dickey / Puckett Affirmative Counseling for Transgender and Gender Diverse Clients

2023
ISBN: 978-1-61334-513-9
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 104 Seiten

Reihe: Advances in Psychotherapy - Evidence-Based Practice

This volume provides fundamental and evidence-based information on working with transgender and gender diverse people in mental health services. The authors, who are experts in the field, outline the key qualities of affirming mental health services and explore strategies for improving inclusivity and evidence-based care with trans clients. dickey and Puckett also provide insight into current topics, such as working with youth, the harmful and ill-advised approach known as rapid onset gender dysphoria, and whether and how autism might be a co-occurring diagnostic concern. Practitioners will find the printable resources provided invaluable for their clinical practice, including sample letters of support for trans clients who are seeking gender affirming medical care.

Zielgruppe

Clinical psychologists, psychiatrists, psychotherapists, family practitioners, and counselors, as well as students.

Autoren/Hrsg.

dickey, lore m.

Puckett, Jae A.

Fachgebiete

• Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie Beratungspsychologie
• Sozialwissenschaften Psychologie Psychologische Disziplinen Sexualpsychologie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Psychiatrie, Sozialpsychiatrie, Suchttherapie
• Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie Familientherapie, Paartherapie, Gruppentherapie

Leseproben

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Description
Although transgender and nonbinary individuals are in the minority, being trans is not so uncommon as to be invisible. Trans people have existed throughout history, and being trans is not a new phenomenon. It has been estimated that there are 1.4 million trans people in the US (Flores et al., 2016). Flores and colleagues suggest that the number of trans people in the US could be as high as 2.3 million and as low as 845,000, given statistically credible intervals. This means that there are as many trans people in the US as there are inhabitants of some cities such as Indianapolis (population 864,447 in 2019), Honolulu (population 348,985 in 2019), Phoenix (population 1.6 million in 2019), Philadelphia (population 1.6 million in 2019), or Houston (population 2.3 million in 2019). Trans people are a subpopulation in the US, and they are often disregarded or turned away from services and care. In the field of psychology, discussions of the needs of trans people have often been addressed in courses such as abnormal psychology, behavioral pathology, or human sexuality. In each of these course offerings, trans people are typically conceptualized from a deficit perspective, and many of the textbooks used have inaccurate or offensive descriptions of the experiences of trans people. This means that those who are trained to work in clinical settings may only learn about the diagnostic nomenclature found in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5; American Psychiatric Association, 2013). There are times when it is appropriate to view trans people’s experiences through the lens of the DSM. This might include referrals for medical care, where the provider or the insurance company requires a diagnosis. But medical care is not a goal for some trans people, and there are many other reasons a trans person might seek mental health care. If a provider is only viewing their work with a trans person from a medicalized approach, they are at best likely to miss important clinical concerns, and at worst, to alienate and pathologize them. 1.1  Terminology
Transgender, nonbinary, and gender diverse people may use a variety of terms to describe their gender identity. In this volume, we will use the term “trans” as we describe the ways to work with these communities. We acknowledge that the term “trans” may not fit for some people under these broader umbrellas; however, it is the most inclusive term being used as this volume is being written. |2|We describe the lives of trans people below using terms that are commonly used. The list of terms below, in Section 1.2: Definitions, is far from being exhaustive, and psychologists are encouraged to be mindful of the need to talk with their clients about the terms that best describe their identity. Trans people may use terms that shift over time. The ability to be flexible with your clients is vital. Inflexibility is likely to lead to a fracture in the clinical relationship. The result could be catastrophic for your trans clients. The terms listed below (Section 1.2: Definitions) are relatively common in trans communities. It should be noted that there are many others that are less commonly used. These include “birl,” “pangender,” “hybrid,” and “aggressive” (Harrison et al., 2012). Harrison and colleagues (2012) noted that over 850 different terms were used in the study they were reporting from. Given that the terms for which definitions are provided below are limited to some of the more commonly used, providers will benefit their clients by taking on the responsibility to learn about terms or identities that clients hold, outside of those listed below, as they come up in their clinical practices. Although it is helpful to learn the basic terms provided here, providers will need to seek out new education as they work with trans clients to broaden their knowledge and to continue to grow this awareness as terminology continues to evolve and change over time. 1.2  Definitions
For readers’ convenience, the terms are listed in alphabetical order. Agender is a term used to by people who do not identify with a gender, those who identify as having a neutral gender, those who choose not to label their gender, those who feel detached from their gender, and those with other types of experiences in which a person does not identify with a specific gender. Like other categories, agender individuals may or may not seek medical means to affirm their gender. Making a medical transition is an individual decision, regardless of identity. Bigender relates to people who feel as though two genders (not necessarily male and female or as a man or woman) are consistent with their felt identity. This is different from having an identity as third gender. Bottom surgery includes the various genital surgeries. For a person assigned male at birth (AMAB), this includes an orchiectomy and a vaginoplasty. For a person assigned female at birth (AFAB), it includes a hysterectomy with or without oophorectomy, metoidioplasty, or phalloplasty (with or without a urethral extension), and a scrotoplasty. For many people, the cost of these procedures prohibits their ability to access care. Cisgender is a label that applies to any person whose gender is consistent or congruent with the sex they were assigned at birth. Another way of thinking about cisgender is that a cisgender person does not have a trans identity. Rather than referring to people in this group as not being transgender, it is important to specifically use the term “cisgender.” Individuals who are in the dominant and majority group often have their identity treated as the norm and as such are not called on to have labels for their identities. Using the term “cisgender” |3|helps to disrupt these power hierarchies and the ways that the cisgender experience is normalized. Not using the term cisgender can result in trans people being “othered” and marginalized. Cisnormative refers to the assumption that a person’s gender or gender identity is congruent, or consistent, with the sex they were assigned at birth. Assumptions regarding a person’s gender can lead to inaccurate conclusions that can be harmful. This is similar to cissexism which involves the systemic marginalization of trans people, such as via discrimination based on their gender identity or gender expression. Gender affirmative is the supportive approach to treatment that preferences and foregrounds the stories and lives of trans people. Gender-affirmative counseling has been defined as counseling that is culturally relevant and responsive to [trans] clients and their multiple social identities, addresses the influence of social inequities on the lives of [trans] clients, enhances [trans] client resilience and coping, advocates to reduce systemic barriers to [trans] mental and physical health, and leverages [trans] client’s strengths. (Singh & dickey, 2017, p. 4) Gender binary is a construct that assumes that there are two, and only two, immutable gender expressions and gender identities that align with these (masculine and feminine expressions that align with identifying as a man or a woman, respectively). Gender creative is a term that is typically used with children (rather than adults). Children with a gender creative identity may still be in an exploration phase. Gender diverse can be used to describe people whose gender identity differs from the sex they were assigned at birth. This is considered by some to be a more inclusive and nonpathological term that is intended to be inclusive of all trans people. Some in the trans community do not like using this term to refer to trans people, as they believe that all people, cisgender or trans, have diversity in the ways they understand their gender. This term tends to be used within academic circles rather than in the trans community. Gender dysphoria is a medical or diagnostic term that is used in the DSM-5 (American Psychiatric Association, 2013). Not all trans people will endorse symptoms consistent with the diagnostic criteria. This is due, in part, to the ways that gender dysphoria is embedded in medicine – ...