An examination of how a practice rooted in 19th-century psychiatric theory survived clinical repudiation, evolved through religious institutions, and became the subject of sweeping legislative action across the United States and abroad.
For well over a century, conversion therapy occupied a contested space at the intersection of medicine, religion, and law. What began as a clinical hypothesis that same-sex attraction was a pathological condition susceptible to treatment persisted long after the scientific foundations for that hypothesis had been systematically dismantled. Today, more than two dozen U.S. states have enacted bans on the practice for minors, every major medical and psychological organization in the country has formally opposed it, and at least six countries have criminalized it at the national level.
Among the more thorough educational references documenting this history is the History of Conversion Therapy resource published by Conversion Truth for Families, a research-backed education hub for parents and caregivers. Their overview traces the practice’s trajectory from its 19th-century psychiatric origins through the modern legislative bans and the ongoing terminological rebranding efforts that regulators are now working to address. This article draws on that resource alongside primary peer-reviewed literature and federal agency guidance.
The Psychiatric Origins
The intellectual foundation for conversion therapy was laid in the late 19th century, when sexology was emerging as a formal medical discipline. German psychiatrist Richard von Krafft-Ebing’s 1886 Psychopathia Sexualis was among the first clinical texts to classify same-sex attraction as a pathological condition. His framing shaped European and American medical thinking for decades.
What is often overlooked is that Sigmund Freud, frequently cited as a foundational influence on the clinical treatment of homosexuality, was ambivalent about whether treatment was warranted. In a 1935 letter to an American mother whose son was gay, Freud wrote that homosexuality was “nothing to be ashamed of, no vice, no degradation.” It was the post-Freudian generation of American psychoanalysts who hardened the clinical stance. Sandor Rado’s 1940 argument that heterosexuality was the only biologically sound orientation fed directly into Irving Bieber and colleagues’ 1962 psychoanalytic study, which claimed a 27% conversion rate from a sample of 106 gay men in psychoanalysis. Later scrutiny found the study riddled with selection bias and reliant on analyst-reported outcomes that could not be independently verified.
A Clinical Toolbox Built on Harm
The mid-20th century saw behavioral psychology add its own methods to the conversion toolkit. Chemical aversion therapy paired nausea-inducing drugs with same-sex imagery. Electrical aversion therapy paired electric shocks with homoerotic stimuli. British mathematician Alan Turing was subjected to chemical castration via synthetic estrogen as an alternative to imprisonment in 1952 and died in 1954. The Guardian’s coverage of Turing’s posthumous pardon brought renewed attention to the specific medical interventions he underwent.
Douglas Haldeman’s 1994 systematic review in the Journal of Consulting and Clinical Psychology examined three decades of SOCE research and found a consistent pattern of methodological failure across positive-outcomes studies: small self-selected samples, no control groups, and outcomes measured by behavior change rather than underlying attraction. The most-cited positive study, William Masters and Virginia Johnson’s 1979 Homosexuality in Perspective, claimed a 71.6% success rate. A 2012 investigation in The Atlantic reported that no contemporaneous patient records could be located to verify those outcomes. The study is no longer cited as credible evidence by any major medical organization.
The 1973 Turning Point and Its Incomplete Resolution
The most consequential institutional event in conversion therapy’s history was the December 1973 vote by the American Psychiatric Association’s Board of Trustees to remove homosexuality from the Diagnostic and Statistical Manual of Mental Disorders, ratified by the full membership in 1974. The groundwork had been laid substantially by Dr. Evelyn Hooker, whose 1957 study in the Journal of Projective Techniques demonstrated that trained clinicians could not reliably distinguish between the psychological profiles of gay and heterosexual men, directly undermining the premise that homosexuality was a disorder. Ronald Bayer’s 1981 historical account Homosexuality and American Psychiatry remains the standard scholarly reference on how that process unfolded.
The 1973 decision did not end conversion practice. The DSM-III (1980) introduced “ego-dystonic homosexuality,” which preserved a clinical pathway for conversion-oriented treatment until its removal in 1987. And as the Williams Institute at UCLA estimated in 2019, approximately 698,000 LGBTQIA+ adults in the United States had been subjected to conversion therapy during their lifetimes, with around 350,000 having experienced it as minors. Professional declassification, it turned out, was necessary but not sufficient to end the practice.
