Research and discussion papers.

 

 

Working Model in Group Setting with Transgender People: Example from Turkey

 

Sahika Yüksel, Banu Aslantas, Pınar Kandemir, Pervin Sevda Bikmaz, Mine Oztürk

 

(paper presented at XVIII World Association for Sexual Health Congress, 14-19 April, 2007, Sydney)

 

(posted on this website 25th May 2007)

 

Introduction:

We are conducting group works with transgender (TG) individuals for twenty years in order to support the process of recognizing or being recognized of themselves and coping with their internalized transphobia.  In this presentation, first, some information about the general attitude towards transgender people in Turkey, a predominantly Muslim country, will be given. Also the evaluation of the group works that we have done with the people who have gender identity discrepancies will be discussed.

 

Transphobia can be described as the prejudiced opinions or the negative attitudes and behaviors towards TG people. In other words it is the fear, hate, anger and disgust towards TG individuals just because of their gender identities that doesn’t fit the standardized gender role models. Transphobic behaviors and attitudes may vary in a spectrum between simple ignoring and the act of severe violence.            

 

In Turkey, just like in the world, TG people usually make their pasts disappeared and behave like they were born in the gender that they were known after the sex reassignment surgery. This ignore of the past may influence the acceptance of their transgender being. Consequently, in Turkey there are only a few TG individual who introduce him/herself as “I am a transgender man” or “transgender woman”, unless there is an obligatory situation, after the sex reassignment surgery.

 

In the group experiences we see that “the belief of totally change including their whole lives and their pasts after the reassignment surgery” is so common. “There must be nothing that reminds me my past after the surgery, all stuff must be forgotten” said one of our TG group member.

Just like their pasts, they usually ignore their bodies too. “I ignored my breasts as if they weren’t there and now it is so late” said a FTM member who had a diagnosis of late metastatic breast cancer when she came to the group session “to get some support”.  

 

Religion is one of the most challenging issue for TG individuals in Turkey. Especially female to male (FTM) members’ families have strict religious beliefs and Islamic dressing may become an important problem for them. During the group process we can observe that also the new FTM members who use headscarf in accordance with their internalized beliefs have some conflicts about their gender identity and religious belief. It is understood that religious beliefs may affect the process of being or feeling ready to sex reassignment. 

 

Partner relationships take place as a common discussion in our group sessions. A person who pays attention for them or wants to date with them makes TG individuals feel more self-confident and worthy. However if the relationship ends because of his or her gender identity, they experience a big frustration. “If she doesn’t care about me than I don’t care about her” said one of our TG member showing the improvement of haecceity.

 

 It is very important for a transgender person to be recognized by his/her family especially in a traditional society like us. Most of the group participants secrete their gender identity problems as long as possible. As they learn to express themselves by the group process, their families also change their approaches too.  Similarly, it was hard for TG individuals to explain their gender identity before taking a job. Most of our group members had to work without a legal contract which means abdication of their social rights.

 

Method:

 

In this study we evaluate the perception of the transgender individuals about the group psychotherapy sessions with a semi-structured interview form. The group psychotherapy sessions conducted once a month with the participation of three therapist and 10-16 transgender individuals. We take 31 transgender individuals who participated group sessions for at least one year. Both therapists’ observations and group members’ feedbacks for group process were evaluated under these titles:

 

  1. Participation to sessions and interaction; evaluated under appropriate or inappropriate behaviors at sessions, considering the others, empathy, attitude towards the others’ problems, problem solving, sarcastic and hypercritical attitudes  subtitles.
  2. Evaluation of transgender identity by the members; evaluated under homophobic attitudes, internalized transgender identity, underwear and  appearance, effort to hide their identities subtitles.

3. Evaluation of group cohesion; evaluated under support to the other members in or out of the sessions, willingness to enter the group, any member who is desired to be expelled, any disappointments about the group.

 

Findings:

 

The participant’s ages were between 17 and 40. The mean age was 24. Biologically women individuals were the majority of the group. All of the participants were single and living with their families. They were working at temporary jobs and had no health insurance mostly because of their gender identity.

 

When we evaluate the data of the participation to the group and interaction subtitle, we found that except 3 members they all (%90,4) participated adequately with appropriate behaviors and interactive enough to explain their emotions or opinions. About considering the others, empathy, problem solving and sarcastic attitudes subtitles 25 of them (%81) showed improvement in different levels for each subtitle.   

 

 About the evaluation of transgender identity, 9 member (%29) showed discriminative and homophobic attitude. This high rate of homophobic attitude can be explained considering that they all are living in a homophobic socio-cultural environment.  

Thirteen (41%) members changed their underwear and appearance, congruent with their own gender identity, after a year in group psychotherapy. The other ones were wearing according to their gender identity before they participated the group.    

 

As an important data for group cohesion,  22 participants (%70) reported that they also meet with the other group members out of the sessions and come together for post operational care, physical illness or hormone therapy ,also they support each other especially for family visits. This was related to the characteristic of a self help group, and this kind of relationship between members were thought to have a positive effect.  All of the participants except one of them (n= 30) reports that they have a great interest for attending group sessions and they like group members so much. None of them wanted to change any group member and they did not feel disappointment about the group. Considering the differences about socio-cultural levels of the participants and dissimilarities other than gender identity problems , it is thought that the enthusiasm shared by the group members is an evident for the internalization of the gender identities.

 

It is noticeable that issues about violating group rules including hormone use without having consulting from a physician, discontinuity, insufficient participation, inappropriate behaviors that negatively effect the group process were fairly good understood by the group. However one of the members went to a TV show in a ridiculing-humiliating appearance to get some financial support for her reassignment surgery. This action caused discomfort among the group regarding the confidentiality and negative effects on stigma.  This member was expelled from the group because of the group rule violation.  

   Conclusion:

Considering the participants’ feedbacks and the observations of the therapists it is understood that after at least one year in the group, the participants showed a significant improvement from the aspects of cognition and functionality. This improvement provides a better quality of life. It is a worthwhile experience to come together for TG individuals who are the minority because of their gender identity. This kind of support work provides us the cooperation for appropriate medical evaluation and treatments.   

 

   References:

 

Atamer YM 2005 The Legal Status of Transsexuals in Turkey International Journal of Transgenderism 8. 65-71

 

Harry Benjamin International Gender Dysphoria Association’s . (2001)The Standards of Care for Gender Identity Disorders. Sixth Version. Symposium Dusseldorf

 

Lev A.L. (2004) Transgender Emergence The Howarth Clinical Practice Press New York

 

Pfefflin F 2002 Understanding Transgendered Phenomenon Levine et al eds. On Sexual Health. Brunner and Mazel

 

Polat A, Yüksel S, Genç-Discigil A Meteris H,. 2005 Family Attitudes towards Transgendered people in Turkey: Experience from a secular Islamic country. International Journal of Psychiatry in Medicine V 35 (4) 383-363

 

Yuksel S, Baral Kulaksizoglu I, Turksoy N, Sahin D.  2000 Archives of Sexual Behavior. 279-290 

 

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