Psychiatrists are seeing an increase in the number of transgender people and members of different sexes (TGD) customers, but many lack the experience to treat them in a way that validates their identity and life experience. Researchers at the University of Nebraska at Lincoln have developed a dozen how-to guides to help you do just that.

“Guidelines should be applicable to clinicians working in geographic areas with limited resources for TGD community, but should be useful even to clinicians with extensive experience treating clients,” said Debra Hope, Aaron Douglas Professor of Psychology and lead author of the new paper outlining the recommendations.

The recommendations stem from the researchers’ collaboration with members of Nebraska’s transgender and gender diverse community.

“For a long time, no one in the psychiatric community knew anything about transgender people. [needs] … and if anyone showed up, they had to train their therapist,” Hope said.

Progress has been slow but steady. Then, “people with a good heart… didn’t really know anything yet, but they are at least open and willing to listen,” she said.

“We are far behind. Now it’s time for people to really be competent and ready to provide these services – for both physical health and mental health.”

Research began about eight years ago when TGD clients began to show up in greater numbers at Rainbow University Hospital, which offers mental health services to residents of the Lincoln community who identify as lesbian, gay, bisexual, transgender, or homosexual.

Resources for clinicians were available, Hope said, but they weren’t primarily based on science or research. Most of them were also based on work in urban coastal areas, which did not reflect the reality of people living in communities with a different cultural, social and legal climate.

Consultation with a local resident TGD the community confirmed the need.

“He said, ‘The services there are terrible. Didn’t you know the services are terrible,” Hope said.

She said, “Well, I said, ‘We can work on it.’

The National Institutes of Health funded a project to survey clinicians specializing in TGD services and treatment of community members.

The 12 adaptations of the practice are included in an article in Professional Psychology: Research and Practice and are available from the University’s Department of Psychology. Web site.

“What we need to do is think carefully about whether our TGD customers’ personalities, how it affects how they interact with the world, and how it affects how the world interacts with them,” Hope said.

In some cases, this may mean helping clients make social connections with others, finding “supportive places to go” and insecure places they should avoid. It can also mean helping clients find work, especially in areas like Nebraska where legal protection is scarce or non-existent.

TGD people may come to therapy partly because of gender identity issues, but they can also come because of anxiety, depression, or substance abuse. … Part of the therapist’s job is to figure out how relevant their gender identity is. To some extent this is always appropriate, but one of the mistakes therapists make is that they either overemphasize it or feel uncomfortable so they ignore it. It’s about finding that balance,” Hope said.

“Every person has their own path depending on gender. There is no standard path. It may well be that someone is about to start hormone therapy, planning an operation, etc. This has huge consequences. There are also people who won’t. So by feeling where people are on the path, you can help them get through it.”

Hope said the research team plans to provide training and seminars for doctors, including online training. They will continue to work closely with members TGD communities to adapt the guide.

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