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

• Il s'agit d'une argumentation sur des idées et l'éthique. Elle ne rapporte aucune donnée nouvelle, aucun cas ni aucun résultat mesuré.
• Ashley décrit la thérapie exploratoire du genre comme une thérapie par la parole qui traite avec méfiance l'identité trans ou la dysphorie d'un jeune, et retarde la transition sociale et médicale jusqu'à ce que d'éventuelles « causes » sous-jacentes aient été explorées.
• L'essai pose aux thérapeutes exploratoires 16 questions, que l'auteure qualifie ouvertement de suggestives, sur la durée de l'exploration, la façon d'identifier les causes et l'existence de preuves que cela aide.
• Ashley soutient que la thérapie exploratoire correspond étroitement aux idées et aux récits de la thérapie de conversion des personnes gays, y compris dans son usage des témoignages de détransitionneurs comme l'étaient jadis les témoignages d'« ex-gays ».
• À partir du devoir du thérapeute de rester neutre, de placer le patient en premier et de construire une relation de confiance, l'auteure conclut que l'approche « pourrait être contraire à l'éthique ».
• L'essai cite une estimation élevée d'environ 3 % de personnes qui détransitionnent, et soutient que même en tenant compte des cas non déclarés, environ 88 % des personnes ne détransitionnent pas.
• Ashley vise surtout les écrits de D'Angelo et collègues (2021), Edwards-Leeper et Anderson (2021), Spiliadis (2019) et la Gender Exploratory Therapy Association. Leurs propres textes décrivent l'exploration comme ouverte et non destinée à changer l'identité d'une personne.

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.