When Kids Say They’re Trans: What to Avoid in Therapists and How to Deal with Schools
The Problem
You may already know how difficult it can be to curate a team of therapists, school administrators and thoughtful adults who will support your parental decisions about how to best help your child. Children’s clinics, hospitals and schools across the world, though tasked with supporting the well-being of youth, have adopted contemporary gender beliefs that only confuse kids and exacerbate their vulnerabilities. This institutional capture is destructive, not only because it can create further deterioration in the mental well-being of young people, but especially because it can push children and families apart. We’ve heard hundreds of stories in which schools, behavioral and mental health centers, therapists, and counselors undermine parental decisions—and in some extreme cases actively conspire to keep secrets from parents and encourage children to regard their own mother or father with suspicion. Or perhaps an external provider delivers part of your school’s curriculum, teaching contested ideas about gender ideology and instructing children that LGBT phobia must be reported (which could mean that a child is disciplined for not using the preferred pronouns of a student or teacher). You might have been treated with hostility by an authority figure who implied that your hesitancy about transition means you don’t “support” your child. Or maybe a therapist suggested (in front of your child) that your refusal to give in to your son’s demands makes him more likely to take his own life.
Not only are many therapists quickly affirming children’s transgender identities and encouraging medicalization, but some are the first to suggest that the child’s eating disorder, body image problems, OCD, autism or other challenges may be caused by an undiscovered “transgender identity.”
We believe that clinicians are likely well-meaning, but they can be just as caught up in the social contagion as any young gender-questioning person. And a look back through the strange history of our field indicates that this parallel contagion has happened before. In the 1980s and 1990s, a bizarre theory swept through America that had originated among mental health professionals: a wave of horrific Satanic abuse rituals was taking place and children subjected to this abuse could completely “repress” the memories. Therapists saw it as their job to help “uncover” these memories. These ideas were intriguing and captured the attention of therapists, patients and the mainstream media. The “extracted memories” were often flamboyant, easily disproved, and coaxed from the imagination using hypnosis, sedative drugs and relaxation techniques.
The implausibility of these recollections didn’t stop the public from subscribing to the repressed memories theory. Innocent people were convicted of shocking crimes and punished on the flimsy imagined memories of abuse that were extracted in therapy. Journalist Ethan Watters has studied the recovered memory trend extensively, and he theorizes how it’s possible that intelligent, educated and competent therapists contributed to its growth: “This was a group of healers who believed that they not only had discovered the key to their patients’ suffering but also were exposing a hidden evil across society. The therapists, in short, were as caught up in the cultural currents as their patients.”1 Similarly, if a clinician truly believes that they can save a closeted “transgender child” from unsupportive parents, this powerful motivation serves as the precursor for bizarre and unethical behavior not seen in other realms of youth mental health services.
Even when clinicians promise parents that therapy will be a slow, careful process, sometimes the therapist comes to see gender exploration as the primary goal and inadvertently leads a child into a ruminative process around identity. We suspect that many clinicians are not well versed in the social drivers of mental health conditions and the ever-present pull of culture-bound syndromes (symptoms found only in certain cultures). Mental health diagnoses tend to be culturally shaped and often cannot be traced to tangible biological factors.
Bad therapy can be worse than no therapy
We often say, “Bad therapy can be worse than no therapy.” This is precisely why we wrote this book for you. We hope to give you the tools and framework you need to navigate your child’s gender-identity distress within the family context. We would like to give you the freedom to think for yourself, trust your parental intuition and act with more loving authority. You may be pursuing all these aspirational parenting goals and still need professional help for your child. Here we’ll lay out some considerations and suggestions to help you connect with a mental health practitioner who treats your child as an individual rather than a walking gender identity.
What does good therapy look like?
The most meaningful therapeutic processes are based on a positive relationship between client and therapist. Clients should feel respected, heard, understood and cared for. The therapist regards their client as a complex, whole person, and considers the client’s development and growth. Therapists must also avoid co-rumination with patients, helping them instead to understand their problems in new ways and ultimately grow beyond their distress.
