The following article features a response to an undercover video alleging conversion therapy by a therapist (Gender conversion video, 2024). It includes a transcript of selected responses made by the therapist and by the person posing as a client (who was apparently seeking exploratory therapy). The article includes a commentary and detailed analysis of the transcript, and argues that the therapist’s responses are consistent with an integrative, exploratory model of therapy (Culley and Bond, 2011; Egan, 1990; Jenkins, 2000; Wosket and Jenkins, 2023). The client’s own comments seem to be closely aligned with the view that any exploratory therapy which was not explicitly gender affirming must constitute a covert or overt form of gender conversion therapy (Jenkins and Panozzo, 2024: 1-2).
NB: the transcript has been formatted into five segments for ease of reading.
| Transcript of session: (T: therapist responses, C: client verbatim responses and reflective comments) |
| Segment 1 |
| T: It’s very easy to hold on to some sort of fantasy about what’s going on to make you into a happy person, but overall it doesn’t change the level of contentment and satisfaction. C: This is a gender conversion therapist trying to convince me that I’m not trans. He’s practising gender conversion therapy, a new anti-trans strategy sweeping across the country, headed by a fringe organisation, called Therapy First. The word ‘explore’ is intentionally misleading. Exploring one’s gender identity is crucial. I did that for three months before getting my own surgery last year. But this organisation has an agenda. Their own website says that gender affirming medical care should be avoided. Their own board calls being transgender “hysteria”. I wanted to see this manipulation in action. So I went undercover and met twice with a therapist who practises this gender exploratory therapy, to see what goes on inside these sessions. |
| Author analytic commentary (italicised) which attempts to understand the therapist’s and client’s responses in terms of an integrative, exploratory model of therapy. |
| The client seems to be constructing therapy in very binary, or black and white, terms. It is either gender affirming, or conversion therapy. Hence, exploratory therapy must fall into one or other category. So, if a therapist is seeking to practise exploratory therapy, then it is likely to be experienced by this client as overt or covert gender conversion therapy. Another perspective might be that any therapy which does not explicitly affirm the client’s sense of gender identity will thus be deemed to be conversion therapy, regardless of the therapist’s intentions. |
| Transcript: Segment 2 |
| T: So, tell me about yourself. C: I told him what I told my own therapist last year, that I’ve never [really] felt like a woman and I’m thinking about getting top surgery so my body reflects how I feel inside. At first, he appeared neutral. T: There are people who proceed with transitioning and then do have regrets. And there are people who proceed with transitioning that are happier – and are happier for it. C: He assured me: T: I think of myself as trying to help you to make a decision for yourself. C: Which sounds great! But here’s where the manipulation comes in. |
| Analysis |
| Going ‘undercover’ means that the client is entering therapy with a hidden agenda. This can happen for various reasons, such as complying with pressure to take part from a parent or partner, or to tick a box for a pending legal case. This means that no meaningful therapy can now take place, as the client only wants to resist the therapy and has no genuine motivation to change (Egan, 1990: 169a). The client is repeating a story from a previous therapy. This would seem to be a classic distancing strategy, to limit engagement, i.e. by talking, in Carl Rogers’ phrase, about ‘There and then’, and not about ‘Here and now’ (Brodley & Lietaer, nd: 20). The therapist makes a number of neutral, fairly balanced statements. The client seems to be expecting, and finds, perceived evidence of manipulation |
| Transcript: Segment 3 |
| T: I’m working with a young woman who has been seriously depressed her whole life. She, now, is very happy about transitioning. But is still extremely depressed. C: Think about it this way. You want to go swimming. And you ask a lifeguard if it’s safe. He says it’s up to you, but…did you hear about the person who got bit by a SHARK. You’re probably not going to go swimming. So, listen as this guy brings up another person he allegedly knows who’s unhappy. T: She’s surprised, troubled that people have a reaction to it and that people see her as a trans woman rather than as a woman. |
| Analysis |
| The therapist seems to be distinguishing between transitioning and other separate mental health conditions, such as depression. The client takes a directive stance towards the video’s intended audience: ‘Think about it this way.’ This is argument by metaphor. The therapist’s distinction is not at all equivalent to swimming with a risk of a shark bite. Issues of informed consent to any change process within therapy need careful attention by the client (and therapist), not simple resort to a shark metaphor. |
| Transcript: Segment 4 |
| C: After he warned me about these two specific people, he started to threaten societal backlash. T: It’s naïve to think there are going to be no social consequences. There is going to be nothing to deal with. You may have seen in looking online. People have strong reactions to being misgendered. C: I told him I really don’t care what other people think. So he pivoted. Is my desire to transition really just a sign of underlying depression? T: It’s very easy to hold on to some sort of fantasy about what’s going on to make you into a happy person, but overall it doesn’t change the level of contentment and satisfaction. C: I told him that no, overall I’m actually a pretty happy person. Especially after cutting my hair. |
| Analysis |
