I always enjoy your thought provoking writing on this topic…
For 3 years my son was in individual therapy with the WRONG therapist … he declined in her care … he was spiraling out of control
and so I relate to the parent who posted … you need the right therapist/fit for your child to improve… that is what we saw also
It wasn’t until my child went to a therapist who was focused on ‘actions’ … moving forward… and not sitting in a ‘rumination loop’ as you’ve so aptly described in a prior article Sasha… did my son finally start getting better
And it wasn’t individual therapy- that ultimately helped our son get well- it was family therapy! My husband and I went to every session with him.
The psychiatrist we finally saw told us he does not ever see minor children alone… he told us- if the child could figure this out alone- we wouldn’t need to see him… he was going to need our help to ‘follow through’ … and implement change…
He was really one of the most brilliant men we’ve ever had involved in our son’s care… Told us he didn’t need medication… and he didn’t want to unpack a single insane thing that had happened over the last three years!… he just said we’re going to work together to get you where you want to go… independent and headed to college in 4 years
So every session he was given homework to complete … mostly social engagement homework… go to a movie with a friend, meet friends for a meal, got to the mall with a friend, join a club, plan a sleepover … HOST A PARTY! - was one of his actual assignments… he learned a lot socially through that process
it would get close to the date of his next session… and I’d prod… ya know- your appt is in 3 days and you still haven’t done x’s homework… and that’s the way it went for a solid year… until suddenly he had friends… and was authentically engaged again- had different groups of friends! Not a single friend… was being invited to do things by people- not always him trying to engage
For our son
The more friends he made … the healthier he got…
The right therapist has the potential to change a child’s outcome- I’m confident of that- I’ve seen it happen with our son.
Hi Sasha, this is a wonderful article, thank you for it. Really loved the push to go back to the first principles of the profession (I’m not a psychotherapist, but work in a related profession with kids with disabilities, some of whom are trans-identified).
What’s your take on Genspect’s recent call for the re-pathologization of trans identity? I have followed the logic of Mia and Stella’s arguments, particularly for youth and young adults, and particularly in light of the political influence on the clinical framing and treatment recommendations, but I have deep reservations about pathologizing an identity that some adults find useful for living a full and functional life.
Wow. Self identification as strategy. Considerations of 'truth' 'reality' or pathology are irrelevant. Bingo. The whole argument about whether to use preferred pronouns or not becomes a pointless argument. It seems one could assign the quality of strategy to the act of self id gender without invalidating the adolescent identity.
I have been struggling with this and frankly getting a lot of heat from gen crits because I use my childs preferred pronouns as I see no value in taking that bull by the horns. I'd rather point out to my child that self identifying as male doesnt cure their anemia.
Calling something strategic doesn't invalidate it.
Question for you, can an adolescent engage in strategy without consciously considering the entirety of the strategy?
I'm SO glad you like it. I'm also getting pummled by some of the GCs on X, so I get it! To your question: Yes! So much of human behavior is stuff we do without fully realizing the function it serves or that we have blind spots. That's precisely what good therapy should do: help us recognize that more clearly and truthfully.
This is absolutely brilliant and it explains the supportive energy you carry when you talk about this topic. You're not like most other therapists, I can see that so clearly. You have the energy and approach that will make a difference for kids who won't listen, trust, or put down their defenses around anyone else. There's no doubt about that! You have a gift to see people and hold space that nobody else is holding and that's rare!
"For some adults who understand its trade-offs, the trans strategy may indeed provide genuine relief and a lasting sense of stability. To deny this, or pretend it never happens, is dishonest—or a reflection of the algorithmic silos that shape what we see (and what we never see)."
