Stephen’s Story: A Culture-Infused Perspective of Life-Making in Therapeutic Work with Transgender Clients

  • Andrew Estefan
  • Robert Roughley
Part of the International and Cultural Psychology book series (ICUP)


In this chapter, we explore the story of Stephen, a composite female-to-male transgender client, derived from the practice experiences of the first author. We engage with Stephen’s story in order to explore key aspects of culture-infused counselling. As part of Stephen’s story, we explore the issue of self-harm to illustrate ways counsellors can engage in life-making and self-composition alongside transgender clients. Culture-infused counselling (CIC; Collins & Arthur, 2010a, 2010b) is woven throughout this chapter to illustrate how it brings counsellor and client together in a therapeutic relationship characterized by a commitment to each know the other and to engage in helpful therapeutic work. In reflecting on the application of the revised CIC framework (see Chap.  2), we emphasize the importance of sustaining sensitivity to the role culture plays in shaping client and therapist identities. We also explore how cultural awareness of self informs the therapeutic relationship. Used concurrently, these approaches help sustain a practice in which transgender clients and counsellors can work together in meaningful and forward-looking ways.


Culture-infused counselling Transgender Trans Self-harm Intersectionality 


  1. Ballan, M. S., Romanelli, M., & Harper, J. N. (2011). The social model: A lens for counseling transgender individuals with disabilities [Special issue]. Journal of Gay and Lesbian Mental Health, 15, 260–280. Scholar
  2. Beck, J. S. (2011). Cognitive therapy: Basics and beyond (2nd ed.). New York: Guilford Press.Google Scholar
  3. Booth, R., Keogh, K., Doyle, J., & Owens, T. (2014). Living through distress: A skills training group for reducing deliberate self-harm. Behavioral and Cognitive Psychotherapy, 42, 156–165. Scholar
  4. Bowers, L., Brennan, G., Flood, C., Lipang, M., & Oladapo, P. (2006). Preliminary outcomes of a trial to reduce conflict and containment on acute psychiatric wards: City nurses. Journal of Psychiatric and Mental Health Nursing, 13, 165–172. Scholar
  5. Chartrand, H., Bhaskaran, J., Sareen, J., Katz, L., & Bolton, J. (2015). Correlates of nonsuicidal self-injury and suicide attempts among tertiary care, emergency department patients. Canadian Journal of Psychiatry, 60(6), 276–283. Retrieved from Scholar
  6. Clandinin, D. J., Caine, V., Estefan, A., Huber, J., Murphy, M. S., & Steeves, P. (2015). Places of practice: Learning to think narratively. Narrative Works: Issues, Investigations, and Interventions, 5(1), 22–39 Retrieved from Scholar
  7. Clark, B. A. (2017). Ethics in child and youth care practice with transgender youth. International Journal of Child, Youth, and Family Studies, 8(1), 74–96. Scholar
  8. Collazo, A., Austin, A., & Craig, S. L. (2013). Facilitating transition among transgender clients: Components of effective clinical practice. Clinical Social Work Journal, 41, 228–237. Scholar
  9. Collins, S., & Arthur, N. (2010a). Culture-infused counselling: A fresh look at a classic framework of multicultural counseling competencies. Counselling Psychology Quarterly, 23(2), 203–216. Scholar
  10. Collins, S., & Arthur, N. (2010b). Culture-infused counselling: A model for developing multicultural competence. Counselling Psychology Quarterly, 23, 217–233. Scholar
  11. Coulter, R. W. S., Blosnich, J. R., Bukowski, L. A., Herrick, A. L., Siconolfi, D. E., & Stall, R. D. (2015). Differences in alcohol use and alcohol-related problems between transgender- and nontransgender-identified young adults. Drug and Alcohol Dependence, 154, 251–259. Scholar
  12. Davidson, A. I. (2001). Foucault, psychoanalysis, and pleasure. In T. Dean & C. Lane (Eds.), Homosexuality and psychoanalysis (pp. 43–50). Chicago: The University of Chicago Press.Google Scholar
