FiLiA Responds to the Conversion Therapy Consultation

February 22, 2022 J Stein

This post is a copy of the FiLiA response to the recent government Conversion Therapy Consultation which sought views on proposals on how to ban conversion therapy practices, which particularly affect LGB&T people. More information on the consultation can be found here.

Our response to this consultation centres women and girls, in line with our aims as a feminist charity.

Do you agree or disagree that the Government should intervene to end conversion therapy in principle?
Somewhat agree.

In principle ending “conversion therapy” is an important issue for women and girls. It is correct for the Government to wish to do more to protect people from coercive and abusive measures that aim to change a woman’s sexuality or sense of self. The legislative proposal as it stands appears to unhelpfully conflate the practice of attempts to change sexual orientation with the subject of psychological and medical interventions for gender dysphoria.

· Sexual orientation is thankfully no longer pathologised. Clinicians have zero justification to offer “therapies” to modify the minds or bodies of lesbian and bisexual women because of their sexuality.

· Gender dysphoria remains significantly linked with medicine, in the form of clinical interventions (such as hormones or surgery). The NHS and private clinicians routinely provide “therapies” for gender dysphoria, which aim to alter the bodies and minds of women and girls because of how they identify.

There is broad consensus that “conversion therapy” that attempts to change lesbian or bisexual women’s sexual orientation is both damaging and futile. In contrast, the question of how to best support women and girls who are in distress because they feel disgust towards their female bodies or restricted by society’s expectations of women is a matter of ongoing debate.

Feminist analyses of sex and gender in this context have been suppressed or labelled hateful. The Government should be sensitive to the fact that what gets called “conversion therapy” when it comes to gender dysphoria may be in the eye of the beholder, particularly in the absence of clear definitions or sufficient evidence on this subject.

This is especially so in the context of distress felt by young and/or vulnerable girls and women, particularly those experiencing same-sex attraction. Giving a new masculine name, chest binder and testosterone to a teenage girl who is being bullied at school for fancying another girl could be viewed as a form of conversion therapy for homosexuality. The actions “convert” the girl from lesbian to, instead, being labelled a transmasculine person, changing the social interpretation of her homosexuality to one that is more heteronormative.

A firm commitment to protect all lesbian and bisexual women from all forms of “conversion therapy” requires much closer examination of such cases. How might routine administration of medical interventions to girls who are distressed about their bodies or behaviour conflict with the interests of lesbian and bisexual women (many of whom may have felt similar discomfort at times during their lives, but were told “it gets better” rather than “better go to a gender clinic”)?

Rather than adding legislation with conflicting interests and concepts that could negatively impact women’s rights, Government resources might be directed elsewhere to better support women who have experienced various forms of “conversion” related abuse. These priorities could include:

· providing better trauma-informed mental health care for women,

· funding more specialist-led safe shelters and programmes for lesbian and bisexual women (as well as females who identify as masculine and/or nonbinary) escaping abuse,

· taking proper actions to prevent and prosecute perpetrators of violence (including hate crimes, rape & coercive control),

· investigating reasons for overt as well as internalised misogyny and lesbophobia, and reducing sources of harmful messaging in society (noting for example social media trends, violent misogyny in pornography and the objectification of women via the sex industry more broadly),

· treating lesbian & bisexual asylum seekers with dignity. It is disgraceful that the Home Office treats many women who may be survivors of “conversion therapy” so poorly when they seek refuge in the UK[1].

Question 1: To what extent do you support, or not support, the Government’s proposal for addressing physical acts of conversion therapy?

Somewhat not support

Physical acts of abuse and harm, including sexual violence, are already criminal in law. Sexual orientation and transgender identity are considered aggravating factors under hate crime legislation. Rebranding certain forms of violence as “conversion therapy” may suggest these forms of abuse somehow stand apart as “therapy” due to the ideology of the perpetrator. Acts of violence have recognised names such as grievous or actual bodily harm and sexual assault in law. These remain the same acts of physical and sexual violence regardless of whether they are carried out in the name of “conversion therapy.” Violence against women should be called what it is.

One of FiLiA’s aims is to defend women’s human rights. Justice must be sought for women whose abusers try to excuse their violence as attempts to change women’s sexual orientation or identity. However, rather than adding a new law, existing frameworks should be better implemented so that more crimes against women are taken seriously, properly investigated, and perpetrators convicted. The prosecution and conviction rates for rape, for example, are abysmal.

