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Gender Identity and Faith: Clinical Postures, Tools, and Case Studies for Client-Centered Care (Book Review)

November 16, 2022
By Josh Blount

Editors note: the following book review appears in the Fall 2022 issue of Eikon.

Mark A. Yarhouse and Julia A. Sadusky. Gender Identity and Faith: Clinical Postures, Tools, and Case Studies for Client-Centered Care. Downer’s Grove, IL: IVP Academic, 2022.


The intersection of gender identity struggles, pastoral care, and counseling methodology is a Gordian knot of complex and competing instincts and convictions. The pastor or counselor wants to show compassion to the person sitting across from them in their office, or to the parents seeking help for their withdrawn teen. Good counseling involves good listening — and yet, with the popularization and cultural acceptance of gender ideologies, the struggles, definitions, and self-diagnoses that the pastor hears in response will increasingly represent a confusing mix of assumptions and presuppositions: 

“Am I transgender?” 

“My son says he is non-binary — what does that mean?”

Or the pastor may not hear questions, but rather declarations: “These are my pronouns. If you misgender me, you are denying my existence.” 

How do pastors and counselors respond in that moment? Is this an apologetics encounter, an opportunity to teach on biblical sexual ethics, a moment to “ignore the culture wars” and display unconditional love? Or are all three of those alternatives (as I have framed them) inadequate? How does the pastor or counselor cut the Gordian — might we say, the Freudian — knot of gender identity in post-LGBT revolution, post-Christian culture?

Mark Yarhouse and Julie Sadusky address just this question with their second co-authored work, Gender Identity and Faith. As their biographies indicate, each brings a wealth of psychological research and clinical experience to the question. And yet, from my perspective, their conclusions in this book are neither helpful nor wise, and represent a potentially harmful influence on theological faithfulness and wise pastoral care. 


This topic is not new for either Yarhouse or Sadusky: on this specific topic, Yarhouse has published Understanding Gender Dysphoria: Navigating Transgender Issues in a Changing Culture, and Yarhouse and Sadusky have co-authored Emerging Gender Identities: Understanding the Diverse Experiences of Today’s Youth. The present book builds on themes they developed in those earlier publications, but focuses especially on the target audience of “clinicians who work with conventionally religious clients and families for whom religious dimensions appear to be in conflict with their gender-identity questions” (6). Yarhouse and Sadusky describe their approach as “balanced, client-centered, and without a fixed outcome” (14). By “balanced” they mean somewhere between the extremes of those who are “critical or dismissive of transgender or gender-diverse experiences” on the one hand, or those who are affirming of such experiences “without sufficient regard for contextual and other issues” (14). “Client-centered” means a posture of listening that allows the client to “sort out” their gender experiences and “determine how to move forward…taking into account their religious faith identity and how their faith informs their decision making” (15). “Without a fixed outcome” means that “our concern is not to push a priori conclusions about the best outcome of a client’s gender-identity exploration” (15). 

The aim of the book is to provide an overview of this counseling model. In Part One they provide an overview of issues of faith and gender, and how to assess the role of the former in questions of the latter. Part Two discusses particular issues arising from counseling children, while Part Three focuses on different counseling methods for adolescents and adults. They end with a series of case studies in Part Four, demonstrating how their model works out in actual practice.

Critical Interaction

There are some helpful tools that the pastor or counselor can glean from Yarhouse and Sadusky’s work. For instance, in Chapters Two and Ten they describe a narrative strategy that involves asking counselees to describe their lives as a chapter book: how many chapters are significant? What are their titles, and why? At the level of technique, this could be a helpful data-generating strategy when coupled with a biblical plan for interpreting and engaging the results. 

Yet it is precisely in that last clause that Yarhouse and Sadusky fall short. Their underlying methodology is clearly based on an integrationist philosophy in which psychological and theological categories each have their own validity. This review is not the place to critique this philosophy on its own terms (though the reader should know I am writing from a biblical counseling perspective, shaped heavily by the late David Powlison’s teaching). Yet in one sense, for those committed to a biblical view of sexuality and gender, this book is itself a critique of the integrationist movement. When integrationist commitments meet LGBT agendas, it is scriptural convictions that suffer. 

As an example, consider Yarhouse’s concept of “three lenses” by which to understand gender identity struggles, which he first published in Understanding Gender Dysphoria and uses as a key premise in this book. These three lenses are “the integrity lens, the disability lens, and the diversity lens” (6). In the first, gender identity is based on “widely held, traditional understandings of male/female differences that reflect sex and gender norms” (6). The disability lens sees “gender atypical behavior as a departure from the norm…[but] does not imbue the lack of congruence with moral significance in the way the integrity, or sacred lens, does” (7). Finally, the diversity lens “views gender incongruence not as a concern to be corrected (integrity) or a condition to sympathize with (disability) but as a difference in experience that reflects a different kind of person” (7). Yet nowhere do Yarhouse and Sadusky argue for the normativity of any of these lenses. While they indicate some concern (e.g., 15, 108–109) with the potential abuses of the diversity lens, there is no indication that these are not three equally valid and necessary approaches to considering gender. In fact, their methodology assumes the opposite: each of these may be helpful perspectives for the counselor addressing issues of gender identity. 

This raises the question: when the diversity lens and the integrity lens come into conflict, which perspective wins? When Scripture is placed on equal terrain with another source of authority, the battle is already lost. There can only be one absolute authority. A counselor cannot serve two masters. By attempting to integrate clinical practices with “religious faith…and religious identity” (5–6), Yarhouse and Sadusky have reduced the latter to a lifestyle preference, one element among many. I fear the result will be destructive to the integrity of the church, and the pastoral care of those who struggle to make sense of their gender in a deeply confused society.


I am not implying that Yarhouse and Sadusky’s work is undertaken with subversive intentions. On the contrary, I presume they are attempting to help clinicians understand clients with religious convictions, and help those religious clients to navigate the clinical world. But the danger is that, whereas philosophical disagreements about a counseling issue like bipolar disorder or depression affect a segment of the church, discussions of gender identity affect all believers — indeed, all humanity. If Scripture offers “a perspective” on gender identity, then the universal experience of being a man or a woman is now to be interpreted only through listening to a harmony of voices. The integrationist answer to gender identity questions does not cut the Freudian knot, but rather validates its existence and so perpetuates the problem. Only the living and active Word of God, wielded not as one tool among others but as our life-giving, ultimate authority, can both wound and heal, tear down and build up. The question of gender identity — who am I as a man or woman — cannot be answered in any other way.

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