Boundaries · 1890
Conversion therapy / SOGICE
Conversion therapy attempts to modify sexual orientation or gender identity by treating diversity as a clinical problem.
Conversion therapy, also called sexual orientation and gender identity change efforts — SOGICE, SOCE or GICE — is a historical constellation of clinical, religious, behavioural, psychoanalytic, suggestive and re-educative practices aimed at changing, suppressing or redirecting a person's sexual orientation, gender identity or gender expression. It has occupied a significant place in the history of clinical practice because it was carried out under psychotherapeutic, diagnostic or moralising language, but it is now widely regarded as discredited by the major professional organisations, owing to the absence of robust evidence of efficacy, its pathologising premises about sexual and gender diversity, and its association with risks of shame, guilt, depression, anxiety, trauma, identity deterioration and suicidality. Its historical significance lies in showing how a practice presented as a therapeutic intervention can become iatrogenic when it confuses cultural norms, religious morality or social prejudice with clinical formulation.
Theory of change
Conversion therapy understands change as the suppression, redirection or modification of sexual orientation, gender identity or gender expression towards a heterosexual or cisgender norm.
Core ideas
-
Sexual orientation or gender identity are understood as modifiable
Conversion therapy starts from the idea that sexual orientation, gender identity or gender expression are not stable or legitimate dimensions of the person but aspects modifiable through psychological, spiritual, behavioural or relational intervention. On this logic, non-normative desire, identity or expression can be redirected, suppressed, weakened or reorganised if their supposed causes are identified and appropriate change procedures are applied. This premise makes it possible to present therapeutic work as a process of personal transformation aimed at a heterosexual or cisgender identity, or one adjusted to traditional gender roles. (Nicolosi, 1991; Bieber et al., 1962).
-
Non-normative desire is interpreted as the expression of an underlying conflict
A central idea in many variants of conversion therapy is that homosexual or bisexual attraction, or gender incongruence, are not taken as primary experiences with a value of their own, but as manifestations of a deeper conflict. That conflict may be formulated as relational wounding, affective deprivation, developmental trauma, a deficit of identification, psychosexual immaturity, a defence against heterosexual intimacy or a symbolic search for repair. Clinical work is then aimed at interpreting desire as a sign of something else, shifting the focus from lived experience towards a supposed hidden cause that must be corrected. (Bieber et al., 1962; Nicolosi, 1991).
-
Reparative therapy seeks to restore an identity considered damaged
In reparative therapy, especially as associated with Joseph Nicolosi, male homosexuality is understood as the result of an incomplete or damaged gender identity, linked to difficulties in masculine identification, wounds involving parental figures or early experiences of rejection. The therapeutic aim is formulated as the repair of that identity structure through the strengthening of a masculinity considered authentic, the review of family ties and the reduction of homosexual desires interpreted as a search for the lost masculine. The notion of repair thus organises the treatment as the reconstruction of an identity supposedly more coherent with expected development. (Nicolosi, 1991).
-
Change is conceived as alignment with a heterosexual or cisgender norm
The horizon of change in conversion therapy is usually defined by approximation to a heterosexual, cisgender or traditional gender norm. Progress is understood as an increase in heterosexual attraction, a decrease in homosexual desire, greater conformity with normative masculine or feminine roles, a reduction in unwanted fantasies, abstinence from behaviours deemed problematic or the adoption of an identity more compatible with religious, family or cultural values. This orientation turns an external norm into the criterion of therapeutic direction and organises the clinical process around adapting the self to that ideal. (Nicolosi, 1991; Spitzer, 2003).
-
Biography is reorganised to find causes of desire or identity
These practices usually review the personal history in search of episodes that would explain the appearance of non-normative desire, identity or gender expression. Bonds with father and mother, experiences of rejection, humiliation, abuse, loneliness, bullying, a lack of belonging with same-sex peers, relational failures or religious conflicts are all explored. The biographical account is organised as a search for origins: the present is understood as the consequence of a deviant or wounded trajectory that must be understood in order to be corrected. (Bieber et al., 1962; Nicolosi, 1991).
