What impact has Gender Identity ‘Conversion Therapy’ (GICT) had on gender diverse people? This is the question at the heart of the recently released 2020 ‘Conversion Therapy’ & Gender Identity Survey.
The research is the collective effort of five LGBT+ charities and was conducted to provide evidence to the Government and Equalities Office as they prepare plans for a ban of ‘conversion therapy’. The report claims to have found that GICT is ‘more widespread and often more violent than has been previously understood’, describing the findings as a ‘wake-up call … for the need to eradicate all gender identity conversion practices’ (p.3).
The key questions at the heart of this research are important. They are relevant to the current discussions about ‘conversion therapy’, but they are also important for equipping us as a society to best support and care for gender diverse people.
Sadly, however, the research suffers from many significant weaknesses which render it largely unable to help us answer these questions.
The definition of ‘conversion therapy’
The issue of definition is the most difficult in discussions about ‘conversion therapy’. The report does give the definition used for the survey (p.7), but it is so broad as to be problematic. The report actually notes that the definition ‘was intentionally left more open’ suggesting that this would allow people ‘to reflect more freely on their experiences’ (p.7). In reality, of course, it renders a huge range of experiences as ‘conversion therapy’.
To highlight one particular issue: the definition includes ‘gender expression’, alongside sexual orientation and gender identity, as an area in which any interventions aimed at change or suppression would constitute ‘conversion therapy’. This means that if an adult remembers a parent insisting they wore a certain type of clothing as a child, they could report having experienced ‘conversion therapy’ (and in this scenario could identify it as having been forced).
The problematic nature of the definition is highlighted by the fact that many respondents ‘were unsure whether or not their experiences actually constituted “conversion therapy”’ (p.13). It’s fairly clear that the report authors believed these respondents had. It’s also highlighted by the fact that the second most common form of GICT reported (second only to talk therapy) is private prayer (distinguished in the questionnaire from ‘prayer with close friends’ (p.13). So, 21 people performed ‘conversion therapy’ on themselves.
An additional problem is that some people may well feel they want support to change their gender expression. This could result from a deeply held religious belief or from a realisation that an earlier change of gender expression, for example through cross-sex hormones, hadn’t brought about the expected benefits. (This would be the sort of situation in which many people who choose to detransition might find themselves.) If the report’s definition was used in legislation banning ‘conversion therapy’, it would be illegal for a doctor to help a patient in such a situation to stop hormone therapy safely.
In its policy recommendations, the report explicitly states that a ban must protect people even from things to which they choose to consent. Therefore, the patient’s wishes in such scenarios would not be enough to ensure they could get the treatment they now needed.
This and other issues render the definition of ‘conversion therapy’ used in this research highly problematic.
Methodology and data limitations
Another reason the research is unable to provide us with any substantial insights is the serious limitations in both methodology and data.
The report is honest about some of these weaknesses, noting, in particular, the limited sample size (p.2), but it fails to communicate quite how poor the data is.
The sample size is very small. The report is quite unclear at this point. It seems 64 gender diverse people had been offered GICT, with 39 having undergone it (p.5), while across all respondents, including cisgender people, 87 had been offered (p.11) and 51 had experienced (p.12) ‘conversion therapy’. It is not clear why the report doesn’t openly state that a number of cisgender people had experienced GICT. One explanation could be that the interventions had worked well for them. (Which, as we’ll see below, was not an uncommon result.)
The sample type is also deeply problematic. The survey used a non-probability, voluntary sample meaning the findings can’t be assumed to be representative of the experience of people more broadly (p.2). Respondents for the survey were recruited through the social media channels of the LGBT+ charities organising the survey (p.7). It’s a known fact that voluntary surveys tend to attract respondents with strong views on the subject, and that reality, combined with the recruitment method, makes it likely that those who learnt about and completed the survey would share a particular perspective. The results could well be biased in a particular direction.
Specific elements of the data are also questionable because of the methodology. To explore the impact of ‘conversion therapy’, respondents were asked to rate how it had affected various elements of their life. These results are therefore based on retrospective, self-report which is not a very reliable measure. On mental health specifically, the report does seek to compare the prevalence of (self-reported) mental health conditions among respondents who have experienced GICT with the prevalence of the same among those who had not experienced it, but there is no controlling for other factors that could potentially explain the discrepancy they find and not even any admission that there could be other explanations.
The data on why people went through ‘conversion therapy’ is also based on this unreliable retrospective self-reporting measure. It would be easy for more recent life experiences or changes of understanding to cause someone to subconsciously reimagine why they consented to GICT in the past.
Problems in the reporting
Much of the reporting of results seems to be fair, and there are several places where the report openly shares results that may not support its overall conclusion, but there are also some omissions and inaccuracies.
In some cases, results are reported that seem to undermine the overall conclusion. Most striking is that 19% of those who had undergone ‘conversion therapy’ reported it working completely. Another 19% reported that it worked for a while but then wore off (p.14). It might be, then, that further therapy would have ensured more lasting success. In total, almost 40% of respondents who had gone through ‘conversion therapy’ found that it was effective to at least some extent. Should we ban something that might help 2 out of 5 people to feel more comfortable in their body and, presumably, alleviate distress and avoid invasive medical interventions?
