Layers of meaning: A Jungian analyst questions the identity model for trans-identified youth

Lisa Marchiano, LCSW, is a Jungian analyst. She blogs at theJungSoul.com (Facebook: https://m.facebook.com/thejungsoul), and can also be found on Twitter @LisaMarchiano.

Lisa’s thoughtful essay stands in stark contrast to the simplistic advice we see from self-declared gender therapists like this one. For the perspective of another therapist skeptical of the “gender affirmative” approach, see this post by Lane Anderson, a former therapist for trans-identified teens who quit her job last year due to ethical concerns.

Lisa would like to thank Miranda Yardley, ThirdWayTrans, and Carey Callahan for their contributions to this post. Though these three individuals were generous in sharing their time and expertise, the views expressed here are Lisa’s own.

Lisa is available to respond to your remarks and questions in the comments section of this post. In addition, Lisa is interested in being in contact with other therapists who share her concerns about the identity therapy model:

If there are other therapists reading this and wanting support to question or work outside of the identity model, please be in touch. Contact me privately on Facebook or Twitter, or ask this blog to put you in touch with me via email. There are lots of us out there. Let’s start talking.


by Lisa Marchiano 

As a social worker and a Jungian analyst, I have become increasingly concerned about the rush to affirm children’s and young people’s transgender self-diagnosis, and then transition them to the opposite sex. I am particularly worried about social and medical transition among teens whose transgender diagnosis arose “out of the blue,” without a significant history of early childhood dysphoria. I fear that, via their well-meaning desire to validate young people in pain, therapists are discarding basic principles of psychotherapeutic care.

My views have been informed by my work with detransitioners, as well as with parents of trans-identifying teens. I have also sought to educate myself further by listening to trans people, parents, clinicians, academics, lesbians, feminists, educators, gays, and others who are writing and speaking about gender. I believe that transition may be a viable and even necessary option for some people. I support the right of adults to choose this option with appropriate therapeutic care and support. I certainly believe that trans people deserve human rights, legal protection, humane care, and respect. However, there are potential physical and psychological dangers of transition, and we need to exercise astute clinical judgment and caution when working with young people who are seeking transition.

I have often seen trans activists and gender specialists promote “social transition” of trans-identifying youth as a positive and “fully reversible” intervention. Social transition refers to a number of steps one can take to present as the opposite sex. These might include making changes to one’s hair style, make-up, name, pronouns, and dress. One might also begin binding breasts or wearing a packer to “present” more convincingly as the opposite sex. Social transition is sometimes described as something that has few if any long-term consequences, and therefore can be recommended with minimal concerns,  even for young children. However, in some significant percentage of cases, social transition leads to medical transition. It appears likely that being conditioned to believe you are the opposite sex creates ever greater pressure to continue to present in this way. Once one has made the investment of coming out to friends and family, having teachers refer to you by a new name and pronouns, will it really be so easy to change back? Children who socially transition at a young age may have little experience living as their natal gender. How easy will it be for them to desist?

At least some of the time, each step taken toward transition creates pressure to continue. Numerous blog posts from detransitioners explore how transition made dysphoria worse, often because the young person became increasingly preoccupied with passing. This further discomfort created pressure to take more steps toward transition in order to present more convincingly as the opposite sex. To take just one example, breast binding may bring relief to some natal females who experience discomfort with their breasts, but binding in itself can be quite painful, restricting breathing and movement—thus creating an incentive to take the next step—“top surgery”/double mastectomy. I have heard one mother of a FtM young person stating that this natal female “got his lungs back” after getting a double mastectomy because he no longer needed to bind. Additionally, anecdotal evidence indicates that it is not uncommon for teens who socially transition to move on to hormones and/or surgery shortly after their 18th birthday. So it’s clear that social transition must be viewed as a treatment that carries with it a significant risk of progressing to medical transition.

Medical transition refers to a number of interventions undertaken to alter one’s body. These can include administration of hormone blockers to children and teens; administration of cross sex hormones; mastectomy; phalloplasty; hysterectomy; body masculinization; orchiectomy; vaginoplasty; facial feminization surgery; and others. All of these procedures can have permanent effects, and most of them carry significant risks. It is unusual (though not unheard of) for minors to have these surgeries. However, it is not uncommon for minors to take hormone blockers and cross sex hormones. And in 100% of the cases reported in the literature, children on puberty blockers went on to cross sex hormones. Top gender clinician Johanna Olson reports that no puberty-blocked children at her clinic in LA Children’s Hospital have ever failed to continue hormone treatment. Therefore, the claim that blockers are “100% reversible” is not accurate in practice. In fact, being on blockers appears to consolidate an investment in a cross sex identification. And although one rarely sees this “side effect” reported in the mainstream media, because gametes do not develop when an adolescent does not undergo natal puberty, hormone blockers followed by cross sex hormones results in permanent, life-long sterility 100% of the time.

Hormone blockers and cross sex hormones are being used off label (that is, they are not FDA-approved for this purpose). We have almost no knowledge about the long-term effects of taking these drugs over the course of decades, as anyone beginning transition as a young person will likely do. According to Madeline Deutsch, clinical director at University of California, San Francisco’s Center of Excellence for Transgender Health, “it scientifically makes sense that if someone is on hormones for decades, it’s highly likely that they’re going to be at higher risk [for certain health issues] than someone who started taking hormones at age 40 or 50.” Even the top pediatric gender doctors admit that there’s a dearth of good data on the long-term health outcomes of transition.

Certainly, there are risks. Cross sex hormones change bodies fairly quickly. Some of these changes are irreversible, such as a deepened voice, facial hair, and baldness for testosterone, and breast growth and, potentially, infertility for estrogen. In addition, use of cross-sex hormones carries with it potential negative side effects. Girls who take testosterone will be at increased risk for developing diabetes, cancer of the endometrium, liver damage, breast cancer, heart attack, and stroke. There may be other adverse effects of which we are not aware at this time, since long-term testosterone use in natal females is a relatively new phenomenon that has not been adequately studied.

I fear that there are young people transitioning – with the ready help of therapists, doctors, and others – who may regret these interventions and need to come to terms with permanent and in some cases drastic changes to their bodies. In fact, I know this is already happening. I have had considerable contact with the growing community of detransitioners. In many cases, the hatred for and disconnection from their bodies that these young people experienced was due to sexual trauma, internalized homophobia, or bullying. In videos and blogs, young women speak about their sadness over their lost voices and breasts. Male detransitioners mourn the loss of their testicles, the loss of their ability to orgasm, in some cases the loss of their fertility. Many have had complications from hormones such as vaginal atrophy, nerve damage, or chronic pain. You can hear some of these stories for yourself here, here, and here, among other places.

I have also spoken with many parents. Their stories are just as heartbreaking. These usually involve a teen who was anxious, depressed, socially isolated, or suffering from PTSD coming to identify as trans after internet binges on social media sites. These parents report that mental health professionals are validating the self-diagnosis of transgender after a handful of therapy sessions, without any exploration of prior mental health issues, trauma, sexual orientation, or history of gender nonconforming behavior. This clearly violates APA recommendations, which urge special caution in treating adolescents who present with sudden onset dysphoria.

All of this comes down to an essential question: When treating someone with gender dysphoria, do we do so using a mental health model, or an identity model?

An identity model is founded on the belief that we ought to be able to define our own experiences for ourselves. It proclaims that each of us has a right to assign our own meaning to our lives, our feelings, and our bodies. We get to decide who we are, and no one has authority over our self-perception. An identity model offers respect and self-determination for every person to define themselves as they would like.

An identity model has a place in psychotherapy. As people, we all self-identify aspects of our personality, values, and experiences in ways that are often very important to us. We might identify as Catholic, or as a Democrat. We might identify as an artist, an introvert, or a lesbian. As therapists, accepting and affirming our clients’ self-identification is important and empowering. As therapists, we can accept and empathize with a client’s story about his or her life experience. We can hold this story as valuable and important whether or not we objectively agree with it. As long as the client’s story does not lead to maladaptive behaviors, we do not need to challenge or attempt to discredit or disprove such a self-identification.

However, an identity model of working with transgender people goes further. An identity model stipulates that it is wrong to explore or question a client’s self-determined identity. Gender dysphoria is seen as evidence that someone is transgender, and merely wondering about underlying psychological reasons for dysphoria or alternative explanations for symptoms is seen as synonymous with denying a person’s identity. Applying our own clinical judgment to someone’s proclaimed self-diagnosis is seen as bigoted and wrong. Our role as therapists becomes limited to enthusiastic affirmation only.

In contrast, when we are working in a mental health model, we understand that clients come to us with symptoms that cause distress, and may interfere with a person’s day-to-day functioning. As therapists, we ought to be interested both in helping to alleviate or manage symptoms, as well as helping to understand the underlying cause of the symptom. If we are psychodynamically oriented, a basic assumption of our work is that every symptom has a meaning beyond its superficial presentation, and a major part of our work is to help our clients gain insight about this meaning.

In opposition to an identity model, then, the main task in mental health therapy with a client experiencing gender dysphoria would be to deeply explore the symptoms without making assumptions about what the symptoms mean. In fact, while identity therapy knows what gender dysphoria means – i.e. that the client is trans – mental health therapy will start with the assumption that we have no idea what the symptom means. We must be open to the meaning that emerges for patients as we explore their experience with them.

Seeking to understand deeply the nature, quality, and etiology of the dysphoria is not at all the same thing as denying the reality or importance of the symptom. When I explore a client’s anxiety – when did it start? What tends to trigger it? How does it feel? – I am not implying that I do not feel that the anxiety is unimportant or illusory. As we come to understand more about a client’s unique experience of a symptom, we may unwrap the meaning behind the suffering so that the problem resolves in a surprising, unexpected way. Or we may simply gain better information about the best course of treatment to alleviate the symptom for that particular person.

An identity model is not an appropriate basis on which to prescribe drastic, permanent medical intervention.

An identity model does not leave room for a therapist to exercise his or her clinical judgment. It disallows the possibility of a thorough assessment and differential diagnosis. According to the identity model, a client’s self-diagnosis is not to be questioned or explored. Therefore, alternative causes of dysphoria cannot be sought. As with many other mental health issues, the symptoms of gender dysphoria can be caused by many different things. Feeling uncomfortable with or disconnected from one’s body can go along with being on the autism spectrum; having experienced trauma; having bipolar disorder; having an eating disorder; or experiencing internalized homophobia. And sadly, it is a normal experience for teen girls, 90% of whom express dissatisfaction with their bodies.

An identity model subverts the normal diagnostic paradigm in which a patient presents with symptoms, and the clinician makes a diagnosis. In an identity model, the diagnosis is the identity. This occludes the focus on symptom resolution and management because the priority becomes affirming the identity. When symptoms are seen as validation of an identity, clinical judgment becomes irrelevant.

Before determining that a young person ought to undergo drastic treatments that may permanently alter their bodies and lead to permanent sterilization, a thorough assessment should be conducted that explores all potential factors contributing to the dysphoria. Unfortunately, because exploration of gender dysphoria is construed by some to be tantamount to “conversion therapy,” this kind of extensive assessment is frequently not performed. Though data is sparse, I personally have had contact with dozens of young people and/or their families who received a transgender diagnosis and a prescription for hormones after one to three appointments with a therapist.  According to this survey of more than 200 detransitioned women, 65% of those who transitioned received no therapy at all, either because they were referred for treatment at their first visit, transitioned through an informed consent clinic, or bought hormones through unofficial sources. (The median age for beginning transition in this survey was 17.) Only 6% of respondents felt they had received adequate counseling about transition. In fact, according to the ideology of gender identity, thorough assessment is seen as inappropriate “gatekeeping.”

