Risk factor: Helping a man with learning disabilities who cross-dresses

CASE NOTES

Practitioner Rhys Bradley, social worker.

Field Learning disabilities

Location South Wales.

Client Roger* is a 45-year-old man with learning disabilities.

Case history Roger has always lived at home with his parents. But, as his parents aged they found it difficult to care for him. They approached the local authority for support, who provided a place at a day centre and a study skills course.

Dilemma Roger has recently started wearing women’s clothing at the day centre and in the local town. Should Roger be supported in this expression of this identity or should he be encouraged to dress less noticeably?

Risk factor Roger is becoming alienated from his peers at the day centre by cross-dressing. He is also being targeted by local youths. If he continues to wear women’s clothing he risks being victimised.

Outcome In spite of initial reluctance from his parents, a compromise is reached with Roger where he is permitted to wear women’s clothing in the safe environment of the family home.

* Not his real name.

Social workers are well-acquainted with promoting the rights of service users, but some cases pose more difficulties than others. Rhys Bradley, a social worker in south Wales, describes a tricky case where one of his male service users started wearing women’s clothing in public: “When Roger dressed in women’s clothing, it did cause some offence and distress to other service users at the day centre who didn’t know what to make of it.”

Outside the centre, the locals were no more tolerant. “Roger is a vulnerable chap who had a history of being targeted by local youths because of his learning disability,” says Bradley. “It’s fairly evident that he has a learning disability, but when he’s in full female dress then that makes him even more of a target. The town is not particularly diverse and attitudes are not as progressive as you might get elsewhere. In Soho his behaviour might not attract so much attention!”

Bradley wrestled with the rights and wrongs of the situation, mindful of the balance to be struck between Roger’s desire to wear women’s clothing and protecting him from the victimisation that arose from this. “Personally, I don’t have any problem with him dressing in women’s clothing, although it does cause problems for Roger and others,” he says sympathetically. “It’s one of the difficult ones where it’s a bit outside the box – there’s no template for dealing with cases like this. I mean, if there’s a service user who has an interest in sports or gardening, we can actively look for services for that. But with cross-dressing, it’s more difficult.”

Safe environment

Roger’s desire to wear women’s clothing was not about sexuality; like most cross-dressers, he is heterosexual. So Bradley was keen to ensure not too much emphasis was attached to just one of his interests. “You don’t want to overstate the importance of his cross-dressing. He has other interests in his life, and he has a girlfriend who he’s had for some time,” he says.

It was important for Bradley to find a way that ensured Roger had a safe environment to express himself. “If we told him he can’t dress in women’s clothing, that would be putting huge restrictions on him, his identity and how he sees himself,” he says.

Finding the way forward was difficult. Initially Bradley worked with Roger’s parents. “The cross-dressing wasn’t acceptable to his parents,” says Bradley. “The generational gap was a factor, certainly. So it was a process of getting his parents to come round to this.”

Bradley eventually managed to get Roger and his parents to agree that he could wear women’s clothing when he was at home, rather than when he was out in public. His parents would have preferred not to have him cross-dressing, but both parties acknowledged that this compromise position was in Roger’s best interests. “Basically it was down to reasoning,” says Bradley. “His parents might not be entirely happy with it themselves, but it allowed Roger to cross-dress in the family home where he can do it safely.”

But what does Roger think of the intervention? “It has worked out for him – the fact that he’s got that safe outlet,” says Bradley, adding: “The success of the outcome is measured by the service user satisfaction. And it’s fair to say he is much happier with the situation.”

➔ The Codes of Practice for Social Care Workers for Wales and for England 

WEIGHING UP THE RISKS

Arguments for taking the risk

● Reducing risk of physical harm

Roger’s cross-dressing was putting him in a vulnerable position. He was in physical danger as hostile youths were targeting him. Intervening ensured this risk was reduced and he was not alienated from his peers at the day centre.

● Compromise solution

The compromise solution had Roger’s best interests at heart and was by far the safest option, allowing him to continue wearing women’s clothing in a safe environment.

● Followed the guidelines

When considering the options available, Bradley was able to establish guiding principles in the relevant section of the Care Council for Wales’s code of practice.

Arguments against taking the risk

● Damaged relationships

The intervention relies on the parents allowing something they are uncomfortable with. This negotiation could have damaged the relationship between social services and Roger’s parents.

● Discouraging difference

The intervention could give the impression to service users that difference is something that should be discouraged.

● Feelings of guilt

Confining his behaviour to the family home could make Roger feel like cross-dressing is shameful.

INDEPENDENT COMMENT

PRACTITIONER: Lance Carver, services ­manager, Herefordshire

A case such as this really illustrates the struggle social work has with its value base when that appears to be at odds with that of the community. It is a common view that good social work should be about championing difference and changing the community by challenging prejudice. However this is a far from simple task especially in the kind of timescales that would have made a difference to Roger.

I wonder why Roger has started to wear women’s clothes. Is this something he has stifled for years? This is something that could be investigated further as according to the nature of this “behaviour” it may be considered something that colleagues from other disciplines, such as psychology, may be able to provide interventions for. This may be helpful when the behaviour is impacts on the family or there are concerns that this may be associated with an underlying mental health condition.

I would have recommended an assessment of Roger’s capacity to make the decision to dress this way and his understanding of the risks this creates to himself. If he was not aware of the impact of this on others, or unable to fully comprehend how this would affect him, then the arguments for intervention are justified.

This article is published in the 8 October 2009 edition of Community Care under the headline “Clothes maketh the man”