Seeing the psychologist

When a psychologist treats a trans person, can they avoid harm? Less than 30% of psychologists were familiar with trans issues, and there is no clue how many of us there are- between 0.00017 and 1.3%. It depends how you define us- the finding in Massachusetts that 0.5% of people identified as trans or gender non-conforming depends on how widely you define GNC, and how restrictively you define “normal” gender roles.

So the American Psychological Association drafted guidelines for working with us, and defined us as those who have a gender identity that is not fully aligned with their sex assigned at birth. The feminine trans man is clear about his sex, and happy with his femininity, but the guidelines conflate sex and gender. Gender role is the appearance, personality and behaviour associated with being a man or a woman in a particular culture, but there can be a feminine personality in a trans-male body, or a feminine AMAB male could be quite clear he is male. Gender identity is called a person’s deeply felt, inherent sense of being male, female or an alternative gender. This matters for trans people, but some cis people deny having a gender identity. Appearance, personality and behaviour do not always coincide.

A woman might dress down with no makeup, hair tied back, jeans and a t-shirt, but people will observe she is a woman from the visual clues. This is very important to most observers, who will then apply their stereotypical understanding of women to that person. Some women respond by joining a feminist group, some by transitioning, and might experience that as a choice, a drive, an innate characteristic, or a mistake. If there is a drive to transition, many respond by resisting, because of family pressure or beliefs.

The words and definitions the APA uses seem more designed to avoid offending trans people than to create a taxonomy of issues and responses. As a taxonomy is so difficult, that may be unavoidable.

Treat the patient as an individual.
Do not see a gender identity or desire to transition as pathological.
Transition may be non-binary
Assist with the mental health problems, including those arising from the stress of being trans.

There. Simple. The APA agrees: A person’s identification as TGNC can be healthy and self-affirming, and is not inherently pathological. However, people may experience distress associated with discordance between their gender identity and their body or sex assigned at birth, as well as societal stigma and discrimination.

They state there is greater recognition of non-binary identities, rather than a concept of transition to the opposite sex with emphasis on passing. Well, passing helps you appear to fit in, and that can reduce stress as well as providing scope for subverting the stereotypes. They insist that affirmative care must be non-binary, non-prescriptive, but unfortunately law and surgery has not caught up.

The psychologist, modelling acceptance of ambiguity, may be ahead of the patient who has internalised transphobia. That will help counter stigma and assist the patient to make informed choices. But, still, we dance between fitting in and being ourselves.

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