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GENDERED INEQUALITY: DECONSTRUCTING BARRIERS TO ENABLE SENSITIVE SYSTEMIC “IF WE COULD CHANGE OURSELVES, PRACTICE WITH DIVERSE PEOPLE AND THE TENDENCIES IN THE WORLD RELATIONSHIPS WOULD ALSO CHANGE.”

ANNE PROUTY - MAHATMA GANDHI OCTOBER 2017 AUSTRALIAN ASSOCIATION FOR FAMILY THERAPY ANNUAL CONFERENCE ADELAIDE, AUSTRALIA

GLOBAL “” (Binary) Gender Inequities DEADLY CUTTING EDGE * MISERABLE TO PROMOTE SOCIAL JUSTICE * REAL ADVOCATE FOR CLIENTS

SEX AND GENDER 2007 “”: 28 Principles of the THE WORLD HEALTH ORGANISATION HAS RECOGNISED Application of International Human Rights Law in SEX AND GENDER GLOBALLY AS CORE SOCIAL Relation to Sexual Orientation DETERMINANTS OF PHYSICAL AND MENTAL HEALTH and Gender Identity 64 AND WELL-BEING 44 • LGBTI are 11% of Australians as of 20146 • www.Yogyakartaprinciples.org • GENDER Keynote/Yogyakarta principles_en.pdf • 1.7% of Australians are estimated to be (Australian Human Rights Commission) • 2% of people globally estimated to be non-binary gender • 34% of LGBTI Australians hide their identity when accessing services

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Approaches to IDENTITY Social Justice

Multiple Cultural Communities • WHO DEFINES WHOM? Human Diversity within Communities/Contexts • EACH PERSON’S EXPERIENCE? Human Diversity Across Lifespans • BY INTERACTING WITH EACH OTHER? • INTERACTING BY PROXY AND VIA COMMUNITIES? INTERSECTIONALITY

INTERSECTIONALITY - IDENTITIES INTERSECTIONALITY - IDENTITIES

SEX &/OR GENDER ID ETHNIC ID SEX &/OR GENDER ID ETHNIC ID

SEXUAL ORIENTATION SPIRITUAL ID SEXUAL ORIENTATION SPIRITUAL ID

RELATIONAL ORIENT CITIZEN ID RELATIONAL ORIENT CITIZEN ID

RELATIONAL ROLES PHYSICAL ABILITY RELATIONAL ROLES PHYSICAL ABILITY

INTERSECTIONALITY - IDENTITIES INTERSECTIONALITY - IDENTITIES TIME PLACE

SEX &/OR GENDER ID ETHNIC ID SEX &/OR GENDER ID ETHNIC ID

SEXUAL ORIENTATION SPIRITUAL ID SEXUAL ORIENTATION SPIRITUAL ID

RELATIONAL ORIENT CITIZEN ID RELATIONAL ORIENT CITIZEN ID

RELATIONAL ROLES PHYSICAL ABILITY RELATIONAL ROLES PHYSICAL ABILITY

AGE

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SEX or GENDER?

“Just as the constant increase of entropy is the basic law of the universe, so it is the basic law of life to struggle against entropy.

- Vaclav Havel

Non-Binary Sex SEX Survey of Medical Literature by Blackless and Colleagues (2000) Historically Relied on Phenotype – Physical Appearance Estimated as high as: 2 % of live births 7 Physical Body Parts – outside and inside – many different reasons

Hormones & Hormone Receptors (can be from chromosomal condition) Example: Androgen Insensitivity Syndrome: Complete or Incomplete

https://medlineplus.gov/ency/article/001180.htm http://emedicine.medscape.com/article/924996-overview

Hormones in-utero exposure and brains – studies with small samples of people who donate brains to science, researchers are showing that cismale and transmale stain alike, cisfemale and transfemale stain alike 35

Medicalized Narrative of Binary Sex SEX and CHROMOSOMES Babies • Used a small caliper to measure penis / clitoris – where is urethra? Male, Female, and Intersex • https://en.wikipedia.org/wiki/Phall-O-Meter Mosaic / Chimaera – some cells XX, others XY

Examples of Sex Chromosome Variants – some cause infertility • (testes) X0 “Turners” XXX+ ”Triple X” XXY “Kleinfelters” XYY “Jacobs” • Differentiation of Testes / Labia • Vaginal Foramen Present?

