Are We Affirming Too Quickly? | Sasha Ayad on Gender, Therapy & Children

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If somebody says to you, Raquel, I'm actually not the woman that you see in front of you.
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I am a male.
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I'm a man.
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Count me out, Zocca.
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When did validating someone's experience begin to mean that we also have to agree with their interpretation of that experience?
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And clinically are those the same thing.
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They shared pretty horrific stories of kids with very complicated mental health issues that were just being kind of shuffled down the medical transition pathway.
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And these whistleblowers were often pressured by the clinics they work for, the institutions they work for.
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My issue is that a lot of the gender identity stuff has become very literal.
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Kids need to see that their parents are competent and in charge.
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I don't know what to do, whatever you want to do.
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I mean, that is not an attitude that stabilizes children.
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Welcome to Capacity Combos.
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I'm Raquel Hopkins, and this is a space for thoughtful conversations about who we become when life adds more of us.
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Here we talk with people whose lives and work reflect real capacity, how they stayed engaged, made hard decisions, and grew without shrinking in the face of challenge.
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This is where we explore what life demanded, and the moment you realize I can hold more than I thought.
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I am your host, Raquel Hopkins, and today I have someone that I really like.
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I normally say I have a guest, and they are amazing, but all of my guests are amazing.
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But I have Sasha here with me today, and I met Sasha at a retreat that we did for exchange moms, and it was a shock to me, one to learn what extrans were dealing with, but also to start learning about the work that you do, Sasha, because I had no idea.
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So I will open up the floor for you to introduce yourself because I think that you would do a much better job than me.
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Well, Roquel, thank you so much for having me.
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I I also really enjoyed meeting you at the retreat.
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So I'm glad that we're able to be together here.
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Um so my name is Sasha Ayad.
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I'm a licensed professional counselor, and um I have been working in the area of gender identity and gender dysphoria for about 10 years.
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Uh, prior to starting to work with this population, I did a variety of things.
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I worked um in sexual abuse and domestic violence, I worked with autism for many years, and I worked with adult intellectual disabilities.
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Um and I started working in the area of gender, as I said, about 10 years ago.
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And particularly, I came into this work when I was working in a middle school around 2014-2015, and some of this came across my radar, which I imagine we'll we'll talk about.
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Yeah, I'm excited to dive into it.
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What is gender identity?
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Let's just just go ahead and get into it.
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What is gender identity and gender what did you say?
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You said gender dysphoria.
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What is what is it?
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Okay.
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Well, this already launches us into a very complex topic.
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So um depending on who you ask, you can get really different answers.
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And that's what makes this area, I think, particularly fraught and complicated.
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I think a very basic definition as it's understood today, because this has changed a lot in the last 20 years or so, gender identity is a person's internal sense of what gender they feel they are or were supposed to have been.
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So this can range from a person who feels, let's say, very, very convinced that they were meant to be the other sex and really want to live in the other sex role, all the way to a person who feels as though their identity is very fluid and day-to-day or moment to moment, they can be non-binary or agender.
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I mean, there are a lot of new labels in the conception of gender identity.
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And, you know, this term in and of itself is relatively new in the field.
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This phenomenon, let's say, has been described in a variety of ways over the course of the last several decades.
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You know, it used to be called in the DSM gender identity disorder.
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Prior to that, it was called transsexualism.
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So gender dysphoria is the DSM diagnosis that we have today, which describes a mismatch between a person's felt sense of gender and the gender that they present to the world.
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Now, already it's really interesting because the word biological sex is not in that category or definition.
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So gender is actually even more subjective than sex, which is much more um clear for the most majority of cases.
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And so we're really now in the realm of, you know, people's subjective experience of gender or gender roles and how they present in the world with those.
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Okay.
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Thank you for educating me and us.
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All right.
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So my next, how did you get into this work?
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Because when I say I really didn't know much about it until I saw you engaging with parents and they were talking about their stories.
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I'm like, what does she do?
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Yeah.
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Yeah.
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So around 2015, um, I was working in a middle school, and I was also keeping my eye on, you know, just cultural stories and news stories.
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And I started to see kind of a congruence happen at the same time.
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So I remember seeing a National Geographic magazine, which showed a transgender child, which that was a very new concept.
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I got, you know, I finished my master's around 2008, 2009, and there was really no talk of transgender children.
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There was gender identity disorder and how it develops.
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But to see a trans child on the cover of National Geographic really struck me.
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And I thought that was interesting because there are some assumptions being made when people raise their child as though they literally are the other sex, right?
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So I'm sorry.
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What do you mean?
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Well, the assumption that if a young person has questions about their gender identity or is experiencing distress about their sex, to raise the child as though they're literally the other sex makes the assumption, first of all, that the child's identity is fixed.
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It's not going to shift.
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And in a way, it it's only really a possible concept when you introduce medications that can make those physical changes to the appearance of the child, right?
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So the idea of social transition, which I think we're kind of tilting into here, and I can finish my story about the middle school, but the idea of socially transitioning a child, let's say, you know, an eight or nine-year-old is saying, hey, mommy, I think I'm really a girl or I'm really a boy.
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You know, up until the early 2000s, the clinical approach to that child was, well, let's be neutral, let's see what unfolds, and let's at least wait for this child to move through puberty to see if this distress resolves.
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And what we know actually is that between 60 and 85% of cases, something like that, kids will resolve their gender identity confusion once they get through puberty.
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So the newer method of gender-affirming care, which I'm sure we'll get into, is really different.
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It has a built-in assumption that whatever the child is presenting with, we should facilitate it rather than being neutral and seeing what happens.
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And only with the introduction of puberty-blocking drugs in the early 2010s, was it even possible to conceive of a child at seven or eight making that decision?
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Because of course, puberty is impending.
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So if you can interrupt puberty with medications, then you can conceptually say to the child, okay, you can live as the other sex.
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So without that relationship between the identity concept and the medications, this would not be a pathway that would be even something considerable.
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And I have a lot of concerns about this medical pathway, but I just want to set the stage for people to understand how did this concept of like kids transitioning, how did this become a thing in the first place?
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And really, I don't think it could have been if we did not see the introduction of things like puberty-blocking drugs in the early 2010s.
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So I'm noticing this cultural phenomenon.
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I'm reading about trans kids in magazines.
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I'm seeing stories online.
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And at the same time, I was working in a middle school at that point.
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I was a middle school counselor working with sixth, seventh, and eighth graders.
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And I started to notice kids that I had already known for about a year, a year and a half, saying things like, you know, miss, I don't think I'm a girl anymore.
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Or, hey, I don't want my teachers using my birth name anymore, or hey, I want to use different pronouns.
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And there were one or two students having questions like this about their gender identity.
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And so I started, you know, working with them and trying to understand where this is coming from.
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And what I discovered is that, you know, one particular girl that comes to mind, she was pretty lonely at school.
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She was a little bit awkward of a kid.
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She didn't have a lot of friends.
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And she shared with me that she was spending a lot of time online at the time.
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I think it was on Tumblr.
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And she told me, well, Miss Ayad, you know, I read online about that transition can make you feel a lot better.
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And, you know, my mom is always telling me, why don't you dress more feminine?
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Well, maybe it's because I'm really a boy.
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So she had some of these characteristics that made her already feel a little bit awkward as a girl.
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She felt some pressure to be more feminine, even though that wasn't really her.
