ABSTRACT
Gender-variant people and their families seek professional help for a variety of reasons. They are often in emotional pain and confused, and are seeking understanding and information. At the time of initial contact, people are often “at the end of their rope,” expressing suicidality and despair. Sometimes they seek services after a disclosure-or exposure-of the gender issues that have caused chaos in their family life. They enter therapy angry, resentful, and feeling hopeless. Clients often seek out specialists in gender issues after years of conventional psychotherapy, wanting to move ahead in their gender transformation and feeling stymied and trapped by the medical establishment. Questions immediately arise:
• What are the clinical responsibilities for a therapist faced with a client dealing with issues surrounding his or her gender?
