Gender Identity and Addictions

1. Gender Identity and Addictions Kristie Overstreet LMHC, LPC, CAP, Certified Sex Therapist Therapy Department 4540 Southside Blvd Suite 401 Jacksonville FL 32250 Kristie@Therapydepartment.com www.Therapydepartment.com

2. Background & Experience Specialized in sex therapy including addictions, relationships, and gender/sexual identity Licensed Mental Health Counselor (FL) Licensed Professional Counselor (GA & LA) Board Certified Sex Therapist Certified Addiction Professional National Certified Counselor 2006 began work with the LGBT population Created and developed LGBT specialty track at Lakeview Health Systems Current practice case load of clients from 6 years old to 74 years old

3. Today’s Schedule 9:00am-10:00am Part 1 10:00am-10:15am Break 10:15am-11:15am Part 2 11:15am-11:25am Break 11:25am-12:00pm Park 3

4. Today’s Goal To provide a broader understanding of gender identity issues as they relate to addiction

5. Objectives 1. To increase knowledge of sexual orientation and gender identity terminology. 2. To increase familiarity with the issues and barriers that the trans gender population faces when seeking substance abuse services. 3. To provide knowledge about the interactions between transgender issues and addiction. 4. To provide an enhanced ability to offer affirmative, culturally relevant, and effective treatment to transgender clients in substance abuse treatment.

6. The Williams Institute study In 2011 four national and two state-level population-based surveys, suggest that there are more than 8 million adults in the US who are lesbian, gay, or bisexual, comprising 3.5% of the adult population. In total, the study suggests that approximately 9 million Americans – roughly the population of New Jersey – identify as LGBT. There are also nearly 700,000 transgender individuals in the US. Gates, G. (April 2011). Citing Websites. In How many people are lesbian, gay, bisexual, and transgender? Retrieved January 15, 2014,fromhttp://williamsinstitute.law.ucla.edu/wp-content/uploads/Gates-How-Many-People-LGBT-Apr-2011.pdf

7. When you think of Transgender… What image comes to mind?

8. Chaz Bono

9. Kylan Wenzel

10. Donna Rose

11. Arin Andrews & Katie Hill

12. Let’s start with the Basics Biological Sex Gender Identity Gender Expression Sexual Orientation

13. Video Gender Identity Project: Gender Basics http://www.youtube.com/watch?v=UXI9w0PbBXY Gender Identity Project. (n.d). Gender Basics. Retrieved on January 15, 2014 from www.genderidentityproject.org

14. Where is it located? -Sexual Orientation -Biological Sex -Gender Identity

15. Killerman, S. (n.d). The Genderbread Person. Retrieved January 15, 2014 from www.ItsPronouncedMetrosexual.com

16. The Transgender Umbrella PFLAG Phoenix. (n.d). Transgender Umbrella. Retrieved January 15, 2014 from www.pflagphoenix.org

17. Transgender Umbrella PDF Retrieved January 15, 2014 from http://www.docstoc.com/docs/108909209/The-Transgender-Umbrella

18. Terms Breakdown Transgender: (adj). 1. describes one whose gender identitydoes not match their sex at birth; 2. more generally, candescribe one whose existence challenges the idea thatgender exists only as two mutually exclusive categoriesof male and female (the gender binary) Transperson:n. one who is transgendered

19. More Terms Transsexual:one whose sex atbirth is “opposite” their genderidentity; i.e. one who wasborn with male parts butis actually female (MTFormale-to-female; atranswoman) or one whowas born with female parts butis actually male (FTMorfemale-to-male; a transman) Crossdresser:one whowears clothing intendedfor the “opposite” genderfor personal comfort orrelaxation

20. More Terms Transvestite:usually anoffensive term, especially when used incorrectly;one who wears clothingintended for the “opposite”gender for sexual satisfaction Drag queenordrag king:onewho wears clothing intended for the“opposite” genderfor the entertainment of others

21. More Terms Bigender:one whose genderidentity is both male and femaleat the same time; may exhibitaspects of both Androgyne:one whose genderidentity is somewhere in-betweenmale and female; may exhibitsome aspects of one and someof the other Agender:one who has no genderat all

22. More Terms Genderqueer:one whose gender identityis something completely different frommale or female; may also include theother gender identities on this side ofthe umbrella Thirdand fourth:two genders thatexist outside of “male” and “female”;like male and female, they cannot reallybe defined as anything other thanthemselves Gender fluid:one whose genderidentity can change(for most people, including mosttranspeople, gender identity cannotbe changed; however, some peoplecan change their gender identity)

