Aversion therapy

1. What it was

Version followed: historical harm account (not a how-to) of chemical (emetic and paralysing-drug), electrical, imaginal (covert sensitisation), odour and shame, and aversive-smoking procedures, as used for alcohol, tobacco, so-called sexual deviations (including same-sex attraction and cross-gender expression) and institutional behaviour control, c. 1930 to the present. There is no single founder or manual; named programmes are identified where sources allow. Drug doses, shock settings and session scripts are deliberately described only qualitatively.

Definition. Aversion therapy is an umbrella term for procedures that repeatedly paired a behaviour, urge or stimulus the treater wanted removed (drinking, smoking, sexual images, clothing, a fantasy) with something unpleasant: drug-induced nausea and vomiting, a drug-induced inability to move or breathe, electric shock, foul smells, public shame, or vividly imagined disgust and punishment. [source: Wikipedia, Aversion therapy; Rachman & Teasdale 1969]

Stated rationale. Classical (Pavlovian) conditioning: if the cue is reliably followed by the aversive event, the cue itself becomes nauseating or frightening and the person avoids it. From the mid-1960s operant variants added escape and avoidance (the person could act to stop the shock) and “aversion relief” (relief paired with an approved alternative, such as an opposite-sex image). Behaviourists presented it as a quick, measurable, “scientific” alternative to psychoanalysis; historians tie its 1950s–60s popularity to Cold War Pavlovian doctrine. [source: Davison 2020 abstract; King, Smith & Bartlett 2004; Wikipedia, Aversion therapy]

Who developed and used it, where and when.

Alcohol, commercial and hospital (USA, 1935–2022): chiropractor Charles Shadel licensed an emetic programme in Seattle (1935) and opened the Shadel Sanitarium (1937), with Walter Voegtlin as medical director and psychiatrist Frederick Lemere as collaborator; the model spread to hospital chains such as Raleigh Hills (24 branches by 1983) and survived at Schick Shadel Hospital until it closed on 30 June 2022. Earlier “drink cure” chains (Gatlin, Neal Institutes, from 1902 and 1909) sold emetic “secret formulas”; Benjamin Rush had proposed lacing brandy with an emetic in 1786. Early electrical aversion for alcohol in the USSR is usually attributed to N. V. Kantorovich (late 1920s) [uncertain]. [source: Filter; Wikipedia, Walter L. Voegtlin; Parsonson 2021]
Same-sex attraction and gender expression: an early US single-case report (Max, 1935); systematic use in Czechoslovakia under Kurt Freund (1950s to early 1960s), whose own follow-up concluded it did not change orientation; in Britain, renewed interest followed M. J. Raymond's 1956 apomorphine case of a man with a handbag-and-pram fetish, and use spread across the British Commonwealth c. 1961–1975, in NHS and university units including the Maudsley (London), Crumpsall (Manchester), Glenside (Bristol), Graylingwell (Chichester), Banstead (Surrey) and Upton (Chester), with clinics also named in Birmingham, Glasgow and Belfast; in Australia, notably Nathaniel McConaghy's studies at the University of New South Wales, Sydney (from 1969); and in the South African Defence Force “Aversion Project” under psychiatrist Aubrey Levin (1971–1989). Raymond, MacCulloch and McConaghy were the main published authors on apomorphine aversion. [source: Davison 2020 abstract; King, Smith & Bartlett 2004; Spandler & Carr 2022; Davison et al. 2025; Auffret, Verin & Lees 2024 (AAN abstract); McConaghy 1969 (BJP abstract page); Wikipedia, The Aversion Project; Medical Journal of Malaysia 1973]
Other targets: smoking (rapid smoking from the early 1970s; commercial shock-based stop-smoking clinics), “transvestism”, “fetishism”, “exhibitionism” and other then-labelled deviations, gambling and overeating; prison and forensic-hospital behaviour control in the US in the 1960s–70s [uncertain: case law]; and punishment of self-injury, aggression or rule-breaking in children and people with intellectual disabilities (Lake Alice, New Zealand, 1970s; the Judge Rotenberg Educational Center, Massachusetts, still in use). [source: Filter; Hajek & Stead; Parsonson 2021; Disability Scoop 2026]

How it was sold to patients and referrers.