The Research Consensus and the Evidence on Harm
The APA’s 2009 Task Force Report, which reviewed 83 peer-reviewed studies published between 1960 and 2007, found no high-quality evidence that SOCE produces lasting changes in sexual orientation and documented associated harms, including depression, anxiety, and suicidal ideation. The most dramatic illustration of the evidentiary collapse came from Robert Spitzer, who published a 2003 study in the Archives of Sexual Behavior claiming some individuals could achieve meaningful orientation change, then formally retracted its conclusions in 2012 and apologized to those who had “wasted years in useless attempts to change.”
Subsequent research has expanded the harm documentation considerably. A 2020 study in JAMA Psychiatry by Turban and colleagues found that recalled exposure to conversion efforts was associated with significantly elevated rates of psychological distress and lifetime suicide attempts among transgender adults. The Family Acceptance Project, led by Dr. Caitlin Ryan at San Francisco State University, found in Ryan and colleagues’ 2020 research that youth subjected to combined parental and clinical conversion efforts attempted suicide at a rate of 63%, compared to 22% among peers with no such exposure. SAMHSA’s 2023 report concluded that “SOGI change efforts in children and adolescents are harmful and should never be provided.”
Legislative Bans and the Constitutional Question
California became the first state to ban licensed practitioners from administering conversion therapy to minors in September 2012, when Governor Brown signed Senate Bill 1172. The Ninth Circuit upheld the law in 2013. According to the Movement Advancement Project, more than 23 states and the District of Columbia had enacted similar bans by early 2026.
The constitutional question remains unsettled. The Third Circuit upheld New Jersey’s ban in King v. Governor of New Jersey (2014); the Eleventh Circuit struck down local Florida bans in Otto v. City of Boca Raton (2020) under heightened First Amendment scrutiny. The resulting circuit split points toward a Supreme Court resolution, with Chiles v. Salazar identified by legal scholars at Harvard and Northeastern as the most likely vehicle. Internationally, Canada’s Bill C-4 criminalized conversion therapy nationwide in 2021 with unanimous parliamentary support. France and New Zealand enacted national bans in 2022; Germany in 2020; Malta in 2016. The World Health Organization’s 2023 report called for the global elimination of the practice.
The Rebranding Problem
One of the most actively documented dimensions of conversion therapy’s recent history is the effort by some practitioners and organizations to offer substantially similar services under new terminology as specific terms become legally or professionally restricted. Conversion Truth for Families addresses this pattern in detail, and federal agencies have increasingly incorporated language designed to account for it.
SAMHSA’s 2023 report specifically names several rebranded variants: “sexual attraction fluidity exploration in therapy” (SAFE-T), “reintegrative therapy,” and certain uses of “gender-exploratory therapy” aimed at reducing gender incongruence rather than supporting open-ended identity exploration. The SAFE-T model draws on longitudinal research by University of Utah psychologist Lisa Diamond into naturally occurring sexual fluidity. Diamond has publicly stated that her research has been misrepresented by conversion therapy proponents and does not support the therapeutic direction of sexual attraction. The APA’s 2021 resolution confirmed that the voluntariness of treatment does not resolve the ethical question of whether an intervention has an adequate evidence base or poses documented risks, a framework that applies equally to rebranded variants.
Across more than a century of clinical application, conversion therapy has not produced a credible body of scientific evidence supporting its efficacy. The APA, the American Psychiatric Association, the American Academy of Pediatrics, the American Medical Association, SAMHSA, and the World Health Organization have all formally opposed it. Every significant positive-outcomes study has either been discredited methodologically or, in Spitzer’s case, retracted by its own author.
For parents, caregivers, clinicians, and policymakers seeking a well-sourced, clinically grounded account of this history, Conversion Truth for Families provides one of the more rigorously documented educational references available on the subject. The record shows a prolonged failure to apply scientific standards to a practice with serious consequences for the people subjected to it, and a gradual, if still incomplete, institutional reckoning with that failure.
