The Rise of the Psychology Influencer

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. 

Letting Your Biases Get In Front Of You

Yesterday, I ran across this essay on X(itter), and it annoyed me because the author makes all kinds of errors of both fact and reason.  Since things on X have a nasty habit of disappearing at random, I will start with a bunch of screen captures of the essay itself.  Then I will delve into the problems with the arguments being made. 

On Psychological Care In Managing Gender Dysphoria

This will be a somewhat lengthy post.  In part, because I find the space I am about to discuss multi-faceted, and the discussion around each facet of the conversation is non-trivial.  The involvement of mental health professionals in the process of Gender Transition (I will use the term "transition" from here on in) is complex and the subject of many strongly-held opinions within the transgender community.    This essay will be my attempt to lay out for readers my perspective on things.

Readers should note that these are my opinions today.  Time, evidence and rational counterpoint may well convince me to revise my position.

[Warning:  Lengthy Essay Follows The Jump]

Intriguing Research Findings ...

Many have speculated on the biological factors that contribute to transsexualism - anything from pre-natal hormone flush irregularities to differences in brain structure have been proposed.

I've never been overly impressed with the BSTc analysis - not only are the numbers too small, but aside from a paper or two in the 1990s, there has been no corroborating study that lends weight to it, and by the authors own admission, there are plenty of explanations for the observed evidence.

The in-utero hormone flush hypothesis has always felt similarly weak - it's an explanation, but it's almost impossible to verify. It would require numerous strokes of luck to identify a candidate or two, and then decades to follow them from pregnancy through to early adulthood. (a process which by itself may have a significant influence on the subjects)

So, when this story popped up, I was initially feeling pretty skeptical about whatever it was going to say (in fact I was worried that it was going to be more on the BSTc study).

After studying the DNA of the male-to-female transsexuals, genetic experts from Prince Henry's Institute at the Monash Medical Centre found they were more likely to have a longer version of a gene known to modify the action of sex hormone testosterone.

The genetic abnormality on the androgen receptor gene is believed to lower testosterone action during fetal development, and "under-masculinise" the person's brain, leading them to feel like a female trapped in a male body.

Actually, this makes a lot more sense as an explanation of causality than the other options that have been put forth to date. It fits well into the "Occam's Razor" principle - it's simple, covers a wide range of possibilities. Even better, it's relatively easy to pursue further. (The BSTc investigations could only be done post-mortem, and long term follow-up research with transsexuals is notoriously difficult)

Further, this particular finding also meshes well with the all too common narrative that so many transsexuals put forth that they "knew something was wrong" from very early ages - often before any awareness of social gender distinctions would be expected.

The work is far from conclusive at this time, and we should always be cautious with early results like this. I am reassured by the breadth of sample size used. (No, it's not a large sample in general population terms, but for a study involving such a tiny fraction of the population, it's actually a pretty good size for a starting point)

This writer is now going to have to go and find the actual article and study it - I'm sure that whatever is in the news is only the surface of the story.

Bible Beaters On Psychology

I love it when some loon decides to "take on" a subject they so obviously know nothing about. Such is the case when Selwyn Duke decides to try trashing psychology in The Hard Truth about a Soft Science: Why Psychology Does More Harm Than Good.

Frankly, I have no idea who Selwyn Duke is, but he (and I presume that Selwyn is a masculine name, forgive me if I am mistaken), but it's pretty clear that they are of the "you don't need a psychologist, you just need The Bible" school of dogma.

“It would be an undoubted advantage if we were to leave God out altogether and admit the purely human origins of all the precepts and regulations of civilization.”

In making this statement, Freud weighed in on one of life’s most important questions: What is the nature of right and wrong? Is it real, something existing apart from man, a reflection of Absolute Truth, of God’s will? Or is it, in accordance with the atheist model, merely a product of mortal minds and thus synonymous with consensus opinion? Freud made it clear he believed the latter.

Oh great - the opening gambit is the classic "it springs forth from atheism, it must be bad" line. Like the Fool's Mate in chess, it appears initially devastating, but it is also fairly easy to put aside. In this case, we have to recognize that Freud was recognizing that in order to achieve any kind of scientific credibility, psychology would have to put aside any reliance on explanations that depend on the unknowable and unprovable assertions that religious faith depends upon.

“Nearly three-fourths of Americans say their whole approach to life is based on religion. But only 32 percent of psychiatrists, 33 percent of clinical psychologists and 46 percent of clinical social workers feel the same.”


