Transgender Communication
Therapy 101:
Working With an
Underserved
Population
By Tara Johnson
[email protected]
April 3rd 2008
A Special Thank You To:
MGH Institute of Health Professions
Dr. Gregory Lof
Dr. Julie Atwood
Dr. Pickering, and Daniel Kayajian
Dr. Richard K. Adler
Northern Berkshire Healthcare
All those who have already, and all those
who will contributed to the research in
this area
All those who took time to discuses their
personal and professional experiences
Overview
Transgender
Terms 101
Is there a need for our services
within this population
How
do we meet this need?
1
Transgender Terms 101:
An overview of
terminology
Terms
Queer
An
umbrella term
Includes
Gender Identities
Includes
Sexual Orientations
Anyone who does not identify
as straight/gender normative
Terms
Sexual Orientations
Vs.
Gender Identities
2
Terms
Sexual
Orientation
External
Sexual
attraction to others
Spectrum
queer SO
straight bisexual gay
Terms
Gender
Identity
Internal
Perception
of self
Spectrum
queer GI
male androgynous female
Terms
Cisgender
Gender
identity consistent with
the gender you are identified
as at birth
3
Terms
Transgender
Gender identity NOT consistent with the
gender you are identified with at birth
An umbrella term for all queer gender
identities
2 subgroups
Terms
Transgender Subgroups
Transsexual
Cross-dresser
Terms
Transsexual
An
individual who desires to
live full time in the gender
opposite that with which they
were identified as at birth.
4
Terms
Transsexual
Male-to-Female
(MtF)
•Trans-woman / woman
Female-to-Male
(FtM)
•Trans-man / man
Terms
Cross-dresser
(Transvestite)
An individual who identifies on
the gender spectrum
DO
not wish to fully transition
Present as the opposite gender
less than 1/2 time
Terms
Transition
The
process one goes through
to live as the gender opposite
that with which you were
identified as at birth.
5
Are our services needed
Is there a need within the
transgender community for
skilled communication
modification services?
If so, how great is this need?
Are our services needed?
Daniel Kayajian, 2006 (The College of Saint Rose)
Survey
at Transgender Conference
93%
rated voice as at least
“somewhat important” to
transition
~25%
rated voice and nonverbal
communication as “most
contributing to passing”
Are our services needed?
Continued…
2007
Northern Arizona
University ASHA presentation
There
is a need in the TG
community for SLP services
New clinic is very successful and
looking to open additional satellite
clinic
Therapy appears beneficial
6
Are our services needed?
Continued…
2007 Northern Arizona University
ASHA presentation
Survey
of clients found
•Communication is important to
passing, but SLP services were not
used
•Clients used Image consultants
(untrained professionals)
•“Do-it-yourself” kits
Are our services needed?
Continued…
Olyslager
& Conway (2006)
Meta-Analysis/Prevalence study
prevalence in the US and EU At
least 1:1000
TG
•Compared to:
•Orofacial Cleft ~1:1000
•Cerebral Palsy ~1:1000
May
be as high as 1:500
How do we meet this
need?
What are the impediments to service delivery?
How do we overcome these impediments?
Once you have TG clients, how to you retain
their patronage?
How do you approach therapy with TG clients?
7
Why services are not being delivered:
Cost of services
A
population with limited
financial resources
Discrimination
in the work place.
The
out of pocket expense of
transition can easily be over
$15,000/yr.
Insurance usually does not cover
TG related medical services
Why services are not being delivered:
Cost of services
Ways
Bill
clinicians overcome this:
for related services
•(e.g. vocal hygiene)
Try
to reduce cost of services:
•Group treatment
•One 90 min sessions every two
weeks
•A scholarship fund.
Why services are not being delivered:
Communication Breakdown
The real problem!!
The Communication breakdown:
From
personal conversations
with:
PCPs, SLPs, Endocrinologists,
Plastic Surgeons, Psycho-Therapists,
LGBT Healthcare Coordinators,
TG Individuals, etc.
8
Why services are not being delivered:
Communication Breakdown
The Communication breakdown:
Health
care providers are not
aware of SLP services in their area
SLPs are not aware of other SLPs
who work with the TG community.
TG individuals are not aware of
SLP’s
How do we meet this
need?
What are the impediments to service delivery?
How do we get the word out?
Once you have TG clients, how to you retain
their patronage?
How do you approach therapy with TG clients?
How do we get the word out?
Historical
Context
WPATH
(World Professional
Association for Transgender
Health)
•Standards of care
•Gatekeepers
9
How do we get the word out?
Medical
Professionals
Psycho-Therapists
•Most diverse group of patients
•Sees patients earlier in transition
•May have a collaborative relationship
with SLP
http://www.drbecky.com/therapists.html
http://www.gender.org/resources/
How do we get the word out?
Medical
Professionals
Endocrinologists
•Sees patients for the longest duration
(life)
•May be the only medical professional
regularly visited
•http://www.gender.org/resources/
http://www.gender.org/resources/
How do we get the word out?
Medical
Plastic
Professionals
Surgeons
•Only sees patients 1-2 times
•Some already offer package deals
with image consultants or phone
interviews with an SLP.
•http://www.gender.org/resources/
10
How do we get the word out?
Medical
Queer
Professionals
Health Care Systems
•Ask for transgender healthcare
coordinator
•May be a collaborative/team tx
opportunity
•May be for referrals only
•http://www.gender.org/resources/
• http://www.cdc.gov/lgbthealth/links.htm
How do we get the word out?
