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WPATH Symposium Attendies Going GENDER ROGUE!

Rachael St.Claire PsyD — 2011-09-26T09:57:28-06:00

It didn’t take long before attendees of the 2012 WPATH Symposium at the Emory University Conference Center went GENDER ROGUE and converted gender segregated bathrooms into all inclusive gender bathrooms. Do-It-Yourself signs were pasted over the traditional “Men” and “Women” signs at the bathroom entrances. Men entered the the women’s bathrooms and women entered the men’s bathrooms. I have to say that a strangely satisfying feeling of purposeful transgression warmed my Soul as I entered the Mens Room walking past the men and the urinals headed for the stalls. Not surprisingly, there was no uproar, no one took down the all inclusive signs, and no police were ever called. How refreshing!

Live Yourself!
Rachael St.Claire PsyD Licensed Psychologist

Denver Film Festival: “Tales of the Waria”

Rachael St.Claire PsyD — 2011-11-05T16:18:25-06:00

The Denver Film Festival is going on now in Denver November 2, 2011 through November 14, 2011.

Tales of the Waria, a film being shown at the Starz Denver Film Festival, documents the lives of transgender women who live in Indonesia. Waria is the term for biological males who transition and live as women in Indonesia, the world’s largest Muslim nation. The film by Chinese-American filmmaker Kathy Huang surprises our Western notions of Muslim intolerance and our assumptions about gender, gender identity, sexual identity, and for that matter transgenderism as we know it in United States.

Kathy Huang, director of the film, informed me that Tales of the Waria will be having its Southwest debut at the Starz Denver Film Festival.

Tales of the Waria is a feature-length documentary that follows a community of transgender women in Indonesia, the world’s largest Muslim country, as they search for romance and intimacy. At times comical and at times heartbreaking, the film uncovers a world that not only defies our expectations of gender and Islam, but also reveals our endless capacity as human beings to search for love -- whatever the consequences.”

This summer, the film screened to sold-out audiences at Frameline in San Francisco and Outfest in Los Angeles. It also won the Audience Choice Award at the Asian American International Film Festival.

Tales of the Waria be playing in Denver at the Starz FilmCenter on:
Saturday, November 12, 9:45pm
Sunday, November 13, 3:15pm

Tickets can be ordered from the Denver Film Festival website.

Website: www.thewaria.com

Facebook: www.facebook.com/thewaria

Live YourSelf!

