At present, the guidelines from the BPS recommend ‘affirmation’ of gender identity rather than therapeutic attempts to discuss and understand the source of any dysphoria (see this document for example).
To understand the implications of these guidelines, they encourage practitioners to see gender dysphoria as a sexuality rather than a body dysphoria. Doing so has significant implications for treatment because body dysphoria would be treated with an examination of a number of causes and remedies. In contrast, if gender identity is simply to be ‘affirmed’ however, then the only option is medical intervention.
One of the issues is that patients can present with gender dysphoria for a number of reasons: some relate to unhappiness with the body, some relate to sexuality, some relate to trauma or personality, and some relate to gender dysphoria (and most likely a combination of some, or all of these factors).
The appropriate response to any of these concerns is detailed assessment, and in-depth discussion in a solid and trusting therapeutic environment. However, the BPS is further leaning toward biological treatment through the insistance that any psychologists treating those with gender dysphoria must do so under the supervision of GIDS (Gender Identity Development Service) clinicians.
Clearly, the affirmation model has implications for all patients, but it places young people in a particularly vulnerable position, not least due to the life-changing implications of biological intervention such as hormone treatments, anti-androgenic treatments, medication, surgeries etc). We have already seen high-profile examples of such cases (see links below), and there may be many more that have not yet received the same exposure.
However, it is a relief to see that alongside the charges of financial and management problems, the Charity Commission is now also investigating the BPS in relation to the damaging advice they are promoting regarding transgender patients.
For a thorough overview of the issues, see Thoughtful Therapists – a website created by psychotherapists and counsellors working in the area of gender and gender dysphoria
Articles relating to dangers of ‘affirmation policies’:
- The well-publicised case of Keira Bell
- A piece from psychotherapists working with trans-identified children:
- A thoughtful piece from Jesse Singal about ‘desistance’
- Personal stories of de-transitioning
- Research regarding a need for more de-transitioning support
- A concise overview of the dangers of framing ‘non-affirmation’ as ‘conversion therapy’
- The Times speaks to five clinicians who resigned from a NHS gender clinic because of concerns over the treatment of vulnerable children who come to the clinic presenting as transgender