The New Zealand Psychologists Board, which is the registration and regulatory body for psychologists in my country, is currently reviewing its professional practice guidelines for gender and sexually diverse clients. As it stands, the Board endorses ‘affirmative therapy’ for transgender young people, and this is a significant concern because so-called affirmative therapy is in fact a sham psychological therapy, and it is also usually the gateway to social and medical transitioning for children and youth with gender issues. The Board’s stance is especially egregious because it sees itself as defining with ethical authority ‘best practices’ for psychologists.

As a retired child psychologist and academic with over 30 years’ experience, I have become increasingly concerned about this ‘worst practice’. My thinking about it has recently been assisted by a masterly new edited book, Cynical Therapies: Perspectives on the Antitherapeutic Nature of Critical Social Justice. It is a fact that much extant psychological therapy is blanketed in client confidentiality, the languages of competing approaches, and some inherent mystery. But it is important now to attempt to pull back the covers because what actually takes place can critically affect the lives of children and grandchildren everywhere.

The first reset of affirmative therapy is in how it views a child who thinks that they may be transgender. The abiding lens is of societal oppression, where outdated understandings of heterosexual privilege are seen as pervasive. It needs to be understood that the daily reality for the emergent ‘trans kid’ is often terrifying, with microaggressions (such as misgendering) being equivalent to brutal physical attacks. The burden of minority stress and stigmatisation that these youngsters experience is believed to be largely responsible for their mental health issues, such as depression, anxiety and substance abuse. However, the biggest danger is that the young person will respond to discrimination and exclusion by taking their own life. The only acceptable response is affirmative therapy, which comes with a new version of informed consent that asserts that each youngster is the expert on their own experience.

Affirmative therapy is described as explicit, and unconditional, acceptance and support for a young person’s self-defined gender identity. As well, psychologists are expected to check their own internalised transphobia, to make strong pro-trans declarations, to educate others, and to literally raise the rainbow flag at the office. In essence, the psychologist’s task is to smooth the trans child’s path, and this includes linking them up with other supportive people and groups, and promptly referring them on to medical and surgical services because time is a limited resource. Traditional therapies are rejected because they are the socially constructed discourses of the dominant majority and they perpetuate bias. It is imperative that the trans client and patient knows that they are accepted and valued unreservedly just for who they say they are.

As it happens, the social and political acceptance of transgender people across the Anglosphere is probably greater than it has been at any other time. As detailed in that defining exposé, Irreversible Damage: Teenage Girls and the Transgender Craze, the world in which young people grow up in today is suffused with references and encouragement regarding sexual diversity.  For children and youth who may think that they are transgender, online influencers are also available to teach them what to wear and how to walk; and how to deceive parents and health professionals.

While best practice guidelines may suggest that children need to be understood as individuals, affirmative therapy is patently premised to a simplistic and stereotyped picture of the client that gives primacy to gender identity over all other aspects of personality. Effectively, the child is seen as a representative of an identity group rather than a girl or boy who likes to play outside, or do cooking with mum, and who will have many other interests and dimensions. Obviously, it is a major concern that self-harm is high in the transgender community. But frankly, perhaps some psychologists need to give priority to treating the presenting anxiety and depression instead of reaching preemptively for a radical gender transformation.

All proper psychological therapy is positive, affirming, collaborative and non-judgemental. It is highly questionable whether it will ever be merely confirming and conforming. Therapists are supposed to be curious, rather than credulous, about the nature of client distress; and typically they will gently challenge the young person to consider alternative interpretations of their circumstance.

What a therapist should never do is to commit (what is known in the trade as) the fundamental attributional error, which is to give undue precedence to a client’s disposition and personality, while underplaying the situational influences in his or her life. Psychological knowledge continues to have an important role, as statistics show that fully eighty per cent, or more, of young people who initially identify as transgender will subsequently accept the sex that they were at birth. And as every adult knows, achieving a mature personal and sexual identity is unlikely to be easy for anybody; but the foreclosed, and predetermined, conclusions of affirmative therapy offer no real answers to anyone.

It may be instructive to look a little more closely at the therapeutic relationship, which is a venerable institution with many years of study and research. As outlined in the career-culminating text How and Why People Change: Foundations of Psychological Therapy, all psychotherapy is a specialised form of social influence. Traditionally, in the therapeutic relationship, therapists have used selective attention and social reinforcement to develop self-management strategies and other life skills that will likely lead to increased autonomy and independence.

But what if there is another agenda on the coffee table entirely, and the clinician is now pledged to always believe the child’s self-report; which every other psychologist knows is notoriously unreliable, and where subjective feelings are rarely a complete representation of reality? In this relationship, the clinician’s cueing, shaping, consequences and modelling (which can be as unobtrusive as tone of voice and body language) would inevitably amplify the child’s transgender identification and could facilitate induction into a select and most-welcoming new community. Self-evidently, the mandated medium of affirmation is insistently, persistently and consistently invested in the message. And what protections does the prevailing shibboleth of informed consent offer? None at all, as it functions solely to set off a process of gender conversion.

Counselling and psychological therapy have clearly made a major misstep with affirmative therapy, which is primarily an ideological and authoritarian tool; and it is a professional travesty and tragedy. Nonetheless, the review of best practices for gender and sexually diverse clients that the NZ Psychologists Board is presently conducting is an opportunity for this legacy authority to rescue itself or to continue to deny the higher callings of its purpose.