The Children's Commissioner for Wales wants to establish a new gender identity service for children. However, her rights-based approach denies the complexity of the issues in society where notions of gender identity are fiercely contested. Her idea is supported by the First Minister of Wales, an advocate for the rights of trans people. However, children and young people who are struggling with self-identity issues need a service that is multi-disciplinary and informed by a sound understanding of child development - and the Child and Adolescent Mental Health Service (CAMHS) in Wales already provides this. The service suggested by the Children's Commissioner is therefore unnecessary.

There is obviously a risk that the proposed Gender Identity Service would assume a new kind of authority shaping society's response to children and young people who are struggling with their gender identity. If we accept that many young people have an innate need to test the rules of behaviour operating within society, we must also recognise the importance of the parental task of offering a firm response to their child's testing-out behaviour. Parents would be wrong to simply accept a child's wish to change gender without challenging this. However, if a child's gender identity difficulties are framed as 'gender dysphoria' a therapeutic service for the child and family might be more appropriate. The concept of 'gender dysphoria' certainly has a place in clinical practice with young people. A clinician could make use of the therapeutic relationship with the young person to give them a lifeline during a difficult period in their life and explore different coping strategies.

In adolescence the struggle to become authentically oneself can take many twists and turns but this is often a healthy process of personal exploration and should be recognised as a natural stage of development. It is normal for adolescents to struggle with the physical changes taking place in their bodies and the ongoing process of growing up into adulthood. Adolescents therefore need support in accepting biological reality and developing an identity and a sexuality that feels right for them. Unfortunately, we now seem to have a generation of children who may not be robust enough to enter adolescence and work through the emotional and sexual issues they inevitably face.

At birth babies are seen and recorded as male or female based on their physical characteristics and it is inevitable that during childhood they are exposed to an ongoing process of gender differentiation. However, there have been considerable cultural changes in recent years and this means there is now more similarity between boys and girls in terms of their aspirations for the future regarding work and family life. Furthermore, the politics of gender equality is now taken for granted and children are less exposed to gender stereotypes than they were in the past.

In recent years state interference in family life has been relentless. A growing concern about the quality of parenting means that schools are increasingly expected to perform a parental role which includes 'safeguarding' children. Responsibility for sex education is shared between parents and school - although government guidance has elevated the simple-minded trans identity as a serious political issue that the education system is now required to address. In recent decades the decline of traditional family relationships, leading to greater diversity in family patterns of living, and the growing influence of social media, with its superficial interactions, have had a significant impact on children's experience of childhood. Add to this the social media preoccupation with trans issues and we have a very serious problem.

The developmental task of establishing a gender identity that feels authentic to the individual is complex. Many different aspects of family life and societal influences will play a part in shaping children's growing awareness of their physical attributes and their feelings about the changes associated with puberty that are linked with a sense of identity. Society now promotes an ideology based on the provision of equal opportunities for males and females and permits a more relaxed approach to different forms of sexual orientation. This should therefore make it easier for children today to find a path through all the different influences bearing down on them, and make use of the knowledge available to them from many different sources, to develop a sense of their own gender identity that feels authentic and offers ways of relating to others that are personally satisfying.

Sexual liberation has certainly transformed the way in which most of us regard our bodies and live our sexual lives. I recognise, from my own personal life, the significance that romantic and sexual experiences during my adolescence played in laying the foundations for ongoing romantic and sexual development in adult life. I have also been struck by the similarities between men and women in terms of their struggle to overcome sexual repression and to seek their own particular ways of finding pleasure in sex. We should therefore recognise the wide range of ways people seek personal fulfilment and display their needs for affection and intimacy.

Wales does not need a Gender Identity Service for children and young people. The underlying reasons for a young person's gender identity problems should be fully explored and consideration given to a referral to CAMHS. The young person may be diagnosed as suffering from gender dysphoria and appropriate help given. While the offer of individual psychotherapy would be considered, some young people would probably be resistant to this initially. The offer of support to the parents in managing the young person's developmental difficulties would also be made and this might lead on to a family meeting to explore relationships within the family. The underlying aim of this kind of therapeutic work would be to provide a safe space for reflection and the opening up of new ideas for the best way forward.

Hilary Searing

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