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

• Detta är ett resonemang om idéer och etik. Det rapporterar inga nya data, fall eller uppmätta resultat.
• Ashley beskriver könsutforskande terapi som samtalsterapi som behandlar en ung persons transidentitet eller dysfori med misstänksamhet och skjuter upp social och medicinsk transition tills möjliga underliggande ‘orsaker’ har utforskats.
• Essän ställer 16 frågor till utforskande terapeuter, som författaren öppet kallar ledande, om hur länge utforskandet pågår, hur orsaker identifieras och om det finns evidens för att det hjälper.
• Ashley hävdar att utforskande terapi nära motsvarar idéerna och berättelserna i konverteringsterapi för homosexuella, inklusive att detransitionerares berättelser används på det sätt som ‘ex-gay’-berättelser en gång användes.
• Utifrån terapeutens plikt att vara neutral, sätta patienten först och bygga en förtroendefull relation drar författaren slutsatsen att metoden ‘kan vara oetisk’.
• Essän citerar en hög uppskattning på cirka 3 % som detransitionerar, och hävdar att även med hänsyn till orapporterade fall detransitionerar cirka 88 % av människorna inte.
• Ashley riktar sig främst mot skrifter av D'Angelo et al. (2021), Edwards-Leeper & Anderson (2021), Spiliadis (2019) och Gender Exploratory Therapy Association. Deras egna redogörelser beskriver utforskandet som öppet och inte syftande till att ändra 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.