Transgender Emergence, by Arlene Istar Lev. 467 pages (soft-cover edition). Haworth Clinical Practice Press. 2004.
The trans therapists I know were already therapists prior to their transition. My journey was quite different – I was propelled into the profession in large part by my experience of transition. I had always been interested in psychology, but would probably not have become a therapist had I not encountered some counterproductive therapy early in my own process. Thus, I entered graduate school already knowing my thesis topic – to make concrete a more appropriate approach for working with trans clients. Had “Transgender Emergence” been written at that time, it would have been a crucial text in helping me “prove” my case, that a new paradigm was badly needed in the field of gender identity therapy.
I read this book from two simultaneous (and inextricably linked) perspectives, that of the transman and that of the therapist. When I was still a lesbian, one of my mantras was, “Question Authority.” As a transman, I have taken this mantra one step further – I question reality. What it means to question authority is to question the answers; what it means to question reality is to question the questions. From my trans perspective, I apply a litmus test to non-trans individuals who attempt discourse on trans issues: Are they questioning authority, or are they questioning reality, or are they questioning my identity? Indisputably, Arlene Istar Lev questions the reality of our current gender binary system, and this is what makes “Transgender Emergence” an authentic reflection of the trans experience. That a non-trans person could write this book is remarkable, as it takes a great deal of empathy and mental gymnastics for an author to so thoroughly enter a world of experience that is not their own. There are so many passages in this book that resonated with my experience, I hesitate to choose one to quote. Thus, from among those passages I bookmarked, I chose at random:
“What does it mean to be a healthy functioning gender-variant person within an immutable dual-gendered world? The mental health problems that are associated with transgenderism may not be etiologically related to the gender variance but caused by the social and political ramifications of being a member of a despised group.” (p. 4)
From my therapist’s perspective, one of my goals is to help my clients shift their world view in precisely this manner – “it’s not you, it’s our culture.” Viewing transgenderism as existing on a spectrum of gender possibility is a cultural paradigm shift away from the gender binary. However, it is not enough to say, “The medical model isn’t correct because it pathologizes various forms of gender identity!” This does not provide an alternate paradigm. Lev grounds her gender therapy perspective in current theory – particularly systems theory and feminist theory – to prove her case for a paradigm shift from psychological pathology and toward identity emergence as a developmental process. She presents a staged model of identity emergence (p. 235) that provides clinicians with a perspective they can use to more effectively guide their clients through a process of self-knowledge and self-actualization, regardless of the clinician’s theoretical orientation or methodology.
“These stages are not meant to ‘label’ people, define transgender maturity, or limit anyone to these experiences. They are meant to outline a general trajectory of experiences for transgendered and transsexual men and women who are coming to terms with gender variance at the beginning of the twenty-first century, and moving from an experience of denial and self-hatred to one of self-respect and gender congruence.” (p. 234)
When one uses a developmental lens rather than a diagnostic lens, it is a natural step to consider the client in a life context, rather than as an individual patient whose diagnosis exists in isolation. Lev’s holistic view of the client in a social context is crucial, as families and partners are less well-served currently than trans people (which is saying a lot). For example, Lev presents one possible scenario: “In rare instances, the partner is completely unaware of the gender issues. When the couple has been together for many years, the shock of this disclosure can be devastating. It is to be expected that partners will experience a range of emotions, including hurt, fear and betrayal…The partner will experience a process that parallels, but is not the same as, the transgendered person’s process. The emotional process they experience is itself an emergence experience.” (p. 250-51) Lev leaves no one behind as she addresses the various issues of children, partners and family members when gender identity is in question.
Lev also addresses the issues faced by intersexed people. Because the etiologies of trangendered and intersexed individuals differ greatly, the clinical issues presented also differ. Thus presenting the two as separate is critical. Some trans individuals make statements such as, “Transition surgeries create intersexed bodies.” While this is a literal truth, it also tends to conflate the conditions, which can mask the clinical differences. Lev’s chapter title (“The Treatment of Intersexed People: Time for a New Paradigm”) makes clear that she realizes the issues are not the same. At the same time, she also recognizes the underlying connection that is our current cultural paradigm: The gender binary must be preserved at all costs, whether this means pathologizing gender identity actualization or converting intersexed infants at birth.
Lev’s holistic view allows her to have compassion for those well-meaning mental health care providers who worked with trans clients in previous decades. Given the context of their times, they were doing the best they could with the information available to them at the time. It is to be hoped that those who are still practicing today can read Lev’s book and shift their own paradigm, as their long clinical experience can be invaluable in the service of their clients.
I was somewhat disappointed that though Lev touched briefly on the needs of post-transition clients, she did not discuss at length the different issues that arise after the client feels “done.” It has been my experience, both personally and professionally, that very different clinical issues arise post-transition, beyond the initial stages of emergence Lev presents in her book. However, no text is ever definitive, in any field, and Lev has given future authors a model to build on in writing about other aspects of the trans experience. She deserves high praise for providing the first book to move the field of gender therapy beyond a pathologization model and into a model of identity actualization.
Based in Portland, Oregon, Reid Vanderburgh, MA, is a private-practice psychotherapist, specializing in gender identity issues.