Summary

Writing as a family therapist at England's youth gender clinic (GIDS), Spiliadis sets out what he calls the Gender Exploratory Model. He argues that both simply going along with a young person's wish for medical transition and trying to change their identity cause problems. He proposes a middle path: respect the young person's stated identity and pronouns, while inviting them and their family to explore what their distress means, including sexuality, bullying, online influences and family life. He illustrates this with one anonymous case of a 15-year-old who later identified as gay and gender-fluid and put his hormone referral on hold. This is a framework and opinion piece, not a study. It reports no results data, relies on one case chosen by the author, and critics argue that exploratory therapy can slide into conversion practice (trying to change someone's identity).

Key findings

• Spiliadis schlägt ein „Gender Exploratory Model“ als dritten Weg für junge Menschen vor, die ihr Geschlecht hinterfragen: zwischen der bloßen Bestätigung ihrer Identität und „reparativen“ oder Konversionsansätzen, die versuchen, sie zu ändern.
• Das Modell stützt sich auf Familientherapie und Theorien der kindlichen Entwicklung. Es betont, dass niemand weiß, wie sich ein junger Mensch entwickeln wird, und dass Behandelnde mit „unbekannten Unbekannten“ konfrontiert sind.
• Die therapeutische Arbeit wird in drei Bereichen beschrieben: die Regeln der Klinik und Behandlungswünsche, die Erkundung von Bedeutung (einschließlich Sexualität und Kultur) sowie die Art, wie Behandelnde erkunden, und die Worte, die sie verwenden.
• Spiliadis argumentiert, dass die Erkundung vor, während und möglicherweise nach medizinischen Entscheidungen stattfinden sollte. Er sagt, das vertrage sich mit der britischen Vereinbarung gegen Konversionstherapie, solange die Behandelnden das Ergebnis nicht lenken.
• In dem einen beschriebenen Fall hatte ein 15-jähriger Junge 11 Beurteilungssitzungen und 7 weitere über etwa 20 Monate. Später beschrieb er sich als gender-fluid, machte seine erste gleichgeschlechtliche Erfahrung und legte mit 17 seine Hormonüberweisung auf Eis.
• Der Autor sagt, das Modell sei nicht für alle jungen Menschen gedacht, und fordert ordentliche Forschung, die Therapieansätze in Gender-Angeboten vergleicht.

Abstract

Throughout the western world, the care of children and adolescents whose sexed corporeality is at odds with their gender-related feelings raises medical, psychological, and ethical dilemmas. There are currently differing views around what constitutes responsive and timely support for these young people and how professionals can operate within a rapidly shifting and contested field, in which evidence-base is scarce. In this article, I aim to reposition the theoretical framework away from 'affirmative' or 'reparative' polarities, arguing that both can be problematic, and to invite the reader into a Gender Exploratory Model (GEM) grounded in a systemic-developmental framework; such a model acknowledges and often embraces the notion of uncertainty with regards to young people's developmental trajectories and clinician's 'unknown unknowns' and exploratory responsibilities. A short introduction to the service (GIDS), as well as a presentation of the current theoretical and clinical debates will offer a contextual base for clinicians supporting young people experiencing gender dysphoria. This is not an attempt to explore the multifactorial aetiology of gender dysphoria but rather one to add on the theoretical underpinning of therapeutic approaches in supporting these young people.

Conclusion

In this paper, I attempted to move away from current theoretical polarities around psychosocial support for gender questioning young people and invite the reader to a different approach, the Gender Exploratory Model. Drawing on systemic and developmental theories, clinicians working with gender identity can invite service users into a process of collaborative exploration, whilst being mindful of the different domains of their action and the intersection with different contexts of the embodied and narrated distress. Such a model offers more possibilities with regards to assessment outcomes and young people's developmental trajectories. Clinicians ought to respect the young person's identity and gender expression, acknowledge the communicated embodied distress, and simultaneously invite service users into a process of exploration which can safely and respectfully shed light into the meaning making of the lived experiences. Finally, the dynamic intersection of gender identity with other markers of broader identity and psychosexual development is important, as is the acknowledgement that the notion of uncertainty is central in exploratory work with gender questioning or trans-identified young people.