On Substack, I'm seeing a wave of what I am going to call "Psychology Influencers" popping up. Some of them are clearly therapists with solid experience who are sharing their professional experiences working with clients, others are mostly peddling the usual assortment of quasi-motivational/self-help sloganeering that sounds nice but is really quite hollow. The third group are the ones that concern me the most - "influencers" who are proposing utterly nonsensical ideas and theories.
The first two groups are relatively harmless, and a few are legitimately talking about real issues in the domain of psychology - both clinical and theoretical issues. I encourage people to seek those out if that's your jam.
The third group is much more concerning because often they are adopting harmful conspiracy theories or approaches to therapy that could be very damaging to clients. I have had several encounters with this group of "Psychology Influencers" on Substack recently, and the discussions have been very interesting for what they revealed.
The "Gender Critical" Therapist Influencer
There are a lot of these running around on Substack right now, and they are identifiable even when they don't declare themselves as such. Often it shows up in wording or non-subtle attempts at "casting shade" on therapeutic models that they don't like. The most common of these is to imply that "Gender Affirming Care" - sometimes reduced to "affirmation" - is somehow "bad". Inevitably, if you chase the conversation far enough, you'll start to see other language being used such as "gender ideology/theory", "sex realism", and a few other keyword phrases that more or less give away the inherent bias of the writer/practitioner.
Now, on its face, a practitioner putting forward a novel (or perhaps new-to-them) conceptualization or treatment modality is fine - I don't have a problem with that. Sometimes "fresh eyes" will see things that others more experienced in a topic area might naturally overlook.
Here's where the problem arises. So-called "gender critical" perspectives are not "fresh eyes" so much as they are an absolute denial of decades of study and evidence. Rather than incorporate that information into their perspective, they often reject it wholesale as "biased" and then demand that new research be done to "explore" their ideas ... even when the idea was "explored" years earlier and rejected for a lack of evidence.
In recent weeks, I have encountered a few of these types of "Therapist Influencer", and I am deeply troubled by what I see. These therapists could do significant harm to transgender clients by adopting positions well outside of any reasonable scientific consensus.
"Therapy Has Been Colonized By Politics"
The first case I want to discuss was an essay wherein the author was complaining that somehow or another "politics" had overtaken "real therapy". At first, as I was reading the essay, I found myself wondering "where exactly are you going here?". There was a lot of vague hand-wringing over therapists not being able to use their skills of nonjudgmental inquiry, but nothing particularly specific.
Then about halfway through is this vague statement about "affirmative care" being "political", and I understood. Here is yet another practitioner who wants to discard the fundamentals of therapy for one population in particular because it makes the practitioner uncomfortable for some reason. "What about exploration?" they complain. As if Gender Affirming Care (GAC) doesn't provide for that at all.
The problem is that the research has led in a direction they find uncomfortable, and they have bought into an entire line of misinformation about what GAC is. From this, the writer derives a notion that good therapy has been overrun by politics.
The reality is more complex than that. Most codes of ethics I am familiar with call upon therapists to be advocates for their clients. Advocacy is inherently political in nature, and when our clients are transgender, that advocacy might well end up being direct engagement in politics on their behalf. As therapists, we have a voice and a kind of privilege that our clients may not experience themselves. When politicians are literally legislating against the fundamental rights our clients should enjoy, then we have an obligation to push back on their behalf.
"What About My Novel Reconceptualization?"
The second case was even more concerning. The author proposed a "novel" conceptualization of transgender identities that was built around a pseudo-Freudian notion that transgender identity was a "strategy" through which someone might be seeking to fulfill some unmet need. Therefore, it would be utterly essential to engage in "exploratory therapy" to identify this "need" and help the client resolve it.
Of course, there was a requisite snipe or two in there at the notion of "affirming" transgender identities, presumably because the writer felt they were somehow fictional or invalid.
When challenged directly, the author tended to ignore fundamental points, and very quickly fell into using the usual collection of tropes that "Gender Critical" advocates use. It eventually became quite clear that the author had little or no actual experience with transgender people as clients, and really was operating from a series of misconceptions as to what Gender Affirming Care actually looks like.
The last, and most direct challenge I put to the writer was to ask "how much exploration would be necessary for you to believe that the client is actually transgender?" They never provided an answer.
The Dangers
It is fairly clear to me that neither of the influencers had a clue about working with transgender clients in a psychotherapy context. They both appeared to believe that Gender Affirming Care was basically a one-way trip to medical interventions. Transgender care is ... fairly specialized. It requires developing a working knowledge of a number of areas that a lot of therapists are profoundly uncomfortable with - gender identity, sexual identity, social transition, medical transition, and so on.
There is a hazard here. These people are putting themselves and their opinions forward as though they are experts in the field of psychotherapy. The problem is that while they have training in the field, that doesn't make them automatically experts in every corner of the field. It was very apparent to me that they have no real expertise in the domain of providing care to transgender people, and yet they were quite happy to opine upon it as if they did.
The codes of ethics and conduct I am most familiar with all urge caution when venturing into areas of practice that you don't have existing expertise in. Seek out supervision and training is always the advice. Similarly, opining on matters well outside of your normal expertise is frowned upon. In both of the above cases, these "influencers" are well outside their apparent expertise and could seriously mislead other clinicians into thinking that they had expertise that they do not possess.
Then there is the danger to prospective clients. If you are transgender, then these therapists could well become a bigger obstacle for you to overcome than any internal barriers you might be experiencing. A practitioner that believes that your gender identity isn't valid on its face could lead you into any number of seriously harmful directions. Ask directly how your prospective therapist feels about transgender identities. If they can't - or won't - tell you that they fully support transgender people, find another therapist. You deserve better than to be treated with suspicion by your therapist.
Gender Affirming Care and Exploration
I want to emphasize a key issue here. There seems to be a lot of people out there, both ordinary citizens and therapists, who believe that "Gender Affirming Care" is a fast track to medical interventions ranging from hormones to surgeries that leaves no room for any kind of exploration. This is patently false.
The Affirming part of the name merely reflects a fundamental principle of therapy that Carl Rogers expressed so clearly: "Meet the client where they are, with a non-judgmental perspective and they will figure things out themselves". In other words, most people need someone to talk things through with and they will work out their own solutions.
Gender Affirming Care doesn't turn into a "railroad to medicalization". That isn't its purpose. The purpose is to address the distress that a transgender client may well be experiencing in part by acknowledging their identity as valid and where needed to take steps with appropriate interventions to reduce distress. That might, for example, involve providing "puberty blockers" to prevent the onset of more advanced stages of puberty to buy the client time to make decisions about what their future should look like.
At the core, especially for younger clients, is the idea of giving the opportunity to transition socially and to come to some kind of conclusions about whether they feel like they "fit" in the new social role that they have expressed a desire to pursue. That is, at its core, exploration.
Unfortunately, a small number of therapists have tried to rebrand coercive therapies designed to "convince" a client not to transition from "conversion therapy" (incredibly harmful - traumatizing even) to calling it "Gender Exploratory Therapy". Still the same old tactics foisted upon 2SLGBTQ people for decades as a "fix" when the underlying problem isn't actually the person's identity but society's judgment of that identity. Whatever you call it, conversion therapy is damaging.
