Many therapists are fearful of the idea of working with trans adolescents and adults in a therapeutic setting. I was recently invited to take part in a study designed to investigate how psychologists and psychotherapists who see trans adolescents in their practices assess their clients’ capacity to make decisions about their treatment and how to approach this subject in an ethical manner. Inevitably it got me thinking…
Is gender exploration any different to any other area in therapy?
No client, adolescent or otherwise, voices questioning their gender if they are not. No one can be made trans simply by talking about possibly being trans. I approach this area as simply as I do with any other; I trust the client knows themself better than anyone. I attune (hopefully) to what they are expressing. We explore together how they feel, when they first felt this way, what their understanding of themself is. I affirm who they say they are in the same way I would affirm someone who tells me they have experienced a bereavement, an assault or anything else. I educate myself so I have the most current knowledge about different identities and all the different biological possibilities.
My client will be one of the many possibilities in terms of biology, identity and expression. It’s our work to discover who they are at that time, knowing that identity and expression can change during the life span along with everything else. Adolescents are rarely given the opportunity to have surgery or take cross-sex hormones before they are emotionally mature enough to make that decision (in the same way they are mature enough to make a decision to join the army, for example). Puberty blockers are designed to buy time and play a valuable role. See High Court Ruling blog.
Looking for certainty
Often, it’s parent’s and/or therapist’s attitudes that generate fear and friction. Often, they’re looking for a level of certainty that cannot be provided. Some clients will explore and decide they want to press forward with further treatments and others will decide not to. In many ways it’s really that simple. In terms of process, the long waiting lists provide copious time for reflection, pausing if needed or even halting the process altogether.
What clients need is to be heard and seen for who they are now and into the future.
Whilst clear ethical guidance is essential in working with trans adolescents and adults in a therapeutic setting, there is no need for fear. Just an open mind to the range of possibilities.