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Medicine and Binary Bodies

• Babies Humans’ Sexes are Complex, Diverse, Unique • Interdisciplinary Team Articles Arising • https://oii.org.au (video hyperlink to Bonnie Hart, author of “Orchids, My Intersex Adventure” – ex. of Androgen Insensitivity Syndrome in a family) • Preteens and Teens • Hormone blockers to pause puberty • Hormones to move puberty toward sexual body development • Adults • Endocrine System Hormones, Bones, Epiglottis, Vocal Cords, Gonads, Secondary Sex Characteristics; Cultural gendered social, vocal, & movement • https://oii.org.au/category/comment/personal-stories/ • Not necessarily a LINEAR or binary gender (medical) journey

Child Development & Gender50 WHAT IS GENDER???? • Gender Identity or Awareness – by age 3

GENETICS • Idea of Gender Stability – if taught – by 5 • Idea of Gender Consistency by 7

BODY MY • CONTEXT! IDENTITY •Familial and Community Reinforcement

CULTURAL •Peers - Options for Trying-on Identities as well as Bullying •Internet Community Options and Bullying

Cisgender Privilege 29 • Sex assigned at birth is linked to your experience of gender Myth of Binary Gender • Your gender identity is not pathologized and dx not required for medical support • Your identity documents have your preferred gender and you do not need to share personal or medical information to get them changed • People use your preferred pronouns (infrequent misgendering) • People and identity documents use your preferred name • Cosmetic surgery probably wasn’t performed on you without your consent just so others would feel more comfortable Male Androgenous Female • No one asks you about your genitals, or whether you will take hormones or get Intergender surgeries • You may be able to marry and stay married– in some countries • Safety – based on gender anyway (intersectionality plays-out here too) • Gender option available on most paperwork and forms • Community, Money & Medical, …..

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Common Examples of Microaggressions Cisgender Assumptions Including Those Used by Partners (see IPV section) • Personal questions, including “why?”

• Not everyone who’s gender does not match their assigned sex (whether it’s • “real” man/woman does x,y,z binary or not) wishes to become either male or female 45 • “Biological man/woman” instead of using person’s preferred • Of those who wish medical corrective interventions not everyone wishes to gender term do them in the order often directed by medical institutions (hormones then surgery or all surgery options or stereotyped outcomes) 45 • Misgendering or misnaming • “You’re not doing it [gender] right” • Pathologizing thoughts, feelings, etc. – in order to obtain access/resource • MORE??

Long History of Gender as Non-Binary Identities Gender Pronouns in English National Geographic 2017: http://www.nationalgeogr aphic.com/magazine/2017/ HE SHE ONE ZE THEY 01/how-science-helps-us- HIM HER ONE ZIR THEM understand-gender- HIS HERS ONE’S ZIR THEIR identity/ HIS HERS ONE’S ZIRS THEIRS http://www.nationalgeogr HIMSELF HERSELF ONESELF ZIRSELF THEMSELF aphic.com/magazine/2017/ 01/gender-issue-reader- comments-faq/#/gender- revolution-ngm- covers.png

Multiculturalism Applied to Gender Gender Diversity within Gender Variant Communities and Communities • Cultures of gender, gender identity, gender journey • Influences on my beliefs • Influence my attitudes about people and their needs • Gender Fluid - Dynamic, Moving Among , Simultaneously More than One • Influence definition of helpful, support, resilience • Some non-binary people identify as Transgender or Gender Variant (TGV), • Experience with gendered communities and diversity of people while others do not • Experience with Advocacy (practical and legal rights)

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Models of Sexual Orientation Relational Intersections • Many models are based on whether the desired person is similar or different from one’s own gender identity (that’s not helpful) •Sexual Orientation • Static? Dynamic? • Influenced by social context’s options? • Should include asexual •Relational Orientation • Often helps if includes an intersection with sex drive, with a definition that can vary over time/situations • Note: I am talking about human adult-adult & consensual only

