Let's talk Therapy, Ethics, Harm, and "Conversion Therapy."

Conversion therapy—sometimes called “reparative therapy” or “Sexual Orientation Change Efforts (SOCE)”—is a deeply controversial and widely discredited practice aimed at changing or suppressing a person’s sexual orientation, gender identity, or gender expression to fit heteronormative or cisnormative standards. Rooted in the harmful belief that LGBTQ+ identities represent a form of “sexual brokenness” or a condition to be “cured,” these practices have caused significant psychological and emotional harm. As society continues to advocate for LGBTQ+ rights, the issue remains a flashpoint of ethical and legal debate. A current Supreme Court case concerning conversion therapy has brought these questions back into sharp focus, raising critical concerns about counselor ethics, the duty to do no harm, and the lasting consequences of attempting to change someone’s identity. In this post, we’ll explore the implications of conversion therapy, the ethical responsibilities of mental health professionals, and the real-world impact of these practices on individuals and communities.

The history of conversion practices is deeply intertwined with the medical and psychological fields' past pathologization of non-heterosexual identities. Efforts to change sexual orientation or gender identity date back to the 1890s. For much of the 20th century, the practice was associated with the time when homosexuality was a diagnosable mental illness.

In the early days of "conversion therapy," practitioners used a wide array of techniques. Extreme methods included abusive aversion techniques where a noxious stimulus, such as electric shocks to the hands and/or genitals or nausea-inducing medication, was administered when a client was exposed to homosexual stimuli.

Contemporary "conversion therapy" often relies on methods that are more social in nature, like religious coercion and manipulation, religious counseling, group counseling, or religiously based interventions (such as prayer or exorcism). The historical foundation remains relevant because the core belief system persists.

A massive shift occurred between 1973 and 1974 when the American Psychiatric Association (APA) removed homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (DSM). This monumental change legally and scientifically undercut the rationale for conversion therapy.

Despite the scientific consensus recognizing that distress related to sexual orientation is usually due to societal discrimination rather than inherent pathology, conversion practices persisted. Religious and social conservative groups continued to advance the illness/behavior model of homosexuality, often justifying conversion efforts with theological arguments that define homosexuality as a moral transgression.

The current consensus among major medical and mental health associations that conversion therapy is ineffective and harmful has fueled a modern wave of legislation.

• California became the first state to ban conversion therapy for minors by licensed professionals in 2012.

• Since then, at least 23 states and several jurisdictions globally have passed legislation prohibiting licensed practitioners from providing conversion therapy to minors.

• However, these bans often allow religious leaders and spiritual advisors, who are generally unlicensed practitioners, to continue offering "conversion therapy" and spreading it's harms. This means conversion practices remain a relevant concern today.

The Role of Counselors and Ethical Considerations

Foundational Ethical Principles and Values

Counseling is a professional relationship dedicated to promoting respect for human dignity and diversity and empowering clients to achieve mental health goals. The ethical practice of counseling is built upon specific core values and principles:

Core Professional Values: Counselors are committed to enhancing human development, honoring diversity, embracing a multicultural approach, promoting social justice, safeguarding the integrity of the counselor–client relationship, and practicing in a competent and ethical manner.

Fundamental Ethical Principles: These values translate into fundamental principles that guide ethical behavior and decision making:

• Autonomy: Fostering the client's right to control the direction of their life.

• Nonmaleficence: Avoiding actions that cause harm. This is a primary ethical directive.

• Beneficence: Working for the good of the individual and society by promoting mental health and well-being.

• Justice: Treating individuals equitably and fostering fairness and equality.

• Fidelity: Honoring commitments and keeping promises, including fulfilling responsibilities of trust in professional relationships.

• Veracity: Dealing truthfully with individuals.

Ethical Standards Governing Professional Conduct

The American Counseling Association (ACA) and National Board of Certified Counselors (NBCC) Codes of Ethics structure professional expectations across areas like client welfare, competence, professional responsibility, and boundaries.

Client Welfare and Responsibility (Section A, ACA; Professional Responsibilities, NBCC) - The primary responsibility of counselors is to respect the dignity and promote the welfare of clients.

• Avoiding Harm (A.4.a; NBCC 17): Counselors must act to avoid harming their clients and minimize or remedy unavoidable harm.

• Informed Consent: Counselors must review client rights and responsibilities, including the purposes, goals, techniques, procedures, limitations, potential risks, and benefits of services. This process is ongoing and must be documented. Consent must be voluntary and is considered suspect, especially in the case of minors, when harm is likely.

• Imposing Values (A.4.b; NBCC 17): Counselors must be aware of and avoid imposing their own values, attitudes, beliefs, and behaviors. They must respect client diversity and seek training if their values risk conflicting with the client's goals or are discriminatory in nature.

Professional Competence and Scope of Practice (Section C, ACA; NBCC 1) - Counselors must practice only within the boundaries of their competence, based on their education, training, and supervised experience.

• Nondiscrimination (C.5; NBCC 7): Counselors do not condone or engage in discrimination against clients based on factors including gender, gender identity, sexual orientation, or religion.

