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 propose un « modèle exploratoire du genre » comme troisième voie pour les jeunes qui s'interrogent sur leur genre, entre l'affirmation pure et simple de leur identité et les approches « réparatrices » ou de conversion qui tentent de la changer.
• Le modèle s'appuie sur la thérapie familiale et la théorie du développement de l'enfant. Il souligne que personne ne sait comment un jeune évoluera, et que les cliniciens font face à des « inconnues inconnues ».
• Le travail thérapeutique est décrit dans trois domaines : les règles de la clinique et les demandes de traitement, l'exploration du sens (y compris la sexualité et la culture), et la façon dont les cliniciens explorent et les mots qu'ils emploient.
• Spiliadis soutient que l'exploration devrait avoir lieu avant, pendant et peut-être après les décisions médicales. Il dit que cela est compatible avec l'accord britannique contre la thérapie de conversion, tant que les cliniciens n'orientent pas le résultat.
• Dans le seul cas décrit, un garçon de 15 ans a eu 11 séances d'évaluation et 7 de plus sur environ 20 mois. Il s'est ensuite décrit comme de genre fluide, a vécu sa première expérience avec une personne de même sexe, et a mis en suspens son orientation pour des hormones à 17 ans.
• L'auteur dit que le modèle n'est pas destiné à tous les jeunes, et appelle à de véritables recherches comparant les approches thérapeutiques dans les services du genre.

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.