During October 2023, I spent three days working in a Gender Identity Clinic up in Newcastle, England and I got to experience a little bit of what it’s like to work in the service. I learnt a lot about how Gender services run, what is involved and how brilliant the people there that work there. Yet most importantly, I learn how great transgender people are as well. which I already knew because I have a lot of transgender friends and I’m trans non-binary myself, but this work experience cemented my positive regard for these critical, life-saving services even more. Therefore, in this podcast episode, we’ll be looking at what happens at a Gender Identity Clinic, what I learnt from them and why I fully support these services. If you enjoy learning about transgender healthcare, mental health and clinical psychology then you’ll love today’s episode.
This podcast episode has been sponsored by Clinical Psychology and Transgender Clients: A Guide To Clinical Psychology, Mental Health and Psychotherapy. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it. Also, you can buy the eBook directly from me at https://www.payhip.com/connorwhiteley
What Is A Gender Identity Clinic? And A First Lesson
Simply put and I actually think Bing defines a Gender Identity Clinic rather well,
“A gender identity clinic is a medical facility that provides support and treatment to individuals who experience gender dysphoria. It accepts referrals from all over the UK for adults with issues related to gender. The clinic is a multi-disciplinary administrative and clinical team, including psychologists, psychiatrists, endocrinologists, speech and language therapists, and nurses. They work together in order to provide holistic gender care, focusing on the biological/medical, psychological and social aspects of gender.”
Source: https://gic.nhs.uk/about-us/
In addition, this is actually one of my first reasons why I really like Gender Identity Clinics as a psychology person, because they’re very holistic. Which, as I’ve mentioned on the podcast before, is flat out critical to delivering the best possible care for our clients. This is even more for Gender Dysphoria because there is a psychological dimension too it, but then there are social and biological aspects which interact. It is only by interacting and looking at these three types of factors we can possibly hope to help our clients to the best of our abilities. Be it through Hormone Replacement Therapy so trans people can have the physical body they want, or the psychological dimension so they can increase their confidence and feel okay in their own body, or the social aspects by wearing gender-affirming clothing.
Addressing all these dimensions of a client’s experience is flat out critical and I’m really glad that this approach is baked into Gender Identity Clinics.
An Overview Of What I Did In Those Three Days
Before I start talking about some of the specific lessons I learnt during these three days, I wanted to give you an overview of what I did. Also, I should mention that in my experience, Gender Identity Clinics are made up of psychology, speech and language therapists, General Practitioners (for our international audience this what the UK calls its doctors) and nurses. I think that’s all of them but as you can see, it is very much a multi-disciplinary approach which is brilliant.
Therefore, like most work experience situations, you’re given to one of the disciplines and you spend the day with them. On the Monday, I spent it with a brilliant nurse that I got on well with and I learnt a lot from her. When I first met her she was looking over some blood test results for a woman that had just started her Hormone Replacement Therapy so I got to learn all about that, the different levels they look for and the importance of liver function testing.
Afterwards, the nurse had a video appointment with a woman to see how she was getting on.
Since it tends to be about every six months, a client gets a “check-in” appointment so the Clinic can make sure everything is okay, the client is happy and to see if anything has changed.
This is when I learnt that after a few years of being on Hormone Replacement Therapy, the effects and changes start to level off. Meaning for the first year or two, the client might notice a lot of changes because of the hormones and this makes them really help. Yet then the effects start to level off.
In addition, I learnt during this call what the term “Pathway” means in Gender Identity Clinics. This is basically their route through the Clinic starting off with their assessment and diagnosis, all the way to whatever their desired end is. For example, if a client only wanted to be diagnosed with Gender Dysphoria then the pathway would be short(ish) for them because they would get the diagnosis and be discharged from the clinic. Yet if someone wanted a diagnosis and then a gender-affirming surgery that had a long waiting time on the NHS then their pathway would be longer.
