The term “conversion therapy” should send a shiver up the spine of any decent person. As originally practised, it attempts to change a person’s sexual orientation from gay to straight by means such as aversion therapy.
This included punishing “undesirable” sexual behaviour with painful and demeaning treatment such as electric shocks, starvation or, in extreme circumstances, “corrective rape”. It is an utterly abhorrent practice, now thankfully outlawed by all reputable psychotherapy bodies and, in Ireland, very rare.
Over the years there have been a few reports of attempted conversion by faith-based groups but it is not something that has been in the news for a long time. So while there is no evidence of conversion therapy currently happening in the Republic, there is certainly no harm in the Government’s plan to ban it.
The programme for government commits to legislation for the ban, and officials at the Department of Children, Equality, Disability, Integration and Youth have now prepared a scoping paper on the issue and are currently liaising with the Department of Health to forward proposals.
Gender dysphoria may have many underlying causes not necessarily related to being transgender. If we explore this, will therapists be accused of practising conversion therapy?
One option being considered is to support a Bill proposed by Sinn Féin Senator Fintan Warfield to the Seanad in April 2018. The Prohibition of Conversion Therapies Bill 2018 is currently at committee stage which is where it has been since September 2020.
It describes conversion therapy as “any practice or treatment by any person that seeks to change, suppress and/or eliminate a person’s sexual orientation, gender identity and/or gender expression”.
We believe the inclusion “suppression of gender identity” in the Bill’s definition risks throwing the baby out with the bathwater. This approach to defining conversion therapy is in danger of unnecessarily restricting the openness, efficacy and ethics of therapy in areas such as gender identity.
Interventions and dysphoria
Sexual orientation and gender identity are very different things and they should not be conflated. Sexual orientation is the enduring pattern of romantic or sexual attraction to the opposite sex, your own sex or both.
We know it is enduring because, among other evidence, we know gay conversion therapy does not work, and tragically many people took their own lives rather than live an outright lie.
“Gender identity” is said to be the “gender” that some feel they “innately” possess, which may or may not be different from the gender which correlates to their birth sex. Not everyone feels they possess a gender identity, but we all have a sexual orientation, another reason for not conflating the two.
The proposed wording of the Bill leaves therapists and clinicians unsure to what extent it is permissible to employ therapeutic interventions around a person’s gender identity.
There has been a very sharp increase in adolescents presenting with gender dysphoria or gender questioning or identifying as trans, particularly in the last three years
Gender dysphoria for example, may have many underlying causes not necessarily related to being transgender. If we explore this, will therapists find themselves accused of practising conversion therapy?
The Bill makes some provision for “facilitation of a person’s coping, social support and identity exploration and development”. This refers to the person’s own sense of their gender identity, but does not leave room for therapeutic intervention which can be challenging at times, one of the main components of effective psychotherapy.
Ethical and efficacious therapy takes a neutral, unpolitical and exploratory stance – and that is what we do and how we practise. It is also how we have worked with trans clients over the years, as we would with any other client. We “affirm” how the client feels absolutely, but need to be confident in employing therapeutic exploration.
This is particularly the case with children and adolescents, who are a large part of our clinical work. There has been a very sharp increase in adolescents presenting with gender dysphoria or gender questioning or simply identifying as trans, particularly in the last three years. Not all will go on to socially or medically transition, nor should they, as not all gender dysphoria means an underlying trans identity.
The World Professional Association for Transgender Health states in its most recent standard of care document that formal research in the area of gender dysphoria in children and adolescents is seriously lacking, and that “Gender-non-conforming behaviours in children may continue into adulthood, but such behaviours are not necessarily indicative of gender dysphoria and a need for treatment”.
Studies also consistently show an association between childhood gender dysphoria and homosexuality and bisexuality in adulthood. An important statistic to keep in mind is that of the “gender non-conforming” or gender-dysphoric children who go through the natural puberty related to their natal sex, approximately 70 per cent go on to realise they are gay, lesbian or bisexual.
So, to affirm a 13 year old with recent gender dysphoria as “trans” when they are in fact gay could certainly leave therapists open to accusations of conversion therapy after the client has completed adolescence.
If therapists are fearful of accusations of “conversion” therapy, first the majority won’t work in the area of gender and, second, there will be no chance for gender-questioning clients of this age to explore or be challenged. No room for growth, no time for reflection or self-discovery. The result of which would be a rigidity most alien to both effective psychological therapy and every single child development model that has every existed.
It is bad practice. As ethical therapists and clinicians, we should not support it.
Jacky Grainger has worked extensively in the LGBT community in Dublin as a psychotherapist for almost 15 years. Madeleine Ní Dhailigh is a GP. Stella O' Malley is a cognitive behavioural therapist