 2013]. (4) Ask what this information means to them; expect grief and anger as well as relief [synthesis].
  • Example language (illustrative): "You weren't failing. The research and the professional bodies say this kind of change doesn't happen, and even the head of Exodus said so publicly before it closed."
  • Watch for: information used as a weapon against family or faith before the client is ready; a sense of wasted years. Working signs: reduced self-blame [synthesis].

4.7 Working with religious and spiritual identity

  • Purpose and when to use: when faith is central to the client's distress, identity or goals, or when loss of faith is part of the harm.
  • Steps: (1) Use the DSM-5-TR Cultural Formulation Interview and its supplementary module on spirituality, religion and moral traditions to learn the client's tradition, its meaning and its supports [synthesis]. (2) Where the difficulty centres on faith, the DSM-5-TR "Religious or Spiritual Problem" may be named, code Z65.8 [source: ICD-10-CM Z65.8 (Unbound Medicine)]; DSM-5-TR wording [uncertain: not verified]. (3) Explore the client's own theology of sexuality and gender, where it came from, and which voices in their tradition they trust [synthesis]. (4) Note that many religious communities reject conversion practices [source: A/HRC/44/53, para 68]; if the client wishes, help them find affirming clergy or communities in their own tradition [synthesis]. (5) Draw on spiritual and religious competencies (Vieten et al. 2013) and consult or co-work with an affirming chaplain if the client wishes [synthesis]. (6) Never argue theology or require the client to leave or stay [synthesis].
  • Example language (illustrative): "Your faith matters to you. Where do you feel God, or your tradition, stands with you now? Are there people in your faith you trust on this?"
  • Watch for: spiritual bypassing, terror of damnation, and the therapist's own religious or anti-religious leanings. Working signs: the client can hold both faith and identity questions without collapse [synthesis].

4.8 Working with shame and internalised stigma

  • Purpose and when to use: with survivors who still experience their orientation or gender identity as defective, sinful or dangerous. The UN Independent Expert lists shame and self-hatred among reported harms, and the IFEG describes the practices as "inherently humiliating, demeaning and discriminatory" as quoted in the UN report [source: A/HRC/44/53, paras 55-58].
  • Steps: (1) Name shame as a learned response to messages received, not a truth about the self [synthesis]. (2) Map the messages: who said what, when, and how they were reinforced [synthesis]. (3) Distinguish the client's own values from those imposed under pressure [synthesis]. (4) Use compassion-focused or cognitive approaches the therapist is trained in to test shame-based beliefs, at the client's pace [synthesis]. (5) Build counter-experiences: affirming relationships, community, and if wished affirming faith settings [synthesis].
  • Example language (illustrative): "That voice saying you're broken, whose voice does it sound like? When did you first hear it?"
  • Watch for: shame turning to self-harm risk (return to 4.4); the client seeking the therapist's approval in place of their own. Working signs: the client can describe their orientation or identity without self-condemnation [synthesis].

4.9 Processing religious trauma and loss of community

  • Purpose and when to use: when ministry or church experiences left fear, intrusive memories, hypervigilance in religious settings, or the client lost a whole community on leaving.
  • Steps: (1) Assess for trauma symptoms with your standard instruments and refer for trauma-focused therapy if indicated and within your competence [synthesis]. (2) Stabilise first: grounding, sleep, routine, safe relationships [synthesis]. (3) Let the client choose which experiences to process and how much detail to give; never ask for ritual or programme content [synthesis]. (4) Name the losses: friends, mentors, roles, worship, music, sense of meaning [synthesis]. (5) Help rebuild community, religious or not [synthesis].
  • Example language (illustrative): "It sounds as though leaving cost you a whole world, not just a set of beliefs. What do you miss most? What are you glad to be free of?"
  • Watch for: retraumatisation through over-detailed recounting; isolation after leaving; pull back to the group from loneliness. Working signs: fewer intrusive reactions; new or restored connections [synthesis].

