Trans and Sexuality

An existentially-informed enquiry with implications for counselling psychology

Christina Richards

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781317447955
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy Counselling
• Index: Psychology

Grounded in cutting-edge qualitative research, Trans and Sexuality explores the sexuality of people who do not identify with the gender that they were assigned at birth. Arguing that whilst splitting members of the trans community into distinct groups might seem like a reasonable theoretical procedure, the pervasive assumption that group membership impacts on the sexuality of trans people has unduly biased opinions in this highly contested, yet dramatically under-researched area. Moreover, whilst existing literature has taken a purely positivistic standpoint, or relies on methodology that could be seen as exploitative towards trans people, Richards is careful to place the real-life experiences of trans research participants at the heart of the work.

Showing that sexuality extends beyond the bedroom, this forward-thinking book touches on topics such as identity, sexuality and the intersections between the two. Richards takes a cross-disciplinary approach and considers the sexuality of trans people within the contexts of psychiatric and psychological settings, including Gender Identity Clinics, as well as in the broader contexts of cultural and community settings. The implications of the research at hand are also explored with respect to counselling psychology and existentialist philosophy.

Trans and Sexuality will appeal to academics, researchers and postgraduate students in the fields of gender and sexuality, counselling, sociology, psychotherapy, psychology and psychiatry. It will be of particular interest to those seeking an in-depth and up-to-date overview of ethics and methodologies with people from marginalised sexualities and genders.

Chapter 1
Introduction

Transgender people – most commonly referred to as simply trans people – are just like cisgender¹ (non-trans) people in that the vast majority of life is spent doing the things that people do – working, studying, playing, laughing, crying, having sex, not having sex, eating buns – all the stuff of life. There are, however, a few key considerations relating to trans and it is some of these, especially to do with sexuality, which this monograph covers.

But what is trans when used in this context? Briefly it is an umbrella term which includes a variety of different identities – all of which are concerned with a person living all, or a part, of the time in a gender other than that to which they were assigned at birth. Within the psychiatric literatures these have previously been split into differing groups: In the as yet current World Health Organization’s (WHO) International Classification of Diseases (ICD) these are transsexualism, in which a person wishes to live all of the time in a gender other than they were assigned at birth; dual role transvestism, in which a person lives in that manner for part of the time; and fetishistic transvestism, in which there is a sexual component to taking on the role of another gender (WHO, 1992). It is likely that transsexualism will be renamed gender incongruence in the forthcoming 2018 edition of the ICD. The more recently published Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association (APA, 2013a) elides the first two categories of transsexualism and dual role transvestism for diagnostic purposes under the category gender dysphoria, which might also include people who identify as something other than male or female. The DSM 5 also includes the category of transvestic fetishism, which roughly correlates with fetishistic transvestism in the ICD. In the DSM, but not in the ICD, there is a requirement that there be “clinically significant distress or impairment in social, occupational, or other important areas of functioning” (APA, 2013a, p. 702). However, somewhat unusually, the diagnosis is often made without this distress in order for robust and supported trans people to access physical assistance to align their bodies with their minds (Murjan & Bouman, 2015).

There is consequently much contention around having diagnoses associated with gender role and identity, given that there are not necessarily any problems with living associated with them² (cf. Karasic & Drescher, 2005). Indeed, the terms transvestite and transsexual have a history of pathologisation associated with them (cf. Karasic & Drescher, 2005), and these words are only partially reclaimed by some members of the communities – in the sense that some people are happy to use them and many are not. Nonetheless, shorn of pathology, these three rough groupings – people living full time in a gender other than that assigned at birth; people living part of the time in a different gender; and people for whom the endeavour appears to have a sexual component – can be a useful heuristic under some circumstances (Barrett, 2007; Ettner, Monstrey & Eyler, 2007; Richards & Barker, 2013). Notwithstanding this, the APA (2013a) and WHO (1992) note that fetishistic stages can precede the wish to live in another gender role, which makes clear demarcation between the different categories somewhat problematic; and further Lawrence (2013) contentiously asserts that, for trans women³ at least, it is possible that there is a sexual component to a cross gender [transsexual] identity.

