The Client Leads in Effective Gender Counselling.
BSC., RGN, PGDC, Gender Counsellor, Nurse, Researcher, Poet, Sussex
Not to seek and have any effective counselling during gender transition is to invite problems later. Some clients feel they need and do need long term counselling, whilst others seek counselling as a form of crisis intervention or to help them to think through what they want to do, can do or can not do, and will do, about their gender identity conflict: or whatever issues may arise connected with this in themselves or their loved ones. They too be they parents, partners, children or siblings, or indeed employers may need or seek an experienced counsellor.
I will start with some definitions:
Client "one who employs a professional"
Effective "causing something successful in producing a result"
Gender "is expressed in terms of masculinity or femininity. It is how people perceive themselves and how they expect others to behave towards them or others."
Gender Dysphoria refers to "dissatisfaction with the fact that one's gender is in conflict with one's physical sex"
Counsellor - a person who goes to a counsellor is "one who employs a professional advisor" In fact a good counsellor does not direct or advise as such, but helps a client to find her or his own direction.
Counselling "A service consisting of helping people to adjust to or deal with personal problems etc., by enabling them to discover for themselves the solution to these problems whilst receiving sympathetic attention from a counsellor".
I would add that it must be within a framework such as the British Association of Counsellors Code of Conduct, being confidential, carried out by trained therapists, is unexploitative and has clear boundaries.
Client led or client centred counselling is that which adopts the methodology suggested by Carl Rogers et al.
It is a therapeutic process, which is not static nor rigid, it is a skill which includes psychotherapeutic and psychological assessment and evaluation.
It is dynamic, but it is not prescriptive or directive. Empathy is important in maintaining trust and seeking inner truth. The client identifies what the problem is using this process and moves towards finding a meaning or a solution, a way of coping or of being. This therapy is a sort of journey of discovery an evolution towards a sense of wholeness and well-being.
Gender identity conflict is when the dysphoria becomes a matter which needs to be addressed, since the person so affected is deeply distressed by this.
What is the role, purpose or goal of counselling?
In "Client led" counselling I would suggest the client will describe what he or she feels is the problem and the counsellor's task is to assist the client towards finding what the actual problem may be, and consider how this could be addressed. In doing so the client grows less confused by the layers of feelings and more able to resolve the difficulty.
What is my methodology?
As you will have guessed my training was eclectic but based largely on the work of Rogers. I do employ some gestalt, transactional, dream and other therapies. I also believe that the work of Individual therapy by Windy Dryden is particularly useful here, especially in crisis management; It is rational emotive and cognitive.
In trying to help clients to overcome their difficulties and achieve their self enhancing goals, rational and emotive therapists have clear and well defined aims. There is agreement on roles and tasks. Flexibility is the key concept underlying this. This method challenges irrational beliefs and involves a client taking personal responsibility for her or his actions with client and counsellor in an adult to adult transactional relationship. This process can be rapid or protracted, but does mean that the client has a fuller understanding of her or his feeling, goals and solutions.
How am I qualified?
I studied for three years for a Post Graduate Diploma in Counselling Psychology (PGDC) and I have a good deal of experience. I see many clients, but since I guess I am something of a specialist with 34 years involvement in the "gender scene", a scientific background, 23 years in nursing, three years post graduate training in counselling psychology and ten years in professional counselling I do seem to see many clients who have problems with their gender identity, or those who are affected by having a loved one who is so affected, which also challenges them in some way be they partners, parents, children, family, friends or even employers. I have provided training and talks to other counsellors who are unfamiliar with this type of client, worked with employers, groups and couples.
I have also assisted researchers, written a "Guide to Transsexualism, Transgenderism and Gender Dysphoria" and much else, as well as working with SHAFT, founding the Gender Trust, GEMS and GENDYS and so on.
The majority of my counselling work is on a one to one basis. It is always confidential. The diversity of my clients is not unrepresentative, as I feel sure clinicians in the field would admit. However there are of course common themes. There are also a range of very different people with diverse experiences, varying feelings and problems, arising from a number of causes. I will illustrate this by bringing some of them to your notice. First I should explain why it became necessary for me to become a trained counsellor.
Why Gender Counselling?
The first time I was aware of how much suffering and lack of understanding could affect people with gender dysphoria was in 1963. I saw a group of people standing round a tree beside Shoreham Harbour. Hanging from this tree was a child of about twelve years old, hanging by her tie. She was dressed in school uniform, her face was ashen and the body stiff. She had short cropped hair, her feet in white socks dangled above the ground. The police were photographing the body. As we could all see she was very dead. A man accompanied by a policeman arrived, and almost shouted "the little bastard, yes that's my son."
