In Brief

Few psychologists have experience working with transgender clients, a population that rarely seeks treatment and, when they do, often has higher than average rates of depression, suicide and self-mutilation, said experts at an APA 2007 Annual Convention session.

But that doesn't mean psychologists can't make a significant difference in their lives, they said. For instance, psychologists can create a safe place for them to explore their identities, said Theo Burnes, PhD, of the University of Pennsylvania. "The therapist's role as a 'transition assistant' allows the client to have someone to assist them in finding possible ways of expressing gender physically and socially," Burnes said.

That transition may be in a physical change, or may be "settling a new gender expression or internal concept of one's gender," he added. Deciding which route to go depends on the needs of each individual client, he noted.

Lydia Sausa, PhD, of the University of California, San Francisco, encouraged psychologists to move beyond a binary view of transgender and not assume everyone is either male-to-female or female-to-male. Sausa stated that there is a wide variety of different transgender identities, with more than 100 documented.

"I think it's important that we accept people at their present identity. We would not say someone is 'heterosexual-to-gay,' they are simply gay. Similarly, many trans people identify as women and men," he said.

Before psychologists work with transgender clients, advised Sausa, it's essential to first identify their own gender biases and expectations. For trans people needing hormones and surgeries there is a huge power imbalance between the psychologist and the client since the psychologist has the power to deny them access. He reminded psychologists to change that dynamic, and not place themselves between a trans person and the medicine or medical services they need to survive and thrive.

"We know that there is a lack of knowledge and comfort and skills among providers who work with transgender folks," Sausa said. "So why do the work? To impact and sustain healthy changes in clients."


--D. Schwartz