What is behind the rise in girls questioning their gender identity?

Amelia Gentleman

The Guardian

Originally posted 24 Nov 22

Here is an excerpt:

The trend was confirmed by clinicians who spoke to the Guardian.

“In the past few years it has become an explosion. Many of us feel confused by what has happened, and it’s often hard to talk about it to colleagues,” said a London-based psychiatrist working in a child and adolescent mental health unit, who has been a consultant for the past 17 years.

Like all NHS employees interviewed, she asked for anonymity due to the sensitivity of the subject.

“I might have seen one child with gender dysphoria once every two years when I started practising. It was very niche and rare.” Now, somewhere between 10% and 20% of her caseload is made up of adolescents registered as female at birth who identify as non-binary or trans, with just an occasional male-registered teenager who identifies as trans.

Another senior child psychiatrist said girls who wanted to transition made up about 5% of her caseload.

“In the last five to 10 years we’ve seen a huge surge in young women who, at the age of around 12 or 13, want to become boys. They’ve changed their name and they are pressing … to have hormones or puberty blockers”

The psychiatrist added: “Often those girls are children who are going through the normal identity and developmental problems of adolescence and finding a solution for themselves in this way.”

Greater awareness of trans issues is likely to be one common-sense explanation for the rise in requests for referrals.

“Left-handedness increased over time after we stopped punishing left-handed children in schools, because some children are naturally left-handed and were now able to express it,” said Cleo Madeleine, a spokesperson for the trans support group Gendered Intelligence.

“In the same way, increased visibility and acceptance of trans people has led to a gradual increase in young people who feel comfortable expressing their trans identity. The most important thing is to recognise that this is not a problem to be solved or a bad outcome to be avoided.”

The mother of a 17-year-old A-level student (who came out as trans at 13, leaving a handwritten letter for his parents on his bed) agreed: “It’s discussed so much more – on Facebook and on social media. It’s no longer a taboo.”

She is confident this was the right decision for her child. “I think I wondered if this was a phase, but I didn’t look to dissuade him. As he began to socially transition he was a different person. It has made him happier,” she said.

The info is here.

Later Career Remedial Supervision - The Practice Event Audit

Jon Amundson
The Practitioner Scholar: Journal of Counseling and Professional Psychology 32 
Volume 5, 2016

Abstract

Clinical supervision has for the most part focused upon early career preparation and training. Fundamental to this process is emphasis upon emerging competency. However, supervision can also be required in relation to enduring competency. Where lapses in professional practice are of a subtle or non-egregious nature, supervision may arise as a remedial route. Through hearing, tribunal mandate or negotiation, arising from Alternative Dispute Resolution (ADR), remedial supervision may be the outcome. In this article mandated or negotiated remedial supervision is discussed with a specific description of a means for such – the Practice Event Audit. Issues related to ethics, conduct and competency, remedial supervision and the Professional Event Audit are discussed in light of a case example.

The paper is here.

With Sobering Science, Doctor Debunks 12-Step Recovery

Interview with Lance Dodes

NPR

Originally posted March 23, 2014

Here is an excerpt:

There is a large body of evidence now looking at AA success rate, and the success rate of AA is between 5 and 10 percent. Most people don't seem to know that because it's not widely publicized. ... There are some studies that have claimed to show scientifically that AA is useful. These studies are riddled with scientific errors and they say no more than what we knew to begin with, which is that AA has probably the worst success rate in all of medicine.

It's not only that AA has a 5 to 10 percent success rate; if it was successful and was neutral the rest of the time, we'd say OK. But it's harmful to the 90 percent who don't do well. And it's harmful for several important reasons. One of them is that everyone believes that AA is the right treatment. AA is never wrong, according to AA. If you fail in AA, it's you that's failed.

The entire interview is here.

Episode 23: Ethics and Skills for Psychologist as Supervisor-Post-Doctoral Supervision - Part 3

Podcasts 21, 22, and 23 will provide supervisors and supervisees with an understanding of the skills and ethical issues surrounding supervision, including the Pennsylvania State Board of Psychology’s Regulations dealing with postdoctoral supervision. The workshop will review the basic requirements for ethical supervision, common pitfalls, and give supervisors an understanding of the requirements that must be met for obtaining post-doctoral supervision.

In this episode, John's guest is Don McAleer, Psy.D., ABPP, a psychologist and post-doctoral supervisor, and Samuel J. Knapp, Ed.D., ABPP, psychologist and Professional Affairs Officer at the Pennsylvania Psychological Association.