Yet even this understates the matter. Like so many nowadays, these people’s ideas about faith aren’t the traditional variety. They may pay homage to an ambiguous conception of spirituality and profess a belief in God, but just ask them about morality. More often than not they will tell you that right and wrong is a matter of perspective.

Ah, so because the percentage of "religious" psychologists out there doesn't reflect the "average American", there's no way they could possibly understand the "average", right? Wrong - dead wrong. Science demands that you explain things in terms of the understandable, not in terms of "God did it" - this is why "Intelligent Design" will never be taken seriously as science - it leaves itself the exit to the untestable when it gets into difficulties.

The problem with this is that reality doesn’t yield to preferences, and you cannot improve something’s function if you misunderstand its nature. If psychology’s predominant school of thought is correct and there is no God, no Truth and we have no souls, then, sure, we are simply a few pounds of chemicals and water; hence, organic robots. And this would have some staggering implications.

Ah, now we start to get to the meat of the argument. Psychology doesn't make any claims about the existence of God, some divine "Truth" or souls (at least not today). I've already stated why it doesn't make such claims. Calling us "organic robots" is also a gross oversimplification, and it suggests something that is quite false - namely the implication that we lack any kind of "free will" that stems from the autonomy of the soul. I don't think any psychologist would argue that we are "bio-mechanical automatons" - there's too much variety in our behaviour and expression to assume that we are 'automatons' of any sort.

The issue of "free will" is simply accepted as a norm. In the absence of any compelling explanation, one accepts the ability of a person to think for themselves. However, the underlying mechanism of how our mind functions as a bio-chemical process is definitely important - not in psychology per se, but rather in biology and medicine. However, the author isn't interested in actually understanding any such thing, instead draws some amusing, but horribly flawed, consequences.

For one, morality is then mere opinion, and we can’t expect opinion to govern the operation of the human “machine” any more than it influences the rotation of the Earth. But what if we are spirit as well as flesh?

Welcome to the first mistake the the religious make when they start criticizing the atheism of modern science. The claim goes that if one is an atheist, then where does one's moral code originate from? Of course, it is inadequate for them to accept that moral codes exist within the context of the society an individual lives in - in spite of the obvious differences in moral codes between (for example) China's villages, tribal Afghanistan and Calgary, Alberta.

Even if, as the author claims, we are possibly "spirit and flesh", that clearly makes very little difference to the contextual nature of human moral codes. The variety of those codes, and the shared objective of achieving some kind of "truth" through them suggests strongly that those moral codes are in fact inventions of human society and the interactions that take place in the context of society.

Yet the problem with psychology is not just that those within the field may be peddling a relativistic creed, but that it has provided a specious scientific basis for relativism’s wider embrace.

Ah - specious argument number two. The classic line that if you do not subscribe to a system of beliefs rooted in millennias-old scripture of some sort, you are a "relativist", and thus fundamentally without moral structure. Of course, nothing could be further from the truth. I may reject the formal practice of "Christianity" as a person, but because of the social context in which I live, there is no doubt that some of my personal moral code is rooted in whatever form of Christianity those most influential in my life followed.

The concept of moral relativism scares the hell out of the devoutly religious because it involves taking each situation on its own merits and evaluating it based upon thought and consideration rather than simply adopting someone else's written code (or worse, someone else's interpretation of a moral code that reflects a society thousands of years in the past). Relativism requires the individual to be actively engaged in their world and willing to consider things they had never thought of before.

For this reason, I might call psychology the science of why we not accountable. Think about it: Everything formerly labeled a sin is now diagnosed as a disease or condition of the brain

Now, here's where he really goes off the rails, and shows us how little he actually understands. Psychology - or perhaps more correctly, Psychotherapy, is in fact all about taking ownership of how one feels and acts. Learning to cope with situations that are often complex and multi-faceted is a long process that beyond all others requires the client to not only be completely honest with themselves, but to then learn to find constructive ways to conduct themselves.

Even in cases where known biochemical problems exist, and there are medications that can be used to treat the symptoms, the patient (or client) still has to learn how to manage those aspects that the medication only mediates.

After all, if we are merely organic robots, at the mercy of our genes (hardware), chemistry and upbringing (software), we have no free will. It then follows that we cannot choose among, well, call them what you will, God’s morals or man’s values, as we are directed by things beyond our control. This reduces us to animals.

Ah yes, argument by "reductio ad absurdium". Of course, the problem with this argument is is that it is based on the slippery slope hypothesis - namely that if "x" is true, then by inference some extreme conclusion must also be true. I don't think anyone - atheist or otherwise - argues that human beings are solely acting on things beyond our control. To argue that we logically reduce to such a simple-minded model of existence is disingenuous, for it ignores our ability to moderate our own responses to stimuli consciously. I may be angered by something, but that doesn't mean I am obliged to act upon that anger, does it? Does this prove in any material sense that I have some divinely-provided soul? No. of course it doesn't.

