Reparative therapy (Moberly, Nicolosi)

1. Introduction

Version followed: reparative therapy as Moberly and Nicolosi described it, for the psychotherapist's own work with clients affected by it, framed by the APA 2009 Task Force report on appropriate therapeutic responses to sexual orientation, the APA 2021 Resolution on Sexual Orientation Change Efforts (as summarised in APA's 2021 press release), the UK Memorandum of Understanding on Conversion Therapy (Version 2, Revision A, July 2019) and UN report A/HRC/44/53 (2020). Reparative therapy is described here historically and for recognition only; this guide does not teach it, and it is not recommended.

"Reparative therapy" is a form of sexual orientation change effort (SOCE) built on a developmental theory that same-sex attraction arises from an incomplete identification with the same-sex parent. Elizabeth Moberly, writing in the early 1980s (her works include Homosexuality: A New Christian Ethic and Psychogenesis), is described by the psychologist Warren Throckmorton as having "conceptually founded" the approach and is credited with the concept of "defensive detachment"; Joseph Nicolosi published Reparative Therapy in 1991, cited Moberly, and co-founded NARTH (National Association for Research and Therapy of Homosexuality) [source: Throckmorton 2019] [uncertain: book publishers and dates (Moberly 1983; Nicolosi 1991, Jason Aronson), NARTH's 1992 founding and the name of its successor body]. In this model, same-sex relationships were read as an attempt to "repair" that early deficit, and change in orientation was the stated goal [source: Throckmorton 2019].

What the professional and international bodies state: the APA's 2021 resolution finds "no evidence of sexual orientation change" and reports that former participants describe the experience as harmful, with a study of LGBTQ young people linking change efforts to suicide attempts [source: APA 2021 press release]. The APA 2009 Task Force concluded that change efforts are unlikely to succeed and carry some risk of harm [source: APA 2009]. The UK Memorandum of Understanding names "reparative therapy" as a form of conversion therapy and states that the signatories consider conversion therapy "unethical and potentially harmful"; neither sexual orientation nor gender identity is a mental disorder [source: MoU v2 rev A]. The UN Independent Expert's 2020 report cites the World Psychiatric Association (2016) that there is "no sound scientific evidence" orientation can be changed, and the Independent Forensic Expert Group of the IRCT (2020) that such practices constitute cruel, inhuman or degrading treatment when conducted forcibly [source: UN A/HRC/44/53, paras 20, 21, 62].

The psychotherapist's core idea of change in this guide: distress about sexual orientation is addressed by reducing stigma and shame, supporting coping and identity development without a predetermined outcome, and repairing the damage that change efforts and their parent-blaming theory left behind [source: APA 2009; MoU v2 rev A].

2. Framework

Historical phases of the practice (outline only) [source: Throckmorton 2019; Spitzer 2012; RNS 2015; SCOTUSblog; NPR]:

• Early 1980s: Moberly's theory of same-sex-parent deficit and defensive detachment, written within a Christian ethical frame.
• 1990s: Nicolosi's clinical book (1991) and NARTH promote reparative therapy as a professional psychotherapy.
• 2001-2003: Robert Spitzer's study of people reporting change is published in 2003; in 2012 he wrote that its critiques were "largely correct", that participants' accounts could not be verified, and apologised to the gay community [source: Spitzer 2012] [uncertain: the 2001 conference presentation date not verified].
• 2015: a New Jersey jury finds the conversion organisation JONAH liable for consumer fraud [source: RNS 2015].
• 2019: Amazon stops selling Nicolosi's books (July 2019) [source: Throckmorton 2019].
• 2026: On 31 March 2026 the US Supreme Court ruled 8–1 in Chiles v. Salazar that Colorado's conversion-therapy law, as applied to a counsellor's talk therapy, regulates speech based on viewpoint; it reversed the lower courts, which had not applied sufficiently rigorous First Amendment scrutiny, and sent the case back (SCOTUSblog; NPR). Its effect on other states' laws is [uncertain].

Phases of the psychotherapist's work [synthesis, structured on APA 2009's affirmative elements]:

Length follows the client's needs; no fixed session count applies [synthesis]. Format is individual, with family or couple sessions by the client's choice (and, for minors, within safeguarding rules) [source: APA 2009].

