Raising the Alarm on Gender Identity Change Efforts Disguised as Talk Therapy

2024-03-12T21:34:50+00:00March 12th, 2024|Advocacy, Gender identity, LGBT, Thoughts From A Psychotherapist|

Below is a petition that some concerned California clinicians wrote to both educate providers and consumers and to use to send to mental health professional organizations to urge them to speak out against these practices.

I want to recognize that the American Psychological Association(APA) issued a very thorough statement February 2024 called APA Policy Statement on Affirming Evidence-Based Inclusive Care for Transgender, Gender Diverse, and Nonbinary Individuals, Addressing Misinformation, and the Role of Psychological Practice and Science. It was a great statement and occurred while this petition was being devleoped. You can find the entire statement here. I will quote below two statements that are especially relevant to the petition ask.

WHEREAS such misinformation is widely disseminated through formal and informal networks, yet credible scientific evidence has not been widely disseminated and is not readily accessible to the public, having the potential to further stigmatize and marginalize all transgender, gender-diverse, and nonbinary individuals, hindering their access to indicated and necessary healthcare, worsening existing geographic disparities in healthcare access, and fostering an environment that may lead to discrimination (DuBois et al., 2023; Goldenberg et al., 2020; Weixel & Wildman, 2022);

THEREFORE, BE IT RESOLVED that the APA supports efforts to address and rectify the dissemination of false information to ensure the well-being and dignity of transgender, gender-diverse, and nonbinary individuals

The below petition can be viewed and signed here. I am encouraging everyone to both sign it and share it. It is important to the well being of the trans community that we get information such as this out there to counter all of the false information that exists. It is also important the reputable organizations like make strong statements like that of the one from the APA to fight the narrative that supporters of gender affirming care are extremists when the reality is that there is wide support of such care.

Thank you to all the therapists that took the time to engage in this work which is critically important right now.



We are a group of concerned therapists, psychologists, and psychiatrists writing to ask your associations to put out a statement regarding the rise in Gender Identity Change Efforts (GICE) disguised as psychoanalytic or talk therapy. The effort to delegitimize and provide an “alternative” to gender-affirming therapy and the World Professional Association for Transgender Health (WPATH) Standards of Care (Coleman et al., 2022) is being led by a small group of clinicians who start many organizations that attempt to wield power through promoting debunked research. The main organizations involved in this effort are Wider Lens Consulting, Therapy First (formally the Gender Exploratory Therapy Association), Thoughtful Therapists, Genspect and SEGM. We are asking your association to put out statements warning against these organizations for their dishonest and fraudulent advertising, as well as naming them as organizations promoting GICE.

1. Dishonesty, Fraud, and Deception:

All of these organizations are careful to sound like they promote reasonable, well-informed, evidence-based treatment for those with gender dysphoria – “a neutral ground between the ‘radical’ gender-affirmative model and ‘unethical’ conversion practices” (Ashley, 2022). The byline for Therapy First reads: “Therapy First exists because we see a great need arising from the current oversimplification and politicization of gender dysphoria in the field of mental health.” Therapy First represents itself as apolitical. However, multiple clinicians on the advisory board and clinical team have participated in political activity aimed at anti-trans legislation and related to many of the trans health bans that we are seeing today. Stephen Levine, one of the clinicians who authored the Therapy First clinical guidelines, was the sole “expert” witness for the state of Arkansas’s ban on gender-affirming care for minors. It was struck down in June of 2023 (Levine, 2020). SEGM has been the central subject of subpoenas by the state of Alabama to the American Academy of Pediatrics, WPATH and the Endocrine Society in the trans youth care ban case Boe v. Marshall (Lannin declaration).

The clinicians involved in founding these organizations are part of a large web of anti-trans organizations aimed at attacking trans rights (Anti-Trans Conversion Therapy Map of Influence), including the American College of Pediatricians, which has been labeled an anti-LGBTQ hate group by the Southern Poverty Law Center (American College of Pediatricians | Southern Poverty Law Center).

Stella O’Malley, who founded SEGM and Wider Lens Consulting, has stated that her mission is to make sure that children are stopped from medical transition (Leveille, 2022). In emails leaked in March of 2023, Lisa Marchiano, LCSW, another board member of Therapy First, SEGM, and Wider Lens Consulting, was caught trying to obtain private information about a transgender journalist with the intent of leaking information to Fox News. When the private information was leaked, it resulted in online harassment of the journalist (Doyle, 2023).

