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A Curious Trend

opryland hotelI am getting ready for an upcoming conference. I’ll be in Nashville next week at the American Association of Christian Counselors’ World Conference. I have two main things going on: a three-hour pre-conference workshop and a regular workshop. The pre-conference workshop introduces people to the three frameworks I first discuss in the book, Understanding Gender Dysphoria, as well as the Christianity Today article on the transgender phenomenon. Those three frameworks are: Integrity, Disability, and Diversity. I’ll go over these three frameworks and the begin to make application to both sexual identity and gender identity concerns. Then I will move toward case discussion, so that we can consider together the ways these frameworks can inform counseling services.

The regular workshop is on working with Christian parents when their children come out. This is based on working with families over the past 16 years and research we have been analyzing from studies conducted through the Institute for the Study of Sexual Identity and through a project headed up by The Marin Foundation. I’ll be making three main points for practical application: map the terrain, recognize the developmental context, and construct a scaffolding for family care.

Ok, it’s this regular workshop I wanted to reflect on a little. There is a curious and somewhat concerning trend I see at professional conferences. Many professionals attend, of course. But I am seeing a remarkable increase in the number of non-professionals who attend in an effort to get help. Let me be clear that I am not critical of this. My heart goes out to these parents and families. What I am saying is that there does not appear to be sufficient resources for the many families who are confused and hurting and trying to find a way to navigate very difficult circumstances. My observation has been that they do not know where to turn.

I’ve wondered whether the closing of Exodus International a couple of years ago, coupled with recent political developments (e.g., SCOTUS ruling) have left Christian parents feeling ill-equipped to know how to respond or where to go for resources when their son or daughter comes out as gay, lesbian, bisexual or transgender. I do think many parents feel confused and unsure where to turn, but they do not seem to have resources local to them that they can rely upon to help them navigate this terrain. Perhaps many churches and ministries, too, feel unsure how to be a resource to families.

I tried to develop my workshop with an understanding that there would likely be people who are actually dealing with these challenges currently. I think that is a good principle to follow anyway–to assume that the persons you are discussing in a workshop are in attendance. To demonstrate respect for them and for their circumstances.

I am looking forward to the conference. I often find it to be an encouraging time. I hope it will be encouraging to both professionals and non-professionals who may be in attendance.

 
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Posted by on September 18, 2015 in Uncategorized

 

Students & Alumni Navigating Sexual Identity on Christian College Campuses

OLYMPUS DIGITAL CAMERASeveral members of my research institute recently published a small, qualitative study of 18 students and alumni of Christian institutions of higher education. The students and alumni all identified as Christian; they all reported same-sex attraction or otherwise identified as lesbian, gay or bisexual (LGB).

We organized the findings around two themes: (1) experiences of attraction, orientation, identity, and associated milestone events, and (2) campus climate. I wanted to share a few impressions from the study–these are just some things that stood out to me.

We asked about specific milestone events in the formation of one’s sexual identity. Milestone events are commonly studied in research on sexual identity development. They refer to sign posts LGB adults recall as important in their own formation of an LGB identity. We ask about these even though we recognize that an LGB identity may not be an outcome for all Christians who are navigating same-sex sexuality and sexual identity considerations. In any case, first awareness of same-sex sexuality is a common milestone event. As you might anticipate, all of our participants reported first awareness of same-sex attractions–with an average age of awareness at about 11. It was interesting to me that those behaviors that are more volitional–those behaviors that a person has say about–were less commonly reported. For instance, only 50% reported a first same-sex relationship.

For good or for ill, there is a lot of discussion in Christian circles about identity labels. Is it okay to identify as gay and Christian?  We did not ask our participants about whether or not it was okay; rather, we asked whether they adopted a gay identity. About 44% identified themselves as gay (“took on the label of gay” was the actual wording). We also asked about disclosure, and each participant shared with someone else that they experienced same-sex attraction (“first disclosure of same-sex attraction” was the wording). But most of that disclosure was to just a few friends while they were students.

