Critical Therapy Antidote

PART 1: INTRODUCTION AND CONTEXT

How should therapists work best with children and young people who are questioning their sexual identity? There seem to be only one strongly preferred answer, according to our own professional therapy associations and many government and third sector agencies – affirm, affirm, affirm! This is the position taken by the Education Wales (2020) School and community-based counselling operating toolkit. The toolkit carries some weight, having been produced by a Welsh Government agency, with enthusiastic support from the British Association for Counselling and Psychotherapy. The Welsh Government was the first of the devolved legislatures in the UK to introduce secondary school-based counselling in 2013. Since then, Wales has rapidly moved to introduce a growing number of policies which apply the concept of gender identity into its social care provision for children and young people (Safer Schools Wales, 2023). The toolkit neatly illustrates the growing convergence between some government agencies, professional therapy associations and gender identity ideology.

Thus the toolkit’s section on working with non-binary and transgender children and young people uncritically rehearses all the usual themes of affirmative therapy, namely an inclusive but vague definition of the term ‘trans’, unreferenced research claims on the supposed benefits of early social transition, the importance of using correct pronouns and the standard but unprovable linkage between positive support for transition and a supposed reduction in suicide rates (Education Wales, 2020: 19-20).

The toolkit does not directly acknowledge the fact there is no substantive evidence base supporting the effectiveness for affirmative therapy with children and young people – this is simply an ideological position which therapists should be very wary of adopting, because of the potential harm caused to their clients. For those therapists needing further encouragement, the toolkit refers in glowing terms to anecdotal opinion, offered up here as “a useful guide for professionals working with trans children and young people”.

Lucy Beney, a member of Thoughtful Therapists, takes issue in the following article with these ‘10 Tips for Working with Trans Students’. Her suggestions are based on her own extensive experience in working with children bringing these issues into the therapy room. Many therapists feel de-skilled and under-confident in working with children in this context, given the pressure to treat trans-identifying clients as exceptional and therefore requiring special treatment, and – of course – yet more specialist training. An alternative approach would be to simply use your already existing skills as a therapist, and work with the client as you would with any presenting issue with which you may not be immediately familiar – therapists are not expected to be experts with every possible client issue. Lucy offers some imaginative and non-affirmative responses for working with clients wanting to explore their concerns further with a therapist. Her approach is also consistent with the government’s much more cautious and nuanced stance in response to school pressure for aiding children’s social transition within schools (DfE, 2023).

We urgently need to reclaim the space to discuss and debate these issues with other therapists, and to free up our colleagues from the notion that any response other than straight affirmation is too radical, too controversial, or just too plain difficult to undertake.

After all, we are therapists. This is what we do.

References

Department for Education (DfE) (2023) Gender Questioning Children: Non-statutory guidance for schools and colleges in England. Draft for consultation.https://www.gov.uk/government/consultations/gender-questioning-children-draft-schools-and-colleges-guidance

Education Wales (2020) School and community-based counselling operating toolkit.
https://www.gov.wales/sites/default/files/publications/2020-06/school-and-community-based-counselling-operating-toolkit.pdf

Safer Schools Wales (2023) Wales Watching. Genspect. https://genspect.org/wales-watching

PART 2: WORKING WITH TRANS YOUNG PEOPLE – AN ALTERNATIVE VIEW

When I recently came across Sam Hope’s “10 Tips for Working with Trans Students”, I was deeply alarmed.  It seemed to me that everything a therapist is taught in any reputable training course had been abandoned in favour of an ideologically driven approach, with a definite direction and outcome in mind.  This demonstrates a significant lack of both respect and care for the individual, and curiosity about their story.  There are also significant safeguarding risks involved in simply “affirming” what a student tells us – risks to their own health and wellbeing, as their needs are not being fully addressed, and risks to the wellbeing of other students who are being required to participate publicly and without consent in an ideological experiment, with no basis in reality or attention paid to biology.

We would never “affirm” that someone suffering with anorexia was obese, and agree that they should be prescribed laxatives and a starvation diet.  We would never “affirm” the dark world view of someone engaging in self-harm, and facilitate the buying of razor blades.  And yet when a distressed and confused young person comes to us and declares that they believe they are the opposite sex, or “non-binary”, we are invited to “affirm” this – to indulge their world view and possibly direct them down a path to the most radical conversion therapy imaginable, leading to surgical removal of healthy body parts and a life on powerful drugs, to maintain a pretence.

Below is my alternative version of Sam Hope’s “10 Tips for Working with Trans Students”. This is based on the experience of working with many gender-questioning teenagers, the vast majority of whom were girls wanting to “identify” as boys.

