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Transgender Emergence: Therapeutic Guidelines for Working with Gender-Variant People and Their Families, Arlene Istar Lev, Bingh

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Transgender Emergence: Therapeutic Guidelines for Working with Gender-Variant People and Their Families, Arlene Istar Lev, Bingh See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/262039302 Book Review. Article in Journal of Sex and Marital Therapy · March 2005 Source: PubMed CITATIONS READS 0 254 1 author: Lara Stepleman Augusta University 67 PUBLICATIONS 637 CITATIONS SEE PROFILE All content following this page was uploaded by Lara Stepleman on 07 February 2015. The user has requested enhancement of the downloaded file. Book Review l69 source for obtaining them. In days when the Internet serves as a source of information and support for many, a few more specific websites might be useful as well. In summary, this book is a welcome addition to my professional library and I am pleased that the Talmadges have chosen to share their knowledge, their wisdom, and themselves with all of us, S, Michael Plaut, Ph,D, Department of Psychiatry University of Maryland School of Medicine Baltimore, MD USA REFERENCE Talmadge, L, D,, & Talmadge, W, C, (2003), Dealing with the unhappy marriage. In S, B, Levine, C, B, Risen, & S, E, Althof (Eds,), Handbook of Clinical Sexuality for Mental Health Professionals, New York: Brunner-Routledge, 75-92, Transgender Emergence: Therapeutic Guidelines for Working with Gender-Variant People and their Families, Arlene Istar Lev, Binghamton: Haworth Press, 2004, 467 pages, $69,95 (hardback), $39,95 (paperback). For many psychologists and therapists, the knowledge and skills for working competently with transgender clients is not collected as part of their initial clinical "toolbox," Although a few clinicians may set out early in their training to work specifically with transgender individuals, most clinicians have taken a more circuitous route to this work. Familiarity with, or specialization in gay and lesbian issues, sexuality and sexual disorders, and trauma often can lead to referrals with transgender clients. Most clinicians, even when well trained in the aforementioned areas, are often ill prepared to handle the unique needs of transgender individuals. Good intentions are not sufficient, yet when seeking out the literature, one may find it too fragmented and theoretical to be clinically useful. Additionally, advanced training on transgender issues has not been offered widely outside of large metropolitan areas, Arlene Istar Lev's book Transgender Emergence; Therapeutic Guide- lines for Working with Gender-Variant People and their Families is a ma- jor accomplishment as a comprehensive text directed toward therapists that covers a vast body of pertinent, theoretical, and clinical literature on trans- gender issues. Although Lev's emphasis on postmodern theory and decon- struction of gender, sexual orientation, and diagnostic categories may make neophytes to transgender concerns somewhat trepidatious. Lev meticulously defines her terminology and conscientiously outlines germane history and debates to provide context for consideration of clinical issues. Lev also 170 Book Review addresses throughout the book and devotes one chapter to intersex indi- viduals. At times. Lev seems to be trying to attend to the complex needs of both transgender and intersex individuals. However, the book best serves as a primer for intersex concerns. On the other hand. Lev has created what will undoubtedly become seen as a "clinical bible" for therapists in search of guidance for working with transgender individuals. The clinical merits of this book are evident throughout. From specific guidelines for psychosocial assessment in medical referrals and therapeutic treatment for individuals with intersex conditions to an example letter of recommendation for hormones, this text will provide practical clinician sup- port. Lev also tackles issues that are less frequently addressed in the trans- gender literature, such as treatment for families of transgender individuals and for gender-variant children and adolescents. With regard to families. Lev provides helpful clinical examples of intimate partner relationships and the great variety of outcomes they may experience when one partner discloses a transgender identity and/or begins the process of gender transitioning. Lev's postmodern lens exposes the fluidity that many relationships are able to experience, providing stark contrast to early thinking in which the expec- tation would be that a relationship would dissolve as part of undergoing sex reassignment surgery. With regard to children and adolescents. Lev pro- vides needed guidance to therapists trying to offer families clinical alterna- tives to "fixing" gender-variant children when parental fear and social stigma predominate. Although Lev has much to offer direct service providers, one need not be a clinician to appreciate this book. In fact, for academics that teach psychol- ogy of sexual diversity or clinical psychology courses. Lev provides in depth examinations of key theoretical debates on gender, sexual orientation, and di- agnosis. In particular. Lev does a admirable job reviewing dualist assumptions of biological sex and gender, and their contribution to our understanding of conventional notions of sexual orientation and sexual identity that render invisible transgender, bisexual, intersex, and other individuals who do not neatly fit into binary categories. Lev not only deconstructs these categories, but also provides useful conceptualizations that further understanding in this area. Similarly, the Diagnostic and Statistical Manual (DSM) classification sys- tem has been critiqued in the past for its problematic categories (Carson, 1996), Yet, I found her analyses of the problems in paraphilias (particularly transvestic fetishism), adult gender identity disorder, and child gender identity disorder not only to be clinically informative, but also useful to the theoretical debates about the utility of the DSM, For example. Lev describes how in the current edition of the DSM, for a diagnosis of transvestic fetishism one must be a heterosexual male who has sexual fantasies, urges, or behaviors about cross-dressing that cause significant distress. Lev questions these criteria on a number of levels. For example, if cross-dressing for heterosexual men is Book Review 171 Stigmatizing in a culture, it might regularly cause distress and dysfunction in occupational, social, and other areas of functioning. However, distress and dysfunction caused by external conditions alone does not and should not constitute mental illness. In fact, this line of reasoning is in part why homo- sexuality was removed from the DSM, Furthermore, if a person cannot be diagnosed with this disorder if one is a female or a gay male, does this make it normal or healthy for these individuals to erotically cross-dress? Utilizing these and similar criticisms. Lev concludes that transvestic fetishism "is a sex- ual behavior, variant perhaps, but merely an erotic sexual inclination, one that causes no inherent harm" (p, 171) and argues for its removal from the DSM, Ultimately, the strength of Lev's book is its inclusivity—of the theoretical and the clinical, of the essential and postmodern, of adults and children, and of men, women, both, and neither. Yet, the book's minor weakness is in some notable exclusions. First, issues of race/ethnicity are under-developed in the book. Although Lev mentions multiple times throughout the book the need to consider diversity issues in the context of other clinical issues, this alone does not adequately address the clinical needs of transgender people of color. Second, the absence of HIV information in the book was surprising. Given the particularly high rate of HIV in the male to female transgender population, especially in people of color, it would seem essential that a therapist using a comprehensive book on transgender issues be able to find information on this topic and its potential clinical ramifications (e.g,, partner notification). These exclusions, although of note, do not diminish the magnitude of Lev's contribution to the transgender and psychology of sexual diversity literature, Lara M, Stepieman, Ph.D, Department of Psychiatry and Health Behavior Medical College of Georgia Augusta, Georgia REFERENCE Carson, R, C, (1996), Aristotle, Galileo, and the DSM taxonomy: The case of schizophrenia, fournal of Consulting and Clinical Psychology, 64, 1133-1139, A Woman's Guide to Living with HIV Infection, Rebecca A, Clark, Robert T. Maupin & Jill Hayes Hammer, John Hopkins Press Health Book: Baltimore & London, 2004, 314 pages, $15,95, Reports from the Center for Disease Control indicate that the number of women diagnosed with HIV/AIDS in United States is increasing at an alarming rate. In 1985, women made up 7% of the U,S, population living with HIV/AIDS; a proportion which has grown to account for 25% of the View publication stats.
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