Mom of Six needing Career Advice

[Rain Sova]

Transgenderism in children, Christian therapists.

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[Sanman]

I have read hundreds of “lcsw vs psyd” threads…. Please bear with my slightly unique (I think) situation..

When I was 14, I decided I would be a Clinical Psychologist. But then, I had been set on becoming an LCSW since I had one at 19 as a teen mom.

I am passionate about *teen mothers* and *children with ptsd* as well as faith-based ministry.

The Boy Who Was Raised as a Dog is one of my favorite books thus far.

I am now 33, my husband and I have six kids. He is in construction. I switched from my BSW program to a Behavioral Health one because I did not feel like I could adequately tackle the questions about gender dysphoria, such as “how would you support a minor during their sex change?” I am just being transparent, (so please do not jump all over me) as a Christian and a mother I was not in a place for that. So I switched to Evangel. Now, with my Behavioral Health undergrad, I am looking into masters to psyd or msw to lcsw. Of course I could have saved time with the BSW to MSW track. But here I am. I am aware transgenderism will come up again so I don’t want this to become the focus of my post – it is just background. I worked at a non-profit for mentally disabled adults and absolutely loved it but I had to take a higher paying job to make ends meet and I was crushed.

I did look at Wheaton College psyd for a cool 45k a year.

It sounds like MSW to LCSW is the “Easiest route” (although it is still of course work and internships, an exam etc, they don't just hand out MSWs and Licenses) but my heart is in psychology specifically. I would like to be able to do testing (I paid about 1200 to have my son’s psychological testing done and there was a six month waiting period. That is the extent of my experience with it).

I ma terrible at math, I love writing and have won contests and such… I also wonder if a funded PhD, should I be accepted, would be more math-heavy than PsyD. I know we all must do stats and such.

What would you do? I am older, it is a huge commitment and I hate to settle because unlike others I may not have time for a “second career”.

My kids are my absolute world as well and people make it sound like a PsyD program is not just 8 hours a day but like 20 hours a day haha

I want to put the work in and be realistic. I also know that risk/reward (debt/salary potential) is a bigger concern for me with all these kids.

I truly appreciate any feedback.

Given everything you have said, have you looked into a faith based counseling degree? Outside of the PsyD vs MSW issue, both fields hold stances related to treating and advocating for LGBTQ+ individuals that might make you uncomfortable. What is your plan if you are given such an individual as a counseling/ case management client?

The other question is, with six children, how much time do you realistically see yourself devoting to school? How flexible do you need it to be (school pickups, babysitting, etc)? Can you relocate 1-2 times for internship and post-doc?

 

[Rain Sova]

Given everything you have said, have you looked into a faith based counseling degree? Outside of the PsyD vs MSW issue, both fields hold stances related to treating and advocating for LGBTQ+ individuals that might make you uncomfortable. What is your plan if you are given such an individual as a counseling/ case management client?

The other question is, with six children, how much time do you realistically see yourself devoting to school? How flexible do you need it to be (school pickups, babysitting, etc)? Can you relocate 1-2 times for internship and post-doc?

I have but it does seem more terminal if that makes sense? Also, they don't make me uncomfortable, I just don't agree with transitioning minors (and I have read literature from clinical psychologists that also argue against it) whearas it seems to be embraced in sw. ETA I am in Chicagoland where I am told internships abound. Our kids range from 17 to 5 months

 

[PsychPhDone]

.

I truly appreciate any feedback.

You can edit this post so that it's not hateful or offensive to colleagues or guests who are visiting this forum and are transgender, care about people who are transgender, or are merely ethical psychologists. I don't think we'd tolerate speech about "disagreeing" with any other protected group. Find a way to ask your question differently please.

 

[Rain Sova]

You can edit this post so that it's not hateful or offensive to colleagues or guests who are visiting this forum and are transgender, care about people who are transgender, or are merely ethical psychologists. I don't think we'd tolerate speech about "disagreeing" with any other protected group. Find a way to ask your question differently please.

This is not against transgenderism. This is very specifically against minors medically transitioning which is very controversial even among professionals. <---- added to post

 

[R. Matey]

I'll say it:

You shouldn't work in this field if you can't work with LBGTQ+ folks, teens or otherwise

period.

 

[Rain Sova]

I'll say it:

You shouldn't work in this field if you can't work with LBGTQ+ folks, teens or otherwise

period.

I knew this would unfairly become the focus of my post. I worked with LGBTQ at my nonprofit. I guess I have to be extra extra clear for those who are easily triggered or have knee jerk reactions.

 

[R. Matey]

I knew this would unfairly become the focus of my post. I worked with LGBTQ at my nonprofit. I guess I have to be extra extra clear for those who are easily triggered or have knee jerk reactions.

Not a trigger. Just a fact. Working with diverse populations is an essential component to competent clinical practice. Being selective because of a personal bias doesn't cut in the mustard.

 

[Rain Sova]

Not a trigger. Just a fact. Working with diverse populations is an essential component to competent clinical practice. Being selective because of a personal bias doesn't cut in the mustard.

Again, this is specifically about hormones, masectomies, etc when dealing with minors which some of them have regretted. Transgenderism is very popular in public middle schools according to ssw mentors of mine and I just think anything permanent should wait until age 18. Would you say I am the only one that feels that way in Human Servuces? Because I know I am not....

 

[R. Matey]

Again, this is specifically about hormones, masectomies, etc when dealing with minors which some of them have regretted. Transgenderism is very popular in public middle schools according to ssw mentors of mine and I just think anything permanent should wait until age 18. Would you say I am the only one that feels that way in Human Servuces? Because I know I am not....

I don't claim to know anything about peoples' personal opinions or their ability to practice competently, but consider this: in order to obtain the interventions you list, the patient often needs a letter of support from a mental health provider. Now suppose a teen comes to you asking for support for gender-affirming surgery. Could you support them based on your professional opinion?

 

[Rain Sova]

I don't claim to know anything about peoples' personal opinions or their ability to practice competently, but consider this: in order to obtain the interventions you list, the patient often needs a letter of support from a mental health provider. Now suppose a teen comes to you asking for support for gender-affirming surgery. Could you support them based on your professional opinion?

