Advice for psychologists working with transgender and gender diverse individuals

Clinical psychologists often ask me about resources for working with transgender youth. These scenarios tend to involve someone discovering that a client from their current caseload may have some kind of ‘gender identity issue’ and the professional feels unprepared and overwhelmed.

This is unsurprising considering the kind of training that psychology tends to deliver in relation to gender issues – either (1) it’s lacking, (2) it focuses on ‘sex differences’, (3) it assumes only two possible gender identities (male/female), or (4) it pathologizes gender diversity by framing it as a mental illness. Also, there has been a lot of debate and disagreement within the profession about how best to support gender diverse individuals. This complexity, and the controversy surrounding some approaches, tend to get left off the curriculum – but are important for people to be aware of. A (very!) brief background Psychology has framed transgender identities and gender diversity as a mental illness for well over a century. This was re-emphasized during the 1980s with the introduction of ‘gender identity disorder’ into the Diagnostic and Statistical Manual of Mental Disorders (DSM). The name of the diagnosis changed in 2013 to ‘gender dysphoria’ (meaning ‘abnormal gender distress’) – but there are still problems with how it frames gender nonconformity as ‘abnormal’. Initially, therapy (particularly with children) focused on changing the person’s gender identity, much like how therapy with homosexual and bisexual individuals focused on attempting to change a person’s sexual orientation. The latter has since been condemned by the American Psychiatric Association, American Psychological Association and the British Psychological Society, amongst many others. Unfortunately, such conversion therapies continue with transgender and gender diverse youth – with aims to stop them from expressing their gender identity but to conform to societal ‘norms’ and gender roles. It’s not difficult to find the painful and distressing consequences of not being able to be yourself, and to be told that who you are is fundamentally wrong or pathological. Thus, increasingly, there is recognition that acceptance and affirmation of someone’s gender identity (rather than trying to change it, or their behaviour) is the preferred form of support. A simple online search will bring many media stories of the potential consequences of conversion therapies - including the criminalization of therapies that aim to change someone's gender identity, as well as the closure of clinics that use these methods. For more information on the history of these debates, and for more details of the controversies and problems with conversion therapies in psychology, see – Bryant, K. (2006). Making gender identity disorder in childhood: Historical lessons for contemporary debates. Sexuality Research and Social Policy, 3(3), 23-39. PDF Tosh, J. (2014). Perverse psychology: The pathologization of sexual violence and transgenderism. London: Routledge. Book details Winters, K. (2009). Gender madness in American psychiatry: Essays from the struggle for dignity. Book details

Working with transgender and gender diverse individuals For those working with individuals who may be transgender or gender diverse –

(1) Firstly, please don’t assume that just because the individual has a gender identity that you are unfamiliar with, that this is the reason they need help. Transgender people are like any other group or community, in that they have a wide range of health needs, and focusing on their gender identity (particularly if you view it as the sole ‘problem’) can stop them from getting help or support. (2) Secondly, don’t make assumptions. Check in with your client about pronouns and names – these may not match the paperwork you have. Make sure you have the right ones, and that you use them. Don’t question it – you don’t have the right to. Questioning someone’s name or pronoun, is another way of saying, ‘your gender identity or expression is not valid’ or ‘I don’t believe you’. Have you ever asked a non-trans person (e.g. a cisgender person) about their name or gender pronoun? To only question those who are gender diverse is discriminatory. While it might not seem like much to you, you’re probably the millionth person to ask them – and all that asking adds up. (3) Refer them to a specialist – if this isn’t your area of expertise and you’re not quite sure how to handle it, then you may do more harm than good - unintentionally. Transphobia and cisgenderism are the foundation of many assumptions regarding gender. It takes time to unlearn some of the problematic ways we think about gender diversity, and to educate ourselves about transgender experiences as well as how psychology has failed this community so terribly for many decades.

(4) Educate yourself - it's unfortunate that psychology training doesn't offer more affirmative and comprehensive teaching and practice on working with transgender and gender diverse individuals. As a result, it can be up to you to learn about this area alongside your training, or contact your course leaders and request that the topic be covered. If you are already qualified, you may want to look into specialist training for your department or courses for yourself as a part of your CPD - such as those offered by Pink Therapy.

(5) Engage with the community - your client doesn't exist in a vacuum and neither should your therapy. Make use of, and introduce your client to, the wealth of local community resources for transgender and gender diverse individuals - such as the Catherine White Holman Wellness Centre for those in Vancouver, Canada or TransForum and the Proud Trust for those in Manchester, UK. For advice on terminology - check out GLAAD's useful guide here Resources for working with children and youth: Ehrensaft, D. & Menvielle, E. (2011). Gender born, gender made: Raising healthy gender-nonconforming children. Book details Ehrensaft, D. (2012). From gender identity disorder to gender creativity: True gender self child therapy. Journal of Homosexuality, 59(3), 337-356. Article details

Hill, D. & Menvielle, E. (2009). ‘You have to give them a place where they feel protected and safe and loved’: The views of parents who have gender-variant children and adolescents. Journal of LGBT Youth, 6, 243-271. Article details

Hill, D., Menvielle, E., Sica, K. & Johnson, A. (2010). An affirmative intervention for families with gender variant children: Parental ratings of child mental health and gender. Journal of Sex and Marital Therapy, 36, 6-23. PDF Lev, A. (2013). Transgender emergence: Therapeutic guidelines for working with gender-variant people and their families. Book details Meyer, E. & Pullen-Sansfacon, A. (2014). Supporting transgender and gender creative youth: Schools, families and communities in action. Book details

Pullen Sansfacon, A., Robichaud, M. & Dumais-Michaud, A. (2015). The experience of parents who support their children’s gender variance. Journal of LGBT Youth, 12(1), 39-63. Article details

Trans Pulse (2012). Impacts of strong parental support for trans youth. PDF Working with adults: Richards, C. & Barker, M. (2013). Sexuality and gender for mental health professionals: A practical guide. London: Sage. Book details Ansara, G. (2010). Beyond cisgenderism: Counselling people with non-assigned gender identities. In L. Moon (Ed.), Counselling ideologies: Queer challenges to heteronormativity, pp.167-200. Surrey: Ashgate. Book details Lev, A. (2013). Transgender emergence: Therapeutic guidelines for working with gender-variant people and their families. Book details If you have questions, or would like advice about a specific case, please contact me at For more updates, follow me on Twitter or like my Facebook page

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