23. What does * stand for? Killerman, S. (n.d). Trans*. Retrieved January 15, 2014 from www.ItsPronouncedMetrosexual.com

24. BIG CHANGES… PAST -DSM IV -Gender Identity Disorder -Controversial due to being seen as a disorder -Focus on identity and incongruence -Variations with on-set in children or adults CURRENT -DSM V (May 2013) -Gender Dysphoria -No longer seen as a “disorder” -More of a focus on importance of “distress” -Focus on relationship with body -Characteristics vary with age, not all children who have gender dysphoria will become transgender adults

25. Gender Dysphoria Criteria for children To be diagnosed with gender dysphoria, a child should: repeatedly insist that they want to be the opposite sex, or that they are the opposite sex, and behave as the opposite sex (this must not be just because they want any supposed advantages of being the opposite sex) dislike or refuse to wear clothes typically worn by their sex and insist on wearing clothes typically worn by the opposite sex, or show dislike or unhappiness with their genitalia and insist that it will change into that of the opposite sex (for example, refusing to pass urine as members of their sex usually do) not yet have reached puberty (when a child progresses into a sexually developed adult) behave this way for at least six months Criteria for teenagers and adults To be diagnosed with gender dysphoria, a teenager or adult should: feel persistently and strongly that they are the wrong sex and feel a strong identification with the opposite sex feel discomfort in their sex and its gender role and strongly dislike and wish to be rid of the physical characteristics of their sex, such as breasts, facial and body hair and genitalia not have a condition that causes them to display physical attributes of the opposite sex (although this is being increasingly questioned) experience long-term anxiety, distress and impairment in social and occupational areas of life due to their condition **NOT every person that identifies as Transgender has Gender Dysphoria American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

26. Limitations to data about substance use in LGBT Population Lack of reliable data on how many LGBT are in the population because surveys on health issues do not routinely ask sexual orientation or gender identity questions. Many LGBT people may not self-disclose identity for fear of discrimination or stigmatization based on sexual orientation, gender identity, or drug use.

27. Why is the Transgender population at risk for addictions? Suicidal rate -46% of trans men and 42% of trans women have attempted suicide -50% of those who disclose to everyone that they are transgender or gender non-conforming have attempted suicide -51% of those that are HIV-positive and 55-65% of those with a disability have elevated prevalence of suicide attempts http://www.youtube.com/watch?v=SNCJ6Vf7qOM American Foundation for Suicide Prevention. (2014, January). Suicide attempts among Transgender and Gender Non-Conforming Adults. Retrieved on January 15, 2014 from http://williamsinstitute.law.ucla.edu/research/suicide-attempts-among-transgender-and-gender-non-conforming-adults/

28. Why is the Transgender population at risk for addictions? Depression Anxiety Denial

29. Treatment information to cover Diversity Sober socializing Sober sex Significant others/family issues Parents/Children of client Religious guilt Confidentiality Dual stigma Finnegan, D.G., & McNally, E.B. (1987). Dual identities, 39-47.

30. What issues do facilities face in assessing? Lack of intake questions regarding sexual orientation and gender identity. Clients’ fear of coming out in a mainstream setting. Clients’ confusion or lack of clarity about their sexual orientation or gender identity.

31. Cultural Issues for LGBT clients There is great diversity of identities within the LGBT communities. Prejudice and discrimination against LGBT persons as well as the effect of stigma on the addiction recovery process.

32. Core aspects of identity Family of Origin Race Ethnicity Age Class Sexual Orientation Gender Identity Abilities Appearance Religion

33. Core Identities Where do these messages about who we are come from? What is an example of a message you got about one of your aspects of your identity? Think of a positive one and a negative one.

34. Definitions Stereotyping Prejudice Myths Stigma

35. Messages about the Transgender Population What are examples of stereotypes, prejudice, myths, and stigmas about Transgender people? Do any of these sound familiar?

36. True or False? Transgender people live crazy lives. Transgender people are confused. Transgender people are mentally disturbed. Transgender people are gay. Transgender people hate their bodies. Transgender people perform drag shows. Transgender people aren’t “real” men or women.

37. Transphobia Definition: the fear and hatred of, or discomfort with, people whose gender identity or gender expression do not conform to cultural gender norms. GRIN Campaign. (2013, July). Retrieved on January 15, 2014 from www.grincampaign.com

38. Examples of Transphobia -Is that a boy or a girl? -What’s your real name? -They’re such a Tranny! -What are you really? -Using “It” or “He-she”