This was a great video call that taught me a lot about transgender people, how kind and helpful they are and there was one thing in particular that the client said that still sticks in my mind. For historical context, my work experience was around the time the UK’s governing political party had their party conference and broadcasted tons of evil, foul lies about transgender people to the nation. This was a depressing time to be transgender.
However, the client on the video call mentioned how whilst the political atmosphere was upsetting, the vast majority of people in their experience couldn’t care less that they’re trans. And that was very affirming for me because that is largely true I think, because this topic is so politicised, sometimes it’s hard to remember that the vast majority of people are okay and support transgender people.
I’ll always be grateful for that reminder because I think that helped me a lot as well.
Then in the afternoon, I was mainly sitting with a former placement student and going through a lot of their research. Something I’ll talk about more later on because that is critical to understand.
What Happened On Tuesday?
As a future clinical psychologist, I really did enjoy Tuesday because I’ve been checking out NHS Assistant Psychologist job descriptions lately and every single one of them requires you to have what’s known as MDT experience. This means jobs want you to have experience in Multi-Disciplinary Meetings, so on Tuesday I went to one.
It was brilliant in a very nerdy sort of way.
Since we all went into this big conference room and sat around a table and everyone was there more or less. You can the Clinical Leads, the head of the service who was a brilliant clinical psychologist, you had speech and language, psychiatrists, nurses and so on. And my personal favourite bit about all of this was there were free homemade biscuits being passed round because it was close to Halloween.
Therefore, for the next 90 minutes, everyone spoke about their cases, they wanted to bounce ideas off each other and there were some good discussions. Granted a lot of the cases, which I would just double-check, like the professional would tell everyone their thoughts and because everyone is really good at their jobs, there was nothing to point out or problems with their thinking.
Towards the end of the meeting, a nurse joined us online and she was going through her caseload and there were some more complex cases and it was really interesting to listen to.
Personally, I was surprised how long this MDT meeting went on for because that was only because I had never been to an MDT meeting before. Yet I was talking to a nurse later on and some of MDTs go on for three hours, I think that was the record at that particular service.
As a result, I really enjoyed this experience because it did give me critical experience that will hopefully benefit my future career as a clinical psychologist.
Then the rest of Tuesday was sitting in on appointments like Monday and checking sure that clients were okay, which was great. As well as I was sitting with a placement student and we were talking for hours about different aspects of the service and client experiences. Including some interesting research the service was doing.
What Happened On Wednesday At The Gender Identity Clinic?
Before this work experience, I had no idea that there were small versions of MDT meetings because at this service, there are things called Huddles. These particularly happen on a Wednesday and these are meant for less complex cases that people take along so they can still talk about them and get ideas, but they need the level of insight that a large-scale MDT meeting provides.
Also, these Huddles require the presence of at least three different professions. In our Huddle, we had psychology, nursing and psychiatry, and I think speech and language might have made an appearance too.
Again, this is another good piece of experience for me because it shows how the NHS works, how dedicated everyone is to multi-disciplinary and holistic approaches to transgenderism. And it also shows me that you can adapt and come up with new ideas to solve problems within problems. For example, if every single case had to go through MDT then I imagine (and this isn’t fact) that those meetings would be rather time-consuming, so coming up with the Huddle idea means everyone can use their idea more effectively.
Finally, besides from sitting in on some more appointments, I had maybe one of the most important conversations I have ever had as a future clinical psychologist. I was talking to this wonderful female GP and she used to be a Commissioning Officer for NHS England and we were talking about Gender Identity Services, how they’re set up and whatnot. I’ll talk more about that in the research section, but she was talking about how on paper the Services might “cost” a lot of money but in reality, these Gender Identity Clinics are very affordable and cheap for the NHS.
