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Gender Identity Formation Theoretical and Treatment Issues in Clinical Practices Copyright © 1997-2002 Melvin W. Wong, Ph.D. All Rights Reserved Melvin.

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Presentation on theme: "Gender Identity Formation Theoretical and Treatment Issues in Clinical Practices Copyright © 1997-2002 Melvin W. Wong, Ph.D. All Rights Reserved Melvin."— Presentation transcript:

1 Gender Identity Formation Theoretical and Treatment Issues in Clinical Practices Copyright © Melvin W. Wong, Ph.D. All Rights Reserved Melvin W. Wong, Ph.D. 黃偉康博士 Licensed Clinical Psychologist ChristianMentalHealth.com 220 Montgomery St., Suite 1098, San Francisco, CA Mowry Avenue, Fremont, CA Tel (510) Fax (510)

2 Video Presentation Formation of Gender Identity And Homosexuality Fairchild Television Vancouver, Calgary & Toronto, Canada (Used by permission)

3 Resource & References Handbook of Child and Adolescent Sexual Problems, George A. Rekers, Lexington Books, 1995 The Psychological Birth of the Human Infant, Margaret S. Mahler, et al, Basic Books, 1975 Comprehensive Textbook of Psychiatry/IV 4 th ed. Harold I. Kaplan & Benjamin J. Sadock, Williams & Wilkins. Homosexuality: A New Christian Ethic, Elizabeth R. Moberly. The Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV) 4 th ed. American Psychiatric Association. 1994

4 Gender Identity Formation Stages Stage 1 (Birth to Four years old) –Parental Same-Gender Attachment Stage 2 (Kindergarten to Elementary School) –Social Same-Gender Attachment Stage 3 (Elementary to Middle School) –Social Opposite-Gender Attachment Stage 4 (Middle to High School) Stage 5 (High School to College) Stage 6 (Beyond College & Marriage)

5 Stage 1 (Birth to Four years old) Parental Same-Gender Attachment –Separation & Individuation –Same-Gender Attachment Failure –Opposite-Gender Attachment

6 Family Tree Diagram Father Son-1 Son-1 Mother Daughter Son-2

7 Healthy Relationship Father Son-1 Son-1 Mother Daughter Son-2 Son separates from mom for psychological individuation successfully

8 Healthy Relationship Father Son-1 Son-1 Mother Daughter Son-2 Son attaches with dad for Gender-Identity formation sucessfully

9 Healthy Relationship Father Son-1 Son-1 Mother Daughter Son-2 Son separates from mom for psychological individuation successfully

10 Healthy Relationship Father Son-1 Son-1 Mother Daughter Son-2 Son attempts to attach to father for Gender- Identity formation

11 Unhealthy Relationship Begins Father Son-1 Son-1 Mother Daughter Son-2 Son’s attempts to attach to father was rebuffed and he experiences rejection and hurt

12 Unhealthy Relationship Defensive Detachment Begins Father Son-1 Son-1 Mother Daughter Son-2 Son’s attempts to defend against more pain from rejection by defensively detaching from father’s relationship emotionally

13 Gender-Identity Development Separation-Individuation Successful Gender-Identity develops after an early dynamic relationship (Separation- Individuation) of child with Mother & FatherSuccessful Gender-Identity develops after an early dynamic relationship (Separation- Individuation) of child with Mother & Father Both Mother and Father are important for healthy gender development of their kidsBoth Mother and Father are important for healthy gender development of their kids Dynamic psychological relationship begins when child walks & talks (Separation-Individuation)Dynamic psychological relationship begins when child walks & talks (Separation-Individuation) –Where Gender-Identity Imprinting begins

14 Gender-Identity-Imprinting Stage Copyright © Melvin W. Wong, Ph.D.1999 Object-RelationsSeparation-Individuation theory suggests there is a critical phase when a child will have to separate from mother to attain gender individuation For gender identity to be formed, child must successfully attach to the same-sex parent emotionally

15 Reference The Psychological Birth of the Human Infant Symbiosis and Individuation Margaret S. Mahler, Fred Pine & Anni Bergman ( pages) Published by Basic Books, Inc. Publishers, New York (Hardcover USD $45 Paperback $22)

