The UK publication of the Cass Review (2024) on gender healthcare for children and young people has represented a watershed moment in the wider debate on this highly conflicted issue. Since then, the Cass Review has been alternately dismissed as biased, or warmly welcomed in providing a firm evidence base for future policy and practice in the National Health Service. However, overall response to Cass within the UK healthcare field has often been largely muted and non-committal. Hence, the British Association for Counselling and Psychotherapy (BACP) is the largest professional association of therapists in the UK, but it has so far signally failed to engage with the Cass Review. Within the BACP, one of its largest membership groups produces the well-known journal, Children, Young people and Families (CYPF). This journal continues the BACP approach of broad support for gender identity affirmative therapy, in this case for children under 18 years. A recent issue of CYPF included a key opinion piece, seeking to promote the need for therapists to integrate ‘trans allyship’ into their therapeutic work with this client group. Peter Jenkins provides here a detailed critique of this ideologically flawed version of therapy with children and young people.
Framing the issues
The article starts with a certain benign framing of the task ahead for the original presentation and later discussion in published form. (The authors’ somewhat symbiotic contributions are merged together here for this purpose: Connor, 2025; Clark & Connor, 2025.) “Whichever role I’m in – editor, author, presenter, psychotherapist, supervisor – I believe it’s imperative to foster meaningful conversations about the themes that matter most to us…” This is a classically liberal position to take, but one that is not necessarily evidenced in the material that is presented. “I seek contributors who ‘get it’ so that we stay relevant:” However, while superficially appealing, the phrase ‘get it’ seems to mean: signed up to a particular ideological worldview, from which dissent is not permitted. So, the winning phrase, “Our opinions may differ, but that ‘rub’ is often where the magic happens,” does not live up to its promise. There may well be smoke and mirrors in abundance, but there is very little actual magic on offer here, unless by that term we include distraction and the redirection of attention away from certain inconvenient truths.
The writers’ philosophical stance is clearly nailed to the mast, in terms of fidelity to social constructionism. So we are instructed that “words matter… words can also be weaponised… Language is power.” It certainly is. However, language can only describe the world in an approximate and imperfect way. It does not actually shape reality, although it can influence our perception and experience of the world. Language is also not violence as such, although it can communicate hostility and aggression. Part of the task facing the writers here is to establish and maintain a particular emotional narrative and tone of feeling, into which their claims and arguments can then be more easily inserted. Writing about trans allyship seems to require a heightened emotional atmosphere, where feelings of selective empathy can be stirred, and feelings of anger against alleged perpetrators of harm can be better mobilised. As the reader’s feelings are aroused, so space for cognitive processing is reduced. Emotional reasoning can more easily kick in, along the lines of ‘I feel this, so this must be objectively true’. This seems to be a characteristic feature of much trans material, as if following a set pattern or template.
Constructing an emotional narrative
So, we are informed that the writer is “accused of misusing my power… concerns about my trans-allyship”,as if it’s“OK toattack someone for their identity, sexuality or allyship”. Anxiety is a key theme here, with “the production of fear…”. One example relates to alleged conversion therapy, with “some therapists actively campaigning to stop the ban. This is terrifying …conversion therapy, which, frighteningly, has still not been banned in the UK”. The effect of this language seems intended to construct an overall environment of fear and threat surrounding this topic.
The authors also enlist a powerful metaphor to heighten this careful ratcheting up of the emotional tone of the piece, by referring to parents “playing a version of Russian Roulette when they choose a therapist for their transgender child”. Metaphors are clearly useful in therapy, as combining an image and a possibly latent or unexpressed emotion. So here we have a mental image of random chance in the choice of therapist, leading to a risk of death or of serious harm, possibly to the child as client. This may also perhaps represent a coded reference to overall suicide narrative relating to children identifying as trans, but who are reportedly denied access to alleged gender affirming care (Appleby, 2014).
So the message seems to be that this topic should engender fear on all sides. Clearly, here there be tygers …
Absence of background and context
Then there is the striking and rather unhelpful absence of any proper context to the material presented here. It is very unclear whether this discussion relates to therapy with children in the context of private practice, in schools, or wherever. Given the complexity of the issues involved, it would be as well to acknowledge some of the key markers and events, if only to situate the discussion within a wider social context. As this talk was originally presented for Metanoia, there are several positive references to this agency. Of course, we may well know that Metanoia was responsible as a training institute for suspending one of its own postgraduate students, James Esses, for raising safeguarding issues about children identifying as trans at his placement with Childline. James fundraised and brought a successful legal action against both Metanoia and the United Kingdom Council for Psychotherapy. Metanoia settled the case out of court in 2024 and issued a fulsome apology, presumably agreed as a part of its legal settlement with James (CTA, 2024). It is unfortunate, however, that this apology, or indeed any reference at all to James’ case, no longer seems to appear to appear on its current website.
