Loyola University Chicago Loyola eCommons Dissertations Theses and Dissertations 2013 Psychotherapist Understanding of Genital Self-Mutilation Amongst Male to Female Transsexuals Michael Robert Kenney Loyola University Chicago Follow this and additional works at: https://ecommons.luc.edu/luc_diss Part of the Social Work Commons Recommended Citation Kenney, Michael Robert, "Psychotherapist Understanding of Genital Self-Mutilation Amongst Male to Female Transsexuals" (2013). Dissertations. 724. https://ecommons.luc.edu/luc_diss/724 This Dissertation is brought to you for free and open access by the Theses and Dissertations at Loyola eCommons. It has been accepted for inclusion in Dissertations by an authorized administrator of Loyola eCommons. For more information, please contact [email protected]. This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License. Copyright © 2013 Michael Robert Kenney LOYOLA UNIVERSITY CHICAGO PSYCHOTHERAPIST UNDERSTANDING OF GENITAL SELF‐MUTILATION AMONGST MALE TO FEMALE TRANSSEXUALS A DISSERTATION SUBMITTED TO THE FACULTY OF THE GRADUATE SCHOOL IN CANDIDACY FOR THE DEGREE OF DOCTOR OF PHILOSOPHY PROGRAM IN SOCIAL WORK BY MICHAEL KENNEY CHICAGO, IL DECEMBER 2013 Copyright by Michael Kenney, 2013 All rights reserved. ACKNOWLEDGEMENTS I could not have completed this dissertation without the encouragement and emotional support that was lovingly provided to me by family, friends, and faculty members. I am humbled and moved by your kindness. I would like to take this opportunity to publicly acknowledge my gratitude to all of you who gave me such inspiration. I could not have accomplished all that I have without the love and support of my parents, Robert and Kathleen Kenney. Words are not enough to express how much I owe to you in terms of who I am as a person and as a professional. I would not be in the position I am today if it were not for your unconditional love and generosity. I only hope I made you proud and that I can aspire to be as kind to others as you both are to me. I owe the second greatest debt of gratitude to my dear friend Cynthia Grant. I would not have finished this program or this research without your wisdom and kind spirit. You kept me going when I wanted to give up; you inspired me to move forward despite my self‐doubt. I am blessed that I was given the opportunity to cross paths with a person who possesses such integrity, warmth and humor. I marvel at your skill as a professional, your generosity as a friend, and your wonderful family. To my committee members: Jim Marley, Ph.D., Terry Northcut, Ph.D., and Jodie Dewey, Ph.D. – you showed infinite patience in mentoring me through this process. Jim, iii your openness to my idea gave me confidence to pursue this topic of research in earnest. Terry, I’m grateful that you allowed me the chance to participate in the Social Work Ph.D. program at Loyola. I’ve learned so much and I’ve grown as a person and as a therapist as a result. Jodie, you were willing to work with me despite no obligation to do so. As a result, I have deepened my appreciation of social influences on human behavior which helps me to be more sensitive to the clients I serve. Thank you for broadening my horizons. To my friends Jeff Godecker, Minal Giri, Mark Horning, and Andrea Taylor. All of you have played such an integral role in my life and how I’ve developed as a person. Despite my adopting the role of a solitary monk in completing this project, you did not abandon our friendship. You are my “anam caras,” soul friends. To my brothers Dan and Steve, and my sister‐in‐law Mary, and my nieces Bethany and Rachel – I’m blessed to have such a loving family. Thank you for being who you are. To my friends who generously gave of their time when they could have easily been doing something much more exciting than reading my research. Prem Pahwa and Ritu Thaker, I thank you for your invaluable feedback which strengthened the quality of my research. To my godmother Mary Higgins, my uncle Ed, and cousin Maryellen – thank you for believing in me. iv To the individuals I admire most as professionals and now have the good fortune to call my friends, Theo Pintzuk and Dakota Cimo. I can only hope to emulate your wisdom and skill. To the friends of my cohort who endured with me through the endless hours of class, studying, and writing; I’ve learned so much from each of you, thank you for sharing yourselves and your knowledge. Kyung‐Mee Choi, I’ve enjoyed our meals together and hope there are many more to come. Mary Pat Clemmons, you will not be forgotten. To my coworkers at Catholic Charities, thank you for your interest in my professional development and your support. It is much appreciated. To my other friends too numerous to mention, thank you for enriching my life. Finally, to the therapists who agreed to participate in my research. I’m forever grateful that you shared your stories with me. Thank you! v TABLE OF CONTENTS ACKNOWLEDGEMENTS ....................................................................................................... iii LIST OF TABLES .................................................................................................................... xi ABSTACT ............................................................................................................................. xii CHAPTER I: INTRODUCTION ................................................................................................ 1 Statement of the Problem................................................................................................ 3 Social Oppression and the Transsexual Individual ........................................................ 4 Oppressive Assumptions Influencing Healthcare Workers Regarding Transsexuals .... 6 Threats to Receiving Adequate Mental Health Treatment for Transsexual Clients ..... 9 Healthcare Professionals Reaction to Genital Self‐Mutilation within this Population: The Risk of Further Rejection and Stigmatization of Vulnerable Individuals ................................................................................................................. 11 The Need to Reduce the Risk of Stigmatizing Countertransference Reactions .......... 12 Missing Social Work Perspective on the Issue: Inadequate Peer Reviewed Literature .................................................................................................................. 12 Incomplete Theoretical Foundations for Understanding the Phenomenon ............... 15 Statement of Purpose of the Proposed Research .......................................................... 17 Definitions and Critical Understanding of Terms ........................................................... 18 Controversy Regarding the Terms Transsexual and Transgender .............................. 24 Controversy Regarding the Differentiation of the Terms Self‐Injury vs. Self‐Mutilation .......................................................................................................... 32 Rationale for the Study/Significance to the Social Work Profession ............................. 35 CHAPTER II: LITERATURE REVIEW ..................................................................................... 41 The Behavioral Phenomenon Including Descriptions of the Behavior and the Clinical Population ....................................................................................................... 43 Single Case Reports ..................................................................................................... 43 Multiple Attempts at Genital Self‐Mutilation, Progression in Level of Severity ......... 46 Themes Emerging Across Case Studies and Critical Discussion .................................. 48 Meta‐Case Reviews Comparing Multiple Cases .......................................................... 50 Limitations of Classification Efforts ............................................................................. 53 Attempts to Establish Comorbidity ............................................................................. 56 Attempts to Establish Prevalence ............................................................................... 60 Medical Risks ............................................................................................................... 64 Countertransference Issues/Beliefs Regarding Efficacy of Psychotherapy ................ 66 Alternative Definitions regarding the Phenomenon ................................................... 71 Motivation ................................................................................................................... 76 Psychoanalytic conceptualizations ........................................................................... 76 Environmental transactions/social factors ............................................................... 85 vi Postmodern/feminist views ...................................................................................... 89 Assessment and Treatment Models .............................................................................. 93 Walsh’s Model ............................................................................................................. 95 Favazza’s Conceptualization ...................................................................................... 102 Israel’s Model ............................................................................................................ 107 Conclusion of Literature Review .................................................................................