Autistic people are more likely to have a gender identity which does not match their sex assigned at birth. Some people experience distress about their sex and gender not matching, which is called gender dysphoria. Such individuals may wish to attend a gender clinic to access healthcare support for gender dysphoria. Currently, there is limited evidence to help clinicians best support autistic people who need healthcare for gender dysphoria. We wanted to find out what healthcare clinicians think about working with autistic patients with gender dysphoria. We interviewed 16 clinicians who work in healthcare services with adults and young people who are autistic and experience gender dysphoria. We recorded the interviews and carefully analysed the content to find key themes. We found that clinicians worked with patients to try and better understand their experiences of gender dysphoria. Clinicians identified features of autism that they believed were related to gender identity and dysphoria including different thinking styles, social differences, and sensory sensitivities. Clinicians noticed that autistic people spoke about their gender in different ways to non-autistic people. Clinicians tried to adapt their practice to better meet the needs of their autistic patients. These adaptations tended to focus on differences in the assessment process, for example, offering longer or shorter appointments and changing their communication style. We conclude that clinicians were offering an individualised approach to autistic patients experiencing gender dysphoria. However, these clinicians were particularly interested in working with autistic people, and so may not be representative of the wider clinician population. Clinicians working in this area should receive training on autism adaptations and the intersection of autism and gender dysphoria.

Relapsing multiple times back into opiate and crack cocaine misuse significantly increases the risk for overdose death, of which rates continue to soar worldwide. This study aims to provide an in-depth understanding of opiate and crack relapse from the lived experience perspectives of people in recovery from substance misuse. Semi-structured interviews were held, and interpretative phenomenological analysis was used to analyze the data. Findings revealed two superordinate themes which highlighted the impact of relapse on an individual's sense of self, their conceptualizations of relapse, and their approach to recovery thereafter. The study offers implications and future directions for mental health authorities and addiction professionals.

Autistic people are more likely to be transgender, which means having a gender identity different to one’s sex assigned at birth. Some transgender people experience distress about this incongruence or gender dysphoria. Few studies have aimed to understand the inner experiences of this group. In this study, we used Interpretive Phenomenological Analysis to understand the lived experience of gender dysphoria. Twenty-one autistic adults were interviewed about their experience of incongruence between their gender identity and sex assigned at birth, and any associated distress. The interviews were transcribed and analysed using Interpretive Phenomenological Analysis. Participants described significant distress because their bodies did not match their gender identities, their need to understand their identities more broadly and to manage complex intersecting needs. Participants experienced distress due to living in a world which is not always accepting of gender- and neuro-diversity. Participants described barriers in accessing healthcare for their gender needs. Some participants felt being autistic had facilitated their understanding of their gender identity. Other participants described challenges such as a tension between their need to undergo a physical gender transition versus a need for sameness and routine. In conclusion, there can be both positive experiences and additional challenges for autistic transgender people. Lay Abstract: Autistic people are more likely to be transgender, which means having a gender identity different to one’s sex assigned at birth. Some transgender people experience distress about their gender and sex assigned at birth not matching which is called gender dysphoria. Research has focused on finding out why autistic people are more likely to have gender dysphoria, and less on what the experience of gender dysphoria is like for autistic people. We interviewed 21 autistic adults about their experience of incongruence between their gender identity and sex assigned at birth, and any associated distress. We carefully read the transcripts of the interviews, focusing on how participants understood their experiences. We found a range of themes from the interviews. Participants were distressed because their bodies did not match their gender identities. Participants told us they had to work hard to understand themselves and who they were, and to manage having multiple different needs such as mental health needs. It was upsetting for participants to experience discrimination because of being autistic and/or transgender. Some participants said it was more difficult to get transgender healthcare as an autistic person. Some participants thought being autistic had helped them understand their gender identity more than non-autistic people. Other participants found it was challenging to be both autistic and transgender. For example, most participants wanted to change their bodies to match their gender identity, but some participants were nervous about making changes to themselves and their routine due to being autistic. We conclude that autism can in some ways be helpful and other ways contribute to challenges for transgender autistic people.

AbstractTransgender individuals and their partners may face unique challenges that other couples do not. These unique challenges merit investigation, understanding and consideration by systemic practitioners in order to provide a culturally attuned service for transgender clients. A systematic review of the literature into the experiences of couples in which one member is transgender identified 22 qualitative papers. A translation and synthesis of constructs from these papers utilising a meta‐ethnographic approach generated a number of third order constructs organised into nine overarching themes. These themes included experiences of stigma and discrimination, issues of power, privilege, visibility and identity, and experiences of dissonance and dysphoria that required adjustments and negotiations on the personal and relationship levels. Implications for practice and avenues for future research are discussed.

