Psychotherapy and counselling in Ireland: affirmation or exploration

How are Irish therapists regulated and trained on gender, and which approach do professional bodies endorse?

“Therapist” is not a single regulated title in Ireland. A person may describe himself or herself as a counsellor, psychotherapist, psychologist, coach or gender therapist while holding very different qualifications, memberships and levels of clinical accountability. This matters for parents, patients, referrers and journalists seeking to understand what is meant by “gender-affirming” or “exploratory” therapy.

Background

“Therapist” is not a single regulated title in Ireland. A person may describe himself or herself as a counsellor, psychotherapist, psychologist, coach or gender therapist while holding very different qualifications, memberships and levels of clinical accountability. This matters for parents, patients, referrers and journalists seeking to understand what is meant by “gender-affirming” or “exploratory” therapy.

Irish statutory regulation remains incomplete. CORU, the State regulator for health and social care professions, has a Counsellors and Psychotherapists Registration Board and published separate standards of proficiency and education criteria in July 2025. However, the registers have not yet opened. Until they do, the titles “counsellor” and “psychotherapist” are not protected by CORU registration in the way that titles such as “social worker” and “physiotherapist” are. CORU also states that membership of a professional body will not determine eligibility for future statutory registration. ([coru.ie](https://www.coru.ie/about-us/registration-boards/counsellors-and-psychotherapists-registration-board/faqs/faq-d-what-does-regulation-mean-for-me/?utm_source=openai))

Psychologists are in a similar transitional position. CORU’s Psychologists Registration Board expects the first registers for clinical, counselling and educational psychologists to open in 2027, followed by a two-year transition before title protection becomes enforceable. The Psychological Society of Ireland is therefore an important professional body, but is not the statutory regulator of all people using the title “psychologist”. ([coru.ie](https://coru.ie/about-us/registration-boards/psychologists-registration-board/faqs/opening-of-registers/?utm_source=openai))

The terms at issue should be separated. A gender-affirming approach commonly means accepting a client’s stated identity, using the language requested by the client and supporting the client’s chosen goals. An exploratory approach does not mean an attempt to change a person’s identity. It means careful, open-ended therapeutic inquiry into distress, development, family context, sexuality, mental health, trauma, neurodevelopmental issues, social pressures and the implications of possible social or medical steps. In competent practice, either description should be subordinate to individual assessment, informed consent, safeguarding and evidence.

What the documents say

CORU: broad standards, not a gender protocol

CORU’s July 2025 standards require trainees to practise safely and effectively; respect service users’ autonomy, rights and dignity; work in a non-discriminatory and culturally sensitive manner; obtain informed consent; conduct detailed assessment; use evidence-informed professional judgement; recognise risk; and modify or cease interventions where appropriate. Counsellors must also assess suitability and readiness for the intervention offered, evaluate progress, consider referral, and reflect on the influence of their own values. ([coru.ie](https://coru.ie/media/3irl4nog/counsellors-standards-of-proficiency-copy.pdf))

These are significant safeguards. Yet neither the counsellor nor psychotherapist standards, nor the accompanying education criteria, mentions gender identity, gender dysphoria, sex, transition, affirmation, detransition or conversion therapy. This is a factual absence, not evidence that CORU has adopted a neutral position on every gender-related clinical question. It means that the State’s published entry-level framework presently leaves the practical content of gender training largely to course providers, employers, supervisors and professional bodies. ([coru.ie](https://coru.ie/media/3irl4nog/counsellors-standards-of-proficiency-copy.pdf))

PSI: equal treatment and open exploration

The PSI’s Good Practice Guidelines for Working with Transgender and Gender Non-Binary People, published in September 2024, say that people of all gender identities should be regarded as equal members of society. The document identifies discrimination and stigma as relevant to mental-health outcomes and recommends gender-related modules in third-level psychology courses and continuing professional development.

Crucially, the PSI guidance does not instruct psychologists simply to endorse an identity declaration or a particular pathway. It says psychologists should create room for “exploring gender identity without making assumptions or applying labels”. It calls for respectful, open interest in the individual’s experiences, family support where needed, self-reflection about practitioner bias, and further training or supervision where competence is lacking. ([psychologicalsociety.ie](https://www.psychologicalsociety.ie/source/PSI%20Working%20with%20Transgender%20and%20Gender%20Non-Binary%20People.pdf))

The PSI’s general Code of Conduct also requires practice within competence, referral where necessary, partnership with patients and families, and support for evidence-based decisions consistent with patients’ needs, values and preferences (PSI, 2019). These principles are compatible with respectful exploration, including where a client is certain, questioning, ambivalent or later changes direction. ([psi.ie](https://www.psi.ie/sites/default/files/2024-06/PSI%27s%20Code%20of%20Conduct%202019.pdf?utm_source=openai))

IACP and the conversion-therapy memorandum

The Irish Association for Counselling and Psychotherapy has published material supporting affirmative counselling for transgender clients. A 2019 article in its journal, prepared with Transgender Equality Network Ireland, described a non-binary understanding of gender and respect for a client’s gender identity as central to affirmative counselling. It also acknowledged that the document was not a substitute for training and urged counsellors to improve their competence. This was published professional material, but it should not be confused with a CORU statutory standard or a clinical protocol binding every Irish therapist. ([iacp.ie](https://iacp.ie/files/UserFiles/IJCP-Public/IJCP-Summer-2019-Art.pdf))

The more important current joint document is the all-island Memorandum of Understanding on Conversion Therapy, signed on 12 July 2024 by the IACP, PSI and College of Psychiatrists of Ireland. It defines conversion therapy as an approach based on the assumption that one sexual orientation or gender identity is inherently preferable and which seeks change or suppression on that basis. It calls such practices unethical, potentially harmful and unsupported by evidence.

