Trajectories towards affirmation: Gender identity in mental health services after the ICD-11

Abstract

Depathologisation of gender diversity in the ICD-11 marks a shift in psychological services for transgender and gender nonconforming people. Even though the stipulated changes are only practically applicable ever since early 2022, a general move towards affirmative psychotherapeutic and counselling practice has been noticed ever since 2018. The present paper covers three main models of mental health care for gender minorities, namely the conversion therapy model, the transsexual gatekeeping model, and the affirmative model, in order to view them under a novel lens. Drawing on Science, Technology and Society Studies, the universalist presumptions and rigid gender roles of the traditional models are brought under scrutiny. Moreover, the itinerary reveals the need for situated narratives that encourage self-determination and renovate the therapeutic relationship as a means of self-exploration instead of an institutional control mechanism. Concluding, it is remarked that intersectional knowledge is crucial in compensating for micro-aggressive practices and dynamics historically promoted by psychologists and other mental health providers.