Atlas›Domain XVI · Historical, discredited & harmful›Guide 078
Guide XVI-078

Abusive exorcism and corrective rape as conversion violence

A 32 · L 59 · M 921 interventions in the Trinity explorer
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[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: the UN Independent Expert on protection against violence and discrimination based on sexual orientation and gender identity, Practices of so-called "conversion therapy" (A/HRC/44/53, 1 May 2020) for definitions and the human-rights frame; the Independent Forensic Expert Group (IFEG) Statement on Conversion Therapy (Torture Journal 30(1), 2020) for the torture and ill-treatment analysis; the APA resolutions of 26 February 2021 and the UK Memorandum of Understanding on Conversion Therapy (version 2, October 2017, revision A 2019) for the clinical stance; Human Rights Watch (2011) and ActionAid (2009, as reported by NBC News) for "corrective" rape in South Africa.

This topic is not a therapy and is not taught here. It names two forms of violence that sources record as part of the wider field of conversion practices: abusive exorcism or "deliverance" aimed at a person's sexual orientation or gender identity, and rape described by perpetrators or communities as "corrective". The UN Independent Expert defines "conversion therapy" as an umbrella term for interventions resting on the belief that a person's sexual orientation or gender identity can and should be changed or suppressed when it differs from a perceived norm (paras. 2, 17), and reports both exorcism rituals (paras. 30, 53) and pervasive rape described as "corrective" against lesbian, bisexual and trans women in all regions (para. 39). [source: UN A/HRC/44/53]

The idea of change behind these acts, as sources record it, is that a person's orientation or gender identity is a spiritual affliction to be expelled or a deviation to be "corrected" by force. Human Rights Watch reports perpetrators framing attacks as discipline, correction or a "lesson" about gender conformity. [source: HRW 2011] Professional and international bodies state that conversion practices do not change sexual orientation or gender identity and are associated with serious harm: the APA (2021) states there is "no evidence of sexual orientation change" and reports harms from gender identity change efforts; the IFEG calls offering conversion therapy "a form of deception, false advertising, and fraud" and states that forced or non-consensual practice is cruel, inhuman or degrading treatment and may amount to torture; the UK MoU calls it "unethical and potentially harmful". [source: APA 2021; IFEG 2020; UK MoU v2] Rape is a crime in itself whatever motive is claimed. [synthesis]

For the psychotherapist, change happens through safety, belief, an affirming and non-directive stance, trauma-informed care, medical and legal routing, and repair of relationships with faith, family and services where the survivor wants it. [synthesis, drawing on UN A/HRC/44/53 para. 87 and UK MoU v2] Cross-refer: the general abusive-exorcism guide in this domain (108) and Domain XIII 211.

2. Framework

Session number and length follow the client's needs and the setting; pace is set by safety and by the survivor [synthesis].

Historical outline of the practice (for recognition, not replication).

  • Faith-based organisations are often major providers of conversion practices; exorcism and "deliverance" rituals aimed at sexual orientation or gender identity are reported in many countries, often in evangelical churches (paras. 30, 53). In Chechnya, people judged free of demonic influence were reportedly deemed to have chosen "deviant" behaviour and so to deserve death (para. 53). [source: UN A/HRC/44/53]
  • "Corrective" rape is reported against lesbian, bisexual and trans women in all regions (para. 39); in Mozambique, families and communities reportedly arranged such rapes (para. 18). [source: UN A/HRC/44/53]
  • In South Africa, ActionAid's 2009 report Hate Crimes: the rise of "corrective" rape in South Africa was reported as finding that a support group recorded ten new cases a week in Cape Town alone, and that of 31 lesbians reported murdered in homophobic attacks since 1998, two cases reached court and one ended in conviction. [source: NBC News report on ActionAid 2009] Human Rights Watch's 2011 report, based on more than 120 interviews in six provinces, documented violence against black lesbians and transgender men and "near-total impunity". [source: HRW 2011] Later developments in South Africa are [uncertain: not verified].
  • The IFEG lists exorcism or ritual beatings and "corrective" rape among conversion practices performed in over 60 countries, in state and private settings. [source: IFEG 2020]

Phases of the psychotherapist's work [synthesis, organised around UN A/HRC/44/53 para. 87 and the IFEG duties]

