You Must Be Some Kind of Therapist

Swell AI Transcript: 132. Jillian Spencer FINAL.mp3
Dr. Jillian Spencer:
A lot of psychiatrists slowly realised, oh my goodness, you can't actually trust the gender clinic with your patient. They're not doing something that looks like the right pathway for the patient and so you end up trying to avoid referring. But then on the other hand, the patients and their parents assume still that this gender clinic is the state-of-the-art specialist centre and that they need to go there. So there's pressure to give in to that without being able to sort of be quite candid about your reservations because expressing that would get you into trouble. So it's really dicey. It slowly became apparent that They didn't have any special skills compared to the rest of us, and they were just blindly following one model with the belief that it would be curative of all these complex problems that young people were going through.

Stephanie Winn: You must be some kind of therapist. Today, I have the pleasure of speaking with Dr. Jillian Spencer. She is a child and adolescent psychiatrist in Brisbane, Australia. In April 2003, she was suspended at the Queensland Children's Hospital for raising concerns about gender interventions for children. Since that time, she has spoken out in the Australian media about her concerns, which has led to further allegations of breaching the Employee Code of Conduct. She remains suspended from her job. Gillian has launched legal action claiming political discrimination in the workplace due to her belief in biological reality. that people can't change sex in the hope of achieving a four-stater decision in Australia. This court case will occur in early 2025. She is also awaiting an Employment Commission outcome as to whether she is officially a whistleblower. If so, this would help her to retain her hospital job. Dr. Gillian Spencer, welcome to the podcast. Great to have you here. Thank you, Stephanie. It's lovely to be here. Thanks for joining me. So today we'll talk a little bit about your whistleblowing and legal case for those who aren't familiar and any updates that maybe you haven't shared in the past. I'm also excited just to give listeners a heads up. We were just chatting about this behind the scenes. Jillian recently wrote a journal paper along with Dr. Roberto D'Angelo, which has been submitted but not yet published, so this is not something you could read anywhere. She sent it to me, but like the space cadet I am, I completely forgot that it was in my inbox until I ended up in this meeting with her and realized I had not read this brilliant paper she wrote. So I'm going to have Dr. Spencer explain what is in this paper and we can just sort of freestyle explore these ideas. I'm really interested in this topic. So the topic is the paper looks at the move away from psychodynamic thinking in the profession and how that may have contributed to mental health clinicians being unable to explore beyond the surface level of the client's presentation and controlling the client-therapist relationship using affirming symbols, et cetera, to preserve their own self-esteem. I just read this little description she had sent me of it. So I'm really excited to hear from Jillian about what's in that paper and just explore some of these ideas of what is going on in the counseling profession psychologically that's contributing to this crisis. So that's something we're going to get into hopefully a little bit later. But let's start for those who are not familiar with your what happened.

Dr. Jillian Spencer: Yes. Well, it's been 18 months now that I've been suspended from my job. Just so people know, I haven't been fired because I haven't been found to have done anything wrong. So that's a relief. And so, yes, I've been raising concerns in the hospital about the gender affirming care model being used in the hospital gender clinic. And those concerns weren't being well received by the hospital executive. I ended up getting a lawful direction from the hospital saying that I must always use the preferred pronouns of children, always take an affirming approach to any child with gender distress and always refer gender affirming children to the gender clinic. And so that came through in January, 2023. Luckily, they'd said that I could use the patient's name instead of pronouns in my written notes and verbal communication. So I'd been using that little clause to get through and keep working. But then unfortunately, in April, I unexpectedly received a patient complaint from a troubled young person. And so the hospital used that as an opportunity to stand me down on the grounds of being a danger to trans and gender diverse children. And also I had spoken in a private capacity without using my name or without saying my profession or employer. I'd spoken privately at the Let Women Speak rallies in Australia, and so the hospital added that on as a breach of the Code of Conduct as an allegation. But yes, as I said before, it's all been not substantiated.

Stephanie Winn: And a few of the things that you've shared about your observations of what what was going on really stood out to me when I listened to your interview on Gender A Wider Lens, which I would refer anyone to who wants to hear the story in a bit greater detail than we'll go into today. One thing you said that really stood out to me is that in this psychiatric hospital, kids with suicidal ideation were fast-tracked to the gender clinic. So it was my understanding that It was your job and your colleague's job to refer kids to the gender clinic basically if they wanted it. And then this was sort of a shortcut, right? And I just think there's a lot to unpack around these types of dynamics happening in hospitals. And I don't think it's just your hospital. I think similar things are happening around the world. So I'd like to invite you to explain a bit more of what you saw going on with that.

Dr. Jillian Spencer: Yes. And I think some of the issues to do with the gender clinic are to do with that they had a massive increase in referrals, particularly during the COVID time. So in Australia, 2020, 2021. And in the name of being overwhelmed with referrals, it influenced their practice. So shortcuts, which I think was identified as an issue at the Tavistock as well. So with this enormous waiting list that at one point was about 12 months, if a child with gender distress presented with suicidality, then they went to the top of the waiting list. And so we're seeing often within days. And that was on the assumption that gender affirming care is life saving, which we now know to be not true, and that their suicidality would be related to not having treatment for their gender distress, which from the cases that I saw, wasn't true either. So it had this sort of heroic assumption to it that we must rush them in and give them this gender affirming care, otherwise they might die. And that was a problem because the gender clinic was already doing things in order to manage their exceptionally long waiting list. Things like a lot of paper-based assessments sent out to the patient before the first appointment. So various rating scales for them to complete. which rating scales are valid, but the gold standard is a clinical interview. And when we're talking about children with gender distress and complex issues, those rating scales are inadequate for fully understanding the situation. Often the rating scales have face validity. So if they tick the boxes saying that they're depressed, then you may say that they've got depression, but really, you've got to get to know, really do a proper clinical interview to understand whether it is depression or something else, such as trauma driving what they're feeling. Yeah. So yeah, the kids with suicidal ideation would be fast-tracked and then They'd have a rapid assessment. In my hospital, there was a model for a three session assessment, intake and assessment. So three sessions before being referred to the sexual health physician for prescribing. Although once the waiting list got longer, I saw them cutting back on the three sessions and going down to one or two sessions. So really complicated kids getting very quickly moved on to hormonal interventions.

