• “I promote a grasp of the possibilities for varied trans identities in order to challenge a passive relationship to diagnosis and classifi cation;
• I create spaces in the work to encourage thinking critically about conventional notions of masculinity and femininity;
• I question the at raction of fi xed categories of meaning, recognising that part of the work of therapy is to help clients to try and evolve new meaning, where the existing categories are limiting and confusing;
• I try to be alert to the dangers of a professional preoccupation with causal and developmental stories, while acknowledging the value of a good narrative to a stable sense of self and an intelligible public presence; • If I see knowledge about the origins of gender identity as radically uncertain, and best theorised as contingent, mutable social construction, this does not imply that I will see any individual’s experience of gender as tentative and unstable;
• I note the struggle for eff ective communication and adequate self-storying when the linguistic resources for doing justice to the trans experience are so impoverished;
• I am, like Harris (2004) ‘always mediating multiple levels of awareness’, trying to stay at uned to the way that consciousness of the body emerges f om the relational, cultural and social context in which the individual lives;
• I think about the contexts in which endocrinological and other clinical services may present medical interventions as a way to sidestep complex psychological dilemmas;
• I acknowledge that while the technology of altering the body is desired by some to secure a coherent personhood, for some it may make too many demands for conformity within the binary gender divide;
• I especially recognise the comforts of certainty and coherence when I see young people apparently suff ering f om the f agmenting eff ects of disrupted and unreliable at achments;
• I give up wondering why people’s gender identity evolves atypically, and asked instead how they are living their gender (Corbet , 1996), and what support they need to do this well, where the issue of how to live ‘well’ is central to the therapeutic work.”
Figure 2 (direct quote from Wren 2014, p. 286)
provide. T e ultimate aim of the assessment and ongoing support is to work with young people, families and networks to generate an eff ective plan together to ensure the child and/or young person thrives in all areas of their life. T is plan may include further therapeutic space for more exploration of all aspects of identity and/or a referral to the endocrinology service for physical interventions when they are capable of informed consent. Informed consent for young people under the age of 16 is assessed by clinicians through discussion about their hopes and wishes for treatment, their understanding of what treatment entails, possible benefi ts and/or side eff ects. Parental views are sought and considered, as are, in some cases, the views of others in the young person’s professional network. T e service continues supporting children
and young people as long as they need it up until the age of 18, through ongoing therapeutic intervention, supervision and consultation with local services, parent-and- young-person groups, or family days. We will also support young people throughout their social and physical transitions, and
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with transferring to adult services when they are approaching the age of 18.
An invitation to explore We as a service have heard at the World
Professional Association for Transgender Health and the European Professional Association for Transgender Health conferences, the call for family work and have responded accordingly as a service. T e positive impact of family support on young transgender people and those questioning their gender identity has been shown (Resnick et al., 1997; Simons et al., 2013). T e Gender Identity Development Service has always maintained a systemic approach to working with children and adolescents, most notably in our network model of care (Eracleous & Davidson, 2009) in multi-agency working and in earlier writings about the service (Di Ceglie, 2008; Wiseman & Davidson, 2011) espousing a systemic approach in engagement and exploration. T ere has been a growing systemic presence in the team over the last several years and there are now eight substantive family
and systemic psychotherapists in post between both offi ces. T ese posts are in addition to multiple clinicians employed in a variety of disciplines and who are qualifi ed systemic psychotherapists, systemic practitioners, and those who have completed the foundation years or who are in the process of completing the MSc. T is growing systemic voice supports a relational approach to working, a continued exploration of all aspects of identity in the form of the social GGRR AACCCEESSS – gender, geography, race, religion, age, ability, accent, colour, class, culture, education, employment, sexuality, sexual orientation and spirituality (Burnham, 1992, 1993, 2012; and Roper-Hall, 1998) with young people and families. Burnham (2012) also writes about visible and invisible GR CES, where visible may include aspects of identity such as age, accent and colour, and invisible may include sexuality, spirituality. One of the unique challenges to young people identifying as trans is that they can move from invisible (seen and responded to as their assigned gender) to visible (changing their appearance, name, pronouns). Oſt en the hope of young people is that in adulthood the sharing of their gender identity will be their decision. Intersectionality (Crenshaw 1989;
Butler, 2015) suggests diff erent markers of identity categories overlap and create particular experiences of various levels of privilege and marginalisation, which impact on us all. T e young people and families seen may negotiate some of these and sometimes feel them particularly acutely as they go through social transition. For instance, clinicians may talk with young people about what it’s like to be afraid of neighbours’ responses to coming out as trans in a small ex-mining community; what it’s like to be the only Muslim you know who is trans; what it’s like as a father to feel more protective of your trans daughter than you did of her older brother – and how these cultural beliefs aff ect individual lives. A systemic framework can also include
an exploration of trans-generational ideas, dominant and subjugated narratives (White & Epston, 1990) about gender embedded within their worlds. Working systemically off ers an eff ective framework for joint work and for refl ective practice, as well as a range of interventive questions (Tomm, 1987a, 1987b, 1988) and playful
Context 155, February 2018
An invitation to explore: A brief overview of the Tavistock and Portman Gender Identity Development Service
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