Effectiveness of testosterone therapy for masculinizing voice in transgender patients: A meta-analytic review

Background: Testosterone therapy is the predominant treatment for voice masculinization in transgender patients. Although lowering of voice fundamental frequency (f₀) occurs with testosterone therapy, evidence suggests voice and gender identity may not fully align—i.e., voice-gender congruence may not be achieved—with its use.

Aim: This meta-analytic review evaluates the effectiveness of testosterone therapy to masculinize voice in transgender patients.

Methods: Multiple electronic databases were queried (inclusion dates: from database inception up to October 27, 2017) to identify original research on voice masculinization using testosterone therapy. Nineteen articles were included in this meta-analytic review, which followed PRISMA guidelines. In addition to qualitative analyses, random effects proportion meta-analyses were performed on data related to f₀, voice-gender congruence, voice problems, and satisfaction with voice.

Results: A meta-analysis on f₀ data showed after 1 year of testosterone therapy a combined estimate of 21% of participants (95% confidence interval [CI]: 5%–43%; I²: 59.9%) did not achieve cisgender male normative frequencies (f₀ ≤ 131 Hz). Meta-analyses on incomplete voice-gender congruence and voice problems indicated combined estimates of 21% (95% CI: 10%–34%; I²: 0.0%) and 46% (95% CI: 14%–79%; I²: 90.2%), respectively. Regarding incomplete satisfaction with voice, a meta-analysis showed a combined estimate of 16% (95% CI: 7%–28%; I²: 0.0%).

Discussion: We found that not all transgender patients using testosterone therapy to masculinize voice should expect f₀ lowering to cisgender male normative frequencies after 1 year. The vocal transition may involve voice problems for many patients, and some might not achieve voice-gender congruence without additional, voice-specific intervention. Given these findings, a voice evaluation should occur prior to initiating testosterone therapy and involve counseling on expectations for voice. Transgender patients who pursue voice masculinization may need management from laryngology and speech and language therapy to improve voice-gender congruence, mitigate voice problems, and increase satisfaction with voice.     

Containment lost: the challenge to child psychotherapists posed by modern CAMHS

The paper is an examination of some emotional challenges facing child psychotherapists working in modern CAMHS following the introduction of the NHS internal market for commissioning and providing services. Its introduction has brought the loss of organisational containment for all CAMHS clinicians. The meaninglessness in work reported by clinicians is a clue to this loss. This loss is especially difficult for child psychotherapists because of their particular investment in the apprehension of meaning in symptoms and other presentations by patients. The paper proposes that meaninglessness is itself a clue to the ascendancy of what Freud called the death instinct, and that this is inherent within the internal market model. Because service design and delivery is predicated upon it, the internal market model structurally determines that clinicians are bound to senior management in a way that leaves child psychotherapists open to professional life-threatening dynamics associated with the death instinct. The ?K (Bion) world of CAMHS is thus deathly, leaving child psychotherapists vulnerable to self-destruction. We have lost a workplace in which our approach flourished conferring on us the identity of a discipline structurally favoured, because of the help we provided through this approach to patient and clinic work. This loss of identity brings the dangers of containment lost. This situation leaves child psychotherapists emotionally vulnerable and is akin to Satan’s loss in Milton’s Paradise Lost.     

Happy thoughts: Enhancing well-being in the classroom with a positive events diary

Positive psychology interventions (PPIs) are effective in increasing well-being across the population. Whilst educators are recognising the importance of well-being in the classroom and of its long-term impact on life trajectory, the transformative potential of PPIs in educational settings is yet to be fully realised. This study investigates, for the first time, the effects of a PPI in school children by means of a daily dairy. Self-report questionnaires were used to measure well-being in school children aged 8–11 years. Across two studies, children kept a positive events diary, recording three experiences every day for a week. The intervention led to an increase in happiness and a decrease in depressive symptoms immediately following the intervention and at a three-month follow-up. Children who had unhappier baseline scores benefitted more from the intervention. This study demonstrates significant scope, in school settings, for targeted light-touch interventions to promote well-being in those with the greatest need.     

死亡心理:外部防御还是内在成长?

对西方主要的死亡心理研究进行了回顾和比较分析,不同的死亡心理研究在研究传统、研究对象和研究方法方面存在差异。但是根据研究的侧重点,可以总结出死亡心理的核心内涵:外部防御和内在成长。对死亡的抽象认知产生死亡焦虑,死亡焦虑产生死亡恐惧、自我保护、外在价值导向等外部防御反应;对死亡的具体认知产生死亡反省,死亡反省产生死亡接受、亲社会动机和行为、内在价值导向等内在成长反应。作者以死亡心理的两类反应为框架,综述了近5年来新的研究证据,并对该领域当前研究的局限和未来研究方向进行了分析。     

BEFORE BABEL: REFLECTIONS ON READING AND TRANSLATING FREUD

The author offers some thoughts on reading and teaching Freud, on translating Freud, on translation in general, and on a possible kinship between translation and the psychoanalytic process. His reading of Freud's works, and the years he spent translating them into Hebrew and editing Hebrew editions of his writings, have made a deep and salient impression on his personal psychoanalytic palimpsest. The author began this labor prior to his psychoanalytic training and has no doubt that, to this day, the experience greatly shapes not only his attitude toward Freud himself, but also the nature of how he listens to patients and the way he thinks and writes about psychoanalysis.     

Relations of Parenting and Negative Life Events to Cognitive Diatheses for Depression in Children

In a sample of 299 children (grades 2, 4, and 6), we examined parenting and negative life events as predictors of depressive cognitions, specifically low self-perceived competence, depressive cognitive schemas, and depressogenic attributional style. We also examined developmental trends in these relations. Children completed measures of parenting, negative life events, and depressive cognitions. Parents also completed measures of parenting and negative life events. Consistent with our hypotheses, negative parenting and negative life events corresponded with higher levels of depressive cognitions, whereas positive parenting corresponded with lower levels of depressive cognitions. The relations between negative parenting and negative automatic thoughts were stronger for older children. Theoretical and practical implications are discussed.     

教师职业倦怠与归因的关系探讨

教师职业倦怠问题越来越受到国内外教育研究者的关注。本研究检验归因对教师倦怠的影响。采用教师职业倦怠量表与归因问卷调查170名中学教师。结果表明,中学教师的情绪倦怠程度并不高,但仍有一定比例的教师体验较严重的倦怠状态;内控性与机遇两个控制源与倦怠3个维度之间的相关达到显著水平,权势只与去个性化维度之间的相关达到显著水平;并且,只有内控性与机遇显著地预测了职业倦怠的三个维度。     

When Prayers Go Unanswered

Many Americans believe God answers prayers, but scholars know little about how individuals handle situations in which they perceive that prayers have gone unanswered. Using data from an in‐depth interview project with current and former victims of intimate partner violence, I argue that perceived unanswered prayers cause challenges to belief systems that elicit attribution processes—or cognitive processes through which individuals try to explain the causes of actors’ behavior—whose outcomes are explanations for why God did not answer their prayers. I find that the outcomes of these attribution processes are God‐serving justifications, or attributions of God's perceived unanticipated or problematic behavior that define this behavior as appropriate to the situation. God‐serving justifications for unanswered prayers fall into three types: (1) appeal to higher loyalties, (2) affirmation of benefits, and (3) denial of the pray‐er. I conclude with a discussion of the implications and limitations of the analysis.