When a scientific journal of a vaunted organization such as the American Medical Association (AMA) publishes research, there is a natural tendency to consider the findings to be reliable, valid and worthy of one's attention and consideration. But as in all things these days, one must be careful.
In a recent JAMA article, researchers summarized their investigation into an alleged cause of "psychological distress and suicide attempts among transgender adults." While it is certainly important to understand the factors that might contribute to any group of people suffering emotional difficulties severe enough to consider taking their own lives, the curious target of this research was the impact of a particular type of care, called in the article "Gender Identity Conversion Efforts" (GICE).
GICE is a recently-coined and rather nebulous designation, used to broadly capture any approach to a gender-identity issue which falls short of full, unequivocal affirmation. The designation is somewhat analogous to the acronym SOCE (Sexual Orientation Change Efforts) which is used to refer to interventions aimed at assisting same-sex attracted persons who desire to lessen those attractions and perhaps develop attractions ordered towards the opposite sex.
SOCE interventions have been the target of much attention in state legislatures, some of which have banned the practice with minors, claiming that the availability of counseling and therapy which provides hope to those adolescents that they might be freed of unwanted feelings, is "harmful and abusive." The GICE study follows the same trajectory.
In his own review of the article, Professor Mark Regnerus details a number of methodological issues - including faulty survey techniques, statistical computation, and causal inferences - which render the study's conclusions suspect at many levels.
Yet a more fundamental problem with the published research regarding GICE, is the lack of clarity regarding precisely what GICE interventions entail.
The study states that GICE are any efforts by a professional (for example a therapist, counselor, or religious advisor) to "make a transgender person cisgender;" in other words, to explore with a person who does not feel he or she can identify with his or her biological sex, the reasons for the confusion. The AMA includes among such efforts:
[a]versive conditioning (e.g., electric shock, deprivation of food and liquids, smelling salts and chemically induced nausea), Biofeedback, Hypnosis, Masturbation Reconditioning, Psychotherapy or systematic desensitization.
What is not obvious in such a list is that the professional ethical codes of all counselors and psychotherapists prohibit the use of the most egregious of these methods and that the methods most likely to be employed would only be enacted with the informed consent and desire of the person seeking services. These eye-catching approaches aside, even the simplest introductory discussions respecting a person's current state and struggles and education of a client as part of the necessary informed consent process are classified as GICE.
Sadly, then, the public is led to believe that seeking help with unwanted same-sex attraction or gender-identity confusion is dangerous and foolhardy. Ironically, lobbying against SOCE or GICE may actually bring about the very concerns regarding increased emotional distress and suicidality that are at the heart of such efforts; withholding care from those who desire a forum for exploring their thoughts, feelings and reactions, denies them the ability to have a safe, therapeutic place to deepen their understanding of themselves.
The actual need of those who seek therapy or counseling, for whatever reason, is to be affirmed in their inherent dignity, to learn to value their unique gifts, to heal their wounds, and to pursue healthy relationships that promote flourishing.
Despite claims to the contrary - which are too-often based on the agenda-driven opinion of the professionals advocating for change - the ethical, compassionate and therapeutic presence of therapists and counselors does not distress the persons seeking help nor increase their levels of suicidality. A trusted relationship with a caring other who is committed to understanding another's needs, is one of the best inhibitors to suicidal thoughts and actions.
The symptoms of depression, anxiety and poor sense of self-worth noted in studies of this kind are sadly predictable for persons who are distressed or confused by the way they are experiencing sexual or gender feelings. In other words, while surveys consistently demonstrate how people who are identifying with something other than their actual - not assigned - biological sex at birth are at increased risk for a host of emotional problems, these struggling persons arrive at the therapist's office with long histories of struggles and needs, often including some experiences of trauma.
The appropriate response of the therapist is to endeavor to understand how the person has come to a point in life where he or she is questioning the most fundamental aspects of one's very self. While this therapeutic work is challenging and difficult to be sure, and the process of healing from trauma always involves some stirring up of uncomfortable feelings and frightening memories, when done appropriately, healing and relief can come, in time. In the course of that healing, a person may come to feel more comfortable with his or her birth sex, and it is certainly not the role of the therapist to discourage this.
Does "Conversion Therapy" Hurt People Who Identify as Transgender? The New JAMA Psychiatry Study Cannot Tell Us