‘Rape mythologising’ has been found to be a reason why survivors of rape feel blamed, and might contribute to low rates of reporting or conviction. No research to date examines whether ‘rape mythologising’ occurs in the conversations of sexual health staff when discussing rape cases. Conversation Analysis was used to analyse a focus group conversation between five sexual healthcare clinic staff who routinely provided support to rape survivors, on the topic of three rape cases presented at the clinic. Three forms of conversation were noted in the focus group: (1) assessing ‘relatability’ in cases, (2) diagnostically reconstructing events and (3) apportioning blame to rapists. Implications for professional training are discussed. In all three, a tension was noted between drawing on rape myths and professional non-blaming discourses. This research demonstrates the need for further training of those who work with rape survivors.

There has been recent emphasis on the assessment of competence in psychotherapy training courses to improve evidence-based practice and outcomes for clients. The Systemic Practice Scale (SPS) was developed as a structured way of evaluating systemic practice. There is, however, little research on the impact and experience of competence measures, particularly in the context of systemic practice. Five focus groups conducted with sixteen students and seven supervisors from systemic family practice (SFP) programmes explored their views of the SPS as an appropriate measure of systemic competence. Data was analysed using a discourse analysis with three dominant discourses identified: feedback as valuable but uncomfortable; measuring competence; and being systemic. The SPS was viewed as a valuable and useful measure of systemic competence when reflexivity and collaboration is maintained between the student and supervisor. Practitioner points: There is limited research exploring the use of competence measures in systemic practice the SPS was perceived as broadening perspectives of students’ practice and competence, reiterating the importance of feedback in a collaborative supervisory relationship Increasingly the SPS is being used across clinical psychotherapy training courses (including systemic IAPT course and Doctorate of Clinical Psychology) it has the potential to be used more widely with wider implications for the development of systemic training standards in systemic practice.

This paper describes the development of a scale for measuring systemic supervision which is called the Systemic Supervision Rating Scale (the 3D-SSRS). This scale was developed through a thematic synthesis of the systemic supervision literature, which included 137 papers on the subject. The scale was then subjected to a face validity investigation via a series of qualitative focus groups. These groups included both supervisors of supervision and students on an AFT Accredited Supervision training. Focus groups were held at the beginning and at the end of the course to understand how useful the 3D-SSRS was to supervision practice. The 3D-SSRS uses a seven-point scale to rate supervision practice and prioritises qualitative comments in 11 dimensions, including the supervisory relationship, context of supervision, developmental stage of supervisee, development of systemic skills and thinking, and attention to power and difference. Practitioner points: Systemic supervision draws on knowledges and skills unique to systemic practice within specific contexts. A new Systemic Supervision Rating Scale (the 3D-SSRS) has been developed for use in clinical and training contexts of supervision. Initial investigations into the usefulness and face validity of the scale find it able to capture many of the unique aspects of systemic supervisory practice. More research is needed into what makes for effective live supervision, perhaps unique to systemic supervisory practice, and supervision provided to groups.

AbstractAdults and children with gender variance (GV) face misunderstanding and discrimination, sometimes leading to mental health difficulties. Family support has been found to buffer these difficulties or to compound them when lacking (Westwater et al. 2019). However, little is known about how GV is considered in the context of families. In the current study, online story completion elicited forty‐five narratives of family life where a protagonist discloses their GV. The older the protagonist, the more seriously their disclosure was taken. All family members were depicted as being impacted by the disclosure, and social stigma and bullying were often the expected consequence. Heteronormative and gender‐binary thinking dominated the stories both in the descriptions of the protagonist's transition from one gender to another, and in the descriptions of the gender‐typical behaviour of the other family members. Non‐binary genders were rarely considered, and a dysphoric view of GV was often held.
Practitioner points


This study confirmed that heteronormative and binary‐gendered views predominate society, and so families, who will want to protect and support their GV member, will value support from therapists to navigate this territory.

Family therapy is helpful to explore the multiple perspectives held within families when one member discloses gender variance, and challenge heteronormative and gender‐binary discourses.


Non‐binary identities should be supported as a valid identity in their own right and not a transition point from one gender to another.

