there are other important areas to consider such as: embodiment, surgery-related trauma and bodily autonomy. In the literature, Harper et al. (2013, p. 28) state, “affi rmation of the client’s identity and lived experience” is an important basic therapeutic competency. A key fi nding in my research supported this, showing that when therapy worked for the clients, it was because the therapist had created an environment where non-judgemental self- exploration felt possible, and which allowed one participant, Jo, “to be more open”. Some knowledge of intersex experiences


is crucial when working with this client group and their families. Research shows, when the therapist uses their intersex clients to make themselves more knowledgeable, there is a danger of re- traumatisation, as further exemplifi ed by Seven who said they found the experience of being “positioned as the expert” by therapists regarding intersex issues problematic, adding that this contributed to a feeling of “disconnect” between them. Lack of therapist knowledge meant clients


felt it was not possible to work at depth on issues directly relating to their being intersex. Eden suggests this lack of knowledge on the part of the therapist was a barrier to deeper exploration of what it was like for her to be intersex and transgender. That said, Jo did feel her therapist gave her the space to explore what it means to have an atypical body. Jo also recalls taking on the label of ‘intersex’ as a political as well as medical category, only when she had begun to make contact with other political activists and developed a sense of community. The explicit permission to discuss being intersex given by a therapist helped Del to “feel better” about being intersex: “I didn’t feel like being intersex was an issue and he didn’t have a problem”.


Vicarious therapist trauma Whilst researching and writing my study, I


was refl exive about the impact of being the adult daughter of a woman who survived the murder of her intersex twin. It’s impossible to know just how the intergenerational traumas, the stories I lived with alongside my mother, and the deep sorrow I felt, interwove with the stories of trauma and injustice I heard whilst researching intersex people’s lives. I found nothing in the literature that explored the potential and/or actual trauma experienced by psychotherapists working side by side with this highly stigmatised, marginalised and oppressed group of people. There is


36


nonetheless research on secondary traumatic stress (Sanderson, 2010, p. 281). My own responses and that of a participant’s therapist, who “cried several times” during their work together, suggests this is a phenomenon therapists will need to consider. Further, it is my belief some clinicians


are so psychologically invested in their own normative physiologies, and so challenged by bodies that violate normative presentations, that they switch off from the trauma they experience at the thought of not having normative bodies. This denial and dissociation is then reproduced at an institutional level through the treatment protocols that enforce a binary gender on all people. This corporeal anxiety additionally suggests that the shame projected into intersex bodies and the conspiracy of silence (Toal, 2014, p. 36) that is so often reproduced between clinicians, parents, and their intersex children, can be replicated in the therapy room when intersex awareness is not made explicit, either verbally by the therapist or in their promotional material. It is this pervasive shame and silence about intersex lives that I believe underpins Seven’s comment about feeling as if they were “less- than human” compared to their therapists. Similarly, Jo mentioned that it wasn’t until she became aware of intersex activism, several years after she fi rst started therapy, that she felt her intersex body and sense of identity were ‘legitimate’ subjects for therapy, despite having spent years trying to hide her facial hair. Finally, Suchet (2011, p. 183) notes that,


“embodiment is not a given, but a complex process of acquiring a sense of ownership of one’s material fl esh, an investment in the bodily self” and understands that whilst it is, “infl uenced by physiological, cultural and unconscious process” it is also “highly sensitive to traumatic disruption,” as evidenced in the stories of all fi ve co-participants. As intersubjectivity is an embodied process, it is important for practitioners to think about how this work will aff ect their own sense of embodiment, in addition to embracing research on the social construction of sex, gender and biology. Science historian, Alice Dreger, author of Hermaphrodites and the Medical Invention of Sex (1998) believes “the way we choose to categorize and delineate males and females (and others) is basically a social decision…a decision some would call a social construction”. There will be more on this in Amanda Middleton and H Howitt’s article on trans sexualities later in this issue.


The main conclusions arising from my


research showed the bodily integrity and autonomy of intersex people has been severely and repeatedly compromised, through institutional treatment practices and through the imposition of normative binary sex and gender categories. It is therefore vital that adequate therapy is provided. This violated bodily integrity also has a wider impact on the lovers, partners, families and friends of intersex people. That said, there is signifi cant mistrust of therapists and clinicians in general, so it is strongly recommended therapists educate themselves on non-normative gender identities and bodies, as well as in regard to treatment protocols and associated legal, socio-political, and cultural impingements imposed upon this client group. The last word goes to Seven who advises


the following to therapists working with intersex clients: “No matter how great a therapist you are, you are probably going to be rejected, you are probably going to experience anger, you are probably going to experience a lot of negative emotional states so you really need to be grounded and you really need not to personalise that stuff ”.


References Dreger, D.A. (1998) Hermaphrodites and the Medical Invention of Sex. Connecticut: Harvard University Press. Harper, A., Finnerty, P., Martinez, M., Brace, A., Crethar, H.C., Loos, B., Harper, B., Graham, S., Singh, A., Kocet, M., Travis, L., Lambert, S., Burnes, T., Dickey, L.M. & Hammer, T.R. (2013) Competencies for Counseling with Lesbian, Gay, Bisexual, Queer, Questioning, Intersex, and Ally Individuals. London: Routledge. Available at: http://www.tandfonline.com/loi/wlco20. [Retrieved 6 April 2013]. Liao, L.M. & Roen, K. (2014) (eds.) Intersex/DSD post-Chicago: New developments and challenges for psychologists. Psychology and Sexuality, 5 (1-2) March-June. London: Routledge. Leidolf, E.M. (2006) The missing vagina monologue... and beyond. The Journal of Gay and Lesbian Psychotherapy, 10: 73-88. Mendez, J. (2013) Report of the Special Rapporteur on Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. Promotion and Protection of All Human Rights, Civil, Political, Economic, Social and Cultural Rights, Including the Right to Development. UN HRC. Available at: http://www.ohchr.org/Documents/HRBodies/ HRCouncil/RegularSession/Session22/A .HRC.22.53_English.pdf. [Accessed 8.10.16]. Roen, K. (2004) Intersex embodiment: when health care means maintaining binary sexes, Sexual Health, Vol 1, Institute for Health Research, Lancaster University, Csiro Publishing & Minnis Communications. www.publish.csiro.au/journals/ sh. Roen, K. (2008) ‘But we have to do something’: Surgical `correction’ of atypical genitalia. Body and Society, 14: 47-66 [Available at http://bod. sagepub.com].


Context 155, February 2018


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


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