Okay, so I was talking about Di Ceglie's article in Journal of Child Psychotherapy 44:1 (special issue on working with gender identity) bit.ly/2K0DJNw. This piece is intended to 'set the scene' for the issue, so my q. is what assumptions are made in the scene he sets?
Di Ceglie foregrounds concern for his service and career over concern for children who use GIDS. Much of this article focusses on the perceived threat of service closure, the fear of being "pushed over the edge and therefore disappearing".
He argues that this 'living on the edge' mirrors the position of trans kids in society, then cites the "closure of a well established GIC for children in Toronto" as an eg. of this risk. Given the history of abuse in this clinic this comparison seems inappropriate & disingenuous.
He introduces the metaphor of Ulysses navigating between the twin threats of Scylla & Charybdis, to illustrate the position of the GIDS service director re. the provision of puberty blockers. Di Ceglie is the 'cunning' protagonist, who must navigate these dangerous waters...
Scylla is the threat of a "too hasty" use of blockers (as called for by pro-trans orgs). Charybdis is the opposition to blockers within the service and wider profession. The risk of getting this wrong is service closure.
It's telling that the evolution of discourse which centres trans perspectives & wellbeing is presented a threat to GIDS & clinicians, at the point that their power and responsibility as gatekeepers to medical interventions is increased
But this stance extends beyond medical qs of access to puberty blockers - should the psychotherapist support a social transition? Should they accept a child's self ID or question the basis of their "atypical gender identity development". Courses of (in)action are all value laden.
This is reflected in Di Ceglie's expansion of the metaphor to - "the ‘scylla’ of focussing on the workings of the mind and neglecting the reality of the body, or...‘Charybdis’ of a focus on the reality of the body which neglects the contribution of the mind."
This language taps into the myth that trans people are unconscious of the "realities" of their bodies. Though he cautions against focussing too much on the body, describing it as real privileges normative ideas of trans people being unable to have reliable knowledge of themselves
Later in this SI @JayAStewart discusses the normativizing functions of the concept of realness with a sensitivity that is simply not demonstrated in the other articles. This FAQ is a much needed counterpoint to the cisnormative practitioner perspective of the rest of the issue.
You can read it here bit.ly/2AktK6h. The questions raised are telling, but Jay does an incredible job of patiently and sensitively challenging the assumptions behind the questions, and demonstrating what a supportive environment for trans youth actually looks like.
Back to Di Ceglie, he proceeds to briefly outline his concept of 'atypical gender identity organisation (AGIO)', theorising re. the psychological origins of 'atypical' gender ID and the persistence & rigidity of the ID based on the nature & timing of the psychological inputs.
Keeping the focus on etiology and predicability of outcome, he moves on to discuss the relatively frequent co-occurrence of ASD and GD and outlines research into ability of trans youth to empathise & systematise relative to cis control groups.
He concludes that more research is needed into possible links between these findings and the persistence & desistance of gender dysphoria (read. 'atypical gender identity development' or 'trans identity).
Oh yeah, on the subject of persistence/desistance there's a bit earlier on where he cites a 10-30% persistence rate for gender dysphoria in pre-pubertal children, without citing his source for the statistic. This figure is contested, he presents it as accepted fact - not cool.
Di Ceglie concludes by appealing for an individualised approach to working with "children who present with atypical gender identity development", emphasising that each is an individual and a 'one size fits all' approach cannot work.
As observed in the editorial for the issue, this mirrors similar appeals from people who work with trans youth in other capacities (e.g. @JayAStewart in his FAQ) and can be a point of common ground to work from.
I would argue that what appears to be a point of agreement on the surface, appears less so once we start getting into questions of what this means practically when supporting trans youth in therapeutic/medical contexts.
So for example one rarely sees in clinical literature an examination (or even acknowledgement) of the power dynamics present in the therapeutic environment. This is certainly not raised in Di Ceglie's discussion.
We also need to be cautious, given the power dynamics at play, that 'individualised' and 'keeping an open mind' doesn't translate to clinicians & therapists adopting a skeptical stance that consciously or not prioritises a 'normative' outcome i.e. desistance is preferable.
And this links into much wider questions of how gender services are structured and funded in this country. Can the therapy room really be a value-free space when the therapist is also the gatekeeper to medical services?
By virtue of being a gatekeeper, the therapist is tasked with determining how 'real' someone's gender identity is, how 'healthy' their presentation is, and the therapy room is haunted by the spectre of pathologisation. And this inevitably limits the therapeutic relationship.
