Applied Behavior Analysis and the LGBTQ+ Community: Historical Context and a Call to Action

Overview & Clinical Significance

The relationship between applied behavior analysis and the LGBTQ+ community is one of the most ethically significant topics facing the field today. This course, presented by Daniel Conine, examines the historical harms caused by conversion therapy, the role that behavior analysts played in those harms, and the urgent need for the field to adopt LGBTQ+-affirming practices in both research and clinical work.

The clinical significance of this topic cannot be overstated: LGBTQ+ individuals continue to face discrimination, marginalization, and barriers to accessing competent, affirming services. When behavior analysts lack awareness of this history and its ongoing implications, they risk perpetuating harm, even unintentionally.

Conversion therapy, which refers to any practice intended to change a person's sexual orientation, gender expression, or gender identity, has been widely discredited by major professional organizations including the American Psychological Association, the American Medical Association, and the World Health Organization. Research consistently demonstrates that conversion therapy is not only ineffective but actively harmful, associated with increased rates of depression, anxiety, substance abuse, homelessness, and suicidality among individuals subjected to it.

Despite this consensus, conversion therapy practices persist in various forms, and applied behavior analysis has a documented history of involvement in such practices.

The BACB Ethics Code (2022) is unambiguous on this point. Core Principle 1.06 (Nondiscrimination) states that behavior analysts do not discriminate against others based on personal factors including gender expression, gender identity, and sexual orientation.

Core Principle 1.01 (Being Truthful) requires honesty about the state of the evidence. Core Principle 2.01 (Providing Effective Treatment) requires that interventions be supported by the best available evidence.

Conversion therapy fails all three of these standards: it discriminates against LGBTQ+ individuals, it misrepresents the evidence, and it is not supported by scientific evidence as an effective or safe intervention.

This course provides behavior analysts with the historical context necessary to understand how the field contributed to harms against LGBTQ+ people, the current state of ethical and empirical knowledge regarding these harms, and practical guidance for integrating LGBTQ+-affirming principles into behavior analytic practice. The call to action is clear: behavior analysts must move beyond mere avoidance of harm and actively work to create professional environments that affirm and support LGBTQ+ individuals as clients, colleagues, and community members.

Background & Context

The history of behavior analysis and its relationship to the LGBTQ+ community is painful and must be confronted honestly. In the mid-twentieth century, homosexuality was classified as a mental disorder by the American Psychiatric Association, and behavioral researchers developed interventions aimed at changing sexual orientation using aversive conditioning procedures.

These procedures, which included pairing same-sex stimuli with electric shock, nausea-inducing drugs, or other aversive stimuli, were presented as clinical treatments grounded in behavioral science. Some of the most well-known early studies in this area were conducted by researchers identifying as behavior analysts or using behavioral methodologies.

These historical practices did not exist in isolation. They reflected broader cultural attitudes toward homosexuality and gender nonconformity that pathologized LGBTQ+ identities.

The classification of homosexuality as a mental disorder was not removed from the Diagnostic and Statistical Manual of Mental Disorders until 1973, and related categories persisted in various forms for decades afterward. Behavioral researchers who developed and published conversion therapy procedures were operating within a cultural and professional context that treated LGBTQ+ identities as problems to be solved rather than aspects of human diversity to be respected.

However, understanding the historical context does not excuse the harm. The fundamental principles of behavior analysis, including the emphasis on socially significant behavior, the importance of social validity, and the requirement that interventions serve the interests of the client, should have provided a check on these practices even within the cultural context of their time.

When behavior analysts treated sexual orientation or gender expression as target behaviors to be changed, they violated the principle that the goals of intervention should be determined by the client's welfare, not by societal prejudice.

The contemporary landscape has shifted significantly. Major professional organizations have issued statements opposing conversion therapy.

Numerous jurisdictions have enacted laws banning conversion therapy, particularly for minors. The BACB has issued guidance affirming that behavior analysts should not engage in conversion therapy practices.

The BACB Ethics Code (2022) explicitly includes sexual orientation, gender identity, and gender expression among the protected personal factors under the nondiscrimination principle.

Despite these developments, concerns persist. Some practitioners may lack awareness of the history or may not recognize how their current practices could inadvertently reflect conversion-like approaches.

For example, targeting gender-nonconforming behavior for reduction, discouraging cross-gender play, or failing to use a client's preferred pronouns are practices that, while not labeled as conversion therapy, communicate that LGBTQ+ identities are problematic. Daniel Conine's presentation calls on behavior analysts to examine their practices with a critical eye and to take affirmative steps toward inclusion.

