Our mascotPapers presented at the 2nd International Congress on Sex & Gender, June 19-22, 1997

Responding to Gender Needs at Multi-Levels:
The Central Ohio Gender Dysphoria Program

by Merâl Crane, M.A., LPCC


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


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