Conflicted — my therapist offers affirmative care

[JoyFreeCake]

This isn't really appropriate for this board but I can't think where else to put it.

I don't know how it came up in conversation, but it turns out that my therapist, who specialises in people with ASD, takes an affirmative approach to children with gender dysphoria.

This therapist has helped me a huge amount with my mental health problems and ASD over the years, and I absolutely believe she thinks she's doing the right thing. But I now can't get out of my mind the harm that I believe she may be unwittingly doing to autistic young people. I've told her my point of view, and that I don't want to use therapy time on debates, but this has saddened me, and I won't be able to forget about it.

Has anyone been in a similar situation and has any tips for how to not have this bother me so much?

It does suggest your therapist doesn't care to help investigate and solve problems as much as be seen to be saying the compulsory thing, despite possible detriment to clients.

It would make me wary whether she prioritised her clients' best interests or her own.

Yes… it's odd, because that's not been my personal experience of her style of therapy. She's never been afraid to say things I didn't like or didn't want to believe were true (over and over again, for months, if necessary).

I assume it's adolescents and adults she sees, not children, as most therapists don't see both adults and preadolescent children. But for me, automatically affirming an autistic adolescent girl in her belief that she's a boy, knowing this could well lead to sterility and amputations, is abusive. And I can't square that in my head with the person who, while she's not perfect, has helped me through some of the worst times of my life.

Even a 'good' therapist can have blind spots.

Can you raise your concerns in therapy?

Just to clarify, I don't mean you should debate her.

I mean just be honest. "I'm really feeling uncomfortable about the approach you expressed on gender last week, and I'm feeling conflicted and worried about it today."

Very worrying. Particularly as she is working specifically with autistic patients. I’d ask her to check the literature, including concerns from international autism experts such as Tony Atwood.

Our relationship with our therapist goes through various stages of attachment, then detachment as therapy nears its natural conclusion.
Its possible that you've reached the stage where you are ready to see her as an ordinary person with flaws just like yourself, and detach from her.

But its also possible this hasn't happened at the right time for you, and instead has damaged your trust and confidence in her. If thats the case you might have to ask her to refer you to another therapist; but you might struggle to find one that doesn't affirm gender questioning children.

While we see affirming gender identity as a type of conversion 'therapy' for gay and non gender conforming children, organisations are pushing it as the opposite.

''The UK Council for Psychotherapy has launched a new Memorandum of Understanding on Conversion Therapy to include ‘gender identity,’ leaving therapists, counsellors, GPs and clinical professionals in a position where they may be afraid to do anything but agree with a patient’s self-diagnosis as ‘transgender.’ Anything other than ‘affirmation’ could lay a professional open to the charge of conversion or reparative therapy.''
www.transgendertrend.com/children-left-unprotected-by-new-memorandum-of-understanding-on-conversion-therapy/

I mean, we briefly discussed it when it came up, and I then sent her what was basically an essay giving my POV on gender issues (I write a lot of stuff down for therapy as I'm not very articulate in person). But my sessions are expensive, and I find it difficult to hold back once I get going; I worry that any conversation would degenerate into a fifty-minute debate on the topic of trans teenagers rather than the actual therapy I need.

I'm pretty sure I'm not going to change her mind… I'm not sure what I'm asking for here, except whether I can in all good conscience keep seeing a therapist who, while she's helped me immensely in the past, carries out what I believe is harmful therapy.

Affirmative care can mean all sorts of things. You can have a person with distress for many reasons and gender dysphoria could be just one of them. Affirming that leaves the therapist free to work with the person on the other issues that are causing their distress and eventually they may come around to realising that they can actually be comfortable with their sex.

It's very common where a person has suffered abuse or sexual assault, for example.

@JoyFreeCake

I mean, we briefly discussed it when it came up, and I then sent her what was basically an essay giving my POV on gender issues (I write a lot of stuff down for therapy as I'm not very articulate in person). But my sessions are expensive, and I find it difficult to hold back once I get going; I worry that any conversation would degenerate into a fifty-minute debate on the topic of trans teenagers rather than the actual therapy I need.

