APA resolution opposes gender identity change efforts

In 1997 and 2009, the American Psychological Association (APA) issued resolutions that focused on sexual orientation change efforts. Earlier this month, the APA again adopted a resolution that, this time, addressed gender identity change efforts (GICE).

According to Clinton W. Anderson, Ph.D, this resolution takes a broader focus against efforts to force individuals to conform to rigid gender identities. The resolution is directed at the public, consumers, and policy makers as well as psychologists.

Anderson is deputy chief, Public Interest Directorate and director, Office on Sexual Orientation and Gender Diversity.

He explained that this resolution takes a stance against pressuring or coercing an individual to conform to their sex assigned at birth. Before issuing the resolution, the APA reviewed scientific evidence, considered professional opinion and clinical judgment and concluded that GICE is harmful and should be avoided.

“This is the most fundamental kernel of the resolution,” he said.

As society continues to stigmatize those who are transgender or nonbinary, the APA is trying to initiate societal change. “Our resolution gives [transgender and nonbinary people] a voice,” he said. “We are very gratified in how much our resolutions are seen as helpful in changing attitudes, policy, and improving situations in society for people discriminated against.”

Michelle Crossley, Ph.D, LMHC, NCC, private practitioner in Pawtucket, Rhode Island, treats gender identity patients and noted that numerous accounts and literature link GICE “to decreasing mental health and possibly suicide.”

“Providing GICE is detrimental and extremely harmful for gender-diverse individuals who rely on mental and medical health professionals as gatekeepers to gender affirming medical procedures,” said Crossley. “There is a level of trust that a client/patient must have in the professional to ‘do no harm’ and this can be deadly for the client/patient if they are then forced into GICE.”

Crossley believes it is problematic that providers are required, at times, to pathologize gender identity exploration and affirmation at all. “We’ve seen how ‘homosexual’ was once pathologized and then later removed from the DSM in 1973. I see a parallel with Gender Dysphoria as a clinical diagnosis and hope that this will also be removed from the DSM/ICD,” she said.

In addition to the problems of diagnosing a gender diverse individual’s authentic self, Crossley also finds it problematic that mental health providers must serve as “gatekeepers” for gender-diverse folks.

“There are few other populations that must provide a letter asserting that the medically affirming procedures are a need for the individual and not related to other mental health diagnoses,” she said. “Basically, in my work I need to provide a letter stating that gender affirming, life-saving medical procedures are necessary and not cosmetic or elective.”

The APA’s resolution does not represent a mandate, but tries to offer guidance to psychologists based on many years’ experience, according to Anderson. “Our resolution is seen as an important support to societal change for a disadvantaged group.”

While the resolution has no “teeth,” aside from potential ethical reprimands, Crossley sees it as an important support for gender nonbinary individuals.

“For this to be utilized, we need to look toward legislative changes, similar to those that have been made recently banning ‘conversion therapy’ for minors, in order to stop licensed clinicians and medical professionals from formally practicing these types of ‘therapies.’ The only way I can foresee this helping to halt GICE practices, is if APA or other organizations, have a way to revoke a license if a complaint is submitted to the organization to investigate and have a hearing process.”

Anderson pointed out that this resolution also applies to sexual orientation change efforts (SOCE).