Report of the APA Task Force on Gender Identity and Gender

106 Pages·2009·1.02 MB·English

Report of the APA Task Force on
Gender Identity and Gender Variance

Report of the APA Task Force on
Gender Identity and Gender Variance
Task Force Members
Margaret S. Schneider, PhD, Chair
University of Toronto, Toronto, Ontario, Canada
Walter O. Bockting, PhD
University of Minnesota Medical School, Minneapolis, MN
Randall D. Ehrbar, PsyD
New Leaf Services Our Community, San Francisco, CA
Anne A. Lawrence, MD, PhD
Seattle, WA
Katherine Rachlin, PhD
New York, NY
Kenneth J. Zucker, PhD
Centre for Addiction and Mental Health, Toronto, Ontario, Canada
APA Staff
Lesbian, Gay, Bisexual, and Transgender Concerns Offi ce
Clinton W. Anderson, PhD, Director
Charlene DeLong, Administrative Coordinator
Report of the Task Force on Gender Identity and
Gender Variance
Available online at www.apa.org/pi/lgbc/
transgender/2008TaskForceReport.html
Printed copies available from:
Lesbian, Gay, Bisexual, and Transgender Concerns Offi ce
Public Interest Directorate
American Psychological Association
750 First Street, NE
Washington, DC 20002-4242
202-336-6041
[email protected]
Suggested bibliographic reference:
American Psychological Association, Task Force on Gender
Identity and Gender Variance. (2009). Report of the Task
Force on Gender Identity and Gender Variance.
Washington, DC: Author.
Copyright © 2009 by the American Psychological
Association. This material may be reproduced in whole
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DC 20002-4242.
APA reports synthesize current psychological knowledge
in a given area and may offer recommendations for future
action. They do not constitute APA policy or commit APA
to the activities described therein. This particular report
originated with the APA Task Force on Gender Identity
and Gender Variance.
Photos courtesy of Mariette Pathy Allen Photography, New
York, NY 10024
Printed in the USA
Contents
Executive Summary ...........................................................................................................................1
Introduction .......................................................................................................................................7
Interpreting Our Change ....................................................................................................................8
The Cultural Context Surrounding Transgender Issues ......................................................................9
Interpreting Our Constituency..........................................................................................................11
Questions of Terminology .................................................................................................................12
Consultation and Fact Finding .......................................................................................................15
Consultation Within APA ................................................................................................................15
Consultations With Other Professional Organizations ....................................................................19
Consultation With Transgender Community-Based Organizations and Individuals .......................22
Review of Existing APA Policies ......................................................................................................24
Review of Research ...........................................................................................................................25
Conclusions and Recommendations ...............................................................................................57
Addressing the Needs of Transgender Psychologists and Students ...................................................57
Research ............................................................................................................................................60
Education and Training ....................................................................................................................60
Policy Issues ......................................................................................................................................62
Practice Issues ...................................................................................................................................62
Advocacy ...........................................................................................................................................63
Recommendations ............................................................................................................................64
Resolution on Transgender, Gender Identity, and Gender Expression Nondiscrimination ...............65
References ........................................................................................................................................73
Appendixes .......................................................................................................................................89
Appendix A: APA Survey on Gender Identity, Gender Variance, and Intersex Conditions .............89
Appendix B: Consultation List..........................................................................................................94
Appendix C: Answers to Your Questions About Transgender Individuals and Gender Identity .....95
Appendix D: P roposed Language to Address Issues in the Publication Manual of the American
Psychological Association.................................................................................................99

Executive Summary
I
n February 2005, the Council of Representatives document might be perceived negatively by people
of the American Psychological Association with DSDs. Eventually, we decided not to address
(APA) authorized the appointment of a Task the issues of persons with DSDs in this report and
Force on Gender Identity and Gender Variance.1 instead recommended the creation of a separate
The task force was changed with the following: task force for this purpose. Further, to avoid mis-
representation, we recommended to the Council
• Review extant APA policies regarding of Representatives a change to the name of the
these issues and affected populations and task force, which the Council accepted.
recommend any indicated changes. To fulfi ll its charge concerning issues of gender
• Develop recommendations for education, identity and gender variance, the members
training, and further research into these of the task force conducted a survey of APA
topics. members, consulted with various APA committees
• Propose how APA can best meet the needs and divisions, contacted other professional
of psychologists and students who identify as organizations that might have interests or
transgender or gender variant. expertise in these issues, and solicited the
• Recommend appropriate collaboration with viewpoints and recommendations of transgender
other professional organizations concerning organizations and individuals. The resulting task
these issues.