At the end of the podcast series the participants will be able to:

1.  Describe essential factors involved in ethically sound and effective supervision;
2.  List or identify the State Board of Psychology requirements for post-doctoral supervision.
3.  Explain ways to improve supervisee's level of competence, self-reflection, and professionalism; &
4.  Identify strategies to comply with the Pennsylvania State Board of Psychology regulations on supervision of post-doctoral trainees.




The associated SlideShare presentation can be found here.

Competency Assessment Form

Sample Supervision Agreement

Sample Post-doctoral Agreement from Northshore Psychological Associates

Sample Post-Doc Performance Problem Sheet

Click here to earn 3 APA-approved continuing education credits for all three supervision episodes

Episode 15: Ethics and Telepsychology (Part 1)

Ethics and Telepsychology involves the rise of technology in the healthcare sector.  There are about 21 states that mandate insurance companies cover telehealth services.  John is joined by Dr. Marlene Maheu, trainer, author, researcher, and the Executive Director of the TeleMental Health Institute, Inc., where she has overseen the delivery of professional training in telemental health to more than 5000 professionals in 39 countries since 2010.  John and Marlene discuss the supporting research for telepsychology and its limitations; practitioner competencies; reimbursable, evidence-based models for telepsychology; and limitations with telepsychology.

At the end of this podcast, the listener will be able to:

1. Outline the general research findings on the usefulness of telepsychology,
2. Describe requirements of competent telepsychology practice,
3. List at least four reimbursable, evidence-based models for legal and ethical telepractice.

Click here to earn one APA-approved CE credit

Find this podcast on iTunes

Or listen directly below

Resources for Episode 15

TeleMental Health Institute, Inc.

American Psychological Association Guidelines on Telepsychology

The Mental Health Professional and the New Technologies: A Handbook for Practice Today

by Marlene Maheu, Myron L. Pulier, Frank H. Wilhelm and Joseph P. McMenamin 

Bibliography from TeleMental Health Institute, Inc.

Marlene Maheu SlideShare

Gros, D. F., Yoder, M., Tuerk, P. W., Lozano, B. E., & Acierno, R. (2011). Exposure therapy for PTSD delivered to veterans via telehealth: Predictors of treatment completion and outcome and comparison to treatment delivered in person. Behavior Therapy, 42, 276-283. 
doi: 10.1016/j.beth.2010.07.005

Harris, E., & Younggren, J. N. (2011). Risk management in the digital world.

Professional Psychology: Research and Practice, 42, 412-418.
doi: 10.1037/a0025139

Suspect in Killings Is Deemed Not Fit

By THE ASSOCIATED PRESS
Published: January 7, 2013

A judge ruled on Monday that a man accused of killing seven people at a small Christian college in Oakland is not mentally fit for trial.

Judge Carrie Panetta of Alameda County Superior Court temporarily suspended the case against One L. Goh after two psychiatric evaluations concluded that he had paranoid schizophrenia.

David Klaus, an Alameda County assistant public defender, said after Monday’s hearing that Mr. Goh’s condition causes him to have hallucinations and delusions and to distrust people, including those trying to help him. Mr. Goh’s lawyers have trouble talking to him, Mr. Klaus said.

The rest of the story is here.

Jared Loughner to plead guilty in Tucson shooting, sources say

Mental health officials reportedly believe he is now competent to understand the charges in the killing of six people and wounding of Rep. Gabrielle Giffords and 12 others in Tucson last year.

By Richard A. Serrano
The Los Angeles Times
Originally published August 4, 2012

Jared Lee Loughner is set to plead guilty Tuesday in the shooting attack that severely wounded Rep. Gabrielle Giffords, according to knowledgeable sources, as mental health officials believe he is now competent to understand the charges against him in the assault, which killed six people and injured 13 at a gathering with the congresswoman’s constituents in Tucson.

At the hearing Tuesday morning in U.S. District Court in Tucson, psychiatric experts who have examined Loughner, 23, are scheduled to testify that they have concluded that despite wide swings in his mental capacity, at this time he comprehends what happened and acknowledges the gravity of the charges, according to two sources who spoke on condition of anonymity because the case was still unfolding.

The entire story is here.

Professional Competence in the Face of Life-Threatening Illness

The new issue of *Professional Psychology* includes an article: "Preventing Problems of Professional Competence in the Face of Life-Threatening Illness."

