YES!! Thank you Eliza! It’s very eye-opening to consider the connection between trans and BPD because both of these deeply affect my family. Great conversation between two inquisitive, nuanced and intelligent women.
“I would love to see someone study three groups of clinicians: those who have always and still do practice “affirmation only;” those who all along questioned gender ideology and the astronomical rise in trans-identified youth; and those who affirmed at first but eventually became gender critical.”
I am also a clinical psychologist, my area is couples/sex therapy with 25+ years experience and unlike most, I received specialized post doctoral training that included treatment of gender dysphoria (with Dr Steve Levine as one of my mentors and clinical supervisors)
My own pathway has been a movement away from initial acceptance of trans identity earlier in my career when I was more skeptical that psychotherapy should be focused on this kind of analysis and I saw it more like sexual orientation (therefore why analyze it?) but this was at a different time when those presenting for therapy were a completely different cohort who arrived at these conclusions at mid life or later, and there was no social media to suggest social contagion
Nonetheless I carefully assessed for co-occurring mental health issues and aimed to treat these alongside requests for medical referral letters as I was trained to do (IOW what is now referred to as gate keeping)
It took many more years and direct clinical experience, recognizing the shift towards a new younger cohort of younger adult females presenting for treatment coupled with awareness that a couple of my clients had detransitioned, that led to a willingness to go outside my usual sources of information (from my professional organizations and mainstream media to online alternative organizations and media like Genspect and Twitter and YouTube and Substack). I owe this to my sex therapy colleague James Cantor, someone who wasn’t afraid to question the affirmation mindset and this allowed me to “wise up” and catch up as to the reality of iatrogenic harm as told by detransitioners, and I also credit Ken Zucker, another sex therapy colleague for his role in always maintaining that therapeutic analysis and intervention that included the family system was relevant and ethical despite later being “cancelled”which also made me aware of the problem of reductionist thinking about trans as the new gay
I think there’s something to be said about the psychoanalytic concept of “splitting” by therapists who are over invested in denying any wrongful convictions or harmful impact of our interventions that fits with what this psychologist says is happening with clients who are gender dysphoric
It’s hard to help anyone else if you haven’t done the work yourself of moving into humility, which is necessary for a healthier, more mature relational stance
A favorite quote I retained from my supervision days with Dr Levine is “If you see Buddha in the road, slay him” He was referring to being careful not to become too sure of yourself and what you think you know, and to always remain a student in my role as a therapist, and in sharing this wisdom with me perhaps he planted that seed for me to be able to later question my own authority and received wisdom
Do you think there's also an element of therapists being unable or unwilling to take the vilification that patients with BPD/BPD traits project onto the therapist whenever the client is challenged on something? Do they take that anger from the patient as a sign they (the therapist) is doing something wrong? Does it maybe trigger the therapist's personal fears and vulnerabilities? Or is there an unconscious drive to affirm because it makes these very challenging patients much easier for the therapist to deal with? The therapists are metaphorically and literally drugging the difficult patient into an easier patient by affirming?
100% There's a quote from Laura Edwards Leeper when she was on Meghan Daum's podcast about how angry these patients get when you don't affirm them, and it felt like in spite of her claim to have the magic thorough assessment battery for "true trans," that is actually more at play.
Then there's the risk of actual physical harm to the therapist. Are you familiar with the 'fell runner' case in the UK? That involved a sports coach, but a therapist is just as vulnerable.
You have really worked with and been influenced by key players in the evolution of this area. Thank you for sharing your trajectory. I've been astounded by colleagues' lack of humility, curiosity, and response to the changing gender questioning cohorts and information from other countries.
Same:( I’ve been trying for quite a few years to influence colleagues and there’s a wall of fear I think, in the way that I’m coming from a place of either ignorance (despite my years of experience) or malice towards trans people aka transphobia that pertains to wider sociopolitical divide where distrust is higher than ever of anyone who might represent the “other side”
Yes, I am also a clinical psychologist and psychotherapist and am very interested in "us" as practitioners (as well as parents and all the other "adults in the room") -- how to understand each of the three groups or kinds of therapists Lisa D identifies here. Great interview and thoughtful discussion.
