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Counseling Transgendered, Transsexual, and Gender‐Variant Clients

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Abstract

The emergent consciousness and political activism within the transgender community has important implications for the field of counseling. In the current paradigm, the focus has shifted from using surgical and hormonal interventions and thereby enabling transgendered persons to “pass” within the traditional gender binary of society to affirming the unique identities of transgendered persons. To prepare counselors, counselor educators, and counseling supervisors for this important challenge, the authors describe the evolving nature of the transgender community, discuss mental health issues and counseling interventions for use with transgendered clients, and present a case study detailing the progression of counseling with 1 transgendered client.

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... It has persuaded the clinicians to rethink their assumptions about gender, sexuality, and sexual orientation. A "trans-positive" or "trans-affirmative" disposition to counselling is the need of the hour [5] that affirms transgendered persons; advocates for their political, social, and economic rights; and educates others about such issues. This approach is similar to the practice of "sex-positive" therapy [5,10]. ...
... A "trans-positive" or "trans-affirmative" disposition to counselling is the need of the hour [5] that affirms transgendered persons; advocates for their political, social, and economic rights; and educates others about such issues. This approach is similar to the practice of "sex-positive" therapy [5,10]. Transgender people may seek mental health care for a number reasons; in addition to mental health issues relating to or resulting from one's gender identity. ...
... Behaviors and expressions are associated with "masculine," or "feminine," and gender identity or selfidentification is categorized as man or woman. The third category or transgender is a pluralism of traditional male and female expressions and therefore encompasses a wide range of personal identity and self-expression (Carroll et al., 2002). ...
... Family discrimination and poverty are identified as a primary factor contributing to the trajectory of transgender persons into the sex trade (Phlong et al., 2012). A study conducted in 2002 surveyed both MSM and transgender persons in three cities in Cambodia (Carroll et al., 2002). A survey of MSM and transgender persons indicated 25% of their primary source of income was in the sex trade and nearly 70% reported they sold sex for money at least once in their lifetime. ...
... Contemporary perspectives endorse viewing gender and sexuality as fluid, particularly in the treatment of TGNC individuals (Bornstein & Bergman, 2010;Carroll, Gilroy, & Ryan, 2002;Ehrensaft, 2012;Hakeem, 2010;Menvielle, 2012;Rosenberg, 2002;Steensma, McGuire, Kreukels, Beekman, & Cohen-Kettenis, 2013;Stein, 2012;Wilchins, 2004). Thus, it is important to explore practitioners' and trainees' attitudes concerning gender expression among TGNC clients to determine whether they are endorsing rigid or fluid views of gender expression in working with this population. ...
... Contemporary perspectives on gender and sexuality within and outside of counseling psychology often highlight diversity in the experiences of TGNC individuals, and stresses the importance of practitioners' understanding of the fluidity in gender identity and forms of expression among this population (Carroll et al., 2002;Ehrensaft, 2013;Hakeem, 2010;Kozee, Tylka, & Bauerband, 2012;Menvielle, 2012;Rosenberg, 2002;Stein, 2012;Tebbe & Moradi, 2012). Although many transgender individuals identify with gender identities of man or woman, many may not feel congruent with these gender identities (Coleman et al., 2012). ...
Article
Effective counselors recognize the diversity that exists in gender expression among transgender and gender nonconforming clients. To aid this understanding, we present the development and evaluation of the Gender Expression Attitudes Towards Transgender Clients scale. In Study I (N = 300 trainees in helping professions), we found evidence of three adequately reliable factors: Emphasis on Assigned Sex Expression, Affirmation of Gender Expression in All Forms, and Generalized Emphasis on Gender Binary Expression. In Study II (N = 202 trainees and practitioners), only the Affirmation of Gender Expression in All Forms subscale was negatively associated with gender essentialist and gender immutable attitudes, and was positively associated with recent guidelines for clinical care of transgender clients. The Emphasis on Assigned Sex Expression subscale was positively associated with gender immutability and negatively associated with guidelines for clinical care of transgender clients, as was the Generalized Emphasis on Gender Binary Expression subscale.
... The term transgender includes people whose inherent sense of gender identity does not match their biological sex (APA 2015;Carroll et al. 2002;Effrig et al. 2011), although the specific gender expression (e.g., appearance and behavior) of trans* individuals can, and does, vary greatly (APA 2015;Bettcher 2006Bettcher , 2014. The term ''trans*'' encompasses those who identify as trans men, trans women, and others who identify as gender non-conforming (Carabez et al. 2015;Wagner et al. 2016). ...
... Given the diversity of the individuals who comprise the trans* community, an important consideration for examining the victimization experiences is the role gender expression plays in vulnerability (Bettcher 2006(Bettcher , 2014Carroll et al. 2002). That is, although people who identify outside the gender binary are indeed vulnerable to discrimination and violence, trans* individuals who do not ''pass'' socially for ''normal gender expression'' (Carroll et al. 2002, p. 132) may be even more vulnerable than those who do (Bettcher 2014;Bornstein 1994). ...
Article
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Under Title IX, institutions of higher education are tasked with ensuring students are protected from gender discrimination. Vulnerabilities of trans individuals call for inclusion of this student population in its assurance of protection and safety. Previous research shows that trans individuals, both on and off campuses, are vulnerable to a range of interpersonal violence, including physical and non-physical forms. This study seeks to examine the discrimination experiences and interpersonal violence victimization among trans undergraduate students in a national sample. In the Fall of 2015, undergraduate students (N= 15,072) participated in the American College Health Association's National College Health Assessment, of which 1.5% (n = 228) identified their gender as trans. Logistic regression analyses revealed trans students had significantly higher odds of reporting negative outcomes, compared to non-trans women, even after adjusting for other demographic variables, such as year in school, racial identity, and sexual orientation. For example, trans students had significantly increased odds of reporting academicaffecting discrimination and having been verbally threatened, compared to non-trans women. In addition, trans students had significantly higher odds of reporting victimization of emotional abuse in a relationship and non-consensual attempted penetration, compared to non-trans women. Trans students are vulnerable to a range of victimization experiences that have detrimental effects on health. Implications for campus policy and programming, as well as future research are discussed.
... The intention of using this film was to open dialogue about the following: (a) how religion and sexuality play a part in LGBTQ clients' lives, including societal support and oppression; (b) how personal values may play a role when working with clients and their families; and (c) how to work effectively and ethically without imposing these values and beliefs (ACA, 2014). (Karslake, 2007), however, does not depict members of the transgender community and students need additional information about contextual factors (e.g., psychological, political, historical) that influence transgender identity development (ALGBTIC, 2009;Carroll, Gilroy, & Ryan, 2002;Preston, 2011). Therefore, the second film, Normal (Busch, Brokaw, Pilcher, & Anderson, 2003), was selected to provide an example of what a person might experience during transition, including emotional responses, clothing choices, voice modulation, and changes at work, home, and in the community. ...
... There were fewer counseling applications can expand students' awareness into transferable counseling interventions by using class discussions, skills-based training, and other experiential activities such as role-plays, community interviews, and discussion panels that include transgender individuals (Long & Serovich, 2003;Pearson, 2003;Preston, 2011). Additionally, students can have class discussions and assignments to increase their knowledge about local and national support networks (Carroll et al., 2002;Chavez-Korell & Johnson, 2010), community resources, and psychoeducational materials they can provide clients. This may include information on the transition process, coming out to family, friends, co-workers, and the community, and acknowledging the outcome may not be as positive as the ending in Normal, and what interventions could be taken to address loss and grief. ...
... To date, only six published articles have focused on the experiences of TGNC individuals in counseling or psychotherapy (Benson, 2013;Bess & Stabb, 2009;Elder, 2016;Hunt, 2014;Rachlin, 2002;Shipherd et al., 2010). However, those articles include a small number of TGNC persons, are conceptual in nature, or are written from a provider's perspective (Benson, 2013;Carroll et al., 2002;Lombardi, 2009). Compared with the counseling experiences of other culturally diverse groups, very little is known about the counseling experiences of TGNC individuals or their experiences with MHPs. ...
... Transaffirmative is a term often used to describe an approach of accepting, advocating, or educating others about TGNC concerns (ACA, 2010;Carroll et al., 2002). Transaffirmative approaches in this study were described as validating or affirming-not pathologizing-TGNC identities, and understanding TGNC experiences of discrimination and marginalization. ...
