Has the Association of Psychotherapists Aotearoa New Zealand (APANZ) forgotten what psychotherapy is for?
New guidance silences discussion and forces psychotherapists to ignore their training and skills when working with children, young people and vulnerable adults presenting with gender issues.
No debate
As the Free Speech Union’s letter to the Minister of Health noted, the preamble to the new policy which was sent to every member on 15 November, says that APANZ “does not support discourse which questions the legitimacy of transgender and gender diverse presentations and identities, and T/LGBQAI+ identities”. This is not only clinically illiterate, it is extremely dangerous. Discussion, debate and the sharing of ideas is a fundamental aspect of psychotherapy as it is in all clinical practice. The attempt to silence is happening at the very time that concerns about gender identity medicine are growing internationally.
Psychotherapists assess patients for medical treatment
Medical pathways for people identifying as transgender are highly contested across the world and yet psychotherapists have a key role in the assessment of clients experiencing gender distress. Beyond New Zealand the prevailing orthodoxy of “affirmative care” is being rapidly replaced by more cautious approaches as the result of evidence-based reviews. The World Professional Association for Transgender Health (WPATH) has been revealed in court documents as subject to activist and political pressure. Its 2022 medical standard was not based on evidence. In New Zealand the Professional Association for Transgender Health Aotearoa (PATHA) guidelines (Oliphant et al., 2018) have been assessed as being of the poorest quality bar one in research supporting the Cass Report. The Ministry of Health Evidence Brief and Position Statement on Puberty Blockers was released only days after the APANZ guidance and it prioritises holistic assessment as the first step in care. APANZ appears to have given no attention to any of these factors.
Unquestioning affirmation is not psychotherapy
The new APANZ guidance fails to differentiate between unquestioning and therefore careless affirmation of a person's gender confusion, (which may in fact be a form of conversion therapy), conversion therapy, and psychotherapy. The organisation’s own Scope of Practice says psychotherapy involves exploring “the origins, maintenance and change of life patterns” and “the assessment, formulation, diagnosis and treatment of mental health problems”. By advocating for only “affirmative” approaches and not differentiating these from legitimate psychotherapy APANZ makes the treatment of gender non-conformity or gender distress an outlier, immune from assessment and diagnosis irrespective of causation. In stark contrast the UK Council of Psychotherapists has written to their members saying “exploratory psychotherapy is not conversion therapy and they should not be confused or linked together under any circumstances”. In contrast to APANZ the UK approach guarantees that patients with gender confusion can have the same standard of psychotherapy that is available to all other clients and, unlike APANZ, it upholds plurality of views and freedom of thought.
Gender distress and confusion
Increasingly, evidence is showing that gender dysphoria has multiple causes including autism, trauma and sexual abuse, homophobic bullying and a strong element of social contagion and should therefore be assessed in the context of the rapidly increasing number of adolescents with complex presentations seeking help. The young gender non-conforming people who will likely become same sex attracted adults are particularly at risk from the APANZ stance.
The APANZ SOGICE1report ignores this wider context completely. To suggest, as the new guidance does, that being transgender is simply a different but valid path is a cruel lie. No-one should be encouraged to resort to hormones and surgery without exploring the reasons for their perception. Why should helping a female child to present as a boy be a better clinical goal than helping her to be comfortable with being female? Only if you value transgender identities more would this make sense.
Limiting psychotherapeutic practice
Already chilled by the CPPLA, the new guidance appears to restrict the profession from using the provisions that were explicitly allowed for by the legislation. A stated purpose of the Act is “to promote respectful and open discussions regarding sexuality and gender” and the law says that any action that a health practitioner takes using their reasonable professional judgement is not a conversion practice provided that legal, ethical and professional requirements are met. By equating conversion practices with the very core of psychotherapeutic practice the APANZ president and council advice is placing members at odds both with the legislation and the Ministry of Health’s guidance.
The guidance paints a picture of an organisation captured by ideological thinking and unable to take on a balanced view, of not only emerging evidence and international changes, but of New Zealand’s law and the Ministry expectations.
All genders and sexualities are equal
On the basis of the new standard should psychotherapists all be examining their untrained, ignorant, judgemental and unconscious biases because they balk at the castration of prepubescent boys? Is autogynephilia (the male sexual fixation on oneself as a woman) really a normal part of human experience? Is there no conceivable end to 'normal sexuality', and nothing to be considered as perverse? Is eunuch a normal part of human experience as maintained by the WPATH Guidelines that New Zealand is due to adopt? These are the kinds of questions about which psychotherapists are told to examine their prejudices rather than as pointing to things that they should be genuinely concerned about. Additional training is available for those who don’t reflect adequately.
Leaking about and silencing its members
APANZ reports that this discussion has been “painful and difficult for many in our Association across the spectrum of gender and sexuality identities, orientations and presentations”. However, there is no recognition of the pain felt by the many APANZ members who have been silenced on the online members only forum “Connect”, which is supposedly the place for discussion about issues of concern.
The profession was promised an in-depth discussion but the leadership encouraged only one side of the debate and discouraged and disapproved of other views allowing members to be bullied by vociferous trans-activists.
The reality is that those who spoke out in 2023, about their rational concerns about the destructive aspects of the transgender ideology have been cast as destructive, have been patronized and told to be kind and to work on themselves. Concerns about the ideology’s effect on women’s rights, enforced speech etc, or how its demand for a no-debate, affirmative therapeutic stance undermines and invalidates the developmental theories, clinical experience and skills that psychodynamic psychotherapists base their practices on have not been welcomed. In fact therapists are being asked to take on board a whole view of reality that conflicts with what many perceive to be true and yet there is no acknowledgment of the huge meaning of this directive.
In one incident, information from a post on the “Connect” forum was leaked, by a member, to a well-known trans-activist who made a complaint (and published it on ”X”) about the member when she advertised the Genspect NZ conference in 2023. That effectively precluded her participation in the conference because of threats that the activist would wreck her career. The visibility of this punishment naturally ensured that others did not dare to say more.
In an attempt to make the organization “safe” for T/LGBQAI+ people, APANZ has become unsafe for both them and its own members.
In conclusion
APANZ guidance fails completely to allow clinicians to do their jobs and puts children, young people and vulnerable adults at risk by assessing them as transgender. Any insights into or discussion of harmful aspects of clients’ sexuality or their gender identities are assessed as being unprofessional. This not only places the APANZ stance at odds with the new Ministry advice and its own regulated Scope of Practice, it amounts to a purposeful attempt to discourage psychotherapists from deploying the skills they have. When gender is an issue APANZ assess psychotherapy as indistinguishable from a conversion practice.
It is not appropriate that a professional body should mandate an ideological, rather than an evidence-based stance, nor that it should show absolute intolerance for sharing information and debate in a heavily contested area of human experience.
This guidance must be withdrawn and the process started again in a way that ensures it complies with the Scope of Practice and with the requirements of evidence based medicine and the Ministry of Health’s new guidance.
SOGICE (Sexual Orientation and Gender Identity Change Efforts) is an acronym used in some of the literature on conversion therapy.
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