The APA Has Known the Problems for at Least Five Years

Ignoring the canaries in the coal mines

Photo by César Ardila on Unsplash

In 2019, four young women met several key figures at the American Psychological Association—including Clinton Anderson, APA’s senior advisor, Psychology in the Public Interest, and Ron Schlittler, APA’s assistant director, Sexual Orientation and Gender Diversity Portfolio.

The women called their group Pique Resilience, and presented themselves as underrepresented members of the LGBT community: one desister, who had stopped identifying as trans before medicating, and three detransitioners, who had medically transitioned then regretted it—taking testosterone that had permanently changed their bodies.

These women were not anti-trans. Rather, they expressed concern about psychologists not properly evaluating young people before approving them for drastic psychological and medical interventions. They were lesbians, bisexuals, women—historically marginalized groups the APA purportedly cared about.

Pique Resilience provided a binder of resources to Anderson and Schlittler, including stories from detransitioners and desisters, and Dr. James Cantor’s fact-check of the American Academy of Pediatrics’ gender-affirmation policy. Cantor’s publication revealed that few of the citations in AAP’s policy backed up its assertions about gender-affirmation.

Later, Schlittler wrote by email that he would share a summary of their meeting with the APA’s Committee on Sexual Orientation and Gender Diversity (CSOGD). “I can let you know that over the past couple of years we have forwarded on to them letters from parents of gender different children concerned about care providers they have turned to who apparently urged, primarily as I understand it, social transition without adequate qualifications for doing so,” he wrote, adding that CSOGD was working on a resource to help “those seeking care related to gender nonconformity” find “competent providers.”

A few weeks ago, Anderson sent me a document the group created about how parents can choose a “gender-competent therapist”—apparently the resource CSOGD produced. Such a therapist must practice “affirmative care.” But Pique Resilience was concerned about the affirmative model itself; it promotes the kind of social transition that the original Dutch model discouraged, and affirms a gender identity, rather than focusing on treating gender dysphoria.

But affirmation is what’s apparently yoked to finding a good therapist. The document, “10 factors to consider when searching for a gender-competent therapist for your child,” notes:

…therapy should be an affirming experience where children, adolescents, their parents, families, and guardians can seek support and assistance if issues around gender identity, or any aspect of identity, arise for the child, family, or larger community.

Also:

Be sure the provider can show evidence they have specialized or focused training in gender identity development in childhood and adolescence.

This may be training they have sought out themselves after obtaining their degree as such training is not included in many training programs. Evidence of specialized or focused training may consist of specialized coursework while in training to become a psychologist, continuing education (such as conferences, workshops, webinars, reading foundational and current journal ar

Yes, in fact, it would be great if children and adolescents saw therapists trained in child and adolescent development. Such therapists might then understand that “gender identity” is a cognitive phase in which children come to understand that there are categories of people known as the sexes, and that each child belongs to one or the other. They base their membership at that stage on sex stereotypes, until their brains develop further and they understand “gender constancy”—that the categories are immutable, and based on bodies.

Those trained in the specialty of gender affirmation, alas, don’t seem to incorporate this fundamental idea of gender identity. Take this social work training, which tells participants: “Our transgender and non-binary youth are being hurt by overt discrimination, microaggressions, and health disparities. It’s a heartbreaking reality—society attacks them for just trying to be themselves.” Very little there about cognitive phases and etiologies of distress.

Or this training, from the Gender Health Training Institute, which provides skills to “competently, ethically, and affirmatively join with your trans, non-binary, gender expansive clients and their families.” Joining seems to imply that nobody—certainly not the therapist—is the expert. These are the mental health professionals young folks with gender distress should consult?

Though officials at the APA were told over five years ago of the problems with the affirmative model, nothing changed. They have dug in deeper on said model, ignoring the findings of the Cass Review, doubling down on social justice-informed practice. This year, they formally adopted an affirmative approach, supporting:

“….evidence-based clinical care for transgender, gender-diverse, and nonbinary children, adolescents, and adults, and for increased public accessibility to timely and accurate information founded in clinical and psychological science. Evidence-based clinical care, including gender-affirming care, should be noncoercive, adaptive to and centered on the needs of the individual receiving care, and rooted in psychological and clinical science, including recognition of gender diversity as a part of normal human diversity as well as recognition of limits in the current state of scientific knowledge.”

Yes to the idea of this—to gender diversity as normal, to evidence-based care, to rooting it in science. But they continue to call the affirming approach “evidence-based healthcare” despite the fact that every systematic evidence review has found that the evidence base is so low quality that none of the conclusions can be relied on as accurate.

As we find out more about Adm. Rachel Levine and HHS pressuring WPATH, the AAP, and Johns Hopkins to suppress that evidence base—or, as some people find out more, since it’s been largely ignored in mainstream media—the long tail of their refusal to engage with those getting hurt seems even more egregious. For years, those seeking therapists to do actual therapy—not affirmation—had to pass names in secret, for fear of outing them. Some therapists had their licenses challenged simply for investigating the source of gender dysphoria, rather than telling kids they were what they said they were.

How long until we get to the point where these mental health and medical advocacy groups actually listen—to Pique Resilience (who’ve long moved on to other pursuits), to those who’ve gotten hurt, to the evidence?

I have no idea. Place your bets in the comments.

(Pique Resilience is no longer active, but they’ve left the website up as a resource for others and, hopefully, as continued inspiration and a record of what they bravely tried to accomplish.)