About Course
Dr. Laura Haynes shares highlights from the news-making, most-comprehensive-ever research review chaired by Dr. Hillary Cass and commissioned by the National Health Service-England on treating gender dysphoria with psychotherapy.
Dr. Cass said in her final report, “there is still no clear evidence” that gender incongruence is simply caused by “hormones” or linked to “brain changes”, but, she said, “There is broad agreement that gender incongruence is a result of a complex interplay between biological, psychological and social factors.” She added, “trans identity may be secondary to mental health problems”, and “ACEs [adverse childhood experiences] are a predisposing factor.”
Her report indicated, “Some therapies…are well-proven for associated mental health problems”, and we need to understand how therapies “may help the core gender dysphoria”.
Dr. Cass wrote that the “intent” of psychotherapy for gender dysphoric children is “not to change the person’s perception of who they are” but to “help alleviate their distress….It is harmful to equate this approach to conversion therapy”.
But a person’s individual preferences may actually be for a therapy intent to change who they perceive themselves to be so they can feel comfortable with and identify with their sex. Their values may include having or saving a marriage and family. Their therapy intent may be to live consistently with their religious beliefs. Are these therapy intents permissible? The Cass report also says, “an individual care plan” should be made “based both on evidence, and a person’s individual preferences, beliefs and values.”
The Cass final report further says, “11.7 No formal science-based training in psychotherapy, psychology or psychiatry teaches or advocates conversion therapy. If an individual were to carry out such practices they would be acting outside of professional guidance, and this would be a matter for the relevant regulator.” Whatever “conversion therapy” means here, this statement is not true of a person’s therapy intent to identify with their sex. Dr. Kenneth Zucker, a world authority on gender dysphoria, taught it in university and advocated for it. Further, research found that, among boys who were referred to his clinic, 88% came to identify with their sex. Among boys who received therapy in his clinic, the goal was to be comfortable in their skin and not want to be girls.
The interim Cass report sounded a warning that fear of “potential accusations of conversion practice” from professional organisations requiring an affirmative approach (as in MoU signatories) and “potential legislation” have led to a significant number of therapists not treating gender dysphoric minors at all. Bans reduce access to care for those they intend to help. They have not been helpful.
Beside the Cass report, we now have several large, prospective, entire population-cohort, registry studies from the United States, Denmark, Finland, and Sweden. They have nearly unanimously concluded that medical gender interventions do not improve mental health or suicidality and may worsen it.
These registry studies and the Cass research review are turning the tide on gender dysphoria treatment.
