Gender Dysphoria

A thoughtful exploration of gender dysphoria, aimed primarily at clinicians to provide a model for understanding, assessing, and treating trans identifying individuals which may also be of interest to other professionals, parents and the gender dysphoric person.Contains a foreword from Stephen B. Levine and a preface from D

In recent years, there has been an explosion in the number of children and young people who diagnose themselves as gender dysphoric, or trans. In the UK, and worldwide, there is a growing tendency to refer them on to ‘specialist’ gender services almost as soon as they express any confusion or distress about their biological sex or gender identity. Due to the rapidly rising numbers and various pressures on the system, patients are increasingly likely to be offered life-altering medication and/or surgical treatments, often with little exploration of their emotional world. As so little is yet known or understood regarding this increase in gender incongruent patients, it seems precipitous to proceed onto physical treatments before any assessment work is undertaken. Many who present as gender dysphoric have complex needs with comorbid problems such as autism, histories of abuse or trauma, social phobias, depression, eating disorders, and other mental health symptoms. Therefore, all aspects of the individual’s life deserve thorough assessment and therapeutic work. This book is aimed primarily at clinicians working in the field to provide a model for understanding, assessing, and treating gender dysphoria. The model uses a psychoanalytic framework to help explain disturbed states of mind and how psychic defences can be enlisted unconsciously to avoid overwhelming psychic pain. This offers professionals a way of trying to think with, and offer understanding to, their trans-identifying clients. Clinical examples are given to illustrate these processes and promote the understanding of transgender children, adolescents, and young people and their internal worlds, their thinking, and their interpersonal relationships. As well as clinical exploration and understanding, the book includes an overview of the current political, social, and clinical environments which have all impacted on the clinical care of trans-identifying individuals. As well as professional and trainee clinicians, this book might also prove useful to parents, other professionals, and possibly the gender dysphoric person too.

Acknowledgements Preface by David Bell Foreword by Stephen B. Levine CHAPTER ONE Why have we written this book? CHAPTER TWO Developmental theory CHAPTER THREE Psychoanalytic ideas regarding gender dysphoria CHAPTER FOUR Working with fixed states of mind CHAPTER FIVE The family CHAPTER SIX Adolescence CHAPTER SEVEN Complexities of delivering therapy CHAPTER EIGHT Detransitioners CHAPTER NINE The link between suicidal ideation and gender dysphoria CHAPTER TEN The link between emotionally unstable personality disorder and gender dysphoria in mental health settings CHAPTER ELEVEN Co-morbid mental health issues and gender dysphoria CHAPTER TWELVE The societal, cultural and political environment References Index,

Acknowledgements
Preface by David Bell
Foreword by Stephen B. Levine

CHAPTER ONE
Why have we written this book?

CHAPTER TWO
Developmental theory

CHAPTER THREE
Psychoanalytic ideas regarding gender dysphoria

CHAPTER FOUR
Working with fixed states of mind

CHAPTER FIVE
The family

CHAPTER SIX
Adolescence

CHAPTER SEVEN
Complexities of delivering therapy

CHAPTER EIGHT
Detransitioners

CHAPTER NINE
The link between suicidal ideation and gender
dysphoria

CHAPTER TEN
The link between emotionally unstable personality disorder and gender dysphoria in mental health settings

CHAPTER ELEVEN
Co-morbid mental health issues and gender dysphoria

CHAPTER TWELVE
The societal, cultural and political environment

References
Index

• By (author) Susan Evans
• By (author) Marcus Evans

In this timely, necessary book, Susan and Marcus Evans provide key insights into what adequate psychotherapeutic explorations of gender dysphoria should look like […] This book is a must-read not only for those working with gender dysphoria but also those who wish to expand their thinking on this cutting-edge work when dealing with the unbearableness of catastrophic anxiety.

— Hessel Willemsen, International Journal of Forensic Psychotherapy, 4:2

This book is as thoughtful as it is necessary. Every responsible clinician and therapist who treats children and adolescents must read it – and read it carefully.

— Abigail Shrier, journalist and author of ‘Irreversible Damage: Teenage Girls and the Transgender Craze’

I highly recommend this sensitive and timely book to laypersons and professionals who are interested in learning about the complex, controversial, and contemporary subject of gender dysphoria. The authors, Susan and Marcus Evans, are open, compassionate, non-judgemental, and able to tolerate uncertainty in their understanding of those who experience gender dysphoria, are transitioning, or detransitioning. Their psychoanalytically oriented therapeutic model takes into account the individual’s development, family, culture, and political environment. I think the reader will especially appreciate the additional attention paid to the response of adolescents, emotionally unstable personality disordered people, and suicidal individuals to gender dysphoria.

— Donald Campbell, past President of the British Psychoanalytical Society and former Secretary General of the International Psychoanalytical Association

Gender dysphoria is increasingly being seen as a part of the spectrum of human diversity. This has resulted in a profoundly reductionistic and decontextualised clinical approach to gender distress. The authors draw on their extensive clinical experience to illustrate how gender dysphoria cannot be understood without understanding the developmental and relational contexts within which it arises. Their detailed case examples document the unique psychic landscapes of people suffering gender dysphoria, illuminating how the ubiquitous “born in the wrong body” conceptualisation can leave vast areas of historical and current lived experience unaddressed. The authors utilise a psychoanalytic lens to understand the experience of both patient and therapist in therapeutic work with gender dysphoria, in a way that is both accessible and insightful. This will be an invaluable reference for those seeking to go beyond the surface to work at depth with gender dysphoria. This work is remarkable for its bravery in presenting a perspective on gender dysphoria that is increasingly being excluded from social and clinical discourse.

— Roberto D’Angelo, Training and Supervising Analyst, Institute of Contemporary Psychoanalysis, Los Angeles and President of the Society for Evidence-Based Gender Medicine

This clear, excellent, clinically based account is very timely. It will help those who want to find their way through the confusing and often contentious writings on the subject of gender identity. It is well founded on experience of helping and working with people who do not feel at home in their bodies, particularly in regard to their sexual identity. They bring to the subject an unusual amount of clinical experience of this specialised psychological area. I strongly recommend it to those in the psychological, medical, and social fields, as well as to anyone who wants an informed account of a confused and confusing subject.

— Dr Ronald Britton, FRCPsych, Distinguished Fellow, British Psychoanalytical Society

Gender Dysphoria is a thoughtful and timely contribution to the current controversy around gender dysphoria, how it is thought about and how it is treated when help is sought. […] The book would clearly be of interest to anyone working with this client group, but I also found it a valuable resource in terms of thinking about the adolescent state of mind. […] Gender Dysphoria is an important book and a valuable contribution to the current debate. The book would grace the shelf of any trainee or practising therapist.

— Helen Lowe, registered member of BACP – BACP Healthcare Counselling and Psychotherapy Journal Jan 2022

'What distinguishes the transgender from the gender dysphoric? Research in this area is not as advanced as we would like, and there is a dearth of good data. While this book does not reflect on gender dysphoric individuals for whom transition may be the right decision and have a positive outcome, it does add a great deal to the argument that careful thought is vital in the process of considering such a move. Transition may, or may not, be in the best interests of the individual. But maintaining a position of neutrality and enquiring curiosity, neither pro- nor anti-transition but pro-thought, is a point repeatedly made by the authors.'

— Alan Colam, International Journal of Psychoanalysis, 2023, (104)(6):1139-1142