Three years in: a clinician’s perspective

I have been a practicing psychologist for over two decades and this is, by far, the most difficult work I have ever engaged in. I can understand why many therapists do not feel equipped to work with young people who are convinced that the only way for them to live in their bodies is to transition socially and medically.

It is challenging to sustain a meaningful connection with someone who is stuck in a black/white mindset and who is exquisitely attuned to whether you participate in the culture and language of social justice and gender affirmation. 

Depending on how committed an individual is to a transgender identity, he or she may not tolerate the slightest indication that the therapist questions or is agnostic with regard to the existence of "true trans". They may see you as a good, kind, caring person for months and then, if in a moment of crisis, they don't perceive you to be fully aligned with their belief system, they will reject you without hesitation.

At the same time, frightened and exhausted parents are putting their faith in you to loosen the vice-like grip that trans identification has on their child and, by extension, on every member of the family. Having been such a parent myself I feel enormous empathy. 

I also know that most of the work has to happen at home, in the family. I am more than willing to offer guidance and support, and even clear instructions in real time on what to do and say when escalations happen. 

When things go wrong, what rage parents and children cannot safely direct at each other will get directed at me. As a process-oriented clinician that’s what I sign up for.

In truth, I don't possess skills or knowledge that any well-trained and experienced mental health practitioner doesn’t have or isn’t capable of acquiring. Therapy is still just therapy. 

What's different is the real damage that medicalized transition can do to young people who are in emotional pain and in need of thoughtful care and attention. What's also different is the urgency with which families approach us hoping we might hold the key to pulling their children out of harm's way. There’s so much on the line.

Clinicians who work with trans-identifying teens and young adults feel a pressure that we do not experience when faced with other issues that are no less serious than gender dysphoria. Moreover, we are doing this work in a professional and political climate that is hostile to the very ethical principle that we vow to live and work by, to first and foremost do no harm.

The good news is that since its establishment three years ago Therapy First (formerly GETA) has grown from a small handful of clinicians to now almost 400 strong. We are here for each other so that we can be there for you and your family. While the treatment of gender dysphoria has become weaponized, our aim is to move the focus away from the political and back to the clinic, back to the work we are confident and passionate about.

If you would like to learn more about Therapy First, to support our work, or to find a therapist for you or your child, please reach out: www.therapyfirst.org.