Stephanie Winn: And adding on to the complexity of the dilemmas you're describing, Something that was coming to mind is I remember a time that I had an autistic adult patient who, when I was working at a clinic where they had people fill out rating skills for every appointment, it wasn't the full generalized anxiety and major depression inventories, but it was kind of like an overall, in the past two weeks, how often have you felt this or that? And this autistic patient I worked with for a long time answered very often to every single question, every single time. And at some point, I commented on it like, you know, this seems to be a really consistent pattern and yet you don't seem to be in extreme despair. Like it doesn't feel like a crisis and it feels like, you know, and so exploring that with a patient and I realized that there's something about an autistic person's very, very literal black and white way of thinking that's going to affect how they're going to perceive things like that. Then you look at the fact that A lot of these youth experiencing so-called gender distress are autistic. That is one more thing adding to the subjective nature of this assessment process. But I think moreover, looking at the issue of suicidality, I mean, what are your thoughts on it? I would imagine that word gets around to other troubled young people that, hey, if you tell them that you're suicidal, then you can jump to the top of the waiting list. What are your thoughts of the sort of ramifications of that?

Dr. Jillian Spencer: Yeah, I that's a great point, Stephanie, I totally agree that this this world online world and then the social world between teenagers is very communicative and any information they claim they share. And so yes, so they would talk about strategies for getting into the gender clinic. And also, because within psychiatry, we don't have any scans or blood tests to confirm conditions. It's all based on diagnostic criteria determined by so-called experts in the field. And it's all written in two different books, DSM or ICD. It was quite easy for the kids to learn the criteria and talk about the criteria and present the criteria. So, yeah, so there isn't a lot of objectivity to this world. It's really just what the young person says. And then if they're saying they're suicidal, then That's obviously very frightening for parents. also can be quite frightening for clinicians. So everything is towards driving, moving towards this fantasy solution, fantasy rescue of gender affirming care, which is being built up as curative, which is not true. But it's all a great fantasy to get involved in.

Stephanie Winn: And with the nature of your job, were you at a psychiatric inpatient ward?

Dr. Jillian Spencer: I was for some of my time. I worked in the child unit for many years, and then I moved over to the consultation liaison team where we would look after the mental health of kids admitted to the medical and surgical wards whilst they're in hospital.

Stephanie Winn: Okay. I guess I'm trying to get a perspective on how much of your job, what portion of your job involved working with youth in a state of psychiatric emergency.

Dr. Jillian Spencer: Oh, well, part of the job was to cover the emergency department on a particular day of more days of the week if colleagues were away on leave or whatever. So yeah, so I got a good feel for who was coming through the emergency department. And that was a red flag to everyone in the hospital in that you could see that over time, There was always a group of regular kids coming into the hospital emergency department with self-harm that's very long standing, often at least once a week, some of the kids coming in second daily. And that group of kids, and they were mainly girls, you would notice that, oh, you know, As time went on from 2017, when the gender clinic was set up, through to 2020, 2021, et cetera, most of those girls were claiming a trans identity. And they're the most troubled girls in the system, just such high degrees of self-loathing and recurrent self-harm, et cetera. So it became obvious that this was something that was a symbol of distress.

Stephanie Winn: Yeah, that well, when you say most of them, I mean, we know it's a lot. But yeah, in the hospitals, where you're providing services to people in an acute state of distress, the fact that you're seeing most is, I think, pretty alarming.

Dr. Jillian Spencer: It would just mean in that group of girls that were self with long-term recurrent self-harm, those girls were really presenting with a trans identification, but it wasn't the girls with, you know, presenting with recurrent malnutrition as part of anorexia. There was like a lower proportion, maybe 10 to 20% of those with a trans identity. So yeah, diagnostically, those emotional dysregulation girls were claiming the trans identity more.

Stephanie Winn: And before we move on, I just want to give you an opportunity to comment on the concerns that you might have about kids presenting with suicidal ideation and gender distress being fast-tracked. I mean, we talked about word getting out and the system sort of being hacked. I think one concern that comes to me, too, is that this is teaching youth that threatening suicide is a viable way to get what you want, which can create a lot of other problems.

Dr. Jillian Spencer: So, you know, if there's anything you wanted to say about that or… Yeah, well, it's incredibly dangerous to reinforce suicidality as a strategy for trying to obtain something. It really needs to be a firm barrier. I think in Finland, they came up with the rule that anyone who does have suicidality isn't eligible for gender affirming interventions, which seems wise. Yeah, it's a massive problem, but it is the case that never before has child psychiatry acquiesced to suicidality. So in the hospital, we were fully aware that a lot of young people wanted to come into the mental health wards to stay there. And there was lots of reasons for that. Some kids are really lonely and they'd get in the mental health ward and be surrounded by other young people which they liked. Some kids were living awful lives and wanted to be away from their home, regular meals, et cetera. Some kids really enjoyed the connection, attention from being in hospital. So we knew that admitting kids with suicidality often wasn't productive. And it was the case that we were always talking to parents about the risks of admission, talking about that it doesn't actually heal suicidality and that young people are often best managed in the community. So we had very good skills about facing suicidality and not acquiescing and not backing down in the face of suicidality. But then gender affirming care came into the hospital and all of a sudden, the message is, well, once someone's suicidal, we have to. So yes, it was completely out of keeping with previous models.

Stephanie Winn: And were you also being pressured to pressure the parents, so to speak? Because I would imagine With these youth, you would experience the full range of parents, from the concerned to the uninformed to the gung-ho, pro-trans, all kinds. But I've heard horror stories, given that I talked to the concerned ones, about the way that they've been treated by mental health professionals in the system. So what kind of messaging were you getting? pressure was on clinicians for how to handle the child-parent relationship and in that setting?

