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Pennsylvania becomes the 27th state to restrict ‘conversion therapy’

Advocates and medical experts say the move could have a powerful impact on young LGBTQ people in the state and beyond

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Over the last decade, more than half the country has moved to protect LGBTQ youth from “conversion therapy,” a widely discredited practice that aims to “cure” queer and transgender people. This week, Pennsylvania became the 27th state to restrict conversion efforts, in a move advocates and medical experts say could have a powerful impact on young LGBTQ people in the state and beyond.

Pennsylvania Gov. Tom Wolf (D) signed an executive order Tuesday that would prevent conversion therapy practitioners from using state funds. The action also directs state agencies to discourage conversion efforts and establish culturally appropriate care and services for LGBTQ people.

“Conversion therapy is a traumatic practice based on junk science that actively harms the people it supposedly seeks to treat,” Wolf said in a press release.

Wolf cited the fact that the conversion efforts have been rejected by most medical and scientific professionals, and has been linked to worse mental health outcomes for LGBTQ youth.

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Troy Stevenson, senior campaign manager for advocacy and government affairs at the Trevor Project, an LGBTQ suicide prevention group, called the order “hugely significant.”

“Our research shows that just a single affirming adult in a young person’s life makes them 40 percent less likely to attempt suicide in the past year,” Stevenson said. While a politician may not have the same impact on a young person’s life as a teacher, parent or coach, he said, “it is a huge message to young people across the Commonwealth that says that they do have that support.”

The action comes amid an increasingly polarized landscape for LGBTQ rights, with much of the energy focused on queer and trans youth. While some states have passed laws restricting the health care, recreational activities and educational support that LGBTQ youth can access, other states have moved to advance protections.

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California was the first state to ban conversion efforts in 2012, according to data from the nonprofit Movement Advancement Project. Since then, 26 states have instituted partial or full bans on conversion therapy for minors. (This doesn’t include local prohibitions, which can be found in cities in Alaska, South Carolina and more.)

For decades, conversion efforts have been denounced by the vast majority of medical associations in the country, including the American Medical Association, the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry, which states that these interventions “lack scientific credibility and clinical utility” and could harm patients.

The underlying premise of conversion therapy, medical experts note, is that same-sex attraction or nonconforming gender expression and identity are pathological — the result of physical or mental illness.

These kinds of “therapies,” practiced by both medical providers and faith-based groups, have taken many forms and been given an array of names over the years, such as “reparative therapy” or “aversion therapy,” which involved giving patients electric shocks or inducing vomiting if they looked at gay pornography or “cross-dressed.” In the most extreme cases, doctors would perform surgeries or chemical castrations.

But the practice has shifted over time. It is now primarily aimed at minors, with therapists using psychotherapy, most commonly “talk” therapy, to push the patient to reject their gender or sexual identity.

Jack Turban, an incoming assistant professor of child and adolescent psychiatry at the University of California at San Francisco, said conversion efforts have been linked to “dramatically higher odds of a range of poor mental health outcomes,” including increased suicidality.

Even when they are not physically abusive, conversion efforts are “very emotionally harmful” and send the message to the patient that who they are is “wrong or shameful,” Turban said. Still, Turban said, conversion therapy is a “fringe practice” among mental health professionals, and most providers reject these efforts.

But the issue has been muddied in recent years as trans youth make up a greater share of those targeted by this practice, experts say. Some therapists attempting to convert trans kids may misleadingly refer to their practice as “gender exploratory therapy.”

The World Professional Association for Transgender Health (WPATH) standards of care advises that mental health professionals not impose a binary view of gender, and “give ample room for clients to explore different options for gender expression.” As Turban described it, proper exploratory therapy means an “open-ended” exploration of “all the nuances of gender and sexuality,” like talking to young people about gender roles and how they relate to them, or how they relate to their body.

“You’re just helping someone understand themselves,” he said.

However, some therapists may have a predetermined goal of discouraging a young patient from expressing their sexuality or gender if it isn’t straight or doesn’t align with their sex at birth, Turban said. In these cases, a therapist may be forcing their own narrative on a child or adolescent instead of letting them explore their own.

“You may not know that [therapists are] practicing conversion efforts, because generally, they’re not publicly advertising this. It’s more something that they’re spreading through word of mouth or among parents,” he said. “Probably the only way you’re going to know is if you see them doing public speeches or making comments on social media.”

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Protecting minors from conversion therapy can be challenging, experts say. Some state governments have tried to do this by revoking clinicians’ licenses for unethical or dangerous practices. But it’s unclear to what extent actions like denying state funds could help, because that would only affect providers who receive public funding, Turban said.

There are also ongoing questions about the legality of banning conversion therapy. Some legal and medical professionals have concerns over the extent to which state and local governments should regulate medical practice, particularly as more lawmakers try to ban gender-affirming care for minors. (Unlike conversion efforts, gender-affirming care is widely considered safe and effective by the medical community.)

Some also view conversion efforts as a free-speech issue. The 11th Circuit Court of Appeals blocked bans in Palm Beach County and Boca Raton in 2020 on the grounds that it violated therapists’ First Amendment rights. The federal appeals court refused to reconsider that decision in July.

“The perspective enforced by these local policies is extremely popular in many communities,” Judge Britt Grant wrote in a concurring opinion. “And the speech barred by these ordinances is rejected by many as wrong, and even dangerous. But the First Amendment applies even to — especially to — speech that is widely unpopular.”

At a time when trans and queer Americans find their rights debated in statehouses and courts across the country, the mental health impact of Wolf’s executive order and other policies supporting LGBTQ youth should not be overlooked, advocates and medical experts say.

One 2017 study found that states that passed marriage equality bills saw lower rates of adolescent suicide attempts, compared with states that did not — with the greatest effect among LGBTQ youth.

“It wasn’t the direct impact of the bill” — these adolescents weren’t getting married — Turban said. “It was the fact that these bills have a really big symbolic value and an impact on the national conversation.”

There is also a valuable public education message when policies like these are enacted, said Stevenson of the Trevor Project — one that is especially important at a time when misinformation about queer and trans people are being spread at alarming rates.

“This type of action, this type of attention shows ... this is not something that should be done,” Stevenson said. “And just that alone, we believe, could reduce the number of young people who this is inflicted upon.”