Calls to ban conversion therapy put children at risk

Proposals to ban conversion therapy or conversion practices are likely to feature among the pledges of political parties as part of their general-election campaigns. 

On the face of it, banning conversion therapy sounds like an uncontroversial and positive step. But voters and the politicians who seek to represent them need to know the facts to understand the reality of such proposals.

Gay and lesbian people of any age should not be forced, by anyone or by any means, to try to be heterosexual. Fortunately, the UK doesn’t need a new law to ban abusive practices: they are already illegal and there’s no evidence to support the case for a new law. But including “gender identity” in a ban of conversion therapy or conversion practices means that countless children and young people will be put at risk of pursuing a medical pathway that will damage their healthy bodies.

It has long been known that the vast majority of children feeling gender distress or convinced of an opposite-sex identity will grow out of this during puberty. NHS England says:

“In many cases, gender-variant behaviour or feelings disappear as children get older – often as they reach puberty.”

But both before and during puberty, children may need support to manage and address their feelings.

The Cass Review made clear that the majority of children and young people referred to gender-identity services have serious mental-health issues. Around a third are autistic, with black-and-white thinking that leads them to think that not conforming to sex stereotypes may mean they really are the other sex inside. Many have anxiety and depression or an eating disorder. Many are uncomfortable at being same-sex attracted, or have experienced sexual trauma. Adverse childhood experiences are prevalent. At the now-closed Gender Identity Development Services at the Tavistock Clinic, almost all patients had one or more comorbidities – that is, other mental-health issues. Hannah Barnes reported in her book about the service, Time to Think, that 70% of referrals had five or more associated features or comorbidities such as depression, self-harm, eating disorders or a history of abuse.

But organisations that promote a ban on “conversion therapy” want to ban any psychoanalytic therapy that looks for another explanation of why a child or young person might feel unhappy about their body. For example Sasha Baker writes, in an article endorsed by previous Stonewall CEO Nancy Kelley:

“The therapy-based approach [proposed by the Cass Review] encourages patients to consider alternative reasons for their gender-related distress, often eating disorders, neurodivergence, or social acceptance (as if being trans makes you popular at school) – all of which must be carefully worked through before medical transition can be considered.The model offers all the harm of conversion therapy, with the convenient excuse that transition may be considered if all other avenues have been exhausted.”

Ilya Maude of Trans Safety Network interprets cognitive behavioural therapy to deal with gender dysphoria as conversion therapy and says:

“Whether Hilary Cass wants conversion therapy to be institutionalised on the NHS again is immaterial: her recommendations have made space for it.”

Those accused by activists of promoting conversion therapy include psychiatrist Dr Lenny Cornwall of Tees, Esk and Wear Valleys NHS Trust, Professor Riittakertu Kaltiala, chief psychiatrist in the Adolescent Forensic unit at Tampere University, Finland; sociologist (and Sex Matters board member) Dr Michael Biggs of the University of Oxford and Professor Sallie Baxendale of University College London. Therapist Stella O’Malley, psychiatrist Dr Az Hakeem, Professor Richard Byng and chartered psychologist Dr Anna Hutchinson are also described as conversion therapists by activists who oppose the Cass Review’s findings. 

These are some descriptions which have been used as evidence to support a ban:

“We started talking about my family history. The counsellor convinced me that because my mum left and my dad would spend more time with my 2 sisters… that I was looking for the attention my sisters had and that was the feelings for my gender identity, so they kept pushing that into my head.”

Conversion therapy: an evidence assessment and qualitative study

“He made it clear from the very start that he was sceptical of my gender and expressed doubt that it could differ to [my] sex.”

Report in i news

Others include sceptical or challenging conversations with friends and family:

“I was actively told by a friend of mine at the time that I wasn’t really trans and that I was doing it for the attention and that they’ll never see me as trans and will actively go against it and tell people I’m lying.”

Galop survey

It is clear that the call to ban “conversion therapy” is a front in the battle between the cautious evidence-based approach advocated by Dr Hilary Cass and the demand of activists for children and young people to be automatically affirmed in identifying as the opposite sex. 

The real conversion therapy happening in the UK today is when children – and other vulnerable people – are told that if they don’t fit in as a girl or a boy, woman or man, there is something wrong with their body and they need to be fixed with hormones and surgery. Those treatments can leave them sterile and without sexual function. And they will never fulfil the impossible promise of changing their sex. 

On top of this, almost all the 70 young people in a study by the Dutch clinic which pioneered the use of puberty blockers were same-sex attracted. Affirming their belief that they need to “transition” because of this is the modern version of gay conversion therapy. It’s pure homophobia to tell young people who are feeling anxious as they discover their emerging sexual orientation that they should try to change sex instead of being gay.

Conversion practices ban would have a chilling effect on therapists. The Cass Review reported that: 

“Clinicians working with this population have expressed concerns about the interpretation of potential legislation on conversion practices and its impact on the practical challenges in providing professional support to gender-questioning young people. This has left some clinical staff fearful of accepting referrals of these children and young people.”

If therapists are not allowed to explore with a patient why they feel so unhappy about their body but are required to affirm a belief in gender identity instead, then young people will not get the support they need to understand themselves and make informed choices about their healthcare and their futures.