Psychotherapy for Gender Dysphoric Young People: It Is Not About Gender

In this paper, I explore the complex question of psychological assessment and therapy for gender dysphoric minors and their families. I begin with a description of the current nosology of gender dysphoria in children and adolescents in the DSM-5-TR. I then discuss the various models of care—gender affirming care, gender exploratory therapy/psychotherapy, and reparative/conversion therapies—before proceeding to a detailed discussion of the elements that comprise a psychological assessment and how this informs therapy. I draw on my own experience of gender dysphoric minors and their families to present a variety of cases that demonstrate the complex psychological dynamics involved in the aetiology of gender dysphoria. I conclude with a cautionary note about the inadequacy and dangers of gender affirming care and the “proper” domain of therapeutic action.