(And as an aside, has anyone noticed how many interesting and thoughtful Lisa psychotherapists there are out there?? )
The reasons the general public are unaware of iatrogenic harms of "affirmative care" are explained by The Trifecta of Deceit. 1. Trans Journalists' Association Style and Coverage Guide, a newly updated website now soliciting donations--they suppress reporting on detransitioners, trans widows, crimes of men claiming female identity as well as the multifaceted family destabilization their ideology causes. 2. "Dutch Protocols" based on the low quality study of DeVries, Steensma, Cohen-Kettenis, 2014, known as The Dutch Study. 70 subjects dwindled to 55, 2 died, 20 declined to finish the exit survey, so final tally 33 subjects. Despite 4 attempts in UK, US to replicate, results were so dismal these were abandoned. 3. Drs. Mark/Marci Bowers and Laura Edwards-Leeper are exemplary practitioners who blame the patients when they regret and detransition, when the risks turn into cancer and kidney failure. Hubris personified.
The GWL episode with DeVries and Steensma was really something for how it highlighted the low quality of the study from which the "gold standard" Dutch Protocol was born (switching the assessment measurement at the end alone), and the Trans Journalists' Style and Coverage Guide really helps explain how all of this stays mostly unknown, even to our Supreme Court Justices as evidenced in just the small amount of the responses to the oral testimonies I was able to listen to today.
Great interview, thanks for posting it. Seems to me that transgender is a *behaviour* rather than an *attribute*, which is why it doesn't always persist. If you're cross-dressing today you are behaving transgenderly, regardless of how you identify, but it doesn't mean you are 'a transgender person' as a member of a permanent category. Once you claim the identity, you are far more likely to behave accordingly.
Much the same way that an intelligent person who did a stupid thing is not a stupid person, regardless of how they feel about that act. It can become a self-fulfilling prophecy, as in "I keep doing stupid things because I'm a stupid person".
Transgender is a behavior - maybe more specifically it's a coping strategy. The problem is that very few people can have only one coping strategy work for them their entire life. The problem is that when this coping strategy stops working, you can't just put it down it's a coping strategy that controls your entire life, and of medicalized, your body too. Even if it is a coping strategy that works for some, for some length of time, should it be encouraged given all the harms and risks to both the individual and society that come with it? A lot of people will tell you that smoking, vaping, or drinking are their coping strategies and work well for managing their anxiety, their weight, or their sleep. But we don't encourage them as healthy, much less the only, coping strategy for these things.
That's a really good point. We have an identity word for someone who uses alcohol as a coping mechanism - alcoholic, of course - but we frame that identity as an addiction caused by poor choices which can be mitigated, not as an innate quality (except when talking about children born to addicted mothers, perhaps).
It might be interesting to view cross-dressing as an addiction based on a maladaptive coping strategy. Defence lawyers could make use of that when their transgender client gets arrested for inappropriate behaviour. However it would imply conversion therapy as the court-mandated treatment; I can imagine the gender lobby would not enjoy that one bit.
Eliza, thank you for your deep critical thinking about the assumptions built into the "trans" social phenomenon. This interview with psychotherapist Lisa Duval is essential reading.
Yes, "trans" is often a cover for, and expression of, serious psychological difficulties, such as borderline personality disorder.
While Borderline personality disorder is not easy to treat, Dialectical Behavioral Therapy, created by Marcia Linehan. has proven highly effective. But it's not widely available. Why? It's not profitable at scale. In fact, the US Medicaid and Medicare Health Care Common Procedure Coding System doesn't even have a billing code for it. That means Medicaid and Medicare won't pay for it. (The National Education Alliance for Borderline Personality Disorder is currently campaigning to get a code added.)
DBT is a humanistic mode of therapy. Trans medicalization fits much better with America's system of healthcare as a commodity. Hormone blockers, cross-sex hormones, and surgeries are technological procedures that serve the profit motive of industrialized medicine. They can be implemented at scale.