3. Guiding principles

• Orientation is not a disorder. Never frame same-sex attraction as a symptom to be treated [source: MoU v2 rev A].
• No agenda. Work "free from any agenda that favours" one orientation or gender identity [source: MoU v2 rev A].
• No change attempts. Do not try to change or suppress orientation; the evidence shows no change and documented harm [source: APA 2021 press release; MoU v2 rev A].
• Explore freely. Exploring uncertainty and distress about sexuality is legitimate work [source: MoU v2 rev A].
• No a priori outcome. Support identity exploration "without a priori treatment goals" for how the client identifies or lives [source: APA 2009].
• Acceptance and support. Unconditional acceptance and respect for the client's values reduce internalised stigma [source: APA 2009].
• Comprehensive assessment. Look at the whole person; other mental health concerns may drive the distress [source: APA 2009].
• Orientation and identity differ. Orientation is unlikely to change; self-labelling, affiliation and behaviour can shift over time, and the client chooses how to live [source: APA 2009].
• Respect faith. Help clients integrate religious and sexual identities where they wish; faith communities can be a support [source: APA 2009].
• Minors: least restrictive, assent, family acceptance. Respect self-determination, obtain at least assent, and work to reduce family rejection [source: APA 2009].
• Safety first. Change efforts are linked to suicidality; assess routinely and follow safe-messaging principles [source: APA 2021 press release; Blosnich et al. 2020].
• Never provide, supervise or refer to reparative therapy. Inform, explore and support instead [synthesis].
• Non-moralising tone. Describe what happened and its effects; the facts carry the weight [synthesis].
• Name the parent-blame frame. The theory located the cause in parenting; affected families may carry unwarranted guilt [synthesis, from the theory as described in Throckmorton 2019].

4. Intervention inventory

The interventions below are the psychotherapist's own work; steps not drawn from a cited source are marked [synthesis].

4.1 Historical literacy and recognising reparative language

• Purpose / when: Before and during work with any client who mentions "healing" or "change" of sexual orientation, so the clinician recognises the model and its legacy [source: Throckmorton 2019; MoU v2 rev A].
• Steps: (1) Know the model and what it looked like to clients (see the Harm account): orientation framed as an outcome of a same-sex-parent deficit and "defensive detachment" (Moberly), developed clinically by Nicolosi and promoted through NARTH. (2) Know the counter-evidence: APA 2009 and 2021, Spitzer's 2012 reassessment, the 2015 JONAH verdict. (3) Know that the MoU notes conversion therapy may be practised covertly and under other names [source: MoU v2 rev A]. (4) Keep this knowledge for recognition, never for practice [synthesis].
• Example language (illustrative): "Some of what you were told sounds like it comes from a particular theory about family and attraction. Would it help to talk about where that idea came from?"
• Watch for: Lecturing or debating the client; aim for shared understanding. Working when the client becomes curious rather than defensive [synthesis].

4.2 Screening for a history of change efforts at intake

• Purpose / when: At intake with every client, and especially sexual minority clients and those from religious communities; about 7% of LGB adults in one US sample reported conversion therapy, most often from a religious leader (about 81%) and sometimes a health provider (about 31%) [source: Blosnich et al. 2020 via Williams Institute].
• Steps: (1) Ask neutrally whether anyone (therapist, pastor, family, programme) ever tried to change or stop their attractions or identity. (2) Ask who, when, for how long in general terms and whether it was chosen or pressured. (3) Ask about effects now. (4) Record without judgement [synthesis].
• Example language (illustrative): "Has anyone, a counsellor, a faith leader, a family member or a programme, ever tried to change who you're attracted to or how you see yourself?"
• Watch for: Clients who do not call it "therapy" (prayer groups, mentoring, retreats). Shame-laden pauses. Working when the client can name the experience [synthesis].

4.3 Comprehensive assessment

• Purpose / when: Early in work, to see the whole person, since other mental health concerns may drive distress about orientation [source: APA 2009].
• Steps: (1) Assess mood, anxiety, trauma, substance use, isolation and relationship stress. (2) Assess internalised stigma and religious or family conflict. (3) Assess adverse childhood experiences, which were associated with being exposed to change efforts [source: Blosnich et al. 2020 via Williams Institute]. (4) Where the difficulty centres on faith, the DSM-5-TR "Religious or Spiritual Problem" may be recorded as Z65.8 [source: ICD-10-CM Z65.8 (Unbound Medicine)]; use the Cultural Formulation Interview's supplementary module on spirituality, religion and moral traditions [uncertain: DSM-5-TR wording not verified]. (5) Formulate with the client [synthesis].
• Example language (illustrative): "I'd like to understand everything that's weighing on you, not only the questions about attraction."
• Watch for: Treating orientation itself as the presenting problem; a depression or trauma picture underneath [source: APA 2009; synthesis].