In July 2020 official figures showed that a victim/survivor reporting rape had around a one in 70 chance of the case being charged, and because of the diminished volumes of prosecutions, convictions are at their lowest numbers on record.[2]

Furthermore, the inclusion of gender dysphoria in any “conversion therapy” legislation complicates the issue of what constitutes a “physical act of conversion” – because the interventions for gender dysphoria often have significant physical effects on the body, such as: rib fractures from chest constriction, testosterone-induced changes including vaginal atrophy, loss of breast tissue through double mastectomy and infertility after hysterectomy. The Government has included in this proposal that attempts to “convert” anyone who is “non-transgender to transgender” should equally be considered “conversion therapy”. Yet, is it increasingly recognised that some women might undergo treatments for gender dysphoria, but later feel more comfortable with their female sex and cease to identify as transgender. Some of these women may deeply regret the medical interventions administered to them for gender dysphoria. For such women, what happened to them can therefore be seen as a form of “conversion therapy” - a failed attempt to turn them from “non-transgender to transgender.” For women who are lesbian, this takes on an additional dimension of “conversion therapy,” namely their medicalisation could be viewed as an attempt to turn the perception of their sexuality from “homosexual to heterosexual.”

It is difficult to estimate how many women could be affected by ultimately inappropriate physical interventions for gender dysphoria, because so much about this area is unknown. We do not know how often women stop taking medical interventions for gender dysphoria and experience regret or detransition. Different numbers are given in the literature, but this is complicated by loss of follow-up and inconsistency in how these terms are defined. Two small UK studies from 2021 examined patient records from a gender clinic and a GP practice, respectively, reporting estimated rates of between 6.9%[3] and around 10%.[4] Such figures may not be representative.

To get a sense of the possible scale of regret around taking medical interventions for gender dysphoria, Stonewall UK estimated that about 1% of the UK population could identify as transgender,[5] which would be around 670,000 people. Not all of these individuals would pursue medical intervention. However, if one hypothesised that around half of that estimated population wished to do so, this would mean approximately 335,000 people. If 6.9% of those individuals regretted those medical interventions, this could mean 23,115 people experienced “physical conversion” attempts from “non-transgender to transgender.”

These numbers are hypothetical, but the Government’s own commissioned research by Jowett et al[6] reported a lack of data on “conversion therapy” around gender dysphoria. The qualitative component of their research included just 6 respondents who identified as transgender and/or nonbinary, and the glossary of their report had no definition of detransition. The omission of this topic is regrettable. Proposals on “conversion therapy” should not ignore detransitioned women’s voices and experiences.

FiLiA supports the protection of all people from physical harms, but the Government’s suggestion as it stands may not do much in the way of helping women and girls abused for their sexual orientation. A preferable strategy might be to provide better resources to more effectively enforce existing legislation, which would allow more lesbian and bisexual women to seek justice.

Question 2. The Government considers that delivering talking therapy with the intention of changing a person’s sexual orientation or changing them from being transgender or to being transgender either to someone who is under 18, or to someone who is 18 or over and who has not consented or lacks the capacity to do so, should be considered a criminal offence. The consultation document describes proposals to introduce a new criminal law to this end. How far do you agree or disagree with this?

Strongly disagree.

Question 3: How far do you agree or disagree with the penalties being proposed?

Strongly disagree.

Question 4: Do you think that these proposals miss anything?

Yes.

FiLiA recognises that talking therapy that specifically aims to change a person’s sexual orientation is abusive and damaging. The legislative proposal, however, conflates this with therapy for gender dysphoria, which is much more contested - an area of uncertainty and legitimate debate. Legislation should not potentially criminalise some types of therapy around women’s distress over their bodies and/or social expectations.

A woman who seeks support as she is extremely uncomfortable in her own skin may benefit from clinicians who are open to exploring issues related to her life from a holistic perspective, and therefore would be hesitant to affix the reductive label of “gender dysphoria” to her issues. Such talking therapy might resist simplistic explanations and instead seek to help her understand her previous experiences, possibly unpicking internalised messages of sexism, misogyny and/or homophobia. Therapists may hold as one possible outcome that the woman will accept (even celebrate) her female body and unique personality, instead of assuming it would be better for her to be re-labelled as “other” than woman and assisted to change her body. Such therapists should not be criminalised. Clinicians who deliver talking therapies are already overseen by regulatory bodies with professional codes of practice.

FiLiA considers this legislative proposal to have insufficient recognition of the current social context around gender dysphoria. There has been a rapid increase of people, especially young girls, who identify as other than their sex. This phenomenon is seen throughout gender identity clinics in the Western world and the reasons for the rise in referrals remain unexplained. Many of these girls have histories of trauma. Distress over gender identity is linked to higher prevalence of issues such as autism, anxiety, depression and a history of adverse childhood events including sexual abuse[7]. This area of healthcare needs clinicians with compassion for the whole person and who are able to provide trauma-informed support. However, fewer clinicians will want to engage with these girls and women if there is a threat of therapists being criminalised. The legislation may well damage the very population the Government seeks to help.

