A fierce row is brewing over the all-Ireland adoption of a UK policy seeking to ban conversion therapy. Conversion therapy is any practice which tries to change a person’s sexual orientation, or internal sense of gender identity. A UK-based Memorandum of Understanding on Conversion Therapy has just been agreed by three major healthcare bodies, the College of Psychiatrists of Ireland (CPI), the Psychological Society of Ireland (PSI), and the Irish Association for Counselling and Psychotherapy (IACP).

As part of its launch, they announced that “There is no place in a modern, progressive society for conversion therapy.” True enough, but maybe not in quite the way that was being claimed here. Research evidence for the actual practice of conversion therapy by therapists has always proven remarkably thin on the ground. This is particularly so in the case of patients claiming attempts to convert them to an unwanted gender identity.

The push for a legal ban on conversion therapy was supposedly buttressed by research previously published last year (Keogh et al, 2023). However, this research has been critically dissected and dismissed as unsound (Genspect, 2023). According to Genspect, the research lacks a clear definition of conversion, conflates gender identity with sexual orientation, and produces only weak evidence for the existence of alleged conversion practices in Ireland.

Politicised research evidence?

In keeping with its seemingly political purpose, the report on Ireland shifts backwards and forwards, from expressing standard academic caution, to adopting the language of implied causation when discussing the alleged harms of conversion therapy. Hence, exposure to conversion practices “as a result had adverse effects on their mental health” (Keogh et al, 2023: 56). Now, any undergraduate course on statistics will point out the crucial difference between causation on the one hand, and association on the other. Thus, these accounts of alleged conversion therapy rest heavily on perception and attribution by the research participants. The most that can be claimed, outside a randomised controlled trial, would be that participants claimed that such exposure to conversion therapy had damaged their mental health.

Yet, this kind of research over-claim seems to occur surprisingly often in this highly contested and speculative field. However, in the real world of politics, small, unrepresentative samples, selectively based on self-report, need to be carefully re-packaged as viable evidence for draconian conversion therapy bans, whether in Victoria, Australia, in the UK, or, as now, in Ireland (Jenkins, 2021).

The research case for a conversion therapy ban in Northern Ireland fares little better (Ashe & Mackle, 2024). Despite extensive networking, the survey could find only ten participants who claimed to have experienced conversion practices. Seven of these were in faith settings, which is a pretty consistent finding across most surveys of this kind. This left a grand total of just three participants claiming to have experienced conversion practices based on their gender identity within a therapeutic relationship.

Unpicking narratives of alleged conversion therapy

And, here, the story gets even more interesting. The Northern Ireland survey gives some detail about the experience of its tiny pool of participants, and why they claimed to have been exposed to conversion practices. Two of the alleged accounts referred to experiences within mental health settings, by people identifying as trans. For Participant 9, the presenting issue was that of bisexuality, with reported co-occurring factors as having had an abusive father, being involved in other abusive relationships, together with experience of bullying, depression and self-harm.

“Participant 9 believed the counsellor believed that his bisexuality ‘as a symptom’ was a fear and distrust of men. His father was abusive, and he had had sexually and physically abusive relationships with other men“ (Ashe & Mackle, 2024: 28). For Participant 10, also seen in mental health services, the presenting issue was that of cross-dressing, together with suicidal ideation, and with autism as a possible co-occurring condition. The participant disputed the relevance of autism as a diagnosis. The views of the therapists involved were not sought out, or recorded, so their professional perspectives may well have differed from those of their clients in both situations.

Conversion therapy or therapeutic rupture?

This does bring us to the nub of the issue. Arguably, these few, limited examples maybe tell us less about the existence of something labelled here as ‘conversion practices’, but perhaps tell us a lot more about what can happen when therapist and client have differing stories, or narratives, about what is happening, or what needs to happen, within the therapy. These two examples point not so much towards conversion therapy, but to a much more common, even everyday, occurrence within therapy, namely a clash in perspective between therapist and client. This even has a technical term for its proper definition, i.e. a therapeutic rupture, with its own literature and attendant research field.

Accordingly, “alliance ruptures are defined as a breakdown in the collaboration between patient and therapist” (Samstag & Muran, 2019: 9). This clash can occur when the therapist offers a perspective which the client rejects, or where the client does not engage with a key reflection coming from the therapist. Given the pervasive nature of trans fragility, i.e. the likelihood of co-occurring mental health conditions, and an exceptional need for high levels of social validation, via use of personal pronouns, affirmation, etc, any overt therapeutic challenge to a trans client is likely to be perceived and experienced by them as a direct existential threat. This can be something of an occupational hazard in therapy with clients identifying as trans. Hence, “patients with psychiatric diagnoses, highly prevalent in transgender populations, can potentially experience or misinterpret neutral interpersonal interactions as invalidating or rejecting” (D’Angelo et al, 2020: 9).

Conclusion

Whilst justifiably concerning, such breakdowns in therapeutic communication require patience and high levels of therapist skill in exploration, negotiation and work in repairing ruptures wherever possible, and not just criminal prosecution. However, the new MOU for Ireland risks putting a hammer into the hands of clients, professional associations and judges, where an everyday therapy rupture from now on will only be recognised as a nail which urgently needs to be decisively flattened.

References

Ashe, F. and Mackle, D. (2024) A study of conversion practices in Northern Ireland. https://www.rainbow-project.org/wp-content/uploads/2024/05/Conversion-Practices-Research-Report.pdf

D’Angelo, R., Syrulnik, E., Ayad, S., Marchiano, L., Kenny, D. T., & Clarke, P. (2020). One size does not fit all: In support of psychotherapy for Gender Dysphoria. Archives of Sexual Behavior. https://doi.org/10.1007/s10508-020-01844-2

Genspect (2023) Genspect Review of the Trinity College Dublin Research on ‘Gender Identity Conversion Therapy’. https://genspect.org/resources/gender-framework-sample-policies/review-of-the-trinity-college-dublin-research-on-gender-identity-conversion-therapy/

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

Keogh, B., Carr, C., Doyle, L., Higgins, A., Morrissey, J., Sheaf, G., & Jowett, A. (2023). An Exploration of Conversion Therapy Practices in Ireland. Trinity College Dublin. An Exploration of Conversion Therapy Practices in Ireland (tcd.ie)

Samstag, L.W. and Muran, C. (2019) Ruptures, repairs, and reflections: contributions of Jeremy Safran. Research in Psychotherapy: Psychopathology, Process and Outcome. 22: 7-14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451308/pdf/ripppo-22-1-376.pdf

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By Peter Jenkins, a counsellor, supervisor, trainer and researcher in the UK and a member of Thoughtful Therapists.

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