Sexual Orientation

http://www.soc.ucsb.edu/sexinfo/article/overview-sexual-orientations

Relational Orientation

An enduring pattern of romantic RELATIONAL ORIENTATION59 or sexual attraction (or a combination of these two) to monogamy, nonmonogamy, or to a degree of both 9,18

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Types of Amorous Relationships • Sexual Freedom/ No Commitment • Friends with Benefits • Monogamy • Serial Monogamy • Partnerships - Committed – Legally Recognized • Non-monogamous (Consensual & Nonconsensual) • Open, Swinging, Geographical • Plural Commitments & Marriages • Polygamy (polygyny, polyandry) • Poly-Network

Global Prevalence of Plural Families Context Challenges & Resiliency Strategies • More than 850 societies within Africa, Asia, Oceania, Middle East, and Americas • Legal – Trusts, Wills, Financial Accounts, Adoption, Custody Papers, • North America: Several Indigenous Nations Divorce/Dissolutions, Official Papers & Gender Identity practiced polygamy prior to European • Immigration – Who is acknowledged as whom invasion (KOSTER 2012). • Spousal Evidentiary • Tibet - polyandry – until China invaded in • Visibility/ Invisibility Management – Adults and Children (parents) 1950 – kept brother-husbands’ family land • Medical & Mental Health Access – gender affirmative care in their family • Police Protection & Respect • Now two religious groups are responsible • Illegality can make vulnerable to cults & other closed systems – these are for most of growth in the U.S. (100,000 + the dynamics that lead to serious vulnerability and harm plural families estimated)

Violence: Hate Crimes

• U.S. National Coalition of Anti-Violence Programs reported that Transgender Women experience 72% of anti-LGBT Violence homicide victims, and 89% of these are people of color 1 • 20% of hate crimes in U.S. are against people who identified as LGBTQ with highest rates among transgender people, and transgender women in particular 23 • Australian Human Rights Commission 2014: 47% of Trans-Men and 37% of Trans-Women report experiencing verbal abuse • Transgender Men and Women experience high rates physical abuse

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PARTNER(S) AND FAMILY VIOLENCE30

• More than half (>60%) of transgender people have been victim of violence Family Violence: Interpersonal Violence • Cisgender and Not-cisgender sample (not just T) of teens in a study of peer violence and bullying and substance use, a history of bullying during recent year fully mediated relationship between gender identity and use of substances, i.e. substance use associated with peer violence, like bullying 44 • Researchers found that transgender people were significantly more likely to report being victims of IPV than were cisgender people in a sample who identified as LGBTQ. No difference in reporting to police. 30

Johnson’s 4 Types of Violent Couples 27, 28 Gender and IPV Based on Heterosexual, Cisgender, Dyads (1) Situational Violence • Researchers have found that a majority of people who are seriously • Can be mutually violent but neither are controlling injured/killed by IPV are women 4 and women are twice as likely to report • Conflict over particular issue(s) – often conceptualized as communication deficit being fearful of bodily injury or death than are men5 • Hypothesized to be the most prevalent type • Gay and lesbian couples under-report violence – heterosexist context – but researchers estimate gay and lesbian couples similar prevalence to (2) Intimate Terrorist heterosexual couples 5 • Unilaterally Violent with High Level of Coercive Control (Violence may be past) Lesbian couples’ violence might be [erroneously] dismissed by therapists as • (3) Violent Resistance mutually combative and unimportant, and heterosexist physical appearance • Violent & Controlling with Partner has (short-lived) violent evaluation was subconsciously involved in evaluation of threat (study of resistance/self-defense therapists) 33 (4) Mutual Violent Controlling • Two controlling partners engaged in struggle for power/control