4.10 Grief work for lost years, relationships and selves

  • Purpose and when to use: when the client mourns time spent trying to change, relationships forgone or ended, or a marriage entered under ministry encouragement.
  • Steps: (1) Validate grief as a natural response [synthesis]. (2) Invite the client to describe the life they put on hold and what they would want now [synthesis]. (3) Address anger, at the ministry, family, church or God, as legitimate and workable [synthesis]. (4) Help the client find meaning on their own terms, which may include advocacy, faith reconstruction or simply living fully [synthesis].
  • Example language (illustrative): "You gave years to something you were told would fix you. It makes sense to grieve that. What would you want those years to have held?"
  • Watch for: grief sliding into hopelessness (risk check); the therapist pushing toward a positive reframe too soon. Working signs: the client talks about the future as well as the past [synthesis].

4.11 Partners, spouses and relationship concerns

  • Purpose and when to use: when a client married or partnered while in a ministry, or a partner or spouse seeks help after disclosure [synthesis].
  • Steps: (1) Clarify who is the client; refer the other partner for their own support if needed [synthesis]. (2) Make space for each partner's distress without assigning blame [synthesis]. (3) Explore options without steering: staying together, redefining the relationship or separating [synthesis]. (4) Address children's needs and safeguarding where relevant (4.13) [synthesis]. (5) Refer to a couple or family therapist with sexual and gender diversity competence if couple work is wanted [synthesis].
  • Example language (illustrative): "You both made promises in good faith based on what you were told. Let's look at what each of you needs now."
  • Watch for: one partner pressing the other back into a ministry; domestic abuse indicators. Working signs: decisions taken with mutual honesty [synthesis].

4.12 Family work with parents

  • Purpose and when to use: with parents who sent or are considering sending a child to a ministry or programme, and with families repairing afterwards. Chambers's 2013 apology specifically named harm from "reparative theories" that stigmatised parents [source: Religion News Service 2013].
  • Steps: (1) Meet parents' fear and grief with respect; many acted from love and their beliefs [synthesis]. (2) Share what professional bodies state about change efforts and harm, including risk for young people [source: APA press release 2021; Trevor Project]. (3) Separate parents' beliefs from their behaviour: they can hold their convictions while keeping the child safe, loved and at home [synthesis]. (4) Help parents relinquish blame ("what did we do wrong?") that reparative theories fostered [source: Religion News Service 2013; synthesis]. (5) Support repair conversations between parent and adult child when both want them, with pacing and ground rules [synthesis]. (6) If a minor is about to be sent to a programme, move to safeguarding assessment (4.13).
  • Example language (illustrative): "You clearly love your child. The professional bodies are clear that trying to change orientation doesn't work and can put young people at serious risk. Can we talk about what keeping them safe looks like for your family?"
  • Watch for: parents seeking an ally against the child; rejection, threats of eviction or withdrawal of support. Working signs: reduced hostility; the child remains safely connected [synthesis].

4.13 Safeguarding minors and reporting

  • Purpose and when to use: whenever a child or adolescent is currently subjected to, or about to be sent to, a change-effort programme, residential or otherwise. The UN Independent Expert concludes that subjecting children to these practices is ill-treatment that may amount to torture [source: A/HRC/44/53, paras 71-74]. In 2005 the Tennessee Department of Children's Services opened an investigation into the Memphis-area ministry Love in Action after a complaint, in the period when a teenager's online account of being sent to its youth programme prompted protests [source: The Advocate 2005; Memphis Flyer 2007].
  • Steps: (1) Assess: the young person's own wishes, any coercion, threats, isolation, confinement, withdrawal of care, and suicide risk [synthesis]. (2) Seek assent from the young person and consent from those with parental responsibility for your own work, within local law [synthesis]. (3) Follow your jurisdiction's mandatory reporting and child-protection procedures where there is reasonable concern of abuse or neglect, and consult your safeguarding lead [synthesis]. (4) Document facts, the young person's words and actions taken [synthesis]. (5) Keep a safe line of contact for the young person, including crisis resources (988 in the US; Samaritans 116 123 in the UK and Ireland) [synthesis].
  • Example language (illustrative): "I'm worried about your safety. I'm going to talk to people whose job is to keep young people safe. I'll tell you what I'm doing and why."
  • Watch for: the family cutting off therapy once concerns are raised; the young person's fear of being outed further. Working signs: a safety plan is in place and the young person stays in contact [synthesis].

