1. Psychological support and psychotherapy for transpeople
Elsa Almås
Specialist in clinical psychology
Specialist in clinical sexology (NACS)
Family therapist (IAP)
Professor in sexology University of Agder
Esben Esther Pirelli Benestad MD

2. Our background Clinical work with trans clients since the 1980´s
Participation at sexological congresses since 1978:
WAS (World Association for Sexual Health)
WPATH (World professional Association for Transgender Health)
EFS (European Federation for Sexology)
NACS (Nordic Association for Clinical Sexology)
And others

3. THEORIES ABOUT SEX AND GENDER

4. Paradigm shift
From Psychosexual disorders to Conditions related to sexual health
From gender binarity to multiple genders, third gender, gender fluidity and non-gender
From medical (psychiatric) diagnosis to self determined legal gender
From gate-keeping to gender affirmative treatment

5. Standards of Care (SOC)
For others, changes in gender role and expression are sufficient to alleviate gender dysphoria.
Some patients may need hormones, a possible change in gender role, but not surgery;
Others may need a change in gender role along with surgery, but not hormones.
In other words, treatment for gender dysphoria has become more individualized.

6. OUR APPROACH

7. Addressing the clients’ wishes and needs
Explore, qualify and expand the clients’ reasons for seeking assistance.
Assist the clients in qualifying their transe-talents or talents linked to gender/non-gender.
Being a good “shopkeeper” goes beyond handling only that which is asked for.

8. Who are our clients and what problems do they have?
People of all ages, their parents, children and partners
Trans clients have less psychological problems
Trans clients are more characterized by pride, competence, higher education, better networks
Psychological problems have a tendency to disappear as the gender issues are addressed
Typical problems are social phobias, shame, depression – Asperger talents (Autism spectre)
Many adult clients (MtF) are in a great hurry because they feel they have waited too long.

9. The PLISSIT model

10. The bio-psycho-social model by George Engel (1980)

12. Ung eller gammel?

13. Bio-psycho-social approach
Biological level: What is happening to your body?
Psychological level: What is your experience?
Wishes and needs
Sexuality
Social level: The need to belong is a basic human need.
Belonging arises as result of an interaction between our inner world and the world around us.
The need to belong as gender is a deepening of the concept of belongingness.

14. Good gender belonging
Good gender belonging arises when we are perceived by others in the same way as we perceive ourseves,
and when that which is perceived is given a positive value.

15. Gender identity as a talent
We regard gender identity as a result of an inborn, hard-wired entity, in interaction with cultural offers.
We name this “trans-talents”

16. Some possible gender options:
Female genders Male genders Intersex genders Transe genders Non-genders or gender dismissers Personal/floating/queer genders Eunuch genders More are welcomed

17. Goals of assistance The overall goal is positive gender belonging
Discuss “Full” transition – as an objective measure
Discuss “Full” transition - as a subjective measure
Individual solutions
Uncover individual wishes and needs
NB: Self experience often change over time and with increased knowledge about options!

18. Esthetics: What is a beautiful person?
Trans-esthetics
Non-gender esthetics
Intersex-esthetics
Other gendered esthetics
Non gendered beauty

19. Gender pride
Inspire the clients to perform and practice gender in accordance with their wishes and needs.
Assist clients in discovering and exploring personal qualities in order to conserve as many present and possible future capasities as possible.
Promote gender pride - including trans-pride, intersex-pride, non-gender pride.
When not utterly chauvinistic, pride battles shame and cultural resistance.

20. Shame and guilt
Assist the clients’ exploration of shame. Detect the origin of shame.
Battling shame is achieved by transforming shame to guilt and then addressing the guilt where it belongs.
Assist the clients to accept the basic build of their bodies in order for them not to forget what kind of body they have (some men get pregnant, and some women get prostate cancer) .

21. Traumatization
Trauma as result of acute violence and sexual assault (rape)
Complex trauma: Result of neglect
Trauma of retention: «Nobody must know!»
In all variants of traumatization, the result is that too much energy is used to protect oneself, and the flow of consciousness is trapped.

22. Sexuality
Assist the clients’ sense of and contact with organs of erotic pleasure - pleasure has no gender!
Explore learned sexual turn-on patterns.
Sex organs are for private joy - and thus not so important in the everyday performance of gender.
Options for sexuality with partner

23. Addressing the outer world
Helping those who are or may be disturbed (families and network)
Free parents from guilt
Address challenges facing present and future partners.
Work with significant and extended networks to increase their capacity to build a positive perception of the atypically gendered.
Use of language: NB: Pronouns!

24. Cultural work
Organize groups and networks based on people of atypical gender/non-gender, their family, partners and friends to create strongholds for human diversity
Give talks and lectures to groups that may find insights on gender interesting or useful (second order of therapy: i.e working with an audience that actively seek the information)
Use media (third order of therapy) in conveying multi-gender positivity.

25. Information about treatment offers
Give updated information about optional medical and surgical treatment
Find the right health providers

26. Euphoria! Good gender belonging is gender euphoria!

27. elsa.almas@uia.no esben.esther@uia.no

28. elsa.almas@uia.no esben.esther@uia.no

29. Thank you! elsa.almas@uia.no esben.esther@uia.no