Dr (Med) Andre Van Mol explains how the UK government’s proposed ‘conversion therapy’ ban against counselling choice puts already-at-risk sexual minorities in harm’s way.
The UK Government’s proposed ban on so-called “conversion” therapy (a pejorative, and ill-defined term used as a jamming tactic) is premised on incomplete research and political activism masquerading as science. A ban on counselling choice would condemn already at-risk sexual minority individuals to further harm.
Partisan report
Demonstrating the disturbing absence of viewpoint diversity common within professional organizations, the GEO-commissioned Coventry Report’s presentation of the literature on the subject was profoundly partisan. [i] Citation bias was evident in using the usual anti-SOCE [sexual orientation change efforts] studies, most of which over the past 20 years share the same two fatal weaknesses.
First, these studies show selection bias through employing flawed designs that exclude most all who have been helped by counselling choice (and who would likely recall more positive experiences with it) by recruiting only GLBT-identified adults at locations and websites sexual minority persons who no longer identify as LGBT would not frequent.
Second, the research cited to suggest harms from therapy consistently failed to compare pre and post therapy mental health status, thus rendering the assigning of blame to therapy impossible. [ii]
This second error violates the principle of temporal precedence wherein the alleged cause (in this case, counselling) must precede the alleged effect (in this case, harm from counselling) to prove a cause-effect relationship. Otherwise, correlation is not causation. Thus, these anti-counselling studies cannot make a claim against therapy.
Therapy generally ‘improves mental health’
Several studies in the past year alone properly accounted for timing of counselling choice and demonstrated that such therapy generally improves mental health on several levels.
The Coventry Report cited Blosnich (2020) to suggest counselling harm, as one example, apparently unaware it had been challenged in the literature in both a critical letter [iii] and a full re-evaluation of the data.
Prof. Paul Sullins, “in the strongest representative sample to date of sexual minority persons,” reanalysed the Generations study from the Williams Institute used by Blosnich and found precisely the opposite findings. Per Sullins, “experiencing higher suicidality appears to encourage recourse to SOCE, which in turn strongly reduces suicidality, particularly initial suicide attempts. Restrictions on SOCE deprive sexual minorities of an important resource for reducing suicidality, putting them at substantially increased suicide risk.” [iv]
Pela and Sutton (2021) completed a prospective study of a group of 75 men in psychotherapy using Reintegrative Therapy™ with repeated measurements taken over two years. The results were statistically significant reductions of same-sex attraction, increased opposite-sex attraction, and improvement in well-being. The authors noted that their findings demonstrate “therapy can be effective, beneficial, and not harmful.” Also, “It is no longer true that there is no scientific evidence concerning whether SAFE-T [sexual attraction fluidity exploration in therapy] is helpful or harmful.” [v] A study using a convenience sample of 125 men by Sullins, Rosik, and Santero showed similar findings overall. [vi]
Coventry missed the memo. In fact, more than one.
Even as a matter of general principle, rejecting LGB identification was shown to not be harmful in a 2021 study published by a socio-politically diverse research team titled, “Sexual Minorities who Reject an LGB Identity: Who Are They and Why Does It Matter?” [vii]
According to their results, “Contrary to minority stress theory and professional assumptions, rejecting LGB identification was not associated with health differences in depression, anxiety, and social flourishing.”
Consensus is not a proxy for truth
The Coventry Report made reference to there being over 60 mental health associations supporting a ban on counselling, but consensus is not a proxy for truth.
Consensus can be a threat to science and health care when it is a herd mentality. More so if it is a Castro consensus, named after Fidel Castro, wherein the appearance of near-unanimous agreement is a result of coercion. [viii]
A counselling therapy ban is group think, and hesitation to speak out against gender affirming therapy (GAT) (actually, transition affirming [TAT]) in gender dysphoric minors is evidence of a Castro consensus wherein therapist and medics fear for their careers, employment, and safety.
Recall that 35 psychologists resigned over 3 years from the NHS Gender Identity Development Service due to being “unable to properly assess patients over fears they will be branded ‘transphobic…’” [ix]
There is no pro-GAT/TAT consensus. In fact, opposition to transitioning of minors with gender dysphoria and transgender identificaion brings together people and organisations across the aisles of politics, faith, sexuality, and even gender ideation.