I am so sorry you have to deal with this. I don't know that I could last a minute without speaking out and then being torched as you describe. Do you have any allies there you talk honestly with about this dynamic? Is there anyone who sees this and is in a position of doing something about it to whom you can explain that while you protect "this sacred trans person" (while cringing inside), their behavior is still not ok and is hurting others? Can you leave? I wouldn't leave without a fight myself. But at some point, abuse is abuse no matter the claimed identity. Could any of their behaviors be seen in that light? When you encounter this dynamic in the wild, it's so different from in therapy. In therapy, someone is coming to you for help, saying that at least some part of their life is not working, so you have a path in to start questioning things. Even if they are court ordered, you can still agree that something is not going well for them. And it's easier to find ways to feel a connection to/sympathy for/acceptance of the wounded core you know is there when you are the therapist and trained to work with them as opposed to being abused by them in your daily life. So I wouldn't even begin to suggest that you see these coworkers in any sympathetic way in order to connect and thereby redirect or appeal to their regard for you. That would be naive and self destructive for you because they most likely don't have regard for you. I wish I had a better answer. If I think of something more, something at all, I will circle back.
Could this be a defence mechanism for entitled men following #MeToo? I'm told that Netflix sets won't put up with traditional Hollywood behaviour. Perhaps appropriation of the feminine identity is a free pass for sexist creeps, with an extra helping of praise and validation?
I have absolutely noticed that from a couple of corners: Publicly, Charlotte (formerly Charles)Clymer had numerous women accusing them of behaving in sexually harassing and bullying ways back when they still identified as male. And then they switched to female and have had a mostly clean slate.
Privately, a person who I knew socially was accused of sexually assaulting someone in undergrad, and while nothing came of this, has since begun the process of transition.
If you want to hear more from Lisa: https://www.youtube.com/watch?app=desktop&v=WLw2y7bGLYo&t=999s
This is one of the best articles I have read in a LONG time. It is pure gold. Thank you
YES!! Thank you Eliza! It’s very eye-opening to consider the connection between trans and BPD because both of these deeply affect my family. Great conversation between two inquisitive, nuanced and intelligent women.
I’m stealing the phrase “malevolent benevolence”— what a clear way to describe “affirmation”!
Very interested in this part of your interview
“I would love to see someone study three groups of clinicians: those who have always and still do practice “affirmation only;” those who all along questioned gender ideology and the astronomical rise in trans-identified youth; and those who affirmed at first but eventually became gender critical.”
I am also a clinical psychologist, my area is couples/sex therapy with 25+ years experience and unlike most, I received specialized post doctoral training that included treatment of gender dysphoria (with Dr Steve Levine as one of my mentors and clinical supervisors)
My own pathway has been a movement away from initial acceptance of trans identity earlier in my career when I was more skeptical that psychotherapy should be focused on this kind of analysis and I saw it more like sexual orientation (therefore why analyze it?) but this was at a different time when those presenting for therapy were a completely different cohort who arrived at these conclusions at mid life or later, and there was no social media to suggest social contagion
Nonetheless I carefully assessed for co-occurring mental health issues and aimed to treat these alongside requests for medical referral letters as I was trained to do (IOW what is now referred to as gate keeping)
It took many more years and direct clinical experience, recognizing the shift towards a new younger cohort of younger adult females presenting for treatment coupled with awareness that a couple of my clients had detransitioned, that led to a willingness to go outside my usual sources of information (from my professional organizations and mainstream media to online alternative organizations and media like Genspect and Twitter and YouTube and Substack). I owe this to my sex therapy colleague James Cantor, someone who wasn’t afraid to question the affirmation mindset and this allowed me to “wise up” and catch up as to the reality of iatrogenic harm as told by detransitioners, and I also credit Ken Zucker, another sex therapy colleague for his role in always maintaining that therapeutic analysis and intervention that included the family system was relevant and ethical despite later being “cancelled”which also made me aware of the problem of reductionist thinking about trans as the new gay
I think there’s something to be said about the psychoanalytic concept of “splitting” by therapists who are over invested in denying any wrongful convictions or harmful impact of our interventions that fits with what this psychologist says is happening with clients who are gender dysphoric
It’s hard to help anyone else if you haven’t done the work yourself of moving into humility, which is necessary for a healthier, more mature relational stance
A favorite quote I retained from my supervision days with Dr Levine is “If you see Buddha in the road, slay him” He was referring to being careful not to become too sure of yourself and what you think you know, and to always remain a student in my role as a therapist, and in sharing this wisdom with me perhaps he planted that seed for me to be able to later question my own authority and received wisdom
Do you think there's also an element of therapists being unable or unwilling to take the vilification that patients with BPD/BPD traits project onto the therapist whenever the client is challenged on something? Do they take that anger from the patient as a sign they (the therapist) is doing something wrong? Does it maybe trigger the therapist's personal fears and vulnerabilities? Or is there an unconscious drive to affirm because it makes these very challenging patients much easier for the therapist to deal with? The therapists are metaphorically and literally drugging the difficult patient into an easier patient by affirming?