Since we know from the research and I’ve mentioned this on previous podcast episodes, gender-affirming practices save lives, decrease suicide rates and improve the mental health of transgender people. Therefore, these Gender Identity Clinics perform these affirming practices and treatments, and if we talk in cold calculations that all policymakers seem to love, these services mean transgender clients are far, far, far less likely to commit suicide. Meaning they can work, pay tax and contribute to the economy. Something policymakers are always interested in.
Therefore, if you compare the money spent on Gender Identity Clinics and the money transgender people pay in tax and other economic activities through working. Then Gender Identity Clinics become very cost-effective for the NHS.
Furthermore, possibly one of the most sobering reminders of why this area is so important is because transgender children are committing suicide a lot more now. Since the GP was telling me that ever since the UK government decided to shut down the Gender Development Service, which is the UK’s under-18 Gender Dysphoria service, the children on the waiting list for treatment have reached double-digit suicide rates for the first time. When the service was open the suicide rates for children were in the single figures.
As a result, I will never let this go but the fact is clear. When transgender healthcare is restricted, this kills people and in this case, transgender healthcare being restricted to children increases the chance of them dying.
Personally, even as I was trying that section, I was getting a little upset because I never wanted to have that conversation. It isn’t natural to have to talk about child suicide but because of the foul and awful decisions of policymakers and politicians and other people that know less, we have to talk about child suicide rates. And as much as it upsets me, it also gives me more determination to do sometimes, to help people and help improve lives.
Lessons Learnt From Working In A Gender Identity Clinic
In addition to the lessons I’ve already mentioned above, I want to talk about some specific lessons that I’ve learnt during these three days and why they’re important to current or future clinical psychologists.
The People Who Work In Mental Health
I think one of the most important things to recognise is just how amazing and brilliant people are who work in mental health settings. I’ve worked in NHS settings before and everyone in the NHS is extremely kind, compassionate and they truly want to do what’s best for their service users.
This was exactly what I had expected and I didn’t really think too much of it, because this is exactly how people who work in mental health settings should be.
However, this could be my upbringing, where I live in the world and the mainstream media, but I was really pleased with how supportive, passionate and dedicated the workers at the Gender Identity Clinic were. I know this shouldn’t have come as a surprise to me, but professional who work at Gender Identity Clinics are some of the nicest, most passionate and hardworking people I have had had the pleasure of working with.
Therefore, I think this is important to realise as current or future clinical psychologists, because I think sometimes we sometimes don’t understand there are other people who are just as passionate about psychology as ourselves in the world. For example, I’m currently doing my clinical psychology Masters and I am very passionate about the topic (hence the podcast and books) but my passion comes through in different ways compared to other students. So sometimes I do feel a minor disconnect between myself and other psychology students, so it was nice going into the Clinic and meeting other professionals that are just as passionate about this area as me.
Understanding Comorbidity
If you study clinical psychology then you might have come across the disconnect in clinical psychology between the academic research and the real-world implications. For example, academic research empirically focuses on a single mental health condition and excludes participants from research that have two or more mental health conditions. This is great for research purposes because it allows us to focus on the effects and treatment outcomes for one single condition. Yet in reality, humans are rarely that clean cut because of comorbidities, where someone has two or more conditions.
And this was something I found really interesting about the MDT meeting on the Tuesday because I got to hear about this in an applied setting. As well as I am having to be a little vague because this is a sensitive topic for a lot of clients so I will not be sharing too much publicly. Yet once you start working in mental health settings, you’ll start to see, appreciate and understand that sometimes it is “rare” to see someone with a single mental health condition because humans are not that simple.
Therefore, as much as I want to elaborate on this section, I really need to refrain from doing so because I was told this podcast episode will probably attract a lot of haters that might try to misquote me in an effort to hurt the amazing clients that myself and the service are trying to help.
Need For Research
Something I found really interesting about Gender Identity Clinics is because they are so politicised, they are so judged by the government and all the transphobes are looking for any excuse to shut down all these life-saving services. There is a massive focus on research within Gender Identity Clinics. Now I’ve seen NHS services focus on research before because research is a critical part of healthcare, but Gender Identity Clinics thankfully take this focus to the next level.