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17 The Psychological Birth of the Human Infant Symbiosis and Individuation Beginning of Gender Identity is 21 monthsBeginning of Gender Identity is 21 months –Boys turn to fathers to gender identify (p. 106) –Boys struggles with castration anxiety Task of becoming a separate individual for little girls are more difficult than boysTask of becoming a separate individual for little girls are more difficult than boys –Girls turn to mother upon discovery of sexual difference –Girls blame, demand, ambivalent toward mom

18 Gender-Identity-Imprinting Stage Copyright © Melvin W. Wong, Ph.D.1999 Defensive Detachment theoryDefensive Detachment theory –Dr. Elizabeth Moberly Defensive Attachment theoryDefensive Attachment theory –Dr. Melvin Wong, Licensed Psychologist (Calif) Father-Son Separation: Emotional DetachmentFather-Son Separation: Emotional Detachment Mother-Son Enmeshment: Close emotional attachment, results in imprinting of mother’s gender-personality characteristicsMother-Son Enmeshment: Close emotional attachment, results in imprinting of mother’s gender-personality characteristics

19 Healthy Relationship Father Son-1 Son-1 Mother Daughter Son-2 Son separates from mom for psychological individuation successfully

20 Healthy Relationship Father Son-1 Son-1 Mother Daughter Son-2 Son attempts to attach to father for Gender- Identity formation

21 Unhealthy Relationship Begins Father Son-1 Son-1 Mother Daughter Son-2 Son’s attempts to attach to father was rebuffed and he experiences rejection and hurt

22 Unhealthy Relationship Defensive Detachment Begins Father Son-1 Son-1 Mother Daughter Son-2 Son ’ s attempts to defend against more pain from rejection by defensively detaching from father ’ s relationship emotionally

23 Unhealthy Relationship Defensive Attachment Begins Father Son-1 Son-1 Mother Daughter Son-2 Son has no choice but to re-attach with mom for emotional security

24 Unhealthy Relationship Defensive Attachment Continues Father Son-1 Son-1 Mother Daughter Son-2 Son has no choice but to re-attach with mom for emotional security Forming Defensive Attachment

25 Unhealthy Relationship Defensive Attachment Intensifies Father Son-1 Son-1 Mother Daughter Son-2 Son generalizes defensive detachment to defensively attach to girls and women: Non- aggressive & softer

26 Unhealthy Relationship Defensive Attachment Intensifies Father Son-1 Son-1 Mother Daughter Son-2 Father becomes a stanger Generalization intensifies. Father becomes a stanger Girl 1 Girl 2

27 Unhealthy Relationship Defensive Attachment Intensifies Father Son-1 Son-1 Mother Daughter Son-2 Men are unfamiliar Generalization intensifies. Men are unfamiliar Girl 1 Girl 2 Girlfriend

28 Unhealthy Relationship Defensive Attachment Solidifies Father Son-1 Son-1 Mother Daughter Son-2 Men are objectified- curious-sexualized Girl 1 Girl 2 Girlfriend Grandma

29 Unhealthy Relationship Defensive Attachment Solidifies Father Son-1 Son-1 Mother Daughter Son-2 Men are objectified- curious-sexualized Girl 1 Girl 2 Girlfriend Grandma Aunt 1

30 Gender-Identity-Imprinting Stage Copyright © Melvin W. Wong, Ph.D.1999 Mother-Daughter Separation: IndividuationMother-Daughter Separation: Individuation Father-Daughter Attachment: Gender-Identity “Confirmation” processFather-Daughter Attachment: Gender-Identity “Confirmation” process –“I am not mother, but I am myself as a wanted girl” Father-Daughter Detachment: ConfusionFather-Daughter Detachment: Confusion Mother-Daughter Attachment-EnmeshmentMother-Daughter Attachment-Enmeshment –Defensive Attachment: “I am wanted as a girl” –“I am not mother, so I must not be like her” Rejects Gender-Identity with mom for Individuation