• Scientific Basis for Treatment (C.7.a): Counselors must use techniques or modalities that are grounded in theory and/or have an empirical or scientific foundation.

• Harmful Practices (C.7.c): Counselors do not use techniques or procedures when substantial evidence suggests harm, even if such services are requested.

Conversion Therapy as an Ethical Violation

Conversion therapy is widely considered a severe breach of counselor ethics because it violates the fundamental principles of Nonmaleficence and Beneficence.

• Failure to "Do No Harm": Conversion therapy is ineffective and likely to cause significant or severe psychological and physical harm. The likely harm cannot be outweighed by any clinical benefits, as there are none. Clinicians readily classify such practices as unethical.

• Fraud and Deception: Offering conversion therapy constitutes a form of deception, false advertising, and fraud because the treatments are ineffective and purport to achieve unattainable results.

• Discriminatory Environment: Conversion therapy creates an inherently discriminatory environment because it supports the belief that non-heterosexual orientations are disorders or sins. It may be motivated by the client's self-hatred or conflict with internalized norms, rather than their true orientation or identity.

• Abandonment: Ethical violations in conversion therapy include abandoning patients who decide to adopt a gay or lesbian identity, such as by being unwilling to refer them to a gay-affirming therapist.

• Imposing Beliefs: Telling patients that homosexuality is a mental disorder based on practitioner beliefs, when there is no evidence, is an ethical violation. This contradicts the responsibility to avoid imposing one's personal values.

• Professional Responsibility: Health professionals who offer conversion therapy violate professional ethics. Health associations should denounce professionals who offer conversion therapy. Social workers, for instance, have an ethical and clinical obligation to provide safe and affirmative treatment for LGBTQIA+ individuals.

The Harms of "Conversion Therapy"

The harms resulting from conversion practices span psychological, emotional, physical, social, and spiritual domains, often leading to long-term or lifelong distress.

Mental Health and Psychological Harms

Conversion therapy causes intense psychological pain and suffering, often exacerbating existing distress and leading to new disorders.

• Increased Psychological Distress and Anxiety: Individuals who undergo SOCE often experience increased psychological distress after the treatment. Clients frequently present with symptoms of depression and anxiety. Conversion efforts may leave individuals more anxious and depressed—worse off than where they started.

• Depression: Chronic depression and depressive tendencies/syndromes are confirmed outcomes in post-conversion clients. The American Psychological Association has stated that talk therapy aimed at change can induce depression among some participants. Individuals exposed to conversion therapy show notably higher rates of depression.

• Suicidality: Exposure to conversion therapy significantly increases a person’s risk of suicide.

  ◦ Survivors present with suicidal ideation and intention.

  ◦ Sexual minority adults who underwent conversion therapy were two times more likely to have suicidal ideation in their lifetime and 88% more likely to have attempted suicide.

  ◦ Trans people who experienced gender identity change efforts were more than twice as likely to have attempted suicide than peers who had other therapy. For children under 10, the relative risk of attempted suicide was four times as high.

  ◦ Among transgender adolescents, exposure to conversion therapy causes a 17 percentage point increase in having attempted suicide over five years following first exposure, amounting to a 55% increase in the risk of attempting suicide.

• Post-Traumatic Stress (PTSD): Conversion therapy is a traumatic event and can lead to Posttraumatic Stress Disorder (PTSD). Survivors may experience symptoms of post-traumatic stress, including intrusive flashbacks and traumatic nightmares.

• Hopelessness and Guilt of Failure: Conversion therapy eliminates any hope for change a client may have had, leading to dangerous levels of hopelessness when the therapy fails. Individuals may feel they have "failed" at conversion therapy and endure debilitating feelings of guilt of failure. Conversion therapists often blame the patient for the failure of the treatment, which induces or worsens depression.

• Damage to Self-Concept: The practices are inherently humiliating, demeaning, and discriminatory. This generates profound feelings of shame, guilt, self-disgust, and worthlessness, resulting in a damaged self-concept and enduring personality changes. Clients frequently feel intense shame and self-loathing from internalized homophobia.

• Cognitive and Identity Crisis: Clients may experience both sexual and spiritual identity crises. The trauma disturbs a client's sense of self on a less conscious level, leading autobiographical knowledge to organize itself into a salient cognitive schema created by the trauma memory, which may be interpreted as a feature of one's personal identity.

• Anger and Grief: Survivors may experience anger as a response to deceptive claims and mistreatment, and grief at the loss of time, opportunity, and youth.

  
  

Physical Health Harms

Trauma associated with conversion therapy can lead to physical illness and chronic health conditions.

• Trauma can lead to a wide range of severe physical harms. These include chronic diseases such as cardiovascular conditions, gastrointestinal disorders, and autoimmune diseases, as well as musculoskeletal issues like fibromyalgia and chronic pain. Conversion therapy, in particular, can introduce unique physical harms, such as sexual dysfunction, aversion techniques (e.g., electric shocks), and medication side effects like movement disorders and weight gain. Additionally, trauma-induced dysregulation of the body’s stress systems can cause long-term effects, including abnormal cortisol levels and inflammation. Reproductive health may also suffer, with trauma linked to infertility, pelvic pain, and pregnancy complications. Sleep disturbances, nightmares, and chronic fatigue syndrome are common among trauma survivors, further compounding the physical toll of these experiences.

