Gay Couples Transitioning

1. z
Gay Couples Transitioning
Melanie Gonzalez, Stacy Arvizu, Adriana Sanchez

2. z
Gender Identity vs. Sexual Orientation

3. z

4. z
Transitioning Involves:
 Identifying as the opposite gender than the sex you were born –can create Gender Dysphoria
(DSM-V 302.85 (F64.1) ; file:///C:/Users/mcgon_000/Downloads/APA_DSM-5-Gender-
Dysphoria.pdf
 Individuals MUST receive diagnosis and be evaluated for Insurance (in CA) to cover
hormones/SRS

5. z
Assessing discomfort throughout development can help with
diagnosing Gender Dysphoria

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Transitioning Involves:
 Identification in the individual
 Exploration
 Choice to pass
 Passing full time vs. Part Time
 Hormones
 Hair removal procedures/Beautification procedures
 Personal Therapy (required)
 Legal name/sex changes on documents
 Breast Augmentation & Sexual Reassignment Surgery
(Tomita, 2016; Addison & Coolhart, 2015; Bettergarcia & Israel, 2018; Giammattei, 2015)

7. z
Transgender and non-binary clients may use pronouns that are new or
unfamiliar to their therapists – It will be important to be somewhat
educated on the main terms.
Therapists should generally be aware of the steps towards a full
transition – ie. presenting, hormones, legal name/sex changes, SRS
The World Professional Association for Transgender Health (WPATH)
and American Psychology Association (APA) are two helpful
organization that provide guidelines to better understand and provide
appropriate treatment for Transsexual, Transgender, and Gender
Nonconforming people.
Therapist should help connect both partners to support groups – one
for person transitioning and one for partner to process the transition
(Wpath, 2019)
Therapist Considerations

8. z

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Couples Therapy Considerations
 Transgender couple describes a relationship where one or more partner(s) identify as transgender.
 There is great diversity among transgender couples.
 Some couples may consist of one transgender partner with a cisgender partner, while other couples may include both
partners identifying as transgender or gender non-conforming (Bischof, Stone, Mustafa, & Wasmpuszyc, 2016).
 Couple therapy:
 Processing shock
 Focus on discussing the transition process
 Possible decreased sexual attraction
 The physical as well as emotional changes and adjustments
 Considering intersectionality
 Financial costs
(Addison & Coolhart, 2015; Bettergarcia & Israel, 2018; Giammattei, 2015; Knutson, Koch, & Goldbach, 2019)

10. z
z
Gay Couplehood to Straight/Queer/Other
Couplehood
Relationships will experience variety of changes as the
trans-identified partner considers transitioning
meanwhile the relationship itself begins to transition as
well.
Although some couples may desire divorce and
separation that is not necessarily the case for everyone.
In one study, less than half (45%) of respondents
reported their partner relationship ending because of
disclosing their gender identity.
Couples may note that while there may be changes in
sexual attraction and desire, their bond as partners may
still be strong.
Couples may desire to navigate the process as a unit,
focusing on a continued level of exploration and support
of each other .
(Gamarel et al., 2014; Grant, Mottet, Tanis, Harrison, Herman, & Keisling,
2011; Nealy, 2008).

11. z Transgender Couples identity Considerations
https://youtu.be/WKndya58NHc

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Family Considerations
 Couple may experience cut off from some or all-family members due to identify
disclosure
 Grant and colleagues (2011) reported that 57% of transgender or gender non-
conforming participants experienced some rejection by their families, while 40%
experienced cut-off form their families after disclosure.
 Same study reported that family rejection had also been correlated with several
negative outcomes such as homelessness, poor health, and suicidal attempts (as
clinicians this is a very vulnerable population that is in need of support )
 Transgender couples with children can also receive positive or negative support
following disclosure.
 (Grant, 2011; Green, 1998; Malpa)

13. z
Transgender Affirmative therapy embraces a positive view of Transsexual, Transgender, and Gender
Nonconforming people. An Affirmative practicing therapist takes a non-pathologizing stance towards
gender non-conforming people in that gender is considered on a fluid spectrum
Social support and community building are very important for reducing the sense of isolation that
many transgender persons and their partners may experience.
Individual, couple, and group therapy can enhance social support for the transgender person,
partner, and children of transgender parent.
Group therapy can serve as a safety zone for transgender person and family members
Such groups can provide useful information about medical, cosmetic, and legal steps in
transition process.
These groups can help foster hope and support for dealing with non-accepting
environments and other challenges that transgender and their families may
encounter .
(Malpas, 2011).
Treatment
Recommendations