My opinion would never back gender-affirming surgery in a minor child. I would be curious how other psychologists who are not in favor of minors undergoing these surgeries would handle it, and I would love more education on the topic.

 

[R. Matey]

My opinion would never back gender-affirming surgery in a minor child.

And that's not a clinical opinion, I take it. Hence, your problem.

 

[Rain Sova]

I don't claim to know anything about peoples' personal opinions or their ability to practice competently, but consider this: in order to obtain the interventions you list, the patient often needs a letter of support from a mental health provider. Now suppose a teen comes to you asking for support for gender-affirming surgery. Could you support them based on your professional opinion?

My opinion would never back gender-affirming surgery in a minor child. I would be curious how other psychologists who are not in favor of minors undergoing these surgeries would handle it, and I would love more education on the topic.

And that's not a clinical opinion, I take it. Hence, your problem.

Lol.... because I'm not a clinician? Also,I feel like you are intentionally ignoring the fact that many clinicians are against children undergoing gender affirming surgery. Its really hijacking the post and I would rather not keep engaging over this minute detail (one type of surgery for a minor population- maybe I'll work with adults 🤷‍♀️)

 

[R. Matey]

My opinion would never back gender-affirming surgery in a minor child. I would be curious how other psychologists who are not in favor of minors undergoing these surgeries would handle it, and I would love more education on the topic.

Lol.... because I'm not a clinician? Also,I feel like you are intentionally ignoring the fact that many clinicians are against children undergoing gender affirming surgery. Its really hijacking the post and I would rather not keep engaging over this minute detail (one type of surgery for a minor population- maybe I'll work with adults 🤷‍♀️)

"Many people do/think x...therefore it's valid" is a weak, fallacious argument that ends in us squabbling over quantities. That misses the point. The point is that your pre-existing views may impact important treatment decisions that you may be in a position to make. It's central to the point because the world needs less, not more biased clinicians.

Edit: and choosing not to take on LBGTQ+ youth because you don't want to is a treatment decision that, arguably, further disenfranchises an already very marginalized group by contributing to fewer treatment options.

 

[foreverbull]

Forewarning, this will be long, but this is one of my interest areas.

There are 3 different models to treatment of trans kids (“watchful waiting,” gender-affirming, and basically gender-denying "live in your own skin" is the third). In the US, prevailing practice is somewhere between watchful waiting and gender affirming in psychology, although it's shifted pretty quickly over the past decade toward affirming (affirming also says society needs to change around us to embrace gender-variance of all kinds).

Some detractors of childhood transition cite a well-known, poor methodology study that says ~2/3 of gender dysphoria kids "desist" and most later identify as gay instead and have no gender dysphoria as adults, but these were mostly male children who were effeminate when young, which alarmed the parents, who took them to "gender clinics" and some of the kids didn't even fit criteria for gender dysphoria per the DSM in the first place. The study also counted children who dropped out of the study as "desistors," which is a HUGE mistake and faulty science. But this study is often cited and very popular amongst the anti-transition crowd.

Research has supported the notion that if the dysphoria in childhood is consistent, pervasive, and the child also consistently identifies as the opposite gender (i.e. biologically-born female says "I am a boy" when asked "are you a boy or a girl?") gender dysphoria is likely to persist into adulthood and worsen without transition. Kids who say "I WISH I was a boy" may not have persistent gender dysphoria. Only the most competent specialists should be evaluating the children to differentiate social contagion and sexual orientation confusion with true gender dysphoria.

Those who believe in the "live in your own skin" model (i.e. tell the child to stop talking like that, encourage gender-specific toys and dress and pronouns and deny that their concerns are a lasting issue) should not be working with children because they are likely to cause harm in terms of psychotherapy outcomes.

For those who believe in watchful waiting, that one is trickier but not necessarily unethical if you are not asking the children to deny their internal identity and can wear what they please and go by preferred pronouns. But you do risk irreversible physical changes at puberty that may lead to further dysphoria. You also have the chance to watch them over the course of several years, which could be a positive if they do not have pervasive dysphoria and you do not want to risk possible sterility from hormones. It has pros and cons.

Research on longterm outcomes with children is scant right now; however, many studies have supported the premise that psychosocial outcomes improve for the vast majority of adults post-transition, with "transition regret" as low as 0-2% in the biggest studies with adults in Europe. Newest meta-analysis: 1%. There is a large body of research supporting transition as an effective intervention at this point, but as I mentioned, for adults. Less is known about longterm outcomes for kids who medically transition.

It is very complicated and nuanced even for those of us who are well-versed in the research, and it does not help when non-psychologists/nonspecialists (JK Rowling, etc.) share their "expertise" about cherry-picked research and anecdotes and others do the same on social media as if they are experts on the topic. "Detransition" has gained traction in social media but is purely anecdotal and not based on research. That said, people who want to study "detransition" have also faced backlash at times or told they should not do so by their universities, so it's gotten extreme going both ways at times. We need research on all fronts to understand all aspects of medical/physical transition.

As I said, research thus far has not supported a large percent of transition "regretters" (see above). That said, factors such as a person having comorbid disorders (gender dysphoria + a personality disorder, etc.), surgical complications, or internalized sexism/homophobia create a higher likelihood of transition regret, which is expected. Ultimately, experts who know the children very well and over time and asking the right questions should be the ones to support the child/family in making these kind of life-changing decisions.

If you worked with a child who had all of the consistent markers for pervasive gender dysphoria over time and the child was working with a gender team at a hospital, I would hope there would be some openness to understanding the situation on a case by case basis and allowing for some flexibility to support them in their journey--at least being open to the possibility that puberty blockers and/or surgical transition could be the best option in some cases, not necessarily all.

On the flipside, if the parents are pushing transition really hard and the child is ambivalent and doesn't seem to be experiencing pervasive/intense dysphoria but just confusion, that should be red flag and a sign to evaluate further. The parents should not be the ones pushing hard for it--there are some rare cases in which parents don't want their child to defy gender norms and would prefer physical transition to their child being seen as violating gender roles.

