Dear forum members,
Today I present to you an interesting article around a therapeutic tool (or rather guidelines maybe) recommended for gender therapists in assessing one's readiness to undergo Gender Affirmation Surgery (GAS, or any major milestone in transition).
Ref: Coolhart, Deborah, et al. "Recommending transsexual clients for gender transition: A therapeutic tool for assessing readiness." Journal of GLBT Family Studies 4.3 (2008): 301-324.
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Here's a breakdown of what the article is about, and my appraisal of it:
- Do not be misled by the title of this article, claiming this to be 'tool', when it is actually a set of guidelines for gender therapists (or any therapists working with the trans community) to assess an individual's readiness for surgical transition. That means that this isn't like a questionnaire with a scoring system to indicate some objective measure of one's level of readiness, the tool still calls for a degree of subjective assessment.
- Despite that, this guideline offers some very sound suggestions for questions for therapists to ask their clients to assess their readiness. The author acknowledged that this idea is not novel and it was built on previous literature which includes the SOC from WPATH and other independent studies.
- This tool is not meant as a 'one-off' assessment, and the author clearly indicates some follow-up is necessary. In other words, the effectiveness of this tool is somewhat reliant on the therapeutic relationship built between the client and the therapist. It will be less accurate or effective if the client has a poor relationship with their therapist.
- This tool is also subject to a therapist's skill and experience in working with transgender clients.
- This tool takes a holistic view of a person's readiness for GAS by looking into several domains including family/childhood contexts, current gender expression, sexual/relationship development, current intimate relationships, physical and mental health, support, and last but not least, future plans and expectations.
Here is an example of the kind of questions therapists and clients ought to consider according to this guideline:
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(The complete list of the question can be obtained from the article itself)
Here are things to be cautious about when reading this article:
- Remember, this is not a 'tool' per se, and there is no objective scoring system to assess one's readiness objectively.
- The author is writing an opinion piece, in other words, this is not backed up by any form of statistical analysis to indicate any predictive value. In other words, there's no way to tell if this guideline can predict any form of outcomes in the future.
- As with any opinion pieces, this is heavily reliant on the author's experience with his/her clients. It is something like a qualitative piece rather than a quantitative piece which has less of an impact in the peer-reviewed articles. But it is an important contribution nonetheless.
- The article does not describe it's target population, this I believe applies mostly to clients from the US (where the author works), thus it may not be generalisable to other cultures.
- The article is targetted towards therapists and it advises therapists to ask these questions appropriately or risk coming across as unnecessarily intrusive. Please do NOT assume that every therapist should go through the entire list of questions if you're a layperson reading this.
- If you are a layperson, please take this is as food for thought for yourself and it is not a substitute for seeing a therapist.
- As with any opinion pieces, you need to do your own research on the author's credentials (Deborah Coolhart). You can google her up.
- The article's conclusion is kinda weak and it doesn't include a 'limitations' section.
Here are some of the things I like about this article:
- The author takes a holistic view on the issue which reflects the complexity of the kind of decisions that transgender people have to make. It also reflects her insight into the challenges we face.
- The author states very clearly that such a list of question is potentially harmful if it is too cumbersome because it will give individuals a sense that they have to jump through inhumane and unnecessary hurdles to get approval for surgery. It advises caution and empathy for therapists conducting assessments, but at the same time acknowledges the importance of not skimping on important details. Again this is a reflection on her insight.
- The author is a licensed family therapist. This in itself bears no significance in the clinical world, but it is highly relevant when dealing with gender dysphoria and transgender individuals because it is a complex phenomenon that almost always involves families. Being a family therapist lends credence to her theories and hypothesis.
Last but not least, why am I doing this, and why should you trust (or not trust) me?
- I'm doing this to create more informed debates and discussions by citing some of the literature that is already OPEN to everybody.
- I believe everybody has the right to be informed by evidence, and not just personal opinions from forum members.
- I do this to dispel some myths and misinformation I see getting spread around here.
- You should NOT trust me. You should google up this article. This is an OPEN source article you can find on google scholar. The reference is up there.
- If you have any questions, you can PM me.
- If this thread gets taken down, then PM me and I will send you the article.
- Please PM me if you would like to request any articles. I might have some which you'll find interesting to read.
EDIT:
I also posted this article in response to an unusual, untherapeutic, and unhelpful list of questions being circulating here recently:
You should definitely switch therapist if they recommend that 'you don't do anything unless your life depended on it'. It is like a doctor saying don't take your antihypertensives until you're about to have a stroke.
Yours,
S