Guest Editors: Jean Malpas, LMHC, LMFT & Arlene (Ari) Istar Lev, LCSW-R, CASAC

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Malpas, J. (in press, December 2011). Family Process, 50, 4.

I contributed an article entitled “Can Couples Change Gender? Couples Therapy with Transgender People and Their Partners?” to this comprehensive text that discusses the diverse and complex issues involved in LGBT couple and family therapy. This book provides an in-depth overview of the best practices for therapists and those in training who wish to work effectively with LGBT clients, couples, and families.

In Press, 2012. In Bigner, J. & Wechtler, J. (Eds) Handbook of Couple and Family Therapy with LGBT People. New York: Routledge.

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This is a Portuguese translation of my 2006 article “From Otherness to Alliance: Transgender Couples in Therapy” (in Journal of LGBT Family Studies) published in 2010 in the Brazilian Journal “Nova Perspectiva Sistemica”.

Abstract: The first part of this article presents the epistemological evolution of the therapeutic frameworks regarding the treatment of transgender individuals and their partners. It outlines a medical approach and two others—the developmental approach and the deconstructive approach, ones not based on the conception of transgender identity as pathological. Two case studies of couples presenting with gender identity-related issues illustrate their application with particular emphasis on the relational process of gender identity formation and on partners of transgender-identified persons.

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Check out the recording of my presentation on Gender Fluidity at the Psychotherapy Networker

Gender, gender identity (the two aren’t necessarily the same), and sexual orientation are far more complex than many of us were raised to believe; categories once thought permanent and boundaries impermeable have proven to be neither. In this workshop, we’ll explore the concept of gender fluidity and the ways in which we make it acceptable or not. Drawing on clinical tapes, movies, presentations, and discussion, you’ll learn how to help children, adults, and families clarify and accept the meaning of their own gender and sexual orientation. We’ll identify how our well-meaning assumptions as clinicians may actually constrict not only the growth of our clients, but our own personal and clinical development. We’ll also discuss the interpersonal implications and potential healing power for the family of embracing a gender-nonconforming child, spouse, or family member.

Abstract: Recent research on crystal methamphetamine use among gay, bisexual and men who have sex with men (MSM) in the greater New York City metropolitan area indicates that crystal meth use is rising in this population and that it is correlated to increased risk for HIV, addiction, medical and mental disorders. Prevention and treatment of crystal meth related problems that are sensitive to the needs of MSM populations must be further developed to address this emerging crisis. Gay-identified community-based programs provide a viable resource within which to develop and deliver such services but will need more resources and funding to meet the growing demand.

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“Mark est gay, de race blanche, âgé de 34 ans, originaire du New England. Au cours de son processus thérapeutique, il me décrivit sa vie comme une « tranquillité oppressante ». Bien qu’il se soit bâti une vie réussie sur le plan social et professionnel, ses réussites matérielles avaient échoué à percer la spirale de solitude dans laquelle il s’était retrouvé. Célibataire pendant deux ans, suite à une longue vie de couple au sein de laquelle il ne se sentait pas suffisamment aimé, Mark trouvait dans les “plans sex-crystal” sur Internet tous les vendredi soirs, une sorte de ferveur inattendue. Ferveur destructive certes, mais rafraîchissante à la fois.”

“Tout comme l’alcoolisme chez certaines communautés de natifs américains, ou la violence parmi les jeunes blacks américains, ne sont pas des problèmes appartenant aux “gens de couleurs”, l’épidémie de l’utilisation du crystal n’est pas un problème spécifiquement gay. Il s’agirait, pour moi, d’un phénomène de crise qui devrait se comprendre au travers d’une lecture contextuelle des facteurs psychologiques et sociaux poussant les communautés opprimées à la guérison ou la destruction.”

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“Mark is a 34-year-old white gay man originally from New England. While he came across as successful both professionally and socially, he described his life as a “suffocating stillness.” Both social and financial achievements had failed to pierce the shell of his loneliness. Single for a couple of years after a long-term relationship in which he did not feel “loved in return,” Mark had Friday night Internet-based hook ups on crystal that offered a sudden burst of passion that was destructive but refreshing nonetheless. …”

“… Just as alcoholism in Native American communities and violence in the Black youth communities are not “people of color issues,” crystal meth is not a “gay issue.” It is another crisis that calls for a contextual understanding of the psychological and social factors pushing an oppressed community towards healing or destruction.”

