Strangers are coming after my license. I'm happy to talk with the board about this.
This article republished with kind courtesy of Stephanie Winn, LMFT. The original post can be found at stephaniewinn.substack.com
After numerous strangers on Twitter started threatening to report me to my licensing board, I thought it would be wise to reach out to the board directly. Here’s what I said.
Greetings colleagues and board members of the OBLPCT,
I am writing today as an Oregon licensee (LMFT T1201) to proactively address a problem: you may be receiving some complaints about me. I am currently being harassed and threatened by people I do not know on Twitter. Many of these accounts are anonymous. Their complaint is regarding gender ideology. They claim that my behavior is illegal and they have grounds for making reports because they believe I am in violation of the ban on conversion therapy.
First, let me clarify a few things:
1. I understand that conversion therapy has been redefined nationwide to include not only sexual orientation, but also gender identity. I understand it is illegal in several states according to different policies. Specifically, in Oregon, it is illegal for minors.
2. I do not practice conversion therapy according to any definition.
3. I have worked in a supportive manner with many trans and nonbinary identified young people.
4. To this date I do not know of a single client of mine, or anyone who knows me in any respect, who has made a complaint to the board. I only know of strangers online, trans rights activists, most of them with anonymous accounts that seem heavily themed around attempts to undermine anyone who questions their agenda. Some, for instance, have “#banconversiontherapy” at the top of their profiles.
5. I fully support the rights of lesbian, gay, and bisexual people. I do have concerns that some “rights” that trans rights activists are fighting for threaten sex-based rights, eg., women’s-only safe spaces, women’s sports, women’s prisons, etc. I believe I am entitled to my political views and freedom of speech when I express these concerns through my writing.
6. I abide by all legal and ethical guidelines of psychotherapists in Oregon. I have maintained my license since 2016 without issue. In addition to meeting CEU’s (I’m currently finishing mine up so that I may renew my license in January 2022), I engage in a lot of self-study. I also sometimes read through the OARs and the sanction list.
7. I believe that the redefinition of conversion therapy in 2015 was a mistake, and will elaborate why.
Why I oppose the redefinition of “conversion therapy”
It is my understanding that in 2015 nationwide “conversion therapy” was redefined from its classical definition - banning attempts to use counseling to “convert” homosexuals into heterosexuals - to now include “gender identity.”
I believe this is unfortunate, for many reasons. I oppose discrimination based on sex or sexual orientation, and have an abundance of clinical experience working supportively with homosexual and bisexual clients. Sexual orientation is a biological reality that tends to be innate and is stable across the lifespan. There is nothing inherently harmful about anyone’s sexual orientation as long as they are engaging with consenting adults.
In contrast, "gender identity" is a new concept, one that is fluid, subject to developmental influences, and especially, subject to social influence. Many people consider “gender identity” to be a metaphysical concept, in that it has no basis in biological reality. For example, there is no scientific basis for phrases such as “born in the wrong body,” or “male brain in a female body.” These are valid and worthy of exploration as attempts to describe certain feelings, but that does not make them objectively real, and many would argue that does not mean someone’s internal, subjective sense of identity should supersede sex-based rights.
I have no problem with anyone holding any religious or spiritual worldview that they please. I have worked with people of a wide range of belief systems. However, as a therapist, it is my job to (1) notice signs of cult involvement, (2) explore what people mean by the things that they say, and (3) help clients examine how their beliefs influence their behavior and emotions. That is not my main point, however. What I would like to address is the point where a belief in a gender identity becomes concerning.
When youth adopt a “gender identity” that is different from their biological sex, many do so under peer pressure, or in response to normal adolescent identity development. In contrast to sexual orientation, adopting a certain “gender identity” can lead to significant harm when coupled with our current sociopolitical and medical environment, which seeks to medicalize gender by assigning youth puberty blockers, cross-sex hormones, and surgeries, all of which pose the risk of a great deal of harm, for myriad reasons. It would be irresponsible not to familiarize oneself with the rapidly growing body of data on this subject.