Article
The counseling experiences of 13 transgender and gender nonconforming (TGNC) individuals were examined via semistructured, in-depth interviews. Using multiple standards of trustworthiness (e.g., member checking, negative case analysis), the authors analyzed each interview from an interpretative phenomenological analytic framework. Four main themes were identified: mental health professional selection process, transaffirmative approach, transnegative approach, and support systems beyond counseling. Implications for implementing culturally responsive TGNC affirmative counseling, TGNC sensitive counselor training, and social justice–oriented research are discussed.
... For example, some studies have restricted their focus to gay men (Lebolt, 1999;Mair & Izzard, 2001), while one focused specifically on lesbians with disabilities (Hunt et al., 2006). There is a paucity of studies investigating bisexual and transgender clients (Carroll, Gilroy, & Ryan, 2002;Israel & Mohr, 2004) as well as those clients who make use of the living lexicon of sexual and gender identity descriptors to self-identify (e.g., queer, genderqueer, pansexual, two-spirit, womyn, asexual). ...
Article
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals face mental health disparities secondary to minority stress and utilize psychological services at greater rates than their heterosexual/cisgender counterparts. Despite pressing demand for culturally competent care for this population, significant gaps in the literature exist, particularly related to the tailoring of psychotherapy to LGBTQ clients’ unique sociocultural context. As such, the current article utilized consensual qualitative research (CQR) methods to distill core themes regarding the manner in which contextual factors and ideographic values of LGBTQ individuals inform their experiences in psychotherapy. Results highlight the importance of interpersonal connectedness and authentic affirmation as central to clients’ sense of mental health and wellness. Moreover, findings revealed multiple and intersecting axes of identity shaping participant experiences of psychotherapy. Specific recommendations for clinicians are provided in the service of advancing culturally competent care for LGBTQ individuals that is as complex and nuanced as the clients themselves.
... In fact, inclusive laws related to locker rooms and bathrooms have been on the books in more than 200 municipalities for years, and over this time, an investigation by CNN researchers uncovered just one incident of sexual assault (Grinberg & Stewart, 2017). Far more common are cases of violence against transgender individuals (Bradford et al., 2013;Cook-Daniels & Munson, 2010;Lombardi, Wilchins, Priesing, & Malouf, 2001), including violence in restrooms and other facilities (Carroll, Gilroy, & Ryan, 2002). Thus, the irrational fear reflected in arguments against inclusion is far greater than any empirical evidence on the matter. ...
Article
Full-text available
The purpose of this article is to articulate the need for a strong commitment to transgender inclusion in sport and physical activity, including in locker rooms and team spaces. The authors begin by defining key constructs and offering a theoretical overview of stigma toward transgender individuals. The focus then shifts to the changing opportunities for transgender athletes at all participation levels, case law and rulings germane to the topic, and the psychological, physical, and social outcomes associated with inclusion and exclusion. Next, the authors present frequently voiced concerns about transgender inclusion, with an emphasis on safety and privacy.Given the review, the authors present the case for inclusive locker rooms, which permit access by transgender athletes to facilities that correspond to their gender identity. The authors conclude with the official AKA position statement-"The American Kinesiology Association endorses inclusive locker rooms, by which we mean sex-segregated facilities that are open to transgender athletes on the basis of their gender identity"-and implications for sport and physical activity.
... Transgender and gender variant youth experience multiple stressors that negatively affect their health and well-being. Transgender youth are adolescents and young adults with a self-identified gender different from their sex assigned at birth (Fenway Health, 2010), while gender variant (GV) youth are those whose characteristics, traits, or identities do not neatly align with societal expectations of traditional male and female roles (e.g., boys and men who behave in ways that society labels feminine; girls and women who behave in ways that society labels masculine; Carroll, Gilroy, & Ryan, 2002). GV youth may include youth who identify as transgender. ...
Article
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Transgender and gender variant (GV) youth experience elevated risk for poor health and academic outcomes due mainly to social experiences of stigma and discrimination. To supplement the growing evidence on health risks encountered by transgender/GV youth, we identified factors theorized to be protective for these youth across all four levels of Bronfenbrenner’s socioecological model (individual, relationship, community, societal). We conducted a systematic search of peer-reviewed research. The articles included in this review were published in peer-reviewed journals in English or Spanish between 1999 and 2014, analyzed data from a sample or subsample of transgender or GV participants with a mean age between 10 and 24 years, and examined the relationship of at least one theorized protective factor to a health or behavioral outcome. Twenty-one articles met inclusion criteria. Transgender/GV youth in included articles ranged from 11 to 26 years of age, were racially/ethnically diverse, and represented varied gender identities. Within these articles, 27 unique protective factors across four levels of the ecological model were identified as related to positive health and well-being. Self-esteem at the individual level, healthy relationships with parents and peers at the relationship-level, and gay-straight alliances at the community level emerged as protective factors across multiple studies. Our findings underscore the relative lack of research on transgender/GV youth and protective factors. Novel recruitment strategies for transgender/GV youth and better measurement of transgender identities are needed to confirm these protective relationships and identify others. Growth in these areas will contribute to building a body of evidence to inform interventions.
... The term cisgender refers to individuals whose experienced gender identity matches that which they were assigned at birth (i.e., an infant assigned female at birth would grow up and self-identify as female; Tate, Bettergarcia, & Brent, 2015). Additional terms have historically been considered synonymous with transgender and have a complex history of stigmatization and, in some cases, later being reclaimed by TGNC individuals (e.g., MTF or male-to-female, FTM or female-to-male, transvestite, transsexual, and transgendered persons and further more terms continue to be in common use such as transfeminine/transmasculine and transfemale/transmale; Carroll, Gilroy, & Ryan, 2002). ...
Article
Background: Emerging research and colloquial dialogues increasingly point to an uptick in non-binary gender identity endorsement, however research has failed to parallel this increase. For example, existing literature often conflates gender identity with sexual orientation, lumping TGNC people under the LGBTQ umbrella, thus rendering the “T” silent in the process. Further, extant research adheres to a binary (i.e., dichotomous male/female) conceptualization of gender, thus excluding individuals who identify as genderqueer, gender non-conforming, or otherwise non-binary as well as those who do not identify with the construct of gender at all (e.g., agender). Method: This qualitative investigation utilized individual interviews with 15 TGNC adults. Data analysis employed two data-driven phases, first identifying themes consistent across the 15 transcripts to identify nuances in TGNC identity formation often missed by theory-driven models and second, establishing similarities and differences between binary and non-binary narratives. Results: Results indicated that various helpful and challenging factors played a stronger role than chronology, physical transition, or activism across all participants which contrasts findings in extant literature. Further, while binary and non-binary narratives were similar in many regards, several noteworthy distinctions emerged. For example, the concepts of “passing or blending”, intersections of gender identity with sexual orientation, and navigating identity presentation and disclosure were described differently for binary and non-binary participants. Conclusions: Historically, the “T” in “LGBTQ” has often been rendered silent. These results indicate that non-binary narratives have been rendered doubly silent. Given the increasing preponderance of non-binary identifications and the unique needs and experiences of non-binary participants, it is crucial that professional and lay communities alike begin to take two steps moving forward: 1) explicitly acknowledge the existence of non-binary TGNC identities and 2) work to achieve fluency regarding the unique needs and experiences of this population.
... Undoing gender evokes resistance (Deutsch 2007) and becomes obvious when people experiment with gender characteristics such as gender bending and gender crossing. Gender bending involves mixing elements of masculinity with femininity (Carroll, Gilroy, and Ryan 2002), while gender crossing refers to an individual's efforts to fully access groups and activities of the other gender (McKenna and Kessler 2006;Thorne 1993). As a result, gender differences can be reduced and gender undone Deutsch 2007). ...
