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
