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Gender exploratory therapy controversy timeline

The role and nature of psychotherapeutic approaches to treating gender dysphoria is controversial. In 2019, Anastassis Spiliadis, then a clinician at the Tavistock Gender Identity Development Service published a paper proposing a "Gender Exploratory Model" of therapy for children and adolescents with gender dysphoria.

In March 2022, the Interim Report of the Cass Review led to a shift in practice within the NHS, prioritising psychotherapy as a first line approach to gender-questioning youth. The interim report defined exploratory approaches as "therapeutic approaches that acknowledge the young person’s subjective gender experience, whilst also engaging in an open, curious, non-directive exploration of the meaning of a range of experiences that may connect to gender and broad self-identity"

In September 2022, bioethicist Florence Ashley published a critique of Spiliadis' approach, describing it as "gender-exploratory therapy", and arguing that it bore conceptual similarities to "reparative" or "reintegrative" therapy.

In December 2022, WPATH released a response to the Interim Cass Review and resulting NHS Service Specification which criticised its reliance on an "outdated" gatekeeping model, and described "exploratory therapy" as "tantamount to conversion".

In March 2023, Alejandro Carabello noted that gender exploratory therapy "is considered by some to be conversion therapy since it presumes that patients suffering gender dysphoria have underlying causes other than being transgender"

In October 2023, in an article discussing exploratory therapy, Lawson et al described "the coercive requirement to ‘complete’ exploration before accessing additional care represents conversion therapy in all but name".

In November 2023, UKCP released a statement restating the interim Cass Review's definition of exploratory approaches, and that these "should not in any circumstances be confused with conversion therapy".

Also in November 2023, in discussing the "exploratory model of care", MacKinnon et al described the difference of clinical opinion, stating that "this model has been likened to gender identity conversion therapy" but also noting that Spiliadis' original paper "differentiates the exploratory model from identity conversion therapy".

Also in November 2023, Roberto D'Angelo argued that to suggest exploratory therapy is conversion therapy is a mischaracterisation, based on "the mid-20th century psychotherapeutic approach to homosexuality, which was pathologising, morally driven and ignored the science".

In April 2024 the final report of the Cass Review repeated the definition of exploratory approaches from the interim report, and further noted that it was harmful to equate exploratory approaches with conversion therapy and that language "such as ‘affirmative’ and ‘exploratory’ approaches have been weaponised to the extent that it is difficult to find any neutral terminology".

