LGBT issues in relation to therapy are increasingly in the spotlight at present within the UK. Calls for a government ban on conversion therapy are gaining ground. At an Albany Trust event, Stephen Fry referred to conversion therapy as ‘this wretched business’. 1 In the House of Commons debate, responding to an e-petition on the topic, Members of Parliament described conversion therapy as “a pseudo-psychiatric 21st-century snake oil”. It was “disgusting, exploitative, damaging and a relic of bigotry”, with calls for rapid legislation to end “the barbarity of conversion therapy”. 2
The Government’s own major 2018 LGBT survey was a key reference point in the Commons debate. Its research suggested the full extent of conversion therapy in the UK. The report, carried out in 2017, was a large-scale survey into the experience and needs of LGBT people in the UK aged 16 or over. 3 It covered a broad range of topics, including personal safety, education, the workplace and healthcare. The survey was based on an online, self-report questionnaire, with 108,000 valid responses, making it “one of the largest collections of empirical evidence from this group to date”. 3
LGBT survey findings:
The survey reported that 2% of respondents had experienced conversion therapy, in order to ostensibly change their sexual orientation, or gender identity. A further 5% had been offered this. 3 It is the former statistic, i.e. 2%, which is frequently cited, as in the House of Commons debate 2 and more broadly elsewhere. 1 It is taken as clear and damning evidence that conversion therapy is an ongoing, rather than purely historic, problem facing LGBT people today, which now requires urgent legislative reform.
There are, however, real problems in taking the survey’s findings as being definitive, rather than exploratory in nature on this issue. The authors of the survey are at pains to point out that the results are not necessarily representative of the wider LGBT population, as the survey was based on self-report. The size of the total LGBT population in the UK is not currently known with any precision. The Office for National Statistics estimated in 2016 that 2.5% of the UK population aged 16 or above identified as lesbian, gay, bisexual or ‘other’, i.e. almost 1.3 million people. 4 There is, however, no robust estimate for the size of UK trans community, with a Government Equalities Office estimate of between 200,000 and 500,000. 3 However large the LGBT survey in terms of responses, it still remains a non-random sample. It cannot, therefore, be generalised with any degree of certainty to the wider LGBT population. 5 Where comparisons are possible, it seems clear that the survey respondents were, on average, much younger, better educated and more London-centric than the known LGBT population. 3
Conversion therapy findings:
This will sound like nit-picking to some, who might well respond: but what about conversion therapy? Surely the survey shows that conversion therapy is a serious problem for LGBT people? There are several problems here. Firstly, the 2% refers to survey respondents, rather than it representing 2% of the LGBT population as a whole, given that this was not a random sample of a precise, known target population. Secondly, the data was gathered via only 4 out of a total of 152 questions, which covered a broad range of topics. 3 While the data can be interrogated according to age, sexual orientation and gender identity, it is lacking in specific information about the precise nature of the conversion therapy undergone. In fact, the survey itself seems conceptually unclear as to what is meant by the term conversion therapy, offering two different definitions.
The definition of conversion therapy provided in the survey’s glossary is: “Interventions aimed at changing someone’s sexual orientation or gender identity. These take many forms. Also referred to as reparative therapy”. 3 However, the definition of conversion therapy outlined in the discussion of the survey’s findings is rather different: “So-called conversion therapies, sometimes also referred to as cure, aversion or reparative therapies, are techniques intended to change someone’s sexual orientation or gender identity. These techniques can take many forms and commonly range from pseudo-psychological treatments to spiritual counselling. In extreme cases, they may also include surgical and hormonal interventions, or so-called ‘corrective’ rape”. 3
Limitations of survey findings:
The first definition is minimal and non-specific, whereas the second includes a very broad spectrum of coercive, punitive and, frankly, illegal interventions. The survey states that “Respondents were asked whether they had ever undergone or been offered any such intervention and, if so, who had conducted or offered it”. 3 It is not at all clear what respondents are choosing to define as conversion therapy in their answers, or from where the broad spectrum of coercive activities included in the second definition has been derived.
The four questions on conversion therapy are necessarily broad-brush, given the wide-ranging nature of the survey (see Box 1: LGBT Survey questions on conversion therapy).
