Bullies,blades, and barricades: Practical considerations for working with adolescents expressing concerns regarding gender and identity

ABSTRACT

Background: Adolescents, by their very nature and need for maturity, struggle with issues of the self and identity, while challenging the very systems that are there to support them. However, gender diverse adolescents may become detached and overwhelmed as a trans identity solidifies during this time. Bullies, blades and barricades describes the challenges, hardship and dispossession that some gender diverse adolescents face from interpersonal and intrapersonal conflicts, societal pressure and hostility.

Method: This paper utilizes the current research on safety and risks affecting trans youth, the authors clinical experience of trans and gender diverse adolescents, and recommendations in the literature for professional care and support of gender diverse adolescents to identify the various ways gender diverse adolescents are negatively affected by their experiences.

Results: Bullying is not limited to school or peer environments and may be present in adolescents' homes, in local communities, in professional services or from sources of information such as the media. The physical dangers gender diverse adolescents face may arise from victimization, violence or rejection, or self-harming behaviors due to negative beliefs, fear or frustration. Barriers preventing disclosure and expression of gender and/or identity may stem from negative experiences, rejection, pubertal changes, imposed limitations, dependence upon school, home or legal environments, or other spheres of influence.

Discussion: Affirmative approaches, individual focus, recognition of family dynamics, inclusion of significant others, advocacy in school and local community environments as well as professional training are the most commonly recommended interventions. This paper provides an inclusive review of the myriad of challenges confronting gender diverse adolescents including often unrecognized forms of pressure, oppression and restrictions. This paper aims to support clinicians by contextualizing the adversity that gender diverse adolescents face and offers strategies for engagement and intervention.     

‘Emotional turbulence’: the development of symbolic thinking in the psychotherapeutic treatment of an adolescent girl

Abstract

This paper is drawn from doctoral research which analysed clinical data from the once weekly psychotherapy of a young person who experienced both gender identity dysphoria and an eating disorder and whose depression had proved resistant to other interventions. Based on the psychoanalytic thinking of Klein, Segal, Bion and others regarding the role of symbolisation in development, the links between symbol formation, the depressive position and the negotiation of the Oedipus complex are outlined. Special attention is given to current thinking about the nature and genesis of gender identity dysphoria in the light of these concepts. The association with autistic features for a number of cases is briefly explored. In the light of these theoretical links, findings from the study are used to investigate and illustrate the movement this patient made within her therapy from an emotionally turbulent position where concrete thinking was manifest, to a more symbolic way of thinking that allowed emotional change, and less concrete acting out. Clinical narrative excerpts as well as findings from the study are used to discuss the progress made by the patient and to evaluate how her journey may inform future practice.     

Gender/ed identities: an overview of our current work as child psychotherapists in the Gender Identity Development Service

Abstract

This paper is adapted from a presentation first given at the 2017 Association of Child Psychotherapists (ACP) Conference. We hope to give a feel of our work as psychoanalytic child psychotherapists working in a Tier 4 national assessment service for gender variant children and connect with our colleagues working therapeutically with these families in Child and Adolescent Mental Health Services (CAMHS) and other settings. Gender variance does not have a single cause, or straightforward developmental pathway; rather it is a complex interplay of multiple factors, akin to sexuality in the diverse manifestations and ‘tributaries’ taken. This paper is given as a plea for complexity, to counter the current intense focus on gender identity and the consequent reductionism this can lead to. To this end, three case studies from the clinic, taken from Under Five, Latency and Adolescent phases of development, are explored. The complexity of the cases is then discussed, followed by parallel issues of development, divergence and difference. These three ‘average’ cases from the Gender Identity Development Services (GIDS) serve to demonstrate the need for child psychotherapy as part of multi-disciplinary thinking about gender variance and how attention must be maintained to each unique story and process of identity development; as well as our clinical task to establish and encourage depressive functioning and secondary processes where possible.     

Genders and sexualities in individuation: theoretical and clinical explorations

Abstract :  Gender assignment, as a key aspect of identity and cultural position, has existed throughout recorded time and across all cultures. An individual's biological sex and particular cultural milieu has a profound effect on their sense of themselves as a gendered being. Sexuality is a more recent marker in identity formation. In the last few decades there has emerged a great deal of interest in the psychology of gender formation, in the interplay of biological sex, culture, brain development, and attachment experiences in the formation of gender identities. Queer theory in its post-modern deconstructionist thinking has suggested that gender is a socially 'constructed' concept having no biological or psychological precursors or realities. Contemporary developmental psychoanalysis is bridging the gap between concepts of gender as purely biological and gender as non-existent. In this paper I explore the emergence of same-sex desire at mid-life, presenting two case histories with extensive dream material. The impact of sexual desire on gender identities is examined through the lenses of culture, dynamic systems theory, neuroscience, and depth psychology. The use of dream analysis as a window into the body/mind movement of gender emergence reflects my sense of gender as a fluidly shifting reality of mind, neither hardwired nor fictional.     

