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?

@Broomfondle

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.

Oh yeah I'm sure she can continue to help me. I don't think of her any differently as a person or, except in this one area which I haven't personally seen, as a therapist, because I know it's very unlikely that she's a terrible person in this one specific area of practice — I'd assume she believes she's doing the right thing. Nothing is any different about her, it's just that I now know this one specific thing which I think is an awful mistake she's making, but which doesn't have any direct relevance to how she treats me.

It's more that my sense of ethical integrity won't allow me to stay silent when I feel something's deeply wrong. And I have spoken up, so perhaps having done that once is enough to satisfy my need for ethical integrity. But it does sadden me.

MrsWooster: no, she was already aware I'm GC when she told me she takes an affirmative approach, as it resulted from a conversation about how I'd felt unable to participate in a lot of the social stuff at uni because of the gender orthodoxy.

I have no idea what skills she does or doesn't have around demonstrations of ego strength, partly because I don't really know what that is I believe what I believe and nobody is going to bully me out of it, if that's what you mean? But I refuse to bully anyone else either (which doesn't work anyway).

'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?'

Yes that's what I meant, sorry if I wasn't clear. Sometimes gender dysphoria can mask the root problems. It's more of a symptom of those problems. If the other issues are addressed, often the person realises that they no long have gender dysphoria.

Oh you were clear enough, I was just being dim. Thanks

Tangentially, Thelnebriati, I'm actually really confused by this: 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.

Is there ever a point where you don't see your therapist as an ordinary person with flaws just like yourself? I mean, I'm pretty sure all the therapists I've seen have been human beings at every stage of the process, and none of them seemed particularly perfect to me :-/ (would be kind of creepy if they did, and also attaining perfection would generally require therapists to be an awful lot better at responding to initial enquiries). And I also don't really think I understand why stopping seeing someone as perfect would lead to "detaching" from them.

Honestly I think if it was me I'd go to another session, I'd see how I felt, see if I felt comfortable talking about gender ideology and if I did discuss it but try not to get into a debate about it and leave when the session ends and see how I felt after that.

There's no immediate need to stop or to find an answer you feel settled on within yourself.

You already have a relationship with this therapist and most therapists are affirming (as PPs said I think that's right and that's a problem for me too).

I guess I'd go and see how I felt as I got closer to the end of the course.

(If it was a new therapist I would just ditch her. I haven't seen my therapist for a while but now I'll check before I go back.)

I really don't wanna quit if I don't have to! It's hard to find therapists who can deal with the exact combo of issues I have, which is why I've ended up going back to this one repeatedly, and also hard to find ones who say they do the particular kind of behavioural therapy I'm currently doing. I just also have a need to be true to my principles. So if I can find a way to do both I will. I think I'll try to start a conversation about it in my next session.

At the moment I have to send a behaviour log once a week, and often mention in the email a couple of things I'd like to discuss in session. How does this sound to people?

"Since discovering you take an affirmative approach to gender dysphoria I'm having trouble ignoring my ethical principles. Keeping my silence about what you do in order to continue working with you on what is, objectively, a fairly minor problem, makes me feel complicit in the harms I believe you risk causing. My instincts tell me that it's wrong for me to benefit through choosing to ignore harm coming to other people. Can we talk about how I can handle this?"

I don't wanna make it look like I'm thinking of quitting because, well, I'm not. If I absolutely have to because I simply can't cope with the cognitive dissonance any more, then I will, but I hope to be able to come to some kind of mental compromise.

Regarding your email, the last sentence: how about 'I would like to talk about...' just , to me, sounds a little more assertive, and the reason assertion popped into my head was the earlier mention of them insisting on you paying a lower rate when you wanted to pay full rate. Which sounds lovely and beneficial, but, years ago, I had a friend who earned more than I did and who would insist on paying for treats eg meals, often at the end when the bill came,and I was too concerned about making a scene to insist at the table, but when I tried to talk about it in private I was brushed off and she even got angry at one point. I started to feel nervous about her and speaking my mind to her. Eventually I ended contact as I actually felt I was being gaslighted. I am aware there is a huge amount of projection in my post, but did wonder what effect that insistence on reduced fees has had on your dynamic. Which is my projection, I know.

That's an interesting one about the payment dynamic. It was very frustrating when I initially told her I wanted to start paying the full fee and she just. wouldn't. let. me, no matter how many discussions we had about it — I was only able to start paying the standard fee because when I went back later and asked to see her again, I told her (honestly) that I genuinely couldn't see her if I had to pay the reduced rate, because of my moral conflicts, and asked her to please reconsider. I had to sign a new contract and everything. And it was so nice not having those constant conversations about money! Then this time I went back, and she kind of just slipped something about "student rates" (which I've never heard her mentioning before) into the conversation and bam, I'm back on a discounted fee, and somehow this fee change doesn't require a new contract

I made a couple of edits before I sent it including changing the last bit to "I need to discuss with you how I can handle this difficulty, because it's pretty uncomfortable".

