Why Traditional Psychotherapy Is Failing Today’s Gender-Confused Teens

Gender ideology has made honest psychotherapy nearly impossible.

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About the Author

Joseph Burgo, Ph.D., is a clinical psychologist and psychotherapist with over 40 years of experience, specializing in narcissism, shame, and psychological defense mechanisms. He is the author of several acclaimed books, including The Narcissist You Know and Why Do I Do That?, and has written for mainstream outlets like The New York Times, The Atlantic, and Psychology Today.

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Thanks in large part to Dr. Anna Hutchinson speaking and writing extensively about her experience at the Tavistock’s GIDS, we know how difficult if not impossible it can be to maintain and pursue an open-minded, questioning approach to trans-identified clients within an institute devoted to gender ideology. One remedy, she notes, is for psychologists to move into private practice to escape institutional environments that discourage traditional psychotherapeutic approaches.

Such a move might offer relief from institutes captured by gender ideology, but psychotherapists can’t escape a society saturated in the same belief system. Even solo practitioners today find it challenging to practice as we might once have done because the world around us disputes our authority as experts, undermines family structures that have traditionally supported our work, and replaces long-held understandings of human nature with newly minted and unevidenced theories presented as unassailable truth.

In other words, it’s difficult to practice traditional psychotherapy in a milieu so different from the social and scientific environment which gave birth to our ideas about human psychology and the drivers of psychopathology. The three main areas where these differences stand out most clearly are: (1) changes in school curricula; (2) the democratization of knowledge via the Internet; and more subtly (3) a pervasive disbelief in the concept of legitimate authority.

Let’s begin with the schools.

Back in 2015, Stephanie Davies-Arai founded Transgender Trend, a parents’ and teachers’ campaign group challenging the introduction of gender ideology into British schools. Davies-Arai has tirelessly tracked down evidence that this ideology permeates the educational system; it shapes curricula, resources, and school policies in ways that pressure children to accept gender identity as indisputable fact. This ideology is now so entrenched that it influences teacher training, classroom teaching, and pastoral care, leaving educators afraid to question its claims. Schools have become a primary channel through which children are indoctrinated into gender ideology, treating contested beliefs as scientific truth and discarding dissent as “unkind” or “transphobic.”

Writing about the educational system here in the United States, Logan Lancing and James Lindsay set forth parallel evidence in their 2024 book The Queering of the American Child. “Queer Theory,” they argue, has evolved into a pervasive ideological force within American education, healthcare, and youth-culture institutions. As Davies-Arai described in the UK, these authors show how Queer Theory has effectively infiltrated schools and teacher-training programs in America, with the goal of reconfiguring children’s understandings of sex, gender, and identity. Advocates of Queer Theory use educational policy and curricula to destabilize traditional categories of male/female, parent/child, and normal/abnormal, in the process promoting “social and medical transition” as a normative path for children.

Many of the adolescent clients who come to us in our private practices have already spent years in school environments permeated by gender ideology and Queer Theory. As a reader of Reality’s Last Stand, you probably believe, like me, that there are two and only two sexes, that one’s sex is immutable and that nobody can change from one sex to the other. Our adolescent clients have often heard a different story from adults they respect–their teachers–and have read books and handouts describing sex as existing along a spectrum. They’ve been told that one’s gender identity sometimes doesn’t align with one’s birth sex, in which case hormones and surgery can bring them into alignment.

In short, we often have very different “priors” from our teenage clients, and they will bolster their own views by reference to the revered teachers who trained them, or the textbooks they have read. They also find support on the Internet.

Whenever I consult with parents of a trans-identified teen, I almost always tell them to stop arguing about gender with their child. No matter how many articles and online resources they ask their kid to read, he or she will claim that those resources must have been culled from a “transphobic” site pedaling fake science. Or they’ll produce articles of their own, even research published in supposedly reputable scientific journals. Noted trans advocate Jack Turban has an impressive list of publications on his CV, most from high status publications such as Pediatrics and the Journal of the American Medical Association.

