Changes in sexual orientation and sexual behavior are not uncommon following gender transition. However, there is not a substantial amount of attention paid to therapeutic intervention with transgender and gender nonconforming (TGNC) people exploring their sexuality. Many psychotherapists may be unfamiliar with how to help these patients. This text seeks to highlight the fact that working with transgender and non-binary patients may “necessitate the exploration of sexuality at its interfaces with the development of identity, bodily awareness, intimate relationship, and specific aspects of social or medical transition” (Niemira et al., 2020, p. 21). The authors point out that sexuality is part of the broader clinical objective to support a patient’s holistic, lived experiences. The text challenges some more individually focused and theoretically siloed clinicians. The aim is to get psychotherapists to look at their TGNC patients and their struggles more broadly; this includes their struggles with sexuality.
The primary audience is quite broad. The authors repeatedly make clear that the primary audience is inclusive of therapists, counselors, psychoanalysts and other behavioral health providers. Helping broaden the appeal of the text is the inclusion of an interdisciplinary set of contributors from various clinical orientations and modalities. The varied orientations and modalities of the authors helped make the text accessible and particularly useful to many types of clinicians.
Readers should expect that this text will challenge them to be bidirectional clinicians — clinicians who work with patients themselves and with the environment of their patients. Authors explore history, power, oppression and pathologizing. For example, the chapter on finding oneself within the work of psychotherapy with TGNC patients and exploring countertransference from therapists’ own gendered sexualities was particularly engaging (Chapter 4 by Jane Fleishman and Julie Mencher, “Two Middle-Aged, White, Jewish, Cisgender Lesbians Sitting Around Talking About Trans Sex”). The reader gains a better understanding of their privilege and the limitations that puts on fully understanding the experience of TGNC patients. TGNC may receive sexual messaging throughout their lives that does not fit their experience, and it can be uniquely alienating.
The authors organized the book into an expansive set of chapters. I particularly appreciated the chapter focused on gender diverse BDSM practices (Chapter 3 by Laura A. Jacobs, “Hormones and Handcuffs”). Jacobs discusses how BDSM offers avenues for sexualizing bodies without an exclusive focus on genitalia, and she discusses how BDSM allows for a safe space to explore power dynamics and assume identities that may not match physical attributes of TGNC persons. Another captivating topic was the intersection of asexuality and aromanticism with gender diversity (Chapter 5 by Katherine Rachlin, “The Intersection of Gender Diversity and Asexuality”). For many readers, it is helpful that Rachlin defines common vocabulary in asexual and aromantic communities. Rachlin also uses case studies to illustrate the uniquely challenging and often isolating intersectional experience of being TGNC and asexual.
I especially benefitted from the chapter on practical applications, which includes many case examples and clinical recommendations (Chapter 1 by Kelly Wise and Dulcinea Alex Pitagora, “The Evolution of Sexuality During Gender Transition”). Wise and Pitagora do an excellent job focusing on the perspective of the patients and providing an emotionally rich and detailed account of their experiences.
Readers will benefit from such an expansive work that focuses on so many facets of the lives of TGNC patients. One chapter on cognitively impaired trans people (Chapter 9 by Andrew Triska, “Sexual Behavior and Identity in Intellectually Disabled Trans People”), discusses a topic not frequently found in the literature, the substantial restrictions placed on TGNC persons with intellectual disabilities.
Another less commonly discussed area of TGNC communities is the experience of partners of people who have transitioned (Chapter 8 by D.M. Maynard and Olivia Fischer, “Interviews with Partners of Transgender People”). Maynard and Fischer point out that the experience of partners of TGNC people is severely underrepresented in the training and the literature and presents a holistic picture that is inclusive of both partners in the couple transitioning.
Overall, the authors extensively researched and prepared a thoughtfully organized and thoroughly enjoyable book to read. Charged topics and under-researched areas relating to TGNC care are highlighted, such as the historic transphobia in mental health communities and current issues faced by TGNC patients such as the “Bathroom Panic.”
Some readers may be looking for a more narrowly focused text. However, this text provides a starting point for students, academics, policy advocates, and practitioners of psychoanalysis, marriage and family therapy, sexology, gender studies, psychology, and social work to improve their work with the TGNC community.