Challenging Cases for Experienced Therapists more

Journal of Gay & Lesbian Mental Health, 15:180–199, 2011

Challenging Cases for Experienced Therapists

Katherine Rachlin, Ph.D. Private Practice, New York, New York, USA and Arlene Istar Lev, LCSW-R, CASAC Choices Counseling and Consulting, Albany, New York, and Albany School of Social Welfare, New York, New York, USA

The authors, both experienced gender therapists, engage in an interactive discussion of two cases that involve ethical dilemmas and complex psychological presentations. Three themes are discussed: (1) writing letters of recommendation for hormonal or surgical treatment when the clinical presentation involves complicating factors, (2) providing support for transgender persons who are not expressing their authentic gender and choose to remain closeted, and (3) the flexible use of the World Professional Association for Transgender Health’s (WPATH’s) Standards of Care. The authors each present a case and then discuss various strategies that are affirming of transgender identities.

KEYWORDS transgender, transsexual, crossdresser, nontransitioning, standards of care, sex reassignment surgery, gender affirmation, gender therapy, hormonal therapy