A Teen Therapist Writes About Gender Identity Issues — Sally’s Story

Sasha Ayad, M. Ed., LPC  is a therapist with extensive experience working with teens, and gender defiant teens in particular. When she started to notice her bright, creative gender defiant teen patients feel that they needed to define themselves by picking a label that then sometimes encouraged them to make permanent changes to their bodies, Sasha found herself thinking critically about this trend. She has researched gender identity issues in teens extensively, and has a private practice where she works to support gender questioning youth. In Sasha’s words

“I use non-judgmental, compassionate, dialogue that focuses on exploration rather than immediately seeking to affirm and transition your child. Together with your teen and family, we consider multiple complex factors that may contribute to their dysphoria, including social, cognitive, environmental, physical, and emotional factors. Treatments may include mindfulness, somatic, and integrative techniques as well as confidence-building, and age-appropriate sexual identity exploration. I also educate parents about the topic of gender identity, break down stereotypes, discuss risks, and encourage parents to become deeply invested in the process so they can best support their child outside of therapy sessions. While transition may be the best option for some kids, many others have had very painful and negative experiences with their transition, and I help families prevent this from happening. I believe I owe it to your child to be thorough and careful in my approach, placing safety, well-being, and happiness above all else.”

The following piece was posted originally on Sasha’s blog. While the current narrative around helping trans identified teens creates a false dichotomy between affirming a teen’s identity and being unsupportive or rejecting, Sasha’s work beautifully illustrates how one can offer unconditional support while helping a teen to navigate the confusing waters of identity.

Sasha can be reached at 888-945-8207 or  Sasha@Inspiredteentherapy.com. You can also find her on Facebook.

sally-blogI was busy working on a behavior plan for a very fidgety 6th grade boy when I heard an assertive knock on my office door. This was the third time this week Sally had left class without permission to come talk to me.

“Ms Ayad, how can I transfer schools? I really don’t think I can get a proper education here and none of the teachers know what they’re doing”, so began our 45 minute conversation. She often got fixated on one or two teachers, who despite their best efforts, could not find a good way to work with Sally. I had a very different relationship with her though, and I was able to help her work through some of her generalizations and logical leaps.

Her hair was always pulled back hastily in a low ponytail, the eczema around her mouth, though visible, wasn’t as noticeable as the smudges that covered her glasses – she pushed them up from the lenses every time. Often a curious little smirk would lift the corner of her mouth, even when she was clearly upset or discussing something serious.

She is one of those kids who teachers were often exacerbated by, but I got to see her in a different light, and I found her endearing, creative, and incredibly interesting.

Once we were able to conclude that switching schools was not the best option, and I taught her some self-regulation skill using a squeeze ball, it seemed she was much more at ease. She took a deep breath and said “Ms Ayad, can we talk about that other thing now?”

“You mean gender?” I replied. She nodded.

Sally and I had been talking for the last several months about her “gender identity”. When she first brought this up to another counselor, they referred her to me, knowing that I am experienced and confident in working with kids around this topic. However, Sally had certainly been exploring this issue online for months she brought it to the attention of her school counselors. Our first conversation on the topic made it clear that she had a broad vocabulary (straight from gender identity theory) which is not typical for most middle-school students.

My approach was patient, inquisitive, and I challenged her… just a bit. When she talked about her parents pressuring her to wear dresses and “act more like a girl”, I made a point of breaking this down, deconstructing what that means, and sharing ways that we all behave outside of gender stereotypes: and that’s a GOOD thing!

When she told me, weeks later, that she was looking for binders online and asked me to stop using the pronouns “her” and “she”, I felt deep pangs of worry, but took it slow. I asked her where some of these ideas were coming from: she was spending hours on tumblr, trans-advocacy sites for teens, and chat groups with other kids who she believed were “just like her”. I treaded very carefully, but told her about the medical dangers of binding and what the long term consequences may be. Our limitations in the school system made it hard to get too deep on these topics, but in every brief interaction with Sally, I found ways to empathize with her struggle, instilling pride in who she is, and still gently challenge her flawed ideas.

I deliberately pointed out all of the ways she doesn’t conform to gender stereotypes, without implying that she’s in the wrong body: her love of manga comics, her cargo pants, her disdain for dresses and “girly” clothes, in my eyes, made her a unique and awesome person. Hearing those compliments always brought that endearing little smile to her face.

Eventually, as her classroom behavior improved, her anxiety lessened, and she started making friends, she relied less and less on me for support that year. Several months passed and before I knew it, the school year was coming to a close. I wanted to follow up with Sally, so I pulled her from her PE class and we talked outside on a particularly nice, sunny afternoon.