An identity model does not allow us to rule out cases of transgenderism where social contagion might be at play. It appears quite likely that the striking increase in trans-identifying teens in recent years is due at least in part to social contagion. There has been a sudden sharp rise in the number of children and teens presenting at gender clinics. The first transgender youth clinic opened in Boston in 2007. Since then, 40 other clinics that cater exclusively to children have opened. Inexplicably, the ratio of natal males to natal females has flipped sharply, with many more natal female teens now presenting. Many of these young people have been presenting with dysphoria “out of the blue” as teens or tweens after extensive social media use without ever having expressed any gender variance before. This now-common presentation was virtually unheard of even a handful of years ago. Thousands of home-made videos on sites such as YouTube chronicle the gender transitions of teenagers. These teens show off their new-found muscles or facial hair. The Tumblr blog Fuck Yeah FTMs  features photo after photo of young FtMs celebrating the changes wrought by testosterone. “I finally have freedom!” posters boast under photographs of their scarred chests post mastectomy. “I’m no longer pre-T!” boasts another under a video of someone injecting testosterone. Almost all of these posters are under 25 years of age. According to Jen Jack Gieseking, a New York academic and researcher who was interviewed by BBC Radio 4 last May, “There really isn’t a trans person I’ve met under the age of 30 who hasn’t been on Tumblr.” There are multiple credible online reports of whole friend groups coming out together as trans.

But correlation isn’t causation. As this brilliant blog post explores, the contagion factor only speaks to the particular way that young people choose to deal with distress. It isn’t that the internet is “causing” the rise in transgenderism. It’s that many young people – particularly young females – are feeling alienated from their bodies due to trauma, porn culture, societal standards of beauty, oppressive gender roles, sexism, homophobia, and so forth. Self-diagnosing as transgender becomes an attractive way to deal with the alienation because it is so validated and even lionized in the culture and the mainstream media. For therapists, an identity therapy model does not allow us to acknowledge the role of social contagion, though contagion has been well-documented in contributing to suicide clusters and other behaviors.

An identity therapy model encourages us not to put safeguards in place to prevent young people from undertaking treatments they may later regret. According to an identity model, self-diagnosis as trans should never be questioned. To do so implies a lack of support and even bigotry. Therefore, the clinician must not stand in the way of transition to the person’s “authentic self.” Because of this, an increasing number of minors are going on hormones and even undergoing surgery that will permanently alter their bodies. Even 18 is probably too young to make such major medical decisions. In cases where the 18-year-old is making medical decisions based on a social transition that she or he began years earlier, it is possibly even more likely that that young person has not carefully considered the consequence of transition. Top gender doctors are hoping to see the recommended age for “bottom surgery” lowered.

In sharp contrast, it’s not easy for non-trans patients to be sterilized before adulthood. For instance, in Massachusetts, a patient must be at least 21 years of age to qualify for sterilizing surgeries under the state’s public health scheme. When such a surgery is undertaken, patients are carefully counseled and must sign a form stating that they understand the permanent nature of the procedure, and that they do not wish to bear or father children. Patients must then wait a minimum of 30 days after signing the form before having the surgery. This procedure has been put in place because surgical sterilization has been shown to come with a high incidence of regret. Why are there not similar safeguards in place for those transgender identifying young people wishing to amputate healthy organs and/or sterilize themselves?

There is a wealth of research about cognitive and emotional development in adolescence. The upshot of it is that teens and young adults are more likely to act impulsively, are unable to assess risks well, and are more emotionally reactive. It is partly for these reasons that we do not allow teens to drink, get tattoos, or use tanning beds without adult consent.

An identity model does not allow us to examine the homophobia that drives some – possibly many — transitions. According to extensive research on desistance, a significant majority of children who identify as the opposite sex will not continue to do so into adulthood. The majority of those who desist will come to identify as lesbian or gay. “Feminine” boys are actually many times more likely to grow up to be gay men rather than transgender women. The same is true for “masculine” girls. Many lesbian bloggers (such as this one and and this one) are very concerned that the current trend to transition young people is disproportionately hurting lesbians and gays, and their fears appear to be well founded. This conservative Christian Texas mother was bothered by her son’s “flamboyant, feminine” behavior. Rather than accepting her son’s gender-defiant presentation, she has decided he is transgender. She now has a very pretty, gender conforming “daughter.”

There is widespread concern in the lesbian community that many young would-be lesbian or bisexual women are finding it easier to become “straight men” due to internalized homophobia. In this article, fourteen-year-old Mason describes how he knew he was transgender. “I’ve always known something was up about how I felt about myself,” says Mason, who as Madelyn had refused to wear pink, or to dress in stereotypically feminine attire. “I thought I was gay or bisexual or something.” In years past, Madelyn most likely would have grown up to be a lesbian or bisexual woman. To paraphrase psychiatrist Ray Blanchard, surely it’s preferable to have an outcome of a reasonably well adjusted lesbian woman, rather than someone who identifies as a trans man who has had many irreversible surgeries and a lifetime of drugs.

An identity model makes us unable to tease out other mental health concerns that may be impacting the desire to transition. There is considerable research that points to a high likelihood of co-occurring disorders in young people who wish to transition. For example, this study from 2015 noted that “severe psychopathology preceding onset of gender dysphoria was common. Autism spectrum problems were very common.” In this study, 68% of the population had first had contact with psychiatric service for reasons other than gender dysphoria. Thirteen percent were being treated for psychotic symptoms.

This study from 2004 found high rates of “comorbidity” in those with gender dysphoria, and noted that this was often not taken into consideration when treatment planning for these patients. “Results: Twenty-nine percent of the patients had no current or lifetime Axis I disorder; 39% fulfilled the criteria for current and 71% for current and/or lifetime Axis I diagnosis. Forty-two percent of the patients were diagnosed with one or more personality disorders. Conclusions: Lifetime psychiatric comorbidity in GID patients is high, and this should be taken into account in the assessment and treatment planning of GID patients.”

This 2015 study found a link between gender dysphoria and dissociative symptoms secondary to trauma. According to this blogger, trauma and dissociation were a big part of her desire to transition. This was also true for this blogger here. Similar stories from detransitioners with histories of unaddressed trauma abound.

An identity model does not allow us to take into account reports from parents or previous therapists who may not agree with the patient’s self-diagnosis. I have received dozens of distraught emails from parents trying in vain to get gender therapists to listen to them when they share information about their child’s mental health history that ought to be taken into consideration while assessing and treating gender dysphoria. While I cannot share the contents of these emails without violating people’s privacy, I can point to quite a few places online where frustrated parents have shared similar stories. For example, this social work professor states that the gender therapist did not review her daughter’s special education records or speak with the previous therapist before recommending hormones and surgery for this young autistic teen.

Parents I have had contact with have told me about their child having a history of anxiety, panic attacks, depression, trauma, loss, bipolar disorder, anorexia, cutting, borderline personality disorder, and psychosis. In these cases, as soon as the young person brought up their transgender self-diagnosis, the focus of the therapy shifted to this alone. The parents’ fears, concerns, and information about past treatments were disregarded as obstructionist and transphobic. I am not alleging that this is happening in every case. However, it certainly is happening with some degree of regularity.

An identity model does not allow us to question the incoherence of gender identity ideology. While gender dysphoria appears to be a meaningful diagnostic term that describes a set of symptoms – namely intense discomfort with one’s sexed body – it does not follow from this that one is “trapped in the wrong body,” has a “female” or “male” brain, or even a “gender identity” that doesn’t match one’s body. Though the concept of gender identity is currently being enshrined into law, the truth is that we have no meaningful definition of the term. (For an excellent analysis of the incoherence of the term, take a look at Rebecca Reilly Cooper’s work.) When a trans-identified person is asked how they know they are transgender, they are usually unable to answer the questions without reference to sex role stereotypes. For example, a physician who prescribed cross sex hormones to a 12-year-old natal female stated that the child had “never worn a dress.” This was offered as evidence of the child’s being “truly trans,” and therefore needing these hormones. I would strenuously argue that one’s clothing preferences should not be a reason to permanently sterilize a child.

It doesn’t make sense to say that one’s sex organs don’t matter, but then assert a primary, essential difference based on a sexed brain. Sexed brains do not exist. It is absurd to posit that one’s chromosomal sex, genitals, and entire reproductive system are meaningless and irrelevant or a social construct, and then assert that a subjective feeling of being the opposite gender is determinative. There is no robust science behind the notion of gender identity. Journalists have been quick to report on studies that seem to prove brain differences among those who are transgender. However, as the sexology researcher James Cantor has pointed out, these studies actually seem to be documenting brain differences among those who are homosexual.

If you want to see a review of some of the literature out there in support of a biological basis for gender dysphoria, this blog post does a good job. There are some solid studies that seem to indicate that genetics or pre-natal hormone exposure may play some role in the development of gender dysphoria. That isn’t really surprising. Pretty much every diagnosis in the DSM – from depression, to anorexia, to borderline personality disorder – has some genetic component. Gender dysphoria is real. As with other mental health diagnoses, its causes are likely complex and involve genetic, biological, environmental, and psychological factors. But it doesn’t follow from any of this that the sufferer has an inborn “gender identity” that ought to supersede any consideration of one’s objective biological sex. Body dysmorphic disorder is associated with brain differences and appears to have a genetic component, and yet the biological component of the condition does not dictate that we understand the patient’s suffering to reflect objective reality.

Transgender activists assert that “gender is between the ears, not between the legs.” However, this is an ideological, faith-based statement that cannot be scientifically validated. What is “between our ears” — meaning our inner experience of ourselves as a gendered person — is purely subjective. Within this context, asserting that one is transgender is an unfalsifiable statement of belief. In reality, feeling like the other sex does not in any way mean that you are the other sex. Identity is an important aspect of one’s experience. We get to define ourselves subjectively, and I would argue that full-fledged adults ought to be able to modify their bodies in accordance with their sense of themselves. However, subjective identity should not dictate a necessity for medical treatment of any kind, especially body-altering treatments with highly significant side effect profiles for minors or young people

An identity model does not allow us to consider treatment outcomes critically. The research on outcomes post transition is mixed at best. It is well-known that one study showed that 41% of transgender people had experienced suicidal ideation or self harm. It is less well-known that the study gives no indication whether the attempt was before or after receiving transition care. Several large studies show astonishingly high rates of suicide among transgender people who have medically transitioned (see here and here). It has been argued that suicide rates continue to be high after transition due to societal prejudice. While this likely is true some of the time, post-transition transsexuals are more likely to “pass” as the target gender, and therefore ought to be less subject to discrimination. Given the undeniably high rates of suicide in post-transition transsexuals, it is disingenuous to claim that transition is a panacea that will prevent suicide.

While this study showed positive outcomes for early transition, there were only 55 subjects included. Perhaps more importantly, they were last assessed at one-year post sex reassignment surgery. In the survey of detransitioned women, the average length of transition was four years. It seems possible that some of the 55 individuals followed in the first study might go on to have regrets if they were followed for longer. Worryingly, one of the 70 individuals invited to participate in the study was unable to do so because the person died as a result of postsurgical necrotizing fasciitis after undergoing vaginoplasty.

While the media is full of stories of young people becoming happier and more confident after being allowed to transition, there is some evidence that this is not always the case. In addition to the research that documents high suicide rates post transition, I am aware of anecdotal evidence of continued or even increased anxiety and depression, social isolation, psychiatric hospitalization, and poor academic outcomes for those who have transitioned.