POWER & CONTROL WHEEL2, 11, 47 LARGER CULTURES/SYSTEMS OWN CULTURE/S HISTORY OF ABUSE/NEGLECT/HATE CRIMES SEXUAL ABUSE COUPLE/FAMILY PHYSICAL ABUSE/NEGLECT PEOPLE & PETS PHYSICAL VIOLENCE WITH/TO THINGS IPV & Context Questions USING CHILDREN OR PETS EMOTIONAL ABUSE • Couple’s Community – Is the couple in an open or closed system? Is the SPIRITUAL ABUSE community a minority? (fear of harming the community by being open INTIMIDATION about violence?) THREATS INTERNALIZED COERCION ISOLATION • Does the Community have resources for People? Resources for Same-Sex CONTROL OF SEXUAL/REPRODUCTIVE HEALTH and non-binary gender people welcomed? ECONOMIC ABUSE IMMIGRATION THREATS PASSING, DENYING, MINIMIZING, BLAMING • What about Violence in Plural Families – Community responsive, visibility HATE CRIMES management risks? GENDERISMS & OTHER LIMITING OR OPPRESIVE STORIES ABOUT IDENTITIES

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RESILIENCE WHEEL OWN CULTURE/S COUPLE/FAMILY ACCESS TO SAFE ENVIRONMENT “SAFE” Assessed and Strengths-based, Solution- CULTURE ACCESS TO MEDICAL CARE OF CHOICE HISTORY OF SUCCESSES focused, Couples Therapy when SENSE OF COMPLEX IDENTITY/IES Situational IPV Exists 32, 48, 54, 55, 56 IDENTITY AS A JOURNEY PRIDE IN IDENTITIES INTERNALIZED PHYSICAL & EMOTIONAL HEALTH • SAFE (Smith et al.) Assessment: Each Adult Reviews own involvement, emotional path, and responsibility COUPLE/FAMILY –VISIBILITY AGREEMENT AND COOPERATION • If thought to be safe, couple reviews, identifies triggers and warning signs RICH NETWORK OF FAMILY & FRIENDS • Negotiated Time-Out training, practice SAFETY PLANS FOR MULTIPLE • Miracle Question to Identify Solution-focused, Steps toward Small Goals SITUATIONS • Communication and Disagreement Training FINANCIAL/ECONOMIC RESOURCES – OVERTLY DISTRIBUTED • Couple Therapy CONCRETE LEGAL PROTECTIONS – LARGER CULTURES/SYSTEMS POWERS OF ATTORNEY; WILLS; TRUSTS

GENDER AFFIRMATIVE THERAPY Pulling Intersections Together and Remembering that Peoples’ SEX &/OR GENDER ID ETHNIC ID Identities Across Systems May Vary SEXUAL ORIENTATION SPIRITUAL ID • Sexes RELATIONAL ORIENT CITIZEN ID • RELATIONAL ROLES PHYSICAL ABILITY • Sexual Orientations • Relational Orientation and Varied Family Structures/Boundaries • Physical, Emotional, & Economic Safety – Visibility Management • Contexts – situational and along developmental life cycle • Intersections with other Identities and Group Memberships – Ethnicity, SES, Nationality/Geography, Ableness, Military/not, Religion, Career, etc…

World Professional Association for Gender Identity Affirmative Therapy Practice Transgender Health (WPATH) • Knowledge of what World Health Organisation calls the Three Traumas: intrapersonal (self), interpersonal, and collective (policy/laws) traumas • Knowledge about Community and On-line Social Support Networks • Standards of Care • In addition to evolving our ideas, assessments, intake and consent paperwork, our language, models of change to be more inclusive of gender • http://www.wpath.org/site_page.cfm?pk_association_webpage_menu=1347&pk_a identity and intersections with other identities…. ssociation_webpage=4233 • Make sure our electronic health records allow for non-binary identities • Make sure our waiting rooms and professional spaces are safe, welcoming, and reflect lots of diverse people • We can use Strengths-Based Assessments • Connor & Davidson’ 17 25-item Resilience Scale

