TRANSGENDER CARE THERAPY
Generally a person’s gender is assigned at birth, this is determined by external genitalia but also can be confirmed by gonads, chromosomes, hormones and internal organs.
Newborns are usually designated male or female and, in some rare occasions, intersex. Gender identity can be explained by the subjective sense of “who” one is in the sense of male, female or other however gender identity is determined by the brain more than sexual anatomy.
It is not a choice, most people can sense there gender identity by age 4 although it may occur earlier or later in life.
Cisgender persons are those whose gender identity and expression are aligned with the social and cultural expectations of their assigned gender at birth. The vast majority of people are cisgender. For those person’s whose gender identity or expressions are inconsistent with societal expectations typically associated with males or females are considered Gender-nonconforming. Some gender-nonconforming persons do not fit into the gender binary (male or female) as others do and may consider themselves to be gender fluid, gender queer or gender nonbinary.Transgender persons (about 0.6 percent or more of the U.S. population) have a strong inner sense that their bodies and the gender assigned to them at birth are not aligned with their gender identity. They may be assigned-at-birth males who identify as female (male to female or MTF) or assigned-at-birth females who identify as male (female to male or FTM).
As a transgender care therapist I seek to understand how my transgender and gender-non conforming clients identify, especially given that gender identity is now considered to be more a spectrum between male and female. Some gender-nonbinary persons do not seek hormone or surgical treatment and are comfortable with a more nonbinary gender expression, whereas others do seek medical interventions.
However with some exceptions, transgender persons desire and, if at all possible, pursue hormone and surgical treatment to experience alignment between their bodies and minds. In other words, most transgender persons desire and pursue transition to the gender with which they identify.
Clients, family members and the general public often want to know how this happens or why some people are transgender. The etiology of transgender may be understood as a complex interaction of social/cultural, cognitive and primarily biological factors, consistent with explanations of gender identity in general.
Gender dysphoria
Since being transgender is not a mental illness, most transgender persons experience dysphoria at various moments in their lives. The dysphoria experienced by transgender persons is likely attributable to having to live in a body and often social role that does not feel congruent with their sense of self in a society that misunderstands and discriminates against them.
The gender dysphoria diagnosis (302.85) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) indicates that it may include symptoms of depression, anxiety, fear, guilt, low self-esteem, shame and self-hatred.
For some transgender persons, these negative emotional experiences may lead to self-harm, substance abuse and eating disorders.
Mental Health Care
According to WPATH SOC-7, minimum qualifications to provide mental health care to transgender persons include;
- a master’s degree in a clinical behavioural science field
- training and competence in the DSM-5
- documented supervised training and competence in counselling/psychotherapy
- Continued education in the treatment of gender identity issues and WPATH SOC.
As a Certified Transgender Care Therapist (www.transgendercertification.org) I meet all the above itemized qualifications.
Transgender persons display several common concerns to counsellors and mental health professionals. They may present with symptoms associated with gender dysphoria, such as depression, anxiety and suicidal ideation. Some may need help with substance abuse or other harmful means of coping with distress. Throughout the therapeutic process we will address any co-occurring mental health issues, traumatic experiences and symptoms of minority stress associated with discrimination, stigmatization and harassment.
Other commonly expressed concerns we will address:
- Disclosure to others (coming out)
- The timing and extent of transition
- The impact of transition on relationships with current partners/spouses/children (in adult transgender persons)
- Support or non-support of parents and extended family
- Concerns about passing as the gender with which they identify
- Reactions from employers, school personnel, leaders/members of their religious groups, and their peers at work or school
