Gender: A Wider Lens
Gender: A Wider Lens
28 - Behind the Curtain: Wrapping Up Gender Exploratory Therapy

28 - Behind the Curtain: Wrapping Up Gender Exploratory Therapy

As they wrap up their initial Behind the Curtain series , Sasha and Stella discuss important issues surrounding the termination of therapy. How do we know when the therapeutic process should end? Does a resolution of gender dysphoria mean it’s time to end the therapeutic relationship? Does the start of a medical transition indicate a good time to end? And how can therapists leave the door open for a client who may want to return at a later date?  

Extended Notes

  • ● When a long-term client leaves. It can be a bittersweet moment.

  • ● If the therapy process is working well, the client should be proactive in how they’re building new connections.

  • ● Therapy is a lot like riding a bike. You are a little wobbling and then, next thing you know, your training wheels are off!

  • ● What do you do when you have a client who has resolved their issues around gender identity, yet other issues are cropping up?

  • ● Upon the discovery of certain deeper issues, some clients realize that they cannot trust themselves.

  • ● Sasha has seen her clients feeling ashamed for their prior thinking.

  • ● Some of Stella’s clients wished the whole event didn’t happen. Well, it did. Let’s forgive ourselves a little.

  • ● Sometimes what feels like progress and going forward can also sidetrack you and you find yourself going completely sideways. Life gets us like that, but therapy helps us process these changes in a healthy way.

  • ● The goal in therapy is not to just help them de-transition. The goal is to help them find the right answers for themselves.

  • ● When is it time for a client to leave?

  • ● What do you do when you, as a therapist, make a mistake?

  • ● Sasha has a lot of her thoughts and opinions online. There have been times clients have read that and disagreed with her, and if the relationship hasn’t been built, this can really hurt progress.

  • ● Stella knows it’s ended badly when the client is always on her mind and she’s rethinking of ways to better handle the situation.

  • ● Stella is curious to know if people “relapse” with gender the same way people might with food disorders.

  • ● Stella has noticed people talking about their feelings of transitioning as if it were a drug.

  • ● It can be so frustrating to see a patient not make progress, yet they still keep coming. There must be something there.

  • ● Stella also worries for younger patients who use therapy as a crutch. She doesn’t want to create chronic patients.

  • ● What do you do when you feel it’s time to terminate the client relationship, but the client still wants to keep going?

  • This podcast is partially sponsored by ReIME, Rethink Identity Medicine Ethics:


  • Learn more about our show:

Gender: A Wider Lens
Gender: A Wider Lens
In this podcast, now in its fourth year, therapists Stella O'Malley and Sasha Ayad take a deep dive into the psychological and cultural forces impacting the social changes around "gender." Through interviews with researchers, doctors, therapists, parents, detransitioners, and others, Sasha and Stella's podcast is a "must listen" for anyone trying to navigate the current gender landscape. With their sharp analytical minds and deep compassionate hearts, Stella and Sasha have also become known throughout many parent networks as lighthouses in the midst of some very stormy seas. Previous guests include Helen Joyce, Jesse Singal, Leor Sapir, Kathleen Stock, Jamie Reed, Peter Boghossian and more.