I am a parent just like you. When my kids get sick, I want the best possible care for them, informed by the best research. This is just as true with mental health as it is with physical health. As a child psychologist, I have been raising awareness that the field of child psychology has been influenced by ideology and politics at the expense of evidence based medicine, and kids and their families are paying the price.
I believe it is only a matter of time until we American healthcare professionals come to our senses and follow the increasingly careful practices of our European counterparts. Until then, I want to inform parents about practices of many child therapists that are concerning, and what they should expect instead.
1) First and foremost, beware of therapists who are not transparent about the nature of the therapy they are providing or who exclude you from the course of therapy. The degree of parental involvement will vary based on factors such as the child’s age and the nature of the problem, but you should get a sense that the therapist is being transparent with you, respectful of your parental opinions, and your knowledge of your child. Good therapy should serve to strengthen your relationship with your child. If you are being pushed further away, that is a red flag.
2) It is inappropriate for therapists to use threats to pressure you to do things you are not comfortable with or that go against your parental instincts. Therapists who use suicide as a reason for you to engage in any gender affirming medical or social transition are either not literate in the relevant research or, worse, are being knowingly manipulative. There is no reliable evidence that gender transition, medical, decreases suicidality or mortality.
3) Be aware that many therapists will recommend going along with social transition. It sounds like a nice thing to do. However, social transition is not a benign act (and incredibly inappropriate to be done by schools unbeknownst to parents) and how it impacts the course of gender dysphoria is unknown. It is not up to the therapist nor a school counselor to make these critical family decisions.
4) I hate to sound like a jerk, I really do. But the widespread ignorance about research surrounding medical and psychological issues related to gender is astounding. Many parents of children with gender concerns will read up on the literature, and will be surprised by their therapist’s lack of substantive knowledge about relevant studies.
For example, in recommending puberty blockers for a gender questioning child, therapists may say puberty blockers are safe and reversible and have been approved for girls with precocious puberty. This is misleading, because kids with precocious puberty will stop the blockers when it is appropriate for them to begin puberty, whereas kids who take puberty blockers for gender dysphoria will almost always proceed to cross sex hormones and will never undergo a natural puberty. We are still learning about the risk to bone health, brain development, and sexual function when puberty is prevented. And I do not believe a young person is capable of giving informed consent to becoming an adult with anorgasmia or infertility, even if their therapist is informed enough to discuss these outcomes with them.
5) Too many child psychologists who are otherwise thoughtful diagnosticians and clinicians leave their critical thinking at the door when dealing with a child with distress over their gender. A clinically complex situation which, for example, involves a history of trauma, mood and behavioral issues, disordered eating, family conflict and recent gender distress will be reduced to a ‘kid who is trans’, whose gender distress is the source of all other problems.
This is known as diagnostic overshadowing and is bad practice. Good child psychologists understand that problems in children’s lives are a complex interaction between biological, psychological, social, and developmental factors. There is no quick solution and there is no quality research demonstrating that gender surgeries, medications, or name/pronoun changes reliably alleviate this suffering or improve long term mental health.
6) Beware of child therapists who specialize in gender. While for other medical or mental health conditions, it makes sense to see a healthcare provider who specializes in the area in question, this is not the case withgender distress in children. While there may be exceptions, I have found child therapists with a specialty in gender tend to be guided more by ideology than by a commitment to evidence based medicine.
Having consulted with some of these practitioners, I have found they undermine parental authority and see parents as hurdles toward child transition. They are more likely to believe in radical concepts like trans-medicalism, i.e., the view that understanding gender dysphoria as a psychological problem (despite its inclusion in the current DSM) is problematic and transphobic. Whatever your child’s problems may be, I urge you to find a good therapist who recognizes that the suffering a child may be experiencing with their body, related to their sex or otherwise, is a discomfort the therapist can attempt to help the child resolve without experimental surgeries or hormones.
7) Many therapists are afraid to say what they really think about the state of youth gender medicine. Given the very obvious concerns I’ve detailed, you may wonder why this is not spoken about more. When I tweeted about my concerns related to youth gender medicine, I was privately thanked by many therapists for saying what they are afraid to say. They fear getting canceled, harassed, doxxed, and losing their professional license. Therapists who are tenured professors, owners of thriving practices, and renowned authors thank me privately but then wish me good luck in my advocacy efforts.
I have already been doxxed, accused of transphobia, and blocked from the largest private practice therapy network on Facebook for expressing reasonable concerns so many therapists share. I recently attended a scientific conference which soberly evaluated the evidence base for various youth gender medical procedures with experts around the world. Why, unlike any conference I have ever been to, did this conference require armed security?
Despite these consequences for speaking out about my concerns, I am undeterred.. As I wrote at the beginning of this article, I have children. One day, should they need help with any mental health problems, I want them to be able to get good care. I don’t want them being told the pseudo-religious belief that they might have been ‘born in the wrong body.’ I want for them what I want for all children: to grow up happy and healthy, in mind and body. I want them to overcome the inevitable growing pains and discomfort with their bodies and become good, sensitive adults who raise kids of their own. This is why I became a child psychologist, and I hope you find a therapist who shares these same values.