Further Reflections on the Nature of Post Traumatic Stress Disorder in Transgender Individuals and Implications for Its Treatment

In October of this year, I completed 12 face to face educational hours and 16.5 hours online learning in depth about the nature and treatment of Post Traumatic Stress Disorder. I became a certified trauma counselor through the International Association of Trauma Professionals. I have had an intensive exposure to learning about the nature of Post Traumatic Stress Disorder as a dis-regulation of the Sympathetic Nervous System resulting in a person on a  frequent to continuous basis experiences being in the state of "flight or fight"response.

 The Sympathetic Nervous System is a subdivision of the Autonomic Nervous System. The other half of the Autonomic Nervous System is called the Parasympathetic Nervous System and it's job is to promote a physical sense of calm and well being, and allowing us to be present in the moment when there is no existing threat to us.

Normally, the Parasympathetic is the dominant or default condition of the autonomic nervous system, In those who experience dis-regulation of the Sympathetic Nervous System, it becomes the dominant system. The individual will experience symptoms of anxiety, excessive perspiration or dry mouth, muscular tension, sleep disturbances, feelings of panic and other symptoms of this nature when in reality, no threat exists for the individual.Experiencing these type of symptoms can range from frequently feeling dysphoria of a mild to a severely incapacitating degree.

It is not known at this time the number of transgender people who suffer from the symptoms of P.T.S.D, In my opinion, to the degree that a transsexual has developed a sense of self awareness, the discovery of one's physical body is not of the gender that matches one's gender identity, the greater the degree of traumatization the individual will experience. Similarly, the longer the individual lives with the inability to live authentically and denies one's true identity, the greater the risk for increasing levels of traumatization over the life span.

It is important to be able to identify the type of trauma experience of the transgender person as a complex trauma or as a developmental trauma, so that the type of treatment selection is important.
Developmental traumas do not respond well to psychotropic medications. That does not mean they have no role in the treatment of developmental or complex trauma, it does imply that medications will not be the solution alone in successfully treating this type of PTSD. Medications will be relatively less effective in this type of PTSD over the long term in resolving symptoms.

What is necessary is a retraining of the Autonomic Nervous System to give people more control in activating and learning to stay in states when the Parasympathetic  system is restored to being the dominant division over the Sympathetic system.

When a person is able to exercise more emotional regulation, it is then the therapy can move forward to process and resolve the significance of the past trauma. In part, this is accomplished by the individual recognizing that the past trauma is not occurring in the here and now. As one is able to leave the past behind, the trauma loses its powerful hold on the individual and she is able to continue through the healing process using the techniques learned to manage her levels of reactivity. She is able to be more present in day to day life as opposed to experiencing symptoms of rumination of negative thoughts of the past or future that remove one from what is going on in the here and now. She becomes free to build a brighter future.

An area that I think deserves further consideration and study is whether  the presence of lingering low self esteem or a sense of stigmatization in individuals who have successfully transitioned represents some type or residual state of PTSD that will be extremely treatment resistant.. Is it possible, as Bob Dylan wrote, "You can always come back, but you can't come back all the way..."?

If it can be addressed, it will likely come through cognitive restructuring requiring long term psychotherapy.  The longevity of the treatment will be as important as the frequency of appointments. In psychotherapy that lasts over several years, appointments are held once a week for a long period of time leading to appointments a few times a year over several years after the most intensive part of the therapy is completed. I believe this type of therapy offers the best chance of resolving residual issues of PTSD such as I described above.

I did a literature search on the National Medical Library of the National Institutes of Health and did several fetches using keywords such as PTSD, Transgender and Trauma and found no articles after an advanced search that directly address the concepts I am writing of here. The closest article was an article in a psychoanalytic journal. It is called Mourning the Body as Bedrock;  Developmental Considerations in Treating the Transsexual Patient Analytically. (www.NCBI.NLM.NIH.gov/pubmed/25277869). It suggests that psychoanalytic treatment can be helpful in resolving developmental or complex traumas experienced by transgender people. Research into the treatment of PTSD reveals that many different therapies can be effective in treating PTSD. What is most important is that the therapist be fluent in the modality of of treatment she employs over any particular school of therapy.

In any event, much more research is obviously indicated to help transgender people effectively resolve past trauma and build a future based on mastery over self and the social environment.

