Posted: April 8th, 2022

Clinical Psychology and Gender Dysphoria

Clinical Psychology and Gender Dysphoria

 

Advancement of Clinical Psychology with Gender Dysphoria

 

Clinical psychology is recognized as a psychology branch that deals with the assessment and treatment of abnormal behavior, mental illness, and psychiatric problems (Brennan, 2003). Clinical psychology integrates the science of psychology with treatment of complicated human problems, which makes it a challenging and rewarding field. American psychologist Lightner Witmer introduced the term in 1907. Witmer defined clinical psychology as a field that studies individuals by experimentation or observation, with the intent of promoting change. A clinical psychologist will try to reduce any psychological distress suffered by a patient and enhance their psychological well-being. Previously clinical psychology focused on the psychological assessment of the patients, and there was little or no attention been paid to treatment. This scenario changed after World War II in the 1940s because there was increased demand for trained clinicians. A clinical psychologist will offer psychotherapy, diagnosis of mental illness, and psychological testing.

 

Gender dysphoria refers to a condition where an individual experiences distress or discomfort because of a mismatch with their biological sex (Steensma, Biemond, de Boer, & Cohen-Kettenis, 2011). The assigned biological sex at birth is done depending on the genitals appearance. The gender that a person identifies with is their gender identity. Biological sex and gender identity are the same for most individuals, but there are cases where there is a discrepancy. This discrepancy or mismatch will cause distress and uncomfortable feelings, which are referred to as gender dysphoria. This is not considered a mental disorder, but rather a medical condition that can be sorted with treatment. There are many ways that this condition will manifest itself in an individual. A person will identify with the opposite gender yet they have normal and secondary sex characteristics of one gender.

 

A clinical psychologist would be in a position to assist an individual suffering from gender dysphoria. The psychologist would perform a psychological assessment of the individual to determine why they identify more with another gender. The psychologist will attempt to lessen the burden by offering the individual help and treatment.

 

Religion and psychology

 

Psychologists have studied religion and religious practices for a long time. According to Leahey (2014) researchers have tried to understand various religious experiences like prayer, cult, and mystical experiences. This study began in early twentieth century, but it faded and was revived in the 1980s by the American Psychological Association. The APA began to investigate formally the aspects of religion in psychology. Most psychologists regard William James as the founder of this field. He was the author of the first psychology textbook Varieties of Religious Experience in 1902. Psychologists have tried to explain and understand the ways a person can be deemed religious. There are supernatural happenings that science cannot explain from a rational point-of-view.

 

People suffering from gender dysphoria and are religious are more likely to recover from their disorder. Religion has been shown to improve a patient’s mental disorder if they are truly religious and spiritual. This is because the patient has found meaning in their life, and this assists them to overlook what is ailing them. Religious affiliation would offer a person suffering from gender dysphoria some relief, and this would be beneficial to the person. The person would not have to suffer mentally, as they would have their religion to assist them understand the feelings they are undergoing. The person would rely on religious texts to formulate and comprehend the situation, which would assist them in coping with their feelings.

 

Biology of psychology

 

The biology of psychology applies the principles of biology in the study of psychology. This theory attempts to investigate biological processes that underlie abnormal and normal behavior (Colomb & Brembs, 2010). Having a biological perspective is vital in three ways comparative method, investigation of inheritance, and physiology. The comparative method studies and compares different species of animals. This helps in understanding human behavior. Investigation of inheritance provides the psychologist with information regarding what the animal has inherited from its parents and the mechanisms of inheritance. Physiology analyses how the hormones and nervous system work, how the brain functions, and how structure changes can affect human behavior. Using these three biological aspects, a clinical psychologist can explain human behavior. This theory was formulated in the 18th and 19th century. Charles Darwin was the first to formulate this theory when he was working on his natural selection theory, as he was observing animals during his travels. Biology has the potential to explain a person’s behavior. Biology of psychology supports nature over nurture, because the theory only analyses biological functions and structures. Nurture plays a big role in a person’s behavior, and it is vital for a psychologist to analyze the person’s behavior using their nurture too.