I have always counseled women in being aware of how their hormones affect their moods. I have encouraged women to track their cycles and take special care during premenstrual periods for those who have monthly mood swings. I have helped teen girls adjust to the awkwardness of their periods and get to know their bodies. I have also always been an advocate for health, encouraging my clients, whenever possible, to reduce coping mechanisms that cause harm, and replace them with healthier coping skills. I have also always been on the side of helping people become more comfortable and accepting toward their bodies, heal from dissociation, and practice embodied self care. A great many clients have benefitted from gaining these tools from me. I am not suddenly going to disregard everything I know about hormones, health, and embodiment, and pretend that massive, unprecedented disruptions to the endocrine system, which have countless side effects, are perfectly harmless. That would be reckless, irresponsible, and inauthentic.
I have also always approached psychotherapy with depth and nuance. I ask many questions, offer many reflections, guide people to unpack the significance things hold for them. Now, if something is off-limits, I don’t push it. I often normalize, positively reframe, validate, and/or encourage people to have boundaries with regard to what they discuss in therapy. For instance, if someone has a history of sexual trauma, I often wait for them to bring it up, and when we do talk about it, I check in frequently about whether it’s still feeling okay to talk about this, or if it’s too vulnerable and overwhelming. I also normalize trust issues in therapy. I tell clients, especially early in our relationship, that just because I’m a professional, that doesn’t mean it will come naturally to tell me everything. It’s normal to feel guarded. Trust and rapport must be developed through time and experience, and I’m here to engage in that process with them in a safe way. However, aside from these sorts of ways in which one might need to step delicately, when appropriate trust and rapport have been established and the client is ready to share, my job is to help open things up for exploration. Even the smallest thing may hold a great deal of significance for them. [Clinical information redacted]. Never underestimate the importance of something as ordinary as [a small object that holds personal meaning for someone.] So with all this being said, you can imagine my incredulity, skepticism and hesitancy regarding the notion that there are some things that are off limits to question in therapy. I do not want to simply take a person’s asserted “gender identity” at face value, and affirm it without examination. That runs contrary to everything I know.
Furthermore, the ban on “conversion therapy” for minors in Oregon is especially concerning because identity development is a tender and fluid process during adolescence. Youth need support more than any other demographic when it comes to exploring what identity means to them and how it is evolving over time.
Another concern with this ban is that it puts therapists at risk of being targeted by clients with personality disorders. (Or, in the case of those with a public presence such as myself, personality disordered strangers online who are not clients, but that’s for another time.) We are all familiar with these patterns. Any therapist who works with people with Borderline Personality Disorder knows to anticipate that the client may quickly shift from idealizing the therapist to demonizing her, in response to the slightest perceived abandonment. Narcissistic, histrionic, and antisocial traits pose similar risks as well. When a therapist signs up to treat people with severe BPD, she knows she may continually need to deal with boundary violations, suicide threats or attempts, and demonizing fits of rage. Now let’s add to the mix that an unstable sense of identity is part of the Borderline picture as well, and combine this with the fact that people who are questioning their gender have that trait. So, how do we deal with the fact that people with these traits and behaviors may flip from adoring their therapist, to wanting to sabotage her career? A therapist working with, let’s say, a 17-year-old who is questioning their gender and displaying Borderline traits could be doing excellent work, but do one thing to trigger their abandonment rage, and end up the subject of a board complaint, accused of doing “conversion therapy” because she attempted to explore what the teen meant by “feeling trans.”
By banning “conversion therapy,” we also make it much more difficult for therapists to conduct a proper differential diagnosis, identify and treat comorbidities. As an example, many people have likened gender dysphoria to anorexia in that both involve hating one’s body and attempting to alter it. So, what do we do if a patient presents with both gender dysphoria and anorexia, and the two are linked? What to speak of other comorbidities. I’d like to give an example.
Let’s say, for instance, that we have a female youth who identifies as a boy. This child hates their body with its feminine distribution of fat, and adopts a very calorie restricted diet in an attempt to appear more masculine. From there, the child’s mental and physical health enter a dangerous downward spiral that anyone who has worked with eating disorders is painfully familiar with. The malnourished brain cannot function properly and lacks the energy to be able to address any psychological issues appropriately in therapy.