Dr. Jillian Spencer: Yeah, well, I was directed to always use the preferred pronouns and so that often was a difficult thing with parents because sometimes they didn't want to but yeah, so I'd use the name and but I wasn't in the position where I was able to speak frankly with parents about any reservations I had. And to some extent, I noticed in my conversations with parents that they seemed a bit hands tied behind their back on this too in talking to me. It seemed like they felt concerned about being perceived as transphobic and perceived as being unsupportive of their child, especially since the strong message is being delivered that by the hospital itself in their messages to parents, like their brochure actually warns parents of increased suicidality Should they not be supportive and affirming? So it was these very dicey sort of coded conversations with parents trying to understand how they were thinking and feeling about it and exploring that with them. But I was never in the position where I could be quite open about my reservations. But luckily, I also wasn't working in the gender clinic, so I wasn't responsible for trying to promote those interventions either.

Stephanie Winn: You you weren't responsible for trying to promote them, but it sounds like there was the expectation that you refer to the gender clinic as if this is all standard procedure. I mean, in the same way that if you were. Let me think of an analogy. Like in the same way that I don't know any kind of health care professional is supposed to refer to a specialist under certain conditions that the patient has a certain need, then you're supposed to refer to a specialist, right? And it was like the same model that we're all used to of, oh, you need to see a, I'm blanking, you need to see a, help me out, a dermatologist or an OBGYN, or I mean, there's a lot of specialties within, right? Or someone seeing a therapist who doesn't prescribe psychiatric medications and they refer to a psychiatrist for for that right it's there is this sort of expectation that's that's normal and then You know, with all things trans, in my mind, it's like this, like, one of these things is not like the other, right? So we're being asked to believe that trans women are just another type of women. You know, we have black women and white women, big women and small women, old women and young women, cis women and trans women. It's like, wait, wait, wait, one of these things is not like the other. Trans is not a type of woman, right? And so similarly, we have endocrinologists and OBGYNs and, you know, pediatricians and geriatric care, we have all these types of medical providers that you refer to under certain circumstances. And that's the standard of care. And then sometimes you refer to the gender clinic as if it's just as legitimate as everything else. But and maybe this is kind of coming around to one of the other points that came up in your conversation on gender, a wider lens that I just really wanted to highlight was you talked about the idea of the idea that some people are so called true trans, and that the people who, whether it's people at the gender clinic or someone on your team, you know, that there's someone who has the authority to go through a magical assessment process that determines who these interventions will be beneficial for in the long term. Like, there was a time that you believed that, just like there was a time that I believed that. And then it changed.

Dr. Jillian Spencer: Well, that's been, yeah, because it's very common in medicine to refer to specialists. And it's part of this wanting the best outcome for your patient. You're like, oh, this is not my area of expertise, but this other person has this area of expertise, and I want you to get the best care, so I'll send you there. usually it's an act of care for the patient. But I think what I slowly realized, and then what a lot of psychiatrists slowly realized, especially those in private practice, was, oh my goodness, you can't actually trust the gender clinic with your patient. They're not doing something that's looks like the right pathway for the patient. And so you end up trying to avoid referring. But then on the other hand, the patients and their parents assume still that this gender clinic is the state of the arts specialist center and that they need to go there. So there's pressure to sort of give into that without being able to sort of be quite candid about your reservations, because expressing that would get you into trouble. really dicey. And I guess one of the things that we did have the advantage of was the medical record system is one that is electronic and you can access it if you're still involved with a patient in the hospital. So there was the opportunity to see the notes from the gender clinic and to see that there wasn't anything magical going on there to be able to identify a child that would be persistent in their gender distress. It was quite a superficial assessment. that was happening with, you know, tick boxes about the gender dysphoria criteria, etc. So, it slowly became apparent that they didn't have any special skills compared to the rest of us and that they were just with the belief that it would be curative of all these complex problems that young people were going through.

Stephanie Winn: So, catch us up to speed on your legal case. So, on that gender wider lens episode, you explained sort of the ramping up and if I hadn't heard that story, I might be asking something like what was the final straw for you, but I feel like it wasn't just you witnessing things and keeping your mouth shut until a certain turning point. I feel like it was a lot more gradual and interactive of a process that led to your suspension. I don't know if there was anything you wanted to say about a tipping point, but if you want to just kind of catch us up to speed on where things are at with your legal case,