I started with, “Sally, I’ve missed you, how are things going? It seems like we haven’t talked in forEVER!” A huge smile emerged on her face, and since her glasses were less smudgy than normal, I could actually see that her eyes were smiling too.

“Doing great! I’m getting along better with Ms Barnay and I haven’t been walking out of class when I feel frustrated”. We talked about the anime club, her plans for summer, and how her other classes were going. She paused, looking ready to tell me something that meant more to her than academics. “Ms Ayad, remember how we used to talk about gender a lot? Well, I’m kinda over it”.

“Ok, tell me what you mean by ‘over it’, Sally”.

“Well before, when I didn’t have any friends at school, I was meeting a lot of people online and I thought they were my friends. Then when I actually started hanging out with people in real life, things felt different. Before, I really wasn’t comfortable with myself so I felt like I needed to change. But now, I’m ok with myself”.

I nearly fell off the bench. This was one of the most profound realizations a therapy client can make – and she, even in her young 13 year-old body and mind, came to this conclusion by herself: “I really wasn’t comfortable with myself, so I felt like I needed to change. But now I’m ok with myself”.

I was grinning from ear to ear by this point. I told her how incredibly proud I was, that I was so happy she was feeling good about herself.

Over the summer I thought often about Sally’s story. While she turned things around largely on her own, I can’t help but wonder how things might have unfolded had I followed the prescribed gender identity model.

What if I had asked about using male pronouns?
What if I had been very supportive of her desire to bind her chest?
What if I had affirmed the idea that because she doesn’t like dresses and feels like she identifies with trans kids online, that she too may be a boy stuck in a girl’s body?

And what if I hadn’t directly (though gently) challenged some of her flawed beliefs – that stereotypes and clothing styles are a good foundation on which to question your biology, to modify your body parts, and to change your entire identity.

These are questions gender therapists HAVE to ask themselves, and it frightens me that most aren’t. Our kids are dynamic, different, and unique. But they also have insecurities, self-doubt, and are vulnerable to finding “solutions” in the wrong places. When a teenager feels isolated and misunderstood, trans-advocacy sites can convince them that hope lies in changing who they are. And isn’t this the opposite of what we’ve always tried to instill in kids: self-love, confidence, and embracing their uniqueness?

Regardless of the misinformation and wayward perspectives currently taking over the mental health field, I will continue to focus on self-acceptance for my clients. Sally’s story, and many others like it, will be our reminder that in counseling, self-loathing should never be promoted over self-love.

*The names in this story have been changed to protect the identities of the people involved.

Marcus lives in the United Kingdom. He can be reached at @LogicalMarcus on Twitter. He has provided an extensive bibliography at the end of this piece. 

   fireworks I am nine years old and at a Halloween party. I am playing with a boy my own age with black curly hair. As the fireworks go off I notice how beautiful he is. I never see him again.

    I am fourteen and unhappy. My school friends talk about girls all the time, and I can’t relate. I am becoming bookish and withdrawn. In the local college library I find a book by William Burroughs describing a wild life where men love other men in a city called San Francisco. I find the book exciting. I have never heard the word “gay” other than as an insult before.

    I am fifteen and at a sleep over with a male friend. We are watching porn. I am thinking about kissing him. I feel scared and the moment passes.

    I’m seventeen and I have a girlfriend. I was so happy to prove I am normal like my other friends. I didn’t care for kissing her, but I try anyway. I tell her I think I am bisexual and we argue. We break up three months later.

    I’m nineteen and I have slept with a boy for the first time. We met on the internet. He is a tall and handsome Indian boy. I am white. We did it in his car to Daft Punk’s Discovery album. For the first time I tell a close straight male friend I think I am gay. He is accepting and supportive.

    I’m twenty-two and my friends know I am gay. A few colleagues at work do too. I have some gay friends and I have dated a couple of guys. I am starting to feel comfortable being who I am. 

    I’m twenty-four and it is the mid 2000s. I am coming out to my parents. I planned it carefully. They have never made a homophobic remark but I have read accounts of coming outs going poorly, so I have waited till I am an independent adult. I tell them I have a boyfriend called Matt. They take the news with no real rancor. My father tells me to be careful about AIDS and my mother cries because I will not have children. We continue to love one another.