Now let’s add to that mix that this same youth was also molested by a babysitter at the age of four, which they (or their parent) may or may not tell you (or even remember). And, they developed breasts early, and were frequently sexually harassed by grown men beginning at the age of 12. These traumas contributed to a sense of feeling unsafe in a female body.
Let’s also add that this child was bullied in elementary school, and never quite fit in. The child learned about being transgender online, where they saw an abundance of promises that by being trans, one would be accepted and belong to a loyal “rainbow family.” Or, the child’s peers in school all recently began identifying as “trans” and mocking “cis” people. This child wants desperately to belong, to be liked, and to be protected. These social factors may have shaped their desire to identify this way as well.
There are many other comorbidities we could add to the clinical picture. Autism, ADHD, learning disabilities, depression, anxiety, OCD, PTSD, you name it. Each of these could be interconnected with the child’s “gender identity” in a myriad of ways.
Perhaps the child was exposed to pornography that depicted women in objectifying, humiliating, degrading, or frightening ways, and this shaped their sense of what a woman is and how she is treated.
There could also be family dynamics at play. Perhaps the family abides by strict gender roles in which women are subservient to men, or in which the child’s interests in soccer and race cars were shamed for not being girlish.
A ban on “conversion therapy” inhibits this child’s therapist from attempting to understand and explore the myriad psychosocial factors as well as psychiatric comorbidities that make up the complex clinical picture in which “feeling trans” is the “presenting problem” and cross-sex hormones and surgeries are desired.
As therapists, we have a responsibility to conduct a thorough assessment and treatment planning process. The treatment plan should be appropriate for the conditions being addressed. According to the medical model, there must be “medical necessity” for treatment, and treatment should always be the minimum necessary treatment that addresses the issue. Therefore, there is no ethical justification for rushing youth into costly, invasive, lifelong, side-effects-riddled medical procedures, when simple talk therapy could help them grow to become more comfortable accepting their birth sex without needing to seek body modification.
These are my reasons for opposing the redefinition of “conversion therapy” to include “gender identity.” I do not believe it is preferable to be homosexual over heterosexual. However, I do believe that it is preferable to be comfortable in one’s birth sex, and free of any desire to medically alter one’s body, than to feel so uncomfortable with one’s sex that they feel the need to permanently alter their body in risky and potentially regrettable ways.
I would like to add that, outside of my clinical work, I research the experiences of detransitioners. My research comes in the form of countless hours of personal accounts on YouTube; studying the work of Dr. Lisa Littman, with whom I have an upcoming interview; as well as personal conversations with detransitioners, desisters, and trans people who question their choices. Some of these interviews have been recorded and will be available through my podcast next year. I have found these acquaintances online outside of therapy. I tremendously appreciate their openness with me as it is helping me learn information that will be invaluable in the years to come as we see a tidal wave of detransitioners coming. I hope to be able to provide continuing education to therapists on how to work with this new population. I can share from my experiences so far that many of these people do not seek therapy because they don’t trust therapists. This is often because their previous therapists simply “affirmed” their “gender identity” without question and did not help them unpack factors such as childhood sexual trauma that played a role in their discomfort with their birth sex. They wish in retrospect that their therapists had approached the issue more in the manner that I would like to be able to approach it myself. Our field desperately needs to hear from these accounts, which is a reason I amplify their voices through my blog, social media and upcoming podcast.
I also research the experiences of parents of youth with rapid onset gender dysphoria - a term that describes an observable phenomenon that is not yet in the DSM but is still worthy of study, though ardent trans rights activists will angrily declare there is “no such thing” as ROGD. Trans rights activists are quick to declare that parents of gender questioning youth are bigots. Unfortunately, many therapists have jumped on this train. However, all of the parents I have spoken with, and whose personal accounts I have read, are loving, thoughtful, people who are worried and want what’s best for their children. They need to be heard and supported. They observed a very rapid shift from no evidence of gender dysphoria to suddenly declaring a trans identity after a period of intense social media usage, often including grooming from adults. We need to learn from these parents.
