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Integration of Coaching Psychology in the Process of Gender Transition

Integration of Coaching Psychology in the Process of Gender Transition



Presentation describing cognitive behavioural approach to coaching. The talk at the Clinical Meetings in Human Sexuality, April 15, 2010, The Porterbrook Clinic, NHS Sheffield Health and Social Care, ...

Presentation describing cognitive behavioural approach to coaching. The talk at the Clinical Meetings in Human Sexuality, April 15, 2010, The Porterbrook Clinic, NHS Sheffield Health and Social Care, UK.



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    Integration of Coaching Psychology in the Process of Gender Transition Integration of Coaching Psychology in the Process of Gender Transition Presentation Transcript

    • Integration of Coaching Psychology in the Process of Gender Transition
      • 15.4.2010
      • Clinical Meetings in Human Sexuality
      • The Porterbrook Clinic
      • Sheffield Health and Social Care
      • Dr Dasha Grajfoner CPsychol MSCP Accred
    • Individuals with Gender Dysphoria
      • 35% Anxiety
      • 44% Depression
      • 4 times more likely to self harm and attempt suicide (Bockting, 2008)
    • Some Reasons
      • Bullying in school (over 50%) ( Reed et al, 2008)
      • Social isolation
      • Poor social integration
      • Lack of social support
          • All leading to lower
              • Self esteem
              • Self-efficacy
              • Self perceived abilities ( Bandura & Schunk , 1981; Lombardi, 1999).
    • Consequences
      • Transsexuals are four times more likely to use medical services (Kouzis & Eaton, 1998).
      • Difficulties finding/returning to employment
    • Transsexualism
      • Gender identity different from biological sex as defined at birth (DSM-IV, 1996)
    • What is Gender Transition (GT)
      • Medical
      • Interactional
      • Social or relational
      • Sexual
      • Emotional
      • Cognitive
      • Behavioural (Cohen-Kettenis & Gooren, 1999)
    • How can we help?
    • We Know That
      • Group cognitive behavioural therapy decreased anxiety and depression
      • Group members reported sessions to be empowering and affirming (Maguen et al., 2005).
    • We Also Know That Coaching Psychology
      • Aims to enhance life experience and increase wellbeing by adopting psychological theories (Palmer & Whybrow, 2007; Grant, 2007)
      • Provides structured framework to encourage individuals to explore their potential and deal with transitions and changes in life (Green et al., 2006)
      • Explore benefits of group Cognitive Behavioural Coaching (CBC) and goal setting for transsexuals
      • Applying coaching psychology to identify and assist with issues associated with
        • Wellbeing
        • Psychosocial adaptation and integration
      Our Attempt
    • Today
      • 4 stage Model of transition - ADAM (Grajfoner, 2009)
      • Goals, progression and evaluations from a coaching course
      • My experience of running the programme
    • 4 Stage Model of Transition (ADAM) AFFIRMATION Identify sustainable gender role Identify supportive environment DISCLOSURE Develop coping strategies Assist with disclosure Develop/implement transition plan MAINTENANCE ADJUSTMENT Career coaching Sexuality, relationships Passing, social adaptation Ageing as transsexual Lifelong health, employment, relationship coaching Post-transition disclosure
    • Structure of the Course Week Participants Activity Details 1 Introduction, problem identification and course plan 2 Individual goals, keeping journal, goal implementation by planning actions. 3 Exploring alternatives, options and consequences (motivation imagery and restating the chosen goal) 4 Core beliefs and values exercise. Relevance for self esteem and self efficacy in relation to the chosen goal. 5 Listening skills and questioning (role playing with emphasis on positive experience - practice for real life situations). Revision of goal implementation by reflecting on progress with individual action plans. 6 Evaluation of individual progress: How to focus and what distracts you. Addressing the fear of not passing. 7 Conflict management. Evaluation and revision of goal setting scale. 8 Discussion on the individual progress of the participants and on future actions related to the chosen goal. 9 Course evaluation and social event.
    • Participants
      • Course 1: 6 male to female transsexuals
      • Course 2: 8 male to female transsexuals
      • Course 3: 4 female to male transsexuals
    • Results
      • Goals
      • Significant progress between week 2 and week 7 (t = 4.583; p<0.05) and between week 1 and two years later (t = 5; p<0.05)
      • Evaluation
    • Goal Setting Scale Not achieved at all Fully achieved
    • P1: To come out to a friend/boss (S1,2)
    • P2: To create “coming out” information pack for relatives (S2)
    • P3: To be less anxious about interacting with other people. To improve my female appearance (S3)