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“Finally, a book that stresses the danger of the drug and its addictive nature while engaging everyone - people in recovery, users and mental health professionals - into a more contextual exploration of the complex factors that lead someone to ‘fill up her life wholes’ with crystal meth.”

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“These numbers might reflect a generational change in social acceptance for LGBT identities,” said psychotherapist Jean Malpas, director of the Gender and Family Project at the New York-based Ackerman Institute for the Family. “Today’s youth and young adults, at least in some communities, are gradually more comfortable being open about their sexual and gender identities.”

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The survey results call into question stereotypes that men compartmentalize sex and emotions, says Jean Malpas, a psychotherapist in New York. “Men are often described as rigidly separating sex and feelings,” he says. “However, many straight, gay or bisexual men I encounter in my clinical practice appreciate meaningful sexual intimacy. They often long for a sexuality anchored in the complicity and playfulness of their romantic relationship.”

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“People rely on gender to help understand the world, to make order out of chaos,” says Jean Malpas, who heads the Gender and Family Project at the Ackerman Institute in Manhattan, “It’s been a way of measuring someone’s well-being“‘Are you adjusted? Do you fit? Or are you unhinged?’ The social categories of man/woman, boy/girl are fundamental, and when and individual challenges that by blurring the lines, it’s very disorienting at first. It’s as if they’re questioning the laws of gravity.”

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“Jean Malpas draws for me what a mother once drew for him: something she called a “gender cookie cutter.” It’s a blobby gingerbread person on which various currently understood components of gender are mapped. There’s biological gender, a matter of chromosomes and genitals, indicated with a circle around the gingerbread crotch. There’s gender style, sometimes called gender expression: a person’s preferred self-presentation in matters such as play and dress and gait and speech pattern. This has been indicated by a circle encompassing the whole body. Next there’s sexual orientation, or romantic attraction to others, assigned to the heart. And finally there’s gender identity, the innate sense of being male or female regardless of biology or style or sexual interest. For this, Malpas surprisingly circles the brain. Some theories now suggest that the prenatal environment renders the brain a “gendered” organ. In most people, brain gender ­matches biological gender. But not in kids like Molly.

Malpas, a psychotherapist in Manhattan who also directs the Gender and Family Project at the Ackerman Institute for the Family, runs a monthly support group for parents of kids on the transgender spectrum. (The Benders attend.) What such parents want is fairly uniform, he says: confirmation that they’re doing the right thing and support for common problems like what to tell the grandparents and whether to “let the girl go to communion in white pants instead of a white dress.” But the kids—who also meet at Ackerman, for a playgroup—are more various. Some need nothing more than the freedom to explore a preferred sense of personal style among others who won’t criticize it. Their nonconformity may be transient; many a boy who enjoys long hair and playing dress-up with tutus happily grows up seeing himself as a man, whether gay or straight.

For others, like Molly, the mismatch is direr and probably permanent. That does not mean it reflects a mental illness, though there is some debate among practitioners about how transgenderism, especially in youth and adolescence, should be categorized and addressed. For its upcoming revision, the Diagnostic and Statistical Manual of Mental Disorders is said to be reconfiguring its approach to the subject, focusing less on gender identity itself and more on the distress—or dysphoria—young people may feel as a result of it.

Regardless, Malpas is unambiguous. “Gender dysphoria in children is not a psychopathology,” he says. “And in the vast majority of cases it is not caused by other psychopathology, either. Nor is it generally caused by a particular family pattern, any more than gayness is caused by the old stereotype of controlling mother and passive father. It is just an essential part of who you are. Not that there aren’t any coexisting psychosocial issues. But the problems generally come from outside. If an 8-year-old girl has a really hard time in school because of her short hair and boyish clothes, and is bullied for that, that’s not her pathology—it’s the world’s.”

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Parenting is tricky enough, but what if your six-year-old son asks you if he could dress up as Tinkerbell in the school play? Or if your daughter wonders if she could grow up to be a man?