4.4 Suicide-risk assessment and safety planning

• Purpose / when: At intake and whenever change efforts, rejection or religious crisis are discussed. Blosnich et al. (2020) report that LGB adults exposed to conversion therapy were "nearly twice as likely" to think about and attempt suicide, after accounting for adverse childhood experiences [source: Blosnich et al. 2020 via Williams Institute]; in the UN Independent Expert's cited survey of 940 people, 98% reported damage, with suicidal thoughts and attempts among the main consequences reported [source: UN A/HRC/44/53, para 19]. The findings' causal interpretation has been disputed in a published exchange (Sullins 2022 and reply) [uncertain: not verified].
• Steps: (1) Ask directly about suicidal thoughts, intent, plans and past attempts using current standard risk assessment. (2) Build a written safety plan: warning signs, coping steps, people to contact, crisis lines. (3) Lethal-means counselling about safe storage and removal only. (4) Escalate to emergency care when risk is acute. (5) Review at each session while risk persists [synthesis].
• Example language (illustrative): "Sometimes when people have been through efforts to change them, they start to feel life isn't worth living. Has that been true for you?"
• Crisis resources: 988 Suicide and Crisis Lifeline (US); Samaritans 116 123 (UK and Ireland).
• Watch for: Hopelessness after a programme "failed", recent family rejection or disclosure, loss of faith community. Follow safe-messaging principles: no method detail, no glamorising [synthesis].

4.5 Responding to a request to change sexual orientation

• Purpose / when: When a client asks the therapist to make them straight or to provide reparative therapy. The MoU allows support for clients unhappy about their orientation to reduce distress and reach self-acceptance, and exploration of uncertainty, but not attempts to change or suppress orientation [source: MoU v2 rev A].
• Steps: (1) Thank the client for being open. (2) Explore what change would mean to them: which fears, losses, values and relationships are at stake. (3) Explain honestly that you will not attempt change, because the evidence shows it does not work and is associated with harm [source: APA 2021 press release]. (4) Offer what you can do: reduce distress, explore identity and values, address faith and family conflict [source: APA 2009]. (5) Agree goals in the client's words [synthesis].
• Example language (illustrative): "I won't try to change your orientation, because the research says that doesn't work and can hurt people. What I can do is help with the pain underneath this request, and help you work out how you want to live."
• Watch for: The client feeling rejected or judged; repair by emphasising that their values are welcome. Working when the request turns into exploration of what they fear [synthesis].

4.6 Psychoeducation on evidence and on the theory

• Purpose / when: When a client has been told change is possible or that their parents caused their orientation, and wants accurate information [source: APA 2009].
• Steps: (1) Ask what they were told and what they believe now. (2) Give a brief, accurate summary: APA finds no evidence of change; the Spitzer study's author withdrew support and apologised; orientation is not a disorder [source: APA 2021 press release; Spitzer 2012; MoU v2 rev A]. (3) Invite questions and doubt. (4) Offer written sources if wanted [synthesis].
• Example language (illustrative): "The psychiatrist whose study was often quoted as proof later wrote that his study couldn't show change and apologised for it."
• Watch for: Information delivered as pressure; let the client weigh it. Working when the client feels less blame [synthesis].

4.7 Acceptance and support

• Purpose / when: Throughout; the first element of the APA 2009 affirmative approach, aimed at reducing internalised stigma [source: APA 2009].
• Steps: (1) Offer consistent, unconditional regard for the client and respect for their values and beliefs. (2) Notice and gently name self-condemning language. (3) Reflect strengths and integrity [source: APA 2009; synthesis].
• Example language (illustrative): "You've been trying so hard to be good by your own lights. I see that, and nothing about your attractions changes how I see you."
• Watch for: Over-reassurance that skips the client's conflict. Working when self-criticism softens [synthesis].