| The client’s possible hostility towards the therapist is suggested by the use of language, i.e. ‘intentionally misleading’, ‘manipulation’, ‘allegedly knows’, ‘threaten societal backlash’, and ‘bit by a shark’ (Egan, 1990, 169b). The client’s statement here seems to be contradicted by the strength of this response. It seems clear that the client does care what this therapist thinks. Exploring the possible role of the client’s other emotional responses would seem to be a legitimate area of discussion for the therapist here (Jenkins, 2000: 168). Maybe the client is accurate with this self- description, maybe not. Context is lacking here. Was it a case of being ‘pretty happy’ before the hair cutting, and ‘especially’ happy afterwards? The hair cutting seems to be very symbolic and important for the client, so again it is worth exploring, rather than simply taking at face value. |
| Transcript: Segment 5 |
| T: You’re happy with it the way it is now and you’ve no intentions of regrowing it, it sounds like. But you kept it until you were 28 or 29. Do you think that was something to wonder about? C: What do you mean? T: It seems sort of incongruous that you would have kept long hair for as long as you did so. I’m curious about it. C: Curious? The curiousity ended when he asked me if I was happy with my haircut. Telling me it’s incongruous with the way I live? That’s an opinion with an agenda. T: Do you ever miss feeling and looking more feminine? Do you ever feel uncomfortable dressing, looking the way you do? C: I don’t. T: You don’t. C: I feel more comfortable presenting more masculine. After that comment, I had to leave. I honestly was feeling pretty frustrated and uncomfortable. But do you know who doesn’t get to leave? Thousands of trans kids and adults, sent to these sessions to be talked out of who they know they are inside. For a list of gender affirming resources and therapists, you can start by visiting mayday.health |
| Analysis |
| The client seems unwilling to explore any other potential meaning or significance of this key event, i.e. the hair cutting. The client seems angry at this point. Any attempt to explore the client’s narrative more fully needs to be defensively batted away, it would seem. The therapist seems to pick up on contrasts for the client between then and now (Egan, 1990: 196, 205) and also to the potential issues of loss involved in any major personal change. The therapist may be picking up on the client’s actual feelings of being comfortable/uncomfortable/frustrated within this session, but lacks sufficient self-disclosure from the client to work with this material more effectively, given the client’s resistance to fully engaging with the therapy? This seems to sum up the client’s firmly held and unshakeable view that the purpose of any exploratory therapy is to be “sent to these sessions to be talked out of who they know they are inside.” |
Coda to transcript
The video transcript is accurate, with one interesting exception: The client states: I’ve never [really] felt like a woman” (at 1.07), but this transcript does not include the word “really”. Slips and omissions can sometimes be significant. Freud might suggest that this “…invariably indicates that some motive has contributed to the occurrence of the interference” (Freud, 1991: 128). Is there a meaningful distinction for the client between ‘never feeling like a woman’ and ‘never really feeling like a woman’? Could it be that this lapse is a clue to the fact that this person is not really a client in therapy, but is just going ‘undercover’?
Exploratory therapy and integrative therapy
The client is alleging that the therapist is “trying to convince me that I’m not trans” and that this constitutes conversion therapy. However, this statement lacks direct evidence. Each of the therapist’s responses are consistent with an integrative, exploratory model of therapy. Hence, for Culley and Bond (2011), it is a central part of their integrative model of therapy to:
- “…explore alternative ways of addressing their problems” (71)
- “…explore means helping clients to open up about themselves and their concerns in a specific and focused manner” (78).
- “…explore discrepancies” (110).
- “…explore issues that are causing concern and finding ways to a better future” (190).
There are, of course, many different versions of integrative therapy. Within Egan’s Skilled Helper model, a key goal of therapy is: “To assist the client in exploring key feelings, experiences and behaviours;” (Jenkins, 2000: 168. Emphasis added: PJ). A more recent outline of Egan’s model also includes the need to “…invite the client to begin to explore possible blindspots and to develop new perspectives on their situation” (Wosket and Jenkins, 2023: 495. Emphasis added: PJ). Exploration would seem to be a core and, indeed, essential part of the integrative model of therapy, and arguably of any reputable model of therapy. While grounded in empathy, exploration of core issues is not necessarily a comfortable process for the client, and may involve skilful, but robust, challenge to the client’s established repertoire of defences and self-perceptions.
Resistant client behaviours as a block to meaningful therapy
Neither is the client’s reported lack of ease in the session a credible form of evidence of having undergone an attempt at conversion therapy. The client has entered into therapy with a hidden agenda, namely to make an undercover tape, in order to prove that the therapist is practising conversion therapy. This hidden agenda means that the therapy is stymied right from the beginning and cannot function in any meaningful way. The client is caught in a double bind of their own making – that is, they cannot be congruent about their own incongruence. A therapist in this situation may well pick up that the client’s non-verbal communication signals a significant degree of discomfort. However, the therapist is then quite unable to work with this therapeutically, without the client’s willing cooperation in exploring what this might be about. Client discomfort is not necessarily an indicator either of the therapist’s failure, or of their acting in bad faith. Exploratory therapy is, after all, not meant to be the psychological equivalent of a warm bath.
