Just Asking Questions

A secretly recorded video of a therapy session shows just how little people understand conversion therapy.

When the Dutch began treating “young transsexuals” in the 1990s, multiple clinicians, including a psychologist and a psychiatrist, rigorously evaluated them over long periods of time. The patients were required to meet the criteria for gender identity disorder, live in supportive families, be psychologically stable, and have suffered from “lifelong extreme gender dysphoria.”

The clinicians wanted to make sure that these young people understood “the familial, interpersonal, educational, and legal consequences of the gender role change.” Of great importance was to “prevent unrealistically high expectations with regard to their future lives,” by clearly informing these adolescents “about the possibilities and limitations of [sex reassignment] and other kinds of treatment.”

This week, a former White House digital director named Olivia Raisner shared a video of a therapy session she surreptitiously recorded. She’d thought about her gender identity for three whole months before getting a double mastectomy, she informs us, so a therapist pushing back is doing conversion therapy. In an effort to discredit Therapy First, an organization set up to remove any political agenda from therapy so that people in gender distress can get good help, she tried to find the worst therapist she could. I’m told that she approached quite a few others, who didn’t give her the outrageous answers she wanted so she didn’t bother with them. Finally, she hooked one! A guy who said stuff she didn’t like! A guy who spoke about how some people are happy and some people regret and sometimes people see these interventions as panaceas! He also asks about her decision to cut her hair short after wearing it long for most of her life, about her relationship to femininity. He’s kind of saying, “What’s going on with all that?”

Look, it’s not the best therapy session. And lord knows, I’ve had a lot of bad therapy sessions. (One therapist insisted I tell her about my dreams, and I said I’d had this very boring dream where I wanted a blueberry smoothie and I got one and was happy, and she said, “Well, you want to be more smooth with people,” and I never went back.)

But this is not conversion therapy. I suggest Raisner watch the movie Boy Erased, or other histories of gay kids sent away to be shamed and shocked out of their proclivities. After awareness-raising and activism around the issue, 20 states now ban conversion therapy; others partially ban it. Here’s my earlier post on this subject. As I wrote then:

We do not have any good research about conversion therapy when it comes to gender identity. One low-quality survey asked the question, “Did any professional (such as a psychologist, counselor, or religious advisor) try to make you identify only with your sex assigned at birth (in other words, try to stop you being trans)?” There was a correlation between those who answered yes and poorer mental health/higher suicidality, but there is absolutely no way to establish causation in this equation. For one thing, this survey was for people who still identified as transgender. Those who might have stopped identifying that way and were doing well wouldn’t have answered the questions. It was also retrospective and unverified. So it tells us very little, but has been used to justify adding “gender identity” to conversion therapy bans. (If there are other studies, please let me know—I know only of this one.)

There’s also a misconception that the “normalizing” therapies of the 50s through 80s were conversion therapy. Those were treatments to try to get gender nonconforming kids to perform their gender roles properly, perhaps with the tacit implication that they not grow up to be gay, back when that outcome was thought to be the result of nurture. This practice was bad, to be sure.

Here’s an excerpt about one from my book TOMBOY:

Becky only wanted to wear boys’ pants, mostly with her favorite cowboy boots. By age seven, she refused to wear dresses, had no time for jewels, and used makeup only to draw a mustache or a beard on her face. Sometimes she lowered her voice when she talked, pretended to be a boy when she role-played. She didn’t want to play with girls. She related better to boys. Some- times she said she wanted to be one. She definitely didn’t want to have a baby when she grew up.

It was the 1970s, the major time of tomboys, but Becky’s single mom thought she acted too much like a boy. She was even rubbing her body up against girls in a way that seemed to her mother like something an older boy would do. So Becky’s mother took her to see some psychologists at UCLA. They were going to teach her to stop being a tomboy, to behave like a girl.

Months and months of sessions—102 in the lab, 96 at home—followed, Pavlovian-style experiments in which she was praised for choosing girl toys, punished for choosing boy toys. She became attached to her female therapist. Longed to please her. Learned to say that she didn’t want to be a boy because boys can’t have babies. Learned to stop saying “I’m getting this stuff off of me, and I ain’t kidding, I better not smell like a girl,” about makeup, and to say, instead, “Where’s the makeup? You should have gotten the makeup. Doesn’t a lady wear makeup?”

After seven months, Becky was pronounced cured because she “spontaneously began wearing jewelry and perfume at home,” as the report said, and because she developed a crush on an adult male examiner, old enough to be her father. She wanted him to have her phone number so he’d call her every night and every day.

It was Dr. George Rekers who oversaw the treatment, whose goal was “normalizing her gender identity and gender role behaviors.” With thousands of dollars of public funding, he studied boys and girls who acted in ways he and his colleagues felt they shouldn’t. He treated “sissy” boys, too, teaching them how to act like men, “curing” them of their feminine behaviors, mostly by way of shaming.

What the therapist in the Raisner video is doing is not normalizing therapy or conversion therapy. These kids and adults were put through hell, not asked a few uncomfortable questions. I keep wondering if these younger folks react so badly because they haven’t experienced enough actual hardship. On the other hand, I’ve overreacted to very minor criticism for most of my life, not because I didn’t have hardship but because I didn’t get mentally strong or healthy. Lord knows I’m trying!

Look, this video shows a therapist saying some stuff that might not be appropriate for the first session. It might not be great. But if you want someone just to tell you you made the right choice, that’s not what therapy is for. Therapy is not supposed to be about affirmation. It’s supposed to be about the hard work of understanding yourself and trying to make changes and move through the world with some strength and some peace. Which all sounds so good and still so elusive to me, the continual struggler.

The real horror is that people believe that this, regular old therapy that echoes the original Dutch protocol, is conversion therapy, and should be outlaw. The real horror is conversion therapy bans, which conflate regular old therapy with the nasty stuff of yore. The real horror is that, as a soon-to-be-released paper will show, eleven members of Therapy First have had their licenses challenged either by activists or disgruntled clients or strangers or other therapists—not because they’ve done something wrong, but because there is a concerted effort to preserve the affirmation model, despite the fact that many detransitioners who were affirmed and not challenged say they wish they had been. The real horror is that non-ideological therapists are scared to work with this population, and many will stop seeing gender dysphoric patients because they don’t want to take the risk, leaving only more ideologues to treat them.

This environment makes it harder and harder for troubled people to get help. What a travesty.