-
Visible behaviour is used as an indicator of change
In many versions of conversion therapy, progress is measured through observable or reported changes: fewer homosexual encounters, abstinence, less pornography use, avoidance of LGBTQ+ contexts, an increase in heterosexual dating, heterosexual marriage, a change in dress, greater gender conformity or a subjective declaration of change. Visible behaviour thus becomes a marker of internal transformation, and the treatment tends to reinforce those actions that bring the person closer to the model's normative ideal. (Haldeman, 1994; Spitzer, 2003).
-
Suppression of desire is presented as self-mastery
An important part of these practices understands the control of desire as a sign of maturity, health, spiritual freedom or self-mastery. The person learns to monitor fantasies, avoid stimuli, cut off impulses, confess relapses, replace internal images or remain abstinent from behaviours considered incompatible with change. Within this framework, a reduction in non-normative sexual or identity-related expression is interpreted as therapeutic progress, and self-control becomes a route towards the desired or prescribed identity. (Haldeman, 1994; Nicolosi, 1991).
-
The group or the community functions as a support for change
In many forms of conversion therapy, especially those linked to ex-gay movements or religious contexts, change is sustained through group belonging, testimonies, accountability, spiritual support, mentoring or community support. The group offers a shared narrative of struggle, fall, recovery and hope, providing models of identification and social reinforcement to maintain the direction of the process. Community belonging thus becomes a support structure that helps sustain abstinence, the reinterpretation of desire and adherence to an alternative identity. (Nicolosi, 1991; Spitzer, 2003).
-
The desired identity is constructed through narratives of restoration
The model usually organises change through narratives of restoration, recovery or return to an identity considered truer. The person is invited to understand their history as a departure from an original or normative identity, and the treatment as a path to recovering it. This narrative makes it possible to give meaning to suffering, inner struggle and efforts at change, shaping a future self associated with heterosexuality, gender conformity, purity, a normative family or reconciliation with religious and community values. (Nicolosi, 1991; Bieber et al., 1962).
-
Therapeutic, moral or spiritual authority guides the process
Conversion therapy usually relies on a figure of authority — therapist, religious leader, mentor, group or institution — who defines the framework of meaning, interprets relapses, validates progress and guides the direction of change. This authority may present itself as clinical expert, spiritual guide or moral companion, and its function is to sustain the reading that the person can and should move towards an identity more congruent with the proposed norm. The therapeutic process is thus structured by a relationship in which change is not discovered openly but directed towards a horizon defined in advance. (Nicolosi, 1991; Haldeman, 1994).
Influences
- Nineteenth-century medical sexology
- Classificatory psychiatry
- Pathologising psychoanalysis of homosexuality
- Aversive behaviourism
- Religious morality applied to clinical practice
- Traditional models of gender role
- Reparative therapy
Key references
- Alempijevic, D., Beriashvili, R., Beynon, J., Duque, M., Ferllini, R., Hess, C., Vieira, D. N., & Cohen, J. (2020). Statement on conversion therapy. Journal of Forensic and Legal Medicine.
- American Psychological Association. (2009). Report of the Task Force on Appropriate Therapeutic Responses to Sexual Orientation.
- American Psychological Association. (2025). Evidence against conversion therapy.
- Bieber, I., Dain, H. J., Dince, P. R., Drellich, M. G., Grand, H. G., Gundlach, R. H., Kremer, M. W., Rifkin, A. H., Wilbur, C. B., & Bieber, T. B. (1962). Homosexuality: A Psychoanalytic Study.
- Forsythe, A., Pick, C., Tremblay, G., Malaviya, S., Green, A., & Sandman, K. (2022). Humanistic and economic burden of conversion therapy among LGBTQ youths in the United States. JAMA Pediatrics.
- Haldeman, D. C. (1994). The practice and ethics of sexual orientation conversion therapy. Journal of Consulting and Clinical Psychology.
- Nicolosi, J. (1991). Reparative Therapy of Male Homosexuality.
- Przeworski, A., Peterson, E., & Piedra, A. (2021). A systematic review of the efficacy, harmful effects, and ethical issues related to sexual orientation change efforts. Clinical Psychology: Science and Practice.
- Socarides, C. W. (1968). The Overt Homosexual.
- Spitzer, R. L. (2003). Can some gay men and lesbians change their sexual orientation? 200 participants reporting a change from homosexual to heterosexual orientation. Archives of Sexual Behavior.
- UK Government Equalities Office. (2021). An assessment of the evidence on conversion therapy for sexual orientation and gender identity.