My experience of working in an NHS gender service for children and adolescents
Between October 2017 and October 2018 I worked as a Clinical Psychologist in the Leeds clinic of the Tavistock Gender Identity Development Service (GIDS). I left GIDS because I had serious concerns about the ethics of the clinical practice of prescribing puberty blockers and cross sex hormones to children and adolescents.
In July 2019 I wrote an open letter about my concerns from working in the service: medium.com/@kirstyentwistle/an-open-letter-to-dr-polly-carmichael-from-a-former-gids-clinician-53c541276b8d
I also featured in an October 2020 episode of Newsnight about historic concerns about the practice at Tavistock GIDS: www.youtube.com/watch?v=8MYWT1Cfp1g&t=1s
Psychological interventions for young people with gender dysphoria
Since leaving the service I have spent time learning more about the broader context and the history of paediatric medical transition for children and adolescents with gender dysphoria. As a result of this investigation I have reached the conclusion that there is neither a robust evidence base nor a robust ethical framework from which to prescribe puberty blockers (GnRHa) and cross sex hormones to children and adolescents.
I believe that the outcome of the Bell v. Tavistock legal case in the High Court was the right decision and I hope that it will give parents and mental health professionals the confidence to insist on psychological interventions for children and adolescents experiencing gender dysphoria.
I also hope that the legal judgement will also give parents and professionals confidence to think critically about social transition for their child. I believe that changing a child's name and using different pronouns is a profound intervention that must be thought about very carefully. Furthermore, I also think its incredibly important to find alternatives to breast binding for female adolescents. There has been very little investigation into the health impact of binding but there is growing anecdotal evidence on its harmful consequences.
I believe that the ethics of adult medical gender transition require separate consideration and I have not reached a conclusion on this issue yet. I believe that adults should be encouraged and supported to undergo extensive psychological exploration of their gender dysphoria and their wish to start medical interventions.
I am confident that there are existing psychological therapy models that can be adapted to working with children and adolescents with gender issues. My approach is to understand what is contributing to their distress about their gender, their body and their relationships with others in the context of other significant aspects of their life such as attachment relationships, other mental health or neurodevelopmental issues, experiences of being bullied and so on.
However, I also strongly believe that clinicians and therapists working with children and adolescents need to have a good understanding of the ever changing landscape of narratives about transgender and medical transition on social media in order to explore their adolescent client's beliefs about gender and medical transition.
I fully support children and young people to experiment, play, take risks and enjoy their self-expression using clothing, make up, language, theatre, creative pursuits. I support young people to explore their sexuality and to develop boundaries that enables them to protect themselves from peer pressure as well as the challenges, stigma and hostility that young people sometimes face in response to their sexuality.
Detransitioned men and women
In the past year or so I have spent a good deal of time studying the public testimonies of detransitioned women and men and I have also started working therapeutically with detransitioned female clients. I have been able to develop a good understanding of the needs and challenges detransitioners may face. I am also open to discussing the possibility of providing more practical support for detransitioned people who are looking to challenge the medical and legal systems that they have been impacted by.
I am also a member of IATDD (International Association of Therapists for Detransitioners and Desisters) a newly formed association of therapists specialising in working with people who are detransitioning or desisting: iatdd.com/
Consultation with Parents
I am happy to discuss with parents of children and adolescents who identify as transgender the possibility of 'consultation' work i.e. thinking through ways that they might navigate this situation or doing therapeutic work with parents (individually) to help them resolve their own psychological conflicts that might be making it hard to cope or may be contributing to conflict with their child.
Dr Kirsty Entwistle (Clinical Psychologist) January 2021.
Pilgrim, D & Entwistle, K. (2020) 'GnRHa ('Puberty Blockers') and Cross Sex Hormones for Children and Adolescents: Informed Consent, Personhood and Freedom of Expression.' https://www.tandfonline.com/doi/full/10.1080/20502877.2020.1796257
Entwistle, K. (2020) 'Reality Check: Detransitioners' testimonies require us to rethink Gender Dysphoria.' https://acamh.onlinelibrary.wiley.com/doi/abs/10.1111/camh.12380
Lisa Marchiano (2017) 'Outbreak: On Transgender Teens and Psychic Epidemics' www.tandfonline.com/doi/full/10.1080/00332925.2017.1350804
David Schwartz (2012) 'Listening to Children Imagining Gender: The Inflation of an Idea' https://www.tandfonline.com/doi/abs/10.1080/00918369.2012.653314
Michael Bailey and Ray Blanchard (2017) 'Gender Dysphoria is not one thing' 4thwavenow.com/2017/12/07/gender-dysphoria-is-not-one-thing/
Peitzmeier et al. (2016) 'Health Impacts of Chest Binding among Transgender Adults' www.tandfonline.com/doi/figure/10.1080/13691058.2016.1191675?scroll=top&needAccess=true
'The Observer view on the High Court ruling on puberty-blocking drugs for Children'. 6th December 2020. www.theguardian.com/commentisfree/2020/dec/06/the-observer-view-on-the-high-courts-ruling-on-puberty-blocking-drugs-for-children?
Anna Hutchinson and Melissa Midgen 'The Natal Female Question' 17th Feb 2020 womansplaceuk.org/2020/02/17/the-natal-female-question/?fbclid=IwAR3r_IEd4VARdtF6DCv_EJT0bEBW9oHQ7nFCFDHAyTJOMRhhwfgLSg-xo7w