100% There's a quote from Laura Edwards Leeper when she was on Meghan Daum's podcast about how angry these patients get when you don't affirm them, and it felt like in spite of her claim to have the magic thorough assessment battery for "true trans," that is actually more at play.
Then there's the risk of actual physical harm to the therapist. Are you familiar with the 'fell runner' case in the UK? That involved a sports coach, but a therapist is just as vulnerable.
You have really worked with and been influenced by key players in the evolution of this area. Thank you for sharing your trajectory. I've been astounded by colleagues' lack of humility, curiosity, and response to the changing gender questioning cohorts and information from other countries.
Same:( I’ve been trying for quite a few years to influence colleagues and there’s a wall of fear I think, in the way that I’m coming from a place of either ignorance (despite my years of experience) or malice towards trans people aka transphobia that pertains to wider sociopolitical divide where distrust is higher than ever of anyone who might represent the “other side”
Just read a very good piece in NYT by another psychologist and couples therapist that also references the concept of splitting to explain political polarization and how it affects relationships https://www.nytimes.com/2024/11/27/opinion/couples-therapy-political-divide.html?unlocked_article_code=1.e04.4_Cs.kAABdRlIniX_&smid=url-share
Yes, I am also a clinical psychologist and psychotherapist and am very interested in "us" as practitioners (as well as parents and all the other "adults in the room") -- how to understand each of the three groups or kinds of therapists Lisa D identifies here. Great interview and thoughtful discussion.
(And as an aside, has anyone noticed how many interesting and thoughtful Lisa psychotherapists there are out there?? )
Humbled to be put in the company of Littman and Marchiano.
Genuinely illuminating in so many ways, and so positive. It deserves the widest possible audience. Thanks - and more power to your elbows!
The reasons the general public are unaware of iatrogenic harms of "affirmative care" are explained by The Trifecta of Deceit. 1. Trans Journalists' Association Style and Coverage Guide, a newly updated website now soliciting donations--they suppress reporting on detransitioners, trans widows, crimes of men claiming female identity as well as the multifaceted family destabilization their ideology causes. 2. "Dutch Protocols" based on the low quality study of DeVries, Steensma, Cohen-Kettenis, 2014, known as The Dutch Study. 70 subjects dwindled to 55, 2 died, 20 declined to finish the exit survey, so final tally 33 subjects. Despite 4 attempts in UK, US to replicate, results were so dismal these were abandoned. 3. Drs. Mark/Marci Bowers and Laura Edwards-Leeper are exemplary practitioners who blame the patients when they regret and detransition, when the risks turn into cancer and kidney failure. Hubris personified.
https://www.youtube.com/watch?v=4VSwPvRZQYE&t=204s
The GWL episode with DeVries and Steensma was really something for how it highlighted the low quality of the study from which the "gold standard" Dutch Protocol was born (switching the assessment measurement at the end alone), and the Trans Journalists' Style and Coverage Guide really helps explain how all of this stays mostly unknown, even to our Supreme Court Justices as evidenced in just the small amount of the responses to the oral testimonies I was able to listen to today.
Pls share link to the GWL episode?
The entire GWL Pioneers Series is terrific. Together the entire series is like a graduate seminar.
https://www.youtube.com/watch?v=QEiE_porazM
You can also find it on the GWL Substack
Great interview, thanks for posting it. Seems to me that transgender is a *behaviour* rather than an *attribute*, which is why it doesn't always persist. If you're cross-dressing today you are behaving transgenderly, regardless of how you identify, but it doesn't mean you are 'a transgender person' as a member of a permanent category. Once you claim the identity, you are far more likely to behave accordingly.
