The ideological Capture of Psychotherapy

[NotHavingIt]

A scray, and deeply concerning, piece by James Esses in which he recounts his attendance at a recent conference on Existential psychotherapy.

https://open.substack.com/pub/jamesesses/p/the-ideological-capture-of-psychotherapy?r=clsg2&utm_campaign=post&utm_medium=email

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

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.

The only issue I see with what you say is that the role of the therapist is to hold open all and explore all angles and possibilities, and not pre-judge anything; but with gender affirming therapists that is simply not the case. So, in effect that means that the therapist is an active and willing participant in the clients' belief - and even encourages it, rather than explore that belief; challenge it; or test it out - which is the actual purpose of psychotherapy.

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.

As evidenced in Hannah Barnes' book about the Tavistock - once a client is affirmed, even in the most simple of ways the path leads inevitably on to hormones and blockers - with the clients gaming the system to get the most affirmative therapist.

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.

Hadley Freeman's recent book on her experieneces with anorexia ( Good Girls) and the surrounding therapeutic support system for anorexia is worth a read. There are many parallels.

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.

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 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.

One other issue when it comes to a therapeutic situation, which should not be over-looked, is the impact of someone's belief in gender identity on others.

It might be considered that focusing on others is not the point or goal of therapy, and that is true - but if you are constructing a identity on the foundations of a belief system that most peole do not share, and who most likely will not be able provide the required affirmation for - then you are constructing an inherently fragile sense of self - certainly if requiring others to use pronouns or to rely on them recognising you as the sex you want to be is the goal.

A healthy, well adapted sense of self is resilient and fairly stable and does not depend, overly, on continual affirmation or recognition from others If you think your existence is under threat because others do not share the foundational beliefs in gender identity, and so continue to recognise you as the sex that you are - that is not a good place to be.

I suspect genderists must know this - hence the need for total control and for continual affirmation. 'Gender' after all is a social construction ( even if you believe it is innate - you cannot locate it, describe it accurately, or prove it) and the queer theorists knew this too. In playing around with gender or with the performance of gender, the idea was to push the boundaries of soociety and 'queer' them. 'Gender' becomes a transgressive act with revolutionary intent.

The problem with utopian ideas, though, is that the world and other people tend not to conform, and we are inherently social creatures requiring workable relationships with others.

Tbf, Psychotherapy was always pseudoscience bs.

Ill get me coat...

One obvious difference between a faith in, or belief in, gender identity and the sort of faith or belief that is to be found those with more tradtional religious belief, is that for gender identity belief the acceptance by, and confirmation from others seems almost universally required, whereas what sustains most people with a personal religious faith is purely that faith alone. One turns inward ( and upwards to God) for sustenance; not outward to others, or to society.

Religious people can be persecuted, of course, in societies which are not pluralistic - and it is then that the group or church becomes more important in providing support. But there are also hermits and solitaries who actively shun society and others in order to be closer to God.

If what is most important is one's own relationship to oneself or to one's God/inner integrity/ truth/whatever you want to call it then it matters not so much what others think or say.

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.

@Ohnohedident I had already scrolled on by after seeing this as nothing more than a disruptive bomb. However, if you want to genuinely talk about this, I'm happy to do so. So that it doesn't disrupt this thread (which is building on the idea that psychotherapy is actually a valuable field, from what I can tell so far), it'd be good to start a new thread. If you do, please tag me in and I'll join you over there. Very happy to have the discussion 👍

Gender Identity belief, in itself, is not an ideology, but stems from a wider ideological construct which posits firstly that there is a thing called a 'gender identity' - and it is this inner identity which determines whether one is male or female, man or woman. A post-modernistic theory of self and society.

Obviously the young person, your daughter, is not cognisant of all of this - she has simply absorbed the ideas that are circulating in society at present, and is using them as a way to frame her developing self.