	10 Tips for Working with Trans Students (Sam Hope sam-hope.co.uk)	10 Tips for Working with Trans Students (Lucy Beney)
1	Education, education, education	Education, education, education
	Training for all staff (because not all trans students will be known to you) and governors, from trans-led agencies. Gender diversity talked about competently and in a non-pathologising way in classes such as PSHE, psychology and sociology. Trans people visible – on posters, in the curriculum, books in the library.	Exclude people from activist groups from delivering training. Treat trans identification in the same way as any other mental/emotional health issue. Feelings are not facts. Safeguarding students from social contagion and from ideological and sexual exploitation is the primary duty of all staff.
2	Celebrate trans people and gender diversity	Celebrate human diversity
	Don’t tolerate, celebrate! Champion anything that challenges gender stereotypes and remember to talk about the trans community during LGBT History month. Share words and images of how gender and gender diversity is expressed differently in different cultures across the world.	Make clear to all staff and students that human sex is binary and cannot be changed. Champion the important and valuable differences between us as humans, making clear that there are as many ways to be male or female as there are men and women. Look at the different ways in which people in diverse cultures live.
3	Reduce gender segregation	The value of separate spaces
	With sports, toilets, dress codes and roles there are often ways around the traditional way of doing things. Don’t wait for a trans or non-binary student to show up before you make those changes because they will benefit everyone and undermine sexism. But allow trans students to use facilities for their identified gender.	Dignity and privacy are important for both girls and boys, especially during adolescence. Feelings do not take precedence over biology, and all students should use the facilities available for their biological sex. All students, however they present, should be treated with respect in their assigned single-sex spaces, as well as within the wider community.
4	Be conscious of what story your language tells	Language matters
	Be aware of the diversity of language, stories and experiences that exist within the trans community. Learn what language hurts or fails to describe trans people. Gender-neutral language is a must; find alternatives to expressions like “boys and girls”. Assume nothing about the gender of the person/group you are addressing.	Language matters; accuracy matters and the truth matters. Language should never be manipulated to deceive or distort facts in a school environment. Students should be taught to be respectful towards others, but should never be punished for speaking the truth. Pronouns should be used in accordance with biological sex – “social transition is not a neutral act”.
5	Don’t “out” trans people	Transparency is the best policy
	Be clear with a trans student exactly what they want shared and with whom. Consider ways in which they could be accidentally outed – e.g. in letters home. Ensure historic name changes and other details do not resurface to expose transitioned students. Know your duties under equality and data protection law.	Make clear to trans students that, as minors, staff must disclose safeguarding issues, to other staff and parents. Believing you are the opposite sex and wishing to live as such is a clear indication of a safeguarding issue, just as secrecy between a member of staff and a pupil can be. Encourage students to “own” their name – make it theirs.
6	Use inclusive admin systems	The truth matters
	Use best practice guidance for monitoring forms and where gender needs to be asked. If a student cannot legally change their name yet, make sure their “known as” name is used. A deed poll is a legal document – accept it. Alert students to potential issues with exams and certificates – think ahead, and draw up protocols.	Recording of accurate data is important. School students’ birth names and sex should be accurately recorded. Students need to understand that their name cannot become “dead” just because they wish it were so. Gender is simply a different word for sex – the two cannot be separated, however we “present”.
7	Rethink safeguarding	Safeguarding is a top priority
	Focus on the known safeguarding risk (high risk of abuse and suicide for the trans person, due to social isolation and stigma) rather than imagined risk (trans person somehow overcoming their social marginalisation enough to have the power to harm other students). Peer support & inclusion are essential.	The supposed increase in suicide risk among trans children has been used to bribe parents into accepting “affirmation”, medication and surgery for healthy young people. This must be challenged. Many of these young people have increased suicidal ideation because they are emotionally distressed, of which presenting as trans is a symptom. The focus must be on the child’s emotional distress and extensive exploration of underlying issues.
8	Zero tolerance for misgendering and transphobia	It is not transphobic to ask questions
	Set a continuous tone of accepting and including trans people, even if trans students are not visible. Act swiftly in response to any transphobia, don’t let it slide. Actively correct any misnaming or misgendering – if it’s you, apologise and move on quickly. Don’t make a big deal about it.	Debate on trans issues should be respectful but open and wide-ranging. Questioning trans identity does not erase the person’s existence.
9	Use a person-centred approach	Explore identity in its widest sense
	Trans people are the experts on their own lives, and their stories are diverse. Listen. Take time to find out what feels safe and comfortable to the trans person. Don’t make assumptions, and don’t assume you know better.	Accept that there is something seriously wrong in the young person’s life, which has led them to reject their healthy body. Use every opportunity to explore identity in its widest sense – sex is an important but small part of our overall identity.
10	No gatekeeping	Child protection
	Just allow the trans person to live as they want to live, and make necessary signposting/referrals as quickly as possible. Unless you’re a highly qualified expert on trans people, it is probably best not to make your own judgement about them or try to intervene in the process they are undergoing.	Recognise that identifying as trans, and wishing to go down a medical/surgical route to become cosmetically and superficially a member of the opposite sex, is fraught with risk and long-term health problems. Cross-sex hormones effect chemical castration in boys; “top surgery” is a bilateral mastectomy; and bottom surgery is genital mutilation, whether female or male. Children are not in a position to make life-changing decisions of this magnitude. As adults, it is our duty to protect them from themselves and those who seek to do them harm. Just because someone feels that they are “trans” does not make them a mental health expert.