The child had been unable to talk to his parents and had dressed in his sister's school uniform to kill himself. We all must realise only too well how wretched and despairing it can feel as a child with nobody near who might understand. If only there had been someone. She could have been any of us.
Why is there a need for qualified help?
In response to the need for a support system we founded the Beaumont Society in 1966. I found myself meeting all sorts of transsexual and transvestite people, their partners and friends. Two I will mention here.
I was asked to help an FtM transsexual who wanted me to help as the relationship he had with his long term lesbian partner was getting very rocky. They had met as women nine years earlier, eventually bought a house with a lovely garden and two dogs, which seemed to be replacement children. He said that the problem was that his partner said she had fallen in love with a woman, but now, as she had said, her lover sounded like a man, smelt like one, dressed like one, was taken as one by others.
It threw this woman into confusion. As she herself explained she had never envisaged being attracted to a man, was content with her own sexuality as a lesbian, still loved the person, but could not relax as her partner became more and more masculine with his androgenic response to hormones.
They had invested years together, liked, even loved each other, but she could no longer fancy him, as her partner moved physically inexorably towards his own masculine identity. Eventually they split up, with heart breaking attempts to be reasonable. The most practical thing they did was to go for joint custody of the dogs, who spent alternate weeks with one or other of them. Eventually she did find another woman partner. His closest companion is still his dog. Neither of these people behaved badly or unkindly. If anything, because he felt he had brought the problem to them, he was inclined to be unrealistically generous in the division of property. If he had not felt so guilty perhaps he would have been financially fairer to himself. Talking to each other, listening and caring, talking to a third party certainly seems to have helped.
A rather bizarre situation came to my notice around the same time. A mother wrote to the Society asking that her son could join the BS. A rather nondescript little forty year old man in a grey suit came to the sponsorship meeting with his mother. He, it transpired, was a civil servant. When each day he got home from work his mother would have laid out a complete set of women's clothes for him to put on. It had been so since childhood. She had even tried to get him into a girls school when he was seven. Though she failed, he would have to change when he got home from school.
Needless to say he had no friends and he actually found this intense unnatural relationship with his mother stifling. He would appear at BS meetings dressed in old fashioned female clothes, always with his mother in attendance. It transpired that she had been sexually abused as a girl, then had a violent abusive husband. He had been killed in the war. She told me she was glad and hated men. She wanted a daughter and despised the fact she had had a little son, so she made him somehow into her replacement daughter. It seems like an act of vengeance on the male sex.
Needless to say as her son began to open up and asked to go to things on his own she became jealous. We heard that she had committed suicide with a plastic bag over her head. Two weeks later the son was found dead crouched in his mother's wardrobe, dressed in her clothes with a plastic bag over his head, flex round the neck. He couldn't cope with life without this tyrant and had performed a copycat suicide. In a sense he had been smothered by his mother. I know that this sounds like the film "Psycho", but it did happen in Surbiton of all places. One wonders whether he had left this damaged awful parent if he could have found a more reasonable life.
I do not think he was either a TV or a TS, they are not made by their parents, but as Philip Larkin writes in his poem "Your parents fuck you up . ." His brainwashing by this abusive mother did not create a trans-person, but someone who crossdressed to satisfy his mothers twisted mind. He became a victim of her ongoing abuse who was never able to cut that strangling umbilical cord his mother held him with. Who could have helped him in the vacuum which was left when she had gone?
As time went by it became clear to me I needed to learn not to take all these people's pain on my shoulders, so I went for Counselling training. In the course of this I met all sorts of clients, mainly via Brighton Area Health Authority. They knew of my work with trans-people so I did get more than my fair share of them as clients.
As a trainee counsellor I came to realise how self empowering it is to receive counselling, and that since any life is stressful it is beneficial to get appropriate help in learning strategies which are enabling.
Who are the Clients?
You do not have to be in any way flawed or ill or inadequate to benefit from counselling. When we have a problem or difficulty doesn't it help to talk to someone? We have all been given unwanted advice by well-meaning friends and others, shared confidences and had them dismissed or ridiculed or worse still had a confidence broken.
Safety, confidentiality, an empathetic, independent person with no axe to grind, no personal agenda, save to try to help you to cope better with your feelings and difficulties seems like a good idea doesn't it? That is genuine counselling.
