Abstract
This study sought to explore the beliefs of marriage and family therapists (MFTs) about why sexual orientation change efforts (SOCE; i.e., conversion therapy) and gender identity change efforts (GICE) should be labeled as unethical in the American Association of Marriage and Family Therapy (AAMFT) Code of Ethics. Utilizing an online survey, this study collected data from 208 clinicians with a range of therapeutic experiences and social location identities. Participants responded to open-ended questions, which were analyzed using thematic analysis. The analysis revealed four themes describing why MFTs support GICE and SOCE being labeled as unethical in the AAMFT Code of Ethics: (1) Does not fit the values/roles of being an MFT; (2) Does not fit the ethics of being an MFT; (3) Is harmful and ineffective; and (4) AAMFT has an ethical imperative. Finally, a fifth theme emerged representing the responses from three participants who felt that SOCE and GICE may be ethical practices. Implications for therapists and MFT training programs are discussed.
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Alempijevic, D., Beriashvili, R., Beynon, J., Birmanns, B., Brasholt, M., Cohen, J., Duque, M., Duterte, P., van Es, A., Fernando, R., Fincanci, S. K., Hamzeh, S., Hansen, S. H., Hardi, L., Heisler, M., Iacopino, V., Leth, P. M., Lin, J., Louahlia, S., & Viera, D. N. (2020). Statement on conversion therapy. Journal of Forensic and Legal Medicine, 72, 101930. https://doi.org/10.1016/j.jflm.2020.101930
American Association for Marriage and Family Therapy (2009). Reparative/conversion therapy. https://www.aamft.org/About_AAMFT/Pos_on_couples.aspx?WebsiteKey=8e8c9bd6-0b71-4cd1-a5ab-013b5f855b01
American Counseling Association (2017). Resolution on reparative therapy/conversion therapy/sexual orientation change efforts (SOCE) as a significant and serious violation of the ACA code of ethics. https://www.counseling.org/docs/default-source/default-document-library/reparative-therapy-resoltution-letter-head_edited.pdf?sfvrsn=8ed562c_4
American Medical Association (2019). LGBTQ change efforts (so-called “conversion therapy”) [Issue Brief]. https://www.ama-assn.org/system/files/2019-12/conversion-therapy-issue-brief.pdf
American Psychological Association (2021). APA resolution on gender identity change efforts. https://www.apa.org/about/policy/resolution-gender-identity-change-efforts.pdf
American Psychological Association, Task Force on Appropriate Therapeutic Responses to Sexual Orientation (2009). Report of the American Psychological Association Task Force on appropriate therapeutic responses to sexual orientation. https://www.apa.org/pi/lgbt/resources/therapeutic-response.pdf
Bradshaw, K., Dehlin, J. P., Crowell, K. A., Galliher, R. V., & Bradshaw, W. S. (2015). Sexual orientation change efforts through psychotherapy for LGBQ individuals affiliated with the Church of Jesus Christ of Latter-day Saints. Journal of Sex & Marital Therapy, 41(4), 391–412. https://doi.org/10.1080/0092623X.2014.915907
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
Bhugra, D., Eckstrand, K., Levounis, P., Kar, A., & Javate, K. R. (2016). WPA position statement on gender identity and same-sex orientation, attraction and behaviours. World Psychiatry, 15(3), 299–300. https://doi.org/10.1002/wps.20340
Chilisa, B. (2012). Indigenous research methodologies. SAGE
Coolhart, D., & Shipman, D. L. (2017). Working toward family attunement: Family therapy with transgender and gender-nonconforming children and adolescents. Psychiatric Clinics of North America, 40(1), 113–125. https://doi.org/10.1016/j.psc.2016.10.002
Cramer, R. J., Golom, F. D., LoPresto, C. T., & Kirkley, S. M. (2008). Weighing the evidence: Empirical assessment and ethical implications of conversion therapy. Ethics & Behavior, 18(1), 93–114. https://doi.org/10.1080/10508420701713014
Cyphers, C. S. (2014). Banning sexual orientation therapy: Constitutionally supported and socially necessary. Journal of Legal Medicine, 35(4), 539–550. https://doi.org/10.1080/01947648.2014.981451
D’Arrigo-Patrick, Hoff, C., Knudson‐Martin, C., & Tuttle, A. (2017). Navigating critical theory and postmodernism: Social justice and therapist power in family therapy. Family Process, 56(3), 574–588. https://doi.org/10.1111/famp.12236
Dehlin, J. P., Galliher, R. V., Bradshaw, W. S., Hyde, D. C., & Crowell, K. A. (2015). Sexual orientation change efforts among current or former LDS church members. Journal of Counseling Psychology, 62(2), 95–105. https://doi.org/10.1037/cou0000011
Gamboni, C., Gutierrez, D., & Morgan-Sowada, H. (2018). Prohibiting versus discouraging: Exploring mental health organizations varied stances on sexual orientation change efforts (SOCE). The American Journal of Family Therapy, 46(1), 96–105. https://doi.org/10.1080/01926187.2018.1437572
