Trayectorias hacia la afirmación: La identidad de género en los servicios de salud mental después del CIE-11
Resumen
La despatologización de la diversidad de género en el CIE-11 marca un giro para los servicios psicológicos para personas trans y no conformes al género. Aunque los cambios estipulados solo se incorporan prácticamente desde principios de 2022, se ha estado observando un movimiento general hacia la práctica psicoterapéutica y de asesoramiento afirmativo desde 2018. El presente artículo realiza un recorrido por los tres modelos principales de atención de salud mental para minorías de género, concretamente el modelo de terapias de conversión, el modelo transexual de vigilancia, y el modelo afirmativo, con el fin de contemplarlos bajo una nueva perspectiva. Partiendo de los Estudios de Ciencia, Tecnología y Sociedad, se examinan las presunciones universalistas y los roles rígidos de los modelos tradicionales. Además, el recorrido revela la necesidad de narrativas situadas que incentiven la autodeterminación y renueven la relación terapéutica como eje de autoexploración en vez de mecanismo de control institucional. Como conclusión, se remarca que el conocimiento interseccional es crucial para compensar las prácticas micro-agresivas y dinámicas que históricamente han promovido psicólogos y otros prestadores de servicios de salud mental.
Palabras clave
Asesoramiento, Psicólogos, Identidad de género, Conocimiento situadoCitas
American Psychiatric Association (2013). Diagnostic and statistical manual of men-tal disorders (5th ed.). Author.
American Psychological Association (2015). Guidelines for psychological practice with transgender and gender nonconforming people. American Psychologist, 70(9), 832-864. https://doi.org/10.1037/a0039906
Athanasiou, Athena & Butler, Judith (2013). Dispossession: The performative in the political. Polity.
Bauer, Greta; Hammond, Rebecca; Travers, Robb; Kaay, Matthias; Hohanadel, Ka-rin & Boyce, Michelle (2009). “I don’t think this is theoretical; this is our lives”: How erasure impacts health care for transgender people. Journal of the Associa-tion of Nurses in AIDS Care, 20(5), 348-361. https://doi.org/10.1016/j.jana.2009.07.004
Benson, Kristen (2013). Seeking support: Transgender client experiences with men-tal health services. Journal of Feminist Family Therapy, 25(1), 17-40. https://doi.org/10.1080/08952833.2013.755081
Billard, Thomas (2019). “Passing” and the Politics of Deception: Transgender Bod-ies, Cisgender Aesthetics, and the Policing of Inconspicuous Marginal Identities. In Tony Docan-Morgan (Ed.), Palgrave Handbook of Deceptive Communication (pp. 463-477). Palgrave Macmillan.
Billings, Dwight & Urban, Thomas (1982). The socio-medical construction of trans-sexualism: An interpretation and critique. Social Problems, 29(3), 266-282.
Bockting, Walter (2008). Psychotherapy and the real-life experience: From gender dichotomy to gender diversity. Sexologies, 17, 211-224. https://doi.org/10.1016/j.sexol.2008.08.001
Bockting, Walter; Robinson, Beatrice; Benner, A. & Scheltema, K. (2004). Patient satisfaction with transgender health services. Journal of Sex & Marital Therapy, 30(4), 277-294. https://doi.org/10.1080/00926230490422467
British Psychological Society (2019). Guidelines for psychologists working with gen-der, sexuality and relationship diversity. British Psychological Society.
Burckell, Lisa & Goldfried, Marvin (2006). Therapist qualities preferred by sexual-minority individuals. Psychotherapy: Theory, Research, Practice, Training, 43(1), 32-49. https://doi.org/10.1037/0033-3204.43.1.32
Butler, Judith (2010). Prólogo: Transexualidad, transformaciones. En Miquel Missé & Gerard Coll-Planas (Eds.), El género desordenado: Críticas en torno a la patolo-gización de la transexualidad (pp. 1-4). Egales.
Campbell, Nancy (2009). Reconstructing science and technology studies: Views from feminist standpoint theory. Frontiers: A Journal of Women Studies, 30(1), 1-29. https://doi.org/10.1353/fro.0.0033
Carroll, Lynne & Gilroy, Paula (2002). Transgender issues in counselor preparation. Counselor Education & Supervision, 41, 233-242. https://doi.org/10.1002/j.1556-6978.2002.tb01286.x
Castro Peraza, Mª Elisa; García Acosta, Jesús; Delgado, Naira; Pedromo Hernández, Ana María; Sosa Álvarez, María Inmaculada; Llabrés Solé, Rosa & Lorenzo Rocha, Nieves (2019). Gender identity: The human right of depathologization. Interna-tional Journal of Environmental Research and Public Health, 16(6), 978. https://doi.org/10.3390/ijerph16060978
Chavez Korell, Shannon & Lorah, Peggy (2007). An overview of affirmative psycho-therapy and counseling with transgender clients. In Kathleen Bieschke, Ruperto Perez & Kurt DeBord (Eds.), Handbook of counseling and psychotherapy with les-bian, gay, bisexual, and transgender clients (pp. 271-288). American Psychologi-cal Association.
