AOTA’s Societal Statement Denouncing Conversion “Therapy”

The American Occupational Therapy Association (AOTA) asserts that occupational therapy practitioners have a role in opposing the harmful, discriminatory practice of conversion “therapy” and protecting LGBTQIA+ people. 1 This assertion is congruent with the AOTA (2020a) Occupational Therapy Code of Ethics principles of Justice, Beneficence, and Nonmaleficence as well as the Occupational Therapy Practice Framework’s definition of Occupational Justice (AOTA, 2020b). Occupational therapy practitioners should never participate in or promote the principles of conversion “therapy” practices as part of occupational therapy intervention.

Conversion “therapy,” also referenced by names including reparative therapy, ex-gay ministry, sexuality counseling, and healing sexuality brokenness, refers to efforts aimed at changing an individual’s gender identity, gender expression, or sexual orientation in any way, with the intention of conformity toward heterosexual or cisgender 2 norms (American Medical Association [AMA], 2019; Higbee et al., 2022). Conversion “therapy” efforts expand among websites, books, youth camps, and other environments; however, most commonly they are performed by mental health professionals and religious and spiritual advisors (Human Rights Campaign & National Center for Lesbian Rights, n.d.). The strategies employed include talk therapy and aversion treatments such as electric shock, humiliation tactics aimed at instigating shame, and hypnosis to induce vomiting (Higbee et al., 2022). All of the aforementioned techniques lack scientific evidence and are not only ineffective but also deeply damaging and have been condemned by most major mental health and medical organizations in the United States for several decades (AMA, 2019; American Psychiatric Association, 2018; American Psychological Association, 2021; National Association of Social Workers, 2015).

The Williams Institute on Sexual Orientation and Gender Identity at the University of California, Los Angeles, published a brief in 2019 reporting that nearly 700,000 LGBT individuals had been subjected to conversion “therapy” in the United States, of whom approximately 350,000 reported being in their adolescence at the time of these traumatizing experiences (Mallory et al., 2019). Young people exposed to these efforts to change sexual orientation, gender identity, or expression reported increased rates of suicide attempts and higher incidents of severe depression and substance use, as well as anxiety, lower self-esteem, sexual dysfunction, and social challenges (AMA, 2019; Higbee et al., 2020; Mallory et al., 2019). At its core, conversion “therapy” pathologizes LGBTQIA+ people and violates their autonomy, furthering societal stigma against those who do not conform to socially constructed heterosexual and/or cisgender binaries.