Dr. Jillian Spencer: Yeah, well, I've got a few legal cases going at the moment in terms of my employment. Yeah, because I have realized that that legal cases are a way to try and get change. And so they're quite important. And of course, they're not desirable because they're stressful and, you know, lengthy, but not everyone is in a position to have legal cases, you've got to, you know, have in some way and been wronged, I guess, or find some other way to get into court. So it's an opportunity. So just with my employment case, I was originally suspended and then I got the allegations initially. And then because I spoke out in the media, I got more allegations last November and I continued speaking out in the media. So I got more allegations of breaching the code of conduct in, I think, April. And then With me and the lawyers, we've responded to all those allegations, very thorough responses, hundreds of pages explaining that the things that I've said in the media have all been true. And so the hospital hasn't been in a position to fire me because they haven't got enough to substantiate wrongdoing against me. And I had a good thing happen about a month ago because the hospital decided to pause all the disciplinary matters against me until the outcome of a case that I've got going through the Queensland Industrial Relations Commission. And that is to see if when I originally raised my concerns with my employer about gender interventions for children, which was mid-2022, whether that information that I provided constitutes a public interest disclosure, which is the words we use in Australia here to signify being a whistleblower. Sorry if that's a bit complex, but with the legislation in Queensland, if a public service, public sector employees are able to disclose information about a substantial and specific danger to public health or a substantial and specific danger to a person with a disability, And if they do that through a formal channel, then they should be protected from any retribution. And because I raised that information in mid-2022, if I'm found to be a whistleblower, then it would make it hard for the hospital to fire me for speaking out. Because if your hospital or if your employer doesn't act on your disclosure, then you are able to speak out. So that is taking a long time. Actually, the Commissioner has been deliberating on that since the 28th of May, which is an inordinate long time, long, it's very lengthy and not traditional. But we've actually got a state election in 11 days time. And we're expecting, according to the polls of change of government. And so I guess I've been wondering whether once that election's over, I'm more likely to receive the outcome of the commission, as it Yeah, so I mean, I'm not sure about that. But that seems to be why it's taking so long, maybe. Yeah, so that's and then Because I became aware of this whistleblower process, this public interest disclosure process, I realized that it's a way to get the hospital to deal with the concerns because there's a formal process around it. It's an annoying process because you put in the disclosure and then the hospital gets their first chance to look at it and say whether they agree that it's a substantial and specific danger. And then in the case of my hospital with these public interest disclosures I've submitted, they've said no, and then you get a chance for a review. And actually you get three chances for review before you can get into court. So it's this back and forth with the hospital where they keep saying, no, there's no danger. No, it's not substantial. No, it's not specific. No, your concerns aren't honestly held. It's been amazing to watch the hospital. recurrently, repeatedly try and find anything possible to say that my concerns aren't valid. And I do hope that it, because at the end of the process through court, it ends up in a published judgment. And so I'll be quite interested if it's possible within that public judgment for the public to see the extent that my hospital's gone to to say that my concerns aren't valid. So the first public interest disclosure was about just gender-affirming care and the risk to fertility and sexual function, long-term health problems, distress and regret. The second one was regarding a very senior person in my organization who I identified had, in five different forums, provided very inaccurate information about the state of the research into the interventions for gender distress in children and thereby influencing the hospital policy. And the third public interest disclosure related to a colleague who disclosed in an open forum that he was approving 25 adolescent girls for mastectomies per year. So yes, so there's the different public interest disclosures. Sorry to be a bit boring with all my legal stuff. But so they're all gradually going through that hospital process and then eventually going into court. And then sorry, just one more thing, which is that I've got a very separate legal case, which is where I'm alleging political discrimination by my employer for my gender critical beliefs, belief in biological reality. So trying to get a four stated decision for Australia so that people when they're working and they're able to have gender critical beliefs. And there's a secondary element to that, which is trying to get it so that the government can't impose a particular health treatment to be delivered by clinicians.

Stephanie Winn: That's really wonderful. So is that for people in any type of employment or specifically for people in the mental health field?

Dr. Jillian Spencer: It should generalize to any employment, but obviously the second element where it's about imposing a health treatment model on clinicians that will affect public health employees.

Stephanie Winn: That's really wonderful. I'm glad you're doing that and I wish you all the success. I'm talking to you right on the heels of talking to James Esses. So he was discriminated against for having gender critical beliefs as a graduate student of counseling psychology who was concerned about issues like the impact of puberty blockers on children's brain development. And as a result of his case, it's sort of like the Maya Forstater case of the counseling profession in the UK. So it's exciting for me to hear from two different people in one day in two different Western English speaking countries about the progress that that is being made here through these cases. And I really hope that's successful, because that would be really groundbreaking. And then with the public interest disclosure question for you about that is, you said that they are basically just denying the issues that you're raising as a whistleblower. But the issues you're raising are quite concrete, right? When you talk about issues like loss of sexual functioning, That's a medical condition that you're talking about iatrogenic harm being created. So when they deny it, I mean, through this legal process, are they forced to respond to the actual claims you're making and explain why they think those things aren't happening? Or are they just saying, nope, nope, that's nothing to see here?

Dr. Jillian Spencer: Yes, they come back with some lengthy letters explaining that there can't be a danger because the treatments being delivered within a multidisciplinary team. And for example, just so people know, that's often a smokescreen that the gender clinics use saying that they're part of a multidisciplinary team. But with the model of care being delivered, it's all according to the affirmation model. So even if you've got 10 different disciplines represented around the table, they're only allowed to provide care according to the affirmation model. So say, for example, a speech pathologist In a community child and youth mental health clinic, that speech pathologist might do communication assessments and help kids to develop in their speech and language socially, where in the gender clinic, the speech pathologist won't do any of that. They'll instead be coaching kids to speak in a way consistent with the opposite sex. So the multidisciplinary element doesn't come into the model of care, they're all just providing affirmation. So they'll say things like, no, it's not dangerous because there's the parental consent involved. I'll write back talking about how parents are being given the information brochure, which suggests that if they don't affirm their child is at high risk of dying by suicide, and so that's not valid informed consent. Yeah, so it's a lot of argy-bargy of arguing over the issues.

Stephanie Winn: It really is such a smokescreen, isn't it? When you talk about that they're using this multidisciplinary while they're saying, okay, we have different types of providers. So let's unpack that a little bit, right? So if it were true. that having different types of specialists involved in a patient's care served as like a checks and balances system that ensured that that patient was not being mistreated. Where would we look for evidence that that worked? Well, we'd look to see that if one of the multidisciplinary care providers, let's say the speech language pathologist or the family therapist or the psychiatrist, let's say that that person raised a concern to the rest of the care team. then the care team responding to that concern and pausing on moving forward with a controversial treatment until there was a consensus would be evidence that this did serve as checks and balances. However, look at what they do to whistleblowers. They treat them like they treat you. So it's a manufactured consensus. And it's like the same principle applies in this case of so-called parental consent. Yeah, if you bully, coerce, and intimidate people into thinking this is their only option, And then point to the fact that they went along with it as, see, everything's copacetic here. I mean, it's.

Dr. Jillian Spencer: Exactly, Stephanie. Yeah. Yeah. It's very controlling. Yeah. There's definitely not an ability to think and to freely express one's opinion on these issues or clinical opinion. And yeah, there's nothing more disturbing than a group of, you know, seemingly well-meaning mental health clinicians sitting around and all pretending a child has changed sex and that their child's gender distress has nothing to do with their anorexia. It's just such a poor standard of care.