There are also some unfortunate omissions in the reporting. It seems odd that the age profile of respondents isn’t given among the demographics, even though this was asked in the questionnaire. Most unhelpfully, we’re not told when GICT took place, so we can’t know if they are current practices. (The only relevant point reported is that a quarter of those offered GICT by a mental health professional are under 25. We’re not told when the more clearly abusive and violent practices took place.)
It’s also unfortunate that we’re not told much about those who reported being forced to undergo ‘conversion therapy’. In particular, it would be useful to know at what age these experiences happened. We would all agree there are times when children need to be ‘forced’ – that is, directed by their parents – to do certain things. Could this account for some of the reports of forced GICT? Possibly, especially since 49% of respondents were under 18 when they began GICT, but with the data available we can’t be sure.
There are also a few questionable elements in the reporting. One seems to be a clear contradiction. The executive summary claims that the research shows GICT to be ‘more widespread’ than commonly believed (p.5). However, in several places the report notes that the survey was not designed in such a way that it is able to offer any insight into the prevalence of GICT (pp.7, 10).
The executive summary also claims that GICT is ‘often more violent’ than commonly believed, but it is questionable whether the data supports this claim: nine people experienced beatings, three corrective rape and three forced feeding or food deprivation. The fact that these things have happened even to these small numbers is horrific and heart-breaking and we mustn’t ever imply that the small numbers make them insignificant, but the numbers don’t support the claim that GICT is often violent.
Underlying assumptions
It is also clear that there are some concerning assumptions lying behind the report. I’ll highlight just a few examples.
The authors of the report seem to overlook the growing recognition that comorbid conditions experienced by gender diverse people may be relevant to their experience of gender. They quote one respondent who reported that two psychotherapists felt their experience of gender may have been linked to their experience of depression and autism (p.13). The authors clearly find this approach unacceptable, but surely it is important for there to be freedom for comorbid conditions to be explored. This is especially important if ignoring such conditions could lead to highly invasive treatments which have irreversible effects and may in turn prove not to provide the hoped-for solution. This is the sort of story we are hearing increasingly often from detransitioners.
The underlying assumption of the authors, that comorbid conditions are always irrelevant to questions on gender identity, clashes with their own claim that affirming therapy must function such that it ‘allows people who are not trans to explore their feelings and come to understand why they may feel discomfort with their gender identity’ (p.15).
Another problematic assumption is that anything that one person may experience as traumatic is unacceptable. Discussing different forms of GICT, the authors note that ‘[w]hilst some people may feel little impact from certain practices of “conversion therapy” such as private prayer or talk therapy, for others these same practices may be invasive, traumatic and cause serious long-lasting harm’ (p.13). Where people experience trauma and harm, we must of course take note and offer care and avenues for healing, but proposing such a subjective basis for practices that are unacceptable could be used to justify unhelpful and unjust bans of many things. While we must take active steps to protect people from harmful practices, it will not work to define harm in such a broad way.
It is also disappointing to see how easily the report brushes off critical voices. This is seen in part in their response to a number of respondents who raised concern that LGB young people are transitioning because of discomfort with their sexuality (p.16) and their response to concerns that an affirming approach to gender diverse people is akin to sexual orientation ‘conversion therapy’ (p.17). These are important concerns based on considerable evidence but are not taken seriously by the report authors.
The same problem is seen in a final section which notes that some respondents submitted comments deemed transphobic. Obviously any comments that are abusive towards gender diverse people or which undermine their dignity as human beings are utterly unacceptable, but this is not what is seen in the two examples provided (p.18). Both represent strong views which clearly clash with those held by the commissioning charities, but they are not abusive or disrespectful.
It is not clear how common this sort of response was, but transphobic remarks are cited as a reason why some responses were excluded from the results since they apparently rendered the data ‘false or irrelevant’ (p.7). In total, 418 responses were excluded (almost a third of the total submissions). We don’t know how many of these were because of claimed transphobia, and we cannot know whether the statistical results would have been different had these responses were retained. The evidence that the authors were quick to reject data that disagreed with their perspective is yet another reason why this report cannot provide us with reliable answers.
What should we think about gender identity ‘conversion therapy’?
We can all agree that any coercive and abusive practices must be stopped. If these are happening today – and this report doesn’t confirm that they are – we must make sure that the existing laws and safeguarding practices in place to address such abuse are rigorously implemented and, if necessary, improved. We must also make sure that suitable support is readily available to the survivors of all forms of abuse.
We can also agree that we need better quality research on GICT. The reality is that at the moment there is very little good quality research available for exploring these important questions. Research using of a carefully crafted definition and reliable methodologies is needed.
Sadly, poor quality research is a problem that hampers many areas of the transgender conversation (as highlighted by the recent NICE evidence reviews into puberty blockers and cross-sex hormones). It is imperative that researchers have the freedom to conduct rigorous, responsible research so that we can know the best and safest ways to help gender diverse people. The ban proposed in this report would remove this freedom.
And with the state of research as it is, gender diverse people and the medical professionals and others seeking to support them, must have the freedom to carefully and sensitively explore different responses to their experience.
A ban such as that proposed in the report of the 2020 ‘Conversion Therapy’ & Gender Identity Survey would subject gender diverse people to yet more discrimination and harm, denying them access to forms of support that may help them to be more comfortable with their bodies and to avoid highly invasive medical interventions.
Those who care about gender diverse people must oppose such a limiting of their freedoms.
Andrew Bunt is a pastor, speaker and writer, and an associate at Living Out.