Rachael St.Claire PsyD
Licensed Psychologist

Diagnosing Gender in DSM-5: Gender Incongruence

Rachael St.Claire PsyD — 2010-11-14T13:21:02-07:00

Diagnosing Gender in DSM-5: Gender Incongruence
See my updated blog post on the most recent proposal by the DSM-5 Working Group to revise the diagnosis of Gender Identity Disorder.
The diagnosis of mental disorders have very real and profound effects on the people who are diagnosed. The stigma that accompanies a psychiatric diagnosis has harmful effects on self-concept and wellbeing, civil liberties, access to healthcare, and can lead to denial of health care coverage for pre-existing conditions. (See more about stigma in Notes below). Persons who experience and express gender outside traditional cultural norms for their birth sex have been harmed by the DSM’s pathologizing diagnosis of Gender Identity Disorder and are advocating for reform. The issue of diagnosis is controversial among the trans community and healthcare professionals alike. Some advocate for the complete removal of any diagnosis related to gender expression on the basis that diversity in gender expression does not reflect an underlying mental disorder. Others do believe that experiencing and/or expressing gender outside traditional cultural norms for their birth sex reflects normal development gone awry. Still others believe that diagnosis plays an important role in recognizing the complex issues that gender identity issues can have on physical and mental health and accessing medically necessary healthcare. We need diagnostic language that preserves the dignity of the person, does not stigmatize, and supports access to needed healthcare.
In 1973, the Board of Directors of the American Psychiatric Society decided to remove homosexuality from it’s Diagnostic and Statistical Manual of Mental Disorders where it was listed under the section “Sexual Deviations” as “Homosexuality” along with Fetishism, Pedophilia, Transvestism, Exhibitionism, Voyeurism, Sadism, and Masochism. Public Radio International aired a program “The story of how the American Psychiatric Association decided in 1973 that homosexuality was no longer a mental illness” today on This American Life, and its available for free now on iTunes.
The DSM-II text includes the following description of the category “Sexual Deviations”. As you read, think about how the pathologizing of gay men and women has contributed to stigmatization, institutional discrimination, and hate crimes in our culture to this very day, and consider how important DSM diagnosis reform is to trans children, teenagers and adults.
This category is for individuals whose sexual interests are directed primarily toward objects other than people of the opposite sex,toward sexual acts not usually associated with coitus, or toward coitus performed under bizarre circumstances as in necrophilia, pedophilia, sexual sadism, and fetishism. Even though many find their practices distasteful, they remain unable to substitute normal sexual behavior for them. This diagnosis is not appropriate for individuals who per-form deviant sexual acts because normal sexual objects are not available to them.”
The American Psychiatric Association is preparing to publish the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in May 2013. As part of the revision process, the preliminary draft revisions to the current diagnostic criteria for psychiatric diagnoses are posted on the internet for public review and comment. These are initial drafts of the recommendations that have been made to date by the DSM-5 Work Groups. Viewers will be able to submit comments until April 20, 2010. Their website includes the DSM-5 proposed revisions to the GID diagnosis, in addition to the rationale for the proposed changes, an introduction of a severity rating, along with the current DSM-IV criteria for GID.
Review the current proposed changes at the American Psychiatric Association’s website here: http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=482#. However, only the most current proposal is posted.
Kelly Winters, a longtime advocate of reform of the existing DSM-IV criteria for GID, is the author of the website GID Reform Advocates. Her site contains a critique of the DSM’s current language and underlying attitudes toward diagnosis of persons who experience and express gender outside traditional cultural norms for their birth sex. She also has detailed information about the controversy within the trans community regarding, Kenneth Zucker PhD, the Chair of the DSM Sexual and Gender Identity Disorders Workgroup, the members of the Gender Identity Disorders Subcommittee.

Revision of GID Diagnosis Proposed for the DSM-5
Gender Incongruence (in Adolescents or Adults)
A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months duration, as manifested by 2 or more of the following indicators:

a marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or, in young adolescents, the anticipated secondary sex characteristics)
a strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or, in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics)
a strong desire for the primary and/or secondary sex characteristics of the other gender
a strong desire to be of the other gender (or some alternative gender different from one’s assigned gender)
a strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender)
a strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender)

Subtypes: With a disorder of sex development, Without a disorder of sex development
What do you think about the proposed diagnosis “Gender Incongruence”? Share your experiences of diagnosis helping or harming you in some way.

Notes: Erving Goffman in his book, Stigma: Notes on the Management of Spoiled Identity, reminds us that the term stigma was originated by the Greeks to refer to the bodily signs designed to expose something unusual or bad about the moral status of the signifier. The signs were cut or burnt into the body and advertised that the bearer was a slave, criminal, or traitor, a blemished person, ritually polluted, to be avoided especially in public places. The term stigma is then an attribute of a person that is deeply discrediting. A person with a stigma is reduced from a whole person to a deviant, to someone who cannot be trusted, someone dangerous, someone fundamentally tainted, a foreigner, an outsider.

