PSYCHOTHERAPY
For minors and vulnerable young adults suffering from gender dysphoria, scientific evidence, detailed in particular in the Cass report, advocates holistic psychotherapeutic care. In Belgium, some clinics still offer ‘trans-affirmative’ treatments for these patients. This means that they treat their gender dysphoria with puberty blockers, sex hormones and surgical interventions. The aim is to irreversibly transform the body to resemble that of the opposite sex, if possible from the onset of puberty. They thus follow the guidelines of the WPATH (World Professional Association for Transgender Health). However, these guidelines have been strongly criticised by many scientists and doctors internationally1.
Young people and/or their parents seeking a holistic psychotherapeutic approach often have great difficulty finding a psychiatrist or psychotherapist to help them. Since the law against conversion therapy was passed in 2023, many mental health professionals fear being accused of practising conversion therapy.
This approach is in line with the 2024 position statement of the ESCAP (European Society for Child and Adolescent Psychiatry): ESCAP Statement on the care of children and adolescents with gender dysphoria: an urgent need to preserve clinical, scientific and ethical standards.
Dr Sofie Crommen, president of the VVK (Flemish Association for Child and Adolescent Psychiatry), co-authored this ESCAP statement.
We recommend that all concerned parties, parents and educators seeking this holistic approach contact our association to find a psychiatrist and/or psychologist who is willing and able to offer it.
1 The Cass report gave a scathing assessment of poor quality and lack of independence for the guidelines by WPATH, The American Academy of Pediatrics (AAP), and the Endocrine Society (ES).
As part of the Cass review, an independent team of research methodologists assessed all the current treatment guidelines and recommendations for quality in a systematic review, using the internationally recognized AGREE II methodology for evaluating guideline quality. The AAP 2018 treatment recommendations scored amongst those at the bottom of the 23 reviewed guidelines. The WPATH and the ES treatment recommendations did not fare much better. The review noted a marked lack of independence in guideline authorship, noting circular referencing: one non-evidence-based guideline was used to justify another non-evidence-based guideline’s recommendation. The marked overlap in authorship between the guidelines (especially between WPATH and ES) was noted as a significant cause for concern, as was WPATH’s refusal to acknowledge the results of their own systematic review in its adolescent section.
Source: SEGM, The Final Cass Review and the NHS England Response – Key take-aways from the single most notable event in the history of youth gender medicine of the last decade, April 11, 2024