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Book SynopsisTransgender and gender expansive people are increasingly becoming the focus of media, politics, and of public conversation. With this increased attention comes greater visibility and counselors are now, more than ever, likely to clinically engage with openly transgender or gender expansive clients during their careers. This is in spite of the fact that many counselors have not received specific training in skills, knowledge, and awareness necessary to provide affirming, informed care for these populations. In this book, the authors provide practical, real-life suggestions and interventions to help therapists, supervisors, and trainees increase in their competence and confidence in working with transgender and gender expansive clients. The resources provided here are informed by evidence-based practice, scholarship on intersectionality, and by social justice and advocacy movements. This book is a useful supplement to clinical work with transgender and gender expansive people, especially for the many clinicians who work in regions with limited transgender-specific resources.In this book, readers can expect to find resources for: Exploration of gender identities (for personal growth, with clients, and in supervision) Understanding how privilege and oppression relate to gender identity and expression Providing supervision to counselors working with transgender and gender expansive (TGE) clients Understanding diverse and intersectional TGE identities Ethical issues when working with TGE people Worksheets and interventions that can be used to support TGE clients Finding regional resources to support TGE clients through diverse social and medical transition processes How finances affect transition for some transgender clients Developing a plan to work with TGE clients in both rural and urban regions Examples of letters of recommendation, carry letters, and how to develop a “resource list” How practitioners can market their practice to TGE clients Recommendations for those working with TGE clients in schools, college counseling centers, and other settings Table of ContentsIntroductionSection I: Laying the Foundation for Affirmative WorkChapter 1: Building an Understanding of GenderBillMollyRowanGender TerminologyGender BinaryGender IdentityGender ExpressionGender ContinuumGender IdentitiesCisgenderTransgenderNonbinaryIntersexTranssexualPronounsSummary and RecommendationsReflection QuestionsReferences and Suggested ReadingsChapter 2: Exploring your Gender IdentityBillMolly RowanThe Unexplored LifeCisnormativityMisgendering/MispronouningDeadnamingGender Identity and Your EnvironmentFamily and FriendsWorkplaceCommunityPrivilegeThe Binary and Me ExerciseSummary and RecommendationsReflection QuestionsReferences and Suggested ReadingsChapter 3: Gender Identity and the Intersectional SelfBillMollyRowanClient IntersectionalityPrivilege and PowerRace and EthnicitySexual Orientation(Dis)ability StatusSocioeconomic StatusHuman Service Professional IntersectionalityGender IdentityExploring Intersectional Gender IdentityConnecting with OthersClient-Professional InteractionsPoints of Interaction Socioeconomic Status Sexual Orientation Minoritized Racial Status Social Support Age Summary and RecommendationsReflection QuestionsReferences and Suggested ReadingsChapter 4: Gender Identity and Lifespan DevelopmentBillMollyRowanEarly AwarenessGender AssumptionsChildhood and AdolescenceChildhoodAdolescencePubertySchoolEarly AdulthoodWorkMiddle to Late AdulthoodSummary and RecommendationsReflection QuestionsReferences and Suggested ReadingsChapter 5: Gender Identity and Geographic LocationBillMollyRowanCultural NuanceTeletherapyUrban AreasTransportationViolence and SafetyFees for ServiceDiscretionFamily, Partners, and FriendsPositive Aspects of Rural AreasProximity to FamilyFaith, Friends, and ChurchThe Beauty of NatureAccess to ServicesLimiting Aspects of Rural AreasProximity to FamilyFaith, Friends, and ChurchSeclusionInternet Access and Remote ConnectionsTravel and Resource AccessAccess to Competent ProvidersSemi-Rural and Semi-Urban AreasPeople Who ImmigrateGeneral GuidelinesExplore the Geographic Culture of OriginAccess Distance and Physical Access to ResourcesExplore Spatial Connections to Community and ReligionAddress Family Businesses, Ties, and