Clark, Dawn & Loewenthal, Del (2015). Counselling psychology. In Christina Richards & Meg John Barker (Eds.), The Palgrave handbook of the psychology of sexuality and gender (pp. 280-299). Palgrave MacMillan.
Denny, Dallas (2004). Changing models of transsexualism. Journal of Gay & Lesbian Psychotherapy, 8(1-2), 25-40. https://doi.org/10.1300/J236v08n01_04
Doan, Petra (2010). The tyranny of gendered spaces: Reflections from beyond the gender dichotomy. Gender, Place & Culture: A Journal of Feminist Geography, 17(5), 635-654. https://doi.org/10.1080/0966369X.2010.503121
Drescher, Jack (2007). I’m your handyman: A history of reparative therapies. In Ar-iel Shidlo, Michael Schroeder & Jack Drescher (Eds.), Sexual conversion therapy: Ethical, clinical and research perspectives (pp. 5-24). The Haworth Medical Press.
Drescher, Jack (2013). Controversies in gender diagnoses. LGBT Health, 1(1), 9-13. https://doi.org/10.1089/lgbt.2013.1500
Egan, Susan & Perry, David (2001). Gender identity: A multidimensional analysis with implications for psychosocial adjustment. Developmental Psychology, 37(4), 451-463. https://doi.org/10.1037/0012-1649.37.4.451
Ehrensaft, Diane (2012). From gender identity disorder to gender identity creativi-ty: True gender self child therapy. Journal of Homosexuality, 59(3), 337-356. https://doi.org/10.1080/00918369.2012.653303
Fausto-Sterling, Anne (2000). Dueling dualisms. In Sexing the body: Gender politics and the construction of sexuality (pp. 1-29). Basic Books.
Fernández Garrido, Sam (2021). La clínica intersexual como “zona de contacto”: Binarismo sexual, saberes expertos y otras artesanías biológicas en la clínica es-pañola contemporánea. Tesis doctoral sin publicar, Universidad de Granada.
Freeman, Lauren & Stewart, Heather (2019). Epistemic microaggressions and epis-temic injustices in clinical medicine. In Benjamin Serman & Stacey Goguen (Eds.), Overcoming epistemic injustice: Social and psychological perspectives (pp. 121-138). Rowman & Littlefield.
Gaebel, Wolfgang; Stricker, Johannes & Kerst, Ariane (2020). Changes from ICD-10 to ICD-11 and future directions in psychiatric classification. Dialogues in Clinical Neuroscience, 22(1), 7-15. https://doi.org/10.31887/DCNS.2020.22.1/wgaebel
García Dauder, Dau (2018). Pedagogías de la diversidad en salud: Diálogos entre ac-tivismos trans e intersex y disciplinas psi. En Teresa Climent Clemente & Marta Carmona Osorio (Eds.), Tranpsiquiatría: Abordajes queer en salud mental (pp. 100-142). Asociación Española de Neuropsiquiatría.
Garfinkel, Harold (1967/1991). Passing and the managed achievement of sexual sta-tus in an intersexed person, part 1. In Studies in ethnomethodology (pp. 116-185). Prentice-Hall.
Gerritse, Karl; Hartman, Laura; Antonides, Marte; Wensing-Kruger & et al. (2018). Moral challenges in transgender care: A thematic analysis based on a focused eth-nography. Archives of Sexual Behavior, 47, 2319-2333. https://doi.org/10.1007/s10508-018-1287-3
Gherovici, Patricia (2017). Transgender psychoanalysis: A lacanian perspective on sexual difference. Routledge.
Gómez-Gil, Esther; Esteva de Antonio, Isabel; Fernández Rodríguez, María; Almaraz, Maricruz; Hurtado Murillo, Felipe; Gómez Balaguer, Marcelino; Asenjo Araque, Nu-ria; Mora Porta, Mireia; Halperin Rabinovich, Irene; Fernández García, Rosa, Mon-tejo, Ángel & Grupo GIDSEEN (2020). Nuevos modelos de atención sanitaria para las personas transgénero en el sistema sanitario español: Demandas, controversias y reflexiones. Revista Española de Salud Pública, 94(16), 1-14.