The claim that Therapy First, Thoughtful Therapists, Wider Lens Consulting, SEGM, and all affiliated organizations have no political agenda is completely dishonest and deceptive. We need reputable clinical organizations to make this known to both consumers and therapists.

2. Gender Identity Change Efforts (GICE) by these organizations:

Even though Therapy First claims to not promote so-called “conversion therapy,” further investigation into the organization and client experiences points to GICE. The Therapy First clinical guidelines promote a “psychotherapeutic approach” to gender dysphoria, stating:

“Psychotherapeutic inquiry does not simply accept that a person has the wrong body or gender, it explores why and how a young person came to have negative feelings about their sexed body or that their body or gender is “wrong.” This involves exploring relational and developmental history, the quality of relationships with parents, any traumas or losses that have affected the family, the presence of marital dysfunction, domestic violence, sexual abuse or other detrimental interpersonal dynamics. It also involves exploring social relationships with friends and peers (Ayad et al., 2022, p. 41).”

In practice, what this often looks like is searching for any possible reason for a youth or young adult being transgender, rather than simply being transgender (Santoro, 2023). Marchiano spoke out against the executive order against conversion therapy signed by Joe Biden in June of 2022, telling The Economist that it would have a “chilling effect” on the practices promoted by these organizations. She acknowledges the goal of gender exploratory therapy, which is for trans children and teens to resolve their dysphoria through finding the root psychological cause of their dysphoria (“The Biden administration’s confused embrace of trans rights,” 2022). Furthermore, the Therapy First Clinical Guidelines contain detailed assessment questions including intrusive inquiries about the client’s masturbation habits and sexual fantasies (Ayad et al., 2022, p.26). This type of pathologizing, gaslighting, and delaying any gender-affirming care until a talk therapist rules out every possible cause for the gender dysphoria, besides being transgender, is highly problematic and psychologically damaging (Matouk & Wald, 2022; Boerner, 2022; Bhatt et al., 2022; Tordoff et al., 2022).

Everything put forth by members of these organizations points to their belief that being transgender is undesirable and therapy should seek to explain and resolve the transgender identity so that the patient “accepts themself” as the gender they were assigned at birth. The case studies presented in the Therapy First’s clinical guidelines highlight these beliefs and intentions (see Therapy First clinical guidelines pages 57-102 for case studies) (Ayad et al, 2022).

These organizations have been able to wield extensive power in a short amount of time and are attempting to replace the WPATH Standards of Care. Gender Exploratory Therapy/Therapy First has been recommended as the treatment in many of the trans health care bans gaining traction across the country (Reed, 2023b). It has also gained notoriety in prominent problematic articles in The New York Times (Paul, 2024), which greatly inflate the statistics regarding “detransitioning” and conversion therapy (Reed, 2024; Urquhart, 2024; Urquhart, 2023).

Research continues to confirm that gender-affirming care is not only evidence-based but life-saving (American Psychological Association, 2024). The results from the national trans survey have found that 94% of people who pursued a form of medical transition report greater life satisfaction (U.S. Trans Survey, 2024).

The NASW, AAMFT, and the two APAs are signatory associations of the United States Joint Statement Against Conversion Efforts (United States Joint Statement, 2023), a statement by 28 professional associations clearly asserting that so-called “conversion therapy” is unethical and potentially harmful.

We ask that the NASW, AAMFT, and the two APAs (both psychological and psychiatric) also make a clear statement about Therapy First, Genspect, SEGM, Wider Lens Consulting, and other affiliated organizations, warning potential clients about their false and deceptive advertising.

We also want it made clear that social workers associated with these organizations are violating the NASW code of ethics, and potentially their local state laws, as they pertain to Gender Identity Change Efforts and conversion therapy.


American College of Pediatricians. Southern Poverty Law Center. (n.d.). https://www.splcenter.org/fighting-hate/extremist-files/group/american-college-pediatricians

American Psychological Association. (2024, February 17). APA policy statement on affirming evidence-based inclusive care for transgender, gender diverse, and nonbinary individuals, addressing misinformation, and the role of psychological practice and science. https://www.apa.org/about/policy/transgender-nonbinary-inclusive-care.pdf

Anti-Trans Conversion Therapy Map of Influence. https://thatweirdolee.github.io/anti-trans-conversion-map/network/index.html#

Ashley, F. (2022, September 6). Interrogating gender-exploratory therapy. Sage Journals. https://journals.sagepub.com/doi/10.1177/17456916221102325

Ayad, S., D’Angelo, R., Kenney, D., Levine, S., Marchiano, L., & O’Malley, S. (2022). A clinical guide for therapists working with gender-questioning youth, Version 1. Clinical Advisory Network on Sex and Gender. https://can-sg.org/wp-content/uploads/2022/12/geta_clinicalguide_2022-2.pd