Thus, insofar as psychology succeeds in convincing us that there is no accountability because there is no free will – no ability to choose sin because there is no sin, only disease – it dehumanizes us.

I've already shown that the claim that psychology tries to remove from us individual accountability is false. The claim that "sin == disease" is similarly a false equivalence. Just as members of different faith communities have very different ideas as to what constitutes "sin", psychology makes no such claims. Further, the author is making the incorrect interpretation that the DSM describes "diseases". The DSM is best seen as a descriptive lexicon. Although it does describe very serious conditions such as schizophrenia that do require medical intervention to control, it also describes a lot of other conditions which are merely descriptive. (For example, it describes tobacco addiction, but someone addicted to tobacco is hardly "mentally ill")

Perhaps this dehumanization is why psychiatry has quite a history of using humans as guinea pigs. There was Benjamin Rush (the father of American psychiatry) and his bloodletting; Nazi experiments; electric shock and lobotomies; our MK ULTRA mind-control program; and Canadian psychiatrist Heinz Lehmann, who illegally used Thorazine on subjects in the 1950s.

While there is some validity to the criticism that psychiatry has made some pretty awful missteps, we should similarly remind ourselves that medicine in general has made similar (and worse) missteps throughout history, and that modern psychology in general is only a little over 100 years old today - making it very much the "baby" of the medical professions.

Frankly, religion has made equally egregious misinterpretations over the years when confronted with new ideas that fall outside of "current dogma", so I am much less than convinced that one can use the biblical notion of "flesh and divine spirit" as a particularly useful guide either. (In fact, there are many aspects of my own reality that in centuries past would have resulted in me being burned at the stake or locked up for most of my life as being "marked by the devil" - for no greater a sin than being born left-handed, for example)

Aside from the obvious lack of compassion inherent in yesterday’s uses of the field, I also have to wonder about today’s. We’re often told that taking people to task for moral lapses, whether the issue is drinking, drug use, perverse behavior or something else, is uncompassionate.

The distinction is in understanding the nature and structure of the various behaviours. Where the religious will often engage prayer to "overcome" some challenge or another, it is hardly definitive that such strategies will work. For example, one must understand that where someone is physically addicted to a substance, that treatment must provide them not only with relief from the cravings that drive the addiction, but also with coping strategies that help them avoid the circumstances under which the addiction manifests itself. Other situations often condemned by religious morals are now understood to be sufficiently core to the person's identity that it is unlikely that any intervention will be effective. While the moral codes of religion may have their place, in such situations one has to re-evaluate whether or not the moral strictures involved are in fact meaningful.

And what happens when the matter of religion is raised? If you’re like many, including someone I know of, you may be told you’re taking your faith too seriously, that such devotion is akin to a mental illness. This isn’t surprising, I suppose. What future could a person have with an “illusion,” even the very attractive one that Freud seemed to believe was the opiate of the masses?

Hmmm...given what I've read of some of the more famous Saints, one could argue that their "divine revelations" would be better described as either hallucinations or other psychological phenomena. (Hey - if you want to believe that St. Francis was divinely inspired, that's fine with me) Most psychologists I know do not dismiss religion as an important coping tool for people; but then again, that doesn't mean that they believe it is "real" either.

Oh yes, it Marx who characterized religion as "the opiate of the masses", not Freud.

Again, the author's dismissiveness of psychology in general appears to stem from his ignorance of the subject as a whole, and his rigid belief that all stems from some divine truth - the nature of which he asserts, but cannot prove - any more than current day psychology (or psychiatry) can actually describe in any detail the causal origins of so many conditions that are part of the human condition.

Simply because something stems from an atheistic tradition (atheism in this case meaning literally "without god" as opposed to an active denial of god), doesn't invalidate it or make it harmful. In fact, many of the issues that people wind up seeing a psychologist about stem not from the issue itself, but in fact from the conflict with arbitrary moral strictures that stem from someone else's religious views.

More Argument By False Authority

It appears that NARTH is at it again. This time, we find them quoting a psychiatrist on gender identity issues - of course in a manner intended to deride and denigrate transsexuals as illegitimate people.

Follow things far enough, and you find the NARTH article linking to an opinion piece on MercatorNet, a "newsmagazine", with a suspiciously overt Christian Conservative slant to its articles. Why an organization like NARTH that is ostensibly about research would like to what is so obviously pure opinion is beyond me, but link they did.

