Transgender Individuals: Can We Help?

Mr. Warren Miller Jr
November 2, 2012 — 2,003 views  
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              Transgender individuals are often marginalized and disenfranchised within society.  To add insult to injury, these individuals experience much intentional and unintentional discrimination with social work clinicians and members of the Lesbian, Gay, Bisexual community. Research and information made available to the social work profession is scarce in the realm of working and implementing change with transgenders. This article views some of the limited literature for professionals to provide a more important description of this population, known effective practices and implications for social work clinicians beginning and currently working with transgender individuals.

Defining Transgender

         “Drag Queen”, “Transsexual”, “Transvestite”, are terms usually used to describe a person who may be “Transgender.” But those terms are not acceptable terms that describe such a population. The term “Transgender” is now used and accepted by the transgender community (Pinto et al, 2008). What does the term “Transgender” actually define? According to Gretchen Kenagy (2002), the term “Transgender” refers to people who have gender identities, behaviors and/or orientations that are different from their sex ascribed at birth. The social work dictionary defines transsexual as “…changing of one’s sex through surgery, hormone injections, psychotherapy and special training” (Barker, 2003). The literature on the transgender community is scarce but the literature that does exist consists of studies and papers on male-to-female (MTF) rather than female-to-male (FTM) transgendered individuals. Transgendered people frequently use the terms MTFs and FTMs to describe their gender identity. 

Transgender and HIV/AIDS

          According to the current literature, the transgendered community has a high prevalence of contracting HIV (Kenagy, 2002). This may be the result of many different factors (i.e. IV drug use, prostitution, non use of protection, lack of HIV/AIDS knowledge). In 2002, Gretchen Kenagy conducted a needs assessment with a group of transgendered individuals which explored their diagnosis with HIV and the risk factors of contracting the virus. The needs assessment was conducted at an AIDS social service agency based out of Philadelphia that works with the transgender population. This study included 81 transgendered persons, which included 49 (60.5%) MTFs and 32 (39.5%) FTMs. The needs assessment instrument was administered by eight transgenders who were trained to administer the assessment. The author used two focus groups and two discussion groups that focused on HIV/AIDS status and health service issues faced by the transgender community. The researcher reports that HIV/AIDS is a major concern facing the transgender community and MTFs were found to be at a high risk for infection through sexual activities. Also, the research posits that FTMs were found to be at a tremendous risk of HIV infection because of lack of knowledge and willingness to participate in high risk sex activities in the future. In the study by Kenagy (2002), some of the limitations included a non perfect sampling design, the lack of detail on IV drug use and sexual transmitted disease (STD) information. This study implicates that HIV/AIDS intervention and prevention strategies should be used in agencies that serve the transgendered community.

Nemoto, Sausa, Operario, & Keatley (2006), also conducted research on the transgender community about the needs for HIV/AIDS interventions and prevention programs. Based on their findings, the researchers developed several transgender-specific HIV prevention, substance use and mental health treatments, and health education programs. The researchers gathered data in two phases; the first phase was a qualitative focus group and the second was a quantitative survey using a structured questioning instrument. In the first phase, the researchers conducted seven focus groups; one pilot focus group, two with the African American MTF transgender participants, two with the Latino MTF transgender participants and two with the Asian Pacific Islander MTF transgender participants. The second phase included MTFs to administer the questionnaire instrument at local places where MTFs frequented (i.e. bars, clubs, health clinics, and apartment buildings).  Four themes emerged from the quantitative and qualitative measures of this study; High levels of HIV-related risk behaviors; inadequate knowledge about HIV transmission; persistent discrimination against MTFs of color in health services; and lack of sexuality education and health services for MTFs. African American and Latina MTFs reported higher rates of HIV infection (41% and 23%) than Asian Pacific Islander MTFs (13%).  From the findings, the researchers created three community based intervention programs that service the MTF transgender community. Transgender Resources and Neighborhood Space (TRANS), the Transgender Recovery Program (TRP) and the Transgender Life Care (TLC) are the name of the programs that were created.

Interventions

            Intervention in social work practice is imperative. The work that is performed with the transgendered population must be appropriate and evidenced based. There are many at-risk activities that are associated with the transgender community (e.g. substance use and abuse, solicitation of sex and unprotected sex). These issues must be approached with the most accurate and effective interventions available. To address substance abuse, Jordan (2000) suggests that involving the transgender client in Alcoholic Anonymous or Narcotics Anonymous to help support their recovery. So, encouraging participation in structured support groups is an effective intervention when working with the transgender population with substance use and abuse problems.

            With the diversity of problems experienced by the transgendered community, the troubles may become complex. Long-term counseling is an intervention that may be beneficial for the improvement of the transgender client. Carroll, Gilroy, & Ryan (2002) posit that transgendered individuals may seek counseling for many issues because of the discrimination experienced. The authors also suggest that counseling using a cognitive-behavioral and a supportive counseling approach works best with the transgendered population. These approaches allow the counselor to help change the faulty thought patterns that are pre-cursors to the at risk behavior. It also helps to support the clients by focusing on strengths and maximizing growth potential.

