Lobotomies, multiple personalities, satanic ritual abuse at day care centres – we all remember them. Each was unprecedented yet topped by the next glaring instance of social contagion amplified by psychologists. At a rate rivalling those past human rights violations, therapists are now confirming a prodigious number of young people identifying as ‘transgender‘ and thus animating the spread of the hottest new social contagion to date: the ‘transgender craze’.

However well-intentioned, the trendy affirmative therapy that perpetuates this craze is incapable of resolving the psychological sources of the drive to transition. To speculate why this is the case, consider Mary Collins, who has become the face of the transgender movement in Alabama. Based on a third-party account, it is possible to sketch a tentative overview of her interaction with a client we’ll call Zoe. A high-functioning vibrant young woman, Zoe walked into the office of the glamorous Mary Collins, a confident bright independent young woman with a drive to transition. Although most likely amenable to appropriate psychotherapy, Zoe’s psychological crisis was subordinated to Mary Collins’ eagerness to affirm.

As practised, affirmative therapy, and the transitioning affirmative therapists who practise it, offers a blank check toward transitioning chemically and surgically. Coming to fame by capitalising on the transgender craze, Mary Collins rose like a rocket star among transitioning-affirmative therapists. She quickly gained statewide notoriety as a supporter of transgender rights, a practitioner who is counted on for gaining access to ‘trans affirmative’ healthcare.

Collins already enjoyed prominence in 2015, becoming what Alabama.com calls ‘a go-to practitioner for transgender people in the region‘. Reading between the lines, it is evident that Mary Collins serves as a proponent of transition, not an unbiased counsellor.  She is the ‘go-to practitioner’ who will escort clients rushing to get onto the transitioning train.

Supplying a particular medical service on demand is more than what psychologists themselves term ‘idiot compassion’ or what common people call cheerleading from the sidelines. Rather, Collins is essentially the state’s pro-transgender counsellor, nominally a therapist yet ‘in-the-game’.

The game in question is a shell game. The term ‘transgender’ does not appear in the DSM, because it isn’t a diagnosis. Transgender is an identity Zoe and others like her claim. The DSM-5 designation of ‘gender dysphoria‘ is more well-known, yet it is a universally applicable diagnosis that distracts from dealing with underlying comorbidities. Considering the lack of clear and stable meaning, terms such as ‘gender dysphoria’ serve merely as professional lip gloss, providing explanatory power for any and all of the client’s symptoms while making its source ambiguous.

Recognising the DSM mainly as a set of billing checklists, therapists such as Collins tend to regard transgender identity as a cause and the related DSM categories as nominally significant. Instead of investigating psychological the affirmative therapist believes her client’s transgender identity needs recognition and liberation.

As a therapist with a pro-trans outlook, Collins is not all that different from an online administrator in a ‘pro-Ana’ community who guides anorexics on how to purge, decides who can be ‘in’ the club, and checks to be sure others are reinforcing the delusion of anorexia as healthy. The Alabama.com article notes: ‘While coming out as transgender continues to expose Alabamians to a range of potential indignities and dangers, a growing web of resources and professionals has emerged in recent years to help members of the transgender community.’

When Zoe ‘came out’ as trans, all it would’ve taken was strolling into one of the several regional offices of Mary Collins, the sophisticated sex therapist. Picture someone like Zoe, dressed in hipster fashion, relieved to meet the disarmingly attractive Mary Collins, ‘transgender’ diagnosis in hand. So we don’t know the specifics of that or subsequent sessions, but we can look at the implications of the standard affirmative approach now shaping the lives of countless young people like Zoe.

As a self-proclaimed identity, ‘transgender’ is the wrench in the affirmation model. Theoretically, the affirmative therapist seeks primarily to journey alongside the client, providing information in a non-judgemental way. Responding to gender confusion, the ideal goal is to help clients accept themselves as they are without feeling the need to conform; in practice, this is not happening. Perhaps that’s because affirmation has proven naively fragile to gamesmanship.

The very phrase ‘coming out as transgender’ suggests why. Highlighting the troubling identity context in which therapists practise affirmation, the phrase gives away the game. Imposing phrasing usually reserved for sexual orientation (‘coming out’), the identity of the client is uppermost, with the clinician seeking to protect the identity at all costs, even to the client.

And the costs are especially severe for those with gender discordance and those with same-sex attraction. Without question, a serious ethical error occurs in assuming individuals with gender nonconformity – and likewise same-sex attracted individuals – must undergo hormone doping and have their physical features altered surgically as a means to superficially mimic stereotypical sex characteristics. A warning sign for Dr Ludden, a cognitive psychologist, has been the realisation that ‘changing physical sex to match experienced gender amplifies the existing sex and gender stereotypes in our culture’. Erasing nonconformity, masculinising drugs, and surgeries are intended to make Zoe look more conventionally male.

Why is Zoe encouraged to cloak her bodily reality through chemical and surgical masking? Ironically, it is the need to demonstrate to her family and within her social circles that she is ‘true trans’. This is where the therapist’s ethics need to intervene, as there is obviously no objective test to substantiate Zoe’s feeling of being ‘true trans’, and affirming it in a neutral way goes against every bit of psychological advice for responding to delusional thinking. Idiot compassion can lead the neutrally-positioned affirmative therapist to stand passively by as a client becomes myopically fixated on the need to pass as ‘transgender’.