Thesis
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In a rapidly changing world characterized by increased ethnic diversity, successful integration depends (among other factors) on social interaction among people. Hence, there is a need for cross-cultural meeting points. Breaking [breakdance] is historically linked to a black, urban street context and has evolved into a global phenomenon with adherents throughout the world. This dissertation investigates the meaning of breaking in the lives of young people living in Oslo, Norway. Considering breaking as a subculture and alternative sport, the dissertation may contribute to the understanding of young people’s choices – their construction of meaning, identity and gender within this activity. Theoretically, the study draws on symbolic interactionism to understand how young breakers in Oslo define their experiences and give meaning to their identities, behaviors, realities and social interactions. However, to address social structure and power, gender perspective has been applied. As a social construction, gender is constantly reconstructed through social interaction, and the dissertation explores how gender influences the breakers’ experiences and how breaking is a site for negotiating gender ideology and power relations. Methodologically, the study uses a qualitative research strategy to create an in-depth understanding of the social practices of breaking. Empirically, the dissertation draws on ethnographic data generated through fieldwork and interviews. The fieldwork involved participant observation four days a week from August 2011 to March 2012. The fieldwork was followed by 17 qualitative interviews with 6 female and 11 male breakers, who reflected the observed diversity within the subculture of breaking.
... On the other hand, participants of the current study highlighted the fundamental role of peers and community connectedness in promoting a process of identity integration. This is in line with previous studies which highlighted that family as a primary support network is often inaccessible to TGNC people and, for this, they often find a support source within TGNC community itself (e.g., Carroll et al., 2002). ...
Article
A great amount of quantitative research has largely demonstrated that transgen-der and gender nonconforming (TGNC) people experience high rates of minority stress, against which they are able to exercise resilience and to use adaptive strategies buffering the negative effects of stress on health. Notwithstanding, qualitative investigations on how TGNC people subjectively experience minority stress are still scarce. This study aims at exploring the subjective experiences of minority stress through a focus group with 8 Italian TGNC individuals (5 male-to-female, 2 female-to-male, and 1 genderqueer; M = 25; SD = 5). Narratives were analyzed through the deductive thematic analysis. The analysis generated four main categories: (1) family rejection; (2) visibility of the body; (3) negative effects of family violence on health; and (4) integration of TGNC identity. Results offer an in-depth exploration of minority stress processes in TGNC people, as well as the impact of stress on health and adaptive strategies to face with stigma. Suggestions for clinical practice are discussed.
... This offered participants the opportunity to share their own distress, helping group members to find some common coping strategies. Thus, the group can also assume protective functions, which transgender people often do not find within their own families (Carroll, Gilroy, & Ryan, 2002). ...
Article
This study presents a training program developed with eight transgender youths who experienced transphobic episodes. Two focus groups were conducted and the 14-Item Resilience Scale was administered to evaluate training effectiveness in improving resilience. The intervention followed an empowerment, peer-group-based methodology. Three themes were identified: identity affirmation, self-acceptance, and group as support. A three-waves repeated measures ANOVA confirmed an increase in resilience levels. Suggestions for clinical practice and social policies are discussed.
... This reflects over 10 years of efforts to include transgender people and issues into discussions about sexual and gender identity issues (Georgemiller, 2009). Nevertheless, the transgender population has a long history of being neglected in research, scholarship, training, and education, even though this population is often included under the umbrella of sexual orientation (Carroll, Gilroy, & Ryan, 2002;Kirk & Belovics, 2008). Future studies that focus exclusively on how therapists learn about working with transgender clients are needed. ...
Article
In the supervision literature, research on sexual orientation considerations often focuses on sexual minority supervisees and less often on their work with sexual minority clients. Yet both heterosexual and sexual minority supervisees serve sexual minority clients and may have different supervision needs. Twelve predoctoral interns from 12 APA-accredited counseling center internships were interviewed about how they made use of supervision for their work with a sexual minority client. The sample consisted of 6 heterosexual-identified supervisees and 6 supervisees who identified as lesbian, gay, or queer (LGQ). Data were analyzed using consensual qualitative research. All participants reported positive gains from supervision that carried over to their work with heterosexual and sexual minority clients, even when not all supervisors disclosed or discussed their own sexual orientation. Heterosexual supervisees used supervision to ensure that their heterosexuality does not interfere with an affirmative experience for their sexual minority client, whereas LGQ supervisees used supervision to explore differences in sexual identity development between themselves and their client to minimize the negative impact of overidentification. Thus, affirmative supervision may unfold with different foci depending on supervisees’ sexual identity. Implications for training and supervision are discussed.
... Although individuals who are transgender seek counseling services to deal with a variety of stressors they encounter (Benson, 2013), scholars have indicated that few counselors possess clinical training and experience to adequately conceptualize experiences of individuals who are transgender and utilize a trans-affirmative approach to therapy (Carroll, Gilroy, & Ryan, 2002;Chavez-Korell & Johnson, 2010;Lev, 2004). Counselors may be challenged to employ effective ways to address a myriad of issues that individuals who are transgender face in their daily lives and have limited resources to address feelings of social and societal isolation and disconnection among the transgender community . ...
Article
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In light of persistent discrimination, many individuals who are transgender lack a safe space to connect with others. Social media has become a platform for establishing social ties, receiving education, and sharing of resources that may not otherwise be available to individuals on the margins of society. Yet little is understood about the role of social media in the lives of individuals who are transgender. In this qualitative study, the researchers examined the experiences of adults who are transgender (N = 5) who use social media. The current study also explored possible benefits and hindrances of social media for individuals who are transgender. Two main themes emerged: social media as a resource and a path to self and authenticity. The researchers encourage counselors to become familiar with various social networking sites and their privacy settings, and propose using a theoretical framework to guide counseling work with individuals who are transgender to reflect on social media connections and disconnections.
... In its most basic form the difference between the two genders can be determined physically and genetically (Arnold, 2004). Yet there are 'XX males' (de la Chapelle, Koo, and Wachtel, 1978) and many who identify as somewhere in-between male and female such as transgender and gender queer, which can cause issues if a binary view of gender is maintained (Carroll, Gilroy, and Ryan, 2002). Therefore, perhaps this study has underestimated the complications surrounding the concept of gender by exclusively exploring the binary terms of male and female. ...
Article
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Female leaders in the outdoor industry are in the minority and initially, guiding me into this research, I wondered why this might be. From this curiosity, the study explores self-perceptions of females in the Outdoors through written accounts of experiences. My research addresses what may make an effective leader in the Outdoors and how gender, and self-perceptions of gender, might impact upon this. I conclude that women may build and project an image of themselves in leadership roles that can be determined by societal norms, and that such norms might also inform their conceptions of competency as leaders. Dear reader: I have chosen to write in first person throughout this project to express my journey as a novice researcher addressing this aim. This unconventional use of personal pronouns supports my philosophical approach and highlights the subjectivity of my work.
... In addition to emphasizing the importance of knowledge of and competence working with this population, professional counselors are expected to engage in various forms of advocacy to promote the wellbeing of the transgender community (ACA, 2014;Carroll, Gilroy, & Ryan, 2002). Sangganjanavanich and Cavazos (2010) proposed to engage in social justice advocacy on micro and macrolevels. ...
Article
Transgender, gender variant, and/or gender nonconforming persons are marginalized and pathologized in society and communities. The advent and widespread use of social media introduce an entirely new avenue of expression where cyber bullying and verbal assaults are common. Yet, social media also has the capacity to reach more people in more places, thus presenting a potentially powerful platform for advocacy. Grounded in digital critical participatory action research, the authors present a multimedia advocacy project that highlights advocacy strategies in which counselors can utilize social media to raise awareness, promote inclusion, and resolve microaggressions toward transgender persons.
... Undoing gender evokes resistance (Deutsch 2007) and becomes obvious when people experiment with gender characteristics such as gender bending and gender crossing. Gender bending involves mixing elements of masculinity with femininity (Carroll, Gilroy, and Ryan 2002), while gender crossing refers to an individual's efforts to fully access groups and activities of the other gender (McKenna and Kessler 2006;Thorne 1993). As a result, gender differences can be reduced and gender undone (Claringbould and Knoppers 2008;Deutsch 2007). ...
Article
Full-text available
Drawing on the perspectives of youth involved in breaking, also known as breakdance, the aim of this article is to explore how their experiences contribute to the doing, redoing and undoing of gender. The negotiation of gender is highlighted through the female breakers’ experiences in a male-dominated culture. The analysis is based on fieldwork and qualitative interviews with young breakers in Norway. The results show that the female breakers challenged the perception of masculinity and femininity as they extended their practice of gender. Their desire to disprove the gendered expectations of female breakers resulted in a mixing of masculinity and femininity. Accordingly, the gender regime among the breakers was simultaneously re-constructed and challenged. We argue that both male and female breakers challenge normative perceptions of doing gender. Consequently, breaking has the capacity to dismantle the gender binary, and to redo and undo the gender order.
