Working with gender dysphoria in young people. A workshop by Stella O’ Malley, Cork, November 2022

by Monica Haughey

I have largely kept my head in the sand around the transgender issue and how it might arise in our work with clients, and so, wishing to educate myself on the topic and with an open mind, I went along to the workshop on the subject in Cork on 26th November 2022 which was given by psychotherapist Stella O’Malley. Whilst it was a well delivered and clear talk, I quickly realised we were hearing just one side of what is now a debate. Stella held the view that whilst gender dysphoria is a complex issue and one that therapists need to look at holistically, she was clearly not in favour of medical transitioning for young people.

It was helpful that Stella was encouraging of therapists to acquaint themselves with the language and terms around sexual orientation and gender identity. She defined trans as an umbrella term to describe people whose gender is not the same as or does not sit comfortably with their biological sex. A related and important, and perhaps obvious point, was that sexual orientation is not the same as gender identity and she defined gender dysphoria as a clinical condition referring to the psychological distress resulting from a discomfort between one’s sex and gender. She emphasised that coming out as trans is different from coming out as gay.

She explained that it’s really important that those with gender dysphoria have a safe space to explore what is really going on. She referred to literature which points to factors such as early trauma, neurodiversity and confusion around sexual orientation as often presenting with the person questioning their gender identity.She highlighted that astherapists we also need to address the other factors that may co-exist with the unease and distress of the person identifying as transgender.

However, on reflection I felt that, whilst there will most likely be other factors affecting the person’s discomfort and distress with their gender identity, it is important that these factors are not a way to explain away the issue,and that the person “will grow out of it.She quoted research that 80% of children who attended specialist clinics for gender dysphoria “grow out of it”. This is obviously a controversial claim and the language perhaps suggests a lack of appreciation of the deeply felt nature of the distress associated with the condition.

She warned against single-minded support for a young person’s desire to transition and that we need to allow them time and space to fully explore the experience and distress they are having.She expressed significant reservations aboutmedical transitioning and asserted that often this may not satisfy the issue and the distress.

Stella also spoke a lot about her own experience and how she herself identified with being a boy whilst growing up. She spoke about being glad that she is now clear about being a female and that she did not transition.

My main criticism of the day was that we didn’t hear of research where people did medically transition successfully and for whom it was a good outcome. Clearly, she has concerns about transitioning and how difficult it is to reverse. However, I was left feeling I would like to hear more from those who are satisfied with transitioning, in order to give balance.

But most importantly there is a vital role for therapists in getting involved in this field of work. She wisely suggested that we should inform ourselves, learn the language and listen to our young people. These issues are not going away and we need to get involved as our young people need good psychotherapists to support them to explore their gender identity and they need a place where they can bring their distress and at times extreme unease in their bodies.

Monica Haughey is an experienced and established psychotherapist, supervisor and trainer who works with individuals and groups. She has been in practice for over 20 years and runs groups for creative entrepreneurs and those seeking to take more agency of their lives and for psychotherapists on the possibilities open to the profession. See www.monicahaughey.ie

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