‘Un-certainty’: working therapeutically with a transgender young person and learning to bear the unknown

Abstract

The rate of referrals to mental health services for children and young people for whom gender dysphoria is the identified clinical issue has increased significantly over the last ten years. Debates around the classifications of gender identity disorder, gender dysphoria or gender incongruence, as well as the involvement of child and adolescent mental health services with this group of children and young people seem to be re-enacting the societal gender binary world view where we see acceptance versus rejection, open-mindedness versus conservative, trans-phobic thinking. In this paper the author will attempt to shed some light on the work with these young people in a clinical setting by reflecting on a year of therapeutic work with a female to male young person. Through the therapist’s reflections upon these binary preconceptions, along with the use of developmental and object relations theory, an in-depth account of the work is given. It is suggested that in some cases the therapist’s capacity to bear the unknown, while gradually observing and mirroring the un-integrated inner self of the patient, can gradually bring the fragments together, even if not in a perfect fit, and that this in turn provides a sense of relief.     

Falling outside of the ‘nice little binary box’: a psychoanalytic exploration of the non-binary gender identity

The non-binary gender identity has recently emerged on the landscape of gender variance. It captures individuals who may experience a gender identity that is neither exclusively male nor female, is a combination of male and female or is between or beyond genders. The availability of literature exploring the non-binary gender experience is somewhat limited. Consequently, our understanding of the development of ‘self’ amongst such individuals seems to lag behind that of other gender variant identity, in particular the binary transgender identity. A psychoanalytically informed qualitative research design was used to explore the psychological realities of 6 individuals, aged between 19 and 29 years, who identified as gender fluid, genderqueer, polygender, non-binary Trans person, non-binary trans guy and non-binary gender. Analysis focused upon the integration of conscious and unconscious material in order to provide some insight into the participants’ internal world and object-relating. Three core themes emerged from the data: ‘A developing gender identity’, ‘Correct and incorrect language’ and ‘Being seen and unseen’. These themes, as well as the heterogeneity and complexity of non-binary gender identity, are explored within the discussion, with some implications around our clinical and wider cultural response to people who identify themselves in this way.     

领导者性别身份的评价差异：基于内隐领导理论的实证分析

本研究基于内隐领导理论,运用配对问卷法,探究领导者性别身份的三种评价差异：自我评价与下属评价的差异,男性领导与女性领导的下属评价差异,男性下属与女性下属的评价差异。结果显示,与领导者自评的性别身份相比,下属易高估领导者的男性化;且下属评价男性领导的男性化显著高于女性化,而评价女性领导时两者并不存在显著差异。此外,男性下属对领导男性化的评价高于女性下属的评价。     

Accessing the multitude within: A psychoanalytic perspective on the transformation of masculinity at mid‐life1

This paper reflects upon the essential components of male identity that commonly are reworked in middle age. The author argues that healthy masculine gender identity involves an ongoing, plastic process of destabilization and reconstruction at various pivotal developmental stages, particularly during middle adulthood. In essence, a man's mature transformation of his sense of masculinity results when finite concepts of gender identity are superseded by an awareness of the complexity of one's multiple, early and diverse gender identifications. A clinical case provides insight into how psychoanalytic treatment can contribute to a new experience of masculinity. The case illustrates how a maturing man, meeting an altered sense of identity in mid‐life, relies less on gender splitting and more on reuniting previously antithetical intrapsychic elements. Why this more pluralistic, polythreaded masculinity frequently must wait until mid‐life is further clarified. Specific importance is attached to the early development of male gender identity as it is founded on the boy's unique struggles in separating from his mother. The foundation for male gender identity formation is reconsidered as the author questions the ‘dis‐identification’ model while explicating how the boy's striving for narcissistic completion shapes the gendered masculine ego ideal. Classically termed ‘phallicism’ is understood both to facilitate and obstruct a man's adult development, while the concept of ‘genitality’ is augmented by the postclassical notion of ‘interiority’. At mid‐life, ‘phallic’ ego ideals (resting on omnipotence, desires for narcissistic completion and gender splitting) are transformed into more realistic, ‘genital’ ego ideals (synthesizing autonomy and connection). The achievement of a mature, less sharply gendered ‘masculine’ ego ideal (revitalizing the foreclosed dimensions of both the early maternal and paternal imagos) occurs as the balance of forces shifts in the direction of true genitality rather than defensive phallicism.     