4.14 Working with a client currently in, or drawn to, a ministry or successor network

  • Purpose and when to use: when a client attends or plans to join an ex-gay ministry, a successor network, or a church programme framed as "freedom" or "healing" from same-sex attraction. Local ministries continued after Exodus closed, and successor networks formed in 2012 [source: Religion News Service 2013; Christianity Today 2012].
  • Steps: (1) Do not demand that the client leave as a condition of therapy; ruptures here can drive clients away from all help [synthesis]. (2) Explore what draws them: belonging, family peace, faith, fear [synthesis]. (3) Share the professional statements once, clearly (4.6) [source: APA 2021; MoU v2 Rev A]. (4) Monitor mood, shame and suicide risk closely while involvement continues (4.4) [synthesis]. (5) Ask whether participation is freely chosen and whether anyone is pressuring them; for minors go to 4.13 [synthesis]. (6) Keep the door open to reconsider at any point [synthesis].
  • Example language (illustrative): "I'm not going to tell you what to do about the group. I do want to be honest about what the evidence says, and I want to keep checking how you're doing while you're part of it."
  • Watch for: rising hopelessness or self-harm; isolation from affirming contacts. Working signs: the client weighs the decision with open eyes and stays connected to care [synthesis].

4.15 Former ministry leaders, staff and volunteers

  • Purpose and when to use: with clients who led or staffed ministries and now carry guilt for harm to others. Public apologies by Exodus's president and a former chairman show this is a recognised experience [source: Religion News Service 2013].
  • Steps: (1) Hold both roles: they may have been harmed and caused harm [synthesis]. (2) Explore moral injury: values violated, people affected [synthesis]. (3) Support proportionate repair (private amends, public statements, advocacy) chosen by the client, with attention to the wishes of those harmed [synthesis]. (4) Watch for self-punishment and suicide risk (4.4) [synthesis].
  • Example language (illustrative): "You believed you were helping, and you now see people were hurt. Both of those can be true. What would repair look like to you?"
  • Watch for: exposure fears; public pressure; collapse into self-blame. Working signs: guilt moves from paralysis to action [synthesis].

4.16 Responding when a colleague, service or institution offers change efforts

  • Purpose and when to use: when a client reports, or the therapist learns, that a fellow practitioner, a service or an employer offers or refers for change efforts.
  • Steps: (1) Do not provide, supervise or refer to any change effort [source: MoU v2 Rev A, para 12; APA 2021]. (2) Where appropriate and safe, raise the concern informally with the colleague, then follow your professional body's complaints or fitness-to-practise route and any employer whistleblowing route [synthesis]. (3) In the UK, the MoU signatories (including BACP, BPS, BPC, BABCP, NHS England and NHS Scotland, with the Royal College of Psychiatrists and the National Counselling and Psychotherapy Society among its supporters) commit to it; the list changes over time, so check the current version; complaints can go to the practitioner's own body [source: MoU v2 Rev A; synthesis]. (4) In the US, consider state licensing boards and professional association ethics committees [synthesis]. (5) If you hold a role in the same congregation or ministry as the client or colleague, address the multiple relationship under APA Ethics Code Standard 3.05 [source: APA Ethics Code]. (6) Protect client confidentiality and obtain consent before reporting on a client's behalf, except where safeguarding law requires otherwise [synthesis].
  • Example language (illustrative): "What you've described sounds like a change effort, which my profession considers harmful. With your permission, I'd like to talk with you about options for raising this."
  • Watch for: retaliation against the client; your own conflict of interest. Working signs: concerns are logged with the right body [synthesis].

