DOES “CONVERSION THERAPY” help, harm, or do neither? The American Psychological Association (APA) sees “insufficient evidence” to prove psychological interventions can change sexual orientation. The American Academy of Child and Adolescent Psychiatry says such interventions may be harmful. The American Academy of Pediatrics claims conversion therapy “can provoke guilt and anxiety.” The American Medical Association (AMA) backs ongoing efforts to outlaw the therapy. 

And yet, the APA has admitted that many people do change sexual preferences over time. Human sexuality may be especially changeable among those who describe themselves as gay, bisexual, or transgender. In her 2016 paper “Sexual Fluidity in Males and Females,” published in Current Sexual Health Reports, University of Utah psychologist Lisa Diamond noted that “change in patterns of same-sex and other-sex attraction is a relatively common experience among sexual minorities.” 

For decades health professionals have discussed the roles of nature and nurture in developing sexual orientations. The APA and AMA claim science does not support any linkage of homosexuality with sexual abuse or a troubled childhood. But many professional therapists and Christian counselors insist many of their clients who struggle with unwanted same-sex attractions carry other serious baggage. Some came from broken families or were victims of rape or childhood sexual abuse.

California psychologist Joseph Nicolosi Jr. says our brains can rewire themselves “and sexuality can shift.” Nicolosi and other therapists say many of their clients have dealt with trauma and resolved unwanted same-sex attractions.

IN THE 1950S AND ’60S, when manuals listed homosexuality as a psychological disorder, scientific researchers tried many methods—even electroshock, induced vomiting, and shame-based conditioning—to change a homosexual orientation. But those techniques were ineffective and often inhumane. When psychologists took homosexuality off the list of mental disorders in 1973, same-sex behavior moved from pathological to acceptable and, for some, virtuous.

The field of psychology doesn’t formally recognize anyone as a “conversion therapist,” and I could find no currently licensed therapist who described his practice as “conversion therapy.” Even church groups and ex-gay ministries shy away from the term, instead pledging accountability and mentoring for anyone seeking help.

Yet public hearings nationwide are replete with shocking conversion therapy stories, many by former clients who claim therapists tried to coerce them into falsely believing they had been sexually abused or had bad parents.

Junior Avalos told Minneapolis city legislators he attended a boot camp in Texas where counselors conditioned male participants to speak with deeper voices and “beat us like dogs” if participants didn’t comply. Jory Miller said he became suicidal after meeting weekly with his pastor, who probed him repeatedly about repressed memories of sexual abuse that Miller said didn’t occur. 

Sam Brinton, head of government advocacy at the Trevor Project, an LGBTQ youth advocacy group, claims his Southern Baptist missionary parents sent him to a conversion therapist in Florida when he was 12. “The therapist told me I was sick, that God hated me, that the government had already exterminated all other gay people,” he told the UN Committee Against Torture in 2014. Brinton said the therapist poked his fingers with needles, placed ice in his strapped-down hands as he looked at erotic pictures, and wrapped hot coils on his hands to electroshock him.

Conversion therapy survivors like these may have experienced real harm from someone they trusted. But it’s hard to know: In the 50 cases of publicized survivor stories that I tracked, only 10 survivors named their therapist (of those, a few named the same therapist)—and that makes it hard to verify most reports of abuse. Brinton, for example, has given conflicting accounts about where his therapy took place and admitted to an LGBT news website his therapist was a “religious therapist and not a doctor.” (Through a spokesperson, Brinton declined to answer specific questions for this story.) 

For a therapy criticized as dangerous and ineffective, the paper trail to track down “bad” therapists is thin. I could identify only one former client—Katherine McCobb—who sued her therapist for attempting to change her orientation. In 2017, McCobb accused Lloyd Willey, a licensed marriage and family therapist, of trying to change her orientation by instructing her to act more feminine and allegedly orchestrating a sexual relationship between her and one of his male clients. McCobb and Willey quietly settled that case out of court last year. Willey still has a valid license in California. 

Survivors I tracked identified by name a total of five therapists who they claim harmed them. One, Joseph Nicolosi (father of Joseph Nicolosi Jr.) died in 2017. Another therapist, James Wilder, I reached by email, but he declined to discuss his client’s case beyond acknowledging “the effort to improve the family closeness and communication with his father was reported to have caused him and his family harm.” An attorney for Lloyd Willey declined to provide his client’s contact info.

Harsh boot camps may still exist. A 2017 ABC News investigation uncovered several “conversion therapy camps” where pastors isolated troubled teens and beat or verbally abused them. All of the camps ABC reported on have since closed, with leaders arrested and charged with child abuse. But these camps, including Restoration Youth Academy in Prichard, Ala., Blessed Hope Boys Academy in Seminole, Ala., and the Joshua Home in Burnet County, Texas, worked with a variety of troubled youth, not just gay teens. Also, it appears none was licensed to perform professional therapy.

