Shifting Perspectives in Psychiatric Practice: From Psychodynamics to Presentism

In this episode, I sit down with Dr. Jillian Spencer, a child and adolescent psychiatrist from Brisbane, Australia, who has found herself at the center of a heated debate surrounding so-called “gender-affirming care” for children. After raising concerns about the practices at her hospital's gender clinic, Jillian was suspended and is now embroiled in legal battles that could redefine workplace protections for those with gender-critical beliefs. What led her to take such a bold stand, and what are the implications for mental health care?

We explore the concepts in a not-yet-published paper Jillian recently co-authored with Dr. Roberto D’Angelo, analyzing the interpersonal dynamics between gender clinicians and their patients using psychodynamic theory. How do psychological dynamics such as repression, collusion, codependency, projection, and reaction formation play into relationships between distressed, vulnerable patients and the professionals who “affirm” them? And what are the risks involved in psychiatry’s shift away from psychodynamic thinking?

We analyze the alarming trend of fast-tracking youth with suicidal ideation to gender clinics and the dangerous message this sends to vulnerable adolescents, potentially incentivizing personality disordered behavior and risking permanently entrenching vulnerable people into problematic problems for life that they could have grown out of in adolescence if only provided with the proper support.

Jillian Spencer is a child and adolescent psychiatrist in Brisbane, Australia. In April 2023, she was stood down from her job at the Queensland Children’s Hospital for raising concerns about gender interventions for children. Since that time, she has spoken out in the Australian media about her concerns which has led to further allegations of breaching the employee Code of Conduct. She remains suspended from her job. Jillian has launched legal action claiming political discrimination in the workplace due to her belief in biological reality, that people can’t change sex, in the hope of achieving a Forstater decision in Australia. This court case will occur in early 2025. She is also awaiting an employment commission outcome as to whether she is officially a ‘whistleblower’. If so, this would help her to retain her hospital job. You can follow her on X @jilliantweeting

Note: I mentioned that an episode with James Esses would come out the week before Jillian’s. The timeline for the release of James’ episode has been pushed back a few weeks to allow him time to finish a project we hope to be able to announce with that episode. Be on the lookout for my conversation with James in November.

 00:00 Start

[00:02:39] Psychodynamic thinking in therapy.

[00:05:36] Gender clinic referral practices.

[00:09:39] Suicidality and gender clinic access.

[00:12:20] Trans identity and self-harm.

[00:16:04] Parent-Child Dynamics in “Trans” Care.

[00:19:07] Gender clinic assessment validity.

[00:23:15] Whistleblower protections in Queensland.

[00:27:22] Political discrimination and beliefs.

[00:30:49] Multidisciplinary care model critique.

[00:34:43] Psychodynamic perspective in treatment.

[00:37:49] Clinician influence on therapy dynamics.

[00:44:36] Projection and hate in therapy.

[00:46:11] Power dynamics in gender clinics.

[00:50:35] Psychological health and gender distress.

[00:53:11] The wounded healer archetype.

[00:56:32] Transgender identity and empathy.

[01:00:17] Gender non-conforming youth sexuality.

[01:04:16] Downfall of psychotherapy.

[01:08:03] Self-care and well-being tips.

ROGD REPAIR Course + Community for Parents is available now! Are you concerned about an adolescent or young adult with Rapid Onset Gender Dysphoria? Join at ROGDrepair.com and get instant access to over 100 lessons designed to equip you with the psychological insights and communication tools you need to get through to your kid. Use code SOMETHERAPIST2024 to take 50% off your first month.

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Watch NO WAY BACK: The Reality of Gender-Affirming Care. Use code SOMETHERAPIST to take 20% off your order. Follow us on X @2022affirmation or Instagram at @affirmationgeneration. 

SHOW NOTES & transcript with help from SwellAI.

MUSIC: Thanks to Joey Pecoraro for our song, “Half Awake,” used with gratitude & permission.

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Show notes & transcript provided with the help of SwellAI.

Special thanks to Joey Pecoraro for our theme song, “Half Awake,” used with gratitude and permission.

Watch NO WAY BACK: The Reality of Gender-Affirming Care (our medical ethics documentary, formerly known as Affirmation Generation). Stream the film or purchase a DVD. Use code SOMETHERAPIST to take 20% off your order. Follow ...