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Holding Complexity In Gender Distress · Inside The Consulting Room - Understanding the Child Behind the Behaviour

• 0:00
  SPEAKER_00: Hello and welcome back.
• 0:02
  SPEAKER_00: This is Kim Lee, child and adolescent psychotherapist.
• 0:06
  SPEAKER_00: And this is a three-part series that is concerned with navigating through gender identity and gender distress and crisis in young people.
• 0:21
  SPEAKER_00: Now this is a very potentially inflammatory topic, and I say that because I am very alert to the range of opinions and feelings, the strong feelings that people hold about this topic.
• 0:41
  SPEAKER_00: And it seems to me there's a kind of continuum with polarity at either end.
• 0:49
  SPEAKER_00: And the at the one end, one polarity is a complete lack of acceptance that such a situation could possibly exist.
• 1:05
  SPEAKER_00: It is perhaps considered to be something which is a made-up state, that it is politically motivated, and that people who have this view are seen to be transphobic.
• 1:25
  SPEAKER_00: At the other end of the spectrum, we have people who take the view that this is real, it's unquestionable, and should not be regarded as something that is wrong.
• 1:47
  SPEAKER_00: Between those two poles lie a range of other views and reactions.
• 1:56
  SPEAKER_00: That's not my intention to direct anybody to anywhere along that spectrum.
• 2:07
  SPEAKER_00: And that's because I'm looking at this from a different perspective.
• 2:15
  SPEAKER_00: I'm looking at it from the perspective of what is happening inside the individual which lies beneath the expressions of certainty or uncertainty about gender identity.
• 2:34
  SPEAKER_00: There's a very great deal written about this, both from a supportive and also a critically analytical perspective.
• 2:51
  SPEAKER_00: I don't intend to offer something that is critically analytical, because I'm not sure that that would speak to people who listen to these podcasts.
• 3:05
  SPEAKER_00: But I'm particularly alert to how parents may experience the fact that the young person who was one gender, biological gender at birth, has now decided, seemingly, that this is no longer valid.
• 3:33
  SPEAKER_00: I know from some experience that parents experience great confusion, sometimes shock.
• 3:45
  SPEAKER_00: Sometimes they will dismiss these statements that the young person is making and regard them as a means of trying to accomplish something else, or that they're just following the rest.
• 4:08
  SPEAKER_00: It's not for me to question the decisions that parents will come to, but I do recognize that it must be incredibly hard to be on the receiving end of what must feel like an enormous curveball.
• 4:28
  SPEAKER_00: So what I want to try and do is understand the complexity of this.
• 4:36
  SPEAKER_00: I really don't want to tell you what to think.
• 4:40
  SPEAKER_00: My aim is to help you think, because that is what protects both you and your child.
• 4:48
  SPEAKER_00: Now, when young people experience gender distress, what we see externally, things like identity statements, certainty, urgency, is often only the surface of something deeper.
• 5:06
  SPEAKER_00: Many adolescents describe feeling alien in their own body, or a sense of disconnection from themselves, and an emotional pain and discomfort that they can't fully explain.
• 5:21
  SPEAKER_00: Often there'll be a wish to escape the confusion, the distress, or the inner conflict, and for some, the body becomes the symbol of the problem.
• 5:33
  SPEAKER_00: And when the body feels like the problem, changing the body can feel like the solution.
• 5:42
  SPEAKER_00: But psychologically, identity is not only about the body, it is about integration, the linking of mind, body, emotion, and meaning.
• 5:55
  SPEAKER_00: And certainty is not always clarity because one of the most confusing things for parents is their child's certainty.
• 6:04
  SPEAKER_00: Parents often say they sound completely sure, like there's no doubt.
• 6:10
  SPEAKER_00: But psychologically, certainty can sometimes be a defense, not a lie, not a manipulation, but a defense.
• 6:21
  SPEAKER_00: So when in a confusion, anxiety, trauma, or fragmentation feel overwhelming, the child or the mind of the child may seek absolute answers to avoid the unbearable ambiguity.
• 6:38
  SPEAKER_00: And this can create a powerful internal narrative.