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And she was quite lonely.
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So she started spending a lot of time in these online spaces where other people, young people, are really encouraging one another to explore these ideas and try a breastbinder, for example, or try using different pronouns.
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And within that context, she started really thinking that maybe this would help her to feel better and to feel like she fits in better and a whole host of things that she was hoping she would get out of this.
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Now, I already had a really good relationship with the student because I had known her for about a year or so before she started questioning her identity.
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And so using, you know, a very curious and neutral approach, I would, you know, asked her where she was um, you know, struggling and what ideas she was encountering, and just kind of cautioned her, well, you know, when we start modifying our bodies, there can be health consequences, like breast spinders can cause issues with breathing and they can, you know, um alter breast tissue.
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And it can be really distressing to wear a breast binder all day.
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So I just kind of warned her about some of those things.
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And I also just validated that it's okay if you are not like all the other kids.
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And it's okay if you don't prefer really feminine clothing.
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You know, I just like you for who you are.
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I mean, I really just tried to validate her as a person and affirm her as a person.
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And what ended up happening, which was so interesting, is that within, you know, the rest of that school year, um, I hadn't seen much of her.
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And then at the end of the school year, I usually went to check in with the kids that I worked with frequently just to see how they were doing.
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And she told me, you know, Miss Ayad, that thing that we used to talk about a lot.
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And I said, Do you mean gender?
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And she said, Yeah, that's not a problem for me anymore.
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And I said, That's so interesting.
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What happened?
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And she said, Well, you know, I started making a couple of friends in school and I just got offline a little bit and I realized I don't, I don't need to do all that.
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So the level of insight was pretty remarkable.
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But what ended up being so fascinating about this is that here I am 10 years later.
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I've worked with something like 1,100 families in the last 10 years.
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And as it turns out, that young woman's story was pretty prototypical of a lot of young people who are exploring different gender identities these days.
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And conventional wisdom right now in our field is that when you do encounter a young person questioning their identity, that the role of the therapist is to affirm it.
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Gender affirming.
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Gender affirming.
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So had I used an approach like that, our conversations would have sounded very different.
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I would have What do you think the danger is in that if you would have?
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Yeah.
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Well, I think, I mean, the starting point is that, like in general, as clinicians, we have a really interesting role.
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First of all, we have to affirm the experiences of our clients, right?
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We never want to disaffirm or disconfirm.
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So if you say to me, you know, Sasha, I'm really struggling with, you know, my body image, I'm not going to say, no, you're not.
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Yeah.
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I'm going to affirm what you're doing.
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Right.
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I'm going to validate it.
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Right.
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However, the the other role that we have is to also get curious along with our client, you know, in a collaborative way, of like, I wonder what that could mean.
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I wonder what's going on there.
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Where do you think that's coming from?
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What are you struggling with in other areas of your life?
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We have to get curious so that we can really pick things apart.
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So to your question, Raquel, I think the the risk is if we take everything at a surface level and we affirm the client, but we don't use that affirmation as a starting point for further understanding, we risk kind of confirming the story that our client is telling themselves about their distress and what it means in a superficial way.
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And so had I simply said to this young lady, well, if you think you're a boy, then I believe you.
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You you are a boy.
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And okay, if you need to get rid of the appearance of your breasts, let's get you a breast binder.
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And I only say that because I've heard many, many stories like this from counselors or clinicians who feel like, well, I have to affirm my client.
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And so where do you think that thinking comes from as clinicians?
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Because I do think that there is I don't think we're neutral completely.
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Yeah.
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Right?
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We we have our own beliefs that we bring into these sessions, but where do you think I mean, I don't even know.
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Like, how do we become so affirming and validating to the point to where we also can't disagree?
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Or or use discernment, right?
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Yeah.
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Well, I mean, I think the other side of this coin is that, you know, when you think about the experiences of let's say people who have transitioned and feel like that really, really helped them because there are many people who feel like having their gender identity affirmed and then having access to medical interventions was really an important part of their process of having better mental health and improvement.
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So when we take those experiences and those stories, and a lot of adult trans people will say, you know, I wish that I had the ability when I was younger to transition and to be believed.
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So, in retrospect, those success stories have largely molded and formed what we now call gender-affirming care.
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So, to your question, where do these ideas come from?
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I think they come from applying the retrospective narratives of people who really feel like transition benefited them, and then blanket applying it to all kids who are exploring their gender.
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Why do you think is dangerous to do gender affirming, or do you believe that it's dangerous to do gender affirming care with children?
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Well, I think we have to be really clear.
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First of all, gender-affirming care is not one concrete thing.
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It is not a model with like a step-by-step manual.
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It is a very broad conception of how to interact with clients who are questioning their identity or have a different gender identity.
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So the way it's applied can look vastly different depending on where it's being applied.
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So for some people, some clinicians who say, hey, I'm a gender-affirming clinician, what they mean is that if a client comes to me and says, Hey, I'd like you to use this name and these pronouns, I'll do it, no problem.
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But I'm still going to try to understand the whole person as an individual and all of the moving parts of their life.
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So that's one type of someone who might call themselves a gender-affirming clinician.
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But on the other extreme of it, I have seen many cases where gender-affirming care means that you have to, as a cis person, check your biases.
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You have to understand that if you're having any questions about your client's identity, it's your own cis heteronormativity and there's a real um kind of social justice component to it.
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And what ends up turns into advocacy.
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Right.
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It turns into advocacy.
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And so what ends up happening is, in my view, when gender affirming care looks like that, you end up having a lot of hesitation to even get curious.
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I mean, I've heard gender-affirming conferences where clinicians are saying, um, hey, I'm concerned, you know, I have a patient who's in uh psychosis or they have multiple personality disorder and they are wanting to transition, and I don't want to be biased.
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So I don't know how to manage this.
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And they're often encouraged to like just trust what the client says about themselves.
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So you see how that is a pretty extreme approach.
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And of course, there are there are a lot of risks.
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And, you know, one of the things that is often talked about, and then when you dig beneath the surface, it's not quite accurate is you know, a lot of clinicians will say, well, gender affirming care is life-saving and necessary.
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I mean, you hear that phrase.
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No, no, you hear like the systemic and liberation, like we have to protect.
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Yeah, yeah.
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We have to affirm.
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Yeah.
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And I mean, I think it's one thing if you want to say, like, we have to verbally just, you know, validate a person's experience, I'm fine with that.
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But I think when it comes to medically confirming a person's identity, we get into very tricky territory because what we don't know is who will and who will not benefit in the long run from these interventions.
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And right now you and I are speaking kind of broadly.
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We have to remember we're talking about children in a lot of these cases or young people who have a lot of really complicated mental health issues or experiencing adolescent is just art in general.
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Yeah.
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Yeah.
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Exactly.
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And it's, I mean, it's a time of life where all of us are asking, who am I?
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Where do I fit in?
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Which click is my click?
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Am I going to experiment with this look or that look?
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Am I this person or that?
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I mean, that is what we're supposed to be doing in adolescence.
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So when, you know, when gender-affirming care advocates say, like, you have to affirm it's medically necessary, you know, that is a little bit of a manipulation of the statistics.
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We don't know that it's medically necessary.
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And furthermore, there's no evidence that if a young person is struggling with complicated mental health issues and they're experiencing gender dysphoria, there's no evidence that transition is going to make them feel better.