Additionally, when I asked about there was such a focus on research, I was told the following, but I need to reword it for our international listeners. A few years ago in the UK, there was a legal case brought forward by a transgender client who basically accused the Tavistock Clinic of trying to push the client through transitioning and a bunch of other stuff. The Tavistock Trust lost the case unfortunately because the Trust couldn’t provide evidence for the effectiveness and life-saving nature of gender-affirming practices. As well as because this was a court case against a Gender Identity Clinic, the mainstream media focused a lot of attention on it and they did a very thorough job reporting on it. Further, adding to the false public narratives that turns public opinion against these critically important services.
Overall, this was a landmark court case in the UK because this was the legal case that was instrumental in bringing down the Gender Identity Development service for under 18s.
Remember earlier when I mentioned those increasing rates of child suicide, this court case was a major factor behind it.
As a result, in an effort to prevent another court case being so easily lost, there is a massive focus on research being done by these services. Because without this research that supports the gender-affirming work these clinics do and the lives they save, then there will be more court cases, more losses and more clinics will be shut down. Resulting in more trans people being denied the medical, social and psychological services they desperately need to prevent the worse mental health outcomes.
Like suicide.
And I do find this particular section upsetting because I know as a trans non-binary person as much trans healthcare in the UK is on a knife’s edge and I know the consequences of what happens if these clinics go away. People die. It is as simple as that and that I find distressing, but it also hardens my resolve about why I want to support trans people and trans healthcare as much as I possibly can.
Overall, there is always a massive need for research in clinical settings, but even more so in Gender Identity Clinics. And one thing I have learnt from this work experience is the importance of research and how research has the power to save services and all the good they do in the world, so I will never ever take conducting research for granted again.
Know And Learn More Than You Think
Finally, I’ve written about this before in a few different places, but there will be times when you realise you know a lot more than you think. For example, there’s a tiny extract from Clinical Psychology Reflections Volume 4 (coming out in March 2024) that introduces this topic well.
“The idea for this reflection actually came from a Prospectus Evening that I attended with some friends after a long day of testing on participants, and as much as the university wanted us to believe otherwise, this entire event was the university just marketing itself and wanting to keep us on.
They had a forensic psychologist, social psychologists, cognitive people and a bunch of clinical psychologists there, and after helping myself to the free pizza and catching up with my Final Year Project supervisor socially, I went back over to my friends to see they were talking to a lecturer of mine, a clinical psychologist.
And what really struck me were the questions they were asking. They weren’t dumb questions, they weren’t ignorant questions (well that ignorant) and they weren’t questions that made me question why the hell they wanted to go into clinical psychology (well slightly). They were simply basic questions that they would have known the answers to if they had taken clinical psychology modules.”
My point here is that if we’re listening, trying to learn and we actively engage in learning or any sort of work experience, then you naturally pick up stuff that you didn’t realise you had learnt. The example above contains a lot of stuff about what I had learnt in clinical psychology that I considered basics but in reality, it was specialised knowledge I was surprised other people with an apparent interest in clinical psychology didn’t know.
I was reminded about this again during this work experience, because on the Wednesday after I returned to Kent I went the trans social group I go to, and there were a few conversations. I was surprised I was able to follow the conversations perfectly and I could actually add the conversations in quite a lot of depth. And it just struck me how much I had actually learnt in those three days.
As a result, my point is that whenever you do psychology work experience, you may think you didn’t learn anything but in reality, you probably learnt a lot more than you ever thought possible.
I really hope you enjoyed today’s clinical psychology podcast episode.
If you want to learn more, please check out:
Working With Children and Young People: A Guide To Clinical Psychology, Mental Health and Psychotherapy. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it. Also, you can buy the eBook directly from me at https://www.payhip.com/connorwhiteley
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