The number of people presenting at gender clinics is increasing worldwide. Many people undergo a gender transition with subsequent improved psychological well-being (Paediatrics, 2014, 134, 696). However, some people choose to stop this journey, 'desisters', or to reverse their transition, 'detransitioners'. It has been suggested that some professionals and activists are reluctant to acknowledge the existence of desisters and detransitioners, possibly fearing that they may delegitimize persisters' experiences (International Journal of Transgenderism, 2018, 19, 231). Certainly, despite their presence in all follow-up studies of young people who have experienced gender dysphoria (GD), little thought has been given to how we might support this cohort. Levine (Archives of Sexual Behaviour, 2017, 47, 1295) reports that the 8th edition of the WPATH Standards of Care will include a section on detransitioning - confirming that this is an increasingly witnessed phenomenon worldwide. It also highlights that compared to the extensive protocols for working with children, adolescents and adults who wish to transition, nothing exists for those working with desisters or detransitioners. With very little research and no clear guidance on how to work with this population, and with numbers of referrals to gender services increasing, this is a timely juncture to consider factors that should be taken into account within clinical settings and areas for future research.

Adolescent substance misuse is increasingly being viewed as a systemic problem and several studies have shown the benefit of increased parental involvement. This article describes the evaluation of a ten-week Non-Violent Resistance (NVR) group parent training programme delivered within a Young People’s Specialist Substance Misuse Treatment Service. Eighteen participants completed questionnaires before and after the programme, and at follow-up. Eight participants also took part in semi-structured interviews. Parents reported experiencing the programme as unique and helpful, and highlighted some challenges. Measures of parental self-efficacy and goal-based outcomes showed significant improvement at the end of the programme, and improvement in parental self-efficacy remained significant at follow-up. This evaluation provides preliminary evidence that NVR parent training may be a useful intervention in this context. However, the generalisability of the data is limited and further research is needed. Practitioner points: Non-Violent Resistance parent training helps parents resist their child’s behaviour, manage their own emotional reactions, and recruit supporters from their wider network Qualitative data suggests that parents who have attended this programme experience additional benefits to those found in qualitative evaluations of other parenting interventions a group training programme delivered within a Young People’s Specialist Substance Misuse Treatment Service improves parents’ self-efficacy and helps them achieve their goals for their children.

Gender dysphoria is distress due to a discrepancy between one's assigned gender and gender identity. Adults who wish to access gender clinics are assessed to ensure they meet the diagnostic criteria for gender dysphoria. Therefore, the definition of gender dysphoria has a significant impact on the lives of individuals who wish to undergo physical gender transition. This systematic review aimed to identify and synthesize all existing qualitative research literature about the lived experience of gender dysphoria in adults. A pre-planned systematic search identified 1491 papers, with 20 of those meeting full inclusion criteria, and a quality assessment of each paper was conducted. Data pertaining to the lived experience of gender dysphoria were extracted from each paper and a meta-ethnographic synthesis was conducted. Four overarching concepts were identified; distress due to dissonance of assigned and experienced gender; interface of assigned gender, gender identity and society; social consequences of gender identity; internal processing of rejection, and transphobia. A key finding was the reciprocal relationship between an individual's feelings about their gender and societal responses to transgender people. Other subthemes contributing to distress were misgendering, mismatch between gender identity and societal expectations, and hypervigilance for transphobia.

University provides individuals with the opportunity to develop greater independence in living skills and social networks, while also gaining valuable qualifications. Despite a high proportion of autistic individuals aspiring to attend university, many either do not seek or gain entry or drop out prematurely. Although some steps have been taken to develop effective support, a recent review highlighted the scarcity of research into programmes designed to support autistic students transitioning to university. In addition, few studies have examined the views of autistic students themselves. This study investigated the perspectives of autistic students transitioning to university. Three focus groups were conducted with 25 autistic students preparing to start university. Participants were asked about their hopes for starting university, as well as their worries and concerns. Data were analysed using thematic analysis, from which five main themes were identified: the Social World, Academic Demands, Practicalities of University Living, Leaving the Scaffolding of Home and Transition to Adulthood. The results provide an important account of the challenges autistic students face when transitioning to university, as well as their aspirations. These findings have a number of practical implications.