What about campus climate? It perhaps comes as no surprise that about half indicated a hesitancy on the part of their campus to discuss sexual identity. I thought it was interesting that about half indicated that their campus was open to discussion/progress in this area. Perhaps its a matter of perspective. Maybe there is greater variability among campuses. One student talked about compassion:

Our university really tries to push the issue to make it more known. Not from a specifically acceptable standpoint, but to say it’s a legitimate struggle just the same as everybody else in the sins that they have. They try to have a biblical view on it and just to encourage people to come alongside people with the struggle. I think it’s been something that’s been getting in motion. (p. 23)

I think as a research group we were also struck by what were referred to as “pockets of safety.” These are friendships or relationships that are places a person can be more honest and forthcoming. One student shared the following:

One group of friends I hung out with I chose very carefully and very intentionally because I realized that they were just a little bit more accepting in general… two of them I can think of didn’t agree that homosexuality was okay, but they still treated me like a human being, still had fun with me, still invited me to things, and my sexuality never defined me. (p. 23)

We asked what I thought was an interesting question toward the end of the study: What advice would you give to other Christian students on your campus who experience same-sex attraction?  The most common response by far was to find trustworthy people. One person shared, “Find at least one person you can be open with.”

When asked what the campus could do differently in this area, answers went in a few different directions, but one thing that was shared is something I hear quite often as a guest speaker at Christian colleges and universities: Provide us with some clarification about what we as students can and cannot do to be supportive of one another without putting ourselves at risk for discipline.

There was a lot more, of course. These are just some of the findings that stood out to me. Perhaps other findings would stand out to you. You can read the entire study here.

We have a separate study along these same lines that is currently underway. It is a larger study with more quantitative measures as well as qualitative interviews. We hope to have data analyzed soon.

 

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New Beginnings

Academics measure time by a different calendar than everyone else. This week marks the start of a new academic year. We have new students arriving for orientation. We meet as a school faculty for a retreat to reflect on matters relevant to the new year, to our students well-being, and to our own experience of cohesion as a team.

People think academics take the summer off. I don’t know anyone in academics who does that, but it does sound appealing. I taught two doctoral-level course at Regent and one at Wheaton. Then I was working as part of a consensus group to provide input to a federal agency on issues related to the lesbian, gay, bisexual, and transgender (LGBT) community. I did actually take 2 weeks to enjoy time with family in Michigan. Then I returned in the nick of time to go to Toronto to the annual convention of the American Psychological Association, where I presented 2 poster sessions–one on the experiences of Christian ministers with LGBT persons and the other on the experiences of celibate gay Christians. The task force I chair for Division 36 (Psychology of Religion and Spirituality) on LGBT issues had a symposium that featured some of our history and some of the challenges in working across the aisle with those in Division 44 (Society for the Study of Lesbian, Gay, Bisexual and Transgender Issues ) on the intersection of LGBT and religious/spiritual issues. We also head two less formal dialogues on the same topics in our respective hospitality suites.

With the publication of Understanding Gender Dysphoria, I also spent a lot of time doing radio interviews and providing families with consultations. There are, of course, other projects, particularly research projects, that are ongoing, but that give you an idea of what a summer “off” can look like for academics. I’m sure my colleagues can share similar stories.

But I enjoy what I get to do for a living, and I look forward to seeing a new group of students come to campus. I look forward to seeing the new cohort that is entering the Doctoral Program in Clinical Psychology, and I look forward to convening our research institute as we anticipate our academic year together.

 
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Posted by on August 17, 2015 in Uncategorized

 

Understanding the Transgender Phenomenon

A little while ago Christianity Today approached me about writing a lead article on Gender Dysphoria. A presentation I gave on the topic caught someone’s attention, and there was interest in a reflection on the topic from a distinctly Christian perspective. The article I wrote was posted on-line recently and will be in the July/August print edition. Here is a quote on not equating management of gender dysphoria with faithfulness:

…Christians are to facilitate communities in which we are all challenged to grow as disciples of Christ. We can be sensitive, though, not to treat as synonymous management of gender dysphoria and faithfulness. Some may live a gender identity that reflects their biological sex, depending on their discomfort. Others may benefit from space to find ways to identify with aspects of the opposite sex, as a way to manage extreme discomfort. And of course, no matter the level of discomfort someone with gender dysphoria experiences (or the degree to which someone identifies with the opposite sex), the church will always encourage a personal relationship with Christ and faithfulness to grow in Christlikeness.