An identity model does not allow us to explore other options for dealing with dysphoria. Transition – social and medical — is currently the only treatment commonly prescribed for gender dysphoria. If what we are treating is an acute discomfort with one’s body, it would seem reasonable to offer a range of different treatments before prescribing transition, including anti-depressants, talk therapy, and emotion-regulation skills to help patients manage their distress. However, none of these treatments is routinely prescribed for gender dysphoria. In the survey of 200 detransitioned women, some significant percentage of them stated that they found alternative ways of dealing with dysphoria other than transition. Detransitioner and therapist in training Carey Callahan offers several specific techniques that she has found helpful on her blog. Clinicians and researchers ought to be mining these experiences to find other effective treatments for dysphoria in addition to transition.

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An identity model makes some questionable assumptions about the nature of identity and our ability to know ourselves. An identity model is predicated on the notion that identity is immutable, essential, and knowable. This is not my experience of human nature. Identities are useful for approximating something about ourselves. They are constructs that allow us to talk about our experience. But they are not absolute truths, and they rarely say something about our most essential, mysterious, and ultimately unknowable essence. To quote Whitman, “do I contradict myself? Very well, then, I contradict myself. I am large. I contain multitudes.” I have had the good fortune to contradict myself many times in my life – contradict myself on things that at one time felt utterly essential and absolutely true. I believe this is a universal human experience, and yet another reason why making permanent changes to one’s body at a young age ought to be approached with extreme caution.

An identity model makes it impossible for us to acknowledge or discuss the varied reasons why a person might want to transition. The desire to transition likely has many varied causes. Seeing all transitions as an expression of innate gender identity obscures the very real differences between one person’s situation and another, making it impossible to assess and treat people in an individualized way. A late transitioning MtT autogynephile has an experience of gender dysphoria that is vastly different than that of a fifteen-year old lesbian, and the former’s experience ought not in any way to dictate how we understand or treat the latter.

An identity model creates a false dichotomy between affirmation and bigotry. According to the current narrative, the only supportive response to a teen who has self-identified as transgender is to affirm this identity and begin transition immediately. Any other response is quickly labeled transphobic. In reality, there is a huge range between assisting a child in transitioning immediately and affirming that they are and in fact always have been the opposite sex, and denigrating or shaming them for their desire to transition or coercively trying to get them to conform to rigid gender expectations. Parents can communicate their unconditional love and support. Parents can offer solace and warmth as the child struggles with distressing feelings. Parents can seek legitimate psychotherapeutic help to offer space for the young person to explore and understand the desire to transition. Teenagers often develop strong beliefs about what they must do or have, and it is well known that these beliefs and demands are not always sound or rational. Never before have parents of teens been told that they have to accede to the demands of their teenager or risk doing irreparable harm. Parents of teens have always had to step in and set loving limits on behavior that may not be in the young person’s long-term best interest. When dealing with a child who has diagnosed themselves as transgender, parents can do what parents of teenagers always do – set sensible limits and help a child to reflect on the potential consequences of his or her actions. Parents can assure the child of their ongoing love and acceptance if he or she does eventually decide, as a full-fledged adult, to transition.

An identity model offers an inferior kind of therapy to those who identify as transgender. As the blogger Third Way Trans has pointed out, “if someone is a member of a dominant class they receive regular psychotherapy but if they aren’t they receive a special kind of social justice therapy.” Those who come into treatment with gender dysphoria are not given the opportunity to explore deeply their experience, but instead have their self-diagnoses affirmed. There are people who will need to live as the opposite sex in order to have the happiest, fullest life possible. These individuals may need to consider taking hormones or having surgery. Surely these people deserve to have a place to explore these consequential decisions without prejudice in favor of a specific outcome so that a process of careful discernment can take place. If therapists are only cheerleaders for transition, how can someone in this situation get help to make the best decision?

I believe we should offer clients with gender dysphoria high quality mental health therapy. In a guest post on this blog, a woman who considered transitioning several times during her life shared a moment from her own therapy that proved important to her.

“When I started therapy in my early twenties, I revealed to my therapist that I had been raped at 18. It had been four years and I had never told anyone. In the process of uncovering that rape and telling her about it, I stated, during a session, that I wanted to become a man. She nodded, she said she understood, and that it was something we could explore, but in the meantime, we really needed to talk about the rape. I appreciated her approach. She wasn’t directive, judgmental, or reactive, she simply stated it was something to keep talking about, but encouraged me to focus on my experience of being raped and other traumas.”

In providing high quality mental health therapy to all patients, we would communicate unconditional positive regard to our gender dysphoric patients, just as we would with anyone else, and as the therapist in this blog post did. We would greet their announcement that they feel as though they may need to transition with acceptance and curiosity, communicating that we are willing to go there with them, to explore this desire in all of its intricacy, without prematurely coming to a fixed notion of what is right for our patient. We would see the person in front of us in all of their miraculous complexity, and not just as a “gender identity.”

As therapists, we have been trained in assessment. We have been trained to wonder about layers of meaning that may not be visible at first glance. We have been trained in how to recognize and work with trauma. We have been trained to help out clients explore their labyrinthine inner lives. When clients come to me wondering whether to end a relationship with a boyfriend or change careers, we typically spend months considering all of the different facets of such a decision. Don’t we owe at least as considered a process to someone contemplating making permanent changes to his or her body, especially when that person is a teen or young adult?

Phase? What phase? Kid trans specialist dishes up the usual gender gruel

What would we do without the crop of gender therapists who seem to have sprung up like mushrooms after a rainstorm in the last few years? How did we raise our tomboys and “effeminate” sons before these specialists arrived on the scene to tell us naïve parents what to think and do?

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This little tidbit in the Chicago Windy City Times is emblematic of the same sort of breezy, reassuring advice dispensed by the therapists I consulted when my own daughter was insisting she was trans. We hear similar gender-therapist stories every day from the parents who blow into 4thWaveNow like so many shipwrecked sailors.

Ariel Groner, the author of  this piece entitled “Transgender kids: Is my child just going through a phase?” is a gender identity therapist (specializing in kids 6 and up) at Chicago’s Juniper Center. The Center has a lot of predictable gender identity ideology on its website. The Windy City Time (“the voice of Chicago’s gay, lesbian, bi, trans and queer community since 1985″) seems to have simply picked up Groner’s piece from the Juniper Center’s own website—sort of like free advertising.

Besides promoting its therapy services, the Juniper Center also instructs parents on how to transition their children in the school system, including a quick mention of Title IX as a way to strong-arm balking school staff; as if President Obama did not singlehandedly reinterpret that statute to redefine sex as “gender identity” (a redefinition that is now wending its way through the US court system).

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But now to a quick review of Groner’s advice column.

Many parents come into my office asking if their child is identifying as transgender because it seems to be a popular trend.

Groner mentions Jazz Jennings, Caitlyn Jenner, the media attention given to trans issues, but instead of delving into whether there’s any truth to these worried parents’ concerns, she simply provides a crash course in Gender Identity Politics 101.

If a person tells you she identifies as a woman and is only sexually interested in women, many people would label her with the identity of being a lesbian.

She may fit the criteria for one’s definition of the term, but she never identified herself as a lesbian. Perhaps she identifies herself as queer. Instead of getting caught up in the terminology, make sure to ask what that person’s identity, or label/term that they are using, means to them.

Who you gonna believe—me or your lying eyes? A woman only interested in women=lesbian? No, don’t get “caught up in terminology” (more like, caught up in reality). Self-defined labels, identities, terms—that’s the ticket.

Just follow your offspring (or anyone else, for that matter) down whatever identity rabbit hole they are currently burrowing into. Whatever you do, don’t attempt to use your own brain to figure things out.

If your child is telling you that they are transgender or that they are struggling with their gender identity, do not dismiss it as a phase; get educated! There are great resources out there to help answer your questions.

But what if it is a phase? Shouldn’t this specialist with “advanced training” in LGBTQ++++++ youth entertain that possibility? Nope. Don’t use your critical thinking skills,  or any past or present knowledge of your own child. Get educated! Consult the great resources out there, including

a support group and/or in the form of a trans aware therapist.

Not just any therapist, mind.

Is the incidence of transgender increasing?

The truth is that trans people have been around forever. There is no evidence that there are more trans people today then there were 50 years ago. People do however, feel freer to explore their gender identity than they did in the past, thanks to a more public dialogue and acceptance, and they are doing so at a younger age. As a result, people are discovering themselves and being given a platform to do so that never existed in past generations. As our society becomes more accepting, people feel more comfortable being themselves.

It’s all so revolutionary! Forget the second wave of feminism, when women abandoned their skirts and makeup in droves and came to the realization that they could be or do anything they set their minds to. Those past generations of trouser-wearing dinosaurs? The tomboys who hung out in treehouses and played with gender-neutral toys instead of color-coded Legos? What did we from “past generations” know about how to “discover ourselves” without the “platform” of gender identity politics built and maintained by fawning therapists and sycophantic journalists?

But hang on. The gender identity specialist tells us it’s NOT about toys or even how the kids act!

Sometimes when children play with toys not associated with their birth gender, parents are concerned that they might be gay or transgender. Sometimes they are and sometimes they are not. Sometimes they are trans and still play with toys that are associated with their birth gender. Sometimes they are cis and only play with toys that are not associated with their given gender. The bottom line is, try not to focus on what they are playing with and how they are acting, and spend some time listening to them. Give them that space to explore without judgement or shame.

Good advice, overall—except for the “cis” and “trans” stuff.  So what makes a kid trans then? This is a trained therapist dispensing advice. There must be some diagnostic criteria.

For children, it is important to listen and validate what they are feeling. Some may know for sure, but others may still be exploring feelings of being different.

Right. So the key diagnostic criterion for a kid to be trans is that they “know for sure.” Turning the old parenting saw on its head, it’s because they said so.

Parents, listen up. Unlike all the generations before you, it’s not your job to guide your offspring based on your own accumulated wisdom or life experience,  nor your knowledge of your own children. You must never contradict your child.  It’s only and always about validating, listening, getting educated, and above all—never seeing your kid’s trans identity as a “phase” (even when it is).

Given that this therapist specializes in kids as young as 6 and has “advanced training in working with LGBTQ-identified youth,” it’d be nice to see some acknowledgment/knowledge about developmental psychology – stuff like magical thinking, obsessive interests, rigid ideas about gender and just about everything else, and, especially for tweens and teens—social contagion.

As someone whose daughter did experience a trans identity as a year-long phase, the pap spooned up by this gender specialist tastes all too familiar in its bland superficiality and circular reasoning: they’re trans if they say they are. PERIOD.

I encourage any parent reading this post to do two things:

Do No Harm: An interview with the founder of Youth Trans Critical Professionals

A new organization has formed for therapists, social workers, medical doctors, educators, and other professionals concerned about the rise in transgender diagnoses among children, adolescents, and young adults. Youth Trans Critical Professionals was founded by a psychotherapist and a university professor just a few short weeks ago. The organization has a website (already publishing thought-provoking pieces from professionals), a Facebook page, a Twitter account, and many followers. If you are a professional skeptical of the transgender youth trend, please visit the website and consider contributing to the effort. Your anonymity will be protected at your request.

4thWaveNow recently interviewed one of the founders of Youth Trans Critical Professionals. She is available to respond to your questions and remarks in the comments section below this post.

ytcp logo.png

Why did you start this organization for professionals skeptical of the trans-kid trend? What is your personal interest in this matter?

I’m going to start by saying something that I will probably say several times. Our main concern is with medical intervention in children and young people that leaves their bodies permanently altered and/or sterilized. We don’t have a moral issue with people identifying as transgender, and believe that those who do should be protected from discrimination like any other minority. However, the medical treatments for children who identify as transgender are risky, not approved by the FDA, and permanent. With any other condition, we would be bending over backwards to find other ways to support these children without resorting to major medical intervention, and would turn to puberty blockers, cross-sex hormones, and surgery in only the rarest and most extreme cases. It is very disturbing to the originators of youthtranscriticalprofessionals.org that these treatments, whose long term effects are not well-studied, are being offered very casually for a condition which isn’t even clearly defined.

