Conversion therapy is the set of practices aimed at changing a person's sexual orientation or gender identity from LGBTQ+ to heterosexual and cisgender. The practices have gone by many names — reparative therapy, sexual orientation change efforts, ex-gay therapy — and have taken many forms, from talk therapy to aversive conditioning to religiously framed interventions. The history of these practices is a history of institutional harm inflicted on people who were told there was something wrong with them that needed to be fixed.

The Medical Origins of a Harmful Idea

The classification of homosexuality as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders, beginning with the first edition in 1952, gave conversion practices a veneer of medical legitimacy. Psychiatrists and psychologists developed techniques specifically designed to change sexual orientation. Some involved aversion therapy — pairing same-sex arousal with electric shock or nausea-inducing drugs. Others involved talk therapy aimed at uncovering the childhood experiences supposedly responsible for "deviant" attractions. The scientific basis for these practices was always thin. The underlying theory — that homosexuality resulted from developmental failures or trauma and could therefore be reversed — was never supported by controlled research. When the APA removed homosexuality from the DSM in 1973 following sustained pressure from gay activists and some sympathetic researchers, the formal medical justification for conversion practices collapsed. Most mainstream mental health organizations followed with their own position statements opposing the practices.

Why the Practices Continued

The removal of homosexuality from the DSM did not end conversion therapy. It drove it into different institutional settings, primarily religious ones. Organizations like Exodus International became the dominant face of the ex-gay movement from the 1970s onward, offering programs rooted in evangelical Christian theology rather than psychiatric theory. The harm was the same; the framing was different. The ex-gay movement reached significant cultural influence in the 1990s, with full-page newspaper advertisements featuring testimonials from people who claimed to have changed their sexual orientation. These campaigns were eventually undermined by the recantations of their own participants. John Paulk, one of the movement's most prominent spokespeople, was photographed in a gay bar in 2000. Alan Chambers, the president of Exodus International, publicly apologized in 2013 before closing the organization, acknowledging that the vast majority of participants had not changed their sexual orientation.

The Research on Harm

The evidence of harm from conversion practices is substantial and consistent. A 2020 report from the Trevor Project found that LGBTQ+ youth who underwent conversion therapy were more than twice as likely to report a suicide attempt compared to those who did not. Research from Williams Institute at UCLA has documented associations between conversion therapy exposure and higher rates of depression, anxiety, and suicidality in adults as well.

The Legislative Landscape

The push to ban conversion therapy on minors has produced a patchwork of state and local laws. California became the first state to ban licensed mental health providers from practicing conversion therapy on minors in 2012. As of 2025, more than half of U.S. states have enacted similar bans. The practices remain legal in others, and religious practitioners — who are not licensed mental health providers — generally operate outside the scope of these bans. This is the tangent that matters: the distinction between licensed providers and religious practitioners is not a technicality. It reflects a genuine constitutional question about the limits of government regulation of religiously motivated speech and practice. Courts have generally upheld bans on licensed providers while leaving the question of religious practice more unsettled. The harm does not diminish based on whether the person administering it holds a license.

The Long Road

The road to bans has required the same combination of survivor testimony, research documentation, and sustained political organizing that has characterized other LGBTQ+ civil rights campaigns. Survivors who were willing to describe what was done to them in public — electroshock, coerced celibacy, being told their attractions were demonic — were essential to moving legislatures. The knowledge that these practices cause harm has existed for a long time. Translating that knowledge into law took far longer than it should have.