GLBT ISSUES IN PSYCHOTHERAPY

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GLBT ISSUES IN PSYCHOTHERAPY
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• PETER C. RUSSELL, PH.D.
• PCRUSSELL_at_UCSD.EDU
• CLINICAL PSYCHOLOGIST
• LIAISON, SCHOOL OF MEDICINE
• UCSD PSYCHOLOGICAL COUNSELING SERVICES

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HOW CAN YOU COMMUNICATE SAFETY TO CLIENTS ?

1. 10 U.S. LGB 30 MILLION
2. PARENTS 60 MILLION
3. GRANDPARENTS 60 MILLION
4. SIBLINGS 60-120 MILLION
5. FRIENDS 60 MILLION
6. TOTAL 270 MILLION

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SEXUAL AND ETHNIC-RACIAL IDENTITY

• REMOVE ANY WATCH, BRACELET, OR RING YOU ARE
  WEARING, AND PUT IT ON THE OPPOSITE HAND OR ARM
• NOTICE HOW IT FEELS TO YOU ON THE OPPOSITE
  HAND OR ARM AS WE CONTINUE WITH OUR DISCUSSION
  TODAY

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SEXUAL ORIENTATION
ONES SEXUAL, EMOTIONAL, SPIRITUAL, AND / OR
AFFECTIONAL ORIENTATION TO MEMBERS OF THE
OPPOSITE, SAME, OR BOTH GENDERS
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SEXUAL ORIENTATION
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MODELS OF SEXUAL ORIENTATION

• MONOSEXUALITY-BISEXUALITY
• (Zinik 1985, Rust, 1992)

MONOSEXUALITY BISEXUALITY
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SEXUAL IDENTITY
THE GROUP WE IDENTIFY WITH MOST STRONGLY WITH
REGARD TO OUR SEXUAL ORIENTATION THE GROUP
OTHERS ASSUME WE IDENTIFY WITH BASED ON OUR
APPEARANCE AND OR BEHAVIOR
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GENDER IDENTITY
THE GENDER WE EXPERIENCE OURSELVES TO BE
MAY BE THE SAME OR DIFFERENT FROM ONES OWN
PHYSICAL, GENETIC, CHROMOSOMAL GENDER MALE,
FEMALE, TRANSGENDER INTERSEX
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GENDER SEX ROLE
OUR EXPERIENCE OF GENDER WITH REGARD TO
STEREOTYPED IDENTITY AS MASCULINE OR FEMININE
VARIES WIDELY BY CULTURE ANDROGENY REFERS
TO THE POSESSION OF BOTH MASCULINE AND FEMININE
QUALITIES
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SEXUAL BEHAVIOR
HOW ONE ACTS BEHAVIORALLY ON FEELINGS OF
SEXUAL ATTRACTION WHAT SOME PEOPLE FEAR WILL
BE DISCUSSED OR PROMOTED BY THOSE WHO ARE GAY,
LESBIAN, OR BISEXUAL
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IN THE CLOSET
MAINTAINING SECRECY ABOUT ONES TRUE SEXUAL
ORIENTATION OFTEN IN ORDER TO AVOID
DISCRIMINATION, VIOLENCE, BUT CAUSING ITS OWN
KIND OF PSYCHIC PAIN
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COMING-OUT
THE PROCESS OF BECOMING AWARE OF ONES OWN
SEXUAL ORIENTATION, ACCEPTING IT, ACTING ON
BEHAVIOR, AND TELLING OTHERS ABOUT IT OR MAY
SIMPLY INVOLVE CONFRONTING THE INNACURATE
ASSUMPTIONS OTHERS MAKE
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HETEROSEXISM
AN UNCONSCIOUS BELIEF SYSTEM WHICH RECOGNIZES
THE EXISTENCE OF ONLY HETERO- ORIENTATIONS
NON-CONSCIOUS BIGOTRY
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HOMOPHOBIA
FEAR AND INTOLERANCE OF GAY, LESBIAN, BISEXUAL,
AND TRANSGENDER ORIENTATIONS OR
IDENTITIES IMPLIES A CONSCIOUS PREJUDICE OR
BIGOTRY AGAINST GAY, LESBIAN, BISEXUAL, AND / OR
TRANSGENDER PERSONS
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INTERNALIZED HOMOPHOBIA
ONES AVERSION TO THE SELF DUE TO THE
RECOGNITION OF A GLBT ORIENTATION AND / OR
NON-TRADITIONAL GENDER ROLE EXPERIENCED BY
GAY AND LESBIAN PEOPLE DUE TO THEIR SOCIALIZATION
WITHIN A HETEROSEXIST AND HOMONEGATIVE CULTURE
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DIFFICULTIES FOR GAY, LESBIAN, BISEXUAL AND
TRANS ADOLESCENTS