1 The task force was originally called the Task Force
on Gender Identity, Gender Variance, and Intersex
Almost from the beginning of its work, the task
Conditions and changed its name to the Task Force on
force began to doubt whether it would be feasible Gender Identity and Gender Variance to remove “Intersex
to address both gender identity/gender variance Conditions,” consistent with the actual content of the
report. The task force found the two populations to be too
and intersex conditions (now usually called dis-
distinct from one another to address their unique issues
orders of sexual development, or DSDs) in one
and needs in a single report, and the task force members
report. In particular, key informants advised us
considered their expertise on intersex conditions to be too
that attempting to address both issues in a single limited for them to handle the topic well.
1
force report reviews current research on gender and other people with gender identity concerns
identity and gender variance and makes several more frequently turning to community mental
recommendations concerning policy development, health professionals for assessment and treatment.
education and training of psychologists, Consequently, it has become increasingly likely
research, ways in which to address the needs of that psychologists will encounter people needing
psychologists and students, and consultation with assistance with gender identity concerns. This
other professional organizations. trend underscores the need for psychologists to
acquire greater knowledge and competence in
addressing transgender issues.
Introduction to Transgender Issues
The concerns of transgender and gender-
variant persons are inextricably tied to issues
Transgender and gender-variant people have a of social justice, which have historically been
variety of concerns for which they may seek the important to APA. The stigmatization and
assistance of psychologists. In addition to the discrimination experienced by transgender people
usual problems that may bring any individual to affect virtually all aspects of their lives, including
therapy, transgender and gender-variant people physical safety, psychological well-being, access
often seek professional help in understanding to services, and basic human rights. This report
their gender identities and patterns of gender highlights opportunities for APA to advance
expression and in addressing the complex social justice as well as to support competent and
social and relational issues that are affected by ethical practice by promoting research, education,
these. Transgender persons not uncommonly and professional development concerning
seek medical services to make their bodies transgender issues among psychologists, by
more congruent with their gender identities; creating a welcoming environment for transgender
involvement of mental health professionals is psychologists and students of psychology, and by
often necessary or desirable in arranging such supporting the human rights of all transgender
services. Moreover, many transgender and gender- citizens.
variant people experience stigmatization and
discrimination as a result of living in a gendered
Review of Research
culture into which they often do not easily fi t.
They may not only experience an inner sense of
not belonging but also discrimination, harassment, The focus of research concerning gender variance
sometimes lethal violence, and denial of basic and transgender issues has changed and expanded
human rights. These issues, too, often bring over the last few decades. As with many mental
transgender people into contact with mental health concerns, research in this fi eld has
health professionals. historically been strongly clinical and positivistic.
In recent years, transgender people have Beginning in the late 1970s, however, the scope of
increasingly been willing to identify themselves research has broadened to include critical analyses
openly. Public awareness of transgender issues of sex, gender identity, and gender variance. It has
has increased dramatically, in part because of an also expanded to include methodologies focused
increasing number of books, motion pictures, on a wide range of issues, including life span,
and television programs featuring transgender public health, community-based interventions,
characters and addressing transgender issues. As a and sociopolitical issues. To some extent, the
result, not only transgender people themselves but emergence of researchers and scholars who are
also their families and friends, employers, schools, themselves gender variant has infl uenced this
and government agencies are increasingly turning expansion. Often these new directions in research
to psychologists for help in addressing these issues have taken a more holistic approach to the lives
on individual and community levels. At the same of transgender people and have moved away from
time, changes in service delivery systems related a focus on pathology. An emergence of alternate
to transgender issues have resulted in transsexuals paradigms for understanding gender and gender
2 Report of the APA Task Force on Gender Identity and Gender Variance
variance has occurred within psychology and transgender people who undergo sex reassignment
related disciplines, although these are, at present, increasingly transition on the job rather than
more evident in research on adults than in change jobs during the transition period.
research involving children and adolescents. There is little published research on the family
Much of the research conducted with issues of adult transgender people, in spite of
transgender adults concerns the treatment of the importance of social support from families
individuals who experience both an intense cross- for satisfactory mental health. There is, however,
gender identifi cation and a sense that their sexed a growing literature on psychosocial issues of
bodies or assigned gender roles are incongruent transgender youth, particularly as they arise
with their gender identities, resulting in clinically because of stigmatization. These issues include
signifi cant distress or functional impairment; relationships with their families; harassment
this constellation of symptoms defi nes gender and abuse, particularly in school settings; access
identity disorder (GID). Much of the adult to transgender-related health care; and HIV
research literature addresses GID-related issues, prevention. There is an urgent need to develop
including typologies, developmental patterns, and evaluate effective interventions with
associated features and comorbidity, the effi cacy transgender youth.
of various aspects of transition-related health Custodial settings for transgender adults (e.g.,
care, and the widely recognized Standards of Care, prisons), many of which are segregated by gender,
published by the World Professional Association raise a number of concerns. One is housing
for Transgender Health (WPATH; formerly the transgender people safely and appropriately.
