Commentary on the Paper by Marcus Evans: ‘Assessment and Treatment of a Gender-Dysphoric Person with a Traumatic History’

We are writing this clinical commentary as a supervision group, with joint and individual experience of work with patients presenting with gender dysphoria, in different NHS Trusts and in private practice. For reasons of ethics and confidentiality, the view we are offering in this clinical commentary will be generalised from our experiences with this patient group. Our views are grounded in work with a wide range of patients presenting with gender dysphoria: latency children entering puberty and requesting ‘puberty blockers’ or hormone treatments, adolescents navigating developing identities, and adults who have undergone surgical transition.

Background

As a small team working together, we receive referrals for psychotherapy that come from a range of services in our NHS Trust, including the perinatal service, adult eating disorders, the personality disorder community service, older adults, and physical health teams including neurology. Treatment may be offered by either qualified or trainee psychotherapists, including trainee psychiatrists, and there are several supervision groups.

A Clinical Conversation

We are grateful to the editors of this edition of the Journal for bringing together a range of views and perspectives on this work. It is often noted that the research and literature on this patient group are limited, new and evolving. We wonder if the absence of such a literature has exacerbated the pressure some clinicians can feel to ‘affirm’ and align dyadically with patients, limiting our potential to step into a reflective, third position from which such a predicament might helpfully be observed. We might hope that with this developing clinical literature and understanding, clinicians may benefit from an