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So when we look at all of these kind of unknowns, and we we can't say for certain, you know, is this even an 18-year-old, is this 18-year-old going to benefit in the long run from this intervention or not?
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We actually don't have a magic crystal ball way to predict that, right?
00:20:10.319 --> 00:20:16.720
So it's a bit different when we're talking about adults, because then you're talking about, you know, autonomy and informed consent.
00:20:16.799 --> 00:20:28.960
But when we're talking about minors, using this affirming approach tends to lead in a direction that really does kind of feed into medical transition.
00:20:29.599 --> 00:20:30.240
Hmm.
00:20:30.880 --> 00:20:47.759
I'd imagine that for your clientele base, particularly the parents, they feel very empowered working with you, especially today when you hear so much talk around mental health and parents are afraid of their kids uh committing suicide and just different things.
00:20:47.920 --> 00:20:55.680
So, how do you find a balance with empowering them and then navigating gender identity challenges?
00:20:56.000 --> 00:20:56.640
Yeah.
00:20:57.119 --> 00:21:03.599
Well, I mean, first thing I'd like to just start out with is like, what are the barriers to empowerment, right?
00:21:03.839 --> 00:21:05.519
And what is the role of the parent?
00:21:05.680 --> 00:21:19.680
It's very tricky because in my experience, there's a a real regional difference from almost one state to the next in how parents are, you know, empowered or not.
00:21:20.000 --> 00:21:36.640
If you look at certain parents within a kind of um enclave of like usually very, very liberal, very educated, academic type parents, the default assumption is that we're gonna affirm and transition our kids.
00:21:36.799 --> 00:21:39.440
Not everywhere, but that's a broad pattern I've noticed.
00:21:39.759 --> 00:21:40.880
You gave a prototype.
00:21:41.119 --> 00:21:41.279
Yeah.
00:21:41.440 --> 00:21:41.599
Yeah.
00:21:41.920 --> 00:21:52.319
And I mean, I don't I I hate that this has become, you know, embroiled in some ways with politics, but I know people from lots of different perspectives who share some of these concerns.
00:21:52.480 --> 00:22:05.039
So if you are a parent in that environment where, you know, your kids' friends are transitioning and taking hormones and The the school is, you know, affirming your kid whether you agree to it or not.
00:22:05.200 --> 00:22:08.880
I mean, you are very institutionally disempowered.
00:22:09.119 --> 00:22:17.279
So it's really challenging when you're dealing with, you know, other authority figures in your child's life or just the social pressures.
00:22:17.759 --> 00:22:19.519
And it's what does that look like?
00:22:19.759 --> 00:22:29.680
Because I couldn't imagine a school or any institution telling me to affirm that for my child.
00:22:29.920 --> 00:22:34.640
Like what I don't even what does that look like out in the work that you're doing?
00:22:35.279 --> 00:22:42.160
Well, I mean, it looks like schools who you know, again, state to state, and things have changed a little bit.
00:22:42.240 --> 00:22:55.680
And I don't really want to get into the political aspect of this, but like, you know, a lot of schools, like the most generous interpretation is that a lot of schools feel like, hey, the law is that we are supposed to affirm our students.
00:22:55.920 --> 00:23:07.279
And our hands are tied because, you know, there there are these um kind of assumptions built in that like if the parents are not affirming, that that's harmful to the child's development.
00:23:07.519 --> 00:23:21.440
So if we take it from that perspective, right, as clinicians, I don't know if you've ever worked in a school setting, but I remember, you know, we are really primed to be on the lookout for cases of horrific things that happen, abuse, neglect, you know.
00:23:21.759 --> 00:23:28.720
So we are ready to feel like protectors of our students, protectors of our clients.
00:23:29.039 --> 00:23:38.240
I mean, I hate having to notice or or learn that a child is being mis, you know, mistreated in their home and then making reports.
00:23:38.400 --> 00:23:41.839
So I think therapists are kind of primed to look out for those types of things.
00:23:42.079 --> 00:23:51.200
And so I think some schools and their school counselors feel like it's our duty to protect a student from parents who are not being sufficiently supportive.
00:23:51.440 --> 00:23:52.960
Now that's a generous interpretation.
00:23:53.200 --> 00:23:53.680
Yeah, yeah.
00:23:53.920 --> 00:23:55.680
I think um It's a good one.
00:23:55.839 --> 00:23:56.160
Yeah.
00:23:56.640 --> 00:24:15.519
And I think there are some teachers who they have a maybe uh teachers or therapists who really do have a very strong conviction about advocacy and their role as, you know, standing up for the oppressed minority trans kid against their parents.
00:24:15.759 --> 00:24:19.599
And look, the world is complicated and full of variety.
00:24:19.759 --> 00:24:26.480
There are families that are um treating their children poorly because they're questioning their gender.
00:24:26.640 --> 00:24:27.599
Of course that happens.
00:24:27.839 --> 00:24:33.839
Parents who are, you know, very, very rigid about what you're allowed to wear or whatever and are maybe cruel about it.
00:24:34.000 --> 00:24:35.359
Of course that happens.
00:24:35.599 --> 00:24:45.680
But in my experience, the vast majority of parents that I work with are like, look, you know, I'm supportive of my kid 100%, but I'm really concerned, you know, she just had an eating disorder.
00:24:45.759 --> 00:24:48.559
And now all of a sudden she's like binding her breasts.
00:24:48.720 --> 00:24:49.920
I feel like they're related.
00:24:50.000 --> 00:24:54.160
Or, you know, my kid went through a really difficult sexual trauma last year.
00:24:54.240 --> 00:24:56.160
And now all of a sudden she doesn't want to be a girl.
00:24:56.319 --> 00:24:58.400
I'm concerned that those things are related.
00:24:58.559 --> 00:25:10.640
And so, you know, coming from that space, it's really hard for parents if they are being looked at like they're bad people for not, you know, affirming or for questioning.
00:25:10.960 --> 00:25:18.079
You know what's so interesting about just the different approaches of clinicians in general?
00:25:18.240 --> 00:25:19.759
It's like who's right, who's wrong.
00:25:19.920 --> 00:25:20.400
Yeah.
00:25:20.720 --> 00:25:31.440
Because I don't want to say that systemic or gender-affirming clinicians are are wrong.
00:25:31.759 --> 00:25:33.599
But I also don't think you're wrong.
00:25:33.839 --> 00:25:36.400
I mean, I I have my preference, right?
00:25:37.200 --> 00:25:48.079
I definitely have my preference, but I I find that just arriving at what is truth, it seems to be so complex these days.
00:25:48.160 --> 00:26:01.839
But when I have the like, I know that we don't have any control over adults, but I do think that as parents, when we're talking about children, I mean, isn't I I believe there's some form of truth in terms of guiding them.
00:26:01.920 --> 00:26:09.359
And even if the truth is like you're a child and you just there's so much to understand about just life, the world, and yourself.
00:26:09.599 --> 00:26:14.160
And because of that, I would not want to affirm on just that alone.
00:26:14.319 --> 00:26:17.440
We don't even have to get into politics or religion or anything else.
00:26:17.599 --> 00:26:24.079
Because I don't even I mean, I don't question my gender, but I mean, sometimes I'm lost as an adult.
00:26:24.240 --> 00:26:28.799
Like you make a decision today, and then it's like, oh man, I didn't really want to do that.
