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Gender
Identity Dysphoria, or Transgenderism
Some men and
women are born into bodies that do not reflect
their truest, most authentic gender. These men
and women are not only widely misunderstood the
general population, but they are also often
misunderstood by professionals. Michele
O'Mara has worked with over a hundred men and
women who are experiencing gender conflicts.
Gender Services
available with Michele include:
- Individual and
Family Counseling
- Gender
clarification, diagnosis (if applicable),
and exploration of options for making peace
with your gender
- Letter of
referral for HRT and SRS
- Transition
assistance and guidance through steps
necessary for a gender transition
- Bi-weekly
Gender Support Group
To
schedule an appointment 24/7 visit this link
As
described in the THE
STANDARDS OF CARE FOR GENDER IDENTITY DISORDERS --
SIXTH VERSION, my role
as the mental health professional is outlined as
follows:
III.
The Mental Health Professional
The
Ten Tasks of the Mental Health Professional.
Mental health professionals (MHP) who work with
individuals with gender identity disorders may
be regularly called upon to carry out many of
these responsibilities:
1.
to accurately diagnose the individual's gender
disorder;
2.
to accurately diagnose any co-morbid psychiatric
conditions and see to their appropriate
treatment;
3.
to counsel the individual about the range of
treatment options and their implications;
4.
to engage in psychotherapy
5.
to ascertain eligibility and readiness for
hormone and surgical therapy;
6.
to make formal recommendations to medical and
surgical colleagues;
7.
to document their patient's relevant history in
a letter of recommendation;
8.
to be a colleague on a team of professionals
with interest in the gender identity disorders;
9.
to educate family members, employers, and
institutions about gender identity disorders;
10.
to be available for follow-up of previously seen
gender patients.
The
Training of Mental Health Professionals.
The
Adult-Specialist.
The
education of the mental health professional who
specializes in adult gender identity disorders
rests upon basic general clinical competence in
diagnosis and treatment of mental or emotional
disorders. The basic clinical training may occur
within any formally credentialing
discipline--for example, psychology, psychiatry,
social work, counseling, or nursing. The
following are the recommended minimal
credentials for special competence with the
gender identity disorders:
1. A
master's degree or its equivalent in a clinical
behavioral science field. This or a more
advanced degree should be granted by an
institution accredited by a recognized national
or regional accrediting board. The mental health
professional should have written credentials
from a proper training facility and a licensing
board.
2.
Specialized training and competence in the
assessment of the DSM-IV/ICD-10 Sexual Disorders
(not simply gender identity disorders).
3.
Documented supervised training and competence in
psychotherapy.
4.
Continuing education in the treatment of gender
identity disorders which may include attendance
at professional meetings, workshops, or seminars
or participating in research related to gender
identity issues.
The
Child-Specialist.
The professional who evaluates and offers
therapy for a child or early adolescent with GID
should have been trained in childhood and
adolescent developmental psychopathology. The
professional should be competent in diagnosing
and treating the ordinary problems of
children and adolescents.
The
Differences between Eligibility and Readiness.
The
SOC provides eligibility requirements for
hormones and surgery. Without first meeting
eligibility requirements, the patient and the
therapist should not request hormones or
surgery. An example of an eligibility
requirement is: a person must live full time in
the preferred gender for twelve months prior to
genital reconstructive surgery. To meet this
criterion, the professional needs to document
that the real life experience has occurred for
this duration. Meeting readiness
criteria--further consolidation of the evolving
gender identity or improving mental health in
the new or confirmed gender role--is more
complicated because it rests upon the
clinician's judgment. The clinician might think
that the person is not yet ready because his
behavior frequently contradicts his stated needs
and goals.
The
Mental Health Professional's Relationship to the
Endocrinologist and Surgeon.
Mental
health professionals who recommend hormonal and
surgical therapy share the legal and ethical
responsibility for that decision with the
physician who undertakes the treatment. Hormonal
treatment can often alleviate anxiety and
depression in people without the use of
additional psychotropic medications. Some
individuals, however, need psychotropic
medication prior to, or concurrent with, taking
hormones or having surgery. The mental health
professional is expected to make these decisions
and see to it that the appropriate psychotropic
medications are offered to the patient. The
presence of psychiatric co-morbidities does not
necessarily preclude hormonal or surgical
treatment, but some diagnoses pose difficult
treatment dilemmas and may delay or preclude the
use of either treatment.
The
Mental Health Professional's Documentation Letters
for Hormones or Surgery Should Succinctly Specify:
-
The
patient's general identifying
characteristics
-
The
initial and evolving gender, sexual, and
other psychiatric diagnoses
-
The
duration of their professional relationship
including the type of psychotherapy or
evaluation that the patient underwent
-
The
eligibility criteria that have been met and
the MHP's rationale for hormones or surgery
-
The
patient's ability to follow the Standards of
Care to date and the likelihood of future
compliance
-
Whether
the author of the report is part of a gender
team or is working without benefit of an
organized team approach
-
That
the sender welcomes a phone call to verify
the fact that the mental health professional
actually wrote the letter as described in
this document.
The
organization and completeness of these letters
provide the hormone-prescribing physician and
the surgeon an important degree of assurance
that mental health professional is knowledgeable
about gender issues and is competent in
conducting the roles of the mental health
professional.
One
Letter is Required for Instituting Hormone
Therapy.
One
letter from a mental health professional,
including the above seven points, written to the
medical professional who will be responsible for
the patient's endocrine treatment is sufficient.
Two-Letters
are Generally Required for Surgery.
It is ideal if mental health professionals
conduct their tasks and periodically report on
these processes to a team of other mental health
professionals and nonpsychiatric physicians.
Letters of recommendation to physicians or
surgeons written after discussion with a gender
team then reflect the influence of the entire
team. One letter to the physician performing
surgery will generally suffice as long as it is
signed by two mental health professionals.
More commonly, however, letters of
recommendation are from mental health
professionals who work alone without colleagues
experienced with gender identity disorders.
Because professionals working independently may
not have the benefit of ongoing professional
consultation on gender cases, two letters of
recommendation are required prior to endorsing
surgery. If the first letter is from a person
with a master's degree, the second letter should
be from a psychiatrist or a clinical
psychologist--those with doctoral degrees who
can be expected to adequately evaluate co-morbid
psychiatric conditions. If the first letter is
from the patient's psychotherapist, the second
letter should be from a person who has only
played an evaluative role for the patient. Each
letter writer, however, is expected to cover the
same topics. At least one of the letters should
be an extensive report. The second letter
writer, having read the first letter, may choose
to offer a briefer summary and an agreement with
the recommendation.
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