Detrans when transition.., p.19
DETRANS: When transition is not the solution, page 19
What I found was that unlike in the original post-op therapy group, where the general feeling in the group (the group transference) was that of hopeless despair, in the mixed group the post-op patients came alive in their active engagement with the idealising ‘pre-op’ patients. They were able to identify with the pre-op patients whose stories resonated with them at the stage in their lives where they too felt that gender transition was the ideal solution. This resonance and empathy made them well placed to help the pre-trans patients, especially in challenging their often somewhat ‘Hollywood Happy Ever After’ fantasies which they described. Each of the patients formed an attachment to the group, and for some whose gender dysphoria resulted in them leading isolated lives, it was the only time they talked to anyone during the week. The group was enquiring, challenging and a form of support. Someone once said to me that a good therapy should be experienced as “holding you with one hand whilst prodding you with the other.”.
What was noticeable was that by dismantling previously held unhelpful gender rule frameworks, the patients became less focussed and less troubled by gender. Its power over their day-to-day lives became less prominent and was similarly dismantled. It became like other variables that were no longer of a concern, such as race, class, weight, age or anything else. Whilst bodily outcomes were less of a concern than psychological outcomes, it is probably not insignificant that less than 2% of the patients going through the therapy service decided to pursue surgical ‘sex change’ interventions, having come to a psychological position which they were comfortable with. As patients were able to remain in the group for as long as they wished, I was able to see how long was needed for useful results. For the transvestites, it usually took around two years to reach an understanding of what function their cross-dressing had, and for them to distinguish this from the transsexual wish for a ‘sex change’. For the pre-op transsexual it was usually between two to four years. After this period of time the patients continued to benefit from being in the group, but in the same way as being in a general analytic group, as their personal concerns were no longer about their gender. The post-op patients benefitted the entire time they were in the group and required differing lengths of time before they were able to move forward comfortably from their experience of loss.
The post-op regretters would frequently state that they wished that they had been able to access this kind of exploratory space when they initially sought help. They described, in great detail, how what we gender critical clinicians are concerned with is the ‘affirmation only’ model of therapy, which many are politically fighting to make the only therapeutic approach to be available for trans people. The post-op regretters said that everyone they had originally approached merely affirmed their proposed new gender role, rather than questioning them as to how or why they were now identifying as another gender. One of my post-op trans female patients, who later reverted to being a male, went back to ask his public sector employers and family members, none of whom ever questioned why he wanted to transition twelve years earlier. The reply he got from both his family and his workplace, was that “We were being supportive”. “That’s what we thought we were supposed to do.” And this was the problem. When having a serious internal conflict and confusion from which one has emerged with a potential solution, rather than having others help think through with them how they came to such a radical conclusion, they instead silenced any such potentially helpful curiosity and blithely colluded and confirmed that their solution was correct and ‘affirmed’. The word ‘affirmation’ is literally a ‘positive’ word, and so our gut instinct is that it must be a good thing. In reality of course an ‘affirmation only’ approach denies the person any thoughtful enquiry, which could be extremely helpful. After all, the phrase ‘a problem shared is a problem solved’, is not merely ‘a solution shared…’. The post-op regretters were universally of the opinion that if they had been able to access an exploratory space in the first place, they would not have pursued the irreversible physical steps which they later came to regret.
Working therapeutically with gender dysphoria patients, a number of common themes became clear, and I have previously described these in detail in my first book TRANS, but I will briefly summarise them here.
i) CONFUSION: in the patients about their gender, sometimes in myself as therapist (for example when patients would change their gender presentation at times during the course of treatment), and in the organisation who were often confused as to which pronouns to use and which toilets to send the patients to.