Furthermore, women who later regret medical interventions for gender dysphoria can be left with serious physical and emotional harms, alongside a deep sense of shame. These effects may be compounded by social stigma, self-blame, and health problems that go unaddressed by clinicians. Women with regret who detransition are often ostracised from their previous LGBTQ+ networks, and report a wider lack of community support or understanding.[8]

The complex interplay between homophobia and gender dysphoria, and by extension the difficulty in interpreting “conversion therapy” in the context of talking therapies around homosexuality versus gender dysphoria, is further outlined in a 2021 study of detransitioners by Dr Lisa Littman. She found that: “Despite the absence of any questions about this topic in the survey, nearly a quarter (23.0%) of the participants expressed the internalized homophobia and difficulty accepting oneself as lesbian, gay, or bisexual narrative by spontaneously describing that these experiences were instrumental to their gender dysphoria, their desire to transition, and their detransition. All of the participants in this category indicated that they were either same-sex attracted exclusively or were same-sex attracted in combination with opposite-sex attraction (such as bisexual, pansexual, etc.). The following responses were written in as “other” for the question about why participants transitioned: “Transitioning to male would mean my attraction to girls would be ‘normal’”; “being a ‘gay trans man’ (female dating other females) felt better than being a lesbian, less shameful”; “I felt being the opposite gender would make my repressed same-sex attraction less scary”; “I didn't want to be a gay man.” Some participants described that it took time for them to gain an understanding of themselves as lesbian, gay, or bisexual as seen in the following: “At the time I was trying to figure out my identity and felt very male and thought I was transgender. I later discovered that I was a lesbian…”; and “Well, after deep discovery, I realized I was a gay man and realized that a sexual trauma after puberty might [have] confused my thought. I wanted to live as a gay man again.” Several natal female respondents expressed that seeing other butch lesbians would have been helpful to them as shown by the following: “What would have helped me is being able to access women's community, specifically lesbian community. I needed access to diverse female role-models and mentors, especially other butch women.” [9]

These findings are especially pertinent for girls and young women. Gender nonconforming behaviour in childhood has long been acknowledged to have an association with homosexuality in adulthood, and many girls go through discomfort with their changing bodies during adolescence (and indeed beyond, as women are given cultural messages that their bodies are faulty or imperfect over the course of their lifetimes). It is very worrying if girls pushing against gendered expectations or showing disdain for puberty become more likely to be socially, medically and institutionally labelled as having gender dysphoria. This would exclude other possibilities for those girls.

Finally, FiLiA notes the paucity of scientific evidence around the effects of medical interventions for gender dysphoria. This was recognised in the judicial review of Bell v Tavistock. While the findings of the Cass Review on gender dysphoria in children are awaited, their assessments of the literature further highlight the absence of reliable data.[10]

Question 9: The consultation document describes proposals to introduce conversion therapy protection orders to tackle a gap in provision for victims of the practice. To what extent do you agree or disagree that there is a gap in the provision for victims of conversion therapy?

Somewhat disagree

Question 10: To what extent do you agree or disagree with our proposals for addressing this gap we have identified?

Somewhat disagree

FiLiA considers that existing safeguarding legislation is adequate to protect children and vulnerable adults. Various forms of abuse, including coercive control, physical and sexual violence, are already criminal. The issue seems more to be one of applying these frameworks appropriately and consistently, so that victims of “conversion therapy” (in other words, targeted abuse that perpetrators are attempting to justify on ideological grounds) are not considered exceptions to safeguarding. All women and girls should be given appropriate protections and agencies should work together to safeguard them. In family law, the focus should be on better communication, rather than additional court orders.

Question 11: Charity trustees are the people who are responsible for governing a charity and directing how it is managed and run. The consultation document describes proposals whereby anyone found guilty of carrying out conversion therapy will have the case against them for being disqualified from serving as a trustee at any charity strengthened. To what extent do you agree or disagree with this approach?

Strongly disagree

The proposal lacks clarity around what will be interpreted as “conversion therapy” and seems likely to make it more difficult for women to speak freely about and organise around their sex-based rights. One of FiLiA’s aims is to amplify the voices of women, particularly those who are less often heard or purposefully silenced. Women need to be able to hold workshops on subjects that are important to them, but might be challenging in the context of gender dysphoria. A topic such as violence against lesbians[11] or the importance of providing lesbian-only spaces,[12] might include discussion of resisting medical interventions on the lesbian body, threats of physical or sexual violence faced by lesbians for asserting boundaries against males regardless of their feelings of identity, or feminist theorising that challenges predominant narratives of gender dyphoria. Women working for women’s rights should not risk becoming erroneously re-labelled as involved in “conversion therapy” or disqualified from being trustees.

Question 12: To what extent do you agree or disagree that the following organisations are providing adequate action against people who might already be carrying out conversion therapy?

· Police: Neither agree or disagree

· Crown Prosecution Service: Neither agree or disagree

· Other statutory service: Neither agree or disagree

Question 13: To what extent do you agree or disagree that the following organisations are providing adequate support for victims of conversion therapy?

