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An exercise in talking shop

Banning “conversion therapy” is not as simple as it seems

Artillery Row

The UK Government wants to ban conversion therapy, including any talking therapy with “the intention of changing a person’s sexual orientation or changing them to or from being transgender”.

To the casual observer, this may look like a laudable attempt to stop heavy-handed therapeutic interventions into the lives of sexual minorities. As the ministerial foreword to the current consultation on the ban says: “We want every individual to have the freedom to be themselves.” Unfortunately, though, the confused thinking behind the Government’s proposals has the potential to achieve the exact opposite.

The basic problem with the Stonewall-sponsored proposals lies in their yoking together of sexual orientation and gender identity under the heading of an “LGBT identity”. In this, they follow standard transactivist logic, already successful in bringing about conversion therapy bans in other countries. But there is no such thing as an LGBT identity — unless you mean the increasing numbers of straight people with edgy haircuts calling themselves “queer”. Rather, there are four groups potentially affected by the proposals: a) gay males b) lesbians c) bisexuals d) people with incongruent gender identities.

To count as belonging to the first three groups, you need to be attracted to members of your own sex, at least some of the time. If applicable to you, this is not so much an identity as a fact about your sexuality. So, only membership of the fourth group is plausibly characterised in terms of an “identity” at all (as indeed the name “gender identity” suggests).

Having an incongruent gender identity means that you strongly identify, psychologically speaking, with an ideal of the opposite sex, or with androgyny (if nonbinary). Males can have female gender identities, and females can have male gender identities, and both sexes can have non-binary identities. These identities are often accompanied by dysphoria: distressing dislike of your own sexed body.

Banning conversion therapy for sexual orientations makes sense because, experts think, these are fixed by at least late adolescence, and possibly earlier. Trying to intervene therapeutically seems futile and potentially traumatic. Exactly the same would apply to attempts to convert someone out of heterosexuality.

Criminalising proper therapeutic exploration may well be conversion therapy by default

But unlike sexual orientation, gender identities can emerge, change, or disappear at various stages in life — which is what you’d expect for psychological acts of identification. Transactivism is often invested in denying this, and Stonewall even defines gender identity as “innate”. Yet its potential mutability is made clear by the growing ranks of desisters — people who formerly classed themselves as trans on the basis of an incongruent gender identity, but who no longer do so.

So, straight away, we see a problem with the Government’s narrative of giving people “the freedom to be themselves” with respect to gender identity. Why should a possibly temporary incongruent gender identity be automatically treated as the true self? It could equally be that the desisted version, arrived at through therapy, is more authentic.

This question may seem merely academic, but becomes pressing when it’s remembered that having an incongruent gender identity is associated with acts of permanent bodily alteration, such as taking puberty blockers, hormones, or surgery.

People with incongruent gender identities include children, adolescents, and young adults. At the moment in the UK, under-16s can access puberty blockers, and over-16s can access cross-sex hormones and surgery. All of these leave their indelible mark on the body. Where there is youth and inexperience, it seems essential to leave room for unfettered therapeutic exploration of what is really going on. Criminalising certain discussions in advance can only be to the detriment of this process.

And it gets worse. Alongside autistic people and people with histories of sexual abuse, gay and lesbian adolescents are more likely to present with incongruent gender identities than other groups. Clinicians from the Tavistock Gender Identity Service have reported higher than average numbers of same-sex-attracted young people in their clinic. The Government implies that, for example, a female with a male gender identity must be trans, and settled as such, but she might actually be a young lesbian yet to come to terms with conflicting feelings about her sexual orientation. 

Depending on the individual, criminalising proper therapeutic exploration of her situation may well be conversion therapy by default: converting her from a path in which she ends up happily accepting her homosexuality — with fertility and natal sex characteristics intact — towards a medicalised trans pathway that she may later come to regret, even if she enthusiastically agrees to it at the time.

The Government seems to think it can circumvent these problems by explicitly targeting only those talking therapies which “have the intention of changing a person … to or from being transgender”. Head of Stonewall Nancy Kelley seems to agree, tweeting soothingly that “nothing about a conversion therapy ban prevents or restricts exploring .. gender identity in the therapeutic relationship”. But this is obviously false.

A therapist who uses years of experience to explore a young woman’s narrative of “feeling like a boy”, with the aim of getting her to acknowledge her homosexuality, may, from the outside, look just like someone who intends to “change” her from a trans person into someone else. No legal test could easily mark the difference.

Clearly the proposals need rethinking. As things stand, what is being envisaged as a means of protecting young gays and lesbians is likely in practice to gravely harm some of them. Under pressure from critics, the Government has recently allowed an additional eight weeks for scrutiny. This is welcome — but the worry remains that no amount of tinkering will remove the serious problems that are bound to arise when the law intrudes to constrain a therapeutic relationship whose outcome may involve irrevocable bodily change.

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