Transgender women and Depression: CBT Approaches
This paper will address the following topics in relation to applying TA-CBT strategies to Transgender women contending with depression. Why depression is a problem among transgender women, how CBT can be applied to working with women who are dealing with depression, the history and development of CBT, how TA-CBT can be used in practice, and evidence that supports the application of TA-CBT in treating depression among Transgender women. By utilizing a TA-CBT approach when working with clients who identify as Transgender women, Social Workers can reduce the severity and prevalence of depression experienced by this vulnerable population.
Why Depression is a Problem among Transgender women In the United States Transgender women (individuals who are sex-assigned male at birth but identify as female) experience high rates of severe depression due to pervasive discrimination that they face in society. According to Hoffman (2014), when compared to the general population, Transgender individuals experience much higher rates of depression with estimates as high as 62% (as cited in Clements-Noel, Marx, Guzman, and Katz, 2001). Due to these high rates of depression, Transgender women are at increased risk for overall negative health outcomes, which severely limits them from living happy, healthy, and productive lives. According to studies by Nemoto, Operario, Keatley, Nguyen, and Sugano, (2005) there is a growing understanding of the
Transgendered individuals are 25 times more likely to attempt suicide than the general population. They tend to be live in abject poverty often surviving n less than $10,00 per year household income compared to the rest of the population. They are more likely to face harassment and physical assault, with transgenders that are people of colour faring worse than all other races across the board. Many
This is in direct correlation with the increased probability of mental illnesses in the transgender population. Traditional views certainly do not help as many transgender citizens are told they are “sick” because of their difference with many religious and personal beliefs. A study from Boston published earlier this year in the Journal of Adolescent Health, reported that transsexual youth had two to three times increased risk of psychiatric disorders, including depression, anxiety disorder, suicidal ideation, suicide attempt, self-harm without lethal intent, and both inpatient and outpatient mental health treatment. These statistics show the clear consequences of mental health transgenders are facing if transgender rights continues to be unregulated. It is essential that the federal government steps in to take action in order to make sure things do not continue on this downwards path.
Further, the Trump administration’s policies specifically affect those who identify as transgender. The administration placed a ban on transgender people from receiving Armed Forces medical care for sex-reassignment surgeries, from enlisting in, and potentially from continuing to serve in the military. The extent of the toll this policy will have on the mental well-being of transgender service members and transgender people at large has yet to be explored in the literature. However, researchers have noted that discriminatory policies have a deleterious impact on the mental health of sexual and gender minorities (Hatzenbuehler et al., 2012; Meyer, 2003). This is particularly troubling considering that the Obama administration declared that transgender service members could serve openly; a move which encouraged many to disclose their gender identity to the military (Cooper, 2017).
Of the study’s 25 participants, 20 were female-to-male. The authors determined the main problem for the participants was the struggle to find transgender-sensitive health care. The subjects described discrimination by healthcare systems, lack of knowledge and hostility by providers, and lack of health insurance to cover transgender-specific healthcare needs. Some of the FtM participants who had problems with pelvic pain, abnormal uterine bleeding, and a history of abnormal Pap tests kept their gender as female on their insurance so they could still get the care they needed. Using a national cross-sectional survey data set, Shires and Jaffee (2015) reported similar findings. Of the 1,711 FtM participants included in this study, 41.8 percent reported verbal harassment, physical assault, or denial of equal treatment in a doctor’s office or
When working with individuals with physical disabilities the TTM model can vary according to how the individual’s culture recognized their disability (Boston, 2015). Gender roles can also affect the process of change (Boston, 2015). The helper needs to empathize with the disabled person to understand how they feel about their disability and the cultural belief system of the client, in an effort to assist the client (Boston, 2015). When a counselor is working with a transgendered person, the helper needs to adjust the model to include the client’s level of social acceptance (Carroll, 2002). The social situation with a transgendered client may not be one of tolerance, therefore the helper needs to be aware of this and balance between the clients needs and the social environment the client occupies (Carroll, 2002). Finally, when working with clients from various populations, the experience should be unique and the therapist should work to help the client feel accepted and understood, the various models can be modified or adjusted to better fit the
Evidence-informed practice is a critical part of nursing care. To be able to have evidence-informed practice, nurses need to be able to conduct research to find the most up-to-date and relevant information related to patient- and family centered care. When caring for patients, it is paramount to recognize the importance of family and the role they play in care. When one comes out as transgender, it is something that is not only going to affect the said person, but also their friends and family. Family members are key support systems so when you are caring for one person, you are in turn caring for the family as well. This is known as patient- and family-centered care. As there has been an increase in literature pertaining to family-centered care, the question of interest is “What is the impact on a spouse when a partner is transgendered?” To find the answer to this clinical question, the database Medline was utilized. The keywords LGBTQ, transgender, family-centered, spouse, nurse, sexuality and health care were used and combined with Boolean operators. Through this research, knowledge can be gained on how to properly care for the spouse of a transgendered person. This paper will discuss the key impacts of having a transgender spouse, nursing approaches that we can integrate into our care, and resources available for the non-transgender spouse.
Legal discrimination is alive and well in the United States. All over the country, groups of people are being forced into situations that are converse to the very nature of their being, subject to extreme violence and hatred. The very narrow minded view of how the country sees sex and gender, as exhibited by the media, is causing immense harm to many American citizens, as the idea of a binary gender system and long-standing sexist views has contributed to the segregation of bathrooms under the thin veil of protection. Bathroom facilities should no longer be segregated by gender to prevent transgender-based discrimination, therefore decreasing the prominence of depression associated with transgender people because a binary view of gender is flawed.