  1. Recognition and assessment. Goal: hear that an exorcism, "deliverance" or sexual assault was aimed at the client's orientation or gender identity; assess current danger, health needs and suicide risk. Move on when immediate safety, medical needs and safeguarding duties are addressed.
  2. Safety, safeguarding and reporting. Goal: protect from ongoing threat (perpetrators often remain in the community, per HRW 2011), meet mandatory-reporting duties for minors, support the survivor's own choices on police and legal routes. Move on when the client has a working safety plan and knows the options.
  3. Stabilisation and trauma processing. Goal: reduce trauma symptoms, shame and self-blame; offer or refer for evidence-based trauma care. Move on when symptoms are manageable and the client can hold the story without overwhelm.
  4. Meaning, faith, identity and family. Goal: address "demonic" attributions, internalised stigma, religious conflict and family rupture, without any agenda about the client's orientation, identity or faith.
  5. Advocacy, repair and follow-up. Goal: redress, documentation, community and peer support, and the clinician's own duties where a colleague or institution is involved.

3. Guiding principles

  • Never attempt change. Orientation and gender identity are not disorders; health professionals have no role in diagnosing or treating them. Practical meaning: no goal, homework or framing aims at change or suppression. [source: IFEG 2020; UK MoU v2]
  • No agenda. The MoU asks practitioners to hold no agenda favouring one orientation or identity while still helping clients reduce distress and reach self-acceptance. Practical meaning: explore the client's distress, not the client's "cure". [source: UK MoU v2]
  • Affirm and validate. APA guidance encourages psychologists to validate and normalise experiences and attend to intersecting identities, including bisexuality. Practical meaning: name the violence as violence and the identity as legitimate. [source: APA 2021 press release]
  • Never refer to a provider. The IFEG says professionals should refuse to provide conversion practices, explain why, and not refer to anyone who offers them. Practical meaning: no "referral for spiritual healing of sexuality". [source: IFEG 2020]
  • Consent must be informed and free. The IFEG treats consent obtained without full information, under detention or coercion, or from a minor, as invalid or suspect. Practical meaning: a client's earlier "agreement" to deliverance does not make it consensual. [source: IFEG 2020]
  • Avoid secondary victimisation. HRW records ridicule, doubt about identity and refusal of services by police and health workers. Practical meaning: believe first; ask only what you need; never question the client's sexuality or gender. [source: HRW 2011]
  • Survivor control. Adults decide whether to report to police; the clinician informs, supports and documents. Practical meaning: offer options and their consequences, then follow the client's lead, except where child-protection duties apply. [synthesis]
  • Children first. Subjecting a child to these practices is ill-treatment that may constitute torture (UN para. 71) and may be child abuse and neglect (IFEG). Practical meaning: any current risk to a minor triggers your jurisdiction's child-protection route. [source: UN A/HRC/44/53; IFEG 2020]
  • Respect faith without endorsing harm. The UN Independent Expert notes that many religious communities are inclusive and some have condemned these practices (para. 68). Practical meaning: never treat the client's religion as the problem; treat the abuse as the problem. [source: UN A/HRC/44/53]
  • Trauma-informed and paced. Practical meaning: choice, predictability, grounding and the right to stop at any point; no pressure for detail of the assault. [synthesis]
  • Safe messaging on suicide. Practical meaning: ask directly about suicidal thoughts, never discuss methods, never present suicide as an understandable response or a release; give 988 (US) and Samaritans 116 123 (UK and Ireland). [synthesis]
  • No description of the abuse in records beyond what is needed. Practical meaning: record facts relevant to risk, health and legal routes; do not record ritual words or sexual detail unless legally required. [synthesis]
  • Even-handed, non-moralising language. Practical meaning: describe what happened plainly; avoid labels for the client's community. [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 and conceptual literacy (preparation)

  • Purpose / when: before working with survivors, so the clinician recognises that an exorcism or a rape may have been aimed at sexual orientation or gender identity, and knows the international position.
  • Steps: (1) Read the UN Independent Expert's 2020 report sections on faith-based practices, sexual violence and torture (paras. 30, 39, 53, 62–71). (2) Read the IFEG statement and the APA 2021 resolutions. (3) Read HRW 2011 on how police and health workers re-victimise survivors. (4) Note local law on rape, hate crimes, child protection and conversion practices (see 4.17). [source: UN A/HRC/44/53; IFEG 2020; APA 2021; HRW 2011]
  • Example language (illustrative): to a colleague, "International bodies treat forced conversion practices, including deliverance aimed at orientation and so-called corrective rape, as ill-treatment that can amount to torture."
  • Watch for: your own assumptions that such violence happens only in one country or one religion; the UN report records it in all regions. Working: you can name the practice without euphemism and without sensational detail.