            Another intervention that has gained wide support for individuals and families is narrative therapy. Narrative therapy is an approach that shuns away from pathologizing  people and their connections and focuses on creating “an empathic and supportive therapeutic context for people to call forth other ways of knowing themselves and their lives in order to bring about change” (Saltzburg, 2007). This particular intervention allows the transgender client to deconstruct certain themes of their stories and re-author their life stories.

            There was a quantitative need assessment study conducted by the Xavier (2002) that established the idea for a need of educational interventions about transgender care and healthcare intervention. This study included 252 transgender participants in the District of Colombia from September 1999 to January 2000. From the findings, the author discovered the need for educational program interventions for transgender care for health officials and agencies that provide invaluable services to the transgendered community. Amongst the survey items in this study, educational program interventions were ranked the second highest in the self-assessment conducted by the transgenders.

Theoretical Approach

            Literature on the transgendered community is scarce but, the literature that is available points out that this population is gaining a voice throughout the communities. Working with transgendered individuals require a special multicultural training for social workers or professionals who practice with this population. Bess and Stabb (2009) points out that newly graduated professionals are not trained on transgender sensitivity issues and evidenced based interventions related to the population. They also conjecture that psychotherapy works well with this population. Within psychotherapy, the psychodynamic approach is recommended. The goal of this type of therapy is for the patient to understand and cope better with these feelings by talking about their experiences. It is imperative that transgender individuals have access to participate in talk therapies because of their experiences of trauma, unresolved family and gender issues, and the oppression of societal norms. Bess and Stabb (2009) recommend group therapy. Group theory/therapy has been an imperative addition to the profession and practice of social work. According to Hartford (2005), group work can be very beneficial for individuals even out of the realm of the group. The impact of group work allows the individual to effectively use the skills learned in group in other areas of life.

Implications to Social Work

            The transgendered community has always been around but attention is beginning to be given to this population. There are several serious factors that play a major role in the transgender community and the HIV epidemic. Many transgendered persons may struggle with discouraging psychological, socioeconomic and substance use and abuse issues. All factors are to be taken into consideration when practicing with this population. Social workers or service providers that service the transgender community must assure that their practice interventions are culturally and subject sensitive to this community. The research presented in this paper also alludes to the idea that social workers should engage in evidenced based practice and research to better understand this population. Engaging in ethical research and practice with this population will lead to a more effective practice. The experience working with a transgender client is like no other. Even though this is an emerging population, knowledge bases and experiences are beginning to appear. This work charges the social worker practicing with this population to learn available community resources, research what works with their individual client and utilize evidenced based interventions and methods to create effective change. Theoretical approach is important and required when working with this population. The age of “shooting from the hip” is beyond our profession and there are theories and perspectives that effectively work with certain populations. Within the transgender population, various forms of psychotherapies and group therapies are identified as effective theoretical approaches. The practitioners whom work with the transgender population should engage in the proper training, certification and practice experience to effectively create change within these individuals.

Moving Forward

            As a social work practitioner and PhD student, I feel that it is important for the profession to be able to understand and provide a cultural competent service to the transgender population. It is tremendously important for clinicians to comprehend the complexities of this population. Literature within this population is emerging, in which, our knowledge base and ability as clinicians to serve this population is increasing. Because of my clinical experience with transgenders, I have learn to appreciate the fact that I can obtain a job, visit a theatre or shop in a grocery store and not be harassed, oppressed, and/or disenfranchised because of my gender. This population is dynamic and growing. More clinical and empirical research is required for the profession to sustain the amount of work that is going to be needed for more effective interventions and advocacy efforts for transgenders.

References

Barker, R. L. (2003). The social work dictionary. Washington, DC: NASW Press.

 

Bess, J. Allison., Stabb, S. D. (2009). The experiences of transgendered persons in

            psychotherapy: Voices and recommendations. Journal of Mental Health

            Counseling, 31(3), 264-282.

 

Carroll, L. Gilroy, P. J., Ryan, J. (2002). Counseling transgendered, transsexual, and

            gender-variant clients. Journal of Counseling & Development, 80, 131-139

 

Hartford, M. E. (2005). Groups in the human services: Some facts and fancies. Journal of

            Social Work with Groups,1, 1-8

 

Jordan, K. M. (2000). Substance abuse among gay, lesbian, bisexual, transgender, and

            questioning adolescents. School Psychology Review, 29(2), 201-206

 

Kenagy, G. P., (2002). HIV among transgendered people.  AIDS CARE, 14(1), 127-134

 

Nemoto, T., Sausa, L. A., Operario, D., Keatley, J. (2006). Need for HIV/AIDS

            education: and intervention for MTF transgenders: Responding to the challenge.

            Journal of Homosexuality, 51(1), 183-202

 

Pinto, R, Melendez, R, & Spector, A (2008). Male-to-female transgender individuals:

            Building social support and capital from within a gender focused network.

            Journal of Gay & Lesbian Social Services, 20(3), 203-220.

 

Saltzburg, S. (2007). Narrative therapy pathways for re-authoring with parents of

            adolescents coming out as lesbians, gay, bisexual and transgender. Journal of

            Contemporary Family Theory, 29, 57-69

 

Xavier, J. M. (2000) The Washington DC transgender needs assessment survey. Us

            Helping Us, Washington, DC

Mr. Warren Miller Jr

Us Helping Us, People Into Living

I currently am working on my PhD in Psychology with an emphasis in Cognition and Instruction.