Goodyear, T., Kinitz, D. J., Dromer, E., Gesink, D., Ferlatte, O., Knight, R., & Salway, T. (2021). They want you to kill your inner queer but somehow leave the human alive”: Delineating the impacts of sexual orientation and gender identity and expression change efforts. The Journal of Sex Research. https://doi.org/10.1080/00224499.2021.1910616. Advance online publication
Green, A. E., DeChants, J. P., Price, M. N., & Davis, C. K. (2021). Association of gender-affirming hormone therapy with depression, thoughts of suicide, and attempted suicide among transgender and nonbinary youth. Journal of Adolescent Health. https://doi.org/10.1016/j.jadohealth.2021.10.036. Advance online publication
Green, A. E., Price-Feeney, M., Dorison, S. H., & Pick, C. J. (2020). Self-reported conversion efforts and suicidality among US LGBTQ youths and young adults, 2018. American Journal of Public Health, 110(8), 1221–1227. https://doi.org/10.2105/AJPH.2020.305701
Haldeman, D. C. (2002). Gay rights, patient rights: The implications of sexual orientation conversion therapy. Professional Psychology: Research and Practice, 33(3), 260–264. https://doi.org/10.1037/0735-7028.33.3.260
Hartwell, E. E., Belous, C. K., Benson, K., Cox, L., Iantaffi, A., McGeorge, C. R., Shipman, D., & Twist, M. L. C. (2022). Clinical guidelines for LGBTQIA-affirming marriage and family therapy. American Association for Marriage and Family Therapy
Heiden-Rootes, K., McGeorge, C. R., Salas, J., & Levine, S. (2022). The effects of gender identity change efforts on Black, Latinx, and White transgender and gender nonbinary adults: Implications for ethical clinical practice. Journal of Marital & Family Therapy, 48(3), 927–944. https://doi.org/10.1111/jmft.12575
Hernandez, P., Almeida, R., & Vecchio, K. D. D. (2005). Critical consciousness, accountability, and empowerment: Key processes for helping families heal. Family Process, 44(1), 105–119. https://doi.org/10.1111/j.1545-5300.2005.00045.x
Higbee, M., Wright, E. R., & Roemerman, R. M. (2020). Conversion therapy in the Southern United States: Prevalence and experiences of the survivors. Journal of Homosexuality. https://doi.org/10.1080/00918369.2020.1840213. Advance online publication
Huffington Post (2017, December 6). Exodus International shuts down: Christian ministry apologizes to LGBT community and halts operations. https://www.huffpost.com/entry/exodus-international-shuts-down_n_3470911
Human Rights Campaign. (n.d.). The lies and dangers of efforts to change sexual orientation or gender identity.https://www.hrc.org/resources/the-lies-and-dangers-of-reparative-therapy
Jordan, L. S., & Seponski, D. M. (2018). “Being a therapist doesn’t exclude you from real life”: Family therapists’ beliefs and barriers to political action. Journal of Marital and Family Therapy, 44(1), 19–31. https://doi.org/10.1111/jmft.12244
Kinitz, D. J., Salway, T., Dromer, E., Giustini, D., Ashley, F., Goodyear, T., Ferlatte, O., Kia, H., & Abramovich, A. (2021). The scope and nature of sexual orientation and gender identity and expression change efforts: A systematic review protocol. Systematic Reviews, 10(1), 1–8. https://doi.org/10.1186/s13643-020-01563-8
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. SAGE
McGeorge, C. R., Carlson, T. S., & Toomey, R. B. (2015). An exploration of family therapists’ beliefs about the ethics of conversion therapy: The influence of negative beliefs and clinical competence with lesbian, gay, and bisexual clients. Journal of Marital & Family Therapy, 41(1), 42–56. https://doi.org/10.1111/jmft.12040
Movement Advancement Project (2021). Conversion “therapy” laws. http://www.lgbtmap.org/equality-maps/conversion_therapy
National Association of Social Workers (2015). Sexual orientation change efforts (SOCE) and conversion therapy with lesbians, gay men, bisexuals, and transgender persons. https://www.socialworkers.org/LinkClick.aspx?fileticket=IQYALknHU6s%253d&portalid=0
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, 28(1), 81–100. https://doi.org/10.1111/cpsp.12377
Ryan, C., Toomey, R. B., Diaz, R. M., & Russell, S. T. (2020). Parent-initiated sexual orientation change efforts with LGBT adolescents: Implications for young adult mental health and adjustment. Journal of Homosexuality, 67(2), 159–173. https://doi.org/10.1080/00918369.2018.1538407
Russon, J., Smithee, L., Simpson, S., Levy, S., & Diamond, G. (2021). Demonstrating attachment-based family therapy for transgender and gender diverse youth with suicidal thoughts and behavior: A case study. Family Process. Advance online publication. https://doi.org/10.1111/famp.12677