... Therapie als freiwillige, trans*-affirmative Begleitung vor, die an die Grundsätze der Parteilichkeit und des "Empowerments" und damit an langjährige praktische Erfahrungen und emanzipatorische Beratungsansätze des Gay Counseling anschließt. Im US-Kontext entwickelt, wird trans*-affirmative Beratung seit 15 Jahren von Professionen im Gesundheitsbereich praktiziert [21]. Grundgedanken der kritischen Psychologie bieten zudem nach Meyer die Möglichkeiten, in einer trans*-affirmativen therapeutischen Haltung Gesellschaftsstrukturen und das Eingebunden-Sein des Individuums zu berücksichtigen. ...
... Transgender participants faced presumptions and bewilderment from clinicians about how to respond to their gender identity and provide a holistic treatment intervention that could handle the complexity of the interrelationship between the ED experience and their identity as transgender. These experiences of transgender people that questioned the mental health professionals 'competence in treating individuals identifying as transgender was of major concern and resonated with previous studies [56,57]. Participant's sought acknowledgement and acceptance of their gender identity by the therapist and reportedly felt ignored and marginalised. ...
Article
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Background Traditionally perceived as a disorder of women, Eating Disorders (EDs) are known to have impacts on people irrespective of their gender. This study is designed to synthesise the available qualitative research studies to more broadly understand the diverse experiences of ED and their treatment, specifically in relationship to issues of gender. Methods The methodology involved a systematic search and quality appraisal of the literature published after 1980 using terms that aimed to represent the primary concepts of “role of gender” and “treatment experiences” and “eating disorders”. Nine qualitative studies met the inclusion criteria. Meta-themes were inductively generated through a synthesis of data across themes from the relevant included papers. Results Analysis of data was constructed around three meta-themes, each with subthemes. The first meta-theme “Out of sight, out of mind” depicted the experience of gender issues that were marginalised in treatment. More specifically for transgender people, when gender issues were ignored by treatment providers, this frequently led to non-disclosure of their gender identity. Furthermore, men were less likely to be assessed for an eating disorder and within this context; diagnosis of an ED and referral to specialist treatment was frequently hindered. The second meta-theme “Lack of literacy among health care providers” focused on issues related to misdiagnosis of EDs, and the question of whether this was related to a lack of health literacy amongst health professionals. The final theme “Pathways into treatment that address stigma and other barriers” highlighted the need for the development of future treatment interventions address the complex social reality of the experiencing person, including questions of gender. Conclusion Gender issues impact upon the ED experience and require broader consideration in the development and evaluation of ED treatment interventions, including the further development of gender-informed interventions. Trial registration Protocol registered on PROSPERO 2017 CRD42017082616. Electronic supplementary material The online version of this article (10.1186/s40337-018-0207-1) contains supplementary material, which is available to authorized users.
... Given the growing consideration for multiple gender identities Carroll, Gilroy, & Ryan, 2002;Eyler, 2007;Saeed, Mughal, Farooq, 2017) we asked participants to choose among several different gender identity options. Thus, participants were asked, "What is your current gender identity". ...
Article
Some health care providers work with gender expansive youth; preliminary evidence notes that many of these youth do not disclose their gender identity to all of their health care providers. No previous research focused on youth has explored gender identity disclosure to health care providers, nor linked youth disclosure to negative mental health outcomes (e.g., symptoms of depression). Data were drawn from the LGBTQ National Teen Survey to test the relationship between gender identity disclosure, symptoms of depression, and self-esteem among 13- to 17-year old (n = 5,637, Mage = 15.6) participants who identified as transgender boys, transgender girls, and nonbinary youth assigned female at birth (AFAB) or assigned male nonbinary youth assigned male at birth (AMAB). Transgender boys reported the highest symptoms of depression and the lowest levels of self-esteem in comparison with other groups. Among the full sample, 66.8% had not disclosed their gender identity health care providers-nonbinary AMAB youth were least likely to disclose (77.6%). Symptoms of depression were the highest and self-esteem was the lowest for transgender boys with mixed levels of disclosure. Transgender girls reported the lowest symptoms of depression-these youth had also disclosed their identities the most. Findings suggest that mixed disclosure to health care providers is problematic for gender expansive youth, especially transgender boys. Findings suggest a need to better prepare health professionals to understand not all gender expansive youth may feel comfortable disclosing their gender identities in medical contexts. Future research should explore gender affirmative health care as a protective factor for negative mental health outcomes.
... Der SPGV ist den Yogyakarta Prinzipien (O'Flaherty/Fisher 2008) verpflichtet und setzt sich dafür ein, dass am USB die Menschenrechte von geschlechtervarianten Personen gewährleistet werden.Medizin-ethischDer SPGV verfolgt ein partizipatives Modell, welches den Behandlungssuchenden und den Behandelnden die Möglichkeit eröffnet, im Rahmen der medizinischen Transition gemeinsame Entscheidungen zu treffen (Share-Decision-Making-Modell) (Charles/Gafni/Whelan 1997).Geschlechtervariante Personen werden am SPGV darin unterstützt, die eigene Geschlechtsidentität zu erforschen, zu bejahen und in die Gesellschaft zu integrieren(Carroll/Gilroy/Ryan 2002). Der SPGV stellt fest, dass westliche Gesellschaften durch cisnormative Geschlechteraxiome strukturiert werden (Fausto-Sterling 2000), was wesentlich zur Stigmatisierung von geschlechtervarianten Personen beiträgt (Hendricks/ Testa 2012; White Hughto/Reisner/Pachankis 2015). ...
Chapter
In Medizin, Psychologie und Pflege werden trans Personen marginalisiert. Geschlechtliche Diversität wird oft mit sexueller Vielfalt zusammen betrachtet - die gelebte Erfahrung von trans Personen wird dadurch jedoch verdeckt. Dieser Band beschäftigt sich erstmals daher nicht nur mit der aktuellen Lage von trans Personen in diversen Versorgungssystemen, sondern auch mit dem Konzept der »Selbstsorge«. Er soll einen Weg bereiten für Handlungsoptionen, die zu einer verbesserten pflegerischen, medizinischen, therapeutischen und sozialen Versorgung von trans Personen führen. Ein Großteil der Beiträge ist aus einer gelebten trans Perspektive heraus verfasst.
... Conservative scholars argue that changes to one's body are only allowed under medical circumstances, such as in the case of khunsa (intersex people), but is this not in contradiction of the principle that "God does not make mistakes"? Not only that, the fact that being transgender has been vigorously explored in a variety of science discourses in the last century as a medical, psychological and socio-cultural phenomenon (e.g., Burgess, 1999;Carroll et al., 2002;Zubernis & Snyder, 2007) automatically nullifies the conservative argument that "changes in one's body are only allowed under medical circumstances". With this coherent argument, Muslim transgender people should be allowed to receive treatment too, as clarified briefly in both the Tantawi and Khomeini fatwas (Alipour, 2017). ...
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In the late 1980s, prompted by an actual case of an assigned male-at-birth (AMAB) transgender person who was allowed to have genital reconstructive surgery, two fatwas were issued. One was by the Mufti of the foremost university in Islamic scholarship, the Al-Azhar University (Tantawi in June, 1988), and the second was by the Spiritual Leader of Iran (who was Khomeini in 1986). Initially, these fatwas were upheld as a tolerant and progressive approach of Islam toward transgender Muslims. However, due to the strong majority of Islamic conservatives who continue to be prevalent in Iran and other Muslim countries, Muslim transgender women are still suffering from heightened stigma and transphobia, discrimination and injustice, violence and persecution. In this editorial, we provide a counter-narrative to Islamic heteropatriarchal conservatism that constructs Islam as homo/bi/intersex/transphobic. We challenge the conservative arguments based on the verse in the Qur”ān (4: 119) that states “God has created everything as it is”, and “changes in one’s body are only allowed under medical circumstances”. These arguments are highly ambiguous and the verse has long been taken out of its original context by the conservative view. Not only are these arguments in contradiction with the principle that “God does not make mistakes”, they are also irrelevant as far as modern medical science is concerned. Tantawi (Sunni) and Khomeini (Shia) fatwas are then explored as they allow Muslim transgender people to receive treatment and/or gender affirming surgery and, therefore, show how the fatwas provide trans-inclusiveness in Islam. While we are cognisant that Tantawi and Khomeini fatwas did not address the legal rights of cisgender same-sex attracted people, we offer a perspective which encourages a deeper understanding of the progressive Muslim standpoint within the periscope of Muslim Sunni construal in order to reach a more nuanced understanding of an archaic position on being transgender posed by Islamic conservatism; and thereby encourage stronger voices and empowerment within transgender Muslim communities.