 

[futureapppsy2]

OP, reading your posts, I think the broader concern is not particularly gender-affirming surgery for minors (which is pretty rare anyway), but the general tone with which you refer to LGBTQ+ people (e.g., "transgenderism," referring to them as "LGBTQs", not "LGBTQ people," etc), which can read as homophobic/transphobic. That said, there are PsyD programs that teach non-LGBTQ+-affirming psychology (Regent, Azusa, Biola, Wheaton, etc), so it is possible to get such education if you really want it. There's an interesting question here on if such training is evidence-based, as the psychological evidence we have overwhelmingly supports the benefits of transition, including social transition for children, for transgender people,

 

[Seven_Costanza]

May I ask what you mean by the following?

"I switched from my BSW program to a Behavioral Health one because I did not feel like I could adequately tackle the questions about gender dysphoria, such as “how would you support a minor during their sex change?” I am just being transparent, (so please do not jump all over me) as a Christian and a mother I was not in a place for that. So I switched to Evangel. Now, with my Behavioral Health undergrad, I am looking into masters to psyd or msw to lcsw."

What is different now that you would want to return to a social work career where you will undoubtedly have to tackle gender dysphoria with patients? Especially given your interest in trauma.

 

[Rain Sova]

OP, reading your posts, I think the broader concern is not particularly gender-affirming surgery for minors (which is pretty rare anyway), but the general tone with which you refer to LGBTQ+ people (e.g., "transgenderism," referring to them as "LGBTQs", not "LGBTQ people," etc), which can read as homophobic/transphobic. That said, there are PsyD programs that teach non-LGTQ+-affirming psychology (Regent, Azusa, Biola, Wheaton, etc), so it is possible to get such education if you really want it. There's an interesting question here on if such training is evidence-based, as the psychological evidence we have overwhelmingly supports the benefits of transition, including social transition for children, for transgender people,

I think I was just rushing so I apologize. Also, Azusa has become affirming after protests and the Director of I believe Gender and Sexuality at Wheaton did an interview that sounded affirming. Thank you for your response!

 

[Rain Sova]

May I ask what you mean by the following?

"I switched from my BSW program to a Behavioral Health one because I did not feel like I could adequately tackle the questions about gender dysphoria, such as “how would you support a minor during their sex change?” I am just being transparent, (so please do not jump all over me) as a Christian and a mother I was not in a place for that. So I switched to Evangel. Now, with my Behavioral Health undergrad, I am looking into masters to psyd or msw to lcsw."

What is different now that you would want to return to a social work career where you will undoubtedly have to tackle gender dysphoria with patients? Especially given your interest in trauma.

Hi, thanks for your question! So what I mean is that I feel like social workers in my area encounter this more than the clinical psyd that I know plus I have more interest in the clinical side.

 

[Rain Sova]

Forewarning, this will be long, but this is one of my interest areas.

There are 3 different models to treatment of trans kids (“watchful waiting,” gender-affirming, and basically gender-denying "live in your own skin" is the third). In the US, prevailing practice is somewhere between watchful waiting and gender affirming in psychology, although it's shifted pretty quickly over the past decade toward affirming (affirming also says society needs to change around us to embrace gender-variance of all kinds).

Some detractors of childhood transition cite a well-known, poor methodology study that says ~2/3 of gender dysphoria kids "desist" and most later identify as gay instead and have no gender dysphoria as adults, but these were mostly male children who were effeminate when young, which alarmed the parents, who took them to "gender clinics" and some of the kids didn't even fit criteria for gender dysphoria per the DSM in the first place. The study also counted children who dropped out of the study as "desistors," which is a HUGE mistake and faulty science. But this study is often cited and very popular amongst the anti-transition crowd.

Research has supported the notion that if the dysphoria in childhood is consistent, pervasive, and the child also consistently identifies as the opposite gender (i.e. biologically-born female says "I am a boy" when asked "are you a boy or a girl?") gender dysphoria is likely to persist into adulthood and worsen without transition. Kids who say "I WISH I was a boy" may not have persistent gender dysphoria. Only the most competent specialists should be evaluating the children to differentiate social contagion and sexual orientation confusion with true gender dysphoria.

Those who believe in the "live in your own skin" model (i.e. tell the child to stop talking like that, encourage gender-specific toys and dress and pronouns and deny that their concerns are a lasting issue) should not be working with children because they are likely to cause harm in terms of psychotherapy outcomes.

For those who believe in watchful waiting, that one is trickier but not necessarily unethical if you are not asking the children to deny their internal identity and can wear what they please and go by preferred pronouns. But you do risk irreversible physical changes at puberty that may lead to further dysphoria. You also have the chance to watch them over the course of several years, which could be a positive if they do not have pervasive dysphoria and you do not want to risk possible sterility from hormones. It has pros and cons.

Research on longterm outcomes with children is scant right now; however, many studies have supported the premise that psychosocial outcomes improve for the vast majority of adults post-transition, with "transition regret" as low as 0-2% in the biggest studies with adults in Europe. Newest meta-analysis: 1%. There is a large body of research supporting transition as an effective intervention at this point, but as I mentioned, for adults. Less is known about longterm outcomes for kids who medically transition.

It is very complicated and nuanced even for those of us who are well-versed in the research, and it does not help when non-psychologists/nonspecialists (JK Rowling, etc.) share their "expertise" about cherry-picked research and anecdotes and others do the same on social media as if they are experts on the topic. "Detransition" has gained traction in social media but is purely anecdotal and not based on research. That said, people who want to study "detransition" have also faced backlash at times or told they should not do so by their universities, so it's gotten extreme going both ways at times. We need research on all fronts to understand all aspects of medical/physical transition.

As I said, research thus far has not supported a large percent of transition "regretters" (see above). That said, factors such as a person having comorbid disorders (gender dysphoria + a personality disorder, etc.), surgical complications, or internalized sexism/homophobia create a higher likelihood of transition regret, which is expected. Ultimately, experts who know the children very well and over time and asking the right questions should be the ones to support the child/family in making these kind of life-changing decisions.

If you worked with a child who had all of the consistent markers for pervasive gender dysphoria over time and the child was working with a gender team at a hospital, I would hope there would be some openness to understanding the situation on a case by case basis and allowing for some flexibility to support them in their journey--at least being open to the possibility that puberty blockers and/or surgical transition could be the best option in some cases, not necessarily all.