31 Gender-Identity-Imprinting Stage Copyright © Melvin W. Wong, Ph.D.1999 Imprinting: An Opportune-Window of time for Gender Identity to take placeImprinting: An Opportune-Window of time for Gender Identity to take place –Successful attainment: Secure Gender Identity –Attainment failure: Incomplete Gender Identity When Imprinting period is passed, child becomes more vulnerable in Gender IdentityWhen Imprinting period is passed, child becomes more vulnerable in Gender Identity Non-Gender-Imprinted child: Seeks attainment indiscriminately due to desperation: MotherNon-Gender-Imprinted child: Seeks attainment indiscriminately due to desperation: Mother

32 Fathers’ Characteristics Inexperience-Distracted: “Teenage Dads”Inexperience-Distracted: “Teenage Dads” –Dads’ orphaned, fostered, disconnected –Dad’s role was insignificant: “ego-centric” Having children “Out-of Wedlock”Having children “Out-of Wedlock” Physically abusivePhysically abusive –Fear-Shame-Blame based “Parenting” –Sexual-Genital based teasing: “Put-Downs” Survival: Dads’ Identity at expense of sonSurvival: Dads’ Identity at expense of son

33 Mother’s Characteristics Inexperience: “Teenage Moms” ImmatureInexperience: “Teenage Moms” Immature –Husband unable to meet her Emotional Needs –Her role is not involved enough: “Grandma” Having children “Out-of Wedlock”Having children “Out-of Wedlock” Emotional Enmeshment: “Favorite Child”Emotional Enmeshment: “Favorite Child” –Unable to help sons-daughters detach from her –Sexual-Boundary Exposure: Intended or not Survival: Mom’s identity at expense of kidsSurvival: Mom’s identity at expense of kids

34 Stage 2 (Kindergarten to Elementary) Social Same-Gender Attachment Polarization-Strengthening Process –Gender Identity Opposite Gender seen as a threat –Clear Limits Boundaries across gender lines Gender Stereotyping: Hair-cut, clothes, toys, Same-Gender familiarity preferred

35 Picture Credit: Janelle Ching, used by permission (Dr. & Mrs. Stephen & Lisa Ching, 2002)

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37 Stage 3 (Elementary to Middle School) Social Same-Gender Attachment Physical Gender Identity Differentiation –Pre-Puberty Gender Ambiguity –Masculine Features: Security vs. Insecurity –Feminine Features: Security vs. Insecurity Acceptance vs. Rejection of Body –Body Discomfort of troubled children

38 Stage 3 (Elementary to Middle School) Social Same-Gender Attachment Physical Gender Identity Differentiation –Pre-Puberty Gender Ambiguity –Masculine Features: Security vs. Insecurity –Feminine Features: Security vs. Insecurity Acceptance vs. Rejection of Body –Body Discomfort of troubled children –Gender Identity Disordered children

39 Stage 4 (Middle to High School) Social Same-Gender Attachment Self-affirmation & acceptance: –Girls: Make-up & clothes –Boys: Power & strength: Sports & work-out Interest & Curiosity over opposite gender –“Puppy Love”: Dating begins Affirmation through opposite sex peers –Comfort with opposite sex peers

40 Stage 5 (High school to College) Social Opposite-Gender Attachment Security in self-affirmation & acceptance: –Girls: Less self-conscious & preoccupation –Boys: Power & strength: Sports & work-out More matured interest over opposite gender –Steady Dating begins Affirmation through opposite sex peers –Comfort with opposite sex peers

41 Stage 6 (Beyond College & Marriage) Navigate a mutually nurturing committed relationship through Marriage & Parenting Marital Relationship Can merge without threat of over-crowding Can be autonomous without fear of abandonment Parenting Relationship Can affirm gender of same-sex children Can affirm gender of opposite-sex children

42 Therapeutic Approaches to Treatment of GID Gender Identity Disorder is an Identity problem and not a sexual disorder per se While sexual issues are symptoms; the key to treatment is not only sexual in focus The focus is in the area of Gender security development Males: Masculine Identity Security Females: Feminine Identity Security