There is also, surprisingly, a later reference to Mermaids, as a potential resource. Mermaids was allegedly encouraging the use of binders for gender-questioning children and young people, at least up until 2019. The use of binders is a quasi-medical intervention, with known risks of harm (Dixon, 2022). Perhaps more seriously still, there is no mention of the closure of the Tavistock GIDS, storm centre of gender-affirming care for children, nor of the Cass Review, nor of the Forstater case. Each of these are significant markers in the developing debate about gender questioning children in the UK. The Tavistock Gender Identity Development Service (GIDS) faced closure after the judicial review brought about by Keira Bell, a detransitioner (with ‘lived experience’, though perhaps not of the preferred kind). There was also the Care Quality Commission review which concluded that the Tavistock GIDS’ performance was inadequate (Jenkins, 2021). The Cass Review is still largely ignored by BACP, with only a cursory paragraph about it to be found in a previous issue of the journal Children Young People and Families (CYPF). The Forstater case in 2021 confirmed the right of gender critical therapists to express their views, even when considered offensive to others. This point is now acknowledged by BACP legal guidance for members (BACP, 2023).
So, words are powerful, the topic is fearful and the territory is unmarked. The discussion unfurls…
What is the risk?
The question being posed is: “Is there a debate, really? We have a situation where the hyperfocus on children’s bodies and physical interventions misrepresents the reality”. This is a potentially a serious charge. ‘Hyperfocus’ is an interesting term, suggesting almost an obsessive and prurient interest at work here. But surely, if children’s bodies are at risk, then it would be appropriate for therapists to express concern, and to perceive potential safeguarding issues? Not so, given that, rest assured, “psychotherapists do not provide medical procedures”. Ah, well, that clears that up. We had wondered, perhaps, about some major degree of professional slippage here. More seriously, this phrase,“psychotherapists do not provide medical procedures” is the mantra employed for fending off repeated queries about BACP’s enforced radio silence about the Cass Review. It provides the rather shaky rationale for BACP’s position: “psychotherapists do not provide medical procedures”, therefore no debate is needed about the Cass Review.
Although, come to think about it, BACP members also work in other medical settings, such as General Practice centres, abortion clinics, and hospices, with each context carrying its own specific professional issues, but without BACP members actually writing prescriptions, carrying out abortions, or providing palliative care. And we have BACP engaging with the relevant ethical, legal, professional and therapeutic issues in each of these contexts (for example, see BACP, 2018a). But not with Cass, perhaps because this would inevitably open up the Pandora’s Box of debating evidence-based care for gender questioning children.
Furthermore, “gender-affirming surgeries are not performed on children”. Though, in reality, this is largely due to the cumulative and continuing fallout from Keira Bell’s judicial review of 2020, the closure of GIDS, and the ending of access to puberty blockers and progression to cross-sex hormones. And, of course, gender-mutilating surgery has been performed on one 16 year-old from the UK, who was sent to Thailand in 2014 for this specific purpose (Sloan, 2012). In the wider context, an estimated 6,000 teen trans mastectomies have been carried out in the US, which still has very weak legal protection for children in many of its states, in sharp contrast to the UK (Sapir, 2024).
But, we digress…
Unpicking the Gillick principle
But rest assured, there is also “legal protection in the form of Gillick Competence”. The Gillick principle provides for confidential medical treatment and therapy for children under 16 years in England and Wales. The Gillick decision, arguably, was widely misused at the GIDS to facilitate consent to puberty blockers for children as young as 10 years of age (Jenkins, 2021). It may also be open to misuse in some schools in order to limit parental awareness of social transition, and of children’s name changes. If so, this would be in open defiance of current education law, which requires full parental involvement in children’s schooling (Moore, 2023). There is also recent significant case law, where one parent objected to their 16 year-old child’s wish for puberty blockers. The court upheld the parent’s objection on medical grounds, even though the child was actually over the threshold for Gillick’s remit (O v. P & Q, 2024). So Gillick and other relevant law on children’s consent is not by any means a blank cheque for endorsing adolescent medical autonomy. The law on consent has definite limits and restrictions, particularly in the field of so-called gender medicine.
The view is also expressed that “I would like to feel reassured that any trans, non-binary or gender questioning person, won’t unwittingly find themselves in the room with a therapist who does not believe in the validity of their existence. Or one who rolls their eyes when invited to share their pronouns”. So it seems that diversity and choice of therapist is great, but not if it leads children and parents to make choices that would not accord with the authors’ view of allyship? This whole view seems to be both centred on adults’ ideological choices and to be deeply authoritarian in its stance.
