Since July, the Government have been publicising a Stonewall-approved major initiative against ‘conversion therapy’. What seems to have been missed is that, according to the definition of conversion therapy endorsed by Stonewall and others, every single therapist working in the area of gender identity is likely to count as engaging in the very practice which the Government is supposedly keen to outlaw.
The concept of ‘conversion therapy’ originally described any therapy attempting to change a homosexual (same-sex) orientation to a heterosexual one. There are two main assumptions behind such therapy’s rejection. Both are reasonable. First, there’s little convincing evidence that a homosexual orientation can be changed after late childhood. Second, homosexuality isn’t harmful, either to the individual or wider society, so there’s no need to try.
In recent times, however, it’s become accepted by many that there’s a second possible variety of conversion therapy: not just from gay to straight, but also from trans to non-trans (or ‘cis’). That is: conversion therapy can illegitimately target, not just sexual orientation, but also ‘gender identity’. See the definition used in a 2017 memorandum of understanding endorsed by many major UK mental health providers. Or see Stonewall’s own definition, which tells us that:
Conversion therapy ..refers to any form of treatment or psychotherapy which aims to change a person’s sexual orientation or to suppress a person’s gender identity (my italics).
Such pronouncements should be read in light of a further, related new paradigm – again, Stonewall-backed - concerning sexual orientation. This says that biologically male transwomen, if sexually oriented exclusively towards women, are ‘lesbians’. Equally: biologically female transmen, if sexually oriented exclusively towards men, are ‘gay’men. Meanwhile, though we hear less about it, logic dictates that a male transwoman sexually oriented exclusively towards men counts as ‘straight’ or ‘heterosexual’, as does a female transman sexually oriented exclusively towards women.
Effectively then, biological sex-class is removed as the main locus for sexual orientation, replaced by ‘gender identity’. This has significant consequences for our understanding of conversion therapy. As noted, it’s a reasonable assumption that homosexual orientation – understood in the old-fashioned sense, as same-sex attraction - starts sufficiently early on in childhood that it would be pointless as well as inappropriate to try to convert it to heterosexuality later. In contrast, in the new paradigm, the gap between a ‘gay’ or ‘lesbian’ person and a ‘trans’ person is paper-thin, and it is entirely plausible that therapeutic intervention might easily convert one to the other.
To illustrate, Imagine a 14 year-old biological female called Margie. Margie’s becoming aware that she is sexually attracted to women (or at least, to females like her). Simultaneously, Margie is developing dysphoria: strong disgust for her changing body. She wishes her breasts and other curves to disappear: she longs to be straight-hipped, angular, muscular. She starts to tell people ‘I’m a boy’.
Such feelings are not unusual. Many feminists would say they are an unconscious response to the social imposition of sexist and heteronormative stereotypes upon females. Such ubiquitous stereotypes tell Margie to be passive, to conceive of herself as weak, to prettify herself up for men, to be more ‘girly’. Margie doesn’t feel ‘girly’ and knows she doesn’t fancy males.
How should therapists respond? Current guidelines tell them to avoid both kinds of conversion therapy just described. But here’s the rub: according to the terms set out by the new paradigm, you can’t avoid both. If Margie’s self-diagnosis (‘I’m a boy’) is questioned by the therapist, the therapist can be construed as failing to affirm, and so putatively ‘converting’, a trans child to a ‘cis’ one. If, on the other hand, Margie’s self-diagnosis is affirmed unquestioningly, the therapist is effectively failing to affirm Margie in a sexual orientation of lesbianism; something which also looks like conversion by omission.
A possible reply here is that therapists should take their cue from the patient. If she says she’s a lesbian, affirm that; if, alternatively, ‘he’ says he’s a trans man, affirm that. This suggestion assumes that both sexual orientation and gender identity are ‘inherent’ and fixed; and that the individual has some privileged, reliable knowledge of both. For instance, in this BBC report, we find Dr Louise Theodosiou of the Royal College of Psychiatrists, arguing that:
" Your sexuality and your gender ID are inherent and there's no evidence base and no therapeutic treatment to change what is simply part of someone's nature."
This assumption is unfounded, however. Perhaps it gets a gloss of legitimacy from a point made earlier: that homosexual orientation (in the old-fashioned sense, involving same-sex attraction) gets fixed early in life. It also seems reasonable to assume that teens and adults can – at least, if unaffected by heteronormative social influences - identify their own sexual desires correctly, and so reliably draw conclusions about their orientations, in the older sense. But this point is of no relevance to what we should say in the case of Margie deciding whether she is a ‘lesbian woman’ (in the new sense) or a ‘straight man’. This isn’t a question about whether Margie exclusively fancies females, for this is a constant in both outcomes. There’s no prior underlying psychological story to give us the ‘real’ fact about Margie’s transness, or lack of it; nor to tell us why Margie would reliably know that fact. What Margie knows is that she’s dysphoric, and fancies females. But such facts alone don’t make you trans. Lots of now-proud and happy female lesbians report a past history of dysphoria.
So: there’s an inherent tension in new definitions of conversion therapy. With a same-sex-attracted person questioning her gender identity, therapists have to convert her, either by act or by omission. If they accept her trans narrative without question, they are converting her out of lesbian sexual orientation. If they therapeutically question that narrative, they are converting her (or rather, him) out of being trans. To this, one might well add: only one of those routes is connected with body-altering, life-changing drugs and surgeries, whose long-term consequences are unknown.