Therapeutic Interventions to resolve Gender Dysphoria

This article shows how a good therapist can identify underlying issues and attempt to resolve Gender Dysphoria without medicalised responses to bodily discomfort.  The therapist is fluent in Gender Identity speak  but does have the courage to honestly interrogate what “Gender” means to the clients they see. It is important to  note that any therapist may, or perhaps will, feel compelled to speak in approved language to get published. Additionally our young people have imbibed the new lexicon so the therapist may need to speak in the approved language, to establish a dialogue with Gender Dysphoric youth.

The article: Psychoanalyst on Transitory Trans Identity   Author Alessandra Lemmas

Psychoanalysis pays attention to unconscious motivations in the formation of “identity”.  This is in marked contrast to Gender Identity proponents of a medicalised response. Lemmas talks of the need for  “a posture of implicit scepticism”  when dealing with claimed identities. This is in marked contrast to Gender Identity medical practitioners who prioritise a subjective sense of self and demand only “belief”.   This is an excerpt from a response to an article in the British Medical Journal about how to treat Gender Dysphoria. The response is from Dr Helen Webberly, currently suspended from the General Medical Council,  who is not alone in her stance: Helen Webberly . 

The belief that people can, literally, be born in the wrong body underpins the lack of a therapeutic approach to young people presenting with Gender Identity Issues. Merely to suggest that this may be an incorrect, self-diagnosis, generates outrage that  we are denying the “lived experience” of the transgender community. Yet we know, as Lemmas, and many others, point out most desist, reconcile to biological sex and many are simply gay. 👇

The author subscribes/pays lip service to the idea that sex is assigned at birth, rather than merely observed, as it is in 99% + cases.  She subshumes both Lesbians and Gay men underneath the “transgender” umbrella. The statistics on post-operative satisfaction accept the narrative from within the Gender Identity community with no acknowledgment of the methodological flaws with the phenomenon of “loss to follow up”. {This is where a patient loses contact with the Gender Identity Service they are using. Detransitioners say they don’t return to the services which, they feel, actively harmed them, so this cohort disappear from the “follow up”}

The three case studies, in this article, cover many of the issues raised by parents dealing with our gender Dysphoric offspring.  All claimed a transgender identity with no prior history  sound puberty. We are told about the huge spike in referrals to the UK’s main Gender Identity Clinics and a wider social context emphasising choice and very much of a piece with the atomising of the individual in neoliberal, capitalist, societies.

The first case is illustrative of the complicity of transgender identity.  More on “Anita” below. 👇. As you can see Anita claims multiple identities encompassing male, gay & female as well as “drag queen”.  Already taking cross sex hormones but with no intention to progress to more surgical changes.

The dialogue seems to settle on the idea that gender identity can be fluid and an exploratory phase. Nevertheless Anita is already medicalising, We leave this case here, though I will just add that I have never seen a satisfactory explanation of what “living as a woman” means. It seems to depend on circular reasoning /a retreat to sex stereotypes.

Janes case is more complex and, arguably, requires a more robust interrogation since Jane seems to fully intend a full transition to “live as a man”.   The sessions are challenging and, on more than one occasion, the analyst reports the anger triggered by the exploration of underlying issues. What emerges is a young girl whose parents have traditional gender roles in the household. Janes perception is that her mother is a “hostess” with little power, standing in the household.  On being pressed much of Janes “Identity” seems built about rejecting all the signs associated with being a “girl” such as make-up and long hair.  Here are some of Jane’s thoughts on what being a girl means to her:

Tellingly., Jane reveals that they did not feel they measured up to the expected level of attractiveness as a girl.  Even more revealing is an expression of same sex attraction. Not as a lesbian but as a male attracted to females. Another common theme in detransitioners is the yearning for passing privilege as a male and how this, in retrospect, seemed to become more unattainable as they sought to identify as male.

Jane is also adopted and vehemently rejects any idea this relates to their gender identity issues, However it later emerges that the birth mother was from a culture which prized male children, in preference to girls.  This prompts some self reflection and the realisation / admission that maybe this was bound up with the idea that her mother may have kept a male child.

Janes situation resolved itself without medical intervention. She is in a same sex relationship and has found a way to identify as a strong woman in her on line world after previously observing that she felt “insubstantial” and, significantly, failed to garner the same respect when she was coded female.

The third case study is Alex, who is a female who identified as male at 16. Alex was not interested in being dissuaded from hormones and surgery, as is common with our Gender Dysphoric youth. Alex’s parents affirmed the new identity and accepted their daughter as a son. Alex, however,still wished to access therapy, but still underwent a double mastectomy at age 19.  Post surgery Alex was, initially “happy” but then became depressed and suicidal and revisited the sexual abuse that they had endured at age 10, and realised the link between the abuse and the desire to remove their breasts . Tellingly, the parents were not aware of the sexual abuse and it did made me reflect on their role as affirming parents and, if they had been aware of this history, would it have made them exercise more caution?  I do NOT say this to judge those parents.  Any one of us could have genuinely advocated for this stance in the belief, pushed relentlessly by our media and advocated by public bodies, that this is the right thing to do.

I am conflicted about the “woke” language. By espousing the idea that someone can born “in the wrong body” {which is the belief system underpinning  transgender ideology} the danger is our Gender Confused children are getting mixed messages.  On the one hand the implication is that they may be hard-wired with a conflict between sexed bodies and an opposite sex brain.  At the same time it is clear that some of these cases are complicated by sexual orientation, history of sexual abuse and family dynamics.  There remains no diagnostic test that can separate the influence of “neuroplasticity” from the notion of an opposite sex brain.  In an ideal world we would start from the clear premise that there is no solid evidence that there is a biological basis for this incongruence between sexed bodies and a “gender identity”.   That does NOT mean that Gender Dysphoria does not exist or that it cannot, in a minority of extreme cases, be extremely debilitating and, for adults, may lead to an inescapable desire for medical intervention.

Irrespective of these misgivings this is a good article and those of us dealing with Gender Dysphoric teens know how hard it is to navigate this terrain.  Some solid therapeutic work seems to have built up sufficient trust to garner some solid insights from these young people.  Of course I wish that self-awareness pre-dated significant surgery but for parents struggling with this, especially,  I do recommend this piece.