To drinkers: as a medical “cure” that would make alcohol physically repulsive, promoted with the providers' own high success figures (Voegtlin and Lemere's uncontrolled 1950 follow-up of over 4,000 patients reported about 60% abstinent at one year, 23% at ten). [source: Filter; Wikipedia, Walter L. Voegtlin]
To gay men, lesbians and bisexual women, and people who cross-dressed: as a modern, humane medical alternative to prison, scandal, a failed marriage or religious condemnation, at a time when sex between men was a crime in England and Wales (until partial decriminalisation in 1967) and homosexuality was a psychiatric diagnosis (removed from DSM in 1973). Referrals came from GPs, psychiatrists, courts and probation (treatment as a condition or alternative to sentence), the armed forces, families and clergy. Many patients “volunteered” under these pressures. [source: King, Smith & Bartlett 2004; Spandler & Carr 2022; Davison et al. 2025]
To institutions: as efficient, measurable behaviour control requiring little staff time. [source: Parsonson 2021] [synthesis]

2. What was actually done

The courses below are described as patients experienced them, as far as the sources allow. There was no shared protocol; British clinicians working on sexual orientation had no common protocol or ethical guidelines, and systematic follow-up existed only in research settings. [source: King, Smith & Bartlett 2004]

2.1 Emetic aversion for drinking (Shadel model and its successors)

Selection and consent: mostly self-referred or employer-sent paying patients, recruited through advertising and alumni word of mouth; consent was nominally free but rested on inflated cure claims. Medical screening was needed because repeated vomiting is a heavy physical strain [synthesis]. [source: Filter]
Setting and staff: a private sanitarium or hospital ward; the treatment room was typically fitted out to resemble a bar, with the patient's usual drinks on display, and a nurse or physician present [uncertain: bar-room detail from general histories, not re-confirmed this session].
Session: the patient was given a nausea-inducing drug (tartar emetic in early cures, later emetine, ipecac or apomorphine) and, as nausea rose, was told to look at, smell, swirl and swallow alcohol so that vomiting followed the taste and smell. Because alcohol's sedating effect blunted conditioning, sequencing was arranged to keep nausea ahead of intoxication. Sessions were repeated, usually on alternate days, over an inpatient stay of roughly one to two weeks [uncertain: course length varies by source], with later “booster” readmissions. [source: Filter; Wikipedia, Walter L. Voegtlin]
Between sessions: rest and recovery on the ward; some later programmes added group meetings, alumni groups and, reportedly, sedative-assisted “interviews” [uncertain: not confirmed in the sources].
How progress was judged: whether the patient reported or showed revulsion to the sight and smell of drink, then the provider's own abstinence follow-ups.
Non-response or relapse: treated as needing more conditioning: further boosters or a repeat admission. [source: Filter]

2.2 Paralysing-drug aversion (alcohol research and forensic use, 1960s–70s)

What was done: a muscle-relaxant drug (succinylcholine) was injected, without anaesthesia, so that the conscious patient was briefly unable to move or breathe while tasting or holding alcohol; the terror of apparent suffocation was the intended aversive event. A Canadian group (Vandewater, Laverty, Campbell and Sanderson, 1963) gave it to alcoholic patients as part of an aversion-therapy programme and recorded marked slowing of the heart during the drug-induced apnoea. The same method was reportedly used in US prison medical facilities as a response to rule-breaking [uncertain: prison accounts and Mackey v. Procunier]. [source: Vandewater et al. 1963, Canadian Anaesthetists' Society Journal abstract]
Consent: in forensic settings often absent or obtained under institutional pressure; US courts later examined such programmes (see 2.9). The 1963 Canadian abstract does not mention consent. [source: Clearinghouse, Knecht v. Gillman; Vandewater et al. 1963] [uncertain for the California programmes]

2.3 Electrical aversion for drinking and smoking

What was done: electrodes on the forearm, hand or leg delivered painful shocks as the patient reached for, sniffed or sipped a drink in a mock bar, or lit, held or inhaled a cigarette. Commercial stop-smoking clinics in the 1970s–80s sold short courses of shock-paired smoking. [source: Filter; King, Smith & Bartlett 2004 for the general method]
Progress and non-response: judged by self-reported urges and abstinence; relapse met with further sessions. [synthesis]

