Gender clash

Transvestites and transsexuals often suffer from isolation,
depression, and poverty. But specialist counselling can alleviate
the pain of their identity crises. Natalie Valios talks to social
worker Barbara Ross, a specialist in this area.

A social worker by profession, Barbara Ross’s main interest for
more than 20 years has been in gender counselling, working with
“gender dysphoric” people or transsexuals and transvestites.

Ross became involved in gender work in 1973 while working as a
social worker in a mental health team for Norfolk Council. A
colleague referred one of his clients to Ross because she had a
well-known interest in minority groups. The client was
cross-dressing and Ross’s colleague assumed this meant he was

Ross found there was limited help available for gender dysphoric
people while working with this client, and it made her realise how
bewildered and isolated such a person can feel.

“It became clear to me that more intensive care was required if
gender dysphoric people were to be helped to come to terms with
their situation, either by being enabled to fulfil themselves in
the role they feel most comfortable in or through self-acceptance,”
says Ross.

She describes gender dysphoria as “an ambivalent feeling of
one’s sexuality”. After working with her first client, Norfolk
social services department allowed her to include gender dysphoric
referrals on her caseload. With up to six referrals at a time in
any one year, Ross was never without a client.

Although retired, Ross still works on a part-time basis for
Norfolk social services department as a social worker in a physical
disability team. She runs a support group for transvestites. And
she continues to run a gender counselling service at her home where
she has an office. She also holds a monthly gender identity clinic
in Norwich. Gender dysphoric people in Norfolk are referred to her
via the local health authority and social services.

Ross’s work with gender dysphoric people addresses a range of
problems such as guilt, loss and self-acceptance. She must also
work with medical, psychiatric and social bodies. Gender dysphoric
people need help with financial, psychological and medical issues
as well as the practical and emotional problems of their lives.
Much of their anguish revolves around the pain they feel they are
causing their loved ones, says Ross.

“They are confronted by impossible choices. To become the person
they want to be may mean losing family and home, friends, sometimes
jobs and their whole way of life.”

Ross’s counselling service provides social and emotional
rehabilitation. She regards medical or physical help as something
for GPs and consultants. She says:”Clients have huge problems
dealing with loss that as a social worker I feel qualified to deal

Some worries are easier to deal with than others, such as
reassuring clients that they are not ill, dangerous or evil, or an
isolated case. Other worries are harder to allay; Ross has to help
clients work through how they are going to tell their family, and
calming fears they may have about losing their job and their rights
at work.

“My job is to help them appreciate their situation, give them
practical advice, help them to understand their rights and
acknowledge what their chosen course of action means on an every
day basis,” explains Ross.

Ross has about 25 clients on her books at the moment. She
assesses them and her report goes to the consultant, GP and health
authority that will fund the operation. Operations are more common
from male to female, but Ross is currently counselling three

In her report, Ross examines the client’s family history and
looks in-depth at their gender history, for example at what age
they knew they felt different, when they started to identify with
the opposite sex, or started cross-dressing.

Once she has recommended that they are suitable for gender
change surgery, clients have to carry out the “real life test”.
They have to live and work as the gender they wish to become for
two years.

During this period, Ross sees clients every three months for
counselling, although some request to see her more regularly. “One
client had told no one [about his transsexuality] throughout his
life, so being able to talk to me was a relief. Suddenly it seems
like a miracle because there is someone to talk to and to wait
three months between appointments seems like waiting three

During the two years, Ross says she provides a willing,
listening ear, looks to the practical things that need to be done,
liaises with psychiatrists, and helps with the move to Charing
Cross Hospital’s gender identity clinic where surgery is carried

Not all choose to go through with the surgery. After counselling
and support a few change their mind, come off the scheme and decide
it is not right for them. “They will go back to where they were,
and try to live their life as normally as they can and try to be

The trauma of undergoing gender change surgery is huge, but
clients are usually more at peace with themselves afterwards, she

“The more I work with transsexuals, the more I realise that
their transsexuality is a disability to be overcome, not an illness
to be cured through aversion therapy or corrective behavioural

“Most of my clients’ aim is to resolve the difference between
their external appearance and their internal psychology. What they
do not want to do is reinvent themselves and lose their sense of

Barbara Ross is organising a gender conference on 7-9
September at the University of East Anglia, Norwich. Call 01508

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