· Police: Neither agree or disagree

· Crown Prosecution Service: Neither agree or disagree

· Other statutory service: Disagree

· The Home Office is not providing enough support for asylum seekers and refugees who are victims of conversion therapy in other countries.

Question 14: Do you think that these services can do more to support victims of conversion therapy?

Yes

While little evidence has been provided over the extent of conversion therapy within the UK, one area for improvement is clear. The Home Office could review and improve its policies to better support women asylum seekers and refugees who are lesbian or bisexual (or otherwise challenge regressive gender norms). The Government could do more to support and protect those fleeing various forms of conversion therapy (including threats of abuse and torture) in other countries.

Question 15: Do you have any evidence on the economic or financial costs or benefits of any of the proposals set out in the consultation?

Question 16: There is a duty on public authorities to consider or think about how their policies or decisions affect people who are protected under the Equality Act 2010. Do you have any evidence of the equalities impacts of any proposals set out in the consultation?

FiLiA is concerned that these proposals may add a legal mechanism that will criminalise certain feminist views on these issues, meaning there is a possible detrimental impact of these proposals on sex (women), sexual orientation and freedom of religion or belief. Women’s sex-based rights are currently difficult for women to speak openly and honestly about, because of the misogyny and hostile climate they face when doing so. Despite this, some brave women do speak on this issue, articulating their concerns, experiences and analyses with reason and compassion. Legal cases, such as those brought by Keira Bell, Maya Forstater, Raquel Rosario Sanchez, Allison Bailey and Sonia Appleby, demonstrate some of the existing personal, reputational and professional challenges faced by women who wish to exercise their lawful right to interrogate how aspects of policies around gender dysphoria might impact women’s rights, or change potentially risky clinical practices.

Further legislation around conversion therapy may make restrictions on what can be said much tighter. Legal proposals to ban conversion therapy for gender identity may become politically weaponised in various ways, such as against women who question why a greater proportion of children are now rejecting their own sex and highlight the clinical risks of transitioning, or against teachers covering topics of sexual orientation and gender dysphoria in schools. Many of those silenced or subject to punitive measures will likely be women, given already visible backlash against feminist activists. For example, the arrests of Marion Millar in Scotland[13] (see: and Jennifer Swayne in Wales[14] (see:) raise significant concerns over the potential for additional carceral measures being taken to punish women whose opinions are deemed unpalatable by their political opponents.

Implications of a ban on “conversion therapy” also need to be understood in a wider context of public opinion, and whether there is a perception that various idiosyncratic views on sex and gender are being undemocratically imposed upon the majority, with minimal or stifled debate and very little clarity of terms or implications.[15] Lesbians are at the forefront of sounding dissent and raising alarm over the harms of policies that prioritise gender reassignment over sex and sexual orientation.[16]

The potential criminalisation of feminists, mothers, counsellors, nurses, teachers or other community members under “conversion therapy” legislation seems poised to make tensions between groups worse. These proposals as they stand may divide people, negatively impact relations between people with different protected characteristics and harm the very people the legislation was intended to protect.

[1] https://www.bbc.co.uk/news/stories-51636642

[2] https://rapecrisis.org.uk/media/2396/c-decriminalisation-of-rape-report-cwj-evaw-imkaan-rcew-nov-2020.pdf

[3] https://www.cambridge.org/core/journals/bjpsych-open/article/access-to-care-and-frequency-of-detransition-among-a-cohort-discharged-by-a-uk-national-adult-gender-identity-clinic-retrospective-casenote-review/3F5AC1315A49813922AAD76D9E28F5CB

[4] https://www.mdpi.com/2227-9032/10/1/121/htm#B51-healthcare-10-00121

[5] https://www.stonewall.org.uk/truth-about-trans#trans-people-britain

[6] https://www.gov.uk/government/publications/conversion-therapy-an-evidence-assessment-and-qualitative-study/conversion-therapy-an-evidence-assessment-and-qualitative-study

[7] https://journals.sagepub.com/doi/full/10.1177/26344041211010777

[8] https://post-trans.com and https://www.tandfonline.com/doi/full/10.1080/00918369.2021.1919479

[9] https://link.springer.com/article/10.1007%2Fs10508-021-02163-w

[10]https://www.evidence.nhs.uk/document?id=2334889&returnUrl=search%3Fq%3Dgender%2Bhormones and https://www.evidence.nhs.uk/document?id=2334888&returnUrl=search%3fq%3dgender%2bdysphoria.

[11] https://www.filia.org.uk/latest-news/2019/9/30/violence-against-lesbians and https://www.filia.org.uk/latest-news/2020/4/7/violence-against-lesbians-filia-conference-2019

[12] https://www.filia.org.uk/latest-news/2021/12/3/recreating-lesbian-spaces