• Harms Specific to Aversion Techniques: Historically documented aversion practices involve inflicting physical pain or discomfort. Extreme forms have included electric shock, ice baths, burning with metal coils, or giving nausea-inducing drugs. The use of unmodified Electroconvulsive Therapy (ECT) for conversion can cause violent convulsions commonly resulting in joint dislocations and bone fractures.
  

Social and Relational Harms

Conversion practices severely damage social support systems and relationships, increasing isolation and vulnerability.

• Social Isolation and Rejection: Clients endure debilitating feelings of guilt and failure that may lead to ostracization by family, community, and work, which are considered significant and potentially incapacitating losses. Individuals who undergo the practice often experience social isolation. Family rejection is strongly correlated with negative health outcomes, including suicide attempts. Conversion therapy increases this risk by deepening the rejection of the patient's identity.

• Family Conflict and Abuse: Conversion therapy is often administered in the context of hostile or unsupportive parents. Participants have reported being verbally assaulted by their conversion counselor. Requests for conversion therapy almost always come from parents and guardians rather than the youth themselves, making it a form of family rejection.

• Running Away: Exposure to conversion therapy substantially increases the likelihood that a transgender adolescent will run away. The risk of running away is more than doubled (a 7.8 percentage point increase) over the five years following first exposure.

• Relational Issues: Conversion efforts, which act as a concentrated dose of anti-homosexual stereotyping, may create intimacy and sexual problems and significant relational issues. The loss of trust caused by the involvement of health professionals can impair future interpersonal and romantic relationships.

• Marital Breakup: If individuals are encouraged to marry during the therapy and later accept that change has not happened, these families may break apart.

Spiritual and Moral Harms

Conversion practices rooted in religious conviction inflict distinct damage on a person's faith and moral sense of self.

• Spiritual Harm and Crisis: Conversion practices can cause damage to the spiritual dimensions of self-identity, the ability to construct existential meaning, and a person's relationship to the divine and/or their religious community. Clients may be in a state of emotional and/or spiritual crisis.

• Religious Trauma and Moral Injury: Conversion practices lead to religious trauma—pervasive psychological damage resulting from long-term exposure to undermining religious messages—and moral injury. Moral injury occurs when a person's own sexual or gender subjectivity transgresses their deeply held moral beliefs, forcing them to attempt to change core parts of themselves.

• Betrayal of Trust: When health professionals or trusted clergy are involved, this exacerbates the pain due to the betrayal of trust. In the religious context, the trauma may involve practices that tried to "turn the God that they loved against them".

Ethical and Professional Violations as Harm

The professional failings of conversion therapy further compound the harms experienced by patients:

• Substandard Care and Deception: Conversion therapy is medically and scientifically invalid and, since it is ineffective, offering it constitutes a form of deception, false advertising, and fraud.

• Coercion and Threats: Practices involve improper pressure placed on patients (e.g., threatening to end treatment if they do not submit to the therapist's authority) and can include explicit coercion and threats.

• Abandonment: Ethical violations include abandoning patients who decide to adopt an LGBTQ+ identity by being unwilling to refer them to an affirming therapist.

• Indiscriminate Use: Conversion therapists may recommend their treatments indiscriminately, regardless of the probability of success.

Healing the Trauma of "conversion therapy"

Healing from the trauma inflicted by conversion therapy and religious coercion is a profound and complex journey that focuses on rebuilding identity and establishing safe, affirmative support. Since conversion practices can cause severe emotional damage, leading to sexual and spiritual identity crises, hopelessness, and symptoms of post-traumatic stress, recovery requires specialized interventions. Therapeutic strategies should incorporate trauma work and grief work, acknowledging the significant and potentially incapacitating losses of family, community, and positive religious associations. A critical step involves adopting integrative solution therapies, which help clients respect all components of their identity and view their difficulties as a "problem of the social environment," not of the self. Furthermore, recovery is strongly supported by finding affirming individuals and environments, including LGBTQ+-affirming communities, and engaging with mental health professionals who are educated and informed of LGBTQ+ issues, resisting the urge to impose secular or religious doctrines and instead assisting the client in deciding which beliefs to cherish and which doctrines to mourn.

Conclusion

Conversion therapy represents one of the most harmful intersections of unethical practice, pseudoscience, and prejudice within the history of mental health care. Despite decades of evidence exposing its devastating psychological, physical, social, and spiritual effects, these practices persist under the guise of moral or religious guidance. The continued existence of conversion therapy underscores the urgent need for stronger legal protections, broader public education, and unwavering ethical accountability within counseling and faith communities alike. True healing begins when we affirm rather than deny identity—when we replace coercion with compassion, shame with dignity, and silence with advocacy. By standing firmly against conversion practices and supporting trauma-informed, LGBTQ+-affirming care, we take a vital step toward ensuring that every individual is free to live authentically, without fear of condemnation or harm.