On Children, Adults, and the Responsibility of Influence

I’m going to try to briefly open up a topic today that I think about almost daily. It’s this question: What does it mean to responsibly influence other people?

This is a big, big topic. It’s one that I have thoughts about as a mother, as a future therapist, as a Christian, as a gay person, and as a human being exposed to the disaster that is contemporary media. Today, I want to focus on therapy though, and put a spotlight on a type of therapeutic practice I think constitutes a dishonest, irresponsible use of influence.

I recently read about a training led by Dr. Diane Ehrensaft of the UC San Francisco Child and Adolescent Gender Center. This training, titled “Fertility Issues for Transgender and Nonbinary Youth.” focused on therapeutic and psychoeducational support for children who are undergoing medical gender transitions, featuring treatments that will result in near-certain infertility and possible loss of sexual function.

To her credit, Dr. Ehrensaft acknowledges that children who are 11, 12, and 13 years old are not developmentally able to understand the life-altering effects of these treatments, and that years down the road, they may experience grief as a result of, for example, not being able to have a biological child. But then (at 8:45 in this video) she suggests a therapeutic intervention clinicians can use with these children: writing a letter to their future selves at thirty, explaining why they chose these infertility-inducing treatments.

My immediate reaction to this intervention was disbelief – what is the purpose of having a child write such a letter? Do these clinicians really believe a 30-year-old who received sterilizing medical treatments as a child is going to feel reassured by a letter they wrote when they were 12? I’d like to be a fly on the wall when those future letters are read.

And didn’t we just acknowledge children don’t understand the impacts of these treatments? How can a 12-year-old be expected to do the job of justifying these choices to their future selves, when they don’t fully understand the choices today?

But there’s another purpose to this letter-writing exercise, I think – it’s to reduce the doctors’, clinicians’, and family’s sense of responsibility for the loss of the child’s fertility. It’s to reinforce the message implicitly to their child that they were the ones who made this choice. It’s a way of acknowledging on paper that children can’t realistically provide informed consent for these procedures, while still in practice placing the burden of these choices on them.

And that’s why I think this is an example of inappropriate therapeutic influence. It blurs the boundaries between the roles of adults and children, and it creates confusion about whose ideas and choices are whose. It’s gaslighting.

I’ll write more about my thoughts about healthy influence in the future – I think it’s a topic that will be at the heart of how we all navigate the 21^st century. So instead of wrapping up this post in a bow, I want to end it with questions I consider often:

• Who gets to influence how I see the world, and what are their motives?
• Who do I influence, and what are my motives?
• Who should I trust, and how can I be trustworthy?