Understanding Dysphoria: A Critical Psychology Perspective
Understanding dysphoria requires us to examine the frameworks that shape how psychology defines, interprets and responds to gendered experience. In this month’s issue of Cairnmillar Insights, Dr Ceri Parsons psychology academic at Cairnmillar draws on her long-standing work in discourse analysis, critical psychology and trans identity to explore how these frameworks have evolved and why rethinking them matters. Read on to continue the conversation.
Where this work began
In the late 1990s I began a PhD examining what was then termed transsexuality. This work arose from both academic interest and vicarious personal experience at that time when psychology and psychiatry were often not experienced as supportive, but as sceptical, intrusive, and regulatory. These perspectives shaped my understanding of what psychological science was doing in the name of care, and what it consistently refused to question. As a young psychology graduate, I wanted to ‘help’. But it quickly became clear that helping did not mean assisting someone to better articulate distress to satisfy diagnostic criteria, nor smoothing their passage through systems that demanded conformity to narrow gender norms and binary terminology. From my perspective as a critical psychologist, help meant interrogating the frameworks such as the ‘Psy’ disciplines, that position certain lives as disordered, unintelligible, or in need of professional verification.
Making psychology the object of analysis
The area of critical psychology begins by treating psychology itself as an object of analysis rather than a neutral tool. It challenges psychology’s habitual tendency to individualise social problems, to translate difference into pathology, and to present professional authority as objective and benevolent. Rather than asking how individuals can be assessed or corrected, critical psychology asks how particular experiences come to be framed as psychological problems at all, and how psychology participates in producing the very phenomena it then claims to manage.
When categories start to look like facts
This stance shaped my critique of psychology’s approach to gender identity and dysphoria. Mainstream models locate gender and distress inside the person, framing dysphoria as an internal misalignment that must be diagnosed and legitimised by experts. Once established, such categories quickly come to feel like natural facts.
My research shows that the categories of masculinity and femininity and male and female function as organising frameworks. They shape what clinicians look for, what questions are asked, and which accounts are recognised as credible. Psychology rarely turns its analytic gaze back on the assumptions that produced these concepts, instead treating them as self-evident features of individual experience.
When care becomes regulation
Collaborative research by Speer & Parsons (2006) used methods that examine language in psychiatric interaction, demonstrates how assessment practices function as forms of social regulation. Clinicians’ questions do more than gather information, they organise interactions, constrain responses, and quietly enforce normative assumptions, while presenting these judgements as care. Such gatekeeping is therefore not an accidental feature of psychological practice, but a mechanism through which authority is exercised and maintained, often rendered invisible by the language of support and protection.
Why language matters in practice
Taking a critical psychological approach foregrounds language as central to practice rather than a neutral vehicle for information. How practitioners speak, listen, and categorise does active work; it can open up possibilities for recognition or foreclose them. Working with the client’s own language, for example, asking how they identify their gender, which pronouns they use, and consistently respecting these in interaction is not a courtesy but an ethical and epistemic practice. It recognises clients as authorities on their own lives and resists the tendency of psychology to overwrite lived experience with professional categories. Attending carefully to language helps prevent misrecognition, reduces harm, and supports forms of care that are genuinely collaborative rather than subtly regulatory.
Reflexivity as a clinical practice
A further key takeaway for clinicians is the importance of reflexivity. From a critical psychology perspective, practitioners like researchers are not detached scientific observers who stand outside the interaction, neutrally assessing an already-formed reality. Clinicians bring theoretical commitments, institutional roles, cultural assumptions, and professional authority into every encounter, all of which shape what can be said, how it is heard, and which accounts are taken up as meaningful or credible. Reflexive practice involves recognising how one’s own language, questions, diagnostic frameworks, and expectations actively participate in producing the clinical interaction itself. Rather than striving for neutrality, reflexivity requires ongoing attention to how power operates in practice and a willingness to question how one’s own professional position may constrain or enable clients’ ways of understanding themselves.
Conclusion
Critical psychology remains less about having better answers and more about asking better questions, especially of our own discipline. It is an ongoing commitment to ensuring that psychology does not mistake its frameworks for truths, or its authority for care. These ideas inform how students are taught to think critically about psychological knowledge itself, encouraging future practitioners to question taken-for-granted categories and frameworks, attend to power and context, and remain open to multiple ways of understanding gendered experience.
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Recommendations for Practice
- Avoid assumptions about identity, experience, or goals. Psychologists should not assume that a client’s gender identity is the primary concern, that they are experiencing gender dysphoria, or that they wish to pursue medical transition. Instead, adopt an open, person-centred stance by asking what the client would like support with and allowing them to define what is relevant to their care.
- Routinely ask and affirm names and pronouns. Practitioners should ask clients which name and pronouns they use and ensure these are consistently applied across sessions and administrative systems. This should not be treated as a one-off question; but rather checking in overtime helps ensure accuracy and demonstrates ongoing respect.
- Repair mistakes promptly and respectfully. If a psychologist uses the wrong name or pronoun, they should briefly acknowledge the error, correct it, and move on without over-apologising. This approach maintains professionalism while avoiding placing additional emotional burden on the client.
Dr Ceri Parsons is a psychology academic and lecturer at the Cairnmillar Institute. She has extensive teaching experience, including previous roles as a psychology lecturer at several universities in the UK. Her work includes research in discourse analysis, critical psychology, and trans identity, with a focus on constructions of sex and gender identity in psychiatric clinic settings. Dr Parsons teaches across the Master of Professional Psychology, Honours, Graduate Diploma and Bachelor’s programs. She has also contributed to the field through her role as Chair of the British Psychological Society’s Media and Press Committee, where she supported media engagement and contributed to The Psychologist publication.
About The Cairnmillar Institute: Founded in 1961, The Cairnmillar Institute is an independent, not-for- profit organisation dedicated to advancing the mental health and resilience of communities across Australia. We provide higher and tertiary education (from vocational to doctoral degrees) with primary focus on psychology, counselling and psychotherapy, accessible mental health services, applied research, and evidence-based capability and workforce development. With more than 65 years of experience, we have built a strong reputation for practical education, high-quality clinical care, community engagement, and strong graduate outcomes. Our approach is guided by the Triple Helix model, which connects research, education and clinical practice in a single integrated system. This model ensures that evidence informs service delivery, insights from practice shape teaching and professional training, and research stays connected to real community needs.
References
Parsons, C. (2005) Exploring transsexual narratives of identity(trans)formation: A search for identity. –Psychology of Women Section Review 7(2):60-70
Speer, S. & Parsons, C. (2006) Gatekeeping gender: some features of the use of hypothetical questions in the psychiatric assessment of transsexual patients. Discourse and Society, 17 (6) 785-812