For most of my career I have thought of myself as a scientist-practitioner. To me, this is exemplified by the intersections of my clinical work as a psychotherapist who specialises in working with transgender children and their families, and my role as an academic whose research primarily focuses on the lives of transgender people. This image of myself as a scientist-practitioner was formed through my training in the discipline of psychology, where the scientist-practitioner model is very much a taken for granted norm, and in which the search for ‘truth’ central. Yet as part of my formation as a psychoanalyst, the topic of what counts as ‘truth’ very much came under question. Coming into a relationship with one’s unconscious, and indeed coming to authorise oneself as a clinician – as is central to Lacanian psychoanalysis – led me to question what it means to ‘know’. Furthermore, coming to grapple with my own complex gender histories as a nominally cisgender (i.e., not transgender) man led me to question what it means to ‘know’ one’s gender, and how, as a clinician, I can understand the gender of another.
This book represents an attempt at coming to terms with what it means to ‘know’ gender in the context of working with transgender young people and their families. To know, I will argue, is always partial, and always situated. This includes what it means to know as a clinician, what it means to know as a young person, and what it means to know as a family member. Each of these different groups make unique claims to knowledge about gender, and each set of claims brings its own set of truths that are intersecting, yet distinct. They are intersecting, as I will explore in greater detail below, in the sense that they are all formed in a broader context of discrimination and social norms perpetuated in relation to transgender people. Yet they are distinct, in the sense that such discrimination and norms play out in very specific ways, according to one’s social location, and the authority that one is differentially accorded.
Clinician readers may reasonably ask, what it means for me to begin this book by questioning what it is that we can know about gender. How, it may be asked, can a clinician work with transgender young people and their families if they cannot truly ‘know’? The astute reader may also question the ontological quandary that such issues of epistemology raise. If there is no pre-given ‘truth’ of gender, how may this potentially undermine the truth claims made by young people about their gender? In this opening chapter I explore these types of questions via a careful unpacking of what it means to know as a scientist-practitioner who works with transgender young people and their families. At its simplest, my argument is that if our knowing is guided by an understanding of young people as experts on their gender, then it can be firmly grounded in a very specific set of ontological claims. At the same time, however, and as the subsequent chapters in this book elaborate, a critical developmental approach to working with transgender young people and their families affords us the necessary epistemological lens through which to understand gender. Such a lens, one that I believe to be novel to this book, enables clinician readers from all walks (i.e., psychologists, social workers, counsellors, and psychiatrists) to have the capacity to truly hear a diverse range of ontological claims about gender.
In the sections that follow, I first unpack in greater detail what it means to be a scientist-practitioner who adopts a critical approach to both ‘science’ and ‘gender’. Through a consideration of the histories of the term ‘scientist-practitioner’ I propose a framing of this role for clinicians as one that adopts a critical account of gender, one informed by a particular understanding of the individual and institutional discrimination directed towards transgender people. Having outlined this account, I then turn to consider how others have outlined the role of clinicians who work with transgender young people and their families, highlighting how my own approach intersects with yet also diverges from the accounts of others, specifically in terms of its developmental focus. With these divergences considered, I then introduce my own conceptual framework for clinical work, one that keeps ‘gender’ at the forefront, whilst being focused on unpacking its constitutive parts. The chapter then finishes by summarising the contents of this book, locating each within a relationship to the epistemological claims outlined in this introductory chapter.
Problematising the Scientist-Practitioner Model
Much has been written about the scientist-practitioner model in psychology, but in this section I draw primarily on the work of John, an Australian critical psychologist whose writing did much to unpack the problems inherent to the model as it has traditionally been understood. As John argues (1994), from its inception the scientist-practitioner model accepted as its basis the assumption that there are universal laws that govern individual behaviour. The role of the scientist-practitioner is thus to identify such laws and apply them in the treatment of individuals. As John argues, however, the idea of universal laws only makes sense if individual behaviours are seen as a ‘natural’ reflection of innate truths about individuals. Moreover, the naturalisation of universal laws positions the scientist-practitioner as an objective bystander, capable of observing laws in situ, and doing so free of personal bias or beliefs.