4.2 Recognition and screening

  • Purpose / when: at intake and whenever a client mentions spiritual "healing", "prayer for freedom", a sexual assault with a stated "lesson", or family pressure about orientation or gender.
  • Steps: (1) Ask a broad, non-leading question about attempts by others to change or punish their orientation or gender. (2) If yes, ask who, in what setting (religious, family, community, health care), whether it is ongoing, and whether the person responsible still has access to them. (3) Ask about sexual violence only in general terms and only if relevant to safety or care; do not ask for detail. (4) Note that HRW found many survivors avoid police and health services; ask what help they have had. [source: HRW 2011; synthesis]
  • Example language (illustrative): "Some people have been through prayer sessions, rituals or other pressure meant to change who they love or their gender. Has anything like that happened to you?" / "You don't need to tell me details. I only need to know whether you're safe now."
  • Watch for: the client calling it "just prayer" or blaming themselves; shame-driven minimising; signs of dissociation when the topic arises. Working: the client can name what happened and whether it continues.

4.3 Trauma-informed response to first disclosure

  • Purpose / when: the moment a client discloses an exorcism, deliverance or sexual assault tied to orientation or gender.
  • Steps: (1) Believe and thank. (2) State plainly that it was not their fault and that their orientation or identity did not cause it. (3) Ask what they need right now. (4) Check immediate safety and medical needs (4.4, 4.6). (5) Explain confidentiality and its limits in plain words. (6) Let the client set the pace. [synthesis; HRW 2011 on secondary victimisation]
  • Example language (illustrative): "Thank you for telling me. What was done to you was wrong, and it was not caused by who you are."
  • Watch for: questions that sound like doubt ("are you sure you're a lesbian?" is the kind HRW records police asking); your own visible shock. Working: the client stays in contact and continues to talk.

4.4 Safety and ongoing-threat assessment

  • Purpose / when: after any disclosure, because perpetrators may live nearby or be relatives, religious leaders or community members (HRW 2011; UN para. 18).
  • Steps: (1) Map who knows about the client's orientation or identity and who poses a risk. (2) Ask about threats, being followed, online threats, being taken to further "sessions". (3) Build a practical safety plan: safe contacts, places to go, how to reach police or shelters. (4) Where relocation is considered (HRW records survivors moving towns), link to housing and legal help. [source: HRW 2011; UN A/HRC/44/53; synthesis]
  • Example language (illustrative): "Is anyone who took part still around you, or still contacting you? Let's work out who you can go to if you feel unsafe."
  • Watch for: the client returning to a family or congregation that arranged the harm without a plan; threats escalating after the client comes out further. Working: a written plan the client can use.

4.5 Suicide-risk assessment and safety planning

  • Purpose / when: at intake and at every key point; LGB adults who underwent conversion efforts were nearly twice as likely to think about and attempt suicide (Blosnich et al. 2020), and HRW records suicide attempts among survivors of violence.
  • Steps: (1) Ask directly about suicidal thoughts, intent, plans and past attempts. (2) Ask about access to means and agree on safer storage or removal where needed, without discussing methods. (3) Build a safety plan with warning signs, coping steps, people and services. (4) Give crisis lines: 988 (US); Samaritans 116 123 (UK and Ireland). (5) Escalate to emergency care where risk is imminent. [source: Blosnich et al. 2020 via Williams Institute; HRW 2011; synthesis]
  • Example language (illustrative): "After what happened, some people have thoughts of ending their life. Have you had thoughts like that?" / "If things get very bad between sessions, you can call 988 in the US, or Samaritans on 116 123 in the UK and Ireland."
  • Watch for: hopelessness about ever being accepted, "I am possessed" or "I am damned" beliefs, anniversaries, renewed family pressure. Working: the client can name their plan and uses it.

