(The first part of this article looks at the background and history of the Memorandum of Understanding on Conversion Therapy in the UK (MOU). The Memorandum sets out a policy on opposing conversion therapy on the grounds of sexual orientation and of gender identity. The Memorandum has been signed by the majority of professional therapist associations and by major employers of therapists in the UK. However, some of the MOU’s statements seem more consistent with the ethos of a trans activist political lobby, rather than demonstrating the values of a professional body which is committed to science-based research, open debate and tolerance of minority views.)    

Critique of the MOU: Research, therapy and strategic goals

The MOU as a trans political activist body, rather than as a professional grouping, can be critiqued in three main areas, i.e. in relation to research, therapeutic practice and its strategic goals. 

MOU attitude towards research

 The MOU’s attitude to research sharply illustrates its anti-scientific and anti-modernist character. Its definition of conversion therapy is “an umbrella term for a therapeutic approach, or any model or individual viewpoint that demonstrates an assumption that any sexual orientation or gender identity is inherently preferable to any other, and which attempts to bring about a change of sexual orientation or gender identity, or seeks to suppress an individual’s expression of sexual orientation or gender identity on that basis” (BPS, 2021: 2). The terms ‘viewpoint’ and assumption’ indicate that this is a belief-based definition, unsuitable for research purposes. The term ‘bring about a change’ and ‘suppress’ are behavioural terms, but depend crucially on the client’s subjective perception and experience of this occurring within therapy, and therefore requires no objective evidence, other than a sense or feeling that this has, or may have, occurred. Research based on subjective perception and attribution may not prove accurate in measuring the actual prevalence of alleged conversion therapy, just as “…individuals perceptions of crime on a national level do not typically match well to reality” (ONS, 2017).    

“Do you know, I always thought Unicorns were fabulous monsters, too? I never saw one alive before!”

“Well, now that we have seen each other,” said the Unicorn, “if you’ll believe in me, I’ll believe in you. Is that a bargain?”

“Yes, if you like,” said the Unicorn

                                         

The MOU has opposed the need for further research to identify the prevalence of conversion therapy for gender identity. The original MOU of 2015 at least referenced earlier and somewhat out-dated research into conversion therapy regarding sexual orientation (Bartlett et al, 2009). However, the MOU has since argued against further research into conversion therapy for gender identity on the spurious grounds that “people are dying” (SP, 2021). Arguably, if people are dying, then this would surely make the need for accurate research even more pressing? There are serious flaws in existing research into the prevalence of conversion therapy in the UK, i.e. in relation to concept definition, sampling strategy and self-report methodology. A detailed discussion of the weaknesses of this research can be found elsewhere (Jenkins and Esses, 2021; Sex Matters, 2021).

MOU attitudes towards therapy

 The MOU offers a complex and contradictory set of positions on therapy. On the one hand, the MOU does not specifically refer to affirmative therapy for gender-questioning clients. Affirmative therapy should be more accurately defined here as gender identity affirmative therapy, as all therapy arguably involves a degree of affirmation, or unconditional positive regard, towards clients. One interview goes so far as to state that “The MOU does not require anyone to affirm anything” (Jackson, 2021: 25). However, this stance is contradicted by the experience of the Tavistock Gender Identity Development Service (GIDS) for young people, where senior figures have confirmed that affirmative therapy, based on the MOU, was the model of therapy used in practice (Evans, 2020; Wren, 2019). In addition, the Cass Interim Review on the GIDS has confirmed unequivocally that: “Primary and secondary care staff have told us that they feel under pressure to adopt an unquestioning affirmative approach and that this is at odds with the standard process of clinical assessment and diagnosis that they have been trained to undertake in all other clinical encounters” (Cass, 2022: 17). The MOU does not appear to have publicly refuted these significant claims regarding the GIDS’ reliance on affirmative therapy, if indeed they have been made in error. Concerns about the uncritical adoption of gender identity affirmative therapy for young people have included: the risk of overlooking key safeguarding issues, and holding an exclusive focus on the primacy of gender identity, to the exclusion of co-morbid features, such as trauma, abuse, anxiety and depression, resulting in inadequate clinical risk assessment and poor standards of therapeutic recording (Jenkins, 2022).