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Gender Affirmative Therapy continued Resilience • Strengths-based approaches • Safe place to be authentic and work on life and relationships AND • Competencies – Against both Macro and Microaggressions • Place to prepare when making changes (ex: relocation, travel, jobs) • Stress is cumulative and so are Resilience Skills • Informed Consent & Advocacy Expectations – clarity • Assess All Clients for PTSD • “Safe passage letters” of support/explanation on professional letterhead - • Compensation 45 In case need such letters for airlines, international border crossing, arrest 52 • Coping Resources • Community Advocate and Educator to promote safe community spaces, 61 interactions, spaces (schools to police forces) • Struggling Well • Community Activism to expand Identity Documents & Human Rights • Explore/Develop Gender identity pride and connections Policies • Develop All Identities Pride – Connect with multiple communities • Connect to Religious and Spiritual Resilience 51, 53

Resiliency as a Relational Process Across Many Human Identities 14, 62 • Relationships buffer and distribute stress Sex/Gender/Sexual Orientation/Relational Orientation • Struggles are seen as part of journey – the “we” humanizes Visibility & Equity Across multiple • People and couples/families gain new skills and resources along Adaptation Legal Recognition of the journey identities - the capacity to Identities, respond to Relationships, and • Identify symptoms and support people when physical and mental Vibrant and changing social Families Multiple environments Communities health symptoms arise across life cycle Security & Respect – Laws and Public Strong Families • Finding and being a part of larger human communities of Innovation Policies Intimate - the capacity to strength and pride - at individual, couple, family levels Access to Relationships and inspire and drive Knowledgeable Care change – socially • Useful in dealing with situational and developmental stressors Friendships Professionals and in concrete environments IN FAMILY THERAPY Health Promoting Communities

Role of Family Therapy Parental Support 46 • Discuss fluidity of gender rather than binary version • Gender Journey • https://www.hrw.org/topic/lgbt-rights • Some people’s journey includes transition to another – with or without • Acknowledge grief, flooding, guilt, whatever people are feeling hormones and/or surgery(ies) 31, 40 • Acknowledge okay to not agree – process – until agree on initial journey • Screen ALL clients for PTSD and trauma 52 map • Family Emergence – non-linear stages of adjustment • Acknowledge lots of people have strong opinions – including medical • Shock, betrayal, grief, confusion (sex, gender, sexual orientation, identities – indiv & family) • Help parents develop skills, resources, community of support 12 • May be chaotic – move toward flexible, trials for success • Affirmative approaches 26,35,37,46 • Pace of change(s) • Gender-queering the whole family in context, in culture(s) – previously invisible privledge now noticed

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Couples 34 Affirmative Approach with Parents 26,34,35,37,46

• Couple Therapy with Transgender People and Their Partners • Work with parents to support child’s gender journey and self-identified gender • New relationship for both/all partners • Help parents to advocate for their child(ren) • New relationships with all family members • Sex not binary and Gender not binary • How people find out, length of secret, involvement in decisions about pace of changes 31 • Saeger’s 4 stages: • Important of connections, relationships, good emotional boundaries • Discovery, Turmoil, Decision-making, Finding Balance • Bisexuality correlated with staying together as a couple 34 • “Balance” – Changes with child’s/teen’s development • Sexual Identities of both partners – is there a wording change/or not or does Extended Family & Community(ies) • it feel that way? – does their community, culture, religion embrace and support them? (any issues of external labels and internal identities?)

Couples Therapy continued “HOPE is a thing with feathers • Writing own, new story(ies) and relationships That perches in the soul • Importance of connection and supports And sings a tune without words, • Importance of grief (everyone’s) throughout journey 34 And never stops at all…” • Ambiguous losses 13 • Constructive instead of destructive separation/divorce 34 • Family Motto of “there are always lots of changes and we always - Emily Dickinson figure them out” correlated with better outcomes

