Counseling in a Gender Expansive World

Douglas Knutson (he, him) PhD, LHSP is an assistant professor in the School of Community Health Sciences, Counseling and Counseling Psychology at Oklahoma State University. Dr. Knutson earned a Masters in Theological Studies in Theology, Philosophy and Ethics at Boston University School of Theology, a Masters of Education in Applied Behavioral Studies with Professional Counseling at Oklahoma City University, and a Doctor of Philosophy in Counseling Psychology at Oklahoma State University. He serves as director of the Diversity and Rural Advocacy Group (DRAG) a consortium of international researchers and advocates who focus on health and resilience in LGBTQ+ populations. Dr. Knutson has published 38 peer reviewed articles, book chapters, professional papers, and encyclopedia entries. He has co-authored 74 presentations delivered at international, national, and local conferences and professional meetings. His work has been referenced in news Stateline and in NPR News. He currently serves on the editorial boards of The Counseling Psychologist and Psychology of Sexual Orientation and Gender Diversity. Dr. Knutson's research focuses on the design and development of transgender and nonbinary affirming interventions for rural populations. Chloe Goldbach (she/her/hers), MS, MA is a White, lesbian, transgender woman and PhD candidate in Counseling Psychology at Southern Illinois University Carbondale (SIUC). She earned a Master of Arts in Psychology from SIUC, and a Bachelor of Arts in Psychology, Bachelor of Science in Mechanical Engineering, and Master in Science in Biomedical Engineering from the University of Florida. She organizes community-wide events on transgender and nonbinary issues as an officer of the SIUC Women, Gender, and Sexuality Studies organization, serves as an associate researcher of the Diversity and Rural Advocacy Group (DRAG) at Oklahoma State University, teaches courses on LGBTQ+ and workplace diversity issues, leads a YouTube channel on transgender and nonbinary topics, and is an therapist-in-training with a focus on serving LGBTQ+ clients and clients with eating and body image concerns. Chloe has published 10 peer reviewed articles, encyclopedia entries, and professional papers, all related to issues impacting LGBTQ+ individuals. She has delivered over 40 presentations at international, national, and local conferences, training workshops, and professional meetings. She is currently conducting research on barriers to healthcare access for transgender and non-binary people, experiences of LGBTQ+ people during the COVID-19 pandemic, and centering the voices and experiences of transgender and nonbinary people in the treatment and conceptualization of gender dysphoria. When she has spare time, Chloe enjoys watching horror movies, playing video games, and cuddling with her cat, Tipsy. Julie M. Koch (she/they), PhD, is Professor of Counseling Psychology in the College of Education at the University of Iowa. She/they has extensive experience with clinical practice with LGBTQ+ rural populations. Dr. Koch is a former high school teacher and school counselor. She/they holds a B.A. in Japanese language and culture from the University of Massachusetts-Amherst, a M.Ed. in Educational Psychology-School Counseling from the University of Texas at Austin, and a Ph.D. in Educational Psychology-Counseling and Student Personnel Psychology from the University of Minnesota-Twin Cities. Dr. Koch enjoys work with schools and international collaborations. She/they was a Monbusho Scholar at University of Hokkaido and received a Fulbright Specialist Grant to work with the LGBT Centre in Mongolia. In her spare time, she/they enjoys hiking, quilting, and spending time with her/their family.

Introduction Section I: Laying the Foundation for Affirmative Work Chapter 1: Building an Understanding of Gender Bill Molly Rowan Gender Terminology Gender Binary Gender Identity Gender Expression Gender Continuum Gender Identities Cisgender Transgender Nonbinary Intersex Transsexual Pronouns Summary and Recommendations Reflection Questions References and Suggested Readings Chapter 2: Exploring your Gender Identity Bill Molly Rowan The Unexplored Life Cisnormativity Misgendering/Mispronouning Deadnaming Gender Identity and Your Environment Family and Friends Workplace Community Privilege The Binary and Me Exercise Summary and Recommendations Reflection Questions References and Suggested Readings Chapter 3: Gender Identity and the Intersectional Self Bill Molly Rowan Client Intersectionality Privilege and Power Race and Ethnicity Sexual Orientation (Dis)ability Status Socioeconomic Status Human Service Professional Intersectionality Gender Identity Exploring Intersectional Gender Identity Connecting with Others Client-Professional Interactions Points of Interaction Socioeconomic Status Sexual Orientation Minoritized Racial Status Social Support Age Summary and Recommendations Reflection Questions References and Suggested Readings Chapter 4: Gender Identity and Lifespan Development Bill Molly Rowan Early Awareness Gender Assumptions Childhood and Adolescence Childhood Adolescence Puberty School Early Adulthood Work Middle to Late Adulthood Summary and Recommendations Reflection Questions References and Suggested