4.6 Medical routing after sexual violence

  • Purpose / when: any recent or past sexual assault. HRW records HIV infection and pregnancy after rape, and fear of health workers.
  • Steps: (1) Encourage prompt medical care and explain that urgent medical options are time-sensitive, without advising any medicine (that decision is for the medical team). (2) Help the client find a specialist sexual-assault service or one-stop centre where one exists (HRW describes such centres in South Africa). (3) Offer to support them in preparing what to say. (4) For past assaults, encourage sexual-health and general health follow-up. [source: HRW 2011; synthesis]
  • Example language (illustrative): "A doctor or sexual-assault service can check your health and talk you through options. Would it help if we found the nearest one together?"
  • Watch for: avoidance of care because of fear of being outed or mocked. Working: the client attends medical care.

4.7 Safeguarding minors

  • Purpose / when: a client is under 18, or a client discloses that a child is being taken to deliverance sessions or is at risk of sexual violence. The UN (para. 71) calls subjecting children to these practices ill-treatment that may constitute torture; the IFEG says it may be child abuse and neglect.
  • Steps: (1) Know your jurisdiction's mandatory-reporting rules and child-protection route before you need them. (2) Tell the young person, in age-appropriate words, what you must share and why. (3) Report to child-protection services or police as your law requires; record facts. (4) Seek the young person's assent to further steps where possible. (5) Do not confront parents in ways that increase risk. [source: UN A/HRC/44/53; IFEG 2020; synthesis]
  • Example language (illustrative): "What you told me means you may not be safe. My job is to make sure people who protect children know, and I'll tell you each step."
  • Watch for: retaliation at home after a report; the young person withdrawing. Working: the child is protected and stays connected to support.

4.8 Supporting decisions about police and legal routes

  • Purpose / when: an adult survivor is considering reporting a sexual assault, an abusive exorcism or threats.
  • Steps: (1) Explain options: police report, protection orders, civil claims, and in some places hate-crime recording; note that in some countries conversion practices are themselves offences (4.17). (2) Prepare the client for possible secondary victimisation, which HRW documents, and identify a supporter to go with them. (3) Offer factual records of what the client disclosed and its effects, if they ask. (4) Where torture or ill-treatment is alleged, consider referral to forensic experts familiar with the Istanbul Protocol, which the IFEG describes as the key international standard for documenting torture. (5) Respect a decision not to report. [source: HRW 2011; IFEG 2020; synthesis]
  • Example language (illustrative): "Reporting is your choice. I can tell you what usually happens, and I'll support you whichever way you decide."
  • Watch for: pressure from you or others; retraumatisation during proceedings (see section 5). Working: the client makes an informed choice and feels supported in it.

4.9 Psychoeducation on conversion practices

  • Purpose / when: a survivor still half-believes the exorcism or assault could or should have "changed" them, or blames themselves for it "not working".
  • Steps: (1) Ask what they were told the practice would do. (2) Share, in plain terms, what professional and international bodies state: no evidence that orientation changes; harms are common; forced practice is ill-treatment. (3) Invite reactions; do not argue. (4) Link to shame work (4.11). [source: APA 2021; IFEG 2020; UN A/HRC/44/53 para. 19]
  • Example language (illustrative): "Psychologists' and human-rights bodies have looked at this closely. They found these practices don't change who people are, and that many people are harmed by them. Nothing failed in you."
  • Watch for: the client hearing this as an attack on their faith; respond by separating the faith from the abuse. Working: self-blame lessens.

4.10 A client who asks to change their orientation or gender identity

  • Purpose / when: a client, often after deliverance or under family pressure, asks you to help them stop being gay, bisexual or trans.
  • Steps: (1) Do not attempt change and say so honestly. (2) Explore the distress behind the request: fear of rejection, threats, religious conflict, trauma. (3) Offer what the MoU describes: help to live more comfortably with their identity, reduce distress and reach greater self-acceptance, with no agenda favouring an outcome. (4) Explain, if asked, why you will not refer to anyone offering change, as the IFEG advises. [source: UK MoU v2; IFEG 2020]
  • Example language (illustrative): "I won't try to change your orientation; that doesn't work and often hurts people. But I'd like to understand what's making this so painful, and help with that."
  • Watch for: the client feeling rejected; acknowledge the wish, keep the door open. Working: the focus moves from "fixing" themselves to what they fear.