The Government’s consultation announcement on the proposed “conversion therapy” ban carries the preordained conclusions that therapy is harmful, coercive and profitable. [x] The Coventry Report noted repeatedly that those they interviewed declared their involvement with counselling was generally voluntary, thus not coerced, and that “aversive techniques were not reported by interviewees.”
Gender affirming therapy is not the standard of care
I have thus far demonstrated the harm claim is poorly supported. But if anything deserves to be described as profitable, it is the subjecting of minors to chemical castration and the surgical mutilation of healthy organs in the name of gender affirming therapy.
Gender affirming therapy (GAT) (better phrased transition affirming – TAT) permanently and prematurely medicalises children for a condition that overwhelmingly resolves by adulthood.
Conservatively, the scientific literature shows a rate of desistance (resolving) of gender dysphoria and associated trangender identification in youths of 85% by the end of adolescence. [xi] [xii] [xiii] [xiv] [xv] [xvi] GAT/TAT is not proven effective, not proven safe, and does not reduce suicides. The experimental nature of GAT/TAT was stated repeatedly in the Bell v Tavistock decision in 2020. [xvii]
The overwhelming majority of gender dysphoric/transgender-identified youth have pre-existing mental health issues and/or neuro-developmental disabilities, notably autism spectrum disorder. Again, these conditions predate their gender dysphoria rather than being caused by it. Also usually present are high rates of family issues and other adverse childhood experiences. Studies confirming this come from Finland, [xviii] Australia, [xix] the USA, [xx] [xxi] and across Europe,[xxii] to name but a few.
This is one reason why the APA Handbook on Sexuality and Psychology cautions that “Premature labeling of gender identity should be avoided,” [xxiii] as “This approach runs the risk of neglecting individual problems the child might be experiencing…” In 2020, the Nordic Journal of Psychiatry warned, “An adolescent’s gender identity concerns must not become a reason for failure to address all her/his other relevant problems in the usual way.” [xxiv] And a 2020 paper stipulated, “trans-identification and its associated medical treatment can constitute an attempt to evade experiences of psychological distress.” [xxv] The Coventry Report was profoundly mistaken in stating that providing “unconditional acceptance” was according to most “evidence-based recommendations.” (p.8)
GAT/TAT is not the standard of care. The 2017 guidelines from the US Endocrine Society, the first professional organisation to support transition in selected minors, carried this disclaimer on page 3895: “The guidelines cannot guarantee any specific outcome, nor do they establish a standard of care…” Psychology professor Ken Zucker noted in 2019. “…the field suffers from a vexing problem: There are no randomized controlled trials (RCT) of different treatment approaches…” [xxvi] Psychiatry professor Stephen Levine stated in 2020. “…the treatment of trans individuals are not based on controlled or long-term comprehensive follow-up studies…” [xxvii]
The international standard of care for youth with gender dysphoria is watchful waiting (due to the probability of desistance by adulthood) and including psychological evaluation and support for the child and family (due to the probability of mental health issues, adverse experiences, home issues, etc.) – exactly what counselling bans prohibit.
The Coventry Report was further mistaken in claiming that “no final judicial decision has overturned a ban on conversion therapy.” Several therapy bans have been overturned in judicial review in the United States, such as Otto v City of Boca Raton in an 11th Circuit Court appeal in 2020 and Vazzo v Tampa in 2019. [xxviii] [xxix] Other cases are pending in high US courts.
The proposed ban on therapy puts already at-risk youth at further risk by prohibiting what the child and family need most.
Andre Van Mol, MD
Board-certified family physician
Co-chair, Committee on Adolescent Sexuality, American College of Pediatricians
Co-chair, Sexual and Gender Identity Task Force, Christian Medical & Dental Assoc.
Footnotes
[iii] Rosik CH, Sullins DP, Schumm WR, Van Mol A. Sexual orientation change efforts, adverse childhood experiences, and suicidality. Am J Public Health. 2021;111(4): e1–e2. Acceptance Date: December 30, 2020. DOI: https://doi.org/10.2105/AJPH.2021.306156
[v] Pela, C., & Sutton, P. (2021). Sexual Attraction Fluidity and Well-being in Men: A Therapeutic Outcome Study. Journal of Human Sexuality, Vol. 12.