On the flipside, if the parents are pushing transition really hard and the child is ambivalent and doesn't seem to be experiencing pervasive/intense dysphoria but just confusion, that should be red flag and a sign to evaluate further. The parents should not be the ones pushing hard for it--there are some rare cases in which parents don't want their child to defy gender norms and would prefer physical transition to their child being seen as violating gender roles.

Thank you for this! I certainly was not trying to undermine anyone hence my hesitation with the assignments at my BSW program. I think the last paragraph of your post was along the lines of what I am referring to. I think that as a clinical psychologist you can potentially specialize whereas social work appears to be broad. So, if even after schooling and theoretically obtaining my license, if I don't feel equipped to handle gender surgery cases, or transgender youth, I would assume I could specialize in a different population? I would never turn anyone away, and I did not at my non profit job of course, but perhaps refer out?

 

[Seven_Costanza]

Hi, thanks for your question! So what I mean is that I feel like social workers in my area encounter this more than the clinical psyd that I know plus I have more interest in the clinical side.

Thank you for your response. I don't believe it is true that SWs are more likely to encounter LGBTQ+ youth than folks who hold doctorates, especially given the need for assessment in this population. And I don't think there is any way to protect yourself from working with this population as an SW or PsyD. My child psychologist friends all work with transgender youth often, and they live in a number of different areas of the country (MO, WI, AL, FL, CA, WA, etc). You mentioned the ability to specialize - there isn't really any specialty that I can think of that would preclude you from seeing transgender patients. Also consider that there will be teens who are not out yet, who may decide to disclose to their awesome, trusted therapist before they come out to their own families because they feel safer with them. What would you do in that situation?

I also think you should know that it is extremely difficult to stay in your preferred location throughout this process (grad school, internship, postdoc, etc). The large majority of us have to relocate at least once. You may want to consider whether relocation would be possible for you and your family when deciding which path to choose.

 

[Rain Sova]

Thank you for your response. I don't believe it is true that SWs are more likely to encounter LGBTQ+ youth than folks who hold doctorates, especially given the need for assessment in this population. And I don't think there is any way to protect yourself from working with this population as an SW or PsyD. My child psychologist friends all work with transgender youth often, and they live in a number of different areas of the country (MO, WI, AL, FL, CA, WA, etc). You mentioned the ability to specialize - there isn't really any specialty that I can think of that would preclude you from seeing transgender patients. Also consider that there will be teens who are not out yet, who may decide to disclose to their awesome, trusted therapist before they come out to their own families because they feel safer with them. What would you do in that situation?

I also think you should know that it is extremely difficult to stay in your preferred location throughout this process (grad school, internship, postdoc, etc). The large majority of us have to relocate at least once. You may want to consider whether relocation would be possible for you and your family when deciding which path to choose.

Thank you. I appreciate the honesty. I live in IL. I would like to work somewhere like this

Central DuPage Pastoral Counseling Center | Compassionate Support/Heart, Soul & Relational Care.

cdpcc.org

But I am not opposed to relocating if that doesn't happen. I don't know anyone who *wants* to stay in IL.
I appreciate your honest feedback, it's been helpful!

 

[futureapppsy2]

Thank you for your response. I don't believe it is true that SWs are more likely to encounter LGBTQ+ youth than folks who hold doctorates, especially given the need for assessment in this population. And I don't think there is any way to protect yourself from working with this population as an SW or PsyD. My child psychologist friends all work with transgender youth often, and they live in a number of different areas of the country (MO, WI, AL, FL, CA, WA, etc). You mentioned the ability to specialize - there isn't really any specialty that I can think of that would preclude you from seeing transgender patients. Also consider that there will be teens who are not out yet, who may decide to disclose to their awesome, trusted therapist before they come out to their own families because they feel safer with them. What would you do in that situation?

I also think you should know that it is extremely difficult to stay in your preferred location throughout this process (grad school, internship, postdoc, etc). The large majority of us have to relocate at least once. You may want to consider whether relocation would be possible for you and your family when deciding which path to choose.

Yes, this are both really critical issues--not all trans/sexual minority/queer people will tell that you at the door, and sometimes they may be unsure of it themselves and will want to disclose or work through their sexuality/gender identities in therapy after they've built a therapeutic alliance. Disclosing that to a therapist and having the therapist dismiss the topic, identity and/or client can be incredibly iatrogenic in multiple ways.

 

[Rain Sova]

Yes, this are both really critical issues--not all trans/sexual minority/queer people will tell that you at the door, and sometimes they may be unsure of it themselves and will want to disclose or work through their sexuality/gender identities in therapy after they've built a therapeutic alliance. Disclosing that to a therapist and having the therapist dismiss the topic, identity and/or client can be incredibly iatrogenic in multiple ways.

I can understand this point of view.

 

[Seven_Costanza]

Thank you. I appreciate the honesty. I live in IL. I would like to work somewhere like this

Central DuPage Pastoral Counseling Center | Compassionate Support/Heart, Soul & Relational Care.

cdpcc.org

But I am not opposed to relocating if that doesn't happen. I don't know anyone who *wants* to stay in IL.
I appreciate your honest feedback, it's been helpful!

That looks like a nice center. But again, working for a religious-based organization is not going to protect your from working with transgender youth. Many come from religious families, they may be devout themselves, and this can also be a source of distress for them (lack of acceptance is directly tied to gender dysphoria, etc) making it more likely that they would want to connect with therapy services. If your response to a minor disclosing their identity to you would be to reject it or want to change it or steer the conversation away from it, then this is not the field for you. Our most important principle in this field is to do no harm.

I appreciate you for being open to having this conversation.

 

[Rain Sova]

That looks like a nice center. But again, working for a religious-based organization is not going to protect your from working with transgender youth. Many come from religious families, they may be devout themselves, and this can also be a source of distress for them (lack of acceptance is directly tied to gender dysphoria, etc) making it more likely that they would want to connect with therapy services. If your response to a minor disclosing their identity to you would be to reject it or want to change it or steer the conversation away from it, then this is not the field for you. Our most important principle in this field is to do no harm.