Sources

Wide = supports wider terminology and/or link to Cass review/Spiliadis

Date	Who	URL	Type	Notes	Used	Cass	Terms
2019/07	Spiliadis	link	MEDRS RSOPINION?	Therefore, it can be inferred that a psychotherapeutic intervention for gender questioning young people does not necessarily align with a conversion approach, as long as the therapist practices from a curious stance, aiming to support people explore the meaning they make of their symptoms of gender dysphoria rather than actively ‘guide’ them to a different identification. and Clinicians ought to respect the young person’s identity and gender expression, acknowledge the communicated embodied distress, and simultaneously invite service users into a process of exploration which can safely and respectfully shed light into the meaningmaking of the lived experiences.	No	No	gender exploratory model (GEM), exploratory approach
2022/09/06	Ashley	link	MEDRS RSOPINION	Opposition to gender-affirmative approaches to care for transgender youths by some clinicians has recently begun to consolidate around “gender exploratory therapy” as a proposed alternative. Whereas gender-affirmative approaches follow the client’s lead when it comes to gender, gender-exploratory therapy discourages gender affirmation in favor of exploring through talk therapy the potential pathological roots of youths’ trans identities or gender dysphoria. and Critics consider gender-exploratory therapy a form of conversion practice, and opponents of proposed bans on conversion practices have claimed that the laws would prohibit gender-exploratory therapy. Also cites and thanks activist group Health Liberation Now.	Yes	No	gender-exploratory therapy
2022/11/25	WPATH	link	PRIMARY MEDORG	Directed at Cass Review and NHS: the denial of gender affirming treatment under the guise of “exploratory therapy” has caused enormous harm to the transgender and gender diverse community and is tantamount to “conversion” or “reparative” therapy under another name.	Yes	Yes	exploratory therapy, psychotherapeutic
2024/04/11	PATHA	link	PRIMARY MEDORG? SPS	Directed at Cass Review: a number of people involved in the review and the advisory group previously advocated for bans on gender affirming care in the United States, and have promoted non-affirming ‘gender exploratory therapy’, which is considered a conversion practice.	No	Yes	gender exploratory therapy
2023/11/29	MacKinnon et al	link	MEDRS	Re "the exploratory model of care" cites Ashley and Spiliadis to say: this model has been likened to gender identity conversion therapy given that some practitioners avoid using clients’ affirmed name and pronouns, while aiming to question trans identification in children and adolescents. However, Spiliadis’ differentiates the exploratory model from identity conversion therapy.	Yes	No	gender exploratory therapy model, gender exploratory therapy, gender exploratory model, exploratory model
2023/11/29	Leising	link	MEDRS RSOPINION	RE" Sinai Dr Sinai referred to “gender exploratory therapy” as an alternative to affirmation. I was unable to find any definition of what “gender exploratory therapy” entails and If a therapeutic approach cannot be clearly distinguished from conversion therapy as defined in the Criminal Code, it seems doubtful that this would be a beneficial or even nonmaleficent intervention to offer our patients.	Yes	No	gender exploratory therapy
2024/06/01	Sinai	link	MEDRS RSOPINION	Response to/critique of Ashley	No	No	Psychodynamic psychotherapy for gender dysphoria (PPGD), exploratory psychotherapy,
2023/03/08	Carabello	link	MEDRS RSOPINION	RE: Stephen Levine: "much of his work around “gender exploratory therapy” is considered by some to be conversion therapy since it presumes that patients suffering gender dysphoria have underlying causes other than being transgender.", citing Ashley.	Yes	No	gender-exploratory therapy
2023/Fall	Amery	link	RSOPINION	Cites activist group Health Liberation Now (!!!) "These trends are international: multiple groups exist worldwide promoting ‘gender exploratory therapy’, a label for a form of conversion therapy targeting trans adolescents and young adults, with some success in influencing legal discussions and clinical guidance across multiple regions (Leveille, 2022b)."	Yes	No	gender-exploratory therapy
2023/10	Zazie et al	link	MEDRS RSOPINION	Cites Ashley, opinion "This has led to the emergence of non-affirmative approaches, or so-called ‘gender exploratory therapy’ (Gender Exploratory Therapy Association, 2023), with its founders implicating social contagion, homophobia, sexual trauma, and autism as causal factors for a TGE identity (D’Angelo et al., 2021; Marchiano, 2017). In our corroborated view (Ashley, 2022; 2023), the coercive requirement to ‘complete’ exploration before accessing additional care represents conversion therapy in all but name."	Yes	No	gender-exploratory therapy
2023/10	Bharat et al	link	RSOPINION	Preprint, Cites Ashley, opinion "efforts nowadays include clinicians gatekeeping life-saving hormonal interventions by encouraging clients to not commit to their transgender identity or initiate gender-affirming care until they are absolutely sure (sometimes euphemistically called “gender exploratory therapy”), or even ascribing transgender identity or asexuality to trauma (Ashley, 2023)"	Yes	No	gender-exploratory therapy
2023/05/02	Santoro (Slate)	link		Cites Ashley, opinion "This type of therapy is typically presented as a “neutral ground between the ‘radical’ gender-affirmative model and ‘unethical’ conversion practices,” bioethicist Florence Ashley wrote in a 2022 paper.Yet GET is just conversion therapy by another name, said Shannon Minter, legal director of the National Center for Lesbian Rights, who has been advocating against conversion therapy for over a decade.". Also quotes Erin Reed and Health Liberation Now.	Yes	No	gender-exploratory therapy