Bhatt, N., Cannella, J., & Gentile, J. P. (2022, Apr-Jun). Gender-affirming care for transgender patients. Innovations in Clinical Neuroscience. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9341318/

The Biden administration’s confused embrace of trans rights. The Economist (2022, June 23). https://www.economist.com/united-states/2022/06/23/the-biden-administrations-confused-embrace-of-trans-rights

Boerner, H. (2023, March 30). What the science on gender-affirming care for transgender kids really shows. Scientific American. https://www.scientificamerican.com/article/what-the-science-on-gender-affirming-care-for-transgender-kids-really-shows/

Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., de Vries, A. L. C., Deutsch, M. B., Ettner, R., Fraser, L., Goodman, M., Green, J., Hancock, A. B., Johnson, T. W., Karasic, D. H., Knudson, G. A., Leibowitz, S. F., Meyer-Bahlburg, H. F. L., Monstrey, S. J., Motmans, J., Nahata, L., Nieder, T. O., … Arcelus, J. (2022). Standards of care for the health of transgender and gender diverse people, Version 8. International Journal of Transgender Health, 23(Suppl 1), S1–S259. https://doi.org/10.1080/26895269.2022.2100644 https://www.tandfonline.com/doi/pdf/10.1080/26895269.2022.2100644

Doyle, J. E. S. (2023, March 23). Inside the Terf Harassment Machine. Medium. https://judedoyle.medium.com/inside-the-terf-harassment-machine-62068333d1d5

Gender Exploratory Therapy Association. https://www.genderexploratory.com/

James, S.E.,Herman, J. L, Durso, L. E. and Heng-Lehtinen, R. (2024, February 8). Early Insights: A Report of the 2022 U.S. Transgender Survey. https://ustranssurvey.org/

Leveille, L. (2022, April 3). Leaked audio confirms Genspect director as anti-trans conversion therapist targeting youth. Health Liberation Now! https://healthliberationnow.com/2022/04/02/leaked-audio-confirms-genspect-director-as-anti-trans-conversion-therapist-targeting-youth/

Levine, S. B. (2020, March 12). Expert Submission of Dr. Stephen B. Levine, MD – PA General Assembly. https://www.legis.state.pa.us/WU01/LI/TR/Transcripts/2020_0046_0001_TSTMNY.pdf

Matouk, K. M., & Wald, M. (2022, December 8). Gender-affirming care saves lives. Columbia University Department of Psychiatry. https://www.columbiapsychiatry.org/news/gender-affirming-care-saves-lives

Paul, P. (2024, Feb. 2). As kids, they thought they were trans. They no longer do. The New York Times. https://www.nytimes.com/2024/02/02/opinion/transgender-children-gender-dysphoria.html

Reed, E. (2023a, January 13). Unpacking ‘gender exploratory therapy,’ a new form of conversion therapy. Xtra Magazine. https://xtramagazine.com/health/gender-exploratory-therapy-243833

Reed, E. (2023b, May 29). Ohio rep. pushes conversion therapy; Bill mandates it for trans kids. Los Angeles Blade. https://www.losangelesblade.com/2023/05/29/ohio-rep-pushes-conversion-therapy-bill-mandates-it-for-trans-kids/

Reed, E. (2024, February 2). Debunked: Misleading NYT Anti-Trans article by Pamela Paul relies on pseudoscience. https://www.erininthemorning.com/p/debunked-misleading-nyt-anti-trans

Santoro, H. (2023, May 2). How therapists are trying to convince children that they’re not actually trans. Slate Magazine. https://slate.com/technology/2023/05/gender-exploratory-therapy-trans-kids-what-is-it.html

Tordoff, D. M., Wanta, J. W., & Collin, A. (2022, February 25). Mental health outcomes in transgender and nonbinary youths receiving gender-affirming care. JAMA Network Open. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2789423

United States Joint Statement (2023, October 11). https://usjs.org/wp-content/uploads/2023/10/News-release.Final_.pdf

Urquhart, E. (2024, February 6). Pamela Paul shows NYT Opinion’s lack of accountability to the truth. Assigned Media. https://www.assignedmedia.org/breaking-news/pamela-paul-shows-opinion-is-opinion-is-opinion

Urquhart, E. (2023, December 1). What it actually means to listen to detransitioners. Slate Magazine. https://slate.com/technology/2023/12/trans-health-care-detransition-research-studies-new.html