Where are the Educational Psychologists When Children Say They’re Transgender?

There is a debate raging nationally. A debate about how to support young people who say they are trans. It’s contentious, it’s emotionally charged, it’s polarising, it’s unresolved. The debate was catalysed further in response to the Cass review of gender identity services for children and young people (Cass, 2022) and the associated closure of the Gender Identity Development Service (GIDS; The Psychologist, 2022). The Cass review cited many failings regarding the support for young people (e.g., utilising affirmative approaches, rather than exploratory ones; lack of comprehensive assessment of mental health and neurodevelopmental conditions; safeguarding concerns; Cass, 2022).  

At the centre of this debate, there is an assumption that psychologists will be the ones who will guide the response and who have the skills to do so (Yavuz, 2016). But the problem is that psychologists are divided too. Well, the clinical psychologists are.

In response to the interim findings of the Cass review (Cass, 2022), the Association of Clinical Psychologists-United Kingdom (ACP-UK; 2022) published a statement demanding a radical shift in the support for young people with gender concerns. They called for more comprehensive multi-disciplinary assessments and increased consideration of sociocultural factors, such as homophobia. The ACP-UK also strongly conveyed the uncertainty about how best to intervene related to the dearth of robust and high-quality data on the safety and effectiveness of medical transition, and the inability of clinicians to ascertain clearly who will persist or desist in their gender dysphoria (ACP-UK, 2022). The ACP-UK statement was met with a rebuttal from a group of clinical psychologists in an open letter to the ACP-UK (Open Letter, 2022). They disassociated themselves from the ACP-UK response, highlighted the negation of the lived experiences of trans-identified people, and endeavoured to contextualise the poor mental health presentation of this group by highlighting the lack of inclusion and discrimination they face.

Interestingly, however, there is no similar raging debate within the educational psychology profession. Amongst the whole profession, to our knowledge, there are only two educational psychologists (EPs) who have publicly referenced the concerns reflected in the Cass review. Firstly, Dr Sargeant on her podcast, Classroom Psychology, explores the statistics from the GIDS, contests the efficacy of the research around Rapid Onset Gender Dysphoria (i.e., gender dysphoria that is proposed to be linked to peer influence; Littman, 2018; Bauer et al., 2022) and draws on much of the transgender lived experience research to encourage an affirmative approach to gender healthcare (e.g., Arnoldussen et al., 2022; Austin et al., 2022). Secondly, Dr Buck proposes that local authority (LA) children’s services are being unduly influenced by transgender lobbying groups, compromising their ability to effectively meet the needs of trans-identified children (Buck, 2022). He proposes that Education, Health, and Care (EHC) assessments conducted by EPs are ways to offset the influence of these lobbying groups as they encourage EPs to draw on a wide range of contextual factors in assessing needs regardless of a LA’s position on any contentious issue (Buck, 2022).

Apart from these two voices, there is silence, avoidance, or suppression.

Silence: No response from the Association of Educational Psychologists (AEP) or the Division of Educational Psychologists (DECP), no guidance or caution. Despite it being purported that EPs are expertly placed to support trans-identified youth (Leonard, 2022).

Avoidance: Within the EP profession, it almost appears as if the Cass review did not happen and that there is a clear consensus on how best to support trans-identified youth. The EP approach in the literature ignores the challenges in the evidence base and instead centres the child’s voice above all else, even above the interim findings of the Cass review. EPs are therefore encouraged to affirm and validate the young person’s experience and work with schools, families, and young people to facilitate adaptations or support that can aid their sense of belonging (e.g., Connor & Atkinson, 2022; New-Brown et al., 2023; Yavuz, 2016), promote their identity (Allen-Biddell & Bond, 2022), facilitate transition (Leonard, 2022) and challenge systems of heteronormativity and binary conceptualisations of gender (e.g., Markland, 2021; Sargeant, 2022).  

In some ways, this emphasis on centring our involvement around the child’s voice isn’t surprising. EPs work primarily in school and family settings advocating for the inclusion of young people with special educational needs and disabilities (SEND). The SEND code of practice itself (Department for Education and Department for Health, 2015) emphasises the importance of child-centred work. However, why would EPs avoid discussing the challenges in the gender-care evidence base (Cass, 2022) when these challenges could have negative implications for young people?