Grzanka, Patrick & Miles, Joseph (2016). The problem with the phrase “intersecting identities”: LGBT affirmative therapy, intersectionality, and neoliberalism. Sexu-ality Research and Social Policy, 13(2), 371-389. https://doi.org/10.1007/s13178-016-0240-2
Halberstam, Jack (1998). Transgender butch: Butch/FTM border wars and the mas-culine continuum. GLQ: A Journal of Lesbian and Gay Studies, 4(2), 287-310.
Hausman, Bernice (1995). Changing sex: Transsexualism, technology, and the idea of gender. Duke University Press.
Hendricks, Michael & Testa, Rylan (2012). A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the minority stress model. Professional Psychology: Research & Practice, 43(5), 460-467. https://doi.org/10.1037/a0029597
Hines, Sally (2013). Gender diversity, recognition and citizenship. Palgrave MacMil-lan.
Iantaffi, Alex & Bockting, Walter (2011). Views from both sides of the bridge? Gen-der, sexual legitimacy, and transgender people’s experiences of relationships. Cul-ture, Health & Sexuality, 13(3), 355-370. https://doi.org/10.1080/13691058.2010.537770
Israel, Tania; Gorcheva, Raya; Burnes, Theodore & Walther, William (2008). Helpful and unhelpful therapy experiences of LGBT clients. Psychotherapy Research, 18(3), 294-305. https://doi.org/10.1080/10503300701506920
Johnson, Austin (2016). Transnormativity: A new concept and its validation through documentary film about transgender men*. Sociological Inquiry, 86(4), 465-491. https://doi.org/10.1111/soin.12127
Latham, JR (2016). Trans men’s sexual narrative-practices: Introducing STS to trans and sexuality studies. Sexualities, 19(3), 347-368. https://doi.org/10.1177/1363460715583609
López-Sáez, Miguel & García Dauder, Dau (2020). Los test de masculini-dad/feminidad como tecnologías psicológicas de control de género. Athenea Digi-tal, 20(2), e2521, 1-30. https://doi.org/10.5565/rev/athenea.2521
López-Sáez, Miguel, García Dauder, Dau & Montero, Ignacio (2020). Correlate atti-tudes toward LGBT and sexism in Spanish psychology students. Frontiers in Psycho-logy, 11(2063), 1-11. https://doi.org/10.3389/fpsyg.2020.02063
Lugones, María (2008). Colonialidad y género: Hacia un feminismo descolonial. In Walter Mingolo (Comp.), Género y descolonialidad (pp. 13-54). Del Signo.
Mason-Schrock, Douglas (1996). Transsexuals’ narrative construction of the “true self”. Social Psychology Quarterly, 59(3), 176-192.
McBee, Clare (2013). Towards a more affirming perspective: Contemporary psycho-dynamic practice with trans* and gender non-conforming individuals. Advocate’s Forum, 37-52. https://crownschool.uchicago.edu/sites/default/files/uploads/AdcovatesForum_2013_TowardsAMoreAffirmingPerspective.pdf
McLemore, Kevin (2014). Experiences with misgendering: Identity misclassification of transgender spectrum individuals. Self and identity, 14(1), 51-74. https://doi.org/10.1080/15298868.2014.950691
Missé, Miquel (2018). A la conquista del cuerpo equivocado. Egales.
Mizock, Lauren & Lundquist, Christine (2016). Missteps in psychotherapy with transgender clients: Promoting gender sensitivity in counseling and psychological practice. Psychology of Sexual Orientation and Gender Diversity, 3(2), 148-155. https://doi.org/10.1037/sgd0000177
Mol, Annemarie (2008). The logic of care: Health and the problem of patient choice. Taylor & Francis.
Nadal, Kevin; Skolnik, Avy & Wong, Yinglee (2012). Interpersonal and systemic mi-croaggressions toward transgender people: Implications for counseling. Journal of LGBT Issues in Counseling, 6(1), 55-82. https://doi.org/10.1080/15538605.2012.648583
Occhino, Molly & Skewes, Lea (2020). Gatekeepers for gendersex norms: Trans (un)intelligibility and (il)legitimacy within the Danish healthcare system. NORA: Nordic Journal of Feminist and Gender Research, 28(4), 314-328, https://doi.org/10.1080/08038740.2020.1834450
Ortega Arjonilla, Esther; García Dauder, Dau; Gregori Flor, Nuria & Pérez Sedeño, Eulalia (2018). Practices and Knowledge: Philosophy of Biomedicine, Governance and Citizen Participation. In Belén Laspra & José Antonio López Cerezo (Eds.), Spanish philosophy of technology: Contemporary work from the Spanish speaking community (pp. 73-86). Springer.
