The Case for Counselling Now

Kenneth Demsky


Issue 35
Autumn 2006

It's not news that many transgendered people look askance at the whole mental health field - and it's no surprise, either.

In past decades Psychology regarded the experience of being transgendered as categorically pathognomic - i.e., indicative of psychological disturbance. When someone walked into a psychotherapist's office and expressed feelings of being in any way gender variant, major diagnostic labels began piling up: schizophrenia, dissociative disorder, atypical psychosis, etc. The received wisdom of mental health insisted that everybody's internal sense of gender had to be identical with their anatomical gender, unless there was a major crack in the pavement.

Then there's the historical "gatekeeper" role in the international guidelines for transition. Some professionals saw themselves as little Nero figures, grandly giving thumbs up or down on people's futures with neither understanding of the true complexity of the issue nor sympathy for those living with it.

But psychology's come a long way, baby! It is no longer The Enemy, as it once was. In fact, a gender-specialist mental health professional can be an extremely valuable guide, ally and advocate before, during and after transition.

The most appropriate contemporary response of psychologists to someone who presents at an intake session with gender variance is to view him or her as a fellow traveller in Life dealing with an extraordinary challenge. Most transgendered and transsexual people come to the consulting room having endured long periods of hostility, misunderstanding and mislabelling, from both family and friends, not to mention those in the medical profession. They have known alienation, and isolation. In their earliest years they may have been shamed, made to feel guilty or even emotionally scarred as they quite innocently attempted to be who they were. They grew up with consistently negative messages from society which might have resulted in self-loathing or self-punishment as well as addictions and compulsions.

Counselling helps people grow from this initial painful place into an empowered and positive one. As individuals come to terms with the demands and rewards of gender transition, working with a counsellor provides a judgment-free personal space to explore the new and the unexpected situations that inevitably arise. Experiences that feel uncomfortable, anxiety-producing or are confusing can be explored to maximize the learning derived from them. The individual gains awareness of residual internalized transphobia or outdated sexual stereotypes that get in the way of progress. There is feedback about one's expectations of oneself as the challenges of transition are encountered and an external observer to remember how much of the distance has already been run.

Sometimes, once people have tackled the challenges of their gender status, they then want to be free of other, non-gender-specific limitations with which they have lived for all their lives. As individuals develop their true selves, they begin to take better care of themselves on all levels, including the emotional-psychological one. This can take the form of addressing longstanding issues (such as self-esteem) or tackling current concerns (at work or at home).

Working with a gender-specialized psychologist means the focus of treatment will be appropriate; one's gender variance need not be "the problem"; one may be a gender-variant person struggling with any of the myriad aspects of modern life that can be troubling. Psychotherapy is a very flexible instrument and can be relevant in a large number of life situations.

It's not an accident that I've specified a gender-specialist psychologist each time. Seeking out someone with the appropriate knowledge and experience about gender is essential for a positive therapy experience.

My website address along with whatever else you may say about me! The address is:

Web page copyright GENDYS Network. Text copyright of the author. Last amended 14.07.09