Gender and Sexuality Competence: Visions for the Future Treatment of Sexual Minority Youth

by Boston Children's Hospital staff on June 10, 2010

June marks Lesbian, Gay, Bisexual, and Transgender Pride Month. In honor of this event Thrive is pleased have Scott Leibowitz, MD, of Children’s Hospital Boston’s department of psychiatry, as a guest poster, blogging about a soon-to-be launched gender and sexuality psychosocial pilot program he has coordinated at Children’s, which will be the first of its kind in the United States.

Scott Leibowitz, MD

Scott Leibowitz, MD

Imagine growing up in a constant state of turmoil, being pushed and pulled by two opposing forces: where your internal sense of self tells you to feel one way, but what seems like the rest of the world, and sometimes even your own body, says you should feel another way. For sexual minority youth—children and adolescents who grow up outside conventional norms applied to gender and sexuality—this shame-induced state of being can be every day life.

For these young people, and to a degree all youth, the outer world, comprised of clinicians, teachers, family members, clergy, peers and popular culture, represents the gold standard of what is “normal.” As a result, sexual minority youth often find themselves in conflict between the simultaneous need to gain societal acceptance and the developmental task of forming and expressing their true identity. This process can be very difficult for adolescents in the sexual minority and many experience invalidation and marginalization to degrees far higher than other minority populations, leading to higher rates of depression, suicide, substance abuse, anxiety and risk-taking behaviors.

Though often a difficult road to travel, growing up as a sexual minority needn’t be a solo journey. Clinicians sensitized to the unique needs of this population can help minimize the difficulties they face by learning to provide “gender and sexuality competent care.” This is especially important given that most clinicians say they don’t receive enough training on how to work effectively with these youth. On an institutional level, developing a level of “gender and sexuality competence” is  a complex process that requires four inter-playing components: clinical exposure, research initiatives, curriculum development and community outreach.

Fortunately that tide seems to be turning, as there have been many advances made recently with respect to the understanding of homosexuality and transgenderism.  The 2009 Endocrine Society Guidelines approved pubertal suppression—a nonpermanent medical process that delays some sexual characteristic development in adolescents who identify more with the opposite gender than their biological one— as standard treatment when coupled with psychotherapy and psychometric testing.  Research initiatives (mostly out of the Netherlands) have broadened our understanding of gender variance in childhood as a developmental precursor to homosexuality. National organizations such as the Association of Gay and Lesbian Psychiatrists (AGLP) have produced online curricula promoting education and competency to clinicians practicing in areas with limited exposure to this population. Lastly, community advocacy groups have been actively pushing for equality and rights through legislation and political awareness.

Despite the advances in each realm, there has been no single institution to effectively initiate universal advances across all four components, until now.  Starting in July, Children’s Hospital Boston’s Department of Psychiatry will be offering a specialized treatment service through the development of a pilot gender and sexuality psychosocial clinic. In doing so, Children’s will be the first children’s hospital in the country to provide interdisciplinary, comprehensive treatment to sexual minority youth in coordination with the hospital’s Gender Management Service. This program will address the needs of sexual minority youth through a new model of treatment that focuses on recognizing and quantifying the sources and intensity of perceived invalidation for any child or adolescent.  This collaboration has the potential to define “gender and sexuality competence” through expansion of clinical services, research initiatives, curriculum development and community outreach.

When providing culturally competent care to patients, the clinician is expected to integrate his or her awareness, attitudes, knowledge and skills about the particular culture in order to maximize the treatment’s success. The concept of treating patients who experience gender incongruence between their minds and bodies can be uncomfortable, especially for a clinician who has limited experience in dealing with these issues, which is why creating a clinic that focuses on this population’s needs has such potential. Though forging new ground is seldom easy, entering the life of a gender-variant child can have profound positive impacts on anyone willing to pause and rethink some of his or her own personal biases.

3 comments

  • 1ConCit

    WOW! Congratulations to Children’s Hospital for having the vision and foresight to support Dr. Leibowitz and his endeavor to bring the much-needed specialized psychiatric help so important to sexual minority youth. Once again, Children’s stands at the forefront of medical advances which continues to catapult Children’s Hospital Boston into one of the finest medical instituions in the world. As the pioneer of a clinic specialized to the needs of sexual minority youth, Children’s is not only providing the counseling needed by these children, but also a forum for other medical professionals throughout the world to turn for guidance. Dr. Leibowitz, who has made presentations regarding sexual minority youth throughout the country to rave reviews, is fast-becoming the “turn-to guy” in this field and kudos again to Children’s for supporting this specialized pilot clinic with Dr. Leibowitz at the helm. BRAVO!

  • DaveP

    Wonderful news! The TKF families have been working with Dr. Norman Spack on gender considerations for a number of years, with excellent results. Now we see the initiation of complete psychosocial suppoort in addition. We are so pleased!!

  • Sue Ulrey

    Boston Children’s Hospital, you are leading the country with this move, and I want to praise you for it. Putting your highly regarded name, resources, and energy behind this specialty will have an enormously positive effect on the lives of children and their families. Thank you, Dr. Leibowitz, for choosing to focus your talents on this segment of the huge world of health care. I’m sure you’ll be rewarded with the smiles of healthier young people and the gratitude of their parents.

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