Therapy First
Therapy First is an American association of mental health professionals focused on children, adolescents and young adults with gender dysphoria. The organization was founded in 2021 by therapist Lisa Marchiano and colleagues under the name Gender Exploratory Therapy Association (GETA), and adopted its current name in 2023 under the leadership of Paul Garcia-Ryan.
What you will find
The website offers a therapist directory, membership for professionals, training, webinars, and links to research and media coverage. Its premise is that psychotherapy should be the first step for gender dysphoria, before any medical treatment is considered.
Background and criticism
The approach is controversial. Critics regard the advocated gender-exploratory therapy as a form of conversion therapy and point out that research on its outcomes is lacking; the association rejects that comparison. The site is useful for learning about this position firsthand, alongside other critical perspectives.
Founders and network
According to the Southern Poverty Law Center, the association was founded in June 2021 by five people: Sasha Ayad, Roberto D'Angelo, Stella O'Malley, Lisa Marchiano and Joseph Burgo, who is the subject of an article on this site: Joe Burgo on boys and masculinity. The first four are affiliated with the Society for Evidence-Based Gender Medicine, and Burgo is an adviser to Genspect. The Southern Poverty Law Center identified two dozen personnel ties between the three organizations. Marchiano is chair of the board. Paul Garcia-Ryan, who describes himself as detransitioned, leads the association. The board also includes Dwight Panozzo, a therapist and lecturer in New York University's social work program.
Positions and publications
The association believes that psychotherapy should be the first treatment for all forms of gender dysphoria. It considers social and medical transition risky and to be avoided where possible. In 2022, it published a clinical guide to gender-exploratory therapy. The association says it has more than 300 practitioners as members, spread across 36 U.S. states and 14 countries. The American Psychological Association has recognized it as a provider of continuing education. According to sources, the name change in late 2023 followed negative coverage of the former name. In 2026, the association clashed with Genspect over the approach to gender-affirming care.
How to use and assess this source
The site describes its own offerings and is written to attract practitioners and parents. The Southern Poverty Law Center considers the association part of a network that spreads pseudoscience about LGBT people, and the professional organization WPATH is also critical. Anyone seeking to assess the approach should examine what research exists on the outcomes of both psychotherapy and medical treatment. See systematic reviews.