The therapist should honor regular appointment times and behave in a professional manner. The informed consent process gives the client an idea of the therapist’s theoretical foundations and how therapy will go. Therapists should not make outsized promises about the outcome of therapy, and clients should feel free to end the relationship at any time. Additionally, therapy should also commit to the injunction “do no harm.” The therapeutic relationship is a powerful force in a client’s life, and therapists should humbly appreciate this fact, being cautious and mindful about how their work may affect the client. When working with youths and families, therapists should be aware of the risk of exacerbating rifts in the parent–child dynamic. Helping increase healthy communication and improving family dynamics is a laudable goal.
The Particulars of Gender in Therapy
Now that we’ve examined general principles of good therapy, let’s turn our attention to some qualities that might make a therapist more adept at working with gender in an exploratory (rather than an affirmative) manner. With younger children, we strongly advocate for family over individual therapy. You may even want to consider counselling for yourself. Whoever enters therapy, and for what purpose, the following characteristics in a therapist can be helpful.
Knowledge about ROGD and Detransition
Therapists who already recognize and have concerns regarding the social influence of gender dysphoria are more likely to be sceptical about a young person’s surface story, rewritten history and claims of certainty about wanting to transition. They will also be more likely to understand the harms and risks associated with medical interventions if they are familiar with the detransition experience. Explicitly rejecting the current “affirmation model” of therapy can be a good indicator of more nuance in the treatment of gender dysphoria. The Global Exploratory Therapy Association (formerly the Gender Exploratory Therapy Association), which we founded in 2021, is a resource for clinicians with this perspective, and also provides a directory for individuals looking for an exploratory therapist. That being said, we’ve met many wonderful therapists who were unfamiliar with ROGD and detransition initially, but who took an active interest in learning more about these phenomena and subsequently worked effectively with young gender-questioning clients.
Supports Family Cohesion
With the exception of rare cases of severe dysfunction and abuse, keeping families together should be a priority for the therapist. While some distancing and differentiation (being able to have different opinions and values while remaining connected) is normal and healthy for adolescence, estrangement can be a real concern for families raising a gender-questioning child. A good therapist should encourage, when possible, intact relationships, improved communication and healthy dynamics.
Offers Touchpoints for Parents of Younger Children
We believe that therapists who treat young clients and minors should work in collaboration with parents and ensure that mothers and fathers have touchpoints of communication, such as regular meetings where the therapist speaks to the parents or has a meeting with the client and their parents. Many parents give away their power and have no idea how the therapy is proceeding. We recommend seeking regular feedback about your child’s treatment. This should ideally be a collaborative arrangement where everyone acknowledges the benefit for family dynamics to keep parents in the loop; however, as the child matures, they might prefer to focus on a more individualized therapy that allows them to begin to move beyond the household. This can be worked out within a staged process.
If you’ve identified a therapist who seems to espouse the ideas we’ve described, it is still important to carefully interview them and assess if you feel comfortable with your child or family entering a therapeutic relationship. Keep in mind that your approach matters: you cannot demand that the therapist address specific issues or respond in certain ways to your child’s gender-questioning. When you engage in a conversation with the therapist, try not to coax out a verbal contract about how they will handle names, pronouns or social transition right away. Instead, discuss potential issues before they start seeing your child. The interview should give you a feeling about who the therapist is, how they approach gender in general, and help you figure out if they’re a good fit. Here are some questions you may want to ask:
How do you work with gender-questioning clients?
What is your stance on the medicalization of young and vulnerable people?
Have you heard of ROGD? What do you think of this term?
Have you ever worked with a detransitioner? Are you familiar with this term?
Are you open to learning more about ROGD or detransition?
