The Journey of an American Gender Specialist
Kenneth Demsky, Ph.D
My initial connection to the field of transgenderism took place when I was a teenager growing up in New York City in the mid-1960s. At that age, anything with the word "sex" in it captured my immediate attention. (Perhaps things have not changed so very much, after all!) That led me to browse through some of the medical journals in the study of my physician-grandfather. It was quite accidentally, therefore, that I came upon the controversial articles of Dr. Harry Benjamin, a prominent New York endocrinologist, as they were being published.
In his case histories, I read about the life-threatening struggles his patients had endured before they found him, when all they wanted was a medical professional who would offer them nonjudgmental help. Perhaps Dr. Benjamin's most significant contribution was to take seriously what his patients told him about themselves and their definition of what was causing them distress, something that had no precedent in the American treatment of sex and gender concerns. His goal , based on his respect for his patients, was to listen to what people told him they felt inside and to help them achieve outer congruence with this. As a result became a much loved champion of appropriate medical treatment for trans people in the US. I remember a black-and-white photograph of Dr. Benjamin smilingly surrounded by a coterie of his M2F patients quite elegantly clothed and coiffed in the style of the era, and giving him what amounted to a group hug. It was through references in these articles, that I was led to read the biography of Christine Jorgensen, the Danish sailor we went public with her transsexual condition. This deepened my understanding of how well trans people fit within the "normal" spectrum.
Continuing to be interested in reading about transgenderism, several years later I read the work of Dr. John Money of the gender clinic at Johns Hopkins. Dr. Money held a very different view of gender. Whereas Dr. Benjamn represented "gender dysphoria" as an organic, biochemical condition that was corrected by crossgender hormones and surgery, and counselling, Dr. Money believed that gender identity was malleable, purely the result of social. conditioning. People who presented with gender dysphoria had experienced adverse social conditioning which had no physiological correlate. The inner sense of gender was the result of external forces.
In application of this belief, he advised the parents of a male twin whose external genitalia had been destroyed during infancy to raise the baby as a girl. Dr. Money's theory held that by doing so the parents would shape the child's gender identity to match the current appearance of the genital area. Initially hailed as a successful demonstration of Dr. Money's view, the experiment ultimately led to disaster. Raised as "Joan", this child grew up unhappily and, after much suffering, eventually requested gender reassignment to be male once again. However, by the time three decades had passed since Dr. Money's experiment, "John" had suffered so greatly - despite being a husband and the father of two (adopted) children - he took his own life. The gender clinic at Johns Hopkins University is no longer in operation.
The two dominant American views of the formation of gender identity were established by the time I went to college,. Medical and psychological professionals held one view or the other: nature or nurture. The presence of gender clinics in a few major cities, and budding trans political activism on the fringe of gay-lesbian politics brought awareness of the needs and rights of an increasingly public trans population.
I first became professionally involved in the field of transgenderism in Austin, Texas. I had served as a volunteer hospice counselor for two years, had completed two Master's degrees - one in seccondary education, one in counseling psychology - and was in Texas to obtain a doctorate in counselling psychology from state university there. A self-supporting student, I worked as a therapist in a small community mental health center dedicated to meeting the needs of the g/l/b/t community. (Regrettably, one didn't recognize the "i" component at that time.) One day, a 22year old male came for an intake appointment. Dressed all in black, clean-shaven with shoulder-length hair, he made an androgynous appearance. The problem he presented was fear of losing his girlfriend after he went through genital reconstruction surgery as he transitioned to being a woman. I began taking the standard information from him as my brain processed the new, but obvious thought, that his gender identity - female - had nothing to do with his sexual "object choice" - which was females. I had never considered the two factors in this way before. (Unfortunately, he was assigned to meet with another therapist due to scheduling difficulties, so I didn't have the opportunity of working with him and learning more.) Thanks for this exceptionally mature twentysomething, I learned that what our own gender is and what gender we are attracted to are factors completely independent of one another.
Wanting to continue to learn about and work with transgendered people, I was fortunate enough to win an internationally competitive postdoctoral fellowship at a gender and sex clinic - a body that did both research and therapy - at a large university in the American Middle West The program was headed by clinicians whose names were known to me as leaders in the field, of sex and gender, including the treatment of "gender dysphoria". I had read articles in journals and books written by them and I saw their names at the masthead of national and international professional associations
It didn't take long for me to feel disappointment at the reality of the institution I had fought to join. Located within the family practice unit of the medical school, the clinic ooperated with a severe form of the top-down orientation characteristic of poor medical practice. I was assigned to several of the institution's treatment tracks: for sex offenders, for those experiencing marital and sexual dysfunction, and for those wishing to change their gender. In every case, participants were required to attend several modalities of therapy ongoingly - e.g., family therapy as well as group and individual therapy - in addition to annual semi-public "Sexuality Attitudes Readjustment Seminars" (known as SARs). Fees were on the high side of average without a sliding scale , although insurance was accepted. At the time I was working there - 1990 - fees were about 45GBP per individudal session and half as much for group therapy sessions. Because of the scarcity of specialised programs within the region, some clients had to travel as long as eight hours each way to make their appointments. (For legally referred clients, not to do so would have involved special risks.) Between the expenditure of time and money, clients were essentially slaves to their treatment program. No modifications were available. A standardized course of therapies was applied to all individuals involved within a treatment track. Client input, requests, special needs were not taken into account; in fact there was a sense that for clients to express these would have brought them negative attention. To me, this represented a betrayal of the basic contract of therapist and client, in which therapists serves the client.
