My client has gender dysphoria- what do I do?
Updated: May 17, 2021
Today, I was asked for advice by a counselor who was approached by a transgender teenager asking for care. She was not specialized in this area, and wasn't sure how to proceed. While there is no one-size-fits-all approach for her or yourself for how best to help your client, I can tell you what some of the variables and best practices are. I hope this helps :)
First, whether or not you're going to work with gender diverse individuals, it is best to be culturally competent. Gender is not a binary spectrum, and any individual can question their gender or may have gender diverse people in their lives. For that aspect, qinclusion and transplaining are great resources. Along those lines, having an inclusive practice also includes how your staff speaks to your clients, your intake paperwork, even how you label bathrooms in your office. Thank you in advance for taking the time and care to make your practice be the safe, compassionate place of business all individuals seeking care want to receive help from.
Second, is this individual someone who happens to be gender diverse, but is not experiencing discomfort/dysphoria, and just wants to work on other issues? If that is the case, and you're culturally competent such that your use of pronouns, names, and perspective is trained to be inclusive and affirming, it should be no different than working with anyone else who wants to work on the same issues. If they are experiencing discomfort due to their gender dysphoria and you are not competent to treat in this area, it would be kind to them, and ethical, to refer to another professional, as long as they have access to someone else to provide the care they need. Speaking of ethics, it is likely your field's practice documents require you to be competent in all areas of practice, as well as non-discriminatory. Following the guidelines in this post will help support you in these areas. Take a look at my article on gender inclusive forms to get started.
If all this individual needs are letters to be able to receive gender affirming care elsewhere, and they are able to express to you that they have gender dysphoria, you can write a letter without needing a long course of care. If someone does need a gender affirming letter, GALAP, the gender affirming letter access project https://thegalap.org/ is a great resource.
For someone who is wishing to transition, they will need to have information and access to transition resources. Transition is different for everyone, but it can involve hormones, gender reassigning surgery on one or multiple places on their body, voice training, changing their gender presentation (such as with hair, clothes and makeup), changing their name, changing their pronouns, changing their legal sex, etc. Their transition may include lots of these things, or it may include none of these things. We don't assume what someone's transition will or will not include. If they are looking for voice coaching, I would love to help them with their voice. Please refer them to Harmonic Speech. For someone who is not yet of legal age their medical transition options may be more limited. Sometimes all they have access to are gender blockers, either because of discriminatory laws in their area or guardian decisions, and won't be able to start transitioning until they are an adult.
One of the most important things we can do to help gender diverse individuals is provide care! Unfortunately, gender diverse individuals are more likely to experience discrimination, violence, suicidal thoughts, and gatekeeping limiting access to care. Let's do our part to help our clients access competent, affirming care!
Finally, having a non-binary or transgender identity is not a mental disorder or pathology that requires psychiatric or psychological intervention. However, if their gender identity is causing them distress, counseling can be very helpful. A psychiatrist would only be needed if they're having other issues that need chemical management, such as anxiety, depression, hallucinations, etc.
I will leave you here with some images I made for a presentation that may help with understanding the relevant terminology and concepts.