{"id":14,"date":"2024-06-14T00:22:38","date_gmt":"2024-06-14T00:22:38","guid":{"rendered":"https:\/\/gendertherapy.co.nz\/?p=14"},"modified":"2024-06-14T03:37:57","modified_gmt":"2024-06-14T03:37:57","slug":"there-is-no-conflict-between-exploratory-and-gender-affirming-therapy","status":"publish","type":"post","link":"https:\/\/gendertherapy.co.nz\/?p=14","title":{"rendered":"The role of exploration in gender-affirming therapy"},"content":{"rendered":"\n

A professional association of which I am a member has seen a number of conversations recently about \u2018gender-affirming\u2019 therapy and how this does or doesn\u2019t align with psychotherapy as a fundamentally \u2018exploratory\u2019 approach to treatment.  In many cases, I believe some of the points being made in these conversations stem from a misunderstanding <\/a>about what gender-affirming therapy actually means.  Some contributors have made the incorrect assertion that gender-affirming therapy precludes exploration by assuming that whatever ideas a client holds about their gender identity are automatically correct and should be affirmed without reflection.  While this is certainly not the case, I thought it might be helpful to articulate what good gender-affirming therapy should look like and clarify how exploration plays a crucial role in effective therapy of this kind.  In doing so, I hope to help clients identify therapists who will be safe to work with while also providing therapists with some ideas to reflect on in their own practice.<\/p>\n\n\n\n

A significant part of how exploration should work in therapy is the same regardless of what kind of issues we are working with, whether we\u2019re talking about gender identity, depression, relationship problems or anything else.  I want to outline a few key criteria for how exploration should be used in therapy in order to demonstrate that this is in no way at odds with gender-affirming care.<\/p>\n\n\n\n

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  1. Firstly, exploration should take as its starting point the existing knowledge and evidence base.\u00a0 Critics of gender-affirming care sometimes make the claim that as therapists we should be equally open to all ideas \u2013 including, say, the idea that gender dysphoria might be a result of trauma, or upbringing, rather than an intrinsic part of someone\u2019s identity.\u00a0 The claim that \u2018we should be open to all ideas\u2019 sounds quite reasonable on the face of it, but when doing so ignores an overwhelming body of existing evidence and research<\/em> \u2013 in this case, that there is no plausible evidence to suggest that gender identity is a response to trauma \u2013 then we are treating as equal two ideas that are not<\/em> equally plausible.\u00a0

    We would not accept it as \u2018simply being open to all ideas\u2019 to entertain the idea that some races are inherently superior to others, or that a client\u2019s problems are perhaps the result of them being \u2018sinful\u2019, and we should not accept this argument when it comes to gender identity either.\u00a0

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  2. Secondly, if we are genuinely to conduct \u2018exploration\u2019 then we must begin \u2013 bearing in mind the existing evidence \u2013 as much from a position of neutrality as possible (but see the next point as well).\u00a0 In the case of gender, this means we cannot truly claim to be conducting exploratory therapy unless we deeply believe that no gender identity or expression is inherently more natural, normal or desirable than any other. \u00a0And yet, when it comes to exploring gender even the most well-meaning of therapists often finds this hard to do.\u00a0 It\u2019s all too easy to work from the perspective that non-cisgender identities are abnormal or at least a divergence from the norm despite overwhelming scientific evidence that they are simply a natural part of human variation<\/a>.

    A consequence of this is that exploration is often biased towards assuming \u2018normality\u2019 unless overwhelming evidence to the contrary is provided, rather than treating all hypotheses as equally plausible and requiring similar levels of evidence.\u00a0 For example, while a therapist might spend a lot of time exploring whether someone might be transgender it is rare for them to spend a similar amount of time questioning whether someone is     cisgendered<\/a>.

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  3. Which ties into the reality that we cannot, as human beings, explore from a position of true neutrality and should not pretend that we can.\u00a0 We inherently bring our biases and assumptions and opinions formed from our own experience into whatever work we do.\u00a0 To suggest that in therapy we can suspend that and work from a position of total openness to all ideas is to suggest that we can do the impossible.\u00a0 Instead, we as therapists have an ethical responsibility to become aware of our biases as much as we can and take steps to actively educate ourselves and counteract these.\u00a0 It\u2019s too easy to assume that we can take up the role of neutral observer, as it frees us from having to do the very difficult work of deconstructing and analysing our own privilege and bias.

