The government cannot ban talking under false claims of harm
Free speech bans need to be necessary - not just desirable - to protect health
[i] Article 10 of the European Convention on Human Rights protects freedom of expression except under certain conditions. These include where it is necessary to limit expression “for the protection of health”.
For more on how a ban would breach human rights, read the report.
Free speech is important. It’s how we exchange ideas and seek to persuade or encourage people.
That’s why free speech protections are built into our laws and recognised in human rights.
The only way the government can justify a ban on consensual conversations is by claiming they are harmful. If these conversations about sexual or gender identity were profoundly dangerous, those free speech protections might be overridden[i].
So, is talking harmful?
The government commissioned a review of the evidence in 2021 to support its commitment to a ban (made several times under severe political pressure). The lead researcher chosen, Adam Jowett, had made his opposition to talking therapies clear since at least 2014.
This provides important context for reading the report and the conclusion.
Both the government which commissioned the report and the lead researcher wanted it to provide evidence to justify a ban.
But it doesn’t. Here’s why.
The government’s review is misleading about harm
It’s no surprise that the review is written in a way to imply that talking therapies cause harm. For example, the conclusion states:
“Modern forms of conversion therapy appear to largely take the form of talking therapies and spiritual interventions. There is evidence that these forms of conversion therapy can be harmful – but there is no robust evidence that identifies whether certain techniques or practices used by conversion therapists are more or less harmful than others.” (1.3, emphasis added)
This conclusion appears to be ‘sexing up’ its own findings. Notice:
(1) It only claims that forms of conversion therapy ‘can be’ harmful. Many things, like participation in sports, can be harmful in some cases but are not generally harmful.
(2) It only claims that ‘there is evidence’ for this harm. But is the evidence compelling? Should it be balanced against possible benefits? These questions are glossed over.
(3) The wrong comparison is made. The question of harm is contrasted with a distinction between different practices. The natural question is whether these interventions can also have positive effects. Within the report itself, there is evidence that it can.
(4) When considering the question of harm, the standard is ‘evidence’ but when distinguishing between practices, the standard is raised to ‘robust evidence’. This is needed to justify a blanket ban, since there is evidence suggesting different approaches have different effects.[ii]
All of this leads to a conclusion that appears much more authoritative and definite than it actually is, while allowing the researchers wriggle room if challenged on the conclusions. The ordinary person would read that paragraph and understand that talking therapies and prayer are more harmful than they are helpful.
This is not what the evidence shows.
Different approaches have different effects
[ii] For example, Dehlin et al. (2015) studied Mormons and ex-Mormons who had sought help. They list nine different categories of interventions, with the more formal therapeutic methods being labelled ‘more helpful than harmful’ 8 times out of 11. If different strategies for seeking change have different effects, with some being generally helpful, a blanket ban would be disproportionate, breaching ECHR rights.
What is ‘harm’?
What counts as ‘harm’ varies within the research literature. Peter Sprigg identifies broad definitions of harm that are not relevant to the question of legal restrictions[iii]:
“Failure to change”
“Waste of time and resources”
“Delay in coming out”
“Reinforces homophobia”
These are not health concerns that could justify restrictions on free speech.
The first of these is particularly important, since several of the key studies mix up the question of efficacy (does it work?) with harm (is it harmful?). These studies ask people to rate their experiences on a scale, with harmful at one end to effective at the other. This leaves no space for people who had a positive but ineffective experience.
This isn’t an academic distinction. In fact, it’s relatively common for those who didn’t experience lasting change to find other benefits:
“Both proponent and opponent participants described positive experiences with conversion therapy, which was an unexpected finding . . .” (Beckstead and Morrow (2004))
“By and large, ex-ex-gay posters [i.e. people posting on message boards for people who are no longer ‘ex-gay’] view their experience in the ex-gay movement as having yielded positive results in the long run” (Wolkomir M. (2001))
Both of these studies are included within the government’s review but brushed away:
This completely misses two critical points. First, people who are accessing therapy or support groups do so because they are motivated by wanting to see a change in their feelings or behaviours.
To make this support unavailable to them would simply mean that they miss out altogether.
Second, the therapeutic practices used are mainstream approaches.
Consider Reintegrative Therapy [iv], advocated by Dr. Joseph Nicolosi Jr. This utilises Eye Movement Desensitisation and Reprocessing and Mindful Self-Compassion. These are standard, evidence-based therapeutic approaches. The only difference is between this and what might happen in any other counsellor’s room is the client’s motivation.
The government’s report clearly considers Reintegrative Therapy to be ‘conversion therapy’, despite the organisation’s denials (7.4). This is simply because the organisation holds out the possibility of change.
