Therapy First's Response to the Cass Review

Therapy First Press Release 10 April 2024.

NEW YORK, NY — Therapy First applauds the work of Dr. Hilary Cass and yesterday’s publication of The Cass Review's final report. We fully endorse the recommendations therein that emphasize the utilization of "standard evidence-based psychological and psychopharmacological treatment approaches to support the management of associated distress and co-occurring conditions” for youth gender dysphoria. Until very recently, psychotherapy had been a fundamental part of the treatment of gender dysphoria.

As The Cass Report details, psychotherapy can play many roles – providing a non-judgmental space to discuss feelings and consider treatment options; promoting resilience; reducing distress; and bolstering insight and self-understanding in ways that support self-determination and informed decision making. According to the systematic review of the evidence carried out by the University of York, psychotherapy for gender distress showed moderate improvements in depression, anxiety, and suicidality, indicating little risk in offering psychotherapy as a first-line intervention. As the review noted, “There was no indication across the studies of adverse or negative effects.” This differs markedly from a medical pathway, which carries the possibility of harm, particularly as a first-line treatment for young people.

While psychotherapy for gender distress has increasingly been referred to as “conversion therapy,” this is a false and misleading characterization. As Dr. Cass points out, “the intent of psychological intervention is not to change the person’s perception of who they are but to work with them to explore their concerns and experiences and help alleviate their distress, regardless of whether they pursue a medical pathway or not. It is harmful to equate this approach to conversion therapy as it may prevent young people from getting the emotional support they deserve.” Cass goes on to clarify that conversion therapy is universally frowned upon. “No formal science-based training in psychotherapy, psychology or psychiatry teaches or advocates conversion therapy. If an individual were to carry out such practices they would be acting out of professional guidance.”

Importantly, Dr. Cass highlights the detrimental effects of bullying and intimidation that Therapy First clinicians are all too familiar with. “There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behavior. This must stop.” Therapy First members have been subjected to name-calling, threats, and attacks on social media – often by fellow clinicians – because we have stood for psychotherapy as a first-line treatment for gender dysphoria in children and young people.

In no other area of mental health care would such unprofessional and uncollegial conduct be tolerated, much less accepted. If a hostile professional environment persists, less clinicians will be inclined to work with youth experiencing gender dysphoria, thereby limiting access to care for this population. Given our strong belief that these young people deserve the highest standard of care, our earnest hope is that this unprofessional behavior will soon come to an end. 

Media Contact:

Paul Garcia-Ryan, LCSW
276 Fifth Avenue, Suite 1101
New York, NY 10001
(917) 830-3324
info@therapyfirst.org