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は、性別に疑問を持つ若者のための第三の道として、自認をそのまま肯定することと、それを変えようとする「是正的」または転向的なアプローチの中間にある「ジェンダー探索モデル」を提案しています。
• このモデルは、家族療法と児童発達の理論に基づいています。若者がどう発達するかは誰にも分からないこと、そして臨床医は「未知の未知」に直面していることを強調しています。
• セラピーの作業は、クリニックの規則と治療の要求、意味の探索（性的指向や文化を含む）、そして臨床医の探索の仕方と使う言葉という3つの領域で説明されています。
• Spiliadisは、探索は医学的な決定の前、最中、そしておそらく後にも行われるべきだと主張しています。臨床医が結果を誘導しない限り、これは転向療法に反対する英国の合意と両立すると述べています。
• 説明された1つの症例では、15歳の男子が、約20か月にわたり11回の評価面談とさらに7回の面談を受けました。後に自分をジェンダーフルイドと表現し、同性との最初の経験をし、17歳でホルモンの紹介を保留しました。
• 著者は、このモデルはすべての若者のためのものではないと述べ、ジェンダーサービス全体でセラピーのアプローチを比較する適切な研究を求めています。

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.