Important article in 'Archives of Sexual Behaviour' critiquing Turban et al's paper on conversion therapy:
Published: 21 October 2020
'One Size Does Not Fit All: In Support of Psychotherapy for Gender Dysphoria'
by Roberto D’Angelo, Ema Syrulnik, Sasha Ayad, Lisa Marchiano, Dianna Theadora Kenny & Patrick Clarke
(extract)
"Turban, Beckwith, Reisner, and Keuroghlian (2020) published a study in which they set out to examine the effects of gender identity conversion on the mental health of transgender-identifying individuals. Using the data from the 2015 U.S. Transgender Survey (USTS) (James et al., 2016), they found that survey participants who responded affirmatively to the survey question, “Did any professional (such as a psychologist, counselor, religious advisor) try to make you identify only with your sex assigned at birth (in other words, try to stop you being trans)?” reported poorer mental health than those who responded negatively to the question. From this, Turban et al. concluded that gender identity conversion efforts (GICE) are detrimental to mental health and should be avoided in children, adolescents, and adults. The study’s conclusions were widely publicized by mass media outlets to advocate for legislative bans on GICE, with the study authors endorsing these calls (Bever, 2019; Fitzsimons, 2019; Turban & Keuroghlian, 2019).
We agree with Turban et al.’s (2020) position that therapies using coercive tactics to force a change in gender identity have no place in health care. We do, however, take issue with their problematic analysis and their flawed conclusions, which they use to justify the misguided notion that anything other than “affirmative” psychotherapy for gender dysphoria (GD) is harmful and should be banned. Their analysis is compromised by serious methodological flaws, including the use of a biased data sample, reliance on survey questions with poor validity, and the omission of a key control variable, namely subjects’ baseline mental health status. Further, their conclusions are not supported by their own analysis. While they claim to have found evidence that GICE is associated with psychological distress, what they actually found was that those recalling GICE were more likely to be suffering from serious mental illness. Further, Turban et al.’s choice to interpret the said association as evidence of harms of GICE disregards the fact that neither the presence nor the direction of causation can be discerned from this study due to its cross-sectional design. In fact, an alternative explanation for the found association—that individuals with poor underlying mental health were less likely to be affirmed by their therapist as transgender—is just as likely, based on the data presented.
Arguably, even more problematic than the flawed analysis itself is the simplistic “affirmation” versus “conversion” binary, which permeates Turban et al.’s (2020) narrative and establishes the foundation for their analysis and conclusions" (continues)
In the ensuing months, as we observed Turban et al.’s unsupported claims of the harms of psychotherapy for GD taking root globally (United Nations, 2020), we felt compelled to write a more detailed critique of the study, which we present here. Our aim is to put the spotlight on the more problematic areas of Turban et al.’s analysis and to illustrate how heeding their recommendations will limit access to ethical psychotherapy for individuals suffering from GD, further disadvantaging this already highly vulnerable population. (continues)
concludes:
We believe that exploratory psychotherapy that is neither “affirmation” nor “conversion” should be the first-line treatment for all young people with GD, potentially reducing the need for invasive and irreversible medical procedures. This is especially critical now, when we are witnessing an exponential rise in the incidence of young people with GD who have diverse and complex mental health presentations and require careful assessment and treatment planning.
We are concerned about the deficit in our knowledge base about psychological interventions for GD, beyond a few successful but small case studies, and we fear that the erroneous conclusions presented by Turban et al. (2020) will make it less likely that such research will be carried out in the future. We call on the scientific community to resist the stigmatization of psychotherapy for GD and to support rigorous outcome research investigating the effectiveness of various psychological treatments aimed at ameliorating or resolving GD. The outcomes of psychotherapeutic treatments must be compared to those of biomedical interventions, so that evidence-based standards of care that allow patients and clinicians to make fully informed decisions about how best to alleviate GD can be developed and put into practice."
link.springer.com/article/10.1007/s10508-020-01844-2