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Sexual orientation is a multidimensional aspect of human experience, comprised of gendered patterns in attraction and behavior, identity related to these patterns, and associated experiences, such as fantasy (Katz-Wise & Hyde, 2014; Klein, 1993; Rosario & Schrimshaw, 2014). “Attraction” is conceptualized as both romantic and sexual (e.g., Rosario & Schrimshaw, 2014) and as focusing on biological characteristics of sex as well as aspects of gender identity and expression (van Anders, 2015). Individuals with same-gender and multiplegender attractions and behaviors have been stigmatized.

Heterosexism and monosexism are social stigmas and societal inequalities that denigrate, discredit, and disadvantage those with same- and multiple-gender attractions, behaviors, and associated identities (American Psychological Association [APA], 2012; Herek, 2007; Roberts, Horne, & Hoyt, 2015).

Because of the social stigma they experience, individuals with same- and multiple-gender attractions and behaviors may be referred to collectively as sexual minorities (Herek, 2007; SavinWilliams, 2001; van Anders, 2015).

Sexual orientation change efforts (SOCE) include a range of techniques used by a variety of mental health professionals and non-professionals with the goal of changing sexual orientation (APA, 2009) or any of its parts. SOCE was a term developed by the APA Task Force on Appropriate Therapeutic Responses to Sexual Orientation (2009) to describe these efforts that have been known by several names and may take a variety of forms.

The term SOCE avoids the use of the term therapy and thus the implication that there is some disorder to be treated. Some mental health professionals who have utilized or promoted SOCE have used the term “therapy” to describe their practices and/or to support the idea that sexual minority youths and adults are mentally ill due to their sexual orientation. In fact, mainstream mental health professions have rejected this idea since the 1970s.

SOCE refer to a wide variety of efforts. SOCE have taken a variety of forms such as one-on-one meetings, drop-in groups, residential programs, conferences, and online groups.

Rationales for SOCE have included assertions that same-gender attractions are caused by bad parenting, peer abuse, sexual trauma, gender “inferiority,” and/or unmet emotional needs. SOCE have included interventions such as recommending dating someone of a different sex; developing nonsexual intimacy and belonging with heterosexual same-gender peers; experiencing same-gender non-erotic touch; using religious practices such as prayer, scripture study, exorcism, and confessing same-gender attractions; implementing aversive conditioning; practicing traditional gender expression and gender role behavior; and suppressing gender nonconforming behaviors (APA, 2009; Dehlin, Galliher, Bradshaw, Hyde, & Crowell, 2015; Hipp, Gore, Toumayan, Anderson, & Thurston, 2019; Flentje, Heck, & Cochran, 2013; Rix, n.d.). The wide variety of SOCE are not consistently reflected in SOCE literature and popular culture. As the latter examples of interventions indicate, SOCE have not only targeted sexual and romantic behavior but also gender expressions that do not conform to stereotypes. In this way, gender identity change efforts have also been a component of SOCE. A focus on White cisgender individuals and sexual orientation may also make less visible the impacts of SOCE on communities of color. For example, in Black Memphis communities, SOCE might not be readily identified as such but appear as violence and “church hurt” (Hipp et al., 2019). SOCE may appear differently in different social contexts.

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An updated policy will also provide more current information to legislators and advocates and dispel the distortions and inaccuracies favored by SOCE proponents (Haldeman, 2018). In nearly half of states (Miller, 2018) and on the federal level (e.g., Therapeutic Fraud Prevention Act, 2017) legislation has been adopted or proposed to prohibit SOCE with minors, to warn consumers that SOCE can be fraudulent, and/or to advise professionals that SOCE are not ethical. SOCE have also been increasingly scrutinized in U.S. legal cases. A New Jersey trial court case (Ferguson v. JONAH, 2015) identified a program of SOCE as a form of consumer fraud. Decisions in cases that have challenged ordinances prohibiting licensed mental health professionals from providing SOCE to minors (Otto v. Boca Raton, 2019; Pickup v. Brown, 2013; Welch v. Brown, 2013) have upheld the authority of professional oversight bodies to regulate professional mental health care interactions and to prohibit SOCE by mental health professionals. Persecution of LGBTQ+ people worldwide is an international humanitarian issue, including systematic abuse, imprisonment, and torture. The U.S. field of psychology is influential around the world, and an updated APA policy has the potential to support the rights and safety of LGBTQ+ persons worldwide.

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