  13. Estefan, A., McAllister, M., & Rowe, J. (2003). Difference, dialogue, dialectics: A study of caring and self-harm. In K. H. Kavanagh & V. Knowlden (Eds.), Many voices: Toward caring culture in healthcare and healing (pp. 21–61). Madison, WI: University of Wisconsin Press.Google Scholar
  14. Estefan, A., & Roughley, R. A. (2013). Composing self on narrative landscapes of sexual difference: A story of wisdom and resilience. Canadian Journal of Counselling and Psychotherapy, 47, 29–48. Retrieved from
  15. Favazza, A., & Rosenthal, R. J. (1993). Diagnostic issues in self-mutilation. Hospital and Community Psychiatry, 44, 134–140. Scholar
  16. Fletcher, J. B., Kisler, K. A., & Reback, C. J. (2014). Housing status and HIV risk behaviors among transgender women in Los Angeles. Archives of Sexual Behavior, 43, 1651–1661. Scholar
  17. Goethals, S. C., & Schwiebert, V. L. (2005). Counseling as a critique of gender: On the ethics of counseling transgendered clients. International Journal for the Advancement of Counselling, 27, 457–469. Scholar
  18. Gordon, E., McKibbin, K., Vasudevan, L., & Vinz, R. (2007). Writing out of the unexpected: Narrative inquiry and the weight of small moments. English Education, 39, 326–351. Retrieved from
  19. Grant, J. M., Mottet, L., Tanis, J.E., Harrison, J., Herman, J., & Keisling, M. (2011) Injustice at every turn: A report of the National Transgender Discrimination Survey. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force. Available from
  20. Grossman, A. H., & D’Augelli, A. R. (2007). Transgender youth and life-threatening behaviors. Suicide and Life-threatening Behavior, 37, 527–537. Retrieved from Scholar
  21. Hawton, K., Witt, K. G., Taylor Salisbury, T. L., Arensman, E., Gunnell, D., Hazel, P., et al. (2016). Psychosocial interventions for self-harm in adults. Cochrane Database of Systematic Reviews, 12(5), 1–4. Scholar
  22. Hazleton, M. (1999). Psychiatric personnel, risk management, and the new institutionalism. Nursing Inquiry, 6, 224–230. Scholar
  23. Ho, D. Y. F. (1995). Internalized culture, culturocentrism, and transference. The Counseling Psychologist, 23, 4–24. Scholar
  24. Hunt, J. (2014). An initial study of transgender people’s experiences of seeking and receiving counselling or psychotherapy in the UK. Counselling and Psychotherapy Research, 14, 288–296. Scholar
  25. James, A. C., Taylor, A., Winmill, L., & Alfoadari, K. (2008). A preliminary community study of dialectical behavior therapy (DBT) with adolescent females demonstrating persistent deliberate self-harm (DSH). Child and Adolescent Mental Health, 13, 148–152. Scholar
  26. Johnston, M. S. (2016). ‘Until that magical day…no campus is safe’: Reflections on how transgender students experience gender and stigma on campus. Reflective Practice, 17(2), 143–158. Scholar
  27. Klonsky, E. D. (2009). The functions of self-injury in young adults who cut themselves: Clarifying the evidence for affect regulation. Psychiatry Research, 166, 260–268. Scholar
  28. Koken, J. A., Bimbi, D. S., & Parsons, J. T. (2009). Experiences of familial acceptance-rejection among transwomen of color. Journal of Family Psychology, 23, 853–860. Scholar
  29. Labelle, R., Pouliot, L., & Janelle, A. (2015). A systematic review and meta-analysis of cognitive behavioural treatments for suicidal and self-harm behaviours in adolescents. Canadian Psychology, 56, 368–378. Scholar
  30. Linehan, M. M., Armstrong, H. E., Suarez, A., Allman, D., & Heard, H. L. (1991). Cognitive behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48, 1060–1064. Scholar
  31. Linehan, M. M., Korslund, K. E., Harned, M. S., Gallop, R. J., Lungu, A., Neacsiu, A. D., et al. (2015). Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: A randomized clinical trial and component analysis. JAMA Psychiatry, 72, 475–482. Scholar
  32. Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36, 38–56. Retrieved from Scholar
  33. Morris, C., Simpson, J., Sampson, M., & Beesley, F. (2014). Cultivating positive emotions: A useful adjunct when working with people who self-harm? Clinical Psychology and Psychotherapy, 21, 352–362. Scholar