    • Evaluation 0-Not at all 7-Very/Definitelly
    • What Did You Enjoy?
      • P1: “The honesty of the group (Social Acceptance) . I liked to be challenged with the goal setting, it really made me look at myself and come to decisions ” (Affirmation).
      • P2: “Opportunity to share goals/experiences with other TS women at different stages in transition in a positive way (Social Acceptance) . Opportunity to discover my core values and use them to inform my transition and vice versa” (Disclosure).
      • P3: “Picking core values. Technique of focusing on a goal. Drawing at the 5-year plan. A positive boost to see the future. Group support in all the above (Social Acceptance). Leadership from you – confidence.”
      • P4: “Learning more about myself. Meeting people like me (Social Acceptance) . Challenging some of my beliefs.”
    • What Did You Gain?
      • P1: “My self acceptance . I was very confused but (the course) has helped me come to realise I am TS and need to transition” (Affirmation).
      • P2: “ Confidence . An understanding I am on the right path; A sense that where I want to go is achievable.” (Disclosure).
      • P3: “Improvement in confidence ” (Adjustment).
      • P4: “Seeing myself more clearly” (Affirmation).
    • Which Other Issues Could be Addressed in a Similar Course?
      • P1: “...practical things like name change, medical, documents, work. ...family/ friends workshop without us being there, to allow them to get info and practical advice.” (next stage: Disclosure).
      • P2: “Assertiveness; Responding to hostility from people; responding and dealing with fertility issues” (next stage: Adjustment).
      • P3: “Learning to love yourself; learning to trust yourself; giving yourself the right to be the person you are” (next stage: Maintenance).
      • P4: “... a physical course run in conjunction with managing change concerning make-up/ personal safety/ going out…” (Adjustment).
    • Goal and Evaluation Summary
      • Participants’ concerns: disclosure and various aspects of social acceptance and integration
      • Four stage model of transition corresponds to participants’ goals and future expectations
      • Significant progress on goal achievement in five weeks and over two years
      • Course positive impact on gaining clarity about transition and increased confidence and happiness about the future
    • Summary
      • Participants’ feedback is coherent with previous findings reporting lower anxiety and depression during and after group cognitive behavioural therapy by Maguen et al. (2005)
    • Summary
      • Importance of social feedback , group acceptance and to be mirrored and validated by individuals in a similar position
      • Social isolation and lack of social support contribute to mental health issues, lower self esteem and self efficacy (Bandura & Schunk, 1981; Lombardi 1999)
    • Is There a Need For Coaching Psychology in GT?
      • Participant feedback indicates the need for it
      • Well informed decisions and well prepared transition plan with social support will increase integration, well-being and self efficacy
      • Results coherent with definition of coaching psychology: “Enhancing life experience and wellbeing” and “Dealing with transitions and changes in life”
    • Coaching Psychologist
      • Clarify whether transition is the right choice
      • Coordinate and execute transition plans and disclosure
      • Psychological adjustment and social integration.
      • Prevent mental health problems and thus decrease the use of medical services.
    • My Observations
      • Start
        • Low self confidence
        • Fear of being ridiculed and rejected
        • Fear of not integrating
        • Looking for coping mechanisms
        • Incongruence between emotions, cognition and behaviour
    • My Observations
      • End
        • Group support of significant importance
        • Positive outlook
        • Clarity
        • Coping tools
    • My Observations
      • Success depends on group coherence regarding the stage of transition (Use of ADAM to determine)
      • Prevention role of group coaching
      • Group processes effective component in the course
    • Recommendations
      • Group coaching available to individuals in Affirmation stage
      • Measure short and long term benefits
      • Reliability and validity of ADAM
      • Toolkit for individual/group use (DVD, workbook)
      • Potential of extending ADAM and Managing Change approach to people going through other types of emotional/ social changes
    • Work in Progress
      • Two courses (MtF and FtM) that included pre and post coaching measurements of:
        • General wellbeing (Edin-Warwick Scale)
        • Depression (Beck’s Depression Inventory)
        • Anxiety (Hospital Depression and Anxiety Scale)
        • Suicidal thoughts (Meltzer et al.)
    • Acknowledgments
      • LGBT Centre for Health and Wellbeing Edinburgh
      • Dr Douglas Young, Chartered psychologist, Accredited coaching psychologist
      • Dr Lyndsey Myskow, Gender specialist