I'm pretty sure I'm not going to change her mind… I'm not sure what I'm asking for here, except whether I can in all good conscience keep seeing a therapist who, while she's helped me immensely in the past, carries out what I believe is harmful therapy.

I think she's not the right therapist for you if she can't listen and lean in to your feelings about her approach to gender. She shouldn't be arguing with you about it, but trying to understand and think about and help you identify and clarify your thoughts and emotions. If she's any good, she should be able to hold space for you as you work through how much of an obstacle this is to future work with her.

Full disclosure: I cannot trust affirmative therapists and found a GC therapist instead.

Our relationship with our therapist goes through various stages of attachment, then detachment as therapy nears its natural conclusion.
Its possible that you've reached the stage where you are ready to see her as an ordinary person with flaws just like yourself, and detach from her.

But its also possible this hasn't happened at the right time for you, and instead has damaged your trust and confidence in her. If thats the case you might have to ask her to refer you to another therapist; but you might struggle to find one that doesn't affirm gender questioning children.

Mmm, I'm not sure this is exactly what's going on here (attachment/detachment). I've seen this therapist in the past a couple of times, for a few months at a time, and recently started again for behavioural therapy for a very specific issue. I'm very aware she's an ordinary person with flaws 😂 This isn't like a child learning "mummy can get things wrong too". This is more like finding out your GP has a side gig selling Valium under the desk — discovering that a professional you've found helpful is doing something you consider unethical. Is it right for me to continue to obtain services from somebody who I believe is harming some of their clients?

Fairenuff: this was specifically with regards to gender dysphoria.

@JoyFreeCake

Fairenuff: this was specifically with regards to gender dysphoria.

Though having re-read your post, it seems like you're implying that "affirming" the gender identity can be a way of parking the issue while you work on the real problems?

Sorry if I've misunderstood you.

That UKCP memorandum is worrying, though, and I can see why therapists would be very wary of doing anything other than affirming. My therapist is BPS; not sure what their position is.

It's a hard one. Ethically, it seems like the answer is no.

But you have a duty of care to yourself also, and so is it unethical to deprive yourself of therapy with a person you know works well with you? Maybe yes?

Personally, I'd find it a block to further therapy. How difficult would it be for you to find someone new? Is the issue urgent, or can it wait?

Is there a sliding scale of harm? Does she encourage blockers, for example, or push clients towards Mermaids? Or us it more that she's doing the minimum to avoid being accused of conversion therapy?

How willing are you to have a clear difference of ethics with a therapist? Does it make a difference if she listens openly to your concerns? Or us she closed to your input?

How complicit are you by paying for her other services? A little or a lot? How does that compare to other financial transactions in your life? For example, it may be a guiding value for you to invest/buy ethically, in which case this is a bigger concern for you.

I don't mean for you to answer these questions here. These are just the kind of questions I'd ask if I were in your shoes.

Unless you have seen what happens in her therapy with trans identifying clients, you have no idea what she means by "affirmative care".

Those are interesting and useful questions ContentiousOne — thank you. Some of them slightly complicated by the fact she's strongarmed me into paying half-rates again 🙄 (I have a very low income but significant savings. When I first started therapy with her I was on half-rates, then realised that I had more savings than I thought I did, and after much argument managed to convince her to accept the standard rate. But when I recently went back to do this behavioural therapy, she told me half-rates, and I couldn't face another argument so just conceded.)

That's true Dione — a little of the subsequent conversation made it sound as though her approach is not one I'd consider ethical, but there really wasn't much detail.

Affirmative care is pretty standard. It involves trusting the trans identity as stable, addressing the client as their opposite sex persona, helping the client express their gender identity, supporting the client through a social transition, and working with other professionals to help the client access hormonal treatments.

@JoyFreeCake

Those are interesting and useful questions ContentiousOne — thank you. Some of them slightly complicated by the fact she's strongarmed me into paying half-rates again 🙄 (I have a very low income but significant savings. When I first started therapy with her I was on half-rates, then realised that I had more savings than I thought I did, and after much argument managed to convince her to accept the standard rate. But when I recently went back to do this behavioural therapy, she told me half-rates, and I couldn't face another argument so just conceded.)