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Dr. Jillian Spencer: Yeah, well, within this profession of psychiatry and possibly other mental health clinician professions, I think there has been a move away from psychodynamic thinking. And what I mean by that is a move away from an understanding that people's surface presentation, their thoughts and behaviors and feelings may relate to factors outside of their conscious awareness that at that stage they're not aware of. So internal drives and conflicts and feelings related to early life experiences or previous life experiences. I think there's been a move away from that. We've moved on to other types of therapies like cognitive behavioral therapy, which are more in the moment, and they certainly have their place. But in some ways, I think the pendulum has swung too far in that certainly in the gender clinic, there's no sort of ability to think about any deeper suppressed or actually unconscious issues going on for the young person. And it's actually not the psychodynamic element is not just about the young person, or, you know, the patient, it's actually about the clinician to the awareness that the clinician has their own unconscious and that may influence the patient clinician interaction. So Robert Roberto D'Angelo, and I wanted to try and raise this as an issue for discussion within our profession.

Stephanie Winn: Well, that's very exciting. So what are some of the psychological factors on the part of the clinician that you and Dr. D'Angelo speculate might be figuring into the equation here?

Dr. Jillian Spencer: Yeah, well, what we notice is that within the model of gender affirming care, it is even in the guidelines in Australia, they talk about making the environment such to be welcoming for young gender diverse young people. And what that manifests in is a huge amount of signage on the walls, pride flags, et cetera, trans pride flags. And then things like rainbow lanyards, people wearing ally and pronoun badges. And traditionally in therapy, Freud had the idea of the blank slate where the clinician doing therapy was meant to be a complete unknown to the patient so that the patient would project their own ideas of what the therapist might be thinking and feeling onto them. And that would be a subject for exploration in the therapy. But I think generally we have moved away from the idea that the clinician can be a blank slate. And we've acknowledged that the clinician is always influencing the therapeutic space. And the main thing we need to do is try to understand, oh, what is it about the clinician that's affecting the material being presented? by the patient. So when you have a clinician who is wearing all these symbols, we need to think about what influence that has on the therapist-patient relationship. And what we're speculating is that it is a very strong communication to the young person that they must feel quite positive about their gender distress and feel positive about the prospect of going down an affirming pathway, changing their body. And it's a very controlling approach because it's essentially saying to the young person, I'm not really comfortable with your distress, fear, self-loathing, trauma. This isn't a space where we can talk and look at that. No, this is a space for declaring and affirming a trans identity. I think with the clinician communicating through these visual symbols, they are communicating that they want to be perceived positively. It's like letting everyone know I'm a good person because I accept gay, lesbian, bisexual, trans people. And so what they're also communicating to the patient is that I'm not comfortable with people perceiving me in a mixed way or having negative thoughts about me. And so it's letting the patient know that they can't sort of let their distress out. And it is very normal in therapy for clients, the patient to express frustration at their therapist. And so they're very much controlling things in a very positive light. And it's sort of understandable for various reasons. Gender affirming care has been marketed as curative, life-saving, very positive. And so it will attract clinicians who only want to dwell in the positive. and will experience anxiety or aggression if they start to perceive that the patient isn't similarly sharing this positive outlook. So it's quite a sort of, there's a risk of attracting people who will experience narcissistic rage if not perceived positively. And I think it works best if both clinician and patient agree to push out any negativity and then they just encourage the young person to come along, be positive, want the treatment. And I mean, it's a terrible thing because often as adults, we have much greater awareness of the fallibility of people and professionals, but children coming along to gender clinics, they have an unrealistic expectation that this therapist, this clinician, knows everything and is an expert in the human mind and will be able to heal them. It's very powerful. So this strong message that you know, this expert is sending through these visual symbols is very powerful and affects the relationship with the patient and doesn't allow for what the patient needs. It's really meeting the clinician's needs.

Stephanie Winn: I love the way you broke that down, that you started with Freud and the idea of the blank slate, And then moved on that, you know, we've most therapists agree that it's impossible to be a blank slate, but that we still look at what's happening relationally between the client and therapist and the transference and counter transference as significant as a part of the process as maybe indicative of what's brought them there. You know, on my side of things, on the flip side, as someone who does not wear pronoun pins, but who is openly critical, I question whether I'll be able to go back to being a therapist ever since I haven't been working as a therapist in six months, partly because I put so much out there into the universe about who I am and what I think. Like, you know, what what we put out there about ourselves factors into a client's expectations, projections, you know, what's going to be happening relationally. Yes. And then you, you talked about how all of that virtue signaling on the part of a therapist, whether it's, you know, hanging a trans flag in their window or what have you, that it can get in the way of a patient's ability to use therapy to to project their self-loathing and all these things. And I think part of what I hear when I hear you say that is I see all of these messages as Sorry, I'm going to, you know that artwork that shows like someone looking through glasses and when they take off the glasses, they can see like the hidden messages and all the billboards, like buy stuff, obey, like it's almost like if you could take off the glasses and look at the trans flag on the wall, what you would see is this message that you just said of like, Believe that I'm one of the good people don't take your anger out on me, right? It's like the therapist the one person you should be able to project on to who should be really skilled at handling Projections more skilled than anyone in your family or friends or anywhere else is saying, don't project onto me. I'm one of the good people. Yes, exactly. And so I talk about this idea of gameable heuristics, meaning when you have a mental shortcut that you take about this is good and this is bad, and when it's that easily hacked as all someone has to do to earn your trust is to wave the right flag or wear the right color or pin or whatever, then you are very easily manipulated. It's like the one place that you should be able to bring your self-doubt and your doubt in others, your mistrust of self and others, your questions about the world, your ambivalence, you're bringing it to someone who's like, No, no, no, we don't do that here. Here we're hopeful that as long as we're the good people who believe in and say the right things, and as long as we follow step one, two, and three with regard to affirming and transitioning you, that there's a way out of this darkness. And then you don't make any room for the person's ambivalence or doubt. You don't make room for honestly, their own hatred, because I feel like there's the concept of hate is really big in the culture right now, like hate speech, and you're hateful, because you're a bit like, all that kind of stuff. And, and I noticed projection just running rampant in this group, because I talked to parents of trans identified youth all day, it's the main thing I do at this point in my life. And I've yet to meet a single one of them that's a hateful person, but some of their children are genuinely very filled with hate. And so there's obviously a lot of hate being projected onto people who are being called hateful, and there's just so much to explore there. But yeah, there's this massive collusion going on between the worldview of an immature young person largely has been shaped by social media. and the therapists and the people who are supposed to be able to help. So it all really does, yeah, like you were saying, it serves to use the authority of the professionals to fast track them. Then you add in the fact that if you do take the youth who have had any conflict with their parents over this issue, parents who are concerned or not affirming, then what's the role of the clinician if they're the ones telling mom and dad, no, you must affirm, if they're the ones waving the flag and saying, here's another authority figure, maybe the same age or so as your parents, who's perfectly happy to use their authority as an adult to put your parents in their place, it just completely screws up the power dynamics. One of the things I speculate about in terms of the long-term impact of screwing up that power dynamic by letting teenagers run the show is is I think down the line in their adulthood when they are dealing with their regret and complications like there's going to be so much guilt and confusion because there is a sense that they were handed more power than they were ready to utilize properly before they were ready for that power. But it's like, well, I did this to myself, or the adults didn't stop me. And that's, I think, just cruel in the long run for adults to abdicate responsibility and power by just giving it all over to a child.

