Psychological support and psychotherapy for transpeople

1. Psychological support and psychotherapy for transpeople Elsa Almås Specialist in clinical psychology Specialist in clinical sexology (NACS) Family therapist (IAP) Professor in sexology University of Agder Esben Esther Pirelli Benestad MD Specialist in clinical sexology (NACS) Family therapist (IAP) Professor in sexology University of Agder

2. Our background • Clinical work with trans clients since the 1980´s • Participation at sexological congresses since 1978: • WAS (World Association for Sexual Health) • WPATH (World professional Association for Transgender Health) • EFS (European Federation for Sexology) • NACS (Nordic Association for Clinical Sexology) • And others elsa.almas@uia.no esben.esther@uia.no

3. THEORIES ABOUT SEX AND GENDER elsa.almas@uia.no esben.esther@uia.no

4. Paradigmshift • From Psychosexualdisordersto Conditionsrelated to sexualhealth • From genderbinarity to multiple genders, thirdgender, genderfluidity and non-gender • From medical (psychiatric) diagnosis to selfdetermined legal gender • From gate-keeping to gender affirmative treatment elsa.almas@uia.no esben.esther@uia.no

5. Standards of Care (SOC) • For others, changes in genderrole and expressionaresufficient to alleviategenderdysphoria. • Somepatientsmayneedhormones, a possiblechange in genderrole, but not surgery; • Othersmayneed a change in genderrolealongwithsurgery, but not hormones. • In otherwords, treatment for genderdysphoria has become more individualized. elsa.almas@uia.no esben.esther@uia.no

6. OUR APPROACH elsa.almas@uia.no esben.esther@uia.no

7. Addressing the clients’ wishes and needs elsa.almas@uia.no esben.esther@uia.no • Explore, qualify and expand the clients’ reasons for seeking assistance. • Assist the clients in qualifying their transe-talents or talents linked to gender/non-gender. • Being a good “shopkeeper” goes beyond handling only that which is asked for.

8. Who areourclients and what problems do they have? • People of all ages, theirparents, children and partners • Trans clients have less psychological problems • Trans clientsare more characterized by pride, competence, highereducation, betternetworks • Psychological problems have a tendency to disappear as thegenderissuesareaddressed • Typical problems aresocialphobias, shame, depression – Asperger talents (Autismspectre) • Many adult clients (MtF) are in a greathurrybecausetheyfeelthey have waitedtoolong. elsa.almas@uia.no esben.esther@uia.no

9. The PLISSIT model elsa.almas@uia.no esben.esther@uia.no

10. The bio-psycho-socialmodelby George Engel (1980) elsa.almas@uia.no

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12. Ung eller gammel? elsa.almas@uia.no

13. Bio-psycho-socialapproach • Biologicallevel: What is happening to your body? • Psychologicallevel: What is yourexperience? • Wishes and needs • Sexuality • Sociallevel: The need to belong is a basic human need. • Belongingarises as resultof an interactionbetweenourinnerworld and theworldaround us. • The need to belongasgender is a deepeningoftheconceptofbelongingness. elsa.almas@uia.noesben.esther@uia.no

14. Good genderbelonging elsa.almas@uia.no esben.esther@uia.no Good genderbelongingariseswhenweareperceived by others in the same way as weperceiveourseves, and whenthatwhich is perceived is given a positive value.

15. Genderidentity as a talent elsa.almas@uia.no esben.esther@uia.no • We regard gender identity as a result of an inborn, hard-wired entity, in interaction with cultural offers. • We name this “trans-talents”

16. Some possible gender options: Female genders Male genders Intersex genders Transe genders Non-genders or gender dismissers Personal/floating/queer genders Eunuch genders More are welcomed elsa.almas@uia.no esben.esther@uia.no

17. Goals ofassistance elsa.almas@uia.no esben.esther@uia.no • The overall goal is positive gender belonging • Discuss “Full” transition – as an objective measure • Discuss “Full” transition - as a subjective measure • Individual solutions • Uncover individual wishes and needs • NB: Self experience often change over time and with increased knowledge about options!

18. Esthetics: What is a beautiful person? elsa.almas@uia.no esben.esther@uia.no Trans-esthetics Non-gender esthetics Intersex-esthetics Other gendered esthetics Non gendered beauty

19. Genderpride elsa.almas@uia.no esben.esther@uia.no Inspire the clients to perform and practice gender in accordance with their wishes and needs. Assist clients in discovering and exploring personal qualities in order to conserve as many present and possible future capasities as possible. Promote gender pride - including trans-pride, intersex-pride, non-gender pride. When not utterly chauvinistic, pride battles shame and cultural resistance.

20. Shame and guilt elsa.almas@uia.no esben.esther@uia.no • Assist the clients’ exploration of shame. Detect the origin of shame. • Battling shame is achieved by transforming shame to guilt and then addressing the guilt where it belongs. • Assist the clients to accept the basic build of their bodies in order for them not to forget what kind of body they have (some men get pregnant, and some women get prostate cancer) .

21. Traumatization • Trauma as resultofacuteviolence and sexualassault (rape) • Complex trauma: Resultofneglect • Trauma ofretention: «Nobody must know!» • In all variants oftraumatization, theresult is thattoomuchenergy is used to protectoneself, and theflowofconsciousness is trapped. elsa.almas@uia.no esben.esther@uia.no

22. Sexuality elsa.almas@uia.no esben.esther@uia.no • Assist the clients’ sense of and contact with organs of erotic pleasure - pleasure has no gender! • Explore learned sexual turn-on patterns. • Sex organs are for private joy - and thus not so important in the everyday performance of gender. • Options for sexuality with partner

23. Addressing the outer world elsa.almas@uia.no esben.esther@uia.no Helping those who are or may be disturbed (families and network) Freeparents from guilt Address challenges facing present and future partners. Work with significant and extended networks to increase their capacity to build a positive perception of the atypically gendered. Use of language: NB: Pronouns!

24. Cultural work elsa.almas@uia.no esben.esther@uia.no Organize groups and networks based on people of atypical gender/non-gender, their family, partners and friends to create strongholds for human diversity Give talks and lectures to groups that may find insights on gender interesting or useful (second order of therapy: i.e working with an audience that actively seek the information) Use media (third order of therapy) in conveying multi-gender positivity.

25. Information abouttreatment offers • Give updated information about optional medical and surgical treatment • Find the right health providers elsa.almas@uia.no esben.esther@uia.no

26. Euphoria! elsa.almas@uia.no esben.esther@uia.no Good genderbelonging is gendereuphoria!

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29. Thankyou!elsa.almas@uia.noesben.esther@uia.no elsa.almas@uia.no esben.esther@uia.no