Gestalt Approaches to Gender Identity Issues: A Case Study of a Transgender Therapy Group in Oslo

Description of Patients:

This study was done using Gestalt therapy, which is a type of therapy that “focuses on the here and now, the what and how, and the I/Thou of relating” (Corey, 2013). The facilitator was “Vikram Kolmannskog, Dr philos, is a Gestalt therapist with a private practice in Oslo, Norway. A philologist and a social scientist with a doctorate in sociolegal studies” (Kolmannskog, 2014). He wanted to see the effect of Gestalt therapy on transgender individuals by having them share their experiences of gender with a group of people and encouraging them to explore themselves.

All who participated in this study do not identify as their assigned gender at birth. Some have gone or are undergoing assessments at The Department of Transsexualism at Rikshospitalet while others are self-identified. Only those who are diagnosed as transsexual (F.64.0) are accepted into the program and can undergo gender affirmation treatment.

“Gestalt therapy is an existential, phenomenological, and process-based approach created on the premise that individuals must be understood in the context of their ongoing relationship with the environment” (Corey, 2013). This therapy focuses on the importance of being self-aware, being in the present, taking accountability for oneself, learning about choices, and taking responsibility for oneself.

Participants:

Alex/Alexander (he/him) is in his early 30’s and is European and Norwegian (multicultural). He is a female to male (FTM) and has not had a gender assessment. “His expectations included: “experience support by hearing other people’s stories, opinions, and feelings about gender and being trans”; “normalize the experience of being trans”; “communicate my own feelings about gender and being trans to others”; and “explore my own gender identity in relation to others” (Kolmannskog, 2014).

Arne (he/him) is in his late 20’s and is Norwegian. He is currently under assessment as a female to male (FTM). “He wanted to hear about the experiences of others; he said it could be a challenge “to come out and share and not just be quiet and observe” (Kolmannskog, 2014).

Jo (he/him) is in his 40’s and is Norwegian. He is a female to male (FTM) and had already undergone gender affirmation treatment. He has been living as a man for several years. “His motivation to participate included supporting others; sharing own experiences; and “being social as who one is” (Kolmannskog, 2014).

Julie/Olav (she/her) is around 50 and is Norwegian. She is a self-identified male to female. She presents as a man in public and a woman in private. She quit after two sessions due to anxiety and continued in individual therapy. “Her goal was to try to be a woman in social settings” (Kolmannskog, 2014).

Kennedy (use name as pronoun) is in Kennedy’s late 30’s and is black; an immigrant to Norway. Kennedy was assigned female at birth (afab) and identifies as gender queer/fluid. “His expectations included: “learn more about trans life in Oslo; “try to speak more about myself (I’m a very guarded person emotionally)”; “accept that I am unique and that is okay” (Kolmannskog, 2014).

Tom (he/him) is in his 30’s and is Norwegian. He is female to male (FTM) and is currently in the process of gender affirmation treatment. “He was skeptical with regard to participating in the group but eventually did join” (Kolmannskog, 2014). He quit after one session due to aggression issues he wanted to work on elsewhere.

Client History

The participant we are going to be focusing on is Jo. Jo is a female to male transgender individual who uses he/him pronouns. He has already undergone gender affirmation treatment and is currently living as a man. Jo used to feel like an invisible man in a woman’s body, although now he feels like the feminine side of him is more prevalent. The anxieties Jo used to feel before treatment is now being felt due to him not feeling like a “standard man”. He said he has “sense of loss and wanted to be able to live out the “female” more” (Kolmannskog, 2014). Due to the norms in society, Jo was afraid to show his feminine side in public. Jo had stated that he would love to be able to dress in something androgynous to a party.

Therapy Plan

I. Contact – learning to connect and to separate

In order to help Jo connect with the “here and now”, I will begin with asking him why he is here, what he hopes to gain, and how he feels about myself and the group session.

providing Gestalt-appropriate nonverbal subtext

nonjudgmental tone of voice

an comfortable yet alert posture

showing interest

paying close attention to Jo’s behavior moment-to-moment

is he making eye contact

is he uncomfortable

is he paying attention

is taking turns with other group members

ensuring that I am at peace with the differences between me and Jo

I will try to create inclusion with Jo by showing empathy; to feel his experience as if it were my own.

My empathy should help bring Jo into the realm of human contact

Contact between Jo and myself will “set the stage” for helping him come to terms with his lost feelings of femininity moment-to-moment.

Contact also helps Jo to clarify where his feelings are coming from and how it fits into his present life.

II. Conscious Awareness – focusing attention on why Jo is feeling the way he does after being on testosterone and living as a man for so many years.

We will identify where his feelings are coming from? We will identify what is going on and how is it happening? What does he need to do and what is he doing? What are his choices? What is needed by others?

I will help Jo identify the things in his life that he is regulating and help create awareness, out of this awareness he can start to recognize how others react to him in social situations. From there he can gain confidence to be himself in public.

Explain to Jo the difference between knowing something and owning what he is doing.

He knows that he feels comfortable as a guy but also misses his feminine side. By owning himself and doing what he was scared to do, he can move past this to a better consciousness.

III. Experimentation –techniques used to facilitate practice and understanding of areas that were brought into awareness throughout sessions

The rehearsal exercise will be used with Jo to have him share his inner rehearsing’s to myself about what he will say if someone says something about him wearing feminine clothing and looking like a man.

I will help Jo to stay with the feelings. I will have him work to stay with his feelings even if they are unpleasant. We will delve deeper into how he feels about his inner femininity and why he is afraid of facing those feelings. This will help him be able to grow.

Treatment Frequency and Duration

Jo may benefit from monthly group sessions where he can feel comfortable with others that understand how he is feeling. Jo may also benefit from biweekly therapy sessions to help him work through his thoughts and feelings to obtain growth.

References

Kolmannskog, V. (2014). Gestalt Approaches to Gender Identity Issues: A Case Study of a Transgender Therapy Group in Oslo. Gestalt Review, 18(3), 244–260. https://doi-org.ezproxy.snhu.edu/10.5325/gestaltreview.18.3.0244

Corey, G., & California State University. (2013). Theory and practice of counseling and psychotherapy. 9th ed. Brooks/Cole / Cengage Learning.