4.17 Legal information and advocacy routes

  • Purpose and when to use: when a client asks about legal remedies or the law where they live, or wants to advocate.
  • Steps: (1) Give only dated, sourced legal information and refer for legal advice [synthesis]. (2) US: 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 the time, America Magazine reported 23 states and DC prohibiting licensed providers from conversion therapy [source: America Magazine 2026]. The Trevor Project notes that consumer-fraud and malpractice claims remain possible routes [source: Trevor Project]. As an often-cited precedent, the Associated Press reported that a New Jersey jury found the organisation JONAH liable for consumer fraud in June 2015 (see 076). (3) Europe (as of June 2023, Euronews): bans in Malta (2016), Germany (2020, minors; non-consenting adults), Albania (2020, minors), France (2022, criminal), Greece (2022, minors), Spain (2023), Cyprus (2023) and Iceland (2023); the UK bill was then pending [source: Euronews 2023]; current status [uncertain: may have changed]. Reported bans elsewhere (for example Canada, Ecuador, Mexico, Brazil, Chile, Taiwan, Vietnam) are [uncertain]. (4) Advocacy: support the client's chosen level, from private repair to testimony or campaigning, and protect their privacy [synthesis].
  • Example language (illustrative): "I can tell you what I know about the law and when it was last reported, but a lawyer will need to advise you. Would that be helpful?"
  • Watch for: legal processes retraumatising the client; the therapist overstating the law. Working signs: the client makes informed decisions with legal advice [synthesis].

4.18 Identity integration and meaning-making

  • Purpose and when to use: in the later phase, when the client builds a coherent story linking sexuality or gender identity, faith or worldview, family and community.
  • Steps: (1) Invite a life narrative that includes the ministry years without letting them define the whole story [synthesis]. (2) Explore which values from their tradition they keep, transform or let go [synthesis]. (3) Support disclosure decisions (to family, church, workplace) with planning for safety and support [synthesis]. (4) Strengthen affirming relationships and community [synthesis].
  • Example language (illustrative): "If you were telling the story of these years to someone you trust, how would you want it to go?"
  • Watch for: pressure to adopt the therapist's view of religion; premature disclosure without support. Working signs: a narrative the client owns [synthesis].

4.19 Relapse-prevention, follow-up and ending

  • Purpose and when to use: before ending, to prepare for triggers and setbacks.
  • Steps: (1) Identify likely triggers: family events, religious holidays, sermons, contact with former ministry members, media about conversion practices or court rulings [synthesis]. (2) Update the safety plan and crisis resources (988; Samaritans 116 123) [synthesis]. (3) Agree how to return to therapy if needed [synthesis]. (4) Taper sessions where useful [synthesis].
  • Example language (illustrative): "News stories or family gatherings may stir things up again. What would help you then, and how would you get back in touch if you needed to?"
  • Watch for: a return of shame or suicidal thinking after a trigger. Working signs: the client uses the plan and recovers [synthesis].

5. Handling problems

The responses below are the psychotherapist's own guidance and are marked [synthesis] unless a source is tagged.

  • Client asks the therapist to make them straight and threatens to leave if refused. Restate what you can and cannot do (4.5); offer exploration of the distress and underlying goals; assess suicide risk; leave the door open. Do not refer to a change effort [source: MoU v2 Rev A; synthesis].
  • Client is stuck in self-blame ("I didn't pray hard enough"). Return to psychoeducation (4.6), including that the former Exodus president disavowed reparative therapy and apologised [source: Religion News Service 2013]; then shame work (4.8) [synthesis].
  • Resistance born of distrust of secular therapists. Name the fear; reaffirm the non-directive frame and respect for faith (4.2, 4.7); consider co-working with an affirming chaplain if the client wants [synthesis].
  • Overwhelm or flooding when recounting. Stop, ground, reduce detail; return to stabilisation; never press for programme content [synthesis].
  • Rising suicide risk. Move immediately to risk assessment and safety planning (4.4); escalate per protocol; give 988 (US) or Samaritans 116 123 (UK and Ireland) [synthesis].
  • Non-adherence or dropping out after family pressure. Offer flexible contact; if a minor, assess safeguarding (4.13) [synthesis].
  • Ruptures over faith. If the client senses the therapist disrespects their religion or, conversely, colludes with condemnation, name it, apologise for your part, and recommit to non-directiveness [synthesis].
  • Client returns to a ministry mid-therapy. Avoid ultimatums; follow 4.14; monitor risk [synthesis].
  • Parent demands the therapist "fix" a teenager. Decline; offer family work (4.12); assess the young person's safety and follow reporting duties if a programme or coercion is planned (4.13) [source: A/HRC/44/53, paras 71-74; synthesis].
  • Therapist's own reactions. Anger at ministries, religious guilt or discomfort with sexuality can distort the work; use supervision and keep knowledge current [source: MoU v2 Rev A, paras 13-16; synthesis].
  • Client wants celibacy or to stay in a non-affirming tradition. Respect an informed, uncoerced choice; keep monitoring shame and risk; avoid both endorsing and pathologising [synthesis].
  • Legal questions beyond competence. Give dated, sourced information only and refer to a lawyer (4.17) [synthesis].
  • Conflict of interest (same congregation or ministry). Address under APA Ethics Code Standard 3.05 and refer on if objectivity is impaired [source: APA Ethics Code].