00:26:28.880 --> 00:26:37.440
So when you start to talk about medically changing things, it's just, it's just, it blows my mind.
00:26:37.759 --> 00:26:38.559
Yeah, I know.
00:26:38.640 --> 00:26:40.559
I know I'm glad that you're doing the work.
00:26:40.720 --> 00:26:41.920
I do have a question.
00:26:42.079 --> 00:26:43.920
Um, Sasha's looking at me like, what?
00:26:44.000 --> 00:26:45.839
It's Well, you've asked like a lot of questions.
00:26:47.440 --> 00:26:48.160
You said so much.
00:26:48.319 --> 00:26:51.519
Like you can tell that you're knowledgeable and you understand this work.
00:26:51.599 --> 00:27:05.920
And what I also, what I'm also hearing you say is while I don't take the gender-affirming approach that modern society takes today, that has transpired over what, since 2010, you say it?
00:27:06.559 --> 00:27:06.960
I say, yeah.
00:27:07.279 --> 00:27:09.359
Around 2020, 2015.
00:27:10.160 --> 00:27:20.319
You also are realistic that even though you don't take that appro take that approach, some clients do end up still going in that direction.
00:27:20.640 --> 00:27:21.359
For sure.
00:27:21.599 --> 00:27:25.359
How do you find the balance with that?
00:27:25.519 --> 00:27:32.160
And do you continue to support clients that do move into the other direction?
00:27:32.559 --> 00:27:32.960
Sure.
00:27:33.200 --> 00:27:38.720
Well, I mean, I think my and I'm gonna answer your question, but like come about it in a real route way.
00:27:39.440 --> 00:27:49.680
Like one of the things that really um strikes me is that within the context of psychotherapy, which, you know, there are lots of different schools.
00:27:49.759 --> 00:27:52.799
There's CBT, there's DBT, I mean, I know there's different philosophies.
00:27:52.880 --> 00:28:11.359
But the idea of psychotherapy is that partnering with a person and becoming curious about their experiences, their behaviors, their thoughts, their feelings, their relationships, we can help them make improvements in their life through recognizing patterns, things that they could, you know, improve upon, change.
00:28:11.519 --> 00:28:13.680
I mean, I believe that's the point of therapy.
00:28:13.920 --> 00:28:21.680
And within that framework, there's a lot of room for understanding things like oppression or mistreatment, right?
00:28:21.839 --> 00:28:38.480
Like you don't have to have an explicit liberation perspective to recognize as you get to know a patient or a client that, like, wow, I think that due to this person's, you know, race, gender, race, sexuality, they're being taken advantage of.
00:28:38.559 --> 00:28:40.720
They're being manipulated by this or that person.
00:28:40.880 --> 00:28:49.200
You don't need a, you know, a specific liberation framework to recognize those problems because those are really human problems.
00:28:49.440 --> 00:28:50.079
I agree.
00:28:50.319 --> 00:29:07.039
So from that perspective, I think inevitably, if you're doing appropriate therapy with a gender dysphoric client or a gender questioning client, you are approaching that individual with no predetermined outcomes in mind.
00:29:07.680 --> 00:29:15.039
You are open, you are curious, you want to get to know the that person's experiences, and you want to take things slow.
00:29:15.519 --> 00:29:27.759
And you want to make sure that they are also engaging in a genuine process to understand themselves better, which could take us in a lot of different directions depending on the person in front of you.
00:29:28.000 --> 00:29:38.240
So, yeah, I have clients who, you know, I met them when they were already detransitioning, which means they th they identified as trans or as a different sex for some time.
00:29:38.720 --> 00:29:39.839
We're talking about kids.
00:29:40.400 --> 00:29:41.039
Well, young adults.
00:29:42.160 --> 00:29:42.240
Right.
00:29:42.480 --> 00:29:43.839
What do you consider like young adults?
00:29:44.079 --> 00:29:44.960
Like 18 or up.
00:29:45.039 --> 00:29:45.200
Okay.
00:29:45.440 --> 00:29:46.720
You know, like not minors.
00:29:46.960 --> 00:29:59.359
I've worked with some young people who, as minors, while we were working together, they felt like their identity issues were really about something else and they no longer identified as trans.
00:29:59.599 --> 00:30:07.680
I've worked with people who worked through a lot of complexity around their identity and decided to transition and feel like it really helped them.
00:30:07.920 --> 00:30:10.000
So there are a variety of outcomes.
00:30:10.160 --> 00:30:14.079
And so I think this is what troubles me about the gender-affirming care model.
00:30:14.240 --> 00:30:20.240
If you have a kind of rubber stamp that you use for every patient that comes by, you're gonna get the same outcomes all the time.
00:30:20.400 --> 00:30:20.799
Yeah.
00:30:21.039 --> 00:30:33.200
And when you hear the experiences of people who detransitioned, what you realize is like, wow, every person that came through the door was evaluated, affirmed, and told they needed the medication.
00:30:33.920 --> 00:30:37.759
So if if that you're just on a conveyor belt, that's not real therapy.
00:30:37.839 --> 00:30:38.640
It's not individual.
00:30:38.960 --> 00:30:40.240
It's not individualized.
00:30:40.319 --> 00:30:40.559
Yeah.
00:30:41.039 --> 00:30:42.319
Yeah, it's a one-size-fits-all.
00:30:43.039 --> 00:30:43.279
Right.
00:30:43.519 --> 00:30:44.160
Right.
00:30:49.279 --> 00:30:49.920
Yeah.
00:30:50.240 --> 00:30:51.519
Oh gosh.
00:30:51.759 --> 00:30:55.039
Um, I really wish you would get on social media.
00:30:55.200 --> 00:31:06.160
I just I'm trying to get her onto social media, but she does very well with what she already does on Substack and have your community.
00:31:06.400 --> 00:31:06.640
Yeah.
00:31:06.720 --> 00:31:13.839
And I mean, I my I so one of the groups that I well, a group that I work with, I'm on the board of a group called Therapy First.
00:31:14.240 --> 00:31:16.319
And we do, we do have a social media.
00:31:16.400 --> 00:31:17.359
So I think people can't.
00:31:17.519 --> 00:31:18.799
Are you on track of it?
00:31:18.960 --> 00:31:19.359
I am on it.
00:31:19.599 --> 00:31:24.559
So um it's I'm gonna tag you on social media, no IG stuff.
00:31:26.480 --> 00:31:30.799
Maybe that'll become a the anti-social media, social media post or something.
00:31:31.119 --> 00:31:32.000
Oh gosh.
00:31:32.160 --> 00:31:35.440
Um, I mean, I have I have so many questions.
00:31:35.759 --> 00:31:50.640
I was reading something to where I think it was in Washington, another therapist is being, I don't know, called to the courts or whatever for not doing gender-affirming care.
00:31:52.000 --> 00:31:56.240
What are your thoughts about that?
00:31:57.759 --> 00:32:00.960
Well, I mean, I don't know the details of the the case.
00:32:01.119 --> 00:32:12.799
Um, what I what I can say, what that reminds me of is that, you know, one of one of the projects I've taken on in the last 10 years is I did a podcast for about four years called Gender a Wider Lens.
00:32:12.880 --> 00:32:19.920
And one of the things that we did was interview different experts in the field, people impacted by gender dysphoria, like a whole variety of things.
00:32:20.079 --> 00:32:22.880
And we've spoken with several whistleblowers.