I offered advice for Hans Villarica’s article for The Atlantic to parents raising children that do not conform to gender norms.

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“This February 14, while most of America translates love into flowers, you might consider giving your loved one a different sort of gift – a trip to a therapist.

“Couples therapy is a safe space for couples to engage, slow down and gain insight on their challenges and resources,” said Jean Malpas, a licensed marriage and family therapist and faculty member at the Ackerman Institute for the Family on the Upper East Side. “It’s a place to rediscover the wonderful aspects of one’s relationship, things that might otherwise get lost under the noise of the conflict.””

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“Of course, when parents push too hard on the marital front, tension can arise. Jean Malpas, a gay psychotherapist in New York who works with many gay couples, advises patients with pushy parents to tell them, gently and repeatedly, “I’m so glad you’re supportive and excited, but we want to make this decision ourselves.”

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HCG’s “On the Couch” Column offers a decorator and a shrink to playfully guess on the owners of an anonymous interior… Enjoy!

Expertos señalan que la falta de deseo o las dudas ante la crianza de los hijos son consultas comunes de parejas heterosexuales como gays y lesbianas (…).

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“It begins like a dream, but it becomes more of a nightmare,” says Jean Malpas, a New York City psychotherapist. He’s talking about crystal meth—a party drug that’s been ravaging gay communities, among others, in many U.S. cities in recent years (…).”

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“Dos terapeutas norteamericanas que trabajan en pareja, familia, sexología y específicamente con la comunidad homosexual, coincidieron en que gays y lesbianas acuden a terapia “por las mismas razones que vienen las parejas heterosexuales” Las parejas homosexuales asisten cada vez más a las terapias donde buscan respuestas a problemáticas que son similares a las de parejas heterosexuales, en tanto la preocupación respecto de cómo prepararse para tener hijos es un motivo cada vez más frecuente en la consulta, afirmaron expertos norteamericanos.”

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“We don’t even know that we’re walking around with this unconscious anticipation of another attack. Only when something happens, like it did on Wednesday, do we realize we live our lives with this fear.”

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“Il y a quelques années, le crystal a fait son apparition sur la scène gaie. D’abord phénomène de mode, il est rapidement devenu pour certains un élément nécessaire à la recherche du plaisir, et pas seulement sexuel. Il donne la sensation d’être uni à soi-même et aux autres (…).”

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“Malpas believes that each community needs to look at the problem contextually. “It is important to look at the social and political reasons, including a lack of equality for gay people,” said Malpas. We are still learning, he said, what the long-term multigenerational impacts of HIV/AIDS will be on the community and on the emotional impacts of being gay today.”

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Listen to the Interview

Since the release of this interview in May 2006, I have continued to give a lot of thought to crystal meth addiction prevention and intervention. Were I to give this interview today, I would express my opinions somewhat differently. Although I continue to think that demonizing meth users increases their isolation and therefore decreases their chance of recovery, I agree with the importance, from a public health perspective, of highlighting - or even dramatizing - the ramifications of crystal meth use on individuals and communities. Too many people continue to lose themselves and their connection to a sustainable community for the illusion of liberation that crystal deceivingly provides. Psychotherapists, such as public health and community leaders, must hold a complex tension between, on the one side, clarity about the drug’s devastating effects and the necessity to abstain from using to reflect on the meaning of the drug taking and, on the other side, the non-judgmental empathetic position that allows individuals and groups to feel respected enough to open up and change.

“Après une expérience de 3 ans comme thérapeute au Centre LGBT de Manhattan, il est actuellement thérapeute de couples et de familles à l’Ackerman Institute à New-York City. Sa consultation privée est spécialisée dans les problématiques gays et lesbiens ainsi que dans les traitements des addictions. Jean Malpass pour THE BODY un très intéressant article sur l’usage de crystal chez les gays, que nous publions en français sur Warning. Interview.”

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“The behaviors associated with it are so strong,” he said. “At some point, when Friday night comes along, they don’t know what else to do.” Malpas believes the frankness of the anti-meth awareness campaigns has been invaluable in deglamorizing the drug, yet he sees potential pitfalls. “We don’t want to create a split — the good and bad, the users and nonusers,” he said. “It’s important to build bridges, not divide.”

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