142. Have you ever had so-called “conversion” or “reparative” therapy in an attempt to “cure” you of being LGBT?
o Yes * GO TO 145
o Don’t know
o Prefer not to say
143. Have you ever been offered this so-called “conversion” or “reparative” therapy?
o Yes * SKIP 145
o No * GO TO 146
o Don’t know * GO TO 146
o Prefer not to say * GO TO 146
144. Who offered you this so-called “conversion” or “reparative” therapy?
□ Parent, guardian or other family member
□ Faith organisation or group
□ Healthcare provider or medical professional
□ Person from my community
□ Any other individual or organisation not listed above
o Prefer not to say
145. Who conducted this so-called “conversion” or “reparative” therapy?
□ Parent, guardian or other family member
□ Faith organisation or group
□ Healthcare provider or medical professional
□ Person from my community
□ Any other individual or organisation not listed above
□ Prefer not to say
Box 1: LGBT Survey questions on conversion therapy.
(Source: GEO 2018: 298-9. http://nationalarchives.gov.uk/doc/open-government-licence/version/3/ )
The survey findings were that the 2% of sample respondents who had experienced conversion therapy were more likely to be older, male, trans, or Black. Muslim respondents were also much more likely to have had conversion therapy, as were those respondents resident in Northern Ireland, or London. In terms of who had conducted the conversion therapy, 51% respondents identified faith organisations, 19% healthcare providers, or medical professionals, with 16% saying that that it had been conducted by their parents, guardians, or other family members. 3
Questions raised by survey data:
Clearly, these figures are very concerning. However, the actual meaning of the data is quite unclear in many respects., The results typically raise many more questions than they answer. Given that this was an exploratory, non-random survey, using online self-report, this is not surprising. However, it does entail a definite limitation to the real value of its findings. For example, does the conversion therapy conducted by healthcare providers and medical professionals include NHS agencies, and/or private medical organisations? Were counsellors, psychotherapists, psychologists and psychiatrists part of the staff carrying out conversion therapy? If therapists were involved, were these members of professional associations, such as BACP or UKCP? Were therapists involved, in any way at all, in conducting pseudo-psychological treatments, spiritual counselling, surgical and hormonal interventions, or corrective rape? The survey data is incapable of answering even elementary questions of this sort. It is very far from constituting “a clear picture of the geographic spread and the demography of conversion therapies across the UK”, as claimed by one MP in the House of Commons debate. 2 It does not, as it stands, provide a convincing, robust, evidence base for sweeping legal reforms to the criminal law relating to conversion therapy, or to any kind of therapy, in the UK.
The case for legal reform in Victoria, Australia:
The argument for legal reform is based, in part, on the example shown by other countries, the most recent being the state of Victoria in Australia. Here, the Change or Suppression (Conversion) Practices Prohibition Bill 2020 contains sweeping changes to the law, by banning conversion practices, with penalties of 10 years in prison and fines of up to $10,000. 6 The proposals for legal reform were underpinned by bespoke research into conversion therapy within faith communities in Victoria, given that “Such data is vital in determining what types of legal and community interventions are appropriate and most likely to be effective in addressing the harms associated with conversion therapy”. 7 Conversion therapy is succinctly defined as “an umbrella term used to describe attempts to ‘convert’ people from diverse sexual and gender identities to an exclusively heterosexual and cisgender identity”. 7 The investigation took the form of a small piece of qualitative research (n: 15) into the experience of adults from faith communities, who had undergone conversion therapy. This is combined with a substantial literature review of international human rights law on conversion therapy. The selection of participants was based on theoretical sampling, in order to illustrate a range of faith-based communities. It was intended to be representative of Australian demographics. Typical faith-based interventions took the form of prayer, scripture reading, fasting, spiritual healing and spiritual deliverance. The report concluded that “conversiontherapy messaging was embedded in all aspects of the culture and day-to-day practices of their faith communities”. 7
Extrapolating from a non-random sample:
The research is on fairly safe ground when describing participants’ direct experiences of conversion therapy within their respective faith communities. However, it runs into difficulties at a number of points, in trying to extrapolate this material into conclusive evidence in favour of sweeping legal reform in Victoria. The extremely small scale of the sample (n: 15) presents real difficulties in estimating the relative scope of the problem within the state. This problem is, however, finessed by referring back to the UK LGBT 2018 survey, and taking the 2% figure from that source. 3 UK and Australian religious demographics are held to be essentially similar. 8, 9 (While this assumption may have been correct in 2011, according to census data, this was definitely no longer the case by 2016, according to UK data released in 2017. 10) However, even this factor is quite irrelevant to establishing their case, given that the UK sample data of 2% cannot be appropriately transferred to a quite separate Australian population. This rather circuitous argument then calculates an alarming, if entirely unproven, headline figure, of no less than 10% of Australian adults being vulnerable to faith-based conversion therapy. 7 Given previous discussion of the UK Government’s survey data of 2% as being based on a non-random sample, 5 this seems to be taking the UK data entirely out of its proper context.