“When I make a word do a lot of work like that”, said Humpty Dumpty, “I always pay it extra.”

(Carroll: 108).

The MOU repeatedly make the point that its document protects the space for therapists to undertake exploratory therapy. However, it has already been noted that this exploratory therapy (and what therapy is not exploratory in some way?) is restricted to include only clients who are explicitly questioning, in distress, or unhappy about their sexual orientation or gender identity. Fixity of belief is no guarantee of successful therapeutic outcome, here or elsewhere. This point has been made previously:

“Therapists would normally seek to respectfully challenge clients over their depressive
cognition, rationale for self-harm or suicide, obsessional beliefs and rituals, excessive drug or
alcohol use, or negative body image influenced by an eating disorder. To impose a
requirement for gender identity affirmative therapy as the default therapeutic response is to
negate the value of prior therapist training and expertise, to jeopardise effective risk
management, and to promote a trans political ideology over and above known evidence based practice” (Jenkins and Esses, 2021: 31).

Trans fragility and trans exceptionalism within therapy

The unstated premise underpinning this assumed need for gender identity affirmative therapy is that of trans psychological and emotional fragility, buttressed by reference to apparently high rates of suicide amongst clients identifying as trans. However, actual reported suicide rates for individuals identifying as trans are difficult to identify with any degree of accuracy. For example, the Office for National Statistics records male or female biological sex for all deaths by suicide (ONS, 2018a). The concept of trans fragility then leads on all too imperceptibly to the key concept of trans exceptionalism within therapy, namely that clients identifying as trans are special and therefore deserve special consideration within therapy. Adopting the stance of trans exceptionalism, for example, by affirming client gender identity beliefs, risks jeopardising therapeutic neutrality and crucial boundaries, in exchange for an ill-defined social advocacy role. The risk here is that, in this unknown, quasi-therapeutic territory, the MOU will be the one to supply the new rules that will be needed for therapists.

The pressure to affirm the exceptional needs of clients identifying as trans further brings with it new and unresolved problems. The MOU may accept the need for some exploratory therapy, but has condemned what it describes as “the extended exploration of someone’s traumatised history”, as potentially representing a covert way of denying required therapeutic or medical services (SP,  2021, Col 30). Here, the MOU is directly in conflict with what is agreed to be best evidence-based therapeutic practice. For example, the Scottish Government Suicide Prevention Action Plan (2018) recommends careful exploration of a client’s past trauma, or what are termed Adverse Childhood Experiences, in order to make an accurate assessment of suicide risk and to then make a careful plan with the client to mitigate this risk. This apparent contradiction with evidence-based practice also does not appear to be acknowledged by the MOU.

MOU’s strategic goals

The MOU’s stated goal is to achieve legislation on a criminal legal ban on conversion therapy in relation to both sexual orientation and gender identity. Some progress towards influencing legislation along these lines has already been achieved by the MOU in Scotland. In addition to this, and less clearly stated, the MOU plans to regulate the training, accreditation and regulation of gender identity therapy along its own preferred lines. As part of this process, the MOU plans to insert the problematic concept of intersectionality into current therapy practice, training and continuous professional development: “In the training of therapists, psychologists, psychiatrists and doctors, effort needs to be made to ensure that there is intersectional thinking” (SP, 2021: Col 26). 

The shift towards intersectional theory, practice and training

So what is intersectionality and why does the MOU now embrace it, even at the apparent expense of affirmative therapy? Intersectionality is emerging as a key theoretical concept for deconstructing oppressive forms of interpersonal power and authority, and as a form of political practice for addressing and potentially reversing these effects, via painstaking analysis and challenge. It emerged in the 1970’s as a key means of understanding the multi-dimensional crossover points of oppression: “…many women of colour had been struggling with the ways they were discriminated against because of both their sex and their race, and how they impacted on each other” (Hattenstone, 2022). Now, according to Pluckrose and Lindsay, trenchant critics of post-modernism and the turn towards intersectionality:

“…the categories in which intersectionality is interested are numerous. In addition to those of race, sex, class, sexuality, gender identity, religion, immigration status, physical ability, mental health, and body size, there are subcategories, such as exact skin tone, body shape, and abstruse gender identities and sexualities, which number in the hundreds. These all have to be understood in relation to one another so that the positionality each intersection of them confers can be identified and engaged” (Pluckrose and Lindsay, 2020: 128).

