Transgender is an umbrella term, encompassing all nontraditional gender expressions, including, but not limited to: transsexual, cross-dresser, gender-bender, gender outlaw, gender queer, and drag king/queen. There are many diverse ways of being transgender. For example, not every transgender person is interested in changing his or her gender presentation (such as from male to female). Instead, some transgender people wish to expand or discard traditional definitions of gender.
How can Family Therapy Help Transgender Clients?
Transgender clients and their families seek therapy for multiple reasons, which are not always because of gender-related concerns. Thus, family therapists do not assume that gender is at the center of the family problem. However, family therapists find it helpful to be sensitive to transgender issues in order to identify when/if gender-related issues may be intersecting with other issues. Conversely, many transgender people do seek therapy for gender-related concerns and the direction of therapy will differ depending on the client’s needs. Typically, transgender people and their families seek the services of family therapists for issues related to gender questioning and exploration, assistance in obtaining medical treatments, and relational difficulties.
Types of Transgender Issues
The first group of clients recognizes feelings of gender variance, but may not know what to do about their feelings. When clients seek therapy while questioning their gender identity, family therapists adopt a client-centered stance, understanding that different clients see the issues differently. Because there are many possible expressions of transgender, when clients do not have a clear picture of how they wish to express gender, family therapists assist them in exploring possibilities. The goal is to find an expression of gender that feels most genuine. During this exploration process, therapists often assist clients in developing social and self-help connections with other gender variant people. With gender-questioning clients, therapy also includes a critical examination of the societal constructions of gender, opening up options outside of the traditional female and male identities.
While a full gender transition may be the best option for some, therapy explores other gender expression possibilities. Therapists often do this by discussing with clients what it will be like if their real desire is not to transition, but to blur the lines of gender. Complete gender transition may seem like a simple solution at first for many transgender people, however the realities of transitioning and passing can be difficult and sometimes unrealistic (financial limitations, passing prevented by body type). Some clients feel more comfortable when they stop focusing on passing as their preferred gender. Thus, clients may choose to take steps towards altering their presentation of gender (like a name change or hormone treatment) and choose not to pursue other steps, like surgery. There are as many different healthy expressions of gender as there are transgender individuals.
The second group of clients seeks therapy with the primary goal of obtaining a recommendation for medical treatment. These clients have a clear vision of gender transition and therapy is structured to assist them with this goal. Family therapists work to ensure that clients have the emotional stability and social support needed to cope with the challenges of transition. Due to society’s rigid gender conceptualization, transgender clients are subject to the stress of not fitting the norm. Not surprisingly, it is common for transgender people to exhibit mental health symptomology. Therapists will consider accompanying mental health symptoms and help stabilize clients so they can make centered decisions about transition. Assisting clients in gender transition often reduces gender-related stress, possibly helping to also reduce mental health symptoms.
The third group of clients seeks therapy for relational issues. In these cases, the family or partner of the transgender person is typically involved in therapy to create deeper understanding and integration of the transgender identity within a relationship. While some parents do not react intensely to their transgender child’s disclosure, other parents have described it as a profound, personal crisis, characterized by strong emotions such as shock, confusion, devastation, fear, and grief. Partners of transgender people may have similar responses if they were unaware of the transgender identity; however, many partners are supportive and couples may seek therapy to deal with the implications of transition, like a new definition of the relationship. Family therapists working with transgender clients and their families both acknowledge and normalize the seriousness of the family disruption.
Ways to Support Transgender People
Due to the challenging and life-changing effects of transition, transgender clients are in need of social support. This support may come from inside and/or outside the family system. Family therapists inquire about the coming out process and explore the risks and dynamics of further disclosures. When adequate support is not found within the family, therapists assist clients in finding alternative support systems, such as continued therapy, connections with other transgender people, friendships, and the Internet.
As clients take steps in gender transition, the decision naturally becomes apparent to more people in their lives, whether or not the client discloses the information. Coupled with society’s low level of understanding transgenderism, gender transition is a process often characterized by stress and misunderstanding. For example, clients often face opposition in the workplace, such as conflicts over whether the employee should use the women’s or men’s bathroom. Therefore, the role of family therapists may include advocating, educating, and consulting with employers, co-workers, teachers, family members, neighbors, and friends.
In cases where family members are angry, intolerant, and/or rejecting of the transgender identity, sessions may not initially include the transgender family member. Family therapists can serve as a sounding board for negative emotions, educate family members on transgender issues, and explore new understandings of the transgender individual. Therapists assist family members to: seek information, exposure, and support; understand their transgender person’s suffering and alienation related to gender identity; understand the politics of gender; help navigate how to disclose the information to others; and realize that the transgender person is essentially the same person on the inside as they always were. Once family members have had time to process some of their own experiences around the disclosure, family therapy including the transgender person may help families repair and redefine relationships, foster healthy communication of emotions, and nurture closeness.
The text of this brochure was written by Deborah Coolhart, PhD and Anibal Torres Bernal, PhD.
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