People are diverse, no two are alike, however much we may tend to slot them into a type, or indeed pathologise them with a diagnosis without a look at the whole person. It is reasonable that they have adequate time, safety and should be allowed the "luxury" of being heard. I would suggest that gender identity conflict is one of the most difficult matters to come to terms with. There is little or no understanding of it from many in even the caring professions, or by the usual backup systems like family, religion, civil rights or law, though things have vastly improved over the last 40 years.
No proper audit has been published of this group of people, but I would suggest that prior to treatment being available the suicide rate was astronomic, and with treatment as it is, it still often fails these people. There are social, residual, practical, peripheral, legal and other difficulties, besides getting the body in tune with the mind: even when they are singing the same song, how little celebration there is by society of a person cured, made more complete?
I will not here talk about typical cases, none really are anyway, but will present a few of my clients who were particularly interesting. In bringing these extreme cases to your notice, I am trying to illustrate the range of problems that can come up besides the more straightforward questions as to whether a person is TV or TS, for example.
In the context of counselling in the 1994 Gendys Conference Report I discussed a client who had two persona, one Debbie Reynolds, the other Lee Marvin. He would dress up as either and watch videos of them imagining he was the hero or heroine. His dressing did not seem to be about sex or gender, but more about brightening up a very boring life. He was described then as being educationally sub-normal and worked as a cleaner. The problems arose when either a cowboy or Debbie Reynolds turned up to work. He got a lot of stick from local kids and found it hard to keep his rented room or his jobs.
Although what he did was harmless, his lack of boundaries and perception did mean that he got himself into trouble quite often. He told me he would have liked to have been a woman, or a man, but mostly what he was saying was that he didn't like being himself. He had had a dreadful childhood in homes and with foster parents. He could barely read or write and had a vacant expression, but when he talked of his videos and how he could become someone brave and strong or graceful or glamorous his eyes lit up and as he talked with his version of a Yankee accent, his hands, which were normally at his sides, would dance. Like the rest of us he had an imagination. Eventually we found him an employer who didn't care what he looked like so long as he did the work, night cleaning.
One of the worst cases I came across locally was that of a 24 year old woman who presented having been traumatised by her GP. Time was the problem and a complete lack of empathy. She was very attractive, worked in radio, was brought up as a happy little girl, had boyfriends and an ordinary happy life. She eventually lived with a boyfriend with whom she had a good sex life and intimacy. After some time he noticed and mentioned that it seemed odd that she did not menstruate. This being true, she went to see her GP. It had not bothered her before, in fact she felt she was fortunate to have avoided "the curse".
He examined her and found nothing, however he did take a buccal smear and said, "come back in a week". When she did he said, without a blink, "the problem is that you are a man". She was devastated. In fact she had XY chromosomes and Androgen Insensitivity Syndrome. He merely said that with AIS she should have her testes removed as they might become pre-cancerous and he arranged for her to see a surgeon. His medicine was right, but his manner was appalling.
Her confidence as a woman was smashed, nobody had explained that as her birth certificate was right so she could marry. However she had not been told she could not give birth to children. She would need to consider adoption and discuss this with her fiancee. She needed to work through her anger, her loss of confidence and the issues of motherhood. Fortunately her boyfriend stood by her. Some less confident men would not. Had the GP handled this delicate matter with a little more care and tact she might have been spared so much shock and horror.
One interesting case was that of a 73 year old widower who started to dress after the death of his wife. In a sense he was trying to recreate her in himself. The trauma of her loss liberated his need to become the woman he loved and his own feelings about how he wished to dress. He did not want surgery, but lived cross-dressed, enjoying gardening in his frock. His eldest son thought his father had gone mad and refused to see him "dressed up". When his father died a few years later I gather from the daughter, who did understand, but thought it eccentric, the son insisted that contrary to the old man's wish to be buried in his night-dress, that no mention of "all that" be made and his dead parent's last wish was ignored. The son burnt all the clothes, diaries and effects of his father as a woman. Perhaps the son needed counselling himself - or a kick up the backside!
One person I came across in my nursing work was a 45 year old man with M.S. He told me that he wished to wear women's clothes, not pyjamas. We nurses went to his house four times a day as he was tetraplegic, and he could no longer dress or feed or change himself. I was able to persuade the District Nursing Officer to comply with this poor soul's wishes, so the nurses did put him in night-dresses after all. As one SEN explained it was easier than pyjamas anyway. So we left him smiling watching his TV. He said it was the first time in his life he felt really happy. Oddly he had never chosen a female name, but I am sorry to say he died before he finally decided on one he really liked.
