Episode 111

111 — Affirmation Therapy: Necessary, But Not Sufficient

Published on: 21st April, 2023

Until recently in many parts of Europe, and currently in the United States and Canada, the affirmative model of care is the primary practice in place for working with gender-nonconforming and gender-diverse youth and children. In this episode, Stella and Sasha put some intention into a deeper exploration of what affirmation therapy is exactly. They take time flushing out not just what it is but also facilitate consideration of what it means and what it achieves. Together they reflect on where the concept of affirming therapy came from, how it evolved into its current practice, when a clinician follows the affirmation model, how does that look in practice, and what are the implications?

Sasha and Stella also explore varying types of therapy, both similar to and in contrast to the fundamental premise of the affirmative approach, what they think about it, and does it actually offer any context for a comprehensive therapeutic process in the name of care?


Gender: A Wider Lens (YouTube Channel)

Live Stream Event from the Genspect Conference: The Bigger Picture

Friday, April 28, 2023 at 11am(PT) / 2pm(ET) / 7pm(IT)


*NEW* Sponsor – GETA

Gender Exploratory Therapy Association


GETA Workshop: Gender Trouble, Authoritarianism, and the Flight from Womanhood

Saturday, April 22, 2023 — 6 pm‒7:30 pm(ET)


Sasha’s YouTube


Genspect Conference: The Bigger Picture


Stella’s Book: What Your Teen is Trying to Tell You


Stella on Benjamin Boyce w/ Eliza Mondegreen

The Dangerous Radicalization of Gender Rhetoric | with Stella O’Malley & Eliza Mondegreen


Critical Therapy Antidote (CTA) book, Sasha & Stella contributing authors

Cynical Therapies: Perspectives on the Antitherapeutic Nature of Critical Social Justice


Carl Rogers: Founder Of The Humanistic Approach To Psychology


APA Guidelines for Psychological Practice With Transgender and Gender Nonconforming People


Embracing a Gender-Affirmative Model for Transgender Youth: A growing number of individuals disclosing their transgender identities underscores the need for competent care for this population


LGBT Affirmative Therapy: Tips for creating a more lesbian, gay, bisexual, transgender, & queer inclusive practice from the AAMFT Queer Affirmative Caucus


If you liked this episode, more episodes you might find interesting:

  • GWL Episode Playlist

“Conversations about Medical Interventions & Gender”


  • GWL Episode Playlist

“Top Episodes for Therapists Working with Gender-Questioning”


  • GWL Episode Playlist

“GIDS at the Tavistock”


  • GWL Episode Playlist

“The Dutch Studies”


Please visit http://www.widerlenspod.com to explore more content, access additional resources, or join our listener community.

To learn more about our sponsors, visit:




Sasha Ayad: https://inspiredteentherapy.com/parent-coaching

Stella O’Malley: http://www.stellaomalley.com/parent-coaching

Extended Notes:

  • The live stream in Killarney includes conversations about the mental, psychological, and sociological aspects of gender.
  • Sasha and Stella are working on the final edits of their upcoming book.
  • Sasha is updating her YouTube channel to include new content.
  • Sasha and Stella discuss the affirmation model and offer their opinions about the process.
  • Stella highlights the differences between the therapeutic process and therapeutic support.
  • Common underlying assumptions of therapists in the affirmative model.
  • How many therapists have a transphobic bias?
  • Sasha discusses the topics that can make therapists uncomfortable.
  • The resurgence of the positivity culture of the ’90s in therapy.
  • Combining positive thinking, social justice, and advocacy piece was a perfect recipe for the affirmative therapy model.
  • How does the affirmative model affect clinicians who don’t 100% believe in it?
  • The culture of the affirmative model is totalizing.


“Affirming a person in the context of therapy is actually quite boilerplate.” — Sasha [17:42]

“There is a difference between therapeutic process and therapeutic support.” — Stella [29:00]

“This positive, affirming thought process was in counseling. We were very ripe for the picking.” — Stella [55:10]

“The philosophy of affirmative therapy, especially as it begins to incorporate a social justice perspective by definition, is totalizing. It reminds me of high-control groups.” — Sasha [1:00:49]

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About the Podcast

Gender: A Wider Lens Podcast
Two therapists explore the expanding concept of "gender" from a psychological depth perspective.
Gender dysphoria has become a minefield for public discussion, with many afraid to express their views or question the narrative. Our mission is to examine this important and complex topic from a range of perspectives, but always through a psychological lens. By openly considering and examining gender identity, transition, and the transgender umbrella, we hope to give all interested parties permission to engage these fascinating topics with less fear and more honesty. Interviews and discussions will involve clinicians, medical professionals, academics, transgender people, parents, detransitioners and other interesting individuals whose lives have been touched by the concept of gender.

