What to look for in a therapist for your trans teen

Many of my clients come to me years after their child has come out as "trans." Parents often describe thinking it was initially a phase, then they took their child to a gender affirming therapist who encouraged the parents to affirm and the mental health concerns the parents had got worse instead of better.

Then the parents go on a rabbit hole of trying to understand what's going on and what is going to help their child who is often struggling with social anxiety, unmanageable emotions, and discomfort with their biological sex.

Zucker (2019) found that many children who have gender dysphoria (the term that's used clinically to describe rejection of biological sex) experience same sex attraction and grow out of their distress by the time they reach adulthood.

Unfortunately while Zucker and those like him were conducting this research activist organizations like WPATH were promoting the idea that gender affirmation was the only valid treatment for gender distress. They encouraged school boards to socially transition children at their request. Instead of waiting for children to ask for help school boards started actively communicating information about gender from a gender affirming position.

Gender affirmation is a belief system that includes the idea that gender is stable and changing the body is the only way to resolve gender distress. A quick look at r/detrans shows many people don't get relief from gender distress by changing their bodies.

IncreMental Health Tips we use a traditional therapy approach to help people understand why they experience emotions and how to figure out what actions resolve emotions. It seems that many instinctive responses to emotions maintain the emotion. Anxiety causes people to avoid what causes anxiety. What resolves anxiety is learning to ignore the anxiety and facing that difficult situation. Others respond to anxiety by seeking reassurance, which ultimately means anytime they feel anxiety they must seek more reassurance. To learn more about how seeking reassurance increases and maintains anxiety read this article.

What to look for in a therapist to help your trans teen:

If you want traditional therapy instead of affirming therapy for your teen here are some things to consider. Look at how they promote themselves.

What training do they have?

Therapists who are members of a regulatory body typically have to engage in professional development on a routine basis. My college requires 20 hours every 2 years. This could be reading research, or another form of professional development, for about 15 minutes a week. I typically spend over an hour a week and they I lose track of how much time I spend in learning.

Before accepting clients for gender dysphoria I took about a dozen different training sessions on gender dysphoria to make sure I understood how this issue is approached from different perspectives. After starting work with trans clients I continue to consult with therapists who use a traditional therapy approach. I've learned more in 2 years of doing this work than I did from the 2 years preparing to do this work.

Is the therapist you're considering engaging in this type of professional development? Are they consulting with others who use a traditional therapy approach?

How do they approach assessment?

Assessment is what the therapist looks at to determine what type of treatment is needed. Every therapist is going to approach this differently. We have a 30 question questionnaire we look for signs of Autism and other comorbidities. We look at 8 categories including existing or potential diagnosis, emotional understanding and regulation, thought patterns and beliefs, social relationships, and developmental factors.

Gender affirming therapists often accept self-diagnosis as trans and have been encouraged to focus on what body and appearance changes the child would like to make. Traditional therapists seek to understand root causes and view gender dysphoria as a symptom of another problem.

Does the therapist look under the surface or accept things at face value?

What does treatment look like?

Every therapist approaches treatment a bit differently. Traditional therapists may use a psychoanalytic approach which is focused on insight through conversation. They may ask questions without directly asking questions. They may not teach specific skills. There are a wide range of ways therapists approach treatment. You can get a sense of this range of approaches which are usually referred to as modalities.

We use an integrated approach which includes but is not limited to CBT, ACT, and DBT.

Cognitive behavioral Therapy (CBT) focuses on increasing awareness of thoughts, challenging beliefs and learning how to let go of unhelpful thoughts.

Acceptance and Commitment Therapy (ACT) focuses on how to accept the things you can't change and take action on the things you can change.

Dialectical Behavior Therapy (DBT) focuses on increasing distress tolerance. This means learning how to tolerate uncomfortable emotions and respond to them in a way that is helpful to you.

How does the therapist help clients reach their goals? Do they include parents in the process?

Be aware:

Many therapists assume that all therapists use a gender affirming approach. Therapists may highlight this by saying they work with the 2LGBT+ community. This can be a sign that their default assumption is gender affirmation whereas traditional therapists will say who they work with without a label that assumes a specific affiliation.

If you are in a rural community with limited access to therapists your teen may be better helped by a therapist who works with body image and eating disorder rather than a therapist who only uses a gender affirming approach.

What we offer:

We offer traditional therapy for those with gender distress. If you are looking for a therapist in Canada please schedule an appointment here: https://www.incrementalhealthtips.com/booking-calendar/intake-assessment

If you are looking for a therapist outside Canada visit https://www.therapyfirst.org/

We also offer a course to support parents in opening communication and building understanding with their teen. To learn more click here: https://www.incrementalhealthtips.com/challenge-page/48499def-bd6d-4c0b-8eed-6600e5ec2867?programId=48499def-bd6d-4c0b-8eed-6600e5ec2867