Dr. Jillian Spencer: Yes, I agree. And I think that with moving away from psychodynamic thinking, we've missed noticing that there's a massive signpost that this is an unhealthy dynamic occurring in the gender clinic in that psychiatrists and other mental health clinicians have not seemingly wondered about why there is such an extraordinary extent to the signage, the flags, the colors. It's this sort of very strange overcompensation, which we would call reaction formation, which is traditionally this psychodynamic defense where someone isn't comfortable with their feeling and so they exclude it from their consciousness by doing exactly the opposite. And it's often signposted by being a complete exaggeration, which feels a bit weird. And I think most of Most clinicians, if they thought about it, would think, well, it is a bit weird, the extent, the absolute extent to which we're all expected to signpost our support. And in my hospital, we had enormous trans flags, meters wide.

Stephanie Winn: I love that you brought up reaction formation. I have a lesson in my course for parents, ROGD Repair. And the title of that lesson is called something like, Preference falsification, reaction formation in the emperor's new clothes, and drag. Somehow I lumped all those things together because I think drag is one of those things that's very much the emperor's new clothes. Did that many people really find this an enjoyable form of entertainment? Oh, exactly. Yes, exactly. But reaction formation is a really, really good descriptor for those who are psychology geeks. And it's basically like Jillian described, right? It's this thing we all do sometimes, some people more prone to it than others, of basically repressing how you really feel, turning it into the opposite, and acting that out. And I think there's so much reaction formation and coddling around the trans stuff. It's like innately, intuitively, it feels like it for women, you know, if we're if we're asked to, you know, praise men as women that feels dangerous to us, if not disgusting and frightening. And so the natural instincts are of repulsion and distancing oneself from a potential predator because men have been disguising themselves to try to hurt us in various ways since the dawn of time. So there's nothing new as a woman of why is this man trying to conceal his motives? He must not be safe. I need to get away from him. That's an ancient feeling for us as women. Yes. But the fact that so many people are acting the opposite, I just feel like reaction formation is so huge these days. So what other psychodynamic interpretations do you have of things going on in gender roles?

Dr. Jillian Spencer: Well, in the paper, we talked quite a bit about what it means for the gender clinic to mainly employ gay, lesbian, bisexual, and trans staff, and whether that impacts on what can be discussed and thought about in the gender clinic. Now, there is a lot of pressure to view all sexuality and gender issues as biological. With our work instruction on the affirmation model, the first sentence is about children with gender distress are considered naturally trans and gender diverse. So we're instructed that we have to consider what they're going through biological. And I think Of course, sexuality has a definite element of biological contribution, a large element probably, but not wholly. Of course, everything's subject to some sort of influence over time. But I think what's important is that often people want to feel completely psychologically healthy and together. We all want that. And so if you're working in a gender clinic and you are gender diverse or have gay, lesbian, bisexual, et cetera, there might be an element there where you don't want to acknowledge that the patient in front of you might not be psychologically healthy and that might be contributing to their gender distress. it's a bit challenging because then it sort of maybe makes you feel for yourself that you're not fully psychologically healthy. So once again, it's about that collusion between there's no problem here. I don't have a problem. You don't have a problem. We don't have a problem. This is just biological.

Stephanie Winn: Yeah, you know, that makes me think of this is like touching the third rail, but people who have sexual trauma from a young age that was same sex sexual trauma and are going through a phase in adolescence or early adulthood of being uncertain of their sexuality. And maybe they identify as somewhere under the umbrella, but they have complicated feelings to sort out about, you know, their aggressor and what was done to them and how that trauma interfered with their natural process of self-discovery. And I can imagine something like that being perhaps threatening to a clinician who's in that mindset of, you know, out and proud and everything pertaining to LGBTQ plus must be affirmed. And it's like, well, what if someone is saying, I'm really not sure how I feel. I'm not sure where my feelings are coming from. I'm angry that that opportunity was taken from me. And you know, can that clinician be with the mixed feelings and the ambivalence? And then it also kind of harkens back to this idea that this very woke idea that you have to see a reflection of yourself in someone in order to trust them, which I was just talking with James about, right? Like, you know, that people can't see a therapist of a different race because they need that lived experience in common. And it's like, well, that's actually quite narcissistic, right? Like, who's to say that you have to see yourself in someone else in terms of a having that mirroring or twinship. And does that maybe take away from our ability to access empathy and put ourselves in other people's shoes?

