Last June PQ reported on an important development which was largely ignored by the media when the Royal College of Psychiatrists (RCP) quietly issued a statement marking a small but significant shift in the direction of acknowledging that likely causes of homosexuality are "a combination of biological and postnatal environmental factors."

This represented a revision of its previous view expressed in 2007 that sexual orientation is "biological in nature determined by genetic factors…and/or the early uterine environment..."; and that "there is no substantive evidence to support the suggestion that the nature of parenting or early childhood experiences play any role in the formation of a person's fundamental heterosexual or homosexual orientation"; or with regard to sexual orientation change efforts (SOCE) that "there is no evidence that such change is possible."

The RCP was now saying that "It is not the case that sexual orientation is immutable or might not vary to some extent in a person's life" even though "there is no sound scientific evidence that sexual orientation can be changed."By introducing the term 'postnatal', the RCP took a significant step towards acknowledging the importance of nurture and environmental influences in explaining sexual orientation.

Effectively the RCP revised its view about whether sexual orientation can change. However, it did not go so far as to acknowledge that change and choice can take place in therapeutic contexts. This caused many commentators to accuse the RCP of 'double-speak' and 'ideological propaganda'.

The RCP continued stubbornly to reject any right of an individual to self-determination in seeking therapeutic help to facilitate sexual orientation change. The College appealed to the American Psychological Association (ASA) in claiming that therapy doesn't work and is harmful, even though the ASA now openly accepts that evidence neither shows whether therapy works or does not work or that SOCE is no more or less harmful than other forms of therapy.

Now, in an important development of this position which will have consequences for everyone who calls themselves a 'counsellor'and for every medical practitioner in the UK, the RCP has joined forces with the Department of Health to issue a Memorandum of Understanding on Conversion Therapy. This document has been endorsed by a number of professional organisations, including the Association of Christian Counsellors.

Despite the absence of any documented evidence and despite the clear findings of the ASA, the memorandum insists its objective is to ensure "The public is well informed about the evidence (of 'potential harm') and risks of conversion therapy" and to achieve this by setting out a best practice framework for professionals engaged in the area of counselling. It is open about its pre-formed ideological basis for the memorandum admitting it "is informed by a position that efforts to try to change or alter sexual orientation through psychological therapies are unethical and potentially harmful."

Citing the previous statement by the RCP, the memorandum affirms that "This position is not intended to discourage clients with conflicted feelings around sexuality seeking help. Psychological therapists routinely work with people who are struggling with inner conflict. 'For people who are unhappy about their sexual orientation – whether heterosexual, homosexual or bisexual – there may be grounds for exploring therapeutic options to help them live more comfortably with it, reduce their distress and reach a greater degree of acceptance of their sexual orientation.'"

It would appear that this memorandum is advisory and does not make reparative therapy as such illegal, but it does effectively prevent any medical or counselling professionals who call themselves 'counsellors' from recommending it. It also appears to give carte blanche for open campaigning against any counsellor alleged to be practising or advocating it. Despite acknowledgment implicit throughout the memorandum that sexual orientation does change and is not fixed, like the RCP it adopts an ideological stance and does not go so far as to sanction reparative therapy, even though that might seem to be a logical conclusion. Perhaps the medical world is seeking to adopt an almost neutral position, in effect saying that therapy should be aimed at helping people to accept themselves as they are. How Christians handle that without appearing to endorse homosexual identity and practice will be a major challenge.

It seems that the memorandum may offer some leeway for those seeking help from unwanted same-sex attraction, but it is clearly not supportive of overt efforts or policies to try to force change of peoples' orientation – although there is no evidence of any existing professional counselling services that would adopt such an approach. Some counsellors may find it possible to maintain the position advocated by the memorandum whilst making it clear that homosexual activity is wrong – although even stating that view is potentially becoming socially unacceptable. However, it is surely right not to discourage responsible sex orientation change efforts when people seek help. Sadly, the memorandum appears to ignore the autonomous rights and freedom of individuals to seek therapy for what they regard as unwanted same-sex attraction. Nevertheless, it is likely there will be differing interpretations of what is and is not permitted following publication of this memorandum and inevitably some counsellors are likely to adopt some other form of self-description.