The authors are W. Brad Johnson & Jeffrey E. Barnett.

Psychologists are human. Like our clients, we are nearly certain to encounter difficult life stressors such as relational break-downs, emotional low points, phase-of-life problems, serious medical challenges, or the onset of cognitive decline. Sadly, being a psychologist does little to insulate us from life's tribulations.

At some point during his or her career, nearly every mental health professional will confront a significant health problem. Medical issues may run the gamut from relatively minor (e.g., pneumonia, minor surgery, thyroid dysfunction) to life-threatening (e.g., cardiovascular disease requiring open heart surgery, neuromuscular disorders with a short life-expectancy, various forms of cancer).

Because many psychologists expect to work beyond the typical retirement age, with nearly a fifth reporting that they plan to work until death (Guy, Stark, Poelstra, & Souder, 1987), the probability of life-threatening medical diagnoses occurring during the course of one's career are significant.

But even early career psychologists are vulnerable to life-altering and potentially fatal medical problems (Philip, 1993).

Recent epidemiologic data for U. S. adults between the ages of 45 and 64 indicate that 13% suffer from some form of heart disease and 9.4% have been diagnosed with cancer; between the ages of 65 and 74, these numbers jump to 25.8% for heart disease and 22.5% for cancer (Centers for Disease Control & Prevention, 2010).

Although practitioner emotional health is considered essential and fundamental to the delivery of competent services (Vasquez, 1992), few things may threaten a psychologist's emotional stability more acutely than the diagnosis of a life-threatening illness.

Unfortunately, psychologists are not always effective when it comes to accepting their own vulnerabilities, taking time for self-care, and identifying decrements in their own competence due to either emotional or physical distress (Barnett & Johnson, 2008).

In this article, we direct our focus to the prospect of a life-threatening illness in the psychologist and the subsequent implications for professional competence.

By life-threatening we mean a terminal disease or a progressive medical condition leading to increasing disability and, in most cases, premature death.

Although psychologists are enjoined by the Ethical Principles of Psychologists and Code of Conduct (American Psychological Association; APA, 2010) to ensure their own competence, psychologists struggling with life-altering medical problems may be especially vulnerable to problems in this area.

We highlight how seriously ill and subsequently distressed psychologists may be ineffective at self-assessing and monitoring their professional competence, as well as in making essential decisions about continued clinical practice.

We conclude with numerous recommendations for psychologists designed to both prevent and manage threats to professional competence caused by a life-threatening illness.

Thanks to Ken Pope for this information.

Loughner's Exams Will Not Be Recorded

(Courthouse News Service) - The government does not have to videotape medical evaluations of the suspected Tucson shooter, a federal judge ruled Thursday, finding that it would be distracting to the suspect, Jared Lee Loughner, and a burden to doctors.

"The defendant's original competency examination was videotaped, and this was apparently very distracting to the defendant and a hindrance to the FMC staff conducting the examination," U.S. District Judge Larry Burns wrote, referring to the Medical Center for Federal Prisons in Springfield, Mo., where Loughner is undergoing treatment for schizophrenia after a federal judge declared him incompetent to stand trial.

Loughner is charged with carrying out a shooting rampage on Jan. 8 that killed six people and injured 13, including Congresswoman Gabrielle Giffords.

During the competency exampination, Loughner "more than once ... questioned the need for the camera while the staff was interacting with him, and on one occasion in particular he reacted violently to it," Burns added.

Loughner's attorney Judy Clarke had asked for an order to videotape future sessions Loughner has since the suspect is expected to remain at the facility indefinitely while doctors assess his competence.

Burns said Clarke's notion of what constitutes a clinical assessment is too broad and would place an undue burden on examiners.

"The uncertain duration of the defendant's present commitment to FMC, coupled with the extensive attention and care he is now receiving because of his mental condition, would make videotaping all clinical assessments a substantial imposition on the work of the FMC staff," the three-page decision states. "This difficulty is partially illustrated by the defendant's conception of a 'clinical assessment,' which defense counsel define as 'interactions by clinical staff at Springfield with Mr. Loughner that relate to discussions of medication, competence, restoration, clinical symptoms, and current functioning.' Such a broad, catch-all definition will invariably invite an interaction-by-interaction analysis as to whether videotaping is necessary, and it is not fair to burden the FMC staff with that analysis."