It's always tricky, half-rates. Good in terms of being able to afford sessions, not so great when there's a client-therapist conflict.

I would have to tell her about my discomfort with her and ask why I ought to trust her. Maybe if she's a good therapist you'll both get something important out of the situation.

I started a thread here a few weeks ago after a conversation with a couple of friends. We lightheartedly said that we needed therapy to help us cope with the whole trans/ identity politics thing but then we started to wonder how we could find a feminist therapist. Not an intersectional feminist 'lite' therapist but someone who really does understand the politics of patriarchy,

I seem to remember that the only responses to that thread were from other women who'd been thinking exactly the same thing. I've begun to wonder whether I shouldn't retrain and offer my services as a radical feminist therapist: there appears to be a shortage. If I was 10 years younger I certainly would.

@Shedbuilder

I would have to tell her about my discomfort with her and ask why I ought to trust her. Maybe if she's a good therapist you'll both get something important out of the situation.

I started a thread here a few weeks ago after a conversation with a couple of friends. We lightheartedly said that we needed therapy to help us cope with the whole trans/ identity politics thing but then we started to wonder how we could find a feminist therapist. Not an intersectional feminist 'lite' therapist but someone who really does understand the politics of patriarchy,

I seem to remember that the only responses to that thread were from other women who'd been thinking exactly the same thing. I've begun to wonder whether I shouldn't retrain and offer my services as a radical feminist therapist: there appears to be a shortage. If I was 10 years younger I certainly would.

I know of one, where I used to live, but I wasn't able to sort out a mutually doable appointment time. If I had to guess, is say you had a better chance with older feminist women.

I do trust this therapist, inasmuch as I need to trust her i.e. I believe she both wants to help and is able to help. It's just that it feels wrong somehow to sit there talking to someone about my (currently) fairly minor problems when I have reason to believe they may be irreparably harming children.

On the other hand, I'm probably about halfway through the course of therapy for the specific issue I'm working on, and can probably push down my noisy conscience for just a few more weeks…

Aw I'm sorry to hear this has happened.
My view is that I don't think you need to make an ethical decision regarding whether you can carry on seeing her 'in good conscience' because of her beliefs even though she is helping you greatly.
I think the question is can she continue to help you greatly now you know this about her? Would things be the same enough for you to keep deriding the same benefit? Only you can answer that and it may be answerable now or you may need some time to see how you feel. I would only explore the effects on you rather than 'the larger ethical question'. I don't think this is something you need to explore in therapy, it's kind of just a personal call.
Of course if it is an important personal value that you give no money or endorsement to people that hold an 'affirmation only' view of gender dysphoria then contradicting that value would likely cause you distress, and that is not good within the therapeutic relationship.
It is easy to fall into the trap of this belief = good person and other belief = bad person when the truth is loads of people with wonderful qualities hold views/make decisions that seem to jarr with that. I'm sure there are things we could all be disturbed by if we knew them about our therapists/doctors/friends. Although they shouldn't be written off as people and their other good work ignored, if it affects a fundamental part of your dynamic in therapy you are well within your rights to acknowledge something has changed that has impacted on how effective she can be as your therapist because of the impact it has on you.
I hope I'm making sense! Sorry that's a bit garbled.

@JoyFreeCake

That UKCP memorandum is worrying, though, and I can see why therapists would be very wary of doing anything other than affirming. My therapist is BPS; not sure what their position is.

The BPS are signatories to the MoU. It is a fearful position for a therapist-to risk being accused of something as awful as conversion therapy. Is there any possibility that your therapist is simply stating the party line, and that her actual practice would (as it should) explore the background of dysphoric feelings etc? She may have been unsure of your perspective and saying what she ‘ought’ to say to close down a situation. If she does engage in the conversation with you, and genuinely believes in affirm only, perhaps it’s something you won’t be able to get past-does she have the skill to help you see this as a demo of your ego strength, as a belief in your own values?