Gender exploratory therapy

Gender exploratory therapy is a psychotherapeutic approach that creates space to explore one’s own gender identity, without transition or affirmation of the claimed identity being a predetermined goal.

What is it?

Gender exploratory therapy is a psychotherapeutic approach that creates space to explore one’s own gender identity, without transition or affirmation of the claimed identity being a predetermined goal. Attention is paid to underlying factors such as mental health issues, neurodivergence, trauma and social influence.

Place in the debate

Supporters view it as an ethical and careful approach that fits within broad clinical standards. Opponents, including some transgender advocacy organisations, fear that it may lead to conversion-like practices.

Internationally

The Cass Review explicitly advocates exploratory approaches rather than automatic affirmation. Several countries that ban conversion therapy (such as France and Canada) have included exceptions or wording choices in their legislation to ensure that exploratory therapy does not fall under the ban. In Northern Ireland, critics warn that a law against conversion practices could also threaten therapy.

How it works in practice

The therapist does not take a position on the outcome. The conversations address when the discomfort began, what the young person expects from a transition, how things are at home and at school, and whether other issues are involved, such as anxiety, depression, autism, an eating disorder or traumatic experiences. Why careful differential diagnosis is needed in cases involving autism and gender questions is explained at genderautisme.nl. The process may result in a transition, but it may also lead to the realisation that the discomfort has a different origin. This openness is what distinguishes the approach from the affirmative model, in which the therapist takes the stated identity as the starting point. Why critics believe that automatic affirmation falls short is explained at genspect.nl.

Organisations

Therapists working in this way joined together in the Gender Exploratory Therapy Association, which has been called Therapy First since 2023. The organisation maintains that psychotherapy should be the first step for young people with gender dysphoria. In 2026, it became clear that Therapy First and Genspect clashed over the approach. Finland established this principle in its national recommendation in 2020; see PALKO Finland 2020.

Criticism and evidence

In 2022, lawyer and bioethicist Florence Ashley argued that exploratory therapy in practice amounts to delaying transition and is therefore related to conversion therapy. Supporters reject this: the therapy has no predetermined goal and differs from conversion therapy precisely for that reason. There is little research for either side. The University of York’s systematic review of psychosocial treatments found only a small number of studies, all of low quality. The Cass Review concluded that exploratory conversations are part of ordinary, careful healthcare and should not be classified as conversion therapy. The claim that failing to affirm someone’s identity causes harm is challenged in the essay Not affirming is not causing harm.