How Psychology’s Ideological Shift Harms Gender-Confused Children

The Hidden Influence of Clinician Bias in Gender Care

Imagine the Scene: You’re a parent desperately seeking assistance for your child who is struggling with gender confusion. You enter a clinic festooned with pride flags — a pronoun badge on every chest. You came expecting a thorough exploration of your child’s distress. Yet, before the session can fully unfold, a conclusion seems to snap into place: Within minutes, your child’s transgender identity is affirmed, and puberty blockers are on the table. You’re left grappling with unease, wondering if this reflects your child’s true needs or, rather, a clinician’s resolute worldview.

This situation is increasingly common and underscores a significant shift within psychology toward ideological practices. Jillian Spencer and Roberto D’Angelo, in their article “A Reflection on How the Absence of a Psychodynamic Perspective May Disadvantage Gender Care and Decision-Making,” identify a critical oversight: Clinicians’ failure to examine their own biases. This article focuses on how these unaddressed biases harm gender-confused children, obscure lesbian and gay identities, and necessitate a return to care rooted in biological reality and evidence.

The Ideological Shift in Psychology

Historically, psychology approached gender dysphoria with caution, guided by evidence and an understanding of biological reality. Research by Kenneth Zucker indicated that 80-95% of gender-dysphoric children resolved their distress naturally by adolescence. However, since the 2010s, the field has embraced gender ideology, favoring immediate affirmation over comprehensive exploration. Spencer and D’Angelo attribute this shift to the profession’s rejection of psychodynamic thinking, which considers unconscious factors such as shame or trauma. By dismissing these elements, clinicians treat gender dysphoria as a fixed identity, disregarding evidence of high desistance rates and the weak foundation for sex trait modification, as highlighted in the Cass Review. This trend reflects ideology rather than scientific rigor, distancing psychology from its grounding in biological facts.

Clinician Biases: The Unseen Driver

Central to this issue are the unexamined biases of clinicians. Psychodynamic theory, as endorsed by Spencer and D’Angelo, emphasizes the importance of countertransference — clinicians’ emotional responses to patients. When this reflection is neglected, biases can subtly influence care. For example, a gay clinician who perceives his or her own sexual orientation as immutable may project this perspective onto a child, assuming a transgender identity is similarly fixed and avoid exploration of internalized homophobia. This assumption can lead children toward transition, potentially obscuring that they are proto-gay or lesbian.

Spencer and D’Angelo also introduce the concept of “reaction formation,” where clinicians mask feelings of despair or helplessness with excessive positivity, evidenced by pride flags and affirmation. Additionally, a desire for narcissistic validation may drive clinicians to adopt the “life-saving” narrative of “gender-affirming care,” despite evidence to the contrary. These biases propel children toward medical interventions, bypassing the critical task of addressing underlying issues.

The Pride Flag Problem

Pride flags and pronoun badges in clinical settings, intended to signal inclusivity, exacerbate these biases. Spencer and D’Angelo argue that these symbols do more than convey acceptance — they shape the therapeutic process. By suggesting a clinician’s expectation of a transgender identity, they may discourage children from expressing doubts or discussing deeper struggles, such as sexual trauma or shame due to same-sex attraction. This reflects an intolerance of uncertainty, imposing a superficial, affirmative narrative rather than fostering genuine exploration.

Furthermore, these symbols may mask clinicians’ discomfort with negative emotions, creating a façade of positivity that aligns with the child’s defenses against pain. Consequently, the therapeutic environment becomes constrained, prioritizing affirmation over a comprehensive understanding of the child’s needs.

Harms to Children and LGB Youth

The repercussions of this approach are profound, particularly for children and LGB youth. When clinicians allow biases to guide care, they often overlook co-occurring conditions. Lisa Littman’s study on “rapid-onset gender dysphoria” suggests that social influences and mental health challenges often underlie gender confusion, yet these factors are frequently ignored. Detransitioners’ experiences, like that of Keira Bell, illustrate the consequences: After rapid affirmation at the Tavistock Clinic, she later regretted her transition, citing unaddressed trauma.

Spencer and D’Angelo note that gay or lesbian clinicians may project their discomfort with their own orientation onto children, neglecting discussions of shame and same-sex attraction — a recurring theme in detransitioner accounts. This practice risks obscuring potential lesbian or gay identities, as many, or even most, gender-dysphoric children grow up gay or lesbian if given the proper support to become themselves.

Moreover, the use of puberty blockers and hormones, which can result in infertility, raises additional concerns. Spencer and D’Angelo question clinicians’ apparent indifference to this outcome, suggesting an unconscious “anti-natalism” that devalues the biological realities of reproduction. For children who may later identify as gay or lesbian, this oversight can result in significant loss — such as the ability to father or bear a child. By prioritizing transition over exploration, psychology inadvertently engages in a form of modern gay conversion therapy, undermining sex-based orientations.

Evidence of Ideology Over Science

The evidence of psychology’s ideological shift is compelling. The Cass Review found no substantial mental health benefits for puberty blockers, yet the APA continues to endorse them, relying on limited, short-term data. The stories of researchers such as Kenneth Zucker, dismissed for evidence-based skepticism, and James Caspian, whose research was suppressed, demonstrate the profession’s intolerance of dissent. Additionally, bans on exploratory therapy in over 20 U.S. states and Canada further illustrate this ideological dominance, prioritizing conformity over patient welfare.

A Psychodynamic Reckoning

Spencer and D’Angelo call for a psychodynamic reckoning, and their argument is persuasive. Clinicians must confront their biases — whether reaction formation, anti-natalism, or a need for validation — embracing uncertainty and exploring all possibilities. This requires addressing not only systemic issues, such as activist-influenced standards, but also the personal distortions clinicians bring to their practice. A return to sex materialism — acknowledging biological sex as a material reality — offers a constructive path forward, grounding care in evidence rather than subjective feelings. Global developments, such as the Cass Review and Finland’s shift to psychological care, indicate that this approach is feasible. Psychology practice must prioritize harm reduction over ideological adherence to protect its integrity and the well-being of children.

Our Call to Action

The Courage Coalition is dedicated to advocating for evidence-based care and protecting LGB rights against the harms of gender ideology. Subscribe to our Substack, share this article, and support our efforts to safeguard children and uphold truth in psychology. Take action today — our children’s future depends on it.