00:32:23.119 --> 00:32:29.119
So these were clinicians or providers who were trained in the gender affirming care model.
00:32:29.279 --> 00:32:40.720
They were working in gender clinics, and they started to see the problems from their perspective of what happens when you use this one size fits all approach with everyone.
00:32:40.799 --> 00:32:51.599
And they, you know, shared pretty horrific stories of kids with very complicated mental health issues that were just being kind of shuffled down the medical transition pathway.
00:32:51.759 --> 00:33:00.960
And these whistleblowers were often pressured by the clinics they work for, the institutions they work for to just affirm, just affirm.
00:33:01.119 --> 00:33:11.279
And they ended up being whistleblowers because they felt like there were no kind of pathways within their institution to try and raise their concerns.
00:33:11.359 --> 00:33:13.839
And so that's, you know, the story of most whistleblowers.
00:33:14.000 --> 00:33:26.079
There were actually, there was a huge case in the UK several years back where at the biggest gender clinic in the world, there were 35 people resigned because they were so concerned about how readily they were transitioning kids.
00:33:26.319 --> 00:33:28.079
So the pressure is real.
00:33:28.240 --> 00:33:44.000
So I don't know about this particular case that you mentioned, but within clinics that are using like this very kind of dogmatic approach, the pressure on individual providers is really strong to just, you know, follow these assumptions.
00:33:44.079 --> 00:33:47.039
That's why I said there's like assumptions built into this model.
00:33:47.519 --> 00:33:51.119
And so I don't know how this clinician approached her clients.
00:33:51.279 --> 00:34:03.599
I mean, I don't know much about it, but people are it seems like she was very like absolutely not, I will not be doing the built-in assumptions of gender-affirming care.
00:34:04.000 --> 00:34:12.800
Like I couldn't imagine someone telling me because as as professionals, we still do have our own values and and beliefs.
00:34:13.039 --> 00:34:18.639
And I think that that gets thrown out of the window at times.
00:34:19.280 --> 00:34:33.760
Well, I think I think a a parallel that a lot of people believe applies here is how we might approach a client who is coming to terms with their sexual orientation.
00:34:34.000 --> 00:34:36.320
And a lot of people think that you should treat those the same.
00:34:36.480 --> 00:34:59.440
So for example, it is considered unethical, rightly, in my opinion, rightly, that if a client comes to you and says, you know, I'm noticing that I'm attracted to other women and I'm feeling really weird about this, I think it's unethical for the therapist to say, well, that's because you're, you know, disordered and having those attractions is bad and it means you're mentally ill.
00:34:59.679 --> 00:35:02.480
I mean, that is, you know, conversion therapy.
00:35:02.639 --> 00:35:02.880
Yeah.
00:35:03.039 --> 00:35:27.280
So what has happened in the last, you know, 10 years or so is that gender identity has just sort of been tacked on, especially to a lot of like policy statements and legislation and you know, standards of practice for clinicians and mental health providers, that when we um, you know, encounter a person questioning their gender identity, we treat it exactly the same as we would treat someone questioning their sexuality.
00:35:27.360 --> 00:35:27.440
Yeah.
00:35:27.679 --> 00:35:30.239
Which is like, no, it's okay that you're feeling those things.
00:35:30.400 --> 00:35:35.119
Let's just explore what that means to you and try to destigmatize, try to normalize.
00:35:35.199 --> 00:35:39.760
And at the end of the day, I mean, the client still has to decide what they want to do with those feelings.
00:35:39.920 --> 00:35:42.639
But our job is to normalize and destigmatize, right?
00:35:42.800 --> 00:35:42.960
Yeah.
00:35:43.119 --> 00:35:44.960
I mean, but we question so much, right?
00:35:45.039 --> 00:35:53.519
I mean, things you may not say out loud, it's like getting married, having children, like those are the things we question a lot.
00:35:53.679 --> 00:35:57.840
Like, shh, so you just mentioned something about conversion therapy.
00:35:58.000 --> 00:36:06.960
What's the difference between conversion therapy versus because I do remember there was a big thing recently, maybe within the last eight months around conversion therapy.
00:36:07.039 --> 00:36:09.760
It was another therapist that was in a hot seat.
00:36:09.920 --> 00:36:22.000
And I I can I recall more of the systemic and liberation therapist, like really speaking up from an advocacy standpoint.
00:36:22.239 --> 00:36:27.280
So, but I don't really know much uh well, I mean, this is this is what is really tricky.
00:36:27.440 --> 00:36:45.599
I mean, conversion therapy, the term uh originated uh to describe practices of what what tended to be religious clinicians or religious kind of counselors trying to get, you know, gay men to not feel attractions to uh to to men.
00:36:45.840 --> 00:36:48.000
So this is a practice that wait, say that again.
00:36:48.239 --> 00:36:53.119
So they were trying to stop gay men from feeling same-sex attractions.
00:36:53.360 --> 00:36:53.679
Okay.
00:36:53.920 --> 00:37:00.079
So this is a practice that was taking I mean, taking place and still to this day, it's kind of changed names.
00:37:00.320 --> 00:37:06.800
And this is considered, first of all, goes against the the science, what we know about sexual orientation.
00:37:06.880 --> 00:37:09.039
It can't really be changed that way.
00:37:09.280 --> 00:37:21.039
Um, and it's now considered, you know, totally um against best practices and therapeutic care, also because being gay is not a mental disorder.
00:37:21.280 --> 00:37:25.679
It used to be in the DSM up until, you know, I think the early 80s.
00:37:26.000 --> 00:37:28.960
So And that's the issue that most people have.
00:37:29.199 --> 00:37:31.679
That's what labeling it as a disorder.
00:37:31.760 --> 00:37:44.480
Because I may have my personal opinion about it, but do I have the right to say that you have a disorder because what you choose is abnormal to me.
00:37:45.440 --> 00:37:46.480
So Yeah.
00:37:46.639 --> 00:37:53.679
And I mean, I think that's that's why we as clinicians are trained to be aware that, like, hey, we're not neutral.
00:37:53.840 --> 00:37:59.760
We all have belief systems, values, backstories, biases, what however you want to frame it.
00:37:59.920 --> 00:38:04.159
And so we're supposed to be mindful of those as we are working with clients.
00:38:04.320 --> 00:38:04.559
Yeah.
00:38:04.800 --> 00:38:15.519
But conversion therapy is a descriptor that was really taken from that application that we just talked about, and again, just tacked onto gender identity.
00:38:15.760 --> 00:38:31.360
So what a lot of people are kind of debating now is like, is it conversion therapy if a 15-year-old comes in and says, you know, a couple months ago I started questioning if I'm really a girl, is it conversion therapy to say, well, you know, you are a female.
00:38:31.519 --> 00:38:32.800
So what does that mean to you?
00:38:32.960 --> 00:38:38.960
Like sometimes people are even nervous that asking questions will be considered conversion therapy.
00:38:39.199 --> 00:38:45.760
So this word has kind of been doing a lot of work and it means a lot of different things to different people.
00:38:46.639 --> 00:38:55.920
I think the use of coercion and, you know, threats and manipulation is always anti-therapeutic.
00:38:56.079 --> 00:39:00.239
And I don't think there's any place in therapy for those types of tactics.
00:39:00.480 --> 00:39:09.679
But I think asking questions and helping a person to understand themselves better should not be construed as conversion therapy.