I hope you will consider reading the article. It is not long, which actually carries risks when writing about something as complex as gender dysphoria. But I discuss the three lenses I wrote about here. If you want more details on any of that, let me encourage you to pick up Understanding Gender Dysphoria, as I dedicate a chapter to these different lenses, and then I draw on an integrated framework throughout the rest of the book as I get into responses to the person and at more of an institutional level.

 
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Posted by on June 8, 2015 in Uncategorized

 

Trends on Christian College and University Campuses

In preparation for a pre-conference workshop at the Association for Christians in Student Development annual conference, I have been thinking a lot about the trends on Christian colleges and universities in relation to sexual minority and transgender students. That’s actually the title of the workshop. I will be discussing the three lenses I introduce in the book Understanding Gender Dysphoria.

The three lenses represent contrasting frameworks people use to “see” various topics (and people who represent those topics) differently. Briefly, they are the integrity lens, the disability lens, and the diversity lens. The integrity lens emphasizes the integrity or sacredness of male female differences from creation, as well as the unitive and procreative purposes of sex and sexual differences.

The disability lens places more emphasis on same-sex sexuality and gender dysphoria as distinct reflections of the fallen world in which people live. In keeping with that, they are nonmoral realities such that the person is not morally culpable for the experiences of same-sex sexuality or gender dysphoria. There may be moral considerations in what is done in light of same-sex sexuality or to manage dysphoria, but the experiences themselves are morally neutral in terms of culpability.

The diversity lens celebrates differences related to same-sex sexuality and gender as praiseworthy, as reflections of a diverse world in which we live. There are different variations on the diversity lens, but the main point is that this lens helps answer fundamental questions people have about identity and community.

I argue for what I refer to as an integrated framework that recognizes the strengths and weaknesses of each of these lenses and attempts to draw on the strengths of each.

So I will be discuss these lenses, as they provide a way of seeing what is happening at Christian colleges and universities around the country. Different stakeholders draw on different frameworks and frequently speak past one another. We will be discussing the many ways in which this happens and affects student development and broader campus policies and practices, as well as residence life, class discussions, relationships among faculty and staff, discussions with board members, parents, and alumni. It will be interesting.

These frameworks also help Christians in student development understand the ways in which the LGBT+ community has become a culture and how multicultural competence is now a reference point for training and services in a way that it had not been previously.

Of course, there are many other trends. I will be sharing some preliminary data from a study that I have been conducting with Stephen Stratton, Janet Dean, and Michael Lastoria. We launched a longitudinal study this past year and invited sexual minorities at Christian colleges and universities to complete a survey and participate in an interview to collect information on their experiences on Christian college campuses. I’ll be discussing milestone events in sexual identity development, public and private identity, experiences of campus climate, and more.

I am deeply grateful to these colleagues and to the student development staff who made this research possible. I think it is important for Christians in the field of psychology to ask the questions that are relevant to our own communities. In LGBT+ studies, this includes asking questions about the experiences of sexual minorities on Christian college campuses, and to use that information to improve our campuses, our ability to care for and love one another in meaningful ways, and our broader cultural witness.

 
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Posted by on May 30, 2015 in Uncategorized

 

Understanding Gender Dysphoria – Part 5

Bert and Faye had been married some 30 years when they came to my office for a consultation. Each of their three children (2 biological and one adopted) had been out of the house now for a couple of years, two were married, and one was now expecting their first grandchild. The reason they came for a consultation was Bert’s relatively recent (within the past 3 years) revelation to Faye that he was a woman. This was really difficult for Faye to process. She would look at me and say, “Does this make any sense to you at all?” In a private meeting, Bert shared with me that he had known about his gender dysphoria for many years before he disclosed to Faye, but he had not known what it was before then. He thought he was losing his mind. He did not have a name for what he experienced, and that lack of understanding only intensified his confusion and distress. He has begun cross-dressing intermittently by wearing female undergarments. He is interested in presenting as female but he and Faye agree that doing so locally would not be advisable. He has considered doing so on business trips, which he takes about every 3-4 weeks to larger cities around the country. He believes that this level of cross-gender identification will likely help him manage his dysphoria by helping him express who he experiences himself to be.

Gender Dysphoria coverAs the story of Bert and Faye exemplifies, the challenges in adult experiences of gender dysphoria are numerous and complex. The last post in our series addressed gender dysphoria in childhood and adolescence, including some of the controversies surrounding prevention and intervention. In this post we reflect on what happens in cases in which gender dysphoria does not resolve–in cases in which the child or adolescent is now an adult who reports an ongoing incongruence between their biological sex and their gender identity. What happens to this person? How does the story end?

In researching answers to these questions, I was surprised to learn that in many cases (an estimated 50% of cases), we actually do not know the answers to these questions. In other words, many people have unresolved outcomes in which we just do not know what happens to a person (again, as many as half of all cases).

Of cases that are tracked and where we do know what happens, it is typically understood that there are three pathways. The first path is to attempt to live one’s gender role and identity in keeping with one’s biological sex. The person may feel gender dysphoric, but they live as their birth sex and corresponding gender identity/role and adopt a lifestyle that reflects that. In the case of Bert and Faye, Bert shared that he would have liked to have experienced some kind of resolution like this, especially if it meant he and Faye could stay married and avoid predictable social stigma in their rather small and conservative hometown. Faye definitely wanted this resolution.

The second path is to engage in cross-gender behavior intermittently. Bert did try this for several years. For a biological male, this might mean growing his hair out longer, wearing make-up occasionally, and cross-dressing either on the weekends or wearing female undergarments during the day to manage the dysphoria. Think of this as a continuum. The extent of cross-dressing behavior varies considerably and typically reflects the degree of dysphoria and how successfully such cross-dressing behaviors reduces or makes the dysphoria more manageable.

The third path is to adopt a cross-gender role and identity. This may or may not involve hormonal treatment and sex reassignment surgery. Many people do not pursue these steps for a variety of reasons. In any case, the last path is reflected in those who cross-gender identify (or adopt the gender identity and role of the opposite sex). Throughout this whole process and again with the discussion of hormonal therapy and/or surgery, most mental health professionals reference the widely-recognized Standards of Care of the World Professional Association for Transgender Health (WPATH; formerly referred to in the literature as the Harry Benjamin International Gender Dysphoria Standards of Care).

If you are interested in this topic, you might be interested in the previous posts in this series. Also, there is so much more to say about these potential pathways and research on outcomes. Learn more by reading, Understanding Gender Dysphoria, forthcoming from InterVarsity Press Academic. The publisher recently released an excerpt if you would like to check it out here.

 
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Posted by on May 4, 2015 in Uncategorized

 

Understanding Gender Dysphoria – Part 4

Gender Dysphoria cover“What can we do?” asked the mother of a 7-year-old boy. She looked up and caught my eye. “What should we do… just last week a woman at the park said something. I couldn’t believe she had the nerve, but she did. I’m worried about him; I’m afraid that kids at school might do worse. There have been a few things said, at least he has hinted at a couple of things. But that could get worse. How they might tease him… I don’t know…” The mother went on to describe her son’s effeminate behavior and mannerisms, as well as how his voice inflection seemed more like that of a girls. She spoke of his tendency to pretend he had long hair and declare, “Mom, I have long hair like you have long hair!” She shared that just this past weekend, he grabbed a towel and put it around his waist and said, “Look, Mom, I’m wearing a dress just like you!” And he would often put on her heeled shoes and walk around in them.

This is obviously a challenging situation for parents, who are often unsure how best to respond to their child. Parents often wonder if this is a phase their child is going through. They may wonder if their child is going to be gay. Most do not know what gender incongruence or gender dysphoria is, so that is often not even on their radar.

Discussions about prevention and/or intervention can be remarkably complicated. Not only are the parents and the child obvious stakeholders, but there are entire emerging communities that have a stake in what happens next. Before we discuss four general approaches that have been in the literature, it is important to know that most cases of Gender Dysphoria (in which the diagnosis applies) actually resolve before a child reaches late adolescence or adulthood. Researchers sometimes refer to “desisters” and “persisters.” A desister is someone for whom the gender dysphoria resolves by late adolescence or adulthood, whereas a persister refers to someone who continues to experience gender dysphoria into later adolescence and adulthood. I discussed developmental trajectories among gender dysphoric children in a previous post, and that might be helpful to review.

