The ideological Capture of Psychotherapy

Very true. I'm not remotely an expert in therapy but this seems key.

I've been thinking about the therapy styles of Sue and Marcus Evans. I devoured their book on gender dysphoria therapy so that I could help my daughter. They are the kind of experts in this field who seem like they could help someone get to this position of understanding. That its a positive to have an inner belief that isn't based on or impacted by what others believe. From this neutral point, exploration about why they are dysphoric is then possible. Either by talking directly about the dysphoria or starting elsewhere with a differential diagnosis on other presenting factors.
It could presumably start wherever the client wanted it to start.

They would be great people to talk at this type of conference. I will loop back to one of my earlier points though (I appreciate I now sound like a broken record 😂) that I don't recall Sue or Marcus Evans ever describing gender identity as an "ideology". I also saw a fantastic interview with them both with Benjamin Boyce, which is what led me to discover their book. They also draw parallels to anorexia at several points in the book but stop short of it being a direct comparison.

If they talked at the conference, their neutral style would be very effective at highlighting how ridiculous the pushback to James Esses was. Perhaps he just wasn't good enough at tempering the impact of his own views in how he positioned them? Good enough for some people (those that privately thanked him) but not good enough to persuade people who either had firm beliefs that affirmation was the only correct approach or who were on the fence on that one. It's very possible that it just came across as unkind to anyone who was on the fence.

Tbf, Psychotherapy was always pseudoscience bs.

Ill get me coat...

I think the difficulty comes, where gender believers who need their therapist to be a believer don't accept that it IS a belief. They come from a position that gender is a fact, so the therapist seeing it as a belief, which can be held or not, is perceived as a threat. It triggers them, it makes them feel unsafe, it's hateful.

Yes, this would definitely be a stalemate. I guess it depends on what the person's goals are for therapy. If they want to explore how they feel when people look at them ("I am constantly worrying about whether I pass [as the opposite sex] or not"), a therapist who will affirm the belief could be a good fit for them. However, if their goal is to understand their dysphoria, I can't think of any scenario where a therapist who shares the same belief in gender identity is a good idea.

An truly open exploration would suggest that the therapist would explore the meaning of pronouns and name changes for the client and try to get to the heart of the complex that was demanding thse changes, not just affirm them.
The gender affirming therapist on the otherhand simply becomes an enabler; a confirmer; a necessary gateway to drugs and to affirmative surgery - in the same way a GP acts as a gatekeeepr to a consultant specialist or to a prescription for medication...The therapist's job is not to confirm the clients belief system, but to help them explore it and see what function it is performing for them. Most therapist ( you would assume) would consider a belief system that led to unnecessary drugs or to damaging surgery, or to affirming an already fragile identity would not be a positive or healthy one.

Totally agree. So I think it comes down to this question of fundamentalism.
Could a therapist (who believes that they have their own gender identity and broadly thinks that "trans people are who they say they are") help someone to unpick their dysphoria with their body? I imagine that a Muslim therapist could help another Muslim unpick themselves from Islamic fundamentalism. Even though both of them share the same belief in Allah and the Koran, there is a vast difference between being an every day peace loving Muslim and a fundamentalist. So is gender "all in"? There is no layer that isn't fundamentalist?
@NotHavingIt . The only therapist that should be near my daughter (she actually stopped therapy, because she found it boring) is one who would unpick the pronoun question neutrally. And to have that neutrality, it may only be possible to do this if you don't have a gender identity belief. Luckily my daughter wasn't pushing her belief hard when she started the therapy and she hadn't reached any conclusion about her gender. She was still saying "I don't know" when asked her pronouns, for example. But for anyone who has already made a decision, therapy is pointless if the goal is to understand the dysphoria and the exploration of the belief is completely off the table. Having a belief that compels someone to change their own body is sort of on par with religious fundamentalism where that belief compels someone to harm others (e.g. suicide attacks). Obviously not the same thing but they are both examples of where someone's belief has led to an extreme outcome. The major difference with dysphoria on this one is that the person is changing their own body, not harming others. So it's possibly only a "gender critical" therapist who could pick through the nuances of that with sufficient neutrality. Similar to anorexia as you say. However, where it differs from anorexia is that there will be some cases where the client changing their body is the right outcome. But this would only be after sufficient neutral exploration. This helps explain why it's such a specialist area of therapeutic care as it's very easy to upset that balance. And also why the influence of Mermaids etc on that delicate balance is so catastrophic. Just as Hannah Barnes found in her book.

thank you I will see if I can find that network, it is good to know that there are a number of GC therapists willing to be known as such.

I believe there is a network of GC therapists. I think I've come across mentions in the context of parents looking for therapists who will explore with rather than automatically affirm their gender-questioning children - but they might have members, or be able to point to you other therapists they know, with more suitable specialties for you.

I'm sure there are some gender dysphoric people who much be aware and accept that not everyone believes in gender identity (so by extension, not everyone believes that TWAW) but it sounds like many (most?) will want the affirmation of the belief as a condition of engagement. At this point, the only logical conclusion is that an affirming therapist is needed.

I think the difficulty comes, where gender believers who need their therapist to be a believer don't accept that it IS a belief. They come from a position that gender is a fact, so the therapist seeing it as a belief, which can be held or not, is perceived as a threat. It triggers them, it makes them feel unsafe, it's hateful. For them to keep their worldview intact, everyone has to subscribe to it.

That being the case, a gender believer as a therapist is probably one of the last things they need, while being the only kind they will accept.