I appreciate you for being open to having this conversation.

I appreciate your thoughts and sharing what you know! It has definitely given me much to think about.

 

[foreverbull]

Thank you for this! I certainly was not trying to undermine anyone hence my hesitation with the assignments at my BSW program. I think the last paragraph of your post was along the lines of what I am referring to. I think that as a clinical psychologist you can potentially specialize whereas social work appears to be broad. So, if even after schooling and theoretically obtaining my license, if I don't feel equipped to handle gender surgery cases, or transgender youth, I would assume I could specialize in a different population? I would never turn anyone away, and I did not at my non profit job of course, but perhaps refer out?

Yes, certainly you can specialize with another population and refer out to a gender specialist when a case is outside of your competence. It will get trickier in the situations @futureapppsy2 mentions, like children not disclosing this until they work with you and in the course of treatment. You’ll want to be prepared as this will likely happen at some point.

 

[Rain Sova]

Yes, certainly you can specialize with another population and refer out to a gender specialist when a case is outside of your competence. It will get trickier in the situations @futureapppsy2 mentions, like children not disclosing this until they work with you and in the course of treatment. You’ll want to be prepared as this will likely happen at some point.

Understood. I think this is inevitable in social work or psych or any human services field.

 

[R. Matey]

Resolution of EMU case confirms ACA Code of Ethics, counseling profession’s stance against client discrimination - Counseling Today

In December, after years of litigation, the court case Julea Ward v. Board of Regents of Eastern Michigan University was resolved.

ct.counseling.org

 

[R. Matey]

From NASW Code of Ethics:

4.02 Discrimination​

Social workers should not practice, condone, facilitate, or collaborate with any form of discrimination on the basis of race, ethnicity, national origin, color, sex, sexual orientation, gender identity or expression, age, marital status, political belief, religion, immigration status, or mental or physical ability.

 

[PsyDr]

I hear admissions committees don't have a lot of applicants who report a ton of limitations, and offer unsolicited disclosures about controversial subjects.

 

[foreverbull]

Resolution of EMU case confirms ACA Code of Ethics, counseling profession’s stance against client discrimination - Counseling Today

In December, after years of litigation, the court case Julea Ward v. Board of Regents of Eastern Michigan University was resolved.

ct.counseling.org

I think the prevailing message in all of this is that psychologists and psychotherapists are bound by ethical standards of practice which are evolving with research and understanding, but still necessary to protect the vulnerable.

SW, counseling, and psychology all have very similar ethical codes. We do not live in a world where it’s okay to practice in a biased manner in conflict with ethics.

Referring out is an option at times, but if values conflict with ongoing clients regularly, that is a problem too, and should give the therapist pause regarding why they chose to enter a field that values social justice and diversity.

 

[R. Matey]

I think the prevailing message in all of this is that psychologists and psychotherapists are bound by ethical standards of practice which are evolving with research and understanding, but still necessary to protect the vulnerable.

SW, counseling, and psychology all have very similar ethical codes. We do not live in a world where it’s okay to practice in a biased manner in conflict with ethics.

And I think that the ethics codes of the helping professions see refusing treatment to a vulnerable group that you are otherwise qualified to treat as discrimination. If anything, I think @PsyDr is right that admissions committees are far more scrupulous on the front end to avoid these sort of conflicts.

During training, the OP would likely encounter teens in a stage of gender transition. Heck, I don't even specialize in children and I've seen at least a dozen of these cases when I was going through training, which as you know, was very recent. I can't imagine passing through practicum/internship/postdoc without encountering a case like this with the expectation from supervisors that I follow evidenced based treatment plans, which include support for gender-affirming practice that may or may not include a clinical assessment of candidacy for gender affirming medical intervention.

I've seen some people suggest in this thread that the OP could skirt the whole problem by attending a faith based institution, but the issue there is that these programs still have to comply with institutions where practicum and internship supervisors reside. When I did my internship, the administrative staff was thinking of refusing to take applicants from a local faith-based institution over reports of experienced discrimination from LBGTQ+ clients receiving services from trainees. It was only after assurances from the program in question that they would comply with training model of the site, that the site allowed students from there. I can't imagine that this is the only place where folks are having this conversation.

 

[Rain Sova]

I think the prevailing message in all of this is that psychologists and psychotherapists are bound by ethical standards of practice which are evolving with research and understanding, but still necessary to protect the vulnerable.

SW, counseling, and psychology all have very similar ethical codes. We do not live in a world where it’s okay to practice in a biased manner in conflict with ethics.

Referring out is an option at times, but if values conflict with ongoing clients regularly, that is a problem too, and should give the therapist pause regarding why they chose to enter a field that values social justice and diversity.

I may look into pastoral counseling. Christians are held by Biblical standards which are grossly misunderstood by non Christians (and include do no harm) and there is a demographic interested in the integration of faith and psychology. I see a pattern of Christians being discouraged from these fields, as if a monoply should be held, but those same professionals will turn around and tell you "find your niche" or "you need to specialize to be successful".
Odd

 

[borne_before]

What do y'all think about this:

I think a lot of the trans debate and controversy could be avoided if there was an agreement that not all trans people are the same and their differing etiologies exist within that people. And the whole debate could be clarified if there was better delineation into what distinct groups we are discussing. Kind of like how intellectual disability, which used to be a huge catch all, is getting carved up into more diagnostic groups (e.g., how autistic people would have been just called mentally ******ed).

 

[R. Matey]

I may look into pastoral counseling. Christians are held by Biblical standards which are grossly misunderstood by non Christians (and include do no harm) and there is a demographic interested in the integration of faith and psychology. I see a pattern of Christians being discouraged from these fields, as if a monoply should be held, but those same professionals will turn around and tell you "find your niche" or "you need to specialize to be successful".
Odd

There are plenty of people of various faith backgrounds within the helping professions. The work, I think, for you is how you can negotiate your religious beliefs with a potential clinical practice. I know there are several books on the subject. You might benefit from also from talking to clinicians who share your worldview to see how they have negotiated this area without refusing treatment to a vulnerable population.