00:39:09.760 --> 00:39:12.400
And that's what has happened in some contexts.
00:39:12.960 --> 00:39:13.679
Question.
00:39:13.920 --> 00:39:20.880
When did validating someone's experience begin to mean that we also have to agree with their interpretation of that experience?
00:39:21.039 --> 00:39:23.119
And clinically, are those the same thing?
00:39:23.440 --> 00:39:24.800
Yeah, that's a great question.
00:39:24.960 --> 00:39:37.840
I think the affirming care model is part of the reason that we are approaching people's gender questions with such a literal affirmation.
00:39:38.320 --> 00:39:43.599
It really came into play, I would say, the early 2010s, mid-2010s.
00:39:43.920 --> 00:39:50.480
And I think it came as a reaction to what was called the gatekeeping model in prior decades.
00:39:51.199 --> 00:39:53.920
And I'll tell you a little bit about that, then I'll answer your question.
00:39:54.079 --> 00:39:58.320
Like the gatekeeping model was basically like if a person is interested in transitioning, right?
00:39:58.480 --> 00:40:07.199
Let's say a person comes to a psychiatrist or a clinician and says, look, for 20 years, I've had this really strong, powerful desire to be the other sex.
00:40:07.280 --> 00:40:09.679
And I heard that there's these hormones and these interventions.
00:40:09.760 --> 00:40:11.280
So I really need these.
00:40:11.679 --> 00:40:25.039
Well, what used to happen is the clinician would do a very thorough evaluation, a psych evaluation, and also tell the person that they had to live in their chosen gender role for two years before they could access these interventions.
00:40:25.280 --> 00:40:28.800
And that was seen as kind of paternalistic, which it is in a way.
00:40:28.960 --> 00:40:35.280
I mean, it's the clinician getting to decide like yay or nay on this thing that you really, really desperately want.
00:40:36.000 --> 00:40:38.880
So again, the with adults, though.
00:40:39.039 --> 00:40:40.480
With adults, with adults.
00:40:40.639 --> 00:40:40.800
Okay.
00:40:40.960 --> 00:40:55.599
So then in retrospect, the the emerging gender-affirming model, which validates the experience, is like, well, if the person's uh interpretation of their experience is that they're really a woman on the inside, then they are.
00:40:55.760 --> 00:40:58.880
They actually are, and we have to validate that for them.
00:40:59.199 --> 00:41:07.599
Now, I think that this is this pattern of clinicians just validating clients' interpretations of experiences.
00:41:07.760 --> 00:41:11.199
This is not unique to gender-affirming care.
00:41:11.360 --> 00:41:13.360
This is something that we're seeing across the board.
00:41:13.519 --> 00:41:14.159
Oh, with everything.
00:41:14.400 --> 00:41:14.800
With everything.
00:41:15.280 --> 00:41:18.000
I mean, just last night I was having dinner with some friends.
00:41:18.159 --> 00:41:20.400
They're they're not related to the gender world at all.
00:41:20.559 --> 00:41:23.599
And they were talking about their own experience in therapy.
00:41:23.840 --> 00:41:30.000
And my friend said, you know, I've had lots of different therapies, but I don't need someone to validate me.
00:41:30.159 --> 00:41:31.920
I actually want to like change.
00:41:32.159 --> 00:41:32.400
Yeah.
00:41:32.480 --> 00:41:34.559
People, people are sick of it.
00:41:34.719 --> 00:41:41.360
And it's expensive like to go pay a lot of money and just sit there and have somebody go, like, yes, exactly.
00:41:41.440 --> 00:41:42.719
What you said is exactly correct.
00:41:44.400 --> 00:41:46.400
That's some easy money.
00:41:47.360 --> 00:41:48.000
I know.
00:41:48.400 --> 00:41:54.480
Especially if you frame it as this like morally higher villains matter.
00:41:55.519 --> 00:42:00.800
And you are the clinician that is like, you know, enlightened about how people work.
00:42:00.960 --> 00:42:06.000
I mean, this is really tempting for our field to move in that direction.
00:42:06.159 --> 00:42:08.480
And like, we are all subject to the streets.
00:42:08.719 --> 00:42:21.519
I just don't understand how we've gotten here because it just does not reflect my understanding of just what mental health is.
00:42:21.920 --> 00:42:22.320
Yes.
00:42:22.559 --> 00:42:24.639
So it I I'm still confused.
00:42:25.039 --> 00:42:25.199
Yeah.
00:42:25.679 --> 00:42:28.880
I know I talk a lot on social media, but I'm really confused.
00:42:28.960 --> 00:42:31.920
Like it just it really blows my mind.
00:42:32.239 --> 00:42:33.519
It really does.
00:42:34.079 --> 00:42:49.840
Well, I mean, I I think I think there's like no there's almost like no shared understanding of what mental health looks like anymore, especially with the proliferation of like online narratives and stuff.
00:42:50.000 --> 00:42:58.320
I mean, there are people who say like, look, you can literally cry all day for two weeks straight, but don't let anyone tell you that you are not well.
00:42:58.800 --> 00:43:04.000
I mean, so I mean, that's just a silly example, but it's it's really complicated.
00:43:04.159 --> 00:43:18.079
And I think the reality is, you know, when it comes to gender identity, there are a lot of people who for for honestly, for mysterious reasons we don't quite understand, some people really do feel much better once they've transitioned.
00:43:18.320 --> 00:43:25.599
And they are able to have fulfilling, rich lives full of relationships and work life balance, all the things that we talk about.
00:43:25.840 --> 00:43:30.239
It's hard for those of us who don't experience gender dysphoria to really understand that.
00:43:30.559 --> 00:43:37.440
And I think that's the biggest thing, too, because I don't think that there's anything wrong with me saying that I don't understand.
00:43:37.599 --> 00:43:42.800
But does that mean that empathy or compassion goes out of the window in terms of how I treat you?
00:43:42.960 --> 00:43:51.679
No, I mean, if you were coming to me as a clinician, I would just have to be honest and wouldn't try to do conversion therapy or anything.
00:43:51.760 --> 00:43:59.760
I would say I really don't understand, but I do think it's important that you have someone that understands what you're trying to.
00:44:00.159 --> 00:44:02.239
convey here's how I can how I can help you.
00:44:02.559 --> 00:44:18.239
But I don't even know if I could go as far as you could go on the other side of it once someone has already decided that they're gonna go into the because I'm just maybe you know what I'm gonna take a page out of your book because you're very careful about what you said.
00:44:19.440 --> 00:44:22.079
I'm gonna shut up Okay.
00:44:22.960 --> 00:44:40.880
Keep me going such well I mean I I think that as a clinician in general let's say gender aside we encounter people with such a variety of life experiences that we have to be honest with ourselves.
00:44:41.039 --> 00:44:50.159
You know, I don't know what it's like to have grown up like that or to be in that kind of marriage or to have this or that experience you know with whatever, whatever circumstance.
00:44:50.480 --> 00:45:00.719
I think therapists have to get comfortable with the idea that we are going to encounter people who we don't understand what their experience is like.
00:45:00.960 --> 00:45:12.239
And I have like I've had clients that are that are gay that doesn't necessarily because that that's not the gist of the conversations that you end up having.
00:45:12.400 --> 00:45:19.440
They've already decided that this is how I live this is my lifestyle and you end up navigating so many other things.
