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Therapist to Therapist Bill of Rights When Working With Gender Dysphoric Children
Parents and family members have a right to be cautious.
Language matters. Use specific terms and avoid minimizing language, e.g., "top" or "bottom" surgery, versus double mastectomy/phalloplasty.
Avoid minimizing this phase of development by referring to it as "a journey" or "getting to know oneself."
Clarify large umbrella terms; what exactly are we discussing? Is this a person who has begun or completed sex reassignment, with chemical or surgical intervention, or a person who has changed their pronouns, attire, or social identification.
Clinical work and treatment plans should withstand the examination of colleagues.
A sound therapist can present a non-defensive position on their work with a child.
Thorough mental health screening of a child is a collaborative process. All practitioners should work in concert for the health and safety of the child/patient.
Be specific and avoid lumping "trans people." Instead, discuss children separately from adults.
Screen for Asperger's Spectrum Disorder and eating disorders, commonly comorbid and often masked by identity focus.
Mental health screening can be a serious reality check for the patient and family system.
An affirmative approach is incomplete and not a stand-alone evidence based therapy.
Always support this fragile population with comprehensive compassion of their suffering.
The serious and long-lasting consequences must be discussed frequently.
Some children will ultimately continue in their desire to fully transition.
Beginning puberty blockers, hormones, and surgery is a big step. Starting "earlier and younger" is anti-therapeutic and brings risks.
There is no science behind the often-quoted suicide rates of children not "permitted" to begin medicalisation.
This undertaking is free from religious or political agenda.
Gender Dysphoria is in the DSM; as of now, it is a psychiatric disorder.
Any CEU's that present on this topic should find themselves open to deep questioning.
If your professional group will not wholly present the complexity, instead choosing an "affirmative" only approach, let them know of your professional concerns. After all, we are child-advocates.
It is perfectly healthy to explore gender identity.
The more passionately you feel about working with this wonderful population, the more important it is to see the whole picture. And to continue to learn better treatment outcomes.
After deep investigation, some people will ultimately transition.
Safety first.
July 2021
I am continuing to add links and research that will further contribute to the discussion of transitioning adolescents (specifically, via chemicals and surgery) as I believe the lack of evidence-based therapy is doing harm. Ideally, a clearing house of knowledge, observation, first-hand accounts and research must be organized in an easy location.
Focusing attention to the recent mega public discussion on child and adolescent gender reassignment, specifically, the transgender population, here are provocative, and I would suggest, intriguing points of view that are delicate and controversial, yet necessary.
As of now, the professional front line helpers do not follow a standardized protocol in facilitating these families. Our children deserve an educated professional - and the brave conversation. My professional ask is that the mental health field establish additional licensure (perhaps a hybrid of medicine and psychology), on-going supervision of attending clinicians, and a psychological screening allowing a therapist to clinically treat and support this vulnerable and specialized population. No credentialing exists to date so each therapist is left to their own bias, best guess, and warm feelings of acceptance.
That may not be enough. Read, Listen, Watch for more below.
Focusing attention to the recent mega public discussion on child and adolescent gender reassignment, specifically, the transgender population, here are provocative, and I would suggest, intriguing points of view that are delicate and controversial, yet necessary.
As of now, the professional front line helpers do not follow a standardized protocol in facilitating these families. Our children deserve an educated professional - and the brave conversation. My professional ask is that the mental health field establish additional licensure (perhaps a hybrid of medicine and psychology), on-going supervision of attending clinicians, and a psychological screening allowing a therapist to clinically treat and support this vulnerable and specialized population. No credentialing exists to date so each therapist is left to their own bias, best guess, and warm feelings of acceptance.
That may not be enough. Read, Listen, Watch for more below.
My Op Ed To American Association for Marriage and Family Therapy
Date: Tue, Apr 27, 2021 at 11:22 AM
Subject: RE: Working with Trans Clients and Their Families
To: <ftm@aamft.org>
Thank you for the March/April edition, Working with Trans Clients and Their
I was hoping to learn more about ROGD, as well as social contagion and discerning the role of media in gender dysphoria. I would’ve appreciated mention of desisters, and detransitioners: they have powerful first-hand accounts and they'd like to be heard. The current Keira Bell lawsuit against Tavistock (UK) may be litigation that sets an important precedent internationally. Where are we with evidence-based outcomes? Affirming is not EBT; it is necessary in the therapeutic relationship, but by no means sufficient. What are best practices for assessment? Are we doing our best to uphold mental health services for the whole family system? As I do my own research, considering LGBTQI a core competency of mine, I have begun to question our collective theoretical approach - perceived subjective screening, poor standardized measurement, and an overall resistance amongst therapists to work with the entire family system, under the framework of "supporting the child."
Chemical and surgical transitioning require medical collaboration; as a clinician, I would love to hear physicians chime in on this issue. Most primary physicians never reach out to on-board counselors for a psych. eval prior to beginning medical treatment of a Trans-identified patient. Families are feeling disenfranchised from talk therapists and they are solely relying on each other at this point (e.g., Our Duty, Parents of ROGD Kids, and secret FB groups), perhaps creating a more tenuous situation for themselves and the child in question; they feel distrustful and pushed aside.
Taking the deep dive into a broader picture for those interested in expanding their knowledge, might I suggest the podcast Gender: A Wider Lens, as well as Dr. Lisa Littman's findings on ROGD. Or, Jesse Singal’s seminal writing When Children Say They're Trans, as well as The Society for Evidence-Based Gender, and
Carl Jung coined the term “psychic epidemic” decades ago, and it fits nicely here as so many boys and girls suddenly think they are the opposite sex. Raise your hand if you remember learning about Eric Erikson in your first psych class, specifically, Role Confusion versus Identity, the normal stage between ages 12-18.
And, is it possible that pharmaceutical companies have fudged the “success” stats, as I am often told by those in the medical community. Drug companies - big pharma - have begun advertising to children via social media with pop-up ads (Supprelin, an implanted gonadotropin, uses a tagline, “Childhood Uninterrupted” with latency-aged girls in their marketing imagery), the equivalent of Juul ads on Nickelodeon. We can assume that a few of our presenting clients, let’s say, 10%, are simply socially anxious eighth graders that have encountered either compelling online promises of emotional freedom and ease, or worse, exploitation.
Again, my hyperfocus here is for minor children, adolescents and their families seeking clinical expertise as they navigate the very real possibility of a medical intervention (s). The most successful cosmetic surgeons frequently deny procedures when they suspect there are deeper issues to be resolved and a therapeutic ‘best practices’ methodical treatment plan might appropriately pump the brakes. That's often the tough but ethical call - psychic pain is rarely cured with external changes.
My vision is to see the requirement of secondary training or accreditation to work with this vulnerable population. The American Academy of Pediatrics seems woefully hesitant to take the lead. Will AAMFT, CAMFT, ACA, NASW, APA, or BBS - maybe our malpractice insurance companies - consider an approved certification process, similar to the Certified Supervisor Program? Perhaps a manualized treatment is around the corner. I hope that our 2021-2022 professional conferences invite all positions to present research, outcome measures and the efficacy of current protocols of gender reassignment in children. Affirmation, empathy and heartfelt compassion for a child's suffering should always be embedded in the therapeutic process but wearing the ally badge is about grasping the full breadth of societal factors and its contribution to our young clients with gender dysphoria.
Respectfully,
Christina Neumeyer, M.A.