320.101 In sections 320.102 to 320.106, conversion therapy means a practice, treatment or service designed to change a person’s sexual orientation to heterosexual or gender identity to cisgender, or to repress or reduce non-heterosexual attraction or sexual behaviour. For greater certainty, this definition does not include a practice, treatment or service that relates
(a) to a person’s gender transition; or(b) to a person’s exploration of their identity or to its development.
Unfortunately, that definition repeats a common error: It treats sexual orientation and gender identity as the same. As pointed out previously however, there is no such thing as conversion therapy for gender identity: The existing evidence pertains to sexual orientation and only to sexual orientation. [For a review, see Cantor (2019) or Cantor (2018).]
Although the proposal includes language apparently aimed at protecting legitimate therapy from the ban, the language is ambiguous (at best), so provides only ambiguous protection. Especially in the current environment, we have every reason to expect extremists to declare that anything and everything other than immediate affirmation counts as conversion therapy. Because there do not exist any manuals or research on conversion therapy for gender identity (again, there actually is no such thing), I do not know how a person, court, or policy-maker might decide what might be in or out. Everyone has, so far, merely adopted something from sexual orientation conversion therapy attempts and imagined a gender identity equivalent. One would reasonably predict a chill effect across licensed mental health providers making the service essentially unavailable.
I do not understand the language of part (a). A practice that “relates to a person’s gender transition” would seem to cover every aspect of the entire issue, including efforts to avoid a gender transition. Similarly incomprehensible to me is part (b), which together with the intro says, “conversion therapy means a practice…designed to change gender identity to cisgender [but] does not include a practice...that relates...to its development”. It is not possible for something to relate to development and not relate to change. Moreover, because the (purported) point of conversion therapy is to develop a new orientation/identity, this language would appear to excuse all of what it is attempting to ban. I can imagine only that there must be legal/political meanings I am not appreciating, as this appears to me to be self-contradictory word salad.
Next, to refer to anything as an “exploration” is to assume there exists something solid and unchanging that we need only to observe. Although the evidence indicates that sexual orientation fits that description, there is no evidence that gender identity does.
Ultimately, the text does not resolve the basic situation: A child attends a clinic and does not know what their identity is. “Exploration” can meaningfully include doing one’s best to feel comfortable with the original gender before approving medical or other dramatic interventions. The efforts to become comfortable in the original gender would be indistinguishable from (or misrepresentable as) conversion therapy wherein cisgender is the goal rather than being the step that happens to have the least associated risk and therefore gets tried first.
I know this is a bit off topic, but has anyone told you that you look a bit like Dr. Zachary Smith?ReplyDelete
I wasn't aware of this bill coming forth until I saw you having a lovely chat with Benjamin Boyce and Dr. Debra Soh. Thanks so much for your work on creating clarity on this.ReplyDelete
LOL Exactly my Halloween costume this year! (I've also been told I look like Carl Sagan or Mr. Spock father...)ReplyDelete
I'm so incredibly upset about all of this and think we are destroying so many children's lives by "affirmation," not to mention the professional lives of those who see what unscientific nonsense it is.ReplyDelete
Hi James, I am very curious about your thoughts on this. As you have highlighted in previous posts, once someone enters into adolescents their gender identity seems to be very stable, which would put it closer to sexual orientation as something that is solid and unchanging. Or am I missing something? Prior to that age, I completely agree, there seems to be more fluidity.ReplyDelete
We also know from other studies that exclusively focusing on trying to change someone's gender identity to match their birth sex is associated with negative outcomes, at least when this is judged retrospectively (Turban et al., 2020). To me this would suggest focusing on becoming comfortable with birth sex should not be 100% the focus, but instead a clinician should aim for a lets try things out and see the results.
It is true that prepubescent gender dysphoria often resolves during puberty, but I wouldn't therefore compare the subsequent stability to a sexual orientation: Sexual orientation does not have that pubertal break-point to begin with.Delete
There have not been any follow-up studies of "conversion therapy" for gender dysphoria: All such studies have been about sexual orientation only. Turban et al. (2020) is not an outcome study at all, and problems in its methodology leave unclear what, if anything, can be concluded from it. Evaluations of his paper can be found at:
Sexual orientation does not have the same breakpoint, but most LGB individuals don't identify as LGB until they hit puberty. This is partially based on clinical and social observation but also Calzo, & Blashill, 2018) who showed .2% of youths aged 9-10 identify as gay or bisexual, which is much lower than the base rate of LGB identities after puberty. Once these youths begin identifying as LGB they seem very stable, similar to trans individuals who's identity seems stable at puberty. Outside of the puberty breakpoint I am not clear as to what is different about the stability? They are not identical but to me they seem similar. Could you elaborate?Delete
Thank you for the references on the responses by the way, I had not read them before. I agree with the criticism that the Turban paper seemed to classify therapies in a binary way, and any therapist should know that there is a range of treatments, and we have to be careful not to classify the boy who says he is a girl because he likes barbies as trans because there is exploration needed.
May I ask what you suggest for therapies you would want to see a full clinical trial on? Just for my perspective, I think you and I agree that we need to have some exploration of identifying with gender present at birth, and I personally believe this should coincide with exploration of cross gendered feelings for a period of time before there are larger social transitions (ideally not until after puberty). From what I have seen of you, I would assume you are against conversion therapies in the way that they have been done with LGB people (using aversive behavioural techniques to reinforce same gender identification and teaching about how a child is sick), as these seem like they would be damaging to any individual regardless of the trait you were trying to change.