Opposition to gender-affirmative approaches to care for transgender youths by some clinicians has recently begun to consolidate around “gender exploratory therapy” as a proposed alternative. Whereas gender-affirmative approaches follow the client’s lead when it comes to gender, gender-exploratory therapy discourages gender affirmation in favor of exploring through talk therapy the potential pathological roots of youths’ trans identities or gender dysphoria. [...] The questions are followed by an exploration of the strong conceptual and narrative similarities between gender-exploratory therapy and conversion practices. Finally, the ethical dimensions of gender-exploratory therapy are discussed from the lenses of therapeutic neutrality, patient-centered care, loving attention, and therapeutic alliance, suggesting that the approach may be unethical.
Thanks for sharing this. I had no idea this was a new trend, and IMO it's a disturbing one, for all the reasons mentioned above.
Clinical ethics
Proponents of gender-exploratory therapy situate their approach as neutral, agenda-free, and more in line with foundational principles of psychotherapy (D’Angelo et al., 2021). Yet approaching trans identities and gender dysphoria from a position of suspicion—suspicion that, regardless of indication, they may be attributable to pathological causes and should be explored as such—is incompatible with therapeutic neutrality. One of the sources quoted by D’Angelo and colleagues (2021), for instance, explained therapeutic neutrality as “knowing one’s place and staying out of the patient’s personal life,” allowing “for the patient’s agenda to be given primary consideration” (Simon, 1992, p. 273). However, gender-exploratory therapy seems to interject itself into clients’ lives by doubting that their gender identity and experience of gender dysphoria are authentic and not pathological. Gender-exploratory therapy also fails to give primary consideration to the client’s agenda of self-actualization by placing undue weight on the risk of detransition. As I showed with the psychiatrist who tried to convince Keira Bell not to transition, discouraging or delaying transition can severely undermine the therapeutic relationship and foreclose the client’s free, self-directed gender exploration. On that account, gender-exploratory therapy seems inconsistent with therapeutic neutrality.
From a patient-centered standpoint, it is crucial to realize that most individuals who enter a clinical relationship because they are trans or experience gender dysphoria do so for the express purpose of securing access to gender-affirming care and, accordingly, living out their felt gender in everyday life. Although some may view their own trans identity or gender dysphoria as a pathological response, they are a minority. There is little basis for doubting clients who believe that their gender identity or gender dysphoria is nonpathological given the rarity of regret and the absence of proven indicators or validated assessment techniques that could accurately predict future regret (Brik et al., 2020; Bustos et al., 2021; Deutsch, 2012; In re: Kelvin, 2017; Lawrence, 2003; Narayan et al., 2021; Pimenoff & Pfäfflin, 2011; Wiepjes et al., 2018). Imposing gender exploration on clients seems manipulative or coercive and incompatible with patient-centered care. Although patient-centered care is not against exploration or assessments, it emphasizes the importance of centering clients’ desires and perspectives as much as possible. Without a clear and compelling justification, suspicion and paternalism run afoul of patient-centered care. Instead, a patient-centered approach would facilitate access to gender-affirming care; scaffold clients’ self-directed and autonomous gender exploration, including through medical transition; and offer health-care services tailored to the needs of detransitioners (Ashley, 2019b; Hildebrand-Chupp, 2020). Rather than imposing gender exploration, patient-centered therapists support clients in their decision-making process and foster a space for them to explore their gender on their own terms, should they want to do so.
Conclusion
Gender-exploratory therapy is an emergent and underdefined paradigm in trans health care. Despite appealing to positive notions such as curiosity, neutrality, and exploration, proponents of gender-exploratory therapy leave many critical questions unanswered and strike a conceptual and normative pose that seems incompatible with evolving understandings of clinical ethics and trans identities. Being trans is not undesirable and should not be approached as if it were.
Proponents of gender-exploratory therapy acknowledge that some consider it a form of conversion practice, paradoxically resenting the suggestion while opposing bans on conversion practices on account that it would prohibit their approach. As for critiques of gender-exploratory therapy, they are presented as evidence of trans health care’s ideological capture. Yet a close comparison of gender-exploratory therapy and conversion practices reveals many conceptual and narrative similarities. How proponents talk about gender-exploratory therapy is nearly identical to how individuals offering conversion practices targeting sexual orientation frame their own work. Despite the language of exploration, gender-exploratory therapy shares more with interrogation, if not inquisition.
When you begin from the premise that trans identities are suspect and often rooted in pathology, your therapeutic approach soon becomes indistinguishable from conversion practices. As a scholar of conversion practices, the uncanny resemblance cannot but give me pause.
Thanks for sharing this. I had no idea this was a new trend, and IMO it's a disturbing one, for all the reasons mentioned above.
Thanks for sharing this. I had no idea this was a new trend, and IMO it's a disturbing one, for all the reasons mentioned above.