From Otherness to Alliance

Abstract

The first part of this article presents the epistemological evolution of the therapeutic frameworks regarding the treatment of transgender individuals and their partners. It outlines a medical approach and two others-the developmental approach and the deconstructive approach, ones not based on the conception of transgender identity as pathological. Two case studies of couples presenting with gender identity-related issues illustrate their application with particular emphasis on the relational process of gender identity formation and on partners of transgender-identified persons.     

Talking About Gender in Motion

Abstract

This is an interview with noted Norwegian sexologists Elsa Almas and Esben Esther Pirelli Benestad, who is bigender and married to Almas. In conversation with narrative therapist Christopher Behan, they discuss, both professionally and personally, working with those who have a transgender family member, the importance of community work to support the transgender child or adolescent, and the continued need for advocacy within the mental health and medical fields for transpeople and their loved ones.     

Normative Accountability: How the Medical Model Influences Transgender Identities and Experiences

The medicalization of gender variance is a key force in transgender people's experiences of embodiment, identity, and community. While most directly dictating experiences of diagnosis and medical classification, it is important to acknowledge that the effects of medicalization are widespread across social contexts and institutions. I explore the medical model of transgender identity, with special attention to its current diagnostic classification, in order to highlight how transgender people's interactional experiences of gender are shaped by medical authority. I review literature that highlights the operation of the medical model as a normative accountability structure in its influence across multiple institutions of social life including health and healthcare, transgender community groups, and legal classification.     

Activating adult allies from a rural community on lesbian,gay, bisexual,transgender, and queer student issues in school using photovoice

Purpose: Many students who are lesbian, gay, bisexual, transgender, or queer (LGBTQ) face hostile school environments that can negatively impact their mental health and education. This study involved a photovoice project where high school students from a gay-straight alliance in the rural southeastern United States took photographs that depicted the issues LGBTQ students were facing and then exhibited their photographs and stories to individuals from the school system and local community to promote awareness, dialogue, and action. Methods: Twenty adults who attended the photovoice exhibit responded to an online survey about their experiences with the intervention. Results: Eighty-five percent of adults reported that the intervention made them think about issues they had not previously considered, including the struggles LGBTQ youths face, gender issues, and living in a rural community. Common emotions experienced at the intervention included feeling excited, concern for the youths, and proud of the youths. Furthermore, 81% of the adults indicated that they would take action or behave differently as a result of the intervention, including supporting and affirming LGBTQ students, using gender-neutral and -inclusive language, and confronting bias in themselves and others. Conclusions: Photovoice is a promising strategy for LGBTQ students to activate adult allies in their community.     

Fighting for survival: The experiences of lesbian,gay, bisexual,transgender, and questioning students in religious colleges and universities

ABSTRACT

Little is known about the experiences of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) students attending religious colleges and universities. This study used grounded theory to analyze the narratives (N = 271) of LGBTQ former and current students. The central theme described by LGBTQ students was a fight for survival with five subthemes: (a) institutionalized homo/transphobia (strict school policies, enforcement of heterosexuality and gender conformity through discipline, conversion therapy); (b) a culture of fear (fear of exposure, homophobic panic and code words, seeking cover); (c) marginalization and isolation; (d) struggle (suffering and suicide, reconciling faith and LGBTQ identity); and (e) coping and resilience (surviving through critical thinking and strategic activism). Implications for practice are provided.     

Translove

Abstract

For the academician, clinician or other person interested in transgender issues, this article defines populations and identity issues. Then, it solicits the reader's empathy by linking transgender survival experiences which are similar to critical GLB lives. In the face of hostility a transgender person's success hinges on receiving critical care, family and social support. Discussion includes those outcomes when these support systems fail, and how having even ‘one’ supportive family member can garner a successful transition and social adjustment. Challenging questions provoke the reader to think through the human experience of transgender men and women. Discussion also focuses on the changing face of transgender politics and social constructs, and how these effect both adults and children of transgender parents. The article summarizes basic coming out and relationship issues for transgender persons, including parents with minor children.     