2.4 Aversive smoking (rapid smoking, satiation and related methods)

What was done: under supervision, smokers puffed far faster than normal, or smoked continuously, until they felt sick, dizzy and unable to continue; this was repeated over several sessions, and some variants used warm smoky air blown at the face or adulterated cigarettes (for example onion powder). Research versions screened out people with heart or lung disease. [source: Hajek & Stead; Wikipedia, Aversion therapy; screening detail uncertain]
Progress: abstinence and reported disgust at cigarettes. Cochrane later judged rapid smoking “an unproven method”. [source: Hajek & Stead]

2.5 Apomorphine aversion for same-sex attraction and cross-dressing (Britain, c. 1950s–1970s)

Selection and consent: men, and some lesbian and bisexual women, referred by GPs, psychiatrists, courts and probation, the services or families, or self-referred out of fear of prosecution, exposure or loss of marriage and job. Agreement to treatment could be the price of avoiding a prison sentence; professionals interviewed later acknowledged that consent was often not free. [source: King, Smith & Bartlett 2004; Spandler & Carr 2022]
Setting and staff: an NHS mental-hospital ward, usually a side room; the patient was often kept there for the whole course, typically several days, with nurses giving the injections and observing. A psychiatric nurse later said he had been instructed to leave patients lying in their bodily fluids, sometimes for days. [source: Davison et al. 2025; Tatchell 2017] [uncertain: wider nursing detail, Dickinson 2014]
Session: repeated injections of the emetic apomorphine, around the clock in some units, while the patient was shown photographs of men (or, for cross-dressing, made to dress in women's clothes or look at them), or played recordings describing their sexuality as disgusting and harmful, timed so that vomiting coincided with the images. The drugs made patients vomit and, in some accounts, lose bowel control repeatedly; patients were left unwashed in vomit, urine and faeces for days. Emetine was used in the same way. [source: Davison et al. 2025; Spandler & Carr 2022; Tatchell 2017; Auffret, Verin & Lees 2024] [uncertain: food and fluid restriction and the recordings are from Dickinson 2014 and Smith, Bartlett & King 2004]
Named example: the earliest UK report found by Davison et al. (Banstead, 1961) concerns a 22-year-old treated for “transvestism”; the record notes humiliation and physical collapse with fever, raised blood pressure and impaired coordination. [source: Davison et al. 2025]
Progress: judged by the patient's stated loss of interest, reported disgust at the images, sometimes by genital-arousal measurement, and by whether he went on to date women or marry. [source: King, Smith & Bartlett 2004; Davison 2020 abstract]
Non-response or refusal: further courses, or a switch to electric shock, which clinicians found easier to control and which caused less visible physical distress than apomorphine. Leaving treatment could carry legal or family consequences. [source: Davison et al. 2025; King, Smith & Bartlett 2004]

2.6 Electrical (faradic) aversion for same-sex attraction and cross-dressing

Setting: inpatient or, increasingly, hospital outpatient clinics; sessions repeated over weeks. [source: King, Smith & Bartlett 2004]
Session: electrodes on the arm or leg; the patient looked at slides or film of the same sex, listened to descriptions, imagined a sexual scene, or put on women's clothes, and received painful shocks while doing so or when signalling arousal. Some clinicians deliberately shocked on unpredictable (intermittent) schedules in the belief that the effect would last longer. A 1973 Malaysian case report of a man treated for a fetish describes a typical outpatient course: sessions twice a week of about 45 minutes, several shocks per session, ten sessions over five weeks, with the patient signalling peak arousal by tapping his hand; its author preferred shock to drugs as “relatively safe and easy to administer” and cited Marks and Gelder's 1967 faradic-aversion work at the Maudsley on cross-dressing and fetishism. Named example: Jeremy Gavins, aged 18 in the early 1970s, was strapped to a chair by his wrists and shocked through his arm while shown pictures of naked men, for several hours a week over six months. [source: King, Smith & Bartlett 2004; Davison et al. 2025; Medical Journal of Malaysia 1973; Tatchell 2017] [uncertain: Marks & Gelder papers]
Homework: McGuire and Vallance (1964) described a portable battery shock box that patients could take home and use on themselves when fantasies arose [uncertain: cited in Davison 2020]. Patients were also told to practise heterosexual fantasy or dating. [synthesis from general accounts]
Women's experience: lesbian and bisexual women in England received both electric and chemical aversion; their accounts, gathered by Spandler and Carr, describe referral by doctors and families, fear, and long-lasting effects. [source: Spandler & Carr 2022]

2.7 Anticipatory avoidance learning and “aversion relief” (Feldman and MacCulloch, Crumpsall Hospital, Manchester, from 1964)