ExpectationsExplore the Impact of Local Laws and PoliciesAccess Availability, Longevity, and CommitmentSummary and RecommendationsReflection QuestionsReferences and Suggested ReadingsSection II: Elements of Affirmative PracticeChapter 6: Relationship BuildingBillMollyRowanPrior to Meeting a ClientFirst AppointmentEarly Stages of RelationshipStrengthening the RelationshipTermination and BeyondSummary and RecommendationsReflection QuestionsReferences and Suggested ReadingsChapter 7: Assessment and Diagnosis FrameworksBillMollyRowanA Brief History of Mental Health Diagnostic CategoriesAssessmentFormal MeasuresInformal or Interview-Based AssessmentIntake ProtocolsDiagnosisDefault DiagnosisDifferential DiagnosesStabilizationDiagnoses as Permission or Endorsement for TreatmentEthics and DiagnosesCommon PitfallsRefusing to Write a LetterIgnoring Gender Expansive Identities and IntersectionsHomogenizing the PopulationBeing Unprepared to Provide Affirming ServicesSummary and RecommendationsReflection QuestionsReferences and Suggested ReadingsChapter 8: Ethics and Professional StandardsBillMollyRowanPositive EthicsTaking a Positive Ethics ApproachPositive Ethics and Decision-MakingNonmaleficence and Positive EthicsEthics and Legal IssuesConversion TherapyEthics and Practice ConcernsMultiple Relationships with a Single ClientRelationships with Client FamiliesRural ConsiderationsInformed ConsentCompetenceMulticultural and Social Justice PracticeSummary and RecommendationsReflection QuestionsReferences and Suggested ReadingsChapter 9: Transition, Care Teams, and Clinical ProcessBillMollyRowanTransitionsSocial TransitionMedical TransitionGender DysphoriaDiagnosis and Access to CareGender EuphoriaPassingDiverse PathwaysCare TeamsClinical ProcessesSummary and RecommendationsReflection QuestionsReferences and Suggested ReadingsChapter 10: Resources and Letter WritingBillMollyRowanResourcesLettersAffirming Hormone TherapyAffirming SurgeriesCarry LettersOther ResourcesCompetence Building ResourcesTransition Care ResourceWeb-Based ResourcesSummary and RecommendationsReflection QuestionsReferences and Suggested ReadingsSection III: Affirmative Care in ContextChapter 11: Affirmative Work in Various SettingsBillMollyRowanGeneral ConsiderationsLeadershipSupport StaffOperating SystemsLocation SpecificsSchoolsCollege or University Counseling CentersPrivate PractitionersCorporate and Large CompaniesConclusionSummary and RecommendationsReflection QuestionsReferences and Suggested ReadingsChapter 12: Partners and FamiliesBillMollyRowanFoundations and Key ConceptsDeconstructing Negative BiasesThe Power of AcceptanceGender in Family DynamicsGender Fixation in FamiliesComponents of the Family SystemSupporting Gender Expansive ChildrenSupporting Gender Expansive ParentsGender Transition and Romantic RelationshipsPartners and Relationship DynamicsTransitioning in Close RelationshipsPolyamorous RelationshipsSummary and RecommendationsReflection QuestionsReferences and Suggested ReadingsChapter 13: GroupsBillMollyRowanGroup StagesGroup FormationGroup Member SelectionFormingStormingNormingPerformingTerminationGeneral SuggestionsSummary and RecommendationsReflection QuestionsReferences and Suggested ReadingsChapter 14: Sex, Sexuality, and Romantic AttractionBillMollyRowanHistorical Perspectives on Sexual HealthGender-Affirming ApproachesGender Expansive Clients and Sex Education MythsTowards a Sex-Positive FrameworkBody PositivityEroto-PositivityKink PositivityRelationship PositivityAdditional ConsiderationsConclusionSummary and RecommendationsReflection QuestionsReferences and Suggested Readings Chapter 15: SupervisionBillMollyRowanLisa, LPC, and Austin, Master’s TraineeSupervision and Contextual FactorsGroup SupervisionIdentity DifferencesPower DynamicsConstructive FeedbackSupportive FeedbackThe Supervisory RelationshipSelf-DisclosureBoundariesParallel ProcessRuptures and ConflictsSupervision as a Professional RoleQualification CompatibilityConsultationContinuing EducationFuture DevelopmentsSummary and RecommendationsReflection QuestionsReferences and Suggested ReadingsConclusionAppendix A: Resources TableFigure 1Appendix B: Letter of Recommendation for Hormone Replacement TherapyAppendix C: Letter of Recommendation for SurgeryAppendix D: “Carry Letter”Appendix E: Clinician Action StepsTable 1IndexAbout the Authors

