Beyond Labels: The Essential Differences Between Gender Affirmation and Conversion Therapy

In today’s political landscape, the delivery of gender-affirming care for youth and adults has become a much-debated topic. So debated in fact, that a local church recently compared the delivery of gender-affirming care for individuals who are trans or non-binary, to providing liposuction for a person who is struggling with anorexia. These views were based on the work of psychologist Paul McHugh, who is an outspoken critic of gender-affirming care and has argued that homosexuality is a choice. In light of these arguments, I would like to explore the differences between gender-affirming care and “reparative” or “conversion” therapy in order to deepen understanding of what these types of care may look like in practice. I want to clarify from the outset that what therapy looks like from one provider to the next is going to be a bit different based on the theoretical model the therapist practices from. What I am attempting to do here is provide a general overview of both of these approaches and what statistics say about the outcomes of these approaches. 

What is gender-affirming care?

According to the World Health Organization, gender-affirming care is defined as care designed to support and affirm an individual's gender identity. As therapists, the way that we provide gender-affirming care is by offering a safe space for clients to explore their emotions regarding gender identity and to address areas of struggle the client may be experiencing due to gender identity (e.g. bullying, stigma, and other stress that may arise). Additionally, we may address mental health concerns that arise due to gender identity including, but not limited to, depression and suicidal ideation. The aim of treatment is often to reduce distress and provide coping skills for symptoms that are negatively impacting the individual. As always, treatment goals and objectives are based on what the client wants to achieve within the therapeutic space. 

What is “reparative” or “conversion” therapy?

“Conversion” therapy, also referred to as “reparative” therapy, aims to shift the sexual or gender identity of the client in order to discourage or change behaviors related to LGBTQIA+ identities and expressions. While emotions regarding gender identity and areas of struggle related to gender identity may be explored in this type of therapy, the aim of treatment is to “cure” or “repair” an individual's same-sex attraction or gender identity in order to conform to a heteronormative gender binary. 

Exploring the Differences

The differences between these two types of care could not be more stark. One of these types of therapy supports an open, non-judgmental, exploration of gender identity and sexuality to reduce distress. The other supports only one outcome which is acceptable and allows for little exploration regarding gender identity or sexuality due to the heteronormative, gender-binary approach utilized. As therapists, our goal is to support the clients’ right to self-determination and assist them in their journey to wellness. In this way, it is the exact opposite of providing liposuction for a client struggling with anorexia. 

The outcomes for each of these types of therapy are vastly different as well. Numerous studies show that gender-affirming therapeutic care reduces depression and suicidality. In some studies rates of moderate to severe depression are reduced by as much as 60 percent.  The increase in depression and suicidality we see in clients who seek gender-affirming care are often a result of bullying and lack of social support leading to a decline in mental wellness. Conversely, outcomes for “reparative” or “conversion” therapy are associated with negative health outcomes and are generally not successful in shifting the sexual or gender identity of their clients long-term. Some studies regarding this method show that participants are up to twice as likely to experience suicidal ideation after “treatment”. 

At the core of our mission is a commitment to enhancing mental wellness through gender-affirming care. In this collaborative process, clients take the lead in setting their goals, while clinicians provide support and guidance. Together, they work to address challenges like depression, anxiety, and suicidality. Importantly, this therapeutic space also offers a safe environment to explore sexual and gender identity, allowing individuals to navigate their journey with understanding and compassion. We aim to empower clients on their path to self-discovery and well-being.

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