I have a private practice where I work mostly with adults, although from time to time, I do see adolescents. I first became aware of this issue because parents were coming in describing kids struggling with gender identity. I started to notice a pattern: an anxious, depressed, or socially awkward kid who spent a lot of time on social media would announce that he or she was “trans,” often requesting access to cross-sex hormones shortly after this announcement. Every one of the mothers in my practice who reported this behavior was incredibly supportive of her child. These moms may have shared feelings of confusion or concern with me, but their initial reaction toward their child was always acceptance.

The first time I heard this story, I didn’t make much of it. It sounded like normal teenage experimentation to me, and I admired the mom’s openness to accepting her child. However, as I saw more of these cases – and I saw the cases progress to the point where the child was demanding medical intervention – I became concerned and wanted to learn more.

What I found once I started looking was that more and more young people are identifying as trans, often after bingeing on social media. For some reason that I can’t quite fathom, there is a tremendous feeling of excitement around this issue among many adults. I found out that administrators at private schools were boasting about “several kids transitioning” at their school. I heard this from more than one school while I was researching this. They shared this as evidence, I think, of how truly progressive and accepting their school is. However, I find it really odd that no one blinks an eye when four kids are transitioning in a grade of sixty kids. Given how rare transsexualism is believed to be, doesn’t that alone ring a warning bell?

The more I learned, the more disturbed I became. Where were the critical voices? Where were the adults familiar with child development speaking out for young people who are in danger of being swept along on a current that may carry them towards sterility before they have even finished high school?

I was shocked to realize that many of my fellow therapists appear to have uncritically bought into the narrative about trans children that goes something like this: 1.) gender identity is a legitimate thing. You cannot question it without being bigoted. 2.) Children know their own gender identity. 3.) If you do not immediately and uncritically affirm a child’s professed gender identity, you will be doing that child grave harm, and may even induce suicidal behavior, 4.)  The best and only treatment for a child who professes to have gender dysphoria or claims to have a gender identity other than that associated with his or her sexed body is transition – social, medical, or both. It doesn’t matter whether that child has comorbid mental health issues such as anxiety, depression, trauma, autism, substance abuse or bipolar disorder. 5.) Once a child has professed his or her gender identity, the adults around that child should follow his or her lead, providing whatever treatment and accommodations are requested by that child.

There is nothing about the narrative outlined above that is beyond controversy and shouldn’t be open to questioning. The construct of gender identity is poorly defined and lacks coherence. It surely shouldn’t be the basis for subjecting our kids to irrevocable body changes and sterilization. Assuming that children have some mysterious knowing about their gender identity seems like poor practice. Children are often very sure of things at one moment in time and believe something completely different a week, a month, or a year later. Child development is a fluid process. Refraining from immediately affirming a child’s gender identity brings with it no documented harm. The oft-quoted figure about suicide among transgender youth is a misuse of statistics. Many children (and adults, for that matter) feel significant distress about an aspect of their body or identity. Usually, therapists explore many ways to support a person facing this kind of discomfort. Sometimes medication can bring relief. Sometimes, exploration brings a new understanding. Sometimes, discomfort must be borne as we come to terms with a difficult or disappointing reality. Why the rush to change the body? Permanently?! Of course we as adults should be putting the brakes on a process that is leading toward permanent sterilization. Of course we should. Where were the other professionals who also believed this?

There is such a dearth of professional voices calling for restraint and caution in turning to medical intervention. Pediatricians, social workers, psychologists – most professional groups state that we must affirm a child’s gender identity. While we appreciate the intention here to be supportive of gender non-conforming kids, it seems the greater value ought to be protecting children from unnecessary medical procedures that often result in sterility; a central aim of youthtranscriticalprofessionals.org is to raise awareness of this.

Yes. Where are the child and developmental psychologists on all of this?  Much of what transgender activists promote seems to fly in the face of what we know about child and adolescent developmental psychology. It has been understood for decades that young children confuse fantasy with reality; that adolescents try on and shed different identities;  that children are conditioned by what they experience; that a child or adolescent’s sense of self is anything but rigid. Have you heard from any skeptical child psychs, and what will it take for some of them to start speaking out?

So far, I haven’t heard from any, but I imagine we will. You are right, and you phrase the issues very clearly. Kids do try on different identities. And we as adults don’t do them any service by privileging gender identity as some special, separate category. There is nothing innate or special or sacred about gender.

And kids have very strong feelings about what they want, and they often confuse things they want with things they need. It is so incredibly difficult to watch out child be in psychic pain. It can send us flying into action as we try to make their suffering stop. But part of our job as a parent is to use our discernment as the adult who knows them best to learn when to listen to the manifest story they are telling us about themselves, and when to listen to a deeper story underneath that.

I was talking recently with a friend who has a daughter in college. She was telling me about the awful, awful time she went through when he daughter was 13. The girl was obsessed with getting an iPhone. She cried nightly about how terrible it was for her not to have one, how it was damaging her social life and making her isolated and depressed. She was visibly distraught over this issue being any reasoning. She begged for it literally as if her life depended on it.

Thinking of this issue with trans kids, I said to her, “At least you knew that she wasn’t going to come to any grave harm if you didn’t give her an iPhone.”

My friend surprised me by saying that at the time, she felt confused about whether she was doing great harm to her daughter by not giving her a phone. “Between the peer pressure and the advertising, I was almost convinced that I was doing her grave psychological damage.” Imagine how hard it would be to stand up to a teen’s desperate demands for hormones if you had mental health professionals telling you that you were damaging your child by withholding them!

I suppose the point is that just because our kids want something very, very badly doesn’t mean that we have to capitulate or surrender our adult judgment. Teenagers don’t have a fully developed prefrontal cortex. We can’t abdicate our responsibility as their parent to say no when what they fervently desire may be harmful for them, or at least may have consequences they aren’t capable of fully appreciating.

Do you believe there are truly transgender children? Are they different from the teens who claim to be trans because of social contagion?

What a complicated question! Let me break it into a couple of parts.

First of all, there is no question that there has been a huge increase in kids identifying as trans. Much of this increase is certainly due to social contagion. Kids are getting exposed to this on social media, where they are taught that “if they are asking whether they are trans, they probably are.” Look, most teenagers go through a period of feeling intensely uncomfortable in their own bodies. I think that for many of these kids, this is an expression of that discomfort. Forty years ago, maybe more kids developed eating disorders. Twenty years ago, they were cutting. This is the current way to express that nearly universal adolescent discomfort. We all need to feel that we fit in, and that we stand out. Identifying as trans hits both of those criteria big time. You go to school and announce you are now Joe instead of Jo, and let people know you want to be referred to by a different pronoun, and in many schools, you are met with excited acclimation from peers. You are different in an exciting, trendy way. At the same time, you can feel a part of the other kids who are also embracing different gender identities. It must be very heady.

So I do believe that there is a huge social contagion piece, and this is one of the things that I don’t hear other people talking about much. This matters a great deal, because it has probably happened that some anxious, socially awkward kid has come out as trans as a way of gaining acceptance and belonging, and has gotten so much support and affirmation that she has continued down the road to take hormones. In short order, she had permanently altered her body – a deepened voice, facial hair, baldness, increased risk for certain diseases – and maybe this wasn’t for her, really? Or not for her forever? But now this person has to live with those consequences forever. Testosterone and other cross-sex hormones are not tattoos that carry trivial risks, or can at least be hidden easily. This ought not to be a life-style or fashion decision, and for some kids at least, I am convinced it is. I realize this is an incredibly unpopular stance, but this is what I am seeing from my little perch.

Of course, there are those who identified significant distress with the sex of their body before transgenderism became a cause celebre. I have read the stories about two-year-olds who ask why God made a mistake. Some of these stories are pretty compelling. I am not an expert in this area, and when I read these stories, my strongest reaction is that I am grateful I have never had to be the person responsible for making a decision about such a case. I’m not at all sure what the right thing to do is, but I will say that I could imagine that transitioning might be right in some cases.

There is an Atlantic article about this from 2008 that I found very interesting. It profiled several of these kids who are “persistent, insistent, and consistent” starting at an early age. Some of the Canadian kids were treated by Dr. Kenneth Zucker. The article describes some of the things involved in the treatment such as “taking all the girl toys away.” I admit that made me cringe. Really?! Who would want to do that to their child? However, at the time the article was written, Chris, the child in question, had grown up to be a gay, effeminate man who had a healthy, intervention-free body.

My understanding is that when Zucker’s team assessed a gender dysphoric child, they closely examined the family system, considering carefully different dynamics that were in play, and then crafting an individualized treatment plan that might involve several different kinds of interventions. I believe that enforcing gendered toys was something that was done in some cases, but was accompanied by other therapeutic interventions that took into account the whole family dynamic. The ultimate aim was to help the child feel comfortable identifying with his or her natal sex.

The article also followed an American child who had been affirmed early, and had begun to live as a girl. And it made reference to the social media star Jazz Jennings, who was profiled by Barbara Walters. I found the reaction of the Canadian parents to this practice of early affirmation very compelling, so let me quote from that part of the article. (The bolding is my own.)

The week before I arrived in Toronto, the Barbara Walters special about Jazz had been re-aired, and both sets of parents had seen it. “I was aghast,” said John’s mother. “It really affected us to see this poor little peanut, and her parents just going to the teacher and saying ‘He is a “she” now.’ Why would you assume a 4-year-old would understand the ramifications of that?”

“We were shocked,” Chris’s father said. “They gave up on their kid too early. Regardless of our beliefs and our values, you look at Chris, and you look at these kids, and they have to go through a sex-change operation and they’ll never look right and they’ll never have a normal life. Look at Chris’s chance for a happy, decent life, and look at theirs. Seeing those kids, it just broke our hearts.”

So I think, if I had a little boy who insisted he were a girl, and I could do this terrible thing of enforcing gendered play, or I could do this terrible thing of altering his body and destroying his ability to have his own children, which would I pick? If I knew I would have a healthy, happy, whole gay man at the end of it, if I had a reasonably good guarantee that would be the outcome, I would much rather pack away the Barbies. The personal and social difficulties of back-tracking on a childhood or adolescence spent transitioning will inevitably be immense. If a child has been transitioned from a young age how will they know, or be able to begin to articulate, that a mistake has been made? At a recent at Cambridge University seminar entitled ‘Gender Non-Conforming Children: Treatment Dilemmas In Puberty Suppression‘ it was stated that 100% of children on puberty blockers go on to transition; it’s clear there is absolutely no going back on medical intervention.

In any case, those of us who started youthtranscriticalprofessionals.org would argue that transition is always an option into adulthood. I am familiar with the view that when someone transitions as a child, they have a better chance of “passing” in adulthood, but given the very real risk of later regret, I think we might decide that medical transition is a choice to be made by full-fledged adults only.

How do you answer charges that you are promoting harmful reparative therapy on trans youth? How is this different from trying to turn gay kids straight?

Well, I’m not sure I believe that we should try to “talk kids out” of believing that they are trans, first of all. If a fourteen year old kid came into my office and said, “I’m pretty sure I’m gay,” or “I am gay,” I would say, “Tell me about that! What is that like for you? How long have you known? What lead you to first wonder about your sexual orientation? What is hard for you about knowing this? What kind of support do you need?”

If a fourteen year old kid came into my office and said, “I think I am trans,” or “I am trans,” I would ask similar questions: “Tell me more about that? What does that mean to you? Help me understand your internal experience that leads you to know yourself as trans? What kind of support would be helpful in addressing this? When did you first start to wonder?”

The purpose is both cases would be to do the thing that therapy is meant to do – to explore our experience so that we can understand it more deeply.

