The Experiences of Transgendered Persons in Psychotherapy: Voices and Recommendations

By Bess, J. Alison; Stabb, Sally D. | Journal of Mental Health Counseling, July 2009 | Go to article overview

The Experiences of Transgendered Persons in Psychotherapy: Voices and Recommendations


Bess, J. Alison, Stabb, Sally D., Journal of Mental Health Counseling


This study explored the therapeutic alliance and satisfaction between transgender clients and their therapists. The design was qualitative and heuristically based. Seven transgendered participants who had lived full-time as their non-natal gender for at least three months and who had spent at least the majority of a course of therapy discussing their current gender identity were recruited. Interviews were semi-structured, and each was transcribed verbatim. Three levels of coding were used)or analysis: seven individual depictions in narrative form, a single composite depiction bringing together similarities between the experiences of the participants, and a single exemplary depiction of critical themes. Results suggest that the participants did not experience many of the heterosexist, sexist, and pathologizing biases described in previous studies. Rather, they described supportive and affirming relationships with their therapists. Some participants had had negative experiences with previous therapists. Participants called for further training and education for therapists and other helping professionals. Implications for theory, research, practice, and policy are explored.

INTRODUCTION AND LITERATURE REVIEW

This article explores how both transgendered and transsexual persons perceive psychotherapy and the current roles and training of mental health professionals who may work with such clients. Transgender refers to "behavior, appearance, or identity of persons who cross, transcend, or do not conform to culturally defined norms for persons of their biological sex" (American Psychological Association [APA], 2008, p. 29). Transsexual refers to "anyone who lives socially as a member of the opposite sex, regardless of which, if any, medical interventions they have undergone or may desire in the future" (p. 29). It is recommended that those to whom the area is new read recent statements by professional organizations, such as the American Psychological Association's (2008) Report on the Task Force Report on Gender Identity and Gender Variance; the reports of the Gay, Lesbian and Straight Education Network (www.glsen.org); and the American Counseling Association's (2008) sponsored podcast on counseling queer youth by the president of the Association of Lesbian, Gay, Bisexual, and Transgender Issues in Counseling, Dr. Anneliese Singh. Other fundamental writings are Bockting and Coleman (1992); Brown and Rounsely (1996); Califia (1997); Ettner (1999); Gainor (2000); Lev (2004); Lothstein (1983); Pauly (1992); Schaefer and Wheeler (1995); and Seil (1996).

Working with transgender and transsexual clients calls for specialized knowledge. Multicultural counseling guidelines (e.g., APA, 2003) warn of the dangers of therapists not receiving proper training in working with clients who are different from them. According to many authors (Cole, Denny, Eyler, & Samons, 2000; Denny & Green, 1996; Ettner, 1999; Fassinger & Arseneau, 2007; Fontaine, 2002; Gainor, 2000; Perez, 2007; and Ramsey, 1996), graduate students are rarely trained in transgender issues. Lev (2004) notes that current training programs for therapists provide little to no education on gender variance, on the rationale that there are too few gender-variant individuals to justify such attention. If any education is provided at all, it is usually theoretical or tacked on to gay/lesbian/bisexual (GLB) issues. Because of the lack of formal specialized training, therapists wishing for specialized training often have to educate themselves about working with transgendered persons. Few receive the recommended levels of education and supervision for providing care to gender-variant people (Israel & Tarver, 1997; Korrell & Lorah, 2007).

One of the key roles clinicians play with transgender clients is as gatekeepers determining which clients are appropriate for sex reassignment surgery (SRS) or hormone treatment and which are not. Guidelines and recommendations for this decision, called the Standards of Care, were drafted in 1979 by the Harry Benjamin International Gender Dysphoria Association (now the World Professional Association of Transgender Health, WPATH). …

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