   Every gay and lesbian person has a story of how they came to accept themselves. Realizing you are gay can take a long time. It took me at least ten years, much denial, some unhappiness, and lasted until I was a grown man. There was never a moment as though a sign turned on in my head to say “You’re gay.” For a long time I tried to ignore it or bargain it away: I didn’t want to be one of “those” people, who seemed to be on the margins of society. Self acceptance and coming out were gradual, constant negotiations between my feelings and what I felt safe and comfortable saying, to myself and others. But I am just who I am, a gay man, and there is nothing wrong with that. The rest is society’s problem, not mine.

  As an adult I hoped growing up gay would be easier for children today. With what’s commonly called LGBT acceptance, gay and lesbian people are full legal citizens in many Western nations, and can marry, and have basic protections from prejudice. We are not yet full social equals – holding hands and kissing as a same sex couple can attract unwanted attention and be dangerous, “gay” is still a playground slur, and we rarely see our lives reflected in the media. But when I see young gay couples walking around, I feel intense pride and happiness that the situation is improving.

    Recently I have read many accounts of parents raising so-called “transgender kids”. This is a new thing, specific to wealthy Western nations and in particular the US, that did not exist when I was growing up. These are children who are held to be “female brains in male bodies”, or vice versa. The science does not support this claim: science shows that there are no male or female brains. These “transgender kids” are not diagnosed by scanning their brains. They are boys who prefer, in some way, “girl things”, or the other way around. These children are dysphoric, that is unhappy, specifically with the kind of things they can do as boys or girls. They can be as young as three or four. For example:

    Calls to help sex-change kids as demand for gender reassignment soars

    For such children, an increasing number go through the following regimen: social transition (dressed as the opposite sex), then subjected to increasingly invasive medical treatment: puberty blockers, then cross-sex hormones, followed by sexual reassignment surgery at adulthood or even mid teenage years. Transgender kids seem to be a trend in the USA and UK, and the numbers reflect that, with steep increases at “gender clinics”. But how is it possible so many children are just now being declared to be in the “wrong bodies”? This looks alarmingly like a kind of conversion therapy.  Studies (links below) have found that most children who express “gender identity disorder” did indeed desist and become gay adults in the past.

    As a gay man, who also has struggled at times to accept myself in a society that does not always accept me, it is troubling to see children encouraged to think their bodies are wrong for the way they behave or the way they feel. The root of this seems to be a conservative enforcement of the same stereotypes that make gay people suffer. Even when these children are said to declare they are in the wrong body I think it is plausible they are doing so out of an awareness some kinds of bodies are being allowed to do some things, but not others, and if you want to do those other things you had better have the other kind of body.  But surely it is better to tell all children that they can do, wear, and enjoy whatever they want without it being “wrong”.

I think there is a fad, or a contagion, going around parents and medical professionals, being pushed by motivated activists and fed by well-meaning liberals and echo chambers on social media, for declaring children to be transgender. Although society recognizes this as real, for example in educational material and school bathroom use, there does not seem to be solid science or evidence behind this condition being more than a cultural issue. I am concerned this fad will harm children through unnecessary medical treatment with permanent effect – sterilization for example, or the irreversible effect of testosterone on the growing female body.

In particular, a trend for transgender kids seems to target those children who do not conform to stereotypes society expects them to obey on account of their sex: who very often grow up to be wonderful, happy, effeminate gay men and butch lesbian or bisexual girls. We need years or decades to grow into ourselves as gay adults and the medicalization of difference through transgender seems like an attack on our personhood, an attack on our right to process being gay, painful and confusing and messy as it can be.

I have known dozens of gay men and lesbian women who might well have been “trans kids” today. Some of these gay men like to paint their nails, or dress up in women’s clothes (drag), and they care very much about clothing, and have some effeminate mannerisms. Some of these lesbians are rough and tough and they like short hair and clothing cut for men. They are happy and comfortable being who they are. I admire these non-conforming gay and lesbian people very much, because most never had the luxury of the closet, like I did. If they had been made into “trans kids” in order to produce humans who conformed better to a standard I think the world would be a poorer place and they would have been harmed. If the prevalent view of transgender is wrong then harm is being done to children and we cannot remain silent.

    I have also met transgender people, in real life and online, and I have listened to their pain over their “wrong bodies”. But I also do not understand how transgender can be destined or “real” in the same way that being gay is real. Transgender and gay are not interchangeable. There are profound differences between gay and transgender. The idea of transgender as a biologically destined, permanent, fixed identity should be justified on its own merits, not by a silencing tactic where activists claim their cause is no different from gay rights and scream “Transphobia” at all questions. Gay activists never had to silence, shame or threaten opponents, because our cause is just, cohesive and reasonable, and stands by itself.