The problem faced by the scientist-practitioner when it comes to clinical work is the fact that any so-called universal laws identified on the basis of experimental research abstracted from the lives of actual people all too often fails to be effective. Whilst psychology has long positioned itself as an evidence-based discipline (and certainly psychology is not alone in this claim, with the mental health professions in general making similar claims), the problem for the clinician, then, is that too often the evidence-base is ill suited to clinical work. This is not to say that certain modalities, developed from research, are entirely inefficacious. Rather, it is to suggest that using research findings to inform practice also requires some sort of translation, so as to meet the need of individuals. And it is this translation – which always involves the clinician’s own views, beliefs, and biases – that draws attention to the shortcomings of the scientist-practitioner model as it is traditionally understood. In other words, if clinicians engage in practices of translation that are always shaped by their own views, beliefs, and biases, then it is almost certainly the case that the evidence base upon which the practice is based is, to a certain degree, lost in translation.
Part of what is lost in translation, I would argue, is keeping open the space for a critical view of science. When the clinician draws upon ‘evidence-based principles’ derived from a normative understanding of science, they do so by reifying a particular view of science. This view of science, as John (1994) argued, is one based upon the assumption that researchers are objective interpreters of the ‘natural’ world. Science as it is produced by scientists is thus seen as free from bias. We know, of course, that this is never the case. Not only do scientists bring their own biases to bear upon the types of research questions they investigate, and the methods by which they investigate them, but the ways in which scientific research is understood by others always occurs in a cultural context, rather than a cultural vacuum. Having a critical view of science, as I will outline in the following sections, is vital to any understanding of the scientist-practitioner model.
Gender and the Scientist-Practitioner Model
In terms of the reification of scientific knowledge, ‘gender’ as a concept is a useful example. Historically, within psychological research gender was framed as ‘sex differences’, thus emphasising differences between people based on presumed-to-be physiological differences ‘between the sexes’ (Stewart and McDermott 2004). ‘Females’ as compared to ‘males’ were seen as having unique strengths and weaknesses that were a product of what was read as uniquely sexed physiologies, and these were then seen to translate into specific psychological differences that were presumed to be consistent and generalisable. In reality, this focus on difference served only to produce the very differences it was purported to be based on (Hare-Mustin and Marecek 1990). For example, based on the assumption that women were inherently weak, best suited to motherhood, and given to emotionality, research that sought to demonstrate the ‘truth’ of these assumptions did just that. Women for whom these assumptions were incorrect, or women for whom these assumptions were true only at one specific moment in time, disappeared as ‘noise’ via a focus on distinct categories of ‘sex differences’.
Similarly lost in translation as a result of research on ‘sex differences’ was any attention to the lived experience of a person’s gendered self, and the expectations placed upon individuals as a result of their assigned sex. The latter, in other words, was seen to trump the former. As a corrective to this, feminist psychologists sought to shift the focus from sex to gender, with the latter being understood as a set of normative understandings of how individuals should experience their assigned sex, understandings located within power dynamics where men’s views and experiences are valued over those of women. This focus on gender as lived experience was an important corrective to research on ‘sex differences’, in that it eschewed the idea that one (of two) genders was inherently better than the other. Unfortunately, however, early feminist research to a certain degree remained mired in the assumption that gender reflected some sort of essential truth about individuals, hard-wired in many of the same ways as what were seen as physiological differences (Weisstein 1993). Whilst the incorporation of an analysis of power was a vital contribution of early feminist work, it nonetheless failed to move beyond an essentialist account of gender.
From the 1990s onwards, critical scholars have examined how gender as a construct is made sense of, indeed how it is produced, within specific cultural contexts. Such accounts, whilst acknowledging that in many such contexts gender is treated as a salient category, and one imbued with considerable regulatory power, that it is not an ahistorical entity that has always existed. This type of account moves us beyond simply challenging gender hierarchies, to instead question how gender itself is naturalised, and how ‘sex differences’ are made to matter on very specific terms. Indeed, from a critical perspective it has been argued that rather than seeing particular types of bodies as producing gender categories, instead it is more accurate to see particular forms of categorisation as producing bodies that are seen as naturally attached to certain genders. This is not to deny that as individuals we typically have a very real and embodied sense of our gender. Rather, it is to suggest that this embodied sense of gender is produced within cultural contexts where ‘having a gender’ offers us access to particular, normative, realms of intelligibil...