4.8 Active coping with stigma and conflict

• Purpose / when: When stigma, family conflict or religious messages drive shame and anxiety; the third element of the APA 2009 approach [source: APA 2009].
• Steps: (1) Identify stigma-based beliefs the client has absorbed. (2) Use cognitive and emotional strategies to examine and soften them. (3) Plan for stressful situations (family events, services). (4) Rehearse responses the client chooses [source: APA 2009; synthesis].
• Example language (illustrative): "When that voice says you're broken, whose voice does it sound like?"
• Watch for: Coping work turning into suppression of feelings; the aim is reduced distress, not hiding [synthesis].

4.9 Identity exploration without a predetermined outcome

• Purpose / when: When the client is uncertain how to identify or live; the fifth element of the APA 2009 approach, which distinguishes orientation (unlikely to change) from sexual orientation identity, affiliation and behaviour (which the client may choose and which can shift) [source: APA 2009].
• Steps: (1) Explore attractions, relationships, values and hopes without steering. (2) Lay out the options the client names (for example coming out, a faith-congruent life, celibacy, partnership) without ranking them. (3) Explore the costs and meanings of each. (4) Revisit over time [source: APA 2009; synthesis].
• Example language (illustrative): "There's no right answer I'm waiting for you to reach. Let's look at what each path would mean to you."
• Watch for: Your own preferred outcome leaking in, in either direction; check in supervision. Working when the client owns the decision [synthesis].

4.10 Integrating faith and sexual identity

• Purpose / when: With religious clients in conflict between faith and orientation; APA 2009 encourages respect for faith and help integrating religious and sexual identities, and cites Throckmorton and Yarhouse (2006) on a "telic" worldview that prioritises living by one's values [source: APA 2009]. Throckmorton and Yarhouse's sexual identity therapy framework aims to help religious clients live congruently with their values without targeting orientation change [uncertain: framework details].
• Steps: (1) Use cultural humility and the Cultural Formulation Interview's spirituality module. (2) Explore the client's tradition, its range of views and the client's own reading. (3) Help the client identify which values matter most. (4) If the client wishes, connect them with welcoming or affirming faith communities or clergy [source: APA 2009; synthesis]. (5) Vieten et al. (2013) spiritual and religious competencies can guide the clinician's own skills [uncertain: not verified].
• Example language (illustrative): "Your faith matters to you and so does honesty about yourself. I'm not here to take either away."
• Watch for: Dismissing faith, or colluding with suppression. A client being pushed by a faith authority into a change programme (see 4.17) [synthesis].

4.11 Mobilising social support

• Purpose / when: When the client is isolated; the fourth APA 2009 element names therapy, self-help groups and welcoming communities, including religious ones [source: APA 2009]. Some former participants reported reduced isolation and community in change groups; support of that kind can be found without change goals [source: APA 2009; synthesis].
• Steps: (1) Map current supports and losses. (2) Identify safe people. (3) Explore groups and communities that fit the client's values. (4) Plan gradual contact [synthesis].
• Example language (illustrative): "The group gave you somewhere to belong. Let's look for belonging that doesn't ask you to change who you are."
• Watch for: Loss of a whole faith or programme community at once; heightened risk then (see 4.4) [synthesis].

4.12 Working with survivors of reparative therapy

• Purpose / when: With adults who went through reparative or other change efforts and feel harmed; former participants describe harm [source: APA 2021 press release]; UN survey respondents reported damage in 98% of cases [source: UN A/HRC/44/53, para 19].
• Steps: (1) Establish safety and pacing; agree the client can stop any topic. (2) Invite the narrative in the client's own words, at their pace, without requiring detail. (3) Name common effects (shame, self-hatred, sexual or relational difficulty, loss of faith, anger, grief for lost years) as understandable. (4) Use trauma-informed methods where trauma symptoms are present. (5) Rebuild the self-account: the client was not broken and did not fail [synthesis].
• Example language (illustrative): "You didn't fail a treatment. You were offered something that the evidence says doesn't work."
• Watch for: Re-traumatisation, dissociation, sudden shame after disclosure; slow down. Working when the client speaks with less self-blame [synthesis].