... A transgender man is an individual assigned female at birth who identifies as a man [or masculine]; a transgender woman was assigned male at birth but identifies as a woman [or feminine] (Hendricks & Testa, 2012). However, not all transgender people identify with these binary (male/female) gender categories, but may identify instead with a nonbinary identity, using terms such as genderqueer, gender non-conforming or two-spirit (American Psychological Association, 2015;Carroll, Gilroy, & Ryan, 2002;Eyler, 2007;Hendricks & Testa, 2012). Agender individuals are those who do not identify with any particular gender (American Psychological Association, 2015). ...
Article
Introduction Minority stress theories suggest that high rates of discrimination experienced by transgender people are precipitants of substance use. This risk is likely exacerbated by an inadequate provision of trans-inclusive substance misuse services. However, the exclusion of transgender people from the general substance misuse literature makes it difficult to determine the extent to which transgender status influences substance use. A systematic review was undertaken to better understand the prevalence, patterns and correlates of substance use among this group. Methods In accordance with the PRISMA guidance, a literature search was conducted to 29th May 2019 on PubMed, PsycInfo, Embase and Global Health databases. Primary quantitative studies, published in English, that reported the prevalence, patterns or correlates of substance use by transgender people were included, with no restriction on methodological design. Results 653 unique records were identified, and 41 studies were included. Half the studies reported on both transgender men and transgender women and half transgender women only. There was high and excess prevalence of substance use among transgender compared with cisgender people, but insufficient evidence to estimate prevalence or quantify the risk for substance use. Correlates of substance use included transphobic discrimination or violence, unemployment and sex work, gender dysphoria, high visual gender non-conformity and intersectional sexual minority status. Conclusions The sparse findings lend support to the minority stress model. However, the overreliance of the literature on disproportionate investigation of transgender women with multiple intersectional disadvantages, means there are significant gaps regarding the wider transgender community. To ensure substance use treatment services are inclusive, gender identity should be recorded and targeted interventions available. Clinicians should be aware of the multiple, complex drivers of substance use and be prepared to ask about substance use and offer support. Given the high prevalence of trauma experienced by transgender people, trauma-informed psychosocial interventions may be useful in the management of problematic substance use in transgender adults.
... The clinical and advocacy implications of the research involved ensuring culturally responsive work with TGNC POC individuals across various settings (see also Carroll et al., 2002;Hendricks & Testa, 2012). There was a call for in-group healthcare providers and approaching TGNC POC clients from a holistic perspective. ...
Article
Transgender and gender non‐conforming people (TGNC), individuals whose gender identity differs from the sex they were assigned at birth, experience unique stressors, discrimination, and barriers to health and wellbeing. TGNC People of Colour (POC) navigate the nexus of racism, cisgenderism (and often homophobia) in their daily lives, resulting in uniquely intersecting forms of discrimination, and pronounced disparities in their health and well‐being. In order to examine the current state of knowledge about the health and wellbeing of TGNC POC, we conducted a systematic search and review of peer‐reviewed journal articles published between 1 January 2010 and 1 May 2020 that focused on this population. A systematic search identified (3,575) papers, with 76 of those meeting full inclusion criteria. In our review, we were able to identify physical health and psychological wellbeing (which included resilience), as core clusters of research focused on TGNC POC. We identified specific factors that hindered physical and psychological health (what we call “push” factors) as well as those that promoted it (what we call “pull” factors). Leveraging these findings, we offer ways forward for best practice in clinical work and carrying out research with this population. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.
Article
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Discrimination heavily impacts the lives of trans populations and causes adverse mental health outcomes. As stated by the Gender Minority Stress Model self-stigmatization could play an important role in this process. The aim of this systematic review is to investigate whether there is a positive association between self-stigmatization and mental health and to identify mediation factors. Studies which quantitatively investigated the association between internalized transnegativity and selected mental health outcomes (depression, anxiety, non-suicidal self-injury, suicidal tendency) in self-identified trans populations were included. Comprehensive search of 5 large databases in June 2020 and the following screening and selection procedure, performed by two researchers separately, identified 14 studies which met criteria. The relationship to be studied was reported with correlation and/or mediation analysis of cross-sectional data. IT was directly positively associated with depression, anxiety and suicidal tendency in most of the reviewed studies. Data indicates links between self-stigmatization and other general mental health stressors such as rumination and thwarted belongingness. Community connectedness showed to be the strongest protective factor for mental health impairments. These results should be considered in transition counseling. More research is needed to better understand the underlying mechanisms of the GMSM and to address unsolved operationalization and measurement issues.
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Several developments over the last 10 years have brought profound changes for trans people in the UK and for their families and friends. While these changes are welcome, there is still much to be done and not all of society, including the therapeutic community, will have caught up with these changes. The trans community is part of an increasingly aging population in the UK, and it has faced, and is still facing, transphobia, discrimination, prejudice and social exclusion. This article seeks to review the literature that identifies the particular needs of trans people and their friends and families as they cope with the challenges of aging, including the death of a loved one or of friends and family. It explores how social exclusion, estrangement and isolation may make contact with bereavement counselling services all the more important for this community. But a history of rejection and prejudice may create a barrier, as potential trans clients remain defensive and wary of these services. Although there is little research on the subject, it is likely that the barriers to counselling will not be overcome unless therapists take action to reach out to this community and reassure them with their trans-affirmative practices.
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Individuals who identify as transgender or gender nonconforming (TGNC) face a number of health disparities compared to individuals who identify as cisgender (those who self-identify with the sex they were assigned at birth). For example, TGNC individuals experience heightened rates of clinical depression, anxiety, general psychological distress, suicidal ideation, and suicide attempts. Despite these troubling disparities, many TGNC individuals report hesitance to seek mental health services due to concerns regarding culturally insensitive or even overtly discriminatory services from providers. In addition to decreasing service utilization among TGNC populations, discriminatory services impair intervention effectiveness even when TGNC individuals persist in seeking mental health services. The American Psychological Association (APA) and the World Professional Association for Transgender Health (WPATH) provide guidelines for culturally competent work with TGNC clients; however, research indicates a profound lack of TGNC-specific training and resources among mental health care providers. To address this gap, the present investigation utilized a mixed-method design to assess training experiences, understanding of terminology, and TGNC competence among mental health care providers at various training levels. Participants were current mental health clinicians across the United States. Implications for improving reported and demonstrated weaknesses are discussed.
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Research demonstrates that transgender and nonconforming (TGNC) elders face social isolation and discrimination in policies and practices in mental and health care settings. The purpose of this article is to provide clinicians with practical input about therapeutic issues and interventions for use with TGNC elders. A case vignette describes the challenges and rewards of therapy with an elder trans woman. Her story illustrates the complex interplay between age, life phase, and sociocultural and historical contexts. Recommendations regarding research, practice, and advocacy are offered.
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Transgender and gender-expansive homeless youth face challenges. These often begin at home where they receive messages that something is wrong with them, frequently continuing at school and for some, the child welfare system. This population may become marginalized and feel the need to leave home. Becoming homeless can reinforce those messages leading to more negative life stories, possibly resulting in devaluation and further vulnerability. Aspects of narrative therapy may challenge those stories allowing space for preferred, empowering narratives that may help bring about change in themselves and their future.
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This grounded theory investigated acceptance from the experiences of 28 Filipino parents whose children are self-identified trans women. Parent participants were recruited via snowball and purposive sampling techniques. Data were collected using in-depth interviews and reflective journals. Parents believe that trans women are God’s creation who manifest the thoughts, feelings, and actions of a woman and who are good natured and self-driven, genetically determined with unchangeable quality, visible in the community and need protection. Parents view themselves as stewards of the God-given gift with the role of protecting the safety and future of their trans women children despite having feelings of certainty and uncertainty. A strengths-based and child-centered process towards supportive environment for trans women’s gender identity was developed describing distinct processes in the pre-acceptance, acceptance, and post-acceptance phases. Parents have offered some alternative ways that strengthened their adaptation to effectively co-exist and maintain a healthy relationship with their trans women children.