Maybe because they have stopped being psychologists and have started becoming activists.

EPs are recently being called upon to embody the values of critical social justice across a range of issues (Kuria & Kelly, 2023; Schulze et al., 2017), especially because psychologists are increasingly conscious of the historic association of psychology and psychiatry with discrimination (e.g., gay conversion therapy; Rhodes & Jowett, 2021; intelligence testing and its historic contribution to racial bias; Harden, 2021). Central to critical social justice is a specific view of the world in which all groups vary in their degree of privilege and power and discrimination is upheld by oppressive systems or approaches within institutions, organisations, and society at large; e.g., the patriarchy; white supremacy; heteronormativity (Pluckrose & Lindsay, 2020). For example, to promote social justice for trans-identified youth, EPs are tasked with dismantling heteronormative systems that may contribute to their reduced inclusion and sense of marginalisation (e.g., Markland, 2021; Sargeant, 2022).  Heteronormativity is the notion that being heterosexual or cisgender (i.e., that one’s sex and sense of gender identity are aligned) is the default or normal position (Cochrane, 2022). This trans-activism is in line with historic EP practice around supporting the rights, inclusion, and acceptance of same-sex-attracted youth (Marks, 2012; Robertson & Monsen, 2001). EPs may be avoiding any challenges to an affirmation-only approach to ensure that they, as psychologists, are not deemed discriminatory once more. They want to be on the right side of history this time. However, to conflate sexual orientation and transgenderism is to obscure the point. It may feel familiar, but it is not the same. This is not just about acceptance and inclusion, which Western society has largely worked hard to achieve for gay, lesbian, and bisexual people (e.g., see: Stonewall, 2016). This is about ensuring that our approaches to promote acceptance don’t inadvertently harm young people and that we don’t ignore the warning calls of professionals in the field (Barnes, 2023; Cass, 2022) when applying a familiar strategy to a different situation.

Related to this conscious activism, EPs appear to have set about listening to and validating the views of trans-identified children and young people and advocating for their expressed needs. It may be that even exploring these expressed needs could compromise their position as an activist for transgender rights. So, anything other than affirmation is avoided or ignored. For example, even when the association between autism and gender diversity was an explicit research focus (Allen-Biddell & Bond, 2022) and EPs in the study expressed their uncertainty around the reason for this association, affirmation of the identities expressed and tackling cisnormative practices in schools to encourage acceptance was still recommended (Allen-Biddell & Bond, 2022), rather than advising caution given the lack of understanding around this phenomenon.

However, this avoidance shifted when an EP decided he wanted to publicly discuss the issue.

Suppression: This lone poster periodically raised concerns and asked questions about approaches to support trans-identified youth in 2023 on a discussion forum for EPs (EPNET). This poster was largely ignored with only sporadic responses, until a different thread was created by another psychologist associating many of the concerns being discussed (e.g., detransition; the link between same-sex attraction and transgender identification; single-sex space concerns) with transphobia, and suggesting that when transphobia as outlined is spotted EPs should report colleagues to the EP professional council (HCPC) with a fitness to practice concern. This thread did finally stimulate the debate. A few posters came out from where they’d been quietly observing and objected to this direct attempt to suppress discussion on a professional issue, instead suggesting that we should be discussing this issue more openly.

The Gender Incongruence and Non-Conformity Interest Group

This exchange led to us setting up a group for EPs who wished to discuss gender-related issues. The open invite emphasised and encouraged viewpoint diversity and stipulated that all attending would engage in good-faith discussion.

A group of approximately 15 EPs met twice in 2023. Disappointingly, however, there was not a range of views represented at the meetings. The opinions expressed within the group were largely critical of an affirmation-only approach and the role of psychologists and schools in promoting this. The affirmation-only approach, which we know is strongly advocated for by some EPs, had no representation in the group.

Participants who attended shared that although transgender themes were appearing in casework and school policy, and were very high profile in societal discourse, they were ironically largely absent in psychology service discourse. Where addressed in EP services, an affirmation-only approach was usually promoted. There were also reported instances of EPs trying to bring up the Cass review within their LA services but being labelled ‘transphobic’ for doing so.

