November 1, 2019
by Tina Arnoldi
In a recent survey of 27,715 transgender adults in JAMA Psychiatry, gender identity conversion efforts (GICE) were associated with higher odds of attempted suicide and severe psychological distress. Many jurisdictions ban this practice and several professional organizations oppose it because they recognize the adverse mental health outcomes seen in those who experienced these efforts.
The American Psychological Association & National Association of School Psychologists “support affirmative interventions with transgender and gender diverse children and adolescents ." The Society for Adolescent Health and Medicine states it is “inherently coercive and inconsistent with current standards of medical care.” Yet some organizations, such as the Church of Jesus of Christ of Latter-day Saints in Utah, oppose any efforts to ban gender conversion therapy.
By banning gender identity conversion therapy, are we also banning the freedom to explore what gender identity means to individuals? Is there no longer a place for professionals to help people who want to become comfortable with their biological identity (gender assigned at birth)?
Carole Lieberman, a psychiatrist and author, says “there is a place for professionals to help people who want to become comfortable with their biological identity (gender assigned at birth).” The problems stem from the intent of GICE and that it’s been used as a catch-all for multiple treatment types. Therapy in any form should provide a safe place to explore confusing feelings. “Treatment that makes patients feel ashamed and tries to force them to convert to one gender or another - will have deleterious effects,” said Lieberman. “But intensive psychotherapy that gets to the root of why a patient feels a certain way about their gender can help them unravel their confusion and understand where those feelings originate.”
Michael Salas, a psychologist, has worked with people who wanted to get to a place where they would accept a cisgender identity, instead of a non-cisgender emerging identity. However, he never steps in to tell clients how to live their lives and does not believe therapists could - or should - create illusions that they can get clients to conform to a cisgender identity. He says his job as a therapist “is to hold space for clients and allow them to figure out their gender in a way that feels authentic. There's no prescribed way to deal with the social and cultural discrimination and lack of understanding that people in non-cis communities will face. Instead, we can just let clients open up with safety and help them learn about themselves. Our job isn't to push them to any type of transition, because pushing them in this way is often assuming that gender is as simple as binary identification. Gender is much more complex than that.”
Liberman believes an approach that allows clients to explore without affirming or disaffirming “is more important than ever these days because of the propaganda taught in elementary and middle schools when children are too young to understand gender, sex, non-binary, and so on. Parents and schools are teaching kids to question their assigned gender and to do the trendy thing of ‘changing’ their gender. Mattel has made things even more confusing by providing toys that parents and schools can use to force their non-binary agenda on kids. This is more destructive than sending kids who are confused into psychotherapy to help them sort out what they really feel versus what their parents or schools want them to feel. For example, sometimes a parent who wanted a child of the opposite gender than they were born with, consciously and unconsciously sends that child messages that they would love them more if they were the other gender. Kids normally go through phases, where boys may play with dolls and girls may be tomboys. It doesn’t mean that they want to actually transition to be the other gender."
The root of therapy is unconditional positive regard. The therapist cannot force a change in either direction and the goal is not to pray the gay away, Rather, therapy that allows patients to explore their feelings in an open environment may be the right approach as opposed to ones that lead clients in a specific direction.