Another interesting person I tried to help was a woman who was turned on by her boyfriend's cross-dressing, since, as she said, he looked wonderful dressed up and was fantastically good lover when so. She liked his feminine-masculine mix. But when he said he wanted to have surgery she became anxious and they started to row. It seem what she wanted was a woman who could make love like a man. She explained "After all I'm not a lesbian, I like willies" I hope she found a suitable glamorous amorous transvestite in the end.
Later I came across another couple who sought my help. He was a gay man who had lived with this very pretty boy who dressed very effectively as a girl. The boyfriend eventually had paid for her surgery, but went right off her once it was completed. She was no longer what he fancied. She had worked in the sex industry with gay clients, she returned to this work. Now her surgery was complete she found the punters paid her much less for her services, though some seemed pleased by the fact she had been male, this was the curiosity factor. I believe that she is still on the game, but is into alcohol abuse and soft drugs. She has almost no self-esteem and hates the punters as she describes her clients. Her work pays for her habits, not for a fulfilling life.
By bringing some of these clients to you I am attempting to show something of the diversity of matters which need to be addressed, and the diversity of clients themselves, not simply the issue of being someone with gender identity problems. Often the real problem is deeper seated. Only the client holds the key to this.
A considerable part of the counselling process in gender counselling is to help a client to find a place in the gender spectrum where she or he feels comfortable, abolishing the tyranny of labels: of gender, of sexual, or sexuality, polarities, so they can be honest with themselves. It is important to use a vocabulary the client feels comfortable with and to avoid psycho-babble, but rather to concentrate on the issues.
Themes and variations:
I have talked at some length in my "Guide to Transsexualism etc." about common themes which do recur with many Gender Dysphoric clients, such as "What am I, TV, TS, TG, gay or mad?".
There are guilty TV's who try to rationalise their guilt by saying that they are really TS so that it is not their fault, and TS's who feel certain they are intersexes or hermaphrodites for the same reason. If we take fault and blame out of the equation it is more possible for them to be themselves and hopefully take responsibility and pride in that. Bags full of guilt seem to be carried by many trans-people, who feel often they have let others down, are not good enough, are to blame in some way for being as they are.
I have a growing conviction and some evidence, that transsexualism may in some cases be reactive rather than innate. That is to say in these cases it is a reaction against being a man (or a woman) rather than there is an irreconcilable conviction of belonging to the other sex.
There are those who seek a solid answer as to why they are as they are, TV, TS or TG or whatever, and theorists try to find reasons for these identities or behaviours. There is the 'nature versus nurture' debate and the "genes are your destiny" advocates to deal with. Behaviourists, predeterminists, geneticists, endocrinologists and neurologists provide varying evidence, but there is no litmus test, no "cure" and no single answer to these questions.
The "why's" are it seems often as important to a client as the "where to now's?" These questions nag away at clients together with moral and religious questions. I may add as a Christian, not helped by the so called Evangelical Alliance. It amazes me that some fellow Christians (and some more strident Moslems and Orthodox Jews) can pontificate about what is right or wrong for others. A chosen few with a vengeful god feel it is reasonable to judge others. Archbishop Desmond Tutu put it succinctly, " If God created an individual in order to punish or despise them, then he is no god of mine and I certainly could not worship such a god". The Bible, Tora and Koran are each interpreted by people who derive their own code from books from which complete contradictions can be chosen.
Nobody now advocates the stoning to death of adulterers or exiling of lepers (Except perhaps in Fundamentalist Moslem countries), but some Christians use words like stones to crush others they see as not as good as themselves. It seems some "religious" minds find satisfaction in condemning others instead of looking to themselves. Hypocrites and bigots are dangerous, but to collude with their view is self destructive.
There is a tyranny of labels, some partners who are horrified at the label lesbian, yet who still love and care about their TS partner and do not know how they will cope, or if they can cope with these changes. There are others with concerns for their children's own gender development if their father is becoming a woman, although the evidence is contrary to the myth that they will "become" gay, trans or otherwise not themselves. Often a messy divorce may occur which in fact does damage the children.