Background: Trans youth have been reported to have high rates of self-harm, depression and bullying, and find it difficult to seek support. However, much of this research comes from gender identity clinics; non-clinical samples and those who reject gender binaries remain under-researched. Aims: This study investigated the experiences of a community school-based sample of Trans, identifying youth, Other, and cis-gendered adolescents in relation to their experiences of low mood, bullying, associated support, self-harm ideation and peer-related self-harm. Methods: an online survey was completed by 8440 13–17 year olds (3625 male, 4361 female, 227 Other, and 55 Trans). Results: Trans and Other students had significantly higher rates of self-harm ideation and peer self-harm, in comparison to cis-gendered students. These Trans and Other students reported significantly higher rates of bullying and self-reported depression and significantly less support from teachers and staff at school, in fact these students did not know where to go to access help. Discussion: This community sample confirms findings of high rates of self-harm ideation, self-reported depression and bullying for Trans youth as previously reported in clinic-based samples. However, by accessing a community sample, the salience of the category “Other” was established for young people today. While Other and Trans identified students both struggled to find support, those who identified as Trans were more likely to have been bullied, and have experienced self-reported depression and thoughts of self-harm. Thus, those who identify as transgender represent a high-risk group that needs targeted support within schools and by statutory and nonstatutory community services. Unpacking the category of Other would be beneficial for future research, as well as exploring resilience within this group and intersecting identities such as sexuality, Autism, or experiences such as earlier abuse.

Increasing life expectancy within cystic fibrosis (CF) raises challenges around previously neglected topics such as sexual and reproductive health (SRH). The study aimed to gather retrospective experiences of service provision around SRH to consider the role of the CF service, age of information provision and unmet needs highlighting possible improvements to provision. A mixed-methods retrospective survey-based design was employed. An Adult CF team participated in a consultation session generating survey questions around SRH. A 20-item online survey was constructed and disseminated to adult CF patients. Unmet needs were found in SRH provision in pediatric and adult CF services, with further information required by patients on topics including parenthood and fertility. Results support previous research findings highlighting the need for standardized provision around SRH. Age of SRH provision suggested individual differences in need within the pediatric service. Further research could explore format and specific age of SRH information provision.

Background: the normalisation movement calls for more recognition of the sexual rights of people with intellectual disabilities to challenge classically paradoxical cultural beliefs: ‘hypersexual’ versus ‘asexual’. Aims: This meta-ethnographic qualitative synthesis aimed to explore the voices of people with intellectual disabilities in regards to their experiences and perceptions of sexuality using a Coordinated Management of Meaning framework to derive new conceptual understandings of how their sexuality exists within multiple contexts. Methods and procedures: a systematic literature search and quality assessment yielded 16 studies that met the inclusion criteria and were synthesised following the method of meta-ethnography. Outcomes and results: Four core themes were identified; 'sociocultural Norms’; ‘Under Others Power’; 'sexual Identity’ and 'sexual Experience’. Conclusions and implications: Application of the hierarchical Coordinated Management of Meaning model suggested caregivers contextual beliefs about people with intellectual disabilities’ sexuality inhibited or facilitated positive expressions of sexuality over and above individual needs and desires. Rights-based cultural messages provided the only context that led to positive sexuality outcomes and research that explores sexuality within this context is much needed. The Coordinated Management of Meaning model identified by this research may act as a framework to support the reflective-practice of caregivers.

Re-offending rates of perpetrators of domestic violence are high (Hester et al.) and there is a need for perpetrator programmes to reduce victimization. There is no clear evidence for the effectiveness of existing programmes (Bowen, Gilchrist and Beech,; Herman, Rotunda, Williamson and Vodanovich,; Smedslund et al.). A new perpetrator programme based on Solution Focused Brief Therapy has been developed (Bowen,), and whilst in its infancy it has received positive feedback from services and clients (International Innovation,). Solution Focused Brief Therapy has been found to be effective in the reduction of aggression and criminal behaviours (Gingerich and Peterson,), and has been effectively used with people with a learning disability (Smith,). This case study will explore the effectiveness of the new perpetrator programme with someone with a learning disability on their attitudes towards domestic violence and abuse as well as self-esteem. Practitioner points: Solution Focused Therapy for domestic violence has been found to successfully change the behaviour and improve the self-esteem of a man with a learning disability Where children are at risk of harm, longer-term interventions remain the recommended therapy the mainstream model for treatment was adapted by using visual aids and role play to work with someone with learning disabilities and these were found to be useful by the client.

