A person-centred approach is antithetical to gender critical beliefs

There have been more and more discussions and mentions of trans people in the press, both here and abroad (notably the US) in recent times. This prompts us, as a group of person-centred therapists with an interest specifically in gender, sexuality and relationship diversity (GSRD) to think about how we as therapists might approach discussions around trans topics, and how person-centred therapists might sit with these topics, and the clients who come to see us.

Recently, we were struck, on finding a register of ‘gender critical’ therapists, by the fact that some of those therapists list themselves as person-centred, and so we start this piece with this statement.

One cannot both be ‘gender critical’ and ‘person-centred’.

Let’s break it down.

Gender-critical (from the Oxford English dictionary): critical of or opposed to the belief that gender identity is more important or significant than biological sex (typically used in contexts relating to the rights of transgender people)

Person-centred: a non-directive approach that believes that fundamentally the client is the expert of themself.

Gender is a construct. But so is sex. So is money. We work with constructs all of the time. In therapy, arguably, we are not working with “scientific evidence” (although there is plenty of science that tells us that sex is not binary, for example), but world views. Do we a) believe that the client is the expert of themself? Do we b) believe that being trans is not an inherently “worse” place to inhabit than being cis.

Either we as therapists believe that a gender critical belief is correct – that no matter what the client "believes", sex is more important or significant than the client’s belief about their gender, OR we can believe that a person-centred approach is correct: the client’s belief about themselves has primacy over our own beliefs about gender. We cannot hold both positions.

If we start from a position that a trans identity is somehow flawed, or undesirable, then the only ‘good’ outcome (at least as far as a therapist is concerned) is a rejection of trans identity by the client. We do this by pathologising trans identities as something to be moved away from (much like the idea of traditional lesbian, gay bisexual and asexual (LGBA) conversion therapies ‘of the past’). There is no place for conversion therapy in a person-centred approach, and arguably, for any therapist signed up with the BACP or the NCPS amongst others (who are signed up to the MoU2, which states that “neither sexual orientation nor gender identity in themselves are indicators of a mental disorder”).

When we talk about conversion therapy there is a general idea that this was almost exclusively enacted upon gay men, but there is evidence to show that lesbian women, and bisexual and asexual people were also extensively subjected to this abhorrent treatment. 

When we say ‘conversion therapy’ we include ‘exploratory therapy’ (as coined by gender critical therapists) here. If we employ exploratory therapy from an internal starting place that sex is the important factor, we are not giving clients space to explore. We are only attempting to find weapons to employ against our clients to somehow convince them of their cisgender status.

Clients come to us with a variety of topics to discuss. We do not (as person-centred therapists) presume ourselves to be the experts on anyone’s life. Gender topics are no different.

The truth is, we do not know what ‘makes people trans’. There are genetic factors at play for sure (children younger in the sibling line tend to be more likely to be trans), and there may well be social, or other epigenetic factors at play also. We do not know. The likelihood is that both are at play. We as therapists have no way of deciding which. Much as we don’t with LGBA identities. It may also entirely be a social construct - that one day someone just “chose” this. 

Either way, this does not matter in working with trans clients. If clients come to us and say they are trans, it is for us to work with them and affirm their right to be themselves, rather than to try any form of conversion therapy. 

If our clients are trans, then our job is to work with them to help them find a sense of ease with themselves in the world (if indeed, that is why they have come to us. A great number of trans people come to therapy to discuss topics that have nothing to do with their trans identity, except for the fact that they are a trans person wanting to discuss those topics).

There is beauty in the person-centred approach in letting our clients address what they want to address, whilst we walk down the path with them. Our job, by definition is not to LEAD them down the path we want them to go.

That being said, for some people, being trans is difficult – just look at the news. Right now, it is difficult for many people to be trans. Since the NHS restricted treatment in the form of hormone blockers, which were prescribed to some trans youth, the number of trans suicides in that population has risen exponentially in the UK, and anti-trans laws have contributed to up to a 72% increase in trans suicides and suicide attempts in the US. The bottom line is that we can’t change trans identities. If being restricted by governments isn’t enough to ‘change’ a trans person and they feel their life is better off ended, we as therapists cannot do something to change their identities, and we should not be trying to.

Our job as therapists is not to try to ‘fix’ our clients in any way (we call this ‘rescuing’ and it is definitively not the job of a therapist to rescue a client). Nor is it our job (or our right) to take away the autonomy of a client, or to suggest that they may be ‘broken’ in any way. Our job is to facilitate an environment that enables our clients to fully understand themselves as they are, no matter how complex their identities.

It is undeniably hard to be a trans person right now. It’s also hard to be a Black or Brown person. It is hard to be disabled. We cannot ‘fix’ these problems in therapy; they are not problems that originate within our clients. They are problems that are systemic – we (and we write from the context of being therapists in the western world) live in a world that prizes some identities and not others. Our best hope (besides becoming activists who advocate for a world in which these minority identities are prized) is in working with our clients to help them to live authentically in a world that doesn’t currently prize who they are.