This exposes the reality that a ban is motivated by ideology, not evidence.
Two therapists could provide essentially the same support to a client, which is beneficial to mental health, but one is liable to be punished simply because the client wanted to reshape their sexuality.
“It can be noted that many of these perceived benefits are not unique to conversion therapy but are common across most types of therapy and support groups (APA, 2009a). These benefits could potentially be gained through alternative therapeutic approaches that do not seek to change a person’s sexual orientation or gender identity (APA, 2009a, Wolkomir, 2001).” (6.3)
79 key studies that don’t demonstrate harm
[iii] Peter Sprigg’s article, 79 Key Studies Do Not Demonstrate That Sexual Orientation Change Efforts (SOCE) Are More Harmful Than Other Counseling, analyses a list of studies that has been used to claim that consensual support is harmful.
It demonstrates that only six of these are even relevant studies and these tell a vastly different story to the ‘harm’ narrative.
This review is well worth reading in full for a detailed understanding of the lack of evidence for claimed harms. Much of the material on this page is based on this more detailed analysis.
Reintegrative Therapy: safe and effective
[iv] A 2021 study has shown Reintegrative Therapy - one talking based approach that could be banned under the government’s plans - to be safe and effective.
75 men completed the study and were shown to generally have an improvement in well-being as well as sometimes experiencing change.
What is an ‘association’ with poor mental health outcomes?
The government’s consultation announcement made another claim about harm:
“there is a growing body of quantitative evidence that exposure to conversion therapy is statistically associated with poor mental health outcomes – although care needs to be taken when making causal inferences, qualitative studies have found that those who have undergone conversion therapy attribute such feelings to the conversion therapy” (3.1)
Here, it refers to the government’s separate assessment of the evidence. Again, it tells a misleading story:
It implies that there is growing evidence that talking is harmful. More research is indeed taking place, but recent studies do not provide better evidence of harm.
The government’s assessment itself only claims an ‘association with harm’ – not ‘harm outcomes’. The word outcomes implies a causal link which the data itself does not support.
Rather than comparing like for like - claims of harm and claims of benefit - the announcement jumps straight to low quality qualitative studies to imply that talking causes harm.
To be clear: the statistical association between talking therapies and poor mental health only means that the people who have received some kind of help are people who in general have poor mental health.
The Coventry researcher’s report notes that “an alternative explanation could be that LGBT people with mental health problems are more likely to seek out conversion therapy” – but wrongly dismisses this possibility based on two studies.
One of these studies (Blosnich and others 2020) has since been shown to have “failed to establish whether [talking therapy] exposure preceded suicide morbidity”, which the authors themselves say is a “valid critique”. In other words, it didn’t consider whether people were feeling suicidal before therapy. A reanalysis by Paul Sullins (2022) argues the opposite conclusion: experiencing [talking therapy] may reduce suicidality.
The second study (Ryan and others, 2018) looked only at self-identifying LGBT youth whose parents had initiated some kind of intervention. This clearly suffers from selection bias [v], but is also irrelevant to the topic at hand: consensual conversations between adults.
In any case, the evidence that these kinds of consensual conversations cause harm is missing.
Selection bias
[v] Many of the studies in this area struggle from selection bias, where those taking part are biased against or in favour of this kind of support.
In this case, anyone who may have benefited from help would not have identified themselves as LGBT youth, and therefore been excluded from the study.
The government’s reports ignore the most robust study
Both of the government’s reports point out that research in the area is limited.
For example:
“The studies included in the rapid evidence assessment therefore fall short of the ‘gold standard’ in clinical evidence for assessing effectiveness. This is mainly due to the following methodological limitations:
a lack of prospective, controlled study designs that can robustly examine causal relationships
a reliance on retrospective self-reporting
a reliance on self-selected and potentially biased samples
a lack of longitudinal studies that follow individuals over time
the use of different (and often unreliable) measures of ‘success’
the inclusion of a wide variety of conversion therapy approaches”
You would think then, that they would place significant weight on a long-term, longitudinal, quantitative study with a large sample size that doesn’t rely on retrospective reporting and uses standard measurements for psychological harm. What a goldmine of information that would be!
However, Jones and Yarhouse (2011) is mysteriously missing from these reviews. The 2007 book it was based on is explained away as part of the ‘grey literature’ but the more recent peer-reviewed journal article is completely missing.[vi]
Jones and Yarhouse conclude that:
“change of homosexual orientation appears possible for some and that psychological distress did not increase on average as a result of the involvement in the change process.”
