Dr Az Hakeem on Conversion Practices Bill

Dr Az Hakeem Consultant Psychiatrist writes about the importance of exploratory therapy for people with gender dysphoria, the outcome of which may be that they come to accept their body does not need to be altered by physical treatments.

I am a Consultant Psychiatrist and Psychotherapist specialising in providing a specialist Psychotherapy for persons over 17 with gender dysphoria for the past 22 years.

For 12 years I ran a specialist UK gender dysphoria psychotherapy service in the NHS working both 1:1 and Group Therapy Settings. The therapy was an exploratory one with only psychological aims and not bodily ones. 

Those presenting with gender dysphoria had a variety of conditions resulting in their presenting confusion in gender and only a proportion would be considered what used to be referred to as Transsexual and many were what would be classified as transvestite or have other related conditions. 

26% of patients referred were people who had later regretted having gender reassignment surgery . They all said that they wished they had access to a neutral exploratory space to consider why they had arrived at their gender dysphoria. 

Rather than ‘affirming’ a hypothesised new gender solution the gender confusion was explored to try and understand why this person now felt that being another gender was a ‘solution’ and trying to work out what it meant to be any gender for them.

The majority of patients were able to arrive at an understanding of why they had come to have problems with their gender and over time the problem abated and they tended not to pursue physical treatments as their gender was no longer a cause of distress.

Those of us who have worked therapeutically in an exploratory way with these patients know that the much quoted ‘born in the wrong body’ idea is a myth. There are numerous reasons why people develop gender dysphoria and in males Autism is very highly represented and trauma in females. Internal and external homophobia also has some relevance. Almost 100% of the males presenting with the wish to change sex would be considered to be on the Autism Spectrum. Some males had a sexualised fetish of being female. 

Exploratory therapy in a neutral setting helps to work out what is felt to be better / worse / unacceptable about being any sex and is what many would expect a young person to be able to recieve if suddenly stating that they were the ‘wrong sex’.

The proposed bill aims to stop any exploration by therapists under the pretence that it is trying to ‘convert’ people into being something. It aims for ‘affirmation’ to be the only therapy available. 

Whilst the word ‘affirmation’ sounds positive it only allows a clinician to collude without questioning any gender which the person finds themselves believing they should be which is increasingly becoming anything up to 100 different ‘neo-genders’.  This is not actual therapy and is of no clinical use to the person and will result in many pursuing irreversible physical treatments which many will later come to regret. 

Affirmation therapy can often collide with a wish to escape from a homosexual sexuality especially in females and as such is in itself a form of conversion therapy rather than helping a same sex attracted person to accept their sexuality. Also with gender non-conforming people it serves as a conversion therapy to fit into gender stereotypes rather than working to facilitate an acceptance that they can present however they wish without having to make surgical changes to confirm. 

As someone offering exploratory therapy I have frequently been targeted by trans activists who have made attempts to destroy my professional life and targeted on social media. As a result after 2 decades of this specialist work I decided last year to stop providing this as the risk of complaints by activists is so high. Many other clinicians find themselves in a similar position and the result will soon be that it will be impossible for young people with gender confusion to benefit from seeing a clinician who is able to think with them about the complexity of their difficulties