 

Biology does play a huge role in gender dysphoria. Using biological studies, a clinical psychologist would be able to establish why a person is suffering from gender dysphoria. Scientifically testing explanations will assist the psychologist to arrive at conclusive results. Clear predictions can be made from the analysis done, and one can see if the condition is genetic or is due to neurotransmitters. Biology of psychology has contributed immensely to the treatment of clinical depression that is mostly suffered by gender dysphoria patients. Genetics knowledge is vital especially for patients suffering from gender identity. Having the capability to perform gene mapping, the clinical psychologist can understand why the condition is manifesting itself in the patient. Having such data, the psychologist can offer a comprehensive treatment that might include suggesting undergoing a sex change.

 

Theories of intelligence

 

Intelligence is amongst the highly talked about subjects in psychology, but there has not been a standard definition of what precisely forms intelligence. There have been two different definitions from researchers in regards to intelligence. One defines intelligence as a single general ability, and the other believes that it covers a range of skills, aptitude, and talents (Miele & Molden, 2010). Theories of intelligence emerged around 1904 when psychologist Charles E. Spearman published his first article on intelligence. Spearman proposed what is known as the g factor, which means general intelligence. Spearman believed that there is only one way to define intelligence. The most recent ideas regarding intelligence were by Howard Gardner. He described intelligence based on skills and abilities, which enabled him to come up with eight intelligences. Robert Sternberg is another modern theorist who concurs with Howard, but he ascertains that some of the intelligences Gardner proposed could be viewed as individual talents. Stenberg proposal was a triarchic theory of intelligence, which distinguished intelligence using three aspects. There is also emotional intelligence, which is described as an ability that assists a person to perceive, understand, regulate, and express emotions. Other researchers have maintained that this are not forms of intelligence, but rather forms of personality traits.

 

Intelligence is vital for clinical psychology as it assists the psychologist to analyze gender dysphoria. Employing analytical intelligence would allow the clinical psychologist to use his or her problem solving abilities in order to offer guidance to a patient. Encouraging the patient to use his practical intelligence in order for them to adapt to the changes taking place in their body. The client should be encouraged to express their feelings and not be ashamed, which would ensure that the psychologist could use their observation and listening skills to determine the best treatment course. Intelligence is gained through practice and study by using appropriate tools. Problem solving is also a vital aspect of intelligence, which allows a person to understand a problem and transform it into a problem they can clearly define.

 

Theory of psychoanalysis

 

The theory of psychoanalysis refers to the influence that the unconscious mind has on a person’s behavior. Sigmund Freud is the pioneer of this theory in late 19th century. Freud held on the belief that a person’s mind was made up of three elements namely the ego, the superego, and the id (Stern & Stern, 2013). Freud also defined psychosexual stages that defined the unconscious and dream symbolism, both of which have remained popular topics among modern psychologists. Erik Erikson is another theorist who expounded on Freud’s theories. He stressed upon growth throughout a person’s lifespan. His theory of psychological stage is still influential today in the understanding of human development. The conscious mind is one of the aspects that Freud was interested with, and he defined it as everything that was inside a person’s awareness. The ego has developed a defense mechanism, which it uses to guard against anxiety. The y safeguard the mind from thought and feelings that the conscious mind cannot deal with. The unconscious is a reservoir of thoughts, feelings, memories, and urges that are outside a person’s conscious awareness. The unconscious influences an individual’s behavior although they are not aware the underlying influences.

 

Using this theory one can see that a person’s unconscious mind has an influence on their behavior. In regards to gender identity, a patient suffering from this condition would find that they are not willingly in control over what they feel or experience. The individual could be struggling with feelings they harbor in the unconscious, which have a direct effect on their behavior. Attempting to control or fighting these feelings could lead to mental torture, and this might result in mental disorders. The internal war that a person might be going through would only manifest itself in their behavior. Trying to suppress some of the unwanted thoughts and impulses would be appropriate for the individual struggling with gender identity, but without guidance from a qualified person, they might fail.