39. Problematic Terms Problematic: "transgenders," "a transgender"Preferred: "transgender people," "a transgender person"Transgender should be used as an adjective, not as a noun. Do not say, "Tony is a transgender," or "The parade included many transgenders." Instead say, "Tony is a transgender man," or "The parade included many transgender people." Problematic: "transgendered"Preferred: "transgender"The adjective transgender should never have an extraneous "-ed" tacked onto the end. An "-ed" suffix adds unnecessary length to the word and can cause tense confusion and grammatical errors. For example, it is grammatically incorrect to turn transgender into a participle, as it is an adjective, not a verb, and only verbs can be used as participles by adding an "-ed" suffix. (Many in the community disagree with this) Problematic: "sex change," "pre-operative," "post-operative"Preferred: "transition"Referring to a sex change operation, or using terms such as pre- or post-operative, inaccurately suggests that one must have surgery in order to transition. Avoid overemphasizing surgery when discussing transgender people or the process of transition. Gay & Lesbian Alliance Against Defamation. (n.d). Transgender Glossary of Terms. Retrieved January 15, 2014 from www.glaad.org/reference/transgender

40. Defamatory Terms Defamatory: "deceptive," "fooling," "pretending," "posing" or "masquerading"Gender identity is an integral part of a person's identity. Do not characterize transgender people as "deceptive," as "fooling" other people, or as "pretending" to be, "posing" or "masquerading" as a man or a woman. Such descriptions are defamatory and insulting. Defamatory: "she-male," "he-she," "it," "trannie," "tranny," "shim," "gender-bender"These words only serve to dehumanize transgender people and should not be used. Defamatory: "bathroom bill"A new term created and used by far-right extremists to oppose non-discrimination laws that protect transgender people. The term is geared to incite fear and panic at the thought of encoun­tering transgender people in public restrooms. Use non-discrimination law/ordinance instead. Gay & Lesbian Alliance Against Defamation. (n.d). Transgender Glossary of Terms. Retrieved January 15, 2014 from www.glaad.org/reference/transgender

41. Kris Beck, Former Navy Seal http://www.youtube.com/watch?v=_zEgvuQPxgA

42. Clinical Competencies There are a wide rage of clinical competencies for working with LGBT population: -Human growth and development -Social and cultural foundations -Helping relationships -Group work -Career and lifestyle development -Appraisal -Research -Professional orientation Association for Lesbian, Gay, Bisexual, and Transgender Issues in Counseling. (2009, September 18). Competencies for Counseling Transgender Clients. Retrieved January 15, 2014) from www.algbtic.org/resources/competencies.html

43. Assumptions & Do not’s Don't make the transgendered feel 'fake' Don't assume that the transgendered are kinky Don't assume that the transgendered have a choice Do not judge a transgendered person based upon your own religious beliefs Do not assume that a transgendered person is mentally ill Do not assume that a transgendered person is a transsexual Do not assume that you can "cure" a transgendered person

44. Names, Pronouns, Descriptions Always use a transgender person's chosen name. Often transgender people cannot afford a legal name change or are not yet old enough to change their name legally. They should be afforded the same respect for their chosen name as anyone else who lives by a name other than their birth name (e.g., celebrities). Whenever possible, ask transgender people which pronoun they would like you to use. A person who identifies as a certain gender, whether or not that person has taken hormones or had some form of surgery, should be referred to using the pronouns appropriate for that gender. If it is not possible to ask a transgender person which pronoun he or she prefers, use the pronoun that is consistent with the person's appearance and gender expression. For example, if a person wears a dress and uses the name Susan, feminine pronouns are appropriate. It is never appropriate to put quotation marks around either a transgender person's chosen name or the pronoun that reflects that person's gender identity. Gay & Lesbian Alliance Against Defamation. (n.d). Transgender Glossary of Terms. Retrieved January 15, 2014 from www.glaad.org/reference/transgender

45. Transgender Addiction Treatment to include: Body image Grief and loss Sexual concerns Social isolation

46. Is there a difference to addiction counseling? There are unique elements that help Transgender clients live more fulfilling lives. Specific focus on core reasons behind the clients drug and/or alcohol use. These behaviors may be tied to stress or depression from being a transsexual, if so, then these need to be addressed in therapy. Possible history of physical or sexual abuse that leads to substance use.

47. Examples to include on Intake Forms Gender Identity: -Woman or Female -Man or Male -Trans-woman -Trans-man -Other Sexual Orientation -Gay/Lesbian -Heterosexual -Bisexual -Questioning -Other

48. How to be supportive Examine your own beliefs and feelings about sexual and gender identity. If you are comfortable with diverse sexual and gender identity, make the clients you are working with more comfortable and let them know it is “ok” to be who they are. Study the gender and sexual development models. Learn terms “heterosexism” and “homophobia” as well as shame due to this. Know the GLBT resources in your community.

49. Recommendations Be Educated Meet Transgender clients where they are Help Transgender clients be themselves Refer Transgender clients to resources Listen Ask Questions Encourage Transgender clients to get support from friends and family when possible

50. Can you can work with LGBT population? Important to do the following: Evaluate your own beliefs and feelings regarding LGBT issues and how these beliefs or feelings impact your work.   Obtain the appropriate training, experience, consultation, or supervision necessary to provide competent services to LGBT population.