Access to a therapist is often the first thing that parents consider when their child tells them about their trans identity. Maybe your child already has already been seeing a therapist, because of underlying mental health issues. Whether privately or through CAMHS, psychotherapy can be a valuable way of helping your child to explore difficult feelings, and to work through the causes of distress.
Whether to opt for therapy…or not
Talking therapy is more likely to be worthwhile if you are open and realistic with your child’s therapist, if you are both clear about goals, and if you inform yourself about the process.
There are several good general guides to talking therapies online:
It is especially important to note that a child who eventually casts off their transgender identity will do so from their own changed understanding of their situation. Be prepared to acknowledge that for a small minority of individuals, permanently transitioning may be their best path to a fulfilling life.
‘Affirmation’ and the Memorandum of Understanding
In 2015, the NHS and all leading psychotherapy groups signed a Memorandum of Understanding on Conversion Therapy in the UK. This banned talking therapy aimed at changing someone’s sexual orientation or to reduce their attraction to others of the same sex – ie trying to ‘convert’ someone from being a homosexual. In 2017, a second version of the Memorandum broadened the definition of ‘conversion therapy’ to include gender identity. As well as sexual orientation, the second Memorandum now also forbids therapists from attempting to change someone’s gender identity. The Royal College of Psychiatrists did not sign up to the second version.
The second Memorandum encourages the therapist to take their patient’s gender identity at face value – which is known as ‘affirming’ them. When Bernadette Wren, the head psychologist at GIDS, spoke at an Association of Child and Adolescent Mental Health conference in 2019, she noted that “many professional bodies now endorse the diagnosis of Gender Dysphoria and the affirmative approach to care via the Memorandum of Understanding.”
Most therapists won’t be aware of the Memorandum but it underlines that the clinical freedom to explore a child’s gender identity is subject to policy constraints. In the US for example, some activist clinicians hold that therapists who do not affirm a client’s transgender identity should be considered as engaging in conversion therapy. As always, the sensible thing is to have a conversation with your child’s therapist so that you are clear about the goals, and to seek out a neutral exploration of a child’s ideas about their body and gender roles, especially if it is something that has confused or distressed them.
Areas of Expertise
Do not assume that a therapist who advertises a speciality in gender identity or LGBT issues will be the most suitable, for your child may benefit most from therapy with someone experienced in a wide range of child and adolescent issues, who can discuss all factors around an individual’s belief that they are transgender. To ensure the best outcome, it is vital to explore other factors at play such as trauma, internalised homophobia, mental illness, peer influence or neuro developmental factors that could create confusion and distress around their sex roles and identity, especially during adolescence.
Parents report that seeing no therapist is better than seeing an ‘affirming’ therapist in this situation (ie one who takes the assumed gender identity at face value, without exploring the underlying reasons for its adoption), and it is worth bearing in mind that some children will struggle to engage with any therapist who does not affirm them. That is not the same as saying you should be dealing with this alone. Take support wherever possible (parent groups such as Bayswater, sympathetic social workers, GPs and family and teachers). Some parents have found it useful to themselves get expert support from therapists about dealing with a trans-identified child. We can help you to identify therapists who might be a suitable fit for your situation.
Some additional resources:
Ex-GIDS clinician Anastassis Spiliadis addresses the current models for understanding gender distress, and proposes a broader exploratory model based on curiosity, incorporating understanding of sexuality and gender norms and accepting there may be a variety of adult outcomes.
Stella O’Malley and Sasha Ayad discuss person centred therapy and therapist collusion.
Sasha Ayad explains how she works with gender-questioning young people.