安娜在一系列没寫成書的講座中報稱成功像治療神经症般治療同性戀。她於1949年在《国际精神分析杂志(英语:The International Journal of Psychoanalysis)》上發表了《關於治療男同性戀者個案的一些臨床評論[注 2]》。她認為需要重點留意同性性幻想與「奮鬥」之間如何互相影響,而後者會使對父親的認同失去。並認為應告訴求診者選擇在性事上被動的伴侶可以讓他享受;而選擇在性事上主動的伴侶則可以讓他重奪失去的男性氣質。她宣稱這樣的解釋能使遭到壓抑的閹割焦慮連同兒時的自戀一併激活,並消解其對異性性交的恐懼。[24]
弗洛伊德对該名希望治好兒子的母親的回信於1951年的《美国精神病学杂志》上刊登[24]。次年美國精神醫學學會所出版的《精神疾病診斷與統計手冊第一版》(DSM-I)把同性戀定性為一种精神障礙[50]。弗洛伊德死後的30年間,轉換療法得到了美國大部分精神病學機構的認可,此一情況直到石牆起義才为终结[51]。歐文·比伯(英语:Irving Bieber)等人所擇寫的《同性戀:男同性戀的心理分析研究(英语:Homosexuality: A Psychoanalytic Study of Male Homosexuals)》於1962年对外發行,他們於當中總結道:「雖然改變性傾向對於一些人而言較为容易,但根據我們的判斷,擁有改變性傾向的強烈渴求的同性戀者皆有此一可能性」[52]。1969年紐約的石牆酒吧發生了一宗暴動事件(石牆暴動),而這對同性戀權利運動有一定象徵意義,並被視為同性戀解放鬥爭的一個新里程碑。此一事件發生之後,對轉換療法的批評便日益增加,此外亦使人更為關注DSM-I對同性戀所下的定義[50]。在經過多年同志活動家的批評和精神病學家之間的激辯後,美國精神醫學學會最终於1973年從手冊中移除了「同性戀」此一診斷。此一改動的支持者引用了金賽和伊夫林·胡克(英语:Evelyn Hooker)等研究者的研究作證據。精神科醫師兼APA命名委員會成員羅伯特·斯皮策(Robert Spitzer)在導致這一改動的事件中起了一定作用。批評者則認為這是同志活動家施壓的結果,並要求該學會就此進行一次公投。於是學會於1974年進行了一次公投,結果美國精神醫學學會的決定獲得了58%的多數支持[50]。
新泽西州和加利福尼亚州對轉換療法的禁令於立法隨後便受到了挑戰。美國地區法院法官弗雷達·L.沃爾夫森(英语:Freda L. Wolfson)駁回了新澤西州父母對此的上訴,他們的理據為聲稱它侵犯了其權利,阻止他們對受同性所吸引的下一代進行治療。在《多伊訴克里斯蒂》一案中(Doe v. Christie),沃爾夫森寫道:「父母的基本權利,並不包括選擇國家合理地認為有害或無效的治療的權利……否則會產生難以想像及無意的後果。」新澤西州高級法院的一名法官於2015年2月10日裁定,以把同性戀形容為異常或精神疾病為基礎的轉換療法違反了《新澤西州消費者欺詐法》[159]。《新澤西法律周刊[注 18]》網站上的一篇文章指,這遭認定為「美国的首次[159]」。美國聯邦第九巡迴上訴法院於2013年8月29日同時對《皮卡訴布朗案》(Pickup v. Brown)和《韋爾奇訴布朗案》(Welch v. Brown)作出裁決,於當中維持加州的禁令[160]。第九巡迴上訴法院於2016年8月再次支持該州的禁令,指立法禁止轉換療法並不違憲[161]。美國最高法院一再駁回對禁止轉換療法的法律的挑戰[162]。
在探討是否應提供治療時,改變性傾向的支持者一般都会关注求診者的自決權。瑞金大學的馬克·雅爾豪斯寫道:「心理學家有容許個體採取遏制同性愛慕的治療措施的道德責任。這樣不僅是為了透過容許客戶自由選擇治療方式,來维護其尊嚴、自主權和代理权,還為了表達對多樣性的關注[198]」。擁有基督教背景的格羅夫城市學院(英语:Grove City College)的亞荷斯和思罗克莫顿则認為,該程序應尊重求診者的價值觀體系,且已有證據證明其是有效的[199]。哈爾德曼同樣認為,如果客戶對轉換療法的情況有充分了解,那麽其便有權接受治療:「對於某些人而言,其宗教認同是非常重要的,因此他們認為比起放棄自己的宗教信仰,還是改變性傾向比較切實……如果有人試圖通過轉換療法來解決性傾向和靈性之間的衝突,他們的念头於許多時候並不能打消」[20]。
美國兒科學會的青少年委員會於2013年指出:「我們從未指示醫師轉介求診者去接受『轉換療法』或『修復療法』;該些治療是無效的,並可能會增加LGBTQ個體的内在恥辱、痛苦和抑鬱情緒,從而對其構成傷害」[205][206]。美國基督教輔導協會(英语:American Association of Christian Counselors)於2014年修改了其倫理準則,於當中以「鼓勵同性戀者保持獨身」取缔「對同性戀者推廣轉換療法」[207]。《美國醫學會倫理學雜誌》上的一篇論文認為,如果一名兒科醫師獲悉一名12歲求診者的父母正為其尋求轉換療法,該名醫師應以建議態度去表示其反對「無效且可能有害的介入措施」,同時在「他們的宗教信仰反對同性戀」此事上保持文化敏感。論文的著者認為,一名维護醫學倫理的醫師應將求診者的利益放於其父母的宗教信仰之上,並保密地向求診者提供以被欺凌的LGBT青年為對象的諮詢渠道,同時向父母建議以LGBT兒童的家長為對象的有關資源[208]。英國的主要醫學團體在2014年發表反對轉換療法的聯合共同聲明。支持該聲明的醫學團體包括英国心理治疗协会、英国精神分析协会、英國皇家精神科醫學院、英國輔導及心理治療協會、英國心理學會、英國國家輔導學會[209]。