Then comes 'telling not telling', 'coming out', who to tell and what to tell and all that entails. Getting or keeping work during the RL Test does involve a lot of courage and resolve from the client if they are already established in one gender at work. Finding a good job was never easy for anyone, and keeping one when in fact your employer finds you an embarrassment is not easy whatever the legislation says. This period and the first few months after surgery I would suggest are the most difficult times. Often family, partners, employment are all gone and the only support is from sisters and brothers in the gender support organisations.
Use of positive versus negative lists is helpful if a client needs to clarify what the emotional, practical, social cost to him or herself might be if they decide to change over, come out, or seek medical intervention or go on in the same way.
Listing the difficulties / disadvantages vs. advantages and setting realistic goals does often help. Dream therapy, where a client walks the counsellor through her dreams in the present tense also is useful way of reaching unconscious anxieties and aspirations. Role playing may help to understand a parent or partners view a little better, positive and negative reinforcements and challenges of uncognitive beliefs may help to develop a sense of personal worth in a client.
I find many clients have other problems which can not be detached entirely from their gender issues, problems of depression, phobias (especially a paranoid view of the public), insomnia, alcohol abuse, and adult victims of child abuse). I carried out a survey of 102 transpeople published in the Gendys2 Conference Report, which give some idea of the problems encountered (by people largely not in counselling), and the variety of responses and diversity of people who replied to the survey.
Uncognitive beliefs and colluding with ideas about how a woman or a man should look or behave can cause considerable problems. Of course so can society's stereotypical view of all women and men. Try being a large woman and finding an outfit in your size not designed for someone in her eighties!
A client may have big feet and believe that no woman has the same problem, she may think she looks good at fifty dressed like a teenager, whilst other women would be reluctant to draw attention to themselves in that way, save perhaps at a disco. Even then, mumblings of "mutton dressed as lamb" will be uttered by the ungenerous.
Of course a certain amount of common sense as to how we present has to be employed to get a balance between what a person feels good wearing, or appearing as, whilst fitting in, being conventional rather than attention drawing. Radical drag challenges all this, but you have to be a strong personality to put up with the attention you may draw to yourself.
A small man may overcompensate by being bossy, but don't they all? Sorry chaps. That's sexist, sizeist and stereotyping!
Equally a large woman may try to take up as little space as possible and skulk in the shadows, which in fact will draw attention to herself.
There are practical cognitive considerations, passing, employment, finances, accommodation and area, age, access to children and relationships with family.
Then come all the "oughts" and "shoulds": women cannot do this or that. I find that many trans-people have very stereotyped ideas about what a woman can or should or should not do, or be interested in. Perhaps it is an anti-male/ masculine reaction which makes a new woman believe that she has had half her brain removed as well as had her GRS. To adopt a lifestyle or a belief that all women do is shop, go clubbing, talk about clothes and housework, take up dressmaking and needlepoint, is a real Women's Own stereotypical view of life. It is also an outmoded view of the life of a woman in the Millennium. I guess what I am saying is that it is not necessary to throw away the fishing rod, car maintenance equipment, hobbies and interests which have formed a happy part of a previous life. Modern women spend as much time in jeans doing DIY as a man, and often as well as a man. Interestingly many post-op women do report that they are not half as strong as they were.
Equally a man does not have to be a beer swilling violent lout to be credible.
I would add that these new men tend to have a more liberated view of how they "should" be, after all many were happy tomboys and later in life were feminists.
There seems to be less of a stigma in joining "the right side" in a patriarchy so there are, it seems, less guilt or restrictions in life expectations and goals.
I find many trans-people report bad experiences with the major NHS GIC's, some seem traumatised, most are frustrated by the gatekeeper mentality of the psychiatrists and pathologisation of their condition. People are seen at best four times a year over a period of three years, a total consultation time of perhaps three hours! Is this enough one wonders to assess anything accurately, let alone provide a therapeutic holistic and beneficial service?
The GIC seems to have a role in the U.K. of sorting out a diagnosis and treatment protocol, rather than addressing the needs of all their patients as individuals. Where there are particular problems or multiple pathologies it would seem that many of these patients are and have not been helped holistically by these under resourced and conservative Units in the past.
There seems still to be a culture of antagonism rather than trust between psychiatrist and patient / client/ unit cost. There is a realisation that psychiatrists expected a type to present who could get surgery, so a script developed in which patients lied to the psychiatrists, telling them what they are believed to be expecting to hear rather than the truth; even to the extent of a client saying they were single when they were not.
In reaction to this the psychiatrists expected many of their patients to lie about the RL Test and change in the loo, rather than be living in role. The whole thing becomes something of a farce, and anyway some do inappropriately get surgery before they are prepared, or worse still, when it was not the real solution; whilst others are refused it, or kept waiting interminably to be seen, let alone treated.
