Transgender Emergence:  Therapeutic Guidelines for Working with Gender
Variant People and Their Families

Arlene Istar Lev has produced a marvelous resource for helping professionals who work with transsexual and transgendered persons and their families.  Her Transgender Emergence is a well-written and well-researched examination of the purpose and practice of psychotherapy and counseling of those who question or transgress gender norms.  She provides, inside the covers of a single book, enough information to give even the most inexperienced psychologist or counselor an understanding of the issues involved in working with the target population-- but even counselors who have treated many gender-variant individuals should read Transgender Emergence.

Lev's discussion of postmodern gender theory-- essential for working with gender-variant clients, but sadly, rarely taught to those in the helping professions-- is especially thorough, written, despite the complexity of the concepts described, in an easy-to-understand manner.  Notable also is her discussion of the unfortunate ways in which gender variance has been historically viewed by the helping professions, and her clear elucidation of alternate viewpoints that do not presume pathology.  Lev understands that a view of gender variance as pathology is a limiting one that causes therapists to view anything the gender-variant client might or might not do as a sign of that supposed pathology, and can make effective psychotherapy possible.  She makes clear the disservice such theories of psychopathology have done not only to gender-variant individuals, but to gay men and lesbians.  In particular, she points out the unbalanced power dynamics in a therapeutic relationship where the therapist holds the power to grant or deny access to desired medical treatments such as hormones and sex reassignment surgery.

Lev does her peers in the helping professions a great service by giving them strategies and case histories that will help them work with gender-variant clients without unconsciously maneuvering the client into an outcome the therapist favors.  She points out, for instance, that a diagnosis of transsexualism does not inevitably lead to gender reassignment, and that many clients may choose to live in full-time cross-gender roles without genital surgery.

Lev includes a section on the issues of the intersexed, which I hope she will consider expanding into a book in its own right.  But perhaps the most useful and valuable service is her repeated observations that gender-variance does not occur in a vacuum; transsexuals and other transgendered people have mothers and fathers, wives and husbands, children, jobs, and positions in the community, and all of these must be acknowledged.

We should thank Arlene Istar Lev for producing a book that will educate and sensitive helping professionals for many years.


Dallas Denny, M.A.
Editor, Transgender Tapestry Journal