4.11 Work on shame, self-blame and "demonic" attributions

  • Purpose / when: the client believes they are possessed, cursed, unclean or deserved the assault.
  • Steps: (1) Elicit the belief in the client's own words and where it came from. (2) Separate the belief imposed by others from the client's own values. (3) Use evidence-based cognitive and compassion-focused methods within your competence to examine self-blame. (4) Where the difficulty centres on religious experience, DSM-5-TR's "Religious or Spiritual Problem" may be recorded as Z65.8 (ICD-10-CM Z65.8 "Other specified problems related to psychosocial circumstances" lists religious or spiritual problem under Includes: ICD-10-CM Z65.8 (Unbound Medicine)); DSM-5-TR wording [uncertain: not verified]. [synthesis]
  • Example language (illustrative): "You were told something was inside you that had to come out. What do you believe about that now, in your own words?"
  • Watch for: intrusive images of the ritual; do not ask for ritual content. Working: the client describes themselves with less contempt.

4.12 Religious clients who want to keep their faith

  • Purpose / when: a survivor wants both their faith and their identity.
  • Steps: (1) Use the DSM-5-TR Cultural Formulation Interview and its supplementary module on spirituality, religion and moral traditions to understand the client's tradition [uncertain: not verified]. (2) Note, as the UN Independent Expert does, that many religious communities are inclusive and some have condemned these practices (para. 68); explore whether the client wants to find such a community or faith resources. (3) Apply spiritual and religious competencies (Vieten et al. 2013) [uncertain: not verified]. (4) Do not steer toward or away from faith. [source: UN A/HRC/44/53; synthesis]
  • Example language (illustrative): "What happened in that church was abuse. Your faith is yours. Would it help to think about what a safe place to practise it might look like?"
  • Watch for: pressure to return to the same congregation; spiritual grief. Working: the client experiences faith and identity as less at war.

4.13 Family work

  • Purpose / when: relatives took part in or arranged the practice (UN para. 18 records families arranging rapes in Mozambique), or a family wants to reconcile.
  • Steps: (1) Screen for safety before any joint session; never hold joint sessions with someone who arranged violence while risk persists. (2) Meet relatives separately first; explore their beliefs and fears. (3) Give the same psychoeducation as 4.9; the UN recommends awareness campaigns for parents and families that these practices are invalid, ineffective and harmful (para. 87). (4) Support the survivor's decision about contact, including no contact. [source: UN A/HRC/44/53; synthesis]
  • Example language (illustrative): to a parent, "Many parents want to protect their child. The evidence is that trying to change them doesn't protect them; acceptance does more."
  • Watch for: relatives using sessions to pressure; disclosures that trigger safeguarding duties. Working: reduced hostility, or a safe and chosen distance.

4.14 Trauma-focused care and referral

  • Purpose / when: PTSD, intrusive memories, nightmares, dissociation or chronic fear, which the UN report lists among documented harms (paras. 56, 58).
  • Steps: (1) Assess trauma symptoms with validated measures within your competence. (2) Stabilise first: grounding, sleep, routines, social support. (3) Offer or refer for an evidence-based trauma-focused therapy delivered by an affirming clinician (current guideline recommendations [uncertain: not verified]). (4) Brief any receiving clinician on the conversion context, with consent. [source: UN A/HRC/44/53; synthesis]
  • Example language (illustrative): "There are treatments that help people when memories of an assault keep coming back. We'd go at your pace and you can stop any time."
  • Watch for: overwhelm or dissociation during exposure work; slow down and return to stabilisation. Working: symptom scores and daily functioning improve.

4.15 Repairing trust after secondary victimisation

  • Purpose / when: a client was ridiculed, doubted or refused by police, health workers or clergy (HRW 2011).
  • Steps: (1) Name the failure as the service's, not the client's. (2) Explore the effects on help-seeking. (3) Rebuild trust through reliability: clear appointments, explained limits, no surprises. (4) Where the client wishes, help them complain or find a trained officer or service. [source: HRW 2011; synthesis]
  • Example language (illustrative): "You were treated badly when you asked for help. That should not have happened, and it was not because you did something wrong."
  • Watch for: testing of your reliability; generalised mistrust. Working: the client uses one new service.

4.16 Practical losses: school, work, housing, displacement

  • Purpose / when: HRW records survivors leaving school and relocating to escape threats.
  • Steps: (1) Ask about education, work, housing and money. (2) Refer to social work, legal aid, LGBTQ+ community organisations and shelters available locally. (3) Address the grief of losing a home community. [source: HRW 2011; synthesis]
  • Example language (illustrative): "Besides what happened, what has this cost you in daily life: school, work, a place to live?"
  • Watch for: isolation after moving. Working: stable housing and at least one supportive connection.