David Pickup, a licensed marriage and family therapist in Texas who meets with clients expressing unwanted same-sex attractions, says states should not pass blanket bans but instead regulate specific therapy practices, separating the bad therapists from the good: “They should take licenses away.”

PICKUP’S FRUSTRATION is understandable. The dissension over conversion therapy has made work difficult for licensed therapists like himself.

Licensed therapy practices vary, but most who work with same-sex attractions prescribe some form of talk therapy, with patient and therapist sitting in chairs facing each other and talking through the patient’s concerns. Most therapists help clients identify potential stressors, such as family conflicts, troubled relationships, or sexual abuse. They say clients must be in control of the therapy for it to work.

Christopher Doyle, a licensed counselor in Virginia, said, “The risk of harm is greater if the family is trying to pressure the kid to change.” In his therapy, he has one-on-one sessions with adults and is particularly cautious with children, requiring family members to sit in on sessions.

The Sunday Sessions, a 2018 documentary by independent filmmaker Richard Yeagley, shows Doyle’s work. The film follows Nathan Gniewek, a real patient of Doyle’s, for a year. One-on-one with Doyle, Gniewek expresses anguish as Doyle recommends letting go of a potential boyfriend. Other times Doyle directs him to throw wads of paper at inanimate objects representing important people in his life. Gniewek in group therapy sits with other men who are all clutching teddy bears, eyes closed, while they attempt to visualize their emotionally wounded inner child.

Doyle said many clients like Gniewek value their religious faith and try to work through their sexuality questions. He said clients rarely develop depression and suicidal thoughts during therapy, but that does happen, especially for clients reprocessing past trauma. In those cases, Doyle refocuses the therapy on self-care and healthy coping mechanisms. More often, Doyle’s patients had already experienced depression and suicidal thoughts before ever visiting his office, he said.

Nicolosi, a licensed psychologist in California who works only with adults, said his “reintegrative therapy” may not even address directly a client’s sexual questions. By focusing on his trauma or addiction, a client can guide how the therapy resolves his sexual and gender identity concerns, Nicolosi said: “I will never tell you to change your sexuality. We just let whatever happens, happen.” His reintegrative therapy involves both talk therapy and “eye movement desensitization and reprocessing,” in which the therapist moves his fingers back and forth through the air as the client watches, a technique widely used to reduce painful memories for trauma sufferers. 

The therapists I spoke with declined to offer estimates of their success rates, saying not every client has the same goal. Doyle said some families under his care have reconciled with their LGBT-identified children, and other clients of his have successfully reduced their same-sex attractions. 

Michael Gasparro, a former client of another licensed therapist, experienced sexual trauma as a child and sought therapy as a 17-year-old. He said his therapist talked him through his anxieties, sexuality questions, and family relationships. Gasparro said the therapy helped him heal personal wounds and remain obedient to his Catholic beliefs about marriage and sexuality: “I got to understand my experience with same-sex attraction and how I was utilizing it to compensate for other aspects in my life.”

Many people seek help. Doyle and Pickup each meet nearly 40 clients a week at their respective offices, they said. Doyle said 65 percent of his clients see him specifically for sexual or gender identity issues.

FOR SOME PEOPLE struggling with same-sex attraction, therapy isn’t the answer. Several people I spoke to described leaving a gay lifestyle with no therapy at all. In some cases, Christian counselors and resources were pivotal (see below).

Charlene Hios said that after 20 years living as a lesbian, her eyes opened once she became a Christian, and she left her past behind. KathyGrace Duncan, a woman who spent 11 years living as a transgender man, said an encounter with God convinced her that lifestyle was wrong, but it took her five years of counseling to deal with inner confusion and transition back to being a woman.

“Well-meaning people gave me lotion or makeup. That’s not what I needed. I needed to be understood on the inside,” Duncan said. “I had to relearn what feelings were. I would have this good feeling and God would say, ‘This is what joy is,’ and I’d say, ‘This is joy? Joy feels good.’”

—This story has been updated to correct the description of the group therapy Nathan Gniewek participated in.

Trouble for Christian counselors?

Some conversion therapy bans make exceptions for clergy and religious counselors. In those jurisdictions, Christian counselors not licensed by the state can still meet legally with young clients struggling with same-sex attraction. 

But if a Christian counselor is state-­licensed, he could be subject to such a ban. ­Alasdair Groves, executive director of the ­Christian Counseling and Educational Foundation (CCEF), ­cautioned that some laws are unclear whether a state-licensed Christian counselor may counsel a minor informally outside his professional practice. And even though most Christian counselors do not promise a counselee the elimination of homosexual desires, they could find themselves in legal ­difficulty if a local ban defines conversion therapy broadly to include not just eliminating but reducing same-sex attractions—as does Colorado’s law. 

Some jurisdictions are edging toward religious restrictions: Maine’s conversion therapy ban restricts certified “pastoral counselors” along with licensed therapists. —J.C.E.