Session: the patient ranked slides of men by attractiveness and was shown them in sequence; a shock followed unless he pressed a switch to remove the slide within a short interval, and on some trials the escape failed or was delayed regardless; removal of the male slide was paired with a slide of a woman (“relief”). Sessions, often outpatient, were repeated over weeks; later versions were automated. [source: Spandler & Carr 2022; King, Smith & Bartlett 2004; Davison et al. 2025]
Progress: sexual-orientation questionnaire scores and self-report; MacCulloch and Feldman reported 43 patients (1967) and up to 77 (1971), results that MacDonough (1972) disputed. [source: Davison et al. 2025; Spandler & Carr 2022 reference list]
What patients went through: the wait before each possible shock added anticipatory dread; the escape switch was sometimes disabled. [source: Davison et al. 2025]

2.8 Other national programmes

Czechoslovakia (Kurt Freund, Prague, 1950s to early 1960s): patients self-referred or came through the criminal-justice system; Freund reportedly selected men not under coercion by the authorities. They received nausea-inducing drugs or electric shocks while viewing images of male bodies, then a second phase in which testosterone injections alternated over about five days with images of semi-naked women meant to build heterosexual response. Outcome was judged by penile plethysmography, which Freund invented in the 1950s (partly at army request, to detect men feigning homosexuality to avoid conscription). His follow-up (1960) found no one with reduced same-sex attraction; some married, about 18% had regular heterosexual intercourse for some years, and some admitted having misrepresented their responses. He concluded homosexuality could not be “cured” and should not be punished; Czechoslovakia decriminalised it in 1961. [source: Wellcome Collection article via Brewminate 2018; McConaghy 1969 (BJP abstract page); Davison 2020 abstract]
Australia (Sydney, from 1969): Nathaniel McConaghy (School of Psychiatry, University of New South Wales) compared apomorphine aversion with electric aversion-relief in men seeking to lose same-sex attraction, measuring outcome by self-report and penile plethysmography (BJP 1969). [source: McConaghy 1969 (BJP abstract page); Auffret, Verin & Lees 2024] [uncertain: methods and results]
South Africa (SADF “Aversion Project”, 1971–1989): gay conscripts and soldiers, and conscripts who used drugs, were treated mainly in Ward 22 of 1 Military Hospital, Voortrekkerhoogte (Pretoria), under psychiatrist Aubrey Levin, who claimed all patients were volunteers. Electrodes were strapped to the upper arm; the man was shown black-and-white pictures of a naked man and shocked when he responded, with the shock increased if responses continued, then shown a colour picture of a woman. Methods also included chemical castration. Men for whom treatment “failed” were reportedly subjected to gender-reassignment surgery and given new identities: up to 900 such operations, mostly on 16- to 24-year-old conscripts, with a reported high death rate, incomplete procedures, no follow-up after discharge and many later suicides [uncertain: figures from investigative reports summarised by Wikipedia, not independently verified]. The Truth and Reconciliation Commission named Levin among 25 doctors whose conduct might have violated human rights. Levin later practised in Calgary, Canada, where he was found guilty on three of nine charges of sexually assaulting patients and sentenced in February 2013 to five years. [source: Wikipedia, The Aversion Project; IOL, 5 Feb 2013] [uncertain: referral by chaplains and officers]

2.9 Prisons and forensic hospitals (USA, 1960s–70s)

What was done: at the Iowa Security Medical Facility, involuntary inmates were injected, without consent, with a drug that made them vomit for about fifteen minutes as a response to minor rule breaking (apomorphine, per secondary accounts; swearing and not getting up are the examples usually cited). On 5 December 1973 the Eighth Circuit (Knecht v. Gillman) held that this was cruel and unusual punishment unless the patient knowingly and intelligently consented, and ordered it stopped except under court-set guidelines. Paralysing-drug “aversion” was also reported at California prison medical facilities and challenged in Mackey v. Procunier (9th Cir. 1973). [source: Clearinghouse, Knecht v. Gillman] [uncertain: drug name and example behaviours from secondary literature; Mackey]

