As debates over gender identity, youth mental health, and parental rights intensify across the United States, one therapist says the issue requires deeper examination beyond political slogans and ideological framing.
Pamela Garfield-Jaeger, a licensed clinical social worker and author who has spent decades working with children and families, says many young people experiencing gender distress are often struggling with underlying emotional or psychological issues that deserve careful exploration in therapy.
The conversation comes amid a rapidly changing legal and cultural landscape surrounding gender identity and medical treatment for minors. In recent rulings, the U.S. Supreme Court allowed certain state restrictions on puberty blockers and cross-sex hormones for minors to remain in place, while also affirming parental rights in disputes involving school policies and gender transitions.
Garfield-Jaeger said the national debate often overlooks the complex mental health dynamics she encounters in clinical settings.
“When a child comes into therapy with gender distress, it’s usually a symptom of something deeper,” she said. “It can be trauma, family conflict, social anxiety, autism spectrum traits, or other issues that need to be carefully assessed.”
She argues that therapy should begin with a thorough evaluation of a child’s emotional and family circumstances rather than focusing immediately on gender identity alone.
Historically, Garfield-Jaeger said therapists were trained to examine multiple factors influencing a young person’s behavior and mental health. In her view, that comprehensive approach has been replaced in some settings by an emphasis on what is commonly described as gender-affirming care.
The term, she said, has become controversial because critics believe it may lead clinicians to move too quickly toward medical interventions rather than extended psychological exploration.
Garfield-Jaeger believes responsible therapy should involve a careful, patient process that evaluates mental health history, family dynamics, trauma, and social influences before drawing conclusions.
She also points to social media and school environments as powerful influences shaping how young people interpret feelings about identity.
According to recent research estimates, roughly 1.8 percent of American adolescents now identify as transgender, representing more than 700,000 teenagers between the ages of 13 and 17. That percentage is significantly higher than the rate among adults.
Garfield-Jaeger believes the rapid rise among young people reflects a combination of cultural messaging, peer influence, and online communities that frame gender identity in ways that resonate strongly with adolescents struggling to understand themselves.
“Kids are looking for explanations for why they feel different,” she said. “And right now there’s a narrative being offered that seems to provide answers.”
She says many parents feel overwhelmed when a child begins questioning gender identity, particularly when schools, online content, and medical professionals appear to send conflicting messages about how families should respond.
To help address those concerns, Garfield-Jaeger wrote a book titled A Practical Response to Gender Distress, which offers guidance for parents navigating the issue. The book outlines common psychological factors associated with gender distress and suggests ways families can approach conversations with children who may be struggling.
She said many parents fear being labeled intolerant or harmful if they question certain approaches to treatment.
“Parents are being told that if they don’t affirm everything immediately, their child will be harmed,” she said. “That puts enormous pressure on families.”
Garfield-Jaeger said her goal is to empower parents with information and practical tools so they can participate more confidently in decisions affecting their children.
She has also written a children’s book titled Froggy Girl, designed to promote themes of self-acceptance and identity development without directly addressing gender politics.
The story follows a young girl who wishes she could be a frog before eventually learning to accept herself as she is.
Garfield-Jaeger said she created the book after noticing that many children’s titles on gender identity contained complex or controversial themes that some parents found difficult to discuss with young readers.
While public debate around gender identity continues to grow more polarized, Garfield-Jaeger says the focus should remain on supporting the emotional well-being of children and families.
“Kids who are struggling need thoughtful mental health care,” she said. “That means taking the time to understand what’s really going on in their lives.”