The perceived need to ‘pass’ fuels the spreading urgency among young people for drugs and surgery in order to live authentically, to prove one is ‘true trans’. For gender discordant youths such as Zoe and same-sex attracted people, the trans craze is serving up conversion therapy as a way to pass and thereby escape the stigma. Dr Ludden observes medical treatments promise ‘if physical sex and psychological gender don’t match, we change the sex to match the gender.’

As is becoming increasingly evident, transitioning as a solution to stigma has resulted in an unethical new type of conversion therapy. Reviewing his profession’s current application of the affirmative approach to the transgender craze, Dr Ludden writes: ‘I see nothing affirmative about hormone therapy and sex reassignment surgery. Rather, it’s conversion therapy at its most insidious. It seeks to change the appearance of the human body so that the way you act won’t offend anyone’s gender stereotypes.’

As many young adults act now, gender noncongruent Zoe ‘came out’ as ‘transgender’ and will be converted through transitioning affirmation – not just in her thinking as in the bad old conversion therapy. Zoe is now under a medical expert’s mandate to convert her body physically following the prescription of the affirming therapist, Mary Collins.

APA warns against treating gender nonconformity as a disorder

There is a very legitimate concern that therapists do not practise conversion therapy, yet that is in reality happening regularly under the trans-friendly sounded affirmation therapy.  Moreover, the APA warns against making gender nonconformance a mental health disorder. The APA specifies its criteria must not be used on gender-nonconforming people in this way: ‘The DSM-5 articulates explicitly that “gender nonconformity” is not in itself a mental disorder.’

Zoe grew up facing stigma for rejecting limiting stereotypes of female appearance and behaviour only to succumb now to the recent ‘trans’ contagion. Mary Collins has perpetuated that ‘trans’ contagion, subjecting Zoe to conversion therapy as egregious as that of any well-intentioned conversion therapist of the past.

It may, in fact, be Zoe’s sexual orientation that propelled her to seek therapy, in which case, Collins again practised conversion therapy. In an ‘aha’ moment, Zoe may have found explanatory power in the magical notion she is really a man and that’s why she’s attracted to women. Such conversion therapy is more excruciatingly damaging than the old kind since Zoe is determined as a result to face the surgeon’s knife.

Affirming the client’s desire for a masked identity merely sets up an additional barrier to self-understanding by projecting a performative self as genuine. Young women especially need counselling that is body affirmative rather than trans affirmative. The affirmative approach Collins utilises provides no failsafe against self-hatred and homophobic motivations for the ‘trans’ delusion.

Perhaps Collins recognises the false promise of transitioning-affirmative therapy because she waves a bright red disclaimer. In the Alabama.com piece, Collins openly admits her therapy carries no real guarantee of success: ‘Part of the counselling is that quite a few people believe that once I start these hormones or once I change my gender everything will be better but the truth is that’s not always the case,’ she said. ‘Going through the process is very difficult and some of the issues that were there are still there.’ It so happens Collins’ wariness is justified, given the starry-eyed magical thinking propelling her clients. While trans-identified youths draw to her like fireflies, Collins may dread the hint of forthcoming lawsuits.

After all, Collins has enjoyed rock star status for enabling her ‘trans’ identified clients in their magical thinking; giving them permission to go forward earns her no end of gratitude. Finally, though, the dopamine-hit wears off, and reality sets in. Once post-mastectomy, Zoe will look in her mirror and experience the uncanny valley that something is off about the chest and there is no going back.

As the gender identity certificate expert in the room, Collins has to know she started Zoe on a therapeutic path incapable of resolving psychological issues. Anyone not yet succumbing to the ‘transgender craze’ understands a medical approach fundamentally cannot address deeply-rooted experiences of trauma and stress, yet social media recruits are routinely misled now to believe it not only possible but the only way forward.

Perhaps, for this reason, Collins further covers for her failure to follow the ethical norms of her profession by linking client satisfaction to what is external to her practice. That is, she stipulates ‘clients need support groups’, which in this context means trans-identified individuals, who will sustain the trans delusion through mutual reinforcement. Collins comments: ‘Support groups are very important, being connected to other people in the community who have gone through transition.’

What the Alabama.com news story reveals is a serious conflict of interest in Collins, a licensed counsellor, being very publicly recognised for her pro-transitioning position, her ability to grant permission to the unthinkable: transitioning. The article makes it clear Collins is less interested in proper screening and employing all her psychological skills in exploring issues such as trauma than in liberating a ‘transgender’ identity.

Therapists make many clinical judgements yet, in the case of social contagion, therapeutic judgement is being set aside in favour of advocacy and affirmation. Particularly in light of the current ‘transgender craze’, it is more incumbent than ever for regulatory agencies to intervene to eliminate malpractice in the guise of seemingly compassionate (nominally affirmative) therapy that actually results in deadly harms including an increased rate of completed suicide. While practising as a counsellor in the state of Alabama, Collins has set vulnerable clients at risk.

When the details come out, affirmation therapy will become as grimace-inducing a term as lobotomies. The public will at once see that therapists who affirmed the transgender identity are little different than the Salem accusers calling out neighbours as ‘witches’. Those like Zoe who endure this decade’s doctor-assisted contagion will look back at their unnecessary baptism by fire and wonder how a predatory trans medical complex could have been allowed such free reign. The answer is that therapists – and the rest of us – must first recognise and then refuse in any way to perpetuate the spreading social contagion that is the ‘transgender craze’.

Faith Kuzma earned a PhD in 20th-century literature from Ohio University, taught composition and literature, and is now retired. She is the mother of a young adult with rapid onset gender dysphoria.