These are my reasons for opposing the ban on “conversion therapy” for minors, when “conversion therapy” has been redefined as therapy that includes questioning “gender identity.” I do believe we need more thoughtful therapy for gender questioning youth. But I am in this for the long haul, and have no desire to sacrifice my license. That’s why...
Everything I do is legal, and I’m here to clarify that with you directly.
I am above ground in all my work, while of course safeguarding patient privacy. I periodically review the OARs governing psychotherapy and the list of sanctions. I am reaching out to you specifically to verify that I am in compliance with all laws in my field.
I do not practice conversion therapy according to any definition. I have worked with many gender questioning and trans and nonbinary identified individual adolescents and adults. I was trained in and practiced the “affirmative” model, though I grew increasingly concerned about it as time went on. It has not been my experience that mental health has improved following transition in the people I have worked with. Many of them found their distress only worsened, but I felt my hands were tied and I could not explore how they felt about their trans identity and body. [Information from letter redacted as it pertains to a clinical case.]
As I have learned more about this issue and developed concerns, I have pulled back from taking on adolescent clients seeking to be “affirmed” in their gender because of the concerns I have outlined in this letter. I understand that if I worked with adolescent clients and questioned their gender, I would be at risk of board investigation. I wish this weren’t the case, because youth need help exploring these issues gently. What I am doing at present is the following:
I’m making myself available for detransitioners and desisters who need therapy. None have reached out so far, but I am learning everything I can about them, in preparation for those who will need support in the future.
I’m making myself available for parents of youth who are questioning their gender.
I am also taking on a limited number of family therapy cases in which there is conflict over the child’s gender and the interventions they are seeking. I do not give medical advice. I work around the issue of gender by examining what all else is going on, including comorbidities such as depression and ADHD, family conflict, loss and grief. I am helping families unpack factors contributing to their communication breakdowns, and other issues adjacent to their battles over gender. So far it is going well. The closest we have come to gender is to explore what gender roles mean, how family and cultural factors have shaped gender role perceptions, and the developmentally appropriate idea of alleviating pressure to engage in “identity foreclosure.” I help youth and parents find agreement over the idea that no one wants them to feel they have to conclude who they are or what they are interested in prematurely - whether that has anything to do with gender or not.
If it is necessary for me to stop working with adolescents as part of family therapy in order to remain in compliance with the law, I will. However, I think this would be very unfortunate. These families are not having any luck with “affirming” therapists, who often only drive a wedge between parent and child.
I cannot fathom any legal or ethical case anyone could make as to why I should stop helping the parents of gender questioning youth in their distress, or why I should refrain from helping detransitioners and desisters.
I would appreciate any feedback on whether I have missed anything here when it comes to compliance with the law.
You may receive a barrage of complaints about me, potentially for a long time.
These issues are only becoming more heated in the broader social culture, while my presence as a writer and podcaster is becoming more publicly known. Trans rights activists who believe they are doing the right thing see it as their job to report me because they believe what I am doing is wrong, although they are not familiar with my work. They seem to have very rigid, indoctrinated mentalities that prevent them from perceiving the nuance in my writing. I suspect some of them may be quite dysfunctional or personality disordered but that is not my problem and they are not my clients. In any case, they will be harassing and reporting me because that is what they have set out to do in the name of their cause. I apologize in advance for the administrative stress that it must cause to deal with these complaints, and I’d like to know how they will be dealt with.
I would love to talk with you, clarify these issues, and share your guidance with others.
This is a very heated topic. Therapists’ confusion, overwhelm, and fear of reprimand leave many patients wanting for appropriate care. I think that it would be very helpful if I and other therapists could hear from you on exactly what “conversion therapy” and its ban do and do not mean for therapists and patients in Oregon. I would love your permission to share anything you would be willing to provide in writing for public view. I would love even more to have the chance to interview a board member for my podcast.
Thank you in advance for your time and consideration.
Stephanie Winn, LMFT
After sending this letter and posting it here, I wrote this brief post directly addressing any trans rights activists who may wish to report me to the board. For their convenience, I pinned this information to the top of my Twitter bio.