Sasha, when you say "trans strategy," are you referring to medicalization for these adults? If so, I want to push back gently on the premise. I've heard people say this before, that transition can provide relief and stability for certain (somewhat rare) individuals. Perhaps you've personally seen such cases, but aren't they in the category of anecdote, not data? And aren't they by definition self-reported? Specifically, there is no counterfactual for these individuals: perhaps they might have achieved relief in a healthier way, if transition had not been available. To answer the question in a scientific way, researchers would have to look at measurable outcomes, comparing these individuals to a matched cohort of non-transitioned, similarly gender-distressed people. I would want to see objective factors like completing school, success in their careers, independent living, diversity of friendships, number of estrangements, longterm partnering, starting families, need for medications, etc., along with their subjective, self-reported levels of depression and anxiety.
I'm writing this comment because I did not understand this before starting therapy with my child and I had to learn this the hard way. It's not just about your child's therapist's mindset about gender identity, relationship building, and affirmation. It's also about what type of therapy the therapist is using separate from this.
Sasha is describing a specific modality of therapy with adolescents: a psychodynamic approach. It's based on helping the adolescent build insights into their feelings and actions and develop those insights through a relationship with the therapist and the dynamics that happen during the session.
I think parents need to understand that this is just one type of therapy and that there are other very different ways to approach therapy. There are also more cognitive-behaviorally based approaches such as CBT, DBT, and ACT.
It is really important to understand the differences between these approaches, know which approach your child's therapist is primarily using (keeping in mind that therapists rarely use only one approach exclusively and never bring in elements from others), and for you and your child's therapist to be open and honest about whether this approach is a good match for your child's therapist and whether he or she is making progress with it.
I think the psychodynamic framework is a very good way of understanding WHY adolescents may reach for a trans identity as a coping skill. However it may not be the best way to help your child with their individual struggles. Many adolescents have not developed the self-awareness or abstract thinking skills needed to benefit from this type of therapy. For others, the format unintentionally reinforces rumination and a focus on looking for problems. And for other teens, their struggles are coming from issues more related to executive function deficits, adhd, or autism that need a more concrete and systematic skill-building approach. For a teen who is suicidal and self-harming, there is strong research supporting DBT (see McCauley 2018).
And for some adolescents, a more psychodynamic approach is the best fit.
But if parents are going to be empowered to make the best informed decision for getting help for their highly distressed adolescent child, they need to understand these differences and how one approach might be a better fit for their child than another and how both the parent and the therapist need to be working together being honest about whether a certain approach is the right fit and seems to be working at different points in the process. A psychodynamic framework may make a lot of sense for understanding WHY your teen has suddenly developed gender dysphoria but it may not be the best fit for helping them work through that distress.
Thanks for your thoughtful comment — I can see your point. However, I’m not describing only one specific modality of therapy. My focus here is on the importance of therapists recognizing the kinds of errors I outlined in the piece, regardless of their theoretical orientation.
For example, I’m not formally trained as a psychodynamic therapist myself. Most clinicians use an eclectic approach, and even those who practice highly structured, manualized therapies still benefit from paying attention to the dynamics that arise between themselves and their clients.
And even when a therapist is primarily working to build insight and self-awareness, they will almost certainly recommend practical interventions when a young person is struggling with maladaptive behaviors or other issues that affect their quality of life. I often refer to these as “experiments” in therapy with young people. They may look similar to CBT techniques or draw on mindfulness and regulation strategies common in DBT.
Even basic things like life skills or financial literacy may end up as part of the therapy, depending on the individual and his or her concerns and needs.
Thank you for your response. Since the psychodynamic was the one you specifically named and described in your article, that was what I was responding to and understanding as your approach. I understand now that it is not. All your points are taken. As a parent who has been through years of therapy with my daughter - everything ranging from good, bad, abusive, and poor fit - I have learned that parents need to understand much more about therapy and therapeutic approaches if they are going to find the right fit for their child and protect their child. It's not just about whether they are affirming or not.