There are a couple of differences. First, while I would be interested in hearing from the gay child about his particular way of experiencing his gayness, we all have a pretty clear idea of what that means. A gay boy experiences sexual attraction to other boys, and not so much with girls.

The notion of gender identity, however, is much less clear. If a boy of fourteen were to tell me he is really a girl, I would want to know about that experience. What does that mean? In what way do you experience this inner sense of femaleness? How does this experience manifest for you? What are the different ways of understanding this experience? Is it a consistent experience, or is it subject to variation? How does this experience influence your understanding of yourself?

Sexual orientation and gender identity are actually quite different and these differences justify different approaches. Sexual orientation has shown itself to be quite stable. Most gays and lesbians knew from very early on that something was different. These feelings aren’t dysphoric, although they may cause distress because of homophobia. It isn’t dysphoria, it is just an awareness of who you are. It isn’t a sense of being wrong, or in the wrong body. And it doesn’t tend to change. These feelings are generally stable throughout the life span.

This isn’t the case for gender dysphoric kids. We know that a majority of them will naturally desist. Unlike sexual orientation, gender identification does tend to change for the large majority of dysphoric kids.

The other major difference – and this is the heart of the artichoke – is intervention. Gays and lesbians are not seeking intervention. They just want to love whom they love. My hypothetical gay boy client and I would be free to discuss and explore his experience of being gay and his coming out process without any high stakes medical decisions hanging over our heads. If I knew that my hypothetical trans patient would not have access to medical intervention until she was, say, 25 years old, she and I could spend our therapeutic hours exploring her experience as a trans woman, and I could offer support for the difficulties involved in being different in this way.

My goal for therapy with a trans kid would be to provide a warm, judgment free space in which they could explore their gender identity and what it means for them without a rush to medical intervention. I wouldn’t aim to convert. No. But I wouldn’t want to close in on this being the final answer, since I know that so many gender dysphoric kids will desist of their own accord.

I would hope that no one would ever be shamed or persecuted or made to feel unworthy or respect and love because of these feelings. I would argue that there is another approach in between rejection and affirmation, and possibly the word for that would be acceptance. I accept you as you are. I support you. I am curious about what you are going through. I want to hear more about your experience. And I accept that your sense of your own identity might change, and I will accept you then as well. But in any case, I would hope to delay medical intervention until the person was at least 25 years old.

Maybe the last thing to say about this is the most controversial. It isn’t really clear what exactly “gender identity” even means. It appears to refer to a subjective inner state, but when pressed, those who identify as trans will often resort to gender stereotypes in describing their discomfort. Forgive me, but I am not going to want to send any person down a conveyor belt toward permanent mutilation and sterilization over a self-diagnosis of an inner state.

Gender is a social construct. If gender is the problem, why on earth change the body? Is seems obvious that the right thing to do is to change or even abolish the construct altogether. Changing the body to fit the social constructs we have around gender only serves to further entrench the constructs we are trying to escape – and these are socially, not biologically constructed; there is no evidence that gender identity is innate.

What is your vision for Youth Trans Critical Professionals? What do you ultimately hope to achieve?

Initially, we are hoping to solicit posts from 100 professionals writing on the trans child trend from how they see it. By doing this we aim to assemble the first collection of voices of Youth Trans Critical Professionals to evidence our mutual concern. There is a meeting being planned, and we are also discussing the possibility of co-authoring a book. Ideally, we would like to help move the needle on this conversation, hopefully resulting in clearer standards of care that protect gender dysphoric and nonconforming young people from unnecessary medical intervention and permanent sterilization.

How can a group of anonymous professionals make a difference? Without a public face and voice, who will believe you are who you say you are?

Anonymity certainly limits our credibility at this point. Many of us are contending with constraints of professional institutions which broker no dissenting views. It is our hope to speak out publicly once there are more of us. In the meantime, I hope that we will be judged by how we write and think. I believe that people that read the site will know that we are striving to do this in order to protect children from unnecessary medical procedures and permanent sterilization, not out of hatred or bigotry. In addition, some professionals working with us are also friends and relations of children and young people identifying as trans and need to remain anonymous to protect their loved one’s privacy.

In the few weeks the site has been live, have you heard from other professionals who want to be on-board?

The site has been up for less than two weeks, and it has already been viewed over 2,000 times. The overwhelming majority of the comments have been positive. (I have not deleted any comments, if that tells you anything. One person wrote a critical comment, which I approved.) And yes, professionals are reaching out and asking how they can be involved not just from professions allied to medicine, but teachers, youth workers, practitioners of law, artists and writers and so on.

How can parents find therapists and other medical providers who will resist the current trend to diagnose kids as trans? There are no public directories, while there are tons of  published resource lists of “gender specialists.”

What a good idea! Perhaps we could gather the names of such providers and maintain a directory. This would be a great resource because families are telling us they reluctant to access services because they do not trust service providers to tread a sensitive line between gender confusion and medical intervention.

As a therapist, how would you suggest a parent deal with a child insisting they are trans? The current trend seems to be “affirming” the child’s identity, no matter how old the child is.

Well, this is another complicated question. Obviously, we always want to communicate love and acceptance of our children. We can accept and affirm our child and respect their struggles and personhood without necessarily affirming a professed identity.

Part of what makes this a thorny problem is that there is no neutral stance. If we affirm the kid’s gender identity, we likely tip the scales in favor of a trans identity. If we look for other ways to express our support and empathy for our child, we likely tip the scales the other way. Given that even doing nothing is not a neutral intervention, we have to ask a difficult question. Is desistance a better outcome? If we had to choose which way to tip things, what is the right way? For me, it is clear that, all things being equal, desistance is a better outcome because it avoids invasive medical procedures and sterilization. Whenever a young person is engaged in keeping the conversation about their trans identity open, they may feel comfortable deferring medical intervention which will have the side effects of irreversible sterilization – at least this puts growing maturity on their side.

There is also the very critical issue of social contagion. I believe that many kids identifying as trans for the first time as teens – and perhaps many younger kids as well – have “picked this up” from social media. Parents are not infallible, but we are likely the best judges of whether our kid is truly suffering from deep-seated gender dysphoria, of whether the gender issue is a way to express other issues.

If a parent has a teen who comes out as trans, I would be interested in knowing the following:

  • Has the child been anxious, depressed, or struggling socially?
  • Does the child have other mental health issues, such as PTSD, substance use, or bipolar disorder?
  • Has the child been spending a lot of time on social media? What sites? How much time?
  • Are the child’s peers (or desired peers) coming out as trans as well?
  • Did the announcement come “out of the blue,” without prior indication that the young person has ever struggled with their gender or identity before?

If the answers to these questions are pretty much “yes,” I would actually suggest that the parent state firmly and clearly that they do not support their child’s transition. I realize this is heresy. I would, as David Schwartz suggests, stop talking about gender. Anxious and depressed teenagers may learn that they can get a rise and a reaction out of adults when they mention gender. Addressing only the gender dysphoria instead of the underlying issues does these kids a huge disservice.

We know that social media sites like Tumblr and Reddit are fertile ground for social contagion and that many children start talking trans following immersion in these worlds. We know it’s easier said than done, but disconnecting them from the internet, especially social media, does give space for developing more self-reliant thinking. For some families it may be possible to remove a young person from their environment completely. Three months spent in nature away from screens, or overseas, or volunteering in a challenging environment may serve as a “hard reset,” allowing them to focus on something other than themselves. (After all, gender dysphoria is in essence very solipsistic.) Of course not all families have the networks or necessary resources to broker new horizons for their child in these ways. Parents are telling us it is extremely difficult to work out the best ways to support their child. But we are gaining increased confidence that saying ‘no’ to your child’s trans aspirations can inspire your child’s confidence for reflection. All parents try to keep their children away from dangerous trends sweeping youth culture and the trans trend requires the same vigilance.

I do believe that parents can have an impact. Letting a kid know that you don’t buy the gender identity drama, stating plainly that you love them as they are, but you don’t want to see them destroy their health and sterility can have an impact. They might roll their eyes, but I believe they hear you. At least if they ever look back in regret and despair they will know that you tried to protect them.

How can we support you?

If you know a lawyer, doctor, therapist, academic, nurse, teacher, guidance counselor or other professional who deals with young people and questions this trend and is thoughtful, please send them to our website! We are hoping to solicit 100 professionals to post on the site over the next few months. They can reach us from the site, and can send us material to post – anonymously if they wish.

Send parents, trans youth and their allies to the site too. Our aim is to cohere strength amongst and between us to bring serious, committed and critical attention to the dangers of trans orthodoxy.

Tumblr snags another girl, but her therapist-mom knows a thing or two about social contagion

Below is a comment recently submitted to 4thWaveNow by (yet another) parent of a girl who discovered the trans-trend on social media. This mom just happens to also be a psychotherapist.

Update: Please see the comments section for a lively and important discussion about the state of psychotherapy for trans-identified kids–including the controversy about what is (and isn’t) “conversion therapy.”

In a time when major professional organizations representing social workers, therapists, and school counselors are fully aboard—hell, they’re steering–the trans-kid bandwagon, it’s refreshing to hear from a therapist who hasn’t drunk the Kool-Aid.

But surely there must be many others who have doubts? Given the stunning disconnect between (on the one hand) the established knowledge about child and adolescent development in both neuroscience and psychology (things like identity formation, executive function, magical thinking, and neuroplasticity, to name only a few important lines of study), and (on the other hand) the simplistic mantra “if you say you’re trans, you are!” touted by “gender specialists,” there has to be some cognitive dissonance churning the minds of thoughtful clinicians.

We’ve heard from a few of them. In Exiles in Their Own Flesh, therapist Lane Anderson wrote that her skepticism about the transgender trend, along with her commitment to professional ethics, eventually drove her to resign her post working with trans-identified adolescents. Psychoanalyst  David Schwartz was featured in a post highlighting his insightful critique of the “inflated idea” of transgenderism.  And blogger Third Way Trans, a detransitioned man/former trans woman who is a graduate student in psychology, does yeoman’s work presenting a more nuanced view of transgenderism and identity politics.

Perhaps skepticaltherapist’s words will move a few more mental health professionals to speak up on behalf of our kids? We can hope.


by skepticaltherapist

There is an episode of Star Trek: The Next Generation where the crew is introduced to a mysterious alien video game. It slowly infiltrates the minds of the crew, and Wesley Crusher and another young ensign watch as the adults around them slip into addiction. Wesley begins to sense that something is amiss, and goes to find Captain Picard. He is so relieved to find the Captain and to be able to confide in him. As Wesley leaves, we see the Captain reach into his desk with sinister sangfroid and take out a gaming device. He too has been infected. As we suspected, the game is really an insidious mind-controlling apparatus that will allow an alien race to gain control of the ship.

star trek

That is what this trans madness feels like to me. When I first began to hear this emerging in the young people around me, I felt confused. As a dyed-in-the wool liberal, I felt I should be accepting and affirming. As a therapist and long-time student of human nature, it just doesn’t make sense to me that people are “born in wrong body” except for perhaps in extremely rare cases. I believe there are “true” cases of transsexualism, but the number of those affected must be vanishingly small. Why all of a sudden did it seem to be everywhere?

When thoughtful colleagues and friends started talking matter of factly about five- and six-year-olds who were being supported and affirmed in choosing another gender, I was stunned. How could that possibly be anything other than very confusing for a young child? What was I missing? I must, I at last concluded, be getting truly old.

