Ex-gay therapy has been in a steady state of decline and disavowal, but the smaller movement of ex-trans therapy — efforts to discourage a transgender identity — have remained ongoing. Now, one of the most prominent clinics providing such treatment is closing and its leader seems to have entered an “end of career” phase in which he will stop advocating for the harmful treatment.
The Centre for Addiction and Mental Health (CAMH) in Toronto, Canada’s largest mental health center, is closing the Child, Youth, and Family Gender Identity Clinic (GIC) following a damning independent review that detailed antiquated practices still in use and an evident anti-transgender bias. Dr. Kenneth Zucker, who has been an advocate for anti-trans reparative therapy and has headed up GIC for over 30 years, has apparently already left.
The independent review of the clinic began earlier this year after CAMH fielded concerns from community partners about what was being practiced within GIC. Two psychologists interviewed the staff and clients, reviewed records, and consulted with other groups that have worked with the clinic. Dr. Suzanne Zinck and Dr. Antonio Pignatiello stopped short of confirming that reparative therapy was definitely taking place, but could not rule out that it was. Indeed, the report found a consistent bias against transgender identities and the use of practices that shame and stigmatize people for embracing them.
Behavior vs. Identity
GIC appealed to families who were looking to stymie the development of gender non-conforming characteristics in children. These kids would be subjected to play therapy in which they were forced to play with gender-conforming toys, and parents would be instructed to schedule more play dates with the same sex.
Zucker has been an adamant proponent of the myth that 80 percent of kids with cross-gender identification will eventually turn out to just be gay, not transgender. The study that produced this conclusion, however, relied on conflating all gender non-conforming behavior with actually asserting a different gender identity. What research has since shown is that the children who assert that they are the other gender actually are and are not likely to change. By over-including all gender non-conforming children, those numbers actually communicate nothing about the outcomes of trans kids, but that hasn’t stopped Zucker from using the study to motivate families into thinking such behavior is just a phase and can be corrected.
Zucker and GIC exhibited a bias against any gender-nonconforming behavior. As the report recounts, one child had resolved all gender and body dysphoria issues, but the clinic still advised the parents to have him “spend more time with cisgendered [sic] boys because he had effeminate speech and mannerisms. These were not the goals of the client or family.” This kind of advice for controlling the behavior and friendships of kids was common.
In other cases, the anti-transgender motivations of the family were prioritized and incorporated into the treatment. One older teen was not referred for gender-affirming hormones despite the fact that such treatment was the best course because “this would be viewed as unacceptable to the parent.”
Unsurprisingly, there was minimal documentation that parents were helped to “work through any worry or grief with the clearly stated goal of accepting any potential outcome and supporting their children.” In other words, parents were provided no resources to help them be more supportive of kids who might still turn out to be transgender. The report, which acknowledges that research has found that family acceptance is important for the well-being of transgender people, notes that this absence “is a concern and one could conclude it is not a main focus of treatment.”
The conflation between behavior and identity wasn’t the only flaw in GIC’s approach. Much in the same way advocates of ex-gay therapy claim that abuse can be — or often is — the cause of homosexuality, Zucker’s team similarly pathologized gender non-conforming behavior.
Patients reported being told that the focus of their treatment was “understanding why” they were gender non-conforming. This “cisgender goal” led to “excessive shame and self-stigma” for transgender and gender fluid people, even after they were provided access to gender-affirming hormone therapies.
GIC’s “developmental model” was backwards. It blamed symptoms like depression and anxiety on the gender non-conforming behavior itself, rather than on the stigma attached to it or the conflict of not being able to fulfill one’s gender identity. This philosophy allowed the clinic to claim it was treating these negative mental health outcomes without affirming the trans behavior. As the report explains:
Application of heterosexual cisgender as the most acceptable treatment outcome is inappropriate. Pathologisation of family and child is evident: correlational mental health problems are interpreted as causative and run counter to the prevailing clinical worldview on the direction of this correlation. Gender variance itself does not cause psychopathology but rather the distress associated with it does. An aim to treat normal human gender variation is unlikely to be successful and unethical.
This pathologization was evident in the ways that transgender patients were talked to or even humiliated. One former patient recalled Zucker saying of them, “I was too smart to be trans.” Another, now an adult transmale, claimed that Zucker asked him to remove his shirt in front of other clinicians, laughingly referring to him as a “hairy little vermin.” (This particular claim has since been found to be false.) A set of parents described how their child was asked about their gender variance “as if my child was not okay as a person.”
The World Professional Association for Transgender Health (WPATH) guidelines state that gender identity is not a matter of pathology.
Was it Reparative Therapy?
Zinck and Pignatiello stopped short of declaring in their report whether GIC’s practices were “reparative therapy” or not, but strongly suggested that they were. “We cannot state that the clinic does not practice reparative approaches (if not outright therapies) with respect to influencing gender identity development,” they wrote.
Additional examples they cited included one patient’s parent who was “encouraged not to give into that” when their child insisted on wearing underwear of their opposite-to-birth gender. Another parent was encouraged to nurture their kid’s gender behavior because “Gender Identity Disorder is a diagnosable illness with treatment.”
The fact that GIC’s practices constituted reparative therapy likely contributed to the fact it was shut down mere weeks after the report was released. In June, Ontario’s lawmakers unanimously approved a ban on all conversion therapy. Like the increasing number of U.S. cities and states passing such laws, Ontario’s ban applies to therapy that addresses both sexual orientation and gender identity. Thus, GIC’s treatment would likely have been found to violate that ban were it to continue.
Brynn Tannehill, an advocate for transgender equality who has long tracked Zucker’s anti-LGBT contributions to the psychological community, praised the closing.
“This report is damning, and long overdue,” she told ThinkProgress. “The transgender community has been saying the same things the report concluded for over a decade. Given the unethical, unscientific, and damaging nature of the work done at CAMH and revealed by this report, the research done there by Dr. Zucker and his cohorts there will be relegated to the dustbin of junk science, where it should have been all along.”
Tannehill nevertheless worries “how much harm was done in the process,” noting that the damage caused by these ideas will not disappear as quickly as the clinic itself.
UPDATE: An investigation by Jesse Singal at New York Magazine found inconsistencies and unproven allegations in the report.