2.10 Covert sensitisation and its “assisted” variants

Origin: credited to Joseph Cautela (“Covert sensitization”, Psychological Reports, 1967) as an imaginal alternative to drugs and shock [uncertain: bibliographic record only]. [source: King, Smith & Bartlett 2004; Wikipedia, Conversion therapy]
Session: after relaxation, the therapist narrated, and the patient imagined, approaching the target (a drink, food, a same-sex partner, an offence scenario) and then a vivid aversive outcome: vomiting, being caught, arrest, family discovery, disgrace; turning away was followed by imagined relief. Homework was rehearsing the scenes, often with audio recordings. [source: King, Smith & Bartlett 2004; Wikipedia, Conversion therapy]
Assisted and related variants: pairing the imagery with foul smells (“olfactory aversion”), used in sex-offender programmes into the 1990s; and “shame aversion”, in which the person performed the behaviour (for example cross-dressing or exposing) in front of observers [uncertain: both from general literature].
Progress: self-reported urges and, in forensic programmes, phallometric change. [synthesis]

2.11 Contingent shock and punitive “aversion” in institutions

Lake Alice adolescent unit, New Zealand (1970s): former child patients describe unmodified electric shocks to the head, limbs and genitals, and painful injections, given as punishment for swearing, fighting, running away, masturbation or same-sex behaviour, without assessment, plans, consent or data. An expert witness to the Royal Commission called it “closer to torture” than therapy. [source: Parsonson 2021]
Judge Rotenberg Educational Center, Massachusetts: residents with intellectual, developmental or psychiatric disabilities wear a remotely triggered skin-shock device, activated by staff after target behaviours. [source: Disability Scoop 2026]

2.12 Other physical methods in conversion settings

Reported methods include ice baths, exposure to cold, burning with heated coils and hard labour, alongside castration and hormonal treatment in mid-20th-century Europe. [source: Wikipedia, Conversion therapy]

2.13 Current research paradigms (for completeness)

Small trials pair drug or alcohol cues in virtual reality with unpleasant sounds alongside standard care. These are experimental, consented and ethics-approved, and differ from the practices above in intensity and coercion; they are not established treatments. [source: Wikipedia, Aversion therapy] [synthesis]

3. How it caused harm

3.1 Physical harm

Emetic drugs: repeated induced vomiting causes dehydration and electrolyte disturbance and risks aspiration and oesophageal injury; early tartar emetic was abandoned as too toxic, and emetine is known to be toxic to the heart [synthesis: pharmacology]. A 1973 case report noted that drug aversion needed hospital admission and carried a risk of serious, possibly lethal, reactions. Apomorphine courses produced collapse, fever, raised blood pressure and impaired coordination in the 1961 Banstead case. Succinylcholine aversion produced marked slowing of the heart during apnoea. [source: Filter; Davison et al. 2025; Medical Journal of Malaysia 1973; Vandewater et al. 1963]
Death: at least one man, Billy Clegg-Hill, died as a result of aversion treatment in Britain, as reported by Peter Tatchell and survivors' campaigners in 2017 [uncertain: date, hospital and cause not given in the sources]. In South Africa, deaths during surgery and later suicides were reported among Aversion Project patients. [source: Tatchell 2017; Wikipedia, The Aversion Project]
Paralysing drugs: a conscious person unable to breathe experiences terror of imminent death, with risk of hypoxic injury if support fails [synthesis].
Electric shock: pain, and in contingent-shock settings burns and tissue damage, as cited by the FDA. [source: Disability Scoop 2026]
Rapid smoking: nicotine overload and cardiovascular strain, a particular risk in heart or lung disease [uncertain: not in the sources].

3.2 Psychological harm

Trauma and conditioned fear: survivors describe pain, terror, humiliation and lasting trauma; the FDA cited PTSD, depression, anxiety and worsened behaviour from contingent shock. [source: King, Smith & Bartlett 2004; Davison et al. 2025; Disability Scoop 2026]
Damaged sexuality and intimacy: professionals described patients left with their sexuality suppressed and nothing in its place; aversion to all sexual feeling, loss of relationships and sexual dysfunction follow from pairing desire with pain or nausea. [source: King, Smith & Bartlett 2004] [synthesis for mechanism]
Shame and self-blame: treatment taught that the person's desire or identity was a disgusting illness; when it “failed”, many blamed themselves. Conversion efforts are associated with higher rates of depression, substance misuse, suicidal thinking and suicide attempts. [source: Wikipedia, Conversion therapy; Davison et al. 2025] [uncertain: primary epidemiological studies, e.g. Blosnich et al. 2020]
Distrust of services: survivors and their communities may avoid mental-health care. [source: Davison et al. 2025]