Until last summer, I worked in a large secondary school and came alongside a number of students identifying as “trans”.  Almost all were girls, who rather than wishing to be male, wished to reject being female.  Many had witnessed violence, against themselves or others and had concluded that women are weak.  Others had been exposed to pornography, or the pornographically-influenced desires of young men, and had decided that if being a woman involves being the passive recipient of sexual assault, it was something they did not wish to be.  Some were same sex attracted – so felt they “should” be the opposite sex and some wished to opt out of a highly sexualised world altogether.  The insidious influence of social media was inevitably evident.  Overwhelmingly, all these students felt “different” and caught between the very narrow tramlines of stereotypical male and female behaviour, which seem regrettably to have been forcefully re-established amongst teenagers in the last few years.

Here, I have put together ten alternative tips for working with gender-questioning young people.  They need our support, our care and our curiosity in addressing their issues – not the incessant drum-beat of a pernicious ideology, which defies reality and can lead to a life time of further intervention.

Working with trans young people – an alternative view

1. Listen: Listen carefully, and listen again. Invite the young person to tell their story in
their own words. Respond as you usually would in a therapeutic situation. If their life
was a book, film or TV series – how would they describe it? What have been the
biggest highs and lows? What meaning was made from these events? Keep listening.

2. Tell me about trans: Ask the young person how and when they became aware they
were “gender fluid” or “trans”. What else was happening in their lives? Were they
suffering any other form of emotional distress at the time? Recognise that rejecting
your body is a symptom of emotional distress – do not affirm that it is just another
choice we have as humans. Use the word sex, rather than gender, wherever possible.

3. What is male and female? Invite them to talk about what being male or female – or
not being male or female – means to them. Remind them that biologically, sex is
binary. Explore the influence of social media and activism on their beliefs. Does the
person believe that there are different ways of being male or female from the
characteristics they have described? How about in different cultures or age groups?

4. Where do I fit in? Usually something will emerge about not “fitting in” or achieving
freedom from something (expectations of others, being like a parent etc). Ask them
how that “fitting in” or “freedom” is working for them now. Who is their “tribe”? Where
is their support network? What are their feelings about sexuality and growing up?

5. Who am I? Widen the discussion to identity as a whole – we are three dimensional
beings, existing in a synthesis of body, mind and spirit. Who are they in the widest
sense? What matters to them? What is meaningful to them?

6. Tell me in two minutes: Give warning that you are going to do the two-minute
exercise – invite the person to describe who they are in two minutes, without any
reference to family, sexuality, sex/gender, education or employment.

7. Being something we are not: Circle back to where this sits with the young person’s
gender beliefs about themselves. Can I be this person and accept my maleness or
femaleness? If not, what is stopping me? How can we know what it feels like to be
someone other than ourselves? Who in particular are we thinking of?

8. Have I escaped? Ask how it feels for the person to have rejected their birth sex – and
their body – and whether or not they believe they can actually escape that?

9. Material reality: Ask about the material reality of their body – this line of questioning
will depend on whether the young person is taking puberty blockers or hormones, or
has had surgery. If the person is merely “identifying” as “trans” etc, ask what they
understand about the reality of medically and/or surgically transitioning? Explore non-medical ways of synthesising body, mind and spirit again.

10. It is who they are, not what they are, which matters: Our biological sex and
sexuality are important, but are only parts of the mosaic which makes up who we are.
We are so much more. We are three dimensional human beings, experiencing
physical, mental, emotional and spiritual reality. What would that feel like for the
person? Can they imagine being at ease or at peace with who they are in all those
dimensions? What do they feel they need to achieve that?

My heart aches for these young people.  My overwhelming aim, as a therapist, is to come alongside them, to listen, to accept and explore their distress, and to signpost them not towards life-changing decisions and pharmaceutical dependence, but to a way in which mind, body and spirit can be synthesised – and they can live in peace, as they are.

This article is published jointly by Thoughtful Therapists and Critical Therapy Antidote.

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AUTHOR: PART 1

By Peter Jenkins, a member of Thoughtful Therapists (https://thoughtfultherapists.org/) and of        Critical Therapy Antidote. He is a counsellor, supervisor, trainer and researcher in the UK. He has been a member of both the BACP Professional Conduct Committee and the UKCP Ethics Committee. He has published a number of books on legal aspects of therapy, including Professional Practice in Counselling and Psychotherapy: Ethics and the Law (Sage, 2017).  

AUTHOR: PART 2

By Lucy Beney, an integrative counsellor with a particular interest in the well-being of children, young people and families. She is a member of the BACP aand facilitator of the Tuning into Teens parenting programme. She is a former journalist and public affairs researcher, and is currently a member of Thoughtful Therapists.