traits that may be challenging for some on the autistic spectrum (Strang et al., 2014). Furthermore, an additional source of tension concerns the belief held by some parents of young autistic trans and gender- diverse children that their child or young person’s gender dysphoria is nothing more than an obsessive trait that will disappear in time (Strang et al., 2014). The challenge, therefore, is helping these parents understand the complexities, whilst remaining open to their child or young person’s desire to change their gender, until it becomes clear that a referral to a specialist gender identity clinic is both necessary and appropriate. Adolescence is a particularly challenging
time for young people who experience gender dysphoria and who fi nd their lives unbearable without hormonal interventions (Cohen-Kettenis & Pfaffl in, 2003). For these young people the onset of puberty constitutes a crisis, since the emergence of secondary sex characteristics can be associated with feelings of betrayal and disgust as well as creating negative body-images. Many of these young people assigned female at birth feel driven to bind their breasts and those assigned male at birth often use surgical tape to hide their penis and testes. Fish and Harvey (2005), suggest that gender-variant youth go through this crucial developmental period struggling with the dissonance between what culture tells them they are and who they feel themselves to be. Psychologically, this can take its toll, since these young people can present to services with symptoms of depression, anxiety, suicidal ideation, self-harm etc. (Grossman & D’Augelli, 2007;). Researchers now view symptoms such as these as artefacts of the cumulative stress (often referred to as minority stress) associated with being marginalised and oppressed (Williams et al., 2005), as well as a response to cisgenderist and transphobic dominant cultural templates. It is somewhat paradoxical, therefore,
despite eff orts to depathologise and to contextualise the suff ering of these trans young people, growing up as they do in a cisgenderist society that, in an eff ort to transition, they are forced to attend services such as child and adolescent mental health services, which serve to reinforce the relationship between gender identity and pathology. This notwithstanding, Raj (2002) suggests
Context 155, February 2018
practitioners constitute one of the few and perhaps the only source of support available to these youth. Yet practitioners, even with the best of intentions, are often intolerant and/or ill equipped to work with sexual and gender minority youth and Ryan (2001) believes counselling and clinical-care professionals have failed to keep pace with the rapidly changing experiences of today’s generation of sexual and gender minority youth. To assist practitioners in working with this population, the British Psychological Society (2012) published guidance in which they advise practitioners to be non-judgmental and in which they place particular emphasis on the need for practitioners to examine their own assumptions regarding gender and its many identities. By way of ending this article, I hope I
have been able to highlight some of the complexities surrounding gender and sexuality in regard to the children, young people and their families approaching CAMHS for help. At the same time, I also wished to highlight some of the challenges that currently exist within CAMHS settings, and to suggest that, although practitioners may be in a prime position to provide excellent care to these children and younger people, they can only really undertake this work if they have examined their own relationship to gender and sexuality. After all, second- order cybernetics includes the therapist as part of the system and emphasises the need for constant refl exivity in our work with individuals, couples and families. It therefore behoves us as practitioners, working with trans and non-binary children and young people to do our own thinking as part of forming and building meaningful and respectful relationships with them and their families.
References British Psychological Society (2012) Guidelines and Literature Review for Psychologists Working Therapeutically with Sexual and Gender Minority Clients. Retrieved 9 November 2017 from http://
www.bps.org.uk/sites/default/fi les/images/rep_92. pdf Carroll, L (2010) Counselling Sexual and Gender Minorities. New Jersey: Pearson Education. Cohen-Kettenis, P.T. & Pfaffl in, F. (2003) Transgenderism and Intersexuality in Childhood and Adolescence. Thousand Oaks, CA: Sage Fish L.S. & Harvey, R. (2005) Nurturing Queer Youth: Family Therapy Transformed. New York: Norton. Grossman, A.H. & D’Augelli, A.R. (2007) Transgender youth and life-threatening behaviour. Suicide and Life Threatening Behaviour, 37: 527-537.
Raj, R. (2002) Towards a transpositive therapeutic model: Developing clinical sensitivity and cultural competence in the eff ective support of transsexual and transgendered clients. International Journal of Transgenderism, 6(2), retrieved April 2005 from
http://www.symposio.com/
ijtvo06no02_04.htm. Ryan, R. (2001) Counselling lesbian, gay and bisexual youths. In A.R. D’Augelli & C.J. Patterson (eds.), Lesbian, Gay And Bisexual Identities And Youth. New York: Oxford University Press. Strang, J.F., Kenworthy, L., Dominska, A. et al. (2014) Increased gender variance in autism spectrum disorder and attention defi cit hyperactivity disorder. Archive of Sexual Behaviour, 43(8): 1525- 1533. van der Miesen, A.L., Hurley, H. & De Vries, A.L. (2016) Gender dysphoria and autism spectrum disorder: A narrative review. International Review of Psychiatry, 28: 70-80. Williams, T., Connelly, J., Pepler, D. & Craig, W. (2005) Peer victimization, social support and psychosocial adjustment of sexual minority adolescents. Journal of Youth and Adolescence, 34: 471-482.
Damian McCann is a couple psychoanalytic psychotherapist working as head of learning and development at Tavistock Relationships. He is also a consultant systemic psychotherapist, working in a child and adolescent mental health service and is an associate of Pink Therapy where he teaches on the diploma in relationship therapy for gender and sexual diversities. His doctoral research was concerned with understanding the meaning and management of violence in the couple relationships of gay men. Personally, he identifi es as a white, cisgender male although, in terms of gender role, during a recent exercise, he placed himself towards the center of the male/female gender divide. He feels passionately about developments in thinking relating to gender and sexuality within systemic practice and hopes the fi eld will become even more responsive to the future needs of children and young people exploring gender and non-binary identities.
17
Re-ordering gender: The challenge of responding to trans and non-binary young people in CAMHS
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