We talk about 'ideology' on here ( Mumsnet) because we are aware of the larger system of thought from which gender identity belief has arisen. But obviously one would alter one's presentation/delivery according to one's audience, and according to the context of the situation you are in.

Regarding James Esses, I can't comment as I was not at the conference, but assume he believed that everyone there was a professional in the field and grounded in foundational principles of psychotherapy - and he had been specifically invited in order to speak about conflicts in practice.

If someone has a firm belief that there is only one way - they are not going to be persuaded by someone being nice and kind. Sometimes you have to confront things head on and get things out into the open where the inherent conflicts and issues can be clearly seen.

I'm reminded of Kier Starmer and what drives people mad about him, and that is that he is so vague, non-committal and vacillating. He wants to please everyone, and in trying to achieve that, pleases no-one. People, subsequently, don't trust him, or believe he has any political integrity. They don't know what he stands for.

At a professional conference people should be able to handle straightforward discussion of ideas without having to package it fluffy 'be-nice'ness.

It's the accusation so often leveled by abusers and misogynists who are pretending to be otherwise - if only you'd say things in a different way, or a nicer tone, or at a better time then we could listen to your arguments.

Oh, I totally agree. I'm just trying to get my head round why it's received in such a polarised way. There will be many factors but I do think this is one. Breaking through with a message that people are receptive to hearing is key. How that is achieved is another matter.

@NotHavingIt as you say, Keir Starmer doesn't achieve that at all when he's so vague.

But I think it's possible to be clear and also considerate. That is different from trying to please everyone. Trying to please everyone is the path to failure.

His message is very wishy-washy. How can 99.9% of women not have a penis? That just sounds odd. So he's saying trans women are women in his view, just in a very wishy-washy way. So if they are women, why can't they play in women's sports? If he thinks they can't, he has just invalidated the "womanhood" of the 0.1% of (trans)women who he thinks are women. He makes no consistent sense.

https://www.thefp.com/p/how-therapists-became-social-justice-warriors

This was shared on Helen Joyce's last newsletter.

It's so bad. I have so many stories, but the most egregious is when I was frozen in place, didn't know how to move forward but didn't want to opt for gender care after seeing it go so poorly for friends, and my psychologist asked "Why should I work with someone who wants to commit suicide?"

Those were thoughts I saw her to get past, but she refused me treatment after that point bc in her view, not going forward with medicalization was "not helping myself."

JFC, Redbird. I'm sorry you've been so badly failed.

Redbird, that is shameful. Ritchie/TullipR said something similar, that he desperately wanted therapy and went ahead with his surgery only because he would have lost access to therapy if he'd not continued on the transition pathway. I really hope that one of these days, the therapists and professional bodies failing clients in this way are held accountable for what they've done. I doubt they will be, but I hope they are.

@Redbird87 that is shocking and truly awful.
It highlights in a very stark way what happens when a therapist can't see beyond the bias of an affirmative path. Blaming you for not wanting to help yourself and then stopping treatment. Wow. On a small plus note, this clearly wasn't the right therapist for the job, so stopping treatment with her was a good outcome. However it doesn't help at that moment. Quite the opposite. There seem to be many more coming through that same training programme of thinking, from the article that @ArabeIIaScott posted. I absolutely applaud James Esses for trying to call this out, I'm just concerned that if the message isn't getting through, the delivery of it may need tweaking.

Going back to something @NotHavingIt it said about the difference between gender identity and a religious belief differing on a key point: gender identity belief is fed through validation by others and a religious belief does not need this - I've been thinking back to a really good conversation I had with a transwoman when I was building up my understanding of all things LGBT. She said something like "Oh, I'm aware that everyone sees me as a man but I'm OK with that". She had transitioned (I don't know to what degree) in her 30s I think and is much more comfortable identifying as a woman. This seems like a much healthier kind of gender identity. I don't know and didn't ask about her wider views on toilet usage etc, so I'm not commenting on being transgender over all. I'm just thinking about that one specific aspect in relation to this thread. If someone is at peace with their own gender identity needing personal validation only (like a belief in God), I wonder if this would make them less susceptible to needing surgery? The training that is being done in this field now would have the exact opposite effect of helping clients reach this kind of stable and healthier conclusion, mental health wise.