Good luck at your next session. I hope your therapist is open to your feelings of discomfort, and that you can see out this course of treatment without further disruption.

Thanks!

It's very frustrating. I can't understand how a reasonable person who treats mental health problems for a living can see what's going on and think "you know what, I'm going to encourage my distressed patients along a path that will put a stop to a healthy and vitally important part of their physical and psychological development, possibly resulting in the removal of healthy tissue and permanent loss of function". It makes no sense to me. This is an individual who spent months and months patiently moving me towards accepting aspects of myself that I'd rather were otherwise but which I can't change. I can't understand the mentality. At all.

I could ask her to be more specific, but I doubt she'll answer… she can be evasive at times, particularly if she thinks providing an answer won't be helpful. But it's worth a try. I think it's my own ability to be at peace with it that's the main thing to deal with, and if her answers were to leave me less able to quiet my noisy conscience, I think she'd likely consider full answers to be counterproductive.

I mean, I have to face facts. I'm not going to persuade somebody more educated, more intelligent and more experienced than me to change the way they do their job. And even if I did, it would be a drop in the ocean, and would only happen through me spending a lot of my own therapy time on it. So it's my own ability to cope with it that I need to change.

I have no issue with, say, having friends with different political or personal viewpoints, and I don't particularly care if the person I buy my morning coffee from is a secret men's rights activist.

It's the combination of the viciousness of people when they find out you don't agree with some of the current ideology around trans issues, with the fact that I believe the individual in front of me may be actively and personally harming autistic and other young people, and that I'm asking them to help me. It's far more complex than being friends with a Brexiteer if you're a Remainer, or having colleagues who vote Green when you're a Conservative, or getting on with pro-life family members when you're pro-choice.

@JoyFreeCake

I mean, I have to face facts. I'm not going to persuade somebody more educated, more intelligent and more experienced than me to change the way they do their job. And even if I did, it would be a drop in the ocean, and would only happen through me spending a lot of my own therapy time on it. So it's my own ability to cope with it that I need to change.

I have no issue with, say, having friends with different political or personal viewpoints, and I don't particularly care if the person I buy my morning coffee from is a secret men's rights activist.

It's the combination of the viciousness of people when they find out you don't agree with some of the current ideology around trans issues, with the fact that I believe the individual in front of me may be actively and personally harming autistic and other young people, and that I'm asking them to help me. It's far more complex than being friends with a Brexiteer if you're a Remainer, or having colleagues who vote Green when you're a Conservative, or getting on with pro-life family members when you're pro-choice.

Yes, you're right. This is about your feelings of discomfort (which of course I think are justified!) and whether your therapist is skilled enough to allow you to have and express those feelings, without defending herself against them by making you feel like the problem.

@ContentiousOne

Even a 'good' therapist can have blind spots.

Can you raise your concerns in therapy?

So no consideration at all about whether it’s you that has a blind spot?

Not saying you dooo.. But you’re so sure in your beliefs that the therapist must be wrong? Despite OPs reality testing of the therapist’s general soundness, skills and approach?

No, I've 'reality tested' my thoughts on so-called affirmative therapy by having two children undergo it, and finding it useless at best, harmful at worst.

Field, I've been quite careful to say that my opinions are what I believe, what I consider things to be, and what I think.

And I know far better than ContentiousOne what this therapist is like, having had many sessions with her — on the whole, fine, otherwise I wouldn't have bothered going back 😂 — and am still able to accept that this can be true at the same time as it being true that she carries out therapy that may be harmful. I don't think ContentiousOne is being unreasonable to surmise that the affirmative therapy carried out by my otherwise-fine therapist is likely much the same as the affirmative therapy experienced by her children.

Oh, and Field, don't you think it's in slightly poor taste to be trying to move the thread into that kind of discussion?

I started this thread as (and it has been) a place for me to gather wisdom from other people about how to deal with my own internal conflicts as they relate to opinions we share on a controversial issue, and a difficult real-life situation I'm in. There are plenty of other threads you can snipe on, if you like.

Good luck Joy I’m glad you’re finding therapy useful.

I can't help but see a correlation between an affirmative therapist and a therapist who believes she knows better than you about how much you should pay. It strikes me that she is dogmatic

I think continuing to use a therapist who is effective for you is not the same as 'affirming her affirmation' if you will. Especially if you voice your concerns.
You may be doing your GC viewpoint more of a service by continuing to be present with it and possibly discussing why you have it.
There are people in the past who I have vehemently disagreed with and even been (somewhat naively) utterly dismissive of however time has changed how I have seen those interactions and their words are still with me. If I didn't have those interactions at all there would be less I had to go on when evaluating my views.
Being present with your view can be an ethical way to honour it as much as being absent with it, if you see what I mean.