Conversations between two practicing therapists give listeners an opportunity to contemplate gender from a depth perspective not currently taken up in most of today’s accessible debates. As a result of their work with gender dysphoric therapy clients as well as their personal divergent experiences with gender, Stella and Sasha hold a refreshing and informed perspective.

Is gender identity a facilitation of development and expression of creativity, or can it be a defense against painful existential realities of living in a human body? What can we discover about masculinity, femininity, identity, gender performance, and sexuality when we peer beneath the surface and dive into a deeper psychological exploration? What is the relationship between body, mind, identity, culture, and psyche?

This podcast engages listeners in an intimate and fascinating behind-the-scenes inquiry about a topic as taboo as it is salient today.

Thank you to our sponsors:
Genspect - an international organization which offers an alternative to WPATH. Providing a range of education, resources and supports to anyone impacted by gender distress, Genspect unites many different organizations globally, and gives voice to 1,000s of previously untold stories. For more info, visit genspect.org.

GETA - an association of therapists who believe that individuals experiencing gender related concerns ought to be treated using a whole person approach. GETA connects like minded clinicians, provides educational resources and trainings, and helps people with gender dysphoria find support. For more info, visit genderexploratory.com.
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About your hosts

Stella O'Malley

Profile picture for Stella O'Malley
Stella O’Malley is a psychotherapist and author who works in private practice in Ireland. Her work focuses on parenting, family dynamics and working with teenagers.

Much of Stella’s counselling and writing focuses on mental health and the importance of well-being and she is a regular contributor to the media. She is also the resident psychotherapist for the current TV series, Raised by the Village, a family programme that helps troubled teenagers reconnect with themselves and their families.

Stella's first book, Cotton Wool Kids, was released in 2015 while Bully-Proof Kids: Practical tools to help kids grow up confident, resilient and strong was released in 2017. Stella’s latest book Fragile, was released in 2019 and focuses on overcoming anxiety and stress.

Stella was the presenter of the documentary Trans - Kids: It’s Time To Talk broadcast on Channel 4 in November 2018 and she contributed a chapter to the 2019 book, Inventing Transgender Children and Young People.

The Jungian analyst, Lisa Marchiano, and Stella launched Secrets of the Motherworld in September 2019, offering thoughtful exploration of the most intimate aspects of motherhood in a bid to help mothers feel less alone.

Stella is a Clinical Advisor for the Society for Evidence-based Gender Medicine and a founding member of the International Association of Therapists for Desisters and Detransitioners. She is also the lead facilitator for the Gender Dysphoria Support Network.

Stella holds a B.A. in Counselling and Psychotherapy and a M.A. in Cognitive Behavioural Therapy.

Sasha Ayad

Profile picture for Sasha Ayad
Sasha Ayad is a Licensed Professional Counselor who works in private practice, and has treated adolescents for over 10 years. Her work focuses on teens and young adults struggling with issues of gender dysphoria and gender identity.

She became interested in the sharp rise in teenagers who declare a trans identity for the first time during adolescence. She discovered, through working with hundreds of families, that many teens were developing gender dysphoria only after adopting a transgender identity. She questions the practice of medical transition for children and teenagers, and her clinical work focuses on developmentally appropriate, least-invasive-first talk therapy.

Sasha is also a founding member and Clinical Advisor in the Society for Evidence-based Gender Medicine and a founding member of the International Association of Therapists for Desisters and Detransitioners.

Sasha’s previous work experience includes:
- School counselor for middle and high school students at a charter school for underserved communities

- Behavioral therapy with children on the autism spectrum

- Individual and group counseling for women and children impacted by domestic abuse and sexual violence

- Developed and ran the first counseling program at a large state supported living facility for adults with intellectual disability

Sasha holds a B.S. in Psychology and an M.Ed. in Counseling Psychology.