Archives of Psychiatric Nursing 29 (2015) 255–256

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Archives of Psychiatric Nursing journal homepage: www.elsevier.com/locate/apnu

Child & Adolescent Mental Health Section Editor: Kathleen Tusaie, PhD, APRN, BC

Learning From our Transgender Youth Kathleen R. Tusaie ⁎ University of Akron

Gender is in the mind, and sex is in the body. There is now a generally accepted recognition that gender exists on a continuum and does not always follow birth assignment across an individual's lifespan. The increased visibility of the lesbian, gay, bisexual, transsexual, questioning (LGBTQ) culture in media and literature is evidence of this recognition. The story of an individual's emerging narrative of self and identity that does not match his or her body receives much attention in lay and professional literature (DSM5 diagnosis of gender dysphoria) and media. There is also informal discussion around the need for a new phobia, transphobia, to become part of our language. In fact a new word, cisgender, has emerged. Cisgender initially was defined as the individual experience of feeling comfortable with the gender assigned at birth, the opposite of transgender (Schelt & Westbrook, 2009). However, now the meaning has morphed to indicate the invalidation of an individual's own understanding of their own gender and bodies (Ansara & Hegarty, 2012). This type of thinking expands the concept of gender from a male/female dichotomy to more of a kaleidoscope as described by Spade and Valentine (2013). Although the awareness of transgender individual issues has increased, there is a dearth of literature examining the family's experience with a gender-transitioning member. Adolescence is a time of identity exploration and may become a time of transgender emergence. Taking a holistic, systems perspective in clinical approaches is extremely important. Reading and learning more about the transgender culture will not lead to exact assumptions about the transitioning experience for the individual or the family, but will assist clinicians in formulating “good” questions. During the process of gender transition, it is not only the individual, but the entire family who experiences a transition. The individual usually goes through the following stages of transition from male to female or female to male: awareness, seeking information/reaching out (often online), disclosure to significant others, exploration with identity formation and self-labeling, exploration of transition issues involving appearance and possible body modification, and finally integration involving acceptance and post-transition issues. The family also has stages of transition such as discovery, turmoil, negotiation, and finding balance (Lev, 2004). However, the stages for the individual and their family are often not in sync. The individual may be feeling a sense of relief and excitement to begin to understand the feeling of alienation from their bodies. However, the ⁎ Corresponding Author: Kathleen R. Tusaie, PhD, APRN-BC, University of Akron, 192 Warner Road, Hubbard, OH, 44425. E-mail address: [email protected]. http://dx.doi.org/10.1016/j.apnu.2015.04.005 0883-9417/© 2015 Elsevier Inc. All rights reserved.

family may be experiencing turmoil and unacceptance. Furthermore, families involved in gender transitions are not only feeling conflicted within their family, but have reported conflicting approaches when seeking out professional help (Riggs & Due, 2014). The clinician requires a sense of curiosity and sensitivity to gain insight into both the individual and family dynamics. Parents often begin to plan and dream about their baby's future at birth. They may think—“he is physically strong and going to be a great ball player…..or she is so beautiful and delicate, she will like to dance as a ballerina and have a big brother to watch over her”. Most parents now know the sex of their unborn child and usually begin to decorate and buy clothing deemed socially appropriate for that gender before birth. Parents need to acknowledge their sense of loss of their son/daughter to allow the relationship to evolve with their transitioning daughter/son. There is often grief that needs to surface as well as anger and perhaps guilt. Reactions of friends and

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extended family are different than with other types of losses. Parents may feel isolated and angry while their child is feeling reborn and happier than ever. Therefore, it is wise to initially see parents separate from the child for freedom of expression. Then gently integrate them for family sessions and encourage open discussion. Although the transgender adolescent is moving off toward a different, exotic culture, the support of parents is important for their successful journey (Riggs & Due, 2014). As clinicians working with gender-transitioning families, we can always refer to those who specialize in LGBTQ issues. However, we can also reflect upon own beliefs, be willing to listen to stories, to be open to lived experiences that may be different from our own, and embrace gender diversity. After all, basic human needs for safety, security, love, self-understanding and meaningful contributions do not change, only the path to attain these goals vary.

Resources for Families Advocates for Youth www.advocatesforyouth.org Anti-Violence Project www.avp.org

National Center for Transgender Equality www.transequality.org PFLAG, Parents, Family, Friends of LGBTQ People www.pflag. org/transgender Welcoming Schools www.welcomingschools.org World Professional Association for Transgender Health www. wpath.org The GLBT National Help Center Hotline 1-888-THE GLNH (888843-4564)

References Ansara, Y., & Hegarty, P. (2012). Cisgenderism in psychology. Psychology and Sexuality, 3(2), 137–160. Lev, A. (2004). Transgender emergence: Therapeutic guidelines for working with gendervariant people and their families. NY: Hawthorne Press. Riggs, D. W., & Due, C. (2014). Supportive experiences and attitudes of parents of gender-variant children. Journal of Child and Family Studieshttp://dx.doi.org/10.1007/s 10826-014-9999-2. Schelt, K., & Westbrook, L. (2009). Doing gender, doing heteronormativity, gender normal, transgender people and the maintenance of heterosexuality. Gender and Society, 23(4), 440–464. Spade, J., & Valentine, C. (2013). The kaleidoscope of gender. Los Angles: Sage.

Learning from our transgender youth.

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