 

Existential vs. humanistic theories

 

The existential theory states that continuously searching for the meaning of their life. Humanistic theory states that individuals are striving constantly to be the best version of themselves. The humanistic theory views humanity in a positive manner, but existential theory tends to delve into the dark side of humanity. The humanistic theory came into focus in the mid-20th century as a response to Freud’s psychoanalytic theory (Waterman, 2013). These two theories recognize that individuals have the ability to make their own independent choices and to lead their own lives. Both humanistic and existential theories stress on the positive side of human nature. Using either of the two theories, a psychologist will view the patient as a whole, which means they look at the individual as having great positive potential who only needs therapy to assist them realize their potential. Watson, Goldman, and Greenberg (2011) states that the humanistic theory views in individual as a good person and the community forces them into bad things. The existential theory will assume that each individual has the capability for both evil and good in them. The choices a person makes are what define if they are good or evil.

 

These two theories would demonstrate that the clinical psychologist should be more understanding and only attempt to encourage the individual to realize their true potential. In seeking a remedy for the person suffering from gender identity, the clinical psychologist will listen to the patient and will attempt to guide them towards making their own choice. Using these methods would ensure that the patient makes a conscientious decision that they would feel is their own. It would not matter if the decision is the correct one or the best, but rather that the person made that decision with guidance from the psychologist. The only grey are is that a humanistic psychologist would view the person’s past actions as overly good, and they have only been influenced by society. If the psychologist were an existential psychologist, they would believe that the patient has the potential to do evil, and they opted to be evil.

 

Behaviorist and cognitive theories

 

Behavioral theory is a learning theory that is based on the idea that all behavior a person or animal acquires is through conditioning. Conditioning would occur through interacting with the environment. John Watson and B.F. Skinner advocate for the theory. The theory was prominent in the early twentieth century, and it is in wide usage today in therapeutic settings in order to assist patients in learning new behaviors and skills. John Watson believed that it was possible to train, measure, and change behaviors. Behaviorists hold on the belief that people’s responses to environmental stimuli will shape their behaviors. Cognitive theory focuses on the internal states like problem solving, motivation, thinking, attention, and decision-making. The theory is mainly concerned about the development of an individual’s thought processes. It analyses how the thought processes influence the individual’s understanding and interaction with the world. The first cognitive theorist was Jean Piaget, who proposed that children think differently from adults. Piaget did propose a cognitive theory that accounted for the sequences and steps of a child’s intellectual development. Classical conditioning refers to behavior training where a natural occurring stimulus is paired with an answer. Next, the naturally occurring stimuli is paired with a neutral stimulus. Eventually, the neutral stimuli will evoke an answer without the naturally occurring stimuli. Operant conditioning is learning behavior by using rewards and punishments. In operant conditioning, the correct response is rewarded, but the wrong answer is punished.

 

Clinical psychology can employ cognitive and behaviorist theories to teach the client new behaviors or conditions for solving their problem. Using behavioral theory the psychologist could teach the client new skills and ensure that they do not harbor the negative feelings in regards to their gender. It is possible to train the client to start liking themselves and their gender and ignore the negative feelings. However, this learning could be unlearnt because the negative feelings are still there, and they might be triggered by something different. Using cognitive theory the psychologist could identify the problem, and way of motivating or changing the clients thinking process. This would be more helpful, and it might have lasting effects.

 

Diversity issues

 

Diversity issues face each person everywhere they go. There are many issues of diversity that a person might be faced with, but for individuals suffering from gender identity crisis the diversity issues are mostly with their gender and sexual orientation. How people are treated by the society is not an easy thing to identify. This is only possible by hearing from the person or having to undergo such an experience. In the case of gender dysphoria, there is discrimination, and this causes many issues for the individuals. American history indicates that it is only prior to 1800 that transgender was accepted. After the 1800s, transgender individuals were incarcerated for faking their gender. It was unacceptable for a man to live as a woman. The mere notion of undergoing a sex change was unfathomable. Individuals suffering from gender dysphoria were persecuted all throughout the 1800 to 1950. There was no psychological help readily available to these persons. Between 1950 and 1960, organizations and publications for transgender started appearing, but the law and medicine field did not react favorably to these advancements. The first publicized person to undergo a sex reassignment surgery was Christine Jorgensen in 1952, which created a worldwide sensation. Christine Jorgensen was denied a marriage license when she attempted to marry a man in 1959, which resulted in her fiancee losing his job.