 

[Rain Sova]

What do y'all think about this:

I think a lot of the trans debate and controversy could be avoided if there was an agreement that not all trans people are the same and their differing etiologies exist within that people. And the whole debate could be clarified if there was better delineation into what distinct groups we are discussing. Kind of like how intellectual disability, which used to be a huge catch all, is getting carved up into more diagnostic groups (e.g., how autistic people would have been just called mentally ******ed).

I think that is a good point.

 

[futureapppsy2]

What do y'all think about this:

I think a lot of the trans debate and controversy could be avoided if there was an agreement that not all trans people are the same and their differing etiologies exist within that people. And the whole debate could be clarified if there was better delineation into what distinct groups we are discussing. Kind of like how intellectual disability, which used to be a huge catch all, is getting carved up into more diagnostic groups (e.g., how autistic people would have been just called mentally ******ed).

I mean, yes, of course not all trans people are the same, but this has the air of "the good ones" and "the bad ones", which happens to marginalized groups all the time--the people in those groups who confirm to certain standard are "good"--and we should just accept *them*--but not the other people in the group. You already see this in trans discussion, actually, with some people arguing that if people don't fit the classic trans narrative, they aren't "really" trans, and we just need too support people who pass well/fit that classic narrative/transitioned in childhood/etc.

 

[foreverbull]

Totally good points.

Qualitatively, and I don't feel prepared enough to clinically enter the fray because the science hasn't quite figured it out yet, and I always refer out. But, I feel that we aren't having honest convos about this stuff because it became so political so fast.

So here is sorta how I think about the issue, and I would love feedback because it will make me a better psychologist.

1) There are just those kids who are, as early as all get out are just "born into the wrong body" and have a strong preference for the gender expression of the opposite sex and end up dating and marrying the same sex relationships.

2) There are adults who basically get the hankering' to transition later in life and generally end up opposite sex relationationships.

3) There are boys who go through some dysphoria, but eventually it goes away, and they are just gay males.

4) There are parents who seem to get a lot of attention for their trans kids. Enough to make worry about munchiness.

5) There are autistic people who find a very supportive community online in the trans community. I have read some accounts of these people being convinced that their internal experience is because of gender dysphoria and not autism and they transition but eventually detransition because it didnt have the desired effect.

6) People who transition because of social influences in high school that eventually end up enby or something else.

I know some of this can be viewed as transphobic. I do believe that each group does deserve upmost empathy are dignity and rights. Some are exceptions, some are rare, some might not really exist. But, my goal is to not be transphobic.

I would suggest taking time to educate yourself more on the topic via research and theory in our field. Some of these groups seem to be stereotypes put out by social media. And I’d be very cautious about assuming sexual orientation in any of the groups you mention because it is a completely separate identity that isn’t linked to gender at all.

The social contagion aspect gets blown out of proportion by certain groups to further their ideologies. Some kids do think it’s cool to be “different” and try on identities briefly (including some folks in the ASD community), but these same teens wouldn’t fit criteria for transition anyway; a specialist can discern this over time. I worked with kids who identified as trans or tried on opposite gender pronouns for a time, but upon further exploration in therapy with me and over time, it just wasn’t that interesting to them anymore at a certain point, not a true core aspect of their identity, and it naturally faded. I think social media people blow this phenomenon up into “no minors should transition because some teens change their pronouns back and forth over time so it must be a phase.”

It’s complicated, so I don’t know that the groupings you mention are really helpful or appropriate other than to say more generally, for a portion of the population:

1. Some folks feel internally the opposite gender and it never changes in their lifetime. They may want gender-affirming surgery, but it depends on personal preference and resources. I would add that some folks also realize this a bit later in life, but it will stay consistent as well.

2. Some folks (particularly minors or early 20s) try on the trans or non-binary identity out of exploration and confusion, and it will pass. Some of these folks may conflate gender and sexuality out of confusion but it also becomes clearer later.

3. Some folks will identify as non-binary/genderqueer and it won’t change. Transition isn’t necessarily the goal for these folks if there isn’t pronounced gender dysphoria, but sometimes physical transition or a partial transition is desired for some of them.

None of these scenarios is a problem. We should evaluate each person on a case by case basis and continue to research the subject, in my opinion.

Edit: and of course it gets extra tricky when we talk about minors transitioning, but I’ve also worked with folks who transitioned as minors and were clear-cut cases in which it made sense to transition, and there were also kids who were just trying on identities in a safe environment and it wasn’t persistent. For a time, I worked at a residential place where many parents of teens identifying as trans sought our center out for treatment. I bristle when people say we’re rushing minors into transition, because where I worked, we were extremely cautious and thoughtful in our work—“rushing” or “pushing” kids into anything couldn’t have a been any further from the truth. Practitioners there were very aware of the stakes, and took it very seriously.

 

[Rain Sova]

I disagree with a lot of this. But the sad truth is that there are children and young adults who rush into life altering medical procedures via an informed consent model and then detransition with irreversible stigmata. Sometimes stereotypes are accurate. I worry about gay kids who parents are more accepting of trans identity over a homosexual one being pressured from that angle, in addition to munchie parents. I do also think that for some trans if a bit of a kink or way to exert control. I also think that the science on gender is lagging (or nonexistent) and view gender expression to a be more useful term from a behavioral/falsifiable point of view.

Maybe the research showing that some trans identified kids are using as a maladaptive coping mechanism (like cutting) and that it can also travel in a contagion isn't exactly transphobic? Maybe instead of demanding its removal from publication, more research and scholarship is the solution? You write like we have it figured out... we don't.

I predict there are going to be some clinics and providers sued into the ground in about five to seven years.

You've got to admit that trans identified people seem to pretty popular right now? Like its a condition holding the zeitgeist more firmly than autism and that is saying something. I dislike the lack of a developmental approach to activism as well.

I can definitely speak to the autism spectrum and gender confusion.

 

[borne_before]

I’ve deleted my posts. It’s obvi that I’ve got some thinking and learning and listening to do.

 

[foreverbull]

I’ve deleted my posts. It’s obvi that I’ve got some thinking and learning and listening to do.