Of course not all gender dysphoric people are like this, I'm sure many are able to make use of therapy which doesn't just affirm. It seems like those who might benefit most from supportive, valuing and questioning therapy are the least likely to get it. I don't know how to change that.

thank you, that is a very good idea and can be sensitively done.

I'm sure it would. When I was creating a safeguarding approach for my daughter (in education and mental health) I included some respectful and clear guidelines. Such as the impact of the question "what are your pronouns?" on her autistic processing - it effectively asks her if she was happy being a girl. I didn't say "Don't ask her her pronouns", instead I asked professionals that were working with her to be mindful of unconscious bias and consider different ways of understanding how she would like to be addressed e.g. "what would you like me to call you? Is there anything else that's important to you about how I address you?"

I've found it to be a real conversation opener and it has been very easy to quickly ascertain whether any professional that is working with my daughter has a belief in gender identity or not. Equally, it would uncover if they did have a belief but were happy to keep it out of the conversation - I personally would be fine with that as long as I was confident from my exploratory conversations that I understood how their belief would or wouldn't impact the delivery of their therapy. As has been said above, it's possible for therapy to be successfully delivered even if the therapist and client have different beliefs. It just sounds like a gender identity belief needs a lot more scrutiny to unpick a "fundamentalist" from someone that simply wants to support those who are distressed in their gender identity. The GP that I worked with to support my daughter fell in to the latter category - he believes that gender identity is real. But he was an integral part in helping to build a balanced safeguarding document with firm boundaries that stop unconcious bias.

Perhaps you could do something similar in an email about your own "safeguarding" needs in relation to your trauma when you approach some potential therapists? To open up the conversation and find the right person.

this is interesting for me: I am a gender critical lesbian and will be going to UK to do a grad course (on a career break, I am not young). I wonder if it would be possible to easily find a GC therapist who would allow me to speak of gender critical concerns (I am receiving therapy for past homophobic violence, which therapy I would hope to continue in UK).

A very thought provoking thread. I had to take some time to read through all the comments.

For me the problem with embracing someone's belief in gender identity is where it can lead. It can lead to the taking of hormones not suited to one's natural biological make-up, and/or to mutilating surgery.

Absolutely. Striking a balance between respecting without judgment and not embracing, encouraging or embedding would be the key skill here. I suspect that many (all?) gender dysphoric people would refuse to engage at all if their pronouns and preffered name (if different) weren't used. Which is fair enough... but this:

For me the difference lies in the client needing me to validate and uphold their belief system, the requirement that I recite the catechism if you like. I can respect a client's beliefs without sharing them, but with gender that isn't enough...But I've had adherents to gender ideology want me to state I believe TWAW, TMAM, NBIAV, and decline to work with me because I won't do that.

....adds the extra dimension that also comes through in the fundamentalist religion examples. I'm sure there are some gender dysphoric people who much be aware and accept that not everyone believes in gender identity (so by extension, not everyone believes that TWAW) but it sounds like many (most?) will want the affirmation of the belief as a condition of engagement. At this point, the only logical conclusion is that an affirming therapist is needed.

For children and young adolescents, I don't imagine many will have deep beliefs in gender identity to the same degree. They may well have a firm belief in their own gender identity and a firm belief that they are dysphoric (which makes both real at that point as a net effect). However, if gender identity can be taken out of the conversation entirely after pronouns and preffered names are accommodated, it could then be possible for the therapy to move on to the other presentations. There may also be some adults for whom this is true too.

No disagreement from me!

But that doesn’t mean it isn’t. DSM is a political document as well as a medical one.

Gender dysphoria is a mental illness - regardless of belief, the idea that the physical body needs to be changed to match a belief must surely be a mental illness.

Stonewall et al have lobbied very hard against that view, and to have it removed from the DSM.

One thing for me (I accept that there are many who disagree with me) is that I won't use the word "ideology" to describe a belief in gender identity. In exactly the same way I wouldn't describe a belief in God as Christian ideology. It inherently has a negative and othering connotation IMO. So if I had a gender identity belief, and was experiencing gender dysphoria, I wouldn't want my therapist to have any implicit bias within their explorations with me. If a therapist calls it an ideology, this might be a red flag. It would be unethical for a therapist to bring any atheist bias in to their work with a Christian client (e.g. unpicking and challenging their beliefs), so the same would be true of a gender identity belief.

This is a good point and, although I can certainly see calling it an ideology in a therapeutic situation harmful, I am not sure I entirely agree. Christians would totally agree that Christianity is a belief system; the creed includes the words “I believe”, it is supernatural, other worldly. ‘Ideology’ suggests it is based on ideas about the nature of the world rather than the nature of God (theology). A Christian is unlikely to object to you calling their believe a type of theology. Those who follow gender identity ideology/belief do not consider it a belief, so calling it gender identity belief would not be considered any less biased by them. Instead it they do base it on a set of ideas about the world so calling it an ideology is more correct.

I don't hold any of those beliefs myself, including a belief in gender identity, but I would still want to show that I respected their belief.

For me the difference lies in the client needing me to validate and uphold their belief system, the requirement that I recite the catechism if you like. I can respect a client's beliefs without sharing them, but with gender that isn't enough. I've worked with clients who hold completely different views to me, and made great working relationships with them. But none of them ever needed me to believe the same as them, in order to make use of therapy. I've never had a Christian client require me to declare I believe in God, or an antivaxxer need me to refuse to have the covid vaccine, though I've worked with clients with those beliefs. But I've had adherents to gender ideology want me to state I believe TWAW, TMAM, NBIAV, and decline to work with me because I won't do that.