David MinorGender exploratory therapy is an approach that dives deep into the world of the client. It helps them explore their gender without restriction. The number of people expressing the need for support around their gender is rising. To meet this need a global association of gender exploratory therapists (GETA) has formed. Guiding principles of gender exploratory therapy include:
- Exploring potential causes of gender dysphoria
- Providing clients a range of ways to cope with gender dysphoria
- Supporting clients at various stages of transition
- Supporting clients who have detransitioned
- Viewing gender identity as fluid
- Employing a developmental lens on identity
The gender exploratory therapist strives to be neutral about outcome. They are continually curious about their clients inner experiences and seek to raise the clients self-understanding. Gender exploratory therapy acknowledges the complexity of human experience and the need to explore and consider many options.
Gender Affirming Care
The American Psychiatric Association (APA) states that gender affirming therapy is a therapeutic stance that focuses on affirming a patient’s gender identity. This view assumes that gender identity is unchanging. Therefore clients should be affirmed in their gender identity at every stage of development. The APA website states that the core interventions for GAT include:
- Gender affirmation
- Space for processing and understanding
- Linking for social supports, legal services, health care providers
- Creating a safe zone
- Allowing for diversity
- Reflection and empathy
The gender affirming approach assumes that there is nothing left to be explored or discovered regarding gender. It assumes that clients have perfect knowledge of themselves and their experiences. Consequently the role of the therapist is to support, affirm, and refer to services. Some critics have argued that any intervention other than gender affirming care should be considered ‘conversion therapy’.
What is Conversion Therapy?
Conversion therapy refers to organized practice that aim to repress, discourage, or change one’s gender identity, gender expression, and/or sexual orientation. In their article, Ridding Canadian Medicine of Conversion Therapy, Travis Salway and Florence Ashley write that “interviewees shared their experiences of conversion therapy which often involved talk therapy ‘with an explicit or implicit bias against an outcome that included a 2SLBTG+ identity”’.
Transgender man Jules Sherred wrote about his experience undergoing conversion therapy. He recounted how his therapist told him that his gender dysphoria was rooted in internalized misogyny. The therapist promised that if he worked through his trauma he could be a “normal girl”. Jules was made to feel guilty for on-going feelings of dysphoria and was told it was a sign he still hated himself. This is an example of when improper therapy practices can caused harm. Conversion therapy is never helpful, and was initially focused on converting homosexuals into heterosexuals.
Applying Conversion Therapy to trans People is Self-contradictory
Conversion therapy was not successful in converting homosexuals into heterosexuals and it damaged many peoples lives. Opponents of gender exploratory therapy are afraid that healthcare providers will inflict the same harms on transgender people. This lens lumps together sexual orientation and gender identity which are distinct and separate. Sexual orientation is stable, whereas gender identity is not. Therefore defining conversion therapy as anything seeking to repress sexuality AND gender identity at the same time is self-contradictory.
For example if I have a client who is a straight trans man and I provide gender affirming therapy wouldn’t that be “holding an implicit bias against the outcome of a cisgender lesbian women”? According to Ashley and Salway’s definition of conversion therapy, gender affirming therapy in this case would be conversion therapy! The counter-argument is that ‘it’s not conversion therapy if the client states they are trans’. However since gender is fluid we can never be certain that they won’t later regret their decision.
Many de-transitioners lament that everyone accepted their trans identity at face value, asked them no questions, and assured them transitioning was the best and only option. This creates immense pressure on people suffering from gender dysphoria. When the culture and everyone around is telling them that transitioning is the only way they can be happy they may feel forced down a narrow path that requires serious medical interventions. Without someone in their life who cares about them, and shares a different perspective many gender questioning people feel trapped. An approach that isn’t exploratory denies the client autonomy, forcing them down a pathway prescribed by the therapist.
Gender Exploratory Therapy is the Opposite of Prescriptive
The gender exploratory therapist does not make assumptions about their client based on what they first tell them. They are open to all potentialities. If I client presents themselves as transgender, the therapist does not disagree, but they also do not close themselves off to other possibilities. We know that gender identity is fluid and can changes over time. Someone who identifies as non-binary may later identify as transgender, and then at a later time cisgender.
The fluidity of gender requires the therapist to be flexible. They must simultaneously hold the clients past, present and future potential identity. This approach arose out of a need, expressed by people who had de-transitioned, for a more careful and patient outlook on gender identity. One that considered many ways of coping with gender dysphoria, and helped clients to reflect on all aspects of themselves and their experiences. This openness is a quality of all good therapy, and is distinctly missing from the gender affirming model.
Gender Affirming Therapy is Rigid and Closed
One of the founders of the Gender Exploratory Therapist Association (GETA), Stella O’Malley, writes that gender affirming therapy turns therapists into facilitators. A therapist dialogues and sometimes challenges their client. A facilitator never disagrees, they only seek how they can get behind whatever the client is saying. This is a rigid approach because clients may not have considered all the aspects of their gender, or all the possible ways of coping with their distress.
A gender affirming therapist is terrified of suggesting other ways of coping with gender dysphoria other than medical transition out of fear they may offend their client. Fear is a terrible position for a therapist to be in and will prevent them from challenging their client. A good therapist builds a strong alliance with their client so that they will be able challenge them to break out of their comfort zone. Courage to break out of one’s comfort zone is essential to self-exploration and being open to change.
How I Practice Gender Exploratory Therapy
In writing this article I am breaking out of my comfort zone because I know it opens me up to criticism. I also know many people are struggling with gender distress and desperately need gender exploratory. When I work with a client who is transgender I treat them as I would any other client. I start by conducting a mental health assessment, agreeing upon goals, and working step by step with them to achieve those goals.
If their goals include working on gender dysphoria I explain the gender exploratory approach so that they can provide informed consent for that process. If they identify as transgender but don’t identify their gender identity as an area of focus I don’t dwell on it. As I tell my clients ‘you set the destination and drive the car, I’m your co-pilot helping you navigate the landscape’. Another reason I practice gender exploratory therapy is because it’s consistent with my personal ethics, and the ethics of my profession of social work.
Gender Affirming Therapy Goes Against Social Work Ethics
The highest value in social work practice is to maintain the best interest of the client. It is not to maintain the desires of the client. Healthcare professionals make a decision about what they think is the best interest of their client based on their clinical experience and judgement, and sometimes this may contradict what the client wants. Gender affirming therapy denies me the ability to make this decision.
A second and important social work ethical principle is to maintain integrity and objectivity in my duties as a social worker. While it is impossible to be completely objective and unbiased, social workers must strive to be. Gender exploratory therapy is more objective because it is open to the client being transgender or not. Gender affirmative therapy is not objective because it does not hold open the possibility that the client may later de-transition which, as we know from the experience of de-transitioners, is always a possibility.
A third social work ethical principle is that I must not practise any intervention that is not evidence-based, i.e. proven to be effective by scientific research. Gender affirmative care is an experimental (not tested by science) approach to gender identity that has only been in existence since 2012. Therefore my social work profession forbids me from practising it. Gender exploratory therapy is simply traditional therapy applied to the topic of gender.
Going Back to the Basics
Gender exploratory therapy seeks to remove politics and ideology from the therapy room and return to simple, effective therapy. I work with gender distress the same way I work with any other issue. I don’t politicize my client. I’m not afraid of my client. I seek to understand and validate their emotions and through dialogue explore where we may travel together. I strive to embrace complexity, challenge, and self-discovery. If you or your family member is struggling with gender distress I’d love to come alongside you in this journey.
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