ii) BINARY RIGIDITY: the very black and white rigid ‘binary’ way of thinking, especially in the transsexual biological males who most probably had co-existing ASD, which was manifest in very inflexible ideas in relation to gender. This very binary system was also manifest in the dyadic setting of individual therapeutic work, which took on a very right/wrong, male/female, are/are not quality. The binary rigidity was also evident on an inter-organisational level between the Portman Clinic and the Charing Cross Gender Clinic, who perceived each other as being ‘for’ or ‘against’ ‘sex change’ interventions, and which resulted in years of fraught conflictual relations between the two clinical services.
iii) GENITAL CENTRALITY: the patients had projected much of their internal conflict onto their sex organs, and the fantasy was that once they were removed, their life would be better. It was also manifest in my clinic, which had been reluctant to take on post-op trans regretters, stating that there was nothing which could be done to reverse the situation. This was not only false therapeutically in terms of mourning and loss, but was also not applicable to other patients whose actions could not be reversed. It was also evident in the way the organisation had previously separated patients into ‘pre’ and ‘post-op’ therapy groups, based on whether or not they had undergone genital surgery.
iv) QUESTIONING OF AUTHENTICITY: the trans patients doubted their authenticity in their biological sex, leading them to fantasise the resolution of such inauthenticity by gender transition. The reality was that the biological males were experiencing their ‘difference’ from others because of their ASD mindset, and mistakenly diagnosing this problem as being with their gender. The post-op regretters described how, after an initial period of post operative transgender euphoria, there emerged an increasing sense of inauthenticity in their new ‘trans’ gender, especially if they were in ‘stealth mode’, where their ‘trans’ status was kept a secret. They eventually found themselves once again with the feeling of inauthenticity, which their fantasy solution had not succeeded in addressing, but now left with a body which had been irreversibly changed.
I set up and ran the adult gender dysphoria psychotherapy service single-handedly, until I left the clinic to live and work in Australia in 2012. One of my gender groups had been running for the entire twelve years, and some of the patients had seen me weekly in that group for that whole time. They knew that when I left, the Portman Clinic would not continue it, as they wanted to focus more on their Forensic remit for which they were funded. The final group session was very touching for all concerned. The group had clubbed together and bought me a pair of ‘Freudian Slippers’ as a thank-you gift. Towards the end of the final group session, one member said to me, “So you’re leaving to go and live in Australia? You’ve never lived in Australia before, so you don’t know what that involves. But you’re giving up your life as it is, for a new life, which you don’t know, which sounds like a bit of an unknown risk. So basically, this is your equivalent of a ‘sex change’ isn’t it?”
They had clearly learned a lot!
And indeed, after a year, I realised that a life and career in Australia were not for me in the long term, and so I returned to the UK (detransitioned) and set up work in private practice back in London once again.
19. DEALING WITH DYSPHORIA, DESISTING AND DETRANSITION. A PEER-LED SUPPORT GROUP
SYLVIA (USA)
Developing the Group
[SYLVIA]
I originally thought of starting a support group for those struggling with dysphoria a few years after I desisted from my own trans identity. I had come to recognize my experience of dysphoria with a fresh understanding of why I had discomfort in my biological sex and how to overcome the distress without medical intervention. I had a feeling that other women had fallen prey to the fictitious narrative that discomfort with one’s sex meant so-called ‘transition’ was the only solution. If I could cope with my dysphoria in healthier ways, so could others. I hoped to help women find peace within their body through other means besides synthetic hormones and cosmetic surgeries. However, I also wanted a space to speak about the moments of dysphoria I still experienced, and to do so without being told it was because I was a man on the inside.
The leaders of LGBA were supportive of my vision. They suggested I find a co-leader for the group and pointed me in the direction of Carol.
[CAROL]
I joined LGBA about a year and a half ago in hopes of shifting my volunteer work from detransition awareness into more centred efforts involving the LGB community. As a detransitioned lesbian who spent over a decade believing I was transgender and four years medically transitioned, I wanted to help other women like myself find peace with themselves as I had. Internal and external homophobia played a big part in my desire to transition, so I knew my work needed to be focused within my own community.