00:45:19.679 --> 00:45:25.760
I think it's the affirming part of it like I have to say that I agree.
00:45:27.920 --> 00:45:32.480
I don't even know if it's that because if if you have a client who's gay, right?
00:45:32.559 --> 00:45:44.639
And let's say they bring to you like hey I've been in this relationship for so and so and I'm so and so amount of time I think about getting engaged my family, you can still work through with them, you know, the family It's like a normal relationship.
00:45:44.880 --> 00:45:45.679
It's like a normal relationship.
00:45:45.920 --> 00:45:52.159
Yeah yeah but if somebody says to you Raquel I'm actually not the woman that you see in front of you.
00:45:52.320 --> 00:45:53.760
I am a male I'm a man.
00:45:54.000 --> 00:45:57.840
Count me out Sanjay to affirm I'm I'm serious.
00:45:58.000 --> 00:45:58.639
Count me out.
00:45:58.719 --> 00:46:26.880
Like I I just I personally that's why I say I think that the work that you do is very complex and I'm glad that you're doing it because you hold enough space for the both in and clearly what I'm saying I don't know because I would be looking I'm like well Sasha I mean I wouldn't say this but it here because we also know what we think is what derives the questions that we ask and that's where those biases come out.
00:46:26.960 --> 00:46:38.880
Like I would have I even struggle with pronouns I'm just being honest because to me it feels the same way that how you feel within your body feels very natural to you.
00:46:39.119 --> 00:46:46.719
It feels unnatural for me to look at you and and say he like it that feels very unnatural to me.
00:46:46.960 --> 00:46:49.519
Yeah well it it I think this is really key.
00:46:49.760 --> 00:46:56.800
There's kind of two things first of all my issue is that a lot of the gender identity stuff has become very literal.
00:46:57.440 --> 00:47:15.039
So the fact that people are expecting to look at somebody and totally pretend like they're not aware of their sex and use pronouns that don't actually match that is a very strange application of this this is a theory.
00:47:15.199 --> 00:47:18.960
This is a theory that on the inside there can be a different gendered soul.
00:47:19.039 --> 00:47:21.679
I mean it's not something you can do a blood test.
00:47:22.320 --> 00:47:37.119
Like it it may very much feel that way and I think that's the thing people's subjective experiences are being asked the word like the world is being asked to validate as though they're literally true a subjective experience.
00:47:37.280 --> 00:47:38.000
That's number one.
00:47:38.159 --> 00:47:40.159
So I understand and I get it.
00:47:40.239 --> 00:47:53.039
And I actually have a problem with you know demanding language of people because we are each entitled to speaking and expressing ourselves in a way that feels authentic to us.
00:47:53.280 --> 00:47:56.800
I mean that's the whole point of pluralistic society.
00:47:56.960 --> 00:48:00.960
We in America everyone's supposed to like live how they live and be yourself right.
00:48:01.039 --> 00:48:03.440
So I I'm I totally understand that.
00:48:03.679 --> 00:48:09.360
But I think the problem is that there's a symbolic dimension to this that I think we've lost.
00:48:10.000 --> 00:48:28.559
And this is I think a challenge in the mental health space in general I think it's really valuable if a person comes to me and says Sasha I don't actually feel like a girl to get out of the literal she's probably not saying literally I don't recognize my biology.
00:48:28.880 --> 00:48:38.000
What she's probably saying is something more metaphorical I feel out of place in my skin.
00:48:38.480 --> 00:48:52.159
I feel awkward in the company of other women sometimes I would compare it to motherhood right like to women that don't feel very nurturing based off of how we assume women should be as mothers.
00:48:52.320 --> 00:48:58.800
I mean there are great moms who are not don't connect with the whole nurturing aspect of things.
00:48:59.119 --> 00:49:11.039
Right because these are I mean this is the irony of this these are social constructs to some degree right across time across space in a different culture in a different family we might define what it means to be a woman or a man differently.
00:49:11.360 --> 00:49:17.599
There are some cultures where women are always like hyper hyper feminine and they can never leave the house unless they look a certain way.
00:49:17.760 --> 00:49:21.280
There are other cultures where women are much more, you know, there's more flexibility.
00:49:21.440 --> 00:49:27.119
So it's it's interesting these are social constructs and yet we're treating them in a very literal way.
00:49:27.199 --> 00:49:30.480
So I think we're missing some of the symbolic dimension.
00:49:30.800 --> 00:49:31.440
Yes.
00:49:32.880 --> 00:49:41.519
Um I told you I wouldn't ask you all these I mean I kind of did I mean you we've talked you love what you do so much.
00:49:41.679 --> 00:50:00.480
So I knew that you would like um bring your expertise in a way that brings balance and nuance because you're not saying yes or or or or no you're continuing to do this work.
00:50:00.800 --> 00:50:16.239
I want to talk a little bit more about what you do within your community especially because you're helping parents right I work with adolescents on my caseload and I also do a lot of parent consulting and parent coaching.
00:50:16.320 --> 00:50:17.519
So yeah both.
00:50:18.079 --> 00:50:26.320
Where is the line between supporting your child and surrendering your responsibility as a parent to think question and exercise judgment?
00:50:26.880 --> 00:50:28.000
That's a huge question.
00:50:28.239 --> 00:50:34.880
I know I know well let me tell you why I asked okay social media just drives me nuts.
00:50:34.960 --> 00:50:38.960
I see so much stuff and this is why I'm not on it.
00:50:39.199 --> 00:50:54.880
It is why like my husband actually texted me yesterday and he was like so you're reporting on the news and stuff because I did that post about the University of Michigan and I was like well it does tap into the rim of mental health to me.
00:50:55.039 --> 00:51:19.119
Like I I saw another post and I'm like I'm I'm just gonna ignore that one where I guess in some states at the age of 14 you can choose to seek therapy without your parents permission and they don't have to share any records like to me that blows my mind because I'm going to raise my children.
00:51:19.360 --> 00:51:30.000
And and I do get that there are parents that may not want their children to go to therapy because there's really abuse happening happening in the home or they're ashamed for them to repeat.
00:51:30.239 --> 00:51:30.480
Right.
00:51:30.719 --> 00:51:42.239
You know so I I understand those things but to remove responsibility from parents I just I would probably go to jail.
00:51:42.480 --> 00:51:43.440
Yeah I get it.
00:51:43.599 --> 00:52:05.920
I would go to jail I don't know what the laws he earned access for any of it but if you see me behind bars it's yeah to my job I will I will bail you out got your back let me let you answer the question I gotta remember we're not off camera having a sit-down dinner the way that we did in Lake Taihoe.
00:52:06.079 --> 00:52:08.719
So when the police shows up we'll know why.
00:52:09.440 --> 00:52:21.280
Okay, so here's some here's some fundamental assumptions I make the parent-child bond is the most important relationship that exists in a child's life.
00:52:21.519 --> 00:52:39.199
And this is why I think parent consulting is so important because even if parents and children are having conflict or challenges, the best way to support the mental health of that child is to support their relationship with their parent and support their parent in supporting the child.
00:52:39.360 --> 00:52:39.679
Okay.
00:52:39.920 --> 00:52:46.000
So that is a fundamental assumption and I don't care what anyone says this has been true from the dawn of time.