Two further rough groupings of people who may fall under the trans⁴ umbrella are gender neutral people – those people who identify with no gender, sometimes referred to as neutrois, agender, or gender neutral people (Richards & Barker, 2013) – and non-binary or genderqueer people – those people who have both genders simultaneously to varying degrees (or who disagree with the binary gender system) (Richards & Barker, 2013; Richards, Bouman & Barker, 2017). These groups of people are emerging communities and a burgeoning political force. Therefore, further research into any necessary or useful assistance such as hormones, surgeries, therapy, and so on for these groups will be required – which is one of the reasons the DSM-5, and likely the ICD-11 have included these gender forms in the diagnostic categories such that aid may be rendered as necessary. There is almost no research or writing on these gender forms, with the exception of Richards et al. (2016); Richards, Bouman & Barker (2017); student dissertations (Evans, 2011); and some community publications (e.g. Bornstein & Bergman, 2010; Diamond, 2011; Queen & Schimel, 1997⁵) with what little there is generally falling under the wider umbrella of studies on trans identities.⁶

Given this complexity, members of the trans communities⁷ themselves generally use the overarching term adopted in this paper – trans – to include all of these practices and identities (Bornstein & Bergman, 2010). Because of this, in this monograph the concept of trans will be assumed to mean living some or all of the time in a gender not assigned at birth. Of course, this does not fully encapsulate the difficult issue of identity, especially within an existential framework (which is discussed below), and indeed, self-definition forms a key part of this phenomenological research. So, while the working definition above is included for clarity, it should not be seen as a structural or theoretical imposition of meaning on participant realities.

Similarly, sex and sexuality are complex and often ill-defined terms both within general discourse and in the grey and academic literatures. Sex, for example, might pertain to chromosomes, coitus, something like gender, etc. Sexuality is a little clearer with the Oxford English Dictionary defining it as “capacity for sexual feelings”; “a person’s sexual orientation or preference”; and “sexual activity” (Oxford Dictionaries, 2015a); with sexual pertinently further defined as, “Relating to the instincts, physiological processes, and activities connected with physical attraction or intimate physical contact between individuals” (Oxford Dictionaries, 2015b). To complicate matters still further, asexuality – not experiencing sexual attraction (AVEN, 2017) is also often regarded as a ‘sexuality’ in much the same way atheism is often included within demography sheets under religion – and with all the same subtleties of degree and type that one might expect in any human practice or identity. Consequently, the definitions above are the broad working definitions used in this monograph; however, for the reasons touched upon above and detailed below, such matters are complex when considering trans people, and indeed it is this complexity which this research seeks to explore.

These complexities around both trans and sexuality, and especially their intersections, have been addressed within literatures from a positivistic tradition (such as medicine and essentialist psychology); and theoretical academic literatures (including queer theory and postmodernism), both of which sometimes appear to utilise trans people’s realities for their own ends. Thus medicine has been accused of appropriating trans voices to buttress the gender dichotomy⁸ (Raymond, 1979), whereas (rather ironically) queer academics have been accused of appropriating trans experience to buttress arguments against the gender dichotomy (Richards, Barker, Lenihan & Iantaffi, 2014; Rubin, 1998).

Where then is the counselling psychologist with a trans client to turn for information on trans experience which is free(er) from such theoretical (and so methodological) bias? Phenomenological enquiry may have an answer. Other valid methods are discussed below (as are issues with phenomenology itself), but the great strength of phenomenology is the rigorous investigation of “things as they are in themselves” (Husserl, 1970 [1900]) which would seem to be just what is needed amidst the brouhaha of enquiry into trans, both within the academy and beyond (cf. Green, 2008). Phenomenology also neatly intersects with the field of Counselling Psychology as it is a very common mode of therapeutic enquiry for counselling psychologists (Woolfe, Dryden & Strawbridge, 2003) – whose credo puts great value on the lived-experience of the client. This credo also recognises the centrality of intersubjectivity for counselling psychological practice (HCPC, 2012; Orlans & Van Scoyoc, 2009) which is something that, it may be argued, is best facilitated though a full phenomenological investigation of the clients’ ‘worlding’ (Spinelli, 2007).

One important area of trans clients’ worlding is, as we have started to touch upon above, that of sexuality. Trans people’s sexuality forms much of the literatures on trans in general and indeed is one of most contentious topics within this field (Dreger, 2008). Again, phenomenology which privileges meanings – rather than a theory-driven method which seeks certain ‘data’ (sometimes without due regard for individual differences – cf. Clarkson, 2008; Richards, 2017b) may be a fecund mode of enquiry. Phenomenology alone, however, could risk leaving the experience of trans sexuality⁹ in a vacuum. The endeavour to situate such experience within a philosophical framework therefore needs to avoid the pitfalls sketched out above in terms of theory driving research, but still needs to find some ‘firm ground’ from which to work without the use of ‘grand narratives’ (Lyotard, 1984). For this reason existentialism offers a philosophical base and hermeneutic (historically intertwined with phenomenology – van Deurzen & Adams, 2011) which may be used to tentatively investigate the phenomenology of trans sexuality, but which itself has few distorting theoretical a priori assumptions (of the ‘meaning’ of trans especially).