The second problem within the argument is that the sample of participants is intentionally drawn from faith communities. This is in order to illustrate the oppressive nature of conversion therapy within that specific setting. However, the experience of this limited sample is then used to endorse the case for widespread legal reform right across the board. This would cover all healthcare professionals, despite their not featuring in any significant way in the abusive conversion therapy outlined within the 15 interviews. Hence “Christian counsellors appear to be the largest providers of conversion therapy and may not be registered or regulated… The counsellor sector requires wholesale reform”. 7 The report is in danger here of over-generalising from a small, qualitative, non-random sample, in order to claim relevance on a quantitative basis, to a much wider population of faith-observing adults. The conversion problem located in some aspects of faith-based counselling and pastoral care is then also generalised to all other healthcare professionals. This is despite the latter’s stated opposition to conversion therapy, and their practical absence from the abusive conversion practices so painfully described by participants and survivors.
Victoria’s law banning conversion therapy:
This research appears to have carried at least some weight in the recent move towards adopting the proposed legal ban on conversion therapy in Victoria, regardless of the serious methodological shortcomings identified here. Clearly, legislative reform is never just based on compelling research data alone, or, in this case, its relative absence. 11 It will also be framed by a much wider political process, including media coverage, and the activities of lobbying groups. In addition, it could well be the case that key agencies, such as the Victorian Equal Opportunity and Human Rights Commission, are looking here for an opportunity to significantly expand their remit and legal powers. In this instance, critics suggest that the Commission, in acting as both investigator and judge of alleged breaches, will thus potentially breach established principles of natural justice. 12
So, there is a strange, indeed, rather circular, process at work here. The 2018 UK government non-random survey produces a figure of 2% of the LGBT sample, as having experienced some form of conversion therapy, although it is not clear exactly what this comprises. 3 The figure is quoted in debate in the House of Commons, as illustrating the scale of the problem, urgently needing legal reform. 2 The same figure of 2% is picked up by researchers in Australia, arguing for similar reform in Victoria. It is then amplified, to produce a figure of no less than 10% of Australians, active in faith organisations, as being at risk of conversion therapy. 7 Finally, to complete this almost perfect feedback loop of questionable research data, the Victoria legal reforms are quoted, in approving terms, back in the House of Commons debate. 2
Politicisation of research:
So what do these two pieces of LGBT research tell us, other than perhaps illustrating the dangers of a degree of research overclaiming and policy over-reach? It is important to acknowledge that the overall research context is far from being benignly neutral on these topics. The background to any discussion of LGBT research is highly politicised. Any research runs the risk of being evaluated primarily from a partisan perspective. So, for example, exploratory research looking at the rapid development of gender dysphoria amongst adolescents 13 is roundly condemned, apparently on the grounds of its use of online self-report. 14 However, the latter research used the same data gathering methodology (i.e. online self-report) as the widely praised LGBT 2018 survey. 3 Key research topics, such as the percentage of trans people later seeking to reverse transition, or the extent of suicidality amongst trans adolescents, and even the longer-term effects of puberty blockers, are all strongly, even bitterly, contested by interested parties in the debate.
The politicisation of LGBT research seems to be very reminiscent of the initial phases of research into child sexual exploitation a decade ago. 15 Early research efforts in this field experienced similar problems, i.e. in agreeing operational definitions of child sexual exploitation. Established institutions, such as children’s social care, jostled defensively for media influence. Research findings were almost drowned out by allegations of racism, before a degree of calm slowly began to emerge.
LGBT research in Europe:
The recent attempt by Kolto et al to scope out current LGBT research with young people in Ireland and the rest of Europe therefore arrives at a particularly important moment. 16 This is a detailed, comprehensive effort to identify research into sexual and gender minority (SGM) people. The latter refers to those identifying as lesbian, gay, bisexual, trans or intersex, or belonging to other sexual or gender minorities (LGBTI+). It notes the overwhelming imbalance existing within published research. Most studies derive from North America, and far fewer from Europe, raising issues of cross-cultural relevance and generalisability. The survey notes that “trans youth are disproportionately affected by serious mental health problems (including self-harm, suicidality, alcohol use and victimisation experiences) compared to their cisgender peers”. 16 The survey also identifies significant gaps in research, for example, in relation to longitudinal studies over the life cycle, the longer-term effects of puberty blockers and the relative dearth of research into intersex youth. Research mainly tends to use a descriptive approach, based on convenience or community sampling strategies. A reliance on obtaining parental consent raises important ethical barriers to research, given the hostile political environment for LGBT youth in certain European countries. Overall, it concludes that there is a need is for “more rigorous and complex methodology, with more ambitious objectives (e.g. analysing the causal mechanisms between discrimination, minority stress and negative health, or monitoring the efficacy of interventions)” 16 (emphasis added: PJ).
