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Gender identity project (1)

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Gender identity project (1)

  1. 1. Gender Identity, Gender Expression, & Biological Sex
  2. 2. Introduction ◉Multicultural counselling and its application to gender identity, gender expression, and biological sex. An issue of grave importance and relevance to the current sociocultural and systemic climate. A political, ethical, and theoretical necessity. Important social justice issue that is manifested in a community of people which experiences marginalization, oppression, and discrimination. Media and social media awareness of non-binary gender.
  3. 3. Introduction Gender identity ≠ biological/ anatomical sex ≠ sexual/ romantic orientation (Gender Spectrum, 2015; Killerman, 2013; Moleiro & Pinto, 2015; Moon, 2014; Roughley & Morrison, 2013)
  4. 4. Introduction ◉Biological/ anatomical sex: comprised of physical characteristics such as external genitalia, sex chromosomes (XY for males, XX for females), gonads, sex hormones, and internal reproductive organs (Gender Spectrum, 2015). Spectrum or range, rather than male/ female binary. Assigned at birth by medical professionals based on external genitals (male or female only; intersex is not on Canadian birth certificates) Defining male/ female: physical reproductive or sex characteristics are consistent with current medical definitions (Gender Spectrum, 2015) Defining intersex:“a general term used for a variety of conditions in which a person is born with a reproductive or sexual anatomy that doesn’t seem to fit the typical definitions of female or male… Intersex is a socially constructed category that reflects real biological variation,” (Intersex Society of North America, 2008, para. 1).
  5. 5. Introduction ◉How common is it to be born intersex? Current and historical definitions of intersex persons Medical documentation Many medical professionals document the prevalence to be 1.7% of all live births (Blackless et al., 2000) Contributing factor as to why counsellors need to be aware of intersex individuals.
  6. 6. Introduction ◉Gender identity: a person’s unique internal and individual perception of gender and how they label themselves (OHRC, 2014). Sense of being a man, a woman, both, neither, or anywhere along a continuum/ gender spectrum (OHRC, 2014) e.g.) gender neutral/ genderless, genderfluid, transgender. May or may not be aligned with their biological sex or gender expression (OHRC, 2014).
  7. 7. Introduction ◉Gender expression: a person’s external display of gender (OHRC, 2014). Outward appearances (dress, hair, makeup…), their demeanor, social behavior, chosen name, or pronoun (he/ his, she/ her, they/ their, ze/ zir…) and other factors (Killerman, 2013; OHRC, 2014). Generally on a scale of masculinity and femininity (Killerman, 2013; OHRC, 2014).
  8. 8. Introduction ◉Cisgender: individuals whose biological sex, gender identity, and gender expression align. E.g.) female, woman, feminine → cis-woman (Killerman, 2013). ◉Transgender: individuals who are not cisgender (Killerman, 2013). May transition culturally, socially, physically, and/or medically to a gender in which they feel more congruent (Everett, MacFarlane, Reynolds, & Anderson, 2012). Different than transsexual which is a term used when someone whose gender identity is binary of their biological sex and is in the process of transitioning with hormones, surgery, and other medical treatments (Killerman, 2013).
  9. 9. Introduction ◉Two-spirit: a term used by First Nations people to recognize individuals who possess qualities or fulfill roles of both genders (Killerman, 2013). “Individuals embracing these genders may have dressed; assumed social, spiritual and cultural roles; or engaged in sexual and other behaviors not typically associated with members of their biological sex,” (Walters, Evans-Campbell, Simoni, Ronquillo, & Bhuyan, 2006, p. 126). Often occupy highly respected social and ceremonial roles (Walters et al., 2006).
  10. 10. Introduction ◉Third Gender = A person whose gender identity is neither male nor female but a third option. Several cultures have different terms to describe their transgender or third gender populations ○ Examples include: ■ Eunuch ■ Hijras ■ Kathoey → Ladyboys
  11. 11. Introduction Gender identity/ expression, biological sex, sexual/ romantic orientation closely tied in the LGBPTIQQAA2S+ community so it is important for counsellors to recognize and learn about the community if they are to work with them.
  12. 12. Introduction ◉Genderbread person!
