Where Did Psychotherapy Go Wrong? | Ian Cox
3 September 2026
With Ian Cox
Ireland
Irish psychologist and lecturer Ian Cox describes how postmodernist, activist-driven ideology has taken hold inside psychology and counselling training, with personal consequences including complaints and doxxing. His account connects directly to concerns the Cass Review raised about ideological capture within clinical professions, and to NHS England's conclusion that affirmative-only approaches lack the evidence base to remain standard practice.
Ian Cox is an Irish psychologist and lecturer who has spent years teaching trainee counsellors and psychotherapists. In this episode he speaks with Stella O'Malley about what he sees as a systematic erosion of scientific standards inside the helping professions, driven by postmodernist assumptions that have moved from university humanities departments into clinical training programmes. His argument is not political polemic but a practitioner's account of watching the epistemological ground shift beneath a discipline that is supposed to be anchored in evidence. The picture Cox paints of the training environment will be familiar to anyone who has followed the Cass Review's analysis of how gender-identity ideology came to dominate clinical thinking in the UK. Dame Hilary Cass found that affirmative-only practice had been adopted not because the evidence supported it but because dissent had become professionally dangerous. Cox describes a parallel dynamic in academic settings: students face social and institutional pressure to accept contested ideological claims as settled fact, and those who raise questions risk being reported, ostracised or worse. Cox recounts the consequences he personally experienced after teaching material that students found ideologically objectionable. He received formal complaints and was subjected to a coordinated campaign on social media, the kind of collective pile-on that has become a recognisable feature of the landscape for clinicians and academics who question gender-identity orthodoxy. His account of being doxxed places him alongside a growing number of UK and Irish professionals whose careers have been targeted for holding positions that are, in many cases, now endorsed by NHS England and the medical evidence literature. One of the most significant threads in the conversation concerns what Cox calls clinics going fully affirmative. NHS England ended the routine prescription of puberty blockers to under-18s in 2024 and commissioned an independent review of the evidence base for paediatric gender services, precisely because the affirmative model had been implemented without the robust trial data that would be required for any other intervention. Cox's observations about how that model became entrenched inside both clinical services and the training pipelines that feed them help explain why institutional change at the NHS has been so difficult to translate into changed practice on the ground. The episode also touches on what Cox regards as an assault on the foundational commitments of psychotherapy itself: the obligation to hold uncertainty, to follow the evidence, and to prioritise the long-term wellbeing of the client over ideological conformity. These are precisely the values that the Cass Review sought to restore to gender medicine, and that NHS England's new service specifications for children and young people are designed to embed. Cox's contribution is to show how those values have been challenged not only in gender clinics but across the broader professional culture that supplies them with practitioners. For anyone trying to understand why evidence-based reform in gender medicine has met sustained resistance from within clinical and academic institutions, this conversation offers a ground-level account of the pressures that shape professional behaviour long before a clinician ever enters a consultation room.
