Gender Identity Disorder

A Parent-and Peer- Based Treatment Protocol & Counseling

Treatment Summary: This treatment approach uses looks at the psychosocial factors and mechanisms that contribute to GID. The focus in counseling is how parents and same-gender peers interact with a child or adolescent wit GID. The parents are the only ones that attend treatment sessions with their child. Counseling is for both individual and family, to help with any depression or anxiety they may be experiencing as a result of GID and can help in the improvement of the individual's self-esteem and help them learn to function with their biological gender and helping the child interact with their parents and peers. Early diagnosis and treatment can prevent the negative outcomes that are associated with Gender Identity Disorder. In most cases of children with GID it ahs been shown to have faded at puberty.

• Reference: Heino, F.L, (2002). Gender Identity Disorder in Young Boys: A Parent and Peer- Based Treatment Protocol. Journal of Clinical Child Psychology and Psychiatry, vol.7 (3),360-376.
• Submitter: Marisa Ybarra

Gender Role Conflict Theory

Treatment Summary: The Gender Role Conflict theory provides the framework for clients that are struggling with their identity and in the transgender process. In the first stage, awareness, the counselor will explore the client's history and current distress to determine if he meets the criteria for Gender Identity Disorder. The second stage, seeking information, involves the client addressing the negativity they may experience from family, friends and society while living without shame and denial. The third stage, exploration, involves the client becoming more comfortable with being transgender and the impact it has on their lives. The exploration stage has three sub categories; identity, incorporation and transitional options. The fourth stage, disclosure, is where the client will inform people in their lives of their transgender identity. The final stage, integration, has two stages, acceptance and post transitional resolution. Acceptance is where the client will embrace their biological self and their new identity. Post transitional resolution occurs at the termination of therapy.

• Reference: Wester, S.R., McDonough, T.A., White, M., Vogel, D.L., & Taylor, L. (2010). Using gender role conflict theory in counseling male-to-female transgender individuals. Journal of Counseling and Development, 88. Retrieved from http://search.proquest.com/docview/219050752?accountid=7078
• Submitter: Liesa Pavoggi

Parent- and Peer-Based Treatment In Young Boys

Treatment Summary: (Note: It is important to read the relevant research before attempting to treat a child with GID. This particular study views the disorder as something that needs to be fixed or "problem behavior". While some children may need gendered role models other children believe themselves to be the opposite sex. To view these children's identity as a problem will only cause the suppression of their "real" selves, which may manifest as an issue in later life.) This treatment is based on Attachment Theory. It is specifically designed to treat 4-6 year-old boys. Therapy consists of a minimum of five sessions. The parents will participate in the first two sessions without the child and a third wrap-up session, and the child will participate in two sessions. When the nuclear family is intact, both parents are required to meet with the therapist during the parent-only sessions. The parent's are asked to have the child undergo a physical examination and should ask for a "form covering potential physical symptoms of somatic intersexuality and of precocious (pubertal development)". Before the first session, an assessment is made by having each parent complete individual questionnaires that focus on the gender-specific issues and symptoms of psychopathology. The questionnaires are then compared to ensure agreement between the perspectives of each parent. Any disparity between the parents would need to be discussed, since this would affect the child's treatment. The first session (parent only) begins with ascertaining the reason for the parents' visit, discusses the cross-gender behavior, investigates the onset and development of the behavior, and views family or individual photos to demonstrate the clinical-development history. At this session, the parents are assigned homework. They must maintain a "structured diary" for at least two weeks. In this diary they are to discuss occurrences of cross-gender behavior and "other problem behavior". During the second session, the parents and therapist review the diary. The therapist then begins a detailed semi-structured interview and a family history. Child's First Session(3rd Session) Next the child evaluation begins. The evaluation usually consists of two sessions and involves structured and unstructured activities. The evaluation begins as soon as the parents leave; the therapist notes any issues involving separation from the parents. In the corner of the therapist office is a "toy" corner. In this corner there is a variety of both male and female specific toys. The child is asked to Draw-a-Person test that is GID specific. Next, a break is given to the child; during this break the child is told he can play in the toy corner. The therapist pretends to do paperwork while observing the child at play. After the break the child is given the Gender-Role Assessment Schedule�Child (GRAS-C). The child is then given LEGOs and told to build whatever he would like. Depending on the comfort level of the child, the therapist may then give the child the Gender Identity Interview. Child's Second Session (4th Session) In the second session with the child, the toys in the toy corner are replaced with gender specific clothing (male-mask, cape, sword; female- high heels, boa, hats) intended for role-playing. The therapist will complete any remaining sections of the GRAS-C. While completing the GRAS-C, he is given the opportunity to play dress-up, table activities, LEGOs, or

• Reference: Meyer-Bahlburg, H. F. L., (2002). Gender identity disorder in young boys: A parent- and peer-based treatment protocol. Clinical Child Psychology and Psychiatry, 7(3), 360-376. doi: 10.1177/1359104502007003005
• Submitter: Sandra Frey

Treatment Summary: ball. Wrap-up Session The wrap-up is a parent-only session. During this session the clinical diagnosis and prognosis is discussed. The next steps in the treatment are discussed. The parents have to choose for themselves if they are invested and have the available time to allocate to the child's intense therapy. Because of the child's age, the therapy will involve the parents and any close friends or family members in the child's life. The parents will continue to keep a structured diary throughout treatment. In relation to parents, the focus of therapy consists of aligning the parents' gender ideology with the treatment approach, increasing the amount of time the child spends with male-figures, allowing the child to distance himself from the female-figure (mother), increase attention when the child behaves in a gender-typical manner and decreasing attention when he displays a gender-atypical behavior. The parents will also instigate a change of the child's peers and playtime to more gender specific play dates and activities.

• Reference: N/A
• Submitter: N/A

Pro -Pubertal Delay

Treatment Summary: Gender identity disorder is a complicated disorder and involves long term therapy. For those before the age of 16, administering Gonadotropin-releasing hormone (GnRH), will block/delay normal puberty development. GnRH delays the development of hormones of the biological sex. This hormonal delay gives the individual, their parents, and their doctors time to investigate the patient's identity and options of sex reassignment (SR). While the individual is on treatment, it is reported that alienation, suicide, and depression decrease.

• Reference: Cohen-Kettenis, P., Delemarre-van de Waal, H., & Gooren, L. (2008). The Treatment of Adolescent Transsexuals: Changing Insights. Journal of Sexual Medicine, 5(8), 1892-1897. doi: 10-1111/j.1743-6109.2008870.x.
• Submitter: Cheryl L. Caldwell

Cognitive Behavioral Treatment

Treatment Summary: Puberty Blocking Hormonal Therapy. A course of hormone-blocker drugs given to an adolescent over several months or years that prevent the development of secondary sex characteristics. This is usually assigned through a clinical test battery to see if the patient is recommended for cross-sex hormonal therapy and later sexual reassignment surgery. In most cases there is no regret with the choice and a significant elimination of the gender dysphoria.

• Reference: Zucker, K. J., Bradley, S. J., Owen-Anderson, A., Singh, D., Blanchard, R., & Bain, J. (2011). Puberty-Blocking Hormonal Therapy for Adolescents with Gender Identity Disorder: A Descriptive Clinical Study. Journal of Gay & Lesbian Mental Health, 15(1), 58. Retrieved from EBSCOhost.
• Submitter: Shanna Schopmeyer