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Book SynopsisTransgender and gender expansive people are increasingly becoming the focus of media, politics, and of public conversation. With this increased attention comes greater visibility and counselors are now, more than ever, likely to clinically engage with openly transgender or gender expansive clients during their careers. This is in spite of the fact that many counselors have not received specific training in skills, knowledge, and awareness necessary to provide affirming, informed care for these populations. In this book, the authors provide practical, real-life suggestions and interventions to help therapists, supervisors, and trainees increase in their competence and confidence in working with transgender and gender expansive clients. The resources provided here are informed by evidence-based practice, scholarship on intersectionality, and by social justice and advocacy movements. This book is a useful supplement to clinical work with transgender and gender expansive people, especially for the many clinicians who work in regions with limited transgender-specific resources.In this book, readers can expect to find resources for: Exploration of gender identities (for personal growth, with clients, and in supervision) Understanding how privilege and oppression relate to gender identity and expression Providing supervision to counselors working with transgender and gender expansive (TGE) clients Understanding diverse and intersectional TGE identities Ethical issues when working with TGE people Worksheets and interventions that can be used to support TGE clients Finding regional resources to support TGE clients through diverse social and medical transition processes How finances affect transition for some transgender clients Developing a plan to work with TGE clients in both rural and urban regions Examples of letters of recommendation, carry letters, and how to develop a “resource list” How practitioners can market their practice to TGE clients Recommendations for those working with TGE clients in schools, college counseling centers, and other settings Table of ContentsIntroductionSection I: Laying the Foundation for Affirmative WorkChapter 1: Building an Understanding of GenderBillMollyRowanGender TerminologyGender BinaryGender IdentityGender ExpressionGender ContinuumGender IdentitiesCisgenderTransgenderNonbinaryIntersexTranssexualPronounsSummary and RecommendationsReflection QuestionsReferences and Suggested ReadingsChapter 2: Exploring your Gender IdentityBillMolly RowanThe Unexplored LifeCisnormativityMisgendering/MispronouningDeadnamingGender Identity and Your EnvironmentFamily and FriendsWorkplaceCommunityPrivilegeThe Binary and Me ExerciseSummary and RecommendationsReflection QuestionsReferences and Suggested ReadingsChapter 3: Gender Identity and the Intersectional SelfBillMollyRowanClient IntersectionalityPrivilege and PowerRace and EthnicitySexual Orientation(Dis)ability StatusSocioeconomic StatusHuman Service Professional IntersectionalityGender IdentityExploring Intersectional Gender IdentityConnecting with OthersClient-Professional InteractionsPoints of Interaction Socioeconomic Status Sexual Orientation Minoritized Racial Status Social Support Age Summary and RecommendationsReflection QuestionsReferences and Suggested ReadingsChapter 4: Gender Identity and Lifespan DevelopmentBillMollyRowanEarly AwarenessGender AssumptionsChildhood and AdolescenceChildhoodAdolescencePubertySchoolEarly AdulthoodWorkMiddle to Late AdulthoodSummary and RecommendationsReflection QuestionsReferences and Suggested ReadingsChapter 5: Gender Identity and Geographic LocationBillMollyRowanCultural NuanceTeletherapyUrban AreasTransportationViolence and SafetyFees for ServiceDiscretionFamily, Partners, and FriendsPositive Aspects of Rural AreasProximity to FamilyFaith, Friends, and ChurchThe Beauty of NatureAccess to ServicesLimiting Aspects of Rural AreasProximity to FamilyFaith, Friends, and ChurchSeclusionInternet Access and Remote ConnectionsTravel and Resource AccessAccess to Competent ProvidersSemi-Rural and Semi-Urban AreasPeople Who ImmigrateGeneral GuidelinesExplore the Geographic Culture of OriginAccess Distance and Physical Access to ResourcesExplore Spatial Connections to Community and ReligionAddress Family Businesses, Ties, and ExpectationsExplore the Impact of