  13. 13. Multicultural-Diversity Constructs/ Theoretical Background ◉Gender expansive practices and policies. ◉Political and ethical considerations around gender (Arthur & Collins, 2010). ◉Cultural awareness of self, cultural awareness of other, and a culturally sensitive working alliance in relation to sex, gender identity, and gender expression (Collins & Arthur, 2008).
  14. 14. Multicultural-Diversity Constructs/ Theoretical Background ◉Total acceptance of non-binary or genderqueer persons aside from support for equal marriage (Roughley & Morrison, 2013). ◉Don’t identify them until they identify to you! The general rule is...there are no rules! :) ◉Historical/ present day use of othering” for anyone outside of social and gender norms e.g.) Conversion/ reparative therapy (Roughley & Morrison, 2013). ◉Self-disclosure, in the community, allies in the community (Everett et al., 2014).
  15. 15. Multicultural-Diversity Constructs/ Theoretical Background ◉Client’s perspective outside of a heteronormative, cisgendered lens and consider various intersectionalities (Davies & Barker, 2015). ◉Be aware of hypervigilance, shame, and resilience of clients (Davies & Barker, 2015). ◉Understand the importance of discourse and microagressions by the dominant group unto the non-dominant group (Smith, Shin, & Officer, 2012). Uphold dynamics of privilege and oppression. Especially dangerous in a helping setting.
  16. 16. About this templateMyths and Misconceptions What does cis mean? What does it mean to be cissexist? Cisgender means an individual’s gender reflects the biological sex they were born with. Biological sex is based on an individuals external genitalia, chromosomes, internal and external reproductive organs, secondary sex characteristic, and horomones (GLAAD, 2015). What is cissexism? Cissexism is when someone who is cisgender assumes everyone has the same experience as them and that individuals who do not are inferior or peculiar. An example of this is when a trans woman uses a men’s washroom (Grant, Mottet, Harrison, Herman, & Keisling, 2011). The considered defamatory term “bathroom bill” refers to individuals who oppose non-discrimination laws that protect transgender people by providing them with a private gender-neutral bathroom that anyone can use, and the term “bathroom bill” is said to incite fear and panic an individual may face when encountering a transgender person in a public washroom (GLAAD, 2015). Sex and gender aren’t really different are they? It doesn’t really matter does it? Yes they are different. Sex refers to your biological sex, but sex does not determine your gender. Gender is a social construct created to identity male and females and is associated with gender roles and gender expression (GLAAD, 2015). To simplify, think of sex in the biological, predetermined at birth way, whereas gender is more linked to masculinity and femininity, which are based on characteristics. (Grant et al., 2011).
  17. 17. About this templateMyths and Misconceptions Aren’t all drag queens transgender? Drag queen is a term usually used to refer to a gay male who dresses up as a female on occasion for personal satisfaction or for entertainment purposes (GLAAD, 2015). Drag queen it is often incorrectly used to refer to all transgender women (Grant et al., 2011). Cross-dressers are typically heterosexual men who occasionally wear women’s clothes, makeup, and accessories and do not want to permanently change their sex (GLAAD, 2015). Cross-dresser replaces the term transvestite, and transvestite should not be used unless someone specifically self-identifies that way (GLAAD, 2015). Transgender, transsexual, tranny, what’s the difference? Transgender is used as an umbrella term that refers to individuals whose gender identity or gender expression does not align with their assigned sex at birth, including transsexuals, androgynous individuals, genderqueers, cross-dressers, and other gender non-conforming people who identify as transgender (GLAAD, 2015). Some (not all) of these individuals desire to transition gender, and some (not all) want to medically alter their bodies as part of the process. Transsexual is an older term that was created in the medical and psychological fields, and it is not an umbrella term like transgender. Transsexual is still preferred by some people who have permanently changed their body to align with their gender, or individuals who desire to change and may be accomplished through surgical and or hormone therapy, or other methods (GLAAD, 2015).
