Psychotherapy and the real-life experience: From gender dichotomy to gender diversity

Elsevier, Sexologies, Volume 17, October 2008
Bockting W.O.
Treatment of gender-identity disorders is guided by standards set forth by the World Professional Association for Transgender Health (WPATH). Although not absolute, WPATH's eligibility criteria for hormone therapy and/or genital-reconstructive surgery include participation in psychotherapy. In addition, applicants for genital-reconstructive surgery are required to live at least one year full-time in the preferred gender role, a period referred to as the real-life experience (RLE). The rationale behind the RLE is to prepare the client as well as possible to make a fully informed decision about irreversible surgery. Psychotherapy can play an important role in planning the RLE and in developing resilience in coping with the inevitable psychosocial challenges. The tasks of the mental-health professional include assessment of gender identity and the impact of stigma on psychological adjustment; treatment of coexisting mental-health concerns; confronting internalized transphobia; giving permission to explore gender and sexuality; managing the gate-keeping role and offering support and advocacy during the RLE and beyond. Moreover, the desire to "change sex" in a binary way and the actual reality of living life as a gender variant person can be quite different; through facilitating a "coming-out" process, psychotherapy can aid in grieving the loss of the ideal to make room for a deeper level of acceptance of one's transgender (as opposed to male or female) identity. © 2008 Elsevier Masson SAS. All rights reserved.