4.13 Repairing parent-blame narratives

• Purpose / when: When the client or family has absorbed the reparative idea that orientation came from a deficient relationship with a parent [source: Throckmorton 2019 for the theory; synthesis for the work].
• Steps: (1) Identify the narrative and who holds it. (2) Offer accurate information: orientation is not a disorder or a parenting failure [source: MoU v2 rev A]. (3) Separate real family hurts (which may deserve attention) from the causal story. (4) Support reconciliation where wanted [synthesis].
• Example language (illustrative): "Your relationship with your dad may have had real pain in it. That's worth talking about. It isn't what made you gay."
• Watch for: Parents' guilt, or a client's anger at parents having been fuelled by the theory [synthesis].

4.14 Family work: reducing rejection, increasing acceptance

• Purpose / when: With parents or families of a sexual minority person, adult or minor; APA 2009 describes interventions that reduce rejection and increase acceptance as helpful, and says licensed providers can give parents accurate information supporting reconciliation [source: APA 2009].
• Steps: (1) Meet the family's fears and values with respect. (2) Give accurate information on orientation and on change efforts. (3) Identify rejecting behaviours and their effects. (4) Build specific accepting behaviours the family can manage. (5) Plan for faith-community pressures [source: APA 2009; synthesis].
• Example language (illustrative): "You love your son and you're frightened for him. The research says that what protects young people most is feeling accepted at home."
• Watch for: Parents seeking a change programme (see 4.17); a young person at risk at home (see 4.15) [synthesis].

4.15 Safeguarding minors

• Purpose / when: When a child or adolescent is being or may be sent to change efforts. APA 2009 finds no research showing that SOCE given to minors affects adult orientation, raises concern about coercive adolescent inpatient programmes, and asks for the least restrictive services, respect for self-determination and at least the youth's assent [source: APA 2009].
• Steps: (1) Assess the young person's safety at home, school and in any programme, and suicide risk. (2) Seek assent and explain confidentiality limits in age-appropriate terms. (3) Where there is coercion, confinement, abuse or risk of significant harm, follow local child-protection procedures and mandatory reporting duties. (4) Work with parents as in 4.14 where safe. (5) Document [synthesis].
• Example language (illustrative): "You have a right to be safe and to have a say in what happens to you. Some things I'd have to share to keep you safe, and I'll tell you before I do."
• Watch for: Out-of-state or residential programmes; sudden withdrawal from school or friends [synthesis].

4.16 Informed consent and documentation

• Purpose / when: At the start of work with any client raising orientation conflict [synthesis].
• Steps: (1) State plainly what you offer and that you do not offer change efforts. (2) Explain confidentiality and its limits. (3) Record goals in the client's words, the information given and risk assessments [synthesis].
• Example language (illustrative): "My approach is to help you with distress and choices, not to change orientation. Is that something you want to work on together?"
• Watch for: Consent that is really a family's, not the client's [synthesis].

4.17 Working with a client drawn to reparative therapy or a change programme

• Purpose / when: When the client is considering a programme, practitioner or ministry offering change [synthesis].
• Steps: (1) Explore what draws them: hope, community, faith, family pressure. (2) Share the professional bodies' positions and the documented harms and fraud findings (see Harm account). (3) Do not refer, and say so. (4) Respect the adult's autonomy if they go; keep the door open and agree warning signs (worsening mood, suicidal thoughts) that should bring them back. (5) Increase risk monitoring [source: APA 2021 press release; RNS 2015; synthesis].
• Example language (illustrative): "It's your decision. I can't recommend it or refer you, and I'd like us to keep meeting so you have somewhere to talk about how it's affecting you."
• Watch for: Rising hopelessness; financial exploitation (see 4.19) [synthesis].

4.18 Duties when a colleague or institution offers reparative therapy

• Purpose / when: When a colleague, supervisee, service or training body provides or promotes change efforts [synthesis].
• Steps: (1) Raise concerns directly where safe and appropriate. (2) Consult your professional body's guidance; UK MoU signatories have committed to guidance and policies on conversion therapy [source: MoU v2 rev A]. (3) Use the professional body's or licensing board's complaints route where a client is at risk or practice is unethical. (4) If you share a faith community with the client or colleague, review multiple relationships under APA Ethics Code Standard 3.05 [source: APA Ethics Code]. (5) Document concerns and actions [synthesis].
• Example language (illustrative, to a colleague): "I'm concerned that offering change work conflicts with our professional body's position and could put clients at risk. Can we talk about it?"
• Watch for: Covert or renamed change work [source: MoU v2 rev A].

