My aim in this presentation is to say a few
words about some of my experiences working with persons exhibiting
the condition known as gender dysphoria, and to suggest some of the
ways in which, as a result of such involvement, my perceptions, both
of the condition itself and of the needs of such individuals, have
changed. By way of introduction I might note that my exposure to
gender dysphoria goes back to 1973, when I was the Director of the
Human Sexuality Center at the University of Massachusetts in
Boston. Because of the nature of the Center,
occasional inquiries from those struggling with their gender identity
came my way. I got involved with other professionals who worked with
transgendered people. It was at that point that I first met Ari Kane,
while attending the gender conference at Boston University in the
spring 1975 which had been put together by Ari and a few other such
brave souls in the New England area. Moving to Columbus, Ohio, in the
autumn of 1975, I joined the Mental Health Clinic of Ohio State
University, and continued to counsel on an ad hoc basis occasional
clients with issues relating to gender identity and gender dysphoria.
My efforts were in large part limited at that point to facilitating
contacts for those in need, exploring the field and simply
learning.
My involvement with gender dysphoria and the issues related it became
more significant in 1978-79 when, together with a local Columbus
psychiatrist, Dr. Judith Box, I began to see people with gender
problems on a regular basis. It soon became apparent that there was a
real need for a more permanent, less ad hoc arrangement to meet the
needs of such individuals, and it was out of that realization that
the Central Ohio Gender Dysphoria Program had its genesis. Over the
intervening two decades,several hundred persons have passed through
the Program.
As to the matter of perceptions and philosophy, although the notion
was, until quite recently, often controversial, it is clear to me
that while there may occasionally be some marginal people who say
they are gender dysphoric, the majority of individuals who present
themselves with the problem are otherwise ordinary functional people
caught up in a dilemma they did not choose. Their distrust,
impatience and at times paranoid and even hostile tendencies can be
normalized when one sees such behavior as occurring in the context of
feeling trapped, being overwhelmed by what is ahead, of having a big
secret which cannot be shared with others, and so on. Because of
this, my own experience has come to suggest that, in spite of the
type of mental health training all of us have received, training
which dictates that we stay within our professional role alone, when
I work with this population, I have to be ready to get quite
thoroughly involved and do so in many levels. As a marriage and
family therapist as well as a sex therapist and educator, I am used
to seeing significant others, such as children, parents, spouses and
work related people. The overall goal there is to work on empathy
building, educating, problem solving. I see this same sort of
involvement to be of great value for this population as well. I
therefore, depending on the wishes of the individual, set times aside
when parents or other close family members can attend group meetings
or meet on a more private basis if they wish to. Being a believer in
"systems theory," I am programed to look at the total picture. I am
interested in details. I often do in service training with a client's
co-workers and work supervisors to sensitize and educate them
regarding the nature of the issues involved and the needs of the
individual client. I see such efforts as necessary steps which help
facilitate a person's transition to the chosen gender. At the same
time, I feel I must be a nurturing, must help build self-esteem, and
therefore act occasionally as a big sister or as an accepting,
supportive, as well as constructively critical, "parent figure."
An individual's involvement with the Central Ohio Gender Dysphoria
Program begins with at least one individual intake meeting. Where we
feel we can be of assistance to the client, this is followed by twice
monthly support /therapy group meetings. The group is not intended
simply as a semi-monthly therapy session, however. Equally if not
more importantly , it also serves to aid and facilitate members'
networking. I thus find myself acting as a "match-maker" of
friendships as I may help create a connection between two or more
people I judge to have similar interests. Thus, I may facilitate the
meeting of a current group member with a "graduate" of the program.
As a way of making such attendance to the group and continuing
involvement attractive for pre and post op program graduates, I have
made group cost free for such individuals; that is
once they meet the requiurements and get their clearance for surgery,
they may attend as much or as little as they wish and at no cost.
Such community and support system-forming is, I feel, essential for
this population, especially since they are often shunned by family
members and old friends, they may have lost their job, and so on.
Indeed, the interactions of group members with one another have not
infrequently developed into close friendships of long duration. In
fact, in some instances friendships developed in group have led to
the individuals involved deciding to live together as housemates or
persons who have shared experiences in the Program forming their own
version of sororities and fraternities! Current and former group
members often extend the twice monthly group meetings by joining each
other again in one of their homes or at a local pub! The caring and
sharing has even extended to invitations to family meals--especially
during holidays--by one married couple to other group members, and to
extending of financial assistance to group members in need of help
with surgery costs by other members of the group. The annual
Christmas reunion which I started several years ago has been a
particular success in creating support systems. One year we called a
graduate group member living in Alaska who we knew to be feeling very
isolated and took turns talking to her. The following year, the same
person flew in all the way from Kodiak, Alaska, for the reunion. At
least twice, another "graduates" flew in from North Carolina to
attend the Columbus reunion. This past year, when it appeared that I
might not get the reunion together, two of the group's graduates got
it together in my stead!
It is my experience that by creating support systems and networks in
this way, transgendered people have a much greater chance of
successful adjustment to the difficult and stressful process of
gender reassignment. And while standard therapy models perhaps frown
on the types of involvement described above, empirical experience
seems to support continued work in this manner.
Merâl Crane, M.A., LPCC
Director of the COGDP
P.O. Box 82008
Columbus, Ohio 43214