Gay conversion therapy, as it is known, supposedly helps gay people overcome same-sex attractions. But mainstream psychologists say the therapy is ineffective, unethical and often harmful, exacerbating anxiety and self-hatred among those treated for what is not a mental disorder.
In 2013, two cases involving the therapy to convert gay people into heterosexuals hit the courts, with one seeking to sue counselors who offer the therapy and the other seeking to defend them.
Here are five things you need to know about the therapy and the current lawsuits.
Why psychologists say conversion therapy doesn't work
Homosexuality is not considered a mental disorder, so the American Psychological Association (APA) does not recommend "curing" same-sex attraction in any case. Instead, societal ignorance, prejudice and pressure to conform to heterosexual desires are the real dangers to gay people's mental health, according to a 1997 statement on "conversion" or "reparative" therapy by the APA.
A 2009 APA task force found that conversion therapies, despite being touted by religious organizations, have little evidence to back them up. A review of studies from 1960 to 2007 found only 83 on the topic, the vast majority of which did not have the experimental muscle to show whether the therapies achieved their stated goals. (Many of the people studied in the early years were court-mandated to take the therapies, adding a coercive element to those outcomes.)
The best-quality studies were more recent and qualitative, the APA task force found, meaning they focused not on the statistical effectiveness of treatment, but of the subjective experience.
"These studies show that enduring change to an individual's sexual orientation is uncommon," the task force wrote in their 2009 report. The participants continued to report same-sex attractions after the conversion therapy, and were not significantly more attracted to the opposite gender.
These studies did find that conversion therapy could be harmful, however. Negative effects included "loss of sexual feeling, depression, suicidality and anxiety."
What happens in conversion therapy?
Because conversion therapy is not a mainstream psychological treatment, there are no professional standards or guidelines for how it is conducted. Early treatments in the 1960s and 70s included aversion therapy, such as shocking patients or giving them nausea-inducing drugs while showing them same-sex erotica, according to a 2004 article in the British Medical Journal.
Other methods included psychoanalysis or talk therapy, estrogen treatments to reduce libido in men, and even electroconvulsive therapy, in which an electric shock is used to induce a seizure, with side effects such as memory loss. [7 Absolutely Evil Medical Experiments]
More recently, people who have been through conversion therapy report talk therapy that emphasizes pseudoscientific theories, such as the idea that an overbearing mother and a distant father make a child gay. In an April 2012 essay in The American Prospect, writer Gabriel Arana describes his "ex-gay" therapy experience. His therapist blamed his parents for Arana's homosexuality, and urged him to distance himself from his female best friends.
Chaim Levin, one of the men suing Jonah for deceptive practices, says that he quit conversion therapy after his therapist had him strip down and touch himself to "reconnect with his masculinity," according to the New York Times.
What's happening in the courts?
Two legal challenges are targeting conversion therapy. The first is a civil suit in New Jersey in which four former clients of a counseling group called Jonah are suing for deceptive practices. The patients argue they paid thousands of dollars for therapies that did not rid them of same-sex attractions, and that they then had to pay for mainstream therapy to repair the damage done by the conversion therapy. [5 Myths About Gay People Debunked]
In a second case in California, a federal judge is hearing arguments against a new state law that bans conversion therapy for minors. The bill was signed into law in September 2013. Conservative legal groups claim the law is a violation of the right to free speech, freedom of religion and privacy.
How did conversion therapy get started?
The desire to turn gay people straight goes way back. In 1920, Sigmund Freud wrote of a lesbian patient whose father wanted to see her converted to heterosexuality. Freud echoed modern psychologists by responding that changing sexual orientation was difficult and unlikely. He offered to see the woman anyway, but later broke off the therapy due to her hostility. In 1935, Freud went even further, writing to a woman who wanted her homosexual son converted that homosexuality "is nothing to be ashamed of, no vice, no degradation; it cannot be classified as an illness."
Other psychologists throughout the early mid-1900s believed homosexuality could be changed and recommended a variety of treatments. One of the stranger attempts was an effort by Viennese endocrinologist Eugen Steinach to transplant testicles from straight men into the scrotums of gay men in an attempt to rid them of same-sex desires. It didn’t work.
One of the most prominent advocates of conversion therapy in the 1940s and 50s was Edmund Bergler, who saw homosexuality as a perversion and believed he could "cure" gay people with a punishment-based, confrontational therapy style.
Once the American Psychiatric Association stopped classifying homosexuality as a mental disorder in 1973, conversion therapies lost support. But religious-right organizations such as Exodus International and Focus on the Family's Love Won Out took up the charge, promoting their own "ex-gay" therapies. A small group of psychologists, splitting with their peers, continue to promote the therapies, founding the conversion therapy organization NARTH, or the National Association for Research & Therapy of Homosexuality. The group has religious links; for example, one of its founders and former president, psychologist Joseph Nicolosi, is a one-time spokesman for Focus on the Family. [The 10 Most Controversial Psychiatric Disorders]
One study says it works
Groups that promote conversion therapy often point to a single study to support their work. In 2003, famed psychiatrist Robert Spitzer, who spearheaded the removal of homosexuality from the American Psychiatric Association's mental disorder list in 1973, reported in the journal Archives of Sexual Behavior that interviews with conversion therapy patients suggested that some people could change their sexual orientation.
The paper was incendiary and highly criticized, given that it relied on interviews with patients instead of measurable benchmarks of same-sex desires. Conservative groups were delighted to have support from Spitzer, who wasn't tainted with religious bias or anti-gay ideology; gay organizations felt betrayed.
In the end, however, Spitzer came to agree with his critics. There was no way to confirm that what his interviewees said was true, he wrote in 2012 to the editor of the journal Archives of Sexual Behavior. The study, he said, was fatally flawed.
"I believe I owe the gay community an apology for my study making unproven claims of the efficacy of reparative therapy," Spitzer wrote.