Transgender Care For Professionals: An Educational Resource

Over the many years of my professional work with transgender people, I began giving a number of workshops all over the eastern United States. While working on my public presentations, I developed over the course of a number of years a power point slide show to consolidate what I have learned over my lifetime about transsexualism.

As I progress in my personal journey, I foresee a time when I will no longer practice with transgender patients or any patients for that matter. I have worked almost exclusively in the human service professions in a volunteer or paid capacity since I was 15 years old. There once was a time when I could never imagine not being a therapist, but now I look forward to other pursuits in about 9 years when I retire.

I do feel a weight of being the only gender therapist in quite a fair distance and worry about those who come along after I am gone seeking to become congruent in mind and body who will have more difficulty in their journey if they can't find a competent therapist.

To that end I offer what I consider one of my best academic works, which I share with some humility in the hope that it will help other mental health practitioners become competent and comfortable with practicing in this interesting area.

Here is a link to access my powerpoint and I hope that it is helpful to you in whatever capacity that you can benefit from it. In this body of my work, you will learn about the presence of transgendered people since ancient times, developmental psychology, co-occurring mental health and substance disorders, as well as goals of treatment and a section on the ethical care of transgender patients. I present information on the historical approach to the treatment of transgender people by health care professionals and review the current World Professional Association of Transgender Health Standards of Care. As always, my powerpoint is a living, breathing document and from time to time it will be updated as I expand my knowledge, skills and abilities to provide cutting edge treatment for transgender people.

 Please do remember when sharing that this is my own original research and please respect my copyright.

Lauren Tancyus LCSW

Diplomate in Clinical Social Work

PLEASE NOTE: In order to open the powerpoint to view, first open a new browser window. Second copy the link below and third paste it in the new browser window address bar. Click enter and you will be taken to my powerpoint which you can then view.

https://www.slideshare.net/secret/AxOqzKXRuLlIty

Further Along.........New Directions?

Well, It's very disappointing to myself that I have not written here since January and didn't write as much last year as I would have liked to have written.

However, I have been writing quite actively, and have been reconstructing my girlhood growing up through the Japanese form of poetry known as Haiku. I came to understand that I had a vast number of flashes of memory of my distinctly being aware from a young age throughout adolescence and young adulthood.

This led to an idea to do a sort of Japanese Western fusion poetry where I could place these individual Haiku into a western style stanza long form poem in a chronological order. The whole body of work serves to validate my gender identity and also demonstrates some of the developmental challenges that many transsexuals experience on their journey. I'm very interested in writing about developmental tasks that are encountered along with looking at mastery vs failure of these developmental tasks.

At the same time, I've renewed my interest in Logotherapy. Logotherapy is a form of psychotherapy founded on the experiences and ideas by Victor Frankl. Dr. Frankl was a psychiatrist in Austria when the Nazis came to power. He was interred in one of the worst concentration camps, Auschwitz solely based on being Jewish, and a rather secular Jewish man at that. He survived the experience. and was able to be reflective about his experience. Specifically, he observed that the difference between those who survived the Holocaust did so because they had not lost a sense of purpose. Their lives continued to have meaning despite the indescribable horror of man's capacity for brutality and sadism that they faced every moment of their existence in the concentration camps.

Furthermore, these people had a vision that was unshakable for a hopeful future. It was these characteristics that allowed those who were not cremated or gassed to survive.

It seems to me that Logotherapy which is based on these ideas, has quite a lot to offer as a potentially highly effective school of therapy. Rather than examining the past in detail and dredging up problems from the past, logotherapy as I understand it at this time, encourages people to find meaning in their present circumstances while creating a vision for how one wants to live her life.

To understand this therapy better, I have been reading Dr. Frankl's seminal book Man's Search For Meaning, and researching articles about Logotherapy. I found a 150 hour program that leads to a degree and Diplomat status for advanced practitioners. I am very seriously considering enrolling in this program so that I may be better prepared to use these powerful tools to help my patients.

In the meantime, I seem to be getting a bit wiser as I gracefully grow a bit older; I decided to do what worked so well last summer and work only three days a week again. I have projects that are ongoing in improving my beloved old home and I continue to find golf to be a spiritual discipline.

Hopefully I'll write a few helpful articles here as well during this time!