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

• Dit is een betoog over ideeën en ethiek. Het meldt geen nieuwe gegevens, gevallen of gemeten resultaten.
• Ashley beschrijft gender-exploratieve therapie als gesprekstherapie die de trans identiteit of dysforie van een jongere met argwaan behandelt en sociale en medische transitie uitstelt tot mogelijke onderliggende 'oorzaken' zijn onderzocht.
• Het essay stelt exploratieve therapeuten 16 vragen, die de auteur openlijk suggestief noemt, over hoe lang verkenning duurt, hoe oorzaken worden vastgesteld en of er bewijs is dat het helpt.
• Ashley betoogt dat exploratieve therapie sterk overeenkomt met de ideeën en verhalen van conversietherapie voor homo's, inclusief het gebruik van verhalen van detransitioners op de manier waarop verhalen van 'ex-gays' vroeger werden gebruikt.
• Op basis van de plicht van de therapeut om neutraal te blijven, de patiënt op de eerste plaats te zetten en een vertrouwensrelatie op te bouwen, concludeert de auteur dat de aanpak 'onethisch kan zijn'.
• Het essay noemt een hoge schatting van ongeveer 3% van de mensen die detransitioneren, en betoogt dat zelfs met rekening voor niet-gemelde gevallen ongeveer 88% van de mensen niet detransitioneert.
• Ashley richt zich vooral op teksten van D'Angelo et al. (2021), Edwards-Leeper & Anderson (2021), Spiliadis (2019) en de Gender Exploratory Therapy Association. Hun eigen beschrijvingen omschrijven verkenning als open en niet gericht op het veranderen van de identiteit van een persoon.

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.