The alien mind control device made its way into my home about two years ago when my then eleven-year-old daughter begged me for a Tumblr account since her friends all had one. Foolishly, I consented without looking into it further. I wish I hadn’t. This trend toward all things pan/bi/non binary/gender fluid/trans, etc. has generated a huge amount of energy among kids my daughter’s age. I had been watching it with some degree of suspicion and concern. But last month the degree of my alarm grew. She started dropping provocative hints, such as asking us if she could get a buzz cut. I found some writing she had left around the house, where she wondered to herself whether she were “really a girl.” She was very excited a few weeks ago when a new friend came out as trans.

It isn’t that I am a hating ogre. I think if I really believed that my kid were profoundly unhappy in her body, that this narrative was coming from her and not from social media and the kids around her, I would be reacting very differently. I would also have a different reaction if I could convince myself that gender identity experimentation were essentially harmless. Girls want to pretend to be boys? Sure! Why not? But it is absolutely chilling to think that, these kids who are just doing what teens do, get support from the adults around them that let them get stuck in the experiment so that many of them wind up permanently changing their bodies.

For the record, this is a kid who has never had any gender nonconforming behavior at all. She has always been a girly girl. As a toddler and young child, she had several “crushes” on boys. She has always been very consistent in having fairly typical “girl” interests, with few to no “boy” interests. She has always been interested in art and dance at school. She is a little socially anxious, and that is about the only thing that makes her susceptible to this, I think. Probing further, she admitted that she has been binding, and has asked her friends at school to call her by a gender-neutral name. She also told us that she had begun researching testosterone. Luckily, her interest in this started just a few weeks ago, as best as I can tell.

After that conversation, I was a wreck. In spite of having taken a sleep aid, I woke up at four am that night, my heart pounding out of my chest. I started googling again, as I had done before, trying to find some place on the internet not infected by either the “trans is terrific” narrative, or hateful speech from the other side. Search term after search term returned similar results. “Trans peer pressure,” for example, returns article after article about how trans kids need support against bullying and peer pressure. Finally, “social contagion trans” brought me to this site.

Such a huge, huge relief. I feel like Wesley Crusher finding the one other person on board the Enterprise whose mind hasn’t been taken over.

Her current school is a wonderfully progressive and nurturing. But the school administrators all seem keen to jump on the “trans is terrific” train. They proudly proclaim to prospective parents that there are several kids transitioning in the upper school. It seems like this fact is sort of exciting to everyone, and establishes without question their all-accepting super liberal cred.

I have decided that the cult indoctrinators have had free access to her beautiful thirteen year-old-brain for two years now, and that it is time that I intervene and fight for my daughter. I am so grateful for the clarity I have found on this site. Because of this blog and the stories shared here, I am feeling cautiously optimistic that we may have been able to pull her back from this brink. We have closed her Tumblr account. My husband and I have been confronting her about thinking she is trans. We haven’t been yelling or ugly or angry. We have just been telling her what we think, how we are seeing things. Partly because of this blog, we have been able to avoid going through the, “Really? Well if you say so. That is great, I guess!” stage. Right when we got wind of this, we have just been very up front that there is something dangerous going on in society and that we will not tolerate her playing around with this. We are going to continue talking to her.

As a mother and a therapist, I have been stunned and saddened to the extent by which I feel silenced, both personally and professionally. I am afraid to discuss my concerns about my daughter with friends for fear of feeling judged and being accused of being a horrible mom who will damage my child. (Certain friends of mine have circulated petitions decrying thoughtful op-ed pieces in major newspapers that were approaching Caitlyn Jenner’s transition with some well-considered feminist questioning.) I am afraid of speaking up in professional circles about the phenomenon more generally for fear of drawing ire and misapprehension. It is so frightening to think that therapy for my daughter doesn’t feel like a safe option, since the process might be so easily hijacked just by the mention of the word “trans.”

As a therapist, I mostly work with adults. A common reason for seeking therapy is being at a place where you are wondering about leaving your marriage. When a woman (or man) comes in, they usually say something like, “I haven’t been happy in my marriage for a long time. My husband isn’t a terrible person, but I just don’t know if I can stay.” What I don’t say at that point is, “Well, if you are wondering that, it must mean that you need to leave the marriage. To stay any longer would be a terrible mistake. Here is the name of a divorce attorney.”

Ending a marriage is a huge deal. There are enormous consequences for several people, even when children aren’t involved. It isn’t a decision to be taken lightly. When a client says to me that they are thinking of leaving, I believe my job is to help create the space for them to explore this as a possibility without judgment in either direction. I want to provide complete acceptance of all of their explorations. It isn’t my job to interpret their feelings or tell them what to do. I listen. I ask questions. I reflect back what I hear. I neither rush them forward nor try to hold them back. It is a slow careful process of discernment, as it should be. There is a marriage in the balance.

I believe that open-ended non-judgmental exploration is the very essence of the therapeutic process. The current prohibition on exploring a patient’s feelings of gender dysphoria seems a perversion of this process. I would feel that I had done someone a terrible disservice by imposing an external yardstick on someone’s private decision as to whether to divorce. The potential for harm is so great! How much greater is the potential for harm when we are talking about impressionable young people electing to undergo permanent sterilization?

This is very lonely, and very frightening.

 

Parents, keep listening to your gut—not the gender therapist

A few months ago, my teenage daughter stopped trying to “pass” as male. She dropped the self-defined-as-male uniform, the stereotyped swagger and the fake-deepened voice and just—moved on. Her fervent desire to be seen and treated as a boy faded away, just as other formerly unshakable ideas and urges had in the past. And our relationship has never been better.

Although I’ve allowed myself to exhale, just a little, she will remain at risk, because every sector of society—the media, the government, the schools, medicine and psychology–is now saturated with the message that trans is real; trans is good;  and if you’re a “gender nonconforming” girl–one who prefers the clothing, activities, and hairstyle more typical of the opposite sex– you just might actually be a boy.

What did I, and the other adults who love her, do? It hasn’t been easy. In fact, for a time it was a living hell, a purgatory of slammed doors, stony silence, yelling matches, and mostly—waiting.

There was no magic answer. We rode it out. I learned something about keeping my mouth shut. About saying my piece and then leaving it be.  About living with uncertainty.  We didn’t cater to demands for instant gratification.  We paid for and encouraged activities that would get her out into nature and off the Internet. Mostly, we waited.

We drew a clear line in the sand: There would be no money to pay for a gender therapist, testosterone, or a binder. If she wanted to pursue those things at the age of medical majority, that would be her choice—and it would be on her dime. At the same time, we let her know that her clothing and hairstyle choices were hers to make. Not always successfully, we tried to calmly and sparingly convey the message that however she dressed, whatever interests she pursued, she was a female—perhaps an unusual one, but a young woman nevertheless, who might someday become a role model to show other girls just how amazing and truly expansive a woman can be.

Like many who read this blog, I phoned gender therapists during the weeks after her announcement that she was trans. Without even meeting my child in the flesh, all four of these therapists talked to me like this trans thing was a done deal. I wrote about one of those conversations here. One very friendly therapist, who identifies as FTM and whose website stressed “his” commitment to “informed consent,” assured me that there was no need for my daughter to first experience a sexual or romantic relationship before deciding whether she was trans. “Most of the young people just skip that step now,” the therapist said.

Skip that step? I thought back to my own adolescence. I didn’t even begin to have a clear idea of who I was, as a sexual being, until after I’d had more than one relationship. It took years for me to come to know my body’s nuances and intricacies, its capacity for pleasure, how I might feel in relation to another.

This same therapist signed my kid up for a “trans teen” support group scheduled for the following week—again, without ever having met her. “There’s nothing you or I can do about your daughter being trans,” said another therapist… on the phone, without having met my kid. Yet another therapist refused to talk to me at all; insisted she’d have to have a private appointment with my kid first.

Contrary to the myth promulgated by the transition promoters, at least in the United States, there is no slow and careful assessment of these kids who profess to be trans. The trend is to kick out the gatekeepers, and  move towards a simple model of “informed consent”: If you say you’re trans, you are–no matter how young and no matter when you “realized” you were trans.

All these therapists seemed well meaning enough. They believed they were doing the correct thing. But with each conversation, I felt more and more uneasy. My gut feeling that something wasn’t right led me to research, to question…to put the brakes on. And the more I read, and thought, and understood, the more determined I became to find an alternative. I started this blog out of sheer desperation. I needed to find someone, anyone, who understood what I was going through. I needed other parents to talk to—badly.

My kid never did go to a gender therapist. Never did sit in a room full of “trans teens.” If she had, I feel certain she’d be sporting a beard right now.

When I first started blogging, I got a lot of hate mail. In every anonymous drive-by comment, the hater referred to my “son” who would grow up to hate my guts. “He” would surely commit suicide, and more than one of them wished me a lifetime of misery when that inevitably happened. Even the mildest posts resulted in hostile reblogs from strangers who had not the slightest idea of my family’s situation.

At first, these anonymous barbs stung, but it didn’t take long for me to realize that I could rely on my inner parental compass. Because, see, I know my daughter. I knew, when she suddenly began spouting the gender-policed jargon planted in her head by Tumblr trans activists, that this wasn’t who she really was. This was a girl who, all through childhood, was never “gender conforming” but who was secure in herself because I’d made sure she knew, via my words and my example, that girls could be and do anything.

Most of all, I knew she needed me—not to blindly “support” and give in to her every demand, but to simply BE THERE, even as a limit; a steady place she could push and rail against. It was scary, and painful, being on the receiving end of teen outrage.  Because a teenager does have the right to make some of their own decisions. And because no parent gets it right all the time. (Paradoxically, part of being a halfway decent parent is knowing how imperfect you are at the job.) But one thing became more and more clear to me:  my child did not need a parent who would collaborate in sending her down a road to being a permanent medical patient. In fact, she needed protection from the very same people who were sending me hate mail on Tumblr.

Not so long ago, child and adolescent psychologists—people who actually study the development of young human beings—were frequently cited and quoted. These experts, as well as every other rational adult, were well aware that kids shift identities: try this one on, shed it like a snake skin, try on another. Younger kids go through a long and wonderful period of make believe and magical thinking. They are actually convinced they ARE the identity they try on. And adolescents are renowned for trying on hairstyles, belief systems, clothing styles—only to discard them after a few weeks, months, or maybe even years.

In contrast to today’s transgender-soaked paradigm, when a kid’s announcement that they are the opposite sex is taken at face value, it has been previously acknowledged–for decades–that parents are largely responsible for the inculcation of gender stereotypes into their children’s minds. Children aren’t born hating their sexed bodies. They only grow to reject themselves when someone they look up to promotes the idea that their likes and dislikes in clothing, toys, activities, or other pursuits are seen as incongruent with their natal sex.

 A child’s burgeoning sense of self, or self-concept, is a result of the multitude of ideas, attitudes, behaviors, and beliefs that he or she is exposed to. The information that surrounds the child and which the child internalizes comes to the child within the family arena through parent-child interactions, role modeling, reinforcement for desired behaviors, and parental approval or disapproval (Santrock, 1994). As children move into the larger world of friends and school, many of their ideas and beliefs are reinforced by those around them. A further reinforcement of acceptable and appropriate behavior is shown to children through the media, in particular, television. Through all these socialization agents, children learn gender stereotyped behavior. As children develop, these gender stereotypes become firmly entrenched beliefs and thus, are a part of the child’s self-concept.

… Often, parents give subtle messages regarding gender and what is acceptable for each gender – messages that are internalized by the developing child (Arliss, 1991). Sex role stereotypes are well established in early childhood. Messages about what is appropriate based on gender are so strong that even when children are exposed to different attitudes and experiences, they will revert to stereotyped choices (Haslett, Geis, & Carter, 1992).

But now, we have people like this: the mother of a six-year-old girl who has “transitioned” to male, writing storybooks to indoctrinate kindergartners. To suggest to them that they, too, might really be the opposite sex:

“Can the doctor have made a mistake? Was I supposed to have been born a boy? Am I the only kid in the world like this?”