Live Yourself!
Rachael St.Claire PsyD Licensed Psychologist

Transgender Job Fair In Denver

Rachael St.Claire PsyD — 2011-03-01T13:09:39-07:00

Transgender Job Fair In Denver
The GLBT Center in Denver is committing resources to provide services to the Transgender Community. The Center has a webpage entitled “Transgender Programs” that lists groups and other services.
A new and exciting program is being offered at The Center, the Transgender Career Advancement Project (TCAP). A series of workshops is planned for transgender job seekers (see the list of workshops below) , culminating in a Transgender Job Fair on May 7, 2011. All the workshops are free and there is a $15 fee for the job fair. Many transgender men and women have been un- or under-employed due to discrimination in the workplace not to mention the unemployment rate. Employers with transgender inclusive policies will be in attendance at the job fair.
The Transgender Career Advancement Project includes the following workshops that I understand will be filmed and available in the future on their website.
Preparedness Workshops:
1. Monday, March 14 – Personal Presentation @ The Center, 6:00 PM
Facilitators: Courtney Gray and Susan
2. Monday, Feb. 28 – Mock Interview Skills @ The Center, 6:00 pm
Facilitator: Ruth Prochnow
3. Monday, March 21 – Ask the Experts @ The Center, 6:00 pm
Facilitators: Terry Hildebrandt Mark Renn
4. Monday, March 28 – Networking Skills @ The Center, 6:00 pm
Facilitator: Christopher Leach
5. Monday, April 18 – Know Your Rights @ The Center, 6:00 pm
Facilitator: Mindy Barton
6. Monday, April 18 – Resume Writing Assistance @ The Tivoli (Auraria Campus), 3:00-5:00 pm
Facilitator: Emily Frank
7. Monday, April 25 – After You’re Hired @ The Center, 6:00 pm
Facilitator: Mindy Barton
8. Monday, April 11 – How to Attend a Job Fair @ The Tivoli (Auraria Campus), 3:00-5:00 pm
Facilitator: Emily Frank

Live Yourself!
Rachael St.Claire PsyD
Licensed Psychologist

What is the Beta Nu Omega Binder Project?

Rachael St.Claire PsyD — 2011-03-06T13:07:10-07:00

What is the Beta Nu Omega Binder Project?
There’s this guy here in the Denver area, Kyle, who is starting something that really sounds cool. Its a binder exchange for the FtM Community connecting new and used binders with guys who need them. Kyle tells me that there is a fundraiser in the works, so stay tuned and I will post it when I find out about it.

The Binder Project is currently run by Beta Nu Omega (BNO), a non-collegiate fraternity for FTM trans people, genderqueer people, and others on the FTM spectrum living in the Denver Metro Area. BNO provides support to trans men and other trans people assigned female at birth through social events and other networking opportunities for members.

Check out The Beta Nu Omega Binder Project website.

Live Yourself!
Rachael St.Claire PsyD
Licensed Psychologist

WPATH Symposium 2011 Opens

Rachael St.Claire PsyD — 2011-09-25T13:04:52-06:00

WPATH Symposium 2011 Opens Today
The World Professional Association for Transgender Health (WPATH) opened today on the campus of Emory University. The symposium was opened by Vin Tangpricha MD PhD withe the symposium theme of Transgender Beyond Disorder: Identity, Community, and Health.
I am excited to be here in Atlanta on the campus of Emory University attending WPATH 2011. Some of the expected highlights include the unveiling of The Standards of Care Version 7. I am interested to find out if there is a statement about the pathologizing diagnosis of Gender Identity Disorder. I have heard that there may be a relaxing of the readiness and eligibility criteria for accessing hormone medical treatments. These criteria have become a barrier to accessing competent care, spawning a burgeoning black market for sex hormones and the dangers of medically unsupervised self-administration of hormones.
A second issue was introduced by the Chair of the Southern Comfort Conference , Alexis Dinyovszky, which was held conjointly with WPATH this year. Lexi announced that her Transgender membership have been calling for a certification for trans competent counselors and therapists. She has formally requested the WPATH membeship to develop a certification program for therapists to remedy the problem of trans clients understanding mote about trans issues than their therapists. While many therapists are willing to see transgender clients, there is a competency gap in their understanding and training about Transgender issues. We’ll see what the hubbub is around the symposium on the certification issues.
A third issue is the concern about the proliferation of electronic medical records and how medical organizations will handle the issue of Transgender persons’ preferred name, sex, and sexual orientation, not to mention what diagnosis may be visible within the medical record to other employees of the health provider. A WPATH EMR Taskforce has formed and will be meeting for the first time later today. I will serve on this committee which meets today, so stay tuned.
I also have to say it’s nice to see many members of the trans community in attendance from the Southern Comfort Conference. An exciting beginning to the WPATH 2011 Symposium!
Live Yourself!
Rachael St.Claire PsyD Licensed Psychologist