4.19 Legal routes and advocacy

• Purpose / when: When a survivor wants redress or wants to act. In 2015 a New Jersey jury found JONAH liable for consumer fraud and awarded the five plaintiffs the cost of their sessions; a February 2015 ruling held that calling same-sex attraction a mental disorder breached the consumer fraud act [source: RNS 2015]. After Chiles v. Salazar, advocates point to consumer-fraud and malpractice claims as remaining routes [source: Trevor Project 2026].
• Steps: (1) Ask what outcome the client wants (acknowledgement, complaint, compensation, advocacy). (2) Signpost to independent legal advice; do not give legal advice. (3) Support the client through complaints or litigation stress. (4) Support advocacy only at the client's choosing [synthesis].
• Example language (illustrative): "Some people have taken complaints or legal action. A lawyer can tell you what's possible where you live."
• Watch for: Re-traumatisation through proceedings; burnout from advocacy [synthesis].

4.20 The clinician's own stance and supervision

• Purpose / when: Ongoing; the MoU commits signatories to cultural competence training and CPD [source: MoU v2 rev A].
• Steps: (1) Examine your own views on sexuality and religion. (2) Bring cases with orientation or faith conflict to supervision. (3) Keep up with training and current legal status [synthesis].
• Example language (illustrative, to self or supervisor): "Am I steering this client toward an outcome I prefer?"
• Watch for: Over-identification with a survivor's anger or with a family's faith position [synthesis].

5. Handling problems

• Client insists on change and feels rejected by your refusal. Validate the distress, restate what you can offer, explore what change would solve (shame, family, faith, loneliness). If they leave, part warmly and give crisis resources [source: MoU v2 rev A; synthesis].
• Client's distress is acute after leaving a programme or community. Prioritise suicide-risk assessment and a safety plan; 988 (US), Samaritans 116 123 (UK and Ireland); arrange more frequent contact [synthesis].
• Overwhelm or dissociation when recalling change efforts. Stop, ground, return to safety; resume only with consent and at a slower pace; consider trauma-focused referral for the client's trauma symptoms [synthesis].
• Stuck: the client cannot choose between faith and relationships. Shift from deciding to exploring values and small experiments the client chooses; normalise that integration takes time [source: APA 2009; synthesis].
• Resistance to evidence ("the studies are biased"). Do not debate; acknowledge the client's sources, note the professional bodies' positions once, and return to the client's own experience of what helped and what harmed [synthesis]. Be even-handed: APA 2009 notes some participants reported benefits such as reduced isolation and community, alongside those who felt harmed [source: APA 2009].
• Rupture: the client experiences you as having an agenda. Name it, ask what felt pushed, recommit to no predetermined outcome [source: APA 2009; MoU v2 rev A; synthesis].
• Non-attendance after a family or pastor learns of therapy. Check safety by agreed channels; for minors follow safeguarding procedures [synthesis].
• Parents demand you change their child. Decline, explain the evidence, offer family work on acceptance (4.14); where there is risk of significant harm, follow child-protection procedures [source: APA 2009; synthesis].
• Client is still attending a change programme while seeing you. Do not coordinate with or endorse it; monitor mood and suicide risk closely; keep exploring its effects [synthesis].
• Mixed-orientation marriage or couple distress. Offer individual and, by both partners' choice, couple sessions focused on honesty, safety and each partner's choices, with no change goal [synthesis].
• Client wants legal action but fears exposure. Discuss confidentiality and support; signpost to independent legal advice [synthesis].
• Legal uncertainty in the US after Chiles v. Salazar. Professional ethics and the bodies' positions still apply to your own practice; check current state law and your licensing board [source: Trevor Project 2026; synthesis].
• Your own anger or discomfort. Take it to supervision; avoid moralising in session [synthesis].