Deep down, Jo Hirst had been anticipating these questions. And she knew she had to get the answers right.

It was bedtime, and her six-year-old was curled up on her lap. Assigned female at birth, from 18 months of age Hirst’s son* had never wanted to wear female clothing and always played with boys.

I challenge anyone to find me a single account of a “transgender child” which does NOT resort to talking about toys, hairstyle, clothing, or play stereotypes to justify the diagnosis of “trans” in a young child.

Our kids are being cheated of the opportunity, the breathing space, to simply explore who they are without a gaggle of adults jumping in to interfere with the process by “validating” their frequently transient identities. Kids are being encouraged to freeze their sense of self in a moment in time, during the period of life when everything is in flux. And even though key researchers have said over and over again that most gender dysphoric kids “desist” and grow up to be gay or lesbian; even though the latest research denies any such thing as a “male” or “female” brain, parents are encouraged to socially transition their kids, put them on “puberty blockers,” and refer to them by “preferred pronouns.”

For very young children, this cementing of the child’s identity in a period when they most need the freedom to simply play and explore—to “make believe”—is essentially stunting the child’s development.

Young children go through a stage where it is difficult for them to distinguish reality from fantasy.  Among many other things, it’s why we have ratings on films. A young child can’t understand that the monster onscreen is not real.

Research indicates that children begin to learn the difference between fantasy and reality between the ages of 3 and 5 (University of Texas, 2006).  However, in various contexts, situations, or individual circumstances, children may still have difficulty discerning the difference between fantasy and reality as old as age 8 or 9, and even through age 11 or 12. For some children this tendency may be stronger than with others.

Just exactly what is motivating doctors and psychologists to jettison decades of research and clinical practice in favor of a completely unsubstantiated and unproven hypothesis of “transgender from birth”? The glib answer is: suicide. But if a gender nonconforming youth expresses the desire to self harm, encouraging that youth to further dissociate from their whole selves (because the body and mind, contrary to the bleating of trans activists, are not separate units, but a whole) is not a responsible way to support mental health.  As this commenter said in a recent post on GenderTrender:

 Wow. Conservatives aren’t the only ones who suck at science. Brain sex? Seriously? If you’re allegedly born in the wrong body, why doesn’t your brain count as part of the “wrong body”? Your brain is telling the truth but the rest of your body is a liar? Wtf? This shit is as sensible as scientology.

And when it comes to teens,

 Teens often pick up on cues and assimilate ideas presented in movies/films viewed in the movie theater and other sources, (online sources for watching movies now eclipse movie theater viewings or film DVD rentals for teens), and while teens already understand the difference between fantasy and reality, they may still absorb or become attached to ideas that are powerfully presented in films but that have no basis in reality, the teen not having enough experience or knowledge to sort propaganda from fact, fiction from reality. Films, television programs, music and statements from celebrities can [and do] become a part of the thinking and emotional/psychological makeup of teens and children.

This used to be a “duh” thing. Are teens influenced by what they imbibe, what’s in fashion, what celebrities (like Jazz Jennings and “Caitlyn” Jenner and Laverne Cox) are doing,  what their peers are saying and doing? Might socially isolated teens be even more swayed by what they see on social media, while they sit for hours, alone in their rooms?

Facebook depression,” defined as emotional disturbance that develops when preteens and teens spend a great deal of time on social media sites, is now a very real malady. Recent studies have shown that comparisons are the main cause of Facebook depression; the study showed that down-comparison (comparing with inferiors) was just as likely to cause depression as up-comparison (comparing with people better than oneself).

…Other risks of extensive social networking among youth are loss of privacy, sharing too much information, and disconnect from reality.

My daughter, like so many others I’ve now heard about, emerged from months of self-imposed social isolation and YouTube/Reddit binges, to announce, out of the blue, that she was transgender. And simply for questioning this, for refusing to hop aboard the train, I’ve been labeled a “child abuser” of my “son”? Until the last few years, parents who recognized that teens go through phases weren’t considered abusive. They were considered well informed.

Not so long ago, parents and helping professionals neither interfered with nor bolstered a particular identity that a kid was trying on. Everyone understood this was an important part of growing up: to allow our young to experiment, to see what worked and what didn’t. It’s called the development of a self. It takes years. It’s not even complete at 21. The self doesn’t emerge, fully formed and immutable at birth. It develops in response to experience, to love, and to adversity.

Given my own daughter’s desistence from the idea that she is or was ever “transgender,” I feel even more strongly that parents are right to resist the push by every sector of society to identify “gender dysphoric” young people as “trans.”

So you bet I’m going to keep doing what I can to support parents who want to challenge and at least delay an adolescent’s decision to permanently alter body and mind with hormones and surgeries. You bet I’m going to try to save my own kid from what amounts to a cult that won’t let you leave if you change your mind, without serious social consequences. You bet I’m going to continue to protect my daughter and others like her from a lifetime of difficulty, from the rapacious medical industry that is profiting from the regressive resurgence and marketing of gender stereotypes.

You can also bet that I’m going to continue shedding light on the frankly insane practice of labeling very young children as transgender, grooming and conditioning them as preschoolers to believe their own bodies are somehow wrong and alien, that they must undergo teasing and torment from other children, that they must wear prosthetics to amplify or hide their own genitalia to be accepted as they are. Or just as bad: That the entire world must be browbeaten into redefining  biological reality such that “some girls have penises” and “some boys have vaginas.”

And this work is not just about protecting kids. It’s also about supporting family members and friends who are so deeply affected by the transgender narrative.  The trans activists, the media, the doctors and psychiatrists–none of them talk about the terrible damage done to the family system, to the fabric of close relationships, when a child “transitions.”  All the activists have to say is that the skeptical parents and loved ones are “transphobes.” No one talks about the fact that the majority of these dysphoric kids would grow up to be gay or lesbian adults if not interfered with;  adults with healthy, intact bodies, not poisoned by drugs and carved up by surgeons’ knives.

So we have to keep talking about it. We have to keep the lights on in our corner of the Internet, even if only to document this strange medical and cultural fad for future historians.

Thanks to everyone who is traveling this road with me. While I know we often feel swamped and hopeless, we have each other for strength and courage. And for now, that will have to be enough.

Guest post: Tips for parents on finding a therapist for their trans-identified teen

So many readers of this blog have agonized over how to find a therapist who won’t immediately jump to the conclusion that their distressed teen is “trans” and in need of “transition” services. I asked Lane, the clinician who wrote the excellent guest post  “Exiles in their own flesh”, if she had any advice to offer. She responded in the comments thread of this recent post. I am reproducing her remarks here for greater visibility. Thank you, Lane!


As a therapist who worked with many teens who came into my office identifying as trans, I want you parents to know I did not automatically support their transitions. Like you, I was struck by the suddenness of this phenomenon of teens thinking they were born into the wrong body. My first concern was for the teen’s mental health, I looked at other causes. It’s interesting: around the time I started noticing an uptick in the number of kids identifying this way, I mentioned my concerns to a psychiatrist and a pediatrician who were both heads of the clinic where I worked. They were both on the brink of retiring, and they did not buy this new “trend” at all. They looked at what was happening as yet another medical fad. But, like I said, they were retiring. They were the old guard. The folks who replaced these dinosaurs (just kidding) had a complete absence of critical thought for the trans-narrative. It was almost as if they wanted to distinguish themselves from those they were replacing by being more open-minded, more patient-oriented.

The two folks who have come in to replace the old guard have a notable lack of developmental psych background. They are somewhat open to learning about it, but in general their work with teens (particularly any group billed as in any way marginalized – trans is pretty much the top of the heap in this regard) tends to be informed by a social-justice paradigm over something more clinical.

So, as far as finding a therapist more critical of the trans-narrative, it might be helpful to find a practitioner who is more classically trained and who is over 50. Also, find someone who is clearly a thinking, intellectual type, rather than someone more prone to falling in with medical fads. I hate to say it, but both of the old dinosaurs were uber smart, male doctors. Perhaps it was their sense of privilege, but these guys were not afraid of stating their opinions and had enough power in the organization to easily hold onto their own sense of reality. The people who embraced the trans-narrative on my team, apparently without a critical thought, were, I hate to say this, all women. So, using this small sample, which admittedly, may be utterly useless, I’d say that finding someone who isn’t as prone to the shifting sands of group-think, who hasn’t been dependent upon being seen by other professionals as “correct,” would help. Have your kid be seen by an arrogant, old man. LOL. Who would have thought I would ever write that!

Then again, I am not an old man, but I am definitely someone who has always valued and prized truth over belonging. I’m weird that way. That could be another way to screen for a trans-critical therapist, someone more old-style intellectual rather than social-justice oriented (not that I’m not down with SJ, but I qualify it when working clinically). Therapists who are critical of trans won’t be able to come out and say they are, so you’ll need to know to look for clues. You could also read their work, if they have any. Some have blogs and websites. If they say something like, well, it seems like your kid has some other mental health concerns, I’d like to focus on those for awhile before exploring their trans issues, that would be a good sign. If they do a thorough history of your family’s mental health, trauma history, that’s a good sign. These histories are an absolute must.

If a therapist is hopping on the trans explanation right out of the gate, that’s a sign they are inexperienced and lacking clinical authority. This is why you probably want your kid to see someone who has been practicing awhile–20 years at least–because, honestly, clinicians were trained so differently in the past. The training was less politicized, more intellectual and critical and I guess a bit more honest as far as research. It wasn’t perfect in the past, obviously there were abuses, but there were general, shared standards of care and it was a bad thing to breach them. There was more personal responsibility, more commitment and investment on the part of the clinicians. Now the vast majority of the clinicians and psychiatrists in the organization where I worked constantly complain about being overworked and exhausted and feel the org is screwing them over. They are too afraid to go into private practice where they could perhaps see fewer people in a day and therefore have more mental space to see each client as an individual. When people are overworked in healthcare, it means the treatment suffers; they don’t have time to look into the background of new therapies. Honestly, none of the folks I worked with had any training in working with transgender kids. They were starting to talk about getting some, but this is just now happening. And I practice in a large, metropolitan city. There are no standards of care or official certification processes yet in place for vetting therapists who work with transgender issues.

These days, training standards for therapists are pretty weak in general. Most good clinicians study for years and years, join institutes and hopefully become critical of a lot of what they learn. The point is, there are no short-cuts; it takes clinicians a really long time to become effective. Younger clinicians tend to be swayed more by current trends because they just don’t have enough experience with seeing loads of different people. Also their training is different, and they have much less clinical confidence.

If I were a parent and my kid were experiencing this issue, I would also just be as honest and loving as you can with them about your concerns, as many of the parents here on this blog have been. It’s hard because you don’t necessarily want to use this situation as the time to explain to your kid that doctors and the medical profession have been co-opted by activists and other folks looking to profit from their distress in some way. There’s so much that needs to fall away in order for you to help your kid. And if your kid is already unstable, it could be frightening to hear mom or dad sounding like they’ve been pulled into a conspiracy theory.

I think the best way to combat becoming reactive (as we do when we feel nobody believes us and yet we feel we must continue to speak since so much is at stake) is to deal with our own grief at being so alone and not being believed. Honestly, this level of self-doubt and invalidation is traumatic for people, particularly people who have in general spent their lives being respected for their measured take on the world (your basic educated liberal parent). I honestly can’t think of anything more hellish than to suddenly find your usual experience of being taken at your word ripped out from beneath you. But this is exactly what is happening to parents who question the trans-narrative. Caring, truly loving parents (not enabling parents necessarily, but good, solid parents) are being made to question their motives. It’s heartbreaking for me as a therapist to see this happening to families. I wish I had more answers for you. It might be best to keep your child away from people who bill themselves as gender specialists.

