Psychological support serving trans people in Bulgaria

About her work with trans people Anna Joukivskaia shares:

"In my work with trans people, I've come across such a colorful palette of identities and experiences that it's hard to describe it all. I have a little resistance to following "protocols" in support of trans people, unless the first point of such rules says: “Anyone seeking support would like to be seen and heard as a human being that comprises of individual needs, experiences, personal background, characteristics, and coping mechanisms, rather than being placed in categories and boxes.". The client is the expert of their life. This is my first point. Everything else should be viewed through this prism."

First step in the process of supporting trans people: the trans person contacts the psychologist / therapist with a specific request for support.

This can vary from:

- need for psychotherapeutic help in the study of gender identity or the expression of gender identity;

- need for support in case of negative influence of gender dysphoria; often the consequences are related to self-harm and suicidal thoughts or attempts.

- need for support during or after coming out;

- the need for support in social transition and gender mainstreaming, which identifies the trans client in the context in which they live.

- need for support for the extended family;

- need for information on next steps in the transition;

- psychological difficulties related to non-acceptance of trans identity (shame, guilt) on individual, family, social level: increased anxiety; depressive states; self-harm; eating disorders, drug abuse, alcohol, etc.

- a request that is not specifically related to trans identity, but to other psychological aspects and difficulties that a person goes through;

- request for support after a negative experience with a psychologist / psychotherapist who has applied conversion practices to "cure" trans identity.

- Need for support in internalized transphobia

Second step in the process of support for trans people: depending on the request, which is identified during the first session, the psychological support service is determined:

Individual psychotherapy

Psychotherapeutic support in a safe and calm environment, with guaranteed confidentiality, can be invaluable in helping people with different gender identities in each of these processes:

(1) clarifying and exploring gender identity, with the therapist's role being to create a safe environment in which the client feels comfortable exploring and learning more about different identities and gender expressions.

(2) clarifying the healthy boundaries between the client and the people in his life, in the environment in which he operates

(3) addressing the impact of stigma and stress on lack of acceptance of identity at the individual, family, social level on mental health and personal development,

(4) facilitating the process of coming out and socialization

(5) support for social transition and the development of social skills and health coping strategies in a non-hostile environment,

(6) assessment of gender dysphoria - history of dysphoric symptoms and development of healthy strategies to deal with them,

(7) assessment of psychosocial adaptation in gender identity, with which the trans person identifies.

Psychological support for the whole family

(1) Support for the whole family is related to awareness, discussion of the next steps in the transition of the trans person - family therapy may include work with the parents of the trans person, with the partner or other family members who are directly related to the life and everyday life of the client.

(2) The psychotherapist provides a safe space for the families, in which they have the peace to go through the different stages of accepting the different gender identity of the client, to work out their fears, the feeling of losing the image of the client as it was, the integration of positive mechanisms to deal with stress and stigma that occur in our society. Lack of security, predictability, fears for the client's health are a big part of the worries that the therapist works with in support of families.

(3) The psychotherapist does not condemn parents and families who have difficulties in accepting the different gender identity of the client. Her task is to facilitate healthy communication between family members to support the quality of life of the client. Systematic awareness and good trusting contact help the accepting process in families who have resistance to the client's different gender identity.

Support group

The trans client and his family may be referred by the therapist to visit a Single Step support group.

The support group provides precisely the safe and calm environment in which the trans client can explore themselves, their social skills, the topics that excite them, in the context of communicating with other LGBT + people with the help of a psychologist. The same goes for the trans client's family - the feeling of belonging and sharing in a group with other families who have gone through or are going through similar stages of acceptance or difficulties, helps to improve mental health, relieves the feeling of isolation and stigma.

Third step in the process of supporting trans people: targeting and collaborating with partners in the process

The psychotherapist does not work in isolation. Her main goal is to improve the quality of life of the trans person who seeks support. This includes, but is not limited to, providing psychotherapeutic support to the client and their family. The psychotherapist provides an opinion and expert opinion for starting hormone therapy, as well as for support in court in changing the administrative gender. Also, if necessary, the therapist can provide a letter with guidelines for creating a tolerant space in the school and support the trans student by informing the teachers and the principal of the school where he / she is studying.

As part of the support, the therapist can direct the trans client to:

- Career counselor (Venture Out) to help the trans client find a job, training or give them advice on how to seek rights if there is transphobia in the work environment, lack of tolerance policies, etc.;

- Lawyer (Natasha Dobreva) to inform about the process of administrative gender reassignment and the rights of trans people, as well as drive this whole process.

- Health consultant (Dr. Momchil Baev) to inform about the next steps in the process of hormonal transition and to be the liaison with an endocrinologist to lead this process.

- A trans person to talk to the client about their personal experience in the transition and answer any questions he may have.

- Psychiatrist to provide an opinion to the endocrinologist to start hormone therapy. The psychiatrist may be able to support more severe psychological symptoms that interfere with the functioning of the trans client on a daily basis.