 Using the concept of intersectionality is crucial within the professional training to be provided by the trans activist lobby, in that it acts as a convenient portal for recruiting participants to an anti-modernist, belief-based ideological worldview. Applying the concept of intersectionality necessarily confers enormous power and advantage to those carrying out the training, or assessment of therapeutic practice. This positional power would be almost impossible to challenge effectively by any participants with apparent claims to some form of privilege, or with allegedly unexamined personal histories. It is an avowedly ideological and political concept and practice, closely linked in turn to Critical Social Justice Theory. If the evidence base for affirmative therapy is vanishingly small (perhaps with the exception of the Tavistock GIDS as a negative case study), then the evidence base for applying intersectionality to professional practice, other than to augment the growing power of the MOU, is even more absent.

“The question is,” said Alice, “whether you can make words mean so many different things.”

“The question is, “said Humpty Dumpty, “which is to be master – that’s all.”

Banning conversion therapy: MOU evidence to the Scottish Parliament

The MOU broadly supports current government proposals for a criminal legal ban on conversion therapy in England and Wales, with the proviso that “the ban must include attempts to suppress as well as change a person’s sexual orientation or gender identity” (MOU, 2021b; emphasis added: PJ). The MOU has also been actively involved in lobbying the Scottish Parliament in order to promote legislation on conversion therapy, with some success. Its provision of evidence to support a legal ban on conversion therapy to the Scottish Parliament is remarkable in a number of ways. There was a general air of positive affirmation about the MOU’s statements, with an almost total absence of challenge to its claims. In this respect, the hearings resembled something an evidential free-fire zone, where broad claims could be made, without any apparent need for empirical evidence. The legislation on conversion therapy introduced in Victoria, Australia, was held out as the ‘gold standard’ by one speaker on this topic, with no acknowledgement that its research justification rests on somewhat slender interview sample of just 15 persons, all drawn from faith-based and non-professional practice settings (Jenkins, 2021). 

 As illustration, the evidence base for conversion therapy carried out by professionals in Scotland is also highly questionable. The usual reference point is taken to be the Government and Equalities Office (GEO) LGBT Survey Report, supplemented by a 2020 survey specifically into conversion therapy for gender identity (GEO, 2018; Matousek, 2020). The GEO Survey produced a figure of 2% of 108,100 participants reporting having experienced conversion therapy. However, when the data is looked at more closely, the figures begin to look far less imposing (see Table 2: Summary of survey data on Conversion Therapy reportedly carried out by professionals in Scotland).

“Can you do sums?” Alice said, turning suddenly on the White Queen, for she didn’t like being found fault with so much.

The Queen gasped and shut her eyes. “I can do Addition,” she said, if you give me time – but I ca’n’t do Subtraction under any circumstances!”. 

(Carroll: 163)

Source	Survey type	Focus	Sample size (n)	Conversion TherapyQuestionnaire Definition	Respondents having had ConversionTherapy
					Cis	Gender Diverse	Not    specified	Total: UK	Total: UK	Total: Scotland
								n	n (by profnls only)	n (by profnls: estimated)
GEO (2018)	non-random	LGBT	108,100	cure;	1758 (1.6%)	613 (0.6%)	–	2371   (2.2%)	450 (0.42%)	36 (0.03%)
Matousek (2020)	non-random	GICT only	450	change;	7 (1.5%)	39 (8.6%)	5 (1.1%)	51 (11.3%)	22   (4.8%)	2   (0.4%)

Table 2: Summary of survey data on Conversion Therapy reportedly carried out by professionals in Scotland.

(Adapted from Jenkins and Esses, 2021: 21).

