What Was Conversion Therapy Like?

Conversion therapy is an umbrella term for various kinds of therapy intended to turn people straight. In this post, I’ll discuss what historical conversion therapy tended to be like, and occasionally mention similarities and differences with modern attempts to change people’s gender identity, which normally go by the name of “gender exploratory therapy.” (Be aware that this post describes psychiatric abuse in some detail.)

The biggest misconception people have about conversion therapy is that recent conversion therapy used aversives like electroshock or nausea-inducing drugs. In fact, aversives were primarily used by behaviorists between the 1950s and the early 1980s. The idea was that, by associating same-sex erotic material with pain, you could classically condition someone to be straight. As the psychological establishment accepted that homosexuality was fine, evidence-based therapists (as behaviorists considered themselves to be) stopped trying to cure homosexuality.¹ After the early 1980s, conversion therapy was done by psychoanalysts—which is to say, it was talk therapy.

Anti-trans conversion therapists often object to being characterized as conversion therapists, because they don’t use aversives. However, “talk therapy, generally with a psychoanalytic bent” is what mainstream anti-gay conversion therapy has been for the past forty years.²

Many people think that the phrase “reparative therapy”—which refers to the most popular school of anti-gay conversion therapy—means that you’re repairing your sexual orientation. Actually, it refers to reparative therapists’ theory of the origins of homosexuality.³ Homosexuality is seen as primarily a gender identity disturbance, which is why anti-gay conversion therapists also treated trans people. Child molestation or rejection by a same-sex parent (through abuse or emotional distance) leads a gay person to reject their gender. That is why gay people are often gender-non-conforming. Gay people seek out same-sex romance and sex to “repair” their gender identity. They sexualize their innate desire for masculinity or femininity, as well as their desire for love from their same-sex parent. Of course, this isn’t going to work well. Anyone they can convince to have sex with them also has rejected their gender identity. And you can’t feel comfortable with yourself as a man by having sex with other men.

Reparative therapists see gay sex in much the same way that ordinary therapists see self-harming, self-sabotage, or substance abuse. You’re trying to meet genuine needs, but you’re trying to meet them in harmful, ineffective ways.

Reparative therapists treat homosexuality using a variety of techniques. They use ordinary techniques for treating trauma and depression, such as encouraging good self-care. Ironically, a lot of clients benefited from that therapy in the same way you benefit from any other therapy. (Still gay though, and it didn’t outweigh the trauma of the rest of the conversion therapy process.) This parallels gender exploratory therapy, which also uses ordinary therapeutic techniques and has (therapist-reported, so questionable) positive outcomes for the patient.

Clients were encouraged to get rid of all their gay possessions, to stop consuming media that says homosexuality is okay, to cut off their gay friends and exes, to avoid anywhere where people cruise for anonymous sex, and to stop doing “camp” behavior. In order to repair their gender identities, clients were taught appropriate gender behavior: sports for men; makeup and fashion for women; cultivating gender-appropriate personality traits for both sexes. In order to get the love they should have gotten from a same-sex parent, clients formed nonsexual friendships with people of the same sex, which included nonsexual touch. (Because of a lack of anti-gay men who wanted to cuddle a gay man, these friendships were often with other ex-gays, which had the effects you’d expect.) Shamefully, some reparative therapists dabbled in the pseudoscience of recovered memory therapy. When a client had loving parents and no history of child sexual abuse, some reparative therapists assumed that they must have repressed the memories of the trauma that caused them to be gay.

One debate I find particularly amusing was about exercise. Reparative therapist Richard Cohen believed that working out and eating right was a necessary part of recovering from homosexuality, because people are most likely to have gay sex when they feel tired or run down, and because poor self-image causes homosexuality. Ex-gay spokesperson John Paulk, conversely, thought that a man gaining weight was a sign of recovery from homosexuality, because it meant that he wasn’t concerned about his appearance anymore.

Nearly all people who received anti-gay conversion therapy were Catholics or evangelical Christians. (There was a small Jewish ex-gay organization, JONAH, but on closer inspection it was mostly Christians attempting to appear ecumenical.) This is unlike modern anti-trans conversion therapy, which is far more secular. Many people seek out anti-trans conversion therapy because they are radical feminists who believe being trans is anti-feminist. Many nonreligious parents seek out anti-trans conversion therapy for their children simply because they believe that social and medical transition aren’t the right treatments for gender dysphoria.⁴

There were four kinds of people who sought out conversion therapy. First: coerced teenagers and young adults, who went through the motions and got out as soon as they could. Second: very religious virgins who probably hadn’t ever met a gay person before they started getting group therapy. Third: people who previously had been in the former group, but discovered that it was very easy for gay men to have casual sex. They compulsively had anonymous sex in a sort of binge/purge cycle. Sadly, many of them cheated on their wives. Fourth: people who were gay but whose lives were very messed up—drug addiction, alcoholism, survival sex work, compulsive sex, homelessness. For these people, finding Jesus could be a way to put their lives back on track. It was easy for them to assume that their own messed-up lives are just what homosexuality is like. The latter two groups often misled the very religious virgins about gay life. If the gay lifestyle was loveless, empty, and frankly quite terrifying to a sheltered evangelical or Catholic, there was nothing to lose from staying in therapy, even if it wasn’t working.