4.17 Legal-status literacy for the client

  • Purpose / when: a client asks whether what was done is illegal where they live.
  • Steps: (1) Separate offences that apply everywhere (rape, assault, threats, child abuse) from laws specifically on conversion practices. (2) Check current law with a lawyer or official source; status changes often. Known points, dated: the UN Independent Expert (2020) reported criminal bans in Ecuador and Malta and local bans in some Canadian cities, Spanish regions and US states (paras. 75–76); Euronews (June 2023) reported bans in Malta (2016), Germany (2020 for minors; 2021 for non-consenting adults), Albania (2020, minors), France (2022), Greece (2022, minors), Spain (2023), Cyprus (2023) and Iceland (2023), with the UK not yet having legislated; national bans in Canada, Mexico and the Netherlands (2026) [uncertain]. 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]. The Trevor Project notes that consumer-fraud and malpractice claims remain possible. [source: UN A/HRC/44/53; Euronews 2023; Dorsey 2026; Trevor Project 2026]
  • Example language (illustrative): "Rape and assault are crimes whatever reason someone gives. Whether the ritual itself is illegal depends on where it happened, so let's check with a legal adviser."
  • Watch for: giving legal advice beyond your role. Working: the client knows where to get accurate advice.

4.18 Duties when a colleague or institution uses conversion practices

  • Purpose / when: you learn that a colleague, service or affiliated religious counselling body offers deliverance or change efforts.
  • Steps: (1) Do not participate, supervise or refer. (2) Report to the relevant regulator or professional body; the IFEG says colleagues who offer the practice should be reported and medical associations should hold them accountable. (3) In the UK, check whether the organisation is an MoU signatory and use its complaints route. (4) If you belong to the same congregation or community as the client or the practitioner, manage the multiple relationship under APA Ethics Code Standard 3.05 (APA Ethics Code). (5) Seek supervision and document. Other ethics steps [synthesis]. [source: IFEG 2020; UK MoU v2]
  • Example language (illustrative): to the colleague, "I can't be part of change efforts, and I'm obliged to raise this with the professional body."
  • Watch for: retaliation or pressure from an employer; client confidentiality in any report. Working: the matter is with the body that can act.

4.19 Advocacy and documentation

  • Purpose / when: survivors or the clinician want systemic change.
  • Steps: (1) With consent, contribute anonymised data to research or monitoring; HRW recommends police record violence by motive, and the UN recommends research involving affected communities (para. 88). (2) Support complaint and redress mechanisms the UN recommends (para. 87). (3) Never identify survivors. [source: HRW 2011; UN A/HRC/44/53]
  • Example language (illustrative): "Some people find it meaningful to have their experience counted, without their name. That's entirely up to you."
  • Watch for: advocacy replacing the client's own care. Working: the client feels agency, not exposure.

4.20 Peer and community support

  • Purpose / when: isolation after rejection by family or congregation.
  • Steps: (1) Ask what community the client wants. (2) Link to vetted local LGBTQ+ groups, survivor groups or affirming faith groups. (3) Check that any group is not itself offering change or deliverance under another name. [synthesis]
  • Example language (illustrative): "Would it help to meet others who have come through something like this?"
  • Watch for: groups that rebrand change efforts (the MoU notes they may go by other names or be covert). Working: the client has people who accept them. [source: UK MoU v2]

4.21 Clinician self-care and supervision

  • Purpose / when: throughout; this work exposes clinicians to accounts of sexual violence and religious abuse.
  • Steps: regular supervision; check your own religious or cultural reactions; limit caseload where possible. [synthesis]
  • Example language (illustrative): in supervision, "I noticed I wanted to change the subject when she mentioned the church."
  • Watch for: avoidance, over-identification, anger at a whole faith. Working: you stay steady and curious with the client.

5. Handling problems

Most guidance here is [synthesis]; source support is noted where it exists.