Harry Benjamin International Gender Dysphoria Another is providing transgender-specifi c health
Association) (Meyer et al., 2001). care for transgender inmates—in particular,
Research on children with gender issues has continuation or reinstitution of previously
focused largely on clinical samples. There have prescribed hormone treatment to transsexual
been a number of studies on the characteristics inmates. Research involving these issues has been
of children with gender identity issues, such as minimal.
the proportion of boys versus girls, concomitant Studies of the mental health of transgender
behavioral problems, developmental trajectories, individuals are often limited by the use of
and the relationship of childhood GID to sexual convenience samples, so the fi ndings of some
orientation. Treatment modalities used with studies may not be generalizable to broader
children have focused on modifying children’s segments of the transgender population. Some
cross-gender behavior or on assisting children to studies demonstrate high rates of substance
feel more satisfi ed or less distressed with their natal abuse, depression, and suicidal ideation or suicide
sex and associated gender roles. These modalities attempts among transgender people. Qualitative
include behavior modifi cation, psychotherapy, and research suggests that stigma is a signifi cant factor
cognitive–behavioral approaches. The comparative that negatively impacts transgender people’s
effi cacy of these various approaches has not yet mental health.
been adequately studied. There is a range of sexual identifi cations,
The research literature has documented behaviors, and concerns among transgender
that many transgender people experience people. Transgender-specifi c sexual concerns
discrimination and rejection by society, family, include managing gender dysphoria in a sexual
friends, coworkers, health care providers, and relationship, concerns relating to erotic cross-
communities of faith. Transgender adults dressing, the impact of hormone therapy and
experience high rates of verbal harassment, sex reassignment surgery on sexual desire and
physical violence, and employment and housing functioning, reproductive issues (e.g., sperm
discrimination; transgender youth also appear to preservation), coming out to partners, and safer
be at risk for these. There has been inadequate sex negotiation.
research concerning the workplace experiences Many topics related to transgenderism and
of transgender persons, despite the fact that gender variance that involve both applied and
Executive Summary 3
theoretical issues merit additional research. Education and Training
Methodological issues, such as conducting Recommendations
controlled clinical trials ethically, sampling,
compliance, and potential confounding variables, APA sponsors a variety of education and training
must be more adequately addressed. Priority areas activities and services for members, including
for research include more rigorous evaluations of hosting conventions, providing continuing education
the Standards of Care (Meyer et al., 2001), life span opportunities, publishing books and journals,
studies that include the aging population, and more and accrediting training sites. To meet its public
inclusive studies of transgender physical and mental education mandate, APA also publishes brochures,
health, with an emphasis on health disparities. reports, periodicals, and Internet materials designed
for laypersons. Accordingly, we believe that APA is
well positioned to address the educational needs of
Policy Recommendations
its members and the general public regarding issues
of transgender and gender variance.
The task force reviewed APA policy documents, To address the needs of psychologists, students,
including bylaws, association rules, policies and and interested members of the public, we outlined
procedures, the Ethical Principles of Psychologists three levels of information, including specifi c
and Code of Conduct (APA, 2002), practice products that should be available at these levels:
guidelines, criteria for continuing education
content and sponsorship, resolutions, and • Basic information on transgender issues
the Guidelines and Principles for Accreditation would be readily available to all psychologists
of Programs in Professional Psychology (APA and students of psychology as an element
Committee on Accreditation, 2006). On the of cultural competence and would also be
basis of this review, we made specifi c policy available to interested members of the public.
recommendations in a number of areas. We
proposed, among other things, the development • Intermediate-level information concerning
of practice guidelines for transgender and gender- transgender issues is important for
variant clients. Although there may not be psychologists who work with transgender
suffi cient research concerning many transgender clients and for interested members of the
issues to develop empirically based guidelines public; such information would address
related to all important areas of practice, we clinical presentations, prevalence, etiology,
believe that there is adequate research concerning life span development, assessment and
discrimination and stereotyping to support the treatment, comorbidity, and aspects of
development of clinical guidelines addressing cultural competency.
these issues specifi cally.
The task force noted that APA is in a position • Advanced or specialized information
to advocate on behalf of transgender people in concerning transgender issues would include
the same way it advocates on behalf of many a more in-depth consideration of the topics
other disadvantaged groups: through activities listed under intermediate-level resources;
such as lobbying and fi ling amicus briefs. Specifi c this information would be most relevant
policy areas that would appropriately be a focus to clinicians working intensively with
of such advocacy include access to transition- transgender clients and to students with
related health care, appropriate placement and particular interests in transgender issues.
treatment within sex-segregated facilities, and
access to appropriate legal documents. Among We concluded that very few psychologists and
our recommendations is the Resolution on students currently possess high-level or specialized
Transgender, Gender Identity, and Gender information on transgender issues.
Expression Nondiscrimination, which outlines We developed several specifi c recommendations
potential areas for advocacy (see pp. 65–69). for creating and disseminating educational materi-
4 Report of the APA Task Force on Gender Identity and Gender Variance