Clinical Implications

The clinical implications of this course are immediate and practical. Every behavior analyst, regardless of their clinical specialty, will encounter LGBTQ+ clients, families, colleagues, and community members.

The question is not whether these encounters will occur but whether the behavior analyst is prepared to respond in ways that are competent, affirming, and aligned with the Ethics Code.

First, behavior analysts must ensure that their intake and assessment procedures are inclusive. Intake forms should include options for gender identity and preferred pronouns that go beyond the male/female binary.

Assessment interviews should use inclusive language that does not assume heterosexuality or cisgender identity. When working with families, behavior analysts should be prepared to encounter diverse family structures, including same-sex parents, transgender parents, and chosen family configurations, and should respond to these families with the same respect and competence they extend to any family.

Second, goal selection must be examined through an LGBTQ+-affirming lens. The BACB Ethics Code (2022), under Section 2.01, requires that treatment goals be in the best interest of the client.

Any goal that targets sexual orientation, gender identity, or gender expression for change is inconsistent with this requirement. This extends beyond overt conversion therapy to subtler practices: reducing gender-nonconforming play, discouraging expressions of same-sex attraction in adolescent clients, or targeting behaviors that are only considered problematic because they do not conform to gender norms.

Third, behavior analysts must attend to the social and emotional well-being of LGBTQ+ clients. LGBTQ+ youth are at significantly elevated risk for bullying, rejection, mental health difficulties, and suicidality.

Behavior analysts working with these youth should be aware of these risk factors and should design environments that are affirming and supportive. This may include teaching social skills that help LGBTQ+ youth navigate hostile environments, building support networks, and advocating for inclusive policies in the settings where services are delivered.

Fourth, practitioners must consider the language they use in clinical documentation, team meetings, and conversations with families. Using a client's preferred name and pronouns is a basic act of respect that is consistent with the Ethics Code's emphasis on dignity.

Failing to do so communicates that the client's identity is not valid or important.

Fifth, behavior analysts have a role in educating other professionals and stakeholders about LGBTQ+-affirming practices. In many settings, behavior analysts work alongside educators, therapists, and caregivers who may hold biased views toward LGBTQ+ individuals.

While behavior analysts cannot control others' beliefs, they can model affirming practices, provide factual information, and advocate for policies that protect LGBTQ+ clients from discrimination.

Ethical Considerations

The ethical dimensions of this course are extensive and touch on foundational principles of the BACB Ethics Code (2022). At the most fundamental level, the course asks behavior analysts to reckon with the fact that their field has caused harm to LGBTQ+ individuals and to take responsibility for ensuring that such harm does not continue.

Core Principle 1.06 (Nondiscrimination) is the most directly relevant ethical standard. This principle prohibits discrimination based on gender expression, gender identity, and sexual orientation.

Compliance with this principle requires more than passive nondiscrimination. It requires behavior analysts to actively examine their practices, policies, and environments for discriminatory elements and to take corrective action when they find them.

Core Principle 1.01 (Being Truthful) is also critical. Conversion therapy is based on the false premise that LGBTQ+ identities are pathological and can be changed through behavioral intervention.

Any behavior analyst who promotes, practices, or fails to challenge these claims is violating the truthfulness principle. The evidence is clear: LGBTQ+ identities are not disorders, conversion therapy does not work, and it causes harm.

Core Principle 2.01 (Providing Effective Treatment) requires that interventions be evidence-based. There is no credible evidence supporting conversion therapy as an effective intervention.

Conversely, there is substantial evidence that LGBTQ+-affirming approaches promote well-being, reduce mental health disparities, and support positive developmental outcomes. Behavior analysts who wish to comply with this principle must align their practice with the affirming evidence base.

Core Principle 2.15 (Minimizing Risk of Behavior-Change Procedures) is relevant to the documented harms of conversion therapy. The historical use of aversive procedures to change sexual orientation represents one of the most extreme violations of this principle in the field's history.

But the principle extends to contemporary practices as well. Any intervention that targets LGBTQ+ identity-related behavior for reduction carries risk of psychological harm, social stigma, and damage to the therapeutic relationship.

Beyond these specific principles, the course raises broader ethical questions about the field's accountability. When a professional discipline has caused harm, does it have an obligation to actively repair that harm?

The course argues that it does. This means not only ceasing harmful practices but also taking affirmative steps: issuing public statements of acknowledgment, developing LGBTQ+-affirming training resources, supporting LGBTQ+ individuals within the profession, funding research on affirming practices, and creating organizational cultures that welcome and affirm LGBTQ+ people.

