view of the Tavistock and Portman
Support – to help young people and families tolerate uncertainty of how their gender identity might develop; Connections – to enable young people and their families to make meaningful connections between their life experiences and how they feel; Acceptance – to promote non-judgmental acceptance of a range of gender identity presentations; Curiosity – to help people to remain curious and thoughtful about their lives, and to understand what might get in the way of them doing this; Freedom of expression – to support young people and families to express themselves freely; Hope – to sustain hope; Holistic approach – to provide help for behavioural, emotional and or relationship diffi culties that young people or their families may be experiencing in relation to their gender identity; Mind/body – to keep in mind the relationship between the body, thoughts and feelings. To work closely together as a group of professionals from diff erent backgrounds including paediatric endocrinology; Independence – to support young people to develop an appropriate level of autonomy and independence; Loss – to allow young people and their families to acknowledge the sense of loss that can result from change.
Figure 1
from the Dutch team (DeVries & Cohen- Ket enis, 2012). T e aims of the service (see ht p://
gids.nhs.uk), building on the work of the founder of the service, Domenico Di Ceglie, can be seen in Figure 1. As we are a national service and the
children and young people we work with do not live in complexity-free worlds, partnership working is key to ensuring a holistic provision of support. Clinicians see their role as working with wider systems that are more local to a young person and family and able to respond on a day-to-day basis. Oſt en, CAMHS are able to provide more frequent and local support for families and so partnership work is usually sought to fully support young people. Clinicians encourage a network model of care (Eracleous & Davidson, 2009), stressing with networks the importance of eff ective multi-agency work as best practice in supporting young people with gender identity needs. Network meetings are oſt en useful forums for local services to hear and
Context 155, February 2018
learn more about gender identity, both in relation to an individual young person and more generally. Clinicians do not see gender identity
issues as a mental health problem but are aware of the impact on young people’s mental health of prejudice and stigma, oſt en expressed in transphobic and homophobic bullying. Holt et al. (2016), in their research looking at 218 children and young people referred to the GIDS between 2012-13, noted that bullying was experienced by 47%, low mood and depression by 42% and self-harming behaviour by 39% and these diffi culties were seen to increase with age (see also Skagerberg et al., 2013). T e young people who access the service are oſt en experiencing micro levels of aggression and stress as a result of identifying as and/or being seen as transgender (Hatzenbuehler & Pachankis, 2016). Clinicians try to negotiate between trying to infl uence a wider system and enabling young people to develop resilience and the recursive link between them. Some of the work is in thinking about
the relationships between wider (sometimes transphobic) communities, mental health and gender identity. T e service off ers teenagers’ and parent/
carers’ groups in London and Leeds with the aim of off ering service users the chance to meet up with and hear from each other. T e feelings of isolation sometimes experienced by young people and their families can be countered with these groups and young people oſt en access more local support from third- sector organisations such as Gendered Intelligence, Barnardos, MESMAC. T e work of the third sector in supporting marginalised young people oſt en makes a signifi cant diff erence – providing community, combating isolation and off ering a sense of being understood and validated. Wren (2014) writes passionately about
her work within the GIDS and highlights the lack of foundational theory about gender. She outlines her principles to working with gender-diverse children and young people (See fi gure 2), which off er an additional framework for exploration. T ere is no ‘cookie cut er’ method; our
service does not have a set outcome and it is diffi cult to generalise an approach, as the service off ered is tailor made to meet the individual needs of every young person who accesses support. Clinicians, young people and families embark on a journey together, not knowing what the destination(s) might be. A secure therapeutic relationship, where all ideas from everyone in the family are thought about and valued, adds depth to understanding all aspects of identity. Clinicians do not have a set of questions, although there is a framework and a confi dent clinician is comfortable with being “clumsy rather than clever” (Burnham & Harris, 1996). T e service eff ectively draws from an integrative approach in trying to ensure gender-diverse children and young people feel like the experts in their own lives (Anderson & Goolishian, 1992) within the collaborative approach we
19
An invitation to explore: A brief overview of the Tavistock and Portman Gender Identity Development Service
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