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Person-Centred Counselling for Trans and Gender Diverse People: A Practical Guide (2019) by Sam Hope, London: Jessica Kingsley Publishers. ISBN: 978-1785925429 (pbk).

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Reviewed by:
John Refshauge

 

John Refshauge, M.Prof.Psych. (Monash University), currently works as a psychologist in the employment area. John identifies as cisgender and queer.

 

Book Review

Sam Hope has produced a helpful resource for counsellors working with trans and gender diverse clients. Hope identifies as a non-binary trans person. They are a U.K.-based therapist experienced with gender diverse clients. They are also a gender diversity trainer and trans community organiser. The book is targeted at a counsellor audience who want to better understand trans clients and provide trans affirming counselling.

This guide is about trans and non-binary people who struggle to live within the restrictive gender binary. Hope is a passionate advocate for trans people and encourages us to confront the ingrained biases that can limit our ability to be trans inclusive.  They combine lived experience and effective argument so we can understand and better respond to the counselling needs of trans clients.

Although trans people are increasingly visible, counsellors may unwittingly stigmatise or delegitimise trans clients through of lack of understanding or pervasive transprejudice. Hope’s guide offers both the knowledge and strategies to counter misunderstandings so trans people can find counselling a welcoming and safe space.

The guide touches on “hot button” issues, such as “the bathroom debate,” “rapid onset gender dysphoria,” “trans kids,” and “de-transition”. However, the guide’s primary focus is on the multiple barriers trans people face. Based on personal experience and a wide knowledge of the literature, Hope’s guide increased my confidence to be trans inclusive.

This guide offers a contemporary view of trans issues and includes space for non-binary identities. The guide’s strength is that it views trans issues through a resolute person-centred lens. Hope is part of an inspiring trend of gender diverse people writing about gender diversity. The book is U.K.-centric and some content does not transfer to an Australian context.

Hope’s guide is divided into nine chapters, well supported with references often by trans academics. The chapters discuss gender, being trans, transitioning, neurodivergence, minority stress, Hope’s web model, trans sexuality, and counselling “dos and don’ts”. The guide has a passionate, combative style that mostly flows well, although due to the quantity and intensity of the content some sections appear crowded.

Each chapter finishes with a “personal reflection” and a case study that are valuable additions. The personal reflections encourage us to sit with uncomfortable ideas and question our beliefs about gender. The case studies present complicated vignettes to demonstrate various aspects of person-centred trans counselling, such as expecting complexity, resisting diagnosis, and trusting trans self-experience.

Hope describes the difference between assigned gender and identified gender; trans people do not identify with the gender they were assigned at birth, while cisgender people do identify with the gender they were assigned at birth. Non-binary people might identify as neither male nor female. When trans people do not identify with their assigned gender they often feel incongruence, which can be relieved through social and medical transition. The desired treatments will change from person to person and not all trans people experience incongruence or require treatments.

The “trans” label covers a variety of experience at odds with assigned gender. Cross dressing, drag, non-binary identities, people who medically transition, trans men, and trans women, can all fit under an inclusive trans umbrella. They may all be in different levels of transitioning, and with different goals.

Trans people often experience an “exhilarating feeling of rightness” when they are better aligned to their gender. Hope details many ways trans-affirming counsellors can support their clients. For example, using correct pronouns gives a sense of being seen, whereas misgendering negatively impacts mental health. 

Hope details transition options, including hormone therapy and surgery. They suggest person-centred counsellors do not make judgements or offer opinions about what trans clients should or should not do, feel, or be (e.g., by suggesting a trans woman should not have a penis).  Therapy is a place where everyone  should be able to be themselves.

They address the issue of neurodivergence, such as autism “and other body and brain quirks” that often co-occur with gender diversity. Hope argues that the idea that trans identity is a “symptom” of neurodivergence delegitimises trans identity, that trying to “cure” trans people is abhorrent, and that we should celebrate all divergence as enriching human experience. Hope want us to acknowledge a social hierarchy that places trans lives below cisgender lives, and that this is internalised by trans people and counsellors alike. The central task of being person-centred with trans clients is equalising these power differences, according to the author.

The minority stress model proposes that the mental health of trans people is adversely affected by their hostile social environment, and Hope provides disturbing figures on trans mental health. Importantly, most trans people say they have benefited from being trans, and evidence suggests that mental health often significantly improves post transition.

The web model for working with trans people proposes that people “heal through relationships” and that minority stress damages the “social threads” that connect trans people. The web model is about building and repairing social webs, through connecting to the trans community, addressing internalised transprejudice, and encouraging connection to family (if possible).

Hope asks us to learn about our clients’ sexualities and reminds us that human sexual interest is very diverse. If sex is safe and consensual, we should not judge the type or amount people are having. Hope is unapologetic about the frustration and confusion their book may create. They are optimistic we will gain insight about ourselves and become excited about diversity. They encourage us to make space for people to talk about gender in therapy as it is often overlooked. However, trans people deserve competent therapists and should not feel they are our educators. Hope reminds us that trans people come to therapy for many reasons other than their transness and it is painful when therapists reduce everything to their trans identity. Although the guide does not address specific “mental health presentations,” the author believes once we can clear away our biases and assumptions, trans people are people, and our general counselling knowledge should be enough.

I was surprised that a counselling guide had such a strong social focus. However, it is appropriate as the obstacles to trans self-expression often come in the form of exclusion, and the biases of cisgender privilege. It is so refreshing to read a counselling guide that asks us to imagine a world where trans identity is fully supported and accepted. Reading this guide has given me a deeper understanding of what it means to be person-centred and trans-inclusive.

 


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