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

• Dette er et argument om ideer og etikk. Det rapporterer ingen nye data, tilfeller eller målte resultater.
• Ashley beskriver kjønnsutforskende terapi som samtaleterapi som behandler en ung persons transidentitet eller dysfori med mistenksomhet, og utsetter sosial og medisinsk overgang til mulige underliggende «årsaker» er utforsket.
• Essayet stiller utforskende terapeuter 16 spørsmål, som forfatteren åpent kaller ledende, om hvor lenge utforskingen varer, hvordan årsaker identifiseres og om det finnes evidens for at det hjelper.
• Ashley hevder at utforskende terapi likner sterkt på ideene og historiene i konverteringsterapi mot homofile, inkludert bruken av historier fra detransisjonerte slik «ex-gay»-historier en gang ble brukt.
• Basert på terapeutens plikt til å være nøytral, sette pasienten først og bygge et tillitsfullt forhold konkluderer forfatteren med at tilnærmingen «kan være uetisk».
• Essayet siterer et høyt anslag på omtrent 3 % som detransisjonerer, og hevder at selv når man tar hensyn til urapporterte tilfeller, detransisjonerer omtrent 88 % ikke.
• Ashley retter seg hovedsakelig mot tekster av D'Angelo et al. (2021), Edwards-Leeper og Anderson (2021), Spiliadis (2019) og Gender Exploratory Therapy Association. Deres egne beskrivelser omtaler utforsking som åpen og ikke rettet mot å endre en persons identitet.

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.