Cross-cultural Child Development for Social Workers: An Introduction

Abstract

The transgender community represents a highly marginalised portion of the Australian population, frequently experiencing discrimination, social isolation, and harm. This review explores literature informing Australian social work with transgender people. It highlights the importance of generating a transgender-positive discourse within Australian social work to effectively engage with and advocate for individuals with nontraditional gender identities. Key themes emerged from reviewing the literature related to the medical model, the mental health of transgender people, interdisciplinary and alternative transgender literature, minority status of transgender people, existing social work approaches to transgenderism, and Indigenous transgender literature. The views of transgender Australians are largely absent from the literature. However, the Australian transgender community's emerging voice and political activism highlights the potential for collaboration to play a significant role in the process of building a working knowledge base for social work. Based on the identified gaps in literature, in this paper we call for continued progress in developing a theoretical and practical knowledge base that incorporates the lived experiences of transgender Australians. We argue for the development of an approach to practice that is responsive to gender diversity. Highlighted in the review are the conditions that promote greater engagement with the transgender community.     

Acknowledging the Impact of Social Forces on Sexual Minority Clients: Introduction to the Special Issue on Clinical Practice with LGBTQ Populations

Over the last two to three decades, advances in clinical practice with lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals have been extensive. Many clinical social workers now incorporate LGBTQ-affirmative approaches into their practice, and a number of social workers have contributed to the literature on clinical practice with sexual minority clients. Despite these advances, we still require specialized knowledge to understand a number of LGBTQ-related mental health issues. The Clinical Social Work Journal’s first special issue on clinical practice with LGBTQ populations emphasizes psychotherapy techniques that acknowledge and also address social forces (e.g., transphobia, homophobia, and heterosexism) that affect the psychosocial functioning of LGBTQ clients. The special issue focuses on LGBTQ populations, such as transgender and bisexual individuals, sexual minority youth, and older adults, and psychotherapy modalities informed by a number of clinical and theoretical approaches. These in-depth articles offer guidance to clinical social workers who need to expand their knowledge of LGBTQ-related mental health issues and also provide those with existing knowledge an opportunity to refine their clinical skills and sharpen their thinking.     

The Attitudes of Social Work Students and Practicing Psychiatric Social Workers Toward the Inclusion in the Community of People with Mental Illness

Abstract

This study measured and compared the attitudes of social work students and practicing psychiatric social workers to the inclusion in the community of people with mental illness. The Community Living Attitude Scale Mental Illness (comprising the four subscales of Empowerment, Exclusion, Sheltering, and Similarity) was administered to a random sample of 68 Israeli BA social work students (first year: n = 35; third year: n = 33) and 28 practicing psychiatric social workers. Overall, the participants endorsed Empowerment and perceived the Similarity of persons with mental illness to themselves more than they agreed with the Exclusion attitude of segregating those persons from community life. First-year students rated Empowerment and Similarity significantly lower than did the third-year students and rated Sheltering significantly higher than did psychiatric social workers. Psychiatric social workers did not differ from third-year students and did not have stronger attitudinal commitment to the inclusion paradigm. They differed from first-year students only in the sheltering attitude; they showed lower support for sheltering people with mental illness.     

Being Transgender and Older

Summary

Tina Donovan conveys her first person account of living as a transgender person and coming of age in the 1950s and 60s. She tells the story of her particularly negative experiences looking for employment and housing, and obtaining medical care. The account focuses on the implications of the lack of financial security as transgender persons who have been prohibited from attaining legitimate work began to reach old age. It also chronicles the abuses and neglect within the medical establishment as one attempts to get assistance for psychological and physical ailments. The author also shows how crucial LGBT organizations and support groups can be to transgender survival.     

Time to ask and tell: Voices of older gay and bisexual male veterans regarding community services

ABSTRACT

This participatory action study involved lesbian, gay, bisexual, transgender, and queer (LGBTQ) veterans in determining community-based service needs for health and wellness, illuminating perspectives of older LGBTQ veterans regarding community services. This study explored veterans' perceptions of being LGBTQ later in life. The study included data from interviews with gay and bisexual male veterans ages 51 to 87. Participants valued engagement as part of community. Their recommendations for action included communal meals, transportation, housing, and the coming-out process. Community services facilitated community engagement to support health and wellness for LGBTQ older veterans. The authors used participatory action research (PAR), a method of systematic inquiry integrating the perspective of persons living the experience, to organize the study. Further PAR is recommended to implement community services to meeting health and wellness needs of participants.     