The article builds a picture of children seemingly put at risk – but who exactly are they at risk from?
So who is putting gender questioning children at risk?
The answer appears to be that the risk is posed by gender critical therapists. There seems to be a relentless ’othering’ of gender critical therapists. Do take care, as “some therapists will hold gender critical beliefs and may even practise conversion therapy”.There are “some that promote a gender critical, anti-affirmative stance, claiming that transgender identities contradict biology, defy common sense, and jeopardise children’s health and wellbeing”. Although, perhaps somewhat surprisingly in view of this, “it is not illegal to hold gender critical views”. Which seems rather like saying it’s not actually illegal for women to vote. Not only is it not illegal to hold gender critical views after Forstater, these views are firmly protected under the Equality Act 2010 after the Forstater case.
And yet,“I don’t think it’s possible to leave our personal beliefs at the therapy room door; if you hold beliefs that are gender critical, anti-affirmative, pro-biological reality, or any other variations that could be perceived as trans-exclusionary, they will be apparent …How could this ever be successfully ‘bracketed’ in a therapeutic space? If your private thoughts are that sex is binary and immutable, how can you empathically enter your trans client’s frame of reference”? The implication here seems to be that gender critical therapists cannot ‘bracket’ off their beliefs (one wonders why on earth not?) and therefore presumably cannot work ethically with clients identifying as trans?
Are gender critical therapists bad therapists?
So the overall message seems to be that gender critical therapists may represent a risk of harm, and a potential threat, to the wellbeing of children identifying as trans. Though not illegal, gender critical therapists might well practise conversion therapy, are probably quite unable to bracket off their hostile beliefs and are therefore unlikely to empathise with their clients facing this issue. So, all in all, gender critical therapists may be bad therapists, who could pose a risk of harm to their clients.
So, we have an atmosphere of threat, a set of potential victims in the form of gender-questioning children, and a set of seemingly harmful, nay, potentially persecutory, actors, namely gender critical therapists. Who can save these vulnerable victims and stave off these allegedly bad therapists? The answer is: trans allies.
Visible trans allyship is needed
What is needed is “visible allyship as professionals, in the form of trans allies, who firmly believe that we should learn about how to work therapeutically with trans people from trans people themselves”. However, this stance is hugely problematic in therapeutic terms. It defers to the (selectively culled) lived experience of children and adults, who define themselves in a particular way, in this case as being transgender. We certainly wouldn’t adopt this naïve and uncritical stance for working with children with a wide range of experiences or conditions, whether subjected to sexual abuse, or experiencing an eating disorder, or disclosing suicidal ideation (all of which can be very pertinent factors in choosing to adopt a so-called transgender identity). This is at the root of our concern (and that of Hilary Cass) as a form of trans exceptionalism. Translated, this stance apparently means for CYPF that ‘the normal rules of therapy do not apply here’. We saw all this before, as enacted at the Tavistock GIDS. We also saw the dire consequences of this approach there too.
Becoming a trans ally
Trans allyship, apparently, can be as simple as “including our pronouns or a statement of inclusion”. Yet even this can be problematic from the point of view of maintaining our neutrality as a therapist. But, we are told, “people fit into one of four types: active discriminator, passive discriminator, passive ally or active ally”.This model suggests briskly inserting all therapists into pre-defined boxes. At another level, this also seems to represent the fusing together of core anti-therapeutic process, such as Kleinian splitting into ‘good and ‘bad’ objects, but with the added blunt force of trans ideology (Mitchell, 1986).
Finally, we need to “take a clear-sighted and critical look at what is unsaid or obscured behind words such as ‘exploratory’ or ‘thoughtful’”. It might well seem a worrying development that exploratory and thoughtful therapists might actually be considered to be a source of threat and harm to clients. But in the context of the material outlined above, with gender questioning clients in the role of victims, gender critical therapists as persecutors and trans allies as rescuers, the Drama Triangle is now finally complete and ready to roll (Karpman, 1968).
Conclusion
To conclude, the framing of the issues about trans allyship seems to rely on an emotively loaded discourse of conflict and fear. There is an apparent evasion, or lack of appropriate context, which might help situate the debate more accurately, such as relevant background on Metanoia, the Tavistock GIDS, the limits to Gillick and crucially, the Forstater case on free speech rights. There is the worrying potential for the splitting and othering of gender critical therapists, so that trans ally therapists are perhaps seen as good; gender critical therapists are presumably bad. We might be tempted to see here a powerful Drama Triangle at work, with readily identified victims, rescuers and persecutors. This overall stance is firmly based, however, on adult preoccupations with gender identity and is deeply authoritarian in nature. There may even be a curious parallel process at play here, between our expected roles in providing gender identity affirmative therapy and the compliant attitude expected of us as members towards BACP policy. This might well be summarised as:
Don’t explore, don’t question anything, just accept it all and affirm, affirm, affirm!
