Thread by @Transgendertrd

Starting a new thread for the afternoon of this important conference. Now we have Clinical Perspectives and the first speaker is Lisa Marchiano @LisaMarchiano.
What happens when therapists abandon reality?
#DoNotAdjustYourSet2021
eventbrite.co.uk/e/do-not-adjus…

We require a shared sense of reality. What happens when we abandon this shared sense of reality? When we become unmoored from reality?

Lisa tells the story of Maya, a detransitioner. At 14 Maya announced to her mother she was trans, after looking online. It's a fairly typical story. Testosterone was offered at first appt, Maya dropped out of college, mental health deteriorated, hospitalised twice. Stopped T.

Maya had sacrificed the truth of her body in exchange for acceptance in the transgender group. When Maya sought help from a therapist, she was met with the gender affirmative model. Diane Ehrensaft sums up the affirmative model: it is up to the child, it is not for us to say.

The gender affirmative model leaves all the psychological issues unaddressed. Maya was encouraged to seek medical intervention as a substitute for addressing the psychological pain. Human sex is binary and cannot be changed. There is no basis for 'gender identity'.

Affirmative model prioritises a child's thoughts and feelings even when in conflict with material reality. Gender identity takes on the quality of an essence, a 'gendered soul'. We do not treat soul as an emprical fact, and we do not base medical treatment on the soul.

We can validate a child's discomfort between mind and body. Confirming a child's false belief puts them out of touch with reality. Lisa quotes a detransitioner: "Transition was a way to get out of the reality of my existence as a homosexual woman."

Coming to terms with bodily reality is a task of adolescence. Coming to terms with reality is part of lifetime psychological growth. You can't get away from the reality of your body. We deny the body at a cost.

Helping a client reclaim the reality of their body is important trauma work. What is the symptom trying to cure? Affirmative care allows us the myth we can transcend our material form.

That was an incredibly moving talk from @LisaMarchiano, we hope we've done it justice, there was so much wisdom, too much to write down.

Now we have Sue Evans @sueevansprotect and Marcus Evans @marcusevanspsyc. Sue became concerned about children at the Tavistock GIDS being referred for hormonal treatments where problems were not explored in any meaningful way.

After publicity about clinician's concerns at the Tavistock GIDS, Marcus and Sue were contacted by worried parents. Sue and Mrs A applied to the High Court for a judicial review which was accepted in 2019. In Feb 2020 Keira Bell joined Mrs A as a claimant.

Sue and Marcus are writing a book due to be published in the Spring. Transition is a way for a person to be free of problems and pain. Marcus talks of the fragile ego and the idea that if I transition all my problems will be solved.

Adolescent distress is a normal part of adolescent development. Patients talk of detachment from the body they were born in. Medical intervention cannot eradicate the reality. Humans are complicated, therapist needs to take an interest in the underlying defensive structures.

Transition involves placing a block on sexual development. A young person in conflict with their sexual development leads to a belief in need to transition. The therapist must keep in mind that the desire to eradicate unwanted parts of the self is common and help to integrate.

The therapist must work with the young person's wish to keep their defensive structure. Painful psychic states need to be understood. Parents are afraid they will damage the realationship with the child, especially with the threat of suicide.

The threat of suicide maybe connected with wish to kill off the unwanted part of the self. Sue Evans is now summing up. Difficult psychological work can be challenging. Medical intervention leaves all underlying problems unaddressed and perhaps confounded.

Thorough psychiatric assessment is essential for these vulnerable patients, who are feeling worthless and suicidal. We need to understand their mental defenses. Sue and Marcus said far too much to record properly, we can only say that their book will be a MUST READ.

Q & A now. The talks today are consistently excellent. Hearing @LisaMarchiano, @sueevansprotect and @marcusevanspsyc talk about how it should, so obviously, be done throws into even more sharp relief the inexcusable failings at the GIDS.

Marcus is now talking about the politicisation of this area, it has been a failure of medicine, a failure of clinical practice, all normal policy and governance is absent in this area.

David Bell talks of the real 'conversion' being the conversion of girls' bodies to suppress the development of their sexuality. Marcus talks of how therapists are put in the position of playing god, able to take away all the pain.

A 5 minute break now. We will start another thread for the next part of the conference Feminist Perspectives. See you there.