UK conference on “Gender Dysphoria – a Therapeutic Model for Children, Adolescents and Young People”: Part Two

by Gary Powell, European Special Consultant on June 29, 2021

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In the first part of my review as a participant in this conference, the main contributors were identified, and the backdrop of political interference from the extreme gender lobby was described, with its widespread political colonisation having engulfed the medical and psychotherapeutic professions.

One explicit purpose of the conference was to encourage therapists to feel they can work with children who have gender dysphoria and gender identity issues. “Fixed states of mind” were described as common traits among such children, where inflexible thinking prevailed around what the child saw his or her problems and their solutions to be. “Gender dysphoria” was defined as a sense of discomfort at a perceived disjunction between a person’s sexed or biological body and his or her “gender identity”.

Concerns were raised at the dominance today of blatant political interventions in what should be purely clinical decisions. Until recently, gender dysphoria was considered to be a “disorder”, but over the past decade, there has been an attempt to separate the experience of gender identity issues from the concept of a person experiencing distress and having a psychological condition. There is a push to treat gender identity as though it has nothing to do with the individual’s internal conflicts and psychological issues.

Children with gender dysphoria are known to exhibit “consistence, persistence and insistence” in their perception of a “gender identity” different from their biological and physical sex. It was suggested that this psychological inflexibility is something with which children need to be helped. Often there is an unwillingness to accept uncertainty, and a sense of relief when the child fixes a point of certainty in order to resolve confusion: but this fixed position can be a narrow and blinkered one that is inconsistent with wider evidence and the child’s broader experience and consciousness. A dogged refusal to subject that fixed position to examination, doubt and questioning, can be very limiting to psychological progress and development.

Adolescence is a highly turbulent period, when it is normal for feelings and beliefs to be in a state of flux. A child who has taken psychological refuge in a fixed position cannot make informed decisions about life-changing and irreversible interventions. It is, in fact, normal when making big decisions to experience doubt and hesitation – and so the absence of doubt and uncertainty here can positively indicate something is wrong. The child’s unassailable certainty about wanting to halt puberty, consent to sterilisation and accept impairment of future sexual pleasure (does a ten-year-old even know what an orgasm is?) is by no means an indication that this “certainty” reflects a proper and considered appreciation of reality.

The traditional therapeutic method for supporting children with gender dysphoria has been an approach named “watchful waiting”. If supported through puberty in this way, the vast majority of children will come to re-identify with their biological, natal sex. Gender dysphoria is often accompanied by other comorbid conditions and psychological issues that have a bearing on the child’s perceived transgender identity. Therapeutic exploration will often reveal that the claimed transgender identity has the flavour of subtle rebellion against his or her parents, or that another issue is a play in response to the family dynamic, or to the child’s perception of that dynamic. Under “watchful waiting”, the therapist will not attempt to push the client in one direction or the other, neither colluding with nor setting himself in opposition to the child’s claimed identity. Instead, the standard therapeutic approach involves asking questions and encouraging the child to explore wider aspects of his or her experience and thinking, as a result of which, new insights can emerge.

By contrast, the new, politically-driven “affirmative approach” demands that therapists immediately and unconditionally affirm the child’s presentation of transgender identity as something that is objectively true. This approach shuts down normal clinical and scientific questioning, examination and discussion, and risks sending the child down a harmful pathway that does not address her real needs. Despite the doubts and concerns of many clinicians, they know that non-compliance and the expression of doubts may jeopardise their career.

Although some individuals, after thorough psychotherapeutic work, may still need to transition in order to alleviate their distress, for many others, the transition will be marked by hopes that it will bring about a psychological improvement that does not in fact ever manifest. This will result in disappointment, depression and even possibly suicidal ideation, and this is also the experience of a specific group of people – the “detransitioners” – who now campaign against the extreme gender ideology and “affirmative approach” that have caused them so much irreversible harm.

Same-sex attracted children represent one group among several who risk being sent down a false and disastrous pathway by the affirmative approach: especially if their parents disapprove of homosexuality and would rather have a trans daughter than an effeminate gay son. Children with high-functioning autism, who can be particularly prone to inflexible thinking and the influence of Internet pro-transgender groups, are another at-risk category.

This full-day conference was rich in interesting psychoanalytical explanations, personal experiences and anecdotes. This review can therefore not hope to provide more than a very general summary with a few snapshots of the day’s detailed content, but for readers who would like to learn more about this area, there is the recently-published “Gender Dysphoria: A Therapeutic Model for Working with Children, Adolescents and Young Adults”, by Susan and Marcus Evans.

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