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. Hopefully I attune 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.
Clear ethical guidance is essential in working with trans adolescents and adults in a therapeutic setting. However, there is no need for fear. Just an open mind to the range of possibilities.
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I have huge concerns over the recent High Court Ruling on puberty blockers for transgender young people. One person’s experience will set back transgender rights for all.
Keira Bell was assigned female at birth. Following several appointments with the specialist services at the Tavistock clinic she takes puberty blockers. Keira is subsequently prescribed testosterone and undergoes top surgery. At this point Keira identified as male. Later, she made the unusual decision to de-transition and now lives and identifies as female.
Longer waiting lists
As a result of the High Court Ruling on Puberty Blockers case individuals aged 16 or under will no longer have access to puberty blockers without the intervention of a further court case. For anyone on the waiting list their treatments are now paused and those already taking blockers are having their medication reviewed.
The media have reported that booking an appointment with a gender clinic is as easy as booking a GP appointment. It really isn’t. They also report that clinics actively encourage young people to transition and that puberty blockers are prescribed at will. This is incorrect information. There’s a very rigorous process involved. Individuals essentially have to prove to several practitioners that they are transgender before being offered any medication and/or surgical intervention. Assessments are carried out at every stage of the process. So the individual has ample opportunity to reflect on the changes happening to them, their body and their identity.
Over several years Keira had first puberty blockers, then testosterone and finally top surgery. At no stage did she raise concerns about the process or the ‘speed’ of the process. That she regrets her decision is heart-breaking. As yet, it is unclear why she felt unable to raise concerns along the way. This one court case will now negatively impact many transgender individuals who are absolutely sure of their need for puberty blockers, hormone treatment and surgery.
Puberty blockers are not new
The courts have given the impression that puberty blockers are new and dangerous. These drugs have been used for many years to stall early-onset puberty. The medication is simply stopped once the child reaches the age when they would more naturally go through puberty. There is only one difference with transgender people. Puberty blockers are used to gain time for the individual to explore their identity before going through irreversible procedures. Going through a puberty out of alignment is traumatic beyond belief.
The anti-trans lobby now uses Bell as a poster girl. I understand the entire case has been crowdfunded by anti-trans supporters.
Something that really concerns me is that, following this case, many will come away with the idea that somehow transitioning is a dangerous thing that should be put off into adulthood. There are some concerns here:
Your child may not live to see adulthood if gender dysphoria is not recognised and treated
The myth is that more people de-transition than they do and therefore we should prevent transition in the first place
That therapists will, having read incorrect information in the media, support the idea that transition is wrong and will not provide the best care and support to their clients/patients.