Much the same way that an intelligent person who did a stupid thing is not a stupid person, regardless of how they feel about that act. It can become a self-fulfilling prophecy, as in "I keep doing stupid things because I'm a stupid person".
Transgender is a behavior - maybe more specifically it's a coping strategy. The problem is that very few people can have only one coping strategy work for them their entire life. The problem is that when this coping strategy stops working, you can't just put it down it's a coping strategy that controls your entire life, and of medicalized, your body too. Even if it is a coping strategy that works for some, for some length of time, should it be encouraged given all the harms and risks to both the individual and society that come with it? A lot of people will tell you that smoking, vaping, or drinking are their coping strategies and work well for managing their anxiety, their weight, or their sleep. But we don't encourage them as healthy, much less the only, coping strategy for these things.
That's a really good point. We have an identity word for someone who uses alcohol as a coping mechanism - alcoholic, of course - but we frame that identity as an addiction caused by poor choices which can be mitigated, not as an innate quality (except when talking about children born to addicted mothers, perhaps).
It might be interesting to view cross-dressing as an addiction based on a maladaptive coping strategy. Defence lawyers could make use of that when their transgender client gets arrested for inappropriate behaviour. However it would imply conversion therapy as the court-mandated treatment; I can imagine the gender lobby would not enjoy that one bit.
excellent! thank you.
Eliza, thank you for your deep critical thinking about the assumptions built into the "trans" social phenomenon. This interview with psychotherapist Lisa Duval is essential reading.
Yes, "trans" is often a cover for, and expression of, serious psychological difficulties, such as borderline personality disorder.
While Borderline personality disorder is not easy to treat, Dialectical Behavioral Therapy, created by Marcia Linehan. has proven highly effective. But it's not widely available. Why? It's not profitable at scale. In fact, the US Medicaid and Medicare Health Care Common Procedure Coding System doesn't even have a billing code for it. That means Medicaid and Medicare won't pay for it. (The National Education Alliance for Borderline Personality Disorder is currently campaigning to get a code added.)
DBT is a humanistic mode of therapy. Trans medicalization fits much better with America's system of healthcare as a commodity. Hormone blockers, cross-sex hormones, and surgeries are technological procedures that serve the profit motive of industrialized medicine. They can be implemented at scale.
Thank you. I appreciate the explanation of how to connect - which is valid even for non-BPD
Spot on and well said, Eliza!
I am so sorry you have to deal with this. I don't know that I could last a minute without speaking out and then being torched as you describe. Do you have any allies there you talk honestly with about this dynamic? Is there anyone who sees this and is in a position of doing something about it to whom you can explain that while you protect "this sacred trans person" (while cringing inside), their behavior is still not ok and is hurting others? Can you leave? I wouldn't leave without a fight myself. But at some point, abuse is abuse no matter the claimed identity. Could any of their behaviors be seen in that light? When you encounter this dynamic in the wild, it's so different from in therapy. In therapy, someone is coming to you for help, saying that at least some part of their life is not working, so you have a path in to start questioning things. Even if they are court ordered, you can still agree that something is not going well for them. And it's easier to find ways to feel a connection to/sympathy for/acceptance of the wounded core you know is there when you are the therapist and trained to work with them as opposed to being abused by them in your daily life. So I wouldn't even begin to suggest that you see these coworkers in any sympathetic way in order to connect and thereby redirect or appeal to their regard for you. That would be naive and self destructive for you because they most likely don't have regard for you. I wish I had a better answer. If I think of something more, something at all, I will circle back.
Could this be a defence mechanism for entitled men following #MeToo? I'm told that Netflix sets won't put up with traditional Hollywood behaviour. Perhaps appropriation of the feminine identity is a free pass for sexist creeps, with an extra helping of praise and validation?
I have absolutely noticed that from a couple of corners: Publicly, Charlotte (formerly Charles)Clymer had numerous women accusing them of behaving in sexually harassing and bullying ways back when they still identified as male. And then they switched to female and have had a mostly clean slate.
Privately, a person who I knew socially was accused of sexually assaulting someone in undergrad, and while nothing came of this, has since begun the process of transition.
Jesus Christ 😒