They write (p424, emphasis added):
“The only statistically significant trends that emerged for the GSI (global) and PSDI (distress intensity) variables indicated improving psychological symptoms T1 to T6.”
And sum up their findings writing:
“Specific individuals may claim to have experienced harm from the attempt to change, and those claims may be legitimate, but although it may be that the attempt to change orientation caused harm by its very nature, it may also be that the harm was caused by particular intervention methods that were inept, harsh, punitive, or otherwise ill-conceived, and not from the attempt to change itself. Our findings mitigate against any absolute claim that attempted change is likely to be harmful in and of itself.”
This study – which probably has the most reliable findings of any such study – completely undermines the government’s ‘harm’ narrative.
Why is it completely missing from its analysis? [vii]
Explaining away what doesn’t fit the narrative
[vi] Footnote 22 does give a brief explanation for why they excluded Jones and Yarhouse’s original 2007 study.
It cherry picks a statement from the authors’ responsible explanation that the study is limited, but ignores their claim that “This study is the best designed and implemented study to date on religiously mediated change of sexual orientation” and that “the study, although not above criticism, is significantly stronger than any other existing study”.
If the government’s report applied these standards to the other studies it cites, there would be no evidence left standing.
Relevant but ignored
[vii] Another relevant study (Santero et al (2018)) is mentioned by the government’s reports and concludes (emphasis added):
“Overall, the hypothesis that any technique was predominantly harmful was strongly rejected…”
“This therapy is not really exceptional but should be considered in the ranks of the conventional …”
The government reports rightly note that this study was retracted by its journal in 2019 over a dispute about the statistical tests used. However, the authors stood by their findings and the data has since been reanalysed, with the finding that (emphasis added):
“a large majority of these sexual minority men perceived their engagement in [sexual orientation change efforts] to enhance their well-being. Less than 5% of participants reported experiencing negative changes. Reports of positive change were stronger and more widely distributed than those of negative change, most strongly for depression, but also for self-esteem, social functioning, self-harm, suicidality, and alcohol/substance abuse.”
Even the evidence the government did include tells a different story
A casual reader of the government’s analysis would be led to think that there is damning evidence that therapeutic conversations causes harm – but even within the evidence that the Coventry researchers and the government itself considered, a very different picture emerges.
For example, Beckstead and Morrow interviewed Mormons who had undergone “therapy to change their sexual orientation”. They categorised participants into those reporting mainly positive outcomes (20) as proponents and those who were mainly negative (22) as opponents.
They say (emphasis added):
“Both proponent and opponent participants described positive experiences with conversion therapy, which was an unexpected finding…”
“…several opponent participants expressed a need for the option of conversion therapy because as they explained, it gave them the space to explore being an ‘ex-gay’ as they met others like themselves”
“proponent participants . . . reported only conversion therapy benefits, no therapeutic harms, and heterosexual functioning”
The study by Shidlo and Schroeder (2002) is frequently cited by the government, including to claim harm. This study was originally advertised using the headline: “Homophobic Therapies: Documenting the Damage” but was changed when some participants “reported being helped as well as harmed”. Despite the clear intent of the researchers, and the likely bias involved in the selection of participants, 61% reported their interventions as being helpful to some degree. In any case, the researchers are clear that:
“The data presented in this article do not provide information on the incidence and the prevalence of failure, success, harm, help, or ethical violations in conversion therapy.”
Weiss et al. (2010) is a qualitative study which analysed posts on internet message boards for ex-gay and (separately) ex-ex-gay people. According to the researchers, very few of the comments were suggestive of depression from the ex-gay (1 in 30) and ex-ex-gay (1 in 26) message boards. The authors also explain the source of these struggles:
“The majority of respondents that reported being suicidal stated that it was the prospect of being gay . . . that led them to thoughts of suicide, rather than the struggle of trying not to be gay”
They also suggest that:
“Most of the posters to the ex-ex-gay boards report currently being in overall good psychological health. The most common statements . . . were that they valued their journey through the process”
One of the original adverts for the Shidlo and Schroeder study
Conclusion
Seeking a change in sexual attraction or behaviour through talking therapy, prayer and support groups is normal and legitimate.
Although some people believe they were harmed by these attempts, the most relevant studies suggest this consensual support is significantly more psychologically helpful than harmful.
Many people who didn’t experience lasting change nevertheless valued the experience.
One recent study suggests that even when ineffective, this support does more good than harm.
In any case, the government’s two reports are inadequate, ignoring important information and twisting the data to give apparent support to its politically-motivated goal of a ban on ‘talking conversion therapy’.
No good evidence has been given that justifies a ban on consensual conversations and no one who believes in freedom of speech or freedom of religion should support a ban.