One of the most prominent clinics practicing reparative therapy in North America, Toronto's Centre for Addiction and Mental Health (CAMH) is closing its Family Gender Identity Clinic (GIC) after an independent review by a team of outside psychologists.

The investigators found that GIC still used antiquated practices with an anti-transgender bias.

Lead reparative therapy proponent, Dr. Kenneth Zucker, who has headed the GIC for over 30 years is, according to officials at CAMH, "no longer at the institution."

Community partners of CAMH had raised concerns about exactly what was being practiced within the GIC.

The review was sparked by criticisms from the transgender community and others that the CAMH clinic headed by psychologist Dr. Ken Zucker was practicing reparative therapy on young people who were questioning their physical gender.

Reparative, or conversion, therapy discourages those who identify as transgender from embracing their non-biological sex.

The reviewers, Dr. Suzanne Zinck of Dalhousie University in Halifax and Dr. Antonio Pignatiello of the Hospital for Sick Children in Toronto, said in their report they were unable to ascertain whether the clinic was in fact practicing reparative therapy — a charge that staff had denied.

The review was made public Tuesday.

Over the next few months, I expect we will see a wave of disbelief and outrage that this treatment ever happened in the first place. Why was this going on in 2015 in a progressive city like Toronto?

But to the people who shake their heads over this news, I would like to propose that it’s actually not so shocking. In fact this publicly funded service that tried to prevent transgender people from existing is the predictable result of a larger social reality.

When lives are devalued, stripped of their worth, their autonomy, their rights, it tends to be the logical conclusion of historical events and long-standing power relations. Institutionalized abuse happens with the permission of those in power as well as the support of everyday people.

--Jake Pyne, the star.com

The team did find, however, that their was a consistent bias against transgender identities and the use of practices that shame and stigmatize people for claiming to be trans.

Zucker was the most well-known advocate of the myth that 80% of children with cross-gender identification will eventually turn out to be gay, not transgender.

The study that produced this conclusion, however, relied on conflating all gender non-conforming behavior with actually asserting a different gender identity. What research has since shown is that the children who assert that they are the other gender actually are and are not likely to change. By over-including all gender non-conforming children, those numbers actually communicate nothing about the outcomes of trans kids, but that hasn’t stopped Zucker from using the study to motivate families into thinking such behavior is just a phase and can be corrected.

Zucker and GIC exhibited a bias against any gender-nonconforming behavior. As the report recounts, one child had resolved all gender and body dysphoria issues, but the clinic still advised the parents to have him “spend more time with cisgendered [sic] boys because he had effeminate speech and mannerisms. These were not the goals of the client or family.” This kind of advice for controlling the behavior and friendships of kids was common.

For almost 40 years, the clinic treated children as young as three years old who were gender-different in some way, using a range of psychological techniques to, essentially, try to convince them not to be. As detailed in more than 100 publications, children were seen as disordered if they differed from expectations and parents were enlisted to modify their child and especially to steer them away from being transgender.

This approach is now linked to a range of dismal outcomes, including a staggering rate of suicidal behaviour. No wonder, when young people are given the message that who they are is unacceptable to the people they love and depend on. Current best practices advise that young people be supported to explore their gender and that parents learn how to offer acceptance.

--Pyne

Unsurprisingly, there was minimal documentation that parents were helped to “work through any worry or grief with the clearly stated goal of accepting any potential outcome and supporting their children.” In other words, parents were provided no resources to help them be more supportive of kids who might still turn out to be transgender. The report, which acknowledges that research has found that family acceptance is important for the well-being of transgender people, notes that this absence “is a concern and one could conclude it is not a main focus of treatment.”

Patients reported being told that the focus of their treatment was “understanding why” they were gender non-conforming. This “cisgender goal” led to “excessive shame and self-stigma” for transgender and gender fluid people, even after they were provided access to gender-affirming hormone therapies.

Application of heterosexual cisgender as the most acceptable treatment outcome is inappropriate. Pathologization of family and child is evident: correlational mental health problems are interpreted as causative and run counter to the prevailing clinical worldview on the direction of this correlation. Gender variance itself does not cause psychopathology but rather the distress associated with it does. An aim to treat normal human gender variation is unlikely to be successful and unethical.

--the report

We cannot state that the clinic does not practice reparative approaches (if not outright therapies) with respect to influencing gender identity development.

--Zinck and Pignatiello

In June Ontario legislators approved a ban on all conversion therapies. GIC began to shut down soon after.

This report is damning, and long overdue. The transgender community has been saying the same things the report concluded for over a decade. Given the unethical, unscientific, and damaging nature of the work done at CAMH and revealed by this report, the research done there by Dr. Zucker and his cohort there will be relegated to the dustbin of junk science, where it should have been all along.

--Brynn Tannehill

Tannehill notes that the damage caused by these ideas will not disappear as quickly as the actual clinic.

I congratulate CAMH for taking this step, for being public and open about it, for the transparency.

--Anna Travers, director of Rainbow Health Ontario

The clinic will remain open for a while yet, to treat its remaining 20-25 clients. CAMH plans to consult community and academic organizations as well as clients and families to develop whatever role they may take in the future with regard to gender identity services.

Early next year, we will start to talk to the community about what we should be doing. What sort of supports do people need? Should that be at CAMH? Should that be in the community?

We’re going to work with the community to build something else. Once we know what that something else looks like ... (we’ll know) exactly what CAMH’s role should be.

--Dr. Kwame McKenzie, medical director of CAMH's Child, Youth and Family Program

I think it’s time for a new look at how to help families and children. I think it’s time for us to look at what people actually need.

--Travers

But the lesson is not that there was a problem and now it has been solved. Indeed, many in the community are already asking what will be done for the young people who were harmed by this treatment. If we learn anything from the Truth and Reconciliation Report on the tragic legacy of Aboriginal residential schools, a document released on the same day as the CAMH report, it is that when certain lives are not valued, we are, as a society, capable of doing terrible things. The lesson is to pay attention to those who are marginalized and devalued and to intervene now rather than be shocked in the decades to come.

--Pyne