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The purpose of this study is to present a description, theming, and status comparison of sexual minorities, such as transgender persons and transsexuals in the Islamic society of Iran. Cultural as well as religious sensitivities have made the living conditions of sexual minorities, as an individual and a social being, extremely challenging. Using a hermeneutic interpretation (interpretative phenomenological analysis) a number of 18 semi-structured interviews were conducted with transgender individuals; from the interviews, three main themes: self-confidence, legal respect (in terms of the self) and social esteem were revealed. These individuals were categorized into three groups: transgender individuals (pre-sex reassignment surgery), transsexuals (under hormone therapy), and transsexuals (post-sex reassignment surgery). The findings indicate that social dignity in relation to transgender individuals is a critical issue. More than other social groups, transgender individuals are under a higher level of mental stress pertaining to role conflict, disappointment in romantic relationships, high risk of suicide, being discriminated against, based on sexual orientation, and physical, verbal and sexual abuse. The interviews also introduced exclusion and the inability to adapt/adjust in socially professional situations, as the leading context condition losing social dignity in all three groups. These difficulties have also been noticed in post-surgical transsexuals, especially from those that have undergone male to female sex reassignment surgeries. These findings support the rights of sexual minorities and more specifically transgender individuals in the Civil Rights Charter which has recently been submitted to the Iranian parliament. Moreover, the establishment of transgender health training centers is proposed in order to complete the medical process of sex reassignment and to facilitate appropriate behavioral adjustment to the reassigned sex, especially for male to female sex reassignment transgender individuals.
Article
The purpose of this study was to explore the way Australian national sport organisations (NSOs) create, develop and implement their policies relevant to trans athletes. Representatives of nine NSOs were interviewed utilising in-depth semi-structured interviews. Four key themes emerged from the organisation spokespersons’ accounts: a) finding the right policy, b) underfunded and under resourced, c) challenges of educating employees and the public, and lastly, d) communication between NSOs and the trans athletic community. Findings revealed that only two NSOs reported had specific policies directed at trans athlete’s sport participation. Several NSOs indicated that they had plans to develop separate policies for the different levels of competition to assist trans athletes to participate in their sport as their identified gender. This is the first study to explore the perspective and views of NSOs on the participation of trans athletes in sport.
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Despite the growing support for equality, diversity and inclusion in UK organisations, the transgender population has received insufficient attention in diversity management, legislation and research. Within this population are individuals who identify as ‘non-binary’ or ‘genderqueer’. These terms are used interchangeably to refer to individuals who challenge the binary gender expression of male or female as a fixed attribute and see gender identity as fluid (Butler, J., Gender trouble: Feminism and the subversion of identity. London: Routledge, 1990; Carroll, L., Gilroy, P.J. and Ryan, J., 2002. Counseling transgendered, transsexual, and gender‐variant clients. Journal of Counseling & Development, 80(2), pp. 131–139). Such persons have to navigate the binary systems of society and are at risk of social ostracism and discrimination both in and out of the workplace (Lorber, J., Paradoxes of gender. New York: Yale University Press, 1994). These inequalities are the focus of this chapter. This chapter considers constructions of gender and identity (Oakley, A., Sex, gender and society. Aldershot: Gower, 1972; Butler, J., Gender trouble: Feminism and the subversion of identity. London: Routledge, 1990, Butler, J., Bodies that matter: On the discursive limits of “sex”. London: Routledge, 1993; Lorber, J., Paradoxes of gender. New York: Yale University Press, 1994; Fausto-Sterling, A., Sexing the body: Gender politics and the construction of sexuality. New York: Basic Books, 2000) which challenge the current views of gender, to better understand the increasing societal awareness of non-binary gender identities. Following this, the authors critically examine the legislative protections, diversity management practices and limited management literature surrounding people with these gender identities in order to highlight the hidden inequalities that exist for them in these areas.
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This study examined the role parasocial contact with a transgender character on an online TV show (Transparent) may play in reducing prejudice toward transgender people. An experiment was conducted with participants randomly assigned to view either a video depicting a transgender character, or a non-transgender character portrayed by the same actor. Results were consistent with predictions derived from the intergroup contact mediation model for explaining how intergroup contact reduces prejudice toward an outgroup. Critical to reduction of prejudice toward transgender people is the quality of the parasocial interaction with the transgender character. Poor quality of parasocial contact may have unintended negative effects on prejudice toward transgender people based on the data. Limitations and implications of the study for the use of entertainment media to reduce stigma toward transgender people are discussed.
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Transgender and Gender-Expansive children and adolescents are resilient, capable, and amazing and deserve to work with school counselors who build upon their strengths. School counselors who espouse fluid, multilayered, and complex conceptualizations of gender and affectional identities are best equipped to meet the needs of TGE children and adolescents. Therefore, it is essential that school counselors be well-versed and knowledgeable about the identities of those with whom they are working, as well as welcome ongoing growth in areas such as self-awareness.
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Purpose The purpose of this paper is to address the barrier to care experienced by LGBTQIA+ populations by binary language for gender, sexual orientation and relationship status. Design/methodology/approach The authors review the research that shows linguistic barriers are a significant obstacle to healthcare for LGBTQIA+ communities. The authors describe both a process and revisions for addressing language bias in psychiatric intake/research research materials as well as quantify its impact in an adult psychotherapy clinic in a public hospital. Findings Patients self-identified their gender, sexual orientation and relationship status in a variety of ways when not presented with binaries and/or pre-established response choices. In addition, the non-response rate to questions decreased and the authors received positive qualitative feedback. The authors also present the revisions to the intake/research materials. Practical implications Other healthcare settings/clinicians can revise language in order to remove significant barriers to treatment and in doing so, be welcoming, non-pathologizing and empowering for LGBTQIA+ consumers of mental health services (as well as for non-LGBTQIA+ consumers who are in non-traditional relationships). Social implications This work is one step in improving healthcare and the healthcare experience for LGBTQIA+ communities and for those in non-traditional relationships. Originality/value This work is set in a public safety-net hospital providing care for underserved and diverse populations. This paper describes the process of revising psychiatric materials to be more inclusive of the range of self-identity are: gender, sexual orientation and relationship status.
Article
Narrative qualitative research design was used to explore the journey of self-acceptance of three transgender individuals throughout the transition process. The primary research questions of this study were the following: (1) How do transgender individuals experience and express their narrative of self-acceptance? (2) How does their level of acceptance in the family and society impact their self-acceptance narrative? Research sub-questions included: (3) How does counseling impact transgender individuals’ self-acceptance throughout the transition process; and (4) What was helpful or unhelpful in counseling? The analysis of narratives through interview and a narrative photo project revealed six superordinate themes that participants shared throughout their process of self-acceptance: (1) Awareness and Self-Discovery, (2) Family Acceptance Levels, (3) Shift in Worldview, (4) Counseling Impact, (5) Influence of Geographical Location, (6) Living in the Ambiguity. A discussion, implications for counselors, and areas of future research are provided.
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There is increased mental-health adversity among individuals with autism spectrum disorder. At the same time, sexual and gender minority groups experience poorer mental-health when compared to heteronormative populations. Recent research suggests that autistic individuals report increased non-heterosexuality and gender-dysphoric traits. The current study aimed to investigate whether as membership of minority grouping becomes increasingly narrowed, mental health worsened. The present study compared the rates of depression, anxiety, and stress using the DASS-21 and Personal Well-Being using the personal well-being index between 261 typically-developing individuals and 309 autistic individuals. As membership to a minority group became more restrictive, mental health symptoms worsened (p < .01), suggesting stressors added. Specialized care is recommended for this vulnerable cohort.
