The Danger of Conflating Ethical Psychotherapy with Conversion Therapy

SEGM clinicians examine a study purporting harms of psychotherapy

In September 2019, JAMA Psychiatry published an article, Association Between Recalled Exposure to Gender Identity Conversion Efforts and Psychological Distress and Suicide Attempts Among Transgender Adults. The article concluded that therapies that did not "affirm" an individual's transgender identity (which the article refers to as "gender-identity conversion efforts / "GICE") lead to severe distress and even suicide attempts. These findings have been used to promote legislative bans on non-affirmative therapies worldwide.

Without a doubt, attempts to force a change in one’s gender identity have no place in the field of mental health. Yet, we have been growing increasingly concerned with the conflation of ethical psychotherapy for gender dysphoria with conversion therapy. The study authors erased the critical lines that separate coercive and unethical attempts of conversion from ethical psychotherapy. Our analysis also revealed a number of serious methodological flaws and misinterpretations of the data that invalidate the study conclusions. In fact, the study provides no credible evidence that either psychological distress or suicide attempts (which are present at elevated rates in gender dysphoric individuals), are a result of ethical psychotherapy.

The authors also fail to reflect on their own key finding—the high prevalence of serious uncontrolled mental illness in the study subjects who recalled “GICE” efforts. The fact that gender dysphoric people continue to struggle with a significant burden of mental illness, both pre- and post-transition, has been documented consistently across a range of studies, and this finding in itself calls for more emphasis on the provision of quality mental health services for this population. 

The more problematic parts of the paper’s analysis and conclusion are outlined in our article in the Archives of Sexual Behavior entitled One Size Does Not Fit All: In Support of Psychotherapy for Gender Dysphoria, which was published earlier this month. 

The full text of our response to the JAMA Psychiatry article is below: