Counselling Dilemma: A Client’s Sex Reassignment Surgery
Mark, 36 years of age, is directed to counselling by his doctor after Mark decides he wants to transition from male to female, undergo sex reassignment surgery, and change his name to Sonia. Mark reports he has suffered for a long time trying to live as a man when he in fact feels like a woman.
Mark is currently experiencing feelings of sadness, anxiety, stress and anger about the way he has been treated by his family and certain friends because of his gender identity. He has started drinking alcohol on daily basis as a way to numb his emotions and fall asleep at night.
What important factors does the Counsellor need to take into consideration when working with Mark? What topics do you think that the counsellor should concentrate on?
For example:
- Exploring his personal history, including the origins of his feelings of being a woman
- His struggles to live as a man
- His expectations for living as a woman.
Do you think the doctor should have checked with the counsellor before referring Mark? Finally, should Mark have a say in choosing his own counsellor given that he is in a unique situation or should he leave it up to the professionals involved?
I feel it is important for a counsellor to have experience with transgender clients, hence the GP and/or Mark need to ascertain this prior to referring/taking appointment. Most GPs would have minimal experience in this subject area. The counsellor needs to facilitate Mark in processing feelings of sadness, anxiety, and anger about the way he has been treated by family/community due to gender identity. The counsellor could also: Explore relationship with father/mother/siblings in childhood/now; Foster an awareness of the complexities and risks of his decision, and also assure client that he has no judgements about the operation decision; By the end of sessions, the counsellor needs to have brought Mark to a place of identifying with “her” new identity; Utilise family therapy to support Mark’s re-integration into family and community.
To begin with, it might have been a good idea for the GP to check if the counsellor had any clashes of values in working with such a client, and if they had any special expertise in working with such clients. Secondly the counsellor would need to monitor their own feelings about the client and discuss these with their supervisor, to ensure any conflict of values do not negatively impact on the client. If so they would need to refer the client to another counsellor.
The counsellor would need to fully explore the client’s current emotions and drinking problem, to determine if they are solely linked to his sexual identity issues and the impact of others’ reactions towards him. They would need to address these emotions first before finding out the Mark’s goals and helping them to explore the positives and negatives of each goal. They would need to help the client explore the full extent of the positives and negatives of his decision to go through with gender reassignment and what would be different for the client if they achieved that goal. They would also need to discuss the possibility of how he could live happily without the gender reassignment and what he would need to do to deal with the conflict he is experiencing from his family members and friends.
Overall, the counsellor’s role would be to enable the client to develop tools for coping with the emotional outcomes of whatever decision he makes, and its impact on his family, friends and his greater social circles.
It is important to take into consideration the client’s age and where he might be on his life transition. Could this be seen as a mid-life crisis by the client? The counsellor would need to explore this further. The counsellor should also refer Mark to support groups as well as other specialist services that have peers who might have walked in “Mark’s shoes” this may assist Mark in not feeling alienated from his community. This would also empower Mark to make a stance and make informed choices using the counselling process as an empowering mechanism.
Is the a unique situation? Out of basic respect for the client, the counseller needs to confirm with the client, how they want to be addressed – which pronouns to use and which name to use also.
Another important factor would be to understand and discuss Mark’s cultural background and socio-economic situation to get a broader view of the impact on him from the other world. I think exploring with Mark how the outer world would see him is another valuable avenue to explore. Often, people are concerned the way the world perceives them.