43 Therapeutic Approaches to Treatment of GID Intervention strategy is different for each age group Younger the child The easier & more effective is the treatment It is most important to diagnose early Average referral is three and a half year-old Remember: Most are victims of sexual abuse

44 Video Presentation Rather Be A Woman Jenny Li, M.Div. Exodus Taiwan (Taipei) Taiwan (some religious references) Used by permission

45 Therapeutic Approaches to Treatment of GID Stage 2 (Kindergarten to Primary School) Parents and teacher need to be in cooperation Prevent GID child from ridicule & bullying No cross-dressing for Halloween Same-Gender Parent influence: Acceptance Dad: Spend more time with son: Gender specific Mom: Spend more time with daughter: Gender specific

46 Therapeutic Approaches to Treatment of GID Stage 3 (Elementary to Middle School) Boys: Dads aligns with son to protects them Girls: Dads able to relate to daughters, Mom is considered strong person, avoid being victims of sexual abuse by close family members

47 Nickelodeon’s “My Family is Different” Discusses homosexuality & growing up in a gay family Linda Ellerbee & Rosie O’Donnell Need to include following items in their discussion Frank discussion about the harm that comes to those who engage in homosexual activities Firsthand testimonies of children of gay parents who are adults: What consequences from parents’ homosexuality? Medical information: Why homosexuality is so detrimental? –Increased risks of STD’s: Hepatitis, Chlamydia, Syphilis & HIV –Increase mortality rate of homosexuals vs. heterosexuals

48 Therapeutic Approaches to Treatment of GID Stage 4 (Middle to High School) Focus is with the children, not only parents Same-gender peer acceptance is important Boys: Athletics potential, self-acceptance of body, reduce individual sports, team work Girls: Make-ups practices, dresses, girl-play

49 Therapeutic Approaches to Treatment of GID Stage 5 (High school to College) Boys: Reduce Same-sex sexual fantasies, increase same-sex non sexual relationships Girls: Reduce codependent same-sex emotional relationships, find a male mentor (teacher, coach), resolve conflicts with dad and mourn abuse issues with self or mom

50 Therapeutic Approaches to Treatment of GID Stage 6 (Beyond College & Marriage) Refer to mental health professional Specific personal addiction issues Men: Sexual addiction (Internet, gay sex) Women: Emotional-Relational addiction

51 Therapeutic Approaches to Treatment of GID Specific Hong Kong Issues Absentee Fathers & Depressed Mothers –Detachment-Rejection of Father & significant males –Detachment-Rejection of Mother & significant females –Increased of Gender Confused male & female children –Increased of GID boys and girls Filipina maids: At-risk-boys –Women’s emotional dominance: Detachment –Ambivalence toward male gender: Teasing & touching –Intentional or “casual” sexual exploitation & abuses

52 Se xual Addiction & Treatment

53 Patrick Carnes, Ph.D.

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56 Why Sexual Addiction? Needs for Arousal Life is Boring GamblingGambling SexSex Stimulant DrugsStimulant Drugs High-Risk BehaviorsHigh-Risk Behaviors

57 Why Sexual Addiction? Needs for Satiation Life is Not Satisfying-Unhappy SexSex Over-Eating (Bulimia-Binging)Over-Eating (Bulimia-Binging) Depressant Drugs (Marijuana)Depressant Drugs (Marijuana) Narcotic Drugs (Anesthetic effect)Narcotic Drugs (Anesthetic effect) AlcoholAlcohol

58 Why Sexual Addiction? Needs for Fantasy Reality is too Hard: Need a Quick Escape Voyeuristic Sex : Intelligent fantasy & RoutineVoyeuristic Sex : Intelligent fantasy & Routine Psychedelic Drugs: LSDPsychedelic Drugs: LSD MarijuanaMarijuana Mystic/ArtisticMystic/Artistic PreoccupationPreoccupation

59 Unhealthy Signs (Mild-Moderate) Husband demands wife to be in a certain physical position for intercourseHusband demands wife to be in a certain physical position for intercourse –Re-enactment (replay) of pornographic materials –Have X-Rated (XXX) video on for sex Husband demands wife to wear a certain kind of lingerie (“To seduce-tease him”)Husband demands wife to wear a certain kind of lingerie (“To seduce-tease him”) –He buys specific pieces of underwear, stockings Husband is distracted by flash backs of pornographic images while love-makingHusband is distracted by flash backs of pornographic images while love-making