Egan accurately describes this situation as one where the client is resistant to the therapy and to the therapist: “…some clients can resist being influenced and respond defensively even to responsible challenge” (!990: 205). He continues: “Resistant clients are likely to present themselves as not needing help, to feel abused, to show no willingness to establish a relationship with the helper…” (1990: 169). Furthermore, such clients “…may be resentful, make active attempts to sabotage the helping process, terminate the process at the earliest possible moment…” (1990: 169). This does prove to be the case in this situation, as the client appears to end the session abruptly, rather than sit with, own and explore their emerging powerful feelings of hostility and anger towards the therapist.
Exploratory therapy and conversion therapy
While therapists from any therapy modality might well criticise this therapist’s actual responses, or even this therapist’s choice of, or skills in using, this particular integrative approach, this does not establish that the therapy so carefully curated and presented here is in any way equivalent to conversion therapy. Criminal law bans on conversion therapy usually require evidence of clear intent on the part of the therapist to change the client’s gender identity. There is no compelling evidence of such criminal intent provided in this transcript.
Equally, under civil law, an integrative, exploratory approach might well be criticised by a therapist who prefers an exploratory approach based on a more person-centred, or psychodynamic, or cognitive behavioural, or any other recognised approach. However, it is not sufficient in civil law to establish that one therapist is negligent simply because they are using an approach different to the one preferred by another therapist, who happens to belong to a different school of therapy. The case law is very clear on this point:
“In the realm of diagnosis and treatment, negligence is not established by preferring one respectable body of professional opinion to another.” (Maynard v. West Midlands RHA [1985] (at 638)).
Finally, the Cass Review for the UK NHS emphasises the essential purpose of exploratory work within therapy:
“The intent of psychological intervention is not to change the person’s perception of who they are but to work with them to explore their concerns and experiences and help alleviate their distress, regardless of whether they pursue a medical pathway or not. It is harmful to equate this approach to conversion therapy as it may prevent young people from getting the emotional support they deserve (Cass, 2024: 150. Emphasis added: PJ).
Conclusion
Allegations of conversion therapy are extremely serious, with potentially devastating consequences for the therapists concerned (Jenkins and Panozzo, 2024). Undercover attempts to garner evidence of conversion therapy are likely to fail in their purpose, but are still highly destructive of the trust between therapist and client which is essential for therapy to have any positive effect. Such attempts are also likely to have a chilling and (presumably intended) deterrent effect on therapists who choose not to use gender identity affirming responses. Defending exploratory therapy means defending mainstream therapy. Exploratory work within therapy is integral to all mainstream therapeutic approaches and is recognised as valuable by the NHS Cass Review. It needs to be strongly defended from any misguided attempts to undermine, marginalise, or traduce it in the future.
References
Brodley B.T. and Lietaer, G. (Eds) (nd) Transcripts of Carl Rogers’ Therapy Sessions. Vol 12. Gloria Filmed Interview: “…moved from the “there and then” of her life to the “here and now”” (20) https://anamartinspsicoterapiaacp.wordpress.com/wp-content/uploads/2016/04/brodley-transcripts-of-carl-rogers-therapy-sessions.pdf
Cass, H. (2024) Independent review of gender identity services for children and young people. https://cass.independent-review.uk/home/publications/final-report/
Culley, S. and Bond, T. (2011) Integrative counselling skills in action. Third edition. London: Sage.
Egan, G. (1990) The skilled helper: A systematic approach to effective helping. Fourth edition. Brooks/Cole: Pacific Grove, CA.
Freud, S. (1991) The psychopathology of everyday life. Volume 5, Penguin Freud Library. Harmondsworth: Penguin.
‘Gender Conversion Therapy’ video: (2024) https://www.youtube.com/watch?v=-RzC6lY7Evc
Jenkins, P. (2000) “Gerard Egan’s Skilled Helper model”, pp. 163-180, In S. Palmer and R. Woolfe (Eds) Integrative and eclectic counselling and psychotherapy. London: Sage.
Jenkins, P. and Panozzo, D. (2024) “Ethical care in secret: Qualitative data from an international survey of exploratory therapists working with gender questioning clients.” Journal of Sex and Marital Therapy. 1-26. https://dx.doi.org/10.1080/0092623X.2024.2329761
“…nonaffirmative responses within therapy … paired with often illegal conversion practices within faith settings” (1)
“A charge of practicing C[onversion] T[herapy], that is, by our definition, nonaffirmative therapy…” (2)
Wosket, V. and Jenkins, P. (2023) “The skilled helper model”, pp. 492-497, In T. Hanley and L.A. Winter (Eds) The Sage Handbook of Counselling and Psychotherapy. Fifth edition. London: Sage.
Legal reference
Maynard v. West Midlands Regional Health Authority [1984] 1 WLR 634, [1985] 1 All ER 635
by Peter Jenkins, a member of Therapy First and Thoughtful Therapists, whose scoping survey for the UK government consultation on conversion therapy can be found here: https://thoughtfultherapists.org/scoping-survey-pdf/
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