  • Client minimises ("it was only prayer", "they meant well"). Do not argue. Ask what effects it has had on sleep, mood, relationships and faith; reflect the effects back. Offer psychoeducation (4.9) later. [synthesis]
  • Client insists on changing their orientation or identity. Hold the line kindly: no change work, and no referral to anyone who offers it (IFEG). Keep exploring the fear underneath (4.10). If the client leaves to seek change elsewhere, part without blame, give crisis numbers and say the door stays open. [source: IFEG 2020; UK MoU v2; synthesis]
  • Client is still in the congregation or family that did it. Prioritise safety planning (4.4) and suicide risk (4.5). Avoid ultimatums; help the client weigh options. Reassess at each session. [synthesis]
  • Ongoing threats or a perpetrator in the community. HRW records perpetrators remaining free nearby. Update the safety plan, involve police or shelters with consent, and consider relocation supports. [source: HRW 2011; synthesis]
  • Overwhelm, flashbacks or dissociation in session. Stop the topic, ground in the present, and return to stabilisation. Never press for detail of the assault or the ritual. Agree a stop signal in advance. [synthesis]
  • Missed sessions and non-adherence. Consider safety first: missed sessions may mean the client is being watched or taken to further "sessions". Agree a safe way to contact them. [synthesis]
  • Rupture over the clinician's perceived religion, identity or culture. Name it openly, ask what the client needs, and repair; offer an alternative clinician if they prefer. [synthesis]
  • Interpreters or staff from the same community. Check confidentiality and bias before using them; use a remote interpreter from elsewhere if needed. [synthesis]
  • Legal proceedings retraumatise. Prepare the client for questioning, plan support around court dates, and coordinate with victim-support services. HRW documents secondary victimisation by police. [source: HRW 2011; synthesis]
  • A minor discloses but begs you not to tell. Explain your duty gently, involve them in how the report is made, and stay with them through it (4.7). [synthesis]
  • Clinician's own beliefs conflict with affirming care. Seek supervision; if you cannot work without an agenda, refer to an affirming colleague, as the MoU's no-agenda principle requires. [source: UK MoU v2; synthesis]
  • Client asks whether US talk-therapy bans still stand after Chiles v. Salazar. Explain that 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]. The ruling did not decide whether such practices are safe, and professional bodies' positions are unchanged. [source: Dorsey 2026; Trevor Project 2026]
  • Rebranded or covert practices. The MoU notes conversion efforts may use other names or be covert. Ask what was actually done and what it aimed at, not what it was called. [source: UK MoU v2]

Harm account

What was actually done

  • Abusive exorcism and "deliverance". The UN Independent Expert reports that faith-based organisations are often major providers of conversion practices and that exorcism and deliverance rituals aimed at sexual orientation or gender identity are reported in many countries, often in evangelical churches (paras. 30, 53). The IFEG lists exorcism or ritual beatings among conversion practices found in over 60 countries. The UN report also records shackling, beatings, force-feeding, forced nudity and isolation in centres in Ecuador (para. 38), camps in Kenya and Somalia using beatings and food deprivation (para. 52), and reports from Chechnya that people judged free of demonic influence were deemed to deserve death (para. 53). [source: UN A/HRC/44/53; IFEG 2020]
  • "Corrective" rape. The UN Independent Expert reports pervasive rape described as "corrective" against lesbian, bisexual and trans women in all regions (para. 39), and that families and communities reportedly arranged such rapes in Mozambique (para. 18). Human Rights Watch (2011), from more than 120 interviews in six South African provinces, records the term's use by media for rape of people presumed or known to be lesbians in order to "convert" them, and documents perpetrators framing attacks as discipline or a "lesson" in femininity; HRW also cautions that the label can narrow attention away from the wider violence and discrimination faced by black lesbians and transgender men. NBC News reported ActionAid's 2009 finding of ten new cases a week in Cape Town recorded by one support group. [source: UN A/HRC/44/53; HRW 2011; NBC News on ActionAid 2009]
  • Impunity. ActionAid (as reported) found that of 31 lesbians reported murdered in homophobic attacks in South Africa since 1998, two cases reached court and one ended in conviction; HRW described "near-total impunity" and police ridicule of survivors. In May 2011 South Africa's Department of Justice announced a national task team on LGBT bias crimes (HRW). [source: NBC News on ActionAid 2009; HRW 2011]

