Why Ethical Therapists Everywhere, Should Be Alarmed by Gender Exploratory Therapy, now dubbed "Therapy First"
The Gender Exploratory Therapy Association GETA (now therapy first), is a relatively small and fringe group of therapists, seeking to wield power as the alternative to gender affirming care and the WPATH (World Profession Association for Transgender Health) standards of care. Just this past week, Nebraska voted on a law that would require trans kids to have 5 months of “non-affirming therapy” opening the doors for Gender Exploratory Therapy as the required first step in treating gender dysphoria. As a trans person and a therapist, imagining a world where GET therapists have incredible power and say over a persons ability to transition is terrifying for trans people and for the entire therapy profession.
I’ve read GETA’s clinical guide of care including the case studies. This group is very clever at seeming reasonable and unbiased, while dropping in guidance and theories that are shocking and dehumanizing. One of the guidelines for gender dysphoria assessments includes unprovoked questions about sexual fantasies and masturbation habits(p.26)
In one disturbing case example, a teen shares that their parents confiscated their binder so they wear multiple sports bras, which makes it hard to breathe. When they went swimming they fainted and had to go to the hospital. The teen shares that their parents didn’t talk to them for days after this incident and that they struggle with shame for wanting a binder so badly. After this disclosure, the therapist wonders to themself, “Is the ‘binder’ a container for her developmental and sexual anxieties as well as an obliterator of them?” The teen has just disclosed that they experienced a medical emergency and then their parents wouldn't speak to them for days. Regardless of views about gender transition, that is a terrifying, traumatic and abusive experience and the therapist does not appear to offer any care. Instead, they retreat into psychobabble, mumbo jumbo pontificating on why the teen desires a binder. This is a prime of example of a therapist being so invested in their own theory and bias that they do not attend to the human in front of them. (See case study pages 57-71)
After reading through GETA’s guidelines, it is clear that these therapists never hypothesize that someone might actually be transgender and that is why they are dysphoric. These therapists, tho they pay lip service to eventually affirming someones gender identity, do not ever seem to accept that trans people exist beyond a pathology. They feel they must rule out any other explanations for the dysphoria, which effectively means that trans people must have no other psychological issues and no familial issues, in order to be deemed valid. Obviously, that is unrealistic. This allows a loophole for practicing on-going conversion therapy and Gender Identity Change Efforts (GICE), which has been outlawed in Canada and some US States.
GETA sets up a false dichotomy between “exploring gender” and “gender affirming” which co-opts a sentiment that gender affirming therapists already practice. I do not work with youth, but I have worked with multiple clients who’ve explored gender for years without any medical transition. I’ve worked with folks who request a medical letter right away and I’ve worked with folks who explore gender and then request a letter. All of my clients who have pursued medical transition continue to explore gender long after any surgeries or initiation of hormones. My clients and every client, deserve to have a therapist, who tries their best to meet them where they are and who respects their right to self-determination.
As of now, GETA is a relatively small number of therapists. This small group is quite prolific at starting organizations to make themselves appear bigger than they are. I encourage people to check out the interactive map at Health Liberation Now! that shows how this small group of people and organizations are connected and working together to gain influence over the field of gender medicine and therapy.
Though I hope this does not happen, I foresee a world where GETA clinicians, some of whom have sought to discredit and defame trans people who question their research and who have said that they want to prevent any transition before 25, may gain a lot of power. Certainly, the door is opening and they are becoming more emboldened by some of the recent laws in more conservative states. More clinicians will be pulled in by their propaganda of being a reasonable alternative to gender affirmation. In a worst case scenario, we return to a time of a more entrenched trans pathology, where it becomes nearly impossible for trans folks to be served and helped through the field of psychotherapy and counseling. That is likely to happen under a different administration, or as a result of a Supreme Court ruling, that wields cruel executive/judicial power on the trans population. Trans therapists, queer therapists and therapists who respect the dignity of their trans clients, may find themselves closely watched and limited in how they can practice openly, especially with youth.
We need therapy organizations to stand up now and affirm the standards of care and dignity for trans patients. We need the NASW, AAMFT, APA, Jungian institutes and all other counseling organizations to pay attention and put out statements calling Gender Exploratory Therapy/Therapy First, what it really is; a Gender Identity Change Effort, which is abusive, unethical and a scourge on the field of psychotherapy.
Thank you for this clear piece. It's sickening how transphoebia is veiled and packaged as "support" to trans folks. I'm with Adin, grateful for this knowledge. My eyes are a little more open.
i am grateful to read this. it's information i need, though i no longer practice psychotherapy, to understand more fully the threats to gender affirmation for trans people. i hadn't thought about the deviousness of looking for every other possible reason for depression/dysphoria than trans phobia, as though that could not be the cause. a kind of determined blindness that enables those therapists to proceed in unaffirming practices...