However, the memorandum also contains a clear qualification often omitted in public discussion. It says it does not deny, discourage or exclude people with uncertain feelings from qualified help; supports therapy for clients who wish to explore, experience conflict with or are distressed about sexuality or gender identity; and does not stop clinical assessments required before medical intervention. ([iacp.ie](https://iacp.ie/files/UserFiles/MoU.pdf))

The HSE context

The HSE’s National Clinical Programme for Gender Healthcare is developing a new Model of Care. Its published information lists psychological assessment and support for gender dysphoria or incongruence among possible services. It says the model will be based on an evidence review and engagement with service users, families, clinicians and other interested parties. Dr Karl Neff is named as National Clinical Lead. ([healthservice.hse.ie](https://healthservice.hse.ie/staff/information-healthcare-workers/gender-healthcare/))

This work has particular relevance because the HSE stated in April 2024 that the emerging international evidence, including the Cass Review published on 10 April 2024, would be considered in developing the Irish model. The Cass Review examined NHS services for children and young people and argued for comprehensive assessment and greater caution where evidence is uncertain. It is not an Irish guideline and does not govern Irish therapists, but the HSE has expressly identified it as material for review. ([about.hse.ie](https://about.hse.ie/publications/hse-safety-and-quality-committee-meeting-minutes-18-april-2024/?utm_source=openai))

The positions

Those favouring an affirmative model argue that transgender and gender-diverse clients have experienced stigma, poor access to care and inappropriate pathologisation. They argue that respectful language, recognition of the client’s own account and support for chosen social or medical pathways can reduce distress and make therapy safer. The PSI guidance and IACP-associated material reflect this concern.

Those favouring a more explicitly exploratory model argue that therapy should not become a route to validating a predetermined conclusion, especially for children, adolescents and people with complex presentations. They argue that clinicians must be free to investigate co-existing anxiety, depression, trauma, autism, family relationships, sexuality, body image and the meanings a client attaches to sex and gender. They also stress that psychological support should not be conflated with endorsement of irreversible medical intervention.

The joint Irish memorandum does not resolve this dispute by choosing affirmation over exploration. Its stated position is narrower: coercive efforts to change or suppress identity are unacceptable, while ethically competent exploration, clinical assessment and support for uncertainty remain legitimate. That distinction deserves more prominence than it usually receives.

Interpretation

Beyond Gender’s reading is that Irish professional documents contain more room for exploration than campaign rhetoric often suggests. The PSI explicitly endorses exploration without assumptions or labels. The 2024 memorandum explicitly protects therapy for uncertainty, conflict and distress, and preserves required assessment before medical intervention. A clinician who carefully explores a client’s history and competing explanations is not, on the wording of those documents, practising conversion therapy merely because he or she does not assume that transition is the correct outcome.

At the same time, Ireland has no nationally mandated gender-specific curriculum for counsellors or psychotherapists. CORU’s new standards establish important general duties, but their silence on gender-specific competence means that a family cannot infer from a job title alone how a therapist has been trained, what evidence he or she uses, or whether he or she is equipped to work with a questioning adolescent.

The practical concern is not that every therapist must become gender-critical, nor that every therapist must become affirming. It is that vulnerable clients need clinicians who can tolerate uncertainty, distinguish compassion from premature certainty, recognise safeguarding issues, discuss benefits and risks honestly, and make referrals when the case exceeds their competence.

Open questions

When will CORU open the counsellor and psychotherapist registers, and will approved courses be required to demonstrate specific teaching on gender-related presentations, safeguarding, informed consent and referral? Will there be a public way to distinguish a counsellor, psychotherapist, clinical psychologist and unregulated “gender therapist”?

Will the HSE’s forthcoming Model of Care specify what psychological assessment should cover, particularly for children and adolescents? Will it publish evidence standards, audit outcomes over the longer term, and include parents as well as service users and advocacy organisations in a meaningful way?

Finally, Ireland still has no enacted conversion-practices legislation. Government statements have repeatedly said that any future law should prohibit harmful practices while protecting legitimate therapeutic support for people questioning sexual orientation or gender identity. The eventual wording will matter: poorly drawn legislation could chill ordinary clinical exploration, while a carefully defined law could target coercion without making thoughtful therapy unsafe. ([oireachtas.ie](https://www.oireachtas.ie/en/debates/question/2024-01-18/291/?utm_source=openai))

On the Irish timeline

Episodes on this subject

Where Did Psychotherapy Go Wrong? | Ian Cox

Why Anorexia is Just Like Gender Dysphoria...? A Conversation with Deanne Jade

When Sexual Fantasy Becomes Medical Treatment | Malcolm Clark