I agree with your earlier point that we need more research, and it’s become a political flashpoint with each side standing their ground and not a lot of thoughtful discussion to meet in the middle as policies move ahead quickly in either direction.

It’s a hard subject. It conflicts with all kinds of norms we have in our culture and involves potentially irreversible physical changes. With adults, it’s easier because that’s their decision and should be their decision to make, as with any other surgery or medical procedure. For minors, we have to be careful, as I discussed. In the future, we’ll know more and be able to educate the broader population of psychologists in general with updated knowledge as it evolves.

It’s good to have the conversation. I’ve seen what’s out there too, and extremes can be unhelpful and stymie discussion. We need to be able to talk about what the concerns are out there (and it provides the opportunity for learning), as long as we can remain respectful of trans folks in the process and keep their best interests in mind.

@Rain Sova can you rename this thread treatment considerations for transgender children or something related for people who search the term?

 

[CheetahGirl]

This is not against transgenderism. This is very specifically against minors medically transitioning which is very controversial even among professionals. <---- added to post

One of the main factors you'll discover when applying to graduate programs in mental health is YOUR mental, psychological, and emotional flexibility. If someone is too rigid (like the value-judgement statement above), I wonder what program of substance would train someone who is not open to discovering more about experiences that they may never have to serve others? Throughout the course of training, you learn your own limits, but you've limited your possibilities when you begin to say that you're against this or that (when it comes to professional discourse). Be against this and that in your personal life (for example, if you're 'prolife,' don't get an abortion yourself, but don't impose your value judgments on others unless it becomes of clinical value- after sufficient training).

Perhaps a religious-based program niches are most effective if you're so focused on having your religious/spiritual faith guide your thinking. (I self-define as a woman of faith, but heck no, my beliefs will not limit my work, but actually make it broader and more meaningful.)

I can relate to the fact that during my training (working with children who had been abused or neglected), I established that I could provide short-term mental health services to a perpetrator of child abuse, but I was not interested in forming a longer-term therapeutic alliance (and developing empathy for this type of perpetrator). But a child with gender-dysphoria is very different than a perpetrator of child abuse, so most of us are taken aback by the initial rigidity of thought for someone who desires to be in the mental health profession (similarly, I don't want someone known to cheat to pursue a career in law...doesn't make sense).

The six children is an entirely different issue. I have four children, and began my doctoral program when two of them were baby & toddler. Doctoral training is more than a full-time job (reliably 60+ hours, at the most active times). If I don't have a 'little village (my spouse, Mom, Nanny and afterschool sports/programs)' helping to raise my kids, then I would not have been able to survive 3-years of course work with co-occurring clinical externships every year, highly-competitive internship process/training, making it through dissertation research, my highly-competitive postdoctoral training, and licensure (took me 6+years).

I am not here to discourage you, @Rain Sova! I appreciate your honesty! In fact, I often feel....if I can do it, anyone can! However, focus on realistic goals and remember you have your entire life to achieve them. I'm just curious about the way this thread unfolded because it seems like folks want those to enter our field who will be alliances to those under discussion (i.e. minors medically transitioning from their cis-gender, for example...or even the abovementioned, child abuse preparator). IMO, we need more well-trained mental health allies because the average layperson has become problematic in today' society with misinformation and Dunning-Kruger effects, so consider if our general field is right for you with your existing beliefs, or are you willing to be challenged & grow outside of your comfort zone to serve others NOT like you, who maybe don't possess your specific beliefs? (After all, that's what we do when we help people grow and modify their existing states, we learn who they are - not impose who we are on them.)

 

[Rain Sova]

One of the main factors you'll discover when applying to graduate programs in mental health is YOUR mental, psychological, and emotional flexibility. If someone is too rigid (like the value-judgement statement above), I wonder what program of substance would train someone who is not open to discovering more about experiences that they may never have to serve others? Throughout the course of training, you learn your own limits, but you've limited your possibilities when you begin to say that you're against this or that (when it comes to professional discourse). Be against this and that in your personal life (for example, if you're 'prolife,' don't get an abortion yourself, but don't impose your value judgments on others unless it becomes of clinical value- after sufficient training).

Perhaps a religious-based program niches are most effective if you're so focused on having your religious/spiritual faith guide your thinking. (I self-define as a woman of faith, but heck no, my beliefs will not limit my work, but actually make it broader and more meaningful.)

I can relate to the fact that during my training (working with children who had been abused or neglected), I established that I could provide short-term mental health services to a perpetrator of child abuse, but I was not interested in forming a longer-term therapeutic alliance (and developing empathy for this type of perpetrator). But a child with gender-dysphoria is very different than a perpetrator of child abuse, so most of us are taken aback by the initial rigidity of thought for someone who desires to be in the mental health profession (similarly, I don't want someone known to cheat to pursue a career in law...doesn't make sense).

The six children is an entirely different issue. I have four children, and began my doctoral program when two of them were baby & toddler. Doctoral training is more than a full-time job (reliably 60+ hours, at the most active times). If I don't have a 'little village (my spouse, Mom, Nanny and afterschool sports/programs)' helping to raise my kids, then I would not have been able to survive 3-years of course work with co-occurring clinical externships every year, highly-competitive internship process/training, making it through dissertation research, my highly-competitive postdoctoral training, and licensure (took me 6+years).

I am not here to discourage you, @Rain Sova! I appreciate your honesty! In fact, I often feel....if I can do it, anyone can! However, focus on realistic goals and remember you have your entire life to achieve them. I'm just curious about the way this thread unfolded because it seems like folks want those to enter our field who will be alliances to those under discussion (i.e. minors medically transitioning from their cis-gender, for example...or even the abovementioned, child abuse preparator). IMO, we need more well-trained mental health allies because the average layperson has become problematic in today' society with misinformation and Dunning-Kruger effects, so consider if our general field is right for you with your existing beliefs, or are you willing to be challenged & grow outside of your comfort zone to serve others NOT like you, who maybe don't possess your specific beliefs? (After all, that's what we do when we help people grow and modify their existing states, we learn who they are - not impose who we are on them.)

