Several states have banned it, but this harmful practice continues in the US.

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Over 700,000 people in America have been subjected to a practice known as conversion therapy, according to the Trevor Project, a national organization that provides support for LGBTQ+ teens and young adults.

Though conversion therapy has existed for decades, recent books and films like Boy Erased and Pray Away have shed light on survivor's experiences, as well as grassroots efforts to protect people from conversion therapy. But if you're new to it or live in a community where it's widely accepted, questions abound.

What is conversion therapy, exactly? Does it work? And if not, why's it still around? Here's everything you need to know, with insight from mental health experts.

What is conversion therapy?

"Conversion therapy" is a term used to describe the practice of attempting to change someone's sexual orientation or gender identity. It's based on the incorrect belief that being lesbian, gay, bisexual, queer, trans, or non-binary is a choice that can be changed, often by altering your behavior or praying.

"Currently in the United States, conversion therapy is a fringe activity, and a lot of the people practicing it are not licensed or are religious practitioners trying to change people for religious reasons," Jack Drescher, MD, a New York City-based clinical psychiatrist who has studied conversion therapy, tells Health.

Conversion therapy approaches could include online groups, conferences, and residential programs, as well as both individual and group sessions often labeled as "therapy," Nicholas E. Grant, PhD, a clinical psychologist and president-elect of GLMA: Health Professionals Advancing LGBTQ Equality, tells Health. But conversion therapy isn't a true therapy in the sense that it's not based on or informed by science, he says.

To conflate the practice with the treatment of an actual medical condition, practitioners often refer to conversion therapy by other names, notes GLAAD. These may include gender critical therapy, reparative or reintegrative therapy, rx-gay ministries, sexual reorientation efforts, sexuality counseling, addressing sexual addictions and disorders, and healing sexual brokenness.

Where did conversion therapy originate?

What's known as conversion therapy today first emerged in the late 1900s when a German psychiatrist claimed he had turned a gay man straight via hypnosis. Earlier in the20th century, attempts to "cure" people of homosexuality were common. But in the 1960s and 1970s, gay rights advocates spoke up, pressuring organizations like the American Psychiatric Association (APA) to stop treating homosexuality as a mental illness.

By 1973, the APA had removed homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (DSM). And in 2013, "gender identity disorder"—a diagnosis for people who did not identify with the gender they were assigned at birth—was also removed and replaced with "gender dysphoria" since gender-nonconformity is also not a mental illness.

Does conversion therapy work?

No; the practice has been discredited. "Conversion therapy doesn't work and it's really not possible to change a person's sexual orientation," says Dr. Drescher. "You can change how you think about how you feel, but that doesn't change how you feel."

In 2009, a report by an American Psychological Association task force concluded that "results of scientifically valid research indicate that it is unlikely that individuals will be able to reduce same-sex attractions or increase other-sex sexual attractions through [sexual orientation change efforts]."

Recently, many former ex-gay leaders and survivors of their programs have also spoken out against conversion therapy, acknowledging that it doesn't work.

Can conversion therapy be harmful?

Yes. "The research is abundantly clear that conversion therapy is not only ineffective, it also causes harm," Dr. Grant says. That's why major medical organizations have widely condemned it, including the American Psychological Association, American Medical Association, and the American Academy of Pediatrics.

While conversion therapy is sometimes advertised as focusing on "changing behaviors," it's "better characterized as efforts for an individual to work against accepting and being open about their authentic self," Dr. Grant adds.

Beyond the pain that comes with hiding or suppressing who you truly are, the typical setup for conversion therapy can cause a number of negative side effects. "The 'therapist' will tell them the major factor that leads to change is their motivation or—in religious treatment—their faith," explains Dr. Drescher. "Which means when the treatment fails, and usually it fails, the person almost always blames themselves."

This can lead to a loss of faith, shame, guilt, hopelessness, emotional numbness, low self-esteem, depression, anxiety, substance use, high-risk sex, and suicide ideation. LGBTQ+ youth who were subjected to conversion therapy by their parents were more than twice as likely to attempt suicide compared to those who weren't, according to a 2017 study by the Family Acceptance Project.

Conversion therapy not only hurts the individual—it can also shatter families. Research shows LGBTQ+ youth who are rejected by their parents are at a much higher risk of mental health and substance use problems as well as homelessness. LGBTQ+ adults encouraged to enter a heterosexual marriage could end up going through a painful divorce or find themselves trapped in an unfulfilling marriage when they realize they can't change.

Why have some states banned conversion therapy?

Conversion therapy is not backed by scientific research and may cause significant harm to individuals and their loved ones. In light of this, 20 states have passed laws fully protecting LGBTQ youth from conversion therapy by licensed mental health practitioners. A handful of other states have partial bans or have introduced legislation.

However, 22 states currently have no law or policy on conversion therapy. And because the majority of conversion therapy practitioners are not licensed in the first place, it's more difficult for public policy to put an end to these practices, says Dr. Grant.

"While preventing conversion therapy in the first place will save future generations from harm, supporting those who survive conversion therapy must be prioritized as well," Sam Brinton, a survivor of conversion therapy and vice president of advocacy at The Trevor Project, tells Health.

If you or someone you know is a survivor of conversion therapy, you can find LGBTQ-affirming health care professionals near you through GLMA's provider directory or the National Queer & Trans Therapists of Color Network. For immediate help, call the TrevorLifeline at (866) 488-7386, text START to 678-678, or open a confidential chat with an advocate online.

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