Main description:

Transgender and gender expansive people are increasingly becoming the focus of media, politics, and of public conversation. With this increased attention comes greater visibility and counselors are now, more than ever, likely to clinically engage with openly transgender or gender expansive clients during their careers. This is in spite of the fact that many counselors have not received specific training in skills, knowledge, and awareness necessary to provide affirming, informed care for these populations. In this book, the authors provide practical, real-life suggestions and interventions to help therapists, supervisors, and trainees increase in their competence and confidence in working with transgender and gender expansive clients. The resources provided here are informed by evidence-based practice, scholarship on intersectionality, and by social justice and advocacy movements. This book is a useful supplement to clinical work with transgender and gender expansive people, especially for the many clinicians who work in regions with limited transgender-specific resources.

In this book, readers can expect to find resources for:

Exploration of gender identities (for personal growth, with clients, and in supervision)
Understanding how privilege and oppression relate to gender identity and expression
Providing supervision to counselors working with transgender and gender expansive (TGE) clients
Understanding diverse and intersectional TGE identities
Ethical issues when working with TGE people
Worksheets and interventions that can be used to support TGE clients
Finding regional resources to support TGE clients through diverse social and medical transition processes
How finances affect transition for some transgender clients
Developing a plan to work with TGE clients in both rural and urban regions
Examples of letters of recommendation, carry letters, and how to develop a "resource list"
How practitioners can market their practice to TGE clients
Recommendations for those working with TGE clients in schools, college counseling centers, and other settings

Contents:

Introduction

Section I: Laying the Foundation for Affirmative Work

Chapter 1: Building an Understanding of Gender

Bill

Molly

Rowan

Gender Terminology

Gender Binary

Gender Identity

Gender Expression

Gender Continuum

Gender Identities

Cisgender

Transgender

Nonbinary

Intersex

Transsexual

Pronouns

Summary and Recommendations

Reflection Questions

References and Suggested Readings

Chapter 2: Exploring your Gender Identity

Bill

Molly

Rowan

The Unexplored Life

Cisnormativity

Misgendering/Mispronouning

Deadnaming

Gender Identity and Your Environment

Family and Friends

Workplace

Community

Privilege

The Binary and Me Exercise

Summary and Recommendations

Reflection Questions

References and Suggested Readings

Chapter 3: Gender Identity and the Intersectional Self

Bill

Molly

Rowan

Client Intersectionality

Privilege and Power

Race and Ethnicity

Sexual Orientation

(Dis)ability Status

Socioeconomic Status

Human Service Professional Intersectionality

Gender Identity

Exploring Intersectional Gender Identity

Connecting with Others

Client-Professional Interactions

Points of Interaction

Socioeconomic Status
Sexual Orientation
Minoritized Racial Status
Social Support
Age