Organizations
Support
Groups
•Members may be suspicious of
outsiders
•Members may be afraid of being
outed
•Members may be afraid of
“gatekeepers”
How do we get the word out?
Support Groups
•When asking to talk with the group
let them know
•Everything you see/hear will be held in
confidence
•Present at the very end/beginning of
meeting so that those who do not wish to
be seen, can come before/after
•You will not be asking for
names/commitment (just leave your
contact information)
11
How do we get the word out?
Support
Groups
•If you can not attend a meeting,
ask to meet with one member
who can then report back to the
group
How do we meet this
need?
What are the impediments to service delivery?
How do we overcome these impediments?
Once you have TG clients, how to you retain
their
there patronage?
patronage?
How do you approach therapy with TG clients?
Retaining Clients:
Client’s
first impressions count
•Staff education
•Use correct gender terminology
•Ask the right questions
12
Retaining Clients:
Multiple names for varying
situations.
Ask what name is preferred for use in
therapy.
Ask what names are used at home,
social situations, and at work.
How do we meet this
need?
What are the impediments to service delivery?
How do we overcome these impediments?
Once you have TG clients, how to you retain
their patronage?
How do you approach therapy with TG clients?
Goals of Treatment:
An Authentic Communication Profile
Consistent
Consistent
Consistent
Consistent
Consistent
with
with
with
with
with
personality,
age
gender
lifestyle
specific environments
13
Goals of Treatment:
Preponderance
of characteristics
consistent with desired gender
Gender perception is the result of how
multiple elements come together
100% feminine behavior = Hyperfeminization
100% masculine behavior = Hypermasculinization
Goals of Treatment:
An
authentic communication
profile
Be
careful of:
•Hetero-normative pragmatics and
nonverbal communication
•Stereotypical interests
How do we deliver treatment?
Voice And Communication Therapy for the
Transgender/Transsexual Client: A Comprehensive Clinical Guide
by Sandy Hirsch, and Michelle Mordaunt, Richard K. Adler (2006)
Limited research with TG clients
3 group studies
5 Single case studies back these up
A number of anecdotal reports
14
How do we deliver treatment?
How
do we proceed
Look
to existing research
•Male and female norms
•Efficacy of intervention techniques
with non TG individuals
Areas We Can Address:
***Only address areas of
communication you would be
comfortable/competent to work on
with any other client. ***
Areas We Can Address:
Speech
•Pitch
•Intonation
•Resonance
•Articulation
•Rate
•Volume
Bold = can have a significant
effect on gender perception
15
Areas We Can Address:
Spoken
Language
•Syntax
•Semantics
•Pragmatics
Bold = can have a significant
effect on gender perception
Areas We Can Address:
Nonverbal
Language
• Body Movement
• (Gesture, posture, stride, etc.)
• Interpersonal interactions
• (Personal space, eye contact, etc.)
• Physical appearance
• (Age appropriate, situation appropriate, etc)
Bold = can have a significant
effect on gender perception
Unique Consideration for Tx
Evaluate
the quality and daily
function of:
•The communication used when
presenting as male
•The communication used when
presenting as female
16
Unique Consideration for Tx
Transition
plans
Understand
the client’s
transition timetable.
•Are there opportunities for carryover
now?
•When will there be opportunities for
additional practice ?
•Is there a point at which the client
must pass with the new voice?
Unique Consideration for Tx
Information
in the history
may change rapidly and
dramatically
•Review history regularly
Unique Consideration for Tx
Relationship with family members:
•TG client’s family can be a
destabilizing force.
•May accompany the client to
treatment, but not be a supportive
communication partner.
•Amount of time the partner has had
to come to terms with the client’s
transition.
17
Special Considerations:
Tools and Techniques
Group
treatment
Reduces overall cost of
treatment
A safe setting for work with
multiple partners
Cannot take the place of
individual treatment
Special Considerations:
Tools and Techniques
Group
treatment
Can be the first step in treatment
Clinician assesses needs of multiple
clients
Client get a feel for what treatment will
entail
Can
be the conclusion to treatment,
Work on carryover in a social setting.
Special Considerations:
Tools and Techniques
Video
Accurate
evaluation over time
Clients acclimate to new
communication profile
Clinicians acclimate to new
communication profile
18
Special Consideration
Tools and Techniques
Video.
Α
tool for client self-evaluation.
Mirror work requires
simultaneous performance
and evaluation
Recordings of behaviors in
multiple environments
Recommended text for
further study:
Voice And Communication
Therapy for the
Transgender/Transsexual
Client: A Comprehensive
Clinical Guide
by Sandy Hirsch, and
Michelle Mordaunt Richard K.
Adler
Paperback - April 30, 2006
Sources
Literature reviewed:
• 2005 Voice And Communication Therapy for the
Transgender/Transsexual Client: A Comprehensive Clinical Guide
on TG Voice and Communication Therapy,by Richard K., Ph.D. Adler,
Sandy Hirsch, and Michelle Mordaunt.
• 2007 Northern Arizona University ASHA presentation
• 2007 Unpublished study from the College of Saint Rose
• 2007 Olyslager & Conway Prevalence study
Conversations
• TG identified individuals
• Healthcare practitioners who work with TG patients
• SLP clinicians
19