So many readers of this blog have agonized over how to find a therapist who won’t immediately jump to the conclusion that their distressed teen is “trans” and in need of “transition” services. I asked Lane, the clinician who wrote the excellent guest post “Exiles in their own flesh”, if she had any advice to offer. She responded in the comments thread of this recent post. I am reproducing her remarks here for greater visibility. Thank you, Lane!
As a therapist who worked with many teens who came into my office identifying as trans, I want you parents to know I did not automatically support their transitions. Like you, I was struck by the suddenness of this phenomenon of teens thinking they were born into the wrong body. My first concern was for the teen’s mental health, I looked at other causes. It’s interesting: around the time I started noticing an uptick in the number of kids identifying this way, I mentioned my concerns to a psychiatrist and a pediatrician who were both heads of the clinic where I worked. They were both on the brink of retiring, and they did not buy this new “trend” at all. They looked at what was happening as yet another medical fad. But, like I said, they were retiring. They were the old guard. The folks who replaced these dinosaurs (just kidding) had a complete absence of critical thought for the trans-narrative. It was almost as if they wanted to distinguish themselves from those they were replacing by being more open-minded, more patient-oriented.
The two folks who have come in to replace the old guard have a notable lack of developmental psych background. They are somewhat open to learning about it, but in general their work with teens (particularly any group billed as in any way marginalized – trans is pretty much the top of the heap in this regard) tends to be informed by a social-justice paradigm over something more clinical.
So, as far as finding a therapist more critical of the trans-narrative, it might be helpful to find a practitioner who is more classically trained and who is over 50. Also, find someone who is clearly a thinking, intellectual type, rather than someone more prone to falling in with medical fads. I hate to say it, but both of the old dinosaurs were uber smart, male doctors. Perhaps it was their sense of privilege, but these guys were not afraid of stating their opinions and had enough power in the organization to easily hold onto their own sense of reality. The people who embraced the trans-narrative on my team, apparently without a critical thought, were, I hate to say this, all women. So, using this small sample, which admittedly, may be utterly useless, I’d say that finding someone who isn’t as prone to the shifting sands of group-think, who hasn’t been dependent upon being seen by other professionals as “correct,” would help. Have your kid be seen by an arrogant, old man. LOL. Who would have thought I would ever write that!
Then again, I am not an old man, but I am definitely someone who has always valued and prized truth over belonging. I’m weird that way. That could be another way to screen for a trans-critical therapist, someone more old-style intellectual rather than social-justice oriented (not that I’m not down with SJ, but I qualify it when working clinically). Therapists who are critical of trans won’t be able to come out and say they are, so you’ll need to know to look for clues. You could also read their work, if they have any. Some have blogs and websites. If they say something like, well, it seems like your kid has some other mental health concerns, I’d like to focus on those for awhile before exploring their trans issues, that would be a good sign. If they do a thorough history of your family’s mental health, trauma history, that’s a good sign. These histories are an absolute must.
If a therapist is hopping on the trans explanation right out of the gate, that’s a sign they are inexperienced and lacking clinical authority. This is why you probably want your kid to see someone who has been practicing awhile–20 years at least–because, honestly, clinicians were trained so differently in the past. The training was less politicized, more intellectual and critical and I guess a bit more honest as far as research. It wasn’t perfect in the past, obviously there were abuses, but there were general, shared standards of care and it was a bad thing to breach them. There was more personal responsibility, more commitment and investment on the part of the clinicians. Now the vast majority of the clinicians and psychiatrists in the organization where I worked constantly complain about being overworked and exhausted and feel the org is screwing them over. They are too afraid to go into private practice where they could perhaps see fewer people in a day and therefore have more mental space to see each client as an individual. When people are overworked in healthcare, it means the treatment suffers; they don’t have time to look into the background of new therapies. Honestly, none of the folks I worked with had any training in working with transgender kids. They were starting to talk about getting some, but this is just now happening. And I practice in a large, metropolitan city. There are no standards of care or official certification processes yet in place for vetting therapists who work with transgender issues.
These days, training standards for therapists are pretty weak in general. Most good clinicians study for years and years, join institutes and hopefully become critical of a lot of what they learn. The point is, there are no short-cuts; it takes clinicians a really long time to become effective. Younger clinicians tend to be swayed more by current trends because they just don’t have enough experience with seeing loads of different people. Also their training is different, and they have much less clinical confidence.
If I were a parent and my kid were experiencing this issue, I would also just be as honest and loving as you can with them about your concerns, as many of the parents here on this blog have been. It’s hard because you don’t necessarily want to use this situation as the time to explain to your kid that doctors and the medical profession have been co-opted by activists and other folks looking to profit from their distress in some way. There’s so much that needs to fall away in order for you to help your kid. And if your kid is already unstable, it could be frightening to hear mom or dad sounding like they’ve been pulled into a conspiracy theory.
I think the best way to combat becoming reactive (as we do when we feel nobody believes us and yet we feel we must continue to speak since so much is at stake) is to deal with our own grief at being so alone and not being believed. Honestly, this level of self-doubt and invalidation is traumatic for people, particularly people who have in general spent their lives being respected for their measured take on the world (your basic educated liberal parent). I honestly can’t think of anything more hellish than to suddenly find your usual experience of being taken at your word ripped out from beneath you. But this is exactly what is happening to parents who question the trans-narrative. Caring, truly loving parents (not enabling parents necessarily, but good, solid parents) are being made to question their motives. It’s heartbreaking for me as a therapist to see this happening to families. I wish I had more answers for you. It might be best to keep your child away from people who bill themselves as gender specialists.
In order to reach your child, you will absolutely need to find a way to regain your own internal grounding. This blog is obviously helping with this task. You may need to “let go a little,” which it sounds like many of you have done. By this I mean, do not fight your kid on this issue. When we deal with kids with other compulsions, such as eating disorders, we encourage parents to stop talking about food.