Thanks Bernard this is a helpful summary. Many of the young people who present with these difficulties appear to have a fragile sense of self, threatened by the demands of transitioning from childhood to adulthood. The physiological, psychological, and social pressures of adolescence can intensify the use of defences aimed at controlling internal conflict and anxiety, leading to a search for certainty in belief as a defence against turmoil. These defences frequently rely on rigid splits between mind and body, and between good and bad versions of the self and others. The cost of such rigidity is developmental. Psychological development requires an atmosphere in which ambiguity can be tolerated, different elements of the self can be held in mind, and doubt can be thought about rather than eliminated. These defensive organisations are often associated with presentations such as eating disorders, depression, obsessive–compulsive symptoms, and schizoid states. As the study suggests, these presentations may reflect serious developmental difficulties. The gender issue, which is sometimes treated as entirely separate from these comorbid conditions, can instead be understood as part of the same overall presentation. A narrow preoccupation with gender may then distract attention from the core developmental problem. Under emotional stress, the individual’s capacity for symbolic and complex thinking can give way to rigid, concrete thought. The Finnish study suggests that a significant proportion of young people presenting with gender distress do so within a broader developmental and psychological context, rather than in isolation. Its long-term follow-up data are particularly valuable. This resonates with the clinical experience of myself and @sueevansprotect, based on seeing many young people and hearing from hundreds of parents since 2019. I first published a paper in the British Psychiatric Bulletin in 2020 that raised similar developmental concerns, titled Freedom to Think: The Need for Thorough Assessment and Treatment of Gender Dysphoric Children: cambridge.org/core/journals/… David Taylor wrote something comparable in his 2006 report on GIDS. Why has it taken so long for these developmental perspectives to be taken seriously? @genspect @Transgendertrd @CanSG_org @segm_ebm

Grateful to the British Journal of Psychotherapy for the courage to support thoughtful clinical debate in a highly contested area. Beyond affirmation: Lessons from Tavistock A psychoanalytic critique of identity certainty and institutional defence. The paper explores how certainty can function defensively in individuals and clinicians. It argues that clinicians need institutions that support reflective work, rather than pushing short-term fixes or ideological certainty. onlinelibrary.wiley.com/doi/… #psychoanalysis #mentalhealth #psychotherapy #GenderDysphoria #ClinicalDebate #ReflectivePractice @TheIoPA @rcpsych @psychoanalysis_ @BPApsychUK @BritPsyCouncil @RosieDuffield1 @ClaireCoutinho @segm_ebm @Transgendertrd