Voices from the stories untold: Lesbian,gay, bisexual,trans, and queer college students' experiences with campus climate

ABSTRACT

Twelve self-identified college students within the lesbian, gay, bisexual, transgender, and queer (LGBTQ) spectrum were interviewed on campus climate perceptions and their experiences of discrimination and isolation at their university. Thematic analysis was conducted to identify themes from the data. This process resulted in the emergence of three themes, identified as discrimination, isolation, and avoidance. The most salient experiences of discrimination and isolation reported by participants came from within LGBTQ organizations or from lesbian or gay male individuals that participants sought out for social support. LGBTQ intra-community discrimination was considered to be particularly damaging to participants' sense of belonging and involvement within the LGBTQ community. Discrimination and isolation from straight-identified organizations or individuals was reported mostly in the context of fraternities/sororities and religious organizations. Furthermore, actions by members of these latter groups caused participants to avoid these groups out of expectations of negative interactions. These results inform empirical research to bring awareness to acts of discrimination that continue to take place within the university toward LGBTQ students. Specific implications for social work practice with LGBTQ college students and future research on diverse LGBTQ populations and resources are discussed.     

Exploring the relationships among practitioners’ consultation skills,competence to counsel lesbian,gay, and bisexual clients,and attitudes toward transgender people

Abstract

Consultation is an intervention that can diffuse expertise in lesbian, gay, bisexual, transgender, and questioning (LGBTQ) issues throughout systems of care. Practitioners (N?=?145) were surveyed on their lesbian, gay, and bisexual (LGB) counseling competence, attitudes toward transgender people, and consultation skills. Hierarchical multiple regression analysis identified that consultation competence significantly influenced (p?≤?.01) LGB counseling skills over and above LGB knowledge and awareness, attitudes toward transgender people, and participant demographic characteristics. The domains of LGB competence and attitudes toward transgender people were also significantly correlated within the participant sample. Implications for practice, training, and future research are discussed.     

Enabling informal digital guanxi for rural doctors in Shaanxi,China

In China, rural healthcare systems have been neglected in favor of the development of market-driven, largely urban health information systems (HIS). We investigated the effective use of information and communication technologies (ICTs) to develop a healthcare model within the rural healthcare system. We investigated information needs, existing healthcare structure, and the use of informal networks – guanxi – to acquire health information mediated by technology. Qualitative interviews (N = 74) were conducted in Shaanxi province of China. Respondents included village doctors (30), rural patients (10), urban doctors (17), and 17 other healthcare stakeholders. We found benefits of the use of ICT in informal networks for village doctors, including the facilitation of communication, greater time efficiency, and better access to medical information, particularly in mobile phone and QQ online social network usage. Guanxi relationships were established at proximate, distant, and virtual levels. Emergent communicative practices, such as Internet-driven medical research by village doctors, led to negotiations in established relationships. As suggested by the theoretical model, infrastructural, economic, socio-cultural, and technological vulnerabilities were also observed. We caution against the drawbacks of replication of the closed guanxi system in the digital ICT healthcare arena, and discuss the implications for research and policy-making.     