It was in that first meeting with LGBA that Amanda pitched her idea of a gender dysphoria support group and asked if I would co-facilitate. I of course said yes and was very excited for the chance to share my own experience of healing from gender dysphoria with other same sex attracted women.
Once we formed the group and began to advertise it, we quickly discovered that the majority of women seeking help were in fact detransitioning women or women who wanted to detransition but couldn't find support to do so. We do have a few women who have never gone down the medical transition path and just seek to manage their gender dysphoria without transition, but most of our group has a history with trans-identification. It's important to recognize this. There is a false idea that someone who detransitions no longer struggles with gender dysphoria, and this is simply not true. Perhaps if our services were more widely known, we would have more women join prior to transitioning rather than after.
As it stands now, the only solution offered to those looking to ease their dysphoria is medical transition. In our group, however, what we all seem to have discovered is that transition did not help our dysphoria. Since the mental health community at large won’t acknowledge that this happens and are unwilling to offer alternative treatment outside of trans-identification and medical transition, we are left to do this work ourselves.
It took us a few group meetings to settle on a style we felt worked well for our demographic. We discovered that good old-fashioned feminist consciousness-raising would be a good fit. The idea was for this to be a place for women to come together and learn from each other, because knowledge is great power.
Group Overview
The overall aim of the group is to find healthier ways to cope with feelings of distress surrounding our biological sex; ways that do not include body modification. Our foundational belief is that nothing is inherently wrong with how we are naturally. We seek to build upon that foundation of self-love and self-acceptance. In this group we do not run from the reality of our biological sex. We not only acknowledge it, but we also practice embracing it!
Before being allowed into the support group, new members must go through a preliminary interview and agree to the group’s rules. Perhaps the most important rule is the agreement that all pronouns used will be sex-based and the understanding that the definition for woman is adult human female. We also require the use of ‘I’ statements when voicing our opinions. We do this to avoid generalized statements, sweeping judgements, and speaking on behalf of other people. Though we never want to police how the women describe their experiences, we do probe them to find alternative words besides ‘masculine’ and ‘feminine’. This is done not to expand our vocabulary but as an exercise in specificity, which seeks to end the perpetuation of sex stereotypes and gender constructs.
We meet once every two weeks over Zoom for an hour and a half. We start off by touching base, talking through any noteworthy bouts of dysphoria or ‘triggering’ moments from the past week. Then, we move on to the topic of discussion. Some examples of our past topics include:
- What does true ‘healing’ look like and how do we know when we have ‘fully healed’?
- What kind of relationship do you have with your mother, and how has it impacted your dysphoria, how you relate to other women, and to yourself?
- Our feelings about pregnancy and/or our capacity to become pregnant.
- Sense of self: How has it been shaped and how has it changed over time?
The topic of the first meeting was Defining Dysphoria. There it was concluded, more or less, that dysphoria is not a disorder, but rather caused by a variety of circumstances. These circumstances, or collection of experiences, resulted in an unhappiness and discomfort with living in our natural bodies. All our topics either grapple with difficult parts of our past or present-day coping mechanisms, or explore our current world view and whether this view serves our well-being.
Group Structure & Strategies
It is important to note that this is not a therapy group; it is a peer-led support group. The group leaders are not medical professionals and do not claim to have the answers for how to cure painful emotions. Instead, we all share what has worked for us and where we still struggle. Frequently, it is due to the diversity of the group members that we are able to help one another. For example, one woman may be struggling with something another has overcome. Sharing coping strategies and healthy habits allows the women to explore solutions that work best for them. Other times, simply hearing you are not alone is healing in itself.