Local Laws and PoliciesAccess Availability, Longevity, and CommitmentSummary and RecommendationsReflection QuestionsReferences and Suggested ReadingsSection II: Elements of Affirmative PracticeChapter 6: Relationship BuildingBillMollyRowanPrior to Meeting a ClientFirst AppointmentEarly Stages of RelationshipStrengthening the RelationshipTermination and BeyondSummary and RecommendationsReflection QuestionsReferences and Suggested ReadingsChapter 7: Assessment and Diagnosis FrameworksBillMollyRowanA Brief History of Mental Health Diagnostic CategoriesAssessmentFormal MeasuresInformal or Interview-Based AssessmentIntake ProtocolsDiagnosisDefault DiagnosisDifferential DiagnosesStabilizationDiagnoses as Permission or Endorsement for TreatmentEthics and DiagnosesCommon PitfallsRefusing to Write a LetterIgnoring Gender Expansive Identities and IntersectionsHomogenizing the PopulationBeing Unprepared to Provide Affirming ServicesSummary and RecommendationsReflection QuestionsReferences and Suggested ReadingsChapter 8: Ethics and Professional StandardsBillMollyRowanPositive EthicsTaking a Positive Ethics ApproachPositive Ethics and Decision-MakingNonmaleficence and Positive EthicsEthics and Legal IssuesConversion TherapyEthics and Practice ConcernsMultiple Relationships with a Single ClientRelationships with Client FamiliesRural ConsiderationsInformed ConsentCompetenceMulticultural and Social Justice PracticeSummary and RecommendationsReflection QuestionsReferences and Suggested ReadingsChapter 9: Transition, Care Teams, and Clinical ProcessBillMollyRowanTransitionsSocial TransitionMedical TransitionGender DysphoriaDiagnosis and Access to CareGender EuphoriaPassingDiverse PathwaysCare TeamsClinical ProcessesSummary and RecommendationsReflection QuestionsReferences and Suggested ReadingsChapter 10: Resources and Letter WritingBillMollyRowanResourcesLettersAffirming Hormone TherapyAffirming SurgeriesCarry LettersOther ResourcesCompetence Building ResourcesTransition Care ResourceWeb-Based ResourcesSummary and RecommendationsReflection QuestionsReferences and Suggested ReadingsSection III: Affirmative Care in ContextChapter 11: Affirmative Work in Various SettingsBillMollyRowanGeneral ConsiderationsLeadershipSupport StaffOperating SystemsLocation SpecificsSchoolsCollege or University Counseling CentersPrivate PractitionersCorporate and Large CompaniesConclusionSummary and RecommendationsReflection QuestionsReferences and Suggested ReadingsChapter 12: Partners and FamiliesBillMollyRowanFoundations and Key ConceptsDeconstructing Negative BiasesThe Power of AcceptanceGender in Family DynamicsGender Fixation in FamiliesComponents of the Family SystemSupporting Gender Expansive ChildrenSupporting Gender Expansive ParentsGender Transition and Romantic RelationshipsPartners and Relationship DynamicsTransitioning in Close RelationshipsPolyamorous RelationshipsSummary and RecommendationsReflection QuestionsReferences and Suggested ReadingsChapter 13: GroupsBillMollyRowanGroup StagesGroup FormationGroup Member SelectionFormingStormingNormingPerformingTerminationGeneral SuggestionsSummary and RecommendationsReflection QuestionsReferences and Suggested ReadingsChapter 14: Sex, Sexuality, and Romantic AttractionBillMollyRowanHistorical Perspectives on Sexual HealthGender-Affirming ApproachesGender Expansive Clients and Sex Education MythsTowards a Sex-Positive FrameworkBody PositivityEroto-PositivityKink PositivityRelationship PositivityAdditional ConsiderationsConclusionSummary and RecommendationsReflection QuestionsReferences and Suggested Readings Chapter 15: SupervisionBillMollyRowanLisa, LPC, and Austin, Master’s TraineeSupervision and Contextual FactorsGroup SupervisionIdentity DifferencesPower DynamicsConstructive FeedbackSupportive FeedbackThe Supervisory RelationshipSelf-DisclosureBoundariesParallel ProcessRuptures and ConflictsSupervision as a Professional RoleQualification CompatibilityConsultationContinuing EducationFuture DevelopmentsSummary and RecommendationsReflection QuestionsReferences and Suggested ReadingsConclusionAppendix A: Resources TableFigure 1Appendix B: Letter of Recommendation for Hormone Replacement TherapyAppendix C: Letter of Recommendation for SurgeryAppendix D: “Carry Letter”Appendix E: Clinician Action StepsTable 1IndexAbout the Authors

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