Purpose Hospitalization can be stressful for patients and their families. Pre-hospitalization information is crucial in establishing a good basis for patient satisfaction. In order to develop better preparatory material for parents, this qualitative study explored whether parents of children with cystic fibrosis, admitted to a UK Children's Hospital, felt adequately prepared for their child's admission. Design and Methods Data were collected from twelve parents whose children had been admitted within the last two years for routine intravenous antibiotics. Semi-structured interviews were analyzed using thematic analysis. Results Four themes emerged from the analysis: (1) preparing for admission, (2) the ward as a challenging environment, (3) changes in the parent-professional relationship and (4) the parental role in medical care. Conclusion Provision of adequate preparatory information is essential in reducing parental stress, influencing how future experiences are appraised and managed. Effective parent-professional communication and opportunities to participate in care are likely to improve parental satisfaction. Practice Implications Preparatory information prior to hospital admission greatly assists parents in making informed decisions and working as joint advocates in their child's inpatient care.

Purpose: the purpose of this paper is to examine the levels of clinician burnout in a community forensic personality disorder (PD) service, and explores how burnout may arise and be minimised within a service of this nature. Design/methodology/approach: a mixed methods approach was utilised, assessing levels of burnout and making comparisons with a comparable previous study. Focus group data regarding burnout and suggestions for reducing the risk of burnout were analysed using thematic analysis. Findings: Levels of burnout were generally found to be higher in the current sample when compared with the generic PD services. Qualitative data suggest that working in a forensic PD setting may pose a range of additional and complex challenges; these are explored in detail. Minimising burnout might be achieved by developing resilience, utilising humour, team coherence and ensuring that breaks are taken, and developing one’s own strategies for “releasing pressure”. Practical implications: the risk for burnout in clinicians working with offenders with PD may be higher than other groups of mental health clinicians. Despite this, attempts to minimise burnout can be made through a range of practical strategies at the individual, team and organisational level. Originality/value: This is the first project to assess levels of burnout specifically in a team of clinicians working with offenders with PD, and offers an exploration of how burnout may manifest and how it can be managed in this unique area of mental health.

While intersectionality has become an established and much used theory in feminist and critical race studies, the concept remains relatively underused by systemic family therapists and on family therapy training courses. and yet systemic therapy embraces the multiplicity of human existence and examines the interplay of power relations. This article attempts to fill this gap by emphasizing the usefulness of intersectionality in representing the complexities of lived experience and by presenting an exercise to introduce students to intersectionality in family therapy training. Practitioner points: Therapists and trainers should be aware of the privileges and oppressions that the intersections of their social locations create. Therapists and trainers should be ready to initiate conversations with clients and students about intersecting identities and their influence. Help students to apply intersectionality theory through structured, well-paced exercises with plenty of in-built reflexive discussion.

While there has been an increase in papers addressing working with lesbian and gay clients over the past two decades, this paper builds on this historical context to combine the latest developments in therapy with sexual and gender minority clients with principles of systemic theory and practice. Clear guidelines are provided on how to apply sexual and gender minority therapy within a systemic frame. Specific issues relating to sexual and gender minority couple and family work are addressed, with the provision of further suggestions and resources. © 2009 the Association for Family Therapy and Systemic Practice.

This article reports on a survey of clinical psychology training courses that measured levels of training in sex and sexuality. Findings suggest there is inconsistent provision in terms of quantity and breadth of coverage.

This paper describes the challenges and opportunities involved in setting up a systemic couples clinic in a medical setting, with increasing pressures to justify the use of psychologist's time.

The need to promote safer sexual behaviour has taken on new urgency in the UK because of large increases in the number of sexually transmitted infections (STIs). The sexual health needs of people living with HIV and AIDS (PLHA) also require attention as part of health promotion efforts. Many sexual health clinics are however struggling with high demand and limited resources. Within this context, this paper describes an innovate attempt at STI prevention with PLHA. Specifically, nursing staff were trained in the use of motivational interviewing to address sexual health issues and safer sexual behaviour in PLHA. We describe the training package and the impact upon participants. We conclude that by providing a positive training experience, front-line health staff that see the highest volume of PLHA with repeat STIs, can be assisted in developing their skills and confidence in prevention work with clients. & 2006 Taylor & Francis.

This paper explores the thinking behind and setting up of a new support scheme targeted at lesbian, gay and bisexual clinical psychology trainees. The journey from conception to reality is explored, detailing the most poignant dilemmas tackled along the way. © the British Psychological Society 2005.

This paper contains a teaching tool devised for a lesbian and gay awareness workshop. The tool takes the form of a-day-in-the-life-of story where homosexuality is the societal norm.