14. VIDEO: Dating While Transitioning
https://www.youtube.com/watch?v=tcXoNgL65Eo

15. Personal Experiences
- Full transition can impact a stable relationship
- Sexuality can begin to be questioned by partner
- Support vs. Curiosity

16. Resources
For Clinicians and Clients:
• https://www.apa.org/practice/guidelines/transgender.pdf
• http://www.transhealth.ucsf.edu/
• https://www.lgbthealtheducation.org/topic/transgender-health/
• National Center for Transgender Equality at transequality.org
• http://transstudent.org/gender
• https://www.glaad.org/transgender/resources
• https://transgenderresources.wordpress.com/resources/
• https://www.plannedparenthood.org/files/4414/0606/9716/PPSFL_Providing_Transgender_Inclusive_Healthcare_H
andbook.pdf

17. z
Questions
1. In thinking about multicultural, international or refugee couples, what are other considerations a
therapist might consider with trans couples?​ How might culture impact a person’s decision to stay or
leave a relationship where their partner decides to transition?
2. As a therapist that might end up working with a trans couples, you may be providing individual,
couples, or family therapy where at any point a loved one may challenge if the client is “really
transgender or going through a phase”. How might you best assist the client and the family in this
scenario? What recommendations or specific treatment approaches you might take?
3. How do we support married couples where one partner has fully transitioned and the other
partner begins to question their own sexuality and are leaning towards divorce?

18. References
Addison, S. M., & Coolhart, D. (2015). Expanding the Therapy Paradigm with Queer Couples: A
Relational Intersectional Lens. Family Process, 54(3), 435–453. https://doi.org/10.1111/famp.12171
American Psychological Association. (2015). Guidelines for Psychological Practice With
Transgender and Gender Nonconforming People. American Psychologist, 70(9), 832-864. http://dx.doi.org/10.1037/a0039906
Bettergarcia, J. N., & Israel, T. (2018). Therapist reactions to transgender identity exploration:
Effects on the therapeutic relationship in an analogue study. Psychology of Sexual Orientation and Gender Diversity, 5(4), 423–431. https://doi.org/10.1037/sgd0000288
Bischof, G. H., Stone, C., Mustafa, M. M., & Wasmpuszyc, T. J. (2016). Couple Relationships of
Transgender Individuals and their Partners: A 2017 Update. Michigan Family Review, 20(1), 37-47. DOI: http://dx.doi.org/10.3998/mfr.4919087.0020.106
Garamel, K.E., Reisner, S.L., Laurenceau, J.P., Nemoto, T., & Operario, D. (2014). Gender minority stress, mental
health, and relationship quality: A dyadic investigation of transgender women and their cisgender male partners. Journal of Family Psychology, 28(4), 437-447.
Green, R. (1998). Transsexuals’ children. The International Journal of Transgenderism, 2(4). Retrieved from
https://www.acthe.fr/upload/1445876170-green-r-1998-transsexuals-s-children.pdf
Giammattei, S. V. (2015). Beyond the Binary: Trans-Negotiations in Couple and Family
Therapy. Family Process, 54(3), 418–434. https://doi.org/10.1111/famp.12167
Knutson, D., Koch, J. M., Goldbach, C., Knutson, D., Koch, J. M., & Goldbach, C. (2019).
Recommended Terminology, Pronouns, and Documentation for Work With Transgender and Non- Binary Populations. Practice Innovations, 1–12. https://doi.org/10.1037/pri0000098
Malpas, J. (2011). Between pink and blue: A multi-dimensional family approach to gender nonconforming children
and their families. Family Process, 50(4), 453-470.
Nealy, E. C. (2008). Working with LGBT families. In M. McGoldrick & K.V. Hardy (Eds.), Re- visioning family
therapy: Race, culture and gender in clinical practice (4th ed., pp. 289– 299). New York: Guilford.
Tomita, K. K. (2016). Gender-Affirming Medical Interventions and Mental Health in Trans
Adults. (Proquest Dissertation), 6(2), 182–193.
Wpath, 2019. WPATH World Professional Association for Transgender Health. Retrieved from
https://www.wpath.org/