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Previous research studies have indicated that intergroup contact between heterosexuals and lesbian, gay, and bisexual (LGB) individuals has been associated with more positive feelings about and understanding of the LGB community. The current study examined how closeness of that intergroup contact between heterosexual, cisgender students and lesbian, gay, bisexual, transgender, and queer (LGBTQ) peers would relate with LGB ally identity and behaviors. Three hundred fifty-three heterosexual, cisgender college students answered questions about their ally identity, knowledge, and behaviors. Close friendships but not coworker-acquaintance relationships with LGBTQ individuals were associated with higher LGB ally identity and behavior measure scores when compared with students who had no such relationships. In the long term, ally relationships can contribute to making the environment safer for LGBTQ people, including students, who may then feel more comfortable to come out. With more out LGBTQ people, close friendships may develop between LGBTQ people and heterosexuals, which could contribute to allyhood.
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Introduction Transgender (trans) people experience stressors related to their minority status which have been associated with increased rates of psychoactive substance use and related harm. Despite this, there is a paucity of evidence relating to the treatment needs of trans people who use psychoactive substances, beyond a small body of literature describing a culture of transphobic hostility in general substance misuse services. This paper aims to describe and compare psychoactive substance misuse help-seeking among trans and cisgender (cis) participants from a large multi-national cross-sectional survey. Methods Over 180,000 participants, recruited from the world's largest annual survey of drug use - the Global Drug Survey - during 2018 and 2019, reported use of a range of psychoactive substances in the preceding 12 months. Five gender groups (118,157 cis men, 64,319 cis women, 369 trans men, 353 trans women and 1857 non-binary people) were compared on items relating to the desire to use less psychoactive substances and the need to seek help to achieve this. Results Trans respondents (n = 1710) to GDS 2018 were significantly more likely to report use of illicit substances (OR = 1.66–2.93) and dependence on cannabis (OR = 2.39) and alcohol (OR = 3.28). In the combined GDS 2018 and 2019 dataset, there were no significant differences between trans (n = 2579) and cis (n = 182,476) participants on the desire to reduce substance use. However, among those who did report wanting to use less, trans participants were more likely to want help to achieve this. Conclusion Trans respondents reported a greater need for help with reducing substance use than cis respondents. Given the deficit of specialist services for psychoactive substance users who are trans, there is a need for a more thorough understanding of the barriers and facilitators to their engagement in general substance misuse services. In the interim, substance misuse service providers require education about gender minority status to help meet the needs of trans clients.
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Youth suicide is a public health problem in India, and young people in school, particularly adolescents, experience heavy psychological burden. Prevention programs, involving peer educators (PEs), have proved useful strategies to address this problem, but their impact on the PEs is less understood, particularly in India. This qualitative study aims to explore the changes observed in PE students who were involved in a ‘mindfulness’ and ‘Support-Appreciate-Listen–Team’ (SALT)-based peer education program to address suicidal behavior in Indian school students. One hundred and fourteen students were trained as PEs in six high schools in Pune to identify and respond to the needs of students in distress. By listening to the narratives of the PEs, their parents, school authorities, and the associated NGO team, we reflect on perceived social, emotional, behavioral, and cognitive changes in PEs. The PEs demonstrated enhanced caring for those in distress both inside and outside school by improved listening skills, self-awareness, care, and empathy. Furthermore, the program had a positive impact on their broad emotional intelligence and PEs expressed increased ownership of life, taking action, and seeking support where needed. The study concludes that mindfulness and SALT-based peer education (PE) programs are valuable for the PEs. This could be used to motivate PEs to volunteer in such programs. Other results are discussed and further research areas are suggested.
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Youth suicide is a public health problem in India, and young people in school, particularly adolescents, experience heavy psychological burden. Prevention programs, involving peer educators (PEs), have proved useful strategies to address this problem, but their impact on the PEs is less understood, particularly in India. This qualitative study aims to explore the changes observed in PE students who were involved in a ‘mindfulness’ and ‘Support-Appreciate-Listen–Team’ (SALT)-based peer education program to address suicidal behavior in Indian school students. One hundred and fourteen students were trained as PEs in six high schools in Pune to identify and respond to the needs of students in distress. By listening to the narratives of the PEs, their parents, school authorities, and the associated NGO team, we reflect on perceived social, emotional, behavioral, and cognitive changes in PEs. The PEs demonstrated enhanced caring for those in distress both inside and outside school by improved listening skills, self-awareness, care, and empathy. Furthermore, the program had a positive impact on their broad emotional intelligence and PEs expressed increased ownership of life, taking action, and seeking support where needed. The study concludes that mindfulness and SALT-based peer education (PE) programs are valuable for the PEs. This could be used to motivate PEs to volunteer in such programs. Other results are discussed and further research areas are suggested.
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Transgender women (in Indonesia known as Waria) still experience social stigma and exclusion in society. This phenomenon is interesting to study because it is related to the existence of transgender women in dealing with stigma and social exclusion. This study aims to describe the way transgender women perceive social exclusion and to describe the construction of their knowledge which, despite facing social exclusion, still maintains their existence. This study used a qualitative-phenomenological study method, using a purposive sampling technique. Data collection was done by conducting observations, in-depth interviews, and documentation. Data were analyzed using qualitative descriptive using symbolic interaction theory. The results showed that transgender women perceive the stigma and social exclusion they faced was manifested by planned actions in the form of conditional neglect and delay in introducing their existence. They respond to social situations they face with adaptive and not frontal. Transgender women's knowledge construction to maintain their existence is passed through four stages, namely impulse, perception, manipulation, and completion.
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Research suggests therapists may be lacking the skills and experience to work with the trans population and may hold a range of personal and professional views about trans people, in line with wider society. The aim of this study is to understand attitudes that qualified cisgender UK therapists have towards this client group, how equipped they feel to work with them and to identify gaps in training and experience. A mixed‐methods, concurrent nested design was used. Data were generated via an online survey. Quantitative data were analysed alongside a reflexive thematic analysis. The politicisation of trans identities has created a toxic debate that has left therapists confused about their professional and personal stance, but there is an earnest attempt to understand this. Therapists are generally supportive of trans people and a majority have worked with this community, but a significant minority of these therapists could be said to hold transphobic views or working practices. Therapists feel ill‐equipped to work with the trans community and are fearful of getting things wrong. Younger, more recently trained therapists are more comfortable working with gender identity, with older, “gender critical” and psychoanalytic therapists struggling the most. The politicisation of trans identities has created a split in UK therapists, and work is necessary to ensure adequate training and ongoing reflexivity regarding personal biases. Clarity and reassurance are needed on the implications of the proposed conversion therapy ban, particularly on exploratory therapeutic work within an affirmative stance.
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Certain features of cyberspace have allowed new forms of minority activism in many spheres of influence. This paper looks at how those features have been particularly appropriate to the life experiences of the transsexual and cross-dressing communities. They have enabled a new community identification category, transgender. This new category has enabled transgender people to acknowledge the transgender self as having an experience outside of the conventional binary dichotomies of sex and gender. Through the experience of the virtual self in cyberspace they have been able to acknowledge an experiential self - an actual self, and become aware of the inade quacies of the self they experience in the real world. This has changed the transgender community's understanding of the legal problems they face and their use of law to tackle those problems. This paper looks at two particular areas in which this new understanding has enabled new forms of activism, and considers how the under standing of the actual self has arisen.
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This paper demonstrates a revised gender scale which we have designed for use in clinical medicine. Our gender schema identifies a continuum of gender identification, and is designed for representation of the self, rather than being primarily relational. In addition, it accommodates ungendered and "other gendered" identities, and permits evolution of the self-perception over time. It is intended to be used in a primary medical care setting, by providing patients with blended identities or other gender concerns with a mechanism with which to discuss these issues with their treating physicians. Its clinical application will be illustrated through the histories of three prototypic individuals, all of whom are genetically female, but only one of whom presented to a gender program. The commonalities in childhood and adolescence among these three people, and their differing adult gender identities, will also be discussed. Currently, one has undergone sex reassignment and is now a man. The other two consider themselves genderblended, and have incorporated this identity into their adult lives. Our goal in presenting this paper is to encourage discussion of gender identity in general medical practice and to improve the medical care of patients with non-traditional gender identities.
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This study employed focus group methodology to evaluate the impact of the first HIV prevention education workshop targeting the transgender community. The impact on AIDS awareness, knowledge, attitudes, and risk reduction; participant satisfaction; and suggestions for program improvement were assessed. Qualitative analysis of the discussion transcript indicated the following: a panel of transgender persons with HIV/AIDS enhanced AIDS awareness and perceived susceptibility to HIV infection, sexual negotiation role-plays facilitated risk reduction by helping participants put knowledge into practice in a transgender-specific context, and assessment of personal risk and the development of an individualized prevention plan appeared effective. Participants suggested paying more attention to the context in which HIV risk occurs, integrating HIV prevention into transgender-specific sexuality education, and diversifying recruitment and intervention strategies to target hard-to-reach subgroups of the transgender population.
