This first of a four-part series for practitioners and service providers includes contributions from those with lived experience (survivors) and from interviews with mental health practitioners conducted for CBRC’s learning course, Mental Health, Conversion “Therapy” Practices in Canada.
Question: How do survivors of conversion practices and change efforts appear to service providers of mental health care?
While many 2S/LGBTQIA+ people have experienced conversion practices and change efforts, not everyone identifies as a survivor. Practitioners and service providers often do not recognize that a service user or client is a survivor of these harmful practices. Becoming more aware of how the trauma of being rejected by one’s family or community can manifest will help practitioners better understand service users, reduce the impacts of harm, and ensure better outcomes.
Many 2S/LGBTQIA+ people have experienced some degree of pressure stemming from societies’ beliefs that being heterosexual is the only normal way to express sexuality, and that a person’s gender identity must match their assigned sex at birth. This predisposes them to being susceptible to conversion practices, often without being fully aware of them—especially if they have sustained other forms of trauma and experienced multiple forms of oppression. This is often a symptom of the “fawn” response to trauma. Service users may present with complex post-traumatic stress symptoms that can lead to dissociation, numbness, a lack of identity or sense of self, and traumatic responses that can cluster around identity, relationship issues, or both.
One of the most common experiences of 2S/LGBTQIA+ trauma survivors are early experiences of rejection or feeling “on the outside”within their families or faith communities. But before they can name that they’ve experienced trauma because of their sexual or gender identity or expression, they need to feel safe. This can help them understand that they are not the problem. Survivors often carry with them a persistent sense that they are wrong, bad, or unworthy. They may not name this experience as shame, but it lives in their body and their core sense of self as shame.
Jorge Andrade, a gay man and conversion practice survivor, shares that “one of the effects of conversion ‘therapy’ is that you can be against receiving counselling even if it’s trauma-informed.” All forms of “counselling” may remind survivors of their experience at some level, and thereby may reactivate old trauma. Trust issues are common. When they do find the courage to be true to themselves, they risk losing family, community, peers, and friendships—they may be choosing themselves above the beliefs and opinions of their family or faith community, creating a high level of anxiety.
Service users who experience conversion practices in the health care system, may have been misdiagnosed, denied access to gender-affirming care (e.g., hormones, surgeries), had their sexual or gender identities pathologized, or had their trauma(s) ignored or dismissed. Clinicians often conflate body image with gender identity, when they are distinct clinical issues. Trans people have heard things like, “Why don’t you just try being a boy or being a girl?” or “not liking your body is common and a sign of low-self-esteem or trauma.”. These practices are often aggravated and reinforced by provincial laws that restrict or limit access to life-saving services. As a result, trans people are terrified of seeing a doctor and being purposefully misgendered, and in many places in Canada, they have no access to safe and respectful health care.
Change efforts are often communicated in the subtext of suggestions that people have made. Those messages and pressures can come from a place of concern, a place of piety (like how well you adhere to a faith or religion), or from a place of obligation and family preservation.
Many conversion practices and change efforts occur in religious contexts. Survivors may have heard, “If you pray you might be able to find a deeper answer around who you are.” Their feelings, which are actually an identity, are framed as a “test from God,” and they are told they need to engage in faith-based practices to overcome them.
Jorge was taught that his “problem” was “the demon of homosexuality and me being sin, which made me hate myself.” When he was 17, he realized that his teenage trauma was not because he was gay but because he was being encouraged to deny his true self.
Religious-based trauma is profound, comprehensive, and all-encompassing, and can spill over into the actions of health care providers. Religious trauma amplifies complex trauma because it impacts so many different areas of someone’s functioning: faith, meaning, purpose, community, relationships, sexuality, identity, coping mechanisms, and more.
When anyone encourages 2S/LGBTQIA+ people to go into conversion “therapy” practices, or pressures 2S/LGBTQIA+ people to change, deny, or suppress their sexual orientations, gender identities, or gender expressions—those are the harmful forms of conversion practices and change efforts.
In Part 2, we will look at the different ways this trauma appears in mental health care when working with survivors.
Contributors:
Rahim Thawer, MSW, RSW, is a psychotherapist, clinical supervisor, facilitator and public speaker, sessional lecturer, writer, and community organizer. Nearly half of Rahim’s clinical practice has evolved into clinical supervision and consultation work.
Sly Sarkisova, MSW, is a queer, nonbinary trans-identified psychotherapist working in the field of mental health, addictions, and trauma therapy. He provides consultation, clinical supervision, and training around trauma informed, holistic, anti-oppressive practices in mental health.
Naj Siritsky, MSSW, BCC, RSW, D.Min., (he/they), is a Professional Practice and Advocacy Consultant at the Nova Scotia College of Social Workers. He is a social worker with doctoral training in spiritual counseling, a survivor of conversion practices, and the first transgender nonbinary Reform rabbi in Canada.
Jorge Andrade is a conversion practice survivor and a refugee from Ecuador. He is currently the Community Engagement and Belonging Coordinator at Rainbow Refugee in Vancouver, British Columbia.
