[News/Health] [UK] The developing role of occupational therapy in gender
Stephanie Stevens
Occupational Therapists), UK
DECEMBER 2010
The developing role of occupational therapy in gender
Jo Taylor discusses the Leeds Gender Identity Clinic and the
developing role of occupational therapy in this area
Gender dysphoria is also known as ‘gender identity disorder’ and is a
medical term for the anxiety, confusion or discomfort about birth
gender. Individuals experiencing gender dysphoria often live for many
years in the gender role that society expects of them until, finally,
their distress becomes intolerable and they undergo transition to live
permanently according to the gender role that is more comfortable for
them. When gender discomfort is this severe, it is referred to as
transsexualism.
The Leeds Gender Identity Clinic offers assessment and psychological
support to people with gender dysphoria who wish to transition into
their chosen role. The service accepts referrals from across the North
of England, but also accepts out of area referrals from around the
country. Referrals are accepted from the age of 18 and above.
If after an assessment period of three to six months the individual
has a diagnosis of primary transsexualism, and is ready to progress,
they can enter the care pathway. The care pathway consists of three to
six months of real life experience, followed by hormone treatment and
then referral to surgery if this is required.
The whole process can take up to three years, but can be shortened
depending on individual circumstances. The care pathway is structured
so that the most reversible options are first. Hormone treatment can
have irreversible consequences, as do surgical procedures, so as a
service we have to be clear that what we are doing is in the service
user’s best interests.
People are usually referred to our service by their GP. There also
needs to be a supporting assessment by a mental health professional to
ensure that their mental and physical health remains stable.
Individuals access our service at different stages of their
transition. A person may have been living in role for many years, or
they may only recently have acknowledged their gender. Service users
access our service from all walks of life and all different ages. Some
people may attend the clinic dressed in role, others may choose not to
while in the assessment stage.
The current team includes a team manager, team administrator,
consultant psychiatrist, clinical nurse specialists, a pharmacist and
a hormone doctor. The service also has a voice coach who offers group
sessions on a twice-yearly basis. I have recently come into post as
the occupational therapist working within the service.
My role is a split one; I act as a care co-ordinator for individuals
who are in the care pathway alongside nursing colleagues and also have
an occupational therapy caseload taking referrals from other people
within the team.
The Leeds service, alongside other gender services within the UK,
abides by the Harry Benjamin International Standards of Care. The
guidelines suggest that in order to progress to hormone treatment and
surgery a client must be able to demonstrate that they have changed
their name by deed poll and that they can evidence working,
volunteering or being in education in their chosen gender.
This provides an interesting starting point for occupational
therapists due to the unique perspective we have of occupation. As the
occupational therapy service develops I have started to primarily take
referrals for service users in this area of the care pathway.
Service users may have a positive occupational identity without
actively being involved in the areas of work, volunteering or
education. They may be in work without being able to sustain a pattern
of occupational behaviour that is productive and satisfying.
Occupational therapy could be a key role in assessing service users at
this stage to provide supporting evidence of their occupational
engagement, support service users with ways they may be able to meet
these criteria, or even to evidence the decision that someone should
not progress further on the care pathway at that time.
I am also hoping to generate support from service users in determining
groups or interventions that may be helpful. Nursing and pharmacy
colleagues currently run one- off group sessions on hormones,
deportment, healthy lifestyles and self- esteem and confidence. I am
keen to develop groups with an occupational focus to meet service user
needs.
Although service users may have made the decision to move forward with
their gender, there are still many aspects of their occupational life
that remain problematic. Alongside the rest of the general population,
many service users have roles as a parent, wife, husband or partner
and can feel guilt about how the decisions that they have to make are
to affect others.
Relationships may have broken down and support may be required for all
those concerned. Service users may be in employment and have the task
of having to transition at work or finding the search for work even
more difficult. Other service users may have supportive and
understanding families, friends and colleagues who can provide the
much-needed support that is required. Often, service users have
suppressed the feelings that they have had for many years due to
societal and environmental pressures placed upon them.
To be an occupational therapist working in the area of gender is an
exciting and challenging prospect and provides opportunities to
demonstrate the positive contribution that occupational therapy can
make in gender identity.
• Jo Taylor, OT, Leeds Gender Identity Service, Leeds Partnerships
Foundation Trust. Email: Jo.T...@leedspft.nhs.uk
http://www.cot.co.uk/MainWebSite/Resources/Document/09%20OT%20in%20gender.pdf