Transformational space: group psychotherapy with young people experiencing gender-related distress

This qualitative research explores what group psychotherapy can offer adolescents experiencing gender-related distress (GRD). An exponential increase in young people seeking help for GRD over the last 15 years, amid legal challenge and public dispute about the ethics and efficacy of associated medical intervention, has focussed attention on what psychological therapies can contribute to an appropriate response. The Cass Review - commissioned to make recommendations on NHS care for this population - stated that ‘a much better understanding is needed’ about the increasing numbers presenting for help, ‘their support needs, and the full range of potential treatment options’ (Cass 2022, p.39). While the diverse and often complex antecedents and manifestations of adolescent GRD indicate no one model will fit all, this study aims to better understand what group psychotherapy can offer this cohort as one such option. It examines a provision informed by psychoanalytic, group analytic, mentalization-based and art therapy approaches that has been shaped through trial, error and collaborative endeavour with adolescents experiencing GRD in a community-based setting across this 15 year period of change. The data are transcripts of interviews with former group members. They are analysed using Braun & Clarke’s (2006, 2019) Reflexive Thematic Analysis method. Findings offer important insights into links between psychosocial experience, the development of GRD and the therapeutic needs of affected adolescents. Identified themes illustrate how key components of this therapy are utilised in practice, including benefits and challenges. Group factors, a balance between safety and challenge, freedom of expression supported by a range of routes for communication and connection, and an analytic, mentalizing framework are identified as key therapeutic features. Young people’s testimonies evidence the many ways in which this therapy has much to contribute to current discussion of what meaningful therapeutic support for this growing and under-served population could look like.