And it didn’t work. Reparative therapy had essentially no successes. Even the books about how to perform reparative therapy didn’t have any unambiguous successes; they just had people who were “still working on it.” This noble tradition is carried on by anti-trans conversion therapy today: the clinical guidelines for gender exploratory therapy feature three case studies, all of whom are of people who are observably still trans.

Hiding the lack of success of reparative therapy, and conversion therapy more broadly, was a bit of a cottage industry. Religious groups often practiced “name it and claim it”: if you wanted God to give you something, you had to have perfect faith, which meant pretending that you already had the thing.⁵ If you wanted to stop being attracted to people of the same gender, you should tell everyone that you're already completely straight.

Another solution was defining down success. If someone didn’t identify as gay anymore, then they obviously weren’t gay, and the therapy was a success—even if they were exclusively attracted to people of the same gender. Anti-trans conversion therapies today use the same strategy, with somewhat more plausibility. If someone detransitions and identifies as their assigned sex at birth, a reasonable person would say they’re cis. The complete failure of anti-trans conversion therapies at reducing gender dysphoria is less of the point.

They also normalize LGBT+ experiences as typical of cis straight people. Conversion therapists taught that all men were instinctively drawn to handsome, masculine men, and so that instant attraction wasn’t a sign you weren’t straight. Similarly, the Gender: A Wider Lens podcast, hosted by two influential gender exploratory therapists, explains that most cis women have gender dysphoria. Most cis women are uncomfortable with their breasts and vulvas, because these body parts are sexualized and because they cause various unpleasant experiences (menstrual cramps, pregnancy, back pain from large breasts). Cis women also usually hate the female gender role, because the female gender role means they are condescended to, forced to do more of the chores, sexualized, and generally victimized by sexism. Therefore, you shouldn’t expect therapy to fix those things.

Therapists also lower expectations for what therapy could achieve. Ex-gays rarely had much heterosexual attraction, but heterosexual attraction as understood by ordinary people is lustful. Obviously God isn’t going to heal you by making you lustful! While they continued to experience gay attraction, this could be thought of as a temptation and not as something which means they aren’t healed. Similarly, the Gender: A Wider Lens podcast typically says that normal life contains a good deal of misery and it’s futile to search for happiness. Instead, you should accept that you are going to be in emotional pain sometimes and be grateful for happiness when it comes. The point of therapy is not to ease the pain associated with living as a particular gender, but to enable the person to accept and live with the fact that they hurt.

Ex-gay therapy is often taken to be straightforwardly bad. However, for many participants, ex-gay group therapy was the first time they ever met another gay person. They could speak openly about their attractions in therapy, instead of hiding and repressing them. It also led to many participants’ first sexual and romantic experience; ex-gay therapy groups were infamous for the amount of hooking up involved. Although quite harmful, ex-gay therapy had harm-reduction benefits for some participants. Anti-trans conversion therapy seems unlikely to me to have such benefits.

Although in this post I’ve mostly discussed similarities between gender exploratory therapy and reparative therapy, I’d like to mention one major difference. In reparative therapy, heterosexuality is the only acceptable outcome. Gender exploratory therapy says that transition may be the right choice for a tiny fraction of clients, after they have fully explored all of the issues that cause them to want to transition; however, transition should be avoided whenever humanly possible. It is too early to say whether this difference makes gender exploratory therapy better (after all, it lets some clients transition) or worse (by increasing therapeutic gaslighting about whether you’re “really” trans).

Anything But Straight: Unmasking the Scandals and Lies Behind the Ex-Gay Movement. By Wayne Besen. Published 2003. 340 pages. $48.

1. Behaviorism was also gradually replaced with therapies like cognitive behavioral therapy which have a less simplistic model of the mind.

2. Aversives are used, albeit rarely, by certain fringe religious groups.

3. This theory applies mostly to gay men. Reparative therapists are more confused about lesbians.

4. I wonder if this is because of the increased secularization of American culture.

5. “Name it and claim it” is associated with the Prosperity Gospel and is one reason for its success.