Online Psychotherapy Group for

Transgender College StudentsCandice C Harley

PSY 690

Spring 2014

The state of one’s gender identity or gender expression that does not match one’s assigned

sex.

Transgender is independent of sexual orientation, transgender individuals may identify as

heterosexual, homosexual, bisexual, or otherwise.

Identities include:

Male-to-female and female-to-male transsexuals (transgender women and men,

respectively, who feminize or masculinize their bodies via hormone therapy or surgery)

Cross dressers or transvestites (individuals who dress in clothing that is typically worn by

another gender as a means of self- or erotic expression)

Drag queens or kings (female or male impersonators)

Other gender-variant individuals

Transgender individuals are particularly vulnerable to

mental health concerns and psychological distress,

as they often face oppression and devaluation

resultant from the social stigma that is attached to

their gender nonconformity.

Among a Minnesota sample of 181 transgender

participants in a sexual health seminar, 66%

reported being discriminated against due to their

gender identity or presentation (Bockting et al.,

2013). In other surveys, high numbers of

transgender individuals report verbal harassment,

employment discrimination and physical violence.

Regarding specific psychological distress, research

has shown that transgender individuals report higher

levels of both anxiety and depression than the

population (Budge et al., 2013).

Social support has a great impact upon the wellbeing and

seamlessness of transition for transgender individuals; there is a

large body of research indicating that greater social support is

related to lower levels of depression and anxiety within the

transgender community.

Many members of the transgender community are ostracized from

their family and/or friends prior to, during, and after the transition

process.

Psychotherapy that facilitates and fosters social support, especially

between members of the community, is pertinent when counseling

the transgender population

Stigma

Though more students are receiving counseling services on college campuses than ever, the stigma surrounding mental

health counseling is still keeping many students in need from attending counseling.

The fear still exists that psychological treatment may be perceived as undesirable or socially unacceptable.

Thus, many students feel embarrassed to attend sessions at campus health centers, making online counseling a

propitious option.

The Working Alliance

The working alliance is a negotiated, collaborative feature of the helping relationship, reflecting the process that both the

therapist and client enter into with the hope of creating change.

Research has supported the notion that the quality of the working alliance between therapist and client is viewed as a

major predictor of the success of online psychotherapy with college students.

Key components of the working alliance include agreement between client and therapist upon the goals of therapy, the

client’s agreement with the therapist that the tasks of the therapy will address the problems that the client brings to

treatment, and the quality of the interpersonal bond between the client and the therapist (Hanley, 2009).

Language

In examining language formality and

informality in online counseling

settings, it has been found that

college counselors who use informal

language following their client’s

formal expressions were perceived

as having less expertise.

Language mirroring seemed to

moderate perceptions of expertise

when counselors followed their

client’s informal language use

(Haberstroh, 2010).

Content analyses of peer support on the internet have demonstrated that people who share certain illness or disability

exchange a large amount of information and also support each other emotionally.

A community of peers allows for a social environment in which self-evaluation can occur in comparison with like others,

rather than with members of the majority culture (Bockting et al., 2013).

Group Cohesion

The main component of the Online Psychotherapy Group for Transgender College Students is group cohesion.

Group cohesion involves a sense of belonging, inclusion, solidarity, and an attractiveness of a group for its

members.

Members will experience warmth and comfort in the group, a sense that they belong, a sense of being valued, and

a feeling that they are supported and accepted in the group.

When group cohesion occurs, transgender students will open up on a deeper level and show a willingness to

reveal painful experiences and take other risks.

The outcomes are a lessened sense of isolation, a greater sense of belonging through universality, and catharsis.

The necessary climate that releases an actualizing tendency within a client is characterized by there primary

attitudes; namely, unconditional positive regard, genuineness, and empathy. The counselor for the Online

Psychotherapy Group for Transgender College Students should express these primary attitudes to group members

during session. In doing so, a favorable climate will be established, clients can drop their defenses, tap their inner

resources, and work towards their goals.

Expressing Unconditional Positive Regard Online:

Unconditional positive regard involves an emphasis on valuing the client as a separate individual whose

thoughts, feelings, beliefs, and entire being are openly accepted, without conditions.