If adjusted for conversion therapy reportedly carried out by professionals, rather than in faith settings, and for the relative proportion of Scottish to UK population size (ONS, 2018b), then the resultant figures from the GEO (2018) and Matousek (2020) surveys appear to be much less substantial. 

Within the Scottish Parliament, oral evidence was taken from 18 speakers representing a range of organisations, including faith-based ones, and academic experts in support of a legal ban, and from just two speakers opposing a criminal ban (Scottish Parliament, 2022). It was left to the Family Education Trust and the Christian Medical Fellowship to raise concerns about the definition of conversion therapy to be applied, the lack of distinction between adults and children, the role of affirmative therapies, the adverse experience of the Tavistock GIDS in this respect and the neglected position of detransitioners. The MOU’s evidence to the Equalities, Human Rights and Civil Justice Committee rather resembled pushing on an already open door in this respect, briefed in this challenging process by BACP. The other major therapist professional association, the Counselling and Psychotherapy In Scotland, is not a signatory to the MOU, and has not been directly involved in the legislative process. It has instead produced its own statement opposing conversion therapy, which is a model of brevity and clarity (COSCA, 2018). The latter organisation appears, however, to be keeping its powder dry regarding the outcome of the Scottish Parliament’s declared intention to bring in a legal ban by 2023. The Equalities, Human Rights and Civil Justice Committee of the Scottish Parliament has stated that “sufficient research and evidence is already available to conclude that the introduction of legislation is necessary” (SP: EHRCJC 2022:2). Significantly, the Committee has shifted in terms of its language, from use of the term ‘conversion therapy’ to ‘conversion practices’. This is perhaps an implicit acknowledgement that the term conversion therapy is itself inaccurate and not fit for legislative purpose.  

Summary

The MOU is emerging as a key player within the current move to impose a criminal law ban on conversion therapy relating to sexual orientation and gender identity. However, the MOU has two distinct aspects, as a document briefly stating the case for such a ban, and as a coalition of organisations representing professional associations and the main employers of therapists. The MOU as a document has major flaws, relating to the lack of safeguards for under 18’s and its limited protection for exploratory forms of therapy. The MOU as an organisation is not easily open to public scrutiny or accountability and does not appear to monitor its own effectiveness, e.g. by reviewing the data from professional complaints systems for evidence of conversion therapy. When compared to standard criteria for professional organisations, the MOU exhibits behaviour more consistent with that of a belief-based political movement, in this case of trans political activism. The MOU provides shifting definitions of affirmative and exploratory therapy and appears to favour restricting some gender therapists from practice in the future. The MOU seems to be resistant to empirical research into the extent of conversion therapy, and now favours the widening of its remit to policing training and accreditation of future gender therapists via the introduction of an unproven model based on intersectionality. While it has had some success in lobbying for political change in Scotland, the future looks bleak for therapists unwilling to suspend belief and enter into this evidence-free looking glass universe.  

References: Part 2

British Psychological Society et al (2021) Memorandum of understanding on conversion therapy. https://www.bacp.co.uk/media/13265/memorandum-of-understanding-on-conversion-therapy-in-the-uk-september-2021.pdf

Carroll, L. (n.d.) Through the Looking Glass, Ward Lock: London.

Cass, H. (2022) The Cass Review: Independent Review of Gender Identity Development Services for Children and Young People: Interim Report. https://cass.independent-review.uk/

Counselling and Psychotherapy in Scotland (COSCA) (2018) Conversion or Reparative Therapies. https://www.cosca.org.uk/download_file/view/204/261

Evans, M. (2020) Freedom to think: the need for thorough assessment and treatment of gender dysphoric children. British Journal of Psychiatry Bulletin. Published online 21^st July: https://www.cambridge.org/core/journals/bjpsych-bulletin/article/freedom-to-think-the-need-for-thorough-assessment-and-treatment-of-gender-dysphoric-children/F4B7F5CAFC0D0BE9FF3C7886BA6E904B 

Government Equalities Office (2018) National LGBT Survey: Research Report. Department for Education: Manchester. www.gov.uk/government/consultations/national-lgbt-survey