WHY IS IT SUCH A STRUGGLE FOR GLBT YOUTH TO
DEVELOP THEIR IDENTITIES?
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WHERE DO GLBTQ ADOLESCENTS FIND SUPPORT
AVAILABLE?

FRIENDS PARENTS FAMILY /
SIBLINGS SCHOOL CLERGY ORGANIZED
CLUBS ATHLETICS
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DIFFICULTIES FOR GAY LESBIAN AND BISEXUAL
ADOLESCENTS
RELATIVE SOCIAL INVISIBILITY SOCIAL
PENALTIES ASSOCIATED WITH HOMOSEXUAL OR GENDER
EXPRESSION LEGAL PENALTIES ASSOCIATED WITH
HOMOSEXUAL / GENDER EXPRESSION STRONG SOCIETAL
FOCUS ON SOCIAL APPROVAL AND SPECIAL HETERO-
PRIVILEGE

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ISSUES FACING GLBT YOUTH
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40 SUFFER VIOLENCE DUE TO THEIR PERCEIVED OR
ACTUAL GLB SEXUAL ORIENTATION
(MARTIN HETRICK, 1988)
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ISSUES FACING GLBT YOUTH
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25 WILL BE THROWN OUT OF THEIR OWN HOMES UPON
DISCLOSING A NON-HETERO IDENTITY TO PARENTS OR
FAMILY
(GLSEN)
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ISSUES FACING GLBT YOUTH
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25OF ALL HOMELESS YOUTH LEFT HOME OR WERE THROWN
OUT DUE TO ISSUES OF SEXUAL ORIENTATION
(GLSEN)
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ISSUES FACING GLBT YOUTH

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21 ATTEMPT SUICIDE AT LEAST ONCE BEFORE AGE 20
(GLSEN)
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ISSUES FACING GLBT YOUTH

EVERY 35 MINUTES
IN THE U.S., AN ADOLESCENT ATTEMPTS SUICIDE EVERY
35 MINUTES DUE TO SEXUAL ORIENTATION ISSUES
(GLSEN)
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ISSUES FACING GLBT YOUTH

EVERY 5 HOURS 48 MINUTES
AN ADOLESCENT SUICIDES EVERY
5 HOURS AND 48 MINUTES
(GLSEN)
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ISSUES FACING GLBT YOUTH

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28 OF GAY YOUTH DROP OUT OF HIGH SCHOOL DUE TO
DISCOMFORT IN THE SCHOOL ENVIRONMENT
(GLSEN)
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ISSUES FACING GLBT YOUTH

