Transgender Identity and Childhood

In the beginning of this month Debra Soh, published an article in the Wall Street Journal tltled: The Transgender Battle Line: Childhood.  She points out that psychologists have figured out how to treat adults with gender dysphoria, but what about a 5-year-old child? 

'What should parents do if their little boy professes an intense desire to be a girl? Or if their daughter comes home from kindergarten and says she wants to be a boy? In recent years the dominant thinking has changed dramatically regarding children’s gender dysphoria.  Previously, parents might hope that it would be a passing phase, as it usually is. But now they are under pressure from gender-identity politics, which asserts that children as young as 5 should be supported in wanting to live as the opposite sex. Any attempts to challenge this approach are deemed intolerant and oppressive.'

How to best deal with prepubescent children who identify with the opposite sex has become so politicized, that, Soh points out, professionals working with  these populations are extremely reluctant to get involved as they have seen what happens when they deviate from the going cultural and political view. 

Soh mentions the recent experience of Kenneth Zucker, a psychologist in Toronto. In December 2015  the city’s Centre for Addiction and Mental Health announced that it would close its Gender Identity Clinic, which Dr. Zucker had led for 35 years. The news came after months of public allegations that Dr. Zucker, an international expert on gender variance in children, had been practicing 'conversion therapy', which aims to change patients’ sexual orientation. However, he had not been trying to dissuade anyone from being transgender. Instead his therapy facilitated exploration of gender identity. Gender-atypical males could consider being boys who simply liked female-typical things. One doesn’t necessarily need to be a girl to enjoy nail polish or bedtime stories about fairy princesses! Pointing that out to a gender-dysphoric child isn’t the same as practicing conversion therapy. By the way, Dr. Zucker had been following the most up-to-date standards of care published by the World Professional Association for Transgender Health—a document he had co-written.

The need to give time to 'explore' is crucial here. In the current climate it seems that when a child expresses gender dysphoria, it needs to be immediately 'fixed.' It is important to take time. This need to slow down and explore is also justified by scientific studies.

In a study of 44 gender-dysphoric boys, conducted by Zucker 80% grow up to be not transgender, but bisexual, gay or lesbian adults. Thus, helping prepubescent children feel comfortable in their birth sex makes more sense than starting a lifetime of hormonal treatments and surgeries that will in all likelihood turn out to be unnecessary and unwanted.

Also when children do transition, some regret it. 'In a 2011 study of 25 adolescents who had been gender dysphoric as children, two girls who had undergone social transitioning to boys—by taking on male-typical appearances—regretted it and struggled to detransition. One wanted to begin wearing earrings, but said she couldn’t because she “looked like a boy.” The other, hoping for a fresh start with high school, hid childhood photos at home that depicted her time living as a boy. Both feared teasing from their peers.'

This is why Dr. Zucker put the emphasis on exploring gender  with childrenr. Then if a child’s dysphoria persisted into adolescence—gender identity becomes more fixed with age, and the start of puberty often determines whether it will desist—Dr. Zucker would recommend transitioning, including puberty-blocking hormonal therapy.

Soh points out that Dr. Zucker was recently awarded $500,000 from the Canadian Institutes of Health Research to conduct an MRI study on the effects of medical transitioning, on adolescents’ neurodevelopment. A grant of this size speaks to both his credibility as a scientist and the importance of this research. The halting of this study in the wake of the closure of Dr. Zucker’s clinic means the critical answers he sought will remain unknown.

'The most current science has been trumped purely because it is at odds with the dominant political view concerning transgender development.' Soh points out that although we don’t allow children to vote or get tattoos, yet in the name of progressive thinking we are allowing them to choose serious biomedical interventions with permanent and irreversible results.

The silencing of those who oppose this sends the message to parents that early transitioning is the only valid and ethical approach for a gender-dysphoric child. This message—pushing children to transition at increasingly younger ages so that they will fit neatly into one of two gender categories—is false and unscientific. It is more progressive to offer them the time and the space they need to figure out who they are and what is ultimately best for them.

To schedule an appointment call An Bulkens at (530) 321-2970

How to begin and end a child's therapy?

As a psychotherapist working with children I am confronted with the question by parents of how long therapy will take. I have come to realize that addressing this question from the beginning with parents is important. The response is that there is no clear cut answer to this. To each individual therapy there is a time and a logic that is unique, it is unique to the child. It might take some time for the child to engage in therapy, to want to come do therapeutic work, and once this work is started it will evolve following a rhythm and logic that ideally is not interrupted prematurely. For parents it might be frustrasting that this logic not necessarily corresponds with what they perceive as 'success.' Dramatic symptoms can disappear in quite a short time, but this does not mean that the child is done with the work.  There is a logic to the therapeutic work of the child that is ideally not interrupted in a random way, with disrespect or disregard to the work the child is doing. Just as we don't want to force a child into therapy, we don't want to force a child out of therapy. Forcing the child into therapy and removing the child prematurely imply a certain disregard for the psychic 'time' of the child. This is why I find it very important in my work with children to also meet with parents on a regular basis, to connect with them with regard to this work of their child. Although I will respect the confidentiality of the child, I find there are ways to have them appreciate the work their child is doing in his or her sessions. 

For Therapy to succeed...

For therapy with a child to succeed it is important that certain parameters are in place. The child needs to understand that the counseling session is confidential, that the therapy room is a place where her feels safe.  The child has to come out of his or her own desire to the counseling session, and not to please the parent or the therapist.  In case the parents are the ones that are suffering from the child, but the child is not suffereing from his symptoms, it would be more indicated to work with the parents.  It can take several sessions to establish this, and for the child to get a full understanding about the working of the therapy. 

But there are certain issues that if not put in place right from the beginning can already immediately predict the failing of therapy.  One common case is when a parent asks for therapy for a child, without telling the other parent with whom they share legal custod  about it. This becomes a very difficult circumstance to work under. The other parent will find out eventually, might become upset, and when the child feels that one of its parents are not in favor of it, the therapist's office stops being a safe place, and the work is jeopardized. As a therapist, for the sake of the child, I typically only work with the child when both parents are consenting to it.  Excluding one parent, would make it impossible for me to talk to this parent, who is equally important to the child as the other parent. Parents often do not fully realize this, as they are hurt by the other parent, and might not consider them a good husband or wife. This might be the case, but still each of the parents, no matter what their human flaws and limitations are need to be genuinely recognized and respected if the work with the child will be successful. 

This became again very clear to me through my work with a foster child. Unable to work with the parents, due to the state funding, as they were considered the 'perpetrators,' I was unable to build an alliance with the parents of the child, to connect with them. The inability to gain the trust of the parents of this child made it very difficult for this child to come to his counseling sessions. He did not experience it as a safe place, as he felt that his father was not in favor of it. 

Another typical situation that undermines the therapy work that can be done with the child is when the parents are engaged in a legal battle.  When the child feels that saying certain things might jeopardize the position of one of the parents, as there is no trust in confidentiality, the child then is torn between parents and therapy is not a safe place for her anymore. 

To schedule an appointment with An call (530) 321-2970