    Nobody has ever shown being gay can be “cured” but there is evidence that transgender people do sometimes stop being transgender. People do detransition.  One way in which gay people have also argued against a notion that being gay was wrong was to point to gay animals. There are gay animals everywhere, and our closest ape relatives the bonobos are thoroughly homosexual, but mammals do not change sex. Nobody has ever seen a transgender sheep, where a ewe becomes a ram. A dominant female hyena can take on a male role but it is still a female that has a different, natural, hormonal balance, not a male hyena.

    Most importantly “the mind does not match the body” is the opposite of what being gay is about. At the end of our coming out stories, gay and lesbian people are comfortable being just who we are. There is nothing wrong with us, nothing wrong with the way we were born. Our problem is society’s prejudice, not our minds or bodies. Lesbian, gay and bisexual people have always demanded freedom from persecution and acceptance as the social and legal equals of straight people, which we are.

    There is no need for medical intervention, hormones and surgery to be gay. In fact the words transition and conversion are synonyms. There are alarming similarities between the discredited notion of conversion therapy against gay children and so-called gender transition therapy. Reinforcing this, conservative Islamic nations such as Iran, the United Arab Emirates, and Pakistan, all punish homosexuality, but encourage or mandate a conversion of gay men to transgender women via sexual reassignment. It is appalling to contemplate supposedly liberal parents replicating Iran-style erasure of gay people on their own children.

    Seen this way transgender could be compared to anorexia, because here too there is great unhappiness about the body. Anorexia is a real and serious condition, and anorexic people must have their human dignity respected, but it would be dangerous to say we should accept anorexia, or tell children anorexia was okay. Magazines that promote anorexic models and celebrities are criticized and there is an attempt to stop the fashion industry from doing this.

I probably would not have been a “trans kid” if I had grown up today. I was not effeminate but bookish and a science geek, and with the trend for medicalized childhoods, I might have been diagnosed with something else. There is a broader and long term trend of over-medicalizing children. A diagnosis like ADHD seems to often reflect an attempt to contain rambunctious childhood personalities. Of course medical treatment is not always bad but it must also be based on the best evidence that it is necessary and not harmful. What kind of evidence should we demand before assigning a child a medicalized identity, setting them down a road that can end in sexual reassignment?

I think parents and children should not always pursue instant gratification even if medicine seems to offer it.

Further reading

Human brains cannot be categorized into two distinct classes: male brain/female brain
There is probably no such thing as a ‘male’ and ‘female’ brain
Is there something unique about the transgender brain? These brain scans don’t reflect gender identity, they reflect sexual orientation.
New MRI studies support the Blanchard typology of male-to-female transsexualism
Ethical issues raised by the treatment of gender-variant prepubescent children: only 6 to 23 percent of boys and 12 to 27 percent of girls treated in gender clinics showed persistence of their gender dysphoria into adulthood
Gender identity clinic for young people sees referrals double
Surge in demand sees one year waits for children’s transgender clinic
Child gender identity referrals show huge rise (930%) in six years
More U.S. hospitals offering gender affirming surgeries
Transgender kids: ‘Exploding’ number of children, parents seek clinical help
‘I was a boy.. then a girl.. now I want to be a boy again’: Agony of of teen who is Britain’s youngest sex-swap patient
Boy ‘living life entirely as a girl’ removed from mother’s care by judge
Mother of Transgender Toddler Gets a Lesson in Love
Clinics are popping up across the country to help kids as young as 3 who might be transgender
‘Thank God I didn’t have a sex change’: Gay actor Rupert Everett tells how he grew up wanting to be a girl but cautions against allowing children to make rash decisions on surgery
Furious parents slam ‘damaging’ BBC sex change show aimed at six-year-olds
100% blocker-to-HRC persistence rate in children
Transgender Youth: Are Puberty-Blocking Drugs An Appropriate Medical Intervention?
53% of mothers of boys with Gender Identity Disorder have Borderline Personality Disorder compared to only 6% of mothers of normal children
Female detransitioner survey
Female detransitioner speaks
Another teen goes from “I’m happy in my male body” to “I am truly a girl” in a few days.
Desistence of gender identity in children:
Do trans- kids stay trans- when they grow up? Only very few trans- kids still want to transition by the time they are adults. Instead, they generally turn out to be regular gay or lesbian folks. The exact number varies by study, but roughly 60–90% of trans- kids turn out no longer to be trans by adulthood.
A New Way to Be Mad: Can the mere description of a condition make it contagious?
Why Some of the Worst Attacks on Social Science Have Come From Liberals
How did transgender get included in LGBT?
The attack on Germaine Greer shows identity politics has become a cult
Purplesagefem: Blatant homophobia