2024/07	Pauly (Mother Jones)	link		Based on Casey Pick of Trevor Project: According to Pick, some conversion therapists have embraced a new label for what they do: “gender exploratory therapy.”. References Cass and UKCP "In November 2023, the UK Council for Psychotherapy—the nation’s top professional association—declared that it was fine for counselors to take GETA’s “exploratory” approach to gender. This April, a long-awaited review of gender-related care for youth in England’s National Health Service endorsed exploratory therapy, according to Alex Keuroghlian, an associate psychiatry professor at Harvard Medical School.". Also Quotes Florence Ashley.	Yes	Yes	gender-exploratory therapy, exploratory therapy, exploratory psychotherapy, change therapy
2023/01/13	Reed (Xtra)	link	OPINION?	Cites Spiliadis: Anastassis Spiliadis, a psychotherapist at the South London and Maudsley NHS Foundation Trust, described a case where he practised this therapy on a trans youth for more than two years without allowing them to transition.”. Describes: "gender exploratory therapy is a new form of conversion therapy itself. In sessions, practitioners ask clients—who are almost always youth—to “explore” the reasons they have gender dysphoria, and encourage them to see their dysphoria as stemming from just about anything other than genuine transness. In fact, desistance from transness is the ultimate goal.".	Yes	No	gender-exploratory therapy, exploratory therapy
2023/11/02	UKCP	link	MEDORG SPS	References Cass: Within the interim Cass Review report, the exploratory approach is described as ‘therapeutic approaches that acknowledge the young person’s subjective gender experience, whilst also engaging in an open, curious, non-directive exploration of the meaning of a range of experiences that may connect to gender and broad self-identity’. and states: Exploratory therapy should not in any circumstances be confused with conversion therapy".	No, see discussion here and here.	Yes	exploratory therapy, exploratory approach
2023/12/12	SPLC	link	PARTISAN SPS	Co-authored by Health Liberation Now, cites Health Liberation Now, Ashley and others. Conflates several terms eg. SEGM, for example, has indicated its belief that exploratory psychotherapy should be a first-line treatment for gender dysphoric people Acknowledges claims that it is not conversion therapy, but points to being cited by ACPeds as proof otherwise: While many in the network claim gender exploratory therapy is not conversion therapy, numerous SEGM, GETA, and Genspect members and studies are cited by ACPed’s[...].	Yes	No	exploratory psychotherapy, gender exploratory, gender exploratory therapy
2024/04	Cass Review	link	MEDRS	Cites Spiliadis: Exploratory Approaches - Therapeutic approaches that acknowledge the young person’s subjective gender experience, whilst also engaging in an open, curious, non-directive exploration of the meaning of a range of experiences that may connect to gender and broader self-identity (Bonfatto & Crasnow, 2018; Churcher Clarke & Spiliadis, 2019; Di Ceglie, 2009; Spiliadis, 2019). Says conversion and exploration should not be equated. Notes explicit weaponisation of terms: Terms such as ‘affirmative’ and ‘exploratory’ approaches have been weaponised to the extent that it is difficult to find any neutral terminology..	No, see here	Yes	exploratory approaches
2023/11/21	D'Angelo	link	MEDRS RSOPINION	To suggest that exploratory therapy or psychotherapy for gender dysphoria is de facto conversion therapy is to mischaracterise psychotherapy as a process that seeks to impose gender conformity and normative sexuality on the patient. This misunderstanding is a consequence of the mid-20th century psychotherapeutic approach to homosexuality, which was pathologising, morally driven and ignored the science. In contrast, the rationale for psychotherapy for young people with gender dysphoria emerges from a careful appraisal of the science highlighting the uncertainties and risks of gender-affirming treatments...	No	No	exploratory therapy, exploratory psychotherapy, gender-exploratory psychotherapy
2023/11/21	Horton	link	RSOPINION	Directed at Cass, cites Ashley conversive practices, or approaches grounded upon the rejection, pathologization or problematisation of gender diversity are commonly veiled under language of “exploratory” therapy (Ashley, 2022c).. Makes it clear this is about "exploratory" (not "gender exploratory therapy") vs affirmation.	No	Yes	exploratory therapy
2023/10/27	Gentleman (Guardian)	link		References Cass and GIDS one group is cautious about the prescription of puberty blockers, while the second is suspicious of exploratory therapy, arguing that it could enter the realm of conversion practices.. Quotes clinician's opinion: What they are proposing to do is gender exploratory therapy. My view, as a clinician working in gender services, is that this is tantamount to conversion therapy for trans youth.	No	Yes	exploratory therapy, gender exploratory therapy
2024/08/31	Clayton et al	link	MEDRS RSOPINION	In this model, GD/GI may well resolve with maturity, treatment of any co-existing psychiatric conditions, and/or supportive psychosocial care or psychotherapy – such as trauma-informed therapy or family therapy as indicated for each individual case. Importantly, this type of therapy does not aim to ‘change someone’s identity’ but validates a young person’s experience while opening space for self-reflection about their experiences and help with alleviating distress. This is not conversion therapy.	No	Yes	psychotherapy