Gender Dysphoria in Counselling

For the early April FellsandDales Counsellors, Arlene Istar Lev’s book, Transgender Emergence, (Therapeutic Guidelines for working with Gender-variant People and Their Families, Haworth Clinical Practical Press, 2004,) provided background reading. Chapter 6 explores ‘Learning to Listen to Gender Narratives.

Peter, who provided this material for this CPD session, presented some of his experience in previous years of clients with gender dysphoria. He shared the experience he had had of being disoriented and his experience of considerable incongruence within himself.

The Lev chapter was significantly helpful in its description of three approaches that others have noted are commonly identifiable:

• Client struggling with Gender-Dysphoria feelings
• Clients seeking Medical Treatments
• Clients presenting with Family-Related issues.

Lev’s research and survey of therapists experience includes therefore that the client’s ‘transsexual narrative’ might be the basis for ‘diagnosis and treatment’ and that that narrative contains certain basic criteria without which the term transsexual cannot be valid. These are (p.213):

• Non erotic cross-dressing and cross-gender behaviours, interests, and expression starting at a young age
• Disgust regarding genitalia and secondary sex characteristics with a desire to change or remove them
• And an ability to “pass the real-life test” which includes full-time living in the new gender, often including paid employment or full-time school attendance and proof of legal paperwork changes.

The group members were aware that clients who knew about these themes whether or not they meet the criteria do, if for example they are seeking medical treatment and gender reassignment in particular, will demonstrate compliance by dissembling or lying.

The group were also able to share various experiences with clients where the complexities of our own conditioning, when faced with gender ambiguities, bring about uncertainty and difficulty in listening empathically to our clients. Clients, of course, are likely to sense our uncertainty, and possibly therefore intuit that their own agenda is not going to be met, or register discomfort and give meaning to  it that confirms their repeated experience of not being listened to by professionals.

The chapter, it was acknowledged, does provide very helpful analysis of what may be in the room with us. It would therefore be of  great benefit for reading in preparation should we be fortunate enough to know that gender dysphoric issues were to be  presented. It is possible that such preparation might enable us as therapists to stand on firmer ground from which to observe the array of themes, characteristics, and personalities that are in the room with us. It is possible that such preparation might permit us to really be listening to the client, perhaps to different ego states, maybe to evident mental health issues, and therefore be better able to explore client history objectively without the tangle of counter -transferential responses that otherwise can destabilise us.