Four Key Challenges to Living a Fulfilling Life After Gender Transition

Rachael St.Claire PsyD — 2011-02-28T12:57:03-07:00

Four Key Challenges to Living a Fulfilling Life After Gender Transition
The following post is a modification of a presentation I made at the 2011 Colorado Gold Rush Conference held in Denver Colorado on February 26, 2011 during a panel discussion on counseling for trans men and women after gender transition. I identify a few key challenges that trans men and women face after gender transition and identify some effective and ineffective coping mechanisms.
Ok, you have successfully transitioned and are now living full time and perhaps have even completed gender affirming surgeries. You have done the heavy lifting putting the big building blocks of your life into place. That was Transgender 1.0. Now its time to live your life and make the most of it.
You may feel the need for a break from therapy and the intense focus on transgender issues. It’s time to focus on living the life you worked so hard for. Welcome to Transgender 2.0! Here are four key life challenges.
Nurture a healthy emotional relationship with yourself as trans men and women. Working at living an authentic life is not over. You have just begun! Now that you are the real you, you are free to explore and discover, and express who you truly are. We all need acceptance and validation from others and ourselves. The risks are: 1) allowing fear to stop you from getting your needs met, 2) judging yourself harshly, 3) feeling unworthy, and 4) comparing how you imagined your life would be as trans men and women to how your life is actually turning out. Mind the Trans Reality Gap! Live your life fully in the moment and never mind the gap.
Secure Love Relationships. We all need to feel securely attached in our relationships in order to live healthy lives. We also may need to seek out new attachment relationships when love relationships end. So, you need to feel that your attachment relationships with the people you love are secure and are not threatened by your gender expression. This includes your spouse or partner, your children, and family members, including your mother and father, sisters and brothers. The risks are: 1) gender transition creating intense fear and insecurity in your relationships, 2) avoiding reaching out to the people you love for emotional comfort out of fear of being rejected or abandoned, 3) avoiding seeking out new adult love relationships out of fear or feeling unworthy.
Friendships. We all need the companionship, support, and joy that creating connections offer us. So, you need relationships with trans men and women and non-trans men and women alike. The risks are: 1) being ineffective in creating connections with other trans people, 2) avoiding friendships with other trans people because of emotional discomfort with being trans, 3) remaining “Stealth” with friends who want a closer and more trusting emotional relationship.
Community. We all need to be belong, to be supported, and to be understood deeply by others with similar life experiences. Connection with community also provides exposure to new people, ideas, and creative energy that help us grow and live creative lives. The risks are: 1) becoming isolated from needed emotional support for living a healthy transgender life, 2) becoming stuck as who you are and not continuing your creative transition into the trans men and women you are becoming.
How do you know when you are not coping effectively with Transgender 2.0 challenges?
You know when you are not aware of your emotional, interpersonal and social needs and/or are ineffective in successfully satisfying these needs. You have to ask yourself, “How do I feel about my new life?”, “What do I really need for a deeply satisfying life?”, “Am I experiencing any recurring negative emotions?”, “Am I satisfied with my relationships?”. Ask yourself if you have been effective in meeting your needs. What emotions keep you from being effective in meeting your needs? Fear is a common one that can stop anyone in their tracks.
Signs of Ineffective Coping:
Overwhelming moods and emotions, for example, depression and sadness, anxiety and fear.
Negative core beliefs about yourself, for example, “I am unworthy of being loved”, “I am unworthy of deep friendship.”
Behaviors that numb emotions and emotional pain, for example, excessive work, alcohol and drug mis-use, excessive self-sufficiency.
Avoidance Behavior, for example, avoiding emotions and needs, avoiding new friendships, avoiding joining new activities and new groups, avoiding seeking new non-transgender friends, avoiding dating.
Feeling insecure and dissatisfied in any important attachment relationship: not seeking out security and comfort from that person; hiding your real feelings; not sharing your vulnerable feelings.
Ineffective and Effective Coping:
Ineffective Coping: Willfulness. Imposing your will on yourself, others, and the world; being unable to accept reality and aspects of yourself and others that you cannot change. Willfulness and not accepting reality create suffering out of emotion pain. Emotional pain is unavoidable in life for all of us. It’s part of the price we pay for being human and for being able to experience love and joy. When we cannot accept the painful realities of our lives, we create emotional suffering on top of the emotional pain. We need a Wise Mind to know what to accept and what to change in our lives. Remember The Serenity Prayer: God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.
Effective Coping: Willingness and Radical Acceptance. Be Willing to Accept whatever causes you pain. Accept what you and others cannot change. Be wise. Being Willing to live creatively and to take risks despite your pain. When you are faced with emotional pain over something you are powerless to change, turn your mind toward acceptance. This is not the same thing as saying what has happened is “good” or that you “approve”.
Ineffective Coping: Denial and Avoidance, for example, not acknowledging or sharing your emotions and needs out of fear; keeping your emotional needs, emotional pain, your fears a secret from others.
Effective Coping: Facing your fears and Reaching Out to others for what you need. Be effective and do what needs to be done to solve problems. Participate in life!
Ineffective Coping: Blame, for example, Blaming yourself or others for your emotional pain. Blame is looking backwards rather than looking forwards. Blame kills the hope and creativity that is needed for moving forward in life.
Effective Coping: Self-acceptance and compassion; strengthen the warm, kind, soothing part of yourself, and turn your attention away from the harsh critic within.