What to Avoid with Gender in Therapy
For reasons we’ve expounded, we recommend avoiding the following characteristics and interventions when seeking therapy for a gender-questioning young person:
Gender-affirmative therapists
Gender clinics
Narrowly focused social justice therapists
Reference to the WPATH Standards of Care
Suggestions to “try on” various gender identities to see what fits
Therapists who completely ignore gender or refuse to address it, claiming it’s outside their scope
Any influenced by queer theory—this may be indicated by the term “kink-allied” in their pitch. These therapists often place too much emphasis on validating identity categories and not enough on exploring the psyche.
Opportunistic Clinicians
With the rising number of families desperate to find help for their child, and the small number of qualified therapists available, some families will inevitably be willing to stretch their budgets and tolerate behavior from therapists that would otherwise be unacceptable. We encourage you to be careful about hiring a therapist if anything about their practice, professionalism or fees feels “off.” For example, we are wary of “concierge” services that ask families to pay upfront for a long block of therapy. Unrealistic promises of guaranteed desistance are also red flags, as no therapist can predict the future or impose their will on a therapy client. Some mercenary therapists focus on affirming parents, as they know these parents pay the bills; however, as we know, affirmation tends to feel immediately satisfying but seldom leads to long-term satisfaction. Be mindful of your own fears, hopes and emotional drivers so that you can make decisions with clarity.
Dealing with Schools
Multiple short-term studies suggest that social transition can increase the likelihood of the persistence of a young person’s gender-related distress, and that it can interfere with children’s natural identity development.2 Nevertheless, there is no qualitative long-term peer-reviewed evidence about the impact of social transition on the current cohort of ROGD adolescents, and so it is imperative that parents make sure that involved adults—be they teachers, school counselors, therapists, parents or others—are sensitive to the needs of the individual child.
Depending on the geographical region, many parents have experienced schools choosing to carry out social transition on their child. One parent, Jean, described how, at a meeting, she highlighted her problems with the school’s decision to socially transition her young and vulnerable child. The school didn’t understand what she meant by “social transition.” Jean became very distressed. “They socially transitioned my child, but they didn’t even know what social transition was. How could I feel confident that they knew what they were doing?” For this reason, it can be valuable for parents to emphasize that this is a child safeguarding issue, so that schools can avoid causing further, more complicated challenges for the child. Jean believes that the social transition of her fifteen-year-old daughter was a significant step on the road to medical transition. “The school cast me as the mean, transphobic parent who didn’t understand her child. But they were wrong. I actually cared much more deeply for my child than they did. My daughter became further entrenched in her identity and very hostile toward me after she had socially transitioned at school. She started cross-sex hormones at eighteen, and had a mastectomy at nineteen. But she has since detransitioned and lives back at home with me now. She’s twenty-two years old and the school have no doubt long since forgotten all about her.”
Historically, young people often change their names and use nicknames during their process of identity exploration in adolescence. These days there is a good deal less formality between teachers and students, and so many teachers might employ the student’s preferred name without thinking about it. Yet teachers are holding a position of responsibility; they are in loco parentis. If they begin to see themselves as saviors, they can set up what is known as a drama triangle, which can significantly undermine parental authority. The drama triangle is an unhealthy scenario where one person is the victim, another the persecutor and another the savior. When teachers take on the role of savior of the poor helpless child victim against the evil, persecuting parent, they are setting the stage for destructive conflict. It is important that you feel empowered to call out any triangulation system developing—especially in the context of overeager school staff who are keen to socially transition your child without considering the impact on their life.
We have worked with schools who, by their own admission, “made a mess of gender.” These schools, in a bid to be kind, had overcelebrated children who came out as trans and later become concerned as they observed social contagion sweeping through the school. Following some workshops provided by Genspect, the schools re-evaluated their approach to sex and gender and reported a “culture of desistance” in the school: a reversal of the initial trans identification contagion.