Harm account

What was actually done

Reparative therapy was a talk-based and group-based change effort aimed at reducing same-sex attraction, grounded in Moberly's theory of a same-sex-parent deficit and "defensive detachment" and developed in Nicolosi's clinical writing (1991) and through NARTH [source: Throckmorton 2019] [uncertain: NARTH's founding year and successor name not verified]. In the 2015 New Jersey case against JONAH (Jews Offering New Alternatives for Healing), the jury heard that clients paid for individual and group sessions and weekend retreats, and the Religion News Service report describes exercises the plaintiffs presented as humiliating and as reliving past abuse; the court had ruled earlier that year that describing same-sex attraction as a mental disorder breached the consumer fraud act, and the jury found the organisation and its leaders liable [source: RNS 2015]. The best-known research claim of success, Spitzer's 2003 study, was reassessed by its author in 2012, who wrote that participants' change reports could not be verified and apologised to the gay community [source: Spitzer 2012]. Religion News Service reported that Exodus International, an umbrella of change ministries, voted to close in June 2013 and that its president apologised (see 074).

What it looked like to clients. Reparative therapy was offered as individual talk therapy by licensed and unlicensed counsellors, often alongside peer groups, weekend retreats and religious ministry [source: RNS 2015; GEO 2021, sections 4.2-4.3]. The UK government's commissioned study of conversion practices (Coventry University for the Government Equalities Office, 2021; interviews with 30 people who had undergone them in the UK) does not use the name reparative therapy, but describes talk-based efforts of this kind: providers attributed same-sex attraction to childhood trauma, a distant relationship with a parent or repressed memories of abuse; psychodrama-style exercises were used to "release" repressed emotion; men were offered touch-based "healthy touch" sessions presented as meeting unmet childhood needs and were encouraged into gender-stereotyped activities such as adventure weekends; and cognitive-behavioural methods treated attraction as an addiction, with avoidance of "triggers" and self-monitoring [source: GEO 2021, sections 4.2-4.3]. The UN Independent Expert likewise describes psychotherapeutic conversion practices as treating sexual diversity as the product of an abnormal upbringing and having clients revisit childhood relationships with their parents (para. 42) [source: A/HRC/44/53]. In the JONAH trial, the Associated Press reported role-plays in which a client struck a pillow representing his mother and a staged locker-room scene in which anti-gay slurs were used (see 076) [source: AP via CBS Philadelphia, 2015]. Interviewees in the UK study often described an early "honeymoon" period of felt change followed by disillusionment [source: GEO 2021].

How it caused harm

• No change in orientation: APA's 2021 resolution finds no evidence of change [source: APA 2021 press release].
• Psychological harm: former participants describe the experience as harmful; APA 2009 records people who felt harmed by recent religious and non-aversive efforts [source: APA 2021 press release; APA 2009]. In the UN Independent Expert's cited survey, 98% of 940 respondents reported damage [source: UN A/HRC/44/53, para 19].
• Suicidality: LGB adults exposed to conversion therapy were nearly twice as likely to think about and attempt suicide, after accounting for adverse childhood experiences [source: Blosnich et al. 2020 via Williams Institute] [uncertain: causal interpretation disputed in a published exchange, not verified].
• Shame and blame: the theory located the cause in parenting and in the person's development, feeding self-blame and family guilt [synthesis, from the theory as described in Throckmorton 2019].
• Wasted time and money: Spitzer apologised to gay people who spent time and energy on reparative therapy believing his study showed it worked [source: Spitzer 2012]; the JONAH jury awarded plaintiffs the cost of their sessions [source: RNS 2015].
• Human rights: the UN Independent Expert describes the practices as discriminatory per se and, citing the IRCT's Independent Forensic Expert Group, as cruel, inhuman or degrading treatment when conducted forcibly; the IFEG also described offering it as deception, false advertising and fraud [source: UN A/HRC/44/53, paras 21, 59, 62].

Recognising it today

• Language: "unwanted same-sex attraction", "healing" or "restoring" gender identity, talk of a same-sex-parent "wound" or "detachment", offers to "reduce" attractions [synthesis, from the theory as described in Throckmorton 2019].
• Settings: faith-based mentoring, ministries and retreats as well as licensed practice; in one US sample most exposure came from religious leaders [source: Blosnich et al. 2020 via Williams Institute]. The MoU notes that conversion therapy may be practised covertly [source: MoU v2 rev A].
• Legal status (dated; may have changed): as of the UN report (May 2020) bans or restrictions existed in Malta (2016 Act), Ecuador (criminal code), Brazil (1999 professional resolution, gender identity added 2018), the Madrid region of Spain (2016 law), Edmonton, Canada (2019 bylaw), and 20 US states plus the District of Columbia and Puerto Rico; the Netherlands has not reimbursed such costs since 2012 [source: UN A/HRC/44/53]. Later national laws (for example in Canada, France, Germany, Mexico and Spain) [uncertain: not verified]. On 31 March 2026 the US Supreme Court ruled 8–1 in Chiles v. Salazar that Colorado's conversion-therapy law, as applied to a counsellor's talk therapy, regulates speech based on viewpoint; it reversed the lower courts, which had not applied sufficiently rigorous First Amendment scrutiny, and sent the case back (SCOTUSblog; NPR). Its effect on other states' laws is [uncertain].