Practitioners must also navigate the ethical complexity of working with families who hold anti-LGBTQ+ views. When a family requests that a behavior analyst help change a child's gender expression or discourage same-sex attraction, the behavior analyst faces a conflict between respecting family autonomy and protecting the client's welfare.

The Ethics Code is clear: the client's welfare takes precedence, and interventions that target sexual orientation or gender identity are not ethically permissible.

Assessment & Decision-Making

Assessment and clinical decision-making in the context of LGBTQ+-affirming practice require behavior analysts to incorporate new variables into their clinical reasoning and to develop sensitivity to issues that may not have been covered in their training.

The first step is self-assessment. Before working with LGBTQ+ clients, behavior analysts should honestly evaluate their own knowledge, attitudes, and competencies related to LGBTQ+ issues.

This includes examining personal biases, cultural and religious beliefs that may affect clinical judgment, and gaps in training. The Ethics Code (2022), under Core Principle 1.10, requires awareness of personal biases and challenges.

If a behavior analyst determines that their biases may negatively affect their ability to provide competent, affirming services, they have an ethical obligation to seek additional training, supervision, or consultation, or to refer the client to a practitioner who can provide affirming care.

The second step is environmental assessment. When working with LGBTQ+ clients, the behavior analyst should assess the environments in which the client lives, learns, and works for factors that support or undermine their well-being.

Are the client's preferred name and pronouns used consistently? Are there anti-LGBTQ+ policies, cultures, or individuals in the client's environment?

Is the client experiencing bullying, rejection, or discrimination? These environmental variables can significantly affect the client's behavior and well-being and should be addressed as part of the intervention plan.

The third step is goal review. For every client who identifies as LGBTQ+ or who exhibits gender-diverse behavior, the behavior analyst should review existing goals to ensure that none target sexual orientation, gender identity, or gender expression for change.

This review should be conducted proactively, not only in response to a complaint or concern. If goals are identified that could be interpreted as targeting LGBTQ+ identity-related behavior, they should be revised or removed.

The fourth step is developing decision-making frameworks for ambiguous situations. Not all clinical situations are straightforward.

A behavior analyst may work with a young child who exhibits gender-diverse behavior and whose family has questions or concerns. The behavior analyst's role is to provide accurate information about gender diversity, to support the child's well-being regardless of their gender expression, and to help the family navigate their questions without pathologizing the child's behavior.

Clinical decision-making frameworks should be informed by the affirming evidence base and should prioritize the child's welfare.

The fifth step is documentation. Clinical documentation should use inclusive language, respect the client's preferred name and pronouns, and accurately reflect the affirming orientation of the intervention.

Documentation that uses outdated or pathologizing language can perpetuate harm and may create legal or ethical liabilities.

What This Means for Your Practice

This course is a call to action, not merely a call to awareness. Understanding the history of ABA's involvement in conversion therapy is important, but knowledge without action is insufficient.

As a behavior analyst, you have a professional and ethical obligation to take concrete steps toward LGBTQ+-affirming practice.

Begin with your own practice. Review your intake forms, assessment procedures, and clinical documentation for inclusive language.

Ensure that you ask about and use preferred names and pronouns. Examine your current caseload for goals that may inadvertently target LGBTQ+ identity-related behavior.

If you find such goals, revise them in collaboration with the client, family, and clinical team.

Expand your competence. Seek out training and continuing education on LGBTQ+-affirming practices.

Read the literature on the harms of conversion therapy and the benefits of affirming approaches. Consult with colleagues who have expertise in working with LGBTQ+ populations.

If your training did not cover these topics, that is a gap you must fill, and the BACB Ethics Code (2022) requires ongoing professional development in areas relevant to your practice.

Advocate within your organization. Push for inclusive policies, affirming training for all staff, and organizational cultures that welcome LGBTQ+ clients and colleagues.

If you observe practices that target LGBTQ+ identity-related behavior, speak up. The Ethics Code requires behavior analysts to address ethical violations, and silence in the face of harm is not a neutral position.

Finally, consider your role in the broader field. The call to action in this course is not just for individual practitioners.

It is for the profession as a whole. Support organizations and initiatives that advance LGBTQ+-affirming behavior analytic practice.

Contribute to the conversation through your research, your teaching, your supervision, and your advocacy. The field's history with the LGBTQ+ community is a source of legitimate harm and distrust, and repairing that trust requires sustained, visible, and genuine effort.