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

• 스필리아디스는 성별에 의문을 품는 청소년을 위한 세 번째 길로 ‘성별 탐색 모델’을 제안합니다. 정체성을 그저 확인해 주는 것과 그것을 바꾸려는 ‘교정’ 또는 전환 요법 사이의 길입니다.
• 이 모델은 가족치료와 아동 발달 이론에 기대고 있습니다. 청소년이 어떻게 발달할지 아무도 모르며 임상의는 ‘알려지지 않은 미지’에 직면한다는 점을 강조합니다.
• 치료 작업은 세 영역으로 설명됩니다. 클리닉의 규칙과 치료 요청, 의미의 탐색(성적 지향과 문화 포함), 그리고 임상의가 탐색하는 방식과 쓰는 말입니다.
• 스필리아디스는 탐색이 의학적 결정 전, 중, 그리고 아마 후에도 이루어져야 한다고 주장합니다. 임상의가 결과를 유도하지 않는 한 이는 영국의 전환 요법 반대 합의와 어긋나지 않는다고 말합니다.
• 설명된 한 사례에서 15세 남아는 평가 11회기와 약 20개월에 걸친 7회기를 더 가졌습니다. 이후 자신을 젠더 플루이드라고 말했고, 처음으로 동성 경험을 했으며, 17세에 호르몬 의뢰를 보류했습니다.
• 저자는 이 모델이 모든 청소년을 위한 것은 아니며 성별 서비스 전반에서 치료 접근을 비교하는 제대로 된 연구를 요구한다고 말합니다.

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.