• 6:43
  SPEAKER_00: If only I were different, everything would make sense.
• 6:47
  SPEAKER_00: This is sometimes called the if only identity.
• 6:51
  SPEAKER_00: It offers relief, but relief is not the same as resolution.
• 6:56
  SPEAKER_00: Now, adolescence is a time of identity vulnerability anyway, because adolescence is a period of psychological upheaval, the body changes rapidly, sexual identity emerges, dependency and independence collide, and self-image becomes fragile.
• 7:18
  SPEAKER_00: So for some young people, this creates profound anxiety, fear of vulnerability, fear of being seen, fear of being trapped in a body that feels unfamiliar.
• 7:29
  SPEAKER_00: And in these moments, identity may become fixed too quickly.
• 7:34
  SPEAKER_00: Not because it's false, but because it is stabilizing.
• 7:39
  SPEAKER_00: And when identity stabilizes too quickly, reflection can close down.
• 7:46
  SPEAKER_00: Healthy identity development requires something subtle but essential.
• 7:53
  SPEAKER_00: And it's the ability to hold contradiction, to say, I feel this and I am not fully sure.
• 8:03
  SPEAKER_00: I am distressed and still discovering.
• 8:07
  SPEAKER_00: I am changing and still forming.
• 8:12
  SPEAKER_00: And when symbolic thinking collapses, identity can become rigid.
• 8:19
  SPEAKER_00: And so what we see is I am this, nothing else is possible.
• 8:23
  SPEAKER_00: And this protects the young person from psychological pain, but it may also prevent deeper integration.
• 8:32
  SPEAKER_00: I have had experiences with young people where their sense of certainty seems to me often to be a request for affirmation, as if they are wanting me to confirm that their certainty is correct, that it is undeniable, and that they want to experience me as an adult who will essentially agree with them.
• 9:10
  SPEAKER_00: And it's tricky because if I were to take a polarized position, then that would wouldn't end well.
• 9:24
  SPEAKER_00: And as I've said, that's not for me to do.
• 9:29
  SPEAKER_00: Generally, what I will say is I think it's really hard to know exactly who you are.
• 9:42
  SPEAKER_00: I say I see you, I don't see a gender, I see you, and you are made up of parts, just like everyone else.
• 10:00
  SPEAKER_00: And it will probably take a while for those parts to come together, just like it does for everyone.
• 10:08
  SPEAKER_00: But the part that you're occupying right now feels just the way you're describing it.
• 10:16
  SPEAKER_00: So, in a sense, I'm saying you are being as you are right now, but you're not the finished article.
• 10:26
  SPEAKER_00: Generally speaking, that seems to be tolerated, but it has to be something that's done with sensitivity, and I think some parents that I've worked with have used a very similar approach.
• 10:44
  SPEAKER_00: But parents often describe that they notice a sudden shift around their child's puberty and they may withdraw into online communities where people are seeking information and they receive affirmation.
• 11:02
  SPEAKER_00: They have a reduced curiosity about their feelings and their internal world, and they have a strong resistance to questioning and urgency towards irreversible decisions.
• 11:15
  SPEAKER_00: And I'm thinking here about hormone treatment or any of the other procedures.
• 11:23
  SPEAKER_00: And these aren't signs of wrongdoing, they're often signs of psychological pressure.
• 11:29
  SPEAKER_00: So your role as a parent is not to force certainty, because if you do, you will either be in opposition or you will be caught in the distress that underpins the need for certainty.
• 11:51
  SPEAKER_00: Your task isn't to deny experience, your task is to hold what we call reflective space, to help your child stay able to think even when emotions are intense.
• 12:09
  SPEAKER_00: Because identity is not something imposed, it's something that emerges.
• 12:14
  SPEAKER_00: In the next episode, we'll explore what happens between the young person and the adults around them, including parents, therapists, and the emotional pressures that can arise in relationships.
• 12:29
  SPEAKER_00: And why?
• 12:30
  SPEAKER_00: Because identity doesn't form in isolation, it forms in relationship.
• 12:39
  SPEAKER_00: Thank you for listening.
• 12:41
  SPEAKER_00: I'll be back.