Summary and Recommendations

Reflection Questions

References and Suggested Readings

Chapter 4: Gender Identity and Lifespan Development

Bill

Molly

Rowan

Early Awareness

Gender Assumptions

Childhood and Adolescence

Childhood

Adolescence

Puberty

School

Early Adulthood

Work

Middle to Late Adulthood

Summary and Recommendations

Reflection Questions

References and Suggested Readings

Chapter 5: Gender Identity and Geographic Location

Bill

Molly

Rowan

Cultural Nuance

Teletherapy

Urban Areas

Transportation

Violence and Safety

Fees for Service

Discretion

Family, Partners, and Friends

Positive Aspects of Rural Areas

Proximity to Family

Faith, Friends, and Church

The Beauty of Nature

Access to Services

Limiting Aspects of Rural Areas

Proximity to Family

Faith, Friends, and Church

Seclusion

Internet Access and Remote Connections

Travel and Resource Access

Access to Competent Providers

Semi-Rural and Semi-Urban Areas

People Who Immigrate

General Guidelines

Explore the Geographic Culture of Origin

Access Distance and Physical Access to Resources

Explore Spatial Connections to Community and Religion

Address Family Businesses, Ties, and Expectations

Explore the Impact of Local Laws and Policies

Access Availability, Longevity, and Commitment

Summary and Recommendations

Reflection Questions

References and Suggested Readings

Section II: Elements of Affirmative Practice

Chapter 6: Relationship Building

Bill

Molly

Rowan

Prior to Meeting a Client

First Appointment

Early Stages of Relationship

Strengthening the Relationship

Termination and Beyond

Summary and Recommendations

Reflection Questions

References and Suggested Readings

Chapter 7: Assessment and Diagnosis Frameworks

Bill

Molly

Rowan

A Brief History of Mental Health Diagnostic Categories

Assessment

Formal Measures

Informal or Interview-Based Assessment

Intake Protocols

Diagnosis

Default Diagnosis

Differential Diagnoses

Stabilization

Diagnoses as Permission or Endorsement for Treatment

Ethics and Diagnoses

Common Pitfalls

Refusing to Write a Letter

Ignoring Gender Expansive Identities and Intersections

Homogenizing the Population

Being Unprepared to Provide Affirming Services

Summary and Recommendations

Reflection Questions

References and Suggested Readings

Chapter 8: Ethics and Professional Standards

Bill

Molly

Rowan

Positive Ethics

Taking a Positive Ethics Approach

Positive Ethics and Decision-Making

Nonmaleficence and Positive Ethics

Ethics and Legal Issues

Conversion Therapy

Ethics and Practice Concerns

Multiple Relationships with a Single Client

Relationships with Client Families

Rural Considerations

Informed Consent

Competence

Multicultural and Social Justice Practice

Summary and Recommendations

Reflection Questions

References and Suggested Readings

Chapter 9: Transition, Care Teams, and Clinical Process

Bill

Molly

Rowan

Transitions

Social Transition

Medical Transition

Gender Dysphoria

Diagnosis and Access to Care

Gender Euphoria

Passing

Diverse Pathways

Care Teams

Clinical Processes

Summary and Recommendations

Reflection Questions

References and Suggested Readings

Chapter 10: Resources and Letter Writing

Bill

Molly

Rowan

Resources

Letters

Affirming Hormone Therapy

Affirming Surgeries

Carry Letters

Other Resources

Competence Building Resources

Transition Care Resource

Web-Based Resources

Summary and Recommendations

Reflection Questions

References and Suggested Readings

Section III: Affirmative Care in Context

Chapter 11: Affirmative Work in Various Settings

Bill

Molly

Rowan

General Considerations

Leadership

Support Staff

Operating Systems

Location Specifics

Schools

College or University Counseling Centers

Private Practitioners

Corporate and Large Companies

Conclusion

Summary and Recommendations

Reflection Questions

References and Suggested Readings

Chapter 12: Partners and Families

Bill

Molly

Rowan

Foundations and Key Concepts

Deconstructing Negative Biases

The Power of Acceptance

Gender in Family Dynamics

Gender Fixation in Families

Components of the Family System

Supporting Gender Expansive Children

Supporting Gender Expansive Parents

Gender Transition and Romantic Relationships

Partners and Relationship Dynamics

Transitioning in Close Relationships

Polyamorous Relationships

Summary and Recommendations

Reflection Questions

References and Suggested Readings

Chapter 13: Groups

Bill

Molly

Rowan

Group Stages

Group Formation

Group Member Selection

Forming

Storming

Norming

Performing

Termination

General Suggestions

Summary and Recommendations

Reflection Questions

References and Suggested Readings

Chapter 14: Sex, Sexuality, and Romantic Attraction

Bill

Molly

Rowan

Historical Perspectives on Sexual Health

Gender-Affirming Approaches

Gender Expansive Clients and Sex Education Myths

Towards a Sex-Positive Framework

Body Positivity

Eroto-Positivity

Kink Positivity

Relationship Positivity

Additional Considerations

Conclusion

Summary and Recommendations

Reflection Questions

References and Suggested Readings

Chapter 15: Supervision

Bill

Molly

Rowan

Lisa, LPC, and Austin, Master's Trainee

Supervision and Contextual Factors

Group Supervision

Identity Differences

Power Dynamics

Constructive Feedback

Supportive Feedback

The Supervisory Relationship

Self-Disclosure

Boundaries

Parallel Process

Ruptures and Conflicts

Supervision as a Professional Role

Qualification Compatibility

Consultation

Continuing Education

Future Developments

Summary and Recommendations

Reflection Questions

References and Suggested Readings

Conclusion

Appendix A: Resources Table

Figure 1

Appendix B: Letter of Recommendation for Hormone Replacement Therapy

Appendix C: Letter of Recommendation for Surgery

Appendix D: "Carry Letter"

Appendix E: Clinician Action Steps

Table 1

Index

About the Authors