澳洲媒体集团費爾法克斯傳媒(英语:Fairfax Media)於2018年發表一篇調查,當中指出:「在澳洲各地認為LGBTI人士可以或應該改變的組織都在努力繼續進行相關工作。轉換療法的實踐目前隱藏於福音派教會和事工內,他們會為該些人士驅邪、祈禱以及進行輔導,並以『牧養關懷』之名義包裝之。他們也出席一些宗教學校的課程,及在衛生專業人員的私人辦公室內繼續接受轉換療法。他們亦被推至各種以『自我改善』或『靈性治療』为名的網上課程和導師中[220]」。一項針對五旬宗-靈恩教會的調查指出,LGBTI教友的選擇一般有四種:拒絕出櫃、出櫃但承諾保持單身、嘗試轉換療法、離開教會。大部分人所採取的選擇為第四種,儘管他們在此以前一般會嘗試「痛苦地調和他們的信仰和他們的性表象[221]」。該研究為「轉換療法仍存於宗教社群中」此一論點提供了佐證。費爾法克斯傳媒的調查發表以後,維多利亞州的總理丹尼爾·安德魯斯呼籲澳大利亞總理麦肯·腾博支持將轉換療法的執行列為非法行為。聯邦衛生部長格雷格·亨特指出這個問題已是一個國家層面的問題,因為儘管政府沒有將資金投放於改變性傾向的嘗試,但「支持轉化同性戀的意識形態已悄悄地在學校經由全国学校牧师精神指导计划(英语:National School Chaplaincy Programme)推廣」[222]。報告指出維多利亞州的法律只適用於醫療服務提供者[220],因此不會涵蓋宣稱「在幫助受同性吸引的人士按照他們的信仰生活」的宗教團體和慈善機構[222]。一名轉換療法的倖存者克里斯跟安德魯斯一起呼籲聯邦政府取締轉換療法,其指:「我以前不斷向上主祈求令自己遠離同性戀,而這幾乎殺了我[223][224]」。他在Change.org上發表了一份請願書,呼籲腾博和亨特採取行動,取締轉換療法,並宣稱:「我不斷向上主祈求要麼令我治好,要麼殺了我;我非常沮喪,我想死」[224]。
^ 8.08.18.28.38.48.5American Psychiatric Association. Position Statement on Therapies Focused on Attempts to Change Sexual Orientation (Reparative or Conversion Therapies). American Psychiatric Association. 2000 [2007-08-28]. (原始内容存档于2011-01-10). In December of 1998, the Board of Trustees issued a position statement that the American Psychiatric Association opposes any psychiatric treatment, such as "reparative" or conversion therapy, which is based upon the assumption that homosexuality per se is a mental disorder or based upon the a priori assumption that a patient should change his/her sexual homosexual orientation. ... The validity, efficacy and ethics of clinical attempts to change an individual's sexual orientation have been challenged. To date, there are no scientifically rigorous outcome studies to determine either the actual efficacy or harm of "reparative" treatments. (references omitted)
^Dieckmann, G.; Horn, H.J.; Schneider, H. Hitchcock, E.R.; Ballantine, H.T.; Meyerson, B.A. , 编. Long-term Results of Anterior Hypothalamotomy in Sexual Offences. Modern Concepts in Psychiatric Surgery (Elsevier/North Holland Biomedical Press). 1979: 187–195.