  18. 18. About this templateMyths and Misconceptions If a cis man is in a relationship with a transwoman, doesn’t that make him gay? o No. This is negative as it is basically saying a transwoman is not a real woman, and it is considered derogatory. Once an individual has identified as a sex, such as a transwoman, they are now for all purposes a woman (Grant et al., 2011). All transgender individuals undergo surgical sex changes. No. The term “sex change” is considered offensive to some and not all transgender individuals get surgery. Sex reassignment surgery is the preferred term. There is also not “one” surgery to change one’s body to align with one’s identity (Grant et al., 2011). What is the difference between Gender Identity Disorder and Gender Dysphoria? Gender identity disorder was a term included in the DSM- V that the body’s physical characteristics at birth differ for the gender an individual believes they are, the term was later changed to gender dysphoria to reduce stigma that a patient is “disordered.” The new term is gender dysphoria is now in the DSM 5 (American Psychiatric Association, 2013).
  19. 19. ● 41% of those surveyed reported attempting suicide, compared to 1.6% of the general population ● Respondents reported had four times the rate of HIV infection compared to the general U.S. population ● 30% of the sample reported they were daily smokers, compared to 20.6% of the general U.S. population ● 78% of grade-school children who are transgender or gender non- conforming reported harassment, 35% were physically assaulted, and 12% reported sexual assault ● 16% of respondents felt compelled to work in the underground economy doing such work as selling drugs or sex for income ● 19% reported encountering housing discrimination; they were denied a home because of their gender identity ● 46% said they were uncomfortable seeking help from the police ● 15% who had been to jail or prison reported being sexually assaulted ● 43% maintained relationships with their family, while 57% were rejected Marginalization of Transgender Individuals
  20. 20. Social Supports
  21. 21. Counselling Techniques Gender Identity, Gender Expression, & Biological Sex
  22. 22. Counselling Techniques ◉Gender affirmative treatment ◉Addressing trans-specific issues (therapeutic relationship) ◉Nature of the gender concerns ◉Gender history & development of gender identity ◉Evaluating capacity to make care decisions ◉Client history & current concerns ◉Exploration of gender expression ◉Identity management decision-making ◉Transgenders-specific elements in general counselling
  23. 23. Why come to counselling? ◉Therapists working with transgender or gender nonconforming clients: Gender incongruence or gender dysphoria Hormone therapy Surgery to change primary and/or secondary sex characteristics General psychotherapy (self-esteem, family, “coming out”, transitioning, questions, issues related to identity, everyday problems)
  24. 24. Why come to counselling?
  25. 25. Gender Affirmative Treatment ◉Therapists working with transgender or gender nonconforming clients: respecting the positive views of transgender clients client’s self-defining identities and the impact of normative gender society on their lives accepting of stigmas understanding of terminology and concepts societal assumptions about gender influence the experiences of clients awareness of implications of surgery and/or hormone therapy
  26. 26. Trans-specific issues (therapeutic rapport) ◉In addition to the regular techniques used to build therapeutic rapport: discuss privacy issues in setting appointment times developing self-advocacy strategies identify appropriate resources how/whether to share gender history for employment anti-trans prejudice and discrimination
  27. 27. “Minnesota Republicans Seek to End Trans- Inclusive Sports Teams”
  28. 28. Nature of the gender concern ◉It is important to evaluate the client’s perspectives related to gender concerns. Here are some useful questions: What is the nature of the gender concerns? Are there obsessive/compulsive features? Are there delusions about sex or gender? Is there evidence of Asperger’s disorder? Is there evidence of dissociation?
  29. 29. Gender History & Development of Gender Identity “As clients become aware of previously hidden or constraining aspects of their gender identity or sexuality, psychologists may provide acceptance, support, and understanding without making assumptions or imposing a specific sexual orientation or gender identity outcome” (APA, 2009)
  30. 30. Gender History & Development of Gender Identity ◉Family How do you define ‘family’? How would you characterize your relationship with your family members when you were a child, and now? Do you have any concerns related to family?
  31. 31. Gender History & Development of Gender Identity ◉Gender concerns Are there any kinds of supports you feel might be helpful as a __________ (trans, asexual, etc.) person? Are there any cultural or religious conflicts for you as a transgender person? Have you ever sought to change your body through hormones/ surgery?