11 References & Suggested Resources

1. Ahmed, O., & Jindasurat, C. (2014). Lesbian, gay, bisexual, and transgender, queer, and HIV-affected hate violence 2013. Cited by Singh, A. A., & Dickey, L. M. (2017). Affirmative Counseling and Psychological Practice with Transgender and Gender Nonconforming Clients. Washington, DC: American Psychological Association. 2. Almeida, R., & Bograd, M. (1990). Sponsorship: Men holding me accountable for domestic violence. Journal of Feminist Family Therapy, 2, 243-256. 3. Almeida, R., Woods, R. Messineo, T., & Font, R. (1998). Cultural context model. In M. McGoldrick (Ed.), Re- visioning family therapy: Race, culture, gender in clinical practice (pp. 414-431). New York, NY: Guilford. 4. Archer, J. (2000). Sex differences in aggression between heterosexual partners: A meta-analytic review. Psychological Bulletin, 126, 651-680. 5. Ard, K. L., & Makadon, H. J. (2011). Addressing intimate partner violence in lesbian, gay, bisexual, and transgender patients. Journal of General Internal Medicine, 26, 930-933. doi: 10.1007/s11606-011-1697-6. 6. Australian Human Rights Commission. (2014). Face the facts: Lesbian, gay, bisexual, trans, and intersex people. ISBN 978-1-921449-67-3 7. Blackless, M., Charuvastra, A., Derryck, A., Fausto-Sterling, A., Lauzanne, K., Lee, E. (2000). How sexually dimorphic are we? Review and synthesis. American Journal of Human Biology, 12, 151-166. 8. Blumer, M. L. C., Ansara, Y. G., & Watson, C. M. (2013). Cisgenderism in family therapy: How everyday clinical practices can delegitimize people's gender self-designations. Journal of Family Psychotherapy, 24, 267-285. doi: 10.1080/08975353.2013.849551 9. Blumer (now Twist), M. L. C., Haym, C., Zimmerman, K., & Prouty, A. (March/April 2014). What’s One Got to Do with It? Considering Monogamous Privilege. Family Therapy Magazine, 13(2), 28-33. http://www.aamft.org/imis15/magazine/MarchApril2014/ 10. diversity. Sexologies, 17, 211-224. 11. Breiding, M. J., & Armour, B. S. (2015). The association between disability and intimate partner violence in the United States. Annals of Epidemiology, 25, 455-457. doi: 10.1016/j.annepidem.2015.03.017. 12. Brill, S., & Pepper, R. (2008). The transgender child. San Francisco, CA: Cleis. 13. Boss, P. (2000). Ambiguous losses: Learning to live with unresolved grief. Boston, MA: Harvard University Press. 14. Cohen, P. J., Lawless, S., Dyer, M., Morgan, M., Saeni, E., Teioli, H., & Kantor, P. (2016). Understanding adaptive capacity and capacity to innovate in social-ecological systems: Applying a gender lens. Ambio, 45(S3), S309-S321. doi: 10.1007/s13280-016-0831-4 15. Cohen-Kettenis, P.T., & Pfafflin, F. (2003). Transgenderism and intersexuality in childhood and adolescence: Making Choices. Series: Developmental Clinical Psychology and Psychiatry: Volume 46. Thousand Oaks, CA: SAGE. 16. Coleman, E., Bockting, W., & Botzer, M., Cohen-Kattenis, P., DeCuypere, J., Feldman, L. Fraser, J. et al. (2011). Standards of care for the health of transsexual, world professional association for transgender health, transgender, and non-gender conforming people, Version 7. International Journal of Transgenderism, 13, 165-232. 17. Connor, K. M., & Davidson, J. R. T. (2003). Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depression and Anxiety, 18, 76-82. doi: 10.1002/da.10113. 18. Davis, C. (2011). Monogamous privilege chicklist [Weblog]. Retrieved from htttp://www.eastportlandblog.com/2011/04/05/monogamous-privilege-checklist-by-cory-davis/ 19. de Vries, B. (2015). Stigma and LGBT aging: Negative and positive marginality. In N. A. Orel, C. A. Fruhauf, N. A. Orel & C. A. Fruhauf (Eds.), The lives of LGBT older adults: Understanding challenges and resilience (pp. 55-71). Washington, DC: American Psychological Association. http://dx.doi.org/10.1037/14436-003. 20. Drescher, J. (2010). Queer diagnoses: Parallels and contrasts in the history of homosexuality, gender variance, and the diagnostic and statistical manual. Archives of Sexual Behaviour, 39, 427-460. 