Building Trust Most Important in Client Relationship

By John Thomas, Associate Editor
July 30, 2015

Patient sitting on sofa and talking to therapist during therapyBuilding an environment of trust is the most important, and possibly the most difficult, task facing psychologists, whether it’s treating residents of the most impoverished part of rural Ohio or the huge influx of  transgendered patients who are beginning to show up in large numbers for counseling.

Among the workshops at the annual Ohio Psychological Association Convention here in late April and early May were sessions on integrating behavioral health and primary care in the southern part of rural Ohio Appalachia and understanding the transgender population and emerging ethical issues.

The rural workshop was led by Dawn Graham, Ph.D., assistant professor in the Department of Family Medicine at Ohio University Heritage School of Osteopathic Medicine, while Cori Yaeger, Ph.D., of Cincinnati, who has worked extensively with transgendered populations, conducted the workshop on the emerging population of transgendered individuals seeking psychological help.

Yaeger told the workshop to get up to speed quickly on the ethical and practice challenges facing psychologists by the large increase in the numbers of transgendered individuals seeking counseling in the coming years.

“They’re coming out of the woodwork, and that’s a good thing” Yaeger said of the emerging transgendered population flocking to therapists’ offices.

She noted that as much as 5 percent of the population is transgendered, with equal numbers of men and women. However, there are more males seeking to be identified as women than there are women wanting to change gender identification. Many transgendered individuals, however, are not interested in undergoing hormone treatment or changes in anatomy.

The transgendered population brings with it a whole different mindset about gender issues and has a language of its own not normally encountered by psychologists. She said, “Do not be afraid to apologize about using the wrong terms when dealing with the transgendered population.”

Psychologists should also become aware of the legal implications in working with the transgender population and seeking advice and guidance from an attorney is always a good idea. “Remember,” she added, “do no harm.” Dual relationships and confidentiality rules also tend to pop up more in treating transgendered individuals, “particularly when you wind up counseling both the kids and their parents.”

It’s important, Yaeger said, to find out early in therapy if transgendered individuals are competent to make decisions about how they want to present themselves to the public and the necessary resources to continue in therapy or for changing gender identification. Treatment for a male wanting to stop whiskers from growing costs around $4,000 and it costs about $6,000 to grow breasts.

There will be cognitive dissonance when first treating transgendered individuals and binary biases will be hard to overcome, but Yaeger said it was necessary to keep up to date on the state of evolution and growth in the transgendered population.

Graham, a native of Greater Chicago, said she had no plans to stay in Appalachia Ohio when she moved there a few years ago, but has settled in on a 40-acre spread and has no plans to leave.

Appalachia, with its poverty, illiteracy, lack of mobility and inconvenient transportation presented several challenges when she started working with families under a $4 million federal grant from Project Launch (Linking Action for Unmet Needs in Children’s Health).

A lot of the money was used to build and fund a transportation system to help insure Appalachian residents could get to far flung and rare mental health and other health facilities.

“A full tank of gas is a luxury to vast numbers of poor people in southern Ohio,” she explained. “In southern Ohio, the biggest cash crop is marijuana, or as it is known down there, ‘Meigs County gold.’”

She told of one doctor in Logan in Hocking County that would have nothing to do with the program unless he could figure out how to make money from joining forces with mental health workers. Finally, the program rented office space in the third floor of his office building and he started seeing that it was to his advantage to refer patients he thought might be suicidal to the mental health worker.

“And that only took five years,” Graham said, but today he is entirely supportive of the work mental health professionals are doing in the area.

Appalachian residents are suspicious of outsiders, especially if they act or dress much differently than their neighbors, she said. Graham related what she told a bureaucrat from the Ohio Department who was coming to Vinton County for an inspection. “I told him not to wear a suit. Nobody will talk to you.”

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