^Milar, Katherine S. The myth buster. Monitor on Psychology (American Psychological Association). 2011, 42 (2): 24 [2016-11-25]. (原始内容存档于2017-01-05).
^Zimmerman, Jonathan. Echoes of an intolerant past. Philadelphia, PA. Philadelphia Inquirer. 2012-05-30. prominent psychiatrist Robert Spitzer renounced his famous 2001 study claiming that some gays could become straight via so-called reparative therapy.
^Besen, Wayne. 2012: Many Celebrations, Few Setbacks. Huffington Post. 2013-01-02 [2013-01-03]. (原始内容存档于2013-01-05). Spitzer renounced his infamous 2001 study that said that some highly motivated homosexuals could change from gay to straight.
^WPA Position Statement on Gender Identity and Same-Sex Orientation, Attraction, and Behaviours. wpanet.org. World Psychiatric Association. March 2016 [2018-04-20]. (原始内容存档于2016-04-17). There is no sound scientific evidence that innate sexual orientation can be changed. Furthermore, so-called treatments of homosexuality can create a setting in which prejudice and discrimination flourish, and they can be potentially harmful. The provision of any intervention purporting to 'treat' something that is not a disorder is wholly unethical. ... WPA considers same-sex attraction, orientation, and behaviour as normal variants of human sexuality. It recognises the multi-factorial causation of human sexuality, orientation, behaviour, and lifestyle. It acknowledges the lack of scientific efficacy of treatments that attempt to change sexual orientation and highlights the harm and adverse effects of such 'therapies'.
^Powell, Lois; Hein, Laura. Position Statement On Reparative Therapy(PDF). ispn-psych.org. International Society of Psychiatric-Mental Health Nurses. [2018-04-20]. (原始内容(PDF)存档于2017-05-17). In fact 'reparative or conversion therapies' have not supported authentic change in sexual orientation itself. ... There is no conclusive evidence that 'reparative therapy' is beneficial to patients. ... Harmful sequelae of reparative therapy reported in the literature include anxiety, depression, avoidance of intimacy, sexual dysfunction, PTSD, loss of self-confidence and self-efficacy, shame/guilt, self-destructive behavior, and suicidality.