6 TIMES MORE LIKELY
GLBT YOUTH ARE 6x MORE LIKELY TO DEVELOP DRUG AND
ALCOHOL PROBLEMS THAN THEIR HETERO PEERS
(GLSEN)
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PSYCHOTHERAPY
1973 THE AMERICAN PSYCHIATRIC (APA) AND
PSYCHOLOGICAL ASSOCIATIONS (APA) STRIKE
HOMOSEXUALITY FROM THE DIAGNOSTIC AND
STATISTICAL MANUAL OF MENTAL DISORDERS DSM
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PSYCHOTHERAPY
1998 APA MAINTAINS POSITION THAT HOMO- AND
BI-SEXUALITY DO NOT REPRESENT MENTAL DISORDERS
LGB ORIENTATIONS ARE ACCEPTABLE ALTERNATIVES TO
HETEROSEXUALITY WHICH IMPLY NO DIFFERENCE IN
PSYCHOLOGICAL, SOCIAL, VOCATIONAL FUNCTIONING, OR
ABILITY TO PARENT
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PSYCHOTHERAPY
PSYCHOLOGISTS TAKE THE LEAD IN REMOVING THE
STIGMA LONG ASSOCIATED WITH GAY AND LESBIAN
ORIENTIONS PSYCHOLOGISTS MUST PROVIDE CLIENTS
WITH ACCURATE INFORMATION ABOUT SEXUAL ORIENTATION
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PSYCHOTHERAPY
PSYCHOLOGISTS RECOGNIZE THAT CLIENTS MAY SEEK
PSYCHOLOGICAL SERVICES IN ORDER TO RID THEMSELVES
OF A SEXUAL ORIENTATION WHICH IS UNACEPTABLE
DUE TO SOCIETAL PRESSURES
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PSYCHOTHERAPY
APA STRONGLY DISCOURAGES CONVERSION
THERAPIES NO EVIDENCE THAT SEXUAL ORIENTATION
CAN TRULY BE ALTERED EVIDENCE SUGGESTS THAT
ATTEMPTING TO CHANGE SOMEONES SEXUAL ORIENTATION
MAY RESULT IN SIGNIFICANT HARM
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• AMERICAN PSYCHIATRIC ASSOCIATION 1998)
• REPARATIVE THERAPY IS DANGEROUSLY MISGUIDED
• "THE POTENTIAL RISKS OF 'REPARATIVE THERAPY' ARE
  GREAT, INCLUDING DEPRESSION, ANXIETY AND
  SELF-DESTRUCTIVE BEHAVIOR, SINCE THE THERAPIST'S
  ALIGNMENT WITH SOCIETAL PREJUDICES AGAINST
  HOMOSEXUALITY MAY REINFORCE SELF-HATRED ALREADY
  EXPERIENCED BY THE PATIENT.

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GLB ISSUES IN PSYCHOTHERAPY
SEXUAL SECRET EXERCISE GUIDED IMAGERY
EXPERIENCE HOW DO YOU FEEL? HOW CAN YOU
SHOW SUPPORT TO GAY, LESBIAN, BISEXUAL
CLIENTS? HOW DO YOU DISCUSS ISSUES OF SEXUAL
ORIENTATION AND GENDER IDENTITY WITH CLIENTS?
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FRIENDSHIPS WITH MEN WOMEN ROMANTIC
RELATIONSHIPS HAVE YOU EVER FALLEN IN LOVE?
CLOSENESS TO THOSE OF SAME AND
OPPOSITE/OTHER GENDER SIGNIFICANT RELATIONSHIP
HISTORY SEXUAL HISTORY FANTASY LIFE SEXUAL
HEALTH WELL-BEING

• TALKING WITH CLIENTS ABOUT
• SEXUAL IDENTITY

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A MODEL OF IDENTITY DEVELOPMENT

VIVIAN CASS (1979)
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I. IDENTITY CONFUSION BEGIN TO QUESTION
WHETHER ONE MIGHT BE LESBIAN, GAY, BISEXUAL
ALTERNATES BETWEEN DENIAL CONFUSION
COULD I BE LESBIAN, GAY, BISEXUAL?