Despite claims that “the science is settled,” there is no authoritative consensus among scientists in this contested area, at least not one that will be acknowledged and accepted by a majority of laypeople across the political spectrum. Each side promotes its own expert consensus; each side refers to a different set of publications to support its own point of view. At times, it can seem like the opposing camps occupy different realities or thought silos, with no possible bridge between them. When children fall into the gender matrix online, they come to believe that all efforts to explore the psychological roots of their trans-identification must be a form of conversion therapy (a discredited treatment modality), and that organizations such as Therapy First which promote traditional psychotherapeutic approaches are patently trans-phobic.

When a parent manages to persuade an adolescent child to engage with an exploratory therapist, most of them will immediately undertake an Internet search and likely land at some point on the Transgender Map website. According to that site, I am an “anti-trans activist” who promotes gender exploratory therapy as well as “gender identity change efforts.” Over the years, I’ve met with many parents as a prelude to working with their child, only to have that child refuse to meet with me after doing a little online research.

Even when a trans-identified teen agrees to meet with me, there’s little chance they’ll regard me as a trusted authority upon whose opinion and expertise they can rely. Yes, they might dismiss me as transphobic if they find me online, but even more, they reject the idea of a professional like me wielding legitimate truth-telling authority. When I began practicing decades ago, the Ph.D. after my name and my status as a licensed mental health professional gave me standing; today, when belief in the concept of legitimate authority has badly eroded, I’m often just another person with a point of view no more valid than what my trans-identified clients carry with them into the room.

How did we get here?

The questioning of authority in Western societies gained significant momentum during the 1960s countercultural movements. Sparked by opposition to the Vietnam War, the civil rights struggle, and second-wave feminism, young people began to challenge the legitimacy of political, institutional, and familial authority. The slogan “Don’t trust anyone over 30” captured the era’s suspicion of entrenched hierarchies. Universities, churches, and the nuclear family were all subjected to critique; radical movements argued that these institutions existed to perpetuate oppression. This cultural upheaval set the stage for a broader skepticism toward the very notion of authority as inherently trustworthy.

In the decades that followed, this anti-authoritarian ethos was amplified by scandals that exposed abuses of power in institutions once thought to be unassailable. The Watergate scandal in the 1970s undermined faith in government; revelations of clergy sexual abuse eroded trust in religious authority; and public disillusionment with psychiatric institutions and coercive treatments weakened confidence in medicine and the mental health professions. Meanwhile, postmodern theory in the academy further eroded the idea of stable, objective truths upon which authority traditionally rested, instead emphasizing social construction, power dynamics (oppressor-oppressed), and the relativity of knowledge.

In the present era, the digital revolution and the rise of social media have accelerated this process. Authority is no longer monopolized by credentialed experts or established institutions but is continually contested in an open, decentralized information environment. “Alternative facts,” influencer culture, and algorithmic echo chambers make it increasingly difficult for therapists—or any professionals—to claim the kind of authority once conferred by training and institutional affiliation. This cultural shift leaves psychotherapists working with clients who may be deeply suspicious of their expertise, more inclined to trust peer networks or online communities, and less receptive to the therapeutic professional as a legitimate source of guidance.

Even within my own profession, the notion of legitimate authority has been subjected to sustained critique. Humanistic and existential therapists, for example, explicitly rejected the image of the clinician as an expert, repositioning the therapist instead as a collaborator or “fellow traveler.” Carl Rogers’ insistence that personal experience is the highest authority undermined reliance on the therapist’s training or institutional position, while R.D. Laing went further in urging psychiatrists to relinquish the fantasy that they are the possessor of special knowledge or authority. These perspectives, while empowering to clients, also reflect how deeply the erosion of authority penetrates: even psychotherapists themselves, once seen as authoritative guides, have increasingly questioned and redefined the legitimacy of their professional stance.

So where does that leave us today? How are therapists to practice traditional psychotherapy with our trans-identified clients when much of the world, even colleagues in our own profession, disputes the idea that we’re legitimate authorities who have valuable skills based on training and experience? How can we deliver difficult truths or special insights to our clients when we lack standing to deliver them? In many situations, questioning authority is a very good thing, but have we dispensed with the idea of reliable expertise altogether?