The article itself is rather long winded, and boils down to "we shouldn't provide gender transition as a treatment for transsexuals, we should treat them as mentally ill instead".

Newsweek also avoided the other key debate about this difficult issue: whether or not transgenders have a mental illness or merely an inconsequential desire.

Since the term "transgender" is rather broad, covering anyone who exhibits some degree of cross-gender identity - from cross-dressing occasionally to transsexuals, this is actually a very misleading statement. The Newsweek article was actually quite specifically focused on transsexuals.

If you are talking about non-transsexuals, then yes, there are legitimate questions as to the degree of their cross-gender identity. (In many respects, this is no different than is often found among bisexuals, who experience varying degrees of attraction to members of either sex. Some bisexuals are primarily heterosexual, with some undercurrent of same-sex interest, others are much more fluid in their experiences of attraction.) However, since the Mercatornet article is focused upon the provision of surgical gender alignment to patients, let's be clear that they should be referring to transsexuals.

However, this is only the beginning of the writer's attempt to dismiss the validity of the transsexual narrative. By misusing the terminology, the author sets the stage to proceed with attempting to invalidate that narrative by insinuation and distortion:

A few years ago I attended a program at the American Psychiatric Association’s Annual Conference. An editor of the DSM was under attack for describing gender identity disorder as a mental illness. But in the course of the debate, in a remarkable display of having your cake and eating it too, the transsexual woman who argued against its inclusion was forced to admit that a DSM diagnosis was necessary after all. Why? Because otherwise people suffering from the disorder could not get their health insurance company to cover the cost of the procedures.

There is a classic error of logic being presented here. The author has attempted to spin it into the "you just need the diagnosis for money". This is false. As I have pointed out before, the DSM is a lexicon needed by medical professionals (both mental health and physicians) in order to communicate in a meaningful manner:

The mistake many people make is that they assume that a diagnostic category in the DSM actually means that someone so diagnosed is "mentally ill". The reality is that for a large number of conditions described in the DSM, the person is not "mentally ill" in the sense that they cannot function in society, but rather the diagnostic category serves primarily as part of a lexicon so that professionals can adequately discuss the particulars of a patient's case with a reasonably common understanding of meaning.

I'm rather appalled to see that Theron Bowers conveniently ignores this reality - especially when Dr. Bowers is a psychiatrist! (Of course, I should point out that Dr. Bowers does not list either sexuality or gender as an area of specialty - and those areas are unique specialties indeed!)

The author conveniently cites writers like Dr. Paul McHugh and Michael Bailey - both authors that in varying degrees seek to refute the transgender narrative. (How you refute someone's life experiences, I do not know, but they keep trying)

Although Theron Bowers does not resort to the language of religiosity, it's pretty obvious that the argument has its roots in the religion. Dr. Bowers does not speak to the clinical realities for transsexuals (such as the fact that the Standards of Care (a document which provides guidelines for treatment of transsexuals) is quite detailed about the management of these cases, and promotes a high degree of professional caution with respect to the clients.

Amusingly, Bowers cites Bailey's assertion:

However, sex researcher J. Michael Bailey in his book, The Man Who Would Be Queen, notes the decision for sex reassignment has a "rational component" and that the "large majority of boys who start out looking transsexual ultimately do not pursue sex reassignment."

Cross-gender children are rare indeed, and still relatively poorly understood. While only a handful of children that exhibit cross-gender behaviour at an early age go on to pursue gender transition, one should point out that the SOC document itself is quite clear about caution, and recognizing that not everybody who is cross-gender identified needs to transition.

However, unlike what Bowers and others attempt to infer, that does not mean that nobody needs that treatment. (Even Bailey, whose positions are generally held in some contempt among transsexuals, admits that some people legitimately need to transition and are quite successful afterwards)

I find it somewhat ironic that in order for NARTH to find pieces that back up their narrow-minded view, they have to resort to people writing opinion pieces in non-refereed publications, and riding upon the fact that the author has a PhD or MD, without actually wondering aloud whether the author has a clue about the subject at hand. (Bowers appears not to, rather relies on a bad mixture of assumptions, public policy commentary and assertions that are weakly supported at best)

It tends to reinforce the perception that these people aren't about research, and are more about forwarding a highly politicized agenda that involves the bully-boy tactics of denying others their stories.

Perhaps most amusing is the assertion that a transsexual needs psychiatric treatment, as if there is no program of treatment involving psychotherapy before surgery - a reality that exposes the lies of these people for what they truly are.