The Ethics of Working with Transgender and Gender Non-Conforming Adults: Guidelines for Practice
Audrey Ervin, Ph.D.
Case Study #1
Gee is a 25 year-old, white, college graduate who identifies as “trans, FTM.” Gee prefers the pronoun he. Gee presents with gender dysphoria and reports discomfort with assigned gender at birth (female) beginning around age 13. Gee reports a history of depression and body dissatisfaction that he now relates to gender dysphoria. While in college, Gee learned about the term gender queer from the campus LGBTQ group and finally felt like he had language to describe his identity. He reports symptoms of depression have mostly disappeared once he sought a more congruent gender identity. Gee reports body disconnection, trouble looking at himself in the mirror, daily chest binding and fear that he will “never be seen as a real man.” Gee plans to move forward with chest surgery, though his parents have reached out to you and asked to meet for a family session. Gee’s parents are concerned that this is a phase and that Gee is making an uninformed impulsive choice. They refer to Gee as “she” and have threatened to disown Gee if Gee moves forward with surgery.
Case Study #2
Sam is a 73 year-old,retired,Latinoauto mechanic who recently came out to his wife as transgender. Sam, who was assigned a male gender at birth, reports that he has always felt like a woman inside but felt enormous family and cultural pressure to hide his identity. His wife found him dressed in her clothing and she demanded that they seek counseling. Sam has been married for 52 years, reports that he is in love with his wife and doesn’t want their relationship to end. Sam has two children and four grandchildren. His wife has labeled him “deviant” and is afraid of what members of their faith community might think.
Case Study #3
Pat is a 32-year old biracial history professor who identifies as gender queer and prefers the pronoun xe. Pat was assigned a male gender at birth but transitioned to gender queer in hir twenties. Pat is in a long term romantic relationship with Baydra that Pat describes as loving and supportive. Pat reports distress that hir department chair refuses to acknowledge Pat’s gender identity and regularly engages in gendered microaggressions (not invitingPat to university functions, giving Pat a poor class schedule, referring to Pat as he and not supporting Pat when students engage in discriminatory actions.)Baydra is pregnant and the university will not recognize Baydra on Pat’s benefits. Pat reports anxiety, anger and depressive symptoms.
Questions to Consider
How do you conceptualize the client and the presenting concerns?
What are salient issues to address in counseling?
What might be the goals for counseling?
What developmental issues should be considered?
How are individual and/or institutional discrimination impacting the client?
How can you apply the APA aspirational guidelines for working with TGNC clients? What ethical concerns might arise?
How can you be a trans-affirmative ally?