Attempting suicide is an epidemic in the United States; especially when 41% of transgender individuals have attempted suicide compared 1.6% of the general population (Gay & Lesbian Alliance Against Defamation). Due to this, the question of whether or not transgender youth have a harder, more straining adolescence than their cisgender counterparts rises. Although adolescence can be hard on everyone, experiences such as a school environment, puberty, laws that guarantee protection, family and social acceptance of transgender youth are harder than those of their cisgender counterparts (harder does not necessarily mean correlate with strenuous, the use of harder is aiming more towards different, costly, and possibly more confusing). The revolution for transgender lives is just beginning, change is happening. But in order for change to occur, adequate information on the material needs to be discussed and terminology must be defined and questions must be answered. Questions such as: what do the terms transgender and cisgender actually mean? Why is it important to know the difference between the two terms? What is the difference between transsexual and transgender?
The transgender population often have complicated medical needs and encounter numerous health disparities including discrimination, lack of access to quality health care and social stigma. Some health disparities include various chronic diseases, cancers, as well as mental health issues (Vanderbilt University, 2017). Transgender individuals are at increased risk of HIV infection with their rates being reported “over four times the national average of HIV infection, with higher rates among transgender people of color (Grant, Mottet, Tanis, 2011).” In addition, they usually do not have health insurance (Makadon, 2017) and have a lower probability of preventative cancer screenings in transgender men (AMSA, 2017).
The purpose of this study was to prove how minority stress correlates with mental health within the transgender community. As defined by Meriam-Webster Dictionary, transgender “is relating to, or being a person who identifies with or expresses a gender identity that differs from the one which corresponds to the person 's sex at birth” (Merriam-Webster, 2016). For example, male to female, or female to male. However, researchers in this study used the minority stress model, which suggested that the stress associated with stigma, prejudice, and discrimination will increase rates of psychological distress in the transgender population (Bockting, Miner…& Coleman, 2013). As evident from past research, physical violence, verbal harassment and employment discriminations were some of the many types of societal prejudices. In fact, as seen in the article, these stresses create depression, anxiety, and other types of mental illness within the transgender community. However, researcher’s goals were to see exactly how these different variables increased levels of stress. For example, was there negative types of stigma that were less or more server, and what could help to alleviate stress?
Regarding access to healthcare, transgender individuals often face the most obstructive barriers when attempting to receive care. Whether they are seeking access to hormones, therapy, general health services, reproductive healthcare, or specialty healthcare, transgender patients typically cannot get what they need without jumping through many hoops or hiding their identities. This occurs especially so in cases of intersecting identities -- where an individual is not just transgender, but is transgender and a person of color, disabled, gay, indigenous, undocumented, poor, etc. These intersecting identities interact in multifaceted ways to produce even more barriers for trans individuals seeking healthcare due to healthcare provider bias, insurance requirements, and doctors’ general unwillingness to help coupled with inaccessibility founded on racism, transphobia, homophobia, mental illness stigmatization, etc.
In a lot of places around the world more and more people are coming out as “Transgender.” The term transgender means that the person’s gender identity does not correspond with the gender they were assigned as having at birth. From personally having a transgender boyfriend I have since realized that these people experience a lot of discrimination in and from society. Many people simply just do not understand what the term transgender means and they see it as someone just “wants to be a man” or “wants to be a woman.” While there may be people who present it this way, it is more so that the individual just “feels” different, and “feels” as if they are “in the wrong body.” Some people experience this feeling at a young age as my boyfriend did in his elementary age. We live in a world who put these people down for being who they truly are, and no human being wants or needs that.
Scholars have been critical of the medical establishment’s and state’s involvement in constructing and policing of transgender identity. These kinds of pressing issues have occupied the small existing literature. There is not much information and studying what is being done on transgender in traditional areas, family studies research, such as their dating behavior and formation of intimate relationships in adulthood. There is little research on the issues around being parents, their children’s experiences with having transgendered parents, as well as relationships in the family as a whole, and relationships in work and school.
Transgender people are discriminated on an almost daily basis. They are discriminated in the workplace, as shown in a study commisioned by the Equalities Review. In a group of transgender people who have jobs and are prone to workplace-enviroment effects and opinions, “many respondents experienced harassment from co-workers and employers.” Nearly 29% of the group experience verbal abuse and harassment in the workplace enviroment, and about 4% received physical abuse. About 7% experienced threats, and about 27% experienced some sort of different treatment due to their gender non-conforming ways.(Whittle 38-39). In another study, it was found that being mistreated in the school years would have a negative effect on future outcomes relating to employment. “Those who were physically attacked in school were considerably more likely to stay in a job (64%) compared to those who were not (42%) (Grant 50).” They are also discriminated in public as well, adding on to the distress that many transgender people suffer from regularly, making it seem as if all transgender people are crazy. Transgender people are just more likely to be diagnosed as someone with a mental disorder because its helpful to see that those who have been diagnosed are “hurting and something needs to be done to help (Kreitler 1).” In
The stigma and discrimination faced by transgender people (i.e. those whose gender differs from their sex at birth) have been associated with increased risk for depression, suicide, and HIV . ). Transgender people also face significant barriers to accessing health care. A national study found double the rate of unemployment among transgender people, compared to the general population. Not surprisingly, transgender people were also less likely than the general population to have health insurance and less likely to be insured by an employer . When considering HIV risk for transgender persons, it is critical to remember that simply being a transgender person does not place a person at risk. Instead, health care providers should