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Outlines and challenges some prevalent myths and misunderstandings that have made it difficult to develop appropriate curricula and relevant counseling/therapy competencies for the different cultures in the US. Cross-cultural counseling/therapy is defined, and the adoption by the American Psychological Association of specific cross-cultural counseling and therapy competencies is recommended as a guideline for accreditation criteria. (43 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
• Although medical interest in individuals adopting the dress and life-style of the opposite sex goes back to antiquity, surgical intervention is a product of the last 50 years. In the last 15 years, evaluation procedures and surgical techniques have been worked out. Extended evaluation, with a one- to two-year trial period prior to formal consideration of surgery, is accepted practice at reputable centers. Cosmetically satisfactory, and often functional, genitalia can be constructed. Less clear-cut, however, are the characteristics of the applicants for sex reassignment, the natural history of the compulsion toward surgery, and surgery's long-term effects. The characteristics of 50 applicants for sex reassignment, both operated and unoperated, are reviewed. The results of long-term follow-up are reported in terms of such indices as job, educational, marital, and domiciliary stability. Outcome data are discussed in terms of the adjustments of operated and unoperated patients.
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Research on transgendered individuals has tended to come from medical, psychiatric, or deviance perspectives, with little attention to the social context in which these individuals exist or their efforts to resist normative expectations of sex and gender. Based upon in-depth interviews with 65 masculine-to-feminine transgendered individuals, this research examines gender as a social institution. Focusing on the pressures experienced by individuals to maintain binary enactments of gender, we demonstrate how the institution of gender is taken for granted as a presumably natural aspect of social life. Social pressures to conform, experienced as desires for relationship maintenance and self-preservation, as well as the overwhelming need to actualize an identity that does not fit within the binary system of sex and gender, illuminate the gender resistance and conformity exhibited among the individuals in our sample. Our analysis is rooted in an expanded Foucauldian perspective incorporating the theoretical insights of contemporary feminists who consider social actors as active agents in the development and enactment of everyday resistance. Transgenderism is a discursive act that both challenges and reifies the binary gender system. As such, it provides important lessons about the power dynamics of gender and how such systems may and may not be resisted.
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Academic psychologists' treatment of `sex' as an ahistorical, pretheoretical notion in theories of `gender' is compared and contrasted with knowledge produced by persons whose own gendered embodiment is outside binary gender/sex categories and whose moral agency is erased by theories depicting them as exceptions to a binary-based scheme. This latter knowledge, emerging from an activist community's reflections on its own personal/political praxis in relation to dominant social institutions and ideologies, has selectively incorporated, challenged and transformed gender/sex discourses in significant segments of medicine and academic disciplines other than psychology. Psychological theories continue to reproduce binary categories (and practices organized around them), in part because they incorporate only some of the implications of a social constructivist perspective, and in part because psychologists seem to theorize gender/sex in isolation from other knowledge-producing communities.
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Drawing on data from interviews with 65 masculine-to-feminine transgenderists, the authors examine the coming-out experiences of transgendered individuals. Drawing on the literature that shows gender to be an inherent component of the social infrastructure that at an individual level is accomplished in interaction with others, they demonstrate that interactional challenges to gender are insufficient to challenge the system of gender. Whereas many transgenderists believe that their actions and identities are radical challenges to the binary system of gender, in fact, the majority of such individuals reinforce and reify the system they hope to change.
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The study of self-narratives thus far has sought to discern the internal structures of the stories people tell to give meaning to themselves. This approach, however, neglects the interactive processes through which self-narratives are constructed. By studying preoperative transsexuals, who are preparing for a radical identity change, one can observe the interactive processes through which stories are used to construct a new self. Based on participant observation in a transgender support group, in-depth interviews, and analysis of written materials, the present study shows how transsexuals collaborated, through modeling, guiding, selective affirming, and tactful blindness, to fashion biographical stories that defined into existence a differently-gendered "true self." It also shows how dominant gender ideologies provided resources for fashioning plausible self-narratives.
Article
Drescher, Foreword. Introduction. Beyond Narcissism: Toward a Negotiation Model of Gender Identity. Gender Benders/Gender Binders: A Psychoanalytic Look at Contemporary Popular Culture. Who's That Girl? Madonna. Trauma, Gender Identity, and Sexuality: Discourses of Fragmentation. Blue Velvet: A Parable of Male Development. What Is a Man? Postmodern Challenges to Clinical Practice. A Deconstruction of Kohut's Concept of Self. Performance Theory, Act 3: The Doer Behind the Deed Gets Depressed.
Article
In April 1991, the Association for Multicultural Counseling and Development (AMCD) approved a document outlining the need and rationale for a multicultural perspective in counseling. The work of the Professional Standards committee went much further in proposing 31 multicultural counseling competencies and strongly encouraged the American Association for Counseling and Development (AACD) and the counseling profession to adopt these competencies in accreditation criteria. The hope was to have the competencies eventually become a standard for curriculum reform and training of helping professionals.
Article
"Bisexuality" presents a state-of-the art glimpse of what is known and what remains to be known about bisexuality. Editor Beth A. Firestein gathers together . . . researchers, activists, educators, theorists, and clinicians to offer insight into this understudied sexual orientation. Written in a scholarly but accessible style, this . . . collection of essays provides a focused, comprehensive introduction to research, theory, and practical clinical knowledge about bisexuality [for professionals and students in bisexuality studies, gender studies, sociology, family studies, human sexuality, social work, and clinical/counseling psychology]. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Like its predecessor—which awakened the therapeutic community to the varying assumptions, needs, and biases of culturally different clients—this updated and revised "Second Edition" opens new doors and lays the groundwork for exciting new directions. While the overall approach has remained the same, there is heightened emphasis on the damaging effects of political and racial biases inherent in the mental health field and on the need for developing culture-specific communication/helping styles for culturally different clients. Also highlighted are the key issues of ethnic and racial identity formation and culturally specific concepts of the family and their relationship to counseling. "Counseling the Culturally Different" moves from the theoretical to the practical in three sections covering: Issues and Concepts—provides a conceptual framework with which to view the complex interplay of values, expectations, and social and political forces in the counselor-client relationship and the practice of cross-cultural counseling in public schools, mental health agencies, industries, and correctional institutions. Counseling Specific Populations—guidelines and detailed methods for counseling specific minority groups (including African Americans, Hispanics, American Indians and Asian Americans). Critical Incidents—a series of case vignettes portraying typical issues and dilemmas. Combining a sound conceptual framework for multicultural counseling with proven therapeutic methods for specific groups, "Counseling the Culturally Different, Second Edition" prepares students, like no other text in the field, for the rigors of counseling in the "real world." At the same time, as a source of enlightenment and guidance for professionals, it has been proven to make a difference in clients' lives. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Thesis (Ph. D.)--University of Windsor, 1997. Includes bibliographical references (p. 258-282). Photocopy.
Article
Although medical interest in individuals adopting the dress and life-style of the opposite sex goes back to antiquity, surgical intervention is a product of the last 50 years. In the last 15 years, evaluation procedures and surgical techniques have been worked out. Extended evaluation, with a one- to two-year trial period prior to formal consideration of surgery, is accepted practice at reputable centers. Cosmetically satisfactory, and often functional, genitalia can be constructed. Less clear-cut however, are the characteristics of the applicants for sex reassignment, the natural history of the compulsion toward surgery, and surgery's long-term effects. The characteristics of 50 applicants for sex reassignment, both operated and unoperated, are reported in terms of such indices as job, education, marital, and domiciliary stability. Outcome are reviewed. The results of long-term follow up data are discussed in terms of the adjustments of operated and unoperated patients.
Article
The purpose of this study is to examine the male to female transgender social networks and how they influence social and political activity. Four Transgender organizations within Northeast Ohio were contacted for this study. Members were asked to complete a questionnaire and to mail it back. Few of the network elements were useful in predicting social and political activity. Network size has a positive effect upon a person's social and political activity, as did meeting attendance. This study suggests the importance of social networks for Trans-people.
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