I think I understand your argument about pathologizing gender identity, but I also think a strategy can be categorized as pathological, even if it provides a relief and is associated with better function. E.g., even if someone is relieved from cutting and overall functions better after cutting, I think it would still be categorized as a pathological strategy to deal with distress. I'm not sure how gender identity is different - even if no physical transition occurs, is it not pathological to hold a belief that brings you into conflict with your physical reality? I don't think that pathologizing gender identity goes against accepting that some individuals are relieved by transitioning. I think it just recognizes the strategy itself as pathological, even if in some cases it brings relief - because it is in conflict with reality, which leads to both physical and mental costs. That is also not to say that the therapist's job is to try to convince the client that this is pathological or to just label them as "mentally ill" - I think a therapist can remain curious about the client's GI and its role in the client's life even while thinking about it as a pathological strategy.
Really wonderful piece. You touch on this a bit but I’m curious if therapists who were once dismayed about the encroachment of GAC activism on therapy are now also feeling some threat to therapy principles from GC activism? I can imagine as the GC side has become more emboldened it’s created a new dynamic that can make adhering to therapy principles more fraught.
I appreciate how carefully you’ve articulated the clinician’s task as one of curiosity, relationship, and discovery rather than ideological allegiance. Your reminder that therapy is, at its heart, a relational practice organized around meaning and emotional truth feels especially necessary at a time when so many conversations about gender care are shaped by fear, partisanship, and institutional pressure.
What strikes me most about your essay is its tone of conscience. You’re clearly trying to protect something essential about psychotherapy, the slow, uncertain, humane encounter between two people, amid a field that often feels like it’s splitting apart. That ethical intention deserves recognition.
At the same time, your framing raises a few questions I find worth exploring, precisely because your goals are so aligned with integrity and care:
• When we invite clients to explore the symbolic meaning of their gender experience, how do we ensure that “symbolic” inquiry doesn’t accidentally overwrite the client’s own sense of literal or embodied truth?
• How do we tell the difference between lingering in uncertainty as an ethical discipline and withholding recognition in a way that might feel like delay or distrust to a young person?
• If trans identification can function as a “strategy,” could the same be said for any identity position that offers coherence in distress, religious conversion, creative vocation, political affiliation? How do we prevent the language of strategy from singling out gendered self-understanding as uniquely suspect?
• You write beautifully about resisting ideological capture. Might that resistance also extend to the inherited ideologies of our own field, especially the historical reflex to treat gender variance as symbolic of something else?
• Finally, how might we honor the relational truth of a young person’s stated identity, not as a foreclosed conclusion, but as a vital starting point for precisely the kind of depth work you describe?
These are not critiques so much as openings. Your essay invites a conversation about what genuine neutrality and curiosity look like when identity itself is the terrain of struggle. I’m grateful that you approach this work with warmth and care for the young people who come to you, and with humility about the mistakes we all make in such charged territory.
Thank you for helping keep the question of what therapy is really for alive. I hope the discussion your piece invites can deepen, not narrow, the space for psychological reflection in this area.
Conceptualizing a trans/non-binary etc identity as a strategy for managing distress is a very compelling framework. Many of my therapy clients of all ages have used eating disorders and addictive substances and behaviors as "strategies" to manage their distress. It makes sense to me that gender identity may be a way for someone who is struggling to feel connected, has suffered from trauma, is desperate to cultivate a sense of identity, etc. to feel the comfort and purposefulness they get from adopting a trans identity. Having a trans identity can be a scapegoat, a way to channel one's self-disgust, hostility toward one or both parents, rage. I think considering it a "strategy" as opposed to a "pathology" invites more compassion and curiosity, which is important within the therapeutic relationship. On the other hand, I can see why many disagree with this conceptualization, because we are at a time in our society where the gender industry ("medicine") is looming over the process, and parents and GC clinicians are aware of the ticking clock for minors. And then there is the fact that schools are teaching this "strategy" as a matter of fact, and shaming educators, students and parents who do not practice GAC. What a mess! All that being said, this is a fabulous article and I am sharing it with other clinicians.
I see the work that needs to be done as two pronged: on one end, we need to help the young people where they are now, which you are trying to do brilliantly. On the other end, the re-psycopathologization moves the concept of trans from a healthy identity (that can/needs to be taught in schools, because if it is healthy, why avoing it?) to a psychological process mostly maladaptive. It is then for the medical (probably not so much the therapists) community to move from anectodes to robustly collected data about long term effects of medicalization, both physical, and on general wellbeing (relationship, work, etc) to determine whether it should be offered to adults at all, as cosmetic/elective, or publicly funded.
