Working with Transgender Clients

After recently having a transgender client start in my outpatient group and his dropping out after only a few sessions, I realized cultural sensitivity regarding GLBTQ (especially the T) is an area where I need a little additional development.  To that end, I started doing some reading and have prepared a blog post focusing on social work with transgender clients.  If you disagree with any of what follows or have anything to add, please, comment below.  I am far from being an expert; I’m just a social worker trying to keep an open mind and provide the best possible care for all people who I have the
opportunity to serve.

Transgender is a term that encompasses several different identities.  Generally, transgender people have a substantial identification with a gender other than the sex they were assigned at birth or who otherwise
challenge the gender binary and press our cultural boundaries around gender norms.  The term sex refers to the sex that a person was born with; I think of it as the parts you came with.  Gender describes a person’s internal sense of being male, female or something else and gender identity refers to what gender you identify with.  Gender identity is generally a deeply felt sense of being male, female, or something else.  Gender identity is different from sexual orientation.  Sexual orientation describes what gender a person partners with.

Because the term transgender includes a number of identities, it is best to listen to how clients describe themselves and use their language and terminology.  In general, the term transvestite is considered outdated and offensive.  Some ways to inquire what terminology a person prefers are as follows:
•       I would like to show you respect.  How would you like to be addressed?
•       How would you like me to refer to you?
•       What name/pronoun is appropriate?
Asking may feel awkward, as it seemed for me, but this is the best way to find out from a client how they want you to address them.  It was suggested to me by a transgender person that it might be simplest to include a question on your intake forms, "Are you transgender?"  Often, I ask cisgender (a word for people who are not transgender) clients what name they prefer to be called, since many people use nicknames.
Making this a habit is a small way to respect people’s identities and how they think about themselves.  It is important to consistently use the name and pronouns that a client prefers.  However, it is also important to keep a person’s transgender status confidential.  To this end, it may be important to ask what pronouns and name the person prefers you use in his or her chart or when speaking to people outside
of your agency.

Sometimes, cisgender clients may feel uncomfortable with the presence of transgender clients.  This can sometimes be mitigated by listening to their concerns and providing information to further their understanding.  Sometimes, it may be appropriate to facilitate a conversation between clients so that the transgender issue is
demystified.  If people see that transgender clients are seeking treatment for the same reasons as any other client, they are likely to be more accepting and open minded about trans clients.

If gender specific groups are provided, transgender clients should go to the group for clients of the gender that the trans client identifies as.  Similarly, trans clients in residential programs should ideally room with the gender that they identify as.  However, the best course is to handle these situations on a case-by-case basis
with the input of the trans client.  Transgender people are often victims of hate crimes, so it is important to house people in a way that will ensure their safety.

Sometimes, a client’s sexual orientation and gender identity may be pertinent in treatment; other times, they may not.  As a therapist, you should not assume that a person’s gender identity is or is not an issue.  Rather, you should find this out as part of a thorough assessment that includes information about the client’s sexual orientation and gender identity.  Either way, therapists should be aware that transgender clients may be exposed to discrimination and stigma particularly when legal documentation reflect their sex but their gender presentation is different.  Think about how it would feel to be questioned when attempting to board a plane because your photo ID says you are a female but you look like a male, or how you would handle going to a job interview knowing that you usually look like a female but your social security card has a “male” name on it.

I’d be interested in hearing other social workers stories and experiences in working with trans clients.  I feel like I got it wrong with my most recent client, but after doing this reading and writing about it, I’m looking forward to having an opportunity to get it “right.”


Sources for this post:

http://www.abct.org/docs/Members/FactSheets/LGBT_for_therapists.doc
Giving the “T” it’s Due Attention: Social Work Practice with
Transgender Clients by David Nylund; www.nylundandtilsen.com
Culturally Competent Approaches for Serving Transgender Populations by
Willy Wilkinson; www.lgbt-tristar.com