One notable example of this happened between two women we will call Ruby and Amber. Ruby is most comfortable viewing herself as more ‘feminine’, though she is often described by others as ‘masculine’. Conversely, Amber prefers to be seen as masculine’ but is typically called ‘feminine’ by others. In addition, both women describe a feeling of alienation from their bodies, from other women, and from womanhood when they are around women that resemble their own appearance. Though their triggers were vastly different, Ruby and Amber had similar descriptions for their discomfort: a disdain for their own self-expression and a self-doubt that they were ‘doing womanhood right’. They laughed and nodded as the other described the insecurities, noting how peculiar it was to have the exact same sensations brought on by opposite causes. Both women could feel seen by the other while they were simultaneously in the same yet entirely different situations.
During the course of the meeting, we typically come to a unanimous conclusion or list of conclusions about the topic at hand. The question then becomes, how do we create resiliency within ourselves, and what are the necessary tools for a healthy mindset?
In one particularly hot-topic session, we discussed the relationship we had to our breasts. Some women had gotten cosmetic double mastectomies and now regretted it, while others had moments of still wanting a flat chest. After unpacking our history with our breasts, we concluded that our discomfort—or even hatred—is learned and not intrinsic. We agreed that the ‘chest dysphoria’ we may feel was caused by our hardship with gross, sexualized objectification and does not mean our body is what must change. We then explored solutions for living prosperously despite the things we cannot change (i.e. culture and misogyny). Recognizing how sexism, trauma, internalised homophobia, and other experiences impacting our daily life does not make unlearning these internalisations simple. Discussing how we are affected, and by what, allows us to develop coping strategies together. Ultimately, we work towards being unfazed by how others view us and building a self-confidence that is too strong to be shaken by how others interact with us. Emotions in the group can run high. Not everyone is prepared to face the difficult process of unlearning harmful thought patterns and practicing radical self-love. Sometimes there is crying or aggravated grunts, but there is always an atmosphere of support.
We conclude each meeting by saying one thing that brought us joy in the time since our last meeting. This can be some big, exciting news, or simply celebrating little victories like making a doctor's appointment or having a scoop of your favourite ice cream. No matter how raw we may have gotten during the course of the one and a half hours, we always want to end with a smile.
In this peer-led group, we work on accepting ourselves as we naturally are, developing coping strategies for when we are seemingly unable to escape the self-hate, and supporting each other into becoming strong women who are unaffected by anyone’s preconceived notions. We do not continue to run from the reality of our sex or aid self-hatred by affirming we were ‘born wrong’. We do not claim our discomfort with our sex as an irreversible thing that must be fixed with the removal of body parts or taking synthetic hormones. We do encourage self-reflection. We foster an environment of radical self-love. We empower each other to take responsibility for our resilience and healing. All this is possible because of the circle of trust we’ve built and the shared determination to overcome. Together, we explore the feelings of dysphoria. We unpack the causes of dysphoria. And then we deal with it.
20. SUPPORTING PARENTS OF TRANS-IDENTIFYING CHILDREN.
THE BAYSWATER GROUP (UK)
In 2018 when my son declared he was ‘transgender’ my first thought was, oh dear, another struggle to add to the list. At that time, I thought I knew what a ‘trans child’ was, and my son had shown none of the signs. He had always struggled at school due to ADHD and dyspraxia, he didn’t like contact sports, he found it hard to maintain friendships and was bullied by both girls and boys at different points. He was a very bright, sensitive and kind child and we were very close, and while happy to discuss all the other aspects of his life not once did he declare either distress or confusion over his sex. He did, however, have a problem with male peer abuse, which was often homophobic, and he felt that girls had an easier time in terms of physical expectations, especially with regards to sport, but that was it. His interests did not mark him out as unusual. Then, shortly after puberty, he announced he was same sex attracted. This led to more severe bullying, and then a descent into severe mental illness – exacerbated by peers online who were encouraging self-harming and cutting as a way to deal with stress. This quickly escalated to three suicide attempts. In that distressed frame of mind, he encountered the idea, widespread across the online communities of like-minded, struggling teens that he was attracted to, that he could be reborn as a girl. “I have found out I am transgender and have been born in the wrong body and I want surgery so my body matches my mind” were his first words on the subject.
