Integration of Coaching Psychology in the Process of Gender Transition

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

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Integration of Coaching Psychology in the Process of Gender Transition

by Dr. Daša Dasha Grajfoner on Apr 17, 2010

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