Transgender Assessments

I work with many clients who suffer from gender dysphoria. During any given week, I host several conversations regarding clients’ gender expression as related to their sense of self and well-being. There are several means, depending on the situation, to bolster client efforts in synchronizing their gender expression (cues visible to others) with their gender identity (their self-experienced gender).

Some people seek an official assessment for potential hormone referral therapy. These assessments include an intake of the client’s life history including child & adolescent development; transition goals; coping resources; and any co-occurring problems (such as depression or trauma histories). During later stages in the process, I may invite clients to bring family members into the meetings for increased social support (this part is required earlier for adolescents).

Other clients, such as gender non-conforming people, benefit from deconstructing any unhelpful gender associations & roles they internalized from developmental and social contexts. Then, therapeutic techniques such as assertiveness training help privilege their own unique identity and facilitate choices & empowerment.

Internal Family Systems

I enjoyed a webinar with Richard Schwartz, developer of the Internal Family Systems therapy model. The IFS model grew out of other family therapy models that examined “roles” each family member inherits in reaction to each other & the family’s overall needs. The IFS model examines various “parts”, or roles, within a person, often developed within confusing family dynamics. For example, an individual is likely to develop various “protector” parts and other parts that are “exiles”–parts that express impulsive or other unwelcome behavior. In the IFS model, healing occurs as each part is attended to with curiosity and awareness. When the parts are understood, they relax and trust a well-informed leader–the “self.”

Schwartz’s IFS website: Center for Self Leadership

Daring Greatly

I am currently re-reading the wonderful book Daring Greatly, by Brene Brown. If I only had a single therapeutic tool or paradigm, Dr. Brown’s work may be the one. Dr. Brown examines yucky problems like scarcity, shame, and defense mechanisms with finesse and humor. For those of you who have not seen her first viral video, here it is: vulnerability .

Trauma and Restoration

When you experience a negative memory, do you experience an inability to move or take action? These “stuck” or “frozen” states are indicative of trauma. The trauma may be related to a single overwhelming event and/or it may be from a developmental disturbance, like childhood abuse or neglect. Trauma is about powerlessness, not being able to DO something helpful within the original situation. A traumatized person’s challenge is to re-train their mind AND body to take calm action when they are triggered into these states. Sometimes, traumatized people over-react to situations, understandably not wanting to be revictimized. Some interventions that help relieve (rather than re-live) trauma are: meditation (noticing disturbing mind/body cues while regulating breathing and heart rate); identifying and using self-soothing stimuli (perhaps a comforting smell, texture, visualization); and articulating the trauma experience within a safe and responsive context.

I recently completed a continuing education training with Dr. Bessel van der Kolk, author of The Body Keeps the Score.

Consultation Form

Clients who would like me to consult with another service provider–for example a psychiatrist, school counselor, judge, previous counselor, or medical doctor–are welcome to complete this Release of Information form. It enables the client to describe what type of information they would like shared and to specify the consultation dates. In some situations, consultations boost the effectiveness of one or both practitioners. Clients are welcome to discuss specific consultation considerations with me.

Feedback Informed Treatment

I am enlisting two new tools to build collaborative client relationships! The Outcome Rating Scale measures a client’s life satisfaction–and any positive or negative trends during the course of treatment. At the end of each meeting, clients use the Session Rating Scale to provide feedback about the meeting’s topics and methodology.  These tools are associated with the International Center for Clinical Excellence. This evaluation process encourages transparency, accountability, and “custom-fit” rather than “cookie-cutter” therapy.

Therapy Style, continued…

Another important part of my therapy style is seeking and developing Exceptions. Exceptions are times/places/relationships when the problem does NOT present itself.

It can be argued that some suffering is part of the human condition; however, the worst problems have a way of becoming a dominant theme, encroaching on multiple areas of life. I help people develop problem-free zones. Articulating and building these exceptional experiences helps develop nuanced awareness and the increased personal agency required to respond to difficulties.

Therapy Style

When asked about my therapy style, people often want to know two things: what are some of my core assumptions? how do I relate to clients?

  • I understand that people have variation, including biological variation. One person may be fundamentally different from other people.
  • An individual’s biochemistry and personality may vary and adapt throughout time.
  • A pattern of thoughts/emotions/and actions may be described as a relational template. Relational templates that are adaptive in a previous context may become generalized into other parts of a person’s life. Unfortunately, the generalizations may become problematic in newer contexts. In that case, the person may revise their thoughts/emotions/actions.
  • I position myself as a collaborator with the client. Rather than take a prescriptive approach or a passive approach, I solicit the client’s participation. I expect clients to challenge themselves while I am an active respondent. We share power and control so that new dynamics and opportunities develop.

Trauma and Avoidance

Trauma often disrupts or prevents otherwise healthy relationships. One way to conceptualize this effect is through Attachment Theory, specifically the avoidant attachment style. People with avoidant attachment may provide vague descriptions of past events, idealize a person in a previous context, dismiss many problems, devalue intimacy, and over-emphasize self-reliance. With such clients, the therapist’s first task is to develop a safe relationship where a client can tolerate connection, exposure, and vulnerability. When a person experiences this vulnerability within a secure connection, he or she has a corrective emotional experience and may enhance other safe relationships.