Imagine a line.
At one end of the line are the words 'conversion therapy' and at the other end of the line is 'affirmation therapy'.
In between is a big space called 'talking therapy'.
'Conversion therapy' here refers specifically to electric shock, aversion therapy, beatings, exorcisms. The message is: "Your thoughts about your body are wrong."
Affirmation therapy at the other end of the line refers specifically to puberty blockers, cross sex hormones, amputation and plastic surgery. The message is: "Your body is wrong for your thoughts."
In between these two poles is a whole lot of potential exploration through personal reflection and talking therapy.
"What does gender identity mean to you? How does gender differ from sex stereotypes for you? How does your ADHD/ASD/OCD/ED/depression/anxiety/abuse/adoption/trauma/bullying/sexuality relate to this identity? For how long have you felt this way? Anything contributed particularly to these ideas becoming dominant now? How does your friendship group feel about your identity? What kind of online support or advice are you getting? Can we explore the difference you think it would make for you if you were to wake up in the opposite body tomorrow? What currently relieves your dysphoria? Here are other non medical strategies that people with dysphoria have tried - which might work for you? What are the practical challenges you think you will face if you transition? And if you don't? Etc, etc, etc"
Curiosity. Keeping outcomes open. Support.
No one is saying that the brutal type of 'conversion therapy' at the end of the line in this model is good.
Lots of us are suggesting that 'affirmation therapy' in this model is also harmful, particularly to children, teenagers and young people, as we have seen evidenced in the Keira Bell case.
Some parents might also draw a harder line on Internet access, particularly if their kids are spending a lot of time online and their real world relationships are suffering. Parents may not feel comfortable with aspects of social transition like name changes and some might resist their daughter binding.
What they and the majority of us, I imagine, would like to see is an enormous investment in the middle ground, the third way of talking through issues, supporting vulnerable young people, helping them to come through puberty with their adult bodies, fertility and sexual pleasure intact.
It’s good to talk. There is no rush.
So many of the detransitioners talk about how little talking therapy they received pre medical/surgical transition and how they wish they had had more challenge from doctors etc. They are telling us that they have been actively harmed by the current affirmation model.
Psychiatrists, psychologists, therapists, counsellors need, therefore, to be able to help and question and support, even if it leads to persisting, even if it leads to desisting. They cannot express curiosity and provide helpful challenge if they are told that to even question gender identity is conversion therapy.
What we are resisting is bundling up and lumping the middle way of 'talking therapy' together with 'conversion therapy' and calling it all conversion therapy if it might potentially lead to a change in gender identity.
We don't want a model that says
"Your thoughts are wrong so let's change your thoughts."
Nor do we want
"Your body is wrong so let's change your body."
But rather
"Let's gently explore what is going on as you form your identity, (particularly in the light of the other challenges you face) and help you find ways in the meantime to think more kindly about your body."