Live Yourself!
Rachael St.Claire PsyD Licensed Psychologist

Diagnosing Gender in DSM-5 UPDATE: Gender Dysphoria

Rachael St.Claire PsyD — 2011-11-05T12:53:42-06:00

Diagnosing Gender in DSM-5 UPDATE: Gender Dysphoria
The Diagnostic and Statistical Manual of Mental Disorders Version 4 (DSM-IV) is in the process of being updated by the American Psychiatric Association. The diagnosis, Gender Identity Disorder, is being reviewed and most certainly will be re-written in part with the input of professional organizations, such as WPATH, and important transgender advocates. Since my original post in March 2011 , the DSM-5 Working Group has made important changes in the proposed diagnostic label and text of the current Gender Identity Disorder. The previous proposal was to change Gender Identity Disorder to Gender Incongruence. The current proposal os for the term Gender Dysphoria, a term that is intended to be non-stigmatizing.
The most recent proposal for changes in the Gender Identity Disorder Diagnosis were recently published on the DSM-5 website here.
Gender Dysphoria (in Adolescents or Adults)**
A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months duration, as manifested by 2* or more of the following indicators: [2, 3, 4]**
1. a marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or, in young adolescents, the anticipated secondary sex characteristics) [13, 16]
2. a strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or, in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics) [17]
3. a strong desire for the primary and/or secondary sex characteristics of the other gender
4. a strong desire to be of the other gender (or some alternative gender different from one’s assigned gender)
5. a strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender)
6. a strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender)
B. The condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning, or with a significantly increased risk of suffering, such as distress or disability**
Subtypes
With a disorder of sex development [14]
Without a disorder of sex development
See also: [15, 16, 19]
Specifier**
Post-transition, i.e., the individual has transitioned to full-time living in the desired gender (with or without legalization of gender change) and has undergone (or is undergoing) at least one cross-sex medical procedure or treatment regimen, namely, regular cross-sex hormone treatment or gender reassignment surgery confirming the desired gender (e.g., penectomy, vaginoplasty in a natal male, mastectomy, phalloplasty in a natal female).
Note: Three changes have been made since the initial website launch in February 2010: the name of the diagnosis, the addition of the B criterion, and the addition of a specifier. Definitions and criterion under A
An important perspective on the use of psychiatric diagnosis with people who express their gender differently comes from trans people themselves. And, like every community, their is a diversity of opinion on psychiatric diagnosis within the trans community. Psychiatric diagnosis has been used to harm, for example, reparative therapies for trans youth. However, trans men and women also recognize that respected medical organizations are supporting medical treatments for trans people, for example hormone therapy and gender affirming surgery, as medically necessary. Treatments that are legitimatized as medically necessary are increasingly being covered by health care insurance in the United States and by national health insurance in other countries. A legitimate, scientifically valid and reliable diagnosis is necessary for trans related medical treatments to be covered by health insurance. The film Diagnosing Difference by Annalise Ophelian represents the diversity of opinion on psychiatric diagnosis within the trans community.
Check out the trailer for the film Diagnosing Difference below, and the website www.diagnosingdifference.com.

Live Yourself!
Rachael St.Claire PsyD Licensed Psychologist