O’ Shaughnessy, Tiffany & Speir, Zachary (2018). The state of LGBQ affirmative therapy clinical research: A mixed-methods systematic synthesis. Psychology of Sexual Orientation and Gender Diversity, 5(1), 82-98. https://doi.org/10.1037/sgd0000259
Pingitore, David; Scheffler, Richard; Sentell, Tetine & West, Joyce (2002). Compar-ison of psychiatrists and psychologists in clinical practice. Psychiatric Services, 53(8), 977-983. https://doi.org/10.1176/appi.ps.53.8.977
Raj, Rupert (2002). Towards a transpositive therapeutic model: Clinical competence in the effective support of transsexual and transgendered clients. International Journal of Transgenderism, 6(2), nn. pp.
Raun, Tobias (2014). Video blogging as a vehicle of transformation: Exploring the intersection between trans identity and information technology. International Journal of Cultural Studies, 20(10), 1-14. https://doi.org/10.1177/1367877913513696
Rood, Brian; Reisner, Sari; Surace, Francisco; Puckett, Jae; Maroney, Meredith & Pantalone, David (2016). Expecting rejection: Understanding the minority stress experiences of transgender and gender-nonconforming individuals. Transgender Health, 1(1), 151-164. https://doi.org/10.1089/trgh.2016.0012
Sennott, Shannon (2010). Gender disorder as gender oppression: A transfeminist ap-proach to rethinking the pathologization of gender non-conformity. Women and Therapy, 34(1-2), 93-113. https://doi.org/10.1080/02703149.2010.532683
Serano, Julia (2016). Outspoken: A decade of transgender activism and trans femi-nism. Switch Hitter Press.
Shamdasani, Sonu (2018). Towards transcultural histories of psychotherapies. Euro-pean Journal of Psychotherapy & Counselling, 20(1), 4-9, https://doi.org/10.1080/13642537.2018.1425111
Shipman, Daran & Martin, Tristan (2017). Clinical and supervisory considerations for transgender therapists: Implications for working with clients. Journal of Marital and Family Therapy, 45(1), 92-105. https://doi.org/10.1111/jmft.12300
shuster, stef (2019). Performing informed consent in transgender medicine. Social Science & Medicine, 226, 190-197. https://doi.org/10.1016/j.socscimed.2019.02.053
Spade, Dean (2006). Mutilating gender. In Susan Stryker & Stephen Whittle (Eds.), The transgender studies reader (pp. 315-332). Routledge.
Spanos, Cassandra; Grace, Julian; Leemaqz, Shalem; Brownhill, Adam; Cundill, Pauline; Locke, Peter; Wong, Peggy; Zajac, Jeffrey & Cheung, Ada (2020). The in-formed consent model of care for accessing gender-affirming hormone therapy is associated with high patient satisfaction. The Journal of Sexual Medicine, 18(1), 201-208. https://doi.org/10.1016/j.jsxm.2020.10.020
Stone, Sandy (1987/1991). The empire strikes back: A posttranssexual manifesto. In Kristina Straub & Julia Epstein (Eds.), Body Guards: The Cultural Politics of Gen-der Ambiguity (pp. 221-235). Routledge.
Suess, Amets (2020). Trans health care from a depathologization and human rights perspective. Public Health Reviews, 41(3), 1-17. https://doi.org/10.1186/s40985-020-0118-y
Tate, Charlotte (2014). Gender identity as a personality process. In Beverly Miller (Ed.), Gender identity: Disorders, developmental perspectives and social implica-tions (pp. 1-22). Nova Science Publishers.
Tosh, Jemma (2016). Psychology and gender dysphoria: Feminist and transgender perspectives. Routledge.
Westbrook, Laurel & Schilt, Kristen (2014). Transgender people, gender panics, and the maintenance of the sex/gender/sexuality system. Gender & Society, 28(1), 32-57. https://doi.org/10.1177/0891243213503203
Wood, Wendy & Eagly, Alice (2015). Two Traditions of Research on Gender Identity. Sex Roles, 73, 461-473. https://doi.org/10.1007/s11199-015-0480-2
World Health Organization (2018). International statistical classification of diseases and related health problems (11th ed.). https://icd.who.int/
Wright, Talen; Candy, Bridget & King, Michael (2018). Conversion therapies and ac-cess to transition-related healthcare in transgender people: A narrative systematic review. BMJ Open, 8, 1-12. https://doi.org/10.1136/bmjopen-2018-022425
Wylie, Kevan; Knudson, Gail; Khan, Sharful; Bonierbale, Mireille; Watanyusakul, Su-porn & Baral, Stefan (2016). Serving transgender people: Clinical care considera-tions and service delivery models in transgender health. The Lancet, 388(10042), 401-411. https://doi.org/10.1016/S0140-6736(16)00682-6
Publicado
Descargas
Derechos de autor 2022 Konstantinos Argyriou
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