 

Psychological, social, and medical support services were established in 1966 for people suffering from gender dysphoria. In 1968, the National Transsexual Counselling Unit (NTCU) was established. It was the first peer-run support organization in the world. There was a lot of transgender activism during the 1950s and 1960s, but this period also had heavy discrimination for people known to be transsexual. Harry Benjamin an American Physician, coined the term transsexual. The American Psychiatric Association officially classified transgender individuals as having a gender identity disorder. This move was highly controversial, but it ensured that transgender people could access health care. Initially, the Diagnostic and statistical Manual referred to the condition as gender identity disorder, but this was replaced with gender dysphoria. This move was intended to demonstrate that being transgender does not necessitate for treatment since it is not a disorder. It only becomes a disorder when the person experiences gender dysphoria. This meant that not everyone who was a transgender had the disorder. During the late 1980s, the term transgender became commonplace, and it referred to all non-conforming gender people.

 

In order to support full equality, the APA adopted a resolution on gender expression nondiscrimination, and gender identity in 2008. The association also recognized the necessity and benefits for gender transition treatments and requested that insurance companies provide covers for these treatments after professional evaluations deem them medically necessary. Before a transgender undergoes a sex change, the physicians will require that they undergo an assessment by a clinical psychologist. The psychologist would analyze the client and if appropriate provide written consent that the client would benefit in health if they underwent the gender transition. Treating the client first for any psychiatric conditions, which ensure that the client is prepared for the procedure. Clinical psychologists would also be called upon to offer their services during the transition period. This will enable the client to adapt slowly to the new changes and learn how to handle different situations. Currently, the APA is working on guidelines that practitioners treating transgender clients should follow.

 

Transgender people still face stigma within the society. A study conducted by Norton and Herek (2013) established that transgender people encounter rejection, which is significantly harsher that any of the negative attitudes that gay, lesbian, and bisexual people experience. A 2011 report by the Institute of Medicine found that there were high rates of attempted suicide, substance abuse, and HIV infection amongst the transgender adults. Eliason, Dibble, and Robertson (2011) posits that the marginalization of transgender people had devastating effects the report concluded. A majority of the transgender men and women have indicated they struggle with shame, isolation, and depression from the stigma caused by how they are treated by others. Recent reports have shown that transgender people are highly discriminated, and some have lost their jobs, bullied, or even physically abused.

 

References

 

Brennan, J.F. (2003). History and systems of psychology. Upper Saddle River, N.J: Prentice Hall.

 

Colomb, J., & Brembs, B. (2010). The biology of psychology:’Simple’conditioning? Communicative & integrative biology, 3(2), 142.

 

Eliason, M.J., Dibble, S.L., & Robertson, P.A. (2011). Lesbian, gay, bisexual, and transgender (LGBT) physicians’ experiences in the workplace. Journal of homosexuality, 58(10), 1355-1371.

 

Leahey, T.H., Greer, S., Lefrancois, G.R., Reiner, T.W., Spencer, J.L., Wickramasekera, I.E., & Willmarth, E.K. (2014). History of Psychology. San Diego, CA: Bridgepoint Education.

 

Miele, D.B., & Molden, D.C. (2010). Naive theories of intelligence and the role of processing fluency in perceived comprehension. Journal of Experimental Psychology: General, 139(3), 535.

 

Norton, A.T., & Herek, G.M. (2013). Heterosexuals’ attitudes toward transgender people: Findings from a national probability sample of U.S. adults. Sex Roles, 68(11-12), 738-753.

 

Steensma, T.D., Biemond, R., de Boer, F., & Cohen-Kettenis, P.T. (2011). Desisting and persisting gender dysphoria after childhood: A qualitative follow-up study. Clinical Child Psychology and Psychiatry, 1359104510378303.

 

Stern, M.M., & Stern, L.B. (2013). Repetition and trauma: Toward a teleonomic theory of psychoanalysis. New York, NY: Routledge.

 

Waterman, A.S. (2013). The humanistic psychology — positive psychology divide: Contrasts in philosophical foundations. American Psychologist, 68(3), 124.

 

Watson, J.C., Goldman, R.N., & Greenberg, L.S. (2011). Humanistic and experiential theories of psychotherapy.

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