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  4. When it comes to exploration, not all sources of evidence are equal.\u00a0 Most importantly, when it comes to the client\u2019s own internal experience, it is imperative that the client\u2019s<\/em> perspective be treated as the most trustworthy source of evidence.\u00a0 It should go without saying that no-one can know the client\u2019s internal experience better than themselves.\u00a0 Not their family, not the broader public, and certainly not us as therapists.\u00a0 Again, it is not<\/em> genuine exploration if we treat the client\u2019s self-report about their internal sense of gender or identity as having equal validity to our own beliefs about how gender or identity works more broadly.\u00a0 The purpose of exploration with a client should be to help them make sense of what that internal experience means to them<\/em>, not to pass any kind of judgement on whether that internal experience is correct.

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  5. Lastly, unless it is what the client has specifically requested then knowledge \u2013 the result of exploration \u2013 is not an end in and of itself.  Exploration is a crucial part of therapy, but we should never lose sight of the purpose of that exploration: to help the client resolve problems in their life, to allow them to live more authentically, to love and to engage in the world more deeply \u2013 or any other goals that the client has explicitly stated.  Exploration should never be pursued for its own sake, but only in service of what the client actually wants out of therapy<\/em>.<\/li>\n<\/ol>\n\n\n\n

    If we can use exploration in the ways described above \u2013 taking into account the existing evidence, from as much of a position of neutrality as we can, being aware of our own biases and taking steps to mitigate these, prioritizing the client\u2019s perspective about their own experience, and treating knowledge as a means to an end rather than an end in itself \u2013 then I believe exploration can and should play an important role in effective gender-affirming therapy. 

    I want to cover what I believe this should look like in therapy \u2013 hopefully if you\u2019re considering therapy yourself you can use this as a guide for finding a therapist and evaluating any therapist you do meet for being able to provide effective gender-affirming care.<\/p>\n\n\n\n

      \n
    1. In my opinion, any good therapy should focus on the problems experienced by the client<\/em>.\u00a0 If something is genuinely not a problem for you, then it is not the role of the therapist to decide that it should be a problem, nor are problems experienced by family members or other people in your life good material for therapy (unless it is also<\/em> causing you distress as a result of the response they are having).\u00a0 When it comes to gender identity, therapy should only focus on aspects of this that are causing you distress or difficulty in some way.\u00a0

      If you are content in your gender identity whatever that may be, then it goes without saying that this should not be something to explore in therapy.\u00a0 \u2018Problems\u2019 can take many forms, and could be as simple as \u2018experiencing distress over not feeling certain about your gender identity\u2019 in which case therapy is a great place to work on this, but again it should not be assumed that gender identity is a problem or a topic for therapy just because someone has a minority or less common identity.\u00a0 This is the first step of effective exploration: to identify the target problems.

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    2. Once the problems you want to work on have been identified, it is crucial to clarify whether these are internal psychological problems<\/em> (and therefore things that can be resolved through therapy) such as patterns of self-criticism or self-doubt about identity, or external\/situational problems <\/em>such as a partner or coworker being judgemental or non-accepting about your identity.\u00a0 Often the issues experienced by transgender and non-binary people are caused by judgement, prejudice and mistreatment by society \u2013 and while it\u2019s still possible for therapy to be helpful in these instances, it\u2019s important that we be clear whether the problem is an internal or an external one.\u00a0 In the case of an internal problem, we can start working to resolve it immediately.\u00a0 If it\u2019s an external problem, it\u2019s a little more complicated.\u00a0 This is the second step of effective exploration: to distinguish internal from external problems.

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    3. If the problems that someone is facing are primarily external<\/em>, then we need to determine whether or not there is also<\/em> an internal problem in response to that external issue.\u00a0 For example, if someone is being misgendered at work this is an external problem and it would be entirely reasonable to think that this would cause someone pain or anger about the experience.\u00a0 If however the person then finds themselves paralysed with anxiety and unable to confront the person doing the misgendering or take the issue to HR (if they are in an environment where it\u2019s safe to do so) then this might be an internal<\/em> problem arising from an external<\/em> experience, and a goal of therapy might then be to help them work through their anxiety or lack of confidence in asserting boundaries.