THe Use of Hormone Therapy in the Male-to-Female Transgender Population: Issues for Consideration in Thailand

ABSTRACT

Objectives: Prejudice against transgender people is evident around the world with discrimination in many aspects of life, including access to health care. Even in Thailand, where male-to-female (MTF) transgender people are particularly visible and society is reputedly accepting, barriers to attaining appropriate health care still exist. The vast majority of MTF transgender people in Thailand are reported to be taking hormone therapy; however, most do not seek medical advice regarding these regimens, with the initiation and tailoring of medication often being guided by sympathetic peers instead. The objectives of this review are to consider hormone therapy in the context of the Thai population and provide recommendations regarding ways to improve practice and reduce health risks. Methods: The data analysis in this article represents a comprehensive literature review regarding hormone therapy for MTF transgender people including the guidelines for initiation, prescribing, and monitoring of hormone therapy, risks for serious adverse events and reported hormone use by the MTF transgender population in Thailand. Results: There is a notable lack of published research regarding hormone therapy in the transgender population. Guidelines, whilst relying considerably on expert opinion, do provide clear recommendations on the initiation, maintenance and monitoring of hormone therapy. Comparison of endocrine guidelines with reported practice in Thailand reveals significant opportunities for improvement in MTF transgender hormone therapy. Conclusions: The incautious use of hormone therapy may represent a considerable health risk behavior undoubtedly contributing to the morbidity and mortality in MTF transgender people. Although there is currently considerable focus on sexually transmitted infections in the MTF transgender population, a more comprehensive approach to health care is required, including education for transgender people and the health professionals who attend to them regarding appropriate hormone therapy.     

Promoting resilience and emotional well-being of transgender young people: research at the intersections of gender and sexuality

Within lesbian, gay, bisexual and transgender (LGBT) research there is increasing health-related scholarship on trans lives, with a growing awareness of the impact of health inequalities on trans well-being. The aim of the paper is to provide greater understanding of transgender young people’s views of what is needed to promote their emotional well-being and resilience by undertaking specific analysis of data collected as part of wider research with young people (n?=?97). The study utilised participatory qualitative methods with a cross sectional design generating data via a focus group with trans youth (n?=?5), followed by thematic analysis. Findings suggest that both individual and collective capacities or resources enable and sustain resilience and well-being for trans young people. The adversity trans youth face is present in school, the community and in healthcare, but they are able to find places where they feel safe and connected to others. Practitioners, teachers and school nurses are well positioned to facilitate structural change in alliance with trans youth to promote resilience. Research results were utilised to inform health improvement, commissioning and service delivery.     

Undergraduate students survey their peers on mental health: Perspectives and strategies for improving college counseling center outreach

Abstract

Objective: The purpose of the study was to examine student perspectives about college mental health including the primary mental health issues affecting students, common college student stressors, student awareness of campus mental health resources, and mental health topics students want more information about. Participants: Participants were 822 undergraduate and graduate students enrolled in a private university. The study was conducted during September 2016. Methods: As part of a public health course in program planning, undergraduate students surveyed their peers about their experience with mental health and mental health resources. Results: Stress was perceived as the largest mental health issue. Students most wanted more information about school/work/life balance followed by stress management. Electronic newsletters, social media, and on-campus seminars were the top strategies that students suggested as ways to reach them. Conclusions: The results provide student perspectives on mental health that may be useful in developing effective outreach efforts.     

Willingness to Participate in Organ Donation Among Black Seventh-Day Adventist College Students

Objective and Participants: The authors studied a group of black and white Seventh-Day Adventist (SDA) college students (N = 334) to compare the power of religious socialization with racial socialization. Methods: The authors compared the levels of willingness to donate organs between black and nonblack students in an availability sample. Results: Black SDA college students were significantly more likely than white SDA students or SDA students of other races to perceive racism in the healthcare system and to believe that doctors would not make heroic efforts to save their lives if they knew they were organ donors; they were 66.9% less likely to donate organs than were white SDA students or SDA students of other races. Conclusions: Despite a common religion with a purposive indoctrination, the racial socialization of black SDA students exerted a stronger influence on willingness to participate in organ donation than did that of white students and students of other races within this religion.     

Beyond alphabet soup: helping college health professionals understand sexual fluidity

ABSTRACT

Many college students today are no longer using the terms straight, gay, lesbian, bisexual, or transgender to self-identify their sexual orientation or gender identity. This commentary explores research related to fluidity of sexual identities, emerging sexual identities used by college students, and how these identities interact with the health and well-being of the student. Additionally, the authors discuss strategies to help college health professionals provide a sensitive environment and clinical experience for students whose sexual identity is fluid.