CACFT/ACTCF Position Statement
Sexual Orientation, Gender Identity, and Expression Change Efforts
The Canadian Association for Couple and Family Therapy/L’association canadienne pour la thérapie conjugale et familiale (CACFT/ACTCF)1 denounces the harmful and oppressive conversion practices and other forms of sexual-orientation, gender-identity, and expression change efforts ([SOGIECE] e.g., reparative therapy). Known more commonly as “conversion therapy,” SOGIECE is a broad term that encompasses four focused methods of changing people’s sexual orientation, gender identity, or gender expression—psychotherapeutic, medical, faith-based, and punitive2—but SOGIECE lacks scientific credibility and clinical utility.3
SOGIECE poses significant risks to individuals, including emotional distress, poor self-esteem, adaptive substance use (to cope or suppress), isolation, mood and behavioral disorders, and suicidality. Intimate and social relationships and family systems are inherently at risk because of these outdated and illegal practices. SOGIECE is deemed fundamentally discriminatory, cruel, inhuman, and degrading; and, depending on the severity of the mental, emotional, relational, and psychological pain inflicted on the victim, SOGIECE amounts to torture that generates “profound feelings of shame, guilt, self-disgust and worthlessness, resulting in a damaged self-concept and enduring personality changes.”4(para11) As many as one in five sexual-minority men in Canada (gay, bisexual, trans, Two-Spirit, and queer) report experience with SOGIECE.5 They are more than twice as likely to report a suicide attempt or multiple suicide attempts.6 Additionally, lower-income, Indigenous, racialized, and gender-diverse persons are disproportionately represented among those exposed to conversion therapy.7
Diverse sexual orientation and gender identity and expression are normative and expected parts of human development and not mental disorders. Although the DSM‑5‑TR9 includes gender dysphoria as a mental disorder, some contend that the terminology is necessary for gender-affirming care and treatment such as hormone therapy and surgery. This perspective has been challenged, because gender dysphoria, in reference to individuals who are transgender, contributes to continued pathologization of this community of individuals.10Further, the ICD-1111 includes gender incongruence in the chapter on sexual health (gender dysphoria was removed from the chapter on mental health).
CACFT/ACTCF joins a list of organizations that represent other caring professions, health professionals, and advocates on the offensiveness, inefficacy, and detriments of these practices.8 SOGIECE directly contradicts the ethical principles, values, and standards of CACFT/ACTCF,1 including the “duties and responsibilities for the protection of the public at large, all those who seek our services, and our members,” and relational and systemic therapists thereby must prohibit them in practice (CACFT/ACTCF).1(para1) CACFT/ACTCF advocates for speaking out on the harmful and abusive nature of these practices that represent cruel and degrading treatment and are therefore a violation of human rights. It is a criminal offense to cause anyone to undergo conversion therapy under Canadian law.7 Bill C4, which criminalizes conversion therapy practices, received Royal Assent after a unanimous vote in the House of Commons and Senate.7
CACFT/ACTCF’s position is that sexual and gender-diversity is normative and that all 2SLGBTQQIA+ individuals must be respected and encouraged to be their authentic selves in the context of marriage, couple+, relationship, and family (or systemic and relational) therapy.
For further information and support, the CACFT/ACTCF 2SLGBTQQIA+ interest group of relational and family therapists can be reached at 2SLGBTQQIAcommunity@cacft.ca
References
1. Canadian Association for Couple and Family Therapy/L’association canadienne pour la thérapie conjugale et familiale. Code of ethics [Internet]. Tottenham, ON: Canadian Association for Couple and Family Therapy/L’association canadienne pour la thérapie conjugale et familiale; 2019. Accessed November 5, 2024. https://camft.ca/Code-of-Ethics
2. Community-Based Research Center. Conversion therapy and SOGIECE [Internet]. [Place unknown] [Publisher unknown] [Date unknown.] Accessed March 6, 2024. https://www.cbrc.net/conversion_therapy_sogiece
3. Human Rights Campaign. The lies and dangers of efforts to change sexual orientation or gender identity [Internet]. [Place unknown] [Publisher unknown] [Date unknown] Accessed March 6, 2024. https://www.hrc.org/resources/the-lies-and- dangers-of-reparative-therapy
4. United Nations Office of the High Commissioner for Human Rights. (2020). ‘Conversion therapy’ can amount to torture and should be banned says UN expert. Accessed March 6, 2024. https://www.ohchr.org/en/stories/2020/07/conversion-therapy-can-amount-torture-and-should-be-banned-says-un-expert
5. Community-Based Research Center. Sex Now Survey results reveal prevalence of change efforts [Internet]. [Place unknown] [Publisher unknown] 2020. [2024 March 6]. Accessed March 6, 2024. https://www.cbrc.net/sex_now_survey_results_reveal_prevalence_of_change_efforts
6. Green, A. E., Price-Feeney, M., Dorison, S. H., & Pick, C. J. Self-reported conversion efforts and suicidality among US LGBTQ youths and young adults, 2018. [Place unknown] American Public Health Association. 2020. Accessed May 30, 2024. https://ajph.aphapublications.org/doi/10.2105/AJPH.2020.305701
7. Government of Canada, Department of Justice Canada. (2021). Joint statement by Minister Lametti and Minister Ien on legislation to criminalize conversion therapy receiving Royal Assent [Internet]. Ottawa: Government of Canada: 2021 [2024 March 6]. Accessed March 6, 2024.. https://www.canada.ca/en/department-justice/news/2021/12/joint- statement-by-minister-lametti-and-minister-ien-on-legislation-to-criminalize-conversion- therapy-receiving-royal-assent.html
8. American Academy of PAs, American Academy of Pediatrics, American Counseling Association, American Federation of Teachers, American Medical Women’s Association, American School Counselor Association, Child Welfare League of America, Devereux Advanced Behavioral Health, Mental Health America, National Association of School Nurses, National Association of School Psychologists, National Association of Secondary School Principals, National Education Association, School Social Work Association of America, & Voice for Adoption. Declaration on the impropriety and dangers of sexual orientation and gender identity change efforts [Internet]. [Place unknown] [Publisher unknown] [Date unknown] [2024 March 6]. Accessed March 6, 2024. http://assets2.hrc.org/files/assets/resources/National_Orgs_Letter_in_Support_of_Legisl ative_Efforts_to_End_Conversion_Therapy.pdf?_ga=2.127699982.246403592.1558460 063-2112112692.1535393527
9. American Psychological Association. Diagnostic and statistical manual of mental disorders, fifth edition, text revision (DSM-5-TR®). Washington, DC: American Psychiatric Association Publishing; 2022.
10. University of New Mexico. LGBTQIA+ health resources: Queering classification: DSM-5 [Internet]. [Place unknown] [Publisher unknown] 2024. [2024 May 30]. Accessed May 30, 2024. https://libguides.health.unm.edu/lgbtplus/context
11. World Health Organization. (2022). ICD-11: International classification of diseases for mortality and morbidity statistics: Reference guide (11th rev.) [Internet]. Geneva, Switzerland: World Health Organization; 2022 [2024 March 6]. Accessed March 6, 2024. https://icdcdn.who.int/icd11referenceguide/en/html/index.html