What to do instead and how to help those harmed

• Supported care: the APA 2009 affirmative approach (acceptance and support, comprehensive assessment, active coping, social support, identity exploration and development, without a priori outcomes) [source: APA 2009]; work that reduces distress and supports self-acceptance as the MoU permits [source: MoU v2 rev A].
• Survivors: trauma-informed individual work (4.12), repair of blame narratives (4.13), support networks (4.11), suicide-risk assessment with 988 (US) and Samaritans 116 123 (UK and Ireland) (4.4).
• Families: acceptance-building family work and accurate information (4.14) [source: APA 2009].
• Minors: safeguarding, mandatory reporting and child-protection routes (4.15) [source: APA 2009; synthesis].
• Reporting and legal routes: professional-body and licensing-board complaints; consumer-fraud and malpractice claims as advocates describe them [source: RNS 2015; Trevor Project 2026]; the UN Independent Expert calls for specific claims to be investigated and, where relevant, prosecuted [source: UN A/HRC/44/53, para 65].

Sources

• APA (2021) press release: APA resolutions on sexual orientation and gender identity change efforts
• APA (2021) Resolution on Sexual Orientation Change Efforts, cited as summarised in the press release above [uncertain: full text not verified]
• American Psychological Association (2009). Report of the American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation. Washington, DC: APA; summary: Insufficient evidence that sexual orientation change efforts work, says APA (APA press release, 5 August 2009)
• Memorandum of Understanding on Conversion Therapy in the UK, Version 2, Revision A (2019), BACP
• UN Human Rights Council (2020) A/HRC/44/53, Practices of so-called "conversion therapy", Report of the Independent Expert on SOGI
• Spitzer, R. L. (2012). Spitzer reassesses his 2003 study of reparative therapy of homosexuality. Archives of Sexual Behavior, 41(4), 757. doi:10.1007/s10508-012-9966-y
• Religion News Service via The Christian Century (2015) Gay-to-straight conversion therapy group committed consumer fraud, jury finds
• Williams Institute (2020) summary of Blosnich, Henderson, Coulter, Goldbach and Meyer, Sexual Orientation Change Efforts, Adverse Childhood Experiences, and Suicide Ideation and Attempt Among Sexual Minority Adults (American Journal of Public Health, 2020)
• Throckmorton, W. (2019) Who invented the therapy in those Joseph Nicolosi books banned by Amazon?
• The Trevor Project (2026) Chiles v. Salazar
• SCOTUSblog, Chiles v. Salazar case page
• NPR (via KUNC), Supreme Court strikes Colorado ban on conversion therapy, 31 March 2026
• Exodus International to shut down after president's apology to gay community (Religion News Service, 20 June 2013)
• APA Ethics Code
• ICD-10-CM Z65.8 (Unbound Medicine)
• Moberly, E. R. (1983) Homosexuality: A New Christian Ethic [uncertain: publication details not verified]
• Nicolosi, J. (1991) Reparative Therapy of Male Homosexuality [uncertain: publication details not verified]
• Throckmorton, W. and Yarhouse, M. A. (2006) sexual identity therapy framework, as cited in APA 2009 [uncertain: not verified]
• Vieten, C. et al. (2013) spiritual and religious competencies [uncertain: not verified]
• Jowett, A., Brady, G., Goodman, S., Pillinger, C. and Bradley, L. (Coventry University) (2021). Conversion therapy: an evidence assessment and qualitative study. Government Equalities Office, published 29 October 2021
• Associated Press via CBS Philadelphia: "Jury finds promise of gay conversion therapy was a fraud" (June 2015)