Dr. Jillian Spencer: Yes. And it might be that actually what the young person needs is a corrective relationship with someone, an authority figure, you know, of the opposite sex, often, you know, a male authority figure that is trusting. And it might be that that's actually what they need, but instead they're avoiding that because of the fear of what they've been through. And so instead they're trying to, as you say, control it so that they don't have to confront those fears by picking a clinician who seems most likely to just align with their current worldview rather than challenging them. And I think also with the clinicians, if they themselves have had some gender nonconformity in childhood and had experienced rejection or shame around that, then there is the potential issue of some of them gaining gratification from helping young people get rid of that gender nonconformity by presenting as the opposite sex. So there's that risk as well.

Stephanie Winn: Yeah, it's the like the archetype of the wounded healer that is such a double edged sword. Like there's, I mean, If people who didn't have their own issues were not allowed to become therapists, we just wouldn't have enough people in the profession. Of course, we all have our own issues. We're all human. There is some truth to the rumors that people who get into our fields do it because we're all a little cuckoo, but you'd hope a person to have enough maturity and differentiation to recognize the inherent danger of your own rescuer complex or of your own enmeshment and boundary issues that your tendency to fuse and merge with other people to collude to or to get your self worth out of a codependent type relationships or, you know, like, we have to have some circumspection around these dynamics that will pop up more often than not if you're not careful. That's what good training and good supervision is for, but I feel like the wokeness that's taken over the field just completely obliterates all of that really necessary humility, to be honest, about what our role is and is not and ways in which we might have the ego gratification of thinking we're doing something really good while we're actually harming people because we're projecting our own issues onto them.

Dr. Jillian Spencer: Yes. And I've actually noticed that I've wondered about that as, you know, because I've spent a lot of time wondering why my profession has been so gullible around gender affirming care. But I think, as you mentioned before, with people in our profession sometimes having gone through challenges psychologically, emotionally, it just feels in my world that my colleagues don't want to acknowledge that any experience in adolescence of uncertainty or mistakes or being rebellious and challenging. It's like amongst colleagues, we're all pretending that we're always really settled adolescents and we're always exactly who we are. And I just can't understand. I mean, it's been my sort of reach for explanation as to why my child psychiatrist colleagues aren't saying, This is crazy because we all know that, you know, as adolescents, we came to ideas and did things that we later realized were a mistake. And that's just part of the stage of life. But is it that our profession is pretending that we don't know that because we never did that? Of course, it does. It feels just so defensive that we're not acknowledging that.

Stephanie Winn: I think of it as a failure of empathy. I think of it as that, you know, the moment you accept the idea that trans is a thing that really exists. The moment you begin to accept the light like rips a hole in the fabric of reality and you see this kind of like haze come over people where they're buying into the magical thinking and I think what it is is that if you believe that some young people really have this experience that is so uniquely different from your own as someone who does not identify that way, so to speak, then there's a suspension of disbelief and a suspension of genuine empathy because now you believe that there's a third class of human beings besides male and female. Now you believe that there's a type of human being whose experience is just fundamentally different from the rest of us in this really, yeah, that's in its fundamental way. and that therefore your job as a so-called cis person is to have a like a pseudo humility about that well I don't have that lived experience I'm not trans so who am I to say all I know is blah blah blah blah blah and the thing is it's like Once you dismantle that logic, and please don't let me put words in your mouth because I don't actually know exactly how you think or feel about any of this. I'm just speaking for myself. I don't believe in trans. I just don't believe it's a real thing at all. I don't believe it. So I just see various human beings, all of whom are male or female, who are suffering in ways that are really not that different from how human beings have always suffered. It's a new idea, and it's a new set of medical procedures, but that's where I actually think that my empathy is, is that I'm seeing that this is a male or female human being no different from any other male or female human being of their age, right? That's where, of course, I can put myself in their shoes, because I was a stupid teenager who made ridiculous decisions, some of which I still have to live with the consequences of, but not nearly to the degree that detransitioners and transition regretters do. I got a tattoo when I was 16. I had it lasered off in my 20s, and that was painful and expensive. But between the ages of 16 and, I don't know, 26 or whenever that process began, I was walking around with this embarrassing thing on my wrist and people would grab my wrist, you know, they just felt entitled to my body. They'd be like, let me see that, you know, and I'd be like, oh, gosh, like, please don't look at the tattoo when I got when I was 16. Yes. And and that's, you know, so to me, it's not that different. It's just orders of magnitude of a difference between my experience of getting a tattoo at an early age and someone else's experience of thinking that they're trans at an early age. And the same thing goes with the idea that nobody knows whether they're going to want to have kids. Sure, you can say when you're 12 or 20, oh, I definitely don't think I'm ever going to want to have children. But there's nothing uniquely different about a person who calls themselves trans making that claim about what their future self is going to want than a person who's just an ordinary boy or girl going through some stuff saying the same thing at that age. We shouldn't treat it any more seriously any more authoritatively just because they have this belief that they're trans. And yet that's exactly what's happening is there's this suspension of disbelief, this entertainment of magical thinking, this tear in the fabric of reality where the laws of human nature don't apply. And you can't just see that this is a struggling, confused work in progress of a human being who happens to be male or female, just like you were at one point in your life. And there's nothing special. There's nothing special about them.

Dr. Jillian Spencer: Yeah, it's a real failure of empathy. And it's shocking. And just the cruelty of imposing these long term consequences on these young people, when we all know full well that for a proportion of the population, having family is, you know, helpful and part of what people like about life, not everyone, but you know, it's a chance that this young person may want that and derive a lot of pleasure from that. And, and it's just, it boggles my mind that people, you know, everyone knows that gender non-conforming boys have a high risk of being same-sex attracted in adults. And to take away the sexuality of a, of a person who's going to be a gay man when, you know, sexuality for gay men is just such a, you know, joy. It just seems very cruel to me that people aren't Yeah, keeping these kids safe from long-term consequences.

Stephanie Winn: So what's next for you, personally, professionally?

