Therapists help transgender patients with psychological issues

“Are you a man or a woman?”

It seems like a simple question, with an obvious and clear-cut answer.

But for psychotherapists Moonhawk River Stone, of Schenectady, and Arlene Istar Lev, of Albany, complicated responses are at the core of their private practices in transgender care.

The way a person answers the question, ranging from certitude to confusion, holds the key to treatment options.

Both therapists view gender with a wider lens than a binary classification of either male or female. Rather than dealing with black and white distinctions, they work with clients who express themselves in many shades of gray when it comes to gender.

In addition, as part of a newly emerging trend, the therapists are seeing youths at ever-younger ages who have a disconnect between their biological sex and the gender they feel compelled to express.

“It’s not a matter of ‘I want’ to be that gender, but ‘I am’ that gender,” said Stone, who prefers the terms ‘gender variant’ or ‘gender non-conforming’ in place of transgender.

Ongoing research suggests that there is a biological component to the transgender experience and scans have shown that the brains of transgender people bear structural differences.

“We don’t understand how people get that way, but in my practice I’ve seen that it tends to run in families and that there is probably some genetic component,” said Stone, who has seen more than 300 transgender clients from ages 4 to 75 in the past 20 years. “Gender variance is a very complex issue grounded in physiology and genetics.”

Stone speaks from both professional and personal experience. He had been a woman who identified herself as a lesbian before beginning hormone therapy and a transgender transition that included surgery in the late-1990s.

“My story is boringly ordinary,” said Stone, who declined to share more of his personal narrative due to professional concerns. “There are some people who say I shouldn’t be treating anybody because I’m ‘one of them.’ People know I have transitioned, but my medical situation is, like everyone else’s, a private matter.”

Lev has been treating transgender clients locally since 1986. She teaches courses on sexual identity at the University at Albany and Empire College. She’s the author of “Transgender Emergence: Therapeutic Guidelines for Working with Gender-Variant People and their Families.”

Stone and Lev have been on the forefront of working to change the way transgender people are viewed by the medical establishment. Lev has worked with the World Professional Association of Transgender Health to develop new standards for transgender care. Currently, their clients are diagnosed with a “gender identity disorder” by the American Psychiatric Association’s fourth edition Diagnostic and Statistical Manual of Mental Disorders, or DSM, the standard text for the profession.

The DSM’s definition includes: “Long-standing and strong identification with another gender” and “long-standing disquiet about the sex assigned or a sense of incongruity in the gender-assigned role of that sex.” Stone and Lev are among advocates of reform urging a change to “gender dysphoria” for the fifth edition of the DSM. Words matter greatly to the therapists and both express optimism when it comes to progress on societal attitudes toward transgender issues in the past decade.

“The problem is that even a majority of social workers and therapists know nothing about this issue,” Lev said. “We’re just beginning to see more therapists seeking out specialized training, which is still hard to find.”

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