Summary

Florence Ashley, a legal scholar and ethicist who works on conversion therapy, wrote this essay to challenge "gender-exploratory therapy". This is talking therapy that looks into possible causes of a young person's trans identity, such as trauma, autism or shame about being gay, before any social or medical transition. The essay asks 16 leading questions for therapists. It compares how exploratory therapists talk with how past "ex-gay" conversion programmes talked. It argues that starting from suspicion goes against the therapist's duty to stay neutral and put the patient first. It contains no data. Its claims that affirming care works better and that detransition is rare (about 3% at most) rest on evidence that later reviews, including those for the 2024 Cass Review, rated as low quality. It is best read as one side's position paper, not as evidence about results.

Key findings

• Dette er et argument om idéer og etik. Det rapporterer ingen nye data, tilfælde eller målte resultater.
• Ashley beskriver kønsudforskende terapi som samtaleterapi, der behandler en ung persons trans-identitet eller dysfori med mistænksomhed og udsætter social og medicinsk transition, indtil mulige underliggende ‘årsager’ er udforsket.
• Essayet stiller udforskende terapeuter 16 spørgsmål, som forfatteren åbent kalder ledende, om hvor længe udforskningen varer, hvordan årsager identificeres, og om der er evidens for, at det hjælper.
• Ashley argumenterer for, at udforskende terapi tæt matcher idéerne og historierne i konverteringsterapi for homoseksuelle, herunder dens brug af detransitionisters historier på samme måde, som ‘ex-gay’-historier engang blev brugt.
• Med udgangspunkt i terapeutens pligt til at forblive neutral, sætte patienten først og opbygge et tillidsfuldt forhold konkluderer forfatteren, at tilgangen ‘kan være uetisk’.
• Essayet citerer et højt skøn på omkring 3 % af folk, der detransitionerer, og argumenterer for, at selv når man tager højde for urapporterede tilfælde, detransitionerer omkring 88 % af folk ikke.
• Ashley retter sig hovedsageligt mod skrifter af D'Angelo m.fl. (2021), Edwards-Leeper & Anderson (2021), Spiliadis (2019) og Gender Exploratory Therapy Association. Deres egne beskrivelser beskriver udforskning som åbent forløb, der ikke sigter mod at ændre en persons identitet.

Abstract

Opposition to gender-affirmative approaches to care for transgender youths by some clinicians has recently begun to consolidate around "gender exploratory therapy" as a proposed alternative. Whereas gender-affirmative approaches follow the client's lead when it comes to gender, gender-exploratory therapy discourages gender affirmation in favor of exploring through talk therapy the potential pathological roots of youths' trans identities or gender dysphoria. Few detailed descriptions of the approach's parameters have been offered. In this article, I invite clinicians to reflect on gender-exploratory therapy through a series of questions. The questions are followed by an exploration of the strong conceptual and narrative similarities between gender-exploratory therapy and conversion practices. Finally, the ethical dimensions of gender-exploratory therapy are discussed from the lenses of therapeutic neutrality, patient-centered care, loving attention, and therapeutic alliance, suggesting that the approach may be unethical.

Conclusion

Ashley concludes that gender-exploratory therapy is an emergent and underdefined paradigm whose proponents leave many critical questions unanswered, and that its conceptual and normative stance seems incompatible with evolving understandings of clinical ethics and trans identities; being trans is not undesirable and should not be approached as if it were. Proponents resent the conversion-practice label while opposing conversion-practice bans because those bans would cover their approach, yet a close comparison shows many conceptual and narrative similarities, and the way proponents describe the therapy is nearly identical to how providers of sexual-orientation conversion practices framed their work. Starting from the premise that trans identities are suspect and often rooted in pathology, Ashley argues, makes the therapeutic approach indistinguishable from conversion practices.