Sasha, I understand what you are attempting and offer you warm wishes in helping kids.
That said, the term I think you mean is “meta narrative”. To see my point, ask one of the ai language models to contrast the two concepts. Chat gpt created a table for me showing how they are best used.
Here’s an excerpt from the response: “The difference between a metanarrative and a metaphor lies in their scope, function, and nature: a metanarrative is an all-encompassing framework for understanding the world, while a metaphor is a specific figure of speech used for comparison“
Gender ideology is a meta narrative. The other day I observed to my husband that our queer daughter who is now claiming to be non binary has a sense that in her relationship with an obese depressed unemployed female partner she will need to be both bread winner and mother to have a family. In her struggle with this realization she may have created the non binary concept to rise to that challenge. This is not a metaphor but it is a meta narrative.
The pathology only exists if she starts to “medicalize” or to become distressed by the identity but otherwise having a story she is using to orient herself in the world is not necessarily pathological. But at the level of medical organizations it should be seen as disordered to reject your birth sex and seek to mutilate yourself. Not recognizing the harm of medicalized self mutilation is diabolical. It is an urgent need that we call a spade a spade to get the doctors to see what they are participating in.
I always enjoy your thought provoking writing on this topic…
For 3 years my son was in individual therapy with the WRONG therapist … he declined in her care … he was spiraling out of control
and so I relate to the parent who posted … you need the right therapist/fit for your child to improve… that is what we saw also
It wasn’t until my child went to a therapist who was focused on ‘actions’ … moving forward… and not sitting in a ‘rumination loop’ as you’ve so aptly described in a prior article Sasha… did my son finally start getting better
And it wasn’t individual therapy- that ultimately helped our son get well- it was family therapy! My husband and I went to every session with him.
The psychiatrist we finally saw told us he does not ever see minor children alone… he told us- if the child could figure this out alone- we wouldn’t need to see him… he was going to need our help to ‘follow through’ … and implement change…
He was really one of the most brilliant men we’ve ever had involved in our son’s care… Told us he didn’t need medication… and he didn’t want to unpack a single insane thing that had happened over the last three years!… he just said we’re going to work together to get you where you want to go… independent and headed to college in 4 years
So every session he was given homework to complete … mostly social engagement homework… go to a movie with a friend, meet friends for a meal, got to the mall with a friend, join a club, plan a sleepover … HOST A PARTY! - was one of his actual assignments… he learned a lot socially through that process
it would get close to the date of his next session… and I’d prod… ya know- your appt is in 3 days and you still haven’t done x’s homework… and that’s the way it went for a solid year… until suddenly he had friends… and was authentically engaged again- had different groups of friends! Not a single friend… was being invited to do things by people- not always him trying to engage
For our son
The more friends he made … the healthier he got…
The right therapist has the potential to change a child’s outcome- I’m confident of that- I’ve seen it happen with our son.
Sasha this is brilliant. Thank you for taking the time to do this. Now if only more psychotherapists would practice these methods!
Hi Sasha, this is a wonderful article, thank you for it. Really loved the push to go back to the first principles of the profession (I’m not a psychotherapist, but work in a related profession with kids with disabilities, some of whom are trans-identified).
What’s your take on Genspect’s recent call for the re-pathologization of trans identity? I have followed the logic of Mia and Stella’s arguments, particularly for youth and young adults, and particularly in light of the political influence on the clinical framing and treatment recommendations, but I have deep reservations about pathologizing an identity that some adults find useful for living a full and functional life.
Sasha’s point 3 in the essay seems to me, to be stating her disagreement with Stella and Mia on this idea, without naming names.