师范生职业认同与自杀意念的关系:抑郁的中介作用及其性别差异

基于心理健康的社会学模型和社会-文化模型,本研究考察师范生职业认同与自杀意念之间的关系,以及性别的调节效应和抑郁的中介效应。被试为700名师范生,研究工具包括师范生职业认同感量表、自杀意念自评量表、流调中心用抑郁自评量表。结果表明：（1）职业认同得分、自杀意念检出率的性别差异显著;（2）职业认同与抑郁、自杀意念均呈显著的负相关,自杀意念和抑郁呈显著的正相关;（3）性别在职业认同负向预测自杀意念的关系中起到调节作用,该调节作用还部分通过抑郁这一中介变量来实现。     

Gender roles and decision making among isiXhosa-speaking adolescents

This exploratory study examined gender roles and decision making among isiXhosa-speaking adolescents. Participants were a non-probability sample of 40 Grade 12 learners (females = 50%; aged between 17 and 24 years). Data were collected using identity status interviews and analysed thematically to profile the adolescents’ gender role identity statuses and related decisions. The findings suggest the adolescents to endorse gender roles somewhat discrepant to traditionalist roles in that females endorsed primary family financing provider and decision making, whereas the males were accepting of nurturing or carer roles in the family home. Gender role statuses and decision making among teenage isiXhosa appear to be shifting away from traditional roles towards modern thinking of gender equality.     

Beyond Male and Female: Poststructuralism and the Spectrum of Gender

ABSTRACT

Transgender explodes the notion that male and female are discrete categories. Transgender people change sex or inhabit third (or multiple) sex, androgynous, or fluid identities. I theorize this by developing and then critiquing poststructuralist transgender theory. A poststructuralist theory of transgender disassociates sex and gender, models both as constructed, and emphasizes the technologisation and commodification of the body. Poststructuralist accounts can, however, entail denial of bodily limitations, erase transgender people's subjective experience, and overlook social and political factors, such as the importance of gender categories as a basis for identity politics. I argue for the deconstruction of gender binaries to be combined with the development of a gender-pluralist, flexible, model of gender. This points to the replacement of bipolar models of gender with a gender spectrum, with important implications for conceptualizing gender. My analysis is based on empirical research with a range of transgender people.     

Oedipus matters

Abstract

Using experience of working clinically in South Africa, a powerfully racialized society, this paper argues that the Oedipal period, associated in psychoanalytic theory with the formation of gender identity and the shaping of sexual desire, is also a period during which perception of racial identity affects entry into the social world. During this pivotal developmental period, marked by awareness of encounters with gender difference and experiences of erotic exclusion and inclusion, children also become aware of racial differences and their effects on class, privilege and custom. The paper suggests that the anxieties, competitive energy, hope, hate and dread that accompany the child's Oedipal strivings are frequently compounded by encounters with forms of social difference both in and beyond the family. Assumption of a gendered identity, in many contexts, is inseparable from the conscious and unconscious habitation of a racialized identity, which emerges during exactly the same period. Just as our gender identity is both simple and infinitely variable and complex, our awareness of our race is also on one level simple – ‘black/white’ – and on another extremely complex. The paper argues that the working through of Oedipal anxieties will cast light and shadow on every intimate relationship, and will also determine whether other kinds of difference, including racial difference, are met with fear or competitiveness, idealization or denigration, joyful curiosity or withdrawal. The argument draws on post-Freudian, relational and self-psychoanalytic theory, and emphasizes the variability of developmental paths and their construction in powerful social, economic and political contexts, all of which have fundamental effects on biology and bodies. Major influences on the argument are psychoanalytic gender theorists, specifically Jessica Benjamin and Jody Messler Davies, and the work of Franz Fanon.     

Gender is what you look like: Emerging gender identities in young children and preoccupation with appearance

Abstract

Our work examining young children’s strong desire to wear gender-stereotypical clothing suggests that physical appearance may be early reflections of developing gender identities. We test implications of this association between gender and appearance with two studies examining young children’s preoccupation with looking pretty or handsome. Findings revealed that being more attuned to gender information was linked to greater appearance preoccupation. Girls were more preoccupied with their appearances compared to boys. Age was associated with greater appearance preoccupation in two of our three measures. These studies suggest that appearances may reflect developing gender identities, and that gender identity development can influence children’s appearance preoccupation. We suggest that future research examine the stability and generalizability of appearance preoccupation.     

