Critical Therapy Antidote

Clinical Psychologist and CTA member, Jaco van Zyl, has authored a peer-reviewed paper in the journal, Psychodynamic Practice. The title of his article is, Formulating gender dysphoria as an affective-perceptual disturbance involving the body. In the paper Van Zyl uses the developmental trajectory of the infant and adolescent from psychoanalytic perspectives to give a formulation of the six body image disorders, or affective-perceptual disturbances involving the body. He argues convincingly that gender dysphoria clearly fits the same formulation of the other five disturbances, and therefore requires similar psychotherapeutic interventions. As with the other disturbances, Van Zyl recommends exploratory psychotherapy (see Moses’ recent paper) as the time-tested, ethical approach to treatment, as opposed to the to the novel, ideologically imagined and antitherapeutic practice of gender-affirmative treatment.

Recent global developments on the gender medicine front – including malpractice revelations, legislative restrictions on the medicalisation of gender dysphoria in minors, political interference and the ground-breaking Cass Report in Britain – necessitate a correction on how gender dysphoria should be understood and treated. Despite deliberate attempts at stalling Cass’s recommendations and outright persecution of those who strive to treat gender distressed minors ethically and responsibly, we urge medical and mental health practitioners to be courageous in upholding the maxim, First Do No Harm.

We are delighted that this article was accepted as a worthy piece of scholarly writing that adds to the discussion on such a crucial contemporary issue. See verbatim extracts below.

From the introduction:

“Gender-affirmative healthcare and the medicalisation of gender distress among minors have recently come under scrutiny with the publishing of the WPATH Files (Hughes, 2024) in Canada and Hilary Cass’s Final Report in Britain (Cass, 2024). The findings in these documents raised crucial issues that are of clinical importance, particularly concerns around informed consent, duty of care, child safeguarding and research-derived treatment protocols. Despite these concerns, treatment of gender distress in minors remains contentions, as identitarian ideologies (Pluckrose, 2024) have entered into these debates.

“These findings also reflect the concerns of clinicians who approach gender incongruence from a psychoanalytic lens and highlight limitations of gender-affirmative approaches. For the purpose of this article, I recognise that ‘transgenderism’, ‘gender incongruence’, and ‘gender dysphoria’ are viewed as psychological phenomena. In order to address the needs of gender dysphoric individuals – minors in particular – in an ethical and responsible way, psychologists and psychotherapists need to draw a clear distinction between ideology and scientific theorising. To this end, psychoanalysis can be a valuable aid in positioning gender dysphoria as an affective-perceptual disturbance involving the body.

“I therefore critically appraise gender-affirmative psychotherapy and provide the psychoanalytic basis for gender-exploratory psychotherapy. To do this, I first provide a psychoanalytic background of the developmental trajectory of the individual subject, as they navigate the complex tension between the reality and pleasure principles. I use Freudian and Bionian concepts of psychological maturation to show how affective-perceptual disturbances involving the body can develop. Secondly, I examine how and why gender distress fits into this psychological formulation, and therefore ought to be included among the affective-perceptual disturbances involving the body. Thirdly, I argue that gender-affirmative psychotherapy is erroneously applied to gender dysphoria, as this therapy fails to adequately take the psychodynamics underlying the condition into account. Fourthly, I illustrate how gender-exploratory psychotherapy facilitates the resolution of maladaptive defence mechanisms and facilitates the resumption of psychological maturation. I conclude the paper by arguing that exploratory psychotherapy meets the treatment needs highlighted in the Cass Review.”