Hattenstone, S. (2022) “We need hope. We can’t do anything without optimism.” Guardian. 5^th March. https://www.theguardian.com/us-news/2022/mar/05/angela-davis-on-the-power-of-protest-we-cant-do-anything-without-optimism

Jackson, C. (2021) “Interview with Igi Moon”, Therapy Today. June, 32(5), pp. 22-25. https://www.bacp.co.uk/bacp-journals/therapy-today/2021/june-2021/articles/the-big-interview/

Jenkins, P. (2021) ”LGBT research and the push for a legal ban on conversion therapy in the UK”, Critical Therapy Antidote, https://criticaltherapyantidote.org/2021/09/26/lgbt-research-and-the-push-for-a-uk-ban-on-conversion-therapy/

Jenkins, P. (2022) “Calibrating Gillick in the age of gender wars, Part 1.” Critical Therapy Antidote. https://criticaltherapyantidote.org/2022/01/03/calibrating-gillick-in-the-age-of-gender-wars-part-1-background-to-the-current-crisis-in-gender-therapy/

Jenkins, P. and Esses, J. (2021) Thoughtful Therapists: Scoping Survey on Conversion Therapy for Government Equalities Office. https://thoughtfultherapists.org/scoping-survey-pdf/

Matousek, R.et al (2020) ‘Conversion therapy’ and gender identity survey. https://www.ozanne.foundation/gender-identity-conversion-therapy/

Memorandum of Understanding on Conversion Therapy (MOU) (2021b) Key messages. https://www.badth.org.uk/DB/news/mou-key-messages-on-governments-conversion-therapy-consultation

Office for National Statistics (2017) Public perceptions of crime in England and Wales: Year ending March 2016.

https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/publicperceptionsofcrimeinenglandandwales/yearendingmarch2016#how-do-perceptions-of-risk-compare-to-victimisation-rates

Office for National Statistics (2018a) Suicide rates and transgender persons. https://www.ons.gov.uk/aboutus/transparencyandgovernance/freedomofinformationfoi/suicideratesandtransgenderpersons

Office for National Statistics (2018b) Population estimates for the UK, England and Wales, Scotland and Northern Ireland: mid-2017. https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/bulletins/annualmidyearpopulationestimates/mid2017

Pluckrose, H and Lindsay. J. (2020) Cynical Theories: How activist scholarship made everything about race, gender and identity – and why this harms everyone. Croydon: Swift.

Scottish Government (2018) Scotland’s Suicide Prevention Action Plan.
https://www.gov.scot › govscot › govscot:document

Scottish Parliament (SP): Equalities, Human Rights and Civil Justice Committee (2021) Conversion Therapy. 21 September. https://www.parliament.scot/chamber-and-committees/committees/committee-official-reports/ehrcj-21-09-2021?meeting=13321

Scottish Parliament (SP): Equalities, Human Rights and Civil Justice Committee (2022) Report on Petition PE 1817: End Conversion Therapy. SP Paper 88. 1st Report (Session 6). 25 January. https://digitalpublications.parliament.scot/Committees/Report/EHRCJ/2022/1/25/8c18e05c-08ab-4c7d-992b-4b0467541d70

Sex Matters (2021) Rapid review of Coventry University research on conversion therapy. https://sex-matters.org/posts/publications/rapid-review-of-coventry-university-research-on-conversion-therapy/

Wren, B. (2019) “Ethical issues in the provision of medical interventions for gender diverse
children and adolescents.” Association for Child and Adolescent Mental Health, 14th June
(Powerpoint presentation, ACAMH Conference). https://www.acamh.org/app/uploads/2015/06/16_05_Dr_Bernadette_Wren.pdf

Note: This article is published jointly by Transgender Trend (https://www.transgendertrend.com/) 

and Critical Therapy Antidote (https://criticaltherapyantidote.org/).

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).  https://us.sagepub.com/en-us/nam/author/peter-jenkins. Peter Jenkins is also a member of Thoughtful Therapists, whose scoping survey for the government consultation on conversion therapy can be found here: https://thoughtfultherapists.org/scoping-survey-pdf/