Here’s an example of what I mean. With more than one of my clients–I’m talking about trans-identified adolescent males–persuasive material from their sessions has led me to an inescapable conclusion; I’ve wanted to say: “I think you felt deeply ashamed of feeling like an outsider as a kid growing up–friendless, out of sync with all your peers, someone rejected by almost everyone as weird or strange. When trans came along, you found a way to ‘explain’ all your pain, with a built-in answer for how to escape it.” Although I could readily point out all the things said during our sessions that demonstrate why this formulation must be true, I’ve never been able to say those words to a client, not even to boys I’ve worked with for many months and with whom I’ve established a relationship based on trust and affection. I know that if I do, it could easily be the last time I see him.

Why? Because a large part of the outside world, his friend group online, and his preferred “facts” will contradict me. I have no standing as an authority to encourage his trust, or even to give me the benefit of the doubt by keeping an open mind.

I was trained as a Kleinian psychoanalyst, and I’m usually comfortable making interpretations about deep unconscious process, then making further interpretations about defensive reactions to my first intervention. Many therapists and even other analysts will say such interpretations are premature, that one should wait until the client is about to come to the same conclusion.

Even my most revered forebear, W.R. Bion, believed that an interpretation given too soon, before the patient is able to use it, may be felt as an attack; one given too late will have lost its force. In other words, the analyst must wait until the patient is on the verge of reaching the realization himself.

Okay, so we should wait until the client is fully prepared to hear what we have to tell him. That might take years. Meanwhile the clock is ticking. Parents are desperate because their child is determined to begin taking cross-sex hormones once they turn 18. Or they’re threatening to estrange themselves from their families, knowing that many liberal colleges and universities will foot the gender-affirming care bill for students whose parents are deemed “trans-phobic.” Many therapists like me decided to work with this specific population due to personal experience with a trans-identified son or daughter; we want desperately to spare the families we work with the pain that tore our own families apart. But we must nonetheless wait for their trans-identified child to be ready to hear what we have to tell them, even when we don’t have the time to wait.

Because of my own desire to “save” my clients, I made some inept and not very useful interventions early on when I began working with this cohort. One example: I’d been meeting with an adolescent girl for about six months on a weekly basis and we had a warm working relationship. She went on at length during one session, lamenting that she’d never pass as a boy, and how painful she found it to admit the truth; I eventually asked, “Does that ever make you wonder whether transitioning is right for you?” Without quite knowing it, I’d been on the lookout for opportunities to encourage doubt.

My unhelpful question prompted her to go home and do an Internet search for my name; the next day she wrote me a terse email, called me a transphobe, and fired me.

The lesson I learned that day was to treat my trans-identified clients as I would treat any other client, and to practice psychotherapy “without memory and desire,” quoting W.R. Bion once again. That is, without having an agenda and without being overly influenced by what you already know about a client. My job, as I often say to trans-identified teens, is neither to affirm their identity nor talk them out of it. My role is to help them understand themselves as deeply as possible so that when they turn 18 and can choose for themselves, they make the best decision they can. I really do try to practice without memory or desire.

I also find it to be nearly impossible at times. Too often when searching for the right words to articulate an insight, I’m anxiously aware of the pitfalls. I often conceal the full truth as I’ve come to understand it. For example, when listening to an awkward-misfit kind of boy like the one I described above, I don’t spell it out–how identifying as trans helped him to escape from unbearable shame. Instead, I say: “After all those years of hating yourself for being a geek [incorporating the client’s own words], it must feel so good to have become someone you actually like.”

While that comment is also true, it’s capable of misinterpretation. It might be construed as affirmation, and I sometimes worry that parents who’ve entrusted their child to me might feel betrayed if they overheard such a session. They might believe I should be more hard-hitting in what I say, deploying my authority as licensed psychotherapist with a doctorate after his name in order to persuade.

If only that were possible in the current pathogenic culture.

I want to maintain contact with my client, and I know that if I say the wrong thing, the affirming world around us will encourage him to bolt. As a result, I struggle to speak plainly; sometimes I feel I’m not entirely honest about what I believe because I’m too scared to say it. I never used to feel that way. The world around me has changed so much that my former ways of practicing don’t fully apply.

