Episode 54

Published on:

17th Dec 2021

54 - Finding a Therapist for Your Gender-Questioning Teen: A Conversation W/ Lisa Marchiano

In this conversation, Lisa joins the show to talk about the difficult task of finding appropriate therapy for a gender-questioning teen or loved one. What is it like working with indoctrinated clients or those under the influence of a partner, belief system, or ideology? Lisa highlights the parental expectations of what therapy should look like, contrasted against the complex and subtle relational dynamics between therapist and client. Stella, Sasha, and Lisa examine some of the common traps therapists fall into: either being too affirming or too challenging before sufficient rapport and exploration have taken place. The three also make an exciting announcement about GETA, a new Gender Exploratory Therapy Association.


Jonathan Shedler on This Jungian Life: Podcasts.apple.com/us/podcast/does-analysis-work-a-conversation-with-jonathan/id1376929139?i=1000538533899

Gender Exploratory Therapy Association: Genderexploratory.com

Extended Notes:

  • What does good therapy look like for an adolescent questioning their gender?
  • Parents often assume the therapist will explore all the options available to their gender-questioning teen. Instead, they are shocked that they pushed medicalization right away.
  • There isn’t a biomarker for depression. Lisa explains how professionals really determine if someone is depressed.
  • Why aren’t we doing the same process for gender-questioning teens?
  • Therapists are being trained to not think of gender dysphoria as an unhealthy coping strategy. Instead, they’re being trained to go straight to helping them find “the cure.” 
  • If someone comes to a therapist for anxiety, the goal is to reduce that anxiety. If someone comes to a therapist for questioning their gender, the goal isn't to reduce their inner conflict.
  • What is the true job of a therapist?
  • Lisa talks about multiple personality disorder and how therapists handled it in the ’70s and ’80s.
  • Patients who were diagnosed and labeled with multiple personality disorder were more likely to commit suicide than those who exhibited the same symptoms but didn’t have a label to it.
  • However, sometimes by giving people a diagnosis, that revelation gives them relief.
  • Lisa talks about the problems the Vietnam veterans were running into when they came home from war. Everything from being spat on at the airport to suffering from PTSD.
  • Therapists are working with indoctrinated clients, and how you approach it is an incredibly sensitive topic.
  • It’s one thing to explore everything going on in a teen’s life beyond their gender. However, these clients are watching hours of YouTube transition videos and trying to educate themselves. The approach has to be different.
  • When you have an indoctrinated client, they split off their ambivalence and feel 100% sure in their decision to medically transition.
  • Lisa talks about the Gender Exploratory Therapy Association and how it aims to help parents, therapists, and de-transitions.
  • There are many teens who are not good candidates for therapy. Lisa explains what she means by this.
  • Lisa shares her WAIT acronym: WAIT = Why Am I Talking.

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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.

* We are sponsored by ReIME and Genspect.
Rethink Identity Medicine Ethics (ReIME) is a non-profit organization dedicated to improving long term care for gender variant individuals. To learn more, visit https://rethinkime.org/

Genspect is an international alliance of parent and professional groups whose aim is to advocate for parents of gender-questioning children and young people. Parents are concerned that their kids are not receiving appropriate treatment and support; many do not feel free to speak out about their concerns.
To learn more, visit https://genspect.org/
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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.