Unpacking ‘gender exploratory therapy,’ a new form of conversion therapy

On June 15, 2022, President Joe Biden released the “Executive Order on Advancing Equality for Lesbian, Gay, Bisexual, Transgender, Queer and Intersex Individuals.” This order, among other things, established a series of initiatives designed to eliminate conversion therapy for LGBTQ2S+ youth. 

One week later, Lisa Marchiano, cofounder of an organization called the Gender Exploratory Therapy Association, spoke with The Economist to outline her opposition to the order, saying that she feared a conversion therapy ban could cause a “chilling effect” on the practices promoted by her organization. Marchiano pushes a type of therapy called “gender exploratory therapy,” a practice with an innocuous and even positive-sounding name. Who would be against “exploring” gender in a therapeutic setting? 

But this language is purposefully misleading. Dig deeper into the practice and it becomes apparent why its defenders are afraid of conversion therapy bans: gender exploratory therapy is a new form of conversion therapy itself. In sessions, practitioners ask clients—who are almost always youth—to “explore” the reasons they have gender dysphoria, and encourage them to see their dysphoria as stemming from just about anything other than genuine transness. In fact, desistance from transness is the ultimate goal.

Being trans is never an acceptable endpoint to a gender exploratory therapist. Treatments are often held just out of reach until the therapist finds an explanation that is convincing enough to persuade a trans person to delay their transition. Therapists who practise gender exploratory therapy do not intend to ever allow transition for the youth they practise on—one therapist listed at the Gender Exploratory Therapy Association’s website, JD Robertson, actively maintains that trans people should not be allowed to transition until “full cognitive development,” which she defines as 25 years old. 

This long-term delaying is a common tactic among practitioners who use gender exploratory therapy as a way to avoid letting youth transition before puberty ends. Therapy will often last for years until the trans youth “desists” from being trans. This has been the case since the start: the original practitioner who coined the phrase “gender exploratory therapy,” Anastassis Spiliadis, a psychotherapist at the South London and Maudsley NHS Foundation Trust, described a case where he practised this therapy on a trans youth for more than two years without allowing them to transition.

Researchers at the Trans Safety Network, a research collective that focuses on threats targeting the trans community, managed to obtain gender exploratory therapy materials from a NHS training in the U.K. held by a consultancy called Explore Consultation. These materials show exactly how the practice of gender exploratory therapy works, and the way it is billed. 

In its materials, Explore Consultation claims that a person’s gender dysphoria can be explained by factors other than transness, such as social contagion, mental health issues, autism, shame over sexual orientation and more. These “alternative causes” of being trans are then used to delay transition. Sometimes, for instance, a practitioner will say that repressed homosexuality is responsible for “feeling trans,” and they will explore these feelings over several months while delaying transition. Other times, they’ll state that alternate mental health issues like depression need to be resolved first—a position that found its way into a recent Ohio bill targeting the healthcare of trans youth. These comorbidities are often best treated by transitioning, and so the delay in transitioning until they are resolved can cause unnecessary suffering. As they wait, trans youth also go through irreversible puberty. 

The materials even advocate for barring trans youth from social transition in many cases. This can be dangerous, as we know that providing gender-affirming care has been shown to reduce self-harm and suicidal ideation among trans youth by up to 73 percent.

Gender exploratory therapy utilizes gaslighting and delay techniques in order to obtain an outcome that is desirable for those ideologically opposed to transition. In many ways, these techniques are similar to crisis pregnancy centres that also seek to “explore options” around pregnancy and “provide counselling” that has been described by pro-choice organization NARAL as “biased, manipulative, and misleading” and utilizing “delay tactics to deter and prevent” abortions. It is no surprise then that religious groups like the Catholic Psychotherapy Association also publish materials that directly link to the Gender Exploratory Therapy Association.

In recent years, gender exploratory therapy has hit the mainstream. In late 2021, prominent proponents of the practice, Dr. Erica Anderson and Laura Edwards-Leepers, published an article in The Washington Post explicitly advocating for gender exploratory therapy. Both of these proponents also appeared in an article in The Atlantic titled “When Children Say They’re Trans,” where Edwards-Leeper encouraged “exploration with a little more nuance.” The article was heavily criticized by trans rights activists and organizations such as the GLAAD Accountability Project for focusing on rare cases of trans regret, misinterpreting studies and claiming that trauma and social contagion can cause trans identification.

The practice’s proponents have even begun to inform health policy in the U.S. Florida recently decided to ban Medicaid coverage for gender-affirming care, for example, as well gender-affirming care for trans youth. In documents related to both bans, gender exploratory therapy was listed as an alternate way of dealing with gender dysphoria.

Multiple medical organizations like the American Academy of Pediatrics and the American Medical Association have spoken out against “wait and see” approaches that seek to delay or deny transition. 

Still, gender exploratory therapy tries to paint itself as a value neutral third option between allowing youth to transition and denying them care outright. Practitioners claim that they do not seek any end goal for their patients. The Gender Exploratory Therapy Association’s welcome message states that it seeks to “provide thoughtful care without pushing ideological or political agendas.” 

Just underneath the welcome message, though, is a link to a brief the organization filed opposing President Biden’s Title IX changes that protect trans students from discrimination. This brief is a steadfastly political document that, among other things, states that trans youth in restrooms would harm the mental health of their peers and therefore they should be banned from restrooms matching their gender identity. It is clear that the proponents of this “therapy” have a political agenda.

“One recipient was told by their therapist that their pronouns would not be respected because their transness was a response to trauma.”

In a recent TikTok where I described the practice, dozens of trans youth and adults recounted their own experience with gender exploratory therapy. One person described an experience where they were told by their therapist that their pronouns would not be respected because their transness was a response to trauma. Another user was told that their trans male identity was actually a result of the person feeling unsafe as a girl. 

I posted on Twitter asking for people’s experiences with gender exploratory therapy, and nearly a hundred people responded. One recounted being told she was just a repressed homosexual while another described a nearly four-year fishing expedition into other reasons why she might be trans. Many of these people have since transitioned and have dealt with the trauma of psychological gaslighting.

I spoke with one such trans person who went through exploratory therapy. Alex* (who requested a pseudonym in order to protect them from potential online harassment) went through years of exploratory therapy with a therapist who implied that their gender identity dysphoria was a product of their struggles with mental health, and not the other way around., “Essentially, if I still had anxiety issues or was struggling in school, or hadn’t fully worked through childhood trauma (in their eyes), that meant I couldn’t know if I was actually trans,” they explain.

Alex says they felt gaslit by the process and realized that any problems they brought to their therapist would be used to discredit their gender identity. “It got to a point where I was engaging in self-harm, but couldn’t tell my therapist because I knew it would ‘set me back’ in the process that I can now see was actually a never-ending cycle.”

Meanwhile, states continue to use gender exploratory therapy to justify banning gender-affirming care for trans youth and even some trans adults. Affirming parents may not recognize this and send their children to gender exploratory therapists with the expectation that the therapist will help their child explore their gender identity, when in reality the therapist seeks to gaslight their child and steer them away from ever transitioning. The damage this causes to the mental health of those exposed to it is immense and readily apparent by those who have suffered it. “Because of the therapy I received, I never got to socially transition in high school, and it made transition in college much much more difficult,” Alex said.

Alex explained that if they had received more affirming therapy, they never would have felt the need to hide their self-harm. When asked about the aftermath, they say, “My parents deeply regret sending me to those therapists and wish they had supported me sooner instead of sending me to a therapist who only told them what they wanted to hear.”