00:52:47.280 --> 00:52:58.320
As mammals we have like the longest period where our children are dependent on their parents and their mothers it's biological it's built into us it's in our DNA it's in our genetics.
00:52:58.559 --> 00:53:03.199
So to cut parents out of the equation is just batshit crazy.
00:53:03.440 --> 00:53:12.960
I mean it just is it there are there are cases where parents are severely dysfunctional and a danger to their child.
00:53:13.039 --> 00:53:29.679
And in those cases and I think anyone who's worked in social services knows this if we can help stabilize the parents if we can get the parents the supports they need if we can give the parents the resources they need to better parent their children that's the best outcome for the child.
00:53:30.559 --> 00:53:33.679
All of our systems are based on that idea.
00:53:34.480 --> 00:53:36.960
So that's kind of like step number one.
00:53:37.599 --> 00:53:49.039
Number two, when I'm working with parents if they come to me and they say hey this is what's going on with my kid I feel like I've been undermined by the gender clinic or by the school or whatever.
00:53:49.119 --> 00:53:50.079
What can I do?
00:53:50.400 --> 00:54:02.239
First question is like well how old is your kid because the kind of interaction that a parent should be having with a 12 year old is dramatically different than what you do with a 17 year old.
00:54:02.559 --> 00:54:02.800
Okay.
00:54:03.840 --> 00:54:15.920
And when young people are in a state of distress and confusion and there's all of this stuff going on, what they often need is stabilization.
00:54:16.960 --> 00:54:26.800
So in my experience a very common story that I see is like a kid is 11 or 12, they're in the the throes of like a really difficult challenge.
00:54:26.960 --> 00:54:35.199
Maybe they moved from one state to the other and they're in a new school or they lost all their friend groups and they start having some sort of mental health complications.
00:54:35.679 --> 00:54:44.000
If parents give the kids the reins they usually lead to a much more distressed and confused kid.
00:54:44.239 --> 00:54:49.119
But when a kid is 11 or 12, again these are pretty young and the parents say, look, honey we love you.
00:54:49.280 --> 00:54:55.760
We know that you're distressed, but we're gonna make some decisions to help you get better.
00:54:56.000 --> 00:55:00.639
Maybe that means we're going to you know spend more quality time together.
00:55:00.800 --> 00:55:08.880
We're gonna reduce the amount of TikTok that you're looking at we're gonna help you get healthier we're gonna adjust your sleep schedule I mean whatever it is.
00:55:09.199 --> 00:55:20.800
Change your diet yeah kids need to see that their parents are competent and in charge and it's actually when parents are like I don't know what to do whatever you want to do.
00:55:20.960 --> 00:55:24.320
I mean that is not an attitude that stabilizes children.
00:55:24.639 --> 00:55:25.360
Do you know what I mean?
00:55:25.599 --> 00:55:36.239
This is yes this is I hate to break your thought but there's this there's this um I don't know if he's a doctor or not but it's his name is Dr.
00:55:36.480 --> 00:55:38.320
Prison something on social media.
00:55:38.559 --> 00:55:41.199
That's an unfortunate name is that like a joke name?
00:55:41.440 --> 00:56:01.199
No it's it's a real name but what he does is when parents are struggling with their children, he comes out and I he's reprimanding the children which I mean I there are some people that can come into your life and like it's kind of like scare straight.
00:56:01.360 --> 00:56:03.519
Have you ever seen that I know the concept.
00:56:03.760 --> 00:56:28.079
So he he basically does that and he has like 1.1 million followers and parents are really calling him to I guess come and scare their children and I'm like how I mean I think it's great that he does it and maybe he feels purposeful and probably has helped families right but you still are in the home with the parents like how sustainable is it?
00:56:28.159 --> 00:56:46.559
And I think that that is what you're speaking to like when parents start I don't know what to do like you better figure it out because you're responsible for these children that are one day going to be adults and this isn't about gender anything it's just you have a responsibility to raise your children.
00:56:47.039 --> 00:57:04.000
And that's what's good for the child right and again there's a difference between being an iron fist do as I say not as I do no conversation about this versus like you you hear what your child has to say, you listen to them and at the end of the day you're like well honey I'm sorry but I've already decided this is not healthy for you.
00:57:04.239 --> 00:57:36.639
Pray that is a calm grounded decision making that is it it really does help stabilize the kids and especially in my parent consultations a lot of parents who come from this more anxious passive stance and look when you dig into it you realize usually they have childhood stuff that they're working through and you know they might be the kind of parent that is really conflict avoidant and they said you know my dad was uh very harsh so I decided when I have kids, I'm gonna be very supportive all the time.
00:57:36.960 --> 00:57:38.559
There's reasons parents do this, right?
00:57:38.719 --> 00:57:38.880
Yeah.
00:57:39.039 --> 00:57:51.199
But usually when parents come from this anxious and permissive state, they're very nervous that if they have any kind of guidance over their child or authority that it's going to break the relationship.
00:57:51.360 --> 00:58:09.360
And what I see much more often is if they're able to approach their child in a confident, calm and direct way, the child actually gets more attached and feels closer to the parent because kids need to know that their parents are competent and love them and are going to make decisions on their behalf.
00:58:09.599 --> 00:58:27.760
Even when the kid is saying from fear in that way too like it I don't I mean I always say that fear just can't be a driver of just about anything in your life like we know that we experience it but that's I love that statement that fear can't be the driver behind your choices.
00:58:28.079 --> 00:58:35.840
No it can't yeah um I love talking to you like I love fucking you let's see if Nancy or somebody can do another dream.
00:58:37.840 --> 00:58:43.119
Sasha where can people find your work?
00:58:43.760 --> 00:58:59.920
Okay you can look at this your camera you can tell them this yep yep okay um so you can look me up Sasha Ayad um I have a Substack where I write pretty regularly it's called Therapist Reflections on a on gender in a polarized world.
00:59:00.239 --> 00:59:03.199
And I would also recommend to look at therapy first.
00:59:03.519 --> 00:59:11.360
So this is the organization that I mentioned earlier and we do um our goal is to improve mental health for dysphoric young people.
00:59:11.440 --> 00:59:16.320
And so if you are a clinician we have professional development there we do trainings there.
00:59:16.480 --> 00:59:31.440
We have our first conference coming up in New York in October and we are really um a hub for clinicians and individuals who want to look at a more nuanced kind of therapy first approach to treating gender issues.
00:59:31.599 --> 00:59:32.960
So that's where you can find me.
00:59:33.280 --> 00:59:36.480
You'll give me the links and I'll just link it to this I will for sure.
00:59:36.800 --> 00:59:42.480
All right everybody thank you so much for joining Capacity Combos until next time.
00:59:42.800 --> 00:59:49.360
This conversation calls you to pause or reflect on how you're showing up in your own life that's intentional.
00:59:49.599 --> 00:59:54.239
Capacity is revealed in the moments we choose engagement over retreat.
00:59:54.480 --> 00:59:56.400
Thank you so much for spending time with us.
00:59:56.559 --> 00:59:59.360
I'm Raquel Hopkins and this is Capacity Combos.
00:59:59.519 --> 01:00:06.400
If you're looking to continue to engage with me I would encourage you to follow me on Instagram.
01:00:06.719 --> 01:00:14.480
You can search me by Raquel the Capacity expert it's Raquel underscore the underscore capacity underscore expert.
01:00:14.639 --> 01:00:16.000
Until next time