Harm account

What was actually done

From 1976 to 2013 Exodus International acted as an umbrella network for local Christian ministries that told gay, lesbian and bisexual people their orientation could be changed or overcome through faith; by 2012 it had more than 250 affiliates [source: Religion News Service 2013; Christianity Today 2012]. For much of its history it promoted reparative therapy and reparative theories, which, in its president's 2013 apology, stigmatised parents as causes of their children's orientation; it moved to a discipleship model only after Chambers disavowed reparative therapy in 2012 [source: Religion News Service 2013; Christianity Today 2012]. Ministries that objected to that shift left and formed the Restored Hope Network [source: Christianity Today 2012]. Local affiliates continued autonomously after the 2013 closure [source: Religion News Service 2013]. Love in Action, a Memphis-area ministry, ran a programme for children and teenagers called Refuge, which it described as addressing behaviours including homosexuality; in June 2005 a teenager's online account of being sent there by his parents led to protests and the Tennessee child-services department opened an investigation after a complaint [source: The Advocate 2005]; that investigation's outcome is [uncertain]. Separately, the Memphis Flyer reported in February 2006 that the state Department of Mental Health and Developmental Disabilities had ruled in late 2005 that Love in Action was operating as an unlicensed supportive living facility, dispensing medication and requiring clients to stay on site, and had ordered it to stop those services; the ministry sued, the state then said it did not intend to pursue any further action, and the federal judge declined to issue an injunction [source: Memphis Flyer 2006]. By 2007 Refuge had closed and been replaced by a short family programme; a spokesman then said, "We don't turn people straight" [source: Memphis Flyer 2007]. Love in Action's affiliation with Exodus is [uncertain].

What it looked like to participants. Love in Action's programme for minors, Refuge, took teenagers whose parents enrolled them; its website described programmes lasting two to six weeks and costing $1,500 to $4,000, and its director said attendance was voluntary and that teenagers came with their parents [source: The Advocate 2005]. UPI reported in July 2005 that one teenager's parents had sent him there shortly after he came out to them [source: UPI via TribLIVE, 19 July 2005]. More broadly, the UN Independent Expert describes faith-based conversion practices as counselling, prayer and spiritual mentoring premised on sexual diversity being sinful or an addiction, sometimes using adapted 12-step models, with celibacy presented as the path to redemption (paras. 50-51, 54) [source: A/HRC/44/53]. In the UK study commissioned by the Government Equalities Office, people described pastoral counselling that began as informal guidance from a church leader and gradually became an attempt at change; being made to confess thoughts or past conduct in front of others; prayer for "healing"; short residential discipleship courses and weekend retreats, some run by US-linked organisations and sometimes under non-disclosure agreements; and, for some, years of moving from one provider to another [source: GEO 2021, sections 4.2-4.4]. Many described an early sense of change that faded into disillusionment [source: GEO 2021].

