What therapists need to know when working with intersex


clients: A primer Jane Czyzselska


Seven (formerly Sarah), who uses the


pronouns “they/their/them”, fi rst sought counselling in their mid-20s, a therapeutic journey that continues today, sixteen years on. It was around this time they also learned doctors had performed a gonadectomy – removal of internal gonads – after misinforming both Seven – then aged 8 – and their parents, telling them they were removing Seven’s ‘ovaries’ to prevent cancer. Seven believes the sexual abuse they subsequently experienced after the operation is connected to the vulnerability they felt having been forced to undergo surgery, leaving them feeling “completely alienated from everybody at school”. Seven believes “nobody understands” what


it is like to be intersex and have their gonads or genitals surgically removed or altered as a child, and this belief has presented diffi culties in some therapy settings where they have felt they might never truly be seen or accepted by a counselling clinician. This horror notwithstanding, Eden also tearfully describes her experiences at the hands of medical staff : feeling as if her body had been “robbed”; being “touched inappropriately” by doctors and of being “sexually abused” by her father as a child. Although raised as a boy, she remembers thinking, “When I hit puberty, I’ll get my vagina back” and, when that didn’t happen, after trying “violent ways to kill myself”, she later elected to transition with a genital reconstruction that “went horribly wrong”. Both Seven and Eden are research


participants who generously shared their stories for my master’s thesis in integrative psychotherapy, which examines the experiences in therapy of fi ve clients who were born with intersex characteristics. This qualitative study, using the interpretative phenomenological-analysis method, found almost all therapists seen by the co- participants knew nothing about intersex lives and experiences. Reassuringly, this fact notwithstanding, most participants


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found therapy helpful. One client, Del, reported working with a therapist who, despite not being heterosexual, held a ‘binary’ understanding of gender, and this made the empathic exploration of Del’s body impossible, causing the repeated reproduction of damaging relational dynamics.


Intersex 101 – Why I undertook this research and key points to understand when working with intersex clients Personal resonances: my mother, now 75


years old, lost her intersex twin-sibling, Paul, when a doctor wrapped him in a blanket, placed him alone and crying in a room, where he was left to die. It is my belief he was murdered because of his atypical genitalia. My mother says that, when she talks about him, she still feels Paul on the arm against which he lay for nine months when they shared their mother’s womb. His death by the hand of a medical clinician and the resultant trauma experienced by my mother, my grandmother and wider family, infl uence my belief in the need for recognition and ethical treatment of people born with intersex characteristics. The intermingling of personal and professional narratives drove my decision to write my master’s paper on the experience of intersex clients in therapy. This ethical positioning is also informed by what psychologist Katrina Roen (2008, p. 47) refers to as, “Feminist and queer theorizing that challenges claims about gender as fi xed and knowable (Butler, 1993; Fausto-Sterling, 2000)”. So, before I address some key points


about working with intersex clients and their families, let’s look at the term ‘intersex’, and consider why this client group is so invisible. Intersex is an umbrella term that


relates to biological sex characteristics. It is used by clinicians and others to refer to developmental anomalies: genitals, hormones, gonads and/or chromosome


patterns that do not fi t typical binary defi nitions of male or female. Intersex activists describe it as a term applied to human beings, “whose biological sex cannot be classifi ed as clearly male or female” (Organisation Intersex International – UK). Some examples of the kinds of anomalies


present among those in the intersex population may include being born with a clitoris that is larger than expected (clitoromegaly) or, in the case of those diagnosed with androgen insensitivity syndrome, the newborn infant has genitals of female appearance, undescended or partially descended testes, and usually a short vagina with no cervix. Occasionally, the vagina is nearly absent. At the onset of puberty, intersex individuals may start to develop secondary sex characteristics typically considered to belong to the ‘opposite’ sex. For instance, those born with Klinefelter syndrome will usually be sterile and, at puberty, blood testosterone levels in men are normal initially but may fail to rise into the expected adult range from age 14 onwards. Intersex status is distinct from a person’s


sexual orientation or gender identity. An intersex person may be straight, gay, lesbian, bisexual or asexual, and may identify as female, male, both or neither. It is worth noting some intersex people also identify as trans and some don’t. Adding insult to injury – at least as far


as most intersex activists are concerned – is the use of the term ‘disorder of sex development’ (DSD) which emerged from debate and the subsequent creation of a consensus statement after a convention in Chicago in 2005, where it was agreed the term would replace ‘intersex’ and ‘hermaphrodite’ in medical literature. The term is controversial because of the implication that what is naturally occurring is considered a ‘disorder’ and so reinforces discourses of pathology and non- normativity for intersex people.


Context 155, February 2018


What therapists need to know when working with intersex clients: A primer


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