[vi] Sullins DP, Rosik CH and Santero P. Efficacy and risk of sexual orientation change efforts: a retrospective analysis of 125 exposed men [version 1; peer review: 2 approved] F1000Research 2021, 10:222 https://doi.org/10.12688/f1000research.51209.1
[vii] Rosik, Christopher & Lefevor, G. & Beckstead, Lee. (2021). Sexual Minorities who Reject an LGB Identity: Who Are They and Why Does It Matter?. Issues in law & medicine. 36. 27-43.
[viii] Jarred Allen, Cindy Lay, Geroge D. Montanez. A Castro Consensus: Understanding the Role of Dependence in Consensus Formation. Proceedings of the 2020 Truth and Trust Online (TTO 2020), pages 12–20, Virtual, October 16-17, 2020. https://www.cs.hmc.edu/~montanez/pdfs/allen-2020-castro-consensus.pdf
[xi] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. P.455.
[xii] Bockting, W. (2014). Chapter 24: Transgender Identity Development. In Tolman, D., & Diamond, L., Co-Editors-in-Chief (2014) APA Handbook of Sexuality and Psychology (2 volumes). Washington D.C.: American Psychological Association, 1: 744.)
[xiii] Zucker, K. J. (2018). The myth of persistence: response to “A critical commentary on follow-up studies and ‘desistance’ theories about transgender and gender nonconforming children” by Temple Newhook et al. International Journal of Transgenderism, 19(2), 231–245. Published online May 29, 2018. http://doi.org/10.1080/15532739.2018.1468293
[xiv] Singh D, Bradley SJ and Zucker KJ (2021) A Follow-Up Study of Boys With Gender Identity Disorder. Front. Psychiatry 12:632784. doi: 10.3389/fpsyt.2021.632784
[xv] Cohen-Kettenis PY, et al. “The treatment of adolescent transsexuals: changing insights.” J Sex Med. 2008 Aug;5(8):1892-7. doi: 10.1111/j.1743-6109.2008.00870.x. Epub 2008 Jun 28.
[xvi] Ristori J, Steensma TD. Gender dysphoria in childhood. Int Rev Psychiatry. 2016;28(1):13-20.
[xviii] Kaltiala-Heino R, Sumia M, Työläjärvi M, Lindberg N. Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development. Child and Adolescent Psychiatry and Mental Health (2015) 9:9..
[xix] Kozlowska K, McClure G, Chudleigh C, et al. Australian children and adolescents with gender dysphoria: Clinical presentations and challenges experienced by a multidisciplinary team and gender service. Human Systems. 2021;1(1):70-95. doi:10.1177/26344041211010777
[xx] Becerra-Culqui TA, Liu Y, Nash R, et al. Mental Health of Transgender and Gender Nonconforming Youth Compared With Their Peers. Pediatrics. 2018;141(5):e20173845.
[xxii] Heylens G, et al. “Psychiatric characteristics in transsexual individuals: multicentre study in four European countries,” The British Journal of Psychiatry Feb 2014, 204 (2) 151-156; DOI: 10.1192/bjp.bp.112.121954.
[xxiii] W. Bockting, Ch. 24: Transgender Identity Development, in 1 American Psychological Association Handbook on Sexuality and Psychology, 744 (D. Tolman & L. Diamond eds., 2014).
[xxiv] Riittakerttu Kaltiala, Elias Heino, Marja Työläjärvi & Laura Suomalainen (2020) Adolescent development and psychosocial functioning after starting cross-sex hormones for gender dysphoria, Nordic Journal of Psychiatry, 74:3, 213-219, DOI: 10.1080/08039488.2019.1691260
[xxv] Withers, R. (2020) Transgender medicalization and the attempt to evade psychological distress. J Anal Psychol, 65: 865– 889. https://doi.org/10.1111/1468-5922.12641.
[xxvi] Zucker, K. J. (2019), Debate: Different strokes for different folks. Child Adolesc Ment Health. doi:10.1111/camh.12330
[xxvii] Levine, S.B. Reflections on the Clinician’s Role with Individuals Who Self-identify as Transgender. Arch Sex Behav (2021). https://doi.org/10.1007/s10508-021-02142-1