Stella and I spoke about our divergent point on this in our last Live + Unfiltered event. Here’s a summary: https://www.widerlenspod.com/p/stella-and-sasha-on-the-re-psychopathologization
Wow. Self identification as strategy. Considerations of 'truth' 'reality' or pathology are irrelevant. Bingo. The whole argument about whether to use preferred pronouns or not becomes a pointless argument. It seems one could assign the quality of strategy to the act of self id gender without invalidating the adolescent identity.
I have been struggling with this and frankly getting a lot of heat from gen crits because I use my childs preferred pronouns as I see no value in taking that bull by the horns. I'd rather point out to my child that self identifying as male doesnt cure their anemia.
Calling something strategic doesn't invalidate it.
Question for you, can an adolescent engage in strategy without consciously considering the entirety of the strategy?
I'm SO glad you like it. I'm also getting pummled by some of the GCs on X, so I get it! To your question: Yes! So much of human behavior is stuff we do without fully realizing the function it serves or that we have blind spots. That's precisely what good therapy should do: help us recognize that more clearly and truthfully.
This is absolutely brilliant and it explains the supportive energy you carry when you talk about this topic. You're not like most other therapists, I can see that so clearly. You have the energy and approach that will make a difference for kids who won't listen, trust, or put down their defenses around anyone else. There's no doubt about that! You have a gift to see people and hold space that nobody else is holding and that's rare!
"For some adults who understand its trade-offs, the trans strategy may indeed provide genuine relief and a lasting sense of stability. To deny this, or pretend it never happens, is dishonest—or a reflection of the algorithmic silos that shape what we see (and what we never see)."
Sasha, when you say "trans strategy," are you referring to medicalization for these adults? If so, I want to push back gently on the premise. I've heard people say this before, that transition can provide relief and stability for certain (somewhat rare) individuals. Perhaps you've personally seen such cases, but aren't they in the category of anecdote, not data? And aren't they by definition self-reported? Specifically, there is no counterfactual for these individuals: perhaps they might have achieved relief in a healthier way, if transition had not been available. To answer the question in a scientific way, researchers would have to look at measurable outcomes, comparing these individuals to a matched cohort of non-transitioned, similarly gender-distressed people. I would want to see objective factors like completing school, success in their careers, independent living, diversity of friendships, number of estrangements, longterm partnering, starting families, need for medications, etc., along with their subjective, self-reported levels of depression and anxiety.
As always, a brilliant piece. You get these youth in a way others don’t. You have a gift.
I'm writing this comment because I did not understand this before starting therapy with my child and I had to learn this the hard way. It's not just about your child's therapist's mindset about gender identity, relationship building, and affirmation. It's also about what type of therapy the therapist is using separate from this.
Sasha is describing a specific modality of therapy with adolescents: a psychodynamic approach. It's based on helping the adolescent build insights into their feelings and actions and develop those insights through a relationship with the therapist and the dynamics that happen during the session.
I think parents need to understand that this is just one type of therapy and that there are other very different ways to approach therapy. There are also more cognitive-behaviorally based approaches such as CBT, DBT, and ACT.
It is really important to understand the differences between these approaches, know which approach your child's therapist is primarily using (keeping in mind that therapists rarely use only one approach exclusively and never bring in elements from others), and for you and your child's therapist to be open and honest about whether this approach is a good match for your child's therapist and whether he or she is making progress with it.
I think the psychodynamic framework is a very good way of understanding WHY adolescents may reach for a trans identity as a coping skill. However it may not be the best way to help your child with their individual struggles. Many adolescents have not developed the self-awareness or abstract thinking skills needed to benefit from this type of therapy. For others, the format unintentionally reinforces rumination and a focus on looking for problems. And for other teens, their struggles are coming from issues more related to executive function deficits, adhd, or autism that need a more concrete and systematic skill-building approach. For a teen who is suicidal and self-harming, there is strong research supporting DBT (see McCauley 2018).
And for some adolescents, a more psychodynamic approach is the best fit.
