Information for health care referrers - help with gender questions
The importance of gender-specific mental health care and the current state of affairs.
(for information about my health care offer for people with gender questions, see the purple box)
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There are currently long waiting lists (on average 2 to 3 years) for an intake consult at a Gender clinic. In the meantime, there are not many care providers who specialize in gender/transgender care. There are also long waiting lists within the GGZ. Outside of mental health care, there are few care providers who provide transgender sensitive care and/or care for people who experience gender dysphoria and/or have gender questions. The route to somatic treatment can be found, but finding gender-sensitive care for psychological complaints before and after this treatment is difficult (Quality Standard for Transgender Psychological Care, 2017).
Transgender care within Gender clinics is often only aimed at working towards somatic treatment, while several diagnostic and treatment options are possible. Referrals to gender clinics are often made too quickly. These teams are only focused on determining whether someone is eligible for a somatic intervention and discussing which interventions someone would like.
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While sometimes someone just feels strongly that the gender assigned at birth is not right, without knowing what ís their gender. Then further exploration is necessary
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While some transgender people do not want medical interventions at all, but can suffer from psychological complaints.
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As a result of better recognition of gender dysphoria, there is an increasing flow of people that apply to gender clinics. The demand for psychological and somatic care will continue to increase. Better accessible psychological gender care is essential. Also outside the GGZ.
Care providers who indicate that they provide LGBTIQ+ care are not always necessarily competent and equipped to provide care to transgenders or gender non-conforming people, as this group does not deal with sexual orientation problems. Research shows that transgender persons or gender non-conforming persons indicate that caregivers often lack basic knowledge to help them (APA, 2015).
Different subgroups of people with gender dysphoria are distinguished based on the Quality Standard for Transgender Psychological Care (2017). Within my counseling practice I supervise the following subgroups:
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Group 1. Adults or adolescents who are confused about their gender identity.
Group 2. Adults or adolescents with gender dysphoria, but without a durable wish for genderconfirming somatic treatment
Group 3. Adults or adolescents with gender dysphoria with a durable wish for genderconfirming somatic treatment and who are eligible for this treatment but are currently on a waiting list.
Group 4. Adults or adolescents who underwent gender-affirming somatic treatment
According to this Quality Standard, Adults or adolescents who have undergone gender-affirming somatic treatment may experience different requests for help, making possible treatment goals:
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Understanding what is going on with them (for example, group 2)
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Understanding what people want (for example, in groups 1 and 2)
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Increasing the psychological strength during the waiting list period by giving personal direction, starting/continuing social transition (in group 3.)
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Adjusting to a new life situation, optimizing social contacts, daytime activities/work, sexuality/intimacy and body experience (in group 4)
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Self-acceptance (in all groups)
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What kind of help and support do I offer for people with genderdysphoria?
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I offer a place where people can explore, express and propagate their gender identity and/or gender expression in a safe environment.
I use various tools hat help someone to find out their gender expression and gender identity to see what fits them.
I also offer support in making choices about and help to discover strategies for the social transition, such as where to start?
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In addition, I offer help with processing emotions, seeking support/support groups based on someone's needs, learning to deal with stress differently; discovering and developing (self-help) strategies for
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Uncertainty/sadness/fear during the search for their gender
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Internalized negative views on one's own gender variation
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Stress from environmental disapproval of gender identity or discrimination
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Changes in the experience of one's emotions due to hormone therapy
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Environmental barriers such as visiting shops and public toilets.
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Dealing with the long waiting times of the gender clinic and the impatience with regard to wanting to start the medical transition
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Coping with life after the medical transition. Transgender people often still experience psychological complaints after the transition.
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What is also important:
Distinguishing between problems that are and are not related to gender dysphoria.
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Helping to provide insight into the fact that the medical transition is the icing on the cake, but that the change from within is also very important. There is often a lot of work that that be done in terms of feeling better about one's self the meantime. The medical transition alone is not enough to feel completely good afterwards.
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References:
Alliance Transgender Care. (2017). Quality Standard for Transgender Mental Health Care.
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American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. American Psychologist, 70(9), 832–864. https://doi.org/10.1037/a0039906
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