^McGeorge, Christi R.; Carlson, Thomas Stone; Toomey, Russell B. An Exploration of Family Therapists' Beliefs about the Ethics of Conversion Therapy: The Influence of Negative Beliefs and Clinical Competence With Lesbian, Gay, and Bisexual Clients. Journal of Marital and Family Therapy. 2015, 41 (1): 42–56. ISSN 0194-472X. doi:10.1111/jmft.12040.
^Committee on Adolescence, Homosexuality and Adolesence(PDF), Pediatrics, Official Journal of the American Academy of Pediatrics, 1993, 92 (4): 631–634 [2007-08-28], (原始内容存档(PDF)于2007-08-11)
^ 182.0182.1Australian Medical Association. AMA Position Statement – Marriage Equality. 2017-05-20 [2018-03-17]. (原始内容存档于2017-07-06). There are real and significant mental and physiological health impacts arising from structural discrimination, and the AMA supports moves to eliminate it in all of its forms. All Australian doctors should offer sensitive, non-discriminatory care to all of their patients, regardless of their sexual orientation or gender identity.
^ 183.0183.1183.2183.3183.4183.5Australian Psychological Society. APS Position Statement on the use of psychological practices that attempt to change sexual orientation(PDF). Australian Psychological Society. 2015 [2018-03-17]. (原始内容存档(PDF)于2018-03-17). (emphases in original) APS strongly opposes any approach to psychological practice or research that treats lesbians, gay men, and bisexual people as disordered. The APS also strongly opposes any approach to psychological practice or research that attempts to change an individual's sexual orientation. There is no peer-reviewed empirical psychological research objectively documenting the ability to 'change' an individual’s sexual orientation. Furthermore, there is no peer-reviewed empirical psychological research demonstrating that homosexuality or bisexuality constitutes a disorder. In addition to the lack of empirical support for the claim that sexual orientation can be changed, empirical evidence indicates that attempts at changing sexual orientation can be harmful.
^ 184.0184.1Rosenstreich, Gabi. LGBTI People: Mental Health and Suicide(PDF) 2nd. Sydney: National LGBTI Health Alliance. 2013: 10 [2018-03-17]. (原始内容(PDF)存档于2015-04-20). Experiences of LGBTI people include violence, refusal or reluctance to treat or if treating to acknowledge a health concern directly related to their sexual orientation, gender identity or intersex status. They also include homophobic and transphobic treatment paradigms, for example, pathologising LGBTI identity as a symptom of mental ill-health and using conversion therapies for same-sex attracted people (also known as reparative therapy). This practice claims to change sexual orientation and has been condemned the Australian Psychological Society and numerous other Australian and international professional associations as not only not working (as it is based on false premises) but also as unethical and harmful to the wellbeing of those who undergo it.
^Royal Australian College of General Practitioners. SG16 – Sex, sexuality, gender diversity and health contextual unit. 2016 [2018-03-17]. (原始内容存档于2017-04-23). [G]eneral practitioners (GPs) [must] have a good understanding of the diversity of sex, sexuality and gender in Australia, and to approach every individual in a holistic and non-judgemental way, minimise discrimination and obstacles to care access, and optimise the quality of healthcare that they provide. The title of this contextual unit is intentionally broad to encompass individuals who may identify as lesbian, gay, bisexual, transgender, intersex, queer (LGBTIQ), asexual, pansexual, those who do not identify with any particular gender or sexual orientation, and those who prefer not to be categorised. The purpose of this unit is to challenge the 'binary' approach to provision of healthcare by GPs, in which assumptions and judgements are made about an individual's sex, sexuality and/or gender based on appearances and/or what is considered by the individual GP to be 'normal.' This approach is essentially flawed and typically impacts the quality of care that can be provided. ... GPs have an important role to play in advocating to reduce discrimination and in creating meaningful therapeutic relationships with LGBTIQ individuals to improve healthcare access. The establishment of high-quality therapeutic relationships and delivery of quality care to these individuals draws on the core skills in The Royal Australian College of General Practitioners' (RACGP's) 2016 curriculum.
