Transgender Emergence: Reviewed By: Rupert Raj, M.A.

Transgender emergence: Therapeutic guidelines for working with gender-variant people and their families. New York: Haworth Clinical Practice Press.

A culmination of clinical social worker Arlene Istar Lev’s life work to date,Transgender Emergence is a definitive work and invaluable resource not only for mental health care practitioners, but also for professional providers of many other disciplines (e.g., medicine, nursing, law, public policy, social work, community services, theology, etc.), students, researchers and educators, as well as the client population itself: gender-variant and trans-identified individuals and their partners and family members.

Lev’s work substantially exemplifies the stated goals and purposes of theJournal of GLBT Family Studies insofar as she focuses on the transgender-emerging couple or family as a social system, examining the developmental stages for partners/ family members, and the resultant diversity of these relationships and family structures.  Additionally, the author addresses such issues as parent-child relations, relationship issues, disclosure of gender identity, and couple and family therapy as they specifically impact on gender-variance, gender dysphoria, transsexualism and transgenderism.

A welcome departure from the mainstay of traditional clinical research in this subject area (“Gender Identity Disorder” [sic]), the core value and singular best practice of Lev’s work is her de-pathologizing of gender variance (and reframing such non-binary identification and behaviour as  gender diversity) and transgenderism, and her attendant compassionate treatment of gender-variant and trans-identified people and their loved ones.  This intervention of normalizing and validating is also effectively applied to the parents of gender-variant and trans-identified children, who often harbor feelings of guilt of somehow being responsible for “producing” their “abnormal” or “deviant” child, as often suggested by “parental psychopathology” in the clinical literature.

Lev’s gender-affirming treatment approach is not surprising given that the author is herself lesbian-identified, and thus, no stranger to homophobia in both her personal and professional life.  Indeed, her lived experience as a member of a still-persecuted minority group (in some cases) sensitizes her to the prevalent societal transphobia faced by many of her clients, with its secondary impact on partners and family members, who are often condemned as “guilty by association.”

The comprehensive scope of Transgender Emergence is breath-taking in its diverse subject matter, even including foci on bi-gendered and intersexed people.  A scholarly, well-researched work, Lev’s book includes extensive case examples and citations from the literature, a history of medical science and gender variance, the de-construction of sex and gender (thinking outside the box), an examination of the essentialist construction of etiological theories (i.e., nature and nurture), a critique of the power of psychiatric diagnoses (e.g., gender as pathology), and a substantial section on treatment issues.

Specifically, these treatment issues and interventions include narrative therapy (learning to listen to gender narratives), the developmental process of the transperson (coming out and transgender emergence), the developmental stages for family members (family emergence), working with gender-variant/ transgendered children and youth (treatment, prevention and parental rights, gender variance and progressive treatments), and the treatment of intersexed individuals.

Lev’s “Model of Family Emergence Stages” (p. 281) is a useful tool for clinicians working with families with gender-variant or trans-identified children (whether they be young children, adolescents or adults) insofar as it outlines the four developmental stages of the transformational process of the family, which is, in itself, undergoing a transition similar to the gender transition of the transperson: Stage One: Discovery and Disclosure, Stage Two: Turmoil, Stage Three: Negotiation, Stage Four: Finding Balance.

Transgender Emergence provides sound clinical guidelines to effectively support gender-variant persons, transpeople and their loved ones.  Lev’s best practices draw largely upon the Harry Benjamin International Gender Dysphoria Association’s “Standards of Care for Gender Identity Disorders,” (Meyer et al, 2001), which are continuously informed by her own clinical practice and treatment interventions.

As a value-added bonus, Lev offers a wealth of resources to readers new to this field, including a brief compendium of some common intersexed conditions, an instructive guide for clinicians around writing letters of recommendation for hormone therapy, and a glossary of selected terms pertaining to gender identity and sexual orientation.

I highly recommend this resource to every careprovider or support professional who works with this population, including, but not restricted to, gender specialists, child/adolescent and adult psychiatrists, psychologists, psychotherapists, social workers, couple counsellors, family therapists and spiritual counsellors.  I further urge the inclusion of this book in the library and curriculum reading list of every educational institution which trains health care, behavioral science, social work, law, political science and theology students.