3.3 Harm through ineffectiveness and coercion

Outcome claims came from the providers' own uncontrolled follow-ups or single cases; Freund's group found orientation unchanged; the 1976 Rand Report found aversion no better than other alcohol treatments; Cochrane found rapid smoking unproven. Patients paid, physically and financially, for little benefit, and effective help was delayed. [source: Davison 2020 abstract; Filter; Hajek & Stead]
Consent obtained under threat of prison, discharge, family rejection or institutional punishment was not free; for children and detained people there was often no consent at all. [source: King, Smith & Bartlett 2004; Parsonson 2021]

3.4 Who was most at risk

People under legal, military, family or religious pressure; children and adolescents; prisoners and detained patients; people with intellectual or developmental disabilities; medically frail drinkers and smokers with heart or lung disease; and anyone with prior trauma. [synthesis from the sources above]

4. Recognising it today

Clinical aversion therapy for sexual orientation is not recorded as current practice in UK services, but its components reappear under other names. [source: Davison et al. 2025] [synthesis for the lists below]

4.1 Features and phrases to watch for

Goals framed as making the client “hate”, “be disgusted by” or “feel sick at” a desire, food, substance or behaviour, or “retraining the brain” by pairing it with pain.
Conversion language: “unwanted same-sex attraction”, “SSA”, “sexual brokenness”, “reorientation”, “restoring” gender, or “exploring the roots” with a fixed heterosexual or cisgender endpoint.
Self-administered aversives: snapping a rubber band, consumer electric-shock wristbands or apps marketed to break habits or “porn addiction”, imagery of hell, illness or arrest rehearsed at home.
Hypnosis or imagery sessions sold to make cigarettes, alcohol or food “revolting”.
Odour, taste (for example lemon juice), water-spray or shock contingencies in behaviour plans for people with intellectual disabilities or autistic children; behaviour plans with no functional assessment.
Restrictive “troubled-teen”, residential or religious programmes using deprivation, cold, humiliation or forced confession.

4.2 Red flags in a colleague's or service's practice

The client did not choose the goal, or the referrer (court, parent, faith leader, employer) set it.
Pain, nausea, fear or shame is deliberately induced as the active ingredient.
The client cannot stop a session or remove a device at will.
No functional assessment, informed-consent record, outcome data or ethics oversight.
Sexual orientation or gender identity treated as the problem rather than distress about it.
Claims of high cure rates from the provider's own follow-up.

4.3 How legitimate techniques differ

Exposure therapy (including imaginal exposure): the client approaches a feared cue to learn it is safe; fear reduction, not induced suffering, is the aim; the client controls pace and can stop. [synthesis]
Cue exposure and urge surfing in addictions: cues are presented without punishment so urges extinguish. [synthesis]
Habit reversal training: builds awareness and a competing response; no punishment. [synthesis]
Contingency management: rewards target behaviour (for example negative test results) rather than punishing. [synthesis]
Alcohol-deterrent medicines (for example disulfiram): a prescribed pharmacological deterrent taken with informed consent and medical monitoring, not a conditioning procedure; distinguish it from emetic aversion when clients ask. [synthesis]
Imagery rescripting and motivational interviewing: may involve imagined consequences, but in the client's own terms and without manufactured disgust. [synthesis]

5. What to do instead and how to help those harmed

5.1 Current positions

Sexual orientation and gender identity: the World Psychiatric Association (2016) called conversion or reparative therapy unethical, unscientific and harmful; the Royal College of Psychiatrists, through its president Wendy Burn (October 2017, after Jeremy Gavins spoke publicly), expressed “profound regret” for the “lifelong impact” of treatments such as aversion therapy and called treating homosexuality as a disorder “wholly unethical”; the American Psychological Association (2021) opposes change efforts; the UN Independent Expert on SOGI, Victor Madrigal-Borloz (2020), said they may amount to torture; the IRCT (2020) called conversion therapy torture. ABCT (2022) and the University of Birmingham (2022) have apologised for their part; the South African Medical Association apologised in 1995 for doctors' past wrongdoing. [source: Tatchell 2017; Spandler & Carr 2022; Wikipedia, Conversion therapy; Wikipedia, The Aversion Project; Davison et al. 2025; Auffret, Verin & Lees 2024] [uncertain: UN report and APA resolution]
UK: the Memorandum of Understanding on Conversion Therapy (version 2; signatories include BPS, BACP, BABCP, RCGP and NHS England) bars providing or commissioning conversion therapy while protecting exploratory, non-directive therapy. [source: MoU v2]
Law: several countries criminalise conversion practices (for example Canada, France, Germany, Malta, Spain); in the US the Supreme Court's Chiles v. Salazar (2026) struck down Colorado's ban as applied to talk therapy, so state rules vary by method. [source: Wikipedia, Conversion therapy]
Contingent shock devices: FDA banned them in 2020; the ban was vacated in 2021; Congress confirmed FDA's authority; a re-proposed ban (2024) was still awaiting a final rule in mid-2026. [source: Disability Scoop 2026; O'Dell 2026] [uncertain: status after July 2026 not checked]
Alcohol and tobacco: aversion methods are not part of current first-line care. [source: Hajek & Stead] [uncertain: current NICE guidance]