The research in this monograph therefore, is an existential-phenomenological investigation of a group of trans people’s sexualities. It critically considers the literature on trans sexuality and seeks to justify the method chosen for exploring trans sexuality with particular reference to ethical considerations of this generally psychologically robust, but sometimes culturally marginalised and academically exploited, group. It then turns to the results of a study undertaken with a group of self-defining trans people and considers the theoretical context of these results within the discussion. There will necessarily be no reporting of ‘answers’ fixed and true for all time, but rather a series of non-generalisable themes are highlighted, which should be held lightly to be properly seen (Richards, 2011a), thus becoming part of an ongoing and hopefully fruitful dialogue within academic, clinical, and, it is to be hoped, community circles.

Lastly, as they read I hope the reader will forgive my, at times, somewhat personal use of language – of reflections about my own work, thoughts, and feelings. I feel that as a counselling psychologist it behoves me, unless there is cause otherwise (see reflexivity below), and in so far as is possible, to speak to you the reader as a person – without endeavouring to hide the fact that we are both human – and so there will be some degree of intersubjectivity between us. This will, of course, be rather limited by the medium. Indeed, as I am unable to respond to your reading except in my imagining of what that response may be, perhaps rather than actual intersubjectivity it would be better to say that I am endeavouring to respond to you as a person, as a reader with both your expert knowledges and our humanity available to us. I shall don my scientific tweed and passive voice as proves necessary then, but where I leave it hanging on the chair and speak to you directly I beg your forbearance as – to me at least – somewhere in all that is something important in being a counselling psychologist.

Notes

1 A cisgender person is a person who is content to remain the gender they were assigned at birth (Richards & Barker, 2013).

2 Of course this book series is entitled Explorations in Mental Health; however, this is not to say that gender diverse matters are mental health matters, as of course they are not. They may inflect and impact upon mental health, but are not mental health matters per se. The inclusion of this book in the Series is to inform people when these matters do affect mental health, but should not be taken as tacit agreement that gender diversity is necessarily about mental health, as it is not; there is a very great deal more contained within this volume, as we shall see.

3 A trans woman is a person who identifies as a woman and who lives in a female role, but who was assigned male at birth. Similarly a trans man is a person who identifies as a man and who lives in a male role, but who was assigned female at birth.

4 Some people have used the term trans* to refer to a wide variety of trans identities with the ‘*’ being a wildcard term from computer programming denoting a variety of possible endings, for example trans-sexual, -vestite, -gender, etc. It also includes a number of terms which don’t have the strict morpheme ‘trans’ in them, but which nonetheless fall in the same rough category, including gender neutral and non-binary gender. Useful as it may be, it can be difficult to read (especially aloud) and, most importantly, at a recent meeting of trans community leaders we convened as part of my clinic’s research for the WHO on the ICD-11 it was unanimously felt to be an exclusionary term which people not keyed into the latest developments in trans may be unaware of – and may therefore serve to marginalise people further. For this reason it is not used in this monograph.

5 Which was twenty years ahead of its time.

6 And occasionally getting wet as they are pushed out from under that umbrella when the street gets bumpy.

7 I should note here for reasons of clarity that, while I shall touch upon cross-cultural considerations below, I am referring to trans communities from high GDP Western countries.

8 The gender dichotomy is the notion that there are only two genders (male and female) which are different in kind rather than degree (Bockting, 2008).

9 Trans sexuality (the sexuality of trans people) should not be confused with transsexuality which is a diagnostic term pertaining to those people who live, or wish to live, permanently in a role other than that assigned at birth.

Chapter 2
Literature review

Literature search method

The following literature review started, as many literature reviews do, with an accumulation of my literature on this topic to this point in time – the contents of my bookshelves and hard drives if you will. Given my other academic work in this fie...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Acknowledgements
• 1 Introduction
• 2 Literature review
• 3 Method
• 4 Analysis
• 5 Discussion
• References
• Index