A few months ago I wrote about the dangers of Gender Exploratory Therapy. The organization promoting this therapy, previously known as The Gender Exploration Therapy Association (GETA) has undergone a name change to Therapy First. Upon examining their revised website, one might find the content appealing, especially in the context of allowing children time and support to explore their gender identity through therapy, which on the surface appears commendable. Notably, a guidebook designed for therapists working with gender-diverse youth has garnered attention for its articulate and seemingly rational content. However, a closer examination of the authors reveals Lisa Marciano’s involvement, who has been advocating for the concept of Rapid Onset Gender Dysphoria since 2017, a purported condition often invoked by conversion therapists to justify their practices.

Upon, reviewing the case studies featured in the aforementioned guidebook, several concerning observations emerged. The first case study involving a teenager named Alina showcased the therapist’s pursuit of various explanations for the teen’s gender identity, none of which acknowledge the possibility of Alina being transgender. The study lacks any clear outcomes apart from a reduction in family conflict and a diagnosis of ADHD for the client. The language employed within Alina’s case study exhibits transphobic undertones, with Alina’s efforts to express their identity dismissed as “antics.” Moreover, the report mentions instances where Alina’s parents intervened by isolating them from perceived negative influences and confiscating their binders, leading Alina to resort to potentially harmful alternatives such as using multiple sports bras, exacerbating their asthma. Rather than recognizing potential signs of transgender identity, the therapist attributes Alina’s behavior to a “hatred of the sexed body and fear of adulthood.” 

I would argue that there was no harm in letting Alina use another name and wear a binder. If they later decide that the name or binders do not work for them they can change their name and stop using their binder. These are social transition steps that are fully reversible. Allowing the client to be where they are at and accepting that is the supportive intervention. Telling an adolescent that they do not know themselves never has a good result. It only invalidates them and makes them feel unheard and unaccepted, which certainly can lead to depression. 

It is imperative to clarify that therapists engaging in gender-affirming therapy do not presuppose that all clients are necessarily transgender or non-binary. Instead, the aim is to facilitate clients in exploring and establishing their identities, acknowledging that identities may evolve. Medical interventions, particularly in youth, are typically limited to reversible measures such as puberty blockers, which afford individuals the opportunity to explore their gender identity without undergoing irreversible physical changes. Social transition steps, such as adopting a different name or using binders, are reversible and serve as avenues for self-expression and exploration. Respect for the client’s journey and acceptance of their current state are central tenets of supportive intervention. Conversely, dismissing or invalidating an adolescent’s self-perceived identity risks exacerbating feelings of alienation and may contribute to mental health challenges such as depression.

Regrettably, prominent news outlets like the New York Times have perpetuated misinformation by featuring articles that promote conversion therapies, citing discredited studies to bolster their arguments. Erin Reed’s comprehensive rebuttal of a recent New York Times article on detransitioning offers a valuable counterpoint to such narratives. A link to the article is provided below. 

As therapists, it is incumbent upon us to speak out against practices that may cause harm to individuals under our care. The alarmingly high suicide rate among transgender youth underscores the urgent need for approaches that affirm and support their identities. A therapist’s role is to provide a nonjudgmental space for clients to navigate their identity journey, recognizing that it is a dynamic and evolving process.

Contrary to these principles, Therapy First adopts an adversarial stance, refusing to acknowledge the possibility that a client may be transgender. Instead, they attribute clients’ identities to external factors such as autism, trauma, or social influences. An affirming therapist approaches trauma with sensitivity and does not discount the self-awareness of neurodivergent clients. The notion of social contagion, proposed by Therapy First, is unfounded and has been debunked by reputable sources.

I would encourage all therapists to stay educated and make sure if any of your clients need information that you direct them to reputable resources.

Please note that I have intentionally not linked to any of the resources provided by Therapy First in this article as I do not want to do anything to validate their website.

Recommended further reading

Why Ethical Therapists Everywhere, Should Be Alarmed by Gender Exploratory Therapy, now dubbed “Therapy First” by Addie Kogan 

Debunked: Misleading NYT Anti-Trans Article By Pamela Paul Relies On Pseudoscience by Erin Reed