Readings Chapter 5: Gender Identity and Geographic Location Bill Molly Rowan Cultural Nuance Teletherapy Urban Areas Transportation Violence and Safety Fees for Service Discretion Family, Partners, and Friends Positive Aspects of Rural Areas Proximity to Family Faith, Friends, and Church The Beauty of Nature Access to Services Limiting Aspects of Rural Areas Proximity to Family Faith, Friends, and Church Seclusion Internet Access and Remote Connections Travel and Resource Access Access to Competent Providers Semi-Rural and Semi-Urban Areas People Who Immigrate General Guidelines Explore the Geographic Culture of Origin Access Distance and Physical Access to Resources Explore Spatial Connections to Community and Religion Address Family Businesses, Ties, and Expectations Explore the Impact of Local Laws and Policies Access Availability, Longevity, and Commitment Summary and Recommendations Reflection Questions References and Suggested Readings Section II: Elements of Affirmative Practice Chapter 6: Relationship Building Bill Molly Rowan Prior to Meeting a Client First Appointment Early Stages of Relationship Strengthening the Relationship Termination and Beyond Summary and Recommendations Reflection Questions References and Suggested Readings Chapter 7: Assessment and Diagnosis Frameworks Bill Molly Rowan A Brief History of Mental Health Diagnostic Categories Assessment Formal Measures Informal or Interview-Based Assessment Intake Protocols Diagnosis Default Diagnosis Differential Diagnoses Stabilization Diagnoses as Permission or Endorsement for Treatment Ethics and Diagnoses Common Pitfalls Refusing to Write a Letter Ignoring Gender Expansive Identities and Intersections Homogenizing the Population Being Unprepared to Provide Affirming Services Summary and Recommendations Reflection Questions References and Suggested Readings Chapter 8: Ethics and Professional Standards Bill Molly Rowan Positive Ethics Taking a Positive Ethics Approach Positive Ethics and Decision-Making Nonmaleficence and Positive Ethics Ethics and Legal Issues Conversion Therapy Ethics and Practice Concerns Multiple Relationships with a Single Client Relationships with Client Families Rural Considerations Informed Consent Competence Multicultural and Social Justice Practice Summary and Recommendations Reflection Questions References and Suggested Readings Chapter 9: Transition, Care Teams, and Clinical Process Bill Molly Rowan Transitions Social Transition Medical Transition Gender Dysphoria Diagnosis and Access to Care Gender Euphoria Passing Diverse Pathways Care Teams Clinical Processes Summary and Recommendations Reflection Questions References and Suggested Readings Chapter 10: Resources and Letter Writing Bill Molly Rowan Resources Letters Affirming Hormone Therapy Affirming Surgeries Carry Letters Other Resources Competence Building Resources Transition Care Resource Web-Based Resources Summary and Recommendations Reflection Questions References and Suggested Readings Section III: Affirmative Care in Context Chapter 11: Affirmative Work in Various Settings Bill Molly Rowan General Considerations Leadership Support Staff Operating Systems Location Specifics Schools College or University Counseling Centers Private Practitioners Corporate and Large Companies Conclusion Summary and Recommendations Reflection Questions References and Suggested Readings Chapter 12: Partners and Families Bill Molly Rowan Foundations and Key Concepts Deconstructing Negative Biases The Power of Acceptance Gender in Family Dynamics Gender Fixation in Families Components of the Family System Supporting Gender Expansive Children Supporting Gender Expansive Parents Gender Transition and Romantic Relationships Partners and Relationship Dynamics Transitioning in Close Relationships Polyamorous Relationships Summary and Recommendations Reflection Questions References and Suggested Readings Chapter 13: Groups Bill Molly Rowan Group Stages Group Formation Group Member Selection Forming Storming Norming Performing Termination General Suggestions Summary and Recommendations Reflection Questions References and Suggested Readings Chapter 14: Sex, Sexuality, and Romantic Attraction Bill Molly Rowan Historical Perspectives on Sexual Health Gender-Affirming Approaches Gender Expansive Clients and Sex Education Myths Towards a Sex-Positive Framework Body Positivity Eroto-Positivity Kink Positivity Relationship Positivity Additional Considerations Conclusion Summary and Recommendations Reflection Questions References and Suggested Readings Chapter 15: Supervision Bill Molly Rowan Lisa, LPC, and Austin, Master's Trainee Supervision and Contextual Factors Group Supervision Identity Differences Power Dynamics Constructive Feedback Supportive Feedback The Supervisory Relationship Self-Disclosure Boundaries Parallel Process Ruptures and Conflicts Supervision as a Professional Role Qualification Compatibility Consultation Continuing Education Future Developments Summary and Recommendations Reflection Questions References and Suggested Readings Conclusion Appendix A: Resources Table Figure 1 Appendix B: Letter of Recommendation for Hormone Replacement Therapy Appendix C: Letter of Recommendation for Surgery Appendix D: "Carry Letter" Appendix E: Clinician Action Steps Table 1 Index About the Authors