Episode 60

60 - Pioneers Series: We Contain Multitudes with Stephen Levine

Published on: 28th January, 2022

Dr. Steve Levine is Clinical Professor of Psychiatry at Case Western Reserve University School of Medicine.  He is the sole author of several books: Sex Is Not Simple in 1989 (translated to German in 1992 and reissued in English in 1997 as Solving Common Sexual Problems); Sexual Life: A clinician’s Guide in 1992; Sexuality in Mid-Life in 1998 and Demystifying Love: Plain Talk for the Mental Health Professional in 2006; Barriers to Loving: A Clinician’s Perspective in 2013; Psychotherapeutic Approaches to Sexual Problems: An Essential Guide for Mental Health Professionals in 2020.


Dr. Levine is also the Senior Editor of the first (2003), second (2010), and third (2016) editions of the Handbook of Clinical Sexuality for Mental Health Professionals. He has been teaching, providing clinical care, and writing since 1973 and has generated original research, invited papers, commentaries, chapters, and book reviews. He has served as a journal manuscript and book prospectus reviewer for many years. He was co-director of the Center for Marital and Sexual Health/Levine, Risen & Associates, Inc. in Beachwood, Ohio from 1992-2017. He and two colleagues received a lifetime achievement Masters and Johnson’s Award from the Society for Sex Therapy and Research in March 2005.  He was given his Department of Psychiatry’s Hall of Fame  Award in 2021.


In our conversation, Stephen is posed the question: Why are we so prone to reductionism in our thinking about transition and gender? He explains the “chain of trust” in medical school training and academia and how it can lead to a broken system and low-quality procedures being used on a massive scale. Additionally, Dr. Levine’s deep perspective on love, intimacy, and what makes us human reflects the great wisdom he has gained from over fifty years working as a psychiatrist.


Solving Common Sexual Problems (1997), by Stephen Levine

Sexual Life: A Clinician’s Guide (1992), by Stephen Levine

Sexuality in Mid-Life (1998), by Stephen Levine

Demystifying Love: Plain Talk for the Mental Health Professional (2006), by Stephen Levine

Barriers to Loving: A Clinician’s Perspective (2013), by Stephen Levine

Psychotherapeutic Approaches to Sexual Problems: An Essential Guide for Mental Health Professionals (2020), by Stephen Levine 

Extended Notes

  • Stephen was first introduced into this field by a suicidal man who wanted to become a woman.
  • Despite working with this person for a number of years, she later did commit suicide.
  • Sixty-three percent of teenagers now identify as a non-binary person.
  • It seems now that if you claim a trans identity, your childhood, your backstory, is totally irrelevant.
  • The influences of the past will always infiltrate the present. This is a basic human characteristic.
  • Stephen noticed that his profession avoided the concept of love in the late ’80s, which is a big part of the human experience.
  • A lot of people in his profession didn’t want to talk about the disappointments in love.
  • What’s at stake here? It’s not only the trans teenager’s future, but their parent’s future, their siblings' future, and their physical future.
  • Gender dysphoria arises within a family.
  • “I’m finally going to be authentic!” is a lie within itself.
  • When Stephen was introduced to the medical field, he realized that facts and understanding are actually changeable events.
  • The current methods of transitioning aren’t ideal. So, how do you increase the chances of success when transitioning?
  • Stephen explains the definition of a disease.
  • There are five assumptions affirmative care doctors make to try to save a potential suicide risk and these assumptions are harmful:
  • 1. That it’s biological.
  • 2. That it’s fixed for life.
  • 3. That psychotherapeutic interventions are useless.
  • 4. That transition will diminish suicides.
  • 5. That trans people’s functioning in the world will be improved.
  • So, what can parents, doctors, and gender-questioning teens do?
  • There’s a lot of evidence to say that people who have transitioned live about 20 years less than people who don’t transition.
  • What does it mean to be human? Stephen dives into why we’re ever-changing and our thoughts and our fears will also naturally change.
  • Stephen examines the prevalence of substance abuse in transgendered children.
  • We need to be able to speak honestly about what’s known and what’s not known.

This podcast is sponsored by ReIME and Genspect. Visit Rethinkime.org and Genspect.org to learn more.


For 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.