Working at the edge
Di Ceglie, D. (2008) Working at the edge: Engaging in therapeutic work with young people with atypical gender identity development. Neuropsychiatrie de l'Enfance et de l'Adolescence, 56(6), 398-402
Professionals working in a service for young people with Gender Identity Disorder (GID) often experience a particular type of pressure in the course of the work which makes thinking and decision-making very difficult. The paper suggests that an examination of the position of the professional and of the service, within the system may bring some relief and be a starting point to direct thinking and possibly action. The perceived position of the professional and of the Gender Identity Development Service within the wider organization of a psychotherapy and mental health trust is discussed. The paper makes reference to the model developed by Rom Harre et al. as described by Campbell and Groenbaek in their book Taking positions in the organisation. The position taken by the professional or the service is also explored as a possible re-enactment of the psychological dynamics of the young people with GID and their families. This view is based on Britton's paper on the re-enactment of individual and family dynamics in the professional network. A view is put forward that this dynamic leads the professional or the service to the risky position of “working at the edge”. The paper discusses processes which could facilitate the move from a position of being psychologically at an edge to the more secure position of being in the mainland. This involves exploration of the model of care and the relationship of the professional to the wider organization in which the service is located and to self-help organizations.
Thinking postmodern and practising in the enlightenment
Wren, B. (2014). Thinking postmodern and practising in the enlightenment: Managing uncertainty in the treatment of children and adolescents. Feminism & Psychology, 24 (2), 271-291.
In this paper, I explore how postmodern ideas about gender may impact on clinicians working with gender variant children and adolescents. The postmodern turn has built on the feminist rejection of the idea of ‘essential’ gender, to further interrogate accepted conceptions of sex and gender and the stability of all identity categories. Some queer theorists have taken a further step, viewing all gender as fictional and artificial and celebrating the subversive potential of transgender identities. However, those working clinically with trans adolescents may experience a troubling tension between, on the one hand, a view of sex and gender categorisations as undecidable and fragmented (as postmodern theory suggests), and, on the other hand, the apparent need of many for a coherent and settled sense of self. In particular, how do we justify supporting trans youngsters to move towards treatment involving irreversible physical change, while ascribing to a highly tentative and provisional account of how we come to identify and live as gendered? I conclude that the meaning of trans rests on no demonstrable foundational truths but is constantly being shaped and re-shaped in our social world. Clinicians must be accountable in this process; far from succumbing to a paralysing relativism, the task for clinicians is to be highly attuned to our young clients’ complex narratives and to question our complex investments in the positions we adopt.
Problems with binary gender discourse
Wiseman, M. & Davidson, S. (2011). Problems with binary gender discourse: Using context to promote flexibility and connection in gender identity. Clinical Child Psychology and Psychiatry, 17 (4), 528-537.
Western society recognises male and female sex from physiological attributes, such as genitals and chromosomes. ‘Gender’ is the social and cultural expectation of how males and females should think, behave and how they should be treated by others (Diamond, 2002). Some children and adolescents experience distress, marginalization, and abuse associated with their gender identifications, preferences and behaviours, which are inconsistent with those expected of their biological sex. Often their families and society find gender non-conformity at best difficult, at worst offensive, distressing and intolerable. There is increasing focus on how mental health professionals work with difference in gender and sexual identity and recent publications highlight the shift from pathologizing transgender to a more ‘identity-based’ perspective, focussing more on the stigmatizing affects of the environment and the impact on the individual (Bockting, 2009). This article describes the challenges of binary gender discourse for young people and their wider contexts and considers how clinicians may more helpfully respond to avoid unhelpful binaries and so keep the young person in mind. The therapeutic aims of the UK Gender Identity Development Service (GIDS) for children and young people are considered and examples of our work provided.