60 Unhealthy Signs (Moderate-Serious) Masturbation after marriage (Decreased desires)Masturbation after marriage (Decreased desires) –Sexual “Anorexia” “Indifference” Very few or no male friendshipsVery few or no male friendships Gets enraged easily or numb emotionallyGets enraged easily or numb emotionally –Polarized emotional expression vs. full-range Happy to sad vs. anger to numbnessHappy to sad vs. anger to numbness Numbness to dissociated vs. euphoria to numbnessNumbness to dissociated vs. euphoria to numbness Rigidity & inflexibilityRigidity & inflexibility Telling half-truths and white lies to cover-upTelling half-truths and white lies to cover-up

61 Unhealthy Signs (Serious) Compulsive (Uncontrolled)“Cyperporn” useCompulsive (Uncontrolled)“Cyperporn” use –Chat Room visits online at work or after bedtime –Rendezvous-meetings via chat room & –Sex for hire experiences : Strip joints, Prostitutes Compulsive (Ritualistic) “Tele-Porn” useCompulsive (Ritualistic) “Tele-Porn” use –Astoundingly high phone bills Unexplained hotel bills, condoms, wigs & underwear found in storage or trunk or carUnexplained hotel bills, condoms, wigs & underwear found in storage or trunk or car Financial-legal problems: BankruptcyFinancial-legal problems: Bankruptcy

62 “Acting-Out Cycle” Copyright © Melvin Wong, Ph.D Compulsivity Impulsivity Abuser-Victim Blame-Shame

63 From Over-Control, Under- Control to Recovery Binge-Purge CyclesBinge-Purge Cycles –Impulsiveness vs. Compulsiveness Over-Control: The VictimizerOver-Control: The Victimizer –Power Position: “A Mouse Click Away!” Under-Control: The VictimUnder-Control: The Victim –Not Responsible for what happened –Don’t blame me! I can get away with it –Rationalization & Justification: Maintains the addiction

64 From Over-Control, Under- Control to Recovery Taking Control: The SurvivorTaking Control: The Survivor –“I don’t have to dominate to succeed!” “I admit I am powerless over my addiction” Step 1“I admit I am powerless over my addiction” Step 1 –“I don’t have to be a victim anymore!” “I will take responsibility for myself!”“I will take responsibility for myself!” “I will not stay in the ‘blame mode’ of helplessness!“I will not stay in the ‘blame mode’ of helplessness! How to broker, balance this Power Dilemma?How to broker, balance this Power Dilemma? –Avoid extremes by identifying feelings accurately –Form effective intimate relationships

65 Healing Compulsions & Addictions Interpersonal: Healthy-Bonds (Safe People)Interpersonal: Healthy-Bonds (Safe People) –Experiential not only rational Non-sexual intimacy –Spiritual: Paradigm shift: Enlightenment Intrapersonal: Mourn loss, Spiritual renewalIntrapersonal: Mourn loss, Spiritual renewal –Rediscover goodness in self (false guilt) –Rediscover meaning & significance (Help others) An Element of “A Loving but Firm Structure” (Live-In programs, 12 step groups)An Element of “A Loving but Firm Structure” (Live-In programs, 12 step groups)

66 Change and Recovery After a crisis then comes a paradigm shift First Order Change Control: Try MoreControl: Try More AlienationAlienation Secret KeepingSecret Keeping Hides Full StoryHides Full Story “No one is Hurt”“No one is Hurt” Addiction is a 1st order problem: The harder you try to control, the worse it gets Second Order Change PowerlessnessPowerlessness Community InvolvementCommunity Involvement No SecretsNo Secrets Disclose full StoryDisclose full Story Accepts Self as HurtAccepts Self as Hurt

67 Self-Help Group Resources SA: Sexaholics Anonymous (615) SLAA: Sex Love Addicts Anonymous EA: Emotions Anonymous (510) CODA: CoDependents Anonymous (415)


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