Therapists need to communicate to clients that care is unconditional.

During a traditional, face-to-face interaction, a therapist communicates unconditional positive regard via eye

contact, facial expressions, and gesturing; however, in an online platform, therapists need to rely more heavily

upon the content of what they say.

Tell the client “I accept you for who you are,” validate the group members’ feelings (ie”that sounds like a

horrible experience, I understand why you would be upset”), encourage group members (“you have a great

deal to be proud of”), and paraphrase (“so cutting was the one way of releasing pressure for you”).

Expressing Genuineness Online:

Genuineness, or congruence, occurs within therapists

who have a high level of self-acceptance, self-

awareness, and self-trust.

To achieve congruence, counselors must express their

thoughts candidly and authentically with clients, while still

maintaining a balance of professionalism.

Expressing Empathy Online:

Counselors show empathy when they are able to

accurately sense the feelings and personal meanings

that group members are experiencing.

The therapist must not only sense the client’s private

world, but also communicate this understanding

effectively to the client.

The online counselor can express this idea to the client

using sensitive and active listening, however insignificant

the utterance may seem.

Group Rules and Regulations

Group members must demonstrate respect for one another and for the group by attending each session from start to

finish, providing at least 24-hour notice for missing a session, being present during sessions, and providing criticisms to

others in a constructive manner.

Confidentiality of information shared during the group must be maintained. This rule is strictly enforced and any member

who violates this term will immediately be dismissed from the group.

This is a semester-long group that meets once per week. Members are encouraged to pursue and maintain contact with

one another outside of the group.

Recommended Hardware

Synchronous group sessions via Skype is the preponderant means of interaction for the Online Psychotherapy Group for

Transgender College Students.

Group members are asked to create an alias Skype account, and address group members by their aliases during

sessions

All group members are required to purchase a sound machine as well as headphones to obscure voices.

Asynchronous e-mail exchanges can occur between sessions amongst group members. Group members are asked to

create alias e-mail accounts for these exchanges, and to log in from a secure provider.

Confidentiality

Mental health professionals have an ethical responsibility to safeguard clients from unauthorized disclosure of the personal information

that is given during sessions.

E-mail and other transmissions can be intercepted by third parties if the transmission is not from an encrypted or secure site (Rummel &

Joyce, 2010). Additionally, computer hackers can decode correspondences, even from secure and encrypted websites.

Group members are made aware of these facts during the first session, and are encouraged to always remember to exchange e-mails

using an encrypted or secure provider.

It is explicitly stated that confidentiality cannot be 100% guaranteed to group members during asynchronous and synchronous

exchanges.

Responding During a Crisis

Online counselors need to know the true identity and location of their client should an emergency arise.

Group members are required to register for the group using their student identification information, which the counselor will store in a

secure database.

Group members are required to sign an electronic agreement consenting to call emergency authorities if they are feeling like harming

themselves or someone else.

Reference List

Bockting, W. O., Miner, M. H., Romine, R., Hamilton, A., & Coleman, E. (2013). Stigma, mental health, and

resilience in an online sample of the US transgender population. American Journal Of Public Health, 103(5), 943-

951

Budge, S. L., Adelson, J. L., & Howard, K. S. (2013). Anxiety and depression in transgender individuals: The

roles of transition status, loss, social support, and coping.Journal Of Consulting And Clinical Psychology, 81(3),

545-557

Haberstroh, S. (2010). College counselors' use of informal language online: Student perceptions of expertness,

trustworthiness, and attractiveness. Cyberpsychology, Behavior, And Social Networking, 13(4), 455-459

Hanley, T. (2009). The working alliance in online therapy with young people: Preliminary findings. British Journal

Of Guidance & Counselling, 37(3), 257-269. doi: 10.1080/03069880902956991

Rummell, C. M., & Joyce, N. R. (2010). “So wat do u want to wrk on 2day?”: The ethical implications of online

counseling. Ethics & Behavior, 20(6), 482-496. doi: 10.1080/10508422.2010.521450