In order to reach your child, you will absolutely need to find a way to regain your own internal grounding. This blog is obviously helping with this task. You may need to “let go a little,” which it sounds like many of you have done. By this I mean, do not fight your kid on this issue. When we deal with kids with other compulsions, such as eating disorders, we encourage parents to stop talking about food.

Exiles in their own flesh: A psychotherapist speaks

This is a guest post submitted by Lane Anderson (a pseudonym), a practicing psychotherapist who has worked extensively with “trans teens” and their families. She shares with us her clinical insights into her clients, adolescent psychology, and the impact of the transgender phenomenon on our society as a whole.

If there are other mental health providers reading this post, please consider guest posting or responding in the comments section below the article. See this earlier post featuring Dr. David Schwartz for another critical perspective from a psychotherapist.

I am extremely grateful to Lane and Dr. Schwartz for speaking up. Time is of the essence, since the American Psychological Association recently released new guidelines which will make it even more difficult for clinicians to step forward.


I am a licensed psychotherapist. I’m writing this post on my last day at a teen health clinic, where I’ve seen patients and their families for nearly a decade.

In the past year especially, it’s become increasingly clear to me that I cannot uphold the primary value of my profession, to do no harm, without also seriously jeopardizing my standing in the professional community.  It’s a terrible and unfortunate conflict of interest. I’ve lost much sleep over the fact that, for a significant portion of my clients and their parents, I am unable to provide what they profess to come to me seeking: sound clinical judgment. Increasingly, providing such judgment puts me at risk of violating the emergent trans narrative which–seemingly overnight and without any explanation or push-back of which I am aware–has usurped the traditional mental health narrative.

When I am suddenly and without warning discouraged from exploring the underlying causes and conditions of certain of my patients’ distress (as I was trained to do), and instead forced to put my professional stamp of approval upon a prefab, one-size-fits-all narrative intended to explain the complexity of my patient’s troubles, I feel confused.  It’s as if I am being held hostage. No longer encouraged or permitted to question, consider or discuss the full spectrum of my patient’s mental health concerns, it has occurred to me that I am being used, my meager professional authority commandeered to legitimize a new narrative I may or may not wish to corroborate.

It’s been perilous to simply admit to not fully understanding it all–let alone disagree with the trans narrative.  There was no training or teaching. I was just suddenly told that some of my patients thought they were trapped in the wrong body and that was that.

After much soul searching, I felt I had no choice but to remove myself from this crippling work setting. Being told to exercise my clinical judgment with some clients, while ignoring it with others, made me feel like a fraud.

Throughout my career, I have come to my work with these thoughts in mind: that life is complex, that people are complex. But in one way or another, most people tend to balk at that kind of ambiguity. I try to assist people in flexing a little, try to help them find ways to manage life’s gray areas, and the occasional distress that comes from simply being conscious. But at the end of the day, I couldn’t deny it was a little weird for me to go on believing I could effectively teach others to be less rigid, more free people facing their lives head on, when I myself, their humble guide, was being exploited, tongue-tied by a new party line.

There are so many complex forces, from many different realms, coming into play with this trans wave.  Most people are completely unaware of these intersecting interests.

Unfortunately the culture war has done a number on the concept of critical thinking.  I have considered myself liberal my entire adult life, and I still am. But for a long time I couldn’t find anyone questioning this trans explosion who wasn’t on the far right. It made me feel like only conservatives were allowed to think, to consider this issue, but ultimately their thoughts were rendered meaningless due to their branding by the culture war. It’s essential that left-leaning people model critical thinking for the masses in this regard.

It’s important to link people like us together, who have been silenced, so we can resume contact with our critical thinking skills and reduce our growing sense of self doubt.  Divide and conquer is best accomplished through silencing, through calling into question those who speak out. There is so much of this attached to the trans movement. Even just wondering about a profound concept such as transgender is  labeled transphobic. What I think has happened is that people are now phobic about their own gut responses to life. We are being systematically separated from our own intuition. This is fatal for a civilization, I think. Not that our intuition always tells the truth with a capital T, but it is a critical piece of who we are. Without it, we remain profoundly directionless, and more susceptible to coercion of all types.

What frightens me most about the trans movement is that the establishment has gotten involved and is leading it. I think that’s really weird. Clearly they are benefiting from it financially. So sad. It disturbs me to see how giddy my former medical director is to be part of this growing craze. We used to treat kids with mental health problems, but now it’s all about validating their emergent and shifting identities.  As professionals, if we don’t loudly prioritize their identities as being the most important thing about them (and identities do shift constantly in kids and teens), we risk coming across as unsupportive and even immoral. Identity development has always been a teen task, but in the past it wasn’t necessarily supposed to become a lifestyle, or colonize the entirety of your existence.

Our world is in a profound state of flux. We can’t begin to comprehend what the Internet has done to how we see ourselves. People are looking for ways to belong, ways to understand who they are in place and in time. They are looking to reduce the anxiety that comes when too much change happens all at once. I try and look at trans folks as people who are seeking to answer the new questions that have emerged in this early 21st century.  I have been trying to find a way to understand their urges to detach from their bodies, to undo that feeling of exile they experience in their own flesh.  We all want to get back to ourselves; it is our duty to reconnect with those weighty parts that inevitably sink to the depths of us, the parts too heavy to remain on the surface of our lives.

From what I can see, the age-old human task to reclaim that which has gone missing appears to be manifesting with great prominence in the trans community. The problem is this: we all look for shortcuts to finding the lost treasure. It’s human nature to resist the long and serpentine journey to our own sense of personal truth. In our fear, in our self doubt, we calculate the risk and often decide it is preferable to be shown what another person–a “helping professional” or an activist–bills as a sure thing, a direct path to what we sense we lack. We all, on some level, hold a childlike fantasy that someone else has figured it out and can provide us a direct map to ourselves. And that’s what the trans narrative does. It promises to guide the follower to their essential, authentic self.  But this, unfortunately, doesn’t happen, because the essential self, whatever that is, is not created from another’s road map, but can only be comprised of the trails we forge ourselves.

What saddens me the most is the way children are being trained to think their parents do not love them if mom and dad don’t jump aboard the trans train. To me, this is a brutal aspect of a near-dictatorship being foisted on everyone. The kids are too young to see that there are no other people who will have their backs, throughout life with lasting devotion, in the unique way their families will. They think these new friends they’ve made online understand them perfectly. And in believing this unquestioningly, they find themselves lulled by the frictionless experience delivered most powerfully by group think.

Of course, I’m describing the pull of all cults; that deep human desire to be known through and through and through.The cult experience seeks to end the frustration that naturally comes when we mature and begin to see ourselves as separate beings. In our separateness, we must do the hard work of truly learning to know another. Group think reduces the fear that comes when we are unsure if we will be located by another, when we remain unable to locate ourselves.

Cults and closed narratives neutralize and tame what we see as the unknown. I think somebody needs to put a refresher out there on the cult mindset and group think.  People seem to have forgotten that we are all very easily influenced by each other. Carl Elliot wrote about this in relation to body dysmorphic disorder (people wanting to amputate their own limbs because they disidentify with them) in the Atlantic, “A new way to be mad.”

One common trait I’ve noticed in nearly all the trans kids I’ve met has been their profound sense of being different, and too alone. They often have had little success with making friends, or what I would call contact with “the other.”  Because of their psychic isolation, they are prime targets for group think narratives. But in addition to looking for a way to belong, they are also craving protection and the stamp of legitimacy, perhaps because they feel a profound lack of it.

Now that the government and medical communities are involved in the creation of who trans folks are, this class of individuals have finally found their safe havens. Now, rather than being merely invisible and awkward, they have been transformed into veritable leaders of a revolution. Now, rather than cower in the shadows, they have commandeered the narratives of others into a similar dark and brooding place where they once were. The tables, as they lived and viewed them, have now turned.

It’s got to be dizzying for these formerly “ugly ducklings” to find themselves at the center of a flock of swans. To become a part of the movement, to finally be seen and found as whole, alive, and most importantly, wanted, all they have to do is renounce the very bodies in which they feel they have been imprisoned. In doing so, the promised payoff is very big, for they have finally found a way to render mute all those who once discounted and disbelieved them. Through silencing others who threaten them, they have unearthed a means of silencing their own self hate. Rather than being afraid of themselves, they make others fear what they have become.

Psychologically these interpersonal tactics would once upon a time have been categorized as immature, “primitive” defenses erected by an undifferentiated self that cannot see the self or others as whole creatures.  But as I witness it in my own practice, this is the basic thinking underlying the psychology of the trans narrative. In her recent blog post, “My Disservice to My Transgender Patients,” Dr. Kathy Mandigo talks about feeling threatened by some of her MTF patients.  Many of the trans kids I’ve worked with will joke about how they and their friends are dictators, “masters of the universe!” I find that clinically significant. This is something toddlers do when they are first discovering they are separate from their rulers (parents). Rather than fear the parent, they seek to control the parent, exert their will on the parent and co-opt the parent’s power as their own. In doing this they hide from view their terror at facing their own powerlessness.  Ideally, the child will gradually outgrow this urge to control, will gradually relinquish the dictatorial need to create safety through controlling the external realm. When that happens,  we say it is a sign of maturity. As our own sense of agency grows, we are better able to forfeit the habit of controlling others. We also begin to feel guilt at the idea of controlling others, as we begin to see them as separate from us, 3D human beings instead of mere props on our psychic stage.

Unfortunately some people have a hard time making this shift. They get stuck or addicted to manipulating their external environment, and will continue to create inner safety through the constant and relentless work of controlling others.

Last week in a team meeting, our medical director said he was meeting with a girl who identifies as FTM to discuss top surgery and testosterone treatment.  Apparently, according to the director,  the girl’s mom is slowing down the process of transition.  Bad mom, right? The director added that the girl’s mom told her that 9 out of 9 of her daughter’s friends also identify as FTM.

At this point I couldn’t hold my tongue any longer. I said, “Can we not be honest and see that we are dealing with a trend?” Of course, everyone else  at the table was mute.  Considering I’m leaving my post, I felt bold enough to say that I found it infuriating we couldn’t discuss this topic clinically. More silent colleagues (except their eyes were wide as if they wanted me to keep talking and taking the risk for them). I said that what we were doing as a medical community was potentially very harmful, and made mention of some of the videos I’d watched featuring transmen who decided to go off testosterone.  The medical director prides himself in providing special services for those patients he deems unjustly marginalized by society. But he can’t see how the medical community has become complicit in the oppression he earnestly seeks to remedy.

A large part of the problem comes with the revolution in health care. More and more, we are giving people the power to define their own treatments. This is good in many ways, but the trans movement is using this moment, and is actively recruiting young, psychologically undefined and frightened people to push their agenda through the medical community. It’s clearly not that difficult to do. These kids are just pawns. That’s how it looks to me anyway. The trans community needs more converts so that the narrative becomes more cohesive. I’m guessing the push for this comes from a need to further cohere so they will have more members to fully cement a fragile, constructed reality.

We–people who don’t identify as trans–are the external realm that must be controlled to bring the trans community the inner peace they now lack. But they don’t get that they will never find calm or strength this way. You cannot find yourself through coercing others. You cannot extinguish your fears by turning from them. The trans community must face their own fears, face themselves and their own demons. They can’t wipe out their fear that they are not really transitioning by censoring the thoughts and expressions of others. If they believe they are trans, they shouldn’t need to spend so much effort foisting that belief on others.

The fact that they do dictate to others is to me diagnostic of their very condition. They are uncertain about who and what they are. No sin in that. That’s human.  The transgression comes in refusing to accept this uncertainty, and in sacrificing the lives and consciences of others to nullify your own self doubt.