But if parents are going to be empowered to make the best informed decision for getting help for their highly distressed adolescent child, they need to understand these differences and how one approach might be a better fit for their child than another and how both the parent and the therapist need to be working together being honest about whether a certain approach is the right fit and seems to be working at different points in the process. A psychodynamic framework may make a lot of sense for understanding WHY your teen has suddenly developed gender dysphoria but it may not be the best fit for helping them work through that distress.
Thanks for your thoughtful comment — I can see your point. However, I’m not describing only one specific modality of therapy. My focus here is on the importance of therapists recognizing the kinds of errors I outlined in the piece, regardless of their theoretical orientation.
For example, I’m not formally trained as a psychodynamic therapist myself. Most clinicians use an eclectic approach, and even those who practice highly structured, manualized therapies still benefit from paying attention to the dynamics that arise between themselves and their clients.
And even when a therapist is primarily working to build insight and self-awareness, they will almost certainly recommend practical interventions when a young person is struggling with maladaptive behaviors or other issues that affect their quality of life. I often refer to these as “experiments” in therapy with young people. They may look similar to CBT techniques or draw on mindfulness and regulation strategies common in DBT.
Even basic things like life skills or financial literacy may end up as part of the therapy, depending on the individual and his or her concerns and needs.
Thank you for your response. Since the psychodynamic was the one you specifically named and described in your article, that was what I was responding to and understanding as your approach. I understand now that it is not. All your points are taken. As a parent who has been through years of therapy with my daughter - everything ranging from good, bad, abusive, and poor fit - I have learned that parents need to understand much more about therapy and therapeutic approaches if they are going to find the right fit for their child and protect their child. It's not just about whether they are affirming or not.
That’s so true. And no matter what the approach of the clinician, therapy is not a magic bullet either.
I think I understand your argument about pathologizing gender identity, but I also think a strategy can be categorized as pathological, even if it provides a relief and is associated with better function. E.g., even if someone is relieved from cutting and overall functions better after cutting, I think it would still be categorized as a pathological strategy to deal with distress. I'm not sure how gender identity is different - even if no physical transition occurs, is it not pathological to hold a belief that brings you into conflict with your physical reality? I don't think that pathologizing gender identity goes against accepting that some individuals are relieved by transitioning. I think it just recognizes the strategy itself as pathological, even if in some cases it brings relief - because it is in conflict with reality, which leads to both physical and mental costs. That is also not to say that the therapist's job is to try to convince the client that this is pathological or to just label them as "mentally ill" - I think a therapist can remain curious about the client's GI and its role in the client's life even while thinking about it as a pathological strategy.
Really wonderful piece. You touch on this a bit but I’m curious if therapists who were once dismayed about the encroachment of GAC activism on therapy are now also feeling some threat to therapy principles from GC activism? I can imagine as the GC side has become more emboldened it’s created a new dynamic that can make adhering to therapy principles more fraught.
Sasha,
I appreciate how carefully you’ve articulated the clinician’s task as one of curiosity, relationship, and discovery rather than ideological allegiance. Your reminder that therapy is, at its heart, a relational practice organized around meaning and emotional truth feels especially necessary at a time when so many conversations about gender care are shaped by fear, partisanship, and institutional pressure.
What strikes me most about your essay is its tone of conscience. You’re clearly trying to protect something essential about psychotherapy, the slow, uncertain, humane encounter between two people, amid a field that often feels like it’s splitting apart. That ethical intention deserves recognition.
At the same time, your framing raises a few questions I find worth exploring, precisely because your goals are so aligned with integrity and care:
• When we invite clients to explore the symbolic meaning of their gender experience, how do we ensure that “symbolic” inquiry doesn’t accidentally overwrite the client’s own sense of literal or embodied truth?
• How do we tell the difference between lingering in uncertainty as an ethical discipline and withholding recognition in a way that might feel like delay or distrust to a young person?
• If trans identification can function as a “strategy,” could the same be said for any identity position that offers coherence in distress, religious conversion, creative vocation, political affiliation? How do we prevent the language of strategy from singling out gendered self-understanding as uniquely suspect?
• You write beautifully about resisting ideological capture. Might that resistance also extend to the inherited ideologies of our own field, especially the historical reflex to treat gender variance as symbolic of something else?