There are also problems with funding and post code treatment and rationing which concerns others who have to use the NHS. There is almost no post op' follow-up or audit. It is a sad state of affairs, and I feel certain that if resources included qualified counselling the outcomes could be greatly enhanced in terms of the well being of this client group.
There seem to be a number of people who feel a real downer, a depression after their surgery. The expectation, the goal will have dominated their life over several years and it has now gone. Interestingly part of the process is about bereavement, although they may have gained or lost breasts and now have appropriate genitals they have also lost part of themselves and they are no longer sexually potent. Besides this there is often real anxiety that the surgery might have resulted in them losing their sexual feelings, their libido.
The problem does not stop there. Often the family has broken up. Limited funds were lost in the divorce and paying for surgery, employment may well be less well paid, family may distance themselves, loneliness can result, and there may be the conviction that they still don't pass. There is also often a considerable mood swing when hormones are withdrawn prior to the surgery.
Then come issues of telling, and those of sexual preference. Many want to try out the new equipment too soon. There seem to be plenty of men ready to give them a "good going over" but what of love and lasting relationships?
Our feelings are complex, we are subjects of our experiences, time, place, the decisions we make and others make on our behalf. One-size-fits-all does not apply. Suitability of treatment, outcomes and audits cannot entirely accurately assess how well a client has or has not responded to the help he or she is given. How do we measure happiness, or depression or despair? Some people beset with appalling problems grow and rise before them, whilst others lapse into self pity, suicide or a state of numbness. There's no magic wand. I wish there was. I would buy one!
You have heard the old adage, "Be careful what you wish for, it may come true". If we are too cerebral, always engaging the brain rather than our feelings this is too cold and can be destructive, however if we do not approach life with a reasoned approach and only live by feelings we are in danger of precipitous actions which can hurt ourselves and others.
Counselling attempts to put clients in touch with their feelings and with their deepest sense of ego, of self. A major part of identity or self is based on one's gender, it affects so much the way we see ourselves and how we hope others will perceive us and react to us. As a feminist I find myself asking why this is so important when we are trying to reduce gender stereotypes and working towards a more equal world? Perhaps the solution to the problem is only possible when we learn to see people as not being male or female, black or white, old or young, but as all different and all similar in aspirations, if we can learn to respect one another and ourselves.
To quote Dr Jacob Bronowsy, in his "Ascent of Man", "For the Scientist there is no absolute, all information is imperfect, all we can do is a best estimate, all lies in the area of uncertainty and that of tolerance"
I will finish with one of the poems I have had published, as you may know Virginia Woolfe probably suffered from manic depression, was a lesbian, a founder of the Bloomsbury set, a woman working in the male dominated world of literature. She drowned herself in the River Ouse just near her house at Rodmell, in Sussex. Among the things she wrote was "Orlando", which was based on a book by Sir Philip Sydney, "Arcadia", which in turn was based on a book by Aristo "Orlando Furioso". In it the hero passes through different historical times and genders and sexualities, until she eventually gives birth to a child. Woolfe's child was her work. I call this poem:
"Client Centred Therapy". Carl Rogers. - Constable ISBN 0 09 453990 1
"Individual Therapy in Britain". Windy Dryden - OUP ISBN 0 335 09810 X
Published Work/Papers by Alice Purnell
"A Guide To Transsexualism, Transgenderism & Gender Dysphoria"
1990 "It's All in the Mind" Gender Dysphoria Conference Report
1992 "An Assessment of Treatments & Follow up on 102 Transsexual People" Gendys II Conference Report
1994 "Gender Counselling & its Difficulties - Cases of Acute & Chronic Gender Dysphoria" Gendys'94 Conference Report ISBN 0 9525107 07
1996 with Dr Dorothy Jerrome "A Survey of 60 over-50 year-old Gender Dysphoric People" Gendys'96 Conference Report ISBN 0 9525107 15
1997 "Parents & Partners of Gender Dysphoric People" Gender Dysphoria Conference Gateshead
1998 "Standard Care?" Gendys'98 Conference Report ISBN 0 9525107 3 1
Citation: Purnell, A., (2000), The Client Leads in Effective Gender Counselling, GENDYS 2k, The Sixth International Gender Dysphoria Conference, Manchester England.
Web page copyright GENDYS Network. Text copyright of the author. Last amended 04.05.02