Exploration or Conversion Therapy? Why the Ban Must Go Deeper
The Council of Europe just voted to ban conversion practices. Good. Now let’s talk about the forms of conversion therapy that are hiding in plain sight.
Last week, the Parliamentary Assembly of the Council of Europe voted 71 to 26 to call on European countries to ban conversion practices. They called for criminal sanctions. They called for monitoring and reporting mechanisms.
They were clear:
These practices aim to change, repress, or suppress a person’s sexual orientation, gender identity, or gender expression, and they are based on the false belief that these characteristics are pathological or undesirable.
This is a significant and welcome step, and I want to acknowledge it properly. Helena Dalli, former European Commissioner for Equality, said it beautifully during the debate:
“These practices are grounded in a lie, the lie that diversity is a defect.”
She went on to describe Malta’s experience as the first European country to outlaw conversion practices back in 2016, saying their legislation
“did not criminalise belief. It did not interfere with legitimate therapeutic support. What it did was establish a non-negotiable boundary: no one has the right to deny another person’s identity.”
I could not agree more. Conversion therapy must be banned. The idea that it is preferable not to be gay, not to be trans, must be challenged at every level.
Yet here is what concerns me.
When most people hear “conversion therapy,” they picture the extreme forms: induced vomiting, electric shocks, elastic bands snapped against wrists, prayer sessions designed to pray the gay away. Those practices are horrific. They cause real, lasting harm, and they absolutely must be outlawed.
We have to look deeper than that, though, because conversion therapy takes many forms. Some of them are happening right now, carried out by well-meaning professionals who would be horrified to hear their approach described that way.
The Cass Approach: Exploration or Conversion?
Let me give you a concrete example. In her review of gender identity services, Hilary Cass describes an approach where a young person presenting with gender dysphoria might also have depression, an eating disorder, or a history of adverse childhood experiences. Her suggestion is that addressing those other issues might cause their gender-related distress to resolve.
I find this really problematic.
This way of thinking implies that gender dysphoria or gender incongruence is something that can be resolved, something that can be caused by depression, by childhood trauma, or by an eating disorder. In my clinical experience, it is completely the other way round. Gender dysphoria and gender incongruence that is not supported and managed correctly causes depression. It results in eating disorders. It contributes massively to childhood trauma.
The idea that we can treat or resolve feelings of gender dysphoria by treating something else fundamentally misunderstands what gender identity is. Gender identity is a deep personal identity set in stone at birth. You cannot change it.
Now, Dr Cass has been careful to say that the intent of psychological treatment is not to change a young person’s gender perception. She has said this publicly. She then followed that statement with something that stopped me in my tracks:
“It may happen during the course of treatment.”
Think about that for a moment. The intent is not to change someone’s gender identity, but it might happen along the way. That is not therapeutic exploration. That is conversion therapy dressed up in clinical language.
The Role of Therapy
This is the problem that arises when the people shaping policy have never treated or managed gender incongruence in childhood, have never sat with a transgender child and their family, and have never walked alongside a young person through the process of understanding who they are.
Psychology should be a support. Everyone involved in this debate is very keen to say they are not talking about conversion therapy. What is alarming, though, is the underlying assumption that psychological therapy exists to make gender dysphoria and gender incongruence go away. It does not. Therapy should be a supportive process to help that person live their best life. It should help them navigate the world, build resilience, manage the very real distress that comes from living in a society that too often refuses to accept who they are.
There is an important distinction here that we must get right. Of course young people with gender dysphoria who also experience depression should have treatment for their depression. Of course those with eating disorders need specialist support. Nobody is arguing otherwise. The critical point is that we must not frame these as causes of gender dysphoria, and we must not operate on the assumption that treating them will make the gender incongruence disappear.
Both Sides of the Coin
Gender distress causes anxiety, sadness, depression, and suicidal ideation. That is well documented. Taking the position that if we simply treat the anxiety and depression, the gender distress will go away, completely misunderstands the nature of gender dysphoria and incongruence.
We have to look at both sides. Yes, a young person with gender dysphoria may also be depressed. The question is: which came first, and what is driving what? In the vast majority of cases, the gender incongruence is the root, and the mental health difficulties are the branches growing from it. Treating the branches without addressing the root does not help anyone. Worse, if the unspoken aim is that treating the branches might make the root disappear, we have crossed a line.
Accountability for Professionals
The Council of Europe vote is a welcome step, and Malta’s pioneering legislation provides a valuable model. These conversations are moving in the right direction. What we need now is to ensure that the definition of conversion practices captures not only the obvious, extreme forms but also the subtler approaches that do the same damage dressed up in professional respectability.
Our professionals must be accountable. If a therapist or a clinician approaches a young person’s gender identity with the underlying belief that it might just go away if they treat the depression, that is not neutral exploration. That is not evidence-based care. That is an approach rooted in the same fundamental misunderstanding that drives formal conversion therapy: the belief that being trans is a problem to be solved rather than an identity to be supported.
We can do better. We must do better.
Sources
• Council of Europe Parliamentary Assembly Resolution on conversion practices, 30 January 2026