中国学生性别自我认同发展过程初步研究

本文将简易性度测量应用于中国学生性别自我认同的研究,考察其发展过程、主要差异和影响因素,并制订性度常模。简易性度测量采用定量方式衡量性度,可从行为方面有效地应用于人群性别自认障碍的筛检,对预防心理疾患、健全个体性意识有一定的医学价值。     

Understanding the Role of Gender and Ethnic Oppression when Treating Mexican American Women for Eating Disorders

Gender, ethnicity, and weight issues are often the basis for internalized oppression. Mexican American women with eating disorders are subject to such internalization, complicated by cultural and family factors. Mexican American women (n = 136) were assessed. The resulting culturally discrepant gender identity theory describes the complicated set of relationships between weight, cultural weightism, gender identity, assimilation to U.S. culture, family factors, and eating disorder symptoms. Therapists treating eating disorders should consider ethnic and gender identity in addressing the conflicts between family, culture, and gender expectations; and demonstrate sensitivity to the complex inter-generational relationships in Mexican American families.     

Gender Identity and Adjustment in Middle Childhood

This article has two purposes. The first is to present a brief (and speculative) account of the developmental origins of the several components of gender identity featured in the multidimensional model of gender identity proposed by Egan and Perry (2001). The second is to offer additional empirical support for the construct and discriminant validity of the various gender identity dimensions. Children (M age = 11.5 years) were assessed for 4 components of gender identity: (a) felt gender typicality, (b) contentment with gender assignment, (c) felt pressure for gender conformity, and (d) intergroup bias (the sentiment that one's own sex is superior). Gender typicality, gender contentedness, and felt pressure (but not intergroup bias) related to indexes of psychosocial adjustment in specific and theoretically meaningful ways. The case for a multidimensional approach to gender identity is strengthened.     

“I knew that I wasn’t cis,I knew that,but I didn’t know exactly”: Gender identity development,expression and affirmation in youth who access gender affirming medical care

Abstract

Background: Research about gender identity development is still in its infancy, especially among youth who experience gender dysphoria and are accessing gender-affirming medical care.

Aims: This article contributes to the literature on how gender identity and gender dysphoria is experienced, expressed and addressed by youth who have started, or are just about to start, a gender-affirming medical intervention.

Methods: The project draws from qualitative interviews with 36 trans children and youth of different ages and stages of puberty. The data were collected in three specialized Canadian clinics that offer gender-affirming care and they were analyzed through inductive thematic analysis.

Results: Two interlinked dimensions of the youth’s lives allow meaning-making of their gender identity: 1) internal or personal and 2) interactional or social processes. Careful analysis reveals three gender identity development pathways that may be taken by youth, from early questioning to the affirmation of their gender identity. A discussion of current models of gender identity development and their limitations concludes the article.     

Barbie and the tree of life: the multiple functions of gender in development

Gender identity is the lens through which people experience being boy or girl, man or woman. It is a complex compromise formation that is not separate from the wishes, fears, and intrapsychic conflicts of other domains. Over the course of development, gender identity becomes layered and reconfigured. This paper looks at one child's experience of gender over several phases in her development in order to learn how gender is integrated into identity. At different times, as different conflicts came to the fore, she used gender to shape and lend definition to these conflicts. Conversely, her experiences in other spheres influenced her experience of gender.     

The spatial contours of wellbeing: A content analysis of metaphor in academic discourse

Abstract

In thinking and talking about wellbeing, people often deploy spatial metaphors, such as identifying positive and negative affect with ‘up’ and ‘down’ respectively. However, there has not yet been a systematic investigation of how wellbeing is represented through metaphor. To shed light on this topic, a content analysis was conducted of spatial metaphors in academic discourse on wellbeing, focusing on recent editions of two leading journals, the Journal of Positive Psychology, and the British Journal of Clinical Psychology. Across 28 papers, 54 spatial metaphors were identified, grouped into four main categories: verticality; horizontality; configuration; and dynamism. Above all, wellbeing is associated with interior expansiveness, with positive valence usually attaching to vertical metaphors of height and depth, horizontal metaphors of width and breadth, and configuration metaphors of size and growth. The analysis thus offers valuable insights into the subjective dynamics of wellbeing.