Additionally, all clients had to undergo a standardized intake procedure which was quite involved and took several hours. Everyone was asked to completely a battery of pen-and-pencil tests in addition to questionnaires created by the clinic to suit its research interests. Clients were routinely asked to share such intimate information as sexual fantasies and masturbatory techniques regardless of the relevance of such material to their presenting problems. This allowed the clinic to collect an impressive data bank from which they could draw for purposes of discussion and publication, but to my mind represented an abuse of clients' trust. Although there was initial ,disclosure that the Program conducted research and that clients' material might be used to contribute towards that research , I did not meet anyone during my brief time there who felt sufficiently empowered to question the process to which they were subjected. It's not hard to understand why one might feel vulnerable at a first meeting with a new therapist, nor is it difficult to understand why clients at a sex and gender clinic might feel especially vulnerable at intake. How likely was it that anyone would be thinking of the appropriateness of questions being asked?
At that point I had been a psychotherapist for ten years. After much debate with members of the clinic, I realized that my treatment philosophy and my views of transgenderism were incompatible with the structure of the program, and that, as a postdoctoral fellow, I lacked the clout to initiate changes. I was sad to leave behind the trans clients with whom I had been doing individual and group psychotherapy, but not sorry to end this phase of my career.
At the same time, I had been teaching graduate seminars for a Boston-based university. In the course on psychodiagnostics I included a few lectures on transgenderism and bisexuality. These were presented together because I had found a paradigm which, while designed to place bisexuality solidly within the continuum of normal, could easily be extended to so the same for transsexuality. I refer to the "Sexual Matrix" of Fritz Klein. Klein's Sexual Matrix is a three-dimensional, multifactorial model of sexuality that breaks down the conventional, rigid model of sex into components that vary independently and can change across time. For instance, Klein plots differences between one's sexual fantasies and one's sexual activity as well as plotting temporal changes in these factors. Thus, a man may have homosexual fantasies but engage in sexual activity only with his female partner in the present; in the past he had homosexual fantasies and engaged in homosexual behavior; and his "ideal" or wished-for configuration might be different again.
It's a short leap to add considerations of genderedness to the Matrix. How much was one's gender identity female in the past? How much was it male? And the same for the present and for a future or "ideal" condition. Unlike more traditional constructions of sex and gender, which differentiates between individuals only according to external genitalia and then into only two categories, Klein's Matrix - with the "Demsky Additions" of gender - can be shaped to fit the individual. By means of this paradigm, it was possible to explain to students that human sexuality is too fluid and complex to be explained by a a bifurcated monolith; each person's sex is multifaceted and dynamic.
I decided to move back to Boston, Massachusetts to re-establish myself as a professional, since the greatest concentration of friends and colleagues was there. My initial schedule involved teaching in combination with a part-time position at another community health centre focussed on the needs of the g/l/b/t and i population. (Times had changed and intersexed people were acknowledged in the "i". In fact, some clinicians preferred to speak of g/l/b/t/i/q and a , which stood for "gay, lesbian, bisexual, transgendered, intersexed, questioning and allies - a bit of American political correctness so inclusive as to be meaningless, in my opinion.) At that health centre, I was able to create a cross-disciplinary transgender treatment team which included psychotherapists, social workers, nurses and physicians. Our goal was to provide outreach - do you Brits use this word of which American social services are much enamoured? - to the regional trans community, letting them know that the "t" was truly as important to us as the "g" the "l" and all the others in the alphabet. With the support of the public relations department of the agency, the transgender team was eventually expanded to include members of the transgender community whose input was vital to keeping our efforts relevant and effective. The number of trans clients served by the agency surpassed official expectations based on earlier numbers. Besides intake and individual therapy, the mental health department launched both thematic and general issues peer-led support groups.
At the same time I was able to do individual and group therapy with trans individuals at the agency and my growing private practice, I was able to network with another gender specialist in the region, Diane Ellaborn, LICSW. Pooling our skills, we created workshops for trans couples counselling - i.e., relationship workshops where one member of the couple is trans.
The transgender team easily survived my leaving the agency when my own practice became a full-time venture. During those remaining years in the US, about a third of my practice was with trans clients, about a third with clients with sexuality concerns - such as compulsive sexuality, sexual orientation conflict, fetishism and exhibitionism - and the remaining third, individuals dealing with some form of emotional distress in response to either historical or current experiences. This is just the kind of practice I would like to establish here.
I have been fortunate in the timing of my relocation to the UK in several ways. I met Dr. Russell Reid - known as "Saint Russell" to some in the trans community - at the moment that space for a psychologist became available in his London offices. A London friend found the perfect flat for me which will also serve as a consulting room. And the passage of recent legislation represents the culmination of many years of a political struggle to achieve basic rights, the beginning of a new era in some ways. I look forward to contributing to the further advancement of trans people as this era unfolds.
Kenneth Demsky, Ph.D., Psychologist,
Telephone: 0207 435 6116
Web page copyright GENDYS Network. Text copyright of the author. Last amended 04.07.06