What a deliverance session looked like to the person. The UN Independent Expert describes these rituals as led by church leaders or traditional healers to drive out a supposed demonic influence (para. 53), and records that families, communities and religious leaders often send or coerce people into conversion practices, including children (paras. 25-26) [source: A/HRC/44/53]. In the UK study commissioned by the Government Equalities Office, interviewees described prayer "healing" and exorcism-style "deliverance ministry" sessions in church settings or at religious conferences that could involve physical contact and shouting over them, sometimes after they had confided in a church leader or a youth group; some had been made to confess thoughts or past conduct in front of others, and some leaders passed private disclosures on within the congregation [source: GEO 2021, sections 4.2-4.4]. In residential settings, the UN report records confinement with isolation, beatings and food deprivation, sometimes in facilities run by religious institutions (paras. 38, 52), and notes that conversion practices can go on for several years, sometimes more than a decade (para. 58) [source: A/HRC/44/53]. Warning signs named in the UK study include a shift from guidance to attempts at change, a focus on "healing" or "deliverance", pressure to keep attending after saying no, conditions placed on church membership, and threats of eviction [source: GEO 2021].

How it caused harm

  • In a survey of 940 people who had undergone conversion practices, 98 per cent reported damage, including suicidal thoughts, depression, anxiety, shame and self-hatred; further documented harms include PTSD, suicide attempts and chronic stress with physical consequences (UN paras. 19, 56, 58). [source: UN A/HRC/44/53]
  • LGB adults who underwent conversion efforts were nearly twice as likely to think about and attempt suicide; 81 per cent of those who underwent it received it from a religious leader (Blosnich et al. 2020, as summarised by the Williams Institute). [source: Williams Institute]
  • Survivors of rape documented by HRW faced HIV infection, pregnancy, lasting fear, anger, substance use, suicide attempts, loss of schooling and forced relocation, compounded by secondary victimisation by police and health workers. [source: HRW 2011]
  • The UN anti-torture machinery has concluded these practices can amount to torture or cruel, inhuman or degrading treatment (para. 62); the IFEG states that forced or non-consensual conversion practice is cruel, inhuman or degrading treatment and may amount to torture, and that for minors it may also be child abuse and neglect. [source: UN A/HRC/44/53; IFEG 2020]

Recognising it today

  • A client describes prayer, rituals or "deliverance" sessions arranged because of their orientation or gender, especially when held against their will, repeated, or combined with confinement, beating, deprivation or humiliation. [source: UN A/HRC/44/53; synthesis]
  • A client describes a sexual assault accompanied by statements that it would "fix", "teach" or "show" them, or arranged with the knowledge of family or community. [source: HRW 2011; UN A/HRC/44/53 para. 18]
  • Signs that follow: shame, beliefs of being possessed or unclean, suicidal thoughts, trauma symptoms, avoidance of police and health care, sudden moves or school dropout. [source: HRW 2011; UN A/HRC/44/53]
  • Practices may be rebranded or covert. [source: UK MoU v2]

What to do instead and how to help those harmed

  • Supported care. Affirming, non-directive therapy that helps people live comfortably with their identity, reduce distress and reach self-acceptance (UK MoU); validation and attention to intersecting identities (APA 2021); services that help people explore and affirm their orientation or identity, address conflicts with religious, social or internalised norms and promote coping and social support (UN para. 87). [source: UK MoU v2; APA 2021; UN A/HRC/44/53]
  • For survivors. Trauma-informed care, medical routing after sexual violence, suicide-risk assessment and safety planning, and practical support (section 4). Crisis lines: 988 (US); Samaritans 116 123 (UK and Ireland). Sexual-violence services through local health or police routes. [synthesis]
  • For families. Psychoeducation that these practices are invalid, ineffective and harmful, as the UN recommends for parents and families (para. 87); safety screening before any joint work. [source: UN A/HRC/44/53; synthesis]
  • Reporting and legal routes. Child-protection reporting for minors; police and protection orders for assault and threats; complaints to regulators and professional bodies about practitioners (IFEG); the UN calls for prompt investigation and prosecution and for complaint mechanisms giving access to reparation including rehabilitation and legal assistance (para. 87). Conversion-practice laws vary by country and date (4.17). [source: IFEG 2020; UN A/HRC/44/53]
  • Organisations. OutRight Action International published Harmful Treatment: The Global Reach of So-Called Conversion Therapy (2019) on forms, perpetrators and vulnerability worldwide; local LGBTQ+ and survivor organisations should be checked before referral. [source: IssueLab record of OutRight 2019]

Sources

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