Episode 25

25 - Behind the Curtain: Depth Work in Gender Exploratory Therapy

Published on: 28th May, 2021

After the therapist has laid the foundations of therapy and established a trusting relationship, the process moves into the middle stage. This is the meat of the therapy! In this episode, Sasha and Stella explore the dynamics that can elicit change in the individual. They consider the curious vs. fixed client, self-esteem issues, broadening the client’s focus, and how to speak meaningfully about gender in therapy.


The Importance of an Unhappy Adolescence: Youtube.com/watch?v=zcUI1Hk0GRU&feature=emb_title


Gender Care Consumer Advocacy Network: Gccan.org


Extended Notes

  • What’s the true job of a therapist when a parent brings their gender-questioning teen in for counseling?
  • Timing is important when approaching therapy. Both Stella and Sasha keep phrases and viewpoints their teen is saying in their back pocket to bring up for exploration at another time.
  • If you’re not careful, it can turn into a “gotcha” moment for your client. You want to avoid that.
  • Teens have very harsh inner voices and, as therapists, it’s important to look into this in a gentle way.
  • A lot of adolescents understand the importance of their mental health, which is why they’re so critical of themselves when they don’t have happiness. It’s a vicious cycle.
  • Whenever there’s an outburst, people might be dismissive and say, “Oh you should talk to your therapist about that.” Although true, there are better ways to reassure a child that their emotions are perfectly normal.
  • Parents don’t like to reveal some of the bad things that happened to them throughout their life, but sharing some of these experiences with their children really humanizes them.
  • When you don’t divulge information, you make your relationship colder. By sharing information and life experiences, you create a deeper friendship.
  • People love to throw out diagnoses left and right, but sometimes these are just children going through normal teenage things.
  • Stella shares an interesting pattern that happens with her clients when they go from gender distress to seemingly being fine, and then back to gender distress.
  • As a therapist, it’s important to position yourself as someone who explores unknown questions together with your client.
  • It’s important to think big picture and dive into what else is going on in their life and not just focus on the teen’s specific gender issue.
  • Teens have reported that social media causes a lot of distress and time wasted. Too much time on these platforms causes them a lot of mental health issues.
  • As therapists, it’s also important to show the client how they can find their strong voice and say no to things that aren’t serving them or causing them distress.
  • What is the sexual self? How do you define it?
  • Therapists need to not hurry this process. A strong relationship can develop over years and so there’s time to explore challenging subjects pieces at a time.
  • The political narrative around puberty blockers is not matching what Stella and Sasha are seeing in their clinic, is it because they have a more biased cohort?

This podcast is partially sponsored by ReIME, Rethink Identity Medicine Ethics:


Learn more about our show: Linktr.ee/WiderLensPod

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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

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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

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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.