Key Findings

• Proposes a Gender Exploratory Model (GEM) as an alternative to both 'affirmative' and 'reparative' approaches to gender questioning youth
• The GEM is grounded in a systemic-developmental framework that embraces uncertainty about developmental trajectories
• Argues clinicians have exploratory responsibilities and should acknowledge their 'unknown unknowns'
• Emphasizes the importance of collaborative exploration of identity before, during, and potentially after medical decision-making
• Repositions therapeutic work within three domains: production, explanation/exploration, and aesthetics

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.

Summary

Spiliadis introduces the Gender Exploratory Model (GEM) as a middle-ground framework for supporting gender-questioning young people, moving beyond the polarities of affirmative and reparative approaches. Grounded in systemic and developmental theory, the GEM invites collaborative exploration of young people's identity development while acknowledging uncertainty about outcomes. The paper argues that clinicians should respect young people's identity while simultaneously facilitating deeper exploration of the meaning of gender-related distress.

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.