Psychotherapy with Transgender and Gender Nonconforming Clients

Psychotherapy with Transgender and Gender Nonconforming Clients

by Karisa Barrow

With attempted suicide rates greater than 40% in the transgender community, it's important for clinicians to be aware of the issues gender nonconforming clients bring to therapy, and to be knowledgeable about how best to support them. Karisa Barrow challenges therapists to deconstruct the gender binary, identify and work through prejudices, and seek guidance from gender specialists to ensure that we "do no harm."

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The Unbearable Otherness of Being

Imagine making your way in a world where your physical appearance makes others uncomfortable, anxious, confused, or uncertain about themselves. Your very presence may be perceived as a threat to another individual’s sense of self or sexual orientation. Everywhere you go, people stare at you—sometimes discreetly, often blatantly—leaving you very little room to walk unselfconsciously through life. The reactions you experience from others, while the result of ignorance and sometimes mere “curiosity,” do nonetheless harm you, for you are perceived as “Other.” At times, people’s reactions are more hostile, the result of conscious and unconscious fears about what it means to deviate from gender norms, and you may be verbally or physically assaulted just for being you.

Everywhere you go, people stare at you—sometimes discreetly, often blatantly—leaving you very little room to walk unselfconsciously through life.
This is what it’s like to be a gender nonconforming or transgender individual in today’s world. Though there is increasing awareness and tolerance around gender issues in certain small segments of American culture, the truth is, the level of misunderstanding, ignorance and prejudice that surrounds gender nonconforming people as they go about their lives has created a mental health crisis in our society. To illustrate the epidemic nature of this crisis, here are a few statistics from the American Foundation for Suicide Prevention’s 2014 Report, “Suicide Attempts among Transgender and Gender Non-Conforming Adults.”
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Karisa BarrowKarisa Barrow, PsyD, is a clinical psychologist and adjunct faculty member at The Wright Institute and Argosy University. She is in private practice in Oakland, CA, providing psychotherapy and consultation for adults and children. She served as president for the Alameda County Psychological Association, is chair of the educational committee for the Northern California Society for Psychoanalytic Psychotherapy, participates in the Child and Adolescent Gender Center, and lends her support to the Mind the Gap collaborative. She specializes in working with gender nonconforming, transgender, and GLBQ children and their families.
Excellent article! As a training psychotherapist I have found the issues Dr. Barrow challenges us to grapple with are front-burner in regard to effectively treating this wonderfully diverse, and yet, often misunderstood population. We are shockingly behind in our efforts to sensitively construct mental health policies that take into consideration the needs of gender variant clients. By asking clinicians to examine their own gendered thinking, Dr. Barrow's article maps out a course for healthcare providers to begin addressing these issues.
Elizabeth B. Cleves, M.A.
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CE credits: 1
Learning objectives:

  • Understand the nature of the mental health epidemic among gender nonconforming individuals.
  • Illustrate both the medical and psychological interventions involved in treating transgender clients.
  • Describe resources available to gender nonconforming individuals and the clinicians who treat them.
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