Parents in the UK, Ireland and Europe appear to have more authority over their kids than parents in certain states in the USA, Canada or Australia. It is essential that you know your legal position and your school’s guidelines, and also the approach your child’s therapist might take. Regular face-to-face meetings where you show that you are a well-informed and loving parent are typically more productive than long emails filled with evidence and science. Many of us who have been in the trenches of the gender world for some time suffer from what we often call “the splutters” when talking to somebody about gender, especially when that person doesn’t know much about the subject and you do. It is important that you are well prepared, with just a few well-chosen points to make. You might have a good think beforehand and consider the most important issues. You might write down some bullet points in order of importance. It is recommended that you suggest another meeting to discuss things further if this is what you need. Some parents will have to be a “polite nuisance” in the school, or with the therapist. This might mean that you insist upon a phone call, and another one and another one, to ensure that the involved adult fully understands the situation. This can be exhausting and intimidating for parents, but then, as Winston Churchill advised, “It is not enough that we do our best; sometimes we must do what is required.”
Mom and Dad: Hi there, we’re here to discuss the need for the school to respect our parental authority.
School principal: We’ve had many trans kids go through our school, and we follow best practice.
Mom and Dad: I’m not sure that you do. You seem to follow WPATH guidelines; however, there are many other professional bodies that disagree with WPATH.
School principal: With due respect, we are fully up to date with the science of trans kids.
Mom and Dad: We need to retain our parental authority. By keeping secrets from us about our child you are undermining us and going against best practice. You are also inadvertently creating a triangulation that will not help our child. We are providing extensive professional support to our child, and you are not aware of how this might be affecting it. We follow Genspect’s guidance on this, and we don’t agree with WPATH. We need you to work with us, work alongside us, rather than presume you know more than us. Could you please agree to refrain from keeping secrets from us and to proceed more slowly, as you are hurrying our child and this is not going well?
School principal: We are following the guidelines.
Mom and Dad: You are following certain guidelines, and others strongly disagree with them. I will send you some information from Genspect, as they show an alternative view to WPATH. Also, I will put you in touch with our child’s therapist. Finally, I will need to meet you again next week so that you can get to know that I am a loving and engaged parent and that it is profoundly inappropriate for the school to keep secrets from me about anything that might have a significant impact on my child’s well-being.
We recommend that parents make regular appointments to speak with involved school staff. Visit the school. Show your love and concern for your child. Demonstrate your awareness of the issues and make sure you retain your authority. Too many parents have spoken about feeling dismissed, and so if you feel waved away, point this out immediately. Stay calm, retreat when necessary, but always make it clear that you will return again and again to make sure that the relevant adults are aware of the impact of complicating factors such as ASD or anxiety, and that social transition is the first step on the road to medical transition. Speak authoritatively about “diagnostic overshadowing” and make sure those involved are aware of the issues highlighted in the Cass Review. You may want to request to see the PSHE (personal, social, health and economic) curriculum, and ask which external agencies are invited to deliver workshops on the subject of gender identity. If this feels beyond you, try to enlist the help of an advocate, perhaps from a supportive organization such as Genspect, who offer a parent advocacy service. Lastly, make sure you access some support for yourself—meet other parents who are going through similar experiences. If you believe that the school are unapologetically dismissive or are actively damaging your child, seriously consider changing schools.
This essay is excerpted from When Kids Say They’re Trans: A Guide for Parents, which is available for purchase at these paid links: Amazon, Bookshop, and Pitchstone.
Sasha Ayad is a licensed professional counselor in private practice who works with teens and young adults struggling with issues of gender dysphoria and gender identity. She also runs a robust parent coaching membership group to help parents navigate their child's identity exploration with discernment, wisdom, and compassion. Sasha is cohost of the podcast Gender: A Wider Lens.
Lisa Marchiano is a licensed clinical social worker and a certified Jungian analyst. She consults with parents of trans-identifying teens and detransitioners and is the author of Motherhood: Facing and Finding Yourself.
Stella O’ Malley is a psychotherapist and best-selling author whose work focuses on teenagers, parenting, and family dynamics. In addition to facilitating a parent coaching site that provides practical help to parents who are navigating their child’s gender-related distress, she is the cohost of Gender: A Wider Lens podcast and director of Genspect, an international organization that offers a healthy approach to sex and gender.