You certainly hear from men who transitioned a long time ago - including full re-assignment surgery, who don't feel the need for continual validation and, at heart, know they remain male. They transitioned primarily in order to feel better in themselves, not to force the world into compliance..

These transitioners tend also to be very honest about the short-comings, failures, regrets and disappointments with their re-assignments and social transitions. There is a very good film on Netflix called 'Regretters', which I've mentioned before: a Swedish production which focuses on two very different individuals, and the motivations and stories behind their transitions.

I think the issue we now have is that radical transgenderism is not just about individuals feeling more comfortable in themsleves, but is a fully fledged political movement for radical social change.

I'll watch that, thank you. My pathway towards understanding this is still primarily driven by my desire to help my daughter (step 1 in my "agenda"... to loop back to a previous conversation just for context) but I realised that in order to do that, I needed a fuller understanding. I had initially skipped over the bit about boys who transition in the Sue and Marcus Evans book, because it all got very Freudian and I couldn't see any direct relevance to my daughter. Since then I've learned tons (including the GAP - rearrange letters - stuff) and I can see it's all indirectly relevant to her... As you say:

I think the issue we now have is that radical transgenderism is not just about individuals feeling more comfortable in themsleves, but is a fully fledged political movement for radical social change

My awakening on this happened quite a long time ago now but I'm still adding to it. It still doesn't change my more hands off approach (hands on with safeguarding, hands off with direct intervention) with my daughter but it helps me understand what I'm up against as it were. I was already far too sceptical of the affirmation pathway, which is why I did everything I could to keep her out of GIDS. However, filling in the blanks along the way with conversations like this and Hannah Barnes' book etc is helpful. The Netflix film will also be helpful.

Going back to the person I mentioned, I still speak to her periodically. Interestingly she's been removed as the trans lead in the LGBT group. She wasn't given a reason and I said that it sounded a shame (at the end of our first conversation she told me she loved working with parents of trans children but was a little concerned at the rising numbers... that comment was left hanging). When I asked her why she had been replaced she said "Nobody will tell me. Perhaps I'm just not the right kind of trans". I took that to mean her age, which it still could be. The majority of the people in the group are young. However, this could be a significant part of it.

She's been very helpful in helping me get my head around everything. I also think she's helped me stay grounded. And another person I also speak to from the LGBT group. For example, they are both a big part of why I feel comfortable with using preferred pronouns the way that I do - not for kids (I just avoid pronouns) and not where it's important for context - for every day interactions. I'm never going to add pronouns to my bio though. That's a whole different subject... and goes back to vulnerable people like my daughter thinking it's an important rite of adolescent passage to "decide".

Another interesting aspect of radical transgenderism is the very real sense of fear. Some TRAs will be driven by hatred of feminism and women (and GAP etc) but I suspect many more are driven by a genuine fear.
There was a really good discussion on another thread about Maslow's hierarchy of needs in this respect. If all other needs are met (home, food, warmth etc) the human psyche can be very easily persuaded in to fighting hard if you believe a different (less foundational need) is at risk. All of the misinformation which is shared around suicide stats and misrepresentations of women's concerns about sports and spaces etc (and the risk to children e.g. safeguarding "against transphobic parents") is enough to whip up a massive genuine fear. I think this describes the majority of people who shout, scream and/or turn violent at protests.

If you have been encouraged to believe that people not affirming your sense of your self or identity is not only 'literal violence' but also a refusal to accept even your existence, then you might well come out fighting.

But how does that explain all of the allies and friends who are not even transidentified themselves. The conceopt of allyship is central to critical social justice activism, is perhaps the answer.