action techniques useful to exploring and widening the context of gender.
The service’s systemic team T is article grew from a discussion
amongst the systemic psychotherapists working in the GIDS teams in London and Leeds. While there is a small and developing family therapy clinic in Leeds, the main work is assessment around gender identity and specifi cally gender dysphoria; and continuing to off er support, sometimes over years, as they continue to explore their gender identities with or without medical interventions. A rich systemic heritage is drawn from in the work. Clinicians seek to hold on to principles of curiosity (Cecchin, 1987) in clinical work, linking to multiple views and eliciting stories of competence. As in so much systemic work, clinicians negotiate between multiple social and personal discourses, and require fl exibility to express a variety of clinical positions. We are interested in how young people and families may perceive us, based on a variety of stories about the service in the public domain and on their experience of us in a clinical room. We seek to retain the systemic commitment to self-refl exivity and an awareness of power and the impact this can have on our relationships with families. Linked to this is an at ention to ourselves as embodied, gendered individuals as we talk about bodies, sexuality and fertility with young people. We fi nd ourselves inviting young people
and their families onto an exploratory and evaluative process. Some services would separate evaluation of gender dysphoria and exploratory work. We hold a developmental framework in the service – we work with young people up to the age of 18 sometimes including young children. We are aware how people identify their gender can change over time and there are diverse trajectories for our clients. For example, young people sometimes talk about fi rst identifying as gay or lesbian, over time feeling that does not quite fi t and coming to a trans identity. Some young people identify as trans and want physical interventions, and then identify as non-binary or gender queer and do not want medical treatments. Many young people who come to us hold unswervingly to the gender identity they state when they fi rst meet us. We are aware that identity is a developing and dynamic process for
Context 155, February 2018
Photo: Katy Davies, © Fashion Space Gallery
everyone. Evaluation and exploration are clearly diffi cult to separate in a developing area of work and there is a hope to make assessment therapeutic and useful to young people and their families as much as possible.
Some theoretical ideas As systemic therapists, we may use
the ideas of Lang, Little and Cronen (1990) to think about our overarching domain of aesthetics. We suggest that we may think about two ethical tenets – seeking consent for work, including the discussion of meanings, and an acknowledgement of our prejudice and preference and experience that ref lective discussions are useful. Our systemic framework leads us to think talking can help families and young people adjust to the transitions in their lifecycle, often precipitated by social and physical changes. How can we invite people into the domain of explanation (Lang et al., 1990) when they would prefer to stay in the domain of production? In the domain of production, young people may come to us clearly requesting medical intervention in the form of hormone blockers and/or cross-sex hormones to alleviate their experience of gender dysphoria. We can be seen as powerful gatekeepers and, sometimes, the invitation to explore can be seen as a denial of the young person and their ‘privileged access’ (Wren, 2014) to their subjective experience of gender identity.
Often, young people have done much thinking and research before they come to see us and we may be able to facilitate further discussion and/or help them communicate some of their thinking to their family. We seek to avoid polarised positions that are unlikely to facilitate exploration through the use of curiosity, self-ref lexivity (Hedges, 2010) and thinking about process as well as content. We try to attend to how people ‘do’
gender expression and the range of gender expressions available to them in their communities. We ask about relationships and whether LGBTQ+ people are visible and acknowledged in the communities young people live in. We therefore pay attention to the embedded (Hardham, 1996) nature of gender and the meanings ascribed to it in particular contexts, whilst paying close attention to the narratives of gender diversity young people are aware and part of – be it through YouTube or a local LGBTQ+ support groups. As we hope to have shown, we engage with the complexity of young people’s lives.
Conclusion There is limited research in this area of
work although, as mentioned above, we do know family support is significant in helping young people questioning their gender identity to thrive. Clinicians maintain a dedicated approach to ensure gender-diverse children and young
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An invitation to explore: A brief overview of the Tavistock and Portman Gender Identity Development Service
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