21. Eckstrand, K. L., Ng, H., & Potter, J. (2016). Affirmative and responsible health care for people with nonconforming gender identities and expressions. American Medical Association Journal of Ethics, 18, 1107- 1118. 22. Farag, T. I, Al-Awadi, S. A., Tippett, P., El-Sayed, M., Sundareshan, T. S., Al-Othman, S. A., & El-Badr, M. H. (1986). Unilateral true with 46,XX/46, XY dispermic chimerism. Case Reports, 24, 784-786. 23. Federal Bureau of Investigation. (2013). Uniform crime report, hate statistics, 2012: Incidents and offenses. As reported by Langenderfer-Maagruder et al. (2016) see citation below. 24. Frost, D. M. (2011). Stigma and intimacy in same-sex relationships: A narrative approach. Journal of Family Psychology, 25, 1-10. http://dx.doi.org/10.1037a0022374. 25. Hendricks, M. L., & Testa, R. J. (2012). A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the Minority Stress Model. Professional Psychology: Research and Practice, 43, 460-467. doi: 10.1037/a0029597 26. Hill, D., Menvielle, E., Sica, K., & Johnson, A. (2010). An affirmative intervention for families with gender variant children: Parental ratings of child mental health and gender. Journal of Sex and Marital Therapy, 36, 6-23. 27. Johnson, M. P. (2006). Conflict and control: Gender symmetry and asymmetry in domestic violence. Violence Against Women, 12, 1003-1018. 28. Johnson, M. P., & Ferraro, K. J. (2000). Research on domestic violence in the 1990s: Making distinctions. Journal of Marriage and the Family, 62, 948-963. 29. Lehman, K., & Leavey, G. (2017). Individuals with gender dysphoria and autism: Barriers to good clinical practice. Journal of Psychiatric and Mental Health Nursing, 20, 171-177. 30. Langenderfer-Magruder, L., Whitfield, D. L., Walls, N. E., Kattari, S. K., & Ramos, D. (2016). Experiences of intimate partner violence and subsequent police reporting among lesbian, gay, bisexual, transgender, and queer adults in Colorado: Comparing rates of cisgender and transgender victimization. Journal of Interpersonal Violence, 31, 855-871. doi: 10.1177/0886260514556767. 31. Lev, A. I. (2015). Resilience in lesbian and gay couples. In K. Skerrett & K. Fergus (Eds.), Couple Resilience (pp. 45-61). New York, NY: Springer. doi:10.1007/978-94-017-9909. 32. Linville, D., Chronister, K., Marsiglio, M., & Brown, T. B. (2012). Treatment of partner violence in gay and lesbian relationships. In J. J. Bigner & J. L. Wetchler (Eds.), Handbook of LGBT-affirmative couple and family therapy. New York, NY: Taylor & Francis. 33. Little, B., & Terrance, C. (2010). Perceptions of domestic violence in lesbian relationships: Stereotypes and gender role expectations. Journal of Homosexuality, 57, 429-440. doi: 10.1080/00918360903543170. 34. Malpas, J. (2006). Can couples change gender? Couple therapy with transgender people and their partners. In J. J. Bigner & J. L. Wetchler (Eds.), Handbook of LGBT-affirmative couple and family therapy. New York, NY: Routledge. 35. Malpas, J. (2011). Beyond pink and blue: A multidimensional family approach to gender nonconforming children and their families. Family Process, 50, 453-470. 36. McNair, R. P., Bush, R. (2016). BMC Psychiatry, 16, 209-224. doi: 10.1186/s12888-016-0916-4 37. Menvielle, E., & Hill, D. (2010). An affirmative intervention for families with gender-variant children: A process evaluation. Journal of Gay & Lesbian Mental Health, 15, 94-123. 38. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674-697. 39. Mizock, L., & Lundquist, C. (2016). Psychotherapy with transgender clients: Promoting gender sensitivity in counseling and psychology practice. 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Notes:

All photos used in presentation were either the presenter’s or were CC0 Creative Commons photos and downloaded from Pixabay.com. Word art created by presenter via the website: www.wordart.com