References
Appleby, L. (2024) Review of suicides and gender dysphoria at the Tavistock and Portman NHS Foundation Trust: Independent report. Department of Health and Social Care. Review of suicides and gender dysphoria at the Tavistock and Portman NHS Foundation Trust: independent report – GOV.UK (www.gov.uk)
Barnes, H. (2023) Time to think: The inside story of the collapse of the Tavistock Gender Service for Children. Swift: London.
British Association for Counselling and Psychotherapy (BACP) (2018a) Abortion: Issues for the counselling professions in England and Wales. Good Practice in Action 059. Abortion: issues for the counselling professions in England and Wales GPiA 059
British Association for Counselling and Psychotherapy (BACP) (2018b) Ethical Framework for the Counselling Professions. Lutterworth: BACP. https://www.bacp.co.uk/media/3103/bacp-ethical-framework-for-the-counselling-professions-2018.pdf
British Association for Counselling and Psychotherapy (BACP) (2023) Equality, diversity and inclusion in the counselling professions. Good Practice in Action 108: Legal Resource. https://www.bacp.co.uk/search?q=legal%20resource%20equality%20diversity%20and%20inclusion (BACP member login may be required)
Cass, H. (2024) Independent review of gender identity services for children and young people. https://webarchive.nationalarchives.gov.uk/ukgwa/20250310143933/https://cass.independent-review.uk/home/publications/final-report/
Clark, S. and Connor, J. (2025) “Language matters”, Children, Young People and Families, June, pp. 11-14. https://www.bacp.co.uk/bacp-journals/bacp-children-young-people-and-families-journal/2025/june/ (BACP member login may be required)
Connor, J. (2025) “From the editor”, Children, Young People and Families, June, p. 3. https://www.bacp.co.uk/bacp-journals/bacp-children-young-people-and-families-journal/2025/june/ (BACP member login may be required)
Critical Therapy Antidote (CTA) (2024) James Esses Reaches a Settlement with Metanoia. Critical Therapy Antidote. https://criticaltherapyantidote.org/2024/08/14/james-esses-reaches-a-settlement-with-metanoia/
Dixon, H. (2022) Trans charity Mermaids giving breast binders to children behind parents’ backs. Daily Telegraph. 25th September. https://www.telegraph.co.uk/news/2022/09/25/exclusive-trans-charity-mermaids-giving-breast-binders-children
Jenkins, P. (2021) Calibrating Gillick in the age of gender wars: Part 2: The curious case of the Tavistock. Critical Therapy Antidote: https://criticaltherapyantidote.org/2022/01/02/calibrating-gillick-in-the-age-of-gender-wars-part-2-the-curious-case-of-the-tavistock/
Karpman, S.B. (1968) “Fairy tales and script drama analysis”, Transactional Analysis Bulletin, 7(26), pp. 39-43. https://karpmandramatriangle.com/pdf/DramaTriangle.pdf
Mitchell, J. (Ed) (1986) The Selected Melanie Klein. Harmondsworth: Penguin
Moore, L. (2023) Asleep at the wheel: An examination of gender and safeguarding in schools. Policy Exchange. https://policyexchange.org.uk/publication/asleep-at-the-wheel/
Sapir, L. (2024) A consensus no longer. City Journal. https://www.city-journal.org/article/a-consensus-no-longer
Sloan, J. (2016) Sex swap teenager to enter Miss England contest. The Sun. 5th April. https://www.thesun.co.uk/archives/news/303371/sex-swap-teenager-to-enter-miss-england-contest/
Legal references
Forstater v. CGD UKEAT/0105/20/JOJ. Maya_Forstater_v_CGD_Europe_and_others_UKEAT0105_20_JOJ.pdf (publishing.service.gov.uk)
Gillick v. West Norfolk AHA [1985] 3 All ER 402; [1986] AC 112 https://www.bailii.org/uk/cases/UKHL/1985/7.html
O-v-P & Q [2024] EWCA Civ 1577 https://www.judiciary.uk/judgments/o-v-p-and-q-2/
R (Quincy Bell) and A v. Tavistock and Portman NHS and others [2020] EWHC 3274 https://www.judiciary.uk/judgments/r-on-the-application-of-quincy-bell-and-a-v-tavistock-and-portman-nhs-trust-and-others/
By Peter Jenkins, 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). https://us.sagepub.com/en-us/nam/author/peter-jenkins
Peter is also a member of Thoughtful Therapists. His critique of the Memorandum of Understanding on Conversion Therapy was described as ‘instrumental’ in persuading the UKCP Board of the case for leaving the MOU in 2024.
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