Working with Gender Identity in the Therapy Room
Gender identity has become an important topic in the public sphere and in psychotherapy in recent years. An increase in public figures talking about gender identity and sexuality has raised awareness of the myriad different ways in which we might identify ourselves. How people feel about their gender identity can play a vital role in how they relate to themselves, to others, and to the choices which they make in life.
Gender refers to the cultural meaning that is given to a person's sex (generally labelled masculine or feminine). Masculinity and femininity are the terms that are often used to identify a set of characteristics, values, and meanings related to gender.
A person’s gender identity can be thought of as a product of four related factors: their biological sex (gender biology); their sexual orientation; the gender they feel (gender identity); and the gender that dominates the way they behave. Each of these factors exists on a spectrum. So gender identity covers four different factors and four different spectrums within those factors – a vast amount of material to explore!
The complex relationships between these factors can give rise to a huge potential for misunderstandings, confusion and pain. Exploring these relationships within the safe, non-judgmental framework of psychotherapy can provide a vital opportunity for self-knowledge and self-acceptance.
Our biological sex is so important to us as a species that we are defined by our gender from the minute of our birth – ‘is it a boy or a girl?’ At primary school we are often divided into ‘boys’ and ‘girls’ with separate toilets and facilities. By senior school we may go to single sex schools. The societal construct of what makes us a male or female becomes much broader than the mere fact of our genitals.
How we feel about that biological gender is important to us, whether it is about the gender we want to be or whether we identify as that gender, or whether we are comfortable with how society views that gender. If any of those feelings make us feel uncomfortable or unhappy it can give rise to problems in how we relate to ourselves and to others. Equally the same issues can arise with sexuality, and with the different connotations of how our feelings about ourselves are constructed.
Within my practice I have seen a steep increase of people specifying gender issues as their primary reason for seeking out psychotherapy. Their concerns have equally covered every possible combination of those factors - gender biology, gender identity, outward presentation of gender, and sexuality – the scope of the issues raised by those factors are numerous.
When a call comes through it might be a young woman who is confused as to her gender identity and sexuality, or it could be a man who has been dressing and identifying as a woman for years in secret. Clients might want to be exploring the gender politics of what it means to be a young gay person in this day and age, or to be taking their first real steps towards reassignment surgery.
There is a huge spectrum between feeling uncomfortable in your assigned role as a societal construct, to feeling that you would like to permanently change your gender. A skilled psychotherapist can tease out what feels right for the client and their needs. As therapists we need to suspend any judgment or set ideas that we might have. We need to be aware of our own feelings and beliefs around gender and sexuality, and ensure we are self aware enough to not impress these upon an often young and receptive person seeking help. We may be influenced heavily depending on our own age – research has shown that the older we are the harder we find it to accept difference in gender and sexuality – or by our personal experiences.
To a young person, defining identity and who they want to be might be the crux of the psychotherapeutic work. What do they call themselves, how do they dress, what do they refer to themselves as? As well as what will older relatives or our peers think? To an older client it might be facing the perhaps very strong feelings of others who have an emotional attachment to you as you are, or as they would like to see you – at work, in our families, in our relationships; particularly if this has been kept hidden a long time. Living with secrets can be one of the hardest parts of the psychological struggle.
The LGBT world with its communities of like-minded individuals can be a vital resource for support and help. The benefits which psychotherapy can provide is a safe environment in which to explore what those identities mean to us personally. Therapy can be an invaluable space to try out different roles and beliefs. It is a place where we can investigate any anger or frustration both at the world and of ourselves for not fitting in.
The freedom afforded by true acceptance in relationship-based therapy can be mind opening. If I am accepted as myself, then I am on the right path to self-actualization. Ultimately, our road on therapy is hopefully (as Shakespeare writes in Hamlet) ‘This above all: to thine own self be true, And it must follow, as the night the day, Thou canst not then be false to any man.’