  32. 32. Capacity to make care decisions ◉“Decision-making capacity is the ability to understand relevant information and to appreciate the reasonable foreseeable consequence of a decision” (Appelbaum & Grisso, 1988) ◉Health care professionals must normally obtain informed consent before treating an adult patient. Clinicians should confirm the client’s capacity to make care decisions as part of the initial evaluation (Bockting et al., 2006)
  33. 33. Document client history & current concerns ◉Comprehensive assessments usually include: instruments to evaluate general mental and physical health person’s past experiences of anti-trans prejudice or discrimination internalized messages related to these experiences anticipation of future victimization (Coolhart, Provancher, Hager, & Wang, 2008) introduction of coping strategies and sources of resilience (Hendricks & Testa, 2012; Singh et al., 2011)
  34. 34. Exploration of options for gender expression The HBIGDA Standards of Care (Meyer et al., 2001) possible options for transgender identity expression • participation in peer support/self-help groups or in the transgender community • counselling to explore gender identity and to deal with pressures relating to work, family, etc. • learning about transgenderism from the Internet, guidelines for care, lay and professional literature relating to legal rights, etc. • participation in peer support/self-help groups or in the transgender community • permanent changes to appearance: surgical reconstruction of face/chest/genitals, electrolysis/laser removal of facial/body hair • integration of gender awareness into daily living • temporary and potentially reversible changes to appearance: changes in hairstyle/makeup, temporary removal of facial/body hair
  35. 35. Implementing identity management skills ◉After the client has decided on a course of action, therapists may focus on helping the client implement their decision to gender expression/ identity management: “coming out” (disclosing transgender identity) to family, friends, co-workers, teachers/students, cultural or social community peers, or others in the transgender person’s life is an important step “coming out” for gay/lesbian vs. transgender visible changes in social role and physical appearance taking calculated risks in disclosure (Coleman, 1982; Horton, 2001), starting with people who are most likely to be accepting adjustment of learning a new gender role and also the discrimination and harassment that is frequently experienced by someone who is visibly gender-variant
  36. 36. Counselling for loved ones ◉Trans/non gender conforming people, partners, families, friends, and communities can benefit: responses upon disclosure range from excitement to disgust, depending on an individual’s perspectives, their relationship with the transgendered person, cultural beliefs about gender variance, and the timing and means of disclosure when transgender issues have been a secret and are disclosed late in a relationship, there can be feelings of betrayal and questioning of intimacy, as with the disclosure of any large secret (Reynolds & Caron, 2000) mixed emotions from loved ones - denial (stage 1) , shock, post-traumatic reactions, trying to bargain with the transgender person or a higher power for the gender issues to disappear, anger (stage 2), grievance (stage 3), self-discovery (stage 4), acceptance and welcoming (stage 5), pride (stage 6)
  37. 37. Transgenders-specific elements in general counselling ◉Common issues experienced by transgender clients; body image problems multiple losses resulting in cumulative grief sexual concerns social isolation spiritual or religious concerns substance use issues difficulty coping with historical or current violence/abuse
  38. 38. NUANCES
  39. 39. NUANCES Consensus among all staff regarding education and commitment to support of LGBTQ+ community ◉Adjust mission statement to clearly state agency’s allied support ◉Training for all staff on education on specific counselling considerations as well as language use ◉Education and training in providing medical and culturally relevant referrals ❏ see following checklist
  40. 40. NUANCES
  41. 41. NUANCES
  42. 42. (planned parenthood, 2006)
  43. 43. NUANCES Post visible LGBTQ+ brochures, books, posters, and psychoeducational material to signal to clients that the agency is aware of specific concerns and considerations.
  44. 44. NUANCES Intake forms // Pronoun use Gender: Preferred pronoun:
  45. 45. NUANCES Gender-neutral bathrooms
  46. 46. NUANCES Support groups Awareness of relevant resources within the community http://www.fyrefly.ualberta.ca/YouthResources (My GSA, 2012)

Notas do Editor

  • http://lgbtqpn.ca/wp-content/uploads/woocommerce_uploads/2014/08/Guidelines-mentalhealth.pdf
  • http://haveagaydayorg.tumblr.com/post/77208244970/language-matters-show-respect-for-transgender