Working with clients Who is at risk Individuals who identify as LGBTQIA+, takatāpui Māori, or MVPFAFF+ Pasifika and who live in families or communities with rigid ideologies can be at risk of conversion practices due to homophobic, transphobic, religious or conservative views. Not only are people who are ‘out’ at risk but also those who are concealing their identity. Transgender and non-binary people, and those who are questioning their gender, tend to experience conversion practices at greater rates than others.xxii Immigrants who have experienced, or are experiencing, conversion practices may also be struggling with their sense of identity due to the challenges of adapting to a new culture. For refugees, language and cultural barriers can exacerbate social isolation and stop them seeking help.xxiii Identifying conversion practices Sometimes people experiencing conversion practices are so indoctrinated they do not have the words to describe what is happening to them or may not realise they are experiencing a conversion practice. Survivors can also have difficulty trusting mental health professionals, particularly if their experience occurred in a similar setting. Feelings of shame can be a barrier to sharing information so it can be easy for a professional, or assessment, to overlook or misattribute indicators of conversion practices.xxiv To avoid this professionals can enquire generally about: • faith and culture • family/community views on other ways of life • exposure to rainbow identities. Talking about what happened “People distressed by their sexual orientation should be assisted with treatment approaches that involve acceptance, support, and identity exploration, and aim to reduce the stigma associated with alternative sexual identities, and demonstrate respect for the person’s religious, spiritual and/or cultural beliefs” RANZCP, 2019 66 Conversion Practices Guidance for mental health professionals Know your client may struggle to articulate their experience. As referenced above they might not know they are experiencing or have experienced a conversion practice. Mention of their community having homophobic or transphobic beliefs, or being pressured to change, is a signal to ask more. Be guided by values of aroha and whanaungatanga. If your client discloses they are experiencing or have experienced a conversion practice, let them know you’re there for them. People in conversion practices are generally experiencing control and the misuse of authority. Go gently and support them to do their own research. Understand that people do not necessarily want to reject their religious beliefs. It is not always the case that a survivor will want to leave their religion when they are recovering from conversion practices. This is particularly in cultures where rejecting religious beliefs could also mean a rejection of community or family. Survivors may not want to disrupt family relationships even when they are causing harm. In some cases, leaving a religious setting may not be possible due to financial or living arrangements. Recognise that shame is often a factor in a survivor’s experience. Moreover, the type of shame will often change. During conversion practices people will likely feel shame about their identity and their inability to change. After people stop the practice they are likely to feel shame for being swayed by conversion practices, particularly when they chose to participate. They may also feel shame for encouraging others to participate or for performing conversion practices on others. Many also feel anger at being coerced, deceived and condemned. First steps for supporting people once conversion practices are established Quickly establish a safe way to stay in contact because it is common for people to return to conversion practices or break off contact without warning. It could be helpful to obtain their phone number and email address in the first session and ask permission to contact them in the future. Address issues of safety because your client could be vulnerable to specific risks like changes to housing, changes to or disappearance of immediate support people, threats to employment, and being “outed”. These can act as additional drivers to a suicide risk.