How it caused harm

  • No change, and harm instead. The APA states there is no evidence of sexual orientation change and that former participants often look back on change efforts as harmful [source: APA press release 2021]. The WPA, as quoted by the UN Independent Expert, finds "no sound scientific evidence" that innate orientation can be changed [source: A/HRC/44/53, para 20].
  • Psychological injury. The UN Independent Expert reports depression, anxiety, suicidal thoughts and attempts, shame and self-hatred; in one survey cited, 98 per cent of 940 respondents who had undergone such practices reported damage [source: A/HRC/44/53, paras 19, 55-58].
  • Suicide risk. Blosnich et al. found LGB adults exposed to conversion therapy nearly twice as likely to think about and attempt suicide; 81% of exposed respondents received it from a religious leader [source: Williams Institute summary of Blosnich et al. 2020]. The Trevor Project reports that LGBTQ+ youth exposed are more than twice as likely to attempt suicide [source: Trevor Project].
  • Family harm. Reparative theories blamed parents; the 2013 apology acknowledged this [source: Religion News Service 2013].
  • Ill-treatment. The UN Independent Expert finds these practices discriminatory per se, potentially "degrading, inhuman and cruel", and possibly torture depending on the circumstances, and especially grave for children [source: A/HRC/44/53, paras 59-65, 71-74]. The IFEG examined forcible or non-consensual conversion therapy as cruel, inhuman or degrading treatment or torture and found no medical justification for it [source: IFEG 2020].
  • Deception. The IFEG, as summarised in the UN report, considers offering these practices a form of deception and fraud [source: A/HRC/44/53, para 21].

Recognising it today

  • Ministries and church programmes, some formerly affiliated with Exodus and some in successor networks, continue [source: Religion News Service 2013; Christianity Today 2012]. Their present names and scale are [uncertain: not verified].
  • Framing has shifted from "therapy" to discipleship and spiritual language, as Exodus itself did in 2012 [source: Christianity Today 2012]. Cues in a client's account: groups or mentoring aimed at overcoming or healing "same-sex attraction" or "unwanted" attractions, promises of "freedom" from homosexuality, teaching that orientation stems from parenting or early wounds, or pressure on a young person to attend such a programme [synthesis, informed by Religion News Service 2013].
  • The UK MoU's definition covers any approach that treats one orientation or gender identity as preferable and tries to change or suppress it, whatever it is called [source: MoU v2 Rev A].
  • Faith-based providers are among the main providers worldwide [source: A/HRC/44/53, para 30]; yet many religious communities reject the practices, so faith itself is not a marker [source: A/HRC/44/53, para 68].
  • Legal status varies and is changing (see 4.17). In the US, 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].

What to do instead and how to help those harmed

  • Supported care. Affirming, non-directive therapy that explores sexuality and gender identity without a preset outcome and is free of any agenda favouring one identity [source: MoU v2 Rev A]; APA's guidelines encourage psychologists to validate and normalise the interplay of sexual orientation, gender identity and gender expression with cultural sensitivity [source: APA press release 2021]. For distress, treat the distress (depression, anxiety, trauma, shame) with established methods within competence [synthesis].
  • Survivors. Screening (4.3), suicide-risk assessment and crisis resources (4.4: 988 in the US; Samaritans 116 123 in the UK and Ireland), shame and trauma work (4.8, 4.9), grief (4.10), identity integration (4.18) [synthesis].
  • Faith. Religious clients can be supported to stay in, reform, change or leave their tradition; affirming clergy and communities exist within many traditions [source: A/HRC/44/53, para 68; synthesis].
  • Families. Parent work that removes blame and keeps the young person safe and connected (4.12) [synthesis].
  • Reporting duties. Child-protection referral where a minor is at risk (4.13); professional complaints where a practitioner offers change efforts (4.16) [synthesis].
  • Legal routes. Dated legal information with referral to a lawyer; in the US, consumer-fraud and malpractice claims remain possible routes [source: Trevor Project] (4.17).
  • Survivor and peer organisations. Survivor-led and faith-affirming groups exist; review each group's own published aims and safeguarding before suggesting one [synthesis].

Sources

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