Salway, T., Ferlatte, O., Gesink, D., & Lachowsky, N. J. (2020). Prevalence of exposure to sexual orientation change efforts and associated sociodemographic characteristics and psychosocial health outcomes among Canadian sexual minority men. The Canadian Journal of Psychiatry, 65(7), 502–509. https://doi.org/10.1177/0706743720902629
Serovich, J. M., Craft, S. M., Toviessi, P., Gangamma, R., McDowell, T., & Grafsky, E. L. (2008). A systematic review of the research base on sexual reorientation therapies. Journal of Marital and Family Therapy, 34(2), 227–238. https://doi.org/10.1111/j.1752-0606.2008.00065.x
Shidlo, A., & Schroeder, M. (2002). Changing sexual orientation: A consumers’ report. Professional Psychology: Research and Practice, 33(3), 249–259. https://doi.org/10.1037/0735-7028.33.3.249
Spitzer, R. L. (2012). Spitzer reassesses his 2003 study of reparative therapy of homosexuality. Archives of Sexual Behavior, 41, 757. https://doi.org/10.1007/s10508-012-9966-y
Therapy Today (2020, September). Healing the wounds of trauma: Catherine Jackson talks to Dr. Gabor Maté about trauma and compassionate inquiry.https://1mb74417820q1ck2sr1ws5qz-wpengine.netdna-ssl.com/wp-content/uploads/2019/03/28-31-Interview-Gabor-Mate.pdf
Tosh, J. (2011). ‘Zuck off ’! A commentary on the protest against Ken Zucker and his ‘treatment’ of Childhood Gender Identity Disorder. Psychology of Women Section Review, 13(1), 10–16
Turban, J. L., King, D., Reisner, S. L., & Keuroghlian, A. S. (2019). Psychological attempts to change a person’s gender identity from transgender to cisgender: Estimated prevalence across US states, 2015. American Journal of Public Health, 109(10), 1452–1454. https://doi.org/10.2105/AJPH.2019.305237
Turban, J. L., Beckwith, N., Reisner, S. L., & Keuroghlian, A. S. (2020). Association between recalled exposure to gender identity conversion efforts and psychological distress and suicide attempts among transgender adults. JAMA Psychiatry, 77(1), 68–76. https://doi.org/10.1001/jamapsychiatry.2019.2285
World Professional Association for Transgender Health (2012). Standards of care for the health of transsexual, transgender, and gender nonconforming people [7th Version]. https://www.wpath.org/publications/soc
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Appendix A: Recruitment Email
Appendix A: Recruitment Email
You are being asked to complete an online survey intended to better understand why therapists think the American Association for Marriage and Family Therapy (AAMFT) should add a statement to the AAMFT Code of Ethics labeling sexual orientation change efforts (SOCE) and gender identity change efforts (GICE) as unethical.
Those who engage in SOCE, also known as conversion or reSimpleParative therapy, falsely claim that such efforts can alter a person’s marginalized sexual orientation (e.g., bisexual, lesbian, gay, pansexual, etc.) to heterosexual. Similarly, those who use GICE are seeking to change an individual’s marginalized gender identity (e.g., transgender, nonbinary, genderqueer, etc.) to a cisgender identity (i.e., gender identity that matches an individual’s sex assigned at birth). Because the purpose of this study is to identify why therapists believe statements labeling SOCE and GICE as unethical need to be added to the AAMFT code of ethics, eligibility for this study is limited to those who align with this stance.
Please complete this online survey by clicking on the following link: [click here]. The survey should take approximately 5 min to complete.
Your participation is voluntary, and you can quit the survey at any time. You may also choose to skip questions that you do not wish to answer. There are no known risks to participating in this survey, and your responses will be anonymous.
If you have any questions about this survey, please contact Dr. Christi McGeorge at christine.mcgeorge@ndsu.edu or (701) 231-7335. If you have questions about the rights of human participants in research, or to report a problem, please contact the University IRB office, 701-231-8995 or toll-free at (855) 800-6717.
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Are you a therapist who believes in banning change efforts for gender identity and sexual orientation (aka conversion or reparative therapy) in the AAMFT Code of Ethics? Follow the QR code or the survey link to voice your thoughts in a 5-minute survey. North Dakota State University #IRB0003686.
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McGeorge, C.R., Coburn, K.O., Walsdorf, A.A. et al. “We Need to State it Overtly”: MFT’s Rationales for Labeling SOCE and GICE as Unethical in the Code of Ethic. Contemp Fam Ther 44, 436–451 (2022). https://doi.org/10.1007/s10591-022-09649-2
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DOI: https://doi.org/10.1007/s10591-022-09649-2