Instructions - Case Study Outline 1. Read the following case study. Week 9 Case Study: Gender Identity - Transgender - Gender Dysphoria Week 9 Obstacles to Care TGNC (Transgender Non-Conforming) Sam t

Week 9: Overview

Family Theories and Family Therapy

By now, I am sure it has become clear that theories guide our work with families.  Theories provide direction for our therapeutic services.  We are able to make adjustments to theoretical techniques based on the family’s needs and without the use of theories; one could argue that our work may not be as fruitful.  The purpose of this week’s lecture is to provide a comparative overview of family theories.  This will challenge you to begin thinking about the theories collectively instead of independently, which will ultimately assist with shaping the theoretical framework that you will feel comfortable applying in your work with families.  Please read the chapter on comparative view of family theories and therapies.  Additionally, as we end our exploration of Marriage, Couples and Family Counseling, you will find it useful to re-visit the Code of Ethics in preparation for your work with clients.  This week, you will participate in three discussion questions and respond to one peer for two different questions.   You will also complete your final exam, along with a reflection paper.  Remember to properly integrate and cite the readings in your work and include a reference list. 

Learning Objectives

By the end of this week, you will:

• Compare family theories for similarities and differences.

• Draw similarities and differences between family therapy interventions.

• Understand ethical decision making and conduct, as determined by the AAMFT Code of Ethics.

Readings

Please read the following for this week as well as All Week 9 Online Course Materials:

• Goldenberg, H., & Goldenberg, I. (2013): Chapter 17, Appendices A and B (Comparative View of Family Theories and Therapies and the AAMFT Code of Ethics)

Week 9: Lecture

We have visited many models of family therapy and I am sure by now, they may all be running together on you.  However, it is important to keep in mind that each model is unique in its approach, yet they all share similarities, even if it is only with the ultimate goal of aiding couples and families.  As you reflect on the readings, begin to think about developing your own approach to working with couples and families using the theories that we have learned about. 

Some snapshot distinctions of family therapy models are as follows:

Psychoanalytic family therapy focuses on the past.  Transgenerational models also focus on the past, but in an attempt to examine unfinished business.  Experiential, Strategic, and Structural Family Therapists focus on the present.  Behavioral/Cognitive Family Therapists seek to examine what issues are currently contributing to the maintenance of the problem.  Social constructionists believe in addressing problems in the present.  Narrative therapists only look to the past for evidence of times when clients may have successfully overcome the issue.  Psychoeducational Family Therapists focus on teaching families how to deal with the presenting issue.

Family Therapy ideally provides a vehicle for positive growth and change within the family unit.  The therapist works closely with the family to see this change come to fruition.  While therapists may approach this process from different perspectives, the ultimate goal typically involves addressing the identified treatment issue in order to improve family functioning.  As counselors in training, you are expected to begin molding, shaping, and sharpening the application of your approach with clients.  This means that you are also open to honoring and have developed an appreciation for other approaches as well.

Psychoanalysts focus on resolving the client’s unconscious conflicts that may be interfering with the family relationship.  Experiential family therapists promote honest exchanges in therapy among family members.  Bowen Family Therapists attempt to avoid becoming a part of the family’s emotional turmoil.  Structural Family Therapists focus on helping the family to change their structure in order to better adapt to change.  Strategic Family Therapists may prescribe the symptom in order to eliminate the problem.  The Milan Group uses strategic techniques, along with circular questioning as a catalyst for the family’s healing process.  Solution-focused therapists focus on helping clients develop solutions through therapeutic conversations.  Narrative therapists help clients to develop meanings by rewriting old negative stories and replacing them with new positive stories.  Feminist family therapists focus on helping clients to understand themselves and their situations outside of stereotypical gender roles.

I realize that the AAMFT Code of Ethics was covered in a previous chapter on professional issues and ethical practices.  However, as we close our discussion of family therapy, it is important to re-visit this document as it will govern your professional conduct as you work with families.  I encourage you to become familiar each ethical code and begin to think about applying them in your work with couples and families, not only as it relates to handling an ethical dilemma, but also with regard to avoiding one altogether.

Primary Needs of Transgender People

Transgender people may seek services from mental health providers when they come to realize that their gender identity does not match the sex they were assigned at birth, or when the distress of this incongruence becomes intolerable. The age at which this realization occurs, and the age at which treatment is initially sought, may vary greatly from one person to the next. It should not be assumed that arrival at this realization or seeking treatment late in life indicates that an individual is any "less" transgender. 

A person’s gender typically is assigned at birth and is determined primarily by external genitalia but also can be confirmed by gonads, chromosomes, hormones and internal organs. Newborns are usually designated male or female and, on rare occasions, intersex. Gender identity refers to the subjective sense of who one is as far as male, female or other. Gender identity is determined more by the brain than by sexual anatomy. It is not something that any of us choose. Most people have a sense of their gender identity by age 4, although this sometimes happens earlier and sometimes later in life.

Cisgender persons are those whose gender identity and expression are aligned with the cultural and social expectations of the gender they were assigned at birth. The majority of persons are cisgender. Gender-nonconforming persons are those whose gender identity or expression are inconsistent with societal expectations typically associated with males and females. Some gender-nonconforming persons do not fit into the gender binary (male or female) as others do and may consider themselves to be gender fluid, gender queer or gender non-binary. Transgender persons (about 0.6 percent or more of the U.S. population) have a strong inner sense that their bodies and the gender assigned to them at birth are incongruent with their gender identity. They may be assigned-at-birth males who identify as female (male to female or MTF) or assigned-at-birth females who identify as male (female to male or FTM).

