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

• Спилиадис предлагает «Гендерную исследовательскую модель» как третий путь для молодых людей, сомневающихся в своём гендере, между простым подтверждением их идентичности и «репаративными» подходами или конверсионной терапией, пытающимися её изменить.
• Модель опирается на семейную терапию и теорию детского развития. Она подчёркивает, что никто не знает, как будет развиваться молодой человек, и что клиницисты сталкиваются с «неизвестными неизвестными».
• Терапевтическая работа описана в трёх областях: правила клиники и просьбы о лечении, исследование смыслов (включая сексуальность и культуру) и то, как исследуют клиницисты и какие слова используют.
• Спилиадис утверждает, что исследование должно происходить до, во время и, возможно, после медицинских решений. Он говорит, что это согласуется с британским соглашением против конверсионной терапии, если клиницисты не направляют результат.
• В описанном случае 15-летний мальчик прошёл 11 сессий оценки и ещё 7 за около 20 месяцев. Позже он назвал себя гендерно-флюидным, имел первый однополый опыт и в 17 лет приостановил направление на гормоны.
• Автор говорит, что модель предназначена не для всех молодых людей, и призывает к надлежащим исследованиям, сравнивающим подходы к терапии в гендерных службах.

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.