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What does Canada’s laws say about conversion practices?
In discussions with therapists new to working with gender questioning clients, some therapists have expressed feeling unclear as to what constitutes conversion therapy and what is simply responsible, ethical exploratory psychotherapy. My hope is that this post will clarify some of the nuances surrounding this issue.
How widespread are conversion practices in Canada?
According to a 2019-2020 Sex Now Survey of 9,214 Canadian LGBTQ participants, approximately 10% self-reported having undergone conversion therapy. Of those who had undergone it, 67% reported experiencing it in a faith-based setting, with the remaining 30% experiencing it through provincially licensed healthcare providers. A Community Based Research Centre study estimates that about 47,000 LGBT Canadians have undergone some form of conversion or reparative therapy.
Most healthcare organizations and regulatory boards have spoken out against conversion practices, including the Canadian Psychological Association, Canadian Association of Social Workers, and the World Health Organization, citing potential long term negative health implications such as anxiety, depression, PTSD and suicidal thoughts.
What does Canada’s federal ban on conversion therapy say, exactly?
Canada’s federal conversion therapy ban, Bill C-4, came into effect on January 7th 2022. The federal ban follows provincial bans in Ontario, Manitoba, Nova Scotia, and municipal bans in cities like Vancouver, Calgary, and Edmonton. It offers protections for both adults and minors. Canada joins many other countries, including France, Germany, India, Malta, and Ecuador and at least 20 US states in banning conversion practices.
Bill C-4 is an amendment to Canada’s criminal code and targets anyone who is providing or promoting services that intends to change or repress a client’s sexual orientation or gender expression.
The Bill enacts new offences to prohibit:
causing another person to undergo conversion therapy;
doing anything for the purpose of removing a child from Canada with the intention that the child undergo conversion therapy outside Canada;
promoting or advertising conversion therapy; and
receiving a financial or other material benefit from the provision of conversion therapy.
It also amends the Criminal Code to authorize courts to order that advertisements for conversion therapy be disposed of or deleted.
The federal amendment on Conversion Therapy reads as follows:
Conversion Therapy
Definition of conversion therapy
320.101 In sections 320.102 to 320.104, conversion therapy means a practice, treatment or service designed to
(a) change a person’s sexual orientation to heterosexual;
(b) change a person’s gender identity to cisgender;
(c) change a person’s gender expression so that it conforms to the sex assigned to the person at birth;
(d) repress or reduce non-heterosexual attraction or sexual behaviour;
(e) repress a person’s non-cisgender gender identity; or
(f) repress or reduce a person’s gender expression that does not conform to the sex assigned to the person at birth.
For greater certainty, this definition does not include a practice, treatment or service that relates to the exploration or development of an integrated personal identity — such as a practice, treatment or service that relates to a person’s gender transition — and that is not based on an assumption that a particular sexual orientation, gender identity or gender expression is to be preferred over another.
Violations of the federal law are indictable offenses and offenders are liable to imprisonment or can be subject to a summary conviction. In short, breaking the federal law can land you with a fine or prison time of up to five years.
What about therapy intended to help a client explore their gender identity or expression?
The federal law and municipal bylaws like Calgary’s are careful to elaborate that the conversion therapy ban does not include therapy that is intended to help someone explore or develop an integrated identity. Ontario’s provincial law also includes an exception for services that “provide acceptance, support or understanding of a person or the facilitation of a person's coping, social support or identity exploration or development; and sex-reassignment surgery or any services related to sex-reassignment surgery.”
But what does this look like in practice? The Alberta College of Social Workers provides the following case example and advice:
“4. I HAVE A CLIENT WHO PREVIOUSLY IDENTIFIED AS A TRANS PERSON AND WHO HAD BEEN EXPLORING GENDER AFFIRMING TREATMENT FOR SEVERAL MONTHS. THEY HAVE NOW INFORMED ME THAT THEY NO LONGER IDENTIFY AS A TRANS PERSON AND INSTEAD THEY WANT TO PURSUE A CISGENDER IDENTITY. DOES A THERAPEUTIC EXPLORATION OF THIS CLIENT’S STATED GOAL CONSTITUTE CONVERSION THERAPY?
There is not a simple answer to this scenario. A client’s journey through any therapeutic process is often not simple or straightforward. As social workers, we strive to align ourselves and our interventions to the client’s desired goals and outcomes as a reflection of our ethical commitment to client autonomy and self-determination. We balance this with our ongoing dedication to evidence-based assessment and interventions. Thorough and thoughtful exploration of the client’s experience is a fundamental component of any therapeutic process. Ask the client to help you better understand this apparent shift. What is motivating or driving this new direction? What internal and external factors are influencing the desire for change? What does the client’s agenda hope to achieve? Based on the client’s answers, a social worker can better assess the situation and determine a way forward. It is our utmost responsibility to ensure that we are using our professional judgement in our client interactions. Social workers should ensure that they have basic competencies when working with this community and where we are unsure, we should always consult with someone who has the knowledge, training and background working with this community. The best care we can provide to our clients is that which is affirming and client-centered and allows for client autonomy and self-determination.”
Concluding thoughts
The evidence is clear that conversion practices cause long term psychological harm to those who have been subjected to these practices, particularly in relation to sexual orientation. That said, the law is also clearly attempting to balance practitioners’ ability to create a safe psychotherapeutic space for clients to explore and deepen their self-understanding where gender is concerned. Clinicians are left to use their clinical judgement on what the line between conversion therapy and exploratory therapy is, as demonstrated by the previous example.
While these laws have passed, popular culture has seen an increase in new gender identities. What this means for therapists, legally, is unclear. For example, If a child identifies as a “catgender”, technically any clinician who challenges a client about that self perception would be practicing conversion therapy under this legislation. Those cases have yet to be tested in court.
Further reading:
Parliament of Canada - Bill C-4 (Royal Assent)
Bill C-4: An Act to amend the Criminal Code (conversion therapy)
Canada: Bill C-4 Banning Conversion Therapy Comes into Force - Library of Congress
Canada Bans ‘Conversion Therapy’ - New York Times article
Conversion therapy is now officially banned in Calgary - CBC News
Bill passes banning conversion therapy in Nova Scotia - CBC news
Position on Conversion Therapy - Manitoba Health
‘Let Me Be Me’ - Legal Info Nova Scotia
FREQUENTLY ASKED QUESTIONS REPARATIVE OR CONVERSION THERAPY - Alberta College of Social Workers