      If, on the other hand, a client does not identify a problem with their response \u2013 for example, if they feel outraged about the situation but recognize that in their particular circumstances there is nothing that can be done about the injustice \u2013 then there is little that can be done in therapy other than validating and witnessing their experience.\u00a0 This is a third way in which exploration can contribute to gender-affirming therapy, by identifying when a client\u2019s responses to mistreatment or injustice represent an internal psychological issue that could be resolved and when they are instead a rational and understandable reaction to unfairness or unkindness.

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    4. Once the problems that we\u2019re trying to address in therapy have been identified then the next function that exploration can have is to investigate what a desirable solution would look like.\u00a0 This is a process that should occur collaboratively between therapist and client, guided by the client\u2019s expert knowledge of themselves.\u00a0 For a client who is uncertain about their gender identity, a desired outcome could be as simple as \u2018reaching a point of confidence and comfort with a gender identity, whatever that might be\u2019.\u00a0 For someone who already has a clear sense of their gender identity, this might be overcoming internalized misogyny, transphobia, sexism etc so that they can experience more pride and less self-criticism about their existing identity.\u00a0

      Again, for this to constitute genuine exploration it is critical that the therapist be open to all possible outcomes and gender identities as being equally valid, natural, and desirable so that the client is free to truly consider all possibilities and find what resonates most fully with them.\u00a0 This is the fourth step in effective exploration: exploring openly what possible and satisfactory resolutions might look like.

      <\/li>\n\n\n\n
    5. Lastly, what constitutes the bulk of therapy is how we then work together to achieve those desired goals.  Exploration plays a crucial role here, in digging in to and investigating all the different ways in which a client\u2019s experiences, thoughts and beliefs contribute to their sense of themselves and their identity.  Exploration can help uncover hidden biases, assumptions and prejudices and uproot deeply held beliefs about gender, sexuality or identity that might be getting in the way of the client feeling truly free to identify and express themselves in the ways that may be most fulfilling to them.  It goes without saying that being raised in a patriarchal culture we are all \u2013 non-binary people, women and men \u2013 exposed to homophobic, transphobic and misogynist ideas and that these shape our sense of what is and isn\u2019t acceptable, within ourselves sometimes more so than in others.

      Through exploration, we can bring to light the ways we have learned to think about ourselves and others and provide space to re-evaluate these, often reducing internalized shame and stigma in the process.  As mentioned before though, this exploration should always be done in the service of achieving the desired outcomes identified previously \u2013 knowledge for its own sake is only of value if it is what the client wants, otherwise knowledge is just a means to an end.  When we have the right<\/em> knowledge, and can use it to examine and make sense of our internal processes and patterns it can be truly transformational and that should always be our goal.  This is the final way that exploration has a place in effective gender-affirming therapy: exploring the ways in which our experiences, thoughts, beliefs, and upbringing have shaped the way our mind works and the patterns we enact and using this knowledge to break free of habitual behaviours and ways of thinking so that we can live more fully and authentically.<\/li>\n<\/ol>\n\n\n\n

      I hope it is clear by now that exploration is not in any way at odds with gender-affirming therapy and indeed plays a crucial role in any effective treatment.  However, it can only do so when that exploration comes from a place of acknowledging existing evidence, biases and prejudices and is done in the service of helping the client achieve their <\/em>goals.  It is not defensible to hide behind the idea of \u2018exploration\u2019 or \u2018being open to all ideas\u2019 as a way to give outdated, unscientific and transphobic, racist or misogynist ideas validity.  The professional literature not to mention decades of experience and research evidence have rejected these ideas.  And so should we.<\/p>\n","protected":false},"excerpt":{"rendered":"

      A professional association of which I am a member has seen a number of conversations recently about \u2018gender-affirming\u2019 therapy and how this does or doesn\u2019t align with psychotherapy as a fundamentally \u2018exploratory\u2019 approach to treatment.  In many cases, I believe some of the points being made in these conversations stem from a misunderstanding about what […]<\/p>\n","protected":false},"author":1,"featured_media":43,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,3],"tags":[],"class_list":["post-14","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-gender-identity","category-therapy"],"yoast_head":"\nThe role of exploration in gender-affirming therapy - gender\/therapy effective gender-affirming therapy<\/title>\n<meta name=\"description\" content=\"An article on the role of exploration in gender-affirming care, and how to identify a good gender-affirming therapist.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/gendertherapy.co.nz\/?p=14\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The role of exploration in gender-affirming therapy - 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