I appreciate your response very much. I will say, theology, Christianity, faith - these are principles that guide our every day lives. I feel like many assume this is a case similar to, I don't know, a white person from a rural white town having to open their minds and embrace the concept of white privilege. Those of us who truly practice Christianity don't appreciate that our beliefs are assumed to be ignorance or hate. My son is deep into theology studies right now and may make a career of it. It is definitely its own beast. There are many professionals i have worked with for my other son's psych testing, therapies (which he no longer needs) who are practicing Christians. I say this to say, I would not be uncomfortable with any demographic. At my non profit job,, I worked with LGBTQ adults, pagan/witches, atheists, and so on. I felt genuine love and care for every individual on my caseload. But I know I would never "grow" to accepting minors having gender affirming surgery, specifically. Maybe I'll make an appointment with a Christian PhD or PsyD in the area and pick his or her brain on the topic.
You having four kids definitely constitutes as "large family" in the USA and your input is invaluable on that front. I don't really have a "village". Although, my oldest will be driving soon but my youngest is a breastfeeding baby.
Thank you again for your reply

 

[Rain Sova]

I agree with your earlier point that we need more research, and it’s become a political flashpoint with each side standing their ground and not a lot of thoughtful discussion to meet in the middle as policies move ahead quickly in either direction.

It’s a hard subject. It conflicts with all kinds of norms we have in our culture and involves potentially irreversible physical changes. With adults, it’s easier because that’s their decision and should be their decision to make, as with any other surgery or medical procedure. For minors, we have to be careful, as I discussed. In the future, we’ll know more and be able to educate the broader population of psychologists in general with updated knowledge as it evolves.

It’s good to have the conversation. I’ve seen what’s out there too, and extremes can be unhelpful and stymie discussion. We need to be able to talk about what the concerns are out there (and it provides the opportunity for learning), as long as we can remain respectful of trans folks in the process and keep their best interests in mind.

@Rain Sova can you rename this thread treatment considerations for transgender children or something related for people who search the term?

Sure I can do that

 

[Cam_Chai19]

I appreciate your response very much. I will say, theology, Christianity, faith - these are principles that guide our every day lives. I feel like many assume this is a case similar to, I don't know, a white person from a rural white town having to open their minds and embrace the concept of white privilege. Those of us who truly practice Christianity don't appreciate that our beliefs are assumed to be ignorance or hate. My son is deep into theology studies right now and may make a career of it. It is definitely its own beast. There are many professionals i have worked with for my other son's psych testing, therapies (which he no longer needs) who are practicing Christians. I say this to say, I would not be uncomfortable with any demographic. At my non profit job,, I worked with LGBTQ adults, pagan/witches, atheists, and so on. I felt genuine love and care for every individual on my caseload. But I know I would never "grow" to accepting minors having gender affirming surgery, specifically. Maybe I'll make an appointment with a Christian PhD or PsyD in the area and pick his or her brain on the topic.
You having four kids definitely constitutes as "large family" in the USA and your input is invaluable on that front. I don't really have a "village". Although, my oldest will be driving soon but my youngest is a breastfeeding baby.
Thank you again for your reply

I don't think the main point being made here is that you and your beliefs are hateful. The issue is if your firmly held beliefs would prevent you from learning about and following best practices in the field if they conflict with your beliefs. For anyone in clinical practice there will be times a client's goals and life choices conflict with your values. It sounds like you've experienced that in your non-profit work and have still been able to be compassionate, which is good, that's an important baseline. But it sounds like in certain situations it would be difficult to put your own beliefs aside and made decisions based on an impartial interpretation of psychology research and best practices alongside the client's goals. And that's a non-negotiable part of clinical practice. You can absolutely be an effective provider as a religious person, but your clinical decisions need to be based on the science rather than your own beliefs.

 

[Rain Sova]

PPrison transgender science

I don't think the main point being made here is that you and your beliefs are hateful. The issue is if your firmly held beliefs would prevent you from learning about and following best practices in the field if they conflict with your beliefs. For anyone in clinical practice there will be times a client's goals and life choices conflict with your values. It sounds like you've experienced that in your non-profit work and have still been able to be compassionate, which is good, that's an important baseline. But it sounds like in certain situations it would be difficult to put your own beliefs aside and made decisions based on an impartial interpretation of psychology research and best practices alongside the client's goals. And that's a non-negotiable part of clinical practice. You can absolutely be an effective provider as a religious person, but your clinical decisions need to be based on the science rather than your own beliefs.

Isn't transgender science ever-evolving? Isn't it true that some professionals disagree with the whole concept of transitioning? Isn't it true that the DSM has been updated to change the definition of transgender?

 

[Cam_Chai19]

PPrison transgender science

Isn't transgender science ever-evolving? Isn't it true that some professionals disagree with the whole concept of transitioning? Isn't it true that the DSM has been updated to change the definition of transgender?

Yes, all science is ever-evolving. Others in this thread can (and already have) spoken to current discussions in the field about transitioning better than I could. Are you open to considering the current perspectives that don't align with your personal beliefs? And if the science leads the field further from your beliefs would you be willing to challenge those perspectives at least in your work life? It sounds like you are very attached only to voices in the field that conform to your beliefs, which is not how being a thoughtful consumer of science works. That is why people on this thread are pointing out that this type of inflexibility in thinking would likely be a barrier for competent clinical practice.

 

[PsyDr]

Isn't it true that the DSM has been updated to change the definition of transgender?

Do you have an advanced copy of the DSM 5-TR?

 

[Rain Sova]

Yes, all science is ever-evolving. Others in this thread can (and already have) spoken to current discussions in the field about transitioning better than I could. Are you open to considering the current perspectives that don't align with your personal beliefs? And if the science leads the field further from your beliefs would you be willing to challenge those perspectives at least in your work life? It sounds like you are very attached only to voices in the field that conform to your beliefs, which is not how being a thoughtful consumer of science works. That is why people on this thread are pointing out that this type of inflexibility in thinking would likely be a barrier for competent clinical practice.

I am definitely open to being further educated. I once didn't believe in white privilege but I took a course in college that showed me that I was totally ignorant on the topic and did not know what I was talking about! My faith is my compass, however, and I know I'm not alone in that. (White privilege doesn't contradict my faith either way)