• Finally, how might we honor the relational truth of a young person’s stated identity, not as a foreclosed conclusion, but as a vital starting point for precisely the kind of depth work you describe?
These are not critiques so much as openings. Your essay invites a conversation about what genuine neutrality and curiosity look like when identity itself is the terrain of struggle. I’m grateful that you approach this work with warmth and care for the young people who come to you, and with humility about the mistakes we all make in such charged territory.
Thank you for helping keep the question of what therapy is really for alive. I hope the discussion your piece invites can deepen, not narrow, the space for psychological reflection in this area.
Therapist needs to start talking directly to our young adults to stop treating their parents so poorly.
They wouldn’t be here without their mothers and if professionals don’t stop the coddling and tell them directly to behave better.
They learn from you that you don’t trust them to have the strength to straighten up and fly right.
Do one is firm with them.
Especially the therapist.
Therapist tell the parents how to talk to their children.
But you need to tell them to trust their parents.
No professional is saying that and they don’t trust themselves because of it.
Conceptualizing a trans/non-binary etc identity as a strategy for managing distress is a very compelling framework. Many of my therapy clients of all ages have used eating disorders and addictive substances and behaviors as "strategies" to manage their distress. It makes sense to me that gender identity may be a way for someone who is struggling to feel connected, has suffered from trauma, is desperate to cultivate a sense of identity, etc. to feel the comfort and purposefulness they get from adopting a trans identity. Having a trans identity can be a scapegoat, a way to channel one's self-disgust, hostility toward one or both parents, rage. I think considering it a "strategy" as opposed to a "pathology" invites more compassion and curiosity, which is important within the therapeutic relationship. On the other hand, I can see why many disagree with this conceptualization, because we are at a time in our society where the gender industry ("medicine") is looming over the process, and parents and GC clinicians are aware of the ticking clock for minors. And then there is the fact that schools are teaching this "strategy" as a matter of fact, and shaming educators, students and parents who do not practice GAC. What a mess! All that being said, this is a fabulous article and I am sharing it with other clinicians.
I just watched your video about trans as a strategy. It makes sense to me.
I wonderi if the trans activists would find it agreeable? I am guessing not. They "sell" trans to the kids as an identity and a community.
I see the work that needs to be done as two pronged: on one end, we need to help the young people where they are now, which you are trying to do brilliantly. On the other end, the re-psycopathologization moves the concept of trans from a healthy identity (that can/needs to be taught in schools, because if it is healthy, why avoing it?) to a psychological process mostly maladaptive. It is then for the medical (probably not so much the therapists) community to move from anectodes to robustly collected data about long term effects of medicalization, both physical, and on general wellbeing (relationship, work, etc) to determine whether it should be offered to adults at all, as cosmetic/elective, or publicly funded.
Sasha, I understand what you are attempting and offer you warm wishes in helping kids.
That said, the term I think you mean is “meta narrative”. To see my point, ask one of the ai language models to contrast the two concepts. Chat gpt created a table for me showing how they are best used.
Here’s an excerpt from the response: “The difference between a metanarrative and a metaphor lies in their scope, function, and nature: a metanarrative is an all-encompassing framework for understanding the world, while a metaphor is a specific figure of speech used for comparison“
Gender ideology is a meta narrative. The other day I observed to my husband that our queer daughter who is now claiming to be non binary has a sense that in her relationship with an obese depressed unemployed female partner she will need to be both bread winner and mother to have a family. In her struggle with this realization she may have created the non binary concept to rise to that challenge. This is not a metaphor but it is a meta narrative.
The pathology only exists if she starts to “medicalize” or to become distressed by the identity but otherwise having a story she is using to orient herself in the world is not necessarily pathological. But at the level of medical organizations it should be seen as disordered to reject your birth sex and seek to mutilate yourself. Not recognizing the harm of medicalized self mutilation is diabolical. It is an urgent need that we call a spade a spade to get the doctors to see what they are participating in.