At the same time, many therapists I know seem comfortable deploying their familiar conceptual toolbox, operating as if these families with trans-identified teens are no different from the other families they worked with earlier in their careers, focusing on the separation-individuation issues that are always a part of adolescence. Many times, I’ve heard therapists describe mothers as overly controlling, unable to allow their child to separate and discover an independent identity; becoming trans, these therapists will argue, may have been the only way that child could separate from the mother and develop an identity of her own. The fact that Mom micro-manages access to the Internet and friend groups, clothing choices, pronouns, haircuts, and college funds, unwilling to make even the smallest concession to her child’s new identity and belief system, just proves the point. So they say.

Maybe those moms and dads wouldn’t be so controlling if they weren’t terrified of their child doing irreversible damage to their bodies with hormones and surgery. Maybe the control isn’t the cause but the result of their child’s trans-identification. Maybe the parents would have more easily tolerated a son or daughter’s efforts to individuate if the path chosen didn’t involve sterility, amputation of body parts, and diminished life expectancy. They might have behaved quite differently many decades ago, in an entirely different social milieu.

I’m also convinced you can’t understand a large number of trans-identified teenage boys without taking into account the misandrist world in which they came of age.

Boys and young men today have absorbed decades of cultural messaging that painted masculinity as a largely negative trait. The Patriarchy. #MeToo. Rape Culture on Campus. Toxic Masculinity. Male Privilege. And so on. Trans-identification in teenage boys may have its roots in family dynamics and individual psychopathology, but you can’t fully understand it if you don’t appreciate how ashamed these boys feel simply to be male. And as a psychotherapist, how can you help a teenage boy to feel good about himself as male when much of the outside world tells him he should feel bad? Or guilty for the sins of his ancestors? Or ashamed of what gives his body pleasure?

I grew up in a different world, and I learned to practice in a socio-cultural environment with very different rules and assumptions. As a result, I’ve had to adapt, and the way I practice today is subtly different from the way I practiced 30 years ago. Back then, without even needing to acknowledge it, I understood that society supported my work and valued me as an expert with useful skills to offer. Clients who came to me for help regarded me as a benign authority upon whose judgment they might rely. And I could articulate painful truths without worrying that my client’s friend group or her teachers or random online “authorities” would tell her I was illegitimate. I took our shared reality for granted and felt more confident as a result.

Today, when I reach into my professional toolbox, I often second-guess myself. Maybe I’ll leave the more incisive insight for another day and opt for something less penetrating. I place more emphasis on maintaining friendly contact with my trans-identified clients than on telling them the truths I think they need to hear. By contrast, I feel much safer with my detransitioned clients, and confident that we occupy the same reality. With trans-identified teens, I’m always aware at the back of my mind that our priors are quite different, and if that difference becomes too apparent, it might mean the end of our work together.

And when I lose a client, I take it harder. Not only did I fail to help that struggling young person, but I’ve also let down his or her parents, and lost ground to a pernicious ideology wreaking havoc within our pathogenic culture. That’s why I now prefer to work with detransitioned young men or offer guidance to the parents of trans-identified boys rather than therapy to their indoctrinated sons. With the young men making peace with their bodies, I can practice “ordinary psychotherapy” the way I’ve always done, and with the parents, I can offer advice, support and deep empathy; like them, I’ve gone through one of the worst betrayals and losses a parent can face in this pathogenic world. In those ways, with these clients, I still feel useful and effective.

I also feel hopeful when I listen to the therapists I supervise, presenting sessions with 16-year-old clients they began seeing two years back. It often takes that long, two years, before you can make headway with these trans-identified kids, to develop a trusting relationship that enables them to question. When you begin work with a 14-year-old, the ticking of the clock isn’t quite so loud. You just might have enough time.

Rather than succumb to pessimism, I hold tight to a quote from Jordan Peterson. “Truth is the antidote to suffering.” In the end, I believe the psychologist’s authority endures not by shouting into the storm, but by remaining steadfast and shining a steady truthful light into the suffering all around, waiting for those ships lost at sea to find us, and for this culture-wide pathology to finally pass.

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