So the question of whether and how to intervene is often held up to scrutiny in light of what appears to be a natural resolution of Gender Dysphoria among desisters. But we do not know enough today about how to distinguish children whose gender dysphoria desists from those whose gender dysphoria persists. You can begin to appreciate how not knowing makes every other decision that much more difficult.

There are four basic approaches under consideration:

Decrease cross-gender identification;

Watchful waiting;

Facilitate cross-gender identity in anticipation of an adult identification; and

Delay puberty until a child can decide about gender identity in later adolescence.

Proponents who discuss the first option generally argue that they are facilitating a resolution that is likely to occur anyway. They tend to emphasize the concern that a child will face a difficult social atmosphere in which peer group disapproval takes its toll. One proponent of this model has written about a protocol to facilitate the resolution of Gender Dysphoria among biological males. It includes interventions such as fostering/facilitating (1) positive relationship with the child’s father or male caregiver or role model; (2) positive relationships with the child’s male peers; (3) gender-typical habits/skills; and (4) male peer group interactions. Interventions are really with the parents who then foster/facilitate these interests with the child.

There was an interesting National Public Radio report a few years ago on whether and how to intervene with gender dysphoric children. The NPR report cited The Portman Clinic’s treatment of 124 children since 1989 using a comparable approach, and it was reported that 80% of the children chose later as adults to maintain a gender identity consistent with their birth sex.

Those who are critical of this kind of intervention express concern about the prevention of gender variant expressions and/or homosexuality (as most desisters do later identify as gay, lesbian, or bisexual), and some wonder whether those who live consistent with their birth sex are natural desisters whose gender dysphoria would have resolved anyway.

Those who argue for watchful waiting anticipate that as a child’s gender identify unfolds, it will be clear whether the child will desist or persist, and that what occurs naturally, if you will, is likely to be the preferred outcome in these that any other resolution will likely go against the grain of what is unfolding. Cross-gender interests are permitted here, and the parents try to be as neutral as possible in response to the child’s expressed interests. In addition to providing a neutral environment with respect to cross-gender behavior and identity, watchful waiting as an approach emphasizes helping the family attend to their anxiety about the outcome and to facilitate a positive view of self for the child.

Concerns here tend to be around the practical issues involved in being truly neutral about gender identity. Also, there is a philosophical concern about whether what is being referred to as a natural unfolding is the best or most reliable guide to gender identity resolutions.

The third approaches supports and facilitates exploration and adoption of the preferred gender identity. I am distinguishing it from a fourth option in which puberty is actually delayed to provide more time for an older child to enter into adolescence and make decisions closer to age 15 or 16 about gender identity. In other words, parents may elect to facilitate cross-gender identification (rather than be neutral) (option three) but may not wish to delay puberty through the administration of hormone blockers (option four).

If we return to the NPR report we see research cited in support of puberty suppression as well. Researchers in the Netherlands have  been following children who underwent hormone-blocking treatment, and in their report on 100 patients, all had made the decision as adults to live as their preferred gender identity (rather than their birth sex). Criticisms of this approach range from the effects on bone-mass development to brain development to questions as to whether co-occurring mental health issues are resolved. Sterility is also a concern. Proponents of puberty suppression say that each of these concerns must also be weighed against risks associated with delaying intervention.

Of course, there are additional criticisms and concerns with each of these four options as well. I just wanted to map out the different paths that are under consideration. Many factors go into making a decision as a parent, and no one decision may be the best decision for every child or family. Decisions should be made in the context of a good assessment, accurate diagnosis, and with an experienced team.

Once a child enters later adolescence or adulthood, we are having a different discussion about ways to manage gender dysphoria. I will either do another post on that or encourage the interested reader to see that part of the forthcoming book, Understanding Gender Dysphoria.

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Note: This blog post is Part 4 of a series. If you found this interesting, you may want to read Part 1, Part 2, and Part 3.  Also of interest may be a recent talk I gave at Calvin College titled Understanding Gender Dysphoria. The book I mentioned can be pre-ordered through IVP or Amazon.

 
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Posted by on April 3, 2015 in Gender Identity, Transgender

 

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