Dr. Jillian Spencer: Yeah, well, I sort of don't know. It wasn't the case quite a few years ago, but now I do tend to live day by day. like Johnny Rambo, which is a Gen X joke. That's what he says at the end of the first Rambo movie. But yeah, so I don't know. I'm just waiting for my disciplinary matters to conclude, which I assume will take into next year and seeing what happens. And then at that point, I'll look around to see what my options are. There is, unfortunately, with the Australian medical registration board, they're waiting to investigate me once the hospital finishes dealing with me. So there's still a little bit of a threat over my registration, which I feel like since the CAS review came out, my registration is much safer, but it's still not. definite because it's not just about expressing concerns, but also at times I've been critical of the profession, which often you're not meant to be. You're meant to instill public confidence in the profession, but it's hard to do when there's a public health issue so serious as this to just fall in line and support it.

Stephanie Winn: For what it's worth, I'm sure you get comments like this. I'm not sure. how people most commonly reach you, but as someone who has a weekly podcast and a YouTube channel, and I get a lot of comments on YouTube, and it's, in my experience from our commenters, at least, it's people like you restoring whatever faith is left in their profession, right? Yeah, that's true. I get to get the comment. It really screws with your mind. We're supposed to be instilling faith in the profession. It's like, yeah, I would love to be able to do that. But can the profession behave in a more respectable manner?

Dr. Jillian Spencer: Yes, exactly. Yes, if only the College of Psychiatry were to do the right thing, then in Australia, then yeah, it'd be much easier to meet one's professional obligations.

Stephanie Winn: It's like we're not going to lead people into harm, right? Bottom line. And that means I'm so critical of the profession on my podcast. And actually, my licensing board put out a statement maybe a year ago. I forget when. It was in one of their quarterly newsletters, and I don't always read those. So I was fortunate that I opened that email and read the PDF. But they did put out a statement saying something like, we've been getting a lot of complaints about what therapists are saying on social media. And we're not going to do that. It basically said, it's not our job to police what people say on social media. Unless there's evidence that they are violating patient confidentiality on social media, we would investigate that. Or if they're saying something on social media that demonstrates that they're unfit to practice like you know, confessing to a major drug addiction, maybe, I don't know. But, you know, they defined, like, here are the edge cases in which it would actually rise to the level of being our jurisdiction. But aside from that, no, like, people are entitled to express their views online. And I was so glad to see that for my licensing board, and I posted it on there. Oh, what a relief! Yes! Like, for everyone who, I don't know how many of these complaints were about me, but… Yes! Yeah, go for it, guys. But I mean, honestly, if if a therapist speaking ill of our profession was a cause for a complaint, I would be toast. I found myself saying, like, I haven't explicitly branded my podcast this way, but I was talking with Warren Smith on the episode that came out the day that you and I are recording this. And he wasn't really familiar with my podcast, and I found myself saying, like, my podcast is basically about the downfall of psychotherapy. Oh, yeah.

Dr. Jillian Spencer: Yeah. Yeah. I wonder how the public will reckon with this once they do, once it becomes fully apparent with the fullness of time about how complicit we've been in harming young people. I don't know what the implications are going to be, but I can't imagine that. I mean, we might go the way of homeopathy. I don't know whether that's still big in America, but once that became just an awareness that there wasn't a therapeutic outcome. In fact, that was just saying that it was not effective, let alone what we're doing, which is actually harming people. Anyway, I don't know what the future holds, but yeah, I think our profession needs to change course.

Stephanie Winn: Yeah, I don't know. The status of homeopathy in Australia sounds maybe a little bit further ahead there. I personally, I see naturopaths, but when I see a naturopath who recommend homeopathic remedies I lose so much respect for them because I'm like I'm seeing you because you understand how the body works holistically and because you can recommend things with actual active ingredients in them.

Dr. Jillian Spencer: Yeah, yeah, yeah. That's the trusted relationship that you have with professionals. And just on that topic, goodness, you can't beat having a good lawyer. That's something that I've learned. Yeah. So yeah, trusting those professionals.

Stephanie Winn: It's interesting that you say that because I've found myself thinking recently that a therapist or anyone in that ballpark cannot replace a lawyer if that is in fact what you need. And I've seen situations where, like, I had a parent who's taking my course, RGDRepair.com, guys, anyone who needs help with your trans-identified kid, please go there now. I had a parent in my course post something really concerning about basically a custody battle and CPS and all this stuff. And I was like, you need legal help right away. Like, this course cannot tell you what to say if someone is threatening your custody, right? I mean, just, yeah. Yeah. So It's about finding the right type of help. Just like, yeah, there's times that you need a lawyer, not a therapist. There's also times you need help with your physical health. Jillian Spencer, thank you so much. It's been a pleasure. Where can people find you?

Dr. Jillian Spencer: Oh, yes. Well, I'm on X or, you know, Twitter under Jillian tweeting. So if anything, anything that I'm doing, I tend to try and post it there so people can see that. Yeah. Thanks so much for having me, Stephanie. It's been lovely to have a chat.

Stephanie Winn: I hope you enjoyed this episode of You Must Be Some Kind of Therapist podcast. To check out my book recommendations, articles, wellness products, guest episodes on other podcasts, consulting services, and lots more, visit SomeTherapist.com or follow me on Twitter or Instagram at SomeTherapist. If you'd like to go deeper, join my community at somekindoftherapist.locals.com. Members can dialogue with other listeners, post questions for upcoming podcast guests to respond to, or ask questions for me to respond to in exclusive members-only Q&A live streams. To learn more about the gender crisis, watch our film, No Way Back, The Reality of Gender-Affirming Care, at nowaybackfilm.com. Special thanks to Joey Pecoraro for our theme song, Half Awake. If you appreciate this podcast and want more people to find it, kindly take a moment to rate, review, like, comment, and share on your platforms of choice. Of course, just because I am some therapist doesn't mean I'm your therapist. This podcast is not a substitute for medical advice. If you need help, ask your doctor or browse your local therapists online. And whatever you do next, please take care of yourself. Eat well, sleep well, move your body, get outside, and tell someone you love them. You're worth it.