The first blog in the LGBT Pride Month series reviewed current DoD policy. This blog will focus on increasing your familiarity with the transgender narrative. As you begin clinical practice with this population, particularly assessment of gender dysphoria, an understanding of the transgender narrative will inform your work. You may want to start by reading this helpful introduction to key transgender terms.
To put it simply, the transgender narrative is the chronicle of someone who identifies as transgender, with an emphasis on their experience of gender. For most of us, the gender narrative is difficult to pinpoint because as cisgender people (gender identity matches the sex assigned at birth), our gender identity and assigned sex match so well they have fused. However for transgender people, their gender identity does not match their assigned sex at birth (natal sex).
Many transgender narratives focus on how an individual comes to know that they are transgender. As you work with transgender and gender nonconforming people (people whose gender identity does not neatly fit into a gender identity binary of male or female), you will find many variations on this storyline. In time, recurring elements emerge which may enrich your understanding of a transgender developmental model.
Although the stories vary greatly from melancholy to liberating, you may find numerous stories center around coming to know that one is different or coping with the stressors that often accompany sharing their status with people in their lives. Some narratives reveal joyful acceptance from friends and family, while others disclose bitter rejection from former friends or family based on their transgender status. Many stories will include tales of discrimination or transphobia, which refers to the harassment, discrimination and even violence that many people in the transgender community navigate on a daily basis. Like all clients, each story is unique. The only rule in a gender narrative is that there is no single gender narrative.
I encourage you to read books and watch documentaries about transgender men and women. This material will help you to recognize major milestones of the transition process as well as unique stressors. As you learn more, you may deepen your understanding of transphobia (intolerance of or prejudice towards transgender people) and its negative impact. In a 2015 civilian survey of transgender individuals conducted by the National Center for Transgender Equality, 48 percent reported they were denied equal treatment or service, verbally harassed and/or physically attacked because of their transgender status in the past year, but such statistics only become meaningful when you learn the stories behind the statistics. Likewise, you may be familiar with the gender minority stress model, but hearing about the experience of life under the weight of discrimination may amplify your compassion.
There are many ways to better understand the transgender narrative and to increase your understanding of key milestones and unique stressors. Several civilian resources, which are not approved for official use by DoD, are included below.
- The American Psychological Association (APA) created a series of training videos on gender and sexual minority issues and published a book in 2016 titled “Affirmative Counseling and Psychological Practice with Transgender and Gender Nonconforming Clients.”
Many resources are available in the LGBT Health Resources section of the Association of American Medical Colleges website:
- Video: lore m. dickey reviews key vocabulary and encourages culturally-sensitive care
- Video: Dr. David Malebranch provides suggestions for working with transgender or gender non-conforming patients
- Short documentary: Features LGBT veterans and includes a brief section on sexual assault (released prior to the introduction of DoD’s new transgender policy).
- Transgender 101: A Simple Guide to a Complex Issue is a helpful introduction to the topic written by a licensed social worker.
Dr. Holly N. O’Reilly is a contracted clinical psychologist and evidence-based practice subject matter expert at the Deployment Health Clinical Center. Her specialties include the consequences of traumatic exposure as well as gender studies.
The views expressed in Clinician's Corner blogs are solely those of the author and do not necessarily reflect the opinion of the Psychological Health Center of Excellence or Department of Defense.