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Gay & Lesbian Issues and Psychology Review, Vol. 4, No.

2, 2008
ISSN 1833-4512 2008 Author/Gay & Lesbian Issues & Psychology Interest Group of the Australian Psychological Society

In over 15 years of private practice specialis-
ing in working with GLBT clients, Ive worked
with a number of transgender clients. What
follows is a personal account of some of the
issues Ive encountered working with this

For each person Ive worked with, Ive realised
I need to expect the unexpected. Ive been
amazed at the strength, fortitude and resil-
ience of some of these clients, and worked
with others who Ive felt have struggled some-
what due to personality disorders and other
issues, rather than issues related to their non-
normative gender per se. There do, however,
appear to be some experiences that are
shared by all of the clients I have worked
with. I will now summarise these similarities in
the remainder of this commentary.

Working with several older transgender clients
who are now in their late 50s, I have often
noticed a sense that they have been pioneers
with no real reference points or role models
and that they had to almost make it up as
they went along. Some of their stories have
taken them across the globe in search of
transgender surgery and many have encoun-
tered all sorts of horrendous physical and psy-
chological distress as a result. The clients I
have worked with seemed to gained much
from these experiences. I have found though
that for some there is enduring psychological
damage in response to years of relentless and
significant hurt, rejection and social isolation.

Some of the female clients I have seen have
worked very hard at altering the many nu-
ances required to be perceived as a straight or
lesbian woman and have been quite success-
ful in this identity. However, for some of
these women I have witnessed an underlying
sadness, which in part appears to be con-
nected to not having had children whilst
knowing they would have made a wonderful
mother. Many of the heterosexual women I
have worked with have also experienced the
inevitable conflicts and rejections around
coming out as transgender when forming
relationships with straight males. I have also
noticed a significant amount of violence that
some of these clients have endured in their

Dealing with misunderstanding and rejection is
often a daily challenge for some of my clients,
particularly those who are transgender. Un-
fortunately, this has not solely been caused by
heterosexual people, but has also occurred
within GLBT communities. For some reason,
many gay men and lesbians dont seem to
connect with my transgender clients. This
may perhaps be a combination of an uncon-
scious belief that there must be something
disordered about a tranny, and that they
therefore do not deserve to be taken seri-
ously. There is also a sense that transgender
people are incorrectly perceived as drag
queens. As a result, some of my transgender
clients have not felt that they belong to GLBT
communities, believing they would be auto-
matically rejected. Furthermore, some of my
clients who identify as straight females have
seen being part of the GLBT communities as
being irrelevant. However, for some they
also dont feel they fit into the straight com-
munity either, and have struggled to gain het-
erosexual or homosexual friendships or social
connections. Some of my clients felt they
would find their tribe in the transgender com-
munity, but expressed a disappointment with
some of their experiences in that community.

So whilst some of my clients would be more
than able to be a wonderful potential friend,
through their own issues and others percep-
tions can end up isolated and unhappy.

Dealing with employment challenges has also
been a significant issue for some of my cli-
ents. Some of my older clients found that the
only options open to them were in the enter-
tainment, prostitution and other underground
areas. These environments for some seemed
to include dealing with exploitation and vio-
lence. However, some of my younger clients
have experienced some employers who genu-
inely care about inclusion and diversity and
make a genuine effort. One of the lesbian psy-
chologists in our practices has worked with
transgender people regarding issues in the
workplace. This has often involved identifying
and modifying specific behaviours that are
perceived by colleagues in the workplace as
aggressive. This opens the door for many
interesting discussions on the unconscious and
conscious difference in gender expectations
and behaviour.

For the female to male clients I have worked
with there are just as many complexities. A
couple of my preoperative clients have experi-
enced difficulties with wanting to become
pregnant. They have had to deal with the
many challenges that have resulted from other
peoples negative reactions to this concept.
This has included their doctors, potential do-
nors who believe the child would be too con-
fused and pull out at the last minute, and the
challenges with having to cease hormonal
treatment to aid the pregnancy and risk aging
as a male.

The clients I have worked with who started
hormonal treatment at a young age have aged
in a way consistent with their chosen gender.
The clients who have done so at a later stage
in life have the aging characteristics of their
original gender which they have found to be
distressing as for these people it is often more
difficult to seem like a straight woman or man,
rather than being perceived as a tranny, a
term often used in pejorative ways.
When I first started working with transgender
clients I found myself having to identify my
own internal irrational beliefs about these cli-
ents and found supervision to be very useful.
In the early days, it took me some time to
adapt to some of the complexities and confu-
sions I had. For example, when doing some
reprocessing work using schema therapy with
a woman, I had to be careful to not confuse
the both of us when going back to her child-
hood memories as a boy. I particularly had to
be careful of not confusing genders when us-
ing past and present tense to demonstrate my
own level of comfort in dealing with trans-
gender issues. As such, I found that being
open and aware of all of my emotional and
underlying beliefs and challenging these con-
stantly was essential.

Overall, Im often left with a slight feeling of
sadness after working with a transgender cli-
ent, knowing they have made wonderful pro-
gress and will no doubt experience a higher
self esteem, greater confidence and happi-
ness, but at the end of the day Im always
aware of the other people out there who, no
matter what, seem to have a real block
around developing meaningful connections
with transgender people. So many of my
transgender clients, however, have shown me
personally what can be achieved in life, no
matter what the seemingly unsurmountable

Author Note

Paul is Principal Psychologist for Centre for
Human Potential, a Brisbane based GLBT spe-
cialist psychology practice combining counsel-
ling, coaching, seminars and workshops. He
is the mental health columnist for QNews
( Br i s bane GL BT magaz i ne) a nd
www.samesame.com.au a GLBT internet
magazine. He also integrates organisational
psychology into the practice including leader-
ship development and coaching in government
and corporate settings.
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