Episode 27

27 - Behind the Curtain: Psychotherapy for Gender Dysphoria with Sue and Marcus Evans

Published on: 11th June, 2021

Marcus and Sue Evans both worked as clinicians in the Tavistock Centre in London for many years. Noticing red flags since the early 2000s, Sue was the first whistle-blower in the Tavistock Centre and Marcus resigned as its governor because the concerns raised by therapists, parents, and managers were systematically dismissed. Marcus and Sue have recently released their book Gender Dysphoria: A Therapeutic Model for Working with Children, Adolescents and Young Adults. They join us to discuss the tasks of adolescents, family dynamics, and how important it is to explore questions about gender dysphoria as part of a more holistic approach to clinical care because nobody yet has all the final answers.


Gender Dysphoria: A Therapeutic Model for Working with Children, Adolescents and Young Adults

Authors: Susan Evans and Marcus Evans



“Freedom to Think: the need for thorough assessment and treatment of gender dysphoric children” by Marcus Evans 



“First do no harm: A new model for treating trans-identified children”



Interview with Marcus Evans:  



Sue Quoted in the Guardian:  



An overview of the Judicial Review and court decision about puberty blockers 



Extended Notes

  • How did Sue get into gender dysphoria?
  • Being involved in this work for many years now, Sue was concerned that children were being medicalized too quickly.
  • It is clear that there needs to be more research in this area and the subject needs to be understood more before we prescribe children with puberty blockers.
  • How did Marcus get into gender dysphoria?
  • In 2006, Sue and Marcus were raising clinical concerns about the effects of puberty blockers. It was tough. Their opinions were unpopular.
  • Marcus retired in 2018 and became a staff governor. He received a letter from 10 parents that were concerned that their children weren’t psychologically examined properly for their gender dysphoria. They felt the whole process was too rushed.
  • After digging deeper into the issues, Marcus felt he had to resign because he disagreed with how his organization was handling the issue. He was terrified his career was going to end.
  • In any other illness or mental health issue, there is an open discussion on what are the best options out there for the patient, but when it comes to gender-questioning teens, that conversation is quickly shut down.
  • We all still have a lot to learn. We should be able to ask smart questions to find the right answers.
  • Sue knew that management was not going to take their child safeguarding concerns that were being raised by the parents and by the clinicians.
  • Sue tried to gather expert witnesses to help bring more clarity around the issue, but not a lot of people were willing to step up in the UK.
  • In the end, what was the outcome of this case that Sue was working on?
  • Marcus was shocked to find out that the most at-risk kids did not have regular follow-ups.
  • The situation in Tavistock was complex. They had relatively inexperienced staff dealing with complex clinician situations.
  • How did the book get started?
  • Sue and Marcus received overwhelmingly positive support from families who finally found professionals who wanted more information about these treatment drugs.
  • We need to take a broader look at the child and how they interact with their family, friends, and how they self-reflect.
  • Why and how did Sue and Marcus pick their target demographics (young children) to study and examine for their book?
  • Many of these children are fearful of their own sexuality.
  • There’s no harm in being curious about external and internal factors at play as to why a child might have gender dysphoria.
  • What are the two biggest challenges in adolescence?
  • This is a unique time in history. Young people have the internet and can easily be influenced by it.
  • Parents and children have been frightened into an “it’s now or never” mentality when it comes to transitioning.

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.