Two years on from 2017 when it began, we’re still in the midst of a
moral panic about trans. Daily news stories across all sections of the
media continue to spread myths and misinformation about trans people.
It’s hard to even imagine the extent of the damage caused to trans
people living our lives in this culture of hatred and denial of our
basic existence and human rights, particularly young people who are
growing up in this climate.
One topic which comes round frequently in this moral panic is the help
and support given to people – particularly young people – who are gender diverse, or exploring their gender. Claims are often made that people
are pressured to go down particular roots, for example that anybody who questions their gender is pressured to come out at trans, or that
everyone is quickly pushed down a particular pathway of medical
treatment and surgeries.
I was recently asked to put together a factsheet about what Gender
Affirmative Therapy – or Gender Affirmative Practice in general –
actually looks like: to put the record straight about what therapists, activists, and other practitioners in this area are actually doing – and inviting others to do. Here it is. You can download the pdf, or read the
whole thing below that.
Gender affirmative therapy (GAT) is any form of counselling or
psychotherapy which seeks to help people to come to a consensual,
comfortable, and self-accepting place with their gender. It is founded
on the position that no gender identity, expression, or experience is
any more valid, ‘natural’ or ‘normal’ than any other. In this way GAT sits in opposition to any form of conversion therapy which attempts to
change a person’s gender identity or suppress their experience or
expression of their gender.
Why is GAT important?
We all have a relationship to gender and these are often related to our experiences of mental health difficulties, for example:
o Attempts to conform to rigid masculine gender roles – including demonstrating strength and suppressing emotion – are linked to the high suicide rates, and to addictions and violent behaviour which also impact
the mental health of others
o Attempts to conform to rigid feminine gender roles – including being defined by attractiveness and relationships with others – are linked to
high rates of body image problems, depression, and anxiety
o Cultural transphobia and assumptions that people should remain in the
gender they were assigned at birth are linked to high rates of suicide attempts, self-harm, and mental health struggles among trans people via
common experiences of bullying, discrimination, and family rejection
o Assumptions that gender is binary, and the cultural invisibility of non-binary genders, are linked to the high rates of mental health
struggles among non-binary people (those who do not experience
themselves as male or female)
For these reasons it is vital that therapists and counsellors are
gender-aware and gender-affirmative: able to help their clients to
understand the range of options they have in relation to gender and to
support them in navigating these
What are the underpinning assumptions of GAT?
GAT is based on the position that gender is diverse and that no gender
identity or expression is inherently superior or more ‘natural’, ‘normal’ or valid than any other. This includes the following assumptions:
o It is no more preferable to be cisgender (remaining in the gender you
were assigned at birth) than it is to be trans (shifting from the gender
you were assigned at birth), or vice versa. Both trans and cisgender are
big umbrella terms encompassing a diverse range of experiences,
expressions, and identities
o It is no more preferable to identify as a woman, as a man, or as a
non-binary person, or to express femininity, masculinity, or any form of androgyny or non-binary gender
o Most people identify, express, and experience their genders in
different ways over time as they find more comfortable and consensual relationships to their gender. This can involve: changing dress and
appearance; shifting titles, names, pronouns and other identifiers;
taking external hormones; undergoing surgical procedures, etc. It’s
important to remember that such changes are commonplace among cisgender
and trans people alike (e.g. women and non-binary people may take
oestrogens and progesterones because they are menopausal, trans, seeking
birth control, intersex, or experiencing endometriosis; people may have mastectomy/breast reduction because they are trans or non-binary,
because they are a man with gynecomastia or pseudogynecomastia, because
they are a woman who doesn’t wish to be sexualized or otherwise
stereotyped on the basis of their breast size, or because they are a
person who is at risk of breast cancer or migraines related to breast size)
o No particular gender journey is preferable to any other. For example,
it is no more preferable: to express gender in culturally normative or non-normative ways, to undergo social or physical changes or not to
What happens in GAT?
The emphasis in GAT is on supporting the client towards a gender
experience, expression, and identity that feels comfortable and
consensual to them.
o We live in a culture which privileges being cisgender over trans,
being binary over non-binary, being a man over being any other gender,
and being masculine over expressing gender in other ways. Therefore GAT
may well involve unpacking cultural norms around gender and how they
have impacted the client
o Our culture also regards some gender identities, expressions, and
journeys as more acceptable or ‘normal’ than others, so GAT may involve normalising and legitimising the various options available to the client
o Gender intersects in vital ways with other aspects of experience (e.g.
race, class, sexuality, age, generation, mental health, disability) so
GAT does not focus exclusively on gender but rather explores it in the
context of the client’s background and wider world
o Given that there is still a great deal of stigma and discrimination
around any gender non-normative expression there may well be exploration
of how clients can navigate the wider world in ways that are
safe-enough, and the balance between this and expressing their gender in
ways that feel comfortable and consensual to them
What doesn’t happen in GAT?
There are many myths about what happens in GAT, largely due to the
current moral panic about trans. The following things would never happen
o Suggesting that a person must be trans simply because they have a
gender non-normative experience or expression, many cisgender people
also have these
o Suggesting that a person must be cisgender because they do not seem
trans and/or non-binary enough to ‘count’
o Encouraging a person to take puberty blockers or hormones, or
discouraging them from doing so if that feels like the best path for them
o Encouraging a person to have surgical interventions, or discouraging
them from doing so if that feels like the best path for them
o Rushing anybody into any form of gender identity, expression, or
o Encouraging any decision before a person is fully informed about what
it would involve and what impact it would have on them physically, psychologically, and socially. Informed consent is vital
You can find the research this factsheet is drawn on in:
o Barker, M-J. (2017). British Association of Counselling &
Psychotherapy Good Practice in Action Fact Sheet 095: Gender, Sexual,
and Relationship Diversity (GSRD).
o Government Equalities Office (2018). National LGBT Survey: Research
Other useful resources include:
o The Memorandum of Understanding on Conversion Therapy in the UK,
o Stonewall trans report
o Trans panic
o Iantaffi, A. and Barker, M-J. (2017). How to Understand Your Gender.
London: Jessica Kingsley.
o Pink Therapy
There is no verifiable evidence that gender dysphoria can be treated in
other ways than transitioning. None whatsoever.
Gender-affirmative trans care *requires* therapy. That is, unless you go
the informed consent route, which you can always refuse to.
Scaring trans people away from transitioning and repressing their
identities *IS* conversion therapy.