It is important for counselors to understand how their transgender and gender-nonconforming clients identify, especially given that gender identity is now considered to be more a spectrum between male and female and may indeed be a galaxy of possibilities. Some gender-non-binary persons do not seek hormone or surgical treatment and are comfortable with a more non-binary gender expression, whereas others do seek medical interventions. With some exceptions, transgender persons desire and, if at all possible, pursue hormone and surgical treatment to experience congruity between their bodies and their minds. In other words, most transgender persons desire and pursue transition to the gender with which they identify.

Here is a list of gender-neutral pronouns:

• He/She -- Zie, Sie, Ey, Ve, Tey, E

• Him/Her -- Zim, Sie, Em, Ver, Ter, Em

• His/Her -- Zir, Hir, Eir, Vis, Tem, Eir

• His/Hers -- Zis, Hirs, Eirs, Vers, Ters, Eirs

• Himself/Herself -- Zieself, Hirself, Eirself, Verself, Terself, Emself

Typically, you won't use one of these gender-neutral pronouns unless a colleague asks you to identify them as such. However, there are more traditional gender neutral pronouns you can introduce into your everyday conversation, regardless of the individual. These include "Them", "They", "Their", "Everyone", and "That Person". When in doubt, refer to someone by their name, rather than "him" or "her".

"They" is one of the more common gender-neutral pronouns, and it's easy to incorporate into your daily conversations. Here are some examples of how to use it:

• "I spoke to the marketing director and they said they'd get back to me."

• "I think someone left their laptop behind."

• "Who's in charge of that campaign? I'll email them."

You probably use "they" "them" and "their" often in your everyday language, even when you know someone identifies as "he" or "she". It's a natural substitute, but can go a long way towards creating a more inclusive office culture.

Finally, when addressing people in a meeting, it's best to say, "Hello, everyone," or "Hey, team." You'll want to avoid "Hey, guys", or similar phrases, since "guys" is typically masculine.

There is a resources for parents and transgender individuals at the Faculty Acceptance Project (Links to an external site.).  Print and keep in appointment book as resource to give to families and individuals or include in a treatment plan as a referral source.

The determination of an effective/needs development case study is guided by whether it is both data driven and makes logical sense, rather than how many isolated elements are found to be effective.

Week 9: Activities

Readings

Please read the following for this week as well as All Week 8 Online Course Materials:

• Goldenberg, H., & Goldenberg, I. (2013): Chapter 17, Appendices A and B (Comparative View of Family Theories and Therapies and the AAMFT Code of Ethics)

  • PowerPoint Handout: Chapter 17 pdf

• Transgender, Non-Conforming, Non- Binary People Link (Links to an external site.)

Video Links

• How to talk (and listen) to transgender people | Jackson Bird (Links to an external site.) 

• Transgender: a mother’s story | Susie Green | TEDxTruro (Links to an external site.) 

Assignments

Please complete the following assignments:

• Week 9 Case Study Discussion - Gender Identity-Transgender - Gender Dysphoria

Erin Ference

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Please use this discussion space to submit your Week 9 Case Study Outline, initial video response, and reply videos to classmates about their case study submissions. 

1. Read the following case study.

Week 9 Obstacles to Care TGNC (Transgender Non-Conforming) Sam to Samantha (Pseudo-names)

Sam to Samantha

Sam starting coming out and questioning his gender identity in high school wearing full makeup to school. He was interested in fashion design. He started cross dressing in high school as well. His mom was incarcerated for drugs when he was 10 years old and had limited contact with her until he was an adult. His father remarried shortly after that and him and his new wife were members of conservative Christian church which did not accept or support the LGBT community. When he left home his parents had a difficult time accepting his changing look and full make up, but were relieved he was not living with them or in the community because they were ashamed and embarrassed by him. He moved to NYC and got a job at one of the leading cosmetics companies and was one of their top performers. At night he MC’d the drag shows in the New York City for years. He was in a relationship with a man who was beginning to medically transition, Sam decided he did not want to go through with the full surgery and began to identify himself as non-binary. That is when he changed his name from Sam to Samantha and wanted to be addressed as “They” or “Them”. Them did not want to be called “his son” by his father, which created a rift between them. Their father has never accepted Them as a transgender person. Them is now in his late 30’s, in a long-term relationship, Their religion is Wiccan, and has limited contact with family except for an aunt who accepts Them unconditionally. How could you provide support to Samantha and educate Samantha’s family on Their Transgender/Non-Conforming/Non binary identity?

Use this as guide to write up an assessment and treatment plan for this case study – “Samantha”

Primary mental health needs of transgender people

Transgender and gender nonconforming people, in general, have three types of need for mental health.

1. Exploration of gender identity. This includes determining exactly what one's gender identity is, coming to terms with this gender identity, self-acceptance and individuation, and exploring individual–level ways to actualize this identity in the world. This may also include preparation and assessment for various gender affirming treatments and procedures.

2. Coming out and social transition. This includes coming out to family, friends, and coworkers, dating and relationships, and developing tools to cope with being transgender in a sometimes transphobic world.

3. General mental health issues, possibly unrelated to gender identity. The variety of mental health concerns experienced by transgender people include mood disorders, generalized anxiety, substance abuse, and post-traumatic stress disorder (PTSD).

1. Complete the Case Study Outline (review the mental health needs listed below for transgender people). 

1. Background information and Socio-cultural considerations.

2. Assessment (assessment methods must be consistent with the theory you have read for this week’s assignments, video clips or theory mentioned in the vignette).

3. Treatment plans, must list 3 treatment goals that follow logical problem solving.

4. Interventions (Interventions must be consistent from theory/ theories you are using for the case study) include collateral stakeholders as part of the interventions as needed.

5. Discuss future research that may be needed.

1. Your Case Study Outline should be attached as a Word .doc file (.doc, .docx) or PDF.