  34. Morris, D. B. (2002). Narrative, ethics, and pain: Thinking with stories). In R. Charon & M. Montello (Eds.), Stories matter: The role of narrative in medical ethics (pp. 196–218). New York: Routledge.Google Scholar
  35. Nadal, K. L., Skolnik, A., & Wong, Y. (2012). Interpersonal and systemic microaggressions toward transgender people: Implications for counseling. Journal of LGBT issues in Counseling, 6, 55–82. Scholar
  36. Nordmarken, S. (2014). Microaggressions. Transgender Studies Quarterly, 1, 129–134. Scholar
  37. Paré, D. (2012). Book review of Culture-infused counselling (2nd ed.). Canadian Journal of Counseling and Psychotherapy, 46, 178–181. Retrieved from
  38. Pearce, R., Steinberg, D. L., & Moon, I. (2018). Introduction: The emergence of ‘trans’. Sexualities, 1–10. Scholar
  39. Peterson, C. M., Matthews, A., Copps-Smith, E., & Conard, L. A. (2016). Suicidality, self-harm, and body dissatisfaction in transgender adolescents and emerging adults with gender dysphoria. Suicide and Life-threatening Behavior, 47(4), 475–482. Scholar
  40. Riley, E. A., Wong, W. K. T., & Sitharthan, G. (2011). Counseling support for the forgotten transgender community. Journal of Gay and Lesbian Social Services, 23, 395–410. Scholar
  41. Rimes, K. A., Goodship, N., Ussher, G., Baker, D., & West, E. (2017). Non-binary and binary transgender youth: Comparison of mental health, self-harm suicidality, substance use, and victimization experiences. International Journal of Transgenderism, 1–11.
  42. Royal College of Psychiatrists. (2010). Self-Harm, suicide, and risk: Helping people who self-harm (Council Report CR158). London: Author.Google Scholar
  43. Sangganjanavanich, V. F. (2009). Career development practitioners as advocates: Understanding gender transition. Journal of Employment Counseling, 46, 128–135. Scholar
  44. Sangganjanavanich, V. F., & Cavazos Jr., J. (2010). Workplace aggression: Toward social justice and advocacy in counseling for transgender individuals. Journal of LGBT Issues in Counseling, 4, 187–201. Scholar
  45. Sevelius, J. M. (2013). Gender affirmation: A framework for conceptualizing risk behavior among transgender women of color. Sex Roles, 68, 675–689. Scholar
  46. Smith, D. L., & Ruiz, M. (2009). Perceived disparities in access to healthcare due to cost for women with disabilities. Journal of Rehabilitation, 75(4), 3–10 Retrieved from Scholar
  47. Strandjord, S. E., Ng, H., & Rome, E. S. (2015). Effects of treating gender dysphoria and anorexia nervosa in a transgender client: Lessons learned. International Journal of Eating Disorders, 48, 942–945. Scholar
  48. Taliaferro, L. A., McMorris, B. J., Rider, G. N., & Eisenberg, M. E. (2018). Risk and protective factors for self-harm in a population-based sample of transgender youth. Archives of Suicide Research [online first], 1–19.
  49. Whittle, S., Turner, L., & Al-Alami, M. (2007). Engendered penalties: Transgender and transexual people’s experiences of inequality and discrimination. London: Press for Change.Google Scholar
  50. Veale, J. F., Watson, R. J., Peter, T., & Saewyc, E. M. (2017). Mental health disparities among Canadian transgender youth. Journal of Adolescent Health, 60(1), 44–49. Scholar
  51. Xavier, J. M., Bobbin, M., Singer, B., & Budd, E. (2005). A needs assessment of transgendered people of color living in Washington, DC. International Journal of Transgenderism, 8(2–3), 31–48. Scholar
  52. Young, R., Sproeber, N., Groschwitz, R. C., Preiss, M., & Plener, P. L. (2014). Why alternative teenagers self-harm: Exploring the link between non-suicidal self-injury, attempted suicide, and adolescent identity. BMC Psychiatry, 14, 137. Retrieved from
  53. Zlotnick, C., Shea, M. T., Pearlstein, T., Simpson, E., Costello, E., & Begin, A. (1996). The relationship between dissociative symptoms, alexithymia, impulsivity, sexual abuse, and self-mutilation. Comprehensive Psychiatry, 37(1), 12–16. Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Faculty of NursingUniversity of CalgaryCalgaryCanada
  2. 2.City University of SeattleCalgaryCanada

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