5.2 Alternatives by former indication

Alcohol use disorder: motivational interviewing, CBT-based relapse prevention, behavioural couples therapy, community reinforcement approach, contingency management, mutual-help facilitation, and medication assessed by a prescriber. [synthesis]
Tobacco: behavioural support combined with licensed cessation medicines or aids per national guidance. [synthesis]
Distress about sexual orientation or gender identity: affirmative or exploratory, non-directive therapy with no preferred outcome; work on minority stress, shame, family and faith conflict. [source: MoU v2; synthesis for approaches]
Paraphilic interests or sexual offending: specialist assessment and offence-focused CBT within risk-need-responsivity or Good Lives frameworks; medication only through specialist prescribers. [synthesis]
Self-injury or aggression in intellectual disability or autism: functional behavioural assessment and positive behaviour support, least-restrictive practice. [synthesis]
Habits and compulsions: habit reversal training, exposure and response prevention, CBT. [synthesis]

5.3 A client asks for aversion therapy

Take the request as a measure of desperation or shame; explain plainly that aversion methods are not recommended because of harm and poor results; explore what lies behind the request (partner, family, faith, legal pressure); offer the matching alternative from 5.2. If the target is orientation or gender identity, say you will not try to change it and offer exploratory work on the distress. Document the discussion. [synthesis; consistent with MoU v2]

5.4 Assessing and treating someone who went through it

Assessment: ask open, non-leading questions about past treatment (where, when, what was done, whether coerced); screen for PTSD, depression, anxiety, substance use, sexual dysfunction, relationship difficulties and internalised shame; assess suicide and self-harm risk by current standard practice (direct collaborative enquiry, a written safety plan, lethal-means counselling on safe storage and removal, follow-up). [synthesis]
Triggers in care: electrodes (ECG, biofeedback), injections, nausea-causing medicines, side rooms, slide or image viewing, imagery exercises and conditioning language can re-evoke treatment; explain any such procedure in advance and give control over stopping. [synthesis]
Treatment: acknowledge that professionals caused the harm, without requiring forgiveness; let the client set pace and disclosure; use trauma-focused therapy (for example trauma-focused CBT or EMDR) where PTSD is present, with full explanation before any exposure-based work; affirm identity; consider peer and survivor support. [synthesis, informed by the truth-and-reconciliation recommendations in Davison et al. 2025]
Practical help: support clients seeking their records, public inquiries or redress schemes (for example New Zealand's Royal Commission into Abuse in Care). [source: Parsonson 2021; synthesis]

5.5 Ethical, reporting and legal duties

Colleague or service using aversive methods: raise it in supervision and governance; report conversion practice under professional-body codes and MoU procedures; use adult safeguarding or child-protection routes for punitive restraint or shock; report device injuries to the relevant regulator (for example FDA MedWatch in the US). [synthesis]
Coerced referrals: where courts, families or institutions press for “cure”, treat consent as compromised and set goals with the client alone. [source: King, Smith & Bartlett 2004; Spandler & Carr 2022; synthesis]
Know local law: check whether conversion practices are a criminal or professional offence in your jurisdiction and whether mandatory reporting applies to minors. [synthesis]

Sources

Sources:

Further reading (not drawn on): Smith, Bartlett & King (2004), experience of patients, BMJ; Dickinson, nurses and aversion therapy, Nursing Inquiry 2013; The Aversion Project – Wikipedia; Aubrey Levin – Wikipedia.