Based on the group discussion and casework examples raised, a series of 10 scenarios was devised, a questionnaire was created, and EPs were asked to reflect on how they might approach each scenario for the follow-up meeting. At the follow-up meeting the themes elicited from the questionnaire data (12 responses) were shared and summarised with the group, and the following questions were used as prompts for discussion:

1. Gender Identity: how do we define this, and do we have a shared understanding?
2. EP Practice: is there a conflict between exploration and affirmation?
3. Individual rights and group rights: how are these balanced?

With regard to gender identity, the usefulness of this as a concept was explored in the group. It was agreed that differences in gender expression exist, and part of the EP’s role is to challenge unhelpful gender stereotypes. However, it was felt by some that the concept of gender identity may further reinforce these gender stereotypes (i.e., basing a transgender identity on interests, activities, mannerisms, or clothing preferences associated traditionally with one sex).

With regard to EP practice, some shared that they did not feel it was an EP’s place to affirm or deny anyone’s identity and that curiosity is a more important value and skill. All believed that youth should be treated with dignity and their expressed needs listened to and empathised with. However, there was a sense that the role of the EP is also to explore unexpressed needs that may not be conveyed directly by young people (e.g., peer/family influences or rejection; social challenges; trauma) to help them in the best way possible. The challenges associated with social transition (e.g., changing pronouns) were examined, especially in relation to the inevitable onset of puberty (Transgender Trend, 2022). The impact of homophobia was also discussed, as this was implicated in the transition of 23% of detransitioners in one survey (Littman, 2021). Finally, the concept of social contagion was explored (i.e., how ideas and behaviours can spread through groups) with reference to the exponential increase in those referred for gender care, especially amongst biological females (Cass, 2022; Geary, 2023).

With regard to individual versus group rights, we discussed issues related to accessing single-sex spaces and sports teams and how to balance the rights of trans-identified youth and the sex-based rights of biological females. We also considered the conflict between consent and privacy in teenage romantic relationships when trans-identified youth are not yet open about their transition.

Since this meeting, a draft school guidance on Supporting Gender Questioning Children (DfE, 2023) has been published for consultation. This guidance currently takes a position of no social transition in schools unless there are exceptional circumstances, clarifies the position on balancing the rights of the gender-questioning child and other children, and addresses the safeguarding issues raised by some EPs. It therefore also challenges the affirmation-only approach advocated by some EPs and is consequently unlikely to resolve the internal, but largely hidden, conflict within the profession on this issue. How then should the profession proceed on this issue? With difficulty, it would seem.

Trying to find a platform for this article to be easily accessed by EPs has not even been possible. The only national blog website for EPs declined to share it with the wider profession, and the British Psychological Society’s (BPS) magazine The Psychologist declined to publish on the basis that they publish articles “which seek to include the voices of trans people and those who work directly with them; and which, in line with our policies, explicitly come from a place of equal respect for all.” We made a complaint to the BPS at the suggestion that this article is not respectful and emphasised that EPs do work directly with children who identify as trans. The decision however was upheld by The Chair of the Psychologist and Digest Editorial Advisory Committee.

Therefore, there are evidently some EPs and other psychologists who believe even acknowledging the societal and professional conflict should not be tolerated. Conversely, however, it is also clear that some EPs have grave concerns about the advocacy for affirmation-only approaches, and see the psychology profession as potentially complicit in significant harm to children unless this is challenged. There are many others, the majority, who are remaining silent on the issue and who presumably are aware of the national debate raging but who do not feel confident in their position to enter the fray. EPs who may, nevertheless, be frequently working with these children and families. Is this a sustainable or healthy position for the profession? More importantly, is it a safe basis for EP practice?

Surely a healthy profession, a profession which prides itself on child-centred, evidence-based, reflective practice cannot continue to avoid, ignore, or suppress this issue any longer and must openly, explicitly, and deeply engage with it. Disagreement must be tolerated and explored. The alternative is avoidance of the issue to protect EPs from discomfort at the expense of the needs of children.

Is that where we are?

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Photo by Towfiqu barbhuiya on Unsplash

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