The Kolto survey brings a degree of clarity to a LGBT research debate which is, perhaps, characterised by rather more heat than light. Meanwhile, the Government is launching its consultation on the topic of conversion therapy, though conflicting claims as to its prevalence continue. While there are calls by some MPs for extensive, UK-wide criminalisation of conversion therapy, it seems that the government is taking a much more cautious, pragmatic approach. Kemi Badenoch, Minister for Equalities, while, of course, referencing the 2018 LGBT survey, 3 notably emphasised the need for a ‘proportionate’ and ‘targeted’ approach 2. The stated intention here is to apply the existing law wherever possible, rather than making widespread legal changes according to the Victorian model.
1 Albany Trust. Webinar: Against conversion therapy in the UK: 2021.
https://www.albanytrust.org/against-conversion-therapy-in-the-uk Accessed 14/6/21.
2 House of Commons LGBT Conversion Therapy, Volume 690: debated on Monday 8 March 2021.
3 Government Equalities Office. National LGBT Survey: Research Report. Department for Education: Manchester; 2018. www.gov.uk/government/consultations/national-lgbt-survey
4 Office for National Statistics. Sexual identity, UK: 2016. Statistical bulletin; 4 October 2017.
5 Patton MQ. Qualitative research and evaluation methods. Third edition. Sage: London; 2002.
6 Jackson C. Interview with Igi Moon. Therapy Today 2021; 32(5): 22-25.
7 Jones T. Brown A. Carnie L. Fletcher G. & Leonard W. Preventing harm, promoting justice: Responding to LGBT conversion therapy in Australia. Melbourne: GLHV@ARCSHS and the Human Rights Law Centre; 2018. https://static1.squarespace.com › static › t › LGBT…
8 Australian Bureau of Statistics. Religion in Australia: 2016 Census data summary. (nd) https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2071.0~2016~Main%20Features~Religion%20Data%20Summary~70 Accessed 16/6/21.
9 Curtice J. Clery E. Perry J. Phillips M. and Rahim N. (eds.) British social attitudes: The 36th report: Religion: identity, behaviour and belief over two decades. London: The National centre for social research; 2019. http://www.bsa,natcen.ac.uk Accessed 17/6/21.
10 Clements C. Religion and the British social attitudes 2016 survey. British religion in numbers. 2017. Posted on October 11, 2017, released by United Kingdom Data Service.
11 Health Complaints Commissioner (Victoria) Report on the inquiry into conversion therapy: Executive summary. HCC: Victoria; 2019. https://www2.health.vic.gov.au/about/publications/researchandreports/report-on-inquiry-into-conversion- therapy-executive-summary Accessed 26/6/21.
12 Sneddon M. Change or Suppression (Conversion) Practices Prohibition Bill 2020 (Vic): Major problems and proposed amendments. Institute for civil society: Victoria, Australia; 2021. http://www.i4cs.com.au/problems-and-proposed-amendments-victorias-change-or-suppression-conversion-practices-prohibition-bill-2020/ Accessed 17/6/21.
13 Littman L. Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria. PLOS ONE, 13(8), e0202330. 2018.
14 Tannahill B. Rapid onset gender dysphoria is biased junk science. The Advocate 2018; 20 February. bit.ly/2oWmYur Accessed 22/6/21.
15 Jenkins P. The politics of research into child sexual exploitation. Healthcare Counselling and Psychotherapy Journal 2015. July, 15:3: 22-25.
16 Költő A. Vaughan E. O’Sullivan L. Kelly C. Saewyc EM. & Nic Gabhainn S. LGBTI+ youth in Ireland and across Europe: A two-phased landscape and research gap analysis. Dublin: Department of Children, Equality, Disability, Integration and Youth; 2021.
Peter Jenkins is a counsellor, supervisor, trainer and researcher. He has been a member of both the BACP Professional Conduct Committee and the UKCP Ethics Committee. He has published a number of books on legal aspects of therapy, including Professional Practice in Counselling and Psychotherapy: Ethics and the Law (Sage, 2017). His Sage website provides access to a range of free resources on legal and ethical issues in counselling and psychotherapy, including video clips, and articles for download: https://us.sagepub.com/en-us/nam/author/peter-jenkins
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