^ 187.0187.1Committee for Therapeutic Interventions and Evidence-Based Practice, Royal Australian and New Zealand College of Psychiatrists. Position Statement 60 – Sexual orientation change efforts. Royal Australian and New Zealand College of Psychiatrists. 2015 [2018-03-17]. (原始内容存档于2018-01-17). The harm such therapies can cause to individuals, the contribution they make to the misrepresentation of homosexuality as a mental disorder, and the prejudice and discrimination that can flourish through the use of such therapies has led all major medical organisations to oppose the use of sexual orientation change efforts. Recommendations * The RANZCP does not support the use of sexual orientation change efforts of any kind * Mental health workers must avoid misrepresenting the efficacy of sexual orientation change efforts when providing assistance to people distressed by their own or others' sexual orientation * Mental health workers should assist people distressed by their sexual orientation by care and treatment approaches that involve acceptance, support, and identity exploration. These should aim to reduce the stigma associated with homosexuality and respect the person’s religious beliefs.
^Questions and Answers: Sexual Orientation in Schools – What do we know?. canada.ca. Government of Canada. [2018-04-21]. (原始内容存档于2017-12-22). A student's sexual orientation is not a 'lifestyle' choice and under no circumstances should a student be counselled to change or attempt to 'repair' their sexual orientation. These kinds of 'conversion' or 'reparative' therapies have been criticized and discouraged by the American Psychological Association and by many teacher associations across Canada. Clinical research has demonstrated that these approaches are largely ineffective, ignore the impact of social stigmatization on mental health, and in some cases, can be extremely dangerous, particularly for vulnerable youth. Instead of attempting to change a student's sexual orientation, educators, administrators, and health care professionals should focus on helping the youth and their family to develop active coping mechanisms to address issues related to internalized homophobia, stigma, prejudice and discrimination.
^Kjær, Reider. Look to Norway? Gay Issues and Mental Health Across the Atlantic Ocean. Journal of Gay & Lesbian Psychotherapy (Haworth Medical Press). 2003, 7 (1/2): 65. doi:10.1300/J236v07n01_05. In October 2000, the General Assembly [of the Norwegian Psychiatric Association] voted overwhelmingly (about 90%) in favor of the following statement ... Homosexuality is no disorder or illness, and can therefore not be subject to treatment. A 'treatment' with the only aim of changing sexual orientation from homosexual to heterosexual must be regarded as ethical malpractice, and has no place in the health system.
^Tozer, Erinn E.; McClanahan, Mary K., Treating the Purple Menace: Ethical Considerations of Conversion Therapy and Affirmative Alternatives, The Counseling Psychologist, 1999, 27 (5): 722–742, doi:10.1177/0011000099275006.
^ 213.0213.1213.2Australian Psychological Society. APS Code of Ethics(PDF). Australian Psychological Society. 2007-09-27 [2018-03-17]. (原始内容存档(PDF)于2018-03-12). The Australian Psychological Society Limited (the Society) adopted this Code of Ethics (the Code) at its Forty-First Annual General Meeting held on 27 September 2007. ... Reprinted October 2016
^Codes, guidelines and policies. Psychology Board of Australia. 2018-01-29 [2018-03-17]. (原始内容存档于2018-03-13). The Board has adopted the Australian Psychological Society Code of Ethics for the profession.
^APS Code of Ethics. Australian Psychological Society. 2018 [2018-03-17]. (原始内容存档于2018-03-17). In 2010 the Psychology Board of Australia adopted the APS Code of Ethics for the profession.
^Jennings, Mark A. C. Impossible Subjects: LGBTIQ Experiences in Australian Pentecostal-Charismatic Churches. Religions (MDPI). 2018, 9 (2). article 53. doi:10.3390/rel9020053.
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