• (CASS 1979)
• MODEL OF GAY LESBIAN IDENTITY DEVELOPMENT

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IDENTITY CONFUSION CHALLENGES

MAY AVOID INFORMATION ABOUT GLBT ISSUES
MAY INHIBIT BEHAVIOR- DENY HOMO FEELINGS
EXPERIMENTING , AN ACCIDENT , JUST DRUNK
MALES MAY SEPARATE EMOTIONAL SEXUAL CONTACT
FEMALES STRONGLY EMOTIONAL, NON-SEXUAL
RELATIONSHIPS
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IDENTITY CONFUSION CHALLENGES

EXPLORE INTERNAL () (-) JUDGMENTS
UNCERTAINTY RE SEXUAL IDENTITY IS OK
EDUCATE ABOUT SPECTRUM OF SEXUAL BEHAVIOR AND
IDENTITY ENCOURAGE IDENTITY EXPLORATION JUST
AS YOU WOULD CAREER OR SOCIAL IDENTITY
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II. IDENTITY COMPARISON ALIENATION FROM WHAT
HAS BEEN FAMILIAR MAYBE I AM LESBIAN, GAY,
OR BISEXUAL? IM ALL ALONE WITH THIS

• (CASS 1979)
• MODEL OF GAY LESBIAN IDENTITY DEVELOPMENT

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IDENTITY COMPARISON CHALLENGES

GRIEVE HETERO IDENTITY LOSSES STRONG
AWARENESS OF THE PRICE FOR EMBRACING SEXUAL
ORIENTATION MAY COMPARTMENTALIZE SEXUALITY
DIFFERENTIATES GLBT BEHAVIOR FROM IDENTITY
MAY VIEW SAME SEX RELATIONSHIP OR BEHAVIORS
AS TEMPORARY
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IDENTITY COMPARISON CHALLENGES

DEVELOPMENT OF PERSONAL DEFINITIONS NEEDS
INFORMATION ABOUT SEXUAL IDENTITY NEEDS LGBT
COMMUNITY RESOURCES MAY GRIEVE LOSS OF LIFE
EXPECTATIONS BALANCE NEW WITH OLD IDENTITY
FEATURES
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III. IDENTITY TOLERANCE ACTIVELY SEEKS
OUT OTHER LGBT PEOPLE AND ENCOUNTER POSITIVE
SUPPORT WHERE ARE OTHER LGBT PEOPLE?

• (CASS 1979)
• MODEL OF GAY LESBIAN IDENTITY DEVELOPMENT

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III. IDENTITY TOLERANCE CHALLENGES

NEW SOPHISTICATION WITH THE ISSUES
RECOGNITION THAT GLB IDENTITY DOES NOT PRECLUDE
OTHER OPTIONS ACCENTUATES THE DIFFERENCE
BETWEEN THE SELF AND HETEROS () CONTACT
WITH GLBT CULTURE LEADS TO () SELF-ESTEEM
(-) CONTACT LEADS TO DEVALUATION OF THE
CULTURE STUNTS GROWTH, MAY EXPERIMENT WITH
STEREOTYPICAL ROLES
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III. IDENTITY TOLERANCE CHALLENGES

HELP EXPLORE SHAME DUE TO INTERNALIZED
HOMOPHOBIA HETEROSEXISM SUPPORT IN FINDING
() GLBT COMMUNITY CONNECTIONS VERY
IMPORTANT TO FAMILIARIZE WITH COMMUNITY
RESOURCES
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IV. IDENTITY ACCEPTANCE PREFER CONTACT
WITH LGBT PEOPLE OVER HETEROS SELECTIVE
COMING OUT I AM LESBIAN, GAY, BISEXUAL,
TRANS I CAN COME OUT TO SOME PEOPLE

• (CASS 1979)
• MODEL OF GAY LESBIAN IDENTITY DEVELOPMENT

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IV. IDENTITY ACCEPTANCE CHALLENGES

ACCEPTS NEW GLBT SELF IDENTIFICATION MAY
COMPARTMENTALIZE "GAY LIFE" DECREASED CONTACT
W/ HETERO COMMUNITY ASSIMILATES INTO GLBT
COMMUNITY WITHOUT CHALLENGING NORMS
SELECTIVELY DISCLOSES SEXUAL IDENTITY
INCREASED COMFORT WITH BEING SEEN WITH GLBT
OTHERS OR GROUPS
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IV. IDENTITY ACCEPTANCE CHALLENGES

CONTINUE EXPLORING GRIEF AND LOSS OF
HETEROSEXUAL LIFE EXPECTATIONS CONTINUE
EXPLORING INTERNALIZED "HOMOPHOBIA" ACQUIRED
SHAME FROM HETEROSEXIST SOCIETY NEEDS SUPPORT
FOR DECISIONS ABOUT WHERE, WHEN, AND TO WHOM HE
OR SHE SELF-DISCLOSES
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V. IDENTITY PRIDE PRIDE IN NEW IDENTITY
AND REJECTION OF ATTEMPTS TO DEVALUE LGBT
PEOPLE I AM PROUD TO BE LESBIAN, GAY,
BISEXUAL, TRANS I DON'T (AND WON'T) PASS
FOR STRAIGHT

• (CASS 1979)
• MODEL OF GAY LESBIAN IDENTITY DEVELOPMENT

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V. IDENTITY PRIDE CHALLENGES

MAY DIVIDE WORLD INTO "GAY" (GOOD) AND
"STRAIGHT" (BAD) MAY EXPERIENCE MORE STRESS
IN HETERO COMMUNITY LESS LIKELY TO FIT IN
GLBTQ CULTURE AS SOLE SOURCE OF SUPPORT ALL GAY
FRIENDS, BUSINESS CONNECTIONS, SOCIAL CONNECTIONS
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V. IDENTITY PRIDE CHALLENGES

NEEDS SUPPORT TO EXPLORE ANGER ISSUES,
HOMPHOBIA, HETEROSEXISM COPING WITH
REACTIONS AND RESPONSES TO DISCLOSURE OF SEXUAL
IDENTITY LEARNING TO MANAGE DEFENSIVENESS
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VI. IDENTITY SYNTHESIS ACCEPTANCE AND
INTEGRATION OF NEW IDENTITY ACCEPTANCE AND
REJECTION OF ASPECTS OF HETEROSEXUAL CULTURE
TYPICALLY OUT TO MOST PEOPLE. I HAPPEN TO BE
GLBT

• (CASS 1979)
• MODEL OF GAY LESBIAN IDENTITY DEVELOPMENT

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VI. IDENTITY SYNTHESIS CHALLENGES

GLBTQ IDENTITY SHIFTS FROM FULL FOCUS OF
IDENTITY TO THAT OF JUST ONE PARTICULAR ASPECT OF
THE SELF
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VI. IDENTITY SYNTHESIS CHALLENGES

INTENSITY OF ANGER RELATED TO HETEROSEXISM
MAY DECREASE SELECTIVE TRUST OF OTHERS
(STRAIGHT OR GLBTQ) BUILDS GLBTQ IDENTITY
BECOMES MORE INTEGRATED WITH ALL ASPECTS OF THE
SELF ABLE TO MAINTAIN OWN DISTINCT IDENTITY
EVEN WITHOUT EMERSION IN GLBTQ CONTEXT
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ETHNIC SEXUAL IDENTITY DEVELOPMENT

A MODEL FOR MULTIPLE IDENTITY DEVELOPMENT
(MORALES, 1990)
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SEXUAL IDENTITY DEVELOPMENT AND ETHNICITY
(MORALES, 1990)

• DENIAL OF CONFLICTS
• BISEXUAL VS. GAY OR LESBIAN
• CONFLICTS IN ALLEGIANCE
• ESTABLISHING PRIORITIES IN ALLEGIANCES
• INTEGRATION OF COMMUNITIES
• GENERAL POPULATION
• ETHNIC/RACIAL/CULTURAL COMMUNITY
• GLBTQ COMMUNITY

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SEXUAL IDENTITY DEVELOPMENT AND ETHNICITY
(MORALES, 1990)

• DENIAL OF CONFLICTS
• MINIMIZATION OF THE REALITY OF RACIAL-ETHNIC
  DISCRIMINATION
• FORCLOSURE ON INITIAL SEXUAL ORIENTATION
• (-) CONSEQUENCES OF S.O. MAY NOT BE FULLY
  APPRECIATED
• GENERAL POPULATION
• ETHNIC/RACIAL/CULTURAL COMMUNITY
• GLBTQ COMMUNITY

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SEXUAL IDENTITY DEVELOPMENT AND ETHNICITY
(MORALES, 1990)

• II. BISEXUAL VS. GAY OR LESBIAN
• MAY BE MORE LIKELY TO IDENTIFY INITIALLY AS
  BISEXUAL DUE TO THE (-) CONSEQUENCES OF GAY OR
  LESBIAN IDENTITY WITHIN COMMUNITIES OF COLOR
• ACTUAL SEXUAL BEHAVIOR MAY NOT DIFFER
  SIGNIFICANTLY FROM THOSE WHO IDENTIFY MORE
  EXCLUSIVELY AS GAY OR LESBIAN
• GENERAL POPULATION
• ETHNIC/RACIAL/CULTURAL COMMUNITY
• GLBTQ COMMUNITY

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SEXUAL IDENTITY DEVELOPMENT AND ETHNICITY
(MORALES, 1990)

• III. CONFLICTS IN ALLEGIANCE
• DUAL STATUS AS ETHNIC-RACIAL AND SEXUAL
  MINORITY GENERATES HIGH ANXIETY
• MAY SEGMENT OR COMPARTMENTALIZE IDENTITIES TO
  OPERATE EFFECTIVELY IN 3 DISTINCT COMMUNITIES
  (GEN POP, ETH/RACIAL, OR GLBT)
• MAY EXPERIENCE MULTIPLE COMMUNITY AFFILIATIONS
  AS A BETRAYAL OF ONE OR THE OTHER
• GENERAL POPULATION
• ETHNIC/RACIAL/CULTURAL COMMUNITY
• GLBTQ COMMUNITY

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SEXUAL IDENTITY DEVELOPMENT AND ETHNICITY
(MORALES, 1990)

• IV. ESTABLISHING PRIORITIES IN ALLEGIANCE
• PRIMARY IDENTIFICATION WITH RACIAL-ETHNIC
  IDENTITY PREVAILS
• RESENTEMENT DUE TO THE POOR INTEGRATION OF
  COMMUNITIES (SPLITTING OF SOCIAL SUPPORT)
• ANGER AND RAGE ARISE IN RESPONSE TO REJECTION
  EXPERIENCES WITHIN THE GLBT COMMUNITY DUE TO
  RACISM
• GENERAL POPULATION
• ETHNIC/RACIAL/CULTURAL COMMUNITY
• GLBTQ COMMUNITY

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SEXUAL IDENTITY DEVELOPMENT AND ETHNICITY
(MORALES, 1990)

• V. INTEGRATION OF COMMUNITIES
• INTEGRATION OF LIFESTYLE AND ETHNIC
  IDENTITY/IES BECOMES OF MAJOR CONCERN
• ANXIETY, ISOLATION, OR ALIENATION MAY ARISE IN
  RESPONSE TO ATTEMPTS AT INTEGRATION
• NOT ALL INDIVIDUALS WILL CHOOSE TO COMPLETELY
  INTEGRATE ALL IDENTITIES
• GENERAL POPULATION
• ETHNIC/RACIAL/CULTURAL COMMUNITY
• GLBTQ COMMUNITY

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TRANSGENDER IDENTITY DEVELOPMENT

A MODEL OF TRANSGENDER IDENTITY DEVELOPMENT
(MASTERS, 1993)
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TRANSGENDER IDENTITY DEVELOPMENT(MASTERS, 1993)

• I. CHILDHOOD AWARENESS
• A. EARLY AWARENESS OF CROSS-GENDER
  IDENTIFICATION
• B. SENSE OF BEING DIFFERENT FROM OTHERS
• C. PREFERENCE FOR OPPOSITE GENDER PLAYMATES
• D. A NATURAL STATE OF LIFE BEFORE SOCIALIZATION
  

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TRANSGENDER IDENTITY DEVELOPMENT(MASTERS, 1993)

• II. GOING INTO THE CLOSET
• INTERNALIZATION OF SOCIETYS STANDARDS
• SOCIALIZATION TO THE PRESCRIBED GENDER ROLE
• ALIENATION FROM TRUE SENSE OF SELF (GOING INTO
  THE CLOSET
• MOTIVATED BY NEED FOR FREEDOM FROM REPRAISAL

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TRANSGENDER IDENTITY DEVELOPMENT(MASTERS, 1993)

• III. PASSING
• CONTINUED DENIAL OF TRUE GENDER IDENTITY
• TREMENDOUS EMOTIONAL TURMOIL
• ADHERENCE TO SOCIALLY PRESCRIBED ROLE
• MAY CROSS-DRESS TO RELIEVE PRESSURE
• ATTEMPTS TO RELIEVE PRESSURE CAN CAUSE FURTHER
  DISTRESS AND CONFUSION

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TRANSGENDER IDENTITY DEVELOPMENT(MASTERS, 1993)

• IV. COMING OUT
• RE-EMERGENCE FROM DENIAL
• REDISCOVERY OF TRUE GENDER IDENTITY
• REGAINING EMOTIONAL HEALTH
• RECOGNITION OF ONES NORMAL STATE, A STATE OF
  TRANSGENDER IDENTITY

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TRANSGENDER IDENTITY DEVELOPMENT(MASTERS, 1993)

• V. PRESENTING
• SEARCH FOR COUNSELING AND ADVICE
• SEARCH FOR SELF-UNDERSTANDING INNER PEACE
• PROFOUND IDENTITY CONFUSION (BODY REVULSION)
• BUILDING SELF-ACCEPTANCE, SOCIAL ACCEPTANCE AND
  SELF-ESTEEM
• RECONCILING IDENTITY WITH SOCIETAL EXPECTATIONS
• HIGH SUICIDE POTENTIAL IF ACCESS DENIED TO
  SUPPORT SERVICES

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TRANSGENDER IDENTITY DEVELOPMENT(MASTERS, 1993)

• VI. TRANSITION
• PRESENTATION TO SOCIOTYPICALLY CONFORM TO TRUE
  GENDER
• MALES WILL BEGIN LIFE AS WOMEN
• FEMALES WILL BEGIN LIFE AS MEN
• HUMAN RIGHTS CHALLENGES CAREER, HOUSING AND
  CONSUMER SERVICES CAN BE THREATENED
• OVERALL LOSS OF ACCESS TO SOCIETY

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TRANSGENDER IDENTITY DEVELOPMENT(MASTERS, 1993)

• VII. CROSS-LIVING
• MAY SIGNAL THE END OF THE FIGHT
• ADJUSTMENT TO NEW LIFESTYLE SORTED OUT
• CROSS-LIVING IN A STRUCTURED WAY
• MALES WILL BE SOCIALLY INTEGRATED AS WOMEN,
  FEMALES